Cheap Home Grow had the pleasure of talking to Dr. Jahan Marcu. Dr. Marcu is the Chief Science officer for Americans for Safe Access.
We talked about the endocannabinoid system and how cannabis can change the future of healthcare.
Dr. Jahan Marcu: I work for Americans for Safe Access, which is a medical cannabis advocacy nonprofit that was founded in 2002 by Steph Sherer. I’m there Chief Science Officer, and also the director of their patients focus certification program. I help Americans for Safe Access with research and working with our partner groups on different research projects as well.
Shane McCormick: How did you get involved in studying cannabis?
Dr. Jahan Marcu: I think it was primarily two things. One was I was really interested in science, and I was working at UCF SF in San Francisco looking at native American plants and breast cancer when an opportunity came to volunteer for a project studying brain cancer and cannabis. What was interesting at the time was nobody wanted to do cannabis research 10, 15 years ago because of the stigma. I had friends in the lab whose sole job was measuring rectal temperatures of mice, and they thought studying cannabis would be embarrassing. It was fascinating all of these cannabis research projects and cannabinoid research projects that no one wanted to do because no one wanted to put up with the DEA inspections, with the random drug tests and with all the bureaucracy and paperwork.
It wasn’t before long until no one in the lab knew my name, they just called me “Mr. Cannabinoid.” What was fun about that is that everything you do was new, there were so many things that had not been repeated because science is all about reproducing, demonstrating reproducibility. There was just a vast blue ocean of opportunities to study cannabinoids. I was fortunate to work on a lot of exciting projects including working on helping to solve the structure and function of the CB one receptor which is the primary target of THC. There’s another part to the science, there’s also the patient aspect, and I was lucky enough to be able to find the American Safe Access San Francisco chapter with many other people and got to do work on policy. I was fortunate to do patient education and doctor education. What made it stick was that I got to work in the lab and then take what I was learning and share it directly with patients who are suddenly talking to their doctors about what the endocannabinoid system is and what cannabis does.
It was a rewarding experience. You have these people have many questions about cannabis and no one’s willing to discuss it with them. Just regarding the mechanism, what research is known. It became a lot of fun, and it still is a lot of fun. I still do webinars. I still do a lot of town halls and public education.
Shane McCormick: What is the current focus of your cannabis research? What are you individually working on right now?
Dr. Jahan Marcu: We have a couple of studies going on. We’ve partnered with the International Cannabis Cannabinoid Institute. We’ve been helping come up with projects most recently I’ve been interested in product safety and product safety studies. In November we published along with collaboration with other universities and laboratories that are in our certification program. We published a report in the Journal of the American Medical Association about the labeling accuracy of products. It was hard to believe, but that was the first ever studied published where people purchased CBD products and tested them to see if they were accurate.
I think another area of interest we have is what role contamination is playing. I was talking with my friend Kyle Boyer at Medicinal Genomics, and he was sharing data that shows that certain fungi, which are things that contaminant the plant produce compounds that can block the effects of CBD and essentially lock it.
I know it’s not traditional research but one of our goals is to have safe and standardized medicine for patients. So when they buy a specific product, it’s the same every time, and they can rely on that consistency. I’m definitely looking at the role, how to prevent contamination to make sure products are safe and that’s the quality control research side of research.
In the therapeutic side. I think there’s a lot of interest in the mental health and wellness effects of cannabis in conditions like autism and other behavioral disorders. We have a national campaign looking at cannabis as a treatment for chronic pain and potentially for opioid use disorders. I think that there’s excellent, promising research that some standardized preparations of cannabis, certain types of formulation, certain types of balance products could be a benefit in some conditions that really don’t have a good treatment right now.
Shane McCormick: I interviewed one individual that was addicted to opioids, and he used cannabis to wean himself off of opiates. I can see how that can work.
Dr. Jahan Marcu: They’ve actually done a study in New York at a university where they had people take oxycodone and smoke marijuana in a clinical setting to look to see if it made one thing worse than the other. They found that people were using [in the study] either the same or less of their prescribed pain medication. The finding was, it didn’t increase the abuse liability of the drugs. People were using more and more of it in the clinical setting. There was basically a less of a risk in some areas when the drugs were combined in a clinical setting, which was very, very, very promising.
Shane McCormick: I’m glad you said that because brings up my next question. How does cannabis interact with other medications?
Dr. Jahan Marcu: There’s a lot of medications, so it depends on which one you have, but I think what it comes down to is it depends on what route of administration. It depends what’s in the cannabis products. There are some statistics out there that say if you’re over 50, you’re on an average of six medications. If you’re taking those orally, that’s a lot of activity going on your liver and if you take a cannabinoid orally, just a regular one, not a specially formulated one. It will go into the liver, and so you’ll interact with those drugs and what we mean by interaction is two different things can happen.
One is you have a group of enzymes that are responsible for drug metabolism and drug transportation, and different drugs affect those. If you have two drugs, three drugs, that need the same group of enzymes, there’ll be some competition. The time to onset, the length of effect, those types of things can happen with drugs.
To give you a few examples. One is combining THC and Warfarin. This is a blood medication and levels will skyrocket in the blood if you take it with THC. There’s a couple of other medications that you’ve probably shouldn’t take CBD with orally. A lot of this is anecdotal, but I think as time goes on, we’re going to slowly realize that inhalation, topical delivery, delivery under the tongue – not swallowed, is going to be probably the safest routes to administer cannabis. It’ll bypass the liver and especially on people who are taking other medications.
We’re talking about pills. There are some general concerns. There are some other medications that cannabis can sort of seamlessly integrate with, for example, many years of chemotherapy studies are that cannabis doesn’t interfere with things like chemotherapy and these types of radiation treatments themselves. In some of the treatment it can be seamlessly integrated until applied, it looks like there are some concerns with taking handfuls of pills and how they interact with the liver. With cannabis we have the same concerns we have with any medicine you’re taking every day and in large amounts.
But still, it’s impossible to overdose from cannabis by itself. We have receptors all over our body except in the brain stem; there are very few there. That area of the brain controls breathing, and that’s where you have many opiate receptors. So a toxic legal overdose from cannabis has never been recorded. We still have some concerns about adverse events with combining a bunch of different substances in the liver. That’s another reason why people if they’re on many drugs and can wean themselves off and as you said, that can be good. There’s been research by Amanda Reiman, which has shown that people are substituting cannabis for other substances, even the most basic level and that could be good for some people.
Shane McCormick: Are there any adverse side effects of weaning yourself off of all those drugs and using cannabis to do so?
Dr. Jahan Marcu: You want to do that with the assistance of your doctor. You don’t want to stop taking medications because a lot of them have drawbacks and things like that. What has been learned from working in the HIV aids community, is that sometimes what’s observed is cannabis can help people either stick to their regimen or help them wean off drugs that have withdrawal or side effects. As well and allowing them to say, for example, opioids are a great example because this has been shown in some limited clinical studies people can get a lower amount of opiates and also get more pain relief. What’s been demonstrated in a study by Staci Gruber is that there are actually improvements in cognitive scores in brain functioning patients who are reducing the number of opioids and other prescription pain medication thereon when substituting cannabis. I think you need to be careful with what medication you take and communicate with your doctor, but I think there can be some enhancement of effects.
So for example, if you’re already taking a muscle relaxer, and you take THC, there might be some additive effects, and so you want to keep track. I would say always proceed with caution and start low, stay low is the general guidance from the literature when it comes this the sort of thing. It’s not a one size fits all. I think it’s a long-term game and I think it’s good to have a strategy with the help of your primary physician.
Shane McCormick: Now, a little while ago you mentioned cancer. Does cannabis show promise in fighting certain types of cancer and do you believe cannabis can potentially cure cancer or certain types of cancer?
Dr. Jahan Marcu: No, I think if it did, if it was the cure-all for cancer, I think a lot of people would still be alive today. Even my father tried, he never used cannabis in his whole life and also he tried oils, and he was battling prostate cancer, and I even studied it in the lab. For every success, there is in a petri dish much work has to be done to prove it works to prove still it actually works. If you’re a rat or a mouse and you have cancer, I think we can cure it with cannabinoids, but with humans, it’s a little more tricky. I think what has been shown using cannabis doesn’t increase the rate of cancer, which is good. There are mechanisms that you can observe that it helps to fight cancer in Petri dishes, but, if you look in the mirror, you can see some subtle differences between you and a petri dish.
I think where cannabis is, is in a complementary and alternative medicine approach and cannabis has been shown in animals to enhance the effects of certain anticancer agents in certain chemotherapy agents. I think that it’s just one more arrow in the quiver that you can use. For example, I’ll say, THC by itself is kind of lousy drug. If you take it orally, it takes hours to kick in, it’s unpredictable, but when you start combining it with other things, you can enhance the positive effects and inhibit some of the adverse effects.
I think that when it comes to fighting cancer, first of all, there isn’t an increase in the amount of cancer in people that inhaled cannabis, that has not been shown. Actually, the opposite has been revealed. However, from the basic point, my Ph.D. was in pharmacology. We published on combining THC and CBD in brain cancer and what people forget about that synergy study is it didn’t work in every cancer cell line. We looked at some very aggressive cancers we looked at where it was very effective in the petri dish, but there were some that it didn’t respond to, I think it’s worth using everything at your disposal, not just one thing. What’s also the tricky thing about using cannabis product is, how do you know it’s going to be the same from one treatment to the next or from one batch to the next and you really need consistency and standardization.
As far as the direct anticancer effect from using cannabis, that has not really been documented. There are positive wellness signs that help people fight cancer, which is improving appetite, improving quality of life, assisting people to stay with their medication regimen. In some cases making things like chemotherapy more tolerable as has been recorded, but it’s not to say that people aren’t developing cannabis cancer treatments.
I think that there’s a lot of promise in developing specialty standardized cannabis-based medicines for direct anticancer effects. However, I think we’re a ways away from having a cannabis product for this cancer or brain cancer or lung cancer or any type of cancer. There really isn’t enough information to know that but definitely, the basic research has shown a tremendous amount of promise, and it’s definitely been reproduced in animals and rats. That is very promising, but I think we still have a long way to go.
For example, if you have a brain tumor, what you would get through inhalation comes nowhere near the concentrations you would need in a petri dish to kill the cancer cells. The amounts we’re talking about that are used in basic research experiments can only be achieved through direct injection to the site of cancer. I think that it’s still part of the journey, but I still think there’s a lot of promise in the future.
Shane McCormick: In layman’s terms, what is the endocannabinoid system and how does it work?
Dr. Jahan Marcu: Good question. So the endocannabinoid system or ECS is a system that’s in our bodies. We have receptors that the active ingredients in cannabis interact with the reason we have those receptors is not that there are some plants out there, we evolved with this. In fact, some of the earliest mammals and multicellular organisms have cannabinoid receptors. It was one of the first to evolve. Cannabinoid receptors actually belong to the same family as Rhodopsin receptors, which were the receptors that are responsible for detecting light, so this is a very old system. It’s made up of many different classes of receptors and things that synthesize and break down our own natural THC like compounds.
So you might have heard of the endorphin system, right? The runner’s high.
It’s a very similar thing to the endocannabinoid system or the ECS, it’s more of a homeostatic regulator and helps to keep things in balance. However, I think the aptest description comes from Vincenzo Di Marzo. That is at the endocannabinoid system helps us to eat, sleep, relax, forget, and protect. So many of us are familiar with the appetite stimulant effects of THC well, that’s something that the endocannabinoids help do. They help you eat, help you to relax, they help you to sleep, help regulate sleep and relaxation. You can also put anti-inflammatory effects under theirs. One of the most important things they do is they actually help you forget and then forgetting is just as important as remembering. I’m in DC today if I remembered every face I saw from leaving my home in Brooklyn, to Washington DC, my head would explode.
You need a system that’s helping you say, “okay, this information is no longer useful, this information is harmful, forget this, forget this” this is also why I can focus on talking to you and not thinking about whether or not I fed my cat. When we start thinking about mental health conditions where people have traumatic events, if they’re not able to forget and we see this in animals that are bread without cannabinoid receptors or something that blocks their cannabinoid receptors, they have trouble forgetting stimuli that are associated with the negative event. When we think about people having flashbacks and PTSD, this is something that could be very important and could leverage for a lot of conditions. I think this is why people are interested in it for PTSD, is the extinction of adverse memories and those sort of learned behaviors.
The endocannabinoid system works to keep your cells alive, helps to reduce damage from inflammation and free radicals. It helps to regulate the lives of ourselves.
Shane McCormick: How does the endocannabinoid system help fight pain?
Dr. Jahan Marcu: There are many different types of pain. So inflammation can result in one type of pain. Now we’re not talking about post-surgery pain, chronic pain, pain related to cancer, pain related to arthritis. A lot of these chronic and inflammatory conditions seem to be mitigated with a cannabinoid-based action.
For example, our cannabinoid receptors are among the most abundant in mammals and in humans, and there are a lot of cannabinoids in our diet, they don’t cause intoxication, but they’re really found throughout nature. For example, aspirin, when you take aspirin, it is metabolized in the liver to this compound. Aspirin was approved and remains approved, and people don’t even know how it works entirely. There was no mechanism of action when aspirin was approved. However, what people have found out recently is that one of the things regarding what’s it’s doing with the body is the compound called AM404. What this compound does is it increases endocannabinoid signaling, and an aspirin mechanism has to deal with augmenting the endocannabinoid system and enhancing its anti-inflammatory activities which help reduce pain.
Shane McCormick: Is there anything a person can do to boost their endocannabinoid system?
Dr. Jahan Marcu: All the typical boring stuff, eat well, sleep well, take care of yourself. Our endocannabinoids are not recycled. You have to get certain things from your diet, like Omega three and Omega. High fructose corn syrup is not good for the endocannabinoid system. So definitely I think some dietary issues are essential. So I think eating healthy helps to fuel your endocannabinoid system, making sure you have all the parts it needs to make those molecules and proteins have a positive interaction with the cannabis medicine and making sure you’re taking care of and feeding the endocannabinoid system.
Shane McCormick: In a youtube video on a channel called cannabis saves lives. You mentioned cannabis researchers are molecular locksmiths. My question is, what’s the difference between type one and type two receptors?
Dr. Jahan Marcu: CB1 was discovered first, so it was designated CB1 and CB2 was this discovered second. The type one receptor is predominantly in brain and neuronal tissue. It’s probably the bodnant protein in the human brain, which is why it’s such a great therapeutic target.
The type two receptors are found on immune cells and in the periphery of the body. The type one receptor helps to regulate in the most basic sense, brain signaling. For example, if you stub your toe and you’re getting these signals that are coming up and down your body telling you about pain, cannabinoids hitting the type one receptor-like THC can slow down that transmission.
Similarly the type two receptor is generally found on immune cells and helps to figure out what causes inflammation. There’s a response, they release factors that cause the swelling and inflammation during injury, and the type two receptor can help control that. THC has both of those. CBD doesn’t stimulate either one of those receptors.
Shane McCormick: How do compounds interact with the receptors? Can it help fight disease?
Dr. Jahan Marcu: Yeah, I think so. It’s been shown in some long-term studies with multiple sclerosis and some types of infections. Receptors sit on the outside of cells helping them sense and react to their environment, and a lot of cells have specialized functions. Receptors have little pockets on them, much like a keyhole on a door and when the right drug floats around and goes into that lock it can turn a mechanism, and those receptors can do different things. When cannabinoid receptors find the right compound, it initiates a cascade of signaling events in the cell. It can affect a vast number of systems, and so it’s an amplification signal, goes out to the cell and cannabinoid receptors are stimulated.
Shane McCormick: Can or should cannabis be used as a neuroprotectant?
Dr. Jahan Marcu: Cannabis is a tricky word because it can mean THC rich in CBD rich material. It could mean many different things, but that can just definitely an area of promise, and certainly, I’ve heard anecdotal research that it does protect people. When I was in graduate school, people were looking at compounds like CBD and THC to reduce brain damage from strokes, so I think there is tremendous potential there. If I ever got a traumatic injury, I hope that there would be some cannabinoids around that could help reduce the damage from that.
Shane McCormick: I like asking this question to everybody that comes on the show, but especially people that are doctors and researchers like yourself, do you believe cannabis can lower healthcare costs?
Dr. Jahan Marcu: Yes and no. One it can definitely reduce opioid-related to fatalities. That’s a lower healthcare cost. There could be other things, but what increases the cost of healthcare is that insurance doesn’t cover cannabis in the United States. I think that adds to healthcare costs, Isaac Newton said you have to add up all those forces. So I think there are some things that cannabis does lower health costs for, but depending on where you live it may cost more in terms of it not being covered by insurance.
Shane McCormick: Well, not to push back, but yes, your right cannabis is not covered by insurance as of right now, but that’s not to say that it won’t be in the future.
Dr. Jahan Marcu: I think if insurance covered it there’d be no debate about lower healthcare costs.
Shane McCormick: As a home growing blog aka Cheap Home Grow do you support people growing their own cannabis?
Dr. Jahan Marcu: Americans For Safe Access has established a patients’ bill of rights, and we do believe that patients have a right to produce their own medicine. There’s even research out there that shows that this can be therapeutic and an improved quality of life for people who are battling things with terminal illnesses and severe conditions. As a patient advocate, I think it can be a tremendous resource for people. We’re not talking about someone managing a thousand plants were focusing on people that want to grow for their condition.
Shane McCormick: True, growing your own can be difficult. There can be a learning curve.
Dr. Jahan Marcu: Right. I have family members who live quite isolated, and they’re getting older, and I think if that was an option for them, I think that it would benefit them and I’m not saying it’s for everybody, but many countries allow patients to grow a few measly plants for themselves. I think the benefits go beyond just having your own medicine. This has been looked at from a mental health and wellness perspective, gardening, growing your own food, growing your medicine, your own other medicinal plants. These are all things that are associated with improved quality of life and people battling terminal or chronic illnesses.
Shane McCormick: What do you think is the future of cannabis research from a medical perspective?
Dr. Jahan Marcu: I think we’re going to see a lot more studies, a lot more focused studies on products. I think we’re going to see a lot more companies in the industry coming around and saying, “What’s our purpose?”, “Why are we doing this?” not just to make money. I think the future of cannabis is going to be purpose driven and more focused on patients. I honestly believe recreational adult use cannabis is going to get hit some roadblocks. I think of medical cannabis needs more support from the industry. That’s where the product safety studies are going to come from, that’s where the ability to match products to particular conditions is going to come from, I think that there’s going to be some international movement to regulate cannabis as medicine even beyond where it’s at right now.
Shane McCormick: You mentioned roadblocks. What type of barriers do you see down the road?
Dr. Jahan Marcu: Every year we have to vote on a budget amendment to keep the DEA from raiding and shut downing plantations. It’s still tough to expand and grow these businesses while they are federally illegal and it also makes it challenging to get investments and to use banking services. We all saw what happens when you get one attorney general who wants to shake things up. If the CARERS act passes, which would help to expand research and move CBD from the controlled substances list among other things I think it will continue to be difficult to regulate cannabis like any other product or medicine.
Shane McCormick: I was talking with another doctor a few weeks ago, and he mentioned big Pharma, and I’ve talked to many people in this space, and a lot of them have negative opinions about big Pharma, but I thought he brought up a good point. He said if big Pharma were to come into the cannabis industry, assuming they’re allowed to study the plant, their treatments, pills, know-how and whatever they can produce and put on the market would be a lot better than having your next door neighbor making CBD or Rick Rick Simpson oil. Is that something that you agree with? Do you think big Pharma will be a positive force or a negative force for the industry?
Dr. Jahan Marcu: Well, devil’s advocate here, with pharmaceutical companies, it’s always been a love-hate relationship, but pharmaceutical companies develop all the research tools. Pfizer, Sterling, Sanofi-Aventis, without the compounds that they’ve developed over the last 20, 30 years it would have been tough to do my thesis and study cannabinoid receptors. Also, almost all of our information about clinical studies come from pharmaceutical companies, GW Pharma, which has something like 30,000 patient years of data on using a cannabis extract we are in their debt for doing those studies and investing in those studies. It’s not like their product is a blockbuster drug used by everyone in the world, they spent much money to do that. That’s another reason I say don’t turn away medical cannabis.
Cannabis is a pharmacological treasure trove, many useful things on there were just discovering. I think the pharmaceutical industry is interested in knowing how to target the endocannabinoid system, whether it’s with cannabis or with another drug remains to be seen. There are in 30 countries licensed cannabis products on the market. Instead of thinking about it as pharmaceutical or not I think it’s more about redefining what medicine is, how we regulate medicine, mainly how we regulate plant-based medicine. I think it’s going to be a maturation of both the pharmaceutical industry evolving as well as the industry.
Shane McCormick: Do you want to make any final statements?
Dr. Jahan Marcu: I would say right now we need support for patients who want to use cannabis for chronic pain as an alternative to opiates. I encourage everyone to check endpainnotlives.org it’s the national medical cannabis opioid campaign, if you want to be a part of something that’s amazing, I would recommend this, and we have reports, information to get you started. We have a whole conference this week just dedicated to that topic. We need more people who want to advocate for cannabis as an option for chronic pain and related conditions. So please check out endpainnotlives.org and join us.