We interviewed Dr. Dara Huang, a Manhattan-based Nephrologist and Brown alumni working in the medical marijuana space, specifically CBD-related products as an effective means to treat pain-related conditions.
Dr. Huang has developed a medical practice dedicated to helping patients develop treatment plans for their chronic pain. Her years of experience have largely contributed to the awareness of CBD as a state and nation-wide movement, forging a new way to lessen the painful side effects of many illnesses, including fibromyalgia, Parkinson’s Disease, MS, inflammatory bowel disease and others.
Dr. Huang was interviewed by OneMed Sentinel editor-in-chief, Brett Johnson.
Read below for a transcript of Dr. Huang’s discussion regarding the latest advances in CBD’s pain treatment.
Brett Johnson: Can you give us a brief summary of your background? How did you separate yourself from a traditional medical practice to becoming an expert in the field of CBDs?
Dr. Dara Huang: I am a Manhattan-based Nephrologist and Medical Cannabis Care physician. I founded the first practice in NYC to approve patients for the NYS Medical Marijuana Program. I earned my undergraduate, Masters in Medical Science and Medical degrees from Brown University and Brown Medical School. I evaluate and certify patients and prescribe the products and dosages available at the medical dispensary. I offer treatment solutions for patients who suffer from the most serious complicated medical conditions such as cancer and intractable chronic pain and monitor them for any cannabis related issues.
Rather than separating myself from a mainstream clinical practice, I have maintained my medical practice and have expanded my services to include the use of medical cannabis as a part of treatment plan to treat patients with debilitating chronic medical illnesses. I believe it’s important for physicians prescribing medical cannabis to understand the medical needs of the patient first, and if indicated, use medical cannabis including CBD dominant products as a safe and effective adjunctive treatment option.
BJ: Can you explain what are CBDs? How would you distinguish it from society’s general, stereotypical view of marijuana?
DH: CBD, or cannabidiol, along with THC (delta-9-tetrahydrocannabinol) are the two major components found in the cannabis plant. Unlike THC, responsible for the mind-altering effects in cannabis, CBD is non- psychoactive. Its main benefits mimic the endocannaboinoids we naturally produce in the human body that functions to self protect, relax and regulate our bodies. Among many other benefits, CBD has been effectively used as analgesic, anticonvulsant and anti-inflammatory medication to alleviate chronic pain, prevent seizures and reduce inflammation without having unwanted side effects. THC, under proper medical supervision, has many medical benefits as well. However, for recreational purposes, cannabis plants have been primarily grown and bred over time to produce plants containing high THC content to elicit the euphoric ‘high” reaction. This is drastically different than the state quality assured legal medical cannabis products used to treat medical conditions and ailments.
BJ: What types of disorders or diseases is CBD known to treat?
DH: Under NYS law, I have used CBD to successfully treat patients with chronic pain, cancer, Parkinson’s disease, multiple sclerosis, neuropathies and inflammatory bowel disease among others. Experimental models have shown CBD to have numerous medical benefits with analgesic, anti-proliferative, anticonvulsant, antipsychotic, antioxidant, neuroprotective, immunomodulatory and anti-inflammatory effects. With further research and development, CBD has the the potential to be a powerful medicine to treat conditions such as chronic pain, cancer, multiple sclerosis and epilepsy without causing the adverse side effects. In fact, CBD can actually be used to counteract the psychoactive effects of THC.
BJ: What is your opinion on the opiate epidemic in America?
DH: It’s an outrage. The opioid addiction in the US is at epic proportions and has reached at a critical level as a public health crisis that simply cannot be ignored. The statistics are staggering, with more than 100 people dying from prescription drug overdoses per day and is predicted to kill nearly half a million Americans over the next decade. This is more than cocaine and heroin deaths combined. Despite increased efforts for doctors to avoid prescribing opioids, there is a lack of alternative solutions to treat our patients who continue to have chronic pain or in many cases, have become opioid dependent after being giving a prescription to treat acute pain after surgery, for example. I am hopeful that as we learn more about CBDs, we can use this medicine to help combat the opioid addiction in this country and address this major public health issue in a constructive way.
BJ: Why is CBD an alternative to other forms of pain management? Do you see it as part of the solution to the opioid crisis?
DH: Treating pain and inflammation is complex and is often treated with a combination of medications and non pharmaceutical therapies. One of the causes of experiencing pain is due to the the body’s lack of endocannabinoids, that serve to relieve pain and reduce inflammation. CBD supplements the body’s endocannabinoid deficiency and as acts on cannabinoid receptors. These cannabinoid receptors are found throughout the body and is different from opioid receptors. Under close medical supervision, CBD is an incredibly useful tool in a doctor’s armamentarium to treat pain and decrease opioid use. I have successfully prescribed CBD as an adjunct to the opioids, NSAIDs and other painkillers to alleviate intractable pain for my patients. In my initial medical evaluation, I add CBD with the goal of achieve better pain control in conjunction with existing medication regimen. Over time, I can adjust their dosage accordingly to taper off their opioids, and eventually use CBD as the primary therapeutic agent to treat their pain.
BJ: Are there certain disorders where CBD would not be a viable treatment option?
DH: There are over 400 different compounds and 65 phytocannabinoids found in the cannabis plant, of which THC and CBD which are the major ones. It is the plant’s unique cannabinoid profile composed of varying percentages of all these components that work synergistically that confers therapeutic effects. This is called the entourage effect. A higher ratio CBD product is typically more effective to treat inflammatory and neuropathic types of pain, seizures and spasticity, while a lower ratio of CBD to THC product is used to treat symptoms such as somatic or nociceptive pain, insomnia and appetite stimulation. Because of the entourage effect, CBD is crucial in treating all these conditions: it is a matter of whether or not CBD is the predominant active ingredient.
BJ: Would you consider the rising popularity of CBDs as a movement?
DH: More than a movement, the use of CBD has exploded onto the scene as a disruptive medical breakthrough, not only in areas of research, healthcare and public health, but in all aspects of businesses directly involved from seed to sale with huge growth potential in ancillary business sectors as well.
BJ: Do CBDs come in different forms? Is one form more effective than others? Does the form change when dealing with medical use versus recreational use?
DH: For recreational use, it’s usually smoked or ingested through what are known as “edibles” – where cannabis added into various baked desserts or candies and consumed. Many states allow for medical cannabis to be smoked or to be in the form of edibles, but New York State does not allow it.
Instead, in New York, it is in the form of oils – which are delivered in three primary ways: oil tinctures or drops that is absorbed sublingually, or under the tongue, in a capsule or pill form that is swallowed, or via inhaled vapor (unlike smoking where there is no combustion).
The inhaled form is definitely the most effective especially when suffering from unpredictable pain. It is the most fast-acting, however it also has the shortest duration. Conversely, the capsule takes the longest to take effect, but it has a longer-lasting effect. The sublingual form is intermediate in terms of duration and amount of time to feel pain relief.
For patients who have never tried medical cannabis, and are new to CBDs, I usually recommend the tincture oils. Many people are uncomfortable with the mechanism of vaporizing, and the sublingual form of administration are extremely effective in managing pain.
BJ: If someone is considering CBDs as a pain relief option, how would they go about starting a course of treatment? What questions should they ask?
The first step for any patient is to find a reputable and experienced medical doctor to certify them legally under the state laws. In NYS, for example, they would see a certified physician, such as myself, to discuss their medical condition, symptoms and have a treatment plan for medication product and dose recommendation. Patient should ask about possible interactions with medications they are already taking and potential side effects. It’s also very important to establish goals of care and what to expect in buying medical cannabis at the dispensary, as it is very different from a typical pharmacy.
BJ: What advice would you give to investors or other entrepreneurs interested in innovations in healthcare and medicine concerning CBD?
DH: With the growing acceptance of the health benefits of medical cannabis and a growing push for the legalization, cannabis has developed into a burgeoning industry that is decidedly marked by entrepreneurship and innovation. Cannabis sales totaled $6.7 billion last year and is expected to top $20 billion within five years. I think it’s a smart time to invest into companies that have the potential to emerge from the rest of the market as a leader of the pharmaceutical cannabis industry and be aware of those that exist within the “gray market” sidestepping high standards due to the lack of unregulated laws and operations.
BJ: Can you tell us a bit about your upcoming event at the Brown Club?
DH: We actually sold out tickets within 1 week of posting our event! Through my alma mater, Brown University, I am organizing a Leaders in Cannabis on Sept 13 at National Opera Center in New York City. It is a unique panel discussion featuring leaders in the cannabis industry. The panel consists of lawyers, journalists, public health advocates, and myself as a physician who all are working to promote a better understanding of cannabis, its legalization, and the revision of cannabis laws. We will discuss the most pressing issues, concerns, obstacles, and challenges facing the cannabis industry.
We have already generated much interest from such industry giants including Columbia Care’s CEO Nicholas Vita, the largest distributor of medical marijuana ; Laurie Wolfe, known as “The Martha Stewart of Cannabis” http://www.newyorker.com/magazine/2017/04/24/the-martha-stewart-of-marijuana-edibles ; and Patrick Rea (Brown alum), The largest investor in cannabis business CEO & Co-Founder at Canopy Accelerator – CanopyBoulder.
BJ: What is your opinion on marijuana or CBD legislation? What needs to change, legislatively, in order to create a more effective system for patients to obtain safe, non-addictive pain relief?
DH: I think that primarily, cannabis needs to be either de-scheduled or rescheduled. Currently, it is categorized as Class I substance, defined as having no medicinal value – only harm. The only other drugs in this category are heroin and LSD. Even cocaine is listed as a Schedule II substance, as are opiates.
De-scheduling or rescheduling cannabis will have a tremendous effect on giving use the green light to do research. Right now, the only research that can be done is related to the harm that cannabis causes, since benefits are disallowed due to the Schedule I classification. The National Institute of Drug Abuse is a great example. They have researched the harms, but are in great need of corresponding research that identifies the benefits, but have been unable to due to the red tape involved.
Unfortunately, due to the current Attorney General, Jeff Sessions, who is a big cannabis opponent, it will be a challenge. However, I believe that the tides are changing. Twenty-nine states have legalized cannabis for medical use, and nine states have legalized it for recreational use. People are seeing the therapeutic benefits and this will hopefully push Congress to being more steadfast as far as laws go. It’s certainly an exciting time and I look forward to seeing what the future brings.
BJ: What do you see in the future for this form of treatment?
DH: Right now, adult use cannabis products and the medical cannabis products is now indistinguishably co-mingled for purposes to treat the same medical conditions. In the future, these products will eventually diverge into two completely different industries. There is a huge growth potential for innovative and cutting edge pharmaceutical companies to develop and pioneer a entirely new medical industry as they race to isolate the components and cannabinoid profiles to target for specific medical conditions and become FDA approved medications.
BJ: Thanks again for joining us, Dr. Huang. We look forward to following your progress in this area.
DH: Thanks for having me, Brett. It was a pleasure.