. . . about her Illuminating book The Medical Marijuana Guide: Cannabis and Your Health
by Karen Larré, Dave Weaver and Carla Garcia
As a physician who focuses on cannabis and cannabinoid medicine and the role it plays in homeostasis and the management of pain and chronic disease, Dr. Frye evaluates and manages patients who are considering the use of medicinal cannabis as a primary or adjunct therapy for illnesses such as chronic pain syndromes, neurodegenerative disorders, gastrointestinal disease, seizures, autism, autoimmune disease, cancer, and psychiatric disorders. Dr. Patricia Frye focuses her practice on cannabis and cannabinoid medicine and the role it plays in homeostasis and the management of pain and chronic disease. She evaluates and manages patients who are considering the use of medical cannabis as a primary or adjunctive therapy for illness. Cannabis and cannabinoids have been used for chronic pain syndromes, neurodegenerative disorder, gastrointestinal disease, seizure, autism, autoimmune disease, cancer and psychiatric disorders.
Dr. Frye graduated from the University of Maryland School of Medicine in 1981 and completed her pediatric residency. She went on to Baylor College of Medicine in Houston, where she completed a residency year in anesthesiology. There she gained experience in medical pain management and pain management procedures. Board-certified in pediatrics, Dr. Frye is professionally certified in Cannabis Science and Medicine by the University of Vermont Larner College of Medicine.
She is a diplomat of the Society of Cannabis Clinicians, a member of the Academy of Cannabis Specialists and a fellow of the Academy of Integrative Pain Management. She lectures extensively on the use of cannabis in medicine for hospitals, universities, physician groups, and cannabis industry groups throughout the mid-Atlantic region.
Truly Alive: What interested you in focusing your practice in this area of medicine?
Dr. Patricia C. Frye: Cannabis found me. I did not go looking for it. I was looking for an online telemedicine job in California from where I lived on the East Coast. I still had my California license and wanted to work from my East Coast location. A recruiter called me about working with a new company formed in 2015 named HelloMD. I knew nothing about marijuana but was a little intrigued and agreed to interview with the company. They seemed very professional, wholesome and clear thinking. It dispelled some of my preconceived notions. I accepted the position. It was slow at first, so I had a lot of time to spend with the patients who had been using cannabis for a number of years. In between patients I had time to do a lot of reading on PubMed, NIH, etc. and Medical Cannabis Institute carries a curriculum developed by medical cannabis clinicians. I took the course and went on to write curriculum for them for about a year. By this time, I was convinced that this was a very amazing plant and that people needed to know more about it and needed access to it. I decided to open a practice in the Washington DC area where I have been doing medical cannabis evaluations and treatments ever since. It has been very rewarding.
TA: How long has cannabis been used as medicine?
Dr. Frye: Human use as a medicine has been documented for about 5,000 years. References in the Chinese Pharmacopeia go back to 2700 BC. There is a first century AD, anesthesia formula used for surgery in China. Literal translation of the Chinese word for anesthesia is cannabis intoxication. It has been used in Ayurvedic medicine and can be found in Egyptian papyri. It was listed in the Canon of Medicine written by an ancient Arab philosopher and used throughout Europe until the mid-1600s. There are many references to its use for pain, seizures, tetanus and menstrual cramps. In the US, it was used as a medical prescription from 1857 until drug companies stopped making it in the 1940s due to the Marijuana Stamp Tax introduced in the early 1930s (that put such a high tax on it).It was used in the US as a medical prescription from 1857 until the 1940s when drug companies stopped making it due to the Marijuana Stamp Tax (a high tax tariff instituted in the early 1930s).
TA: Is there a standard dose for medical marijuana?
Dr. Frye: No. Due to it being a Schedule 1 drug, there have been very few human clinical trials done on it however, it has been found to have a balancing effect on the endocannabinoid system. The dosage for each individual is different. One patient may only need 1mg while another may need 15mg. The appropriate dose varies widely from one person to the next. There is no standard. Titration is a process where we start with a small amount and increase until we find the optimal amount. In this way, everyone finds their individual optimum.
TA: Isn’t medical cannabis part of the current drug epidemic?
Dr. Frye: It is illegal for no medical or scientific reason. It is the most widely used illegal substance in the world. Even the National Institute of Drug Abuse has reworded their website. They no longer refer to cannabis as a gateway drug. To claim that cannabis is a gateway drug is akin to claiming that french fries are a gateway drug. The addiction rate for cannabis is about 9% which is less than alcohol, tobacco, cocaine, and far less than opioids. There are no withdrawal symptoms, unlike thosefound with other addictive substances like alcohol and opioids. Cannabis can even help mitigate withdrawal symptoms because it is a muscle relaxant and pain reliever. It can alleviate some of the symptoms that opioids are used for, such as pain. When combining CBD oil with an opioid prescription, we can lower the opioid dose level by 50%-60%, and sometimes more, because of the interaction of the two substances in the endocannabinoid system. Patients typically get better pain relief and no withdrawal symptoms when lowering the opioid dose.
TA: Can you give our readers a brief explanation of what CBD and THC are?
Dr. Frye: These are only two of over 160 compounds found in the cannabis plant. CBD is not intoxicating, THC is. There are receptors in the endocannabinoid system (cannabis-like substances that naturally occur inside us) that help regulate and balance neurotransmitters like Dopamine, GABA, etc. THC directly interacts with the cannabinoid receptors whereas CBD tends to increase the natural cannabinoids that our bodies make. Our bodies produce these compounds that activate cannabinoid receptors. A lot of people’s bodies don’t make enough cannabinoids. It has been found that most people who respond to cannabis also tend to have lower levels of these natural endocannabinoids, including people with autism, migraines and fibromyalgia. By using CBD, we are increasing these natural levels of endocannabinoids. THC is directly activating some of those receptors and balancing some of those circulating compounds that control functions like inflammation, muscle tone, pain signaling, anxiety, depression, memory, sleep, etc. The endocannabinoid system regulates many systems. THC activates brain receptors causing an intoxicating effect which can have medicinal benefits, if it is not too profound. Recent plant strains have been bred to have higher THC and/or CBD levels. THC can offer benefits that CBD can’t, such as stronger pain relief. If it can’t completely eliminate the pain, it can take your mind off of it. THC can help you relax or change your focus.
TA: Why do you prefer the sublingual form of medical marijuana?
Dr. Frye: Absorption is slower, and it lasts longer than inhalation. With sublingual THC , you don’t get that blast across the blood/brain barrier which can cause anxiety or dysphoria. When taken under the tongue some is absorbed directly into the blood stream and the rest is swallowed and goes through the GI tract. Relief can start in about 20 minutes but can last 5-8 hours vs the 3-4 hour relief experienced when inhaled. For some working people, they can dose in the morning and it may last until they get home when they can take their second dose.
TA: What happens to our muscles when we sustain an injury and how does that contribute to pain?
Dr. Frye: Pain is adaptive. It is part of survival. It tells the brain there is a problem. The brain sends signals to the muscles and the surrounding area of the injury to stop moving until it can assess the problem. In the case of an acute injury this is good but the same can happen with chronic pain which is mal-adaptive (not good). The body can get in the habit of sending signals to the brain, telling it there is a problem and the brain is unable to differentiate chronic pain problems from fresh injury problems. The body signals the same solution ‘Let’s shut everything down, no body move’. People with many types of chronic pain, particularly lower back pain, are nearly unable to move. The muscles spasm, which is in itself painful. This mal-adaptive signal is not helping anything, because the brain is responding as if it is an acute injury.
TA: How does medical marijuana affect injury pain differently from chronic pain?
Dr. Frye: We don’t have human studies for acute pain, so we don’t fully understand the benefits of THC for this. We can say the THC molecule and the endocannabinoids that our bodies make respond to certain neurotransmitters that are released through pain neurons by shutting them off. I have patients using cannabis for post-surgical pain, sprained ankles and even menstrual cramps. This approach has been effective.
A note of caution. Be careful about dismissing large quantities of anecdotal evidence. That evidence exists for a valid reason. Keep in mind there was a Chinese physician in the 1st century who used cannabis as an anesthetic for abdominal surgery. Let’s compare this to the FDA standards of approving a drug for efficacy. If 30% of the people experience a benefit 30% of the time, that is good enough for the FDA. In my personal practice, I found (through the follow up process) that about half of my patients suffering with migraines (more than 100), over 60% experienced some benefit with cannabis, such as shorter duration, decrease in frequency and/ or decrease in severity of the migraines. You can’t ignore that.
TA: Do the topicals like CBD salve have any psycho active effects (altering brain function, resulting in temporary changes in perception, mood, consciousness and behavior)?
Dr. Frye: CBD does not have psycho active effects. Also, CBD oil will penetrate the upper layers of the skin activating the local receptors. It works very well for joint pain, muscles spasms, and even plantar fasciitis (on feet) for getting significant relief. THC does have psycho active properties, but for intact skin it does not penetrate the skin as well as CBD, nor does it penetrate far enough to get into the blood stream.
TA: Can those with auto-immune disease benefit from Medical Marijuana?
Dr. Frye: Absolutely! CBD modulates the immune system. THC and CBD influence the release of immune compounds like cytokines and interleukins, (actually there are many types of immune compounds). Modulation means increasing some while decreasing others , including cytokines (cell chemicals) that cause inflammation. Patients with Lupus, Fibromyalgia, Connective Tissue Disorder do very well with CBD. For patients with Autoimmune disease, I tend to give slightly higher doses, 20-30mg range, and we have seen remarkable improvements.
TA: Does Medical Marijuana have cancer curing properties or does it only help with symptoms?
Dr. Frye: We use it for symptoms but all cannabis flavonoids (found throughout nature), have anti-tumor properties. These flavonoids increase apoptosis (cell death). Whenever a cell mutates, it is programmed to commit suicide, implode. When that doesn’t happen, cells can aggregate and proliferate and form into tumors. This is what differentiates a person with cancer from someone who does not have cancer. A person with cancer does not have their apoptotic (cancer cell death) mechanism functioning properly. Certain cannabinoids in cannabis can help the body remove tumors. Some tumor cells can be killed by CBD but not THC, and some cancer cells can be killed with THC but not CBD, or it might be other compounds like terpenes or flavonoids that do the job. It is a ‘hit and miss’ treatment for cancer cells. Cannabis does affect some but not all tumor or cancer cells. I don’t recommend it as a treatment for cancer. We don’t know yet which plant varieties best affect cancer and tumor cells. Studies in Spain and Israel have found using cannabis in combination with chemotherapy is more effective than using only one or the other.
TA: Almost everyone suffers with some degree of anxiety. How does Medical Marijuana/CBD help anxiety?
Dr. Frye: CBD is very good for anxiety. THC at low doses can also help with this. A lot of current products have very high levels of THC so I wouldn’t recommend using them for anxiety. CBD also interrupts the stress response. If you are stressed, the brain releases neurotransmitters that signal the adrenal glands to increase glucocorticoids that divert blood flow away from your gut and brain to your arms and legs making you hyper alert. This fight or flight function is designed to keep you alive in life threatening situations. If you have sustained or frequent exposure to stress like a difficult boss or marriage, damage is done to your body. CBD can interrupt that stress signal. CBD is also an appetite suppressant. This has been helpful for those who have difficulty reducing weight through other efforts. Stress is a significant contributor to weight gain. CBD can lower anxiety, stress and appetite, and help a person feel better. CBD also helps to modulate glucose and lipid levels in the body thus, helping with diabetes and weight reduction however, CBD is most effective when combined with lifestyle changes.
TA: Can Medical Marijuana help people to quit smoking?
Dr. Frye: A recent study found CBD reduced craving for nicotine, alcohol and opioids. It did not have as good of an effect on stimulants like cocaine. I put one patient on a high dose of CBD for Crohn’s and lower back pain who also smoked 2 packs of cigarettes a day. He reduced his consumption down to 5 cigarettes per day in less than a month. Receptors in the reward centers of our brain are satisfied by the endocannabinoids in CBD and then don’t need that from other sources like opioids, nicotine or alcohol.
TA: If THC impairs memory, why is it recommended for post-traumatic stress disorder?
Dr. Frye: Because there are some memories that are best forgotten. The area of the brain that controls memory is the hippocampus and it is loaded with cannabinoid receptors. By activating those receptors in the hippocampus, it might be helpful in “letting go” of some of those memories that are not useful, memories that might be destructive or impair our ability to relate with others.
TA: What are the dangers in using a non-regulated medicine like Medical Marijuana?
Dr. Frye: Though nearly perfect, cannabis is not perfect. Adverse effects typically derive from the THC molecule and are dose related. Adverse effects tend to be in the nuisance category rather than the serious category. Typical adverse effects of THC are anxiety, paranoia, rapid heart rate, low blood pressure, interference with coordination or reaction response. CBD could cause insomnia in low doses if taken too close to bedtime. CBD taken in high doses could cause diarrhea. CBD could also interfere with blood thinners and statins by slowing down their metabolism.
Cannabis is an environmental cleaner. If the plants are grown where there are high levels of heavy metals, herbicides, or pesticides, the plant will absorb them. Contamination is a problem with hemp coming from China. Some hemp oils could have concentrated levels of toxins in them. The good brands will remove things like mold, heavy metals, pesticides and herbicides. There are reliable sources of clean, high quality cannabis oils.
TA: What is the legal status of Cannabis?
Dr. Frye: Hemp is legal. It contains both CBD and a very small amount of THC. But CBD is still listed by the FDA as a Schedule 1 drug. This is mind boggling! Even worse, we have an FDA approved drug called Epidiol that is CBD molecule derived. Epidiol, is a Schedule 5 drug. There is another FDA approved drug (since 1986 ) that contains lab derived THC molecules. Let’s understand this. Hemp is legal and contains small amounts of THC. CBD is legal in Epidiol and THC is legal if it is made in the lab, but those same molecules if they are removed from the plant are classified as a Schedule 1 drug.
There is also the social justice issue of the number of people who have gone to jail for having a gram or ounce of cannabis flower in their pocket. They have gone to jail because of the FDA Scheduling of the plant. So many ruined lives because of a crazy drug policy. The Federal government is in an awkward position regarding how to change this crazy policy after so many years of lies and propaganda. Pharmaceutical profit is also an influencing factor, hampering the government from taking appropriate action to correct its errors. Keep in mind, drug makers like Eli Lily and Merck used to make cannabis tinctures.
TA: Is there anything else you would like my readers to know about?
Dr. Frye: Ayurveda says that cannabis heals and poisons. That is probably true for any medication, depending on what the therapeutic dose is for the individual’s relief. This is the benefit and the healing aspect of cannabis. When you use too much cannabis or too often, there can be consequences. You just need to be careful with how you use cannabis. While it can be a problem for some people, this plant has many benefits. If you are not getting full benefits from the medications you are on or are suffering adverse effects from those drugs, and you have legal access to cannabis, consider trying it. People have been shocked at how much better they feel when doing so and all of this without the adverse effects inherent in prescription drugs. Another amazing fact is there is no lethal dose, unlike any other medication. You may get sick if you way overdo it, but you won’t stop breathing or have a heart attack. It’s safe and effective!