Dr. Alita Sikora, Sikora Integrative Medicine in Vero Beach, explains how the Endocannabinoid System (ECS) works and why medical marijuana is a match for the ECS. She shares how cannabis (marijuana) can be a helpful option for addressing pain, insomnia, anxiety, PTSD, Crohn's and many other conditions, as well as, the conditions outlined by the state of Florida that may be addressed by medical marijuana. Discover how different cannabis products have varying absorption rates and why that is a consideration when matching the product to the condition.

She will cover: 

• How medical marijuana works with the body and the benefits. (1:31)
• What conditions are likely to benefit from medical marijuana? (5:08)
• What are the side effects or health risks? (7:08)
• How does a dispensary differ from the pharmacy model? (10:25)
• Why choose one form over the the other? How does it impact absorption? (12:57)
• How does medical marijuana work for chronic anxiety? (14:34)
• Where to find more information. (17:10)

Transcription:

Kris Urquhart  1:04  

 Hi, Dr. Sikora. Thank you so much for joining me today.

 

Dr. Alita Sikora  1:19  

Thank you very much for having me today.

 

Kris Urquhart  1:21  

So we're going to talk a little bit about medical marijuana. Can you share with us how medical marijuana works with the body and where we might see some benefits?

 

Dr. Alita Sikora  1:31  

Absolutely. I did provide a diagram for you because it's really based on the endocannabinoid system in our body. This is a system that I never learned about in medical school. But it is very important. This maintains homeostasis in our body, which has to do with sleep, appetite, memory, mood, basically, this system balances the body. That's a diagram from a website called healer.com, which is a great website about medical marijuana. That shows the different receptors you can see that they're in the brain. They are in organs, the lungs, the gut. So there are receptors called CB one and CB two receptors. We have natural chemicals in our body that bind to these receptors. One of them is called anandamide. This is the chemical that causes a runner's high. So the marijuana actually works at those same receptors. We have different molecules in the marijuana plant. It's not that well studied. But there are at least 400 different chemicals called cannabinoids. Each one has a different effect on the body. There are many different receptors in the body that the cannabinoids will bind to, not just CB one and CB two that you're seeing there. But it's really thought that the main medicinal effects of marijuana are happening when the cannabinoids from the plant bind to those receptors that you're seeing on the screen. So you can see there you have receptors in your brain. That's thought to be why people get benefits with mood, anxiety, sleep and pain. Those are mainly the CB one receptors, they're called. And then you have CB two receptors that you're seeing in other parts of the body. You can see it in the lungs, the gut, the liver, the colon. cb two was thought to be more beneficial for the immune system, for inflammation, it's also in the brain but also felt to be critical in neuro protection. CBD is another molecule that everybody's heard of that's very closely connected, it is a cannabinoid, it also binds to some of these receptors. THC is the molecule that we all know of is marijuana. THC is the psychoactive component. So one of those 400 chemicals, that's the psychoactive one. So that's the one that is going to cause the euphoria. Most of those other molecules in the plant do not have those effects. So the main ones that we're talking about when we're talking about medical marijuana is THC, which is also known as delta nine tetrahydrocannabinol or delta nine THC. You know, we hear a lot in the news in the media right now about different strains. You might hear about Delta eight THC, CBG, CBN. These are all different cannabinoids that all are part of the plant and all work in that endocannabinoid system.

 

Kris Urquhart  4:57  

So what Conditions are likely to benefit from medical marijuana and what are you seeing with your patients?

 

Dr. Alita Sikora  5:08  

So, you know, my specialty is physical medicine and rehabilitation. That's what I'm board certified in. So I see a lot of people with chronic pain conditions, rheumatoid arthritis, osteo arthritis, stroke related pain, fibromyalgia. I also see a lot of people with insomnia, PTSD, anxiety, depression, they're all getting some benefits, I can list off with the state of Florida. You know, if you want to get a medical marijuana card in the state of Florida, where we're located, I'm just going to read off the conditions, cancer, epilepsy or seizures, glaucoma, positive HIV status or AIDS, ALS, Crohn's disease, Parkinson's disease, multiple sclerosis, and then they have another one for any terminal condition. They have another one for chronic non malignant pain. There are some special conditions related to that. They said it has to be related to one of those other conditions, or they have a class called medical conditions of the same kind or class or comparable to those enumerated above. I do see a lot of people with chronic pain that have failed multiple other treatments. And a lot of times they're already on opioids. And in my practice, I have had a lot of success in helping people reduce or get off the opioid. So it's been really remarkable. And the studies show that it does help chronic pain patients, you know, about 40% of patients in different studies have been able to get off of opioids or reduce their opioid use with with the medical marijuana. I do see some people with seizures, Crohn's disease or other gi issues, they're they're all getting benefits.

 

Kris Urquhart  7:08  

So we know that all of you opioids are going to have side effects. I mean, they're notorious for that. Do you find that to be side effects and/or health risks with using medical marijuana?

 

Dr. Alita Sikora  7:20  

Well, again, it depends on the strength, we have different products. To get a medical marijuana card, the amount of marijuana is going to be more than 0.3% of the THC, which is the psychoactive component. So you can get products in the dispensaries that are very low percents, you know, less than 1% THC and no people don't have really any significant side effects from that. As you go up in the percentage of THC, you may get some side effects such as dizziness, dry mouth, you know, if you get to the higher percentages, you can get that psychotropic effect, that euphoria. I really advise patients to try with the lowest dose first and slowly increase and that'll help avoid some of those side effects. There's also with marijuana something called a bi phasic effect, where low doses can help a condition but then if you go to too high doses, they actually can have the reverse effect. So you actually want to start with something called micro dosing, which is where less is more. So taking small amounts to avoid all those intoxicating effects. So a lot of times I'll have people start with something called a one to one tincture, or gummies, or capsules, that that is equal parts THC, which is the psychoactive part to CBD, which we've all heard of. The CBD actually counter acts, the psychotropic effects. So a lot of times, you know, people say that they're feeling it, I'll say get something that has a higher amount of CBD in it. That'll help you from getting that feeling. There really have not been I mean, overall marijuana is much safer than opioids, you don't have the risk of overdose people don't stop breathing, that kind of thing with marijuana. You have to take some caution when you're taking it orally. The oral forms or capsules, gummies, because it's metabolized a different way. It actually is metabolized into it even stronger component when it goes through the whole digestive tract. So that's where people have to be careful. You know, it can take an hour or so to work and they may think it hasn't worked and they may take more. They need to give it time and realize that it may be stronger and it's going to last longer than if you were to vape it or smoke it. So, again, it also has to do with people's individual, the way their liver breaks down. It's called the CYP 450 liver enzyme pathway. So that's also genetic. There are a lot of factors involved in how people respond to marijuana, and if they're going to have any risks or side effects.

 

Kris Urquhart  10:25  

So a couple of nuggets in there, I kind of want to go back and gra. When you certify someone for medical marijuana, it's a little different model than what we're used to where, you get a prescription from your doctor, you go to the pharmacy, and they give you what the doctor said you needed. Right, so you're going to a dispensary, but it sounds like you're gonna give some guidance, but then they also need to look for guidance on the other end. Can you explain that a little bit more?

 

Dr. Alita Sikora  10:54  

Yes, that is correct. So it's almost like a different language. When you get your card you go to the different dispensaries. Like I mentioned, there are all these different chemicals or Phyto cannabinoids, that are part of the plant. There's also something called terpenes. Terpenes are what give plants their flavor and odor. So terpenes are also part of what makes different medicinal properties of the plant. So every dispensary is going to have different strains that have different kinds of terpenes different cannabinoids different percentages of marijuana. So I may not always know what different strains each particular dispensary has. So what I do is with the state, it's called a recommendation, I certified that the patient meets the criteria and I give them the recommendation. And I put in what kinds of forms they can get, they can get oral, which are the gummies the capsules, they can get the sublingual, which are the drops that you put on your tongue, you can get the inhaled or the vapes, you can get the smokeable. And I put a very general order so that when patients go to the dispensaries, they do have some freedom and flexibility to try different strains, different varieties, because there may be something that really works well for their condition that that has been, designed by that dispensary or that grower. So yes, people have a lot of freedom with it. The state law is that they have to come back every seven months to be recertified. So really, you know, I'm here for to help advise you, I usually give you some advice when you first come in what may be helpful. But you really do have a lot of freedom with this to go talk to different dispensary's, try different products, see what really works for you. So that that is very different than the pharmaceutical prescriptions. For sure.

 

Kris Urquhart  12:57  

You also mentioned the absorption where you might choose something that's going to go through the digestive system versus, say a vaping. Are there certain conditions that map to one better than the other. So like when you need a quicker response versus a longer term?

 

Dr. Alita Sikora  13:16  

Absolutely. So if somebody is getting this for seizures, or Parkinson's or they're having a lot of tremors, they may want to get really fast delivery. And that is something where vaping or smoking is going to go through the bloodstream through the lungs, it's going to work very fast. tinctures are also going to work faster than taking something orally. So people in a lot of pain, they might want something for breakthrough pain where they can just take an inhalation or two and their pain gets better. For sleep, I'll usually recommend the oral because even though it's going to take longer to work, it's going to last longer. So they can sleep through the night with a capsule or a gummy. It just again, it really depends on on the conditions. And some people do a combination. They might take the oral for pain, but then do the vape for breakthrough when you know when they have flares of the pain throughout the day. And some people absolutely don't want to smoke or vape. So that's another consideration. That's where the tinctures that you put onto your tongue can be very helpful because they work faster but don't have the risk of putting any smoke in your lungs.

 

Kris Urquhart  14:27  

Okay, so it sounds like it's definitely not a one size fits all kind of thing. 

 

Dr. Alita Sikora  14:32  

Oh, no, it isn't. 

 

Kris Urquhart  14:34  

It isn't very individualized. We haven't touched very much on anxiety. How does medical marijuana work with someone who maybe has chronic anxiety if not PTSD?

 

Dr. Alita Sikora  14:48  

Well, you saw in that diagram of the endocannabinoid system that you have the different receptors in the brain. You know, the CB one receptors. So those receptors Also have to do with relaxation. You know, like I talked about, there's that natural chemical we make that causes the runner's high when we run called indef. Oh my gosh, I'm gonna mispronounce it. Well, you have the runner's high. You feel that well being that calm. That's all the endocannabinoid system, that's our natural cannabinoids binding to those receptors. So with anxiety, both THC and CBD have effects on those same receptors that have to do with calm and mood. Too much THC like I mentioned can sometimes like I said, in high doses can have the opposite effect. So that's where you might have heard of people getting paranoid with THC. I know you'd asked about some risks and side effects before. But that's where a lower percent of THC with more CBD could be very beneficial for anxiety. But again, it's all because of that endocannabinoid system. Again, a lot of the chemistry of this is not that well known, there's still so much that needs to be studied about this. In my experience, I have had people you know, again, be able to reduce the amount of some of their sleeping medications, benzodiazepines, I've been able to help people get off like Xanax and Ambien, those have a lot of risks of addiction. Because they are able to get that calm and well being with marijuana, having some CBD in it. If it's just THC, it usually doesn't help so much with the anxiety, it's going to be strains that have more of the CBD. There are also terpenes that I mentioned. There are certain terpenes, there's one that's similar to one found in lavender that has a calming effect. So that's where going to the dispensary and talking to them about the specific strains is very helpful. Because they may have ones that they have specifically grown for anxiety.

 

Kris Urquhart  16:59  

This is fascinating. I really appreciate you sharing all your expertise and knowledge and for being there to help guide people through this new exciting time.

 

Dr. Alita Sikora  17:10  

There's alot, like that diagram I showed you was from a site that I recommend healer.com there are a lot of really good articles and diagrams information if you have questions. I have some short videos on my website, www.SikoraMedical.com where I have Frequently Asked Questions, mostly related to getting the card in the state of Florida. So if you have you know, if you have more specific questions, you can look at my little videos. And then again, the state of Florida also has a lot of information. That's MMUregistry.com or KnowTheFactsMMJ.com  That'll go through all the information for patients in the state of Florida.

 

Kris Urquhart  17:53  

Fabulous. That's lots of information for people to pick through. If they're thinking that maybe this is something that could work for them. And then of course they need to consult a physician that's licensed. Thank you so much for your time today. 

 

Dr. Alita Sikora  18:08  

I really appreciate it for having me. 

 

Kris Urquhart  18:14  

 For everyone listening be well stay connected.