Michelle Weiner

My View

In Florida, the details pertaining to the rules and regulations about medical cannabis are still not defined and pending clarification. As an interventional pain physician for Spine and Wellness Centers of America in South Florida, and as someone who is certified by the state to lawfully make recommendations for medical cannabis, I would like to educate the public on the science that exists pertaining to “whole flower.”

It is important to recognize the cannabis plant itself contains hundreds of therapeutic substances and separate compounds including cannabinoids, terpenoids and flavoinoids, all with potential medicinal benefits. We are most acquainted with two categories: THC (tetrahydrocannabinol), which can cause a euphoric effect, and CBD or cannabidiol, which has no psychoactive effect.

In addition, when marijuana is processed for medicinal purposes, physicians often have several options to offer as recommendations to their patients. There is the non-euphoric version of the medicine – or low THC – mainly CBD, and the medical cannabis or high THC product. The high CBD option is similar to “Charlotte’s Web,” which has been gaining momentum recently as it has helped many children with epilepsy.

Both products are extracted by isolating specific profiles in order to achieve the correct product result. The third potential option is a flower product that remains unprocessed and does not isolate specific compounds, but offers the patients the full profile of the active ingredients from the plant.

This third option called “whole plant medicine” utilizing the full spectrum is what is currently being debated.

By offering patients a more complete and less processed part of the plant in the form of whole flower, the synergy between the compounds creates what is known as an “entourage” effect. This beneficial aspect is well-recognized in the literature and is becoming increasingly more common in the practice of medicine in other states as a means of administering medical cannabis.

In 2001, the British Journal of Pharmacology outlined the positive impact of this effect, noting it offers “complementary pharmacological activities that may strengthen and broaden clinical applications and improve the therapeutic index of cannabis extracts containing THC.”

Ethan Russo, a neurologist, details how cannabis compounds influence each other’s mechanisms in a study, “Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects.” Medical literature supports the concept that for some patients, isolating two active ingredients in the plant may not be the best course of treatment.

With the passage of Amendment 2, which clearly and unequivocally allows for the entire marijuana plant to be considered as part of a course of treatment, the state must simply recognize both the positive medical impact of non-isolated marijuana while acknowledging that 71 percent of Florida voted for this.

When treating patients with acute and chronic pain secondary to a multitude of primary diagnoses, I look at the whole person and not individual symptoms. I focus on function and emotional and physical well-being. I hope to offer my patients options that may be beneficial for their conditions in routes that are safe and effective thereby decreasing pharmaceutical consumption and possible side effects.

I hope the leaders of our state will agree this is the medication of our future and our physicians should have options to recommend for their patients.

Dr. Michelle Weiner is an interventional pain management physician, board certified in Physical Medicine and Rehabilitation. She is a Certified Medical Cannabis recommending physician.