The second edition of author Michael Backes’ “Cannabis Pharmacy” has just landed on bookshelves. In the newly revised edition, Backes offers the most up-to-date information on delivery and dosing of cannabis, including e-cigarette designs, additional cannabis varieties, a new system for their classification as well as 21 additional ailments and conditions that can be treated with medical cannabis.

I had a type of migraine headache that was intractable, it’s called a hemiplegic migraine. Conventional migraine medications don’t work particularly well with it and there’s an increased risk of stroke if you use those medications. Somebody suggested that I try cannabis. I hadn’t used it since college and I tried it and reduced the frequency of the headaches dramatically. I decided to learn more about it and I couldn’t. I would go to dispensaries and ask questions around 2004 and 2005 and nobody knew anything about it and my background had been doing a lot of research for movie projects so I just kind of dove into it. I got more and more into it and was just fascinated that there was all this research about cannabis and the endocannabinoid system with which it interacts, but it hadn’t really percolated down to the medical cannabis consumer.

Yes, I ended up getting more and more obsessed with it and ended up opening a dispensary in 2007. It was called Cornerstone Research Collective and it was the first dispensary with an evidence-based approach. It became really popular in Los Angeles so much so that we closed the membership and went to an interview process for members because it just got to be too much. I left it about six years ago and went off to do research on cannabis breeding. It’s still around, it’s in Los Angeles and thriving.

Primarily through vaping. The problem with edibles is they are effectively a different drug. The rule of thumb is the effects are twice as strong and it will last twice as long. So, it takes a little bit of fine tuning to get the same kind of effects from orally consumed cannabis as when you inhale it and are just getting Delta 9-THC. While I learned how to use edibles effectively, it’s a different approach. When you swallow THC your liver turns it into 11-Hydroxy-THC, which is effectively a different drug.

The thing that has kept me in the cannabis business is there is just so little high-quality information for users of cannabis whether they are using medicinally or recreationally. With vaping, for example, the compounds come off the vaporized cannabis at different rates. So, when you are first vaporizing cannabis you are primarily getting the essential oils or terpenes, and because cannabinoids, when they are vaporized have no taste, people think when the floral taste of the vapor declines they are no longer getting cannabinoids but they are wrong. What happens is people have a tendency to not vape enough. Vaping can be incredibly efficient in delivering cannabinoids, you just have to understand how vaporization works. It will often take three or four or five inhalations off a single vapor load to get the complete effects of what you are using. Vape pens are totally different, they work with concentrates and don’t have that problem because they are so hot that they are delivering everything at once. Even when you are talking about vaporizing you are talking about two different approaches. The classic vaporization of cannabis flowers or these new vape pens, and they are different in how they deliver the cannabinoids and terpenes, so there’s a lot to learn.

I wanted a book that had all the information that I had been seeking. It was more of a collation process but also it was an opportunity to really dig deep into the topic. It is a very, very broad subject — you have the botanical aspects, the chemical aspects, you have the pharmacological aspects, the social aspects, there is just a lot going on with cannabis and it’s use. It’s not a simple subject, which is one of the reasons there wasn’t a book like mine out there when I wrote it in 2014.

Getting legitimate information about the chemistry, there’s a lot of nonsense out there. You go in the average dispensary and you ask them to describe what they carry, and they say we have indicas, sativas and hybrids, and the indicas have more CBD in it and that’s all complete nonsense. You can’t distinguish cannabis by indica and sativa.The reality among plant taxonomists these days is that sativas refer strictly to hemp plants that only produce CBD and indicas refer to plants that produce only THC for the most part. But you don’t get that information at the dispensaries. Dispensaries have it completely backwards, the truth is the sativas that produce a lot of CBD are sold not as sativas but as CBD plants by the dispensaries so it’s kind of a mess. You have to walk into a dispensary and figure out what they have got and how it might be useful to you and that was the hardest part of the book. To actually get some testing done on these varieties and figure out what their terpene composition was and their cannabinoid composition, so people could get more consistent results.

The terpene thing is kind of overstated. I think with terpenes there is no question that they subtlety effect the psycho-activity and medicinal effects of cannabis varieties when inhaled. When you swallow them it’s very hard to get those terpenes through to the bloodstream. Your body actually is designed to disarm what are often considered by the body as plant toxins. Your body has basically evolved defense mechanisms against them because the plants develop them to control insect nervous systems. When you swallow them they don’t affect you, when you inhale them they get around that system. Terpenes work primarily through inhalation and they subtlety modify the effects of cannabinoids and they have some effects on their own.
For example, myrcene, which is the most common of the terpenes produced by cannabis, interacts with the opioid receptor which is one of the reasons its more analgesic. Some of the more recent research on myrcene seems to indicate that it is biphasic which means it does two different things at two different dose ranges. And what’s interesting about that is myrcene has a reputation for being more sedative but that’s at high doses, at lower doses it tends to focus you and not be sedating and stimulating. That’s interesting because that’s the truth with most cannabinoids as well. For example, THC at low doses reduces anxiety but at high doses can cause anxiety. So, understanding the biphasic nature of cannabis is really important because cannabis is used to exhibiting different effects at different dose ranges. Let’s say you want to use it for something like ADHD, the dose is going to be really, really small. For appetite stimulation the dose is also going to be really, really small. Understanding the dose is really going to affect the outcome that will enable you to use the plant with a lot more precision.

Oh, for sure, in just the amount of quality products that are available. The information about the products is also a little better. The quality of the products has really increased dramatically over the last few years and that is completely due to more analytical testing of the crop. A lot of growers get their stuff tested now and are better able to understand it. The quality of the laboratory testing out there varies somewhat but its improved dramatically as well over the last couple of years. You will also see the changes in things like the Emerald Cup, which just completed in Northern California and is kind of the Oscars of Weed. It’s fascinating because the quality of these products we are testing has really dramatically increased. For a long time, it was just about potency and how strong you can make something. Now the effects are getting more subtle. Now people are saying, “Oh, wow, so this combination of cannabinoids with this combination of terpenes gives you this result.” Now you are seeing more interesting cannabis show up rather than just stronger cannabis, which is, I think, super encouraging and that’s changed since the first edition of the book.

There has been a huge explosion of research in the last three or four years and my understanding of it has increased so I can better translate it to the average consumer. It’s a very complex topic, so it’s taken me a long time to get deeper and deeper into it, so I can try and translate that for the average consumer. It went from several hundred papers a year on the topic to several thousand. There’s research being conducted all over the globe and a lot of it is high quality research from countries like Hungary, Switzerland, Israel, England, the Netherlands, US, and increasingly in China. Even countries like Iran have really good research programs to look at the plant and what it is producing and its effects so there was a lot of material to go through to produce the second edition which made it tough to keep the book from expanding only 50 pages. I had to really tighten stuff up in order to incorporate all the material. It’s frustrating because the second you lock the book down, you will get that new paper and wish you could include it. I’m already collecting stuff for the third edition. But I think the second edition is the book I really wanted to write. It gives me a much better picture of how to use the plant, both medicinally and recreationally.
I think the distinction between medical and recreational use of cannabis is a little bit artificial. I find a lot of people who use it recreationally are, in fact, using it to reduce what you would normally call symptoms like they are slightly anxious, etc. I find some medical users really begin to enjoy it. So, it’s this interesting balance you have to strike between the two definitions because I don’t think they are that firm.

I think there is no question that low dose CBD is really interesting. CBD is phenomenally complex in its activity, it’s not just targeting one receptor. Its targeting over a dozen and ion channels on top of that. It works broadly throughout the body and our understanding of its mechanism of action I think is going to continue to evolve over several years. It’s a reason to be slightly cautious with CBD just because it doesn’t exhibit any psycho-activity, doesn’t mean it’s not a powerful substance and it needs to be respected. I think my recommendation on any cannabis use, is use just enough to get the affects you are looking for and no more. In the case of CBD where you aren’t going to have psycho-activity as a benchmark for effect, then just err on the side of caution and use a little less to address whatever you are trying to address whether its social anxiety or whatever.

It’s kind of in process. There are certainly a lot of people who want to research it. While NIDA (National Institute on Drug Abuse) has said we want to study this more, and fund research for CBD and encourage University of Mississippi to grow more CBD plants under the monopolistic contract that they have with the government to provide research cannabis in the US, it’s still a work in progress and I think the laws need to change. As long as it remains a schedule 1 substance, the barriers to research remain formidable. As long as you have only one contracted producer of cannabis, the supply is limited because there are a lot of varieties of cannabis out there. While University of Mississippi has tried over the last few years to provide a wider range of cannabis, it doesn’t really reflect the complete range of cannabis available to consumers, you have to study what people are taking, you can’t just study what you have got. I want to see research increase in the US. I think it’s kind of backwards right now in comparison to a county like Israel. Even though we have a lot more cannabis here and more interesting cannabis than they have in Israel, it’s hard to study it.

No, cause it’s not performance enhancing its performance enabling. It’s really a great recovery drug for athletic endeavors and it may have significant neural protection capabilities for contact sports and so I think it’s just a smart move, that just shows somebody is actually practicing medicine.

That’s complete nonsense. Your body doesn’t produce anything like CBD. Your body produces endocannabinoids. Typically, what happens is you have hemp-derived or cannabis-derived CBD but it comes with a tiny bit of THC and that is easily detected by the exquisite sensitivity of the instruments they use for drug testing these days. So, what happens is take CBD that has a little bit of THC in it and they will test positive. If they have access to absolutely pure CBD they will not test positive.
There was a scare and a big controversy in the last 18 months in the cannabis research community. Some people did an experiment that it really wasn’t that hard to cycle CBD to THC under acidic conditions that are found in the stomach. So, the concern was if you are taking a lot of CBD orally, your stomach acid was converting a small amount of it to THC. Some people say that’s absolute nonsense. And other people say, “No, we have the evidence.” So, I have a tendency to align with the side that says CBD is not being converted to THC in the body. But I do know that when Raphael Mechoulam, who discovered THC, makes THC from CBD. He cycles it with an acidic solution from CBD to THC. It’s not really tough chemistry which is interesting for these states that have just legalized CBD, thinking they are protecting their populace from the evils of THC when, in fact, with some pool supply chemicals and a hot plate in your garage you could probably convert any CBD product to pure THC.

More consistent information about the effects that are caused by different variations of cannabis and different formulations that use cannabis. I think you are going to get more predictable effects and a wider range of effects. I think we are really starting to understand how cannabis works. Eventually an informed consumer will be able to go into a shop and know what chemistry works best for what they are looking for and be able to get it. The problem with cannabis over the last 50 years in the US has been that it was all grown for potency and that was because of Prohibition. Just like beer disappeared during alcohol prohibition and was replaced by hard spirits because concentrated forms of alcohol were easier to conceal. The exact same thing happened to cannabis where it became how strong can you make it. That means I can carry the most amount of THC in the smallest space. So, concentrates became popular. Super-strong, high THC cannabis
became dominant. Cannabis went from being around two or three percent THC to varieties that have almost 30 percent today. That’s an extraordinary increase by a single compound in a plant. That just shows you how assiduous breeders were in approaching this task of making this plant flower faster, grow smaller, and be more potent and that’s what happened over the last 50 years. Now you are going to see that roll back and that’s actually going to increase the range of effects available from the plants. Dropping this obsession with potency and starting to go for an obsession with quality, I think that’s the big trend.
I had a discussion with really prominent Northern California cultivators who have been doing this for half a century and asked why they don’t grow the tall sativa style plants anymore as they had a better effect. Back in the day they used to distinguish between the high of marijuana versus the stoned of marijuana and these narrow leaf varieties that we came to call sativas produced a high, and these broad leaf varieties that we brought in from Afghanistan that flowered quickly and had short squat plants — those were indicas and they were more sedating. So, I said, “Why did you a grow a plant that has a dulling effect?” They said, “Because they come out of the ground faster, they produce more, and the THC content is higher.” So, it was literally just the economics of everybody chasing THC, and they found the plant that produced the most, as quickly as possible, and that became the driving force behind marijuana breeding for half a century. It’s a classic economic pressure, you want to make a product that’s valuable and you want to stay out of jail. Those were the driving forces behind super high potency cannabis products.

It really does the consumer a disservice because it encourages the consumer to use what they can withstand rather than what they need. Really that’s what it is. It’s a little bit fascist to me in the sense that it’s one of these things where you have to learn how to handle your high. I find that absurd. A lot of people are looking for a glass of wine effect in cannabis, not a half of bottle of Tequila effect. After you get out of school you usually don’t have the luxury of being able to recover or commit to super intense psycho-activity whether it’s with half a bottle of tequila or a couple of joints with 30 percent THC weed. A lot of people have really dysphoric reactions.

It’s a really interesting thing about cannabis. Cannabis has a really tough time retaining consumers. Over 100 million people have tried cannabis in the US and only 20 million people still use it. While with alcohol nearly 60 percent of the people who tried it continue to use it.
I have stood at dispensary counters and had novice cannabis patients come in and have somebody behind the counter say, “Oh, yeah, you should try this edible. It’s 50 mg.” While the average cannabis-naïve patient will have a dysphoric unpleasant reaction with 15 milligrams of THC, you will have these nuts recommend something three or four times stronger to a cannabis-naïve patient. Are you going to keep that patient around? No, they will try it once and it will scare the hell out of them and they won’t use it again. A lot of people have exited cannabis as a drug of choice because they had a bad reaction from taking too much. Dose control, if you control the dose you can have a great time. Even if you have had a bad time in the past, just reduce your dose dramatically.

You have to take control of the consistency of the extract you are using to make that work because there’s no reasonable or handheld device that’s going to be able to handle different potencies and have extracts and flower deliver the same consistent dose. That is not on the horizon. It will be some kind of metered vape pen. But the problem is what goes into those vape pens really doesn’t represent the flower that well. You lose a lot of stuff during extraction. If you manage to extract it, it’s tough to keep it around. A lot of these extracts are ridiculously perishable although almost none of them are sold as perishable. You buy a vape pen, you don’t know when it was made or how much of its chemistry has changed since extraction. I guarantee you it does not resemble the flower from which it was extracted from a chemistry standpoint. There’s a lot of nonsense out there and people are not forthcoming about this — about how close to a flower effect these vape pens can deliver. Certain terpenes like myrcene are super super fragile and within 40 days a lot of myrcene will have degraded if you extract it, it makes it even more vulnerable though oxidation and breakdown. I recommend that when people buy extractions that have been frozen since manufacture that they are kept frozen until you use them. The idea that you can walk around with a room temperature product for weeks or a month and not have it change is naïve.

The biggest discovery I have made in the last couple of years is the importance of CBD to buffer THC. Transform, which is the drug policy research group think tank in the UK, did a report recently on legalization of cannabis in the UK and they recommended mandating a CBD buffer. I look at CBD as the seatbelt for cannabis use. It doesn’t mean you can’t drive really fast, it just means if you have a problem you have some protection. I think CBD provides that protection. I am not trying to ban your sportscar, I’m just trying to keep you from getting killed in it. I don’t think THC is going to kill you, but I definitely think we have all met people who have that thousand-yard stare that I think is a kind of uncharacterized neurological deficit caused by taking too much THC for too long. You talk to somebody who has been smoking 20 joints a day for 30 years and it’s like they are on tape delay. If taking a little CBD prevents that, that’s a big deal.

Biphasic dosing is the most interesting thing in cannabis right now. The idea that you can change your dose to get two different effects with the exact same chemistry. It’s going to change how I use cannabis and I think it’s going to change how other people use cannabis. I think it’s the future of this. If I want to get the munchies, I’m going to use a small dose. If I want to treat nausea, I’m going to have to use a high dose. Or somebody wants to treat social anxiety and take a small amount of THC, buffering it with a little bit of CBD. I think that’s going to trickle down to adult-use recreational scenarios as well.
That leads to the second biggest discovery I have made, which is how CBD can protect the brain from the adverse effects of THC, which has been shown pretty conclusively now in at least four brain scan studies conducted in the UK, US and Australia. What they found was that THC by itself consistently effects the hippocampus part of the brain, that’s imminently linked to memory and learning. If you use CBD at the same time as THC, even if you use THC chronically, you protect the brain, specifically the hippocampus from those changes, and that’s a really big deal. Because what it’s saying is that THC should be buffered with CBD just like it is in nature. For the most part, most large drug crops of cannabis produce equal amounts of CBD and THC when you grow cannabis in a field. During prohibition particular plants were selected for their THC content and they accidently bred out CBD. But it may well be that our coevolution with this plant required that both cannabinoids be used together, and I think there is increasing evidence to support that.