1st Conference on Therapeutic use of cannabis in Figueres (Part 3 of 4)

Transcript of Dr. Joan Parés speech :

Oscar Parés

Well, the next speaker will be Joan, Joan Parés... he's a retired doctor who has been involved in different cannabis projects since 2008. He started in a Club in Sants, the quarter where his family lived, and then he started to advise different Clubs belonging to FAC (Federation of Cannabis Associations), to CAT-FAC...

As José Carlos, he also collaborates with the Spanish Observatory of Medical Cannabis and more recently with the KALAPA Clinic. When you want Joan...

Dr. Joan Parés

Thanks a lot. Good evening everyone. Can you hear me? Well, I'm a newbie with regard to medical cannabis, although I've used it recreationally since I was 20 years old.

I've managed my career as doctor without taking into account medical cannabis. I'm specialist in the respiratory system and never thought about using it as medicine.  I had my education and I have been practicing medicine, but when I retired, about 8 years ago, and in order to have the cannabis I liked to use, my son recommended me to go to a Cannabis Club.

And here starts my experience with medical cannabis. It all started at La MACA, one of the first and most militant clubs in Barcelona, in Sants, where the former president told me: "Listen, you're a doctor, and we have plenty of people looking for cannabis to treat their diseases. You could talk to them, advise them..." And so I started to meet people in a small office and talk to them.

Soon after, a treatment team was formed in CAT-FAC, which is the Federation, and we improved our structure and started to meet people who required medical cannabis, whether they were members of the club or not. We interviewed them for about an hour and collected data, about which I'll talk a little later.

This lasted for 2 years, when this therapeutic service was closed, and since  then I collaborate with the KALAPA Clinic (advising patients), with Alchimia in our online doctor's office, with the Spanish Observatory of Medical Cannabis, an entity born about one year ago in Madrid, which is very interesting because it gathers researchers with years of experience.

I'm feeling like a newbie, a complete ignorant. Because Manuel Guzmán, Cristina...they all have more than 20 years experience... José Carlos Bouso is also a veteran...so I'm constantly learning. So, I'd like to tell you what I've learned during these last 8 years in this field. First thing I learned, about which I was completely ignorant, is about the endocannabinoid system. I realized then that all animals, all types of animals and not only humans have a system called  endo (because it is internal) cannabinoid system.

We synthesize substances which are almost identical to those found in the plant. And these substances are called endocannabinoids. We already know about 2 of them. One is called "anandamide" and the other one "2-AG".

What do these substances do? How do they work for normal people? Well, these substances somehow modulate the metabolic systems of cells. In technical words, it is said that they promote homeostasis, the proper functioning of our cells, of their metabolism.

And that was new to me. All this was discovered in the 90s, so it was not only new for me, but for almost every person that I've met during these years looking for medical cannabis. 80 to 90% didn't know about the endocannabinoid system, which allows us to understand why cannabis works, because it is acting on a system that we already have.

We can then find substances coming from the plant, called phytocannabinoids, or coming from our own body, called endocannabinoids, and we also have some obtained by artificial synthesis in a laboratory.

Which are synthetic cannabinoids. These can be found in some pharmacies under names like nabilone, dronamidol, etc. These three sources can produce molecules that act on our endocannabinoid system.

And our endocannabinoid system has molecules and receptors. It's the beautiful same example explained by Manuel Guzmán; imagine that you have locks on your cells and phytocannabinoids come and BOOM... they open the locks and generate a number of beneficial reactions for the cells, very beneficial indeed.

Well, I didn't know about all this, so something changed inside me and I said "what happens here", right? We owe much to Professor Raphael Mechoulam, who was recently in Madrid telling us about this subject. He's a brilliant researcher from Israel who discovered all this during the 90s and published his studies...which we have been reading about. An interesting point is that when we take phytocannabinoids we are interfering in the activity of our endocannabinoid system.

Our body is wise, and a bit lazy. If cannabinoids come from any external source, it will stop producing them, so it will happen the same as with insulin or other things. If you give insulin every day to a normal person after some time his pancreas will stop producing it, so this person will need insulin from external sources.

So all regular users be advised, it is good to stop from time to time and give our body a rest, a fast, so that our endocannabinoid system doesn't lose its working capacity. These are things that I've learned and that I now explain you.

Cannabis is a great surprise, as José Carlos already told you, I'm only reminding you about it. It has plenty of different strains, types and subtypes, and every single plant hosts a true pharmacy inside it. As he said, more than 100 cannabinoids, terpenes, flavonoids...in total, I'd say 400 and he said 800...I mean...it is a true factory of substances and many of them have medicinal effects, psychosomatic effects.

Terpenes are also being studied, their effects and so, but the complete cocktail is in the plant. And every single plant is different. Those who have tried different plants know it.

Some are relaxing, others stimulating, some enhance colors while others are sedative... Because each plant has its own internal formula, and we also have what he mentioned, the recently discovered entourage effect... so all substances entouraging the 2 main compounds, which are THC and CBD, are important. So that's the reason, as he also mentioned, why plants are much more effective than isolated cannabinoids.

Another thing I learned is that marijuana can contain a large amount of contaminants. We have a very curious anecdote. At first, some CBD capsules appeared on the market. Wow, CBD capsules coming from Czechoslovakia. Hey, that's great, we have isolated CBD...they were studied, analyzed looking for their origin.

Well, it turned out that some of these plants came from China. And what were these plants doing in China? Marijuana is capable of "cleaning" the land from heavy materials. Plants absorb these materials from the land and clean it in that sense. So, marijuana plants have been used to clean the land from industry waste materials, which should had been incinerated in specialized treatment plants so that all contaminants should had been trapped by the filters of these incineration plants, and then these filters should had been treated in a specific way. But they didn't do this in China...

They simply harvested the plants and instead of incinerating them as special waste they sold them to Czechoslovakia. And someone there processed the plants into capsules and sold them as medical CBD.  That's terrible. I mean, you may know what you take and if it is good or not, but someone poisoning you without your knowledge is a whole different story. Well, cannabis can contain a vast number of contaminants. Arsenic, lead, mercury, cupper, cadmium...and it can also host pathogenic microorganisms.

Cancer management. Cannabis grown with compost have a higher tendency since compost contains lots of microbes. Normally, microbes present in the plant are not hazardous, and a normal person can easily deal with them, but if you give this plant as medicine to someone with depressed immune system...FAIL!!

Then this person is exposed to these microbes, which can be really bad for him. Another possible contaminants are fertilizers and pesticides. Some nutrients and pesticides contain phosphorous.

I remember when I purchased cannabis on the black market that my joints sizzled sometimes, as one match that doesn't light properly, with a strange noise...you should discard things like that immediately. That plant contained some type of phosphorous derivative, and phosphorous is a very toxic substance to the brain.

This is something that should be known. And that's why the origins of the plant, its source, is so important, as we'll see later.

Another thing that should be known is that when we make tinctures, oils, concentrates...all contaminants are also being concentrated. In other words, perhaps smoking a joint with some Cadmium traces is not that dangerous, but if you're smoking a concentrated oil then you'll taking much more contaminants, and that should be known.

Another thing I've learned in my cannabis training is to distinguish smoke from vapor. José Carlos Bouso has also mentioned this. Smoking and vaping are very different things. I've been only vaping for some time now. There are wonderful vaporizers and you avoid all cardiovascular problems derived from tobacco, smoke, rolling paper and contaminants. Combustion is incomplete, so it generates many improper products.

I don't know if you noticed, but the smoke released from a joint is dark, almost black. If you put a flame in the smoke you'll see it burning...that means it is carrying substances which haven't been properly burnt, from the paper, the tobacco, which are harmful...and you get rid of all this when you vape.

I've also learned that. Therefore, your confidence in the person who supply you must be strong, either buds or oils. That is basic, because otherwise...I remember when we didn't have clubs, I often went to Plaza Real (Barcelona) to buy something. And there in Plaza Real I had to meet with that tall and skinny guy with a terrifying scar on his face, "El Lejía" he was called, and I just couldn't trust that guy. and I just couldn't trust that guy. Imagine I ask him for crop guarantee, or quality guarantee...he'd have sent me to hell. He gave me what he had, no jokes. And I could only say “thanks”.

Well, not anymore, now we know that this subject must be strictly controlled and monitored. The quality of the crop, la concentración que tienen los diferentes productos que te dan en los diferentes cannabinoides...

It is not the same a high-THC plant with low CBD content than a CBD rich plant...that must be known. Today we can have everything tested and analyzed easily and fast. We even have an NGO called "Energy Control" that analyses for free the first sample that you bring them.

To know what we are taking is so important...because if we don't, we can fall into a trap. Another important thing is the absence of toxic products, as I said before, make sure that it doesn't contain microbes or pathogens. It's important that regular cannabis users know about all this.

What is good use? What is bad use? What have I learnt about good uses and bad uses of cannabis? In the first place, good use implies that there are no contraindications to this use. Because there are some too...

A person suffering from tachycardia, a person suffering from hyperactivity, a person suffering from certain mental diseases, a person taking many medicines... Bear in mind that, I'll explain it later, we've had 70 and 80 year old people coming to us for chronic pains, asking us if cannabis could help. And when we asked: "Well, are you taking any medicine?" they grabbed a list with perhaps 10.Then, let's be cautious, giving someone a new medicine when he's already taking 10 is not recommended, especially if we don't know the possible interactions between most of them.

And that should also be known. I mean, there must be no contraindications. What other contraindications can we find, apart from pathological ones? Obviously, age. A 12 year old kid must not smoke cannabis because his brain is still not fully developed and it could alter his endocannabinoid system, resulting in incorrect development. Therefore, it is another contraindication. Being sick, and carrying out for example  mechanical activity, handling heavy machinery which requires good reaction capacity.

There is a number of contraindications which should be studied. Each person is a different world and there is the importance of being advised by a good therapist when taking the first steps in the world of cannabis.

Another important aspect is quality, as we already mentioned. Substances must be of good quality. Poor-quality substances can make you fall...and this happens with any substance, with any addiction. Even sex, whatever... The quality and dosage of the product must always be taken into account. At first, only dosages were important.

Yes, we already know that dosage is the difference between a toxic and a remedy. But take caution, dosages must also be suited for each case. It is not the same using marijuana for a person whose weight is 100kg than for someone weighing 40kg. It is not the same for a person who is on his 60's than for someone who is 20 years old. All this must be evaluated, each of these points must be evaluated.

Another important factor is obviously the place and company. Depending on the circumstances surrounding the cannabis user the effects may vary, whether we talk about recreational or medicinal use. Then, let's talk about recreational use now. The main character here is THC, that's why most products in Cannabis Clubs have high THC content. It causes a distortion of time and space, of colors, of sounds, of smells, flavors and touch. And that's something wonderful for those who enjoy it. But horrific for those who don't.

The other day someone told me "I don't know if I'm in Barcelona or Amsterdam"... that's great! That's what I want, not caring much about time and all that, but there are people who cope very badly with that. Feelings, colors, touch, caresses, music, concerts...everything changes with recreational cannabis if the person has empathy, and if he doesn't is just the opposite...he vomits, he feels bad, he goes to the Hospital.

Another symptom is that it increases the feeling of being intoxicated...what is commonly called "being high" and that is something enjoyed by some and hated by others. Well, everyone should know that all this will happen if they use cannabis.

Another effect of cannabis is to facilitate introspection when being used along with entheogens. Entheogens provide a trip to other dimensions which is normally better enjoyed with cannabis. Cannabis usually connects well with ayahuasca, psilocybes, LSD, there are also cases in which...we even have religions or religious sects which use some of these substances along with cannabis, like Santo Daime sects, it is also used there...

We can use it recreationally. But then we also have medicinal uses, which are different. In my experience, we've told around 500 people that cannabis could help. But we also told 120 pople not to use it. That we felt like cannabis was not going to help.

What diseases we had among these 500 cases? Most of them...well not most but many, 57% were chronic pain. Chronic pain derived from long term anthritis, fibromyalgia, diabetes with neuropatic pain, and other causes of chronic pain.

We're not talking about toothache, but a pain that has been there for a long time...and why? Because we know about the antiinfammatory and antialgic properties of cannabinoids. It is also suitable for other things like tremors and spasticity.

We'd really need the input from Dr. García de Palau now, since his experience in administering oils to kids with epileptic seizures is wide, where classic anti-epileptic medicines don't work. Well, it turns out that CBD works great. Normally, it must be used along with other anticonvulsant medicines, but it has made things a lot easier for kids suffering from 30 seizures per day. (I also ignored this. There are newborns that start suffering from seizures 2 days after being born, 30 or 40 seizures per day) and all of a sudden they only have 1 or 2 seizures, even none, with cannabis. And that's fantastic...

The fact that cannabis can undermine their nervous development, well...we'll see about it, but the kid is doing well for the moment, he smiles, he's hungry, he eats...something that he couldn't do.

These are exceptions to normal treatments for refractary epilepsy... There are also diseases derived from treatments, symptoms derived from chemotherapy...nausea and vomiting. In that sense I had a very close experience, and I could check that it does work. Literally, nausea and vomiting are highly reduced, and from telling you: “I don't want to eat because everything seems expanded polystyrene” they go to “I can feel the taste of a strawberry, I can feel the taste of everything...” that's a major change. The quality of life, as José Carlos said, of people using cannabis...the quality is improved.

People being treated with chemotherapy, I can assure you they go through very difficult moments, not only for the taste of food, but also for the anxiety, fears, insufficient sleep, etc.

And cannabis is truly a wonderful coach back, in most cases, not always. Other conditions, those called autoimmune diseases, can also be trated with cannabis. Multiple sclerosis, scleroderma, lupus and others...why? Because it has been found that our endocannabinoid system, where we have many receptors is also present in our immune system, so we should not be surprised.

In regard to medicinal uses, medical science is becoming a more accurate science... which measures, analyzes...today, nobody practices without an analysis of 20 or 30 parameters.

Pharmacology also monitors the dosages, etc... These are medicinal uses. When the patient needs to know the miligrams of cannabis he's taking, these are medicinal uses in my opinion, while someone smoking a joint to feel better, to relax, it would not be so medicinal but  “maintenance”. To me, there are three uses of cannabis: recreational, for partying, dancing, listening to music, enjoying a good meal after smoking a joint...

Then we have maintenance uses. Planty of people who smoke a joint before going to bed. Beause it helps them to relax, or because they've been in a stressing meeting, after the meeting one smokes a joint and feels better... What's that? Medicinal? Recereational? None of them. I say it is “maintenance”.

Just to avoid conflicts in certain situations. Sometimes, before a meeting, you say: “hey, I'm going to argue with everyone. I'll smoke a joint and just chill...”. I don't know if you've seen it, but there's a very interesting study from England. Football hooligans, who are very aggressive with alcohol, become much less aggressive if they take less alcohol and some cannabis. It's curious...but also a bit funny.

In short, it's just a matter of achieving well-being. Hey, I'm quite well, right? And that's something well known for cannabis users. After a joint I feel better, I'm not looking for some “party” effect or an extraordinary effect. I just want to feel “normal”, to feel my normality...

So, the word therapeutic is wonderful because it comes from the Greek, and is referred to the art of “caring”. The therapist was the person or technician that accompained someone to pave their way. For a therapist, that is his task. Then, I always say that using marijuana correctly is always therapeutic. Either if it is recreational, maintenance, medicinal...it accompanies, it helps. The good use obviously requires the aforementioned conditions. No contraindications, quality, dosages, place and company.

If done like this, marijuana is always therapeutic, it always accompanies. Then, we doctors have the tendency to embrace noble words and all physicians are called doctors, and we're all happy! And none of us is a doctorate, but they call us doctors and it is ok to us...all right then, doctors. Also with medicinal and therapeutic cannabis we say: medicinal and therapeutic.

Well, it may be therapeutic, but it can be therapeutic without being medicinal. In this sense, the wideness of the therapeutic concept goes far beyond of that of medicinal, and I'd love to have approved something that judges could not understand, and they'd approve therapeutic cannabis, that'd mean that everything is approved. But they normally stick to medicinal. I repeat: it provides well-being...wellness. And that is crucial.

Forms of use are many and varied, but I'm most interested in vaporization. I discovered it 2 years ago... I smoked joints but one day I had pneumonia. That day I stopped smoking and started vaping.

I haven't had a problem with my vaporizer, not a cough, nothing...and it's been some years now with my vaporizer without a problem. Then, it also depends on the symptoms to treat...the pathologic antecedents of the person, as we said before, if he has some experience with cannabis. It's not the same for a 60 year old person to start using cannabis than for a 20 year old person. Age, corporal weight, concomitant medication, social and employment situation...it's not the same.

And then, precautions are: first, try not to smoke, as we said, to avoid cardiovascular problems, and if the person is not an expert on medical cannabis, please, ask for help from a therapist. It's not necessary to find a doctor, but at least a therapist. Someone who can advise him wisely, who takes into account everything we've said and helps him. Because dosages must be varied, as José Carlos said, You can't prescribe a dosage and that's all, everyday the same, done...no. Depending on the evolution of the person you can vary things, but supervision is needed, external supervision. Not self-supervision.

Finally, to end my speech, it seems like addiction is a disease now. Well, that's not something very old, you know? But today, to have an addiction is to have a disease.

I'm totally against that. Having addictions...addictions are good...are very good, if they're not harmful. Furthermore, I recommend to have several addictions, not just one. The problem is to have just one.

And addiction...why is it addiction? The word itself explains it. Addiction is a force that unites you with something. It is as real as the force of gravity. The force of addiction...and I repeat, it's not bad to have addictions. It is an exercise of personal freedom, and freedom is there to be exercised, not for being kept in a drawer.

Then, I want to be educated on the addictions that I want to have, which is contrary to prohibitionism. When some of my addictions are prohibited, I must break this prohibition and find the knowledge in it.

Life in this world without addictions is totally unthinkable and unbearable, only those who are dead are free from addictions...all living ones are addicted to something.

Well, thanks...

Notice that we're addicts to certain foods. That is true. I love chocolate, that guy loves bread, the other one loves sugar, and that other one loves I-don't-know-what...we're addict to music, to work, to sex, to cars, to money... and to certain feelings, like emotions, vanity, love. All these things are addictions that all living persons have...

Another issue is incorrect management of these addictions. That's true. If we don't manage our addictions properly, we can fall into compulsion, we can be in trouble.

But we won't if we manage our addictions correctly! Sorry, it happens the same with cars. Cars are not dangerous. Drivers are dangerous. Drivers are dangerous. Drivers, either for ignorance or imprudence, can do crazy things. But the driver that knows how to properly drive his car enjoys it. It allows us to travel far away, on our own, and that's great! It happens the same with drugs.

If we are educated, if we know how to deal with them, it brings well-being, will to live, and that is so important. And those who say they have no addictions, they're simply lying, or are hypocrites, or ignorants or living deads...and nothing else.

I shall end here.