Dr. Justin Marchegiani and Dr. Rachna Patel talk about medical marijuana. Learn more about this drug as Dr. Patel, an expert in medicinal marijuana, shares her knowledge about it, including its types and chemical composition. Understand its uses, benefits, as well as the side effects on different medical conditions like cancer, epilepsy and autoimmune diseases.
The medical marijuana industry has evolved through the years. At present, there are different delivery methods and formulations available. Even options like sugar-free, gluta-free and vegan alternative are now available. Click on the podcast below to find out more about this.
In this episode, we will cover:
5:14 THC vs CBD types of Marijuana
8:47 How to use marijuana and delivery mechanism
15:23 Side effects and addiction of marijuana
19:22 Recommendations on how to obtain marijuana
25:48 CBD vs. THC Strains
Dr. Justin Marchegiani: Hey there! It’s Dr. Justin Marchegiani. Welcome back to Beyond Wellness Radio. Today, we have a great guest, Dr. Patel. She’s out in the bay area. Where you up in the Vallejo?
Dr. Rachna Patel: In uhhmm, Walnut Creek.
Dr. Justin Marchegiani: Walnut Creek. Awesome. Great, yeah. You went to uhhmm Med School in Vallejo, Vallejo over at Touro, correct?
Dr. Rachna Patel: Yep, yep.
Dr. Justin Marchegiani: Excellent. Dr. Patel is a expert on medicinal marijuana, so we really look forward to kind of diving into all the key topics in and around that – side effects, benefits, well THC versus CBD. We’ll run the gamete today, and go over all this area. So, Dr. Patel, how are you doing today?
Dr. Rachna Patel: Good. I’m doing really well.
Dr. Justin Marchegiani: So, what did you have for breakfast?
Dr. Rachna Patel: For breakfast, I had uhhmm a protein bar, uhhmm and a glass of half and half.
Dr. Justin Marchegiani: Got it.
Dr. Rachna Patel: Kind of an unusual breakfast.
Dr. Justin Marchegiani: Got it. Okay. Today I’m having a little smoothie here.
Dr. Rachna Patel: Okay.
Dr. Justin Marchegiani: My wife made it with some collagen. So…
Dr. Rachna Patel: Oh.
Dr. Justin Marchegiani: …about 20 grams of protein and a lot of vital nutrients. I’d, we started to juice some beets ‘cause the beets are really high in NO2. You know uhhmm took really good…
Dr. Rachna Patel: Okay.
Dr. Justin Marchegiani: vessel dilator, helped the blood flow so my brain is ready. So let’s dig in.
Dr. Rachna Patel: Okay. Alright. Let’s go.
Dr. Justin Marchegiani: So, tell me a little more about yourself. How did you get into this field? During the pre-interview, we kinda talked about it a bit. How did you find your way around this field? And uhhmm… Yeah, we’ll start there first.
Dr. Rachna Patel: Sure, so, uhhmm, basically, I happened to found an ad on Craigslist that said, “Medical Marijuana Doctor Needed.” Uhhmm, and uhh at this time I was uhhmm training in emergency medicine. And as I was going through my training, uhhmm some interesting things were coming up, well, not-so-interesting.
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: But, basically what was going on was that I was seeing a lot of overdoses uhhmm on OPD’s. Whether they were intentional or unintentional. Then the other thing I was seeing is that what has started of as a prescription for patients turned into an addiction for patients. So, these patients will then come into the emergency room and uhhmm uhh uhh try to finagle a prescription out of, out of, out of doctors…
Dr. Justin Marchegiani: Totally.
Dr. Rachna Patel: …just to feed their addiction.
Dr. Justin Marchegiani: Totally.
Dr. Rachna Patel: Then the other thing is that uhhmm, I also did some toxicology rotation. And uhhmm, the, the sole purpose of this rotation was to treat overdoses mainly on prescription medications but also oh uhhmm over-the-counter medications as well. Okay, so as a doctor, uhhmm I uhh uhh really this is all sitting really heavy with me. Uhhmm, because my ultimate purpose as a doctor was to impact lives, to change lives, uhhmm uhh, in a good way. And, and instead what I was doing was essentially handing out prescriptions to kill. Uhhmm, and then seeing the aftermath of it, and having to treat the aftermath of it.
So when I, when I hopped on this ad, it definitely peaked my curiosity ‘cause I hadn’t known at that point that this field existed. And, uhhmm, started looking into the research and was definitely compelled by the standpoint of, of, of medical marijuana treating chronic pain. Uhhmm, so then what I did was, uhhmm, a year later after going through all the research, I then decided to work at a medical marijuana clinic ‘cause I wanted to gain clinical experience. Uhhmm, and, and that’s pretty much how the whole journey started about, about half a decade ago.
Dr. Justin Marchegiani: Excellent. So, with your experience with medical marijuana, imagine, you’re probably making couple of recommendations, like THC versus CBD types of marijuana. Can you kind of just differentiate the two – the Tetrahydro Cannabis versus the Cannabidiol. Can you talk about who you’ll recommend what strand to? Maybe there are other strands that you are used to that other listeners aren’t.
Dr. Rachna Patel: Yeah. So, uhhmm, marijuana makes mainly two different types. Well it makes a whole bunch of different chemicals – Cannabinoids. But it makes two types, types of chemicals in high concentrations. And that’s the THC and the CBD that you’re referring to. Okay. Now, THC is a psychoactive compound that typically what causes the high. Okay?
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: CBD, uhhmm, is non-psychoactive. Doesn’t, doesn’t cause any sort of high. Now, in, in terms of uhh combinations of chemicals, it really varies by medical condition. Okay?
Dr. Justin Marchegiani: Uhhhmm.
Dr. Rachna Patel: So, may I give you a couple of examples.
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: Someone with multiple sclerosis. Mainly what they suffer from is a lot of spasticity. They get, they get… Basically, we think of a Charlie horse times a hundred. So pretty painful experience. Uhhmm, and so, uhh, fo-for them, higher amounts of CBD are very helpful because CBD is an anti-spasmodic. Okay? Now. Uhhmm, uhh, I don’t know if you used marijuana but or if you know that marijuana typically has, has this, uhhmm, uhh, uh, uh, forget what the, what. I don’t know what word I want to use. But basically one of its, one of its characteristics…
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: …is that it causes the munchies. Right?
Dr. Justin Marchegiani: Yeah, exactly.
Dr. Rachna Patel: Well, that is actually beneficial in for instance cancer patients…
Dr. Justin Marchegiani: Right.
Dr. Rachna Patel: …under chemotherapy. Okay?
Dr. Justin Marchegiani: When I have lots of nausea without getting enough good ca…
Dr. Rachna Patel: Right.
Dr. Justin Marchegiani: …calories in there could be cancer. And then, yep.
Dr. Rachna Patel: Yeah. So in those patients they benefit more from high amounts of THC ‘cause this tends to stimulate appetite. And then there are conditions that benefit from both. Those are mainly uhhmm inflammatory conditions like uhhmm, like uhhmm, like uh, psoriasis for instance. Uhh, a big component of psoriasis, autoimmune conditions, are inflammations. They tend to benefit from those. So it really depends uhhmm on the medical condition that you have, as well as the combination of medical conditions that you have.
Dr. Justin Marchegiani: Got it. With THC, I really haven’t done marijuana about much of my past. I mean, I’ve done it a few times. Maybe the last time I did it was maybe ten years ago. Now, the biggest issue with me and marijuana is that it makes me tired and gives me the munchies. So I mean…
Dr. Rachna Patel: Okay.
Dr. Justin Marchegiani: all the scrappy foods that I’m feeling really fatigue. So, obviously, you know, we look at who we recommend it for. There should be a specific condition like you mentioned the CBD like really good for epilepsy. Uhh, I have patients to do some of the CBD oil or some of the CBD tinctures and it does great for joint pain and just chronic pain issues.
Dr. Rachna Patel: Okay.
Dr. Justin Marchegiani: So, the THC patient, you mentioned the cancer. It makes sense because of the low appetite. Right, the, the cachexia from the cancer and such. They need to get mo-more calories into… The THC makes sense.
Dr. Rachna Patel: Yeah. Right.
Dr. Justin Marchegiani: Is there are any other recommendations for people that benefit from THC aside from the cancer patients?
Dr. Rachna Patel: Uhhmm, uh, yeah. So, like I said, uhhmm, some, uh, autoimmune conditions do benefit from uhhmm…
Dr. Justin Marchegiani: So, autoimmune with the THC too?
Dr. Rachna Patel: Yeah, yeah. And as well as, uhhmm, patients that, uh, uhhmm, that are suffering from uhhmm, Fibromyalgia, as well. Okay. Uhhmm, I’m trying to think what else..
Dr. Justin Marchegiani: Did you try the CBD as well for those patients? Do you find the CBD is as effective or do you see the THC is still being better for some of those patients?
Dr. Rachna Patel: So with autoimmune conditions in general, I felt that uhhmm you need both. Uhhmm, same with Fibromyalgia, you need both. Uhhmm, so, uhh, so, it’s just gonna depend on, on the medical conditions, specifically…
Dr. Justin Marchegiani: And what’s the delivery mechanism because you know when you’re smoking, you’re getting the amine {hydrolystic} amines and the polyaromatic hydrocarbons in the incineration of the paper in the marijuana.
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: What do you recommend. You do like uhhmm tincture? Do you put it in foods, edibles? Do you do it in a vaporizer? How do you recommend the delivery?
Dr. Rachna Patel: Okay. So, delivery method. Again, in some delivery methods were better for certain conditions than others. Uhhmm, at, there’s a wider variety of delivery methods now. Typically, I don’t recommend that my patients smoke, okay, ‘cause long term it does do damage to the lungs. Okay?
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: Uhhmm, so, but other methods include tincture, which are drops you put in your tongue, there are also topical formulations that you can apply to the affected area on the skin and anything that’s affected beneath, beneath it. Uhhmm, uhh, you can also, let’s see. What else is there’s rectal formulations, there’s vaginal formulations. Uhhmm, there are, uhhmm, uhh, there’s edibles as you mentioned. Mainly what you’re gonna find are, are gonna be chocolates and gummies. But what’s interesting is that the industry has evolved, because now we are also are finding gluta-free options…
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: …and sugar-free options and vegan options as well. So a wide variety of options available to patients. Vaporization is another alternative to smoking. It’s a method of inhalation. So, uhhhmm, so it’s really, again, just gonna depend on uhhmm the medical condition. Uhhmm. Because a lot of main differences is that uhhmm how, how long it takes for these methods to take effect, how long there uhhmm. ‘Cause with each method, what mainly varies is how, how long it’s gonna take to take effect and also how long it’s lasting in your system. So, all of that can play into what’s gonna work well uhhmm for your particular medical condition.
Dr. Justin Marchegiani: Generally speaking, what are like, let’s say, the top three. I know, I know it’s condition-specific, but would you say…
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: …tincture uhhmm kind of a, a uhhmm, vaporization mechanism, or cream. What are the top three would you say that you actually recommend most of the time?
Dr. Rachna Patel: Top three?
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: Uhhmm, top three, uh, uh, uhh ingestion?
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: Sublingual, so under the tongue?
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: And uhhmm, uh, uhh vaporization. Those are the top three.
Dr. Justin Marchegiani: In sublingual, is that be like alcohol dropper or is it glycerin, what’s the mechanism?
Dr. Rachna Patel: It could be glycerin, alcohol, or sometimes they even use oils.
Dr. Justin Marchegiani: Okay.
Dr. Rachna Patel: …as a, as a base. Yeah.
Dr. Justin Marchegiani: Cool. Very cool. So we have the THC. We kind’a have the CBD, right? I’ve…
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: seen a lot of patients but the CBD is not, not gonna be, not gonna have the psychoactive components, correct?
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: So you gonna have to operate, drive a car, do things like that, that may…
Dr. Rachna Patel: Well…
Dr. Justin Marchegiani: No or yes?
Dr. Rachna Patel: Well, I still wouldn’t recommend uhhmm, uhh, uhh, uhh driving a car. Or, or operating heavy machines..
Dr. Justin Marchegiani: So any, any type of marijuana, even if it’s non-psychoactive,…
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: you still don’t wanna like drive…
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: or operate heavy machinery.
Dr. Rachna Patel: Yeah, ‘cause it’s still impair your coordination. It’s dose-dependent, so I tend to err on the side of caution. “cause if you overdo it, it could potentially impair coordination. It’s just like alcohol, right?
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: You have a glass of wine versus you have yo-you know a case of beer. Uhhmm, i-it’s that sort of thing. So, I tend to err on the side of caution. Now, another important thing to keep in mind is that uhhm, uhh, the way the laws are established in most states is that uhhmm, uh, uh, if marijuana is found in your system, uhhmm, uh, and you’re, you know, driving, you know, carelessly, then that is a potential, uhhmm, uhh, probable cause for a DOI.
Dr. Justin Marchegiani: Exactly. I quite haven’t figured out the best way to test it. there are some salivary test that are starting to come out with a contested acuity , right?
Dr. Rachna Patel: Yeah, well, uhhmm. W-Wha I-i-i-i-i-it’s over preliminary ‘cause here’s the thing with marijuana. It lasts in your system. It’s a fat-soluble compound so basically, uhhmm, uhh, it gets stored in the fats in your body. So, what’s, what’s difficult is that with, with alcohol you can tell. You know that somebody used it within the past couple of hours.
Dr. Justin Marchegiani: yeah.
Dr. Rachna Patel: That’s the case of marijuana. You could’ve used it, you know, like 45 days ago, and it’s still present in your system.
Dr. Justin Marchegiani: But it’s gonna build up so if you’re using it more, acutely… Let’s say you used it in a while, it won’t last more than a few days, correct, versus chronic user it could lasts up to a month?
Dr. Rachna Patel: It, you know, it all depends…
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: …it depends on how you, a lot of it comes down to how you’re processing these chemicals and how you’re processing fats. And as you know, we all process fats differently. Some of us tend to hold on to our fat cells uh, uh, uh, more strongly than others.
Dr. Justin Marchegiani: Got it. I see like…
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: Geogorian being like proponents of like marijuana. He seems to think it’s a safer, like regarding behind the wheel and such. I’ve read some of the studies looking at reaction time of marijuana. And there’s like, there’s good and bad. There are some that say it’s no problem. Others that say uhm, it’s just as bad as alcohol. Some say it’s really dose-dependent, dose and time-dependent, so let’s say you smoked a joint within a couple of hours your reaction time will be impaired. What’s your opinion on that? Like how long will you be totally impaired when you do that? What’s the side effects like time profile and dose-dependency.
Dr. Rachna Patel: Okay. So tricky question, right? Because we, we, uhhmm, in terms of how long, so here’s what we don’t know.
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: We don’t know at what point at what cutoff the, that you’re uhh, uhhmm, you’re not gonna be impaired. Okay. And that what, what level, like, like alcohol we have, uhh, we have alcohol concentration levels, right? So we know at what point you’re going to, to, where you’re not impaired versus where you are impaired.
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: That’s, we, we don’t know that information when it comes to marijuana. We don’t have that cutoff, which makes it difficult. Uhhmm, so, uhhmm, so typ-, so typically, it’s to err on the side of caution, I don’t like patients uhhmm, uhh, you know, don’t drive for, for, for eight to ten hours after consuming marijuana.
Dr. Justin Marchegiani: So, probably better to do at the end of the day, so you can sleep well so to speak…
Dr. Rachna Patel: Yeah. Yeah, typically. Or you’re gonna do it at day time then, then, you know, make sure you have a caretaker who can, who can drive you places sort of thing.
Dr. Justin Marchegiani: Yeah. Or uhh, pull out your uber app, right?
Dr. Rachna Patel: Yeah. Uber.
Dr. Justin Marchegiani: Yeah. Exactly. So we kind of laid some of the pro’s and cons there. So, I’ve seen…
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: …studies on both sides of defense. But, in general, do you find that people that have marijuana in there system have that slightly bit slower reaction time?
Dr. Rachna Patel: That’s what the research says.
Dr. Justin Marchegiani: Yeah.
P: Specially when they’re put in a car, uhhmm, they, they, uhh, again, depends on how much they’ve taken, but uhhm, they do have a, a slower reaction time. Almost like you’re driving uhhmm, uhh, even, you know, extra cautiously.
Dr. Justin Marchegiani: Yeah. Exactly.
Dr. Rachna Patel:Uhhmm, Yeah.
Dr. Justin Marchegiani: And then what about marijuana compared to alcohol? I mean, I’ve seen some studies that look at like students who have the highest grades, for instance. They look at the ones and they compare thee usage of alcohol to marijuana. And the ones that have the higher grades were the ones that uses more marijuana than alcohol and the big reason why is the hangover. You don’t get the crazy hangover, like you do with alcohol, with marijuana as much. So can you kind of compare…
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: and contrast? You know, from a side effects standpoint? Will you paint us to one.
Dr. Rachna Patel: Yeah. Sure. Actually, it’s a funny story. So back in high school, uhhmm, uhh, before a physics test, an AC physics test, there is this, this group of kids that would go out, and uhhmm, they would smoke weed.
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: And they’d come back and take the test and ace it.
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: And, and I remember being like, “what the heck?” You would, you would know it like, when you were in high school, you’re kind of under this naïve impression that, “Oh, you know, they’re doing a bad thing, they shouldn’t be doing well in a test.”
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: But in any case, uhhmm, In terms of addiction potential, okay, marijuana versus alcohol. Uhhmm, alcohol is actually more addictive compared to marijuana. And I’ll, I’ll, I’ll spill out some numbers here. Uhhmm, the potential for addiction in anybody that’s been using marijuana on an everyday basis and in this particular side that I was referring to, these patients, uhhmm, are these participants using marijuana specifically to get high.
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: Uhhmm. The potential for addiction is 9 percent. In, in, with alcohol use, uhhmm, uhh, basically the gauge that they use is that anybody used alcohol more than, I think it was like 12 times in a year. Uhhmm, the potential for addiction was 14 percent. So, so there is a difference in the potential per addiction. It is a lot less addictive but there is still a potential for addiction when it comes to, to marijuana. Again, again, it comes down to how you use it. You know, same with alcohol. I, you know, I go back to that glass of wine versus case of beer example.
Dr. Justin Marchegiani: Got it. So, basically, the 50 percent increase in addictive tendencies with alcohol compared to marijuana, so to speak?
Dr. Rachna Patel: Yeah. Yeah, yeah.
Dr. Justin Marchegiani: Are there anything that you mix with it or that you recommend to your patients to take with the marijuana to, to lessen the side effects so for instance, with my patients, if they’re gonna consume like some healthy alcohol substitutes right, let’s say a cleaner version of wine. Or, uhh I’ll say my doctor, Jayce Moscom, you’ll recommend now vitamin C now or Activated Charcoal that gonna help blunt the hangover and help decrease the alcohol side effects. Are the things that you recommend to patients that are doing the THC with the more psychoactive components to help lessen those side effects.
Dr. Rachna Patel: Okay. So, here’s what I’m gonna tell you. Uhhmm, well we do know is that marijuana is processed about 70 percent of it in the liver. Okay?
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: So I don’t, I don’t have factual information from you, but based on theory, anything that helps to uhhmm, uh, uh, uh, enhance this processing, uhhmm, it mainly Cytochrome P450.
Dr. Justin Marchegiani: 50, yeah.
Dr. Rachna Patel: The mechanics that we have in our liver that breaks down chemicals. Uhhmm, anything that helps to enhance the effect of that will have to uhhmm, uhh, uh, uh, uh, break down the marijuana, uhhmm, more so from the theory standpoint. Now, but the other thing to keep in mind is again it’s that soluble to really, uhhmm, the only remedy in that sense that you have is time.
Dr. Justin Marchegiani: Got it. So anything that’s really gonna up regulate your Cytochrome P450
Dr. Rachna Patel:Uhhmmhum.
Dr. Justin Marchegiani: ..have to stay halfway. Maybe NAC, milk fizzle, vitamin C, extra B vitamins. Those things that run those cytochrome a good idea?
Dr. Rachna Patel: Potentially.
Dr. Justin Marchegiani: Potentially.
Dr. Rachna Patel: You should try. I don’t know if, if there is any validity to it or not, I’m telling you basics on the science…
Dr. Justin Marchegiani: Science, right.
Dr. Rachna Patel: …that I know. Yeah.
Dr. Justin Marchegiani: Based on the facts viable to talk to the occasion.
Dr. Rachna Patel: Uhh’mm. Yeah.
Dr. Justin Marchegiani: Total success.
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: What types of marijuana products are you recommending. Is everything gonna be at a pharmacy? Were you writing a prescription or do you provide like a medical marijuana card and they go to one of these shops to procure it. How are you, how are you compounding that? How are you delivering it? Do you have it in any of your own settlements that you recommend?
Dr. Rachna Patel: Now, so by law, physicians are not allowed to, to… the Federal Government actually has this order in place. Physicians are not allowed to aid or vet patients in obtaining uh, uh marijuana.
Dr. Justin Marchegiani: Got it.
Dr. Rachna Patel: Okay? So basically, in states where marijuana is either medically or recreationally legal, you have licensed facilities. Facilities licensed by the state, uhhmm, they’re specifically designated to sell marijuana products and typically they’re called medical marijuana dispensaries.
Dr. Justin Marchegiani: Dispensaries.
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: And so you write a…
Dr. Rachna Patel: Yeah, yeah.
Dr. Justin Marchegiani: ..prescription or give them prescription from a medical marijuana card and then they can go to these dispensaries and procure it?
Dr. Rachna Patel: Yeah. And the thing is that, it’s actually not a prescription, because again, because it’s a class 1 substance, uhhmm, uhh, for the federal government, which is basically a designation that uhh this is a substance that they consider has no medical value, and is highly addictive. You can’t write a prescription for it. So, so really, the terminology is the recommendation or what’s called a medical marijuana card. So, in, the way the process workd in California is uhh, you uhhmm, you go and see a physician, to really, there could be any licensed physician, but not all physicians are open to writing recommendations.
Dr. Justin Marchegiani: Totally.
Dr. Rachna Patel: So, uhhmm, so typically you have medical marijuana doctors uhhmm and, and you’re go and get evaluated by the doctor, and then basically you’re…
Dr. Justin Marchegiani: What does it look like? Will it be a clinical exam; certain tests? What are you doing?
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: So I walk into your office, let’s say I have some type of symptom and you want to address that with the medical marijuana, how, how do you evaluate me?
Dr. Rachna Patel: Okay, so, depends. If you go to a shady clinic, it’s a very, it’s a 5-minute process. Sometimes you even can see the doctor over Skype. And, and you know, they, they may or may not speak to you. Uhh, maybe ask you one or two questions. And that’s it. It’s sort of a done process. Done deal. Uhhmm, but, it, but then there’s, doctors have practiced differently. This is the route that I’d chosen to take.
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: Which is that, you know, I sit down with the patient, we go through their medical history, go through their surgical history …
Dr. Justin Marchegiani:Yeah.
Dr. Rachna Patel: …I go through the medications that they, that they are on, and that they have taken for their particular medical conditions. Uhhmm, then I do a, a focused physical exam. And then, I, I walk them through how to, how to safely use the marijuana for their particular medical condition. And then, based on my evaluation, if I feel that they will benefit from the medical marijuana, I issue what’s the recommendation and the medical marijuana card. And then you can then take this documentation to a medical marijuana dispensary. And then that allows you to gain entry into the dispensary. Now there’s no restrictions as to what, uh, uhhmm, you know. The patient’s not limited in terms of what they can buy. What the guidance that I give them is simply just that. It’s guidance.
Dr. Justin Marchegiani: So you may write the recommendation, let’s say how many times a day, or how many times a week I wanna see what that looks like. And then they can obviously go above or below that. Correct?
Dr. Rachna Patel: Yeah. It’s them, it’s, you know, it’s really up to them. It’s not like a prescription that you get from a pharmacy. It’s not uhhmm, as, as restricted.
Dr. Justin Marchegiani: So yeah.
Dr. Rachna Patel: Which is kind of neat. Yeah.
Dr. Justin Marchegiani: So you get these patients coming in, let’s just say I’m coming in and I have anxiety or some kind of mood issue.
Dr. Rachna Patel: Uhhmm.
Dr. Justin Marchegiani: And you tried to prescribe some marijuana that kind of relaxed me, calmed me down…
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: What would it look like. So we go through my history, no major issues, right. What would your recommendations be after that? How would you dose that or recommend that for that issue?
Dr. Rachna Patel: Okay. Here’s what I’m walking the patient through, specifically. I’m walking them through, uhhmm, uhh, the combination of chemicals to use. Okay? How to read a label to find those combinations of chemicals.
Dr. Justin Marchegiani: The chemical, meaning like THC or CBD, is that what you are referring to?
Dr. Rachna Patel: Yeah. Mainly. Yeah. And then uhhmm I’m walking them through how to figure out the, the appropriate dose to take, when to take the marijuana, how often to take it, uhhmm, uhh, side effects, you know, what are the side effects, uhhmm, uhh, what, uhh, what to do in case they, they do get side effects, how to avoid side effects. Uhhmm, those are, those are all different things that I’m, that I walk patients through. Yeah.
Dr. Justin Marchegiani: And then what is the dose and what it look like? It’s not like a one time for day kind of thing or recommending more or less?
Dr. Rachna Patel: So, I, uhhmm, I never recommended that patients take in more than once in a day. But my biggest concern with marijuana, is tolerance.
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: Just like when you overdose your medications. If you overdo it, if you, if you take it too often, if, if you take too much of it, then you will develop a tolerance to it. Okay? And…
Dr. Justin Marchegiani: Then you need more, more frequency?
Dr. Rachna Patel: Yeah. So, there’s a scientific reason behind this. What is it? So, every cell, okay, has, uhhmm, well not every cell but, but a lot of cells in our body have receptors for these chemicals in marijuana. Okay? But if you overexpose these cells to these receptors, the cells will stop making the receptors. Okay? So basically, you get to the point where uhhmm you, you start to, to need more and more of your medication. But guess what, you’re not necessarily getting the same effect from it. okay?
Dr. Justin Marchegiani: Got it.
Dr. Rachna Patel: So you have the optimal effect from it, so my main priority with my patients when I’m educating them is, is, we focus on lowest effective dose and minimal frequency.
Dr. Justin Marchegiani: Got it. So it’s kind of like insulin resistance to someone’s consuming too much refined sugar, or too much carbohydrates. Those insulin receptors sides that pull, pull in the sugar were kind of down regulate. And essentially the, the cells become numb so that more sugar circulate on the bloodstream and doesn’t get into the cell to have the effect. Same…
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: with the marijuana, right?
Dr. Rachna Patel: Yep, Receptor down regulation. Yeah.
Dr. Justin Marchegiani: What are the things that you were doing to help mitigate that? And also to mitigate the side effects too.
Dr. Rachna Patel: Uhh, again we focus on lowest effective dose and minimal frequency. Yeah, and that’s gonna, that’s gonna vary from patient to patient. Those things vary highly from patient to patient. So:
Dr. Justin Marchegiani: Sounds like they crossed the lines though. They’re already into the point where they’re doing a little too much or is there something that they can do to increase the potency. Or can we kind of bring it back and still get that kind of potency again?
Dr. Rachna Patel: Uhhmm, yeah, you just, you come back and I’m gonna listen. Yeah.
Dr. Justin Marchegiani: That’s it?
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: You’re pretty straight forward there.
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: Anyway, when you’re looking at THC strain versus the CBD strain, do you have any specific strains that you like or you recommend the patients on either side of defense?
Dr. Rachna Patel: Yeah. Let’s talk about strains.
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: Uhhmm, a lot of them have kind of funny names. Right?
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: So, like a, well, let’s see, a, Train Wreck, Purple Train Wreck, uhh, uhh. What else is there? OG kush Uhhmm, all sorts of interesting names. Creative names that the, that the growers come up with. Here’s the thing though. Uhh, uhhmm, strains are named very arbitrarily.
Dr. Justin Marchegiani: Right.
Dr. Rachna Patel: In fact, recently, I was reading a study that was just done. They looked at a bunch of different strains that were called the same thing from different sort of, you know, different dispensaries. And guess what. They all had differing amounts of THC and CBD. And that’s…
Dr. Justin Marchegiani: Got it. So it’s not standardized across the board.
Dr. Rachna Patel: No, it’s not. Uhhmm, and so, so the thing is, is that, uhhmm, the other thing is that you can pick up a, what’s called a, a, let’s call it a Grand Daddy Purple. You can pick up a Grand Daddy Purple, uhhmm, uhh, at a dispensary one time, and then you go to the same dispensary the second time, and you can have a completely different combination of chemicals. Same thing if you go from one dispensary to another dispensary, you know, Grand Daddy Purple from one dispensary is completely different Grand Daddy Purple from another dispensary. You know, what I am really honing in with my patients is uhh, uhh, uhh, is laboratory testing, and specifically, laboratory testing for the exact amounts of the different chemicals. And you know, being in California, I think patients here are very fortunate because products are laboratory-tested.
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: So, in states where laboratory testing is, uhhmm, state-mandated, for the states where marijuana has been legalized for recreational use, uhhmm, even in the states where marijuana is legalized for medical use, not all states necessarily mandates laboratory testing. Why? I’m not sure why that’s the case. Uhhmm, but in California, again, it still not mandated, it will be starting 2018, once the recreational use, uhhmm, regulation’s going to place. But it’s been, it’s been being done, uhhmm, uhh, recently on a voluntary basis. So…
Dr. Justin Marchegiani: Got it.
Dr. Rachna Patel: …so,so patients here are fortunate. But otherwise you’re kind of, you are at a loss, because, because, you’re not gonna know what’s in uhhmm, in whatever it is that you’re using.
Dr. Justin Marchegiani: Got it. I notice that there’s more over-the-counter CBD uhh oils on the market now. So the CBD illustrates…
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: So do you have any companies or products that you like that are over-the-counter that you’d like to recommend to a patient a good success?
Dr. Rachna Patel: Okay. So let’s talk about rules and regulations ‘cause this is important. Recently in December of 2016, uhhmm, the DEA deemed CBD a class one substance. So, so I know I have a lot of patients coming in uhhmm to my office that were using over-the-counter CBD products that they found on, on Amazon or at, at health foods, food stores. So there maybe a change going on, now I know, the last I read I believed somebody I can call some sort of lawsuits saying that the DEA can’t do that. It’s not up to them. It’s up to some other. I forgot who it was, but some other governing body that’s, that has uhhmm, uhh authority to do that. Not the DEA. So, so the right, so the legal status of that is still in question. Uhhmm, but here’s what I’ll tell you. Uhh, the patients that have come in, having used those over-the-counter products. Uhhmm, they’ve come in to me specifically, because they haven’t had success with over-the-counter products. Now obviously I’m not saying the patients that have had success with over-the counter products. Uhhmm, anything that I would tell, uhhmm, uhh, people looking to you for those products. Make sure you research it well. Uhh, Make sure it’s laboratory tested…
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: …to see the exact amounts of, of the CBD are in that particular product. And these products are typically derived from hemp. Okay?
Dr. Justin Marchegiani: Got it.
Dr. Rachna Patel: So, main difference between hemp and marijuana. Uhh, basic fundamental difference, hemp has less than .3 THC. So, its gonna have a lot less THC in it. And like I mentioned, some conditions do benefit from THC.
Dr. Justin Marchegiani: And the marijuana plants today, they’re up to 20 percent THC? Is that correct?
Dr. Rachna Patel: Oh yeah. Yeah. So that kind of like uhhmm around the 60’s. They did some research and the potencies of THC in these flowers that were just, you know, confiscated, uhhmm from growers was about from two to five percent. Now, uhhmm, it’s not unusual to see THC levels in flowers of 20 to 30 percent THC. So it has gone upward over time, but that’s because uhhmm plants are being bred that way.
Dr. Justin Marchegiani: Yeah. Okay. Then you personally partake in the THC or CBD marijuana, yourself? Yeah. So I suffered from insomnia. Uhhmm, uhh, it’s not constant insomnia but sporadic depends on uhhmm, you know, what source of stress triggered there is in my life. But you know it’s something really stressful, then my sleep gets impacted right away. Right.
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: So I started to have difficulty either falling asleep or staying asleep. And during those times, I do use medical marijuana to help me sleep.
Dr. Rachna Patel: And then once I get into regular sleep pattern again, I don’t have to use it.
Dr. Justin Marchegiani: Now, is it marijuana coke? Yeah?
Dr. Rachna Patel: Oh, so, basically, uhhmm, uhh, marijuana can be used as an as needed medication.
Dr. Justin Marchegiani: And like we have sleep medication like the Lunesta and the Ambien, and the bigger problem with those medications is you don’t get deeper phase three phase four REM sleep. That’s more distortive…
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: What do you know about using marijuana strains and getting in those deeper pair of distorted REM sleep cycle.
Dr. Rachna Patel: Okay. So, there is some preliminary research that shows that THC shortens REM sleep, but I haven’t found that to be the case clinically. Okay.
Dr. Justin Marchegiani: Uhhumm.
Dr. Rachna Patel: And this, I’m based on saying after having treated veterans with PTST, because a lot of what they experienced is sleep disturbance. They’ll wake up with sleep nightmares, night terrors. Okay? This is what they’ll describe to me as. But when they started to use the medical marijuana. Now I am having them use higher dose of CBD marijuana but, but I, uhh, you know during a fallible preliminary I make it to a point to ask them what is the quality of your sleep like, what, what about dreaming. No. I dream fine. I don’t have any, you know, it’s not like they’re not dreaming, So, it’s, so we need more information essentially both in terms of research. Uhhmm, uhh, clinically this is not what I’ve seen, but I haven’t had too many patients complaining to me that, you know, I’m not, I’m not dreaming. Really. They’re saying telling me that the quality of their sleep overall has improved.
Dr. Justin Marchegiani: That’s great. Very good.
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: Do you combine marijuana with other types of herbs or nutrients. Do you ever tried combining with magnesium or other adapt genic herbs that can help stress like Ashwagandha or various ginseng herbs. What’s your experience with that?
Dr. Rachna Patel: You know, I’m not well-informed about those other herbs. Uhhmm, with inflammatory conditions, I do encourage my patients to use turmeric.
Dr. Justin Marchegiani: Turmeric. Yeah?
Dr. Rachna Patel: Uhhmm, because it has very potent anti-inflammatory properties. And then also advising them to make sure, uhhmm, they, they, they upkeep on taking their omega 3’s.
Dr. Justin Marchegiani: Yeah.
Dr. Rachna Patel: uhhmm, and making sure their vitamin D levels are, are, are, yeah, within normal range. But, but I’m not really, well informed about, about the other herbs to, to be advising them.
Dr. Justin Marchegiani: Got it. These are some good comments and recommendations, are you familiar with the field of functional medicine at all?
Dr. Rachna Patel: Oh, yeah, definitely.
Dr. Justin Marchegiani: Right, good. Are you taking, are you using any of those modalities at all, like from a dire perspective, or any lab testing. As well to look at things deeper. Outside of just the recommendations of marijuana too?
Dr. Rachna Patel: I’m not. I strictly just specialize in the area of medical marijuana.
Dr. Justin Marchegiani: Excellent. Sure. What’s your website, Doc?
Dr. Rachna Patel: Sure. It’s www.drrachnapatel.com – www dot doctor D-R, Rachna, R-A-C-H-N-A, Patel P-A-T-E-L dot com.
Dr. Justin Marchegiani: Great. We’ll put the link right below the uhhmm, video description in podcast.
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: So people can get a hold of you. I know you schedule online there as well so we’ll make sure that could these types of resources, that’ perfect. Especially, you’re educating people in both sides so you were able to make a recommendation on the THC strain versus the CBD. And I have functional medicine patients that, that, you know, autoimmune issues. We made diet and lifestyle changes, working on adrenal health, working on nutrients. But I find that, you know, some of them are really, well, like introducing some CBD oil into their regimen. It’s helped with information and helped support…
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: their immune system. So I, I think there’s definitely be some very good palliative, supportive types of treatment with those, uhhmm.
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: With those types of supplements so to speak. I’ve seen..
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: Really, provide the benefit.
Dr. Rachna Patel: What the, so you’re in Texas, what uhh, do you know the status is of medical marijuana in Texas?
Dr. Justin Marchegiani: I don’t know. I mean, I don’t know. I think, it’s 100 percent illegal. I mean, most part I think Colorado, Texas in the upper Northwest there. But there are some good CBD oils that are online that…
Dr. Rachna Patel: Okay.
Dr. Justin Marchegiani: …patients have used with really good success. Like the ones you recommend with a lab test such and such.
Dr. Rachna Patel: Yeah, yeah. So, uhhmm, yeah. The only thing I wanted to mention is that uhh, uhhmm, I’ve been more than happy to answer questions for your viewers. Uhhmm, uhh, uhh, and I’ll do that on my YouTube channel and on my Facebook page. So, if your viewers have questions for me, they can post them on either one of these platforms. And, uhhmm, I put up videos, answering calmly asked questions about every one to two weeks.
Dr. Justin Marchegiani: That’s great.
Dr. Rachna Patel: So I do that as well.
Dr. Justin Marchegiani: And the drrachnapatel.com is a site with the links to the YouTube there as well?
Dr. Rachna Patel: Uhhmm, I think, yeah. You should be able to find my uhh, uhh YouTube, uhhmm, stuff on, on my website.
Dr. Justin Marchegiani: We’ll make sure we put the YouTube links and the other links there in the description. People can easily find that out.
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: Now, couple of questions here before we…
Dr. Rachna Patel: Sure.
Dr. Justin Marchegiani: …wrap up. Now, I’ve read some literature talking about brain development and marijuana. So there’s kind of this idea that incorporating or introducing marijuana early can help stun or essentially retard development of the frontal cortex here. Kind of what makes the entire human species. So…
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: Can you speak to that more? Is there an age you recommend marijuana? Like what’s the cutoff for you? Do you see any of those neurological developmental delays with the exposure early on?
Dr. Rachna Patel: So here’s the thing. There’s a study that I was looking at. Uhhmm, the size, shapes of brains in adolescents, uhhmm, that have used marijuana on a regular basis, uhhmm, for at least two to three months. Okay, and they can compare it to non-users. Uhhmm, and they really found no difference in the size or shape of their brain. So, that’s more, uhh, more of a look at a macro level. We still need more information at a micro level. But I don’t, I don’t have enough information to give you a cutoff, but I also don’t have enough information in, uhhmm, in terms of if and how impacts the brain development. Uhhmm. Now here’s a thing though. I haven’t had adolescents coming into my office. Uhhmm, uhh, who, this is really interesting, ‘cause these are adolescents that, that are using marijuana, or using marijuana recreationally. And then their parents happen to, to, to find out that they’re using and they explore it further. Uhh, uhhm, these kids also uhhmm, have a diagnosis of ADD or ADHD. In the end of telling their parents that you know it’s helping me. Uhhmm, it’s helping me, and I don’t like the side effects that I get from, uhhmm, basically the class of amphetamines that are typically prescribed for, for…
Dr. Justin Marchegiani: Oh, yeah.
Dr. Rachna Patel: you shouldn’t. So uhhmm, so I have seen these patients, you know, over and now to three years, and have I, have I found any sort of impact on academic performance, on behavior. No. I mean when, when you know. When these patients come in, they, they there hasn’t been anything that reported from the patients themselves, or uhhmm, from the parent.
Dr. Justin Marchegiani: Got it. You’re up in the North Bay area of California, are you familiar with Dr. Julie Ross’ work at all? With the Mood Cure or the Diet Cure which she uses amino acids to help kind of support some of these nutrients, mineral levels to help lessen addictive tendencies?
Dr. Rachna Patel: No, I’m not actually.
Dr. Justin Marchegiani: Okay, I’m just curious.
Dr. Rachna Patel: Yeah
Dr. Justin Marchegiani: Combining some of those amino acids yeah, that’d be really useful. Yeah.Obviously there’s gonna be a difference with the addictive tendencies with the CBD vs. THC, do you find people addicted to CBD at all?
Dr. Rachna Patel: Overall, uhm, we know about, we know more about THC than we know about CBD. Uhm and we know about overall addictive potential of marijuana, but each individually, I don’t know if there’s study done to compare of the two uhm, to the two chemicals. So I really don’t have any answer for that particular question.
Dr. Justin Marchegiani: Got it. There’s a neuro surgeon, Dr., Dr., I forgot his name on Frontline. I did that. He did a neuro surgeon and he did an article of a whole expose on marijuana and he was using some of the high dose of CBD oils, with children who have epilepsy and those was amazing.
Dr. Rachna Patel: Okay
Dr. Justin Marchegiani: ‘Cause he literally seen them having a seizure and then they put some of the CBD butter, oil, on their mouth and it was like, some of them turn the light off. What’s the mechanism. What is it doing to the brain to stabilize, to prevent that epileptic seizure?
Dr. Rachna Patel: So, a couple things could be bring on. Uhm, One is that, uhm, it could be trigerring uhm, other uhh uhh, basically the chemical activity along the neuron, possibly slowing it down. Uhm, uhh and you know, this is obviously happening at about chemical level where it’s impacting signalling among chemicals. Uhm, so that one thing. The other thing, it could also be reducing inflammation that’s going on as well. So couple different mechanisms by which it could be working.
Dr. Justin Marchegiani: Okay, alright. Cool. And are you familiar with ketogenic diet at all and then the similar effect with Epilepsy, at least?
Dr. Rachna Patel: I, uhm, that’s not something I studied in depth.
Dr. Justin Marchegiani: Okay
Dr. Rachna Patel: Yeah
Dr. Justin Marchegiani: Great. Well, you really provide us some great information so we’ll put the links of your site down here below. Now, last question. If you’re stuck in a desert on an island and you only bring one supplement or nutrient but it can’t be marijuana, what will it be?
Dr. Rachna Patel: One nutrient or supplement with me. Uhm, it’d be protein.
Dr. Justin Marchegiani: Protein? I love that,
Dr. Rachna Patel: Some of the protein, I’d bring with me.
Dr. Justin Marchegiani: Very cool.
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: I like it protein is great. Is there anything, powerful information on the tip that you’re telling that you want the show of the listeners before we depart.
Dr. Rachna Patel: Yes. Knowledge is power. So, make sure you’re proactive when it comes to your health and, and, and go out there and find probable resources to get information from.
Dr. Justin Marchegiani: Thank you. That’s great. And the patients that aren’t nearby in the North Bay Walnut Creek area.
Dr. Rachna Patel: Yeah.
Dr. Justin Marcheagiani: Are you also available via phone call or Skype?
Dr. Rachna Patel: Yes, so here’s what I’m doing. I’m creating protocols of, for medical marijuana by medical condition because I know, I’ve found that there’s a great need for this information. That’s in a work. It should be out in a couple of months. Uhm and then I am also gonna make myself accessible uhm, at through videos.
Dr. Justin Marchegiani: Skype, videos, that’s great.
Dr. Rachna Patel: Yeah.
Dr. Justin Marchegiani: Awesome, Dr. Patel. We did this via Skype video as well as audio. So if you’re listening to audio version and you wanna see us live, click below for the YouTube link. Dr. Patel, thank you for your time. What a great interview and I’ll talk to you soon.
Dr. Rachna Patel: Yeah yeah, it was great.
Dr. Justin Marchegiani: Take care.
References:
http://www.drrachnapatel.com/blog/
https://www.youtube.com/channel/UCNtN7JXpNKHAYA7ZdWzpi1A
https://www.facebook.com/Dr-Rachna-Patel-The-Medical-Marijuana-Expert-158338067700593/
https://twitter.com/DrRachnaPatel
https://plus.google.com/+DrRachnaPatel-TheMedicalMarijuanaExpert/about
https://www.linkedin.com/in/drrachnapatel
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