This is part 3 of our in-depth interview with Cannabis Pain and Healing Guru Dr. Michael Moskowitz. His story is so astounding, and the interview is so in depth, that we had to split it into several parts. Part One of this interview is about his experience with intense pain and his journey back from a probable cancer diagnosis and how he used cannabis in its various forms to get back to health. In Part 2 he talks in depth about Cannabis, THC and CBD in its various forms for pain management and anxiety.

In Part 3 we cover the astounding positives of medical marijuana and the new frontier that isolating the myriad cannabinoids hold for medicine in areas of physical as well as mental and psychological healing properties.

Dr. Moskowitz: There’s a big thing coming up in the world of medical cannabis in the next year or so, that is going to be a tremendous trend medically, which is we’re going to be able to get isolates of every one of the medically active cannabinoids, and then recombine them the way we want to, rather than the way they’ve come in the plants and the way we can mix and match plants together to get close to what we want. We’ll be able to dial in precise levels of every cannabinoid that’s medically active.

Charlotte Parker: How is that going to happen?

Dr. Moskowitz: People have been working on extracts and all kinds of different concentrates of cannabinoids. What they’ve done is they’ve taken the plant and they’ve concentrated down the cannabinoid element or elements into a much more concentrated form. The original one of that was hashish, but since then, like I said, they’ve made waxes, shatters, crystals, extracts, and resins, they make all of these things out of them.

The latest trend has been to use different techniques; the most sophisticated ones, liquid chromatography, where they can pull out each individual cannabinoid in a column. Each level of the column pulls out a different cannabinoid and they can then get complete isolates of those cannabinoids. They’re no longer stuck with what the plant produces or what combining different plants or different manufactured products produces, but now they can actually take 5 milligrams of THC and mix it with 25 milligrams of CBD and mix that with 25 milligrams of CBDA and mix that with 3 milligrams of THCV, et cetera, et cetera, et cetera.

Charlotte: When do you think that will be available?

Dr. Moskowitz: A year. Where we are here for me, it’s going to be available in probably about a month, and I’ve already got some of it available. That’s how I got the CBD isolate, but now all the other isolates are being extracted. The problem is most people don’t know what to do with the isolates because they don’t know what they do, but I’ve studied that. I know what the ones we know about do, there are probably about another half dozen to a dozen that are active, that we just don’t know what they’re doing. There are over 120, 130 identified cannabinoids in the plant.

Charlotte: Wow.

Dr. Moskowitz: I’m sorry. I didn’t mean to do that. [chuckles]

Charlotte: No. It’s a huge amount of enormous, wonderful things. I’m just thinking to myself. If somebody wanted to get benefit if they smoked some pot, does that give them some benefit -or do you have to take this tincture every day if someone feels they have something wrong?

Woman with CBD tincture

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Dr. Moskowitz: It depends on the person and it depends on the strain. People can get benefit from the highest dankest THC you can possibly find, they can still get benefit from that if no other cannabinoid is in there, and all they’re getting is THC. Like I said, THC has identified 16 different medical effects, the problem is it can also make people paranoid. It can also make people hypomanic. It can make people anxious. It can do things like that, and so there are limits to what THC can do, and people also build up tolerance to it over time, but it’s the only cannabinoid that people build up tolerance to. They don’t seem to build up tolerance to the other cannabinoids.

If you look at the other cannabinoids CBD has 23 medical effects, THCV has 13 identified medical effects. THCA has 13 identified medical effects, CBG has 9 identified medical effects. Then when you combine them, you get different medical effects. There are all kinds of synergies in this. Synergies are all those overlaps that happen when one cannabinoid does a similar thing to another, but they approach it in a different way, and there’s a broader effect from all that.

My strategy has been that to do this medically, you want around the clock treatment. You want things during the day that don’t alter you and you want something to take at bedtime that may alter you, but that at least gets THC into your system. You also want to get some of these other cannabinoids in different ratios in your system, because you want to get the broadest, total cannabinoid profile you can find.

With the isolates, we’ll be able to actually select those for specific conditions. While we can aim the treatments at specific conditions, there are more general effects from them, and effects that we weren’t necessarily looking for. We’ll now be able to dial out the ones we don’t want and dial in the ones we do want.

Charlotte: It would be nice to be able to get the right information of what to get. I’m also hoping that it would be nice if they could just make the marijuana the way that it was in the ’70s and ’80s.

Dr. Moskowitz: They do, Charlotte. There are plants grown right now, that are every bit the same as they were in the ’70s and the ’80s.

Charlotte: How do you get those?

Dr. Moskowitz: Again, you have to find dispensaries that are interested in medical, not just recreational. They aren’t just interested as a side business, they’re interested as their main business. There are more of them around because some counties like for instance, the county I’m in, Marin County, there are no recreational shops allowed, only medical. There are other counties like that as well. The problem with that is that, a lot of the times, it’s wink, wink, nudge, nudge, it’s medical, but they’re really just getting people high.

Again, I’m not anti people doing that, it’s just that that it’s very limited medically. If you want to do something medically, the best choice is to find different kinds of cannabis. For instance, I’ll use Synergy as an example. They use several forms of cannabis that are two to one or three to one CBD to THC. That’s a lot closer to the old days. Probably closer yet would be ones that are one to one, one to two, one to three, CBD to THC. More THC than the CBD, but not dramatically more, but enough.

Charlotte: How much THC is in those?

Dr. Moskowitz: Again, it depends on the plant. I’ll go on a website from Synergy and I’ll give you an example. Let’s see. Give me a sec here to get it.

Look, if you look at tinctures, for instance, if you look at tinctures that are pretty rich in CBD and I’m just looking at Synergy stuff because I’ve got it available to me. You can get everything from a 24 to one AC/DC, to– The other ones I was mentioning to you, versus you can get Catatonic, which is a two to one, you could get Cashews Honey, which is a two to one.

Charlotte: Is it a tincture or what is it?

Dr. Moskowitz: This isn’t tincture, just to do that. If you were looking at flowers of all this stuff and you wanted to look at a plant, let’s see flowers, see what they’ve got. You could look at CBD rich flowers and they run from a 24 to one to a two to one. You can get some of these same things in flowers. You can get Cashews Honey as a two to one in a flower, and what that has in it is, it means that there’s twice as much CBD as there is THC.

You can also get things that are like one to four, or one to three where it’s mostly THC, but there’s enough CBD in there to take the edge off of the THC high. That’s what CBD has always done and that’s why people bred it out of the plant because they were trying to make plants that were stronger and stronger and stronger.

Charlotte: If for example, one wanted to get the high that one got, like in the ’70s and ’80s, from pot that was there, I think that just the THC in and of itself was lower, don’t you think?

Plant green kush in clear glass jar

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Dr. Moskowitz: It was. When you look at these plants that are two to one, or one to two, or one to one, the THC is naturally lower that it’s more in the 10-milligram range per gram than the 25-milligram range per gram. The CBD that’s in there is either higher or lower than that but it mellows out some of the high of the THC.

Charlotte: I know. I’ve smoked some pot that could send you to the moon.

Dr. Moskowitz: I’ve had it too and it’s not that pleasant. Some people must like it, but for people that are not into just getting high, it can be a real difficult thing. The room can spin, you can get anxious, you can get freaked out by the whole thing. I always recommend that when people start this, they start with five drops or less of a tincture and then slowly build it up every day by anywhere from a drop to five drops depending on how they react, and build it up slowly to a maximum of one milliliter which is about 30 drops.

Then do that if they’re taking something during the day and it’s not making them high, try that twice a day. If it is making them high, back off from that and get a lower amount that doesn’t make them high. They can try that twice a day and in the evening, I tell them the same thing with the THC stuff. Start low and just build it up drop by drop by drop, until you find out what helps you sleep well without being hung over in the morning and that you slept better through the night in a deeper sleep.

We’ve also lately been able to get an isolate of CBN and we’ve started adding that to THC tinctures at night and that improves the depth of sleep tremendously.

Charlotte: I have these sleep gels I thought they were CBD – but they’re THC only. They’re five milligrams. That’s a lot for me, five milligrams of THC at night.

Dr. Moskowitz: Five milligrams of THC in them. Yes.

Charlotte: Yes. I don’t want my head spinning when I try to go to sleep.

Dr. Moskowitz: If you look at things like gummies, they’re maxed out it in legal markets at usually about 10 milligrams, and 5 milligrams is another typical dose for them. Every once in a while you see ones down at one or two milligrams but not very often because nobody’s really interested in those. For some people, that five-milligram dose is too strong and that’s one of the reasons I like tinctures because you could titrate up 0.03 milligrams with a tincture. You can make a tincture very weak, so if the tinctures come as they come, but the amount you use will determine how strong the THC is.

Charlotte: I’ve gotten some tinctures that are in hemp oil.

Dr. Moskowitz: Those are interesting too. Hemp is cannabis. It’s not a different plant. It’s actually cannabis sativa linnaeus and to be certified as hemp, it has to have less than 0.3 milligrams of THC per gram.

Charlotte: How do you feel about tinctures that are in hemp oil?

Dr. Moskowitz: It just depends. If the tinctures are really made from hemp grown the right way, so it’s grown like cannabis is grown, not like hemp is usually grown and that means it’s taken to flowering, the male plants are removed, the female plants are only allowed to grow and flower and they become sex-starved as they start to flower and the flower produces more resin, that’s good hemp.

If they’re grown to be three feet tall, and most of them are going to be used for fiber and they’re going to try to save the leaves and whatever flowers come out to make CBD, it’s crummy CBD, it’s low-quality CBD. Even though CBD is CBD is CBD, how it’s affected by the other compounds in the plant makes it low quality or high quality. You want the flowering hemp for this.

Charlotte: We don’t know. In other words …

Dr. Moskowitz: No, you don’t know.

Charlotte: We have no idea.

Dr. Moskowitz: You don’t know. The trick is, if you want to find out, first of all, hemp cannot be sold in cannabis dispensaries. It’s not legal, at least in California. You’ll find it in beauty shops and health food stores and grocery stores and Walgreens. It’s all over the place as hemp-based CBD, but the problem is, there’s no standardization of it and you can claim anything you want on a hemp label, you cannot on a medically certified cannabis label. It has to be tested, it has to be tested for pesticides, it has to be tested for everything.

That testing is expensive and it’s part of what drives the price up for medical cannabis, but it’s all very highly regulated and it’s careful. Hemp, I could grow a hemp plant, I could make an oil from it by putting it in a slow cooker after I’ve heated it up just the same way you would cannabis in the oven for 30 minutes at 225 degrees, put it in a slow cooker with sesame oil, heat it in there on high for eight hours, and I will have a plant that comes out with some measurement.

I could just claim it’s 25 milligrams of CBD per mil, and it doesn’t have to be any CBD at all, you could have gotten nothing out of it. No one tests it, no one regulates it, no one tells you what it is. Having said that, there are honest hemp brokers that make really good CBD from hemp. I’ve just got a fella I’ve worked with, guy grows the Black Beauty.

He just grew one that was genetically modified to not allow the original cannabinoid, CBG, to break down into THC, CBD, CBC, and CBG. It’s blocked from doing that, and so it came out hemp. There was no THC in it at all, but it was pure CBGa. That’s hemp, that’s considered hemp. That’s a brilliant little plant because CBG does a lot of stuff.

Charlotte: Yes, that’s something I’m learning about.

Dr. Moskowitz: That’s a problem with the hemp industry – it’s very poorly regulated. Farmer Joe can grow any kind of hemp he wants, turn it over to the guy who buys it from him who’s going to manufacture and make oils out of it, and it could have no CBD in it but be claimed to have 25 milligrams per milliliter. There’s nothing to regulate that right now. Having said that, you have to know your source if you’re going to be buying hemp, that’s the big difference. It’s perfectly good CBD when it’s grown right.

Charlotte: Can someone speak with the Synergy Wellness people and talk to them about their needs? They’ll understand?

Cannabis

Image by Alissa De Leva from Pixabay

Dr. Moskowitz: Absolutely. We’ve done a study with Synergy and myself where we looked at 150 people that were taking this, we followed them over the course of a year. We looked at the average length of time they were taking it, what their effects were, what their side effects were, what their benefits were. That was remarkably consistent with the prior study that I’d done for a year and a half on a bunch of my patients.

We’ve looked at all the stuff, we’ve trained their people in a lot of this. The guy who runs the company has written his own book, his name’s Leonard Leinow. He’s written a book called, CBD: A Patient’s Guide to Medicinal Cannabis – Healing Without the High. It’s a very good book and has sold a lot, and it’s excellent. He’s taught his people all this stuff, so they’re very knowledgeable. This is an unusual dispensary.

They can talk to people very informatively about what products they have and what they can do.

Charlotte: I understand that you gave a presentation to the doctors at Walter Reed.

Dr. Moskowitz: Yes I did.

Charlotte: Can you tell me about that?

Dr. Moskowitz: Yes. I’m one of the two doctors that I know of that has lectured about medical cannabis to the federal government. This was the fifth annual international pain conference for Army, Navy, Air Force, and VA. There were about 300 people there, 350 people there from all over the world. I gave a lecture on the benefits of medical cannabis. There were three other lecturers on the panel with me.

One of them also lectured about the benefits of this with veterans, one of them lectured about the side effects and problems with cannabis, and one of them was against cannabis, [chuckles] that it’s a drug of abuse. It was like a balanced group of lecturers that talked about all this stuff. I’ve got a certificate hanging in my office that says the Department of Defense thanks me for giving this lecture at Walter Reed Hospital.

Charlotte: I hope it helped the veterans a lot.

Dr. Moskowitz: I hope. The issue, again, is there’s so much misinformation. Think about this for a minute, you’ve been doing this how long?

Charlotte: Long. I’ll tell you about that in a minute.

Dr. Moskowitz: Okay. If you look over the years that you’ve done this stuff, over and over you’ll read in the paper, medical cannabis does this, medical cannabis does that. The truth of the matter is there’s no such thing. Every plant is different than every other plant. Every plant has different ratios of medically active cannabinoids, it’s not the same no matter what you’re using. Even if you grow two plants in the same garden, they’re going to have different numbers, they’re not going to be the same numbers. That’s the whole point of all this.

This is an infinitely variable plant. You can’t say medical cannabis does this or that, you can say that people have gotten benefits from medical cannabis along these lines with these kinds of symptoms and these kinds of conditions. But to be able to say medical cannabis does this and that, how can you do that? It’s a different presentation each time you use it. I like that because it’s very different than our medicines as a compound that keeps changing, your body has a very hard time adapting around it, and our bodies will adapt around anything.

This makes it much harder for the body to adapt. If you purposefully then rotate strains, rotate embodiments, rotate delivery systems for bringing it into your body, you’re giving your body no chance to adjust around what you’re giving it. I love that about the plant. What I’ve seen with this plant with my patients is not just benefit but long-lasting benefit that gets better over time. I don’t see that with any medicine I use. None.

You can read Part One of the interview here and Part Two is available here.

Stay tuned for Part 4 coming up!

Note: Please do not use any of the above information without consulting with your physician. The above is exclusively the experience of the person being interviewed.

Photograph of Dr. Michael Moskowitz

Dr. Michael Moskowitz

Michael H. Moskowitz, MD, is the President of Bay Area Pain Medical Associates. He is Board Certified in both Psychiatry and Pain Medicine and has served as a member of the Examination Council for the American Board of Pain Medicine and as the Chairman of the Educational Committee of the American Academy of Pain Medicine.

Dr. Moskowitz’ clinical practice in pain medicine uses the Biopsychosocial approach and he is a pioneer in the development of treatment approaches to brain neuroplasticity and pain. He co-founded Neuroplastic Partners and built the top rated website in the world on neuroplastic treatment (http:// www.neuroplastix.com). He coauthored, with Marla Golden, the Neuroplastic Transformation Workbook, used by practitioners and people with persistent pain to guide them through non-medication, brain based approaches to treating persistent pain.

Dr Moskowitz was a guest at the fifth annual international pain conference at  for Army, Navy, Air Force, and VA at Walter Reed Medical Center where he lectured on the benefits of medical cannabis.

Since 2015 Moskowitz has specialized in the use of medical cannabis for the treatment of pain and anxiety and he wrote a book on the subject, Medical Cannabis: A Guide for Patients, Practitioners and Caregivers.