November 29, 2023 • 11 mins
Ready to unravel the complexities of cannabis and its myriad chemical compounds? Prepare to be enlightened as we invite family physician and researcher Dr. Erich Schramm to share his insights on the medicinal use of this fascinating plant. With years of experience under his belt, Dr. Schramm dives into the differences between cannabidiol (CBD) and tetrahydrocannabinoid (THC), as well as the intoxicating potential of Delta 8 and Delta 9 components. He also provides valuable context on how the 2014 Farm Bill influenced the rise of the CBD industry.
Dr. Schramm further explores the accessibility of Delta 8 over-the-counter and the reasons why certain products necessitate a medical marijuana solution. Touched upon, too, are the integral roles terpenes, terpenoids, and flavonoids play in the composition of the plant. This illuminating episode promises to expand your understanding of cannabis, with Dr. Schramm's wealth of knowledge giving you the facts and debunking the myths along the way. Tune in the following weeks as new episodes are released.
You will learn:
- Cannabis 101 Released November 27, 2023
- CBD vs. THC
- Delta-8 and Delta-9
- Terpenoids and Flavonoids
- Sativa, Indica and Hybrids
- Endocannabinoid System
- Cannabis Conversations Released December 6, 2023
- Common Conditions Treated
- Cast Studies
- Practicalities: Step by Step to Cannabis Released December 13, 2023
- How does a patient get certified
- Certification Process
- Driving and Traveling with Cannabis
- Health and Healing Benefits
- Rescheduling & Research of Cannabis Released December 20, 2023
- Schedule 1 vs 2 vs 3
- Financial Implications
- Research Implications
Recording Date: November 16, 2023
Be a part of advancing science by participating in clinical research.
Have a question for Dr. Koren? Email him at askDrKoren@MedEvidence.com
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Music: Storyblocks - Corporate Inspired
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Narrator (00:01):
Welcome to MedEvidence , where we help you navigate the
truth behind medical researchwith unbiased, evidence-proven
facts, powered by ENCOREResearch Group and hosted by
cardiologist and top medicalresearcher, Dr.
Michael Koren.
Dr. Michael Koren (00:16):
Hello, I'm Dr .
Michael Koren, and today Erichis joining me for our episode of
MedEvidence.
And I'm really excited Erichthis episode, Erich, for a
number of reasons.
Erich and I have known eachother for a long time and Erich
has worked with us here in theClinical Research Center and
he's been a family physician inour community for a number of
(00:37):
years and we've hadcross-referral of patients Me as
a cardiologist, you as thefamily physician so that's been
a fun relationship.
But Erich has gotten into theconcept of understanding the use
of cannabinoids or cannabisover the last several years and
he's now dedicated his practiceto help people by using this
mechanism of treatment.
So I'm really interested inlearning more from you and
(01:00):
really taking a deep dive intothis so you can educate me and
other members of the MedEvidencefamily about how to use
cannabis and what you've learnedand how we can share that
information to help people inthe community.
Dr. Erich Schramm (01:11):
Great, thank you.
Dr. Michael Koren (01:12):
And thank you so much for having me on, and
we've collaborated since 2003,since I joined Clinical Research
, so we've had a lot of greatopportunities to talk about
research and you're a fabulousresearcher, and actually that's
one of the reasons I'm reallyexcited about this conversation,
because the reputation forcannabis is that it's not always
evidence-based, and you'regoing to help us understand that
.
(01:33):
So let's jump in.
So let's start with the basicdefinitions for everybody we
hear about CBD, THC, explainwhat that is to people.
Dr. Erich Schramm (01:40):
Great.
So the cannabis plant.
It's a very complex plant andhas probably about 400 chemical
compounds, but the importantelements of the plant are ,
which is your THC, andcannabidiol, which is CBD.
Now, a lot of times people say,okay, which part of that plant
is the one that has thepotential for intoxication?
(02:01):
And I'll say, well, that's yourTHC component.
The plant naturally makes oneparticular type of THC, which is
Delta 9, but more recently nowit is being able to be produced
Delta 8.
So it's kind of a very similarmolecule, but those are the more
potentially psychoactivecompounds of it the CBD, the
(02:25):
cannabidiol, is not associatedwith any potential for
intoxication but has greatpotential benefits in terms of
anti-inflammatory effect.
Dr. Michael Koren (02:35):
So just to explain, the Delta 8 versus
Delta 9, this is not the NavySeals, but it's actually what we
call stereoisomers, and thatmeans that it's the same
molecule, but they can be mirrorimages of one another and I
guess it sounds like they havedifferent effects depending upon
which of the mirror images itis.
Dr. Erich Schramm (02:53):
Absolutely correct.
So it's just a very slightchange in the chemical
composition.
The reason that Delta 8 existsis because it can be
manufactured from CBD, and so itcan be, as you can acquire CBD
over the counter.
This is possible to acquireDelta 8 over the counter without
having to go through a medicalmarijuana solution.
Dr. Michael Koren (03:14):
So let's dig into that a little bit more so
explain what is available overthe counter versus what requires
a prescription in the state ofFlorida.
I know it's probably differentin different states.
Dr. Erich Schramm (03:23):
Well, fundamentally, if you look at
the potency of Delta 8, it'sabout half as potent as Delta 9
in terms of its potentialeffects in terms of intoxication
.
The reason that it exists andbecame about from CBD is because
at one point in 2014, we passedthe Farm Bill, which allowed
for the CBD industry to belaunched, and during that time
(03:47):
and over those many years, wehad a big glut of CBD on the
market, and so those CBDmanufacturers were looking for
products that they couldpotentially produce, and Delta 8
was one of those products.
So it evolved into that spacebecause it categorically is
derived from the hemp plant,which has, by design, much less
(04:11):
THC than a traditional medicalcannabis plant.
So that was the big divider inthe products.
Dr. Michael Koren (04:18):
Now, in this area we talk about terpenoids
and flavonoids, so tell us alittle bit what that means.
Dr. Erich Schramm (04:24):
Exactly so.
A big one, important part ofthe composition and the effect
of the plant relates to terpenes.
Terpenes are found in allplants it's the oils that give
it its scent and taste, and inmedical marijuana it's important
because the different terpenesare important in driving
(04:44):
different functions.
Different effects whether it'ssedation or whether it's
antidepressant effects orwhether it's an
anti-inflammatory effect canhave profound effect on things
like seizures, and so it has animportant part in guiding the
effects of the plant.
It isn't just that we havetraditionally what we thought of
(05:05):
as a sativa plant, which is alittle bit more of a considered
cannabis sativa, more activatingstrain versus, say, an indica
plant, which is historicallymore sedating and can be used
for relaxation.
So it's true that those planttypes can affect certain effects
, but at the end of the day,terpenes have a huge impact on
(05:29):
how patients experience thecannabis.
Dr. Michael Koren (05:32):
So it's almost like wine making you have
different types of grapes andthe effects at the end of the
day are somewhat similar, but alittle bit different.
Dr. Erich Schramm (05:40):
Exactly.
So here is an interesting one.
You can go online and exactlyyou can decide what particular
strains suits you, whether it'sa dessert strain, or whether you
know it's a gas strain, or theyhave all these different types
of strains for different typesof effects.
Dr. Michael Koren (05:57):
Does sativa go better with meat and go
better with fish or vegetables?
Yeah, I would.
That would be a great pair.
I would think that would be agreat pair.
Dr. Erich Schramm (06:05):
Yes, so yeah, but the flavonoids, t hey give
the color and they provide also,i t's very interesting because
they can have anti-inflammatoryeffects.
They tend to have anti-anxietyeffects, and the purpose of all
those compounds is basicallythey protect the plant against
insects and so it's theirself-defense mechanism.
Dr. Michael Koren (06:25):
All right, so let's talk about why it works,
why it affects our brains, andthis gets into some research
that you and I have worked on inthe past.
I remember a number of yearsago there was a product on the
market called Ramonobons.
Do you remember that?
Yeah, and so that was a productthat actually blocked a CBD
receptor, and we all know thatwhen you stimulate CBD receptors
(06:47):
, you stimulate your appetite,right, and the concept behind
this drug was to block thatreceptor and reduce your
appetite, right, and it did infact work to reduce appetite and
, as I recall, people actuallylost weight when they took
Rimonabant.
But it was actually taken offthe market in many jurisdictions
and I think probably alljurisdictions at this point,
(07:08):
because people became depressedwhen they took this drug.
So it gets into the conceptthat we have receptors that are
able to process the chemicalsignal from cannabis and cause
effects in our body.
Dr. Erich Schramm (07:24):
Right and I remember when I first joined in
clinical research Rimonabantwas, it was about the time that
it looked to have great promise.
Ultimately, that turned out tobe quite disappointing because a
number of people that hadconsidered suicide worsening
depression committed suicide andit really gave people a
newfound respect for what theCBD receptors are doing,
particularly in the brain yourCB1 receptor, and so it in fact
(07:49):
it was a THC variant, so it wasTHCV, and the question now is
and as a synthetic it had hadthat problem.
Now the question is well, ifyou get that from the naturally
derived plant, is it possiblethat this in the future could be
still looked at as a potentialtherapeutic product for weight
loss that doesn't have thesignificant effects of mind
(08:14):
altering or potentially, youknow, mood altering disturbances
, and that's hopefully they'llmight reconsider that as a
possibility.
Dr. Michael Koren (08:22):
Yeah, so explain CB1 versus CB2 receptors
for everybody, right.
Dr. Erich Schramm (08:26):
So CB1 receptor, the most important
place it's found is in yourbrain, and to have a THC have an
effect on that receptor, youknow it has to get through the
blood-brain barrier and so thatallows for, i f people are
saying, well, how, is that goingto, you know, affect in terms
of causing people to get high orintoxicated or what have you,
(08:47):
then that's the effect of THC ona CB1 receptor in your brain.
Now we have CB2 receptors toothat are found in the peripheral
nervous system.
We have CB2 receptors thatregulate a big part of our
immune system, which is, whichis hugely important, because
when people start looking at andsay, well, how does you know
CBD, you know how does it do somany different things
(09:09):
Anti-inflammatory can help yourmood, it can do anti-cancer
effects and you're going to say,because it's reflecting its
effect on different different CBreceptors that we have all over
our body.
So we have CB1 and two receptorsin the gut, and so there's
recently some development comingalong that looks like at a
product that may be affectingCB2 receptors in the gut to
(09:32):
decrease, you know, acid reflux,irritable bowel and you know, a
pharmaceutical company justrecently invested over $6
billion to get access to thatpotential product.
So, it's very interesting where,how these receptors show up,
understanding at what point thatyou know certain types of
products have the potential forintoxication.
(09:53):
I don't like to tell peoplethat they're going to get high.
People are like, hey, I talkabout the possibility, as a side
effect is intoxication, and sounderstanding where the
receptors are and the skin hasboth CB1 and CB2 receptors,
which makes the skin a greatpotential source as a
(10:13):
therapeutic source.
Dr. Michael Koren (10:14):
Yeah, and for our audience.
It's important for them tounderstand that if your body has
a receptor, it can respond tothat chemical signal.
So our bodies are programmed tobe able to respond to chemical
signals and they're receptorsfor a lot of different things.
You know, for adrenaline, foropioid analogs, and certainly we
now know that there are manyreceptors for cannabinoids.
Dr. Erich Schramm (10:37):
Right and we have our own natural.
We have two naturalendocannabinoids called
anandamide and 2AG, and Anandais Sanskrit for bliss, and so
they figured this out.
Dr. Michael Koren (10:48):
So, it's.
Dr. Erich Schramm (10:49):
We're hardwired for cannabis and to
understanding what the why do wehave an endocannabinoid system
in the first place?
And it's balanced right.
So this system evolved toprovide balance to your whole
body, whether it was thephysiologic stresses, illness,
infection, and so when you lookat the potential benefits for
(11:09):
cannabis, it spans a whole widevariety of disease states.
So that's that counts for thewidespread receptor system.
It's kind of the master, youknow I call it.
It's the like at the airport,it's the control tower.
It's running everything andregulating everything downstream
.
Dr. Michael Koren (11:27):
So, Erich, thank you for those wonderful
explanations.
I think I'm ready to passCannabis 101.
Dr. Erich Schramm (11:32):
Oh man, you are right on top of that, Mike.
I love it Okay.
Dr. Michael Koren (11:35):
I'm ready for the exam.
So let's take a quick break andthen we'll reconvene and talk
about this from a clinicalperspective who are the patients
and how do you approach them?
Narrator (11:44):
Thanks for joining the MedEvidence podcast.
To learn more, head over toMedEvidence.
com or subscribe to our podcaston your favorite podcast
platform.
Welcome to MedEvidence , where we help you navigate the
truth behind medical researchwith unbiased, evidence-proven
facts, powered by ENCOREResearch Group and hosted by
cardiologist and top medicalresearcher, Dr.
Michael Koren.
Dr. Michael Koren (00:16):
Hello, I'm Dr .
Michael Koren, and today Erichis joining me for our episode of
MedEvidence.
And I'm really excited Erichthis episode, Erich, for a
number of reasons.
Erich and I have known eachother for a long time and Erich
has worked with us here in theClinical Research Center and
he's been a family physician inour community for a number of
(00:37):
years and we've hadcross-referral of patients Me as
a cardiologist, you as thefamily physician so that's been
a fun relationship.
But Erich has gotten into theconcept of understanding the use
of cannabinoids or cannabisover the last several years and
he's now dedicated his practiceto help people by using this
mechanism of treatment.
So I'm really interested inlearning more from you and
(01:00):
really taking a deep dive intothis so you can educate me and
other members of the MedEvidencefamily about how to use
cannabis and what you've learnedand how we can share that
information to help people inthe community.
Dr. Erich Schramm (01:11):
Great, thank you.
Dr. Michael Koren (01:12):
And thank you so much for having me on, and
we've collaborated since 2003,since I joined Clinical Research
, so we've had a lot of greatopportunities to talk about
research and you're a fabulousresearcher, and actually that's
one of the reasons I'm reallyexcited about this conversation,
because the reputation forcannabis is that it's not always
evidence-based, and you'regoing to help us understand that
.
(01:33):
So let's jump in.
So let's start with the basicdefinitions for everybody we
hear about CBD, THC, explainwhat that is to people.
Dr. Erich Schramm (01:40):
Great.
So the cannabis plant.
It's a very complex plant andhas probably about 400 chemical
compounds, but the importantelements of the plant are ,
which is your THC, andcannabidiol, which is CBD.
Now, a lot of times people say,okay, which part of that plant
is the one that has thepotential for intoxication?
(02:01):
And I'll say, well, that's yourTHC component.
The plant naturally makes oneparticular type of THC, which is
Delta 9, but more recently nowit is being able to be produced
Delta 8.
So it's kind of a very similarmolecule, but those are the more
potentially psychoactivecompounds of it the CBD, the
(02:25):
cannabidiol, is not associatedwith any potential for
intoxication but has greatpotential benefits in terms of
anti-inflammatory effect.
Dr. Michael Koren (02:35):
So just to explain, the Delta 8 versus
Delta 9, this is not the NavySeals, but it's actually what we
call stereoisomers, and thatmeans that it's the same
molecule, but they can be mirrorimages of one another and I
guess it sounds like they havedifferent effects depending upon
which of the mirror images itis.
Dr. Erich Schramm (02:53):
Absolutely correct.
So it's just a very slightchange in the chemical
composition.
The reason that Delta 8 existsis because it can be
manufactured from CBD, and so itcan be, as you can acquire CBD
over the counter.
This is possible to acquireDelta 8 over the counter without
having to go through a medicalmarijuana solution.
Dr. Michael Koren (03:14):
So let's dig into that a little bit more so
explain what is available overthe counter versus what requires
a prescription in the state ofFlorida.
I know it's probably differentin different states.
Dr. Erich Schramm (03:23):
Well, fundamentally, if you look at
the potency of Delta 8, it'sabout half as potent as Delta 9
in terms of its potentialeffects in terms of intoxication
.
The reason that it exists andbecame about from CBD is because
at one point in 2014, we passedthe Farm Bill, which allowed
for the CBD industry to belaunched, and during that time
(03:47):
and over those many years, wehad a big glut of CBD on the
market, and so those CBDmanufacturers were looking for
products that they couldpotentially produce, and Delta 8
was one of those products.
So it evolved into that spacebecause it categorically is
derived from the hemp plant,which has, by design, much less
(04:11):
THC than a traditional medicalcannabis plant.
So that was the big divider inthe products.
Dr. Michael Koren (04:18):
Now, in this area we talk about terpenoids
and flavonoids, so tell us alittle bit what that means.
Dr. Erich Schramm (04:24):
Exactly so.
A big one, important part ofthe composition and the effect
of the plant relates to terpenes.
Terpenes are found in allplants it's the oils that give
it its scent and taste, and inmedical marijuana it's important
because the different terpenesare important in driving
(04:44):
different functions.
Different effects whether it'ssedation or whether it's
antidepressant effects orwhether it's an
anti-inflammatory effect canhave profound effect on things
like seizures, and so it has animportant part in guiding the
effects of the plant.
It isn't just that we havetraditionally what we thought of
(05:05):
as a sativa plant, which is alittle bit more of a considered
cannabis sativa, more activatingstrain versus, say, an indica
plant, which is historicallymore sedating and can be used
for relaxation.
So it's true that those planttypes can affect certain effects
, but at the end of the day,terpenes have a huge impact on
(05:29):
how patients experience thecannabis.
Dr. Michael Koren (05:32):
So it's almost like wine making you have
different types of grapes andthe effects at the end of the
day are somewhat similar, but alittle bit different.
Dr. Erich Schramm (05:40):
Exactly.
So here is an interesting one.
You can go online and exactlyyou can decide what particular
strains suits you, whether it'sa dessert strain, or whether you
know it's a gas strain, or theyhave all these different types
of strains for different typesof effects.
Dr. Michael Koren (05:57):
Does sativa go better with meat and go
better with fish or vegetables?
Yeah, I would.
That would be a great pair.
I would think that would be agreat pair.
Dr. Erich Schramm (06:05):
Yes, so yeah, but the flavonoids, t hey give
the color and they provide also,i t's very interesting because
they can have anti-inflammatoryeffects.
They tend to have anti-anxietyeffects, and the purpose of all
those compounds is basicallythey protect the plant against
insects and so it's theirself-defense mechanism.
Dr. Michael Koren (06:25):
All right, so let's talk about why it works,
why it affects our brains, andthis gets into some research
that you and I have worked on inthe past.
I remember a number of yearsago there was a product on the
market called Ramonobons.
Do you remember that?
Yeah, and so that was a productthat actually blocked a CBD
receptor, and we all know thatwhen you stimulate CBD receptors
(06:47):
, you stimulate your appetite,right, and the concept behind
this drug was to block thatreceptor and reduce your
appetite, right, and it did infact work to reduce appetite and
, as I recall, people actuallylost weight when they took
Rimonabant.
But it was actually taken offthe market in many jurisdictions
and I think probably alljurisdictions at this point,
(07:08):
because people became depressedwhen they took this drug.
So it gets into the conceptthat we have receptors that are
able to process the chemicalsignal from cannabis and cause
effects in our body.
Dr. Erich Schramm (07:24):
Right and I remember when I first joined in
clinical research Rimonabantwas, it was about the time that
it looked to have great promise.
Ultimately, that turned out tobe quite disappointing because a
number of people that hadconsidered suicide worsening
depression committed suicide andit really gave people a
newfound respect for what theCBD receptors are doing,
particularly in the brain yourCB1 receptor, and so it in fact
(07:49):
it was a THC variant, so it wasTHCV, and the question now is
and as a synthetic it had hadthat problem.
Now the question is well, ifyou get that from the naturally
derived plant, is it possiblethat this in the future could be
still looked at as a potentialtherapeutic product for weight
loss that doesn't have thesignificant effects of mind
(08:14):
altering or potentially, youknow, mood altering disturbances
, and that's hopefully they'llmight reconsider that as a
possibility.
Dr. Michael Koren (08:22):
Yeah, so explain CB1 versus CB2 receptors
for everybody, right.
Dr. Erich Schramm (08:26):
So CB1 receptor, the most important
place it's found is in yourbrain, and to have a THC have an
effect on that receptor, youknow it has to get through the
blood-brain barrier and so thatallows for, i f people are
saying, well, how, is that goingto, you know, affect in terms
of causing people to get high orintoxicated or what have you,
(08:47):
then that's the effect of THC ona CB1 receptor in your brain.
Now we have CB2 receptors toothat are found in the peripheral
nervous system.
We have CB2 receptors thatregulate a big part of our
immune system, which is, whichis hugely important, because
when people start looking at andsay, well, how does you know
CBD, you know how does it do somany different things
(09:09):
Anti-inflammatory can help yourmood, it can do anti-cancer
effects and you're going to say,because it's reflecting its
effect on different different CBreceptors that we have all over
our body.
So we have CB1 and two receptorsin the gut, and so there's
recently some development comingalong that looks like at a
product that may be affectingCB2 receptors in the gut to
(09:32):
decrease, you know, acid reflux,irritable bowel and you know, a
pharmaceutical company justrecently invested over $6
billion to get access to thatpotential product.
So, it's very interesting where,how these receptors show up,
understanding at what point thatyou know certain types of
products have the potential forintoxication.
(09:53):
I don't like to tell peoplethat they're going to get high.
People are like, hey, I talkabout the possibility, as a side
effect is intoxication, and sounderstanding where the
receptors are and the skin hasboth CB1 and CB2 receptors,
which makes the skin a greatpotential source as a
(10:13):
therapeutic source.
Dr. Michael Koren (10:14):
Yeah, and for our audience.
It's important for them tounderstand that if your body has
a receptor, it can respond tothat chemical signal.
So our bodies are programmed tobe able to respond to chemical
signals and they're receptorsfor a lot of different things.
You know, for adrenaline, foropioid analogs, and certainly we
now know that there are manyreceptors for cannabinoids.
Dr. Erich Schramm (10:37):
Right and we have our own natural.
We have two naturalendocannabinoids called
anandamide and 2AG, and Anandais Sanskrit for bliss, and so
they figured this out.
Dr. Michael Koren (10:48):
So, it's.
Dr. Erich Schramm (10:49):
We're hardwired for cannabis and to
understanding what the why do wehave an endocannabinoid system
in the first place?
And it's balanced right.
So this system evolved toprovide balance to your whole
body, whether it was thephysiologic stresses, illness,
infection, and so when you lookat the potential benefits for
(11:09):
cannabis, it spans a whole widevariety of disease states.
So that's that counts for thewidespread receptor system.
It's kind of the master, youknow I call it.
It's the like at the airport,it's the control tower.
It's running everything andregulating everything downstream
.
Dr. Michael Koren (11:27):
So, Erich, thank you for those wonderful
explanations.
I think I'm ready to passCannabis 101.
Dr. Erich Schramm (11:32):
Oh man, you are right on top of that, Mike.
I love it Okay.
Dr. Michael Koren (11:35):
I'm ready for the exam.
So let's take a quick break andthen we'll reconvene and talk
about this from a clinicalperspective who are the patients
and how do you approach them?
Narrator (11:44):
Thanks for joining the MedEvidence podcast.
To learn more, head over toMedEvidence.
com or subscribe to our podcaston your favorite podcast
platform.
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