Reflections on a Short Discussion with Joel Stanley (Grower of Charlotte's Web) by David Bearman, M.D.

Whatever you call it, cannabis is a plant with amazing therapeutic applications

By David Bearman, M.D.

? Introduction

Cannabis has been used as incense and in religious rituals. No doubt in both instances it contained the full spectrum of cannabinoids and terpenes. There are a wide variety of products that have traditionally been derived from Cannabis sativa including textiles, oils, foods, rope, building materials and medicine. Per Dr. Donald Abrams, oncology professor at UCSF, except for the period from 1942-1996, cannabis has been a medicine for over 4,000 years.1  

Over the past decade, cannabis has been returning to the prominence in mainstream medicine that it held as recently as the first third of the 20th century. Even with increased recognition of its efficacy, we are still combating the stigma and misinformation regarding cannabis that has been with us since Pope Innocent VI in the 15th century. He assailed midwives as witches2 for using cannabis to treat the pain of childbirth, Eve's punishment for eating from the tree of knowledge. This witch hunt was built on and ramped up in the 1930s by several industries such as the petrochemical, economic competitors of hemp and one very ambitious bureaucrat, Harry J. Anslinger.

That misinformation came not from organized medicine, but from the government. This misinformation was at least in part due to pressure from the petrochemical industry. They were motivated to eliminate hemp as a competitor to their petrochemical industry products. Harry Anslinger, an opportunistic bureaucrat,3 fanned the flames of this misinformation with racist rhetoric. The petrochemical industry were concerned not about cannabis (aka marijuana), but about hemp. The late ethnobotanist pioneer and Harvard professor Richard E. Shultes, Ph.D., pointed out hemp and cannabis are one and the same4 but in the 1930s people knew what hemp was. The industry used marijuana to confuse people about what they were talking about. People knew what cannabis and hemp were but marijuana was an unfamiliar foreign sounding term that could be used to demonize the plant.

This concern of the petrochemical industry was generated in part by the development of Henry Ford's hemp-centric auto in the 1930s. Its body was an acrylic embedded with hemp fiber and the car ran on hemp ethanol.5 Their fear of competition from hemp was further based on the fact that the 1916 patent protection on Schlichten's labor saving decorticator6  had run out. The decorticator had lowered the cost of hemp by combining the two processes of harvesting and preparing for industrial use into one process.

In the early 1930s Schlicten's patent had run out and new inventors were improving on the decorticator's original design. Economical hemp posed a real threat not only to oil companies but cotton growers and companies with cellulose based products such as Dupont. Dupont made Nylon, Rayon, and Cellophane.7 Dupont was also the largest shareholder in GM. They made tetraethyl lead, a gas additive and sulfites for making paper from cellulose (hemp or wood pulp) but 4 times as much of these sulfites are required to make paper from wood pulp as from hemp.

A few years back I asked Joel Stanley of Charlotte's Web fame, “What is the most challenging aspect of your role?” He responded, “It is unchartered waters. Cannabis and hemp industries are constantly evolving, politically and legally” (I might add scientifically and clinically). He continued that “there are landmines, mazes and tightropes that change every day.” His observation still remains true.

You may recall Dr. Sanjay Gupta's ground-breaking medicinal cannabis documentary that first appeared on CNN in 2014 which showed remarkable results in decreasing intractable seizures in a young girl, Charlotte Figi. This was attributed to a strain of cannabis which came to be named Charlotte's Web.

Charlotte’s Web is a whole plant, alcohol extract made from a plant high in CBD. Since it is a whole plant alcohol extract, it contains the entire range of alcohol-soluble cannabinoids and terpenes found in the plant. Both cannabinoids and terpenes have therapeutic value. Each day more and more are discovered. To date well over 150 cannabinoids and over 200 terpenes have been found in cannabis.8

? Know Your Taxonomy

Both the plant and the endocannabinoid system (ECS) are complicated. The vocabulary around both these complex issues can be confusing and impede informed discussion. When speaking about cannabis it is important to have a familiarity with some general information regarding the basic plant.

Hemp, cannabis, marijuana, sativa, indica, ruderalis; the vocabulary around cannabis is very confusing. The origin of the word ‘marijuana’ is lost in antiquity although cannabis is said to be found in the Bible as Kaneh Bosn.2 Some historians theorize that Jesus of Nazareth used tincture of cannabis as one of his emollients. This would make sense in treating the skin lesions of the leper and also to stop the seizures of the epileptic.3

The word marijuana is likely derived from Portuguese although Chinese, Spanish and Moroccan have also been suggested. Call it what you will, cannabis is one of the oldest cultivated agricultural crops in human history. It’s agricultural production goes back at least 10,000 years to when humankind came out of the forests and turned from hunter-gatherering to agriculture.9 It is not overstating the case to conclude that cannabis is one of the earliest, and longest lasting pillars of human civilization.

David Ables in his excellent book, “Marijuana The First 12,000 Years” spends a page or two speculating on the origin of the word marijuana or marihuana. Ables suggests that the origin of the word marijuana could be Spanish, Moroccan, Chinese or Portuguese. My guess is it was based on the Portuguese word “maryerona” or “maran griago” which connotes intoxication.10 This is consistent with the introduction of cannabis into Brazil by Angolan slaves in the 16th century. These slaves allegedly planted cannabis between the rows of sugar cane which they were enslaved to harvest. They are said to have smoked cannabis after the hard work of the sugar cane harvest.5 

? What's In a Name

Let’s look at how the terminology evolved around the general botanical name, Cannabis sativa. According to noted neurologist and herbologist, Dr. Ethan Russo, Cannabis sativa, meaning “cultivated Cannabis,” was so named by Fuchs,6 among others, in 1542. This was more than two centuries before Swedish botanist, Linnaeus, published his Species Plantarum in the eighteenth century. Linaeus developed the standardized plant nomenclature still used today. He gave cannabis its botanical name (cannabis sativa).11 Lamarck suggested the name Cannabis indica,12 which Russo describes “as a more diminutive intoxicating Indian plant from India,” as a separate species. Russo says that the nomenclature issue has remained unresolved in the subsequent centuries with two opposing philosophies.” It is no wonder we find the terms used to describe the CBD and THC content of the plant confusing.

According to the late ethnobotanist pioneer, Harvard Professor Dr. Richard E. Schultes, this has no basis in the science of botany for this supposed distinction. It is an arbitrary bureaucratic determination NOT based on science.13

Whole plant cannabis has been around for over 4,000 years, and as Dr. Schultes points out, hemp and cannabis are the same plant. Cannabis was historically THC dominant, with about 4% THC. Hemp is more CBD dominant. Hemp and cannabis are the same plant. The alleged distinction is not based on botany but on a bureaucratic decision. There is an arbitrary demarcation point of < 0.3% THC that bureaucratically designates this low THC Cannabis sativa as “hemp” rather than cannabis.

There is a continuum of the amount of THC in cannabis sativa from the high THC (chemotype I) to the high CBD (chemotype III (3). Cannabis is an important source for medicine across the cannabinoid content continuum from THC-rich to CBD-rich genotypes. Of course we need to remember that many cannabinoids as well as numerous terpenes have therapeutic value.

Many think of “HEMP” as being high in CBD low in THC and cannabis (aka marijuana) being high in THC and low in CBD, however cannabis is more appropriately categorized using genetic profiling to describe the “chemotype” or even more accurately the “genotype” or the cannabinoid profile of a given plant. Per well-known and respected cannabinologists, Dr. McPartland and Dr. Russo, the use of Sativa and Indica is now more confusing than helpful.

Indica was initially used to distinguish this higher THC plant which often came from India from Cannabis Americana, the high CBD plant grown in the British colonies. Hemp was required to be grown in most colonies by law. Hemp was the oil of the 15th to mid-19th century. It took 60 tons of hemp to make the rigging, rope and sail of the USS Constitution. Cannabis Americana was what was mainly found in the Americas while Indica was found in India. Cannabis Americana was more like hemp or sativa, and cannabis indica, also hemp or cannabis, more like what was once called Indica. But that was years ago, well before cannabis became popular as a recreational substance and cross-breeding destroyed the distinctions that once existed.

Today's Confused Nomenclature

There is a lot of confusion with the definition of whole plant, full spectrum and isolates. This confusion can also be seen in the names related to so-called Rick Simpson Oil. Sometimes it is referred to as:

Hemp seed oil

Hemp oil

Cannabis oil

Cannabidiol (CBD) oil or tincture

Rick Simpson Oil (RSO)

Fully Extracted Cannabis Oil (FECO)

But these names don't always mean Rick Simpson Oil (RSO). Since real RSO contains naphlta which can be problematic that is likely a good thing. They can be variants using another solvent and/or may actually refer to other cannabis products like oil from the pressed hemp seeds. Their names are as confusing as Indica and Sativa. It is critical to read the label to see what cannabinoids and terpenes are in the product.

Dr. Ethan Russo notes that “The cannabis species controversy, cannabis sativa vs. indica vs. afghanica, has continued unabated to the current day with impassioned arguments advanced by the protagonists.” In a recent seminal review by Russo, Dr. John McPartland agreed, “Categorizing Cannabis as either ‘sativa’ and ‘indica’ has become an exercise in futility. Ubiquitous interbreeding and hybridization renders their distinction meaningless.”9 Today we are more accurate, moving forward using the cultivars, Type I, Type II and Type III.

? Charting a New Course

Joel is right when he says that we are in unchartered waters. We are on a long journey to bring pharmacy, medicine and personal responsibility for health and healing back to many of the positive practices of the past. We are reinventing and retracing the history of healing. In many ways we know less about how to keep ourselves healthy, prevent and treat illness with low side effects plants than 19th century herbalists and possibly less than healers in the time of Christ . Hippocrates, considered the father of medicine, said “food is medicine and medicine is food.” We should pay attention to our elders.

? Science

This is a very brief overview of the science of cannabis and cannabinoids. Plants are complicated and cannabis is no exception. The cannabis plant has at least 512 different molecules and counting. A plant containing a vast array of molecules is not uncommon. Coffee has 880 different molecules, tomatoes 380 molecules, and cannabis is no exception. Of cannabis’ over 500 different molecules, 150 or more are cannabinoids and over 200 are terpenes.

Entourage effect

This concept is important to having a better understanding of how plants work their magic. The entourage effect (aka the ensemble effect) is the combined therapeutic effect of all the therapeutic constituents of a plant. Of the 512 molecules in cannabis, over 150 are cannabinoids. The cannabinoids are all, or almost all, 21 carbon molecules that are similar in structure to the body's own endocannabinoids, anandamide and 2AG. They have many therapeutic values. There are over 200 terpenes in cannabis. Some terpenes are similar in structure to cannabinoids and many of them also have therapeutic value. In the modern world, pharmaceutical companies often focus on just one plant constituent. This may lead to a single molecule pharmaceutical having more side effects than the plant it was derived from. Concentrating on one constituent of the plant may overlook the total healing potential of all the therapeutic constituents of the plant. Also whole plant medicine may have fewer side effects than a single molecule extracted from the plant.

Cannabinoids

Cannabinoids are 21 carbon molecules that can affect the endocannabinoid system, such as blocking or stimulating CB1 and CB2 receptors. The two cannabinoids we hear the most about are THC and CBD. These two cannabinoids that have so far revealed the lion's share of public attention, but there are many other cannabinoids with therapeutic value. Several such as CBN, CBG, CBC and CBD, have anti inflammatory effects. Here are some examples:

· THC (delta 9 Tetrahydrocannabinol)

This is the first discovered (in 1964) and the most famous cannabinoid. This may be not only because it was characterized first, but also because it provides euphoria. THC has many therapeutic properties including anti cancer, anti nauseant, analgesia, appetite stimulant, anti spasmodic, muscle relaxant, anti microbial neuroprotective, anti inflammatory, and antioxidant. It is useful in treating Crohns (anti spasmodic, anti inflammatory).

Relieves rheumatoid arthritis, anti oxidant, anti psychotic.

CBD

Here are some examples of therapeutic applications of CBD: Protects against cancer, reduces nausea, pain reliever, sleep aid, relieves spasms, decreases seizures, reduces anxiety, muscle relaxant, anti bacterial, neuroprotective, anti seizure, anti diabetic, improves circulation, anti inflammatory. So it relieves psoriasis, relives Crohns Disease, bone stimulant.

 Both whole plant cannabis and CBD are extremely safe with few side effects. CBD has an important role to play as an anti-anxiety medicine, as a treatment for Crohn’s Disease and an anti-inflammatory.

·CBN (Cannabichromene)

Pain reliever, Sleep aid, Anti spasmodic, Anti inflammatory, Antioxidant.

·CBG (Cannabigerol)

Anti cancer, Anti inflammatory, Stimulates bone.

·CBC (Cannabichomene)

Anti cancer, Anti bacterial, Anti fungal, Anti inflammatory, Stimulates bone.

·Cannabinoids In the Acid Form

Cannabinoids found in the raw plant are all in the acid form, meaning they contain a carbonyl group. When these acid form cannabinoids are heated they become decarboxylated (lose the carboxyl group). This decaroxylation creates THC which is a euphorogenic. THCA, although, is not.

Terpenes and Terpenoids

The name “terpene” is derived from the word “terpentine,” terpenes are also major biosynthetic building blocks within nearly every living creature. Steroids, for example, are derivatives of the triterpene, squalene.

Terpenes are derived biosynthetically from units of isoprene, which has the molecular formula C5H8. Terpenes are classified by the number of isoprene units in the molecule; a prefix in the name indicates the number of terpene units needed to assemble the molecule. Isoprene units are C5 H8 chains. The basic molecular formula of terpenes are multiples of that, (C5 H8)n where n is the number of linked isoprene units. This is called the biogenetic isoprene rule.

Terpenes often have a strong odor and may protect the plants that produce them by deterring herbivores and by attracting predators and parasites of herbivores. The difference between terpenes and terpenoids is that terpenes are hydrocarbons, whereas terpenoids contain additional functional groups.

Terpenoids

When terpenes are modified chemically, such as by oxidation or rearrangement of the carbon skeleton, the resulting compounds are generally referred to as terpenoids. Some authors will use the term terpene to include all terpenoids. Terpenoids are also known as isoprenoids.

? Anti Inflammatory Effect

Cannabinoids down regulate the immune system, probably by affecting the CB2 receptor. Some of the cannabinoids, which have been found to reduce inflammation, are THC, CBD, CBDA, CBC, CBG and CBGA. The A is short for acid. This anti-inflammatory mechanism of action is different than other anti inflammatories, or aspirin, used to treat symptoms of autoimmune disorders. As with all medicines we need to balance therapeutic effects against the side effect. These cannabinoids are safer than steroids.

? Auto Immune Disease

Cannabis’ anti-inflammation effect has proved beneficial in addressing auto immune diseases, such as Rheumatoid Athritis, Ulcer Colitis, Systemic Lupus Erythematosus, scleroderma, Reflex Sympothetic Dystrophy, Chronic Regional Pain Syndrome, Restless Leg Syndrome, fibromyalgia and the like. Just to reiterate, not only are many of the cannabinoids such as CBD, CBDa, THCa, CBC, CBG, CBGa, anti inflammatory, but so too are many of the terpenes such as beta pinene, eucalyptus, alpha pinene, limonene, delta 5 carene, beta-caryophyllene, alpha humulene, linalool, myrcene, humulene.

Medical Cannabis: The History

Cannabis has appeared in every major materia medica since the first one known, the Ping Ts’ao Ching, dated to 2637 BCE by Chinese oral tradition. Cannabis is also found in an Ayervedic stone tablet Medicine Pharmacopeia dated between 1000-1700 BCE. The Ebers Papyrus dated 1500 BCE, the pharmacopeia of Descordes in Rome written in 70 BCE, down to and including being in the United States Pharmacopeia (USP) from the 1850s until 1942.11 At the turn of the 19th to the 20th century cannabis was the third most common ingredient, after alcohol and opium, found in prescriptions and patent medicine in the United States.12 And in the 1920s American physicians wrote three million cannabis containing prescriptions per year.13

One of the first prominent people to demonize cannabis was Pope Innocent VI in the fifteenth century, long after cannabis/hemp had become a successful agricultural crop. This was part and parcel of the Inquisition and the witch hunts. In a famous papal bull this pope demonized cannabis as a tool of the devil.10 This description was aimed at midwives, the so-called witches. In point of fact they were herbologists and lay healers. Their “sin” was to know how to use plants to treat medical conditions. This use of plant-based medicine was in addition to faith or in some cases in lieu of faith, either way sometimes viewed as heretical. Their worst sin was knowing that cannabis could ease the pain of childbirth and using it for just that purpose. According to the clergy of the time, this pain was punishment for Eve eating the apple from the tree of knowledge.

Retrograde Inhibition

In order to understand the many therapeutic applications of cannabis, we need to not only be aware of the therapeutic role of many of the cannabinoids and terpenes, but also have at least a rudimentary understanding of the ECS and particularly retrograde inhibition. This is likely where THC plays a large role in treating seizure disorder. While CBD epidiolex has shown a 30% drop in seizure frequency in Dravet's Syndrome, THC has shown in a 1947 study that in 80% of the subjects they had a 100% or near 100% drop in seizure frequency. This is because of the role the ECS plays in modulating the speed of neural transmission. It does this by a mechanism called retrograde inhibition. The post synaptic neuron contains amandamide, which when stimulated comes backwards to the presynaptic neuron causing release of dopamine. The dopamine causes depolarization of the presynaptic neuron making it more difficult to stimulant that neuron. This decreases the frequency of neurologic input. It is postulated that retrograde inhibition is why cannabis has been found useful not only in treating seizure disorder but migraines, Crohn's Disease, Attention Deficit Disorder, ADD/ADHD, PTSD, explosive emotional syndrome, Tourette's Syndrome, essential tremor, Parkinson's Disease and other movement disorders.

Introduction of Recreational Cannabis into the U.S.

After being introduced into the port of New Orleans in the 1890s by Caribbean sailors,14 cannabis was referred to by such appellations as muggles, reefer, and Mary Jane. It was being used by the jazz musicians who provided the background music for the bordellos in the red light district of New Orleans. This area of town was called Storeyville named after City Councilman Story who had designated that part of town for houses of ill repute.15 Many of these establishments had jazz accompaniment and the jazz musicians smoked muggles. Famed jazz musician and singer Louis Armstrong wrote in his autobiography that after 1925 he smoked cannabis every day of his life. It was the only way he could deal with the incessant racism of the day.16

If you found this article interesting you may wish to read further in one of my books: CANNABINOID MEDICINE: A Guide to the Practice of Cannabinoid Medicine (co-written by Maria Pettitano, RN, PhD). If the history of drugs in medicine, spirituality, religion, celebration, trade you might like Drugs Are NOT The Devil's Tools: How Greed, Discrimination and Demonization Gave Us a Dysfunctional Drug Policy and How to Fix It.