12/11/15 Ethan Russo

2015 DPA Conf IV: Dr. Ethan Russo re cannabis medicine, research and potential medicines + Ethan Nadelmann Exec Dir of Drug Policy Alliance + Denver bible & cannabis congregation

Program: 
Cultural Baggage Radio Show
Date: 
Friday, December 11, 2015
Guest: 
Ethan Russo
Organization: 
Doctor
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CULTURAL BAGGAGE

DECEMBER 11, 2015

TRANSCRIPT

DEAN BECKER: Broadcasting on the Drug Truth Network, this is Cultural Baggage.

DR. G. ALAN ROBISON: It is not only inhumane, it is really fundamentally un-American.

CROWD: No more! Drug war! No More! Drug War! No More! Drug War!

DEAN BECKER: My name is Dean Becker. I don't condone or encourage the use of any drugs, legal or illegal. I report the unvarnished truth about the pharmaceutical, banking, prison, and judicial nightmare that feeds on eternal drug war.

Hi, this is Dean Becker. Thank you for joining us on this edition of Cultural Baggage. There's much to get to, so let's get to it.

ETHAN RUSSO: I'm Ethan Russo, I'm a neurologist by training, and I've been working in the area of cannabis and cannabinoids for about nineteen years now. Currently, I'm the medical director at a new company called Phytex. Its mission is investigation of the endocannabinoid system. So this is a different target. This would include cannabis, but other approaches towards health involving the endocannabinoid system, which would include other herbs besides cannabis, but also lifestyle approaches that can include aerobic exercise and dietary manipulation, as a couple of examples.

DEAN BECKER: You know, I keep hearing about lavender and other products, you know, having some benefit in combination with others. Would that kind of fit in with what you're saying, sir?

ETHAN RUSSO: Oh, absolutely. Although I had classical training as a physician and standard pharmacology, I've been a plant guy for a long time. Actually came to cannabis research through ethnobotany, the study of medicinal plants among indigenous cultures. Basically, my sojourn started after I'd been in practice for seven years of neurology, and was giving increasingly toxic pharmaceuticals to my patients with less and less return. At a certain point, you have to tell yourself, there has to be a better way. And that led me back into use of medicinal plants in my practice. And I was interested in investigating treatments for migraine that would use herbal products, and that led me to take a sabbatical in the Amazon rain forest, where I worked with a tribe called the Machiganga. After three months of doing that, I realized that I wanted to make medicinal plants the focus of my career. It took me a long while after that for that to become the case.

By 1996, I was back and rapidly became embroiled in the cannabis controversy, let's call it. I tried to do a research project using cannabis to treat migraines through the FDA process, and working with the National Institute on Drug Abuse, but found myself stymied. To make a long story short, after spending three years trying to get this project off the ground, I became involved in writing, publishing, and research on cannabis. That did become the focus of my career, subsequently.

DEAN BECKER: As I understand it, you spent some time with a company, GW Pharmaceuticals, who were involved in developing and I guess distributing cannabis medicines. Correct?

ETHAN RUSSO: That's exactly right. Basically, and this is a bit ironic, since in this country, in the states, we like to think of ourselves at the vanguard of biomedical research. Unfortunately, that isn't always the case. Because I was not able to properly study cannabis as medicine in the US, I ended up becoming a full-time consultant to GW Pharmaceuticals, a British firm that developed cannabis-based medicines.

DEAN BECKER: Yeah, I've seen some pictures. I think I once did an interview with Mister, Guy -- if I'm correct -- and he shared some pictures of some beautiful warehouses full of cannabis plants. They had some success and some, let's just say, setbacks, not failures.

ETHAN RUSSO: Yeah. To put it in context, their lead product is something called Sativex. This is a cannabis-based medicine. It's an oro-mucosal spray, so a spray that's sprayed in the cheek or under the tongue. It has equal amounts of THC, tetra-hydrocannabinol, the main psychoactive ingredient of cannabis, but about equal amounts of cannabidiol. Cannabidiol is probably less familiar to your listeners, but becoming much better known. It is a non-intoxicating component of cannabis, with very powerful medicinal properties as an anti-inflammatory and analgesic painkiller. And it is complimentary to THC. It boosts some of its activity, but opposes the intoxication, the panic that can ensue with too much THC, those bad side effects. In any event, Sativex is actually approved in 27 countries, outside the US, for treating spasticity, muscle tightness associated with multiple sclerosis. It is still under investigation in the US for a different indication, that being people with cancer pain whose pain did not respond to optimized opioids, in other words, they're on morphine or similar drugs with inadequate pain control.

Unfortunately, the last couple of studies did not read out, and it is unclear what's going to happen with that medicine in this country. They have another application in for the multiple sclerosis indication, and that may go forward. However, at the same time, GW Pharmaceuticals has another product called Epidiolex. This is essentially pure cannabidiol. And it's currently under investigation for treating intractable seizures in children with a couple of syndromes, Dravet Syndrome and Lennox-Gastaut Syndromes. These are severe convulsive disorders that respond extremely poorly to a whole host of standard drugs used to treat this kind of condition. That program is going extremely well, and my expectation would be that Epidiolex will probably be approved in 2016 for seizure disorders in this group of children.

So, one way or the other, cannabis-based medicines are coming in the US. We have been behind the curve in this area for sure. But at the same time, in addition to pharmaceutical preparations, people are well aware that cannabis is available as a medicine in herbal or concentrated form in many jurisdictions in this country. I think we're up to about 23 states that have one kind of medical cannabis law or another. So certainly, this is something that the public is becoming more familiar with, and like it or not, physicians are going to need to become more familiar with.

DEAN BECKER: We are speaking with Doctor Ethan Russo. We're here at the Drug Policy Alliance conference. You know, Doctor Russo, I think about, you see it on TV all the time, they have a bright shiny picture of a couple enjoying life, and using a pill, and then at the end they talk about all the horrible consequences that may occur from taking that drug. We have to be careful which medicines we embrace, do we not?

ETHAN RUSSO: Oh, absolutely. As a physician who was in clinical practice in neurology for 20 years, I have an acute awareness of how dangerous even approved medicines can be. All you have to do is look at the track record of medicines approved by the FDA, and unfortunately a large number in recent years have had to come off the market subsequently because of really severe side effects. And you point out something important. If you look at pharmaceutical ads on TV, it really is scary what some of these drugs do. Well, let's put that in context. In fact, cannabis is very safe compared to many of those drugs that are advertised on TV. This is not to say that it doesn't have side effects, it absolutely does, and particularly in relation to the THC content. THC, when there's too much, causes panic reactions, can produce rapid heart rate. If the dose is really excessive, people can have what's called orthostatic hypotension, which is basically that you stand up and pass out because your blood pressure is inadequate to maintain the brain. But that takes care of itself, once the person is horizontal there's adequate blood flow. But it can be a scary thing, and people certainly get hurt from the fall.

DEAN BECKER: I know, I was outside a concert venue, smoking some ultra-bud with some friends. A gentleman stepped in, took a hit, and fell backwards onto the pavement.

ETHAN RUSSO: Unfortunately, that's becoming more common. It is true to say that there has been an increase in the average potency of cannabis available, and in addition to that, with vaping and the use of dabs, cannabis concentrates, some very high doses are easily available to people. What I would tell people is, they need to be very careful with these preparations, and they need to titrate their dose, which is to say, certainly anybody who is new to cannabis should be starting with a weak preparation and the tiniest possible dosing. Especially for medical users, inhalation in any form is not necessarily the best approach. In fact, what's needed to treat symptoms of most disorders, whether it be pain or spasticity, the doses of cannabinoids needed are actually very little, and would be a lot lower than what the recreational user of cannabis would typically employ. Those concentrates are something that should be avoided, except by people who've already built up a little tolerance to the psychoactive effects of THC.

But, in context, properly done, cannabis is, can be a very safe and effective medicine, in the right form, and particularly preparations with cannabidiol. Cannabidiol is a remarkably safe medicine. For as many benefits as it has, it's very hard to identify the side effects. This is not to say that there are none. In very high doses, such as have been used to treat these children with intractable seizures disorders, there can be sedation at very high doses. It can effect the blood levels of some of their concomitant medicines, so adjustments may be needed. But in terms of the kinds of things you hear on TV about poisoning of the blood, producing diabetes, or precipitating infectious diseases, none of those things happen with cannabidiol. It's remarkably safe.

DEAN BECKER: I hear reports from the media talking about, you know, in Colorado, the number of children overdosing has increased. But that word "overdose" seems to distract from the fact that they're not going to die, they're, they may pass out and wake up a few hours later rather than being near death. Am I right?

ETHAN RUSSO: No, that's true, Dean. The most common side effect of an overdose, let's call it, of THC or cannabis, would be a panic reaction. So the person may be scared, they may feel like they're going to die, they may feel like they're going crazy. That's the bad part. The good part is, it will pass within a few hours. The standard treatment is just quiet reassurance. And it will pass. Chances are very good that the next day there will be no residual at all. This does lead -- because of, a lot of people may not be used to high potency preparations, there can be an increase in emergency room visits. But, besides the panic reactions and the orthostatic hypotension we mentioned, that's really about it.

There has been concern about an association between the use of cannabis, particularly among youth, and the development of psychosis or schizophrenia. The best research would support that it does not create this condition where there was not a prior predisposition. In other words, it is true to say, if someone has a propensity to develop schizophrenia, it could manifest itself earlier because of excessive cannabis use. That's clear. However, there is no solid epidemiological evidence that it would produce psychosis in someone that did not have this predisposition. For anyone who did have schizophrenia in the family, they would be well advised to either avoid cannabis, or use it only very gingerly.

DEAN BECKER: I've also heard, there is kind of a flip side to that, that many of the people who have schizophrenia -- not all, certainly -- but have found relief or the ability to control their lives through the use of cannabis. Am I correct?

ETHAN RUSSO: Certainly the case, people with schizophrenia use a lot of substances. The incidence of smoking cigarettes is amazingly high in people with schizophrenia. They have an increased use in all drugs of abuse, not just cannabis, but also things like meth, and the opioids. Part of this seems to come from an effort of the person to self-medicate, but we've got a real double-edged sword here. THC can be a problem, as I mentioned, with people with schizophrenia, but the other side of the coin is, cannabidiol. Cannabidiol has now been used in two well-designed clinical trials with positive results in treatment of schizophrenia. It is an anti-psychotic, I mean, it works like some of the standard medicines, but with far fewer side effects. The drugs that are used to treat schizophrenia are very difficult for anyone to handle, they're extremely sedating. They have some very severe long-term side effects, including the production of a movement disorder. So, in fact, cannabidiol is a drug of the future in treatment of schizophrenia, and probably is better off with little or no THC.

But, when we're talking about cannabis, people have to realize that it isn't just about THC. There are actually a hundred other cannabinoids that the plant makes, many of which have very important medicinal properties in their own right. Cannabidiol would certainly be paramount among those.

DEAN BECKER: Now, you know, as a 50-year user of cannabis, I, you know, I find relief from the day's stress. I like to eat a cookie at night. What about the edibles, are they, I mean, in Colorado, there were a couple of horrible situations where people didn't know what they were doing and made horrible mistakes, but in general, if you know your dosage and have a safe set and settings, the edibles can be of great benefit, correct?

ETHAN RUSSO: Sure, they can be. It's like anything else, as you mentioned, both the providers and the consumers need to be aware of what they have. The problem with edibles is dosing. You have to know what's in it, what your tolerance is. It also has to be something that's properly kept out of the way of children, because a cookie on the table that's not marked is going to be a problem for someone. In some jurisdictions, there are now rules about the upper limit of what a dose can be. Additionally, people are accustomed to eating a whole candy bar. If the candy bar is 180 milligrams of THC, that's going to be a problem for anyone. And it may be that a real serving is actually a tiny square out of that chocolate bar. So, particularly for medical users that have a chronic condition, edibles are an advantage because of the longer duration of action, you know, so with an edible, probably they can dose two or three times a day as opposed to inhalation, which may require dosing every few hours. And in the long term, oral medicines are more of what we're accustomed to, as a form to take our medicine in this country.

DEAN BECKER: Well, once again, we're here with Dr. Ethan Russo, we're at the Drug Policy Alliance conference in Washington, DC. I guess we have to wrap it up, but Dr. Russo, I think the science is standing tall, is being recognized in recent years, and the stature, the authority of the DEA and ONDCP is being diminished because they won't answer certain questions about cannabis, will they?

ETHAN RUSSO: Well, they may answer the questions, but the answers can be skewed or biased, to be fair. I think we're at the dawn of a new era with cannabis therapeutics. This is something that's happening. There will be cannabis pharmaceuticals available in the USA. There are other forms of cannabis available to people in legal jurisdictions. This is happening. I would urge both potential patients and their physicians to try and get educated about what this is about, realize that, to an extent, it's like any other medicine. It has pros, it has cons. People need to know the limitations, but I'm hoping that the benefits will also be realized by both patients and physicians.

DEAN BECKER: I appreciate it so much.

ETHAN RUSSO: Thank you.

DEAN BECKER: It's time to play Name That Drug By Its Side Effects! Nausea, heart burn, development of bleeding ulcers, vomiting, swelling of the brain, extensive liver damage, difficulty with mental functioning, Reye's Syndrome, and death. Time's up! The answer: aspirin. Another FDA-approved product.

We're somewhere near the midway point of the Drug Policy Alliance's major conference here in our nation's capitol. I'm privileging to be sitting with the executive director of that organization, Mr. Ethan Nadelmann. Hello, sir.

ETHAN NADELMANN: Hi, Dean, good to be back with you.

DEAN BECKER: I've got to tell you something. The enthusiasm, the awareness of our progress and future progress, is astounding at this conference. Is it not?

ETHAN NADELMANN: I would say so. And also, the intellectual caliber of the presentations and the discussions. I mean, first of all, in terms of the size we broke 1,500 people by the first afternoon registered for this conference, which must be 30 to 40 percent bigger than has ever happened before. So that was incredible. We had people not just from 40 plus states, but 71 countries around the world. I mean, that was extraordinary. I mean, I'm just feeling just great about the thing. We've had evening sessions, which are typically poorly attended, five hundred people I think last night at a session on Black Lives Matter meets drug policy reform. You know, we had the honor of giving an award to Mark Golding, the Jamaican Minister of Justice, this morning, who really just drove through the final stages of that major ganja law reform in Jamaica. It's just an incredible gathering, and the question always is, is, you know, each, every two years it will be, can we top this? And I have to say, as of 2015, we've topped anything we've done before.

DEAN BECKER: Oh, you walloped it with a hammer, you did indeed. Now, there's 71 countries being represented. I'm trying to find as many of them as I can, to get their perspective on this, which is starting to coincide fairly well with what we have been saying all these years. Am I right?

ETHAN NADELMANN: Oh, no, that's right. I mean, look, we're very fortunate that the Open Society Foundation made a special allocation of funding to get people here from around the world. But there's people from about a dozen countries in Africa, many Asian countries, obviously all over Europe and Latin America, New Zealand, Iceland, Australia. So it really is quite remarkable, but the other thing is, it's also a new generation of people coming in. I walked into the planning session for the UNGASS, the UN General Assembly Special Session on Drugs that's coming up in April, and -- I know a lot of the international players, people who've been doing this for years. I walked into that room, I did not recognize 70 percent of the faces. A whole new generation of people getting involved in global drug policy reform. And when I don't recognize faces, that's also really special.

DEAN BECKER: Indeed it is. I think about Texas. Starting to think about change. The district attorney, the police chief, they're all beginning to walk away from the hard drug war of yesteryear. Your thoughts.

ETHAN NADELMANN: Well, you know, I think it's all good. The question for many in this with law enforcement and others, is, are they just beating a strategic retreat and then retrenching? Are they just realizing that the winds are going one way, they better take a step back strategically and defend their new position, and then look to move forward again once people get freaked out about crime again? Or is it a fact there's a change of heart going on? And I think both things are going on.

We organized with a few others a conference on July First in Washington, DC, on LEAD, which stands for Law Enforcement Assisted Diversion. It's really the cutting edge of diversion of people arrested for drug and other petty offenses from the criminal justice system. It involves people being sent to social service programs before they get booked, before they get put into the system. And this was a gathering of 150 people in law enforcement, all around the country. And people really wanted to move forward, to embrace this new approach. So even as I see law enforcement having a very difficult time with the legalization of marijuana, I see them -- a lot of them wanting to step forward about not being so quick to throw people in jail or prison. Or understanding that, you know, drug addiction, and being caught up in situations of poverty, can just be a furious cycling situation, and that tossing them away in jail just maybe is not the right thing to do.

DEAN BECKER: So true. We have the situation, again I'm coming back to Texas, where the DA is telling children, our youngsters, not to plead guilty to the minor marijuana charges, because it's going to ruin their life potential. She's still prosecuting them if they go ahead and plead guilty, to get that light sentence, but she's wanting them to go through a training program, they urine test them for a few months, and erase that record. It shows a willingness to at least move from prior stance.

ETHAN NADELMANN: It does show a willingness, and with something like that, just like with drug courts, one has to be careful that when you see a well-meaning person in law enforcement wanting to find alternatives, are they actually managing to take three steps forward and only two steps back? Or are they ending up taking two steps forward and three steps back? Because as we know, some of these alternatives that look good and seem well-intentioned on their face, but for people who can't turn it around on a dime, and will end up needing many more opportunities, well, this could become a trap. So we've just got to stay in tune to what's happening on the ground with those reforms.

DEAN BECKER: Ethan, I know your time is limited, this thing's still very much ongoing. But, what's going on here in DC this morning? They took a petition to deliver it to the head of the DEA, looking to remove him from his position for calling medical marijuana a joke. Your thoughts in that regard, sir.

ETHAN NADELMANN: Yeah, no, I mean, there's many actions happening here, sort of connected to the conference but not driven by it. I think this was one that Change.org and Marijuana Majority were doing, so it sounds like a very good initiative. I will say that, with respect to the current head of the DEA, it's good to keep the pressure on him about that. On the other hand, he's so far been a relatively, you know, notable improvement over his predecessor, and I think he has, you know, he was willing to say things she didn't say, acknowledging the lesser harms of marijuana. He put his foot in his mouth about using that old line about medical marijuana, but my sense is, this guy might be more of a professional director, maybe a little less likely to repeat all the mistakes of his predecessor. So, for DPA, we've not yet jumped on "let's dump this new DEA guy," you know, let's see how it works out. But I definitely don't oppose what our allies are trying to do. I think we've got to keep the heat on him.

DEAN BECKER: Yeah. Got to rattle the cage to get their attention.

ETHAN NADELMANN: Exactly.

DEAN BECKER: All right, once again, speaking with Mr. Ethan Nadelmann, executive director of the Drug Policy Alliance. Ethan, thank you so much.

ETHAN NADELMANN: Thank you, Dean, enjoy the rest of the conference.

DEAN BECKER: The following comes to us courtesy of CBS Denver.

MARK GIONET: Here's proof spirituality can be found in different places in different ways.

BRITT MORENO: You know, I sat in on a unique bible study which combines faith and weed.

This suburban group of professionals and students meets in Centennial once a week.

PASTOR GREG: Let's all bow our heads and go to the father in prayer.

BRITT MORENO: To strengthen their faith.

JETAUN BROWN: Every day when I wake up, you know, I'm thankful.

BRITT MORENO: In this bible study, people share their views on god and Jesus, pass on words of encouragement, and --

UNKNOWN FEMALE VOICE: We'll get that circulating.

BRITT MORENO: joints.

MIA WILLIAMS: We're just a bunch of stoners that come together and just learn about Jesus and the word of god.

BRITT MORENO: These Christians call themselves the Stoner Jesus Bible Study.

MARK BUTTON: It's like we get really deep into spirituality, like, deeper than I've ever been able to get before. I mean, it's just the perfect setting for it.

DEAN BECKER: What can I say, but hallelujah. Well, that's about it for this week. I urge you to join us next week on Cultural Baggage, when our guest will be Mr. Paul Armentano, author of a brand new book, The Citizen's Guide To State By State Marijuana Laws. And as always, I remind you, because of prohibition, you don't know what's in that bag. Please be careful.