We need to actively engage in Medical Cannabis science: Messages from #ExpoMedeWeed 2017

Medellin, host city of #ExpoMedeWeed 2017

This past weekend, Medellin, Colombia, celebrated the second iteration of the largest Medical Cannabis Expo in Latin America: ExpoMedeWeed 2017. The previous year I attended the first version of the Expo a little scared and not knowing what to expect. In fact, the fair was focused on the “cannabis culture” — since that was what existed in Colombia so far. However, the Fair had a large line of international speakers, such as Mara Gordon, the founder of Aunt Zelda’s in California, Dr. Cristina Sánchez who conducts pre-clinical research in Spain about the anti-tumor effects of cannabinoids, and other international researchers who have worked with Dr. Raphael Mechoulam, who isolated the THC molecule, and the endocannabinoids 2-AG and Anandamide.
This year, the event was significantly superior. Not only did the academic talks addressed more complex issues, we saw an evolution of the discourse regarding the need for serious and well-conducted research to confirm the potential effects of the cannabis plant. The Expo as such was attended by national and international companies that intend to produce cannabis-based medicines with the standards that the Colombian government expects. Also in attendance were people interested in becoming small growers to supply the companies that would hold the transformation and production licenses.
From a medical and scientific point of view, the conferences and the academic seminar could not be better! Again, international experts such as Ms. Gordon, Dr. Cristina Sanchez, Ana Maria Gazmuri of the Fundación Daya in Chile and Dr. Paola Pineda, who has steered the medical Cannabis movement in Colombia. And as if these excellent speakers were not enough, we had the honor of having Dr. Raphael Mechoulam join via video from Israel, and Dr. Ethan Russo, neurologist and renowned scientist who has written hundreds of scientific articles about the effects and potential benefits of different cannabinoids from the cannabis plant.
The academic talks to which the Expo attendees had access dealt with issues such as the endocannabinoid system, the myths that exist about mental illness and the use of cannabis, the impact of endocannabinoids on the protection of the nervous system. From these talks the most important conclusion is that the balance of the endocannabinoid system — a system that includes a series of molecules and receptors present around the the human anatomy and whose components resemble the phyto-cannabinoids from the cannabis plant — is crucial to maintain the proper functioning of key areas of the body, especially the neurological system
On Saturday morning I had the pleasure of sharing the stage with other doctors who were presenting their clinical cases: Dr. Terry Colmenares from Barranquilla spoke about the treatment of pain in a patient with prostate cancer with cannabinoids; Dr. Celeste Romero from Argentina presented a the case of a patient with schizophrenia who has used cannabinoids to reduce the dose of many of their antipsychotic medications — which were causing significant adverse effects — and allow this patient to regain the ability to enjoy life outside of his bed and his couch. The best thing about this case, in my opinion, was the fact that Dr. Romero helped her patient to learn the therapeutic value that cultivating, being in contact with nature and outdoors can have. Dr. Paola Pineda shared her experience treating a patient with an autoimmune disease, ankylosing spondylitis, to whom her biological treatments had caused the appearance of carcinoma in situ of the cervix — biologic drugs interfere with the immune system in such a way that they can cause the reactivation of latent viruses. This patient managed to adequately control her inflammation and pain levels with the cannabinoids.

Yours truly speaking about opioid tapering using cannabis

The case I shared was the experience of a patient who, due to a serious accident, had the need to resort to high doses of opioids to manage the subsequent pain. Given the adverse effects profile of these medicines and their high potential to trigger a true addiction, cannabis was used as an alternative for the management of pain and the reduction of opioid. This was achieved in a gradual, moderate, always taking into account the doses of cannabis and the adverse effects that this would be generating.
Other personalities of the world of medicinal cannabis took the stage on Sunday, such as Joel Stanley, founder of Charlotte’s Web and which products were part of a documentary produced by CNN with Dr. Sanjay Gupta about the benefits of cannabidiol oil, one of the cannabinoids from the most prominent plant- for the treatment of patients with epilepsy. Dr. Ethan Russo explained in an eloquent way the importance of subjecting cannabinoids from plants to the same standard that other pharmaceutical products undergo to produce compounds with strong effects and away from anecdotal experiences.
Monday was reserved for the academic seminar — lectures geared towards healthcare practitioners and scientists. The presentations that day gave us valuable information that will definitely change the way we see cannabinoids. The morning began with Dr. Mechoulam’s talk, who recalled the history of the discovery of the THC molecule and endogenous endocannabinoids. It was followed by a presentation by Andres Lopez, director of Colombia’s National Narcotics Fund who reminded us that the intention behind establishing a legal framework for the cultivation, production, processing of cannabis for medical purposes is to produce high quality compounds, which meet the standards established for pharmaceutical products and that should meet the needs of Colombian patients, and not to generate products to create a market. Dr. Cristina Sánchez talked about her experience working with breast cancer and mouse cell lines and the effect that THC cannabinoids have on programmed cell death — or apoptosis — and how the presence of more or less cannabinoid receptors could mean a different prognosis for people with breast cancer. Very interesting!

Mara Gordon, founder of Aunt Zelda’s

Mara Gordon from Aunt Zelda’s highlighted the need to subject cannabis-based products to rigorous tests that determine not only the concentration of cannabinoids, terpenes — other substances with therapeutic potential that the plant has and that can change the effect of the cannabinoids themselves — but also to analyze the heavy metal contents, contaminants, agrochemicals and other substances that can alter the desired effect of the product. Her company Aunt Zelda’s currently supports clinical and preclinical studies using the extract of the whole plant, and not just a combination of cannabinoids.

Dr. Gregory Gederman from Florida explained the importance of the endocannabinoid system in the modulation of stress, emphasizing exercise as a factor that directly influences the health of the endocannabinoid system.
Dr. Celeste Romero, Argentinian psychiatrist, spoke in a more comprehensive way about the evidence related to the use of cannabis with possible psycotic episodes some people experience, and explained that although a link has been found historically, science suggests that this phenomenon occurs in those with a genetic susceptibility. On the contrary, she explained, the latest studies describe — which she has also confirmed in her clinical practice — the possible role that cannabinoids play, especially CBD in the treatment of schizophrenia itself.

Ethan Russo, board-certified neurologist and psychopharmacology researcher

Dr. Ethan Russo described some of his experience developing one of the only derivatives of cannabinoids from plants that has been approved by the FDA in the United States, and the potential that cannabinoids have for the treatment of neurodegenerative diseases such as Alzheimer’s, post-traumatic stress, Parkinson’s disease among others. Interestingly, he highlighted the role that the relationship between cannabinoids and the intestinal microbe can play in modulating neuroinflammation, an aspect little explored and that will fit into a system of functional medicine like the one I practice.

Later in this interesting day of learning, Dr. Paola Pineda not only expanded her experience treating pediatric patients with epilepsy making use of local cannabinoid products, but also the legal and ethical aspects of the use of cannabis-based medicines. Dr. Orlando Carreño, pediatric neurologist, highlighted once again the need to conduct studies of high academic rigour to expand and advance knowledge about the scientific use of cannabis.
In short, there were about four days of intense learning alongside national and international experts in the field of medical cannabis. Much of the conversation revolved around the great potential Colombia has to forge an ethical and scientific medical cannabis industry in the best possible way, following the precepts of science at every step for the creation of quality products for our Colombian patients who need them.
The time to think that the cannabis plant has miraculous effects must be left behind. I am infinitely happy to have been part of the illustrious group of professionals who from their own experiences express support for a more regulated medical cannabis industry with a strong line of research that supports its therapeutic uses.
Big Thanks to Dr. Paola Pineda, Henry Muñoz and the rest of the organizing committee of ExpoMedeWeed for inviting me to be part of this world-class event and for providing a space for Colombians to learn from experts about the real therapeutic potential of the cannabis plant