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MedEvidence! Truth Behind the Data
Welcome to the MedEvidence! podcast, hosted by Dr. Michael Koren. MedEvidence, where we help you navigate the real truth behind medical research with both a clinical and research perspective. In this podcast, we will discuss with physicians with extensive experience in patient care and research. How do you know that something works? In medicine, we conduct clinical trials to see if things work! Now, let's get to the Truth Behind the Data. Contact us at www.MedEvidence.com
MedEvidence! Truth Behind the Data
🎙Two Docs Talk Natural Products: Part 3 - Venturing into the World of Psilocybin Therapy and Marijuana Regulation Ep 140
This episode wraps up our Two Docs Talk Natural Products series spotlighting marijuana, psilocybin, and magic mushrooms as promising therapeutic alternatives. Dr. Kirvin-Dawes and Dr. Koren unveil the mysteries of THC and CBD, as cultural nuances of pain management in Jamaica, we also explore the therapeutic benefits of cannabis in treating certain cancers and alleviating the discomforts of chemotherapy.
The conversation takes an exciting turn as we delve into the potential of psilocybin and magic mushrooms as a promising therapeutic alternative. We emphasize the need for professional guidance while undergoing this unique psychedelic experience. You don't want to miss the convergence of nature, culture, and contemporary medicine.
Full Series:
🌿Two Docs Talk: Developing Natural Products Pt 1 - Unraveling the History of Nature-Inspired Medicine
🌿Two Docs Talk Developing Natural Products: Part 2 -From Ether to Red Yeast Rice
🌿Two Docs Talk Natural Products Part 3 The World of Psilocybin Therapy & Marijuana Regulation
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Have a question for Dr. Koren? Email him at askDrKoren@MedEvidence.com
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Music: Storyblocks - Corporate Inspired
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Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts, powered by ENCORE Research Group and hosted by cardiologist and top medical researcher, Dr. Michael Koren.
Dr. Koren:Hello again. I'm Dr. Michael Koren hosting another episode of MedEvidence, and I have the great pleasure and privilege to be with my dear friend and colleague, Dr. Lisa Kirvin-Dawes, who is a friend of mine from medical school and somebody that now practices internal medicine in Jamaica. She did her training with me in Boston and in New York and eventually practiced a bit in Maryland and then moved down to Jamaica where she is both a country physician, helping people with natural remedies and also running internal medicine at a hospital. So those are two very, very different things. Lisa and I can do that, but anyhow, we're going to talk a little bit more about things that went from sort of natural discoveries or even recreational drugs to therapies that are either being studied or that we use day to day, and Lisa has had actually an interest in cannabis and psilocybin.
Dr. Koren:You actually have a really nice lecture about cannabis at the Academy of Physicians and Clinical Research a couple of years ago. I learned a lot from that lecture, so tell me a little bit about how your interest developed in those areas and what you're doing with it these days. Other than using it in college. Excuse me, please edit that out, okay?
Dr. Kirvin-Dawes:So in terms of cannabis, marijuana, we use it in Jamaica a lot for medical reasons.
Dr. Kirvin-Dawes:It's one of the things we actually use for pain. As I said, Jamaica uses a lot of natural remedies, so people have always used it for pain and cancer. When I moved back, I realized we had to use a lot of herbs because the country couldn't afford to buy big medicines sometimes. So for certain cancers pancreatic cancers, the nausea and the pain we always use marijuana, and they allowed you to use it prior to becoming marijuana becoming very popular and then, because of politics, really try to be controlled. As long as the consultant or the attending in the hospital was taking responsibility, you could use it with patients.
Dr. Koren:So as long as the attending was using it, then the patient can use it as well. By the way, I came up with that because it was actually an ethical principle in research years ago. They used to say that to protect the patients against the use of products that were not proven, that were investigational, that the PI the principal investigator can only prescribe to the patients if he or she was willing to use it himself?
Dr. Kirvin-Dawes:Or if they were willing, okay, but granted, that was actually a concept, but granted, though, what we used it for and now I mean in terms of cancers was really, really helpful. Even now, when we use chemotherapy, we realize, for certain chemotherapy- if you give marijuana they actually have less nerve damage. So they don't have the nerve problems that a lot of people get that have known with certain sort of chemotherapy. So that's how we became interested. We were using it mostly for cancer and pain in the early days.
Dr. Koren:Explain to people. A lot of people know this, but some people don't. THC versus CBD Okay so.
Dr. Kirvin-Dawes:THC is what people know it as it's part that gets you high, but CBD is the part that and that's tetrahyba-hydro-cannabinoid.
Dr. Koren:Cannabinoid, right, Cannabinoid. Okay, thank you.
Dr. Kirvin-Dawes:And the CBDs are usually what people think is the one that actually is helping to treat the problem. However, you need both in order for it to work. People say you need strictly CBDs. It doesn't tend to work that. You always need a little THC to activate it, and marijuana probably has over 200 active components in it. So that is what becomes very tricky and we don't know which ones are doing what. We know some of the main ones, but we don't know all of them.
Dr. Kirvin-Dawes:But you need both what the US has done in many places to call it CBD. You have a lesser percentage of THC, but it's usually not just none Interesting.
Dr. Koren:Yeah, so that chemistry is fascinating. So we obviously have receptors in our body that respond to both THC and CBD and there's been research in the area. I was very involved as an investigator in our organization. I was very involved in the studies that looked at a drug called Rimonabant, if you remember that from about 10, 15 years ago, Rimonabant.
Dr. Kirvin-Dawes:That's about it.
Dr. Koren:Yeah, and so that was basically something that was being used for weight loss. So we know that marijuana causes the munchies and Rimonabant blocked those receptors and was considered an anti-munchies drug and it actually worked. It worked really really well to help people lose weight.
Dr. Koren:But, it didn't come to the market because it was increased suicidality for people that were taking the drug. So obviously, as it helped people lose weight, it also made them feel more depressed. And we actually had quite a few patients in those studies and a lot of them did not want to stop the drug because they were losing weight. But they also said you know, I feel kind of blue and I'm not feeling great, but I am at least intellectually excited about the fact that I'm not that hungry and I can control my appetite. So it was really interesting to see that observation within a randomized clinical trial that ultimately produced really neat data about how these receptors are activated and how we can manipulate these receptors to try to create some medical benefits. But at the same time there's a trade off. So I think that was fascinating. But getting back sorry to interrupt you, but getting back to marijuana so you use that a lot for pain Is that your number one go to, or do you give opioids at all?
Dr. Kirvin-Dawes:We give opioids. Now Jamaica is interesting. We do not have a big opioid problem.
Dr. Koren:W hat's the theory for that?
Dr. Kirvin-Dawes:We've been trying to figure it out. I think our culture looks at pain differently, so that's part of the problem. It's sort of a culture where you just handle the pain, be a man and just deal with it and move on.
Dr. Kirvin-Dawes:So, I think that's part of it is cultural as well, and we do use a lot of marijuana for pain, but we use it to increase appetite also with cancer patients. But I mean a lot of people in terms of cancer use marijuana and have been using it for many years. People are allowed to, or used to, grow their own marijuana without regulation. Now they have some regulation that you're allowed to grow a limited about per household.
Dr. Koren:The government can get it on the deal right.
Dr. Kirvin-Dawes:Yeah, it's become mostly over-regulated, which is why Jamaican marijuana, which everybody used to know about Jamaican Ganges, it's hard to get any more.
Narrator:Is that right?
Dr. Kirvin-Dawes:Yeah, because it's become very expensive to grow, unless you're doing it illegally.
Dr. Koren:Really.
Dr. Kirvin-Dawes:The licensing are five to 15,000.
Dr. Koren:Wow Interesting.
Dr. Kirvin-Dawes:For a small plot.
Dr. Koren:How many joints to get of a small plot. It's bad.
Dr. Kirvin-Dawes:It's really is over-regulated and they come in and check. You have to have electric fences, the security and the average person that was growing marijuana and the poor Gange farm. I can't do that. It's out of business.
Dr. Koren:Interesting. Yes, the downside of regulation is you can sometimes take away the means of survival for people in prosperity. So let's move to psilocybin. So tell me how you use that.
Dr. Kirvin-Dawes:Magic mushrooms. Yeah, there we go. Well, it is not illegal in Jamaica, while I hear in the US it is.
Dr. Koren:Yeah, I think it is pretty illegal here.
Dr. Kirvin-Dawes:Right. So in Jamaica it's not. It's just not regulated. So people are trying to do it quietly so it doesn't get regulated. But people have used magic mushrooms to. They go on a retreat and they take the mushrooms and then they have certain insights into what's really been bothering them. So people say, like a week of going on a retreat of mushrooms somebody has said is equal to 20 years of therapy.
Dr. Koren:So interesting, okay.
Dr. Kirvin-Dawes:It does put you I have tried it in another state of mind and things that you haven't thought about in years it does bring up. It is a psychedelic, so people can't see things. I don't think people should do it on their own unless they know and have done it before, because it can make people see things and be very afraid. You need proper support of what's going on with you? But in fact there are a number of American retreats in Jamaica doing psychedelic mushrooms. I have friends who run programs.
Dr. Koren:So how would you guide somebody in terms of this? Is it, do you know how much psilocybin people are getting per mushroom or has? That depends on the mushroom.
Dr. Kirvin-Dawes:Okay, so it depends on the mushroom. There are certain grams and it. Well, okay, this is a thing that's not regulated well. So you find most of the people that run their own sites favor certain types of mushrooms. They all don't use the same ones, and so the amount of grams you get and usually now they're a little better and measuring it in terms of grams, but it will differ per each person and your tolerance. So they'll start lower, see how you react, and then go up.
Dr. Koren:I see. So how long do you have to assess somebody's response, l ike give me, get a little bit more explicit.
Dr. Kirvin-Dawes:You know the okay, so when you take it most people you'll start to see a response in about three hours to three hours, so you start with like a half mushroom or no, they come in pills about five grams.
Dr. Koren:Okay, five gram pill Okay.
Dr. Kirvin-Dawes:But it really depends on you. Can anyway from 0.5,. Some people start with one milligram some people start with two. It really depends on the person.
Dr. Koren:So when you prescribe that for somebody who's say, has PTSD post-traumatic stress disorder. And they said Dr. Dawes, I heard that you're the expert on helping people with this. I'm talking to a therapist and not getting anywhere. I see these flashbacks of the government taking over my marijuana farm and I need your help, so tell me how you would address that patient.
Dr. Kirvin-Dawes:Usually if they're interested in psilocyberin therapy for PTSD. I wouldn't recommend you just start that on their own. They actually need to go into a treatment program and actually be there with a number of people, in case there are people that can have psychotic episodes.
Dr. Koren:Okay, so it's not something you wouldn't give them a prescription for two milligrams of magic mushrooms.
Dr. Kirvin-Dawes:No.
Dr. Koren:Okay, but you have a dispensary that you would trust to.
Dr. Kirvin-Dawes:Yes, we have. There are a few dispensaries in Jamaica.
Dr. Koren:yes, and so how about a friend of yours that is gonna be a little bit off the grid and say I'm really having a hard time? I was wondering if maybe a mushroom weekend can.
Dr. Kirvin-Dawes:Yeah, we have people there. We have people we can refer to. Okay, because you want to have people that if something happens they know how to deal with it.
Dr. Koren:Okay, so you would advise them to be with other people.
Dr. Kirvin-Dawes:Usually, most of the retreats are with anywhere from 10 people altogether.
Dr. Koren:So you wouldn't advise it, staying home on the weekend with your partner and taking two milligrams of mushrooms.
Dr. Kirvin-Dawes:No, it shouldn't be done with somebody who doesn't know anything about mushroom therapy.
Dr. Koren:So the consequences are severe enough where it should be done in some sort of group setting where there's people around.
Dr. Kirvin-Dawes:You need support. Yes. But the thing is, because you don't know who is going to, you have some people that go through it, and they're quite mild, and there are other people that just go off and when you're taking it.
Dr. Koren:It's unpredictable.
Dr. Kirvin-Dawes:Yeah, so you can predict.
Dr. Koren:Yeah, yeah so.
Dr. Kirvin-Dawes:You want somebody there when you're seeing certain things, can help you to interpret it, because people do see things.
Dr. Koren:Yeah.
Dr. Kirvin-Dawes:And to sort of help with the interpretation and be supportive. So it has to be someone that they trust as well. So, no, not recommended to do it on your own, even if you have access, unless you're very experienced.
Dr. Koren:It's interesting. Yeah, it's definitely unpredictable. Now I know there are clinical trials that are looking at it. I know I brought up PTSD because I know specifically there have been some trials talking about that as a potential, potential problem that would particularly respond well to psilocybin, and I know that it's been also looked at for a severe depression. And you know, having gone to college in the United States, I also have some experience with some college kids that took it. In fact, my college roommate took mushrooms when we were senior. He remained nameless one of my college roommates and he I don't know what was going on, but he became obsessed with the idea of burying a chair from our apartment. So he literally started like trying to figure out how to get shovels and build a hole or construct a hole that he can put the chair in, to bury the chair. And so where this came from I have no idea, but that was a famous college story amongst my peer group.
Dr. Kirvin-Dawes:But it's interesting the whole concept of him burying a chair if he had someone there who knows what's going on they actually sit and talk to him a little bit about it and sometimes you can get what they're really thinking about. But if the person has no, because it may not have been about the chair, it may have been about burying a secret that happened and it's really bringing that out of the person.
Dr. Koren:That's genius, oh my God. I'm a little reluctant to say this but the insight just hit me on this particular person, but you're exactly right. It's funny how, like, you think about things that happened years ago and you have more experiences, and then your whole insight changes and what you just said just triggered something that is spot on. I can't say it on camera because it would identify the person. But now I just understand something in a very different way than
Dr. Koren:I just did so. Thank you for that. And so that gets to our you know sort of. The final concept is how you get trained medical people to interface with non-traditional therapies so that they tend to have more good than harm and, either from a counseling standpoint or a side effect management standpoint or a dose choosing standpoint or a patient selection standpoint, come up with the best solutions, and we desperately need more research in those areas.
Dr. Kirvin-Dawes:Well, what the herbal guys have told me is that they feel disrespected and some of them say I'm one of the few doctors that will sit there, talk to them and actually work with them. I think because we go to medical school and because we have done different training, some of these guys have had things passed down for years, have a lot of experience, have seen what it does and we can learn from each other. It's just a about respect and they need to feel our respect. They don't feel respected.
Dr. Koren:Well, respect is important, but structured observation is also important.
Dr. Kirvin-Dawes:You can work with them on that. That's what they are thinking. Well, you can.
Dr. Koren:Yeah, and again I've been in a situation where people have come to me I want to do a study that shows this and the other thing, and we always have to tell people. Well, how about if the study shows your idea doesn't work? So you have to be prepared for that, and that's the humbling part of doing clinical research is that, as much as we believe in something, once you put it through an objective test, it may work and may not. And, of course, if it doesn't work doesn't mean that your idea is completely nonsense. It means that you need to redevelop your idea and come up with a solution in which that situation will actually work to accomplish what you're trying to accomplish. Hey, Lisa, this was a fabulous conversation. I really appreciate it. I always learned something from you. It's a pleasure and keep the good work and thank you for being part of Two Docs. Talk Natural Medicine.
Dr. Kirvin-Dawes:Thanks for having me.
Narrator:Thanks for joining the MedEvidence podcast. To learn more, head over to MedEvidence. com or subscribe to our podcast on your favorite podcast platform.
