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Pharmerkate's Pharmacy Corner

Hello, brethren and sistren readers of Skunk Pharm Research, LLC. My name is Kate and I am thrilled as all-get-out to have been invited to contribute some knowledge based on my particular area of expertise here amongst the incredible collective resource of intelligence, experience and talent that the Skunk Pharm Research Power Trio has already grown.

I’m currently a community pharmacist by trade. I earned my Pharm.D (that’s Doctor of Pharmacy) degree from Oregon State University, and I’ve been helping patients and prescribers pick the right drugs, avoid the wrong ones, and find the best dosages for their particular needs ever since.

I have been a practicing herbalist for at least twice as long as I have been a professional pharmacist, so one of my passions is building a bridge between the worlds of alternative/complementary and conventional medicine, so we can all have the best of both worlds.

So here’s where the cannabis comes in: cannabis extract was part of the official US Pharmacopoiea until 1942, when it was removed for political and economic reasons. I certainly don’t have to tell you all here about its continued use and importance as medicine, subsequently, despite that!

However, largely because of its erasure by modern medicine I’ve noticed an alarming gap in knowledge about the drug between medical professionals and their patients who use cannabis regularly to treat a chronic condition.

Since, for so long, no one was “supposed” to be using it, patients stopped talking about it with their doctors and pharmacists, and the doctors and pharmacists either didn’t want to know or didn’t ask!

It’s my goal, here, to start to remedy this situation by opening up this conversation between patients and medical professionals so we can start to figure out some “best practices” for the use of cannabis to treat chronic medical conditions and its interactions with other drugs.

I do not, myself, use cannabis medicinally, but many of my patients (primarily those treating chronic intractable pain and/or cancer) do. From them I’ve acquired valuable insights about how to treat various conditions with cannabis-as-medicine, and I want to know more. In many cases, I believe that cannabis is the better choice for treatment than pharmaceuticals, and we will explore why that might be so.

However, since most people use both alternative and conventional medicine at various times in their lives, there’s great potential for both synergy (complementary actions) between the two modes, and interactions (situations where the two modes conflict or cancel each other out). For example, if you are over 50 and use cannabis daily, and you are about to have a colonoscopy, you NEED to alert your doctor first (more about why in a future post!).

So, some of the topics I’ll be writing about here include: pharmacokinetics of cannabis (what the body does to the drug); pharmacodynamics of cannabis (what the drug does to the body); summaries of the latest research on the body’s own endocannabinoid system; how various specific components of the cannabis plant may target relief to specific chronic or acute conditions; how to craft specific oral and topical dosage forms from cannabis extracts to get optimal absorption and delivery of its active ingredients.

I’m eager to get Skunk Pharm Research readers’ feedback and questions as well. I must insert the standard disclaimer here that I cannot diagnose or treat any condition over the internet. My research, opinions, and advice should never ever be substituted for a thorough physical examination or the advice of your own trusted health-care practitioners.

Also, readers here should note that I cannot and do not, as a practicing licensed pharmacist bound to state and federal laws, create cannabis extracts or concoct other formulas out of cannabis. Furthermore, even if I did do that (and I would like to someday when it is fully legal for me to do so), I do not and will not make claims about any particular cannabis extract or formulation as having specific healing properties or known effectiveness for treating any medical condition or disease. I am here at Skunk Pharm as a consultant only, with the goal of expanding the safe, ethical, and evidence-based use of cannabis as medicine.

I strongly support the individual’s right to grow and use cannabis (or any other herb for that matter) and treat oneself with it, just as our ancestors have done for millennia. Still, cannabis is a powerful drug that we humans have tinkered with and will continue to tinker with, just like any other drug. And, just like any other drug, it can have both profound and unpredictable effects in any individual patient. I want to share and encourage my respect for that. I hope that I myself am smart enough to know what I DON’T know at any given time, and ask for more information, or for help from someone with more knowledge or experience.

That’s what I really want to do: to help. Sounds cheesy, I know. But it’s a crazy beautiful mixed-up semi-regulated era in the world of cannabis right now, so now is the time to start gathering our resources and separate the snake oil from the hash oil.

About The Author

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28 Comments

  1. dc

    I would like to compound my own topical cannabis cream utilizing DMSO but I'm having a terrible time getting the DMSO to stay mixed properly as it wants to settle out as it sits. There is a commercial produce called: DMSO Cream with Aloe Vera Rose Scented -- 4 oz. It is available on Amazon and in stored but is kinda pricey so I'd like to make my own. I have added concentrated cannabis oil (RSO) to this cream and it works well and is pleasant to use. Any ideas on incorporating Cannabis and DMSO in a nice cream base? I am a retired pharmacist so I no longer have access to libraries and shelves full of wets and dries to experiment with. Thank you.

    Reply
  2. Silversouth

    Hi Kate, You guys rock! The best site in the world for this type of information. Many thanks from "the militarized zone". Hopefully we will soon all have the same freedom that you guys have. Mark

    Reply
  3. Glenn

    Welcome Kate, I'd like to share a remedy I'm currently developing a salve to alleviate the symptoms of herpes, (kind of a THC/natural herb Abreva). It has significantly shortened my outbreak periods from weeks to days and lessens the pain of the blisters. In addition to that I've never had a blister erupt since I started using it. I've shared this among friends and there's and there's a widespread consensus as to its effectiveness. A friend of mine has also successfully used it to shorten the outbreak period and alleviate the pain of his Shingles outbreaks. The primary ingredients are a 1% solution of Melissa essential oil, and Cannabis infused coconut oil. Both Melissa and Cannabis have been documented as being useful against both Herpes and Shingles: Topical uses of Cannabis in Alleviatibg Shingles shttp://www.hempista.com/2015/cannabis-salve-pain-neuropathy-shingles/ http://michiganmedicalmarijuana.org/topic/37682-treating-pain-from-shingles/ Topical Uses of Cannabis in treatment of Herpes: http://www.onlinepot.org/medical/herpestreatment.htm http://rxmarijuana.com/shared_comments/Genital_Herpes.htm http://boards.cannabis.com/threads/use-marijuana-to-treat-cold-sores-herpes.168156/ Lemon Balm used in treatment of Herpes/Shingles http://www.ncbi.nlm.nih.gov/pubmed/?term=melissa+herpes+simplex http://umm.edu/health/medical/altmed/herb/lemon-balm http://www.herbsociety.org/factsheets/Lemon%20Balm%20Guide.pdf (Documents anti-viral effects of the Herb) http://www.webmd.com/vitamins-supplements/ingredientmono-437-lemon%20balm.aspx?activeingredientid=437&activeingredientname=lemon%20balm http://www.findhomeremedy.com/5-herbs-to-cure-shingles-effectively/ Additionally I've added emu oil specified your Holy Anointing Oil recipe to enhance absorption. I've also added a bee propolis/honey mixture both to boost the immune system, (the last might be superfluous, but it does taste good). My recioe is as follows: 1) Infuse a ratio two oz. of shake into 16 lq. oz. of coconut oil in a crockpot for 12 hours. 2) melt coconut oil in a double boiler or microwave and add emu oil at a ratio 1 oz emu oil : 3 oz. infused coconut oil. 3:) add bee propolis/honey 1:10 (combined oils) 4) Melissa essential oil (By Far the most expensive ingredient) 1:100 5) Calendula essential oil 1:50 6) Spanish Melissa essential oil 1:50 7) Melt beeswax and add to mixture at a ratio 1:10 (add more beeswax if you want to use the salve as a lip balm. I am not a trained Herbalist, (though I did have ACS certified BS in chemistry 20 years ago) as you can tell by my recipe. Doubtless, there';s a lot of improvements to be made.

    Reply
  4. Blake Pearce

    Hello Kate: As far as the CBD component of Harley's oil I add a compound called CBDPlus to the Honey Oil (Petzoil). This comes from the States and is waxlike in consistency. It is legal in all 50 States and as it does not contain THC is legal in Canada. Also it has dropped in price dramatically in the last six months, bonus. I have also just received my medical marijauna card and can purchase CBD rich pot from The Dispensary in Vancouver, BC. Hopefully with a benign extraction (crock pot over three days with 50% low heat simmer and 50% cool down period) the many uncharted waters of the other 90plus medicinally active compounds in pot will not be denatured. The various synergies can only be speculated upon but it is highly probable that they enhance each other. I will use this as medium to mix the Petzoil and CBDPlus together. This is planned for next batch which will be in a couple weeks. I will inform you of the outcome probably in about 4/5 weeks. Thanks again for your time and expertise, it sure helps having a sounding board with your background. Blake

    Reply
  5. Rusty

    Hello Kate, I have been using cannabis in different forms for the past 4 years to treat the disgusting and painful symptoms of severe crohn's disease. I live in Wisconsin, so it has been somewhat difficult to find the best strain out there to treat the different symptoms. I flew out there to Portland a few years back to see a doctor and get my Oregon card. While there, I found the time to visit G.W. and Carla from Skunkpharm. I have had miraculous results from this medicine but can't safely share them with many people because of legal issues. It is great to see a pharmacist join the Skunkpharm people. For me, it was like I was in a dream to be able to talk freely with many very intelligent people that are also very caring and really want to help improve quality of life for sick humans and animals. Luckily, I have been able to meet some good people in Michigan that have helped me obtain medicine and try many strains and ingestion methods. I have read the above posts and I think you have found the best people to associate with to further the advancement of cannabis medicine. Thank you for the knowledge and information that you are providing to everyone here. I am very happy and excited to see where this is going in this country finally. I believe that the CNN specials with Dr. Sanjay Gupta have changed many minds on this subject. I am still a criminal here in Wisconsin, but I am at least now a criminal that no longer has to suffer. Thanks to all of you at Skunkpharm for all that you do!!

    Reply
    1. Accidental Medicine

      Hi Rusty: Thanks for the encouragement! I am glad you have found relief using cannabis. I have many patients with IBD/Chron's/Ulcerative Colitis who have found relief using cannabis. I have to say that it is a very individual journey, as each patient has responded via a different method of ingestion/strain/dosing frequency. Sometimes it has taken up to 6 months to find the right combination for a patient. So: if something does not seem to be working for you, take heart and try something else! I'm curious to know what is working for you...I generally see better results via sublingual or oral ingestion for patients with GI autoimmune issues...has that been your experience? Good luck and best of health! Pharmerkate

      Reply
      1. rusty2112

        Hello Kate, Yes I have found that edibles help to slow down my digestive system.I make malts with banana and this really tasty cannabis infused hazelnut chocolate spread that I get from Michigan. I also really like vaporizing now that I spent the money to get a true high quality vaporizer. I have tried many different strains but don't have access to edibles made from specific strains. Hopefully this will change in the future in Wisconsin. I am considering moving to a state that would let me use this medicine legally.

        Reply
      2. Jeffrey

        Hi Kate, I am also a practicing pharmacist and cannot provide medical advice but I thought I would share some info that I found in the US nationial library of medicine. Three cannabinoids that seem to help with IBS, and inflamatory conditions of the bowels, are CBG( cannbigerol) CBC (cannabichromene) , and CDB. They are relatively non-psychtropic cannabinoids and found in higher concentrations in Mickey kush, Agent Orange, Jack Herer, Grandadaddy purple, and certain Hemp fiber strains as well.-pharmachine

        Reply
  6. Silversouth

    Thank you Kate for contributing your time and expertise. The thing that I appreciate the most about this site is the level of professionalism and intelligence that can be accessed here and I think you will be a valuable addition to the lineup. Thanks and welcome! Mark

    Reply
  7. William

    Hi Kate, Thanks!, Along with the miraculous feeling of peace and relaxation and inspiration and connection with cannabis use, in some users there can be after effects like slight headache, and a general sense in the body of mild discomfort, like there is cloudy energy that needs to be worked through or released. I'm not talking about those in pain who use mj for medication, but those who start from a fairly comfortable body state using high quality pesticide/chemical free mj and Always feel these after effects whether smoked,vaped, or ingested. The headachey feeling seems to be the most discomforting and feels somewhat like dehydration does regardless of water intake by the user. While it may be a minority of people who experience these, it has a major impact on their ability to use frequently and comfortably. These are usually felt sometime around 2 hours through 6 hours after using flower, and around 6 hrs through 12 hours after food/MIP. In simple terms, it could be called a mild hangover. I am interested in learning what causes that. If it's certain components, could it be remediated through supplements, or removed through processing. Thank You. William

    Reply
    1. Accidental Medicine

      Hi William: Fascinating question. I am going to have to do more research and get back to you! A couple of thoughts however: 1) There may be an allergy at play here. Pain = inflammation, and a delayed response like you are describing may be due to the after-effects of a mild allergic reaction (which is also an inflammatory-mediated reaction) to some or multiple components of cannabis. 2) Headaches are also commonly caused by vasodilation. The ultimate cause of the vasodilation, again, could be an "allergic" reaction, or a natural reaction of the vessels in your brain to some component of cannabis that you are especially sensitive to. Does anything else you eat or smoke cause headaches that you know of? Caffeine is a potent vasoconstrictor...do you notice a difference in headache intensity/prevent headaches if you drink a cup of coffee post-cannabis ingestion? Until we find some literature, the best thing you can do is experiment...with different strains of cannabis (high CBD, for example...does that do the same thing? How about alcohol tinctures taken sublingually?) and with different prophylactic approaches (how about pre-treating with a benadryl? Or 400mg ibuprofen? or a cup of coffee?). Let me know what you find out, and good luck!! Pharmerkate

      Reply
  8. shimmer48

    Hello Kate, I am a 66 years old reoocuring tonsilar cancer dancer... ( I have not and will not use any chemo or radiation)....and I am looking for more information on the use of cannabinoids via suppository. As in most cases the info is scarce. From my experience there seems to be no psychotropic experience which is what I am looking for. To load this body with 1.-1.5 grams a day is not what I can do. I have been making my own with coconut oil, using them mostly at night... with about .5-.75 gram. thank you for any light you can shed or sites to send me to.

    Reply
    1. Accidental Medicine

      Hi Shimmer48! First of all, I must apologize for my very late reply to your question! After posting for the first couple months, I stopped checking for replies, but I did not realize that replies to my posts were appearing in my email but being routed in a different in-box! I have fixed this, so I should be able to respond to replies a lot more quickly now. I hope you are still healthy and that I can help. Suppositories remain a somewhat controversial way of delivering cannabinoids, mostly because bio-availability in animal and human studies (most done in the 1990s) has proved to be very erratic and/or low (less than 15% bioavailability on average, but this varies WIDELY with various subjects and also does not correlate well with predicting desired effects in subjects, which is probably why it is less favored--it is less dependable and/or predictable!!). However, rectal administration remains an important delivery method option as there are two large benefits to delivering cannabinoids rectally: 1) it delivers the medicine into the rectal cavity and lower intestinal area directly...clearly a benefit if we want to target rectal or colon cancers directly with medications that we think might be helpful; and 2) Rectal administration of medications helps them bypass the "first pass" effect, which occurs when we take medicines orally--the "first pass" effect refers to the changes most drugs undergo through our livers before they make it to our bloodstreams and are delivered to their sites of action. In many cases our livers de-activate a large portion of the drugs we take orally (for better or for worse!). Rectal delivery of drugs via suppository encourages absorption of drugs directly into the bloodstream (bypassing the liver) via absorption through the middle and inferior rectal veins, which bypass the liver (although some drug is absorbed via the superior rectal vein, which does drain into the liver). There have been limited studies in monkeys and humans with varied results when delivering various forms of THC rectally. Most showed low bioavailability; however, this did not necessarily correlate with absence of effect or lower efficacy than oral dosing. One 1993 study gave the equivalent of 9mg THC rectally to three females who had previously exhibited low plasma levels of the drug after oral ingestion of 10mg doses...in these patients, the suppository delivered plasma levels of drug 30 times higher than an oral dose; the doses lasted longer; and all were well tolerated without side-effect and with achieved effect (in this case, anti-nausea). If rectal delivery appears to be helping you, then by all means continue!! However I have a tip for you that may help more of your medication get delivered into your body via the rectal route, since you suggest in your question that you may need higher doses: You state that you are making the suppositories yourself in coconut oil. Coconut oil is a fine suppository base, as it melts at body temperature. However, Coconut oil is a fat, and we know that THC and other cannabinoids are fat-loving molecules. Therefore, some of the THC is not absorbing into your system fast enough, because it does not want to "leave" the fatty base of the coconut oil...instead it is hanging out on the residue of the oil on your skin, and getting flushed out with your stool. You may get better results by incorporating the cannabis into a NON-fatty suppository base, like PEG1450 (aka polyethylene glycol 1450). The benefit of using a PEG base is that PEG is a water-soluble base, so the cannabinoids will actually "flee" this base faster and penetrate into the fatty layer of your tissue faster, and therefore more of it will penetrate into the rectal blood vessels. The down side of a PEG base is that it needs MOISTURE to dissolve more than body heat, so I recommend dipping the suppository in water before inserting to enhance dissolution in the (normally dry) rectal cavity. Another downside to using a PEG base is that PEG1450 is not available to the general public commercially! Generally, only pharmacies can legally order PEG base. To get your hands on some PEG, ask your doctor to call in a prescription for PEG1450 placebo suppositories to your local compounding pharmacy. They shouldn't be expensive. When you pick them up, you can unwrap them and melt them in a double boiler just like you do the coconut oil, and incorporate your cannabis medication into the base by heating gently, then re-insert the combined liquid into some fresh suppository shells and allow to harden before using. I hope that helps. Please let me know if you notice a difference between the two different suppository bases! Best, PharmerKate

      Reply
      1. Jeffrey

        Cbd and especially CBG seem to have the most potential for cancer harm reduction at this point. Having a strain with higher ammounts limonene "might theoretically have synergism in this regard" - blend it in smoothy may take longer but it will get where it needs to.

        Reply
        1. Skunk Pharm Research,LLC

          And non psychoactive CBG appears to be the new rising star with regard to both pain management and cancer treatment! GW

          Reply
  9. Dan Parker

    H E L L O !!!!! ANYBODY HOME???? I'll try once more... Please PLEASE P L E A S E Provide me with a price list and order info for the "Generic Terpenator" Thank you so verrry much for your soonest convenient attention and consideration !!! Sincerely serious, Dan Parker djp98798@gmail.com 408-625-9192 Thanxxx

    Reply
    1. skunkpharmresearch

      We don't sell Terpenators Dan, we are a research and public information LLC. We sell tickets to lectures and are working on DVD's. While I invented the Terpenator, there are many different brothers and sisters manufacturing them world wide, so the generic post was an attempt to provide a standardized reference for operating one. Consider specializedformulations.com or specializedformulations@gmail.com for a Mk III or Transforminator conversion and WolfWurx.com or Wolfwurx1@g.mail.com for Mk IV & V turnkey systems.

      Reply
    2. DENNIS

      Hey Dan they don't sell these here, go online and look for manufacturers that do sell this is a BLOG not a sales organization Try terppextractors in Colorado or any BHO manufacturer , please read these messages they clearly state this and have offered you contact info already.

      Reply
      1. Dan Parker

        Thank you, I'm kind of an idiot sometimes when it comes to what anyone with any tech savy would know by rote, sorry, and thanxx for the clue in...

        Reply
  10. Dan Parker

    Alrighty then !!! I would verrrrry much like to purchase a Terpenator "Deluxe" (if there's is such a unit...otherwise, your basic model will have to suffice.. Please text/call me at : 408-625-9192 or email - - djp98798@gmail.com Your pricing and related operational instruction manual (?) All in due course.... Thank you for your soonest convenient response, have a stupendous day !!! Sincerely serious, Dan "JP" Parker "TEMERARIOUSIST" ;~}

    Reply
    1. skunkpharmresearch

      Sorry Dan, we don't sell equipment, just do R&D which we share.. Consider specializedformulations.com or specializedformulations@gmail.com for a Mk III or Transforminator conversion and WolfWurx.com or Wolfwurx1@g.mail.com for Mk V turnkey systems. Terppextractors.com sell Mk IV kits. GW

      Reply
  11. DENNIS CHARLES DUFFY

    Thank God! someone made all the incredibly confusing instructions at least somewhat clearer and established a baseline to go forward, my only suggestion is,those people who write instructions already understand what they are talking about but often those reading the instructions may not get it as they have often not had the opportunity to practice, so personally I prefer tremendous and redundant detail.

    Reply
    1. skunkpharmresearch

      The generic thread is an ongoing work, to which I will be adding embellishments, some already planned as time permits, but also edits based on reader input. I already have edited the original post to include more information about loading and vacuum distilling butane. As time permits, is the key phrase here, and it was only by starting with existing material, that I have been able to share the kind of detail I have here, and will continue to share as a side benefit of my efforts supporting my son's WolfWurx, Inc, offering turnkey systems, in which the package includes hands on training, so that there is no question what the manual data detailed here means. This is also Skunk Pharm Research, LLC, not WolfWurx, Inc, and we sell no equipment. We do research, and provide public education on a time available, pro bono volunteer basis, and though not a non profit, we have as a matter of record consistently been not just non profit, but a money hole. This thread will never be suitable for a rank novice, with little to no technical background or skills, to safely build and operate their own Terpenator closed loop extraction system and produce museum quality extractions. To encourage such a person to do so, would be negligence on my part, cause I can't possibly tell them everything they need to know to stay safe, in a thread they may or may not understand. It is meant to provide a standard we can point to and modify as necessary. A standard that you can also deviate from correctly, if you understand why it was written the way it was in the first place. It is easy to ask for more and deeper explanations, and as time permits I will elaborate to answer arising questions, but some of the onus is on the reader and unless you're starting with applicable technical background, your best option for detailed hands on explanations of the nuances, would be to purchase a turnkey system from someone providing training like wolfwurx1@gmail.com, or if you are building your own, take a class from Carla at specializedformulations@gmail.com, or Joe at joeoakes@skunkpharmresearch.com. Peace, and stay safe, Graywolf

      Reply
  12. Dan Parker

    I am interested in obtaining ALL available info on your Terpenator unit, as well as comparative results data on alternative units...

    Reply
  13. Kim

    Hello Kate, just wanted to say thank you for the work you are doing. I guess we live in times of big revelations to come, yet for now all we can do is try to be pioneers and look after each other. I wanted to give a small comment here about diet and treating people. I think our community might benefit greatly from reminding people that are fighting cancer to watch their diet (sugars!). I am convinced their diet might be as important to their healing as is the oil, a symbiotic relationship is how I like to think of it. Could you maybe share your opinion on possible things that might aid in the healing process, symbiotic elements for the oil treatment so to speak? Thank you for your time, Kim

    Reply
    1. skunkpharmresearch

      Hi Kim: Thanks for your comment! I wholeheartedly agree that any treatment plan for any sort of cancer must include a comprehensive nutrition plan that emphasizes the ingestion of nutrient-dense, phytogen-rich, preservative-free, as-fresh-as-possible REAL food. And yes, the plan must include avoidance of all sugar (i.e. sucrose and fructose in their purest and most absorbable forms, as found in table sugar and high-fructose corn syrup, a very common additive in everything from commercial soft drinks to spaghetti sauce) since sugar almost certainly plays a role in exacerbating and sustaining tumor growth. A recent study (among others, but the summary published here is very readable) showed that a sugar molecule metabolized to a form that sticks to proteins (a process we call "glycosylation") stimulated the ability of cancer cells to grow and spread. It makes intuitive sense as well. Our cells need glucose for energy, but the modern diet has loaded the human organism with so much easily-absorbed sugars that we cannot process them effectively or quickly; and on the other side of the equation, our lack of exercise fails to stimulate our muscle cells to take up and burn the sugars that we are loading the body with. Hence, they build up on cells and tissues and create problems from insulin insensitivity (where insulin no longer responds to or is able to clear sugars from the blood and give it to the cells for energy) to cancer (tumor cells, because they are rapidly-replicating cells, suck up the sugar at a higher rate than healthy cells for energy). I would certainly from a biochemical and pharmaceutical perspective counsel any patient fighting cancer to avoid all processed foods and sugars completely in addition to any plan that employs drugs and/or supplements intended to fight cancer by enhancing natural immunity or killing tumor development and spread. And I'd certainly advise the rest of us who want to stay healthy to ingest as little processed sugar as we can, as well as follow a healthy plan of plant-centered diet and regular exercise. Dr. Kate

      Reply
  14. Blake

    Hello Kate: My interest is driven by my dog's epileptic condition. I posted on the 'Anna' forum with details. One question which you may have an answer for is about dosing in general terms. Would it make sense that when the dog is going to be active to dose him just prior to beginning the activity. I rub the honey oil drops on his gums so it should be in his blood stream fairly quickly??? Is 15 minutes a good figure for the effects to establish themselves? My basic regime has been to increase frequency of dose rather than dose size when desiring to raise blood levels of medicinally active compounds. This based on my theory that because this is a medicinally active compound of organic nature which is compatible with mammals, the more active the body the quicker these desirable compounds are broken down into their constituent parts. Once this occurs then the desirable effects have disappeared. I do have some basic scientific knowledge, probably just enough to get me in trouble. Am I even close in my thinking?

    Reply
    1. skunkpharmresearch

      Hi Blake: Your dosing strategy is sound, not because cannabis is a medicinally active compound of organic nature, but because more frequent dosing is more effective than increasing dose size at raising serum levels--especially when dosing topically or transmucosally, when variables like moisture, surface area, and epithelial thickness create significant rate-limiting factors for any large dose size. Put more simply, if we put drug dosing on an xy-plane where "time" is our "x", and "serum levels" is our 'y", more frequent dosing (more points along the "x" tends to "flatten out the curves" of the natural increase in blood levels after a dose and decrease in blood levels as the body clears the drug, leading to a more "steady-state" delivery of the drug. In terms of the absorption of the drug and the time it takes to get the therapeutic effect, that is a bit more difficult to predict. The mouths of both humans and canines are rich in capillaries, enhancing absorption, most especially under the tongue. Sublingual doses of alcoholic tinctures in humans definitely can be felt within 15 minutes (I would avoid chronic dosing with alcoholic tinctures in both humans and dogs, however, because of the irritation that alcohol can cause those tissues). So, if your goal is to get more of the drug into your dog's system more quickly to enhance treatment, the other things to do besides more frequent dosing are: 1) increase the surface area on which you are applying the oil (the greater the surface area, the greater the absorption); and 2) increase the length of time that the drug is going to stick to the gum and mouth tissues (the longer it sticks, the more time the tissues have to absorb the active constituents from the oil base, so try to incorporate the drug into a "stickier" base). Your dog is probably swallowing a good bit of the dose, which may have some longer-lasting effects on his condition, though, like humans, dogs probably metabolize most of the active constituents in their livers (with the caveat here that dogs metabolize many drugs differently than humans. I've practiced veterinary pharmacy but I'm not a veterinarian so I can't give you the specifics on this about cannabis or any other drug, but I know that human drugs are dosed therapeutically very differently in dogs, and it's not just due to their size or weight!). Unfortunately until we do a pharmacokinetic study on canines, we won't know what dogs absorb from the oil in what period of time and what percentage of the dose gets into their systems, and what percentage of that, at any given time, is effective at controlling or preventing their symptoms for any given condition, including epilepsy. It sounds like you have had good success so far in treating your dog based on close observation, so congratulations and keep up the good work! I hope you have the advice of an experienced and compassionate veterinarian, as I have helped treat several dogs who have had to rely on two or even three different drugs to control their seizures. And it might be prudent to have a vet prescribe some rectal diazepam to have on hand just in case you have to administer something during a seizure to stop it (both potassium bromide and phenobarbital are ineffective this way as they take far too long to build up in the system to work that quickly).

      Reply
      1. Blake

        Thank-you very much for your thorough response. My vet is working with me on this and she is hoping to learn more so as possibly to incorporate these protocols into her practice. Thanks again and will update in a month or so as to Harley's progress. Blake

        Reply
        1. Blake

          I updated Harley's progress on Anna's forum. Thanks again for your very helpful reply to my earlier question. Harley is doing well right now. Blake

          Reply
          1. Accidental Medicine

            SO glad to hear it! I hope you have found a way to deliver the drug in a sticky-enough base that both enhances the surface area of application and decreases the time that the drug takes to make its way into the dog's bloodstream. Direct absorption into the bloodstream is important for onset of affect, but as I stated earlier, Harley may also be benefiting from oral absorption of the medication at regular intervals over time. With many seizure disorders in both humans and animals, we often give a longer-acting "baseline" daily oral dose of a controller anti-seizure medication, along with more frequent doses of "shorter-acting" anti-seizure medication, so this model may prove beneficial with the cannabinoid-based medications as well. Also, are you using a high-CBD strain of cannabis? We associate high CBD strains with reductions of seizures in humans...not sure if it is the same with dogs. Please keep us apprised of Harley's condition! Pharmerkate

            Reply
  15. SativaHybrid

    Hi ya,I have a question for you, I have a neurological condition called narcolepsy and also cataplexia. I find marijuana really helpful. It wakes me up ( narcolepsy ) and helps control my loss of muscle control ( cataplexia ) . Any ideas on why this may be ?

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    1. skunkpharmresearch

      Hi there SH: Thanks for the fascinating question. Marijuana has been investigated in several small studies for treatment of spasticity and tremor in patients with multiple sclerosis, dystonia, and Parkinson's disease. Most of them examined concentrated oral doses of THC, and a few examined inhaled marijuana. Almost all showed some statistically significant reduction in muscle pain and spasticity. The proposed mechanisms for this are still unproven, but most likely relate to marijuana's effect on cannabinoid receptors in the brain that in turn modulate neurotransmitters which affect muscle control. I couldn't find a published study anywhere on marijuana and narcolepsy; it has been far better investigated as a treatment for insomnia. Some insomnia studies, however, have suggested that the cannabinoid THC is more sedating while the cannabinoid CBD is more stimulating. Perhaps you are ingesting a plant that has the perfect balance of neuromodulating THC and stimulating CBD for both your conditions; if so, carry on! Or try experimenting with different varieties and see if your response varies to plant THC and CBD content. I am still investigating all the various clinical studies in depth, so I wish I had more specific answers for you right now; and more research is being published all the time, so stay tuned!--Kate

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  16. Jonas L

    Welcome and I'd like to jump in and ask a specific question. My wife has been on oil for several months for metastatic breast cancer and we successfully sent a 2 cm tumor in her brain packing. Now however, there are more lesions up there and I'm wondering if the oil can stop working. Can your resistance get so high that it has no effect? Or, can the cancer become resistant to it? Thank you.

    Reply
    1. skunkpharmresearch

      Hi Jonas: I apologize for my delay in replying to your comment! Unfortunately, with regard to cannabis, cancer, and resistance, the broad answer is: "There is not enough research, so we don't know for sure yet." But here's a few things we do know that might be applicable to your wife's situation: 1) cancer genes can mutate, which can make them both resistant to--or uniquely susceptible to--various forms of treatment (check out this recent article from the NYT on "exceptional" survivors). 2) With regards to cannabis receptors in the brain, at least one study suggests that receptor density declines as cannabis consumption increases. This is called "receptor down-regulation" and is a common occurrence with many drugs and receptor types, from beta to opioid to dopamine. Depending on the length of usage and the type of drug, the body's endogenous receptors tend to re-generate over time with decreased usage or abstinence (the cannabinoid study found complete restoration within 28 days). 3)There are hundreds and hundreds of phytochemicals in cannabis, and hundreds of different combinations and synchronicities of these phytochemicals in the various species of plants being cultivated today, so you might try mixing it up a bit to keep those receptors (and cancer genes) "guessing." Perhaps a different source of oil, a more concentrated or better absorbed dosage form, or a unique measured course of dosing the cannabis might yield better results. I'd defer here to specific suggestions on the above from experienced clinicians or other survivors. Congrats on getting that first tumor out and keep it up!--Kate

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  17. The pessimist

    Thank you for your participation in the largest drug conspiracy to ever take place in America. The government, drug companies, physicians, and pharmacists have worked very hard to create the biggest drug problem our country has ever seen, the abuse of prescription drugs. Pharmacist is a four letter word in the cannabis community, I welcome your attempt to change that. Good luck!

    Reply
    1. skunkpharmresearch

      Hello pessimist: Yes I agree, conventional medicine embedded in a profit-driven healthcare system has created many monsters. I have seen up close how the sausage is made, and it ain't pretty. I do value my education and the mentorship of several compassionate, principled professionals in the field, however, and I hope I can use those skills to help us all evolve. It's not going to be easy!--Kate

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    2. Jeffrey

      As a pharmacist whose first mandate is public protection, and has a background in research and seen firsthand the biomedical ethical dilemma of crucifying millions of innocent animals in the name of "modern medicine". I can tell you that its possible to forsee pharmacist being a bad word to much more than the cannabis community in the near future. I can however tell you that there are pharmacists who help 100s of patients with cannabis based therapeutics and have a knowledge base far broader than THC and CBD. You might be interested in the work of GW pharmaceuticals and their association with Bayer and Monsanto. 100 years ago pharmacists used cannabis and its extracts a great deal. Pretty sure it wasn't them that forced it underground and the American Medical Association wasn't listened to when Dr William Woodward expressed concern over legislation that ultimately hampered its therapeutic potentialities. And we have been lied to ever since. Trust me pessimistic, when a health care professionial cares about their patients, it shows and our community accepted my perspectives on cannabis. Can't say the same for the police who find jailing pot-heads easy money. Why is 4% of your population in prison anyway?

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  18. Gris

    Welcome, Kate! Your desire to help is commendable and appreciated. I look forward to your contributions! I am definitely interested in the many compounds within cannabis and how (and in what dosages) they contribute, both individually and in concert, to its various therapeutic effects such as relief for various types of pain, mood support, etc. I believe that with more information and research done in the areas you're discussing, we'll be able to grow and use cannabis in the most effective ways for the purposes we desire.

    Reply
    1. skunkpharmresearch

      Thanks for the warm welcome, Gris! Pain and depression--perhaps the two most common things I get asked about. Often they go hand in hand; a recent major study on chronic pain revealed that depression was alarmingly either ignored or under-treated. Definitely a topic worthy of summary in a future post; thanks for the suggestion.--Kate

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      1. Jeffrey

        I read these posts humming " everybody/back streetsback"- its good to see another corporate drug dealer with an open mind. Pain depression? Terpenes high in beta-myracene, linalool, and limonene,and beta-caryophyllene, with a strain higher in CBD. Cbd has been found in vitro and vivo to act as an agonist at 5HT-1a serotonin receptors....well activates it but we are not sure if it binds allosterically or activates it indirectly, but ultimately activating this receptor correlates to decreased depressive/ anxious systems. WIth regard to pain managment: CBD reduces inflamation, nociception, and does potentiate opioids (endogenous like endorphins or exogenous like oxycodone), it activates TRPA-1 cation channels. CBG and CBC has this effect on TRP ankyrin channels as well, but blocks the activity of the 5HT-1a receptor. Cannabis also contains 4 phenanthrene (opioid ) structures as well. Phenanthrenes are opiates like codeine, morphine, heroin, but I've studied those to death. By the way the, synergistic effects of these medicines are very complicated and I'm just a talking monkey deciphering cartoons so the important part for the patient is to Grandaddy purple the pain at night, and Blue dream the blues away in the day with a little tetrahydrcannabivarin. Isn't a rock just a stone that is a bit bigger than a pebble?-joke

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  19. Julie

    Welcome! Nice to have a Pharmacist on board! I have a general question ( I'm new at this) about dosages- can I ask it here? IT has to do with an oil concentrate with 3:1 Cbd : ThC ratio. Do the same rules of Dosage apply regardless of THC dominant or CBD dominant? A lot of the research I'm reading on dosages even RSO dosages, deal with strains that are primarily THC. So If the CBD synergy is that powerful in a heavy THC strain, what if the CBD was 3 times that of the THC? I'm trying to reduce a tumor behind the eye for a family member. The inflammation or pressure from it is causing chronic pain and blurring of that eye. Doctors said- "we got 90% of it- you gotta live with the rest." I would need to start very low for sure, but what would be logical? Maybe I'm over thinking it. Any info would be welcomed. thanks Julie

    Reply
    1. skunkpharmresearch

      Hi Julie: My first question is: how are you dosing? Oral? Because formal cannabis research has been so suppressed in this country, we don't have much reference for particular dosing. I'd defer here to case studies (meaning: those people who have tried it out and can vouch for a certain outcome). It's one of the things I want to gather information on systematically in order to propose some reasonable dosing schedules that others may benefit from. Until then, use the rule "Start low and go slow."--Kate

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    2. Jeffrey

      at nanomolar concentrations CBD can activate CB1 and CB2 receptors. At micromolar concentrations CBD acts as a receptor blocker kinda---its acts as a weak antagonist or more precisely an inverse agonist. Inverse agonism is a newer concept and it has to do with eliciting the opposite effect that an agonist (thcv and thc ) would have. Therefore when we are talking about the synergistic effects the THC and CBD actually they oppose each other from a pharmacodynamic standpoint, however a new concept will likely develop as our brains evolve and come to understand that there are shades of gray between the black and white and we may have to try to wrap our minds around , pharmacokinetic, pharmacodynamics, and something like pharmacodynakinetics (drug effects on drugs in an in vivo circumstance). One of the things that the key accounts manger for an LP wants me to me to focus on is THC and CBD. Its more complicated than this and cannabis therapeutics challenges our understanding of human physiology and how we treat conditions. No deaths noted in 4000 years of medicine versus the leading cause of accidental death on this continent? Maybe we owe it to our patients to keep learning or was the opioid megadeath of the last decade not something that weighs on our conscience because its easier to blame the patient? I heard from Dr schecter that starting dose is 5 mg. (thats really low) and I'm assuming he was talking about THC.

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  20. Joanne Holland

    Thanks for being on board, Kate. I am a physician and have come also to call myself an herbalist. I use herbal "remedies" in my medical practice as well as allopathic medications. I do sign for patients to get the right to use cannabis, after review of their records from other physicians to be sure they qualify. One of the things I also do is review how they are using cannabis and make recommendations for their management. It will be good to have someone else peruse the literature and review this to improve my knowledge. I am only one person and my time is limited. I am interested in the recent literature on adjuvant and additive effects of the targeted active product (THC, or CBD) with other cannabinoid hydrocarbons, such as the turpines. It was the finding that vanilloids have action in the cells that mediate noxious stimuli that really got me thinking about these aromatics. It is clear in other herbals that part of their power is the complexity of the product. Not surprising that may be true with cannabis. I am glad you are here. Joanne

    Reply
    1. skunkpharmresearch

      Thank you, Joanne! I am so glad to know that there are physicians out there like you actively working with patients and also working to close the gap between research and use in the professional medical community. There is so much to learn. I too am particularly interested in the components of cannabis and their potential individual and collective therapeutic outcomes, it's definitely a topic we will cover here.--Kate

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  21. Gersh Avery

    The set of compounds that exist within cannabis are like a collection of musical instruments that form an orchestra playing a symphony. The audience is like your receptor system .. Music can be played by one single instrument. Like a violin solo .. but that's not the symphony. It's very very different than the entire band playing. Understanding cannabis is understanding synergy. Massive failure results by attempting to force cannabis to play a "solo." Such as with synthetic THC. Without the supporting compounds the THC doesn't work anywhere near as well as natural extracts. The primary reason that GW works plant extracted material. BTW I'm a co-founder of the Michigan Cannabis Cancer project. Working with cancer patients for five years.

    Reply
    1. skunkpharmresearch

      Hello Gersh: I really like your analogy. I also agree that we must be careful when we single out any one compound in a plant for study or application. As an herbalist, I've always advocated for using plants as medicine in the most traditional manner possible, and believe one can often get the best results that way. Taking one compound out of a plant and concentrating it into a highly potent dosage form can even lead to disastrous results: eating whole soy foods = possibly staving off cancer. Ingesting high doses of soy isoflavone extracts = possibly causing cancer. That being said, I still find research on the individual compounds useful both for unlocking the mysteries of the plant itself and also the mysteries of the human body. And sometimes, high concentrated doses are needed for the best result: I'd honestly rather have a shot of morphine after surgery than drink some poppy tea (so bitter!). Thanks for your post, I look forward to learning more from your experience with cancer patients.--Kate

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  22. Gersh Avery

    Hello Kate!! Very glad that you are here. I also look forward to the time when this herb is normalized among the professionals. I feel sad for many of these medical professionals. They have taken the time to earn a degree that says they know stuff. So everyone expects them to know stuff about cannabis. To date, they have not had one single class about applied cannabioid science. The government limits knowledge to negative impacts only .. They are not allowed to apply this medicine at all. So .. with zero education and zero experience they are supposed to be the experts. And many think of themselves that way also. Because they have a piece of paper saying they are the expert .. At that point the full cup has no more room .. :( You on the other hand, have taken a step in the direction of real practical knowledge about cannabis. Welcome to the party ..

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  23. Zypher

    Hello Kate. Welcome!! We hope you feel welcomed. I am glad you have decided to step on board this magical mystery tour. I don't mean to speak for everybody but I am sure many would agree that we are all very interested in a community pharmacists' opinions, insight, and knowledge on the subject at hand. I personally will be checking back often. I am anticipating exponentially informative posts to follow. I take great interest. I personally share a similar passion as the path you took. Forever learning, Zypher

    Reply
    1. skunkpharmresearch

      Thanks so much for the welcome, Zypher! Wow...exponentially...I'd better produce :-). Seriously, though, I must apologize for the delay between posts. It is my hope to post every 4 to 8 weeks. I tend to get obsessive about research, and don't want to publish until I get "every last thing" perfect. I have to remember that one of the benefits of the blog format is that I can always update. Another benefit of the blog format is the ability to "converse" which I appreciate very much, so I look forward to your future comments!--Kate

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  24. Mainah

    Sweet! Welcome Kate! As a chronic pain patient who uses cannabis daily under a state approved system with very little information available, I really am looking forward to your posts. Thank you so much for sharing your talents with us. Sounds like you'll fit right in and round out the Skunk Pharm team nicely! Mainah

    Reply
    1. skunkpharmresearch

      Hello Mainah and thanks for the welcome! I really appreciate it. I look forward to conversing with more patients, too. I've been working with chronic pain patients in depth for about seven years now, and one thing I've taken to heart is: every patient's pain is truly unique and requires a unique therapeutic approach. That's why I'm excited about the potential cannabis has for various dosage forms (especially topical) and also for use with synergistic herbs (turmeric, capsaicin) and possibly even some pharmaceutical drugs (ketoprofen, lidocaine) for targeting different types of pain and the differing pain receptors. The number one complaint I get from my patients who are currently dependent on opioids for the bulk of their pain relief is the side-effects (nausea, loss of appetite, sleepiness, the downregulation of hormones) and currently all traditional pharmacy can offer them is more pills to counter the effects of the first pills! Not good! I believe cannabis will offer us a true alternative. I look forward to your comments and insights!-Kate

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