Medical Cannabis with Mary Biles

Welcome back to the doctor body mind soul podcast. My name is Dr. Jude. And this is a podcast which explores how we can integrate modern medicine and alternative therapies to help you get the holistic health care that you deserve. I will be speaking to healers and seekers, researchers and authors who will share their experiences and the evidence to help guide us all to Holistic Health. Let's do this. Mary Biles is author of the CBD book, The Essential Guide to CBD oil, and regular contributing writer for nonprofit projects CBD and host of the podcast cannabis voices. She is a trusted voice in the cannabis industry, both in Europe and around the globe, and an advocate for greater access to medical cannabis, psychedelics, and plant medicine in general. Welcome, Mary.

Hello, thank you for having me.

Well, thank you. Thank you for coming on to the podcast because, well, I what I really love about your work is your focus on the emerging evidence that has been published in the fields and using this to educate not only the public, but healthcare professionals in particular, so we can all be aware of its uses and how we should and could be using it for our patients, because there's certainly a knowledge gap.

Yeah, it's a massive, massive knowledge gap. Also, because it's quite, it's quite complicated. You know, we're talking about a plant, you know, it's not like a single molecule that we know, it works in a certain way targeting a certain receptor. You've got, like hundreds of compounds in a plant, there are all targeting different receptors, hopefully all working in synergy, but sometimes not, you know, and it doesn't fit within the pharmaceutical paradigm, with which, you know, doctors are used to operating, you know, and there's randomized clinical trials and all that kind of stuff. So, yeah, so it's, I understand why there is a knowledge gap. And also you have to remember for like, I don't know, 60 or 70 years, doctors have just been told this is cannabis as a drug of abuse. So to suddenly have to, you know, turn full circle and start prescribing it to patients. You know, when you know, it's a big ask, it's a big ask, so I, you know, I am, I understand the predicament, but there's, you know, there's stuff we can do working together, I think kind of with a little bit of an open mind.

Agreed. And, you know, it was it was shocking to me when I was sort of was coming across your work as to what a knowledge gap you know, I had in its in its approach, and I suddenly realized, I actually don't know anything about how the endocannabinoid system actually works. As you say, it's a complex group of compounds that are working on multiple receptors and multiple organs and systems in the body. Can you simply outline just as a basic, like how the system operates and how it affects as many systems as it does?

Okay, so the sort of referring to the endocannabinoid system, so like, sometimes when you hear people talking about cannabis, it's like they're saying, Oh, it really, you know, has helped my chronic pain. Oh, it's, you know, it's it's helped me with nausea, you know, during chemotherapy, oh, it's reduced seizures. Oh, so other people report that, you know, it's had anti tumor effects, and it can seem to be hang on a sec, you know, how can this plant have so many different effects on the body and help with so many seemingly unrelated conditions? And I think that's why, for the medical profession, again, because this doesn't kind of fit within the, you know, the pharmaceutical paradigm, it's like, well, there this has got to be a bit woowoo or, you know, it's it there isn't, this doesn't stack up basically. So the big kind of the missing piece, in all this is the endocannabinoid system. So back in the kind of end of the 80s, beginning of the 90s, some very clever researchers in Israel were researching or trying to understand the effects of THC. So THC is one of the compounds in the cannabis plant, which is most known possibly for having the kind of intoxicating effects so when people smoke a joint and they feel a bit stoned, it's because of the THC basically. So the researchers were like, okay, so how what's the kind of biological mechanisms of action for for these effects that THC have and what they found is we have

a network of receptors in our brains and the central nervous system, which are close to the Endocannabinoid receptors and we have another class of receptors which are throughout the body, but primarily in the in the immune system. And THC basically binds with these receptors. And so particularly for the ones that are in the central nervous system in the brain, that's Why do we have you know, the kind of the intoxicating effect essentially? So then this kind of led the question, okay, so these receptors aren't just sitting in, you know, in our bodies waiting for us to smoke a joint there must be something else going on. So, further research revealed that actually we produce our own cannabis like compounds which are kind of similar to neurotransmitters which also bind, you know, they, they bind with these receptors, and then there's also kind of, you know, enzymes that break them down in the body and one of them is called anandamide. So for all our kind of spiritual people listening, there'll be familiar with the word Ananda, the Sanskrit Sanskrit word Ananda, which is the word for bliss. So it was named with this endocannabinoid, endo meaning within an cannabinoid being the compounds found in the cannabis plant. So they they named this particular compound that we produce an up with G Ananda because it is, you know, partly responsible for the kind of the things to bliss that sometimes we experience with cannabis, and also, you know, in this, this compounds also binds with with these receptors. So then the question was asked, well, what's the point of this system? You know, what's it doing? And what's the conclusion that was reached was that it's what they called a homeostatic regulator. So that means that it's basically acting like a dimmer switch for all the other systems in the body. So it's just keeping everything in balance. So we're not talking in a kind of like, you know, keeping your chakras in balance, you know, I mean, I believe in chakras. I'm a big proponent of like, you know, energetic medicine, etc. But this is a physiological system in the body that actually exists, you know, it's not some kind of woowoo it's just the we don't know about it, because it only kind of came to light in the 90s. So it's actually a really, really exciting field of medicine. If only it was taken seriously. You know, for doctors, if you you know, if you had a patient coming in with that kind of cluster of, you know, fibromyalgia, migraines, probably anxiety as well and you can't get to the bottom of it. You know, you're just throwing medicines at it, you know, if you're just like, oh, well, maybe you know, there could be an endocannabinoid deficiency on what can you do when there's an endocannabinoid deficiency where you can support the endocannabinoid system with the cannabis plants or the hemp plants and and compounds found within the cannabis plants. So, so we're talking here, you know, your kind of your, your CBD oils, which I think we might talk about later. Also, you know, for example, patients with conditions like fibromyalgia, actually, you know, sometimes they've ended up self medicating or perhaps their recreational users. And actually, then they find that actually, the cannabis is helping with their pain and their sleep and all the other conditions in their practice, they end up getting down the prescription routes, and so they can actually take a legal Avenue so so it's actually really, really, really interesting. And it kind of explains when you when you think about, you know, these receptors are everywhere in the body, they're on our organs, they're, you know, it's literally everywhere, and and so it's kind of, you know, the system is helping to control and regulate everything else. It makes sense, then why you know, cannabis can be so helpful for such a seemingly unrelated collection of conditions.

Absolutely, absolutely. It's what's really like coming to mind about the endo cannabinoid system is just how it is. So in keeping with the psycho neuro immunology field that has also been increasingly explored in the last few decades, and this idea that there are this group and probably multiple groups of chemicals, neurotransmitters, chemicals, and hormones, whoever we want to call them that are working to connect the body, mind and self and I'm seeing self as to represent I think the immune the immune system. So really sort of working to pull our body mind and soul really in line. And this is one the same this seems to be one group of, of chemicals that work in this way.

Yeah, it's really interesting. I love what you say about that as well. And I think you can even kind of you know, bring in the you know, the kind of the gut brain access as well it's you know, it's yeah, it's it's super interesting and I think something you know, just sort of touching back again on on on the bliss element to it. You know, that what they found is, you know, it's not doesn't just have to be cannabis that helps to, you know, sort of top up or support the endocannabinoid system. than when we go to the gym or if you're on the treadmill. We associate that that high feeling the runner's high with endorphins, but actually what they found it but yes, it's endorphins but also it's anandamide, it's your it's your naturally your cannabis that your body is producing naturally. And what they found actually, well I've read that that that an anti crosses the blood brain barrier more than actually endorphins do and then there was a super interesting study that was had the participants were a group of women sort of middle aged women who were in a choir and there are measuring in you know, the sort of the best way they can. I think it was just an undermined for different activities. So I think they, you know, they might have done a Zumba class. They they sang with their choir teacher, I think they maybe I didn't know you're on the kind of, sort of bike that you have in the gym. And for them, you know, it was actually the singing that caused a massive spike in their anandamide. So for me, it's like, it's another reason to follow your joy. Basically, follow your bliss. I know I love ecstatic dance. And I can guarantee if they did a lumbar puncture, which doesn't sound very fun to be fair, rhotic static dance but I'm pretty sure that my my anandamide would be would be through the roof. And what's interesting, all the things that deplete it, it's, you know, it's it's stress, obviously, it's poor diet. It's not a love sleep, it's too much alcohol, all the things that we know aren't good for us also deplete our endocannabinoid system.

This is so so interesting to to, to explore the concept because as you're saying, So following your bliss, following your joy is increasing the amount of anandamide in your body. And in doing that, your body becomes more imbalanced and so follows following your bliss actually balances your body and mind and soul. So real bliss is really the key to, to balance. Yeah. Yeah, I think sometimes we can think that we can be overindulgent if we're following our bliss and that this is maybe not good going to be good for us. In fact, what I'm really hearing you say is that actually if we follow our natural bliss, we will be we will be more balanced people.

I think it also you know, a common sort of manifestation of you know, an endocannabinoid imbalance or deficiency could be chronic pain and and if you're in you know, if you're in pain, yeah, going down to the gym, it's not an attractive proposition. But if you get a little kind of because one of the things that anandamide does you know, when we're when we're you know, running and I think it's part of our kind of evolutionary process it was you know, to kind of help us run and have stamina but we you know, we feel good but actually it's anti inflammatory as well so it's going to be also reducing pain and you know, so it's it's part of our evolutionary process that we're out there hunting and gathering and running you know, for a few miles and wood so it's but if you're if you're in chronic pain you know, maybe actually you don't need to go to the gym to get there they will shoot of the good stuff maybe you know, it's it's yours sort of singing with your choir or whatever whatever it is, you know, that touches your touches your heart and just you know, kind of and it's that sort of lovely feedback isn't it you're feeling happy you are producing kind of chemicals are actually going to make you feel better have an anti inflammatory effects anyway. So there are also other pathways through which it has a you know, a kind of anti inflammatory effect as well. So so a lot of patients you know, start off trying CBD they might, you know, I think the most common reasons to take it off or anxiety for paying for sleep. I know there's a kind of big movement at the moment in everyone's you know, thankfully talking about managing perimenopause and menopause and menopausal symptoms. So, you know, I know for example, Mike Matthews who basically is kind of one of the first queens of the menopause. She had found CBD so helpful during that that phase that she's, you know, launched her own brand and so, yeah, it's it's it's a good kind of gateway. And for some people, that's enough you know, some people that's enough. I find from from speaking to patients, so for example, with neuropathic pain, more serious ongoing chronic pain that CBD isn't enough actually. And they tend to need a little bit of THC or a lot of THC, you know, it depends depends on on on their levels of pain. And then that kind of puts you in the territory of, Well, thankfully, now there is a legal route to access, you can get a prescription in the UK, it's not conditioned dependent. But unfortunately, it's pretty much entirely through the private sector. That's only been three. Since 2018, when the law change came about, there's only been three prescriptions through the NHS. And that's just been for three cases of children with with very severe cases of epilepsy i That's another thing with CBD actually, it's kind of bonkers. But you know, essentially, this whole movement of CBD was was largely down to one little girl actually called Charlotte Figi, in Colorado, and she had a devastating rare type of epilepsy called Dravet Syndrome, which is, you know, in most cases, not controlled by anti seizure meds, and so she was having hundreds of seizures a week. And, you know, as you as you will know, when seizure activity isn't controlled, and there's brain damage, and you know, the kind of, yeah, that most children, they may have had a few little words when they before they started getting seizures, but then they, you know, they lose their language, they lose their ability to dress themselves, and they just know, the development goes backwards, basically. And at some point, you know, unfortunately, they probably will be one catastrophic seizure, and they'll short life will be ended. So with this little girl

she found and this was before the whole CBD boom, I'd say largely, it's down to her that, funnily enough, it was a CBD cannabis strain called I think it was hippies disappointment, because because it was CBD, you couldn't get high with it. So this was, you know, it's being sold in a dispensary, and in Colorado, and no one really was where he wants to try it. And there's been a little bit of research that happens in in Israel, showing that it could reduce seizures, and then it just like that all the stars aligned that this doctor who just read the paper was approached by the mother of this child, they found the dispensary that had a CBD strain. And they started giving it to Charlotte. And her seizures stopped almost overnight. Basically, I still have all these things still made me feel really emotional, because it's like, you know, I know a lot of parents of children with intractable epilepsy, and they live a half life, you know, it's the most horrific thing ever, when you, you're just constantly thinking your child is going to have a seizure and die basically, when they're not controlled the seizures. So this started the whole movement. And there's been a whole, you know, other children, the two children that changed the law, really, in the UK responsible for it, again, these are children with intractable epilepsy. And, and this is the, you know, the sad situation at the moment in the UK is that I think there's maybe like 200 families whose children are, they have prescriptions, but they have to go privately, they're there, you know, they, the NHS won't fund their prescriptions, they are actually sent saving NHS 1000s and 1000s a year because they're not being rushed into a&e. I know, you're an a&e doctor, it's, you know, these children, before that were being, you know, rushed in every week spending a lot of time in hospital, that doesn't happen anymore. They're, you know, their cognitive development is improving, you know, they're starting to develop little personalities, you know, and it's, and yet, from the from, you know, kind of NHS point of view, there's not enough evidence for it to be funded by the NHS. And so these, these parents are having to sell funds and remortgage their houses, you know, do crowdfunding campaigns, you know, live from month to month, you know, worried about whether they can actually afford to keep to give their child their life saving medicines. So that's, you know, a situation that I really, really hope changes, but at the moment, it's it's not on the, you know, on the on the government's kind of list of priorities really.

Gosh, that, that seems, that seems really sad. And also, I'm just, I'm also seeing a bit more clarity here. You mentioned a few things. One is, you know, we've got, we're talking about sort of CBD that you can find in Holland and Barrett and boots, as you mentioned, to help with sort of mild anxiety and a bit of maybe a little bit of pain. But it sounds like there is a difference between that and prescription level medical cannabis. And then there seems to be issues around access on the NHS to those prescriptions. So if we rewind just a little bit, can you in fence, really where CBD and medical cannabis lies?

Yeah, it's really hard. I mean, I'm not like, you know, there are some decent CBD products. And I should point out that although it's sort of slightly less of the case now, which I won't kind of go into the boring details, but originally what these products were the kind of thing that this Child Charlotte Figi was taking and then all the products that you know sort of started this whole kind of craze in the way in the UK were actually full spectrum hemp extracts that were abundant in CBD. So they were as near as you can get to the natural sort of mix of molecules from the hemp plant. And you know, trying to kind of mess around with it the least amount possible. But it was kind of the CBD part that got the headlines. So that's what kind of media latched on to is the hemp, hemp extract abundant and CBD is not very sexy CBD oil sounds great. So, yeah, so that's kind of what what was getting the really great effects due to kind of regulatory stuff that's happened in the meantime, essentially, now most of the products are a purified CBD which can be helpful in some cases. I'm not such a fan of it, but you know that I'm just a bit old school I think. So but you know, still, you know, if you're buying your CBD products, you don't need prescription, you should always look for it, it comes with a certificate of analysis. The big difference for me with if you've got a you know, a health condition and potentially well, you're taking other prescription medication, probably you've you've tried lots of things, you know, your doctors prescribed you various, let's say for chronic pain you've been on you know, you've worked your way up from codeine to Tramadol, then you're on your kind of your Gabapentin and, and all sorts of things like that. And you know, maybe they've got you on the sort of antidepressants now, because now you're not supposed to be on opiates anymore. And but but basically, nothing's working still, and you've tried everything. But you're probably still on all those drugs still, because they tend tend to keep you on them anyway, because they seem to like polypharmacy, for some bizarre reason. But anyway, there you go. So, you know, it's really, really important that if you're going to explore medicinal cannabis, that ideally you should be under the care of a doctor. Right? So and they can, you know, look at your case, you know, so for example, the situation that we have, at the moment, there is a growing number of private medical cannabis clinics. At the moment, GPS cannot prescribe medical cannabis, be it through the NHS, we know that's not an option anyway, or privately. It has to be a doctor on a specialist register. So it's going to be a consultant, basically. So what you have at these private clinics, you have pain consultants, you have psychiatrist, maybe some neurologists, if you're lucky, I think there's maybe one pediatrician or pediatric neurologists, you're kind of you know, there's, that's a bit of a closed shop, and they're really against cannabis. But there is, I think there's one pediatrician who is prescribing for these children with, with epilepsy. So yeah, so you go to the private clinic, and you wonder that you're under the care of a specialist. And they will, you know, look at your case, before they can kind of, you know, say yes, we can prescribe you have to show that you've tried, I think it's three other standard treatments, they then have to take it to their multidisciplinary team meeting where you're kind of it's decided whether you are a suitable candidate or not. And then hopefully, you know, that point you can actually start getting your prescription there was a point as well once the no GPS can can prescribe under shared care, but it's always going to be essentially a private GP. So if you are a patient listening to this and you're like, Okay, what does that mean to me, you can self refer you can self refer to one of these clinics or you can get your GP to refer you to one of these clinics and then you go through this whole process you have your initial consultation and and all the rest of it

and then what you're prescribed really depends on your condition if you are what they call cannabis naive. They're not going to sort of whack you on like high THC strange, first of all, because you know, it's, it's it does have quite strong psychoactive effects. And actually, you know, most people when they're wanting to, you know, medicate or manage their their symptoms, they don't really want to get high, you want to get on with your daily tasks, be it I don't know, running a business or like hoovering or whatever else that might be. So usually, it's the kind of you know, very much a collaborative process with your with your consultant to find out what's the best ratio of cannabinoids. There's also terpenes, which I haven't even spoke about, which are basically a class of organic molecules that provide you know, everyone kind of recognizes the smell of cannabis, right? That's not to do with the cannabinoids, that's actually to do with the terpenes and terpenes are found in every kind of aromatic plants and flower, you know, lavender, we know we know that lavender is referred to as a kind of relaxing effect. And that's largely due to a terpene called linenhall I think it's called and And, you know, there's certain strains of cannabis that were also really abundant in that particular type of terpene. There's another one called limonene, which you can get gathered from the name, it's that kind of citrusy smell, which can be very kind of elevating, for some people like a strain very high and limonene can actually make them feel a little bit of anxious. So it's really, you know, it's really important. And it's can be a bit of a kind of, you know, a gradual process to refine, you know, what is the best strain for and also, you know, you've got a different kind of ways of, of taking cannabis

ash. And so I was just really, just really hearing that, you know, this is medical cannabis is really very different from CBD products that you can buy over the counter. Because in in simple terms, it's the entire cannabis plant that's going to be described, yeah,

it can be sometimes you might have isolated products, it's also the guarantee, they know that they're standardized, you know, the way in which they're grown. You know, it's,

it's a dual thing different.

Not really, you know, it's, it's, it's, you've got more options. So, you know, if you're, for example, if you've got chronic pain, in order to manage the pain, you might well need to have quite a high dose of just CBD that you're buying in Holland and Barrett, whereas if you've got a prescription or you know, a lot of people go to the illicit market, you know, grow their own, but you might have a strain that has one to one ratio between THC and CBD or, you know, just more than their legal, legal allowable amount, if you were, you know, if you if you weren't going through the prescription route. And so that just means that you don't have to take as much CBD because the THC is working in a different way. And it's actually helping manage the pain and the different ways. So it's not really necessarily about about the dosing, it's just, there's more options, there's more options, potentially, you know, as I say, it's standardized. I think all the products have to, you know, they're kind of, there's more regulated, that's really, really important, the fact that it's regulated, you know, there should be less risk that, you know, you're consuming anything with heavy metals, or mold or anything like that. So, so yeah, I just think, you know, and it's not even, at the beginning, it was really, really expensive. That was like very prohibitive. And actually, particularly for patients, as they, you know, there are 1.4 million people who are basically medicating through the black market at the moment, in the UK, which is a huge amount. You know, I That's a point where that was a lot, you know, people are, it's just too expensive to go the clinic route, now it's more or less comparable. And I just think if you can be under the care of a doctor, it's much better, although having said that, dude, it's, it's interesting, because there are a lot of, you know, bearing in mind, this kind of this movement is patient lead, you know, so, and as I say, I don't know what proportion of the 1.4 million have now moved into the sort of the legal market or the legal access through, but they are patient experts, you know, these are people who've been maybe growing their own or like, and they really, really understand the different strains and how it affects their body, etc, often, much more than their consultants do. So quite often, in those cases, they are the ones that are educating the consultants and that's, you know, I think actually, maybe it's unique to this this sort of sector that often they're quite humble the consultant because they don't, you know, they've received training, but they're literally they've, their, their their babies in this you know, they're they're coming into this completely fresh, and I would add as well and this is something I don't know if there are health professionals listening to this, but the the, the narrative that I've heard time and time again, it's just one that they are absolutely delighted that they've got an extra tool that they can offer patients, you know, particularly patients with chronic pain when they've literally literally tried everything, you know, and what happens is, you know, it's sort of touched on polypharmacy before so that they can start to reduce their other meds. You know, I've heard time and time again, but just this morning, I was talking to a woman with Ehlers Danlos Syndrome, who has pretty much come off all her other meds now, you know, she was on opiates and she had to admit she was on like Gabapentin so mess with her head she was she had a kind of quite a you know, sort of think as a travel agents business that it made her so fuzzy headed she had to stop her business because she was making terrible mistakes you know and so she's come off all that now so it's like it's it's a real eye opener and and for these consultants who are working in this you know, in this sector and it's like, they are delighted.

Imagine relieved I imagine that those are there is actually something that kind of help a section of patients that have been really unreachable. And, and can be quite despairing as, as a as a doctor working with patients that you just don't have an answer or other choice available. I think that when when a doctor feels so helpless like that it can be, it can be really difficult for both sides.

So like, you know, so my entry to this world was through palliative care, basically. So it was through a close friend, her mom had pancreatic cancer. And actually, morphine didn't agree with her. And actually, for some reason, it wasn't controlling the pain and she was just like a zombie. And it was awful. And she was, you know, she, she was dying. But I really believe that whenever possible, we should have a good death, you know, die with dignity, I think that is possible. And so she had a kind of forward thinking Doctor, this is in Belgium, so it still wasn't even properly legal. But anyways, for the last six weeks of her life, she was she was taking cannabis oil. And for her it could manage their pain, she was completely lucid until the moment she died. She had because you know another thing with THC, it stimulates appetite. It just, you know, allowed her to enjoy her last few weeks and our family to enjoy their lives meets with her. So for me, that was like, a moment of like, holy shit, you know, this is insane that this even if it's just in palliative care, this isn't what you know, available. And I've seen my mom when she she was dying that, you know, morphine didn't agree with her either. And like, every time it was literally like taking a hammer, you know, just with oramorph. And I would you know, there's precious last weeks when they're just there's all I had left and she was like out like a zombie. It was like, okay, she's not in pain, but she's also not here, you know, so that I think for me, and it's something that has not really spoken about that much but like palliative care, it's that that should be an area where there's there's more movement in the sector. Maybe it's because in palliative you know, when you're dying, you have less of a voice, you know, it's but it's something I feel incredibly strongly about that, yeah, that's an area where it's just free. Again, even if you're a consultant in palliative care, it would be a gift because you know, if you're like giving your patients that, you know, as you know, like oramorph they also get nauseous, my mom did at least and then they also get constipated. And you know, and it's like, and they also are anxious and agitated at different times. And you're having to give like a zillion different meds, all kinds of interacting with each other. Whereas, you know, they could just have a cannabis oil and help with pain, give them some appetite, help them sleep, take the edge off, you know, it's like,

it's certainly worth exploring because actually, you know, this this week, I saw two patients with really severe back pain, really severe back pain. And as, as you mentioned, struggling on strong painkillers on Gabapentin on paracetamol or nonsteroidals on codeine, want to try Tramadol, but the side effects of these opiates are significant. And we're talking about nausea, constipation, feeling foggy headed, these are medications that a lot of patients don't like and don't tolerate well. And yet, there are just not other options to offer. But the other options we have like neuropathic agents. And these were the non medical listeners among us like our strong pain killers that are specifically targeting our nerves all carry very similar side effects to a greater or lesser degree. So it can be really difficult to find an analgesic painkiller with a less aggressive or side effect profile. We as doctors, I find myself very limited as to what is possible. Now obviously from an any prospective medical cannabis is not going to be one of the tools that I have available to me, but it is really good to know that this is an option that may potentially help somebody with intractable pain. And somebody who is looking for a painkiller with a with a potentially easier side effect profile.

And also, you know, with chronic pain quite often as a kind of, you know, an addition the patient might also have sleeping problems and depression because it's not it's certainly not a who've been in pain for years and years and years. And so again, it's something that rather than having to prescribe a whole bunch of medication, just one one basic cliquant can be helpful and cover all those bases. And

incredible Isn't it incredible that when you are delivering medicine in its whole natural plant form, it has this constellation of elements that actually work together in synergy to counteract the side effect profiles. That afternoon. We are working in a reductionist pharmaceutical basis and just are trying to pull out one of these active ingredients, we're losing the effect of taking it in its entirety.

It says a word this as a phrase in the cannabis, which I think has been kind of, you know, expanded to to Well, I mean, you can use it for anything really from like, oranges to whatever, it's the entourage effect,

the entourage effect entourage effect.

Yeah. So so in the kind of in the cannabis context, it's like okay, you've got your kind of stars of the of the show, but you know, you're kind of THC or CBD, and then you have all the kind of you know, that the the bit players or the rest of the cast where they're kind of, you know, supporting, supporting role basically, and without them you haven't got a performance, but was interesting with CBD and THC. So, for example, you know, I used to, in my 20s, I used to smoke hash, basically, I lived in Spain, and there was quite a lot of Moroccan hash around. And it was really nice. I was like, you know, kind of the nice what you imagined is a nice effect of having joint and like now I'm not really a weed smoker, because what if you go to the black markets, mostly, like really high THC, and I just don't tolerate it and, you know, all the kind of makes you feel a bit, you know, not just bit more anxious, really, which is not the desired effect. What was interesting is though, you know, the, the strains have a higher in THC, and there's barely anything of CBD. And what CBD does is actually, it kind of like balances out starts intoxicating effect. And so actually, therapeutically, for when when doctors are prescribing it, it kind of like gives a bigger therapeutic window. So if you if your patient actually have this as the case in patients who do use it to treat cancer, which is a whole other area, in order to be able to kind of tolerate the high doses of THC, the CBD worth has a therapeutic effect, but it also just opens up that therapeutic window. So it's not so overwhelming.

That's yeah, that's really interesting. What I would love to yeah, I'd like what I'd love to come back to you actually is there's talk about is this talk about how patients can consume cannabis. Because I'm hearing that, you know, you obviously we all know about smoking recreationally and you've mentioned the use of cannabis oil.

So so actually the two main main routes of administration are vaping so so actually it's really interesting and somewhat problematic because from the eyes of the police if you see like some cannabis flowers, how would you differentiate between prescription and you know, what you bought from the illicit market but essentially, you know, patients if they're if they're vaping as part of their prescription they will get a tub of flowers and they have some really kind of advanced vaporizers that you can measure out doses and etc you also depending on the temperature at which you're vaping the flour you can actually have more kind of effect from the THC or I think you have to increase the temperature lower the temperature then your is kind of you know better for CBD. So this is particularly for patients with breakthrough pain. So, so if you know it's not all about chronic pain, but just to give you know to kind of give a good example often pain patients will have an oil which is kind of giving them their baseline cover so you know depending you know what kind of ratio that is it might be you know, kind of CBD or with a little bit of THC or it might be one that's more THC really depends and then you know, sometimes still they will get the breakthrough pain particularly I think with neuropathic pain, you know and so then that's when they'll have the vaporizer it's more quick act in and that will just like you know, because it was with the oil it takes, I don't know, it could be half an hour to an hour for it to take effect. So it's similar to you know, how it looks to what you might you know, by your kind of standard CBD or if it's full spectrum is going to be a lot darker, you know, so when you if you go and get your CBD, you know over the counter or what have you and it's just like clear, then you can pretty much guarantee that's the kind of just what they call the CBD isolate, which I'm not such a fan of but as I say, that's just me, but it's not just me actually, there's lots of people who aren't such fans, but if it's a full spectrum, it's going to be darker. Normally it's you know, because they've just sent you know, they haven't like revealed all the other distilled it and all the rest of it. So Yeah, that's sad. But you know, there's there's quite a lot of research going on, you know, that probably for patients, you know, who are new to this are used to having their white tablet let's you know like a paracetamol and you know, it's, there will be capsules are probably I think there may be awesome capsules, but there'll be definitely you know, there's certainly research going on into other other delivery mechanisms, which I think is, which is good really. But you know, for these children, the children with epilepsy, they're having their little little drops of oil under the tongue. That's what they have. Yeah,

that's so that's so accessible, it's so accessible,

it's accessible, but it's very different to what we're used to. Yes.

And that will carry in effect, as we, as we know about placebo and masivo effects is that you know, how a medicine is given and delivered to us expecting then from that plays a big role. So it may be a while before our brains catch up, catch up with it. But it's, especially for the poor children knowing it's available in such an accessible format is a comfort. And I know that you are organizing a conference on the fourth of November. And so can you tell us, Mary, what is this conference about? I know it's already sold out. But there are online tickets. So what can people who want to come along to this conference expect?

So it's not I'm not I'm like kind of hosting a couple of panels. So it's organized by drug science. Some of you might have heard of Professor David Nutt he was the kind of the drugs are then kind of Gordon Brown. And it's very well known in the kind of psychedelic space, as you know, being involved with lots of research in the UK, and it's very much about, let's just listen to the science when it comes to when it comes to, you know, drug legislation, basically. So drug science has a project called Project 2021, which is an ongoing data gathering exercise that patients can sign up to, it's a way with, if they're with a clinic that signed up to it as well, they can have reduced price consultations in medicine. So actually, it's you know, cost them less and actually, then, you know, the data that comes from their treatment then goes towards a kind of, you know, a study and kind of real world evidence and that kind of stuff. So drug and drug science are co organizing this conference with med cam, which is an organization which is there advocating and supporting, particularly these children with epilepsy and supporting the parents, not just epilepsy, but just general pediatric conditions. So they are kind of CO organizers. And it's, it's a day that's aimed at patients and parents patients, because in this kind of weird sector, that is the cannabis industry, there's a lot of kind of b2b events where, you know, you've got all men in suits, investors, you know, talking a load of all crap if you ask me, but back slapping and like, the patients are just as complete second thought, if even second thoughts somewhere much further down the line. And so, you know, patients, just frankly, you know, haven't been listened to enough and, you know, without the patience, if there's no cannabis industry, so So yeah, so it's an event that's really there to kind of the patients to to have their their chance their moment really to have discussions. It's also you know, there for patients who are prospective patients, you know, you are kind of cannabis curious or interested in, you know, how to get a prescription, what is the process? We're going to have some interesting discussions, you know, talking about, you know, the difference between what's now called the legacy market, which is the kind of the illicit market, and, you know, the difference between that in going the prescription routes. I'm hosting a panel that kind of from the clinicians perspective, and also one about the patient's lived experience. But yeah, I mean, it's something that if somebody, you know, has an interest and wants to find out more, there are infinite on tickets available. It's completely free free of charge. So, oh, and have you

look at how can people find out about purchasing a ticket for this conference? Well, it's

free, so no need to splash any cash. So I mean, I can give you the you know, can put on your show notes, the link to it and Eventbrite thing, and you just like, sign up through that. And, and that's it. Really. Yeah, I mean, usually with these things, there's a way also if you can't miss it on the day I say this, but I imagine you'd be able to watch it back as well.

Yeah. Great. I think I'd be I think I would definitely be interested in catching a few of these talks on the replay. I think I'm, I'm away from that conference on the day, but this sounds really fascinating.

but it's also to be honest, there's an organization, you know, there are clinicians listening to this, you know, there's the cannabis clinician society. So as also for GPS as a primary care Cannabis Network or something, I give all these links, you know that too, just to kind of, you know, their educational district, you know, what, if you want to get involved, or you want to get trained, you know, because you do need to get trained. These are organizations, you know, they're nurses, that these clinics era, you know, nurses are a really key part of the team. You know, it's, it's for health professionals, and it's what's kind of really gratifying is that for the, you know, the kind of newly qualified graduates and young doctors, they're the ones who are really interested in this, you know, so yeah, and what we're hoping now is because the big stumbling block for, you know, prescriptions for the NHS, is that the clinical trials, basically. So what we're hoping is, you know, they will start accepting real world evidence, because there are these, you know, databases of amazing, you know, cases and now in the 1000s, that can prove that it's safe, and that it's effective for certain conditions enough, you know, to start considering prescribing it with the NHS, I would say,

wonderful, wonderful. Well, thank you so much for sharing such a wealth of information about this field, a field that I think has been so underrepresented. And I feel like I'm coming away with a lot more grounded knowledge and curiosity after this conversation. I

really know my pleasure. It's kind of complicated, but I just think it's, I think it's there's a potential to empower people. That's the thing. It's like, you know, and I think that's when I think medicine can be disempowering. You know, it's like, it really can and, and, you know, I know, that's something that you feel very strongly about, but shouldn't we be, you know, I'm not a medical professional, but like, shouldn't, that's what it is, people should feel the power to get better for God's sake.

Absolutely. And with another tool in our toolbox to toolbelt, doctors and patients alike can actually feel empowered, and feel that actually, there are empowering solutions that we offer to our patients. So this is a wonderful addition, in an area of medicine, and not just in the chronic pain, but all the conditions that you've mentioned before, anxiety, IBS, menopause, these are conditions that are historically difficult to treat the current pharmaceutical approaches so I really, I'm really welcome any addition to the evidence base on new treatments. And it sounds like this is really making the resurgence and I'm very grateful for the evidence that's being produced people like you who are educating us on it in very accessible language. So I would really encourage you to go and check out Mary's website Mary, what's your website,

just my name is Mary ma ry Byles bi le s.com. There's information about the book the CBD book on there also the podcast, cannabis voices Yeah. And and a few articles

and one and a lot of articles which really breaks down the evidence and the science behind how the endo kind of cannabinoid system works. So really appreciate, really appreciate your dedication to this work.

Oh, my pleasure. I'm glad it's it's of help.