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I would very much hope that the Canadian and the provincial governments would stop pussyfooting around, and start giving some real and concrete advice on how to use cannabis responsibly.
Dr. Claude Cyr is a family physician in practice for over twenty years and a part-time lecturer at the Department of Family Medicine at McGill University and an associate researcher for the Quebec Cannabis Registry. He has extensive experience prescribing medical cannabis to patients and is widely considered a pillar of the medical cannabis community.
In 2015, Prime Minister Justin Trudeau announced his intention to legalize cannabis. One year later, Claude created Doctors for Responsible Access (DRA), a not for profit association of doctors and nurse practitioners whose mission is to protect the health of all Canadians by advocating for an informed medical perspective on cannabis legalization.
In this conversation, Claude shares his level-headed, informed, and nuanced views on the benefits and drawbacks of legalization of cannabis.
Joe and Claude discussed:
- The medical uses of cannabis
- The potential benefits and drawbacks of cannabis on mental health
- How to responsibly use cannabis
- How parents should talk to their teenagers about using cannabis
- The medical potential of psychedelics
If you have any concerns about your own or loved ones’ consumption of cannabis, please reach out to Mindspace and one of our experts can help you figure it out. If you are a physician and would like more information on DRA, please visit: https://doctorsforresponsibleaccess.com Dr. Joe would love to hear your questions, ideas, and stories on the topic, so please write to him on Facebook or Twitter.
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Here are some highlights of the conversation with Claude:
3:45 Who are you and what do you do?
4:00 How did you get into the medical cannabis space?
5:00 What was it about your meeting with Dr. Ware that convinced you that there might be something there?
5:32 What can you tell us about the state of the science on using cannabis as a medicine?
The sad part is that because of prohibition, and because of the fact that most of the science comes out from of the United States, we’re just at the beginning right now of where the science should be.
If I was going to put a number on it, I’d say we know about one percent of what the therapeutic potential of cannabis is. We know that there are hundreds of cannabinoids. No, there’s at least a hundred cannabinoids in cannabis. Only two of which are actually being researched clinically right now: THC and CBD. And there are probably half a dozen cannabinoid receptors.
The only one we really know about is the CB-1 receptor in the central nervous system. So right now the science is pretty good in terms of the CB-1 receptor and THC.
But if we want to look at the science for the hundred and ten other cannabinoids and the other half dozen receptors, we’re just at the beginning. So when it comes to pain, muscle spasms, and nausea, and all of the other symptoms that respond to THC, it’s starting to look pretty good. But the rest–well, we’ll talk in 5 or 10 years, and I’ll tell you about it.
6:47 What are the guiding principles for prescribing cannabis?
8:28 I think that the middle ground area is what you try to stake out with the non-profit you started, Doctors for Responsible Access.
9:28 So what did you learn?
10:57 Have you ever had to work through this level of uncertainty or lack of information in dealing with certain conditions or medication?
13:19 What’s all the excitement about cannabis? Why is there so much research going on? Why are doctors so passionate about it? Why are you so passionate about it?
When I first started medical school back in the late 1980s, early 1990s, we didn’t even know there was an endocannabinoid system. The receptors were only discovered in the early 1990s. We’ve always known that there were these orphan receptors in the body. Receptors we’d find on cells, but we didn’t know which ligand or which product actually connected to them.
And lo and behold, we’re realizing that a lot of these receptors, almost half a dozen, if not more now, are endocannabinoid receptors. So the cannabinoids, whether they are endocannabinoids or external cannabinoids, they interact with these receptors.
And they’re everywhere in the body. So we know that these receptors are in the brain, they’re in the liver, the lungs, kidneys, the reproductive system, the skin, bones, bone marrow. So for the time being, what’s exciting is that there are these receptors everywhere, and we know that cannabinoids interact with them. And there are over a hundred different cannabinoids in cannabis.
14:51 You said that there are over 100 cannabinoids in the cannabis plant. But why does that mean that it has the potential to be therapeutic?
16:04 Is it possible that the impact of the molecule binding with the receptor could be negative?
17:20 As you know I’m a psychologist and I’ve been monitoring my clients and the trends in consumption of cannabis in my community. It’s incredible to me how little we know about the impact of cannabis use on mental health. I also see a lot of clients smoking to self-medicate for anxiety. What’s your take on that?
19:32 In my experience, I wouldn’t say that people are saying to themselves, ‘I feel anxious, and this is a substance that helps me with that.’ It just becomes a habit because there is some temporary relief.
20:12 What about cannabis’ interaction with antidepressants? 21:13 What about the risk for psychosis?
23:39 Another thing that I see a lot in my practice is that people who smoke a lot have difficulty with motivation and some cognitive functioning as well. Is that just me?
24:25 What about cannabis’ impact on motivation?
25:47 Is cannabis addictive?
26:45 Can cannabis have any detrimental effects on sleep?
28:26 What about using cannabis to help people with PTSD?
31:00 What about depression?
32:23 CBD, one of the active compounds in cannabis, is receiving a lot of attention. What’s the difference between THC and CBD?
35:02 And what about the difference between CBD and THC when it comes to the subjective experience of the high itself?
35:35 I’ve heard people talk about two different types of plants: Sativa and Indica. Is there a real difference between the two?
37:27 Do set and setting have a big impact on the subjective experience of the high? And a related question, to what extent does the expectation of the high you’re going to get make a difference? I remember learning in grad school that more than any other drug, what you experience after consuming cannabis depends on what you expect to happen.
39:52 There are all these different ways to consume cannabis now: edibles, smoking, drinks, oils, all with different concentrations of THC. I know there are these famous stories of gummy bears in Colorado that are really dangerous. What can you tell us about these different forms of consumption?
43:17 That is a big concern. When we were talking the other night, you referred to this Tsunami of important cultural changes that were happening since legalization. So let’s get into that now. Why is cannabis legal? What’s the history of legalization? How did we get here?
44:55 What are you expecting in terms of the public consuming cannabis?
47:30 We know that with alcohol that one drink is a glass of wine, an ounce and a half of liquor, or a beer. But what is a dose of THC?
I’m asking you Joe. What is a dose of THC?
Well, we’re all in real trouble if you’re asking me here [laughs].
So you should know. We should know. Everyone should know what a dose of THC is. But we don’t know what a dose of THC is.
We can surmise about what the experience–for example, in Colorado and Oregon and Washington, when they first legalized and they started seeing hospital admissions shooting up, people becoming completely psychotic, they said, ‘Oh. Wait a second. Maybe it’s a dose thing here going on’ because people were buying chocolate bars with a thousand milligrams of THC and you had a hundred milligrams in a gummy bear for example. Which is a massive dose for somebody who has never consumed anything.
But when you look at a gummy bear, it looks so benign. It looks so friendly. But a couple of hours later, that person is locked down in a gurney in an emergency room.
So if you look at what happened in Colorado after the first initial years of legalization, and the problems they had with emergency rooms and psychosis, they came out with public campaigns that actually warned, not only the people from Colorado, but the tourists that were coming in to start with a maximum dose of five milligrams of THC.
These campaigns were called “First Time Five.” Which I thought was just brilliant. So if you didn’t know what cannabis was and if you didn’t what to use, it didn’t matter if you inhaled it, or if you ate it as a candy, a gummy bear, or a chocolate bar, as long as you didn’t take more than five milligrams of THC the first time you used it, and you never took a second dose on the first day.
Those were the main recommendations to avoid ending up at the hospital.
49:34 One of the advantages of having this substance regulated by the government is that the government is going to take care and provide information on how to responsibly use cannabis, but I’m not really seeing a lot of that out there. What’s your take on the level of public education on responsible using cannabis?
51:10 Besides being aware of dosage, what else do people need to know to consume responsibly?
53:22 Can you tell us about the large longitudinal study happening in Canada and Finland?
56:51 So you have two teenagers. How are you managing on the parenting side? And what advice do you have for parents for talking to their kids?
59:05 Any other public information we should all know?
1:00:55 So imagine you’re an adult and you’re having a dinner party or watching a movie and you smoke a joint, when do you know if it’s okay to drive home?
1:04:01 So the person who gets pulled over by the cop for driving poorly could say, ‘Don’t worry, I smoke everyday.’
1:06:02 There’s another class of psychoactive drugs that seem to be following a similar trajectory in terms of legalization and medical use, and that are psychedelics, more specifically psilocybin, LSD, and MDMA.
What’s your take on the research literature and the historical trends that we’re seeing there? Are we seeing the next cannabis or is it a different class of phenomenon?
I think there is incredible potential in those drugs. When you look at the initial studies that were done in the 1950s and 60s–I mean they weren’t small studies, they were done on thousands and thousands of patients. And the results were spectacular.
But the sixties came and then the counterculture. Then it became a street drug and it was banned. But over the last 10, 15 years, there has been a rebirth of research in psychedelics.
The great thing about psychedelics, unlike cannabis–cannabis when you’re using it medically, you have to use it pretty much like everyday because it is for chronic symptoms. Psychedelics are usually like a one shot deal. People use it, a couple of sessions, three, four sessions, eight sessions. It’s usually in psychotherapy. It’s usually used for psychotherapeutic purposes.
So it’s not something that you’re going to be using everyday to treat a condition. So the long term effects in terms of impact on your cognition are really not a huge issue.
But I believe it’s going to completely revolutionize how we practice medicine in the 10 to 15 years for sure. When you look at most of the problems we have–I mean in family medicine, 50% of the people who come into my office don’t have a physical problem. So it’s anxiety issues, it’s depression, it’s a lot of mental health problems. And the drugs that we have and the interventions that we have are effective, but it takes a long time. And the results are not always spectacular.
Whereas, as with these compounds, when we look at addiction for example, for depression, for obsessive compulsive disorders, in many of these studies, the results were like almost immediate. So we’re looking at like short term, high intensity interventions with long term results. And that’s what we want in mental health. We don’t want this in the dropper kind of thing.
1:09:13 Just for the record, I’m also very excited about the tremendous potential that psychedelics can play in revolutionizing mental health. But to play devil’s advocate here, I’m a little suspicious of the studies because, first of all, it is impossible to do a proper control, since you know if you got the active substance.
And second of all, there is so much excitement, and the researchers are so passionate. Those are suspicious conditions to read the data with. What’s your take on that?
1:11:01 If you took 10,000 people, and say, ‘Okay. I’m going to take you into a room and something really weird is going to happen. But I’m going to be here to support you.’ You could just give people a carrot at that point and a big chunk of those 10,000 people will have a mind-blowing experience.
Of course something will happen to your subjective experience, but that being therapeutic I think is subject to a placebo.
1:13:04 We’ll see if the results stand up to more rigorous tests. Is there anything else that you want to say?
1:13:40 What’s the obstacle to that? Why aren’t they doing that already?