High Hopesby Natalie Jacobs April 3, 2017
Jeffrey Spivak had been having seizures for three years when Sanjay Gupta’s CNN special “Weed” came out. The documentary introduced Jeffrey, now 68, and his wife Deborah to a girl named Charlotte who has a debilitating seizure disorder called Dravet. By the time Charlotte was 5 she was having up to 300 seizures a week. Her parents heard that the non-psychoactive strain in marijuana, called cannabidiol (CBD), may help control her seizures. After using a tincture, or oil, with a drop under the tongue, Charlotte went from having 300 seizures a week to one. In the documentary, the Spivaks saw hope for Jeffrey, who developed epilepsy as a result of a cavernous hemangioma, or a malformed blood vessel in his brain in 2010.
“We saw that and we were like wow, if that’s going to help her, I want some of that,” says Deborah over the phone one afternoon.
Medical marijuana has been legal in California since 1996, but research and business development have gone through waves of progress and stagnation as federal administrations have alternately cracked down and eased up on enforcing the fact that marijuana is a schedule one narcotic. There are some physicians who will discuss marijuana as a treatment option for patients, but in Deborah and Jeffrey’s experience in San Diego, none of their doctors were talking about it. All the while, Jeffrey’s pharmaceuticals were not stopping the seizures and were in fact creating painful side effects.
Eventually, the Spivaks found one dispensary in California that carried CBD oil, Harborside in Oakland.
“We bought a ticket and we flew up to the Bay Area,” Deborah recalls. “We got a medical marijuana card for Jeffrey and we just went.”
Armed with sparse dosage instructions from the dispensary, the Spivaks arrived home in San Diego and gave the CBD oil a try. With a couple drops under the tongue twice a day, Jeffrey was seizure-free for five months. They traveled back to Oakland once during that time to get more CBD oil, and excitedly talked about moving there soon if it continued to work.
“But it stopped working,” Deborah says. “And then we were frustrated because no one could tell us what the next step was.”
They belonged to an epilepsy support group where other members were also experimenting with CBD. Some suggested they add small amounts of THC (the psychoactive component in marijuana) into the dosing regimen.
“Everyone has a different take on what they were doing and if it was working or not working,” Deborah says. “For a lot of people it was cost prohibitive because insurance doesn’t cover it. It’s a big jumble.”
A quick search of the Harborside website in early March found 17 different kinds of CBD tinctures ranging from $300 for a 2-ounce bottle to $35 for a half-ounce bottle. Some offer dosage information and organic certification, others just note the name of the brand and the CBD to THC ratio.
“When you go to a dispensary and you say I have back pain,” Deborah offers as an example, “they give you 10 different choices of strains of marijuana and it has a certain percentage of indica and a certain percentage of sativa. That’s all they tell you. You have to then purchase all these different kinds and then go home and experiment. Then you also can experiment with how you take it – should you smoke it in a cigarette like a joint, should you use a vaporizer, should you make a compound butter, should you bake it in a brownie, should you drink it, what time of the day? It’s all these factors. It’s expensive and time consuming.”
All for a big maybe, she says.
Jeffrey stopped using the CBD tincture after five months and three different renewals. In 2014, he had brain surgery to remove the hemangioma. Now, he uses marijuana (edibles) to control the side effects of the medications – pain, nausea, headaches. But the seizures persist.
Jeffrey’s experience with marijuana is not that different from his and many people’s experience with pharmaceuticals. For everything from bipolar disorder to cancer, it’s rare that a patient gets a perfect medication and dosage on the first prescription. Sick people and doctors spend years perfecting drug regimens. And still, pharmaceuticals stop working or create harmful side effects that eventually create difficult either/or scenarios for patients. Even so, for many people, there’s a lot riding on the potential of marijuana in medical applications.
Israel is a noted leader in marijuana research, but here in the United States, doctors are reluctant to suggest marijuana to patients because there is little domestic scientific research to show its efficacy and in what instances. Because of its narcotic classification, research is tightly regulated and funding is scarce. Under the control of the National Institute on Drug Abuse in coordination with the FDA and DEA, there is only one entity allowed to provide marijuana for research in the entire country, that’s the University of Mississippi.
Under those constraints, the Center for Medicinal Cannabis Research (CMCR) at UC San Diego was opened with state funding in 1999 to research pharmaceutical applications for marijuana shortly after medical usage became legal in the state. Similarly, the November 2016 passage of Proposition 64 will allow for additional funding to CMCR through the taxation of medical and recreational pot in the state.
Dr. Joseph Hamp Atkinson is a clinical psychiatrist and co-founding researcher at the Center. He says investigators there are currently exploring “drugged driving” to “assess what are the effects of acute intoxication with marijuana on driving abilities.”
“It turns out,” he says, “cannabis’s time course in the body is much more complicated than alcohol. So it’s not as straightforward as setting a limit of so many nanograms per milliliter of blood, or some concentration in the breath. Those data simply aren’t there. [And] it’s not so straight forward as some of the states [where medical and recreational pot is legal] have said.”
The legalization of recreational marijuana in California has created increased need for this kind of research to identify legal limits, but in the past CMCR has also conducted investigations on the efficacy of cannabis in treating diseases. Such studies, published or submitted for publication, include cannabis for treatment of HIV-related peripheral neuropathy, short-term side effects of cannabis therapy on spasticity in MS, analgesic efficacy of smoked cannabis, and on general neuropathic pain.
Studies conducted by other research institutes have supported the seizure-reducing qualities of cannabidiol, but only on specific epilepsies Lennox-Gastaut syndrome and Dravet syndrome.
The difference between marijuana strains is found in the THC potency. Dr. Atkinson notes that CMCR’s research typically uses potencies of 2-8 percent THC per marijuana cigarette (those that come from the University of Mississippi), compared to 12-14 percent THC in street pot (tested from marijuana seized by law enforcement).
“We compare the pain-taming affects of each potency [in the 2-8 percent range] and in general, the lower potencies did just as well as the higher potency and had fewer side effects,” says Dr. Atkinson. “There was even some suggestion that higher potency cannabis was associated with more, rather than less pain.”
In order for marijuana to truly penetrate the pharmaceutical market, chemists need to be able to derive a “pure product” from the plant, Atkinson explains.
“There are dozens of cannabinoids in the overall cannabis plant. There are literally hundreds of other chemical constituents.”
As cannabis becomes more legal in more states, growers are creating new hybrids, like the brothers who created the virtually CBD-only plant now called “Charlotte’s Web” after the little girl who saw such remarkable seizure reduction from consuming its tincture.
I happened to speak with a local cannabis lawyer, Jessica McElfresh, on a day when White House Press Secretary Sean Spicer made headlines by suggesting that the Trump administration may direct the Justice Department to go after states that have legalized marijuana.
“They might do a lot of things,” McElfresh says frankly. “He also [previously] made a statement that they weren’t going to do anything.”
The fact is, she says, we don’t know.
“I do think we’ve reached a point where over half the states in this country have a medical marijuana program. We have eight states where people have voted to pass adult use or recreational cannabis. And over 40 states have voted that they think CBD should be available in some form. So they’d basically be taking on a lot of people.”
Over the past two decades, California’s stance has effectively been to simply not enforce some criminal laws on pot at the state level. That has left marijuana businesses subject to federal raids, like those that happened under the Obama administration in 2011-2012. But, McElfresh says many people have been and will continue to be willing to take on those risks, for a piece of what some analysts are predicting will be a $2.6 billion market by 2020. Under the new California laws, which are now operating under a tax-and-regulate model instead of a turn-the-other-cheek model, the state, law enforcement and select research institutes each stand to consume pieces of that pot pie as well.
It’s all of these converging interests and rapidly changing laws that got the local Hadassah group interested in hosting a forum about marijuana.
“It’s not something, I have to be honest, that I know very much about,” says Lori Good, a pediatric dentist and president of Hadassah San Diego’s Yachad group, the sub-committee for women in their 40s and 50s. “I was looking for something that would inform me about what’s going on.”
Deborah Spivak, Dr. Atkinson and attorney Jessica McElfresh will speak about their various involvements with marijuana at the Hadassah event “Post-Passover Pizza and Pot” taking place on April 20. Unbeknownst to the organizers, that date, 4/20, is something of a national holiday for pot enthusiasts. Organizers are careful to note that no marijuana will be served at the event, but don’t be surprised if you smell some skunk elsewhere throughout the day.
“Post-Passover Pizza and Pot,” at Congregation Beth Israel is open to men and women and the community at large. For more information and to register, call Deena Feinman at (858) 268-3200.