Cannabis Sustainability Symposium 2019 Comprehensive Ensuring the Sustainable Future of the Cannabis Industry in All Phases Dr. Rachel Knox, MD, MBA October 4, 2019
Background The Knox Docs are a family of physicians with backgrounds in Emergency Medicine, Anesthesia, Family Medicine, Integrative Medicine, and Preventive Medicine. Founders of the American Cannabinoid Clinics and ADVENT Academy Pioneers of Functional and Integrative Endocannabinology
New Cannabinology (kuh-nab-uh-nol-uh-jee): The study of the pharmacology of cannabinoids and Terms cannabimimetic substances Endocannabinology (en-doh-kuh-nab-uh-nol-uh-jee): The study of the endocannabinoid system (ECS), its dysfunction, and modulation by cannabimimetic practices Functional and Integrative Endocannabinology: The application of integrative medicine to correct ECS dysfunctions at their root causes using natural medicines and alternative health modalities
Why am I uniquely positioned to talk about sustainability in the cannabis industry?
Experience Oregon Cannabis Commission Chair ● Design a new framework for medical cannabis in Oregon ● Develop long-term strategies for medical research and assuring cannabis remains accessible to patients Portland Cannabis Policy Oversight Team Teammate ● Advise Portland City Counsel and develop policies that support equitable access and outcomes Minority Cannabis Business Assoc. Medical Chair; Medical Committee Chair ● Consumer and patient (and Industry) awareness ● Define health equity in the context of social equity Oregon Cannabis Clinicians Group Co-founder ● Create a intradisciplinary voice representing the interests and advice of clinicians in support of cannabis medicine
The supply and demand chain ends in my office. Clinicians Cultivatio Processing Distribution Retail n Consumers
The cannabis industry of our dreams is already unsustainable.
What are the industry’s blind spots?
Blind Spots 1 in 2 American adults are “sick with something.” Stress Heart Chronic pain Insomnia Headache disease Mental illness High BP Diabetes* Cancer IBS Pre-diabetes 1. Dahlhamer J, Lucas J, Zelaya, C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001– 1006. 2. https://www.nami.org/learn-more/mental-health-by-the-numbers 3. University of Pennsylvania School of Medicine. "One in four Americans develop insomnia each year: 75 percent of those with insomnia recover." ScienceDaily. ScienceDaily, 5 June 2018. 4. American Psychological Association, American Institute of Stress. Research Date: 7.8.2014 5. https://www.cdc.gov/diabetes/data/statistics-report/prevalence.html 6. https://www.who.int/news-room/fact-sheets/detail/headache-disorders1
Products on shelves often don’t match clinical (or wellness) needs.
Blind Spots The industry is currently flooded with “stuff.”
Emotional Chemical Stress Insult Contributors to Disease and Illness Poor Diet Rx Drugs Genetics Aging
Our society is sick.
Why do these blind spots exist in cannabis?
#1 Our view of the cannabis supply and demand chain is too narrow.
The Narrow Model “From seed to sale” ● Limited stakeholder contemplation ● Promoted and marketed with “good science,” but not informed by science ● Just put CBD in “everything” ● Lacking social responsibility
The Narrow Model Unmet sustainability needs Human Capital Social Capital Health, education, skills, Investments and services that create the basic framework for society. knowledge, leadership and access to services that Total facilitate these. Sustainability is the Sum of All Parts Environmental Capital Economic Capital (Natural Capital) Money/currency Water, land, air, minerals and ecosystem services; their preservation improves human welfare. 1. Goodland, Robert. Sustainability: Human, Social, Economic and Environmental. World Bank, Washington, DC, US. 2002
#2 Bifurcation has proven problematic.
Short-Sighted Bifurcation New Frontier Data, 2016
Short-Sighted Bifurcation Patients are Consumers and vice versa.
#3 Brutal Capitalism
Brutal Capitalism Where making millions is the mission. Image Credit: iPad Screenshot
#4 Cannaphobia
Cannaphobia Overregulation is rooted in fear
#5 Cannabis tax revenue is not being reinvested into the industry.
Lack of Reinvestment Cannabis Tax Revenue
#6 Our understanding of health is too narrow.
The Narrow Model Our health is a function of our ecosystem ● An ecological problem ● An industrial complex problem Emotional Chemical Stress Insult Poor Diet Rx Drugs ● Cannabis as medicine will not solve Genetics Aging
What is the solution?
#1 Build for sustainability by looking at the big picture.
The Ecosystem Model The big picture: the 4 pillars of total sustainability Human Capital Social Capital Health, education, skills, Investments and services that create the basic framework for society. knowledge, leadership and access to services that facilitate these. The Ecosystem of Sustainability Environmental Capital Economic Capital (Natural Capital) Money/currency Water, land, air, minerals and ecosystem services; their preservation improves human welfare. 1. Goodland, Robert. Sustainability: Human, Social, Economic and Environmental. World Bank, Washington, DC, US. 2002
The Ecosystem Model Exhaustive Stakeholder Contemplation
#2 Lead with science.
Lead With Science ECS-Literacy and Cannabis Competency for All
The Endocannabinoid System (ECS) Decades of research have revealed an intricate system integral to homeostasis and health. Image Credit: Wai Natural
ECS Function A retrograde signaling system at the synaptic junction provides feedback to help the body “relax, eat, sleep, forget, and protect.” Di Marzo V (1998) ‘Endocannabinoids’ and other fatty acid derivatives with cannabimimetic properties: biochemistry and possible physiopathological relevance. Lipids and Lipid Metabolism 1392: 153–175. Image Credit: John Karapelou for Phytecs
Endocannabinoids (Endogenous Cannabinoids) The “bliss” molecule Multiple additional targets Anandamide N-arachidonoylethanolamine Made on demand when (AEA) needed to maintain homeostasis (i.e. self- modulation) Stronger agonist at CBRs than AEA 2-AG Made on demand when 2-Arachidonoyl glycerol needed to maintain homeostasis (i.e. self- modulation)
ECS Dysfunction ECS Excess ( ↑ eCBs/CBRs) 1 ECS Deficiency ( ↓ eCBs) 2 Obesity Diabetes Migraines Rheumatic disease Fibromyalgia Cancer Irritable bowel syndrome Post Traumatic Stress Disorder 1. Pacher, P . and Kunos, G. (2013). Modulating the endocannabinoid system in human health and disease - successes and failures. FEBS Journal, 280(9), pp.1918-1943. 2. Russo, E. (2016). Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment- Resistant Syndromes. Cannabis and Cannabinoid Research, 1(1), pp.154-165.
The Major Phytocannabinoids (Exogenous Cannabinoids) THC Analogous to anandamide Tetrahydrocannabinol (AEA) ● Euphoric, intoxicating* Blocks AEA breakdown by CBD FAAH ● Increases available AEA Cannabidiol ● Activation at 65 different non-CBRs and enzymes ● Also psychoactive
Modulating the ECS Endo cannabinoids Exo cannabinoids Cannabimimetics McPartland JM, Guy GW, Di Marzo V. Care and feeding of the endocannabinoid system: a systematic review of potential clinical interventions that upregulate the endocannabinoid system. PLoS One. 2014;9(3):e89566. Published 2014 Mar 12. doi:10.1371/journal.pone.0089566
Foods Herbs Substances Spices Essential Oils Cannabimimetics Exercise Massage Practices Meditation Acupuncture 1. Kumar, A., Premoli, M., Aria, F . et al. Cannabimimetic plants: are they new cannabinoidergic modulators? Planta (2019). https://doi.org/10.1007/s00425-019-03138-x 2. McPartland JM, Guy GW, Di Marzo V. Care and feeding of the endocannabinoid system: a systematic review of potential clinical interventions that upregulate the endocannabinoid system. PLoS One. 2014;9(3):e89566. Published 2014 Mar 12. doi:10.1371/journal.pone.0089566 3. Hu B., Bai F ., Xiong L., Wang Q. The endocannabinoid system, a novel and key participant in acupuncture's multiple beneficial effects. Neuroscience and Biobehavioral Reviews, 77 , pp. 340-357, 2017. 4. Andrew D. Vigotsky and Ryan P . Bruhns, “The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications: A Narrative Review,” Pain Research and Treatment, vol. 2015, Article ID 292805, 11 pages, 2015. 5. Johannes Fuss, Jörg Steinle, Laura Bindila, Matthias K. Auer, Hartmut Kirchherr, Beat Lutz, Peter Gass. A runner's high depends on cannabinoid receptors. Proceedings of the National Academy of Sciences Oct 2015, 201514996; DOI: 10.1073/pnas.1514996112
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