Extract: Blank Slate

BLANK SLATE Oklahoma’s lack of qualifying conditions allows patients to experiment with cannabis treatment.

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PG FOUR

PG ELEVEN

INTERNAL THE

AUTHORITY

BY J. Kyle Davis

MUNCHIES

BY Dr. Steven Ross, MD

PG SIX

COUNTDOWN

BEGINS

BY Lawrence Cagigal

PG EIGHT COVER STORY

OFF-LABEL

TREATMENTS

PG THIRTEEN

SHOW US

YOUR GROW

BY Matt Dinger & Nikita Lewchuk

When Oklahoma voters passed State Question 788, it was written intentionally without qualifying conditions, or certain diseases and disorders cannabis patients must be diagnosed with to receive a medical recommendation. For that reason, not only does Oklahoma have 6 percent of its population participating in its cannabis program, but many patients are experimenting with regimens for various ailments that otherwise wouldn’t be considered treatable in other states. Extract spoke with one such patient who moved from Texas to Oklahoma to treat his cystic fibrosis and also spoke with a man from the United Kingdom who has used cannabidiol, or CBD, to tackle his rare form of cerebral palsy. J. Kyle Johnson with Climb Collective and Overman Legal Group explains the nuances of administrative law or why certain agencies can amend the rules without legislative or voter input. Lawrence Cagigal explains the ins and outs of what you will need to file your cannabis taxes from 2019 and not risk a complicated and stressful IRS audit or fines and fees that would otherwise not befall industry business owners. Dr. Steven Ross explains why patients can get the munchies and still not gain as much weight as they otherwise would without the cannabis driving them. This will be the last month Extract appears in its current format. As you might have noticed over the past few months, there has been some experimenting within our pages with how we will present content and what issues we choose to highlight. We feel like our first phase of educational cornerstones has been successful, and while you can expect to see more of that coverage moving forward, we are excited to highlight how Oklahoma’s medical cannabis program has created unique opportunities that have not been seen in other states. Onward.

Matt Dinger Managing Editor Extract mdinger@okgazette.com

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OPERATIONS & MARKETING MANAGER Kelsey Lowe

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CONTRIBUTORS Lawrence Cagigal J. Kyle Davis Nikita Lewchuk Dr. Steven Ross, MD

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FE B R UARY 2020

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Internal authority While most of the changes made to Oklahoma’s medical cannabis program occur through the Legislature, J. Kyle Davis explains how and why state agencies can make rules without public input.

By J. Kyle Davis

The passage of State Question 788 marked a dramatic shift in Oklahoma’s legal treatment of cannabis and ushered in a new regime in charge of overseeing the Oklahoma medical cannabis program — Oklahoma Medical Marijuana Authority, or OMMA. First, however, a set of early emergency rules drew the ire of many of the 500,000 voters who came out to pass 788 into law in Oklahoma. When smokable cannabis was banned by Oklahoma State Board of Health, plenty of upset commentators asked how or why a group of doctors was able to essentially override what they saw as the will of the people. And now, as new changes are being promulgated via proposed permanent rules, what opportunities, if any, do local businesses and Oklahoma citizens have in guiding the decision of policymakers that don’t face the threat of accountability via democratic election?

The intricacies of both rulemaking procedures and others are a part of the administrative law framework, one that uses the legislative power specifically entrusted to the government through elections but delegated to other unelected officials who work in government agencies. Federally, legislation empowers administrative agencies to act and provides guidance on the scope of an agency’s authority. Whether a particular agency exceeds this grant of authority or acts contrary to its stated goals or established evidence is often the subject of lawsuits against the federal government. In Oklahoma, however, our Constitution creates this power for agencies to act outside the proper branches. So while

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Article Four of the Oklahoma Constitution makes clear that each of the three branches of government are not to exercise powers properly held by the others, section six of Article Twenty-Five creates the Legislature’s authority to create departments to faithfully administer and execute all laws enacted by the body. Thus, an agency entrusted by the Legislature can create rules, at least as long as they are not contrary to that law that they are further delineating.

The rules that apply to administrative agencies are generally governed by the Oklahoma Administrative Procedures Act along with the Oklahoma Open Meeting Act and the Oklahoma Open Records Act. The primary purpose of handing down this power to make rules is one of pragmatism; often, members of the Legislature don’t have specialized knowledge to provide guidance in areas outside their expertise. For example, the Legislature might want to limit emission of a certain contaminant into the environment after it is shown to cause health problems to people in the vicinity. It would be the rare elected official who would possess the requisite scientific knowledge to make a proper determination of how many parts per million cross the threshold into a danger to the public. To properly address this problem, they therefore can delegate some of their authority to a body suited to make that determination — like the Environmental Protection Agency, which is strategically staffed with scientists with expertise in the minutiae of the field so that they might more specifically address the goals of the Legislature.

When Oklahoma State Board of Health met to create the now-infamous rules soon after passage of 788, they did so under emergency rulemaking procedure. This can only be done when they deem an imminent peril exists to public health, safety or welfare or a compelling public interest requires emergency rules. Administrative agencies can

then create rules without notice to the public or a hearing.

At that point, the governor has the option of approving or disapproving the emergency rules.

The governor approved those emergency rules, but the ban on smokable cannabis never took effect. That’s because before a formal challenge was underway, Attorney General Mike Hunter issued guidance to the Board of Health that stated it had promulgated rules beyond its statutory authority. That authority is the limit of the Legislature’s granted power under which administrative agencies may act, and Hunter determined that it exceeded its limit by imposing new rules and straying from the plain meaning of the words in 788. Had he not, many businesses and citizens were preparing to challenge the agency action as well — but those rules might have very well dictated the state’s regulatory scheme for medical cannabis until the Legislature passed law that said otherwise.

The other major function of administrative law is to provide something similar to a judicial function, or an administrative hearing. Much in the way an administrative rulemaking mirrors the executive function, an administrative hearing functions as an adjudicating body, but often without all the protections afforded to parties in a standard judicial setting. Sometimes this is as simple as a paper hearing, where an affected party can submit a written explanation of their position, all the way up to a more formal hearing in front of a quasi-judicial official acting as a judge. A notice and comment is used after a rulemaking, like the permanent rules that were recently proposed by the Department of Health. The scope of involvement from affected parties depends on the type of rulemaking, and in the case of the new proposed cannabis rules, business entities that will bear expenses if these rules take effect may provide data on their impact on direct and

J. Kyle Davis | Photo Phillip Danner

indirect costs. The window to do so is open until March 7, and participating businesses must submit this data to the Agency Rules Liaison.

Ultimately, it can be difficult to know what steps a company should take when an administrative agency acts and it creates issues for the business. Often at issue is whether the claimant is being deprived of an interest that rises to the level that would require a hearing of some sort. In the case of these new rules, the threat of increased costs to businesses affords them a chance to be heard. A prospective interest, however, is typically not enough to trigger a formal hearing, while deprivation of a concrete and individualized property right, for instance, would allow for some level of recourse.

Proper guidance in heavily regulated industries like cannabis requires precise knowledge of administrative procedures. And though the cannabis regulatory scheme is under an administrative framework, there are also important intersections with more established agency oversight, like in agriculture — another heavily regulated sector. This is also true of the environmental concerns related to cannabis-waste management and processing byproducts as well as public health in relation to food product manufacturing. The framework through which the industry is regulated can be confusing, and a background in the procedures that govern it are essential to staying on top of the current rules and guiding businesses through coming changes.

FE B R UARY 2020

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Countdown beg ins With tax deadlines looming in March and April, now is the time to be gathering materials for your accountants.

By Lawerence Cagigal

One of the most despised phrases that will be said for the next few months: “Tax season is upon us.”

Every tax professional is counting down the days to March 15 (S-Corp, C-Corp, multi-member partnerships) and April 15 (individuals, single-member LLCs, schedule C only) deadlines. The GreenGrowth CPAs tax team counts down each day like the days until Santa arrives, except Santa (IRS) only takes instead of gives. (“Ho, ho, ho!

Give me all your hardearned dough, dough, dough!”)

We understand that every day, the stress builds for cannabis operators until they take the initial step to begin the tax return process.

To help unburden your minds, we will provide some practical guidance to assist you.

Let us work off the correct assumption that taxes will be reviewed for a regular entity eventually. Cannabis is still federally illegal, and the IRS applies 280E to cartels and state-legal cannabis operators alike, so it would seem logical to pay attention to how you operate your business and file your tax returns. There is an entirely higher level of complexity and oversight by the IRS for cannabis operators and their tax filings versus how they deal with ordinary businesses because they know that most operators of cannabis businesses will file incorrectly. IRC 280E is very

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restrictive on purpose, and the federal government generates revenue from its misinterpretation and the negative consequences of noncompliance, including but not limited to penalties, fines and interest.

Empirical evidence from some of our legal partners out in early legalization states says that the audit rate is approximately 17 percent for cannabis businesses compared to the 1.5 percent for ordinary businesses. It is not hard to find the cannabis businesses either because states have a published list of licensed commercial entities and all the relevant information an auditor

experience with, then why would you try to tackle cannabis taxes on your own?

When speaking to prospects who are in the cannabis industry, I encourage them to seek out multiple tax firms to find a comfortable fit for their operation, and I stress that the firms should be cannabis-specific with deep experience in the industry. Let me clarify that prior experience is not buying an e-book, attending one class in Colorado and then pivoting your tax practice from oil and gas in late 2018 or early 2019 to cannabis to take advantage of this so-called “green rush.”

“Lawrence, you work for a cannabis-specific firm.

Of course you say that.” Agreed, and I have never hidden the fact that I try to help float my boat by riding the overall CPA specialist tide.

But I also do it for your benefit. The real point to focus on is that I know for a fact who does not want you to act on this sound advice: your competition.

I get referrals from clients all the time, typically from another vertical operation or from across the state but never for someone that is “across the street,” if you will. They Lawrence Cagigal | Photo Phillip Danner disclose to me as much, and some would need to get started. What is clients even wish to restrict who even more astonishing is that most we work with. As of January 2020, CPAs in any state won’t touch a canthere are more than 5,400 cultinabis tax return, and they are doing vators, 1,400 manufacturers and this for your benefit and probably 2,200 dispensaries in the state of theirs too.

Oklahoma. It is quite crowded out So if cannabis is federally illegal there. Let’s be real here. Your comwith a high audit rate and competition doesn’t want you to seek pounded by a tricky tax code that out a cannabis specialist, and they is different from what 99.87 persurely don’t want you to seek out cent of traditional CPA firms have an industry association to learn

about the business. Your competitors want you to use your big brain to stay “too smart” to pay anything other than a rock-bottom fee for services. They know that rock-bottom fee will end up costing you much more money in the future, and they now have one less competitor to deal with.

If you don’t believe that you need a cannabis-specific CPA firm to help, you can just wait a few years for when the IRS and Oklahoma Medical Marijuana Authority (OMMA) come knocking at your door, asking you to reconstruct all of your financials for their finetooth-comb audit and no general CPA will help you out.

BEST PRACTICES A truly bulletproof tax return requires year-round tax planning and service. Here are a few strategic items to maximize your return or minimize your bill. If not feasible now, there are some detailed items to collect at tax time to reduce your tax exposure and mitigate the impact of an audit.

Remember, audits are only painful if you’re not ready for them.

1) Understand what “cost of goods sold” and 280E are.

COGS is the direct costs associated with producing the goods you sell. This will be different from one business to another. (What is a COGS for a cultivator might not be a COGS for a dispensary).

There is tons of valuable content online that will describe it in laypersons terms.

2) Create detailed job descriptions for your employees.

Being comprehensive on job descriptions can give you and your CPA a fighting chance to deduct employee wages. Some job duties will open up wages to deductions that many businesses assume would not be eligible.

OKLAHOMA’S B2B ONLINE

3) Save all receipts.

Let’s assume you are a cannabis operator named Teale. She made some money and then immediately reinvested it back in the business. She even only purchased items that qualify for COGS. In this scenario, with no receipts, she cannot prove where the money went; therefore, the IRS will assume that she still has all of that cash and will pay full taxes on it.

The onus is on her to prove where your money went. Luckily, Teale had a detail-oriented CPA she took advice from and knew to keep all her receipts. Ideally save and catalog electronically, but a shoebox full of receipts is way better than no shoebox full of receipts.

4) Be a student of the industry.

“I didn’t know” is not a solid excuse. Wouldn’t any logical or smart business owner err on the side of being safe and asking a professional for help and not just assuming something doesn’t apply to them?

Stay up-to-date by reading new regulations and leaning on your team of tax professionals to keep up with the ever-changing cannabis industry. If there is one constant in cannabis, it is that matters change all the time and you need to keep up or you will fail.

“Lawrence, we have done some of this. What now?” No one likes taxes; everyone hates doing taxes even more. In our experience, just starting the process helps reduce stress. Action relieves anxiety.

Whether you tackle this on your own or find someone you wish to work with, here is a solid starting list of miscellaneous documents and information to gather: • Tax returns for prior years, if applicable • Copies of sales, excise and local tax returns • Cash-handling log • Articles of incorporation • IRS-issued EIN (Employer

• • • •

• •

•

Identification Number) Monthly bank statements, if applicable Balance sheet Profit and loss statement List of owners/business partners and their ownership percentages Social Security numbers for each partner Building information to include lease and tenant improvement receipts QuickBooks and point-ofsale login info

Income • Gross receipts — THC versus non-THC • Returns and allowances • Business checking/savings account interest (1099-INT) • Other income Cost of Goods Sold • THC purchases • Non-THC purchases • Expenses* • Advertising • Bank charges and finance fees • Commissions/fees • Contract labor (1099-Misc and 1096) • Computer and internet bills • Health insurance • Other insurance • Interest expense (mortgage and business loan) • Meals and entertainment • Office supplies • Rent (building, business vehicles, equipment) • Utilities • Repairs and maintenance • Miscellaneous supplies • Taxes paid • Licensing fees • Transportation and travel • Wages paid to employees • Payroll tax returns • Employee benefits *There is literally no way to disclose for each person reading this what expenses on this list are deductible in their operation.

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OFF-LABEL treatments While the effectiveness of cannabis is well documented in treating some diseases or disorders, others are finding relief using the compound in absence of peerreviewed medical literature.

By Matt Dinger & Nikita Lewchuk

While many applications for cannabis have already been discovered, scientists and patients alike are finding new and different ways that the plant is enriching lives.

Oklahoma has no qualifying conditions for its medical patients, which is why Dryden Groat moved here from Texas to legally experiment with medical cannabis. He also landed a job with The Highgrade Testing Lab, so the chemist by trade can also experiment outside his own personal experiences.

At six days old, Groat was diagnosed with cystic fibrosis.

“When I was born and diagnosed, they pretty much told my parents, ‘Enjoy your time with him because he probably won’t live until he’s 16,’” Groat said. “Cystic fibrosis is a respiratory and digestive disease, and it affects about 30,000 people in the U.S. alone and about 70,000 to 80,000 worldwide. Our cells cannot transport sodium and potassium through the cell membrane, and so that means there is a smaller concentration of sodium in our bodies.

When we sweat, we sweat out more salts and stuff like that, and then that is what causes the thick secretions of mucus in our lungs, because salt is actually a mucus thinner. It thins the mucus so we can cough it out properly, and so without the concentration of sodium in our bodies, our mucus is thicker, stickier, harder to get out of our bodies, and that’s the reason for breathing treatments. Pretty much just to give our lungs an irritant so that we can cough out the mucus before it gets infected and leads to scarring.”

Groat said he does breathing treatments every morning and night and also has to take medica-

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tion before he eats.

“It’s my way of life, so I don’t really think of it as anything too extreme, but for people on the outside, they see I’m pretty regimented. I’m pretty good about doing my treatments and stuff just because I have to be if I want to keep living,” he said.

A friend with cystic fibrosis he had met through social media told him her doctor recommended she try a dry herb vaporizer. While she was living in Canada where cannabis was just legalized nationally, Groat was living in Texas where there is no medical cannabis program, so he had to go to the black market to see if it would also work for him.

“From the first time I inhaled the dry herb vapor, I knew it was something special. And so then I started researching,” Groat said. “It just piqued my interest that much because I just felt so much relief. Not just the lungs. Cystic fibrosis affects my digestion more than anything, so I wake up nauseated, and I just live in a constant state of nausea and decreased appetite leading to malnutrition, lower body mass index, all that bullshit. And so it helps with my lungs. It helps with my appetite for sure. Definitely helps with the nausea, and I’m able to eat more to maintain my weight better through using cannabis. And then my depression and anxiety stemmed from my cystic fibrosis as well, just having that feeling of your life has a due date, essentially, and this disease will eventually be the reason I die. So it’s pretty morbid, but cannabis takes away that anxi-

ety that depression and it makes me breathe better and it makes me eat more, so it’s just like a cure-all.”

The vapor also helps agitate the mucus in his lungs in the same way the breathing treatments do.

“Every time I cough, it’s a productive cough, meaning I do cough out mucus and actually, my breathing treatments are just there if I need

Dryden Groat | Photo Phillip Danner

them pretty much because after vaping, it feels like I do a breathing treatment,” he said. “It just has the same effects, but through vaping, it’s natural. It’s a medicine. It’s just amazing how this one plant has, I wouldn’t say replaced, but pretty much does the same exact thing that 28 years of breathing treatments has done for me.”

GOOD TERPENES

Groat has found that certain terpenes benefit him more than the THC or CBD. “I hate that Blue Dream is my favorite strain because it’s just so common and all that, but really and truly, Blue Dream has the pinene.

It has the caryophyllene for the

inflammation,” Groat said. “The pinene is the bronchodilator, and so that gets in there and opens my airways, and then if there’s any inflammation, I find that the caryophyllene goes in and kind of calms the inflammation. I don’t feel as heavy-chested due to the inflammation after I vape some caryophyllene, but it’s not just Blue Dream.

There’s other strains that I’ve tried, and I kind of keep a little log book of what works for me and what doesn’t. Everybody in the lab kind of lets me know, like, ‘Hey, this strain has a lot of pinene,’ and I put it on my list, and then when I can get my hands on some, I try it and test it out. But I tend to stick with the pinene terpenes because I know that they work.”

While his doctors were not pleased when they found out what he was doing, the test results from August to November 2019 have helped convince them.

“My lung functions are that of a normal range.

I’m very fortunate in my case of CF. Every case is different,” Groat said. “I have friends that have died waiting for transplants, and they were 22, and then I have some friends that are 55 and they’ve never had a transplant. So it’s really an individual case, which is why it’s so hard to treat. But with my specific case, my lung functions sit around 90 to 100 percent whereas most people my age are in the 40s and 50s range, and so that’s kind of why I was more experimental with cannabis, because I kind of have that room that if it didn’t work, I could still afford to lose some points on my lung function. But my last appointment, I went, and my previous appointment my lung functions were 93 percent, I believe, and then at that appointment, I blew again and my

Blue Dream | Image Shutterstock.com

lung functions were 98 [percent]. It went up, which is really good, and I had done no changes to my lifestyle.

I didn’t start working out. I didn’t start running. I didn’t start getting any better. It was just with the addition of cannabis.”

CBD EFFECTS Phillip Nicholson has been medicating with CBD for a year and a half.

He has a rare form of cerebral palsy, called ataxic cerebral palsy, which affects the part of his brain called the basal ganglia that causes difficulty with balance, fine motor skills, short-term memory and occasional slurred speech.

The primary treatment courses for cerebral palsy are typically a combination of physical and occupational therapy and surgery, though muscle relaxants such as Baclofen or Valium can also help relieve symptoms.

Managing his symptoms is a daily battle for Nicholson, who works as a bartender. His job requires balance and coordination, both of which are affected by his ataxic cerebral palsy.

“I have people tell me all day every day, ‘It’s not your fault. Don’t worry; it’s not your fault,’” he said.

“Yeah, I know it’s not my fault, but it doesn’t fuckin’ help the situation.”

Nicholson had his first experience with cannabis in his teenage years, though he did not consider its potential therapeutic effects until he was in college.

“When I was at university, we all smoked weed in the house I lived in. My housemates were well aware of my cerebral palsy, and they knew I kind of used weed to ease those symptoms as well, but they also knew I didn’t want to be stoned all the time. My old university housemate came home with a bottle of CBD, let me try some, and sure enough, I realized it was very helpful.”

There is not yet any conclusive evidence that CBD positively affects people with cerebral palsy.

There are a variety of studies that examine the effects of cannabis on fine motor skills and spasticity-related multiple sclerosis, but to date, the only comprehensive study done specifically on people with cerebral palsy was done at Wolfson Medical Center near Tel Aviv, Israel, in 2017.

According to the Israeli news site Haaretz, the study found that in children with severe cerebral palsy, cannabis oil substantially improved motor function, sleep quality and general mood.

The report did not recommend using cannabis as the only treatment method, but instead using it to enhance the effects of physical therapy and other treatments. This study has not been replicated, making it hard for scientists to draw conclusions about the specific effects on these symptoms.

What is clear is that the basal ganglia — the part of Nicholson’s brain that was damaged — has an abun-

dance of cannabinoid receptors, suggesting some level of connection.

“Sometimes it does more than other days, depending on how bad I am in my symptoms, in my tremors, in my balance. ... When I take CBD, it makes me feel more uplifted mentally and more, kind of, awake cognitively,” Nicholson said. “So, when I feel more awake cognitively, I’m using CBD comboed with a good diet and exercise.

It works perfectly. My tremors are so calm, I speak better, my memory is better — I’m just generally more switched on as a person; it even makes me walk better.”

He did not consult a doctor before he started using CBD because he was not required to.

GETTING CBD Nicholson lives in the United Kingdom (UK), which officially legalized the sale of CBD for medical purposes in 2018.

The UK draws a clear distinction in terms of legality when it comes to THC. The UK has what is called a “psychoactive substances ban,” which includes most forms of cannabis.

The plant cannabis had been classified as a Schedule I substance until November of last year, when it was moved to Schedule II. Compounds with more than 0.02 percent THC remain entirely illegal, though CBD itself was never scheduled.

Today in the United Kingdom, CBD is available through medically licensed distributors or private companies with no medical license.

Although CBD was never considered a psychoactive substance, it can still be difficult to find in stores.

“I have to go online and wait x amount of days to get CBD oils and stuff like that. A lot of the time, it is very overpriced for what you’re getting — we’re talking a 10 mL bottle for sometimes up to

60 pounds [73 dollars] — but I’m lucky in the sense that I’ve got a friend that runs a company in Bristol called CBD Genetics that does it for 30 quid [36 dollars], full-spectrum CBD.” Full-spectrum CBD is an extract from the actual cannabis plant, meaning in addition to the CBD, there are other cannabinoids, flavonoids, and terpenes present.

The two brands of medicinal CBD available are Dronabinol and nabilone. Both are synthetic CBD, or a chemical designed in a lab that mimics CBD’s effects without the full cannabinoid profile.

Officially, the National Health Service (NHS) in Britain recommends against using non-medicinal products due to the lack of quality assurance.

The NHS website also says, even after the legalization of CBD for medical purposes last year, “Possessing cannabis is illegal, whatever you’re using it for.

That includes medical use unless it has been prescribed for you.”

General practitioners in Britain are not allowed to prescribe CBD. In order to get a prescription, you need to see a specialist, and even then, the chances of getting it are low. The only conditions treatable with CBD listed on the NHS website are rare forms of childhood epilepsy, spasticity from MS and vomiting from chemotherapy.

“Weed is still illegal in the U.K because of the psychoactive blanket ban. Now, debates are happening and rules might change within the next five or so years, but I don’t see it happening anytime soon,” Nicholson said.

In the meantime, Nicholson will continue to buy and use CBD without a prescription.

“CBD was my own conscious decision, and buying it regularly and using it every day — whether that’s in my cup of tea in the morning, under my tongue or in the vaporizer,” he said.

FE B R UARY 2020

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FE B R UARY 2020

The munchies While the effects of cannabis upon hunger pangs are well documented, precisely how “the munchies” affect weight gain is still being studied.

By Dr. Steven Ross, MD

They call them “the munchies.”

They’re the THC-induced desire to eat, well, just about anything but most typically some sort of junk food. If you watch the movies, the munchies are probably one of the most well-known parts of cannabis use lore. Of course, if you are taking something that gives you an appetite far above normal, it is going to make you gain a bunch of weight, right?

Well, no, it doesn’t. As is such a common theme in discussions of cannabis, the obvious answer is not the correct one.

At this point, you might be thinking, “That I can’t be right.”

You’ve eaten an entire pan of brownies after using cannabis and the only thing stopping you from eating more was that the last crusty corner piece was finally gone. That part is correct. THC is an agonist (activator) of the CB1 receptor, and this receptor plays a large part in our short-term hunger signaling. The munchies are real. What isn’t real is that cannabis is typically a cause of longer-term weight gain.

The scientific evidence is piling up showing cannabis generally reduces body weight. My suspicion is that cannabis generally trends the adult person to a more normal, homeostatic weight.

Considering that these studies were done in our current environment of an obesity epidemic, it is not a surprise that cannabis appears to be associated with weight loss. A recent metanalysis of several studies with over 156,000 patients showed 7 percent lower average body mass index (BMI) in cannabis users despite the fact that cannabis users reported eating 800 more calories per day. Studies in specific adult groups such as the mor-

bidly obese, those with psychosis on antipsychotic medications and specific racial groups such as the Inuit also showed similar weight loss in cannabis users.

The study of patients on antipsychotic medications also showed improved cholesterol levels that worsened in the patients that stopped using cannabis.

A warning for teens or parents of teens if you are reading this: Cannabis is not helpful for weight loss in that age group. While development is still occurring, that is a different homeostatic situation. A 2010 study of students 1117 years old found an association between cannabis use and obesity in girls. A second 2013 study found that cannabis use in the teen years was associated with a higher incidence of obesity in the late teens and early 20s.

THE SCIENCE

The first question is, How does cannabis do this? The second question is, Can we use it to our advantage?

Thus far, it has been mainly a surprising and pleasant side effect.

Unfortunately, we don’t have clear answers to these questions yet. The simple idea is if THC activates the receptor and makes you hungry, if we block the receptor, you won’t be hungry anymore. Unfortunately, simplicity is not the case with cannabis and weight loss. Pharmaceutical companies tried, and it failed miserably. Sanofi-Aventis, the large French multinational drug company, created a CB1 receptor blocker on the premise that if THC activates this receptor and it makes you very hungry, then a receptor blocker would suppress appetite. They created a drug called Rimonabant that did exactly this and did make people lose weight. It was approved in Europe and Mexico, but not in the US. However, it did not last long on the market, as psychiatric side effects including suicide, depression and anxiety were far too common. This would not be a surprise to people who use cannabis to treat those disorders.

They were possibly on the right track but did not take into consideration all of the effects of the plant.

For example, Cannabis consumption is known to cause food cravings, otherwise known as “the munchies.” | Photo Bigstock.com it is known that in addition to THC being a receptor out the neuropsychiatric effects. agonist, there are other moleThey have not yet created such a cules in the plant that can act to molecule for human physiology. block the receptor and suppress Our bodies have two phenoappetite. THCV (tetrahydrocantypes of fat: white fat and brown nabivarin) is the most studied of fat. White fat is more common these. THCV can be an agonist and what we typically think of as of the receptor and an antagofat. Brown fat tends to be more nist (blocker) at other concenabundant in people of lower body trations. This explains how the weight and in children. Brown psychiatric symptoms associated fat uses large amounts of energy with a full receptor blocker like to help keep us warm so is more Rimonabant are avoided by the metabolically active than white natural molecules. Even the acfat. In an in-vitro study (outside tivation of the receptor by THC the body), CBD was shown to itself appears to cause hunger in convert white fat cell lines to the the first few hours after activabrown fat phenotype. This findtion, but appetite suppression is ing would need to be replicated in the activity of the receptor over a vivo (in the body) but does hint at longer time. Cannabinoid recepanother method in which cannator physiology is very complex. bis can produce weight loss.

We are still learning the details.

In another study helping to Science only discovered this recombat the mouse obesity epiceptor system in our bodies in demic, mice were fed a “Western 1988. While that might seem like diet” to the point of obesity and a long time ago, it really is not in normal weight mice were given the world of science.

THC. They found that the obese There could be further ways to mice lost weight but the normanipulate this system to promal weight mice did not. That is voke weight loss more signifino surprise, but the interesting cantly. There are cannabinoid refinding of the study was that the ceptors in many of the organs of gut microbiota, the ecosystem of our bodies, including adipocytes bacteria that live within our gas(fat cells). Most see fat cells as just trointestinal tract, also changed “dumb” storage depots for excess with THC. The gut microbiota calories, but the reality is that is influenced by our diet, as the these are complex cells that crebacteria feed on the foods we inate enzymes, hormones, proteins gest. “Western diet”-type foods and other growth factors that play have been implicated in adverse a large part in the regulation of changes in the gut microbiota, our energy homeostasis. In mice, which actually causes more calscientists have found that if they ories to be obtained from foods block the cannabinoid receptors and leads to further weight gain. specifically on the adipocytes In this study, the addition of with molecules that cannot cross THC kept the gut microbiota of into the central nervous system, the obese mice fed a “Western weight loss can be achieved withdiet” from changing to the less FE B R UARY 2020

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helpful types of bacteria. THC kept the gut microbiota more like the microbiota of the normal weight mice.

In addition to its actions at the receptors, adipocytes and gut microbiota, there are also other potential ways in which cannabis induces weight loss. A 2014 study in Health Economics looked at the effects of medical marijuana laws on body weight, physical wellness and exercise. Interestingly, they found age-associated causes of decreased BMI with cannabis use. In the younger (18-24-yearolds) cohort, the decrease in weight is associated with a 3.1 percent reduction in alcohol use. They attributed some of the weight loss to limited alcohol since it is a high-calorie content product. In the older cohort, the reduction of BMI appeared to be due to increased physical activity due to improved physical health, pain control and wellness.

The skeptical among you are probably thinking about the indication of cannabis for patients with cachexia (severe underweight) from diseases such as cancer or HIV. How can studies show that cannabis helps them gain weight while other studies show cannabis helping others lose weight? That doesn’t seem logical. However, if you look at the mechanism of cannabis, it is merely supplementing the endogenous molecules of our endocannabinoid system that help us maintain normal weight.

Therefore, the effects are going to move the patient toward homeostasis, not further away.

In summary, at this point, we have evidence that cannabis use is associated with lower weight in the adult population. We have had some unsuccessful attempts to take this finding and create a specific medication. And finally, we have some basic science that

points to several possible mechanisms that could explain the effects.

How about right now? What if I want to use cannabis right now for weight loss?

You can Google “cannabis weight loss� and find many strains suggested to be the best ones for weight loss. But that is mostly based Dr. Steven Ross, MD | Photo Alexa Ace on having THCV in them and user opinion. There is no science yet showThat is unlikely. There are many ing one strain to be better than difficult factors in this issue, and another. Given the lack of known there isn’t going to be one simple evidence at this time, I believe a solution. But with time and better product with moderate amounts understanding, I do think there of THC, CBD given its effect on are bright possibilities for this to adipocytes, and THCV is a reasonbe a safer tool in the process than able place to start. much of what we do now.

Is cannabis the panacea that will fix our obesity epidemic?

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