Expert

Bonni Goldstein, MD, helps parents navigate complicated treatment decisions

By Marc Lewis

Bonni Goldstein, MD, is the medical director at Canna-Centers, a medical practice in Los Angeles, California. There she helps families understand the therapeutic potential of cannabis as it relates to conditions like autism, cancer, and epilepsy. She is also a Medical Consultant to WeedMaps.com and a Member of the International Association of Cannabis as Medicine, the International Cannabinoid Research Society, and the Society of Cannabis Clinicians.

We first came across Dr. Goldstein’s work in the documentary Weed the People, which is about how families are turning to cannabis to help with difficult to treat conditions. Recently, we spoke to Dr. Goldstein about the current CBD craze, what it means to the medical community, and what parents interested in the potential of cannabis need to know.

We have talked to a number of researchers and clinicians about the health potential of cannabis. I think the general thought was that society was moving along faster than the clinical space. Do you think that’s still the case or are you seeing medical professionals start to catch up to how society feels about cannabis?

I think that is a correct statement. The medical community has been slow to accept cannabis as medicine but due to patients and parents of patients bringing up the topic of cannabis when they see their physicians, and also due to the media—seems like every day there is something about CBD in the news—I think that clinicians have no choice but to start to learn about this if they’re going to have meaningful conversations with their patients. I’ve heard from physician colleagues who report that in a week’s time at least ten patients will ask about cannabis or CBD.

We’ve heard from people who studied whole plant therapies, especially on the marijuana side, that CBD is maybe good because it helps break down some of those barriers, brings cannabis a little more mainstream. We’ve also heard that it might be a distraction because of a belief in the entourage effect, the capacity of the whole cannabis plant. Do you see CBD in this kind of current health craze as a positive?

I see it as a positive, yes, because it’s a foot in the door. It helps to begin the discussion. But then when one delves further into the science, one has to realize that it is all the cannabinoids and all the terpenoids that have medicinal value.

It is extremely important that we do not encourage the idea that CBD is a “good” cannabinoid and THC is a “bad” cannabinoid. That is utterly incorrect, and it is based on propaganda and on a complete misunderstanding of how cannabinoids work and their benefits.

I have recommended THC-rich cannabis since I started working as a medical cannabis physician in 2008. From 1996 when the first medical cannabis law was passed, until about 2012, only THC-rich products were available. Many patients were finding benefits with no harms or unwanted side effects. We have to remember that the intention of medical use is to help with the medical condition and that these patients were not looking just to get high. In fact, most were trying to discontinue prescription medications. Unfortunately our government took a negative stance a long time ago and has only allowed studies to look at the detriments of THC, much of which is incorrect and biased, but this approach certainly has brainwashed many against THC. I hope that people will understand that cannabinoid treatment is very safe and effective when patients are given proper medical advice and education about cannabinoids and products.

As physicians, we have this incredible toolbox filled with dangerous pharmaceuticals but yet so many are still afraid of THC. In my view, THC is a cupcake compared to an opiate.

I think that’s the interesting thing here is that we’re watching the FDA drag its feet on hemp or marijuana and they’re the people who have approved these opioids. Does it create distrust in the system from a patient perspective?

Yes, I have patients say to me it seems upside down. They ask “Why is it okay for them to give me multiple pills that can kill me but then my doctor looks at me like I’m crazy when I ask about medical cannabis?”

We met with a parent who uses a hemp derivative for their child. They have seen a change and are believers. I think they also felt that they had to do all the research online themselves and they were kind of alone in that pursuit. These conversations aren’t happening in a physician’s office, they are largely taking place online. Is that dangerous to parents, dangerous to children?

It is not dangerous in the way that somebody will give their child CBD oil and the child’s going to fall asleep and not wake up. Let’s take that out of the equation. That doesn’t happen.

However it is concerning that families who want to try cannabis because they have a very sick child still have a hard time getting their physician to help them. Some children are quite medically complex and they may be on other medications where there can be drug interactions. There can be complications such as unwanted side effects if parents don’t know what they’re doing with dosing. There are nuances to treating a medically fragile child. I always encourage families to try to find a physician knowledgeable in cannabis medicine to help them.

That being said, most physicians are not educated about how to treat patients with medical cannabis. I definitely see this changing, but still there is a significant problem finding good cannabis advice for complex patients.

The good news is that there is increasingly more interest in medical cannabis from physicians. Physicians learn a huge amount during a residency program where they are being supervised and learning about how to treat patients, basically learning the art of medicine. Unfortunately, there’s no residency program to learn about cannabis.

Often physicians will visit my office and spend a day or a week in my practice shadowing me to learn about the nuances of treating patients with cannabis and about the different cannabinoids and products that are available. I try to educate how to approach cannabis treatment using the science that we have, much of which comes from other countries that don’t restrict research on cannabis.

Obviously, there are forces against those who are trying to free cannabis from the Schedule I status. But it seems obvious that the right thing to do is to allow people to have legal access to cannabis and to be a supportive society in that we do the proper research that we need.

There are those who have said to me, “How much more research do you need? You’ve already seen thousands of patients with your own eyes improved with cannabis medicine.” And that is true. But what I would like to know is, for instance when a patient comes in, let’s say with a specific type of cancer: which cannabinoids will work best? Which terpenes? What kind of dosing? How long does the patient have to take this treatment? Is there a specific timing that should be used?

We’re missing all that data. I have some cancer patients that do really well and others that don’t. Why is there such a discrepancy? Why do some people respond, and others don’t? Is it the strain cannabinoids, terpenes? We are missing a fair amount of information for many conditions. These are all questions that we should be answering with robust research. Why are we not doing it? I guess we all know the bottom line is that cannabis may replace other medicines and many companies do not want this to happen.

When we talked to a congressman, he said that it was all about the pharmaceutical industry. Then a researcher who has been studying cannabis for a long time said that he can get all the money he wants to study the negative impact of marijuana but he’s never able to get money to study the benefits. 

That’s right. A number of years ago, the DEA came out and said that they’re going to make cannabis more available for research on the benefits. I have yet to see evidence of that.

What are maybe three topics people should know about, what should our site be talking about as we go forward?

One of the biggest issues, and I think you already know this and you cover it well on your site, is that the word “hemp” on a label or “CBD” on a label does not reflect what is actually contained the bottle. You must look at test results for any product that you may want to try. I have seen products that are labeled as CBD that have no CBD content when tested.

Number two: You should look at the cost. Knowing how many “cents per milligram” cost allows you to compare bottle to bottle. Different products contain different amounts of CBD milligrams and the cost of CBD can vary widely, ranging from about 2 cents per milligram up to over $1 per milligram. The best way to compare is to take the cost of the bottle and divide it by total number of milligrams of CBD in the bottle—this gives you how many cents you’re paying per milligram. This is the only way to compare pricing.

Another thing that’s very important for people who want to try cannabis who do not have a physician to help them is to look at potential drug interactions. There’s a non-profit called projectcbd.org that offers a downloadable guide to drug interactions with cannabinoids.

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