Episode 90 of Utah in the Weeds is for anyone interested in using cannabis for pain management. Listen to a presentation on this topic from Tim Pickett and his Discover Marijuana co-host, Blake Smith.
Tim Pickett:
Welcome, everyone, out to Utah in the Weeds. My name is Tim Pickett, and this is episode 90, episode 90. This episode is the episode before my two-year anniversary, and you know what? We go along so fast and we’re doing these episodes. Chris Holifield reached out to me and mentioned, “Hey, you know what came up in my Facebook feed? The fact that this is the two-year anniversary of Utah in the Weeds this month.” I wasn’t even thinking about it.
Tim Pickett:
Next week, we’re going to do something special and give away something for the two-year anniversary of Utah in the Weeds, so stay tuned. Subscribe at any podcast player that you have access to. Subscribe to Utah in the Weeds. Tell your friends we’re going to give away something, something cool. Definitely a sweatshirt, definitely a Utah in the Weeds sweatshirt is coming at you, probably a t-shirt, as well, and then something else that’s a surprise, so there’s the hook.
Tim Pickett:
Today’s episode is with Blake Smith. We did a webinar. We’re going to rebroadcast that because we talk a lot about pain, and we talk about cannabis for pain, so a little more educational, maybe, this podcast. I love to rerelease these webinars because they’re kind of a different style, a little more educational format. You can always catch that webinar on Discover Marijuana on YouTube, just about to hit 2000 subscribers.
Tim Pickett:
If you’re not subscribed to Discover Marijuana, you’re going to want to be subscribed because March is a massive month for giveaways. We’re going to be giving something away every single week on Discover Marijuana on YouTube. If you know what we gave away last time, we gave away a PAX 3 complete kit. We gave away some, I think, PAX 2. We gave away a bunch of clothes and swag. We’re going to blow the doors off this time. Excited to keep these episodes coming at you. Again, subscribe. This is Blake Smith and Tim talking about pain and the Utah cannabis program and how it might help you. Enjoy.
Tim Pickett:
Welcome, everybody, out to our webinar, Discover Marijuana webinar series. I’m Tim Pickett.
Blake Smith:
I’m Blake Smith.
Tim Pickett:
Blake is the chief science … You’ve got so many titles. I can’t even keep them all straight. CEO of Zion Medicinal, chief science officer.
Blake Smith:
Yup.
Tim Pickett:
Zion Medicinal.
Blake Smith:
I’m also-
Tim Pickett:
I … Go ahead.
Blake Smith:
I’m also the chief science officer and CEO of Intrepid Biosciences and the chief technical officer for [inaudible 00:03:08] and probably the chief science officer for the Henderson Group.
Tim Pickett:
I think you may need to start saying no to some things.
Blake Smith:
That’s absolutely right. That’s absolutely right, but they’re all doing good things. They’re trying to make life better for people, and they want to do it doing cannabis science and nanotechnologies and so how can I say no?
Tim Pickett:
I know. That’s what’s so hard. Tonight, and for those of you who don’t know me, I’m a medical cannabis provider. I specialize in taking care of people who need to use medical cannabis for their medical condition. I teach people how to use cannabis. I educate them on all of the things surrounding cannabis. I love it. It’s so rewarding and so fun to watch people feel better with something natural instead of something and reduce the use of pharmaceuticals.
Tim Pickett:
Tonight, we’re going to be talking about pain specifically, kind of all about pain, chronic pain, acute pain, cannabis use for pain and so well titled here, The Hurt Blocker. Yeah, again, we’ll talk about acute and chronic pain. We’ll get into a little bit of the mechanism of action of cannabis and cannabinoids, what we know and maybe what we don’t know. We’ll talk a little bit about cannabinoids and terpenes that may be good for pain, deep dive into THC, and, of course, our favorites, some suggestions at the end.
Tim Pickett:
Let’s talk about acute pain first. What is acute pain? We’re talking sharp pain, sudden pain. Ten days ago, my psoas spasmed up, and I was completely incapacitated. That’s acute pain, couldn’t walk from the bedroom to the kitchen. Acute pain disappears as injury heals. That’s the key with acute pain. It happens now, but it’s going to go away. We have a good process in the body for acute pain, broken bones, surgery, of course, labor and childbirth. God bless them, dental and orthodontic work and everything, bump your hand.
Tim Pickett:
Chronic pain is a little different. In Utah, for the cannabis program in Utah, chronic pain is two weeks or more of pain that is not well controlled with a typical treatment or medication or therapy. Typically, chronic in medicine is something that is longer than three months, tends to be kind of that threshold of chronic when we talk to patients and something lasts a little bit longer than three months.
Tim Pickett:
The issue with chronic pain is sometimes the … With acute pain, you get a broken bone. You have pain. You have healing. You have no more pain. What if your bone healed, but you still had pain? That’s kind of one of the keys with chronic pain. It’s a disassociation with what’s happening physically, and it becomes this longterm thing almost regardless of whether or not you have some type of physical or mechanical dysfunction or problem in the body, but you just have this pain response. [crosstalk 00:07:02]. Go ahead.
Blake Smith:
One other thing that often causes this is when you think about injury, so you break a bone, for example. You have nerve bundles. You have nerve fibers. You have certain areas in the body that are hard for your body to get all of the repair mechanisms into those spaces. Your bone may heal within eight weeks completely, but the nerve fibers themselves may not heal in that same amount of time and so longer. What will often happen with chronic pain is your acute pain masks something that’s going to last much longer and so as the acute pain starts to go away from the broken bone or the burn, you’ll discover that you had other injuries that you were unaware of that is going to take a lot more time to get fixed.
Tim Pickett:
Yes. Nerves are notoriously hard to heal, if they ever heal, a lot of times. I think in school, we were taught that nerves can grow about a centimeter a year, so sometimes, you get some nerves back. Arthritis here, I want to highlight arthritis because arthritis is it’s the number one cause of chronic pain, I think, nationwide. It has to do with the aging population, frankly. Everybody’s going to get arthritis, eventually some type of arthritis from overuse. We just, we’re not built to live forever.
Blake Smith:
Well, and arthritis particularly occurs where you have joints and you’re not using bone or muscle or tendon. It’s, literally, like the material in your nose, the material in your ears, but in your joints, typically, because the way this typically works is you have all these self-recognition proteins that tell you in the case of Tim, “Hey, I’m Tim. I’m a Tim cell.” Then an immune system cell will go by and communicate and say, “I’m also a Tim cell. Everything’s cool.” Those transmembrane-bound, self-recognition proteins inside your body identifies things that are foreign invaders and so it mounts an immune response when it says, “Hi, I’m Tim.” And the other one says, “Well, I’m not,” or, “I’m Bob,” or whatever it is.
Blake Smith:
What ends up happening there is when you look at your joints with collagen and things like that, you break off through multiple use those was transmembrane-bound proteins and so all of a sudden, your immune system doesn’t recognize your own joint cells as being self cells. One of the first immune responses you have is to attack it with chemicals, histamines, [isophils 00:09:50], neutrophils and all of these other things. That is where you get this red inflammation and the locking of the joints and pain with arthritis. The problem is you can repair those proteins for most cells. You cannot repair them for your joints, for cells that are, basically, fixed, that don’t have an ability to multiply and then replenish themselves. Sorry, I went on a diatribe, but [crosstalk 00:10:21].
Tim Pickett:
No, you didn’t. No, you absolutely didn’t. Now let’s switch over to the mechanism of action, what we know about … Well, we were really talking about kind of the mechanism of pain, right? We’re talking about when we talk about the mechanism of action, explain a little bit more about the mechanism of action. It’s hard to describe the mechanism of action of the endocannabinoid system as a whole, right, other than to say from my side, when I talk to patients, I talk about the fact that cannabinoids are going to stimulate healing when it needs to be, when something needs to be healed. Cannabinoids are going to inhibit things when they need to be inhibited. I use broad terms when I talk to patients because the endocannabinoid system is a system that strives for homeostasis. It strives for balance, right?
Blake Smith:
Yup.
Tim Pickett:
And cannabis tends to, I feel like it tends to try to balance things.
Blake Smith:
So a body enters into homeostasis because, ultimately, it’s thermodynamically more favorable for a body to do that. The whole purpose of organic life is to fight entropy. I’m getting kind of really big here, but when we think about it, we’re thinking about it like there’s a finite amount of usable energy in the universe. When we say usable energy, we’re talking about energy that can do other things, convert and so forth. Heat energy doesn’t convert back to, say, kinetic energy or heat energy doesn’t convert back to usable other forms of energy.
Blake Smith:
Your body uses energy to stay organized. We’re now talking about the second law of thermodynamics, all ordered things start to move to an unordered state and the only way to maintain that order is to use energy to do so. What ends up happening is your body has been designed, and whether you believe in God or evolution or whatever it is, your body has been honed in based on these laws of thermodynamics to specifically be in its most energetically favorable state.
Blake Smith:
When we talk about homeostasis, what we’re talking about is expending the least amount of energy to do all the functions that your body has to do. Endocannabinoids, or your endocannabinoid receptor system, is a helper to your normal central nervous system at maintaining homeostasis. Think about it like if you have a bag of M&M’s and all those M&M’s are neurotransmitters. If you have more brown ones, your body’s natural inclination is to get more brown ones into equal piles onto both sides. What ends up happening is if you have imbalance, cannabinoids can help reestablish balance in places where you’re either having deficit or too much. Anyway, sorry.
Tim Pickett:
No. I think what’s important there is we understand the broad piece of the endocannabinoid system, right? We understand broadly what it does and we’re trying to figure out all of the little details. There are certainly too many details that we don’t know, but we know it finds balance. Chronic pain, when you’re talking about pain, it’s essentially trying to figure out the system and try to balance it back out.
Tim Pickett:
There’s a theory. It’s a growing theory that because humans evolved next to the cannabis plant, that cannabinoid deficiency actually almost can be a cause of these chronic problems.
Blake Smith:
Yeah.
Tim Pickett:
Let’s go to we’re talking about cannabinoids for pain relief, terpenes for pain relief. I feel like my favorite terpene for pain relief is beta-caryophyllene. It’s a good antiinflammatory, tends to be strong in strains that are good for pain relief, Kushes and Hazes, but talk [inaudible 00:14:51] information about cannabinoids for pain.
Blake Smith:
Yeah. Again, most cannabinoids are mimicking a natural neurotransmitter that’s already being produced. Now, we don’t know all of them, but we know some of them. When we look at CBC, CBC is typically an anticonvulsant, and it is most effective for things like Parkinson’s and seizure-type conditions that are energetic seizures, not necessarily freezing-type seizures, where all of a sudden you lock. Instead, this is one where you’re having misfires of energy, energetic signals. CBC can help with pain, specifically, because if you’re having nerve misfiring, CBC can help regulate that.
Blake Smith:
When we look at CBD, CBD is mimicking normal GABA pathways. Now, one of the things that’s cool about CBD is it doesn’t inhabit all the normal receptor sites that GABA does, but it inhabits some of them. This is why when people talk about CBD, well, it’s great for pain. It’s great for inflammation. It’s great for stress. It’s great. If you want to know all the things that CBD potentially can affect, start looking at all the different receptor sites and uses that your body has for GABA. That’s why that one becomes so effective in terms of pain relief.
Blake Smith:
When we think about CBG, CBG is absolutely, and you’re going to get to this in your slides, basically CNS pain that comes from the brain down versus pain from an acute place moving back up to the brain. CBG is extremely effective at blocking signaling coming from an acute source to the brain that basically says we don’t have to enact the sympathetic nervous system to start having a histamine reaction, epinephrine, cortisol, and all these other things associated with a pain response, which are almost always associated with fight or flight, right? CBG is effective in that particular space.
Blake Smith:
CBN downregulates, when you’re awake, serotonin pathways. It downregulates also, when you’re going to sleep, the melatonin pathway. If you’re having overall stress or anxiety or sleep issues and that’s causing longterm pain, CBN is effective. Especially if you think about your body does almost all of its repair while you’re sleeping, so if your pain is keeping you awake and you’re not getting good sleep, you’re not fixing the thing, your body’s not fixing those areas of pain, so CBN can be extremely effective there.
Blake Smith:
Delta-8 has a very high absorption cellular rate and so when we look, especially, at organ pain, stuff that’s in the trunk of the body, Delta-8 is extremely effective at lowering inflammation or, at least, the pain response associated with that. Whereas Delta-9 is a more CNS response where your body then responds and stimulates the dopamine pathway, ultimately, and so you mask pain using Delta-9.
Blake Smith:
The terpenes are particularly interesting. You brought up beta-caryophyllene. Beta-caryophyllene and your other caryophyllenes in general are all derived from pepper plants and so at some point, humans were growing weed with pepper plants. Most likely, what we’ve seen genetically is that mostly came from the Middle East. Plants have a unique thing where they will often share genetic and chemicals back and forth with each other. Terpenes are one of the things that plants will freely share back and forth over periods of time in generations and so it’s likely that most forms of weed that are high in caryophyllene were originally derived from the Middle East, but that’s neither here nor there. The point is we know pepper plants are often used for acute pain and relief of those type of things in several ways or forms and that’s the reason why.
Blake Smith:
Here’s the biggest problem with terpenes in general is I believe very, very much that they’re effective. The mechanism of action of terpenes is almost impossible to determine. It’s just like lavender and some of these other things. I don’t think they don’t work. I mean, there’s plenty of studies that show that enough people are affected in a positive way by taking certain types of oils and natural products that it’s effective. When we try to break it down how it actually is a dose response, 10 milligrams of lavender oil equates to this lowering of stress, it’s really hard to do. On the terpene profile, I believe in it, but I don’t know how it’s doing what it’s doing per se.
Tim Pickett:
That’s where you come into more than these cannabinoids, as well, right?
Blake Smith:
Yeah.
Tim Pickett:
We’re describing these, the mechanism of action a little bit, or the function of these cannabinoids in the body, but there are 120 cannabinoids, so most, the vast majority we still don’t know much about.
Blake Smith:
Yeah. Really, most of these start with the precursor molecules. GABA is a precursor molecule. In the case of Delta-9 and Delta-8, it’s anandamide that are initially starting that process for the production of dopamine and so forth. We can look at those precursors, but they’re pretty tightly linked with an ultimate outcome of a final chemical. The terpenes are like, the precursor molecules with terpenes are, like, there’s 30 or 50 of them or even more, so it’s like, well, where does humulene go in and actually cause an effect? I don’t know. We have a grab bag of all kinds of places it could go and all kinds of things it can do. That’s why when you find a really cool combination of cannabinoids with terpenes, high five. Stick with it because there’s something synergistic going on with that combination that is providing the relief that you need.
Tim Pickett:
That particular point right there is good enough to be repeated. When you find a strain or a product and a combination of cannabinoids and terpenes that work for you, you’ve got to write that down. Write the strain down. Write the product down because it’s no kidding that one strain is going to work for somebody and it might not work for somebody else. I think there are probably countless examples of this. One I know of in Israel, a seizure patient who is using a cannabis product, a natural cannabis product, seizures are almost completely gone. Change the formulation, seizures come back. They had to do a lot of research to figure out the breakdown of what they grew.
Blake Smith:
Tim, so you’re very smart, too, and really, really good job on this one because that bears repeating, too. This is the biggest challenge in the marijuana industry as a whole, both on the medical side, as well as the adult use side, getting the same product every single time, produced in the same way, with the same outcomes, is really not many people are doing that or doing that well. That’s one of the things that makes this really important as we do this because we have to treat this like medicine and so that somebody who’s relying on this for relief gets the same thing every time they take it.
Tim Pickett:
Yup. Okay. Let’s dive into Delta-9. Really, in my opinion, Delta-9 is one of the biggest factors for pain relief. It’s because of the disassociation. You’re, essentially, putting your pain over there on the couch. That’s what Delta-9 does, from a practical standpoint. It disassociates the brain and the thought process from that pain and that symptom. People will have headaches or toothaches, and it’s almost like I am my headache or I am my toothache. THC takes the toothache, puts it over there. It doesn’t necessarily take away the pain. It takes away the perception of the pain so that a person can move on and do what they want to do during the day.
Tim Pickett:
I think it’s important to talk about that because we talk about a lot of cannabis users just want to get high. Then we talk about chronic pain and people just want to get high. Well, the truth is people being high, for some patients, is part of the process.
Blake Smith:
Yeah. Look, especially if you’ve been self-medicating for a really long period of time, if you’re self-medicating, how do you know that your self-medication is doing what you need it to do? Well, a head change is a really clear indicator that you know the medicine is doing what it’s supposed to do. We’ve talked about this before. It’s a challenge because you have this legacy group that uses, that that’s the indicator they use, but as we’ve talked about before, it would be really odd if you take a Tums and you got high from that to let you know your Tums is working or your aspirin or something. Most medicine is not designed to have you feel a particular way as an indicator that it’s doing what its job is.
Blake Smith:
This is one of the reasons why a lot of people who are high in THC think that CBD is not very effective because they’re expecting to feel this grandiose change. What I would say is from my case, I have bum shoulders from being too rowdy in my younger days. Without CBD or a lot of NSAIDs, I can’t raise my arm above my head. I just did it right now, but I can tell you it’s because my inflammation is so much lower. It’s not like I take CBD and I’m like, oh, I could do cartwheels now. I don’t feel like a billion bucks. The difference is when I’m sitting here talking with you, I can raise my arms, whereas if I’m not taking it, oh boy, that would probably cause me pain for about two to three days.
Tim Pickett:
It is going to be different for chronic pain. It’s going to be different for acute pain. One thing that I really noticed recently with my, frankly, with my back injury, is you have … Let’s talk about chronic pain for a minute and then acute pain. With chronic pain, I like to have people learn how to low dose or microdose more consistently and then use inhaled methods on top of their low dose because it gives you a more therapeutic, kind of tends to give you more therapeutic effect. The microdose may be at the head change level or below and so just enough maybe disassociation that you know it’s there or, like Blake said, maybe you can raise your shoulder. You don’t feel high, and there is THC on board. It’s disassociating you from your pain, but you don’t know. It’s not enough. It’s enough to reduce your symptoms, but it’s not enough to get you high. That’s ideal.
Blake Smith:
Yeah.
Tim Pickett:
That would be ideal.
Blake Smith:
Yeah. One of the coolest things about THC Delta-9 as a pain reliever, especially for acute use, is like you get a root canal, for example, and they traditionally would give you codeine or whatever it is. What really just needs to happen is basically, you’ve just had your jaw punched a bazillion times. You just need to heal. That’s all that really needs to happen there. You don’t. And so you need some time-
Tim Pickett:
You need time. You need time to heal.
Blake Smith:
That’s right. You just need to heal. Okay. Rather than being loopy with your codeine or something like that, we’ll just go ahead and disassociate using some THC, which is not as much as you have to take on the codeine side. It doesn’t have the negative effects, and it can get you over that acute pain pretty quickly. It’s really a kind of a cool way to think about it.
Tim Pickett:
This is exactly what happened to me with my back 10 days ago. I mean, you lock it up and there’s healing that needs to take place. There’s anti-inflammation that needs to take place. In my case, there was prednisone involved to try to really lower that inflammation and get that going. There was a significant amount of and there was a lot of discussion with a couple of other providers about this, but there was a lot of THC use because really, what I needed was time. I needed muscle relaxation and I needed time. Me personally, I tend to be a person who’s very, very motivated to get a lot done, so it is extremely hard for me to lay in a bed all day long for two or three days. It really takes some disassociation in order to do that for me to kind of keep me down.
Blake Smith:
Yeah, and it’s more effective to use an indica-like strain so that you want to sink into your couch versus wanting to go do pushups. Right?
Tim Pickett:
Yes.
Blake Smith:
Sometimes, you’re going to want to disassociate, but still have to get up and run around and do stuff, and so that’s one type of sativa-like strain you would want. Then there’s other times you literally just need to be in bed and sleep it off, so let’s get you sinking into your couch. That’s why there’s two ways to kind of think about using the different types of sativa versus indica.
Tim Pickett:
And that comes to, really, product selection. There’s going to be products that are going to be better for chronic issues, some better for acute issues. Obviously, pain can be mechanical, can be in the gut. There’s all kinds of places it can be. That’s where we try to, we, as providers, and Blake, as a producer, he’s trying to design products that are specific for specific conditions or specific types of pain. I’m trying to figure out with the patient, listen to the patient. What type of pain is it? Where is it? What do we know about the cannabinoids? What do we know about Delta-9, Delta-8? How can we build a product or how can we choose a natural flower that is going to help, help you get through, help you get more time, do more things, if that’s what, where you’re at in the pain cycle.
Tim Pickett:
I found that there was a couple of strains from local growers that I used a lot of that did not work near as well as when I switched to a Fatso or a Mad Max. It was really night and day, so in the physical therapy situation, it was very, very strain specific. If you’re using one strain, it’s not as helpful. If you’re using another strain, it is. Every strain is different for people. Temperatures seem to be a little bit deal, too. Not a part of this webinar, but …
Blake Smith:
Well, one of the things, if I can address, is I think this is super interesting, by the way, because if you go and look at the genetic profile of most flower that’s in the universe, the THC is always going to be somewhere within a couple percentage points one way or another. Really, the only difference is a couple percentage points on the terpene profiles, so what makes one more therapeutic than another?
Blake Smith:
Really, it has to do with those profiles and how you’re metabolizing those profiles. The reason why Mad Max, and I’m going to throw down with Mad Max because I like it so much. The reason why I like Mad Max so much is because it’s high enough in CBG that even if it’s not your normal strain that would help, like if you’re used to Dutch Treat, for example, or you’re into-
Tim Pickett:
[crosstalk 00:31:50]
Blake Smith:
… Golden Spike or something [inaudible 00:31:55] progeny, so-
Tim Pickett:
Did you see that?
Blake Smith:
I saw that.
Tim Pickett:
That’s Mac.
Blake Smith:
If you’re using those and those are usually helpful for you, they don’t typically have much difference in the profile. Mad Max, specifically, always has somewhere between 6% and 8% CBG, so I know it’s going to lower inflammation. Now, it may not be enough to fix you, but I know you’re at least going to get an anti-inflammatory effect from it. That’s why I like that strain so much. The Fatso is really high in caryophyllene, which makes sense of why that one is usually quite therapeutic. Anyway, that’s kind of the thing. It becomes hard to find your right thing, but there are some ways to sort of tip it in your favor, right?
Tim Pickett:
Yeah.
Blake Smith:
Get out your [crosstalk 00:32:45]-
Tim Pickett:
When you’re going to the pharmacy, you’re trying to choose. Sometimes, it’s choosing an eighth of two different things and then going home and trying them both. Sometimes, it’s mixing them and that can be a thing. For when it comes to flower, it’s a journal. It’s a journal issue. It’s what did I take? How do I feel two hours later? What did I take? How did I feel two hours later? Then you can go back and you can look at the profiles a little bit more and you can make a little bit better … You can tip the scales even more in your favor when you choose new strains because there will always be … I’m talking to Brandon at Two North and there will always be strains that come and then eventually, the mothers, the genetics will change. The mother will change maybe. I don’t know. The genetics are going to change just a little bit through time, I feel like, with flower. Would you agree with that, Blake?
Blake Smith:
Yeah, absolutely. That’s one of the main reasons why almost every flower that’s out there is a hybrid now There’s very few true sativa or true indicas. You’re getting an indica or a sativa experience based on the terpene profile, but yeah, true, unique by themselves strains sort of don’t even exist anymore.
Tim Pickett:
They don’t, and they just don’t last forever.
Blake Smith:
That’s right.
Tim Pickett:
I mean, the plant eventually won’t … The mother eventually will be discarded.
Blake Smith:
Yeah, that’s right. That’s exactly right. And if you’re treating your weed like the soup of the day, people are just cycling as many combinations as they can cycle as quickly as they can cycle it, just like I want to try Kitchen Sink. Next week, I want Donuts. The week after that, I want Cherry AK. The week after that, I want Fatso. That’s also a challenge because a lot of growers are cycling their flower so quickly because just trying to appeal to a taste or a sensation, like getting a new candy or a soda, which is awesome, in some ways, but it’s also like, well, if you found the right flower for helping a particular illness, you can’t find that flower anymore, it’s a problem.
Tim Pickett:
Right. Oral, I’ve chosen a couple of my favorites here. The Plush gummies I like because they’re a mix Delta-8, Delta-9 and so they tend to be a little less psychoactive, a little better in the GI system from a absorption standpoint. I don’t have experience with the fuel cubes, but have had a lot of people have good results with that.
Blake Smith:
I hear a lot of people like them. I hear a lot of good things about the fuel cubes. I think they’re probably a pretty cool product out there. I haven’t had any myself yet, but there’s time.
Tim Pickett:
There’s a lot of products.
Blake Smith:
There’s a lot of products.
Tim Pickett:
There’s a lot of products out there.
Blake Smith:
Yeah. It’s hard to get through them all.
Tim Pickett:
Then topical, I always go to the Sage balm, but I go to the Sage balm because it’s an ointment and ointments tend to stay on the skin longer, absorb longer. To me, it’s just a practical thing from a medical, from what we learned in dermatology, a cream or a lotion. It’s nice and it feels nice and it’s not greasy, but an ointment, eh, stays on longer. It’s going to absorb a little bit better and so it’s going to work a little better.
Blake Smith:
Yeah. Really, we have found now we have a lot of patients that use the Cypress Sage for foot pain because what you do is you slather it on your feet because your feet have a lot of callouses and so forth, so you’re having to get through a lot more skin in the feet, so a lot of topicals don’t really hit it the way that it needs to. Standard Wellness produces a pretty cool patch that works for certain things. The patch doesn’t work great on feet because it can’t get through. In the old days, we used to throw things like DMSO in with it, which makes you can bypass your skin and get right into the bloodstream using DMSO. DMSO is not healthy for you. It has some implications for your liver and some other things and so you don’t really want to do that. You get a thicker balm. You literally put it on your feet, put a sock over it, whew. You’re golden. It’s going to absorb. It’s going to make your feet feel better. We have a whole bunch of people that even have avoided bone spur surgery as a result of using the Cypress Sage balm.
Tim Pickett:
I’m so surprised.
Blake Smith:
Sorry. This is not designed to be a plug for my stuff [crosstalk 00:37:22].
Tim Pickett:
No, but topicals in general are surprisingly effective in ways that you don’t really think that they will be, like with back pain. Again, coming back to that, you think well, the muscle, the muscle belly is too big. It’s too deep. The psoas is too deep. It just works. Some things just work. Topicals just kind of, they just tend to work.
Blake Smith:
We have found also with menstrual cramping and so forth that a nice balm, especially with little CBN, is really effective at relieving pain there. I [crosstalk 00:38:01]-
Tim Pickett:
Whether it’s distracting or it’s working down into the tissues doesn’t really matter because it’s safe and it works. Some things just work.
Blake Smith:
That’s right.
Tim Pickett:
Okay. Let’s get to some questions. We have-
Blake Smith:
Four so far.
Tim Pickett:
I’d like to … Okay. Let’s look. Let’s look. We’ve had a little bit of chat discussion. I’m familiar with a little bit of the chat discussion. Let’s go with, okay. Terry. How long would it take for the cell to heal? I’m going to say different different times. Depends on the cell.
Blake Smith:
Totally depends on the cell. Typically, cells have different life spans. Blood replenishes within about 24 hours and so forth. Muscle cells repair pretty quickly because they have a lot of access to ATP and energy, plus, they have high oxygen rate. Typically, when you think about healing for cells, you’re looking at oxygenation is a huge part. Oxygen is a huge part of that whole process. That’s because of the CREB cycle and the citric acid cycle. Essentially, it’s the conversion into energy that’s important for healing mechanisms.
Blake Smith:
Protein is also important, areas that have higher amount of protein, so you have little, tiny machines, essentially. I mean, they’re little organs, but your endoplasmic reticulum basically chart out and make proteins and so you use amino acids to, basically, allow your endoplasmic reticulum to make proteins. Those proteins are essential.
Blake Smith:
When you have muscle, muscle has tons of endoplasmic reticulum. It has tons of mitochondria for producing energy. Muscle will heal quick. Nerve cells already are firing electricity back and forth. You don’t move a lot of excess energy into nerve cells. You don’t oxygenate nerve cells the same way as quickly, so nerve cells take a lot longer. Some cells heal really fast and some don’t heal almost. It takes really long periods of time.
Tim Pickett:
[crosstalk 00:40:07].
Blake Smith:
That probably was an unsatisfactory answer, but it depends on the type of cell.
Tim Pickett:
Okay. What if the pain is all over the body? To me, this is kind of the same question is how do you figure out what will work? I know they seem unrelated, but to me and the patient discussion, they’re related. You start from scratch. You learn how … Here’s what I would say. You need to know your lowest effective dose for a head change. That’s a dose that you absolutely need to know. You need to know kind of how many milligrams THC you can take orally and get a head change. That’s the threshold dose. That’s kind of the baseline. You want to stay with that. That’s a dose you can take very consistently and be very productive, not have a lot of psychoactivity, be very functional. Then you need to know your maximum dose, the dose at which you are-
Blake Smith:
Paranoid.
Tim Pickett:
If you take anymore, you’re going to get paranoid, right, the maximum dose of THC that you can have. While not everybody needs to know that dose, it is helpful when you’re trying to create a therapy for somebody with pain all over the body or trying to figure out what will work. You need to know that. Then for me, it’s going through what Blake said earlier, which is try to tip the scales. Use the pharmacist. Use the Q and P, the provider, to try to choose products that maybe in that window, and then you’re keeping a journal.
Blake Smith:
Yeah.
Tim Pickett:
That really is kind of a practical answer. It’s not really cannabinoid or a terpene answer. It’s just practical.
Blake Smith:
One of the reasons I like doing this with you, Tim, is because your answer was spot on and really practical. I tend to go off into these weird tangents, which I’m about to do.
Tim Pickett:
Lay it on us.
Blake Smith:
When you think about whole body pain, you need to actually affect the central nervous system. It’s different from putting a balm on because a balm is acute. It’s going to fix your joints in the area. It’s going to fix your lower back for arthritis. It’s going to fix things locally. You need to affect endocannabinoid receptor system, one, and you need a full across the blood-brain barrier to affect the entire system for whole body pain. That’s the only effective way to start thinking about this because you need to actually start shifting the way the body is thinking and dealing with the pain structurally across the entire organism versus just something that you’re fixing in an area.
Blake Smith:
I also like layering. You talk a lot about this, Tim, and I agree with you on this one a hundred percent, layering your products. I take a tincture before bed. I wake up the next day. I take my gummy or rub, vice versa, whatever it is. Then all of a sudden, I’m at work and I feel like I’m going to die. This is now an inhalation method or this is now I’m going to dose again. It’s that’s to get immediate relief, but I’m keeping the normal under control through my daily ritual of taking something. That’s my response.
Tim Pickett:
We’re going to get to more questions. We kind of answered this question earlier. Can topicals help with deep tissue pain, and for some reason, for some reason they do. Blake can’t tell me the mechanism because you can’t get it deep enough. You cannot get the THC deep enough in the tissue, but it works.
Blake Smith:
So I don’t fully know the mechanism, but I do know this. There’s cellular to cellular communication and if one cell is in pain and the cell right next to it has been relieved, the one that’s relieved says, “I’ve been relieved. I don’t have a stress response anymore.” That tends to calm down the cells that are next to it, as well. For treating, I only have to get to a nerve cell to start treating it with cannabinoids and nerves are about an eighth of a millimeter in, so I’m not going to, to your point, Tim, and I agree with you. If I’m trying to hit my glute or something, I’m not going to get deep enough. I don’t really need to get all the way to where my muscle is hurting on my quadriceps. I only have to get to the nerves around the quadriceps to start downregulating the pain response. That seems to be one-
Tim Pickett:
I’m learning something right now. This is interesting, and it makes a lot of sense.
Blake Smith:
Yeah.
Tim Pickett:
This is besides the mechanical help that you’re getting really from the massage of rubbing in the topical, too. Touch is a very powerful healing tool, as well, and so if you can combine the cellular communication things with the natural product and you don’t have to get high, why not?
Blake Smith:
Yeah. I like topicals a lot, and plus, they last a long time, so you’ll go and you’ll buy one. They’re a little bit pricey, but they should last you 3/4 of a month or a month and so you’re not buying them. Most of the people I know who are buying flower are buying flower every week, sometimes multiple times. I don’t have to do that with tinctures and balms. Typically, those will last me a month.
Tim Pickett:
Next question is, let’s see, we’ll go to-
Blake Smith:
Can you get a card for migraines as in the slide? Can you do-
Tim Pickett:
As in the slide?
Blake Smith:
Yeah. You’re the guy on that one. You know better than I do.
Tim Pickett:
Okay. In Utah, qualifying under the pain qualification, I wrote an article about this in 2020, in the very, very beginning when we were starting out, so pain lasting longer than two weeks that is not well controlled with a typical medication. Every provider is going to have a little different approach for this and with migraines, if you have migraines and you’ve been diagnosed with them and tried some medications for them and they’re not working and you want to try cannabis, then we look at well, do you qualify under the pain? Are you missing work for a migraine? Do these migraines bother you over and over and over in a pattern?
Tim Pickett:
Then most providers, myself included, I would say, “Look, yeah, that’s a chronic pain issue.” It’s pain. It lasts longer than two weeks, and it is not well controlled. We are, with migraine patients, we’re trying to use indica and hybrid medications, trying to stay away from sativas. Inhalation methods tend to work. A lot of CBD sometimes helps, but technically, migraine is not a qualifying condition in Utah, but pain is a qualifying condition.
Tim Pickett:
Let’s see. What would you suggest for a very busy, active person who has been diagnosed with chronic back pain, with the only solution being pain management for during the working day? Easy at night.
Blake Smith:
Can I make one quick comment about migraines?
Tim Pickett:
Yeah.
Blake Smith:
We have found it’s pretty effective, actually, to take like the Cypress Sage balm or an equivalent topical. You put it right at the base of the skull right here, rubbing on when because most people can feel them coming on. You start getting your tunnel vision and you can feel it happening, so you put the topical right there. You also put a little bit right across your forehead. Go into a dark room. Sit and close your eyes for about 15 minutes. We’ve had a lot of success on people arresting or stopping their migraine from starting because what ends up happening a lot with migraines is you get tons of vasoconstriction. You get optical restriction around the optic nerve and so getting stimulation for all your senses down won’t cause as much energy influx in the head, so you’re going to want to take all of that down. Then the balm, the topicals in those areas will help relax blood flow and everything within those areas and so it’s an effective way to think about migraines.
Tim Pickett:
Great recommendation, Blake. Okay. Excuse me.
Blake Smith:
Very active person.
Tim Pickett:
Active chronic pain person. It feels like I’m talking to myself.
Blake Smith:
Teresa is running around everywhere. Can’t stop.
Tim Pickett:
Running everywhere.
Blake Smith:
Just going crazy.
Tim Pickett:
Got running shoes on all the time, all the time. Yeah, what are you going to do? So this is where I layer. This is where layering comes in big time because you want, first of all, I feel like you want CBD at a milligram per kilogram. Take the pounds you weigh. Divide it by 2.2. You need that much CBD every day. That’s where I would start. Then I would layer a oral cannabis method with THC or Delta-8, Delta-9, whatever works better for you. I would put that at the threshold of psychoactivity or just barely below because on a scale of one to 10, 10 being maximum dose, three being where that head change is, I want you at a three or a two, 2.7, but I want you to take regular doses morning, noon, night. I want to make sure that those doses are pretty consistent. Then when it’s bad, then I can use an inhaled method on top of that and go up to seven or five or six.
Tim Pickett:
The three, this does a lot of things. The layering does a lot of really cool things. It keeps you at that level so that you’re using inhaled. You’re going up to the seven, but you’re only coming back down to the level three when that wears off, which it will do earlier than the oral. It keeps your inhaled methods down over your lifetime, so you’re inhaling 10, 20, 30% less over your lifetime. Your lungs will thank you. You won’t get COPD and chronic bronchitis from. Not that you will, if you’re not using a lot, but the inflammation in your lungs will be less.
Tim Pickett:
That low threshold tends to be something that patients get used to. They don’t have the psychoactivity, but they keep the therapy. A lot of patients can continue to use the same dose for two to five years. I have a patient that has been using the same dose for five years for his chronic pain, same dose.
Blake Smith:
Tim Pearl asked earlier, too, was asking about well, does your tolerance always go up? It doesn’t have to. It’s only when you keep stimulating and taking more that all of a sudden, you’ll start noticing tolerance changes. If you find an effective dose, that will stay effective as long as all things being equal don’t change. Right?
Tim Pickett:
Mm-hmm (affirmative). Yup.
Blake Smith:
The other thing I would just … Tim, you’re so smart at all of this stuff. I mean, you are exactly right. I will say this. I have lower back pain. I have arthritis in my lower back. After sleeping in the same position for multiple hours and I need a good sleep and so I will often take CBN or something and knock myself out. Then I wake rested, but my back is so stiff, it’s hard for me to move out of bed. I have a topical by the bed. I put it on a little bit in the morning and within 30 seconds to a minute, I can move out of bed and I can move for the day. Then I layer on top of that.
Tim Pickett:
Hmm. That’s a great idea. Let’s see. We’ve got a stage four metastatic pancreatic cancer. What can I use for abdominal pain? I don’t know about you Blake, but this is one of these specific conditions where you go no holds barred.
Blake Smith:
Yup. I agree.
Tim Pickett:
You go all the way. We’re going to jack up the CBD dose, if we can tolerate that. We’re going to do oral methods consistently through the day. We’re going to learn what’s good in the daytime, what’s good in the bad, what’s good when I have a really bad day, what’s not. Then I’m going to layer on not only flower, potentially, but I’m going to layer on even concentrates.
Tim Pickett:
Here’s where, before we get too far into the discussion, because I know you want to add to this, here’s where tolerance to me, it becomes a little different discussion. I want to build up tolerance here because I’m not so concerned about using more and more and more because we have metastatic pancreatic cancer. The reality is there, right? What we want to do is we want to have a high enough tolerance that we can use a lot of cannabinoids because I now think I need to load this person up with cannabinoids. I need to be getting a lot of milligrams of cannabinoids in this person to help.
Blake Smith:
Yeah. Tim, I am a hundred percent in agreement with that because most people who have pancreatic cancer, it’s not whether or not you had a good day or a bad day. I either had a bad day or I had a worse day and so really, it’s no, I agree with you. There’s no holds barred. You want to build up a tolerance to multiple cannabinoids and you want to hit it with everything. Unlike certain types of cancer, we have not seen cannabis directly solve that as a cancer issue. There are some implications that cannabis can help with certain types of cancer. Pancreatic cancer has … I’ve heard of people being healed, but there’s not a lot of data to support that. There’s pretty good data to suggest that CBG helps with glioblastoma in the brain. Pancreatic cancer, you need relief to enjoy your life, what life you have left, and so you do what you got to do. Your doctor should [crosstalk 00:54:57].
Tim Pickett:
Yeah, and this is where journaling is important because if one strain is not working, you need to discard it and move to another strain. If one product isn’t working, you need to either increase the dose. This is where you’re really trying to get religious about it. Get technical about it, I think, too, because some things, there’s going to be some strains that help with appetite more than others and finding those might be helpful during the day. Then at night, other products. I also put a plug in for RSO here, true RSO, because I think for some reason, there’s something to the whole blend up the whole cannabis plant kind of mentality.
Blake Smith:
Yeah. I agree with that, too. Really, Delta-8 may be helpful taking the edge off, too. If we’re talking about specific products, Delta-8 may help taking the edge off. It won’t be sufficient for all your pain, but at least it will start that process because Delta-8 will just give you more of a body high than a head change. In the trunk, you have a high absorption rate of cannabinoids and so I like Delta-8 in those circumstances.
Tim Pickett:
But excellent question. Okay. We’re available for this type of discussion outside of the webinar series. Okay. Colin asks non-psychotropic cannabinoid cartridges. Yes or no? No question a CBD, a heavy dose of CBD vape cart helps immensely. It’s like topicals to me. I’m just surprised at how effective they are when you use a straight CBD product or a CBD-CBN-CBG. There’s more and more of these good products on the market. I’d say yes.
Blake Smith:
Yeah, so yes, definitely. Be careful where you get it.
Tim Pickett:
There’s a bill on the hill. We don’t want to go down this rabbit hole, but you’ve got to-
Blake Smith:
You’ve got to be-
Tim Pickett:
I can give you two products I carry. I know where it’s made, the cartridge in Logan. I know where your tincture is made and grown. Just limit yourself to good, reputable products, adequate testing.
Blake Smith:
You have to.
Tim Pickett:
Yes, especially with inhaled and especially with cartridges.
Blake Smith:
Especially with cartridges. Trust who you have making them.
Tim Pickett:
Yes. Yes. Okay. What if you can’t get the same product? Yup.
Blake Smith:
Okay. Here, I can answer this from a Zion perspective. If it’s a Zion product and you can’t seem to find that same Zion product, literally just email the company. If it’s a product that we have that worked for you, but for some reason we discontinued, I will make it just specifically for you. Tell me what pharmacy you go to and I will ensure that they always have that product for you, always. I can’t offer that for everybody else. I can offer that for Zion products because we typically don’t phase out a lot of our products very often and so because when you make a medicine, people become reliant on that medicine, so you always have to have it available.
Blake Smith:
That’s actually a good indicator about companies in general. I don’t just mean Utah. I just mean in general in the universe. If somebody is changing their product so often that you can never find the same product repeatedly over and over and over again, they’re not doing it from a perspective of trying to make a medicine for somebody to have for the rest of their lives and so make it.
Tim Pickett:
He [crosstalk 00:58:57].
Blake Smith:
Send an email that is strongly worded email that says, “Hey, I use this for medicine. Keep making it.”
Tim Pickett:
Yeah. Okay. Last question, and a difficult one. This is a patient. I know specifically the patient. If the Delta-8 is causing vertigo and headaches, this is a patient with a lot of chronic pain, lot of chronic abdominal pain, flares. It comes and goes, but it’s hospitalizations, that type of thing, so if I change to a different, but the Delta-8, so we talked about Delta-8, recommended it. For some reason, causing vertigo and headaches.
Tim Pickett:
Here’s my question. I don’t think we’re going to get to a great answer on this tonight, but I guess I could generalize it for the rest of the audience here a little bit, too, is when you have a chronic pain issue and the products that you’re trying to take are causing a side effect that you don’t love, that is, it’s causing a problem and you can’t get through the side effect to get the relief, what do we do? I think that really is more of the question here, like we have this problem. We think we’re leaning, we’re again, tipping the scales to products that we want, we think are going to help based on what we know, but we’re getting a side effect that we can’t get through. So what do we do?
Blake Smith:
Yeah. My initial gut, man, I would love to know what the product is and the administration route is the first two things I think of because a lot of times, I’ve heard this specifically around vape carts, around Delta-8. Sometimes, I’ve heard people getting vertigo from an inhaled method of Delta-8, but they don’t seem to have the same problems with like a gummy with Delta-8, so I’d want to know the route of administration. Also, the product in particular, because it could be the terpene combination or if somebody’s using botanical terpenes, not … By the way, I’m not against botanical terpenes per se, but it may not be the right thing. Also, if you don’t know where they’re being made, so it looks like try gummies, tincture, and capsule. Do we have Delta-8 capsules in Utah?
Tim Pickett:
Mm-mm (negative). I don’t think so.
Blake Smith:
Because if all-
Tim Pickett:
Oh, this is … I-
Blake Smith:
Oh, you’re in Colorado. Okay. I’m going to even take a couple steps back. This is the whole debate around Delta-8. Delta-8 is a cannabinoid that is an analog to Delta-9. It’s typically made the way most people make it is they take sulfuric acid or hydrochloric acid and they dump it into either CBD or Delta-9 and they start to force the bond to shift thermodynamically under heat. The acid serves a catalytic bridge to move that bond over, and then they either take the acid back out. They neutralize it. They should be washing it. There’s a whole bunch of stuff to do to clean that Delta-8 up. If they don’t clean it up, you can notice a lot of health implications around that. You can get vertigo. I mean, I have heard headaches. I’ve heard all kinds of things associated with that, so knowing your source and how they make it becomes really important.
Blake Smith:
Now, you don’t have to make Delta-8 that way, by the way. I’ll just speak for my own company. We use energetic oxygen, heat, and UV light, and you can still get the bond to move without having to use harsh acids to do that. I would try one from Zion or somebody else that’s local, where you know where it’s being made. I would try that first to see if it helps. If it does help and you don’t have the exact same experience, it tells you that your Delta-8 you were using before is adulterated. If you do use it and you get the same effect, what that tells me is we need to think about different forms or higher levels of Delta-9 with lower levels of Delta-8 so that you’re getting a masking of that.
Blake Smith:
I would continue to use Delta-8 if you need … If it’s giving pain relief and you find unadulterated and it works, that’s the right way to do it. If you can’t find unadulterated Delta-8, I would switch strains because if you don’t know how it’s being made and somebody’s in their garage with radiator hoses dumping hydrochloric acid in something, that’s sketchy. You need to be careful of that. That’s not the right way to think about it.
Tim Pickett:
And let me bring this back to medicine with the medicine that I was practicing before, which is to prescribe a pill. If you come in with a problem and I make a prescription, usually, we are taught that you should try three different medications, basically at least three, if the first one didn’t work, so we’re going to give one a trial. Then we might give a different one a trial, and we might give a third one a trial. In many cases, in some conditions, we’re trying up to five medications before we’re giving up on that even almost class of medication.
Tim Pickett:
This isn’t to say this is common. I’m not trying to dilute the issue, but this is it’s unfortunately kind of where we’re at is sometimes, these things take a while to figure out and again, why keeping a journal is probably a good idea. Trying multiple products is a good idea, but like Blake said, when anything you know about with Delta-8 is just such a controversial topic that you want to know. You want to know where you’re getting your products.
Blake Smith:
Yeah. I-
Tim Pickett:
And to Terry’s point, comment there, getting help for chronic pain is hard because providers are we’re busy. We’re impatient. You come in. We write your prescription. You’re out the door. Thank you for your copay. That’s just, we don’t like that. It’s the reason why Blake and I or part of the reason why Blake and I are in this.
Blake Smith:
Well, and this one, in particular, hits a home with me a lot because when we had the stuff going on with my daughter and thinking about what the implications of that are, when I went and got product from everywhere, I was getting inconsistent results, metals, pesticides, horrible chromophore showing up, all kinds of things everywhere, which is why I got into this in the first place because I decided I had to go just do this on my own.
Blake Smith:
I’ve been trained as a bioanalytical chemist. My background is bioanalytical chemistry and so I’ve been used to making medicine the way Tim is used to it in the pharmaceutical company. I’m like why can’t cannabis be the same way because that’s the thing that helps my daughter. I’m moving away from all this craziness. There are more producers of cannabis products in the US than most other businesses at this point, but you can’t trust 80% of them.
Blake Smith:
I do like medical markets a lot because medical markets typically are more tested and more rigorous than often adult use markets. That doesn’t mean there’s not good products there. It just means that typically in Utah, I’ve been audited. My company’s been audited by the state every week for the last, like, month and a half. Maybe it’s because they’re just really trying to find something wrong. The point is every single thing I make is tested. The state is in my business all the time and so you can trust it.
Tim Pickett:
Well, Blake, this has been a good discussion.
Blake Smith:
It is.
Tim Pickett:
I like this one. I think we’ve done a good job. Let’s see. How do we know-
Blake Smith:
There’s so many smart people who have been on tonight and so many people who are just so great. Thank you everybody for attending. I hope it was useful. If you have more specific questions, you can always come to Tim and if he needs [crosstalk 01:08:18]-
Tim Pickett:
Well, yes. One of the best ways to do this, too, is to go to Utah, is to go to the YouTube channel. In fact, we’re answering questions all the time. If you go to the YouTube channel on Discover Marijuana where this would be posted and you make a comment on one of those videos, you ask a question on one of those videos, we’ll try to answer it. That way, we can answer it for everybody and we don’t have to just keep the answer to ourselves and keep it secret just between us. I think that is probably the best way to get ahold of us. Subscribe to that YouTube channel. We really appreciate feedback that we’ve gotten tonight and Teresa, to your question, yes, all the pharmacies are selling mostly the same products. There’s a little bit of variation, but most are selling a lot of similar products from the same companies, all tested. Anyway, take care, everybody.
Blake Smith:
Thanks everybody.
