Physical therapist turned medical marijuana consultant Rhea Jacobson takes a deep dive into the benefits of CBD oil and marijuana based on the latest research in this episode of My Smart and Funny Friends.
The following is a partial transcript of the episode. To hear the full discussion, click on the link above or go to www.mysmartandfunnyfriends.com.
Lisa Richter (LR): Rhea, thanks for joining me today. Why don’t you start by giving a little background about yourself?
Rhea Jacobson (RJ): Hi Lisa! Well, this I find to be the hardest question… because where does somebody begin?
LR: It’s kind of an existential question right?
RJ: Yes, yes. I grew up in Chicago, I am a physical therapist, I am a mother, I am a wife, I am a daughter, I am a friend… and now I’m a medicinal marijuana consultant. So depending on the day and the hour, I have a different title.
LR: As you mentioned, you’re a wife, you live in the suburbs, you’re connected to your religious community… you just seem like the last person in the world to be into — or interested in medical marijuana. How did you get interested in cannabis?
RJ: It’s a really — it’s an interesting story… I don’t know how many years ago, I saw something on TV about medicinal marijuana, and I just thought, ‘Wow, this is really fascinating.” I knew nothing about it. I was actually a person who thought that the whole medicinal marijuana thing was just a way for people to get high legally. I really had no idea — I knew nothing about marijuana. I went back to school a few years ago to get my DPT, and a course I took in pharmacology, we had to do a project on something pharmacologically related and my professor agreed to [let me] research marijuana as medicine — as pharmacology. It just opened my eyes up to a whole new world that I knew nothing about. Absolutely nothing about.
LR: Alright — so talk about that a little bit — what did you learn that surprised you?
RJ: The most surprising thing is that we have — all of our bodies, all animals have an endocannabinoid system. I had never heard of the endocannabinoid system, I — really, this was a whole new thing. It was only discovered in 1992, actually. The endocannabinoid system is a major bodily system that actually helps to regulate all of our other body systems — you know, our digestive system, and our immune system — all these other systems in our body are regulated by the endocannabinoid system… and who knew?
LR: This topic is so trendy right now — it seems like everybody is using CBD. I’ve talked to people who’ve recommended it for my dog because, you know, he [has] anxiety… and then you’ll hear about somebody else recommending it because they [have] pain in their joints. But… can one drug really be such a“miracle cure”?
RJ: CBD itself — cannabidiol I believe is, how it’s pronounced — is only one of over 100 cannabinoids that are in the cannabis plant. So, marijuana… cannabis… you know, all these names [has] over 100 cannabinoids — CBD only being one of them. Our bodies have, as we know — up to now, seven different cannabinoid receptors, and they’re located all over the body. The brain, the skin, the digestive tract — everything… there are cannabinoid receptors everywhere. Can CBD help with everything? Probably not just CBD — but if you look at the plant as a whole, it can really help with a lot of what ails us — yes.
LR: What areas do you see as the most promising?
RJ: So if we talk about CBD itself, CBD is very promising for seizure disorders — it is an anticonvulsant… it is also an anti-inflammatory, it’s very calming… and another thing that CBD does is it enhances our body’s internal endocannabinoid system. So we produce cannabinoids that attach onto all of these cannabinoid receptors — and what the CBD does is it helps stimulate our body to produce more of these cannabinoids that will attach to the receptors, which will help us feel better.
LR: Okay, so… are there any downsides to CBD? I mean, it doesn’t sound like it’s addictive… but I’m sure there’s this perception out there, we’ve all seen the PSAs, you know, it’s a gateway drug, your brain’s going to be like a fried egg’ you know? You’re going to gain 10 pounds because you ate a lot of Doritos because you got the munchies — but what are [the real] downsides?
RJ: The downsides have more to do with marijuana as a whole — not necessarily just CBD. The psychotropic part of cannabis is THC… delta-9-tetrahydrocannabinol …
LR: Now you’re just showing off!
RJ: Exactly — THC for short. So THC — when people want to get high, that’s what they’re looking for. The marijuana that is purchased on the street now is very different than the marijuana that was purchased 30 years ago — the plants have been [hybridized] and changed because what people wanted is to get high, they weren’t looking for all of the other cannabinoids that have a little bit more of a medicinal quality. So, if we talk about the downsides of marijuana — in general — that has to do with [the fact that] it’s not good for the developing brain — for teenagers to be using it to get high — it does alter the brain. Marijuana is not really an addictive drug but people can develop a marijuana use disorder .. It’s not like being on heroin or cocaine — the withdrawal from cannabis is similar to the withdrawal from coffee — or sugar. You might be irritable for a couple of days, have a hard time sleeping, people might want to stay away from you, but it doesn’t have the same physically addictive quality as the opioid medications do or cocaine or any of those other drugs. Adult use… is really not that dangerous. It’s just not.
LR: Yeah, other than it can make you not get your stuff done.
RJ: Right, and that’s when people are using it recreationally with very high doses of THC — when you use it medicinally and there’s more of a balance of the cannabinoids, you won’t even get high. It is possible to use marijuana — have whatever product you’re using have a low dose of THC — so you get the medicinal benefits of THC, because there are medicinal benefits to THC, and get the medicinal benefits of the other cannabinoids without feeling high.
LR: Okay, so that all sounds super complicated. How in the world does a person — how could I begin to know what to buy?
RJ: As of right now, THC is federally illegal. Some states have medicinal marijuana where you’re allowed to get THC — a product with THC — allowed either medicinally or recreationally. So, if we’re talking about just CBD, you have to know what you’re buying. You have to know that whoever is manufacturing it is reliable; that the plants are being treated properly; that there’s no fungus and no mold and blah blah blah; and it’s always best to use a full-spectrum — so it’s not only CBD in isolate — it is all the cannabinoids together. It just has a very, very low dose of THC in it, legally I think you’re allowed up to 0.3%. But it is not regulated — so similar to vitamins, which are not regulated, it could say something on the package and nobody really knows what’s in it. So you do have to be careful and really know a reliable vendor to purchase from.
LR: So you mentioned earlier that there are some parts of the marijuana plant that [are] really good for… maybe seizures. Extrapolating from that then, there are probably other correlations you can draw that a particular cannabinoid is good for this type of pain or nausea or whatever — are there different varieties and strains designed for different diseases/ailments/symptoms?
RJ: Of the over 100 cannabinoids, there are probably only six or seven that have been really researched and the two most researched are CBD and THC. The others do have a lot of good qualities… so THC — even though it is the psychoactive part, it is the part of the cannabis plant that will give a person that high — but it also works in pain reduction and muscle relaxation and it helps with nausea and vomiting. So, there are pharmaceutical drugs that are made chemically equivalent to THC… that are prescribed for people that are going through chemotherapy or have some wasting away syndrome — from AIDs — and they would be prescribed this drug that is pure, lab-created THC, to help with those symptoms. They’ve isolated that out. CBD is a wonderful anti-inflammatory, but it is also relaxing. It doesn’t make a person high, but it really does have a very calming effect on the body — so it can be used as an anti-anxiety drug. It is also a wonderful drug for epilepsy — it’s an anticonvulsant. There is another cannabinoid called CBN and when CBN [is] combined with THC, [it] is very sedative -- that can help someone sleep at night. So if a person goes into a dispensary, and they want help with sleep, they might want a product that has THC with CBN. But if they need to use it during the day for pain control, they probably wouldn’t want to combine THC with CBN because they don’t want to fall asleep at work.
LR: Right.
RJ: So it’s just understanding the different cannabinoids, what their properties are, and how to combine them to get the most bang for your buck.
LR: So we’ve all heard that stat that people would, like, rather die than do a public speaking gig. So for those people, what would you recommend? The calming one?
RJ: That’s actually very interesting — there was just a study that came out talking about cannabis and anxiety, and part of it was public speaking, and they found that people that took nothing — I mean, there were ways that they measured the anxiety and all that. So, people that took nothing had one level of anxiety… low dosage — which they consider to be about 7 milligrams, which to me would be a high dose — they were only using people that did smoke so their bodies were used to it — lowered anxiety, but higher doses increased anxiety. The same drug, but just in a different [dose] had a different effect. But it can reduce anxiety, yeah. I don’t know that I personally would use before I go speak but… yeah.
LR: That’s interesting too, that you mention that it can give you the high anxiety, because — I know this isn’t a direct corollary but — I haven’t smoked pot since my 20s, which is a while ago now, I can say that — I hated it, because I always used to get so paranoid and anxious — like it did not make me feel good. Do you think that’s just because… that’s how my body is? Or do you think it was a bad batch? Or… too much?
RJ: Well, it could’ve — all of the above. I mean, it’s really hard to say how your body is going to respond to it. You know, some people — their bodies need this — they have a deficiency. They can take — let’s say — 100 milligrams of CBD and it really does help with whatever it is that ails them. For other people — they can take 12 milligrams and just feel knocked out and non-functional. So, it’s figuring out what’s right for you and what strength — there are so many strains — and I’m not even going to get into talking about terpenes, because that adds a whole [new] level of complications to how this is all combined and works together. The idea really is that… these cannabinoids were not necessarily meant to work isolated… they’re meant to work together — it’s called the entourage effect — and you want the combination, which is why, you know, full-spectrum or whole-plant CBD oils have more than CBD — it’s got other cannabinoids in it that — in working together in sync — they have a more profound effect on the body.
LR: I’ve seen creams, I’ve seen tablets — I’m sure there are other forms — gels, people smoke it. Once you’ve determined what the combination is that you should have — how do you know if you should put it on your body or ingest it?
RJ: So there are a lot of different modes of administration. Smoking is the one that is most common — that’s what everybody thinks of when they think about people using marijuana… the good news about smoking is [that] it has the most immediate effect. It doesn’t last as long but it does have a very immediate effect, so that people can feel that change right away — whatever change they might be looking for. When someone uses an edible — so that’s anything that they’re eating — it first has to go through the digestive system and get metabolized by the liver before they start to feel an effect. So that’s when you hear stories about people — if they start eating a gummy and then they don’t feel anything and they eat 10 of them and then they’re just… so high that they’re just out of it for a period of time. The other issue with that is that the THC becomes stronger after it’s metabolized by the liver — so it’s changed from Delta-9-tetrahydrocannabinol to Delta-11… and it is stronger and it lasts longer. So people have to be really careful with edibles — take less than they think that they need and then wait an hour… or sometimes longer depending on if you’re taking it on an empty stomach or a full stomach. Some people’s bodies might metabolize it in such a way that they have no reaction, and some people might metabolize it in a way that they have a very strong reaction — so, you have to be really careful with it. It also looks like candy, so it’s important to keep it away from kids and pets
The other way is with a tincture, or even with some things that will dissolve if you — if someone takes it and puts it under their tongue, it will be absorbed faster into the system — kind of bypassing that whole digestive system metabolic pathway — so they’ll work quicker than swallowing, but not quite as fast as smoking — but it will still have a much longer effect, it could last up 8 to 10 hours.
LR: What about the cream? I’ve seen that being sold… to rub on your hands if they’re sore -- I think it might even be a muscle ointment? Like if you pull a muscle or something…
RJ: Creams are really good, again, it depends on what you’re using it for and which cannabinoids you want in the creams. But there is a limit to how much the cream will go through the skin — to actually get into the bloodstream. Very little — I mean, the molecules have to be a certain size to be able to penetrate through the skin -- so very little medicine actually gets into the bloodstream, but topically it helps quite a bit.
LR: This is all sounding pretty complicated. So, it sounds like you would recommend that people consult someone who knows what they’re doing — a specialist.
RJ: Yes, Yes!
LR: So if that’s the case, then how — what should you look for when you’re choosing a provider or consultant, or what’s even the word?
RJ: Provider is probably not the best word, because legally a physician can’t write a prescription for medical marijuana — a physician can verify that a person has a diagnosis that will allow them to get a medicinal marijuana card — and that’s where it ends. No dosages, no advice on what kind of plant, what kind of cannabinoids — none of that is there. So what a lot of people do is they rely on the budtenders, they are the people who work in dispensaries, and they’re the ones that, supposedly, should know whatever it is you’re looking to treat — what is the best product to use.
LR: How do you know…
RJ: I know, this is not — this isn’t a great system.
LR: Right… because then you’re relying on the dispensary — or wherever you’re getting it — to educate their employees, make sure the employees take the training seriously — are there certifications?
RJ: There are certifications… and there are certain continuing education courses I know [of] that budtenders have to — I don’t know much about it though, but I do know that they have to do regular continuing education — but I’m not sure what is all involved in that.
LR: You’ve learned an awful lot about this and you’re obviously comfortable talking about it — are you comfortable using it, or with your family members. Have you had any personal experience with CBD or medicinal marijuana ... and experienced or witnessed how it’s helped somebody?
RJ: Yeah! I take CBD when I feel I need to — for a variety of reasons — it really does help sleep. I sleep very soundly at night — when you reach a certain age, you don’t sleep that well — so it really does help [me] get a good night’s sleep. The CBD… I’ve had family members with pretty severe arthritis start taking — in various forms — CBD and they really noticed when they stopped taking it… how much better they felt when they were on it. So that was really the big difference for them. Some people that I know have used it post-surgically, with the THC, and have not had to use any opioid medication after surgery.
LR: That’s significant.
RJ: Yes, that is very significant. It’s a wonderful alternative to opioids, and a lot of studies — not a lot, there are a few studies — about how if people that are taking opioids regularly are offered to use medicinal marijuana instead, they’re able to completely go of the opioid medication or significantly reduce the amount that they take.
LR: Because there’s so much in the news now about all of the addiction that goes along with the opioids and it’s just that these drugs keep getting stronger and stronger and stronger — so the idea that there could be something less harmful, less side effects…
RJ: Yeah! And a fun fact is: Nobody has ever died from an overdose of marijuana. Because there are no — we talked about the cannabinoid receptors — there are very few cannabinoid receptors in the brain stem. So the breathing centers of the brain are not affected No. 1, as opposed to opium. That’s not to say that people that get very high might not do something stupid — but the marijuana itself… no deaths from overdosing marijuana.
LR: So with so much potential that you’re hearing about and getting to know — what are the barriers to a more full-scale adoption? Why can’t doctors start to prescribe this versus the opioids or — or maybe they can, but what’s stopping this from becoming more widespread?
RJ: It’s interesting — historically, marijuana was used as a medicinal drug. There are countless places where it’s been written about — and even in the United States, doctors would actually dose people with marijuana in — I think it was 1970 — for, I’m sure, a lot of political reasons that we could get into, but there’s no point. Marijuana was made a Schedule 1 drug — and Schedule 1 means that it has no medicinal properties and that it is highly addictive.
Heroin, LSD, ecstasy are all examples of Schedule 1 drugs, and marijuana is up there as a Schedule 1 drug — so that’s really the inhibiting factor — the National Institution on Drug Abuse [is] not allowed to do research on marijuana unless you want to prove it’s negative effects — because it is a Schedule 1 drug. The only place that you can get marijuana for research is a little farm out of the University of Mississippi, I think… that’s the only place that grows marijuana that’s allowed to be used for research purposes. It’s so controlled and so restricted that… it’s hard to do good research studies on marijuana. Like I said, doctors aren’t allowed to be specific about what a person should do — how much they should take, what kind they should take — all they can say is, ‘I know someone who used this and it helped them,’ or, you know, that kind of thing — but they can’t give any specifics.
LR: What should we be aware of if we want to go online and try to buy something or try something?
RJ: I think it’s best to speak to someone who knows about it — you know, going online without understanding what you’re buying and from whom — you have no idea what is really going to show up at your door. So dispensaries — the CBD dispensaries are probably much more reliable in terms of good products — than just randomly purchasing something online.