Ohio’s newest prescription: CBD oil

The world of cannabis use seems to become more complicated and confusing by the minute. What is CBD? How do you get a medical card? Can you get high from someone’s hemp bracelet?

These are just some of the questions that spring from new policies regarding cannabis’ legal and medical standing and they often don’t entirely have straightforward answers. It may seem like one answer leads to another question.

There are two predominant components to the marijuana plant: cannabidiol and tetrahydrocannabinol. Each have differences in chemistry, packaging, use and legality, yet each are growing into what could become the next big pharma.

THE NEW CORNERSTORE CURE-ALL

Cannabidiol, marijuana’s more neutral component, is one of the 113 cannabinoids of the cannabis plant that has hit the market and seemingly every corner store within a five mile radius.

Although it may not be fully understood, cannabidiol has shown potential as a major player in legitimate clinical uses.

Kent State biology professor Eric Mintz explained there are two categories of cannabinoids: phytocannabinoids and endocannabinoids.

“We think of them as two different kinds of cannabinoids,” Mintz said. “There are endocannabinoids that are natural to our bodies that we make in our cells and the phytocannabinoids that we can get from plants.”

Mintz explained they are different molecules that affect our systems in different ways. The endocannabinoid system is important to brain development, including the formation of synapses to allow chemical signaling within the brain. Endocannabinoids are also important in regulating stress and metabolism.

“They are important in the regulation of pain and the regulation of feeding,” Mintz said. “We know it relaxes, so it clearly has an effect on the brain and it makes people hungry, so it affects feeding.”

Mintz also explained phytocannabinoids affect our bodies differently based on receptors they interact with.

“Different cannabinoids act on different receptors,” Mintz said. “For example, tetrahydrocannabinol, which is the active ingredient of marijuana, acts on the cannabinoid one receptor, versus cannabidiol, packaged as CBD, which acts entirely differently and can have blocking effects on the cannabinoid one receptor.”

Mintz said that although marijuana is highly engineered now, the cannabidiol extract still remains pure.

“Now we’ve engineered marijuana through selective breeding, so a marijuana plant has incredible amounts of tetrahydrocannabinol,” Mintz said. “Whereas cannabidiol can be found in natural hemp.”

Hemp is a fiber strain of cannabis that has a lower concentration of THC. The Farm Bill, signed into effect in 2018, made it legal for licensed farmers to grow hemp with a 0.3 percent THC content and removed hemp from Schedule I of controlled substances.

“It’s being looked at for use for other promising things,” Mintz said. “Other brain activity related things like anxiety and migraines which are an overactivity in parts of the brain.”

CBD is even less researched than THC in regards to it’s effects on body systems. So far the only FDA-approved use for cannabidiol is in treating epilepsy.

In September of 2019, the government approved nine research studies for studying the uses of cannabinoids as pain relievers, totaling three million dollars in CBD research.

“We are at that stage right now because it’s a relatively new thing,” Mintz said. “We think it does some good things, but we don’t know much about the long-term effects. We go through this a lot where we find this new thing, and everyone thinks it’s going to cure everything and then we find out later that it might have some side effects.”

Mintz was recently approved a National Institute of Health grant to look at how cannabinoids interact with the body’s internal circadian clock.

“We were interested in whether the cannabinoid system plays a role in regulating this clock,” Mintz said. “After some investigating we found that they are.”

The circadian clock, a biological maintenance process that regulates sleeping and eating, is a highly regulated system within the body that runs on levels of weekly, daily and hourly fluctuations within body chemistry. Mintz wants to understand cannabinoids, whether the ones already within our system or the ones we take on the weekends, effect this master clock.

“The deficiencies in signaling by cannabinoids changed the timing of the clock, the speed at which the clock ran and how it responded to the world,” Mintz said.

Mintz explains that within the brain a master clock uses a tightly controlled biochemical process to drive behavior, such as the urge to sleep at night and wake up in the morning. The clock is also important in directing regular physiological functions. It can be harmful if the clock is disrupted or “desynchronized.”

“We think that there are receptors for cannabinoids actually in that clock in that part of the brain,” Mintz said. “What we don’t know is what triggers those cannabinoids to do something, what makes them go up and what makes them go down.”

More and more people are taking some form of cannabinoid. A BDS analytics projection has the CBD market hitting $20 billion by 2024.

“While they are not necessarily harmful and addictive, they can turn into habitual use,” Mintz said. “We don’t know the exact impact of that physiologically.”

Korey Cleaver, owner of massage studio and health store Well Being in Akron, sells CBD products and offers specific CBD massages. The CBD massages are offered with pure cannabidiol as either a lidocaine-supplemented balm or the more popular oil extract with a 700mg CBD content.

“A lot of people are very curious about it,” Cleaver said. “It can be very controversial. A lot of people are misinformed about it.”

Cleaver explained clients are sometimes nervous about the misunderstood legality of it as well as being generally confused about what CBD is.

“I give those people credit for being able to branch out of their box and try something new,” Cleaver said. “I think it’s a worthwhile thing. I’ve seen it make a difference in my life and make a difference to the clients that come through the door.”

Clients range from elderly customers seeking relief from chronic pain to athletes looking for a more natural approach to recovery and healing.

“We’ve had great results in the case of increased mobility,” Cleaver said. “I can’t make any official claims, but based on what I’ve seen, I know it’s a beneficial thing.”

Cleaver said research is a key factor to furthering the market for CBD and it would be constructive in writing regulations to allow for a less anxious customer experience.

“I’d like a lot more research to be done,” he said. “There is so much more to discover with how it reacts within our brain chemistry.”

Cleaver hopes more research and understanding will open the public to this alternative approach of health and wellness.

“I want to connect with the community and get the community to connect with us,” Cleaver said. “I know we are doing something valuable and we’ve gotten great feedback that shows we are doing the right thing.“

OHIO’S MEDICAL MARIJUANA 

Medical marijuana is a new system for Ohio, being approved only four years ago. Maria Bonvechio, manager of Akron’s Ohio Marijuana Card office, said patients can be nervous about starting the process due to a lack of knowledge about the program.

“There is a lot of miscommunication and miseducation about our program out there,” Bonvechio said. “I have patients daily who have never used a cannabis product in their lives.”

The process of applying for a medical card is simple and quick; a mock run-through at Akron’s Ohio Marijuana Card office took 30 minutes. Patients must have one of the 21 qualifying conditions listed on the Ohio Medical Marijuana Program website and bring up to date medical records to the office.

Qualifying patients will be scheduled to see a certified cannabis doctor for a brief exam, checking general health and reviewing family history. The doctor will also ensure any current prescriptions will not interfere negatively with cannabis.

“There are very few medications that interact negatively or positively with marijuana in anyway,” Dr. Morris Pulliu, one of the office’s marijuana-certified doctors, said. “Rarely would it be that (patients) couldn’t have the marijuana.”

The doctor will then either approve or deny a recommendation for the patient to use medical cannabis. Most patients bring the correct medical records and qualify are approved for a recommendation by the doctor.

After approval, patients register with the state medical marijuana board and receive a digital card via email to be printed or kept on a phone.

The whole process costs about $310. However, there are discounts for veterans and people in need and payment plans are available.

Bonvechio said the largest age demographic are those anywhere from 40 to 90 looking to alleviate conditions in a more holistic approach.

According to a Harvard Health Publishing Journal, daily prescription opioid doses dropped by 3.74 million when dispensaries began to open. The most prominent conditions being seen at the Akron Ohio Marijuana Card office are chronic pain and PTSD.

“People are coming in here in pain. They’ve tried everything and I know this works. I’ve seen it work,” Bonvechio said. “They’ve listened to the doctors and trusted the physicians and tried all the traditional mediations and now they are looking for a holistic alternative.”

Bonvechio said the renewal process and speaking with patients helps her to guide new patients in the process.

“This is the first time in the state of Ohio with the renewal process where they come back in,” Bonvechio said. “I’m asking the returning patients questions about what dispensary they are using and what are you seeing that’s benefiting you so I can have the education to articulate back to our new patients.”

Bonvechio said education is the most important thing for the program’s growth. With a growing market and patients in need, it’s more important than ever to keep people from turning to cheaper street marijuana.

“In a dispensary the quality is there. You’re not going to find that anywhere else,” Bonvechio said. “And you get an education: you get to talk to the budtenders, you get to talk to pharmacists, you get to talk to the doctors about this. That’s revolutionizing cannabis.”

Patients who are approved for a card and use marjiuana will still be required to make regular visits with their primary physicians as well as continue to submit records to the office for a yearly renewal of the card to continue purchasing cannabis. However, according to the Ohio medical marijuana control programs, only 66 percent of cardholders are buying.

Self-titled marijuana guru Rick Johnson believes this is due to lack of education and patient support from the state.

“This program is not reaching the number of people it should,” Johnson said. “The commerce board and physician board are not stepping in to help.”

Ohio’s medical marijuana program had a bumpy start, with a six month delay in opening dispensaries and high prices turning many away.

Johnson believes the state’s medical marijuana control program committee, which is overseen by the pharmacy board, is not meeting or understanding the needs of the patients.

“If you are not a patient how can you tell me what is or isn’t good for me? Patients know what patients need,” Johnson said. “How can you teach baseball if you’ve never played?”

Johnson has not used pharmaceuticals in three years. He began supplementing his regimented med schedule and eventually replaced it with cannabis. Now, Johnson has reduced his stage 4 kidney failure diagnosis to a stage 2.

“I’m so happy that God put this plant on the earth,” Johnson said. “All the doctors call me the wild guy.”

Johnson, who worked at a dispensary as a budtender for a time, said there is an amount of experimentation to find the right strain for treatment and the first dispensary visit can be overwhelming.

“Trying cannabis is a trial and error situation; finding the right one is an adventure,” Johnson said.

Johnson recommends keeping a journal record of what strains work and which don’t to find the right one.

“Talking to friends who make recommendations is another way I find out about how different strains work,” Johnson said.

The most cited reason for lack of marijuana purchased is the prices. Ohio’s marijuana price is an average $470 per ounce according to a Cincinnati Enquirer article, more than $150 above the national average.

“It’s unaffordable for most people,” Johnson said. “People need it, but cannot purchase it.”

Other criticisms include the odd “Ohio Tenth,” a provision placed by Ohio’s medical marijuana control board which sells in units of 2.83 grams rather than the usual 3.5 eighth grams.

Customers also find issues with the 90-day supply limit. Customers are limited to purchasing only 90 doses in a 90-day period which can be difficult with patients that travel and have trouble affording large quantities at a time.

Johnson hopes to begin a community outreach program for seniors to educate and inform them on the alternative use of cannabis.

“I think it is working for so many different people and their conditions,” Johnson said. “I’d love to be a patient advocate for people who have questions.”

Johnson is a dedicated advocate for the recreational legalization movement and like Bonvechio, is an adamant advocate for more education, a theme that is lacking in the program.

“The state is not providing enough education for people,” Johnson said. “Many people come in uneducated and ill-advised when they are looking for medical cannabis.”

Bonvechio said one way to research is through reviews. Leafly is a reliable resource to learn the benefits of cannabis, read reviews and discover different strains.

“It’s becoming more acceptable and more people are hungry for knowledge about cannabis as a whole,” Bonvechio said. “I truly believe it’s the future.”