Intro to Medical Marijuana

all right hello everyone welcome I'm very happy to introduce to welcome you to the 19th annual Parkinson's symposium I know it said 18th in the flyer it's actually the 19th symposium the living well with Parkinson's disease beyond traditional medicines you know you may its if the speakers have 18th on their slides I just want to take responsibility for that my apologies the we we had actually a very large number of registrants this year more than we had in past years I don't know if that's because of the topics or just because we're growing year to year but I'm glad to see so much interest in this I'm I couldn't use myself I'm David Simon I'm the director of our Parkland Foundation Center of Excellence and chief of the division of movement disorders at Beth Israel Deaconess Medical Center a couple of just comments I want to make at the beginning one is if you have a cell phone please make sure the sound is off or the phone itself is off also I apologize for the conflict conflicting event across the street and the extra time it might have taken to come in I expect some people will be coming in late so for those of you where it would be easy to move in towards the middle to make it so people don't have to climb over you to get in when they arrive late that would be welcome it looks like there's still seats available so it should be fine we have a few people I want to just thank before we get started with our first speaker biggest thanks goes to Elizabeth Morrison and Althea silver Althea is in the back I don't see Elizabeth right now but you might have seen her at the table they did it thank you Joe they did a great job in a lot of work in making this symposium happen I also want to give a special thanks to some of our the people with Parkinson's who are going to participate in the demonstration of Rocksteady boxing a little later this morning also our sponsors Medtronic Abdi and patients like me who each have given donations to help support the cost of the symposium it still doesn't support the full cost of the symposium so if anybody else is interested in in donating we're very happy to offer this for free but it still does cost money and you're welcome to you can look at our website or kind Frank wicks dead from development I don't know if he's in the room right now but I would write in the back there or let me know and I can help you one other thing I want to mention there's actually an opportunity it was in our last newsletter for those of you on our email list and if you're not on our email list you can give your email to LC or Elizabeth today and get periodic emails about events like this we also have a bib available for the upcoming next year's Boston Marathon if anybody is interested in running in the marathon to help generate support for our research and Parkinson's support programs so let me know if you're anybody is interested or if you know somebody who's interested also we have quite a few wellness works programs which is very relevant to the theme today in terms of you know complementary ways to help support your Parkinson's disease treatment I think as Kyle here in the audience and Stacy right here are instrumental in our wellness works programs you can let her know if you have any questions or again you can let me know and there's an again information on our website about these programs also want to so we have programs that we run here we also run some through a collaboration with JCC I want to thank Audrey for that and also Althea again and also the Parkinson foundation which provides funding to help support that collaborative effort you know new event this year is our lunch with research scientists who are doing research on Parkinson's disease or early stages in their career and we're gonna have a lunch afterwards only for those of you who registered in advance for Ed we were only able to do that this time for a hundred people so it filled up quickly because most people who registered for this event also signed up for the lunch so I apologize for those of you who might have wanted to join that lunch afterwards but we have to restrict it to those who registered in advance and I think with that I will it's yeah I think that's oh yeah one last thing before we move on to introducing our speaker we're gonna hold questions not we're not gonna have questions during the talk at the end of the talk even though this program said we're going to have both dr. levy and dr. Ellis talk first and then questions actually going to shift that a little bit and we'll take questions for dr. levy after his talk and my apologist again in the program it's Donald levy not Dan levy but we'll take questions after his talk but rather than have people step up to the mic what we found worked for us in the past years was we're gonna hand out note cards and anybody during the talk and write down a question on the note card and then we'll collect them and most likely unfortunately only be have time to answer a you know a subset of the questions that are asked but they'll give us a chance to to choose some that especially those that we see multiple people asking so hopefully you'll get those note cards shortly so again I'm very happy to introduce dr. Donald levy he's an assistant professor of medicine at Harvard Medical School and medical director of the osher Center for Integrative Medicine at Brigham and Women's Hospital he's taught harvard medical students interns residents and fellow physicians in a variety of settings over 35 years and maintained a practice in primary care internal medicine until 2007 when he gave when he became director of the osher center he's a recipient of numerous awards for excellence in teaching and citations for excellence in patient care and patient satisfaction and his current professional interests include integrating the scientific advances in modern medicine with age-old therapies and principles of healing and the use of therapeutic lifestyle changes including nutrition and dietary habits and herbal supplements to recover from illness and maintain good health and also the power of an effective doctor-patient relationship in medical care he lectures often on these topics and sees patients in consultation for an integrative medicine approach to the management of medical problems and I'm very happy to welcome him today [Applause] [Music] can you hear come hear me I stay away from this I like to be able to wander thank you for having me I'm honored to be here I'm going to talk to you a little bit about medical marijuana make a distinction between recreational use and medical use you could hear him right so you're gonna be able to hear me I hope yes all right you don't appear to be shy so speak up if you can't hear me we've learned how to use this sorry I'm obviously learning okay I'll go this way I need help thank you oh that one okay sorry okay so what I was saying is that it's a very interesting history that marijuana began as a method medicinal became recreational and now we're back to medicinal I'd love to give you some basic theory and understanding in medical marijuana and not get into all the absolute research and the moral and immoral and all the implications of legalizing it but give you information to help you understand it and if you don't think marijuana is available recreationally somebody was getting out of their car in p-town and this that's the kerb on the left and growing right there was some I guess recreational marijuana it is probably the most commonly used substance of this sort in the United States and I guess we're up to almost half of us have admitted over our lifetime to have tried it what's really interesting is this with all of the controversy about it there's almost no life threatening toxicity that don't think there's a recorded case anywhere of somebody dying of an overdose of just marijuana so with all the issues and ills and worries you're probably not going to kill yourself if you play around with medical marijuana I do worry tremendously about the use of marijuana for adolescents because the developing brain may not be the best place to expose marijuana there is addiction syndromes you can get addicted almost most of the folks that get addicted to marijuana our kids who started in teenage years and use it for recreational use I have I don't think there's data to suggest how many people get addicted who begin for medicinal uses and there isn't withdrawal syndrome which makes it medically valid to talk about addiction marijuana is very interesting because you can grow it in two different ways the cannabis species you can grow it as you know hemp hemp been around forever and it's used as a rope same species if you cut off the the flowering buds at the right time you get a whole different you get a different product and very different obviously and their outcomes here's some of the differences I'm not a botanist cannabis they're both cannabis species hemp as are those tall stalks you just saw in what we generally referred to as marijuana there are these leafy parts with trichomes and buds and flowers that these glandular parts have all the active ingredients and if you harvest a plant like this before all that happens you end up getting something like hemp the one on the Left met what we it's generally what we call marijuana but hemp is also a cannabis plant marijuana is high in THC and hemp is high in CBD and if you don't know what those are you will in a minute I promise here's on the left that the leaves with the trichomes and then on the right the trichomes are a hundred thousand times magnified that's where all the active ingredients in marijuana most of them reside it's good to know the recreational terms because whether you use it or your kids use it or a friend uses it or someone refers to it I do come from the 60s and yes I used hashish it was lit it was about as potent as a normal marijuana cigarette today we're a very different time we're living in and I'll tell you more about that it's that resin all pushed together and then if you take the resin and put a solvent and dry it out you get this stuff called kief which is remarkably potent in that thing called THC hash oil or honey or dab or wax or butter bu d de r is important to know about only because it's remarkably potent remarkably potent and people call it dabbing when they take a little bit of that I'll show it to you it's on the right there honey oil or dab and a little dab will do you it's it's remarkably potent and that's right what assume kids easily can get addicted because you dab and then your dad began in an hour and an hour and it looks pretty innocent there looks like candy if you took that whole thing you would you'd be on quite a trip you went it wouldn't be enjoyable so let's talk about there sativa and indica - the most well-known species or subspecies of marijuana they're beginning to blend together so much that I don't know if we'll even make this distinction anymore down the road but people who are who are veterans will tell you they need an indica plant they need a certain particular one here's an interesting comparison recreationally there's a gazillion people I guess using twenty two million using marijuana but medicinally probably 1/10 or less and here's the interesting thing well you know if you're using marijuana for recreational purposes its - its to alter your mood whereas for people who are ill with any kind of chronic illness it's to help them feel better or relieve some symptom very big difference in intention and in the first one your cognitive function is impaired because you want it to be you want to get high people who are ill who are using medical marijuana are doing it because it's an adjunct to their treatment and they want to feel better and function better and they actually their cognitive status actually can improve for example if you use it to sleep and you sleep better you're going to feel better and think better and the effect on opiate use is another fascinating thing there's actually a reduction a reduction in lethal opioid overdoses in places where marijuana has been legal I might talk on that if we have time in a few minutes medical use let me give you the five thousand year history in 30 seconds there was this Empress Shenyang 2700 BC who got sick of his shaman's shamans who couldn't get anything done people were complaining they still had a lot of ailments he discovered that marijuana was fantastic for a whole bunch of things in marijuana tea of course back then all these things listed and he gave it out and had great results reported by him skip ahead a couple of thousand years in the 1850s it was if I had a medical bag it was in it it was very well used by doctors and in 1937 for all kinds of political issues it got banned that the AMA wrote a letter to Congress which is in the Congressional Record saying don't ban marijuana we wanted bag but that was was not listened to and then states took it on themselves to legalize marijuana and we're in a kind of messy legal position right now all over the country famous physicians Sir William Osler is the God one of the gods of medicine said it's one of the best things for migraine and Morris Fishbein who was general the American Medical Medical Journal American Medical Association editor wrote about it fermentable migraine if there's literature loaded with the value of medical marijuana disappeared after the 1930s and if you know about scheduled drugs that this is the craziness schedule one drugs which marijuana is is our drugs such as heroin LSD ecstasy peyote some of those silly to be Schedule one drug probably heroin belongs there for sure but to put marijuana in that category silly and I bring it up only because if we want to learn more about it and have people like you or me or anyone use it for a medical condition it's hard to research it it's hard to get it and it's so dangerous to try to work with it legally that we can't get anywhere this past year I think finally the DEA said we're not going to change its status but entities so I guess Harvard Medical School or a place that does research can apply and start doing research with it so I think things are going to change but it's really important I think that it becomes scheduled appropriately it is not a lethal drug or as dangerous as heroin okay the pharmacology when you leave here I hope you know the basic pharmacology of marijuana they're the two big cannabinoids THC CB and CBD THC is always considered the most active but it isn't it's just the one that makes you high gives you quite a hallucinogenic and high enough doses trip cannabidiol different effect it actually calms you can reduce anxiety can reverse some of the problems that THC gives you it's got anti-inflammatory properties and other things what really made this take off and start to have research in the 90s is that they discovered we have marijuana receptors this happened with opiates when we discovered you talk about your endorphins get getting boosted when you run or something like that doesn't those are morphine receptors technically or opioid receptors once they discovered endogenous within us marijuana receptors are cb1 and cb2 this became a fabulous area for research what can we do with this stuff why do we have receptors within us how can we use it to our advantage and the cb1 are mostly in the central nervous system and the cb2 are mostly unconnected with the immune system and I think the reason nobody dies from a terrible overdose of marijuana is just what I wrote there in red that there's no cp1 or cb2 receptors in the brain stem which is where it controls breathing when someone overdoses with an opiate they often die because they stop breathing that doesn't happen with marijuana I don't know if that's good or bad well I think it's good that nobody hurt themselves but it's just an interesting fact and lucky for people who are playing around with it this is another picture of that system that's on the top and these are two nerve endings meeting and there's receptors to study and we can we use marijuana for the pre presynaptic and postsynaptic receptor tons of research now if of cannabinoids and the endogenous system and then of course that what follows as drug companies getting the act and make synthetic versions of marijuana and sell them as medications and some of you might have been on Marinol in your lives the one that's really interesting to me is sativex but it's not available yet in this country it didn't pass some tests the criteria was silly it's all it's available in Canada and all over the world but it's the closest thing to a tincture of pure marijuana with a one to one ratio of THC and CBD that's not the only ratio that's best but we're getting closer to a legal clean prescribe 'el version of marijuana and stranger that's not a Schedule one drug the system doesn't make sense and then there's FBA dole X which was if you ever saw as Sanjay Gupta's on TV the terrible seizure disorder and children that was it was healed by CBD that's almost pure hemp oil or pure CBD that has been now made to a patented medicine here they are on the left is the Sativex which I hope becomes legal in this country and for those poor kids who have this terrible seizure disorder there is now a medication they can legally get here's the issue to me pharmaceuticals I do integrative medicine and you do a lot of prescribing of herbal supplements and supplements are different than pharmaceuticals I call them nutriceuticals the whole plant works differently than a sub part for example what I had here like marinol it's a synthetic part it's a synthetic derivative of one part of marijuana it's nothing like the whole plant so most of the research that's been done has been on these sub parts synthetically manufactured and sold pharmaceutically but patients will tell me there's a real difference when I smoke marijuana total difference what is that all about well here's some more pharmacology I told you about THC and CBD tetrahydrocannabinol cannabidiol those are the big two then there's a good four more this will get you crazy there's kind of bigger all kind of been all counted by chroming I loved the last week hetra Hydra counter by Byron they're all different though they're each being studied at McLean hospital right now or some of them are the last one might have anti psychotic features some have anti-inflammatory some of it might be useful for movement disorders and then there's more here there's 60 others there's 60 other cannabinoids in marijuana and then even hotter topic for research or terpenoids if anybody's walking around and they smell something and they think that's marijuana it's the terpenoids in marijuana that smell like that distinctive odor or fragrance depending on what you think so all of this together is not the same as extracting one part and putting it into a pill big issue so I will raise this for you which I raise for doctors when we talk our herbal preparations just messy drugs we were taught in medical school it's so against our teaching to not just to think of an herbal preparation get the active ingredient out usually we learned about some drug or plant from those savages of some place somewhere in the jungle or perhaps Native Americans in a you know condescending way and we want to take out what the active ingredient is and it turns out they knew better they knew that the whole plant was more helpful and and easier to use so pharmaceuticals we know about you take out the active ingredient it's identifiable herbal extracts 92 things going on too messy don't want to do it on the other hand there are people now starting all over the world saying there's a thing called the entourage effect that is when multiple parts of a plant have synergistic activity it might be better than any single one part so for example THC is the psychoactive part that gets you really high and maybe anxious and nervous and paranoid as well and it but it seems to activate people who ever using any kind of marijuana CBD goes the other way and calms you down so those two together what a little on the other sixty things in there are a good combination so to separate them out you're actually doing something silly and think it's in the name of progress and science there's a lot of good reasons to keep the whole entourage together I always use the example well when the Celtics were winning championships Larry Bird he was the active ingredient on the team maybe but he needed four other players or he would not have won or Michael Jordan or wherever you live an entourage is like that maybe that's what's needed in medical nutraceuticals and in fact there was a congress in europe that came out with this discussion and said attempts to isolate the active principles from plant extracts may be ultimately self-defeating the quote Silver Bullet concept adopted by Orthodox Doc's for the last hundred years you can read it it's now increasingly viewed as inadequate and I think that's an important issue and marijuana is really important to demonstrate that issue we're not looking for the Silver Bullet we have to learn how to use the whole plant and that is messy but unfortunately it's or fortunately there's something to be learned there so for example one more point about this of the other big six cannabinoids CBC that kind of bigger kind of been on kind of kind of banal or can a bigger role or tetrahedra can have by Virant they're all different they all have different components different and different efficacies and different applications and maybe they all need to go together or we need to figure out the right mix so keep that in mind when you read literature if they use the synthetic single part it may not apply to you at all here are some of the things that some of the the cannabis components are known for all these things are really important and we again we need to learn how to balance them and why I'm really interested in research on the whole plant hope hope products from if you add up and look through anecdotes case series clinical animal studies you will find at least these same indications coming up over and over again and same from people who've had personal experience if you have marijuana you get the munchies you get hungry generally you don't throw up if you're having chemotherapy it's an analgesic it helps reduce anxiety and can help people sleep its antispasmodic so for people with MS especially it's been very helpful and it's anti-inflammatory which is fascinating and needs to be explored further so the hike there are some high-quality studies but most of them as I look back in the literature most of them are synthetic THC some of them are THC put CBD like that oral spray sativex or in a Bick so malls fewer studies use the whole cannabis plant there's a great couple of references here and I can get them to anybody or through david about how this is how this all plays out but again really important to look in a study of people tell you the literature is and isn't satisfactory it isn't satisfactory because we're not studying the whole product so now I'll give you a little bit about cannabis back when I came of age in the 60s if you bought a joint maybe it had 1 or 2% marijuana THC maybe if you smoked hashish it had 6 7 or 8% now that won't even qualify as a cigarette the the stuff that's out now 13% 15% that 30% this is very potent this is like you knowing I can have one mixed drink with an ounce and a half of gin and suddenly there's 13 ounces in it that's a very different drink very different drink so to compare old and new marijuana it's very important to know something about the dose and which what you're getting a very important reason to be able to go to a dispensary and have it labeled probably the best way to get it is to vaporize it if you're going to think about the ways to get marijuana into you and now every one of those including rectal suppositories have been used most people probably smoked it oral or edibles is becoming more popular I'll tell you about the different ways it's used if you inhale it or smoke it you're going to get a serum peak within a few minutes eight minutes so one bit of advice that I've given people is that if that's how you're doing it I'm just jumping into now practical stuff if you're trying to figure out if marijuana is helpful to you take a puff and wait 8 minutes and don't take another puff for a while give it a little bit of time to see what happened if you are taking it orally you're gonna have to find out in you on an empty stomach or a full stomach how long it takes most people it's somewhere between 30 and 30 minutes and an hour and a half and once they know it's very helpful and very useful so I tell people between bites of whatever they're there they're eating wait a half an hour wait an hour and see what's happening I do not think it's funny when people give people something that has and inedible just for a joke it's not a funny joke because often people an hour later at home and freaking out because I don't know what they've been given it used to be considered amusing I don't think so at all I think you got to be very careful if you haven't had a bowl find out how it works for you and then you can experiment a little vaporizing is probably the one way used in a lot of medical experiments you're basically heating it in something and the portable ones are like the old cigarette lighters in a car or something that heats something up but just short of burning it and then you can it becomes a vapor and you can you can inhale it here's the big one that was used it's called the volcano it's because of that volcano looking device in the middle you can actually set the temperature then you put that bag on the top the bag looks inflated there it's usually collapsed you put the bed on the top you heat up the marijuana the bag fills up like a popcorn like you didn't have popcorn then you put that black plug take it off and you can put it aside for the day and you can absolutely meter your doses you can also have it for your own use if this is being used medically for experimental studies that's a good way to get a somewhat scientific to say if they took six inhalations or twelve and they knew exactly what they were giving people still by the volcano but nowadays almost everybody is using some kind of pen like device to vaporize it this one looks like on the left there's that's vapor not smoke if it's if it's being done properly so you don't get all of the noxious materials from smoke I don't recommend that anybody smoke anything so vaporizing makes the most sense to me medically or trying something in an edible fashion it scares me though edibles scare me because they look too much especially when the free market they look like candies we have no idea what's in them unless you're getting at a dispensary and all the issues of absorption and delayed onset of action and the next slide is shocking to me this is the the DEA confiscated some candies and look at these we've got Keef cat we've got Buddha fingers munch away all these cute little names for candy bars that look quite similar to two you know well-known candy bars and I think that's crazy and dangerous and probably should be made illegal and that somehow as we learn how to regulate this substance and not throw the baby out with the bathwater we learned how to make edibles in a fashion that looks something medical perhaps or something easily identifiable and also able to break into doses this was this was I've seen more and more of this I don't know what's going to happen when it gets fully recreational illegal but this is one of the things that scares me I think the stuff that I studied the most originally because patients came to me and taught me this is that it helped them with their chronic pain and some studies have shown that this was surprising to me the studies the kind of studies that are rats you'll look back on retrospective study asking people how they used it and getting some really deep dive into their use of marijuana this first study was 244 people who were taking it for chronic pain and they said the same thing that I hear personally anecdotally and seeing other studies like the second one was from Australia first of all what's interesting is I thought marijuana would work best for fibromyalgia patients because it would do something centrally amplified pain and it didn't it actually worked better for neuropathic pain the second thing is everybody found their own dose but the most important thing was it became an exit drug not an entrance drug for opioids many many people report I used to take ten of X you know opioid I'm on five now and it's fabulous and again it gets back to the difference between recreational and medical use I assume everyone here if you are going to try it or use it or have it prescribed it's going to be for medical use and you're using it because you want to improve some part of your life and so people tell me now I could be with my family at Thanksgiving I used to be a zombie when I took enough pain twisters pain relief now or now I can sleep or now there's other things unless anxious and I don't need as much of the opioids so just for control it's very interesting what marijuana is done in fact they did a really deep dive pretend the first the 10 years from 2000 to 2010 and in there was in any state where marijuana became legal there was a drop in opioid overdose deaths and this is a strong association that continues to this day so it's interesting when I hear all this stuff about it it's an entrance drug it might be for kids and we have to be careful that but for people using it not recreationally but medically it's actually an exit drug from opioids I think it can help the opioid epidemic so I looked a little bit cannabis in Parkinson's disease it's really hard to find as in every area not as much evidence or studies as with neuropathic pain I think but there is some interesting things that if I was a researcher I'd want to follow up how does it in any way affect motor activity it looks like right now the best things I see are the non motor problems in Parkinson's especially sleep and anxiety I don't know about depression or pain pain for sure if because of my other experiences with marijuana use for people with chronic pain whether it's going to have neuroprotective effects and in any way change progression long way to go on that one and of course every paper written anywhere says we need to standardize it and get more evidence about its safety and efficacy ensure that's fine but it's going to happen it's gonna happen a little bit haphazardly because there are now it's going to become legal and people in this audience and anyone else are going to start experimenting themselves to see what works for them one one good article if you looked up one article to look about to read about medical marijuana this the article by Savage and the Journal of pain I could give that out to you for a it's sort of a consensus document looking at all the things the issues regarding marijuana a few more slides because they'll have time for questions what's fascinating is when they when they became legal in Massachusetts cancer about common AIDS right away became a okay for as a reason to have marijuana prescribed and then the list changes in each state Hep C is is on the list here but not in Colorado Parkinson's disease is on the list in Massachusetts but look in Colorado Parkinson's disease isn't even mentioned that's strange we're all we're all I call it the Braille the Braille method stolen from a guy named Levine who was we're all sort of reaching trying to figure out how to do this actually we do that more often than you think in science and then we hit a discovery and make it sound like oh yeah we knew that was coming but it isn't true but we're all trying to reach and figure out and that's why I think there's another really fascinating thing going on with marijuana that has to do with the patient-doctor relationship which I'll say more about in a moment at this point I think when when doctors suggest that someone go get a medical card it would be for these reasons nausea and vomiting especially chemotherapy related that's pretty high on the list now chronic neuropathic pain yes it will reduce may as the possibility of reducing your need for opioids anyone who's losing weight from it from a condition might be helped by marijuana people with MS or reporting a benefit with the spasticity and then down the list a couple of more I'm seeing more and more people tell me about insomnia that they don't like sleeping pills and this has been one of the when they found the right dose this was a way to get a good night's sleep and everyone will tell you a good night's sleep is helpful for any condition you have including just enjoying life so I think this is one of my last slides a lot of everybody will cite all the problems by the way the first problem to me is that we can't research it enough it's still a Schedule one drug and hopefully that's changing yes the rigorous trials are not going to happen until we get people who if David wanted to research it he could do it here without jumping through 52 hoops yes we need to know the composition and the purity and the concentration again need people being able to give us this information there's no clear optimal dose for various conditions and this next one it's unconventional it's unconventional because guess why patients are in charge more than the doctor and to me that is the future of medicine I think patients should be equal partners where I I have expertise I went to this thing called medical school and I've been reading for the last 35 years but I don't know you better than you and you know how to how your body works and you know what you've done and and you can be an equal partner and it'll never happen more than in the use of medical marijuana because there's just not allowed a lot of information out there so you will go to a dispensary if you got the card and decided it was an appropriate thing and we're gonna work together then and talk because I don't know how it's going to work for you I can just give you this kind of advice and you're gonna lead be patients are going to lead I think which will be wonderful for a restructuring of patient doctor relationships for chronic disease in general it's it's what could be a benefit although here it's considered a terrible thing doctors have to give up the power of writing the prescription you will take this drug at this dose three times a day like I said and don't don't deviate and let me know that's just not going to work it doesn't work anyway but if you surveys of people taking prescribed medicines some of them are found in the trash on the way out the clinic door because nobody listens to the person enough to know that they already had that drug and it caused the problem that's our problem in connecting with our patients yes there's some side effects yes there are some neurocognitive changes and we need to know more about that I'm especially worried about the neurocognitive changes for recreational use not medical and young people this cannabis use disorder is real for young people and people who think you may activate the opioid overdose I think every bit of literature so far shows that to be not true so what I've tried to say so far is a few things medical versus recreational you got to ask that question every you hear a study or a person talking about it you're talking about medical or recreational use because two different populations exists there the biochemistry learn about it when you can think about the entourage effect and that a whole plant is perhaps more effective not less effective than a pharmaceutical Silver Bullet extract I've told you about some of the formulations but edible and vaporize to the I think two of the preferred ways to take it if you're ever going to experiment some of the things that it can definitely do when others we just need to research I think I'm done and we can talk there's time right yeah thank you very much there was we've got quite a few questions here and as I mentioned I won't be able to get to them all but I'll just do a couple of them actually one of them I think is a sign that you seem to have expressed interest in some of the potential uses one person asked where they can get seeds to grow marijuana and it does just actually lead me to just feel obligated to make one point here which is that you know as a physician I don't endorse the use of marijuana for Parkinson's disease but I recognize that some patients use it and and I think it's important to have information to make decisions like that which is why I'm glad we have an expert like Dunleavy here to talk to us about it I don't know if you want to actually answer that question whether what about it - I I don't know how to grow it so I I have no idea what to say about seeds I think as it becomes recreationally legal it's going to happen anyway right so again this is just cascading forward without us even having a chance to comment I'm not against that but I would sure like a manual of what to do and how to use it but that's all I can say one question relates to the studies that have been done how often and how many of the indications are there placebo-controlled studies plus Evo effect is particularly important in Parkinson's disease where expectation of reward causes dopamine release so people really do get better if they think something's going to help so how can you tell that's what's going on or if it's a more you know biological effect of of the drug there are not enough studies with placebo groups mostly retrospective asking people what happened kind of studies and then there are some with that bag when you think you can you can get something different different strengths but again if it becomes legitimate to research it if you could get ahold of somewhere it's somebody on your team that loved to do this will get much better studies that's a major criticism and I great we just don't know so we're relying on retrospective studies where the placebo you know that expectation I'm going to take this stuff I'm going to feel better and you will feel better even if I gave you a salty vapor to inhale another question relates to cognitive problems so some some part not all but some Parkinson's patients have a significant cognitive troubles and is that a concern in terms of a risk for you for using these agents I think for me there is some literature going on that with cognitive function in general some really interesting ones you ever heard of this group test that's where you they have the word like blue but but you're supposed to say the color of the word white because the word is and I had this test I didn't show it to you that the word the word blue is written in white letters and you're supposed to actually say white not blue if you mind it's a way to test how you can keep yourself focused so they're doing a lot of studies of cognitive function and in general with marijuana so to me if you were worried about this I would get neuropsych testing which I'm sure is available before and then use that as a baseline because I think it's difficult for you to judge that and it's this is a legitimate thing to say I want to use this I'm not sure I think Dad mom my friend myself are getting confused using marijuana it might be messing me up of course you got to look at the dose and what you're doing but might not get a battery of neuropsych tests and then see what happens when you start using marijuana so you have a baseline that's my recommendation to people again we have to struggle with these kind of recommendations because there's no there's no guidelines for any of us in this field as physicians of how to use a substance that we don't prescribe fact it's technically illegal for us to it a couple of questions related to sleep and what's the data on it is a sleep aid and also what aspects of sleep there's Parkinson's disease patients have various types of sleep disorders sometimes insomnia difficulty getting to sleep sometimes REM behavior disorder where people act out their dreams sometimes periodic limb movements of sleep there's various types so what's known about I again I don't know the date on each of these things as well a lot of it I get from patients it seems like I ask patients my simple questions how is your sleep do you have vivid and wild dreams etc a few questions and the general thing is when they found the right dose and the right product they just sleep better that's that's a crude answer that's a great study though commit it's so easy to do in a sleep lab if it became legal to do it you know how to put people in the sleep lab and study what's going on maybe we can make recommendations then that know you're on the wrong product that's why you're so you're having vivid dreams or going bananas or it's keeping you up or it's leaving you hungover so here's a question relevant to something I've said which is that I don't specifically endorse this so I don't prescribe it for anybody but some people are actually asking well if my physician doesn't prescribe it what what should I do you know how you know who is prescribing it yeah I guess what you you end up getting folks and I've stayed away from this of certifying people for the marijuana card because everybody told me my clinical become the weed clinic and we like to do other things and I don't want to be inundated I know are the partners MS center some people are now sort of are certifying people for specific reasons so I say to people we're gonna have to do this together you me your primary care doc your neurologist you can go to a place to a doc that'll certify you you'll get that card you'll go into a dispensary and you'll be shocked that there's all kinds of young people telling you what might and might not work for you what happened to the people in white coats and labs and science you're going to be given a possible product to try and I think it's that kind of power to patients is disconcerting to doctors and a little worrisome but think it can work out because I have found again if it's medicinal use not recreational medicinal use people are pretty responsible if anything they're skeptical if anything they don't want another drug and they've had enough drugs and they've had enough experiences medically so we have to stand back and just coach and you have to say to them I don't think this is where can I just did it the way you walk down the hall doesn't look good what are you doing you need to stay in touch with your neurologist your primary care doctor who's ever helping you it's messy it's very messy right now but I think it's doable and it's the only way we have now custom for me to say don't wait until we get every one of these issues completely satisfied it's going to be a long time I actually think people I'm looking forward to the medicinal crowd helping us the recreational crowds all over the place they're trying to get high the kids are there other people and that's not going to help us learn as much as we need to learn there's a lot of other questions but I think just because of time or we've already allowed the questions to go a little beyond what we needed I think we're gonna have to stop there I'm sorry for those of you who had other questions that we're not gonna be able to get to right now again thank you very much for taking the time to talk with us today [Applause]

Channel: Beth Israel Deaconess Medical Center (BIDMC)

Views: 4,429

Rating: 4.9333334 out of 5

Keywords: bidmc, parkinson's disease, symposium, movement disorders, neurology

Id: vopMWewbkqw

Length: 45min 51sec (2751 seconds)

Published: Fri Dec 20 2019