August 01, 2018

Where Science Takes Over

A conversation with Dr. Douglas Jorgensen of New England Sport and Spine



While the entry of GW Pharmaceuticals into the cannabis industry may have created a stir within some circles, the scientific research which is now taking place all over the world is not only changing laws, it’s changing perspectives. With thorough medical research into the various compounds provided by the cannabis sativa plant, many respected physicians and researchers are painting a very different picture of the herb than previously considered.

This week, CannabisTech had the opportunity to speak with Dr. Douglas Jorgensen of New England Sport and Spine, in Manchester, Maine. Dr. Jorgensen is a triple board-certified physician in Family Medicine, Neuromusculoskeletal Medicine, Osteopathic Manipulative Medicine and Pain Medicine. Additionally, Dr. Jorgensen’s involvement as a medical consultant in the medical cannabis industry may be helping to change the landscape of legal cannabis. By providing the science and technology necessary to provide the consistency and predictability in cannabis production, Dr. Jorgensen isn’t just optimistic about the future of medical cannabis but foresees vast improvements in the future of recreational cannabis as well.

 

Osteopathic Medicine and Cannabis

Dr. Jorgensen says he never opposed the use of medical cannabis in his patients, but the conundrum was the federal legality of the substance, so many times patients would have to choose between the care they were receiving at the clinic or cannabis because legally they couldn’t recommend it. However, with the data emerging from a 2014 study which reported a 25% decrease in heroin and opiate overdoses in states with cannabis legalization, along with more than a $162 million savings in Medicare drugs, Dr. Jorgensen strived to understand why.

“What we began noticing, is people needed a substitution methodology to have an efficacious change from a controlled substance to use a cannabis-based product.” As such, Dr. Jorgensen was compelled to further research."

Soon, Jorgensen started to see patients who were doing drug substitutions. “A woman in my practice was taking nighttime oxycontin for intractable pain… and she asked about cannabis… I helped her wean down, within a matter of 3 weeks she was only using cannabis, she was vaping at that point, and was able to come completely off her oxycontin,” Dr. Jorgensen explained.

 

The Problem with Plants

Jorgensen goes on to explain how dosing inconsistencies are the biggest frustration in recommending cannabis as an herbal substitution. Even with the most well-intentioned, well-run dispensaries, without plant-tissue cultures to clone the exact characteristics of the plant’s genetic profile, there will always be inconsistencies from plant to plant and ultimately in the end product.

Pointing out the lack of data, lack of research and lack of overall understanding of the plant has left consumers and physicians alike behind the 8-ball so to speak.

“I am optimistic,” Jorgensen stated. “We’ve been watching the walls come down, we are even beginning to get some queries from insurance companies and the prison industry, who are also interested in the drug cost savings seen in Medicare.”

 

Science Improves Recreational Use, Too

Consistency is important. Regardless of whether the consumer is a patient looking for symptom control, or the use is strictly recreational, consumers should be able to predict the outcome of consuming any substance. “If we have a martini or a glass of wine, the effect is predictable. Consumers should have the same confidence with a cannabis-based product.”

While many dispensaries are most interested in volume, Dr. Jorgensen predicts as the consumer becomes more educated, they are understanding there is a big difference between quality and quantity. Jorgensen goes on to explain, “The delta will become noticeable in a very short order. The science is here, the science is real, and we have a high level of specificity.”

Again, using alcohol as a reference, Jorgensen points out that vodka is a different product than Everclear for example. If someone orders three shots of vodka and is instead served three shots of Everclear, the outcome will likely be different than the consumer expected. From a patient perspective, this variable in cannabis could put someone’s health at risk.

 

Genomic Specifics = Effect Variables

Due to the variables in genetics, specifically in the production of Cytochrome P450 enzymes, each person has the potential to metabolize drugs, including the cannabinoids found in cannabis, differently. Through research, science has shown that when inhaled, THC travels to the brain more quickly. Yet, when metabolized through the gastrointestinal system, the rate at which the substance is metabolized is going to be dependent on the consumer’s own body chemistry and genetics.

Astonishingly, Dr. Jorgensen also suspects, these genomic differences in people may also be responsible for the handful of instances where people claim to get impaired from a pure CBD product. While mislabeling can definitely be part of the problem, others may actually experience a psychoactive effect due to CBD’s reaction with the backdoor activation of CB1 receptors in some individuals who have more active ion channels than others.

 

Subjective Experience

Because of these subtle differences in the chemical makeup of each individual, Jorgensen reminds finding the absolute right combination of compounds is going to be a very subjective experience for the patient, and there may be a fine line between a comfortable, euphoric experience and over-consumption which can lead to a very uncomfortable experience for the cannabis naïve person.

“The type of product, or the source of the product, and/or combined with that person’s genetics. That is the variable that people just kind of have to figure out. But the lack of specificity in the product is just one more variable that we shouldn’t have.”

Jorgensen predicts products will eventually come in 2 to 2 ½ milligram increments to meet the specific needs of each individual. In doing so, the only variable consumers need to learn is their own genetics, which is going to be purely experiential.

 

A Cannabis Substitution

While the opiate epidemic is at the forefront of cannabis legalization, Jorgensen explained there’s a bigger problem looming which hasn’t received much attention. Although withdrawal from pain medications is horribly uncomfortable and may make the patient feel as though they are dying, death from withdrawing from pain medication is very rare. On the other hand, benzodiazepines are widely prescribed, they easily create a physical addiction which leads the body into demanding more of the drug, and withdrawal from benzos can be deadly. Since the majority of benzodiazepines are prescribed for anxiety or stress, Dr. Jorgensen believes CBD is a promising substitute because it doesn’t create the “I need more” effect and without any signs of physical addiction.

Jorgensen stated, “Nearly all drug overdose deaths involved benzos and something else… it was never ‘just’ heroin, or ‘just’ pain meds or ‘just’ alcohol. Benzos are one of the least regulated, but most dangerous drugs in the country.”

 

CG-Bio Genomics

Today, Dr. Jorgensen is focused on a new venture in cannabis with CG-Bio Genomics. Working with Dr. Dustin Sulak, who opened one of the first cannabis medical practices in the state of Maine, they were learning together and sharing patients.

 “The really interesting thing was to watch these patients who were coming back from Memorial Sloan Kettering, coming back from Duke, coming back from Dana Farber, being told ‘You’re going home to die,’… yet several of them came back in complete remission.”

He continued, “I sort of had a ‘whiskey-tango-foxtrot’ moment, going how did that happen?!”

Today, CG-Bio Genomics has two patent-pending products, one for pain and one for cancer. While they don’t want to make claims about the benefits presented by their products, anecdotal stories are quite promising.

Cannabis consumers, regardless of their intent, can be thankful for physicians and researchers like Dr. Douglas Jorgensen for clearing the air and presenting a safer, more educated approach to using cannabis with intent. Despite keeping their process relatively quiet in the recent past, patients can look for more from CG-Bio Genomics in the near future. A new website at CGbiogenomics.com is in the works and will be published very soon to help bring further insight to consumers and patients.