Group 5 Dr. Hashemiyoon is a member of the American College of Phlebology (disease of the veins), American Academy of Anti-Aging Medicine and the American College of Aesthetic/Cosmetic Surgeons. He developed a new antiviral agent for treating DNA diseases, in particular for the Human Papilloma Virus (HPV), created specific protocols for Andropause/male menopause (low testosterone), was the first doctor to use finasteride for the treatment of androgenetic alopecia (male-pattern baldness) before Propecia got FDA approved, and helped to develop a tertiary care center at George Washington University Hospital to treat the worst cases of respiratory benign tumors medically rather than surgically. We’re all about non-invasive treatments wherever possible here at Leafwell, so Dr. Hashemiyoon in in good company in this regard. Knowing that medical marijuana and the endocannabinoid system (ECS) might be one of the keys towards developing less invasive forms of medical health care. When did you first start thinking of cannabis as medicine? Well, I became familiar with the use of cannabis as medication probably over 10-15 years ago, because I remember in the mid-90s when studies came out showing that it was very effective – and actually even more effective than some of the prescriptions medicine that we had – for helping cancer and chemotherapy patients for nausea and vomiting. So that was when it first came to my attention that cannabis could have medicinal benefits. But, other than reading that study in a medical journal article, I didn’t really pay much attention and still actually had a pretty much overall, general, neutral-to-slightly-negative attitude towards cannabis. I thought that it maybe has a very small role [in therapeutic usage and the human body], and that’s about it. It wasn’t until 2010, when medical marijuana had become so popular here in California and throughout the country that I actually took the time to sit down and personally research medical marijuana. I became curious because multiple states had started to approve it for medicinal use. And when I did that research in 2010, that’s when I began to really understand and appreciate all the various medical applications that cannabis had. In addition, I began to understand the relatively safe side effect profile that it had. In other words, the risk-benefit ratio, which is what we refer to in medicine, “i.e. How much benefit is there compared to risk taken?” Cannabis is actually really pretty high on that scale, and I didn’t know any of this until I did that research in 2010. Would you say that there has been a significant change in attitude towards cannabis in medicine? Well, there definitely has been a very significant change amongst medical doctors in the United States in their attitudes towards medical marijuana. I don’t think it’s 100%, but it’s pretty significant. I would say more than 50% of the doctors in this country recognize that medical marijuana has some very good potential and therapeutic uses and benefits, with a very, very good side-effect and safety profile. Interestingly, I literally followed the same arc that Dr. Sanjay Gupta did. You know, where years ago, from early childhood until my early-to-mid 30s, I always thought of marijuana as being “An illegal drug that’s bad for you, and it’s something only ‘bad’ people do.” Now, I’ve done a 180° turn … I really am so appalled that marijuana was ever made illegal in the first place with no real scientific or medical reason at all! There was really no basis for that [making cannabis illegal] whatsoever. It was very a political and economical move; and if you actually look at it objectively, there is an incredible risk:benefit ratio for medical marijuana compared to a lot of other over-the-counter and prescription medicines that we use. So, for me, it was a whole 180 in terms of my attitude towards it. Is cannabis one of the new “cutting-edge” or “frontier” medications? Well, that depends on how you look at it! You could say it’s a “rediscovered” cutting-edge medicine, because it’s been around for 5,000-plus years. So, mankind’s been using it for thousands and thousands of years, both recreationally and medicinally, with no problems or issues. Suddenly, in the 1930s, this whole sort of propaganda-based project was undertaken to make it illegal and remove access for public use. And it’s taken 90 years for the educated grassroots to sort of come back to realize and ask, “Why is this illegal? It has lots of potential benefits, medicinally-speaking.” So, yeah, I would say it’s new, cutting-edge medicine, but it’s really “rediscovered” cutting-edge medicine, because we knew about it from thousands of years ago. For whatever reason, it fell out-of-favor, and now it’s making a comeback. And most things that are genuine, do! You can’t keep the truth hidden or suppressed forever. The truth will come out, and it has, and it’s starting to spread. Cannabis tincture oil from early 1900s. Could you tell us more about your work at American Medical Evaluation Center (AMEC) and any research you’ve done there? Well, I don’t really work at the AMEC. I’m the Founder. Basically I created it as a venue for doctors and patients to have access to each other. There are several doctors that work there who see the patients, and have been evaluating patients for the last 5-6 years for various ailments. It’s just your regular medical office that’s established and compliant under California state statutes. The doctors perform a proper physical exam and history on a patient, and evaluate whether they have an ailment that could possibly benefit from the use of medical marijuana. Have you noticed any particular strain or cannabinoid and terpenoid profiles that are useful for specific conditions? Well, there’s a general contextualization that the sativa strains tend to be more adrenergic, meaning that they give you a more “upbeat” type of benefit or effect. The indica strains tend to have a more suppressive or sedative type of effect. So it depends on, I guess, what kind of particular ailment you have. And now there are all these specialized hybrids out there. Honestly, because there’s been so little research – mostly because the government has suppressed major efforts at research and study of this herb – doctors are not the greatest resource of understanding what cannabis strains works best for which disease. Believe it or not, it’s the people who grow marijuana and use it who know these things best, mostly through trial-and-error and exchange of information. Yes, I’ve sort of seen that as well … … It’s more of an anecdotal route of research…I mean, there have been some published researched that is good work, but compared to other prescription drugs, there is not as much information. Again, because it’s (research) been mostly suppressed by the government. Yes, I suppose those who have been growing it have been doing so in a sort of “open source” manner … Right, that’s essentially what it’s been. That kind of trial-and-error and information exchange by people that have been using it is useful. It was mostly clandestine and only more recently, in the last 5-10-15 years, become overtly known. Because the numbers are so high the information is fairly reliable. In other words, we know “sativa” is more of an “upper” and indica is more of a “downer”. So if you have insomnia or anxiety, an indica might work better for you. But of course, that all depend on the individual patient’s body chemistry as well. We’ve been reading a lot of Dr. Russo’s work, and he feels that the separation between “indica” and “sativa” is quite arbitrary, possibly due to the hybridization over the years … Yeah, there’s been a lot of hybridization now, so yes, those lines have been blurred. But not necessarily extensively. It’s not an absolute. So what advice would you give to those thinking of trying medical cannabis for the first time? Well, first I would say, “Make sure you are absolutely legal and compliant with state laws.” On the federal level, there is no legal. Shamefully, it doesn’t matter if you’re going to die in a week, you can’t use it. You know, “Too bad for you.” For the average patient I would advise to try to be as compliant as you can be to individual state laws – that’s the first thing I would advise. Then the next thing would be to start with a very conservative amount, especially with edibles. The same with inhalation or even salves and topicals. Start with small amounts, and see how it works and then build up from there. The reason for this is because there is not enough data and not enough sort of stringent, consistent dosing methods out there to know that every single time what you get is exactly what it is, so you want to be careful. I also recommend not to smoke it, because anything smoked – it doesn’t matter what it is, whether lemongrass, tobacco or marijuana – is bad for the lungs. Always better to use vaporizers. Fewer potential pulmonary problems, like COPD (Chronic Obstructive Pulmonary Disease) and cancer. You mentioned topicals. Could you tell us more about their potential uses? Topicals have become very popular right now. Again, self-reporting back from patients has been generally positive, in that topical ointments seem to work very well for various skin conditions, for chronic joint and muscle inflammation and pain, and with fewer mental status side-effects. You know, that “high” feeling. So less of that. It’s become much more popular amongst patients, these salves and creams. One of our past interviewees, Bo Money, used a topical to help clear her friend’s MRSA infection … … Like I said, there’s a lot of this stuff out there, you just have to be very careful and conservative with jumping the gun. You want to do your due diligence and always start very conservatively. See if something works for you, then ramp it up from there as necessary. Where do you see medical marijuana in 5-10 years’ time, or even next year? There’s no question in my opinion that eventually it’ll be completely legal, probably worldwide. It’ll certainly become legal in the United States, definitely. I mean look, once you have, let’s say 45 out of 50 states in which it’s legal, it doesn’t make sense for it to be illegal on the federal level. That would be ridiculous. Plus, many changes are economically-driven, and there’s a lot of money to be made in the use of cannabis, whether it’s recreational or medicinal. And those economic pressures will finally bear out, and it will finally in my opinion become completely legal in the United States. I beleive it will be the next “gold rush” or “internet boom.” From there, it’ll sort of be like dropping a stone in a pond with the ripples sort of spreading out and go on to other countries. I know Canada and Germany are already considering making marijuana legal. South American countries are considering making it legal. It’s just a matter of time. Are there any other medications or activities you could use to combine with cannabis for greater therapeutic effect? Say for example music & art therapy, meditation and so on? Difficult to say. Music and art therapy is certainly safe and you could try that. I’m very, very hesitant to mix medical marijuana with other medications, because it does have an effect on the central nervous system (CNS). There’s always a potential with cross-reaction with other medications and you can tip that risk-benefit ratio into a worse ratio where the risk now outweighs the benefits. Art therapy with a veteran. I guess that’s the same with any medicine, then? Yeah, as with other medications, you want to be careful of mixing them. One of the problems with medical marijuana being mixed with other medications is that there’s not enough data out there. We just don’t know. Hopefully, as it becomes more-and-more legal and as more-and-more studies are done, like anything else, our knowledge base will expand and we’ll be able to use it more effectively by itself or in conjunction with other medications. Is cannabis a potential anti-aging medicine? You know, there is some evidence that sort of points in that direction. Certainly, we know that cannabis has anti-tumor properties. One of the things that kills you as you get older is cancer. So, if it helps to prevent you from getting some cancers, and you don’t get it, you’re obviously going to live longer. There’s your anti-aging right there. So there is definitely some evidence that points to the fact that it may have some anti-aging properties in the sense that it would prevent certain diseases of aging from developing or progressing. If you don’t die from those diseases, you’re going to live longer…. and healthier! Could cannabis be seen as a preventative medication, then? Again, that’s a very difficult question to answer, because there’s not enough research done with proper double-blind, controlled, prospective studies that indicate one way or another. I think the answers to these questions are probably not going to be answered for the next 50 years. Once marijuana becomes legal on the federal level, or at least off schedule I … Once it becomes more accessible to the general public and researchers in the lab, then you’ll start getting all these different studies and this body of work will start to emerge that will help delineate the answers to a lot of these questions. But let’s say marijuana becomes schedule II, or at least more available to these researchers within the next 10 years. Next we’ll have to start doing all these research studies, which will take another 10-15 years for the initial studies to be done and analyzed. And then of course, more and more studies will be done. So we’re not going to know the answers to these questions for probably about 20-25 years minimum, up to 50+ years from now. Are there any instances in the past when you thought, “I wish I could have recommended cannabis instead?” Well, ever since I started finding out about its therapeutic properties, there have been many instances where I’ve thought that “Medical marijuana would be useful for a patient.” And usually I tell them that! You know, I do say, “You’re in California. You realize that you have the alternative of using medical marijuana and fewer of these prescription medications.” Sometimes the patients are in favor of that, sometimes they’re not. If they are in favor, I usually tell them that they need to be evaluated either by their own doctor or a medical marijuana physician or specialist to determine that medical marijuana can, in fact, help them. Then they can use it along legal pathways, if they decide that’s something they would opt for. Cannabis fractal art by 7th Dwarf. https://pixabay.com/en/fractal-chaos-marijuana-cannabis-1224923/ Finally, what makes the cannabis plant so special to you? For me, it’s the fact that, again, its risk:benefit ratio seems to be so high. There are so many potential benefits that it has, with essentially very, very little risk across the board. It’s not zero, but it’s better than some of the prescription medications out there. I’ve just finished my Suboxone CME (Continuing Medical Education) course – I actually scored 100% on the test – the specialty field is for doctors who want to understand addiction and addiction treatment. One of the things that I was surprised to discover in that course is that, currently, there are more Americans addicted to prescription opioids than heroin and cocaine combined. Yes, as a country we have more people addicted to Vicodin, Percocet, Percodan and others than “illegal drugs.” Now, who got these people addicted? We got them addicted. Doctors got them addicted. Because, a decade or two ago, pharmaceutical companies solicited doctors and purported that these opioids were being underutilized, that patients were suffering with pain, and that patients needed to get these pain meds. So then doctors went to pain management courses (some mandatory by state law) and got all sorts of reports from research studies done by the pharmaceutical companies and various governmental agencies that indicated the doctors were not treating pain sufficiently. Well, that’s not good for a doctor to hear because we, as doctors, are supposed to allay patient suffering. So doctors began prescribing a more considerable amount of pain medicines. Fast forward 20 years later, and now we’re finding out that, “Oh my God! These things are more addictive than practically anything else under the sun, and we’ve created a generation of people that are absolutely addicted to these medicines.” And these are not the stereotypical people that you’d think of as “drug addicts”. These are, you know, regular people going to regular jobs. These are businessmen, and housewives, and retail workers, and doctors and lawyers, and nurses and teachers and police officers and sports stars and accountants and celebrities, and so on. Regular people, who don’t want to take this medicine anymore. They aren’t necessarily in pain, but they can’t stop; because the minute they stop, they begin to feel so horrible physically with stomach cramps and the flu like symptoms, and shaking…. [withdrawal symptoms],. It’s like the worst flu they’ve ever had. And so they have to keep taking the medication just so they can function and keep going to work and supporting their families. So they’re physically addicted and can’t stop. Now they have to go and see a detox doctor, to figure how they can try to get clear their addiction to these prescription medications. Patients who stop using marijuana don’t have this problem. There’s no real hard evidence of any physical addiction to marijuana, certainly not to that extent. For another perspective consider this: there’s never been a recorded case of a single death attributable to the use of cannabis alone. Now, you mix it with alcohol, with Valium or other drugs, then yes the combination can be lethal. But if you use just cannabis by itself, there’s never been a recorded case of death attributable to its use by itself. Every year, there are over 800 deaths recorded from the overuse of Tylenol (paracetamol, acetaminophen), which any 6 year-old can walk into a store and buy. How does that make sense? For me, the fascinating thing about cannabis is its risk-benefit ratio, which indicates that if it’s used properly is very, very good. You have a high chance of obtaining the benefit, with a very low chance of having a nefarious side-effect that could actually harm you. What more can you ask for than that? A drug’s benefit comes from how well it binds to receptors throughout the body. Cannabinoids bind to receptors throughout the body to a degree any big pharmaceutical company would drool over. Cannabis is extremely well-binding to the various receptors in the body for things like nausea, migraine headaches, insomnia, etc.. So it clearly works well for several various indications.