During the Facebook Live we went over what is new in the Cannabis world. The Dent Cannabis Clinic sees about 115 Cannabis patients on a daily basis. We have over 30 individuals seeing patients for various reasons for using Cannabis. When we talk about Cannabis, there are three types of Cannabis: recreational, Medical, and Hemp-based products.
Type 1: Recreational Cannabis
Recreational Cannabis is what you hear about smoking and is legal in 10 states.
“I don’t deal with that [recreational Cannabis],” Dr. Mechtler says. “It is hard for me to support recreational Cannabis when individuals have to smoke it. At the end of the day, I’m a Physician. For me to promote smoking, when I have been anti-smoking my whole career, would be very difficult.”
When Recreational and Medical Cannabis are compared, there is a huge difference. Recreational Cannabis is mostly high THC and low CBD. Naturally, the plant does not produce a lot of CBD. There are some exceptions to the rule, but the higher the CBD content, the higher the price of the product.
Type 2: Medical Cannabis
Legal in 33 states, including New York State, Medical Cannabis allows the physician to change the THC to CBD ratio to help with specific medical disorders, many of which are neurological. This includes, but is not limited to: MS, ALS, Neuropathy, Spinal Cord Injury, Epilepsy and HIV. In New York State, they added Chronic Pain, Substance Abuse and Opioid Abuse.
“With these indications, we can now look at a patient at our Cannabis Clinic,” Dr. Mechtler explains. “Most of our patients come here because of Chronic Pain, but other disorders also happen. We see close to 10% of all patients in New York State.
Type 3: Hemp-Based CBD Products
The Hemp Farm Act of 2018 that was signed in December 2018 has lead to hemp-based CBD products being sold nationally. It comes from the same plant. The difference between hemp and recreational cannabis is that in hemp, you have less than 0.3% THC.
“That number is very important. Once it is above 0.3% THC, it is not legal to sell in stores,” says Dr. Mechtler. “It is very low THC and high CBD. People who are looking for CBD are looking for its health benefits. The are four main health benefits of CBD. The first is that It’s an anti-inflammatory, like ibuprofen but without the stomach problems. Second, it is a pain killer, but without the problems of Opioids, such as addiction. Third, it is an anxiety medication without the side effects. Lastly, it helps you sleep without the side effects of Ambien.”
CBD is natural with minimum side effects. This is something that can help anybody, and is a product you can find almost everywhere.
Be cautious of where you buy CBD
The problem with CBD right now is that it is not regulated. Arno Hazekamp did a study where he bought 46 different CBD products online. These products were checked to see what exactly the CBD content was. The CBD content was 0 in 39% of these products. This tells us that there is a 39% chance that the product you have does not have any CBD. The other problem is that the THC level in the products were high. Some of them were 57% THC. Those products should not be legal, but it is not regulated.
Products with CBD need to be regulated and third-party tested. What does that mean? This means that when you buy a CBD product, look for a QR code. The QR code, when scanned, will give you all the information about the product from a third party. It will tell you what is in the product you just bought.
“There are two things you have to look for,” says Dr. Mechtler. “First, what is the actual CBD content and what is the THC content? That is very important. Second, you are looking for what we call contaminants. These products can have contaminants such as: heavy metals, insecticides, pesticides, and fungus.”
Not all products have third party testing, as it could make the product more expensive. In addition, not all third party testing tests for contaminants. As a consumer you need to understand that what you are buying is not regulated by the government.
At Dent, a full spectrum physician formulated CBD stored located on the first floor, called Mend. Mendis a retail hemp-based CBD store owned by Jushi, Inc as is a tenant within the Dent Tower building in Amherst. Dent is not affiliated with the store, however, our providers believe in the high quality products that it produces and feel strongly that our patients can benefit from utilizing their products.
The Mend products are third-party tested for CBD and THC amounts, as well as for contaminants. They offer soft gels, lotion, and tincture (eye drop in the mouth). The formula is based on the research from Dent.
The MORE Act
New legislation waiting to be passed in New York, called the MORE Act, states the change in federal law to take Cannabis off of the Controlled Substance Act, which is category one. This will allow researchers in Cannabis to see more patients and do research without the any issues with the federal government. The MORE Act is hoped to be passed by the end of this year.
Retrospective Cannabis Research in the Elderly Population
One of the unique things about Dent is the amount of patients we see. However, current legislation makes it difficult to do prospective research. A prospective study watches for outcomes, such as the development of a disease, during the study period and relates this to other factors such as suspected risk or protection factor(s). The study usually involves taking a cohort of subjects and watching them over a long period.
What we are able to do is retrospective research. A retrospective study looks backwards and examines exposures to suspected risk or protection factors in relation to an outcome that is established at the start of the study. It has been difficult to tell providers what to give patients because we do not have that data. The things that you typically have with a pharmaceutical medication, like dosage and safety, we don’t have yet with Cannabis.
“What we have been doing is creating a database and looking at different patient populations to see what works, what doesn’t work, what is safe and what is not safe,” explains Paul Hart, Research Assistant at Dent.
This last year, the researchers at Dent looked closely at how the Elderly population reacted to Cannabis. What dosage can they receive while having the least amount of side effects? This research was presented at the American Academy of Neurology (AAN), and it was selected for press release. That means that the AAN saw our research, thought that it was beneficial enough and helpful enough to be presented at their annual meeting.
“Our research had the average population age of about 81 years. This population is probably on several different medications, and has different side effects from those medications,” explains Hart. “If they switch to Cannabis as an alternative, they should have fewer side effects. We found that only 30% of patients had side effects, and of that, half were resolved from changing.”
One of the focuses is to get patients off of Opioids to help ensure our patients do not form an addiction or have serious side effects. Although we have a long way to go, a solid foundation has been put into place from our funding.
Chronic Migraine and Cannabis
Chronic Migraine is a debilitating disease that affects millions of Americans. The Dent research team looked at 316 patients at Dent who incorporated Cannabis into their Chronic Migraine plan.
“We looked at Quantitative data, numbers that we can find out from patients, but also Qualitative,” explained Vincent Bargnes, Research Assistant at Dent. “We took a look at what numbers we can pull from how Cannabis has been affecting these patients, but also the non-number things, see how it makes them feel.”
The research team at Dent saw an improvement in 88% of our patients. There was also a decrease in monthly headache days – from about 24 days to about 17. Additionally, we found that 56% of patients who were on Opioids reduce the amount of Opioids. Improvements in anxiety, mood and sleep were also found. “It was very, very well tolerated with minimal side effects,” explains Bargnes.
With excellent results, the Dent team has been trying to get these findings published. Unfortunately, the finding have been rejected by both organizations that Dent has submitted to.
“This is the problem in cannabis research,” Dr. Mechtler explains. “Not only does the Federal Government give us a difficulty using cannabis in research on human beings even though it’s been used as 12,000 years. But also, the establishment of medicine is resistant to the science that we are producing here, which is very unfortunate. Now trust me, we are not giving up, we are moving forward and will find a journal that will publish our findings.”
The Cost of Cannabis
We see that the average cost of treatment is about $200 a month. The Dent Research team looked at underserved populations to get a better understanding of cost as a factor of their treatment plan.
The Dent Research team ran a study that looked at 1,200 people that are in the Cannabis Clinic and looked to see how they are doing with Medical Cannabis. “What we found is that 80% of all people that use Medical Cannabis had some positive outcome from using the treatment,” explains Chris Ralyea, Research Assistant at Dent. “We also saw that in the underserved populations, the ability to afford medical cannabis went down significantly. The retention rates in what we call normal populations at about 70%. In the underserved population, the retention rate was about 50%.” This means we are losing half the underserved population, visit after visit.
What is the Opioid use? Are we able to reduce the amount of Opioids our patients are using? “We found that about 36% of all patients included in this study were able to reduce their use of Opioids by using Medical Cannabis, even if it was a lower dosage than what we recommend here in our clinic,” explains Ralyea.
The geriatric research had patients from 75 to 102 years old. Age is not an issue. “Our publications showed that in that population, we don’t see significant side effects. So, it’s safe,” reports Dr. Mechtler. “We don’t see people getting high. Nobody comes to us because they want to abuse Medical Cannabis.”
Dr. Laszlo Mechter is also working with an insurance company in Western New York to do some research with Albany to see what happens when you pay for Medical Cannabis. “I can tell you right now, some initial research has shown that people who take Medical Cannabis save payers a significant amount of money on the use of other drugs,” explains Dr. Mechtler. “I have so many patients that throw away 4-5 medications since they have been on Medical Cannabis.”
The Dent Cannabis Clinic
One of the biggest complaints we have received is the wait time for an appointment at the Cannabis Clinic. “We have added more providers on, and are excited to say that our wait time is cut down,” says Amanda McFayden, DENT Cannabis Clinic Program Director. “Right now we are accepting referrals.”
To be seen at the Dent Cannabis Clinic, have your primary doctor fill out the Cannabis Clinic referral form. Once we receive that form, it will be reviewed and you will be put with the appropriate provider. We do not accept workers comp older than 2 years. We do not accept self-pay, we go through insurance. Feel free to call 716-250-2000 for any further questions. For more information, click here.