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“My name is Ken Weinberg. After completing a residency in Internal Medicine and doing a fellowship in Psychoneuroimmunology, I became a board certified Emergency Physician for over 30 years. In 2016 I started Cannabis Doctors of New York. We provide a concierge service, offering telemedicine, home, and in-person visits at our midtown Manhattan location... We pride ourselves on the loving care and follow-up we provide to all the patients we see and certify.” Dr. Weinberg has seen the life-changing results that Marijuana use can provide. Prescription marijuana medication has helped our patients safely cope with a variety of serious ailments such as Cancer, AIDS, Chronic Pain, & Inflammatory Bowel Disease. Kenneth R Weinberg M.D., Chief Medical Officer of Cannabis Doctors of New York , is the leading marijuana doctor serving patients in New York & nearby areas. Cannabis Doctors of New York is the first all-cannabis practice in the state of NY & the only practice of its kind. The team at Cannabis Doctors of New York is dedicated to providing education, resources, & concierge medical marijuana services for patients diagnosed with any of NY’s now expanded qualifying conditions. → Request an appointment with Dr. Weinberg to get your medical marijuana certification. Kenneth R. Weinberg M.D. in the news: A Doctor’s Perspective: Marijuana Legalization Now - Gotham Gazette Military vets push NYS Senate to approve medical marijuana for PTSD - PIX11 News Lecture seeks to break misconceptions about medical marijuana - Hudson Valley 360 Cannabis Activist Group Opens Upstate NY Chapter - WAMC Northeast Public Radio Chronic Pain is Now a Qualifying Condition in New York State. What That Means for Patients - Leafly

Pot for Pain? Can cannabis treat pain as well as opioids? 1. Long History & New Research Cannabis has been used for pain relief by people around the world for many thousands of years. However, unlike opium and its’ derivatives, also used from antiquity till the present time for pain relief, nothing was known about what compound(s) produced the much sought after analgesic effects of marijuana until very recently. The structure of morphine (the main active compound in opium) was isolated in 1925. For a variety of reasons, it wasn’t until 1964 that the structure of THC (tetrahydrocannabinol, the main active compound in cannabis) was discovered. Because so little was known up till then about cannabis and how it worked, very little research was done on cannabis and it’s analgesic properties. Assistant studies marijuana in the Maripharma Laboratory in Rotterdam, Netherlands. MICHEL PORRO/GETTY IMAGES 2. We are naturally receptive! Since that time though we have discovered that there are over 100 (phyto) cannabinoids made by the plant, in addition to terpenes that have many medicinal properties themselves; that we make our own internal (endo) cannabinoids; and, that we have a vast system throughout the brain and body of (endocannabinoid) receptors that produce the effects of cannabis. In addition, since 1964 much more research has been done on producing analogs of the naturally occurring phyto or plant cannabinoids. Not only can cannabis treat pain as well as opioids, it can help treat patients addicted to them and help with their (opioid) withdrawal symptoms. There are no cannabis receptors in the brain areas involved with respiration, unlike the many receptors for morphine in those areas. Intentionally or accidentally taking too many opiates can cause overdose and death. On the other hand there is no risk of overdosing from taking too much cannabis for treatment of pain and, in fact, there have been no documented overdoses from cannabis, ever. Health effects and benefits of Marijuana. 3. Stop pain impulses + Anti-Inflammatory When people take THC or CBD (cannabidiol, the second most abundant compound in cannabis) for the relief of pain the endocannabinoid receptors can actually stop or seriously limit the pain impulses coming up to the brain from injured or swollen muscles, joints, nerves and skin or intestinal tissue. In addition, CBD works directly in those tissues to decrease or eliminate the inflammation that is such an integral part of the pain cycle. This is another difference with opioids as they have no anti-inflammatory properties. Taking too many opiates can cause overdose and death. On the other hand there is no risk of overdosing from taking too much cannabis for treatment of pain and, in fact, there have been no documented overdoses from cannabis, ever. 4. It’s Legal New York! In New York State, the vast proportion of patients enrolled in the Medical Marihuana Program are being treated for chronic pain. Many conditions have some component of pain involved with them. What we are finding is that, for those conditions, once the correct ratio of THC and CBD, and form of ingestion (vaping, drops, pills, etc.) is found for a particular patient, they can begin to get back to a more normal, pain free life. With the help of a certified treating physician, you can legally obtain medical marijuana products to relieve chronic pain. The Marihuana Regulation and Taxation Act (MRTA) which passed on March 31st 2021, includes provisions to expand the Medical Marijuana Program’s qualifying conditions. The Office of Cannabis Management & the NYS Department of Health have been making updates within the state-wide system that will allow practioners to certify conditions previously not listed. Kenneth R. Weinberg, M.D. © 2021 Cannabis Doctors of New York CDONY can now certify patients for the medical use of cannabis for any condition based on the practitioner’s clinical discretion. Patients are no longer limited by the list of qualifying conditions to be eligible for the use of medical cannabis. *We are currently booking appointments for expanded conditions. Your condition may benefit from Cannabis, please contact us for an appointment. Call us: (212) 838-4965 or you can easily Request an appointment online.

With the recent interest in cannabis for the treatment of so many diseases and the increasing number of states and countries legalizing it’s use (after 80 or 90 years of it’s being criminalized in the 1930’s), one of the many questions that has arisen is about it’s efficacy, and safety, for use in the elderly. Recent articles in the lay press, NY Times and at sites like the National Council on Aging and in the medical literature reveal that not only is marijuana the most frequently used “illicit” substance in those over the age of 65 but that, with it’s panoply of medical benefits and, the issue of it’s interactions with the many drugs older people tend to be on, there needs to be much more research done to come up with an overview of where and when older patients should be using this (array of) substance(s). A recent article in Forbes magazine looked at a company based in Israel and the United States that is helping seniors who may benefit from cannabis and gives them guidance on products, dispensaries and drug interactions to be aware of as they start using cannabis for their pain, anxiety, cancer, glaucoma, etc. Unfortunately, as in all of the rest of the burgeoning field of medical cannabis the stigma that still lingers from the “Reefer Madness” propagandizing of nearly 100 years ago and, the politically ill conceived classification of marijuana as a Schedule 1 Narcotic of 50 years ago, have created a massive impediment to acquiring data that are essential to moving forward. For those of us who are cannabis practitioners, there is great frustration with these impediments; with the (lessening) approbation of our colleagues; with the inability of our patients to legally travel with this life changing substance (though two of my 80+ year olds have confided in me that they have “smuggled” it on their visits out of state); with the lack of uniformity of product from one dispensary to another; and, especially for those on fixed income, the price of the product. Neither office visits nor prescriptions for cannabis are being covered by Medicare at this time. That being said, with the pressure of so many elderly patients and their families and friends finding cannabis so useful for them, including in hospice situations, more and more states legalizing medical cannabis and more practitioners and hospitals seeing it’s efficacy, the tides will shift, cannabis will be legalized and more meaningful research can start occurring. In the meantime, cannabis practitioners will, continue to educate our patients and colleagues and politicians, speak to the media and ensure that all patients who will benefit from it can access medical cannabis in their “golden” years. Dr. Kenneth R. Weinberg, M.D. Cannabis Doctors of New York © 2019

*NORML Medical Laws Outline https://norml.org/laws/medical-laws/ Last updated on 01/06/2022 What Is Medical Cannabis Reciprocity? Medical marijuana reciprocity simply refers to whether or not each state has reciprocal (equal) laws with regards to whether patients can legally purchase medical marijuana when they are not in their home state where the card was issued. Some states have reciprocity with other states, but others require tourists to get a new card which is only valid in the state where they are traveling to. What states have reciprocity with New York? Every state is different, laws vary widely, please read carefully. Below you will find states with specific requirements, laws, and registration processes. We have listed all states where both medical and recreational marijuana sales, possession and consumption are legal for visitors and residents. States with legal recreational marijuana: Alaska California Colorado Connecticut Illinois Maine Massachusetts Michigan Montana Nevada New York New Jersey New Mexico Northern Mariana Islands Oregon Virginia Vermont Washington State Washington D.C States with legal medical marijuana: Alabama State Medical Marijuana Laws Senate Bill 46 — Passed by the Senate on Feb. 24, 2021 (20-10); Passed by the House on May 6, 2021 (68-34); Signed by Gov. Kay Ivey on May 17, 2021 State Website: Alabama Department of Public Health Effective: May 17, 2021 Possession and Cultivation Limits* Usable Marijuana: up to 70 daily dosages Approved Conditions* “a. Autism Spectrum Disorder (ASD). b. Cancer-related cachexia, nausea or vomiting, weight loss, or chronic pain. c. Crohn’s Disease. d. Depression. e. Epilepsy or a condition causing seizures. f. HIV/AIDS-related nausea or weight loss. g. Panic disorder. h. Parkinson’s disease. i. Persistent nausea that is not significantly responsive to traditional treatment, except for nausea related to pregnancy, cannabis-induced cyclical vomiting syndrome, or cannabinoid hyperemesis syndrome. j. Post Traumatic Stress Disorder (PTSD). SB46 k. Sickle Cell Anemia. l. Spasticity associated with a motor neuron disease, including Amyotrophic Lateral Sclerosis. m. Spasticity associated with Multiple Sclerosis or a spinal cord injury. n. A terminal illness. o. Tourette’s Syndrome. p. A condition causing chronic or intractable pain in which conventional therapeutic intervention and opiate therapy is contraindicated or has proved ineffective” *Please consult the state for the most recent possession/cultivation limits and the current list of approved conditions. Arkansas Only Arkansas residents are eligible for the Registry ID card for the Arkansas Medical Marijuana Program. You may apply as a visiting patient. See the visiting patient application here. A visiting patient application is $50.00 (non-refundable). If approved a visiting patient may purchase medical marijuana in Arkansas for a 30-day period, per application. “Visiting qualifying patient” means a patient with a qualifying medical condition who is not a resident of Arkansas or who has been a resident of Arkansas for less than 30 days and who is in actual possession of a registry identification card or its equivalent that is issued under the laws of another state, district, territory, commonwealth, or insular possession of the United States and pertains to a qualifying medical condition under this section. For more information, visit https://www.healthy.arkansas.gov/programs-services/topics/medical-marijuana Guam Until dispensaries are operational, it seems as though visiting patients who are at least 21 years old would have to attempt to procure gifted cannabis from those who cultivate it at home and that minors would be unable to access it. While minors can be registered as patients, the 2019 cannabis legalization law does not provide for the transfer of cannabis to those under the age of 21, regardless of patient status. Once dispensaries are open, access to medical cannabis will become easier for visitors. In 2018, Guam’s medical cannabis law was amended to remove the residency requirement for qualified patients. Visiting patients may register with the DPHSS by obtaining a written certification from a Guamanian healthcare practitioner, completing a qualified patient registration form, and paying the $15 registration fee. Cards will not be required to participate in the program. For more information, visit https://dphss.guam.gov/medical-cannabis-information-2/ Georgia April 16, 2015: use of low-THC CBD oil legalized for medical use, but in-state cultivation, production, and sale remains illegal.[40] Medical Program is very strict. Unsure of reciprocity, likely none. Hawaii For a $49.50 application fee, out-of-state patients can apply for registration up to 60 days before visiting. Using an online registration system, qualified patients can quickly obtain an electronic registration card. The state requires applicants to submit an ID and their medical cannabis registration from their home state. This system allows out-of-state patients to register before arriving in Hawaii, so they can purchase from certified dispensaries once they are in the state. The registration card is valid for 60 days, and patients can apply twice in a calendar year. For more information, visit https://medmj.ehawaii.gov/medmj/welcome Maine A qualifying visiting patient may purchase up to 2.5 ounces of a combination of medical marijuana and marijuana products every 15 days while visiting the state. The following states have provided the Office of Marijuana Policy with sufficient information to allow qualified medical marijuana patients visiting Maine to use their state-issued medical marijuana patient credential to obtain medical marijuana while visiting Maine: Alaska, Arizona, Arkansas, California, Connecticut, Florida, Hawaii, Illinois, Maryland, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Oregon, Rhode Island, Vermont, Washington, and Washington, DC. For more information, visit https://www.maine.gov/dafs/omp/medical-use/certification-process/visiting-patients Maryland If a patient from out of state is in Maryland for medical treatment, they can register to receive medical marijuana, but the state does not recognize out-of-state medical marijuana cards. For more information, visit Maryland Medical Cannabis Commission: Registration. Michigan Michigan treats medical marijuana visitors the same way they treat locals; possession of up to 2.5 ounces is legal in the state as is consumption *if* consumption is kept low-key. Public consumption is strictly prohibited. You might be able to purchase medical cannabis from a dispensary with an out-of-state card, but it is up to the shop so be sure to call around before visiting. For more information, visit https://www.michigan.gov/documents/marijuana/UPDATED.12.10.2018_Visiting_Qualifying_Patients-_Out_of_State_Registration_640525_7.pdf as well as http://www.legislature.mi.gov/(S(llp2kqhfexg5bu0hlnoei3q1))/mileg.aspx?page=GetObject&objectname=mcl-333-26424 and also https://www.michigan.gov/mra/0,9306,7-386-79575---,00.html Nevada Out-of-state medical marijuana patients can use their medical marijuana registration card to purchase medical marijuana (and save around 10 percent on cannabis tax). For more information, visit http://dpbh.nv.gov/Reg/MM-Patient-Cardholder-Registry/MM_Patient_Cardholder_Registry_-_Home/ New Hampshire You are only legally allowed to possess cannabis for medicinal purposes, so no purchasing within the state. For more information, visit He-C 401.16 Visiting Qualifying Patients and https://www.dhhs.nh.gov/oos/tcp/ New Mexico On August 5, 2019, a New Mexico judge ruled that the state’s Department of Health has to issue medical cannabis cards to non-residents because of how the state redefined “qualified patient” when it amended the Compassionate Use Act in March 2019. However, the Governor, Michelle Lujan Grisham, has intervened in this lawsuit on the premise that it was not the intent of the New Mexico regulations to allow any non-resident to obtain a medical cannabis card in the state. Rather, the intent was to provide a traditional reciprocity program through which residents from other states could access New Mexico’s program with a registry ID card or its equivalent from another state. This case is ongoing, so it is important to follow updates on the New Mexico Department of Health’s website. Reciprocity regulations must be in place by March 1, 2020. 2021: recreational marijuana signed into law by Governor Michelle Lujan Grisham, effective June 29, 2021; commercial sales to begin April 1, 2022.[98] Oklahoma A medical marijuana temporary adult patient license allows an individual with a valid medical marijuana license from another state to legally buy, use, and grow medical marijuana and medical marijuana products in Oklahoma. For more information, visit http://omma.ok.gov/temporary-adult-patient-application-information1 Pennsylvania At this time Pennsylvania does not have a medical marijuana reciprocity program. However, the Pennsylvania Department of Health has begun a process of implementation. For more information, visit https://www.health.pa.gov/topics/programs/Medical%20Marijuana/Pages/Medical%20Marijuana.aspx Puerto Rico The US territory of Puerto Rico has an emerging medical cannabis industry that is welcoming to visiting tourists who possess valid medical marijuana cards from their home states. Puerto Rico allows medical cannabis reciprocity and sales to any registered U.S. patient. For more information, visit http://www.salud.gov.pr/Pages/Home.aspx and https://www.fns.usda.gov/contact/puerto-rico-department-health and http://www.bdopr.com/en-gb/insights/tax/tax-alert/medical-cannabis-in-puerto-rico-and-taxation Rhode Island If you have an out-of-state cannabis authorization, be sure to check-off the following boxes before you attempt to purchase cannabis in Rhode Island: Bring two forms of government ID. You must be in a state database that tracks sales (WA, OR, CA, NV, AK, HI, MT, CO, NM, ND, AR, IL, MI, OH, PA, NY, MD, DE, RI, MA, & DC). You’ll be limited to 2.5 ounces or an equivalent concentrate form every 15 days. For more information, visit The Edward O. Hawkins and Thomas C. Slater Medical Marijuana Act § 21-28.6-4 (n) and https://health.ri.gov/healthcare/medicalmarijuana/ Washington D.C. Marijuana, both medical and recreational, is legal in D.C., so long as you are an adult over 21. Possession limits are one oz of flower, 16 oz of edibles, 72 oz of liquid and 7 oz of concentrate. For more information, visit https://dchealth.dc.gov/sites/default/files/dc/sites/doh/page_content/attachments/Reciprocity%20Chart%20-%20Functionally%20Equivalent%20-%204-11-18.pdf and https://dchealth.dc.gov/service/medical-marijuana-program-patient-applications States with where marijuana is ILLEGAL: Indiana Idaho Iowa Kansas Kentucky Mississippi Nebraska North Carolina South Carolina *Georgia Texas Wisconsin Wyoming 3. Here’s a checklist to help medical cannabis users stay safe and stress-free during travel: Always have your medical cannabis card with you, along with all documentation. Be completely familiar with state laws in the states you are traveling to, including possession limits for your preferred type(s) of cannabis products. Call ahead to local dispensaries if you think you will need to purchase more cannabis on the road. Travel by car whenever possible. Keep your cannabis in the original container and with a receipt. Do not travel internationally with cannabis. More helpful travel tips can be found at: https://www.safeaccessnow.org/travel Sources for Further Reading: https://www.leafly.com/news/cannabis-101/which-us-states-accept-out-of-state-medical-marijuana-authorizati https://www.wikileaf.com/thestash/medical-marijuana-states-accept-out-of-state-licenses/ https://potguide.com/pot-guide-marijuana-news/article/medical-cannabis-reciprocity-who-accepts-out-of-state-mmj-cards/ https://medicalmarijuana.procon.org/legal-medical-marijuana-states-and-dc/ https://en.wikipedia.org/wiki/Legality_of_cannabis_by_U.S._jurisdiction *NOTE* Last updated on 01/06/2022 Get My NY MMJ Card ⮕ We are here for you through every step of the process. Reach out to us if you need assistance.

The incidence of autoimmune diseases, of which there are over 100 types, has been on the rise for many years. Our current understanding of the development of these illnesses points to a confluence of 3 factors: genetics, environment and gut dysbiosis [1] (basically, abnormalities in the overall composition of bacteria in the intestines.) This gut dysbiosis leads to abnormalities in the bodies usual immune response so that our own organs: brain, nervous system, GI tract, lungs, etc. are seen not as “self” but as “other”. This causes them to be attacked by various parts of our immune system with the typical results we see in the many autoimmune diseases. Some examples are Type 1 Diabetes (insulin producing cells in the pancreas being attacked), Lupus (joints, skin structures, lungs, etc. being attacked) or Multiple Sclerosis (the myelin sheath that covers nerves and affects nerve transmission being attacked) . Research that has been carried out over the last 20-30 years has shown increasing evidence that the Endocannibinoid System (ECS, made up of both receptors and the chemicals that cause activation of the system) is intimately involved in modulating the immune response. There are two main arms of this response, known as cellular and humoral. Cellular refers to the various white cells that circulate in the blood or are situated in various tissues. Humoral refers to substances that circulate in the body, such as antibodies, prostaglandins or cytokines which can increase or decrease the immune response in any given situation. Both cellular and humoral immune responses respond to the chemicals produced in the ECS (2-AG, anandamide, PEA) or substances from the cannabis plant, known as phyto (or plant) cannabinoids. It is clear, from the basic science work that is being done, and the large amount of clinical data being accumulated, that cannabis can be a very useful tool in the clinicians armamentarium for treating these diseases. The standard medications now in use for treatment of autoimmune diseases, while often effective, can have many serious side effects and interactions with other drugs. Phytocannabinoids, on the other hand, are largely free of side effects, or drug interactions and can have profoundly positive results in the treatment of autoimmune illnesses. There are many examples of patients discontinuing or lowering their standard medications and switching to cannabis with encouraging results. While any medication changes should always be done under the supervision of a physician, there is an increasing sense that, while medical cannabis does not cure autoimmune ailments, it seems, because of it’s intimate involvement with modulation of the immune system, that it can “reset” that system and bring significant relief to sufferers of these diseases. 1.) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4143175/ Kenneth R. Weinberg, MD. © 2019

Cannabis Doctors of New York presents Chief Medical Officer Dr. Kenneth R. Weinberg. In this video, he briefly explains what the endocannabinoid system is. “The endocannabinoid system or the ECS is a system that, just like the endorphin system which mediates the effects of opiates, the ECS mediates the effects of cannabis. It is a master system that is involved with learning, with sleep, with reproduction, with behavior, with balance, and with memory, among many other effects.” - Kenneth R. Weinberg, M.D. A Glimpse Into The Endocannabinoid System Gregory Sondrol 05/01/22 The endogenous cannabinoid system—named for the plant that led to its discovery—is one of the most important physiologic systems involved in establishing and maintaining human health. Endocannabinoids and their receptors are found throughout the body: in the brain, organs, connective tissues, glands, and immune cells. With its complex actions in our immune system, nervous system, and virtually all of the body’s organs, the endocannabinoids are literally a bridge between body and mind. By understanding this system, we begin to see a mechanism that could connect brain activity and states of physical health and disease. - Bradley E. Alger, PH.D. Despite how the ECS is extremely prevalent and necessary for all functions of life, the ECS is not mentioned in my 2000-page New Oxford Dictionary. So... let's dive into the world of the ECS. The endogenous cannabinoid system, AKA The endocannabinoid system, AKA the ECS, is present in our guts, our brains (almost all our synapses), our cells, and nearly everywhere in our nervous system. The ECS consists of endocannabinoids, their receptors, and the enzymes facilitating the synthesis and breaking down of endocannabinoids after use. Within our body, we classify cannabinoid receptors as either CB1 or CB2. These receptors receive signals from either endogenous (endocannabinoids made by our body) or exogenous cannabinoids (produced by cannabis or similar external derivatives). These cannabinoids interact with receptors that are highly concentrated in our brains. CB1 receptors reside heavily within the central nervous system (densely located in the hypothalamus, basal ganglia, amygdala, striatum, cerebellum, neocortex, and hippocampus). CB2s have almost no psycho-activity and are mostly found along the spinal column, immune cells, or in the bone marrow. It wasn't until scientists discovered exogenous cannabinoids in cannabis that we even began to look into and discover the Endogenous cannabinoids, the receptors that correlate, and even the whole ECS in our bodies. "Since the time exogenous cannabinoids revealed their existence, the entire natural complex came to be called the endogenous cannabinoid system or endocannabinoid system”9. Delta 9- Tetrahydrocannabinol (THC), CBD, CBN, and over 170 different cannabinoids are found in cannabis. How the ECS heals us and its recent practical application… Cannabinoids and the ECS, from birth to death, are necessary for life. From synaptogenesis and synaptic pruning in the head to the sensory functions in the tips of our toes, the endocannabinoid system is there supporting us. The ECS holds many secrets to unraveling the mysteries of disorders like Post Traumatic Stress Disorder, for example. This is why it is crucial to understand the mechanisms behind cannabinoid signaling so we can close the gap and give relief to PTSD patients who often neurochemically fail to extinguish exaggerated or unwanted fear responses. In one study Lab mice that were genetically engineered without CB1 receptors acquired fearful responses quicker and were unable to extinguish learned fearful responses even after redundant high costs. There is much research being done on how cannabis could help veterans and others suffering from PTSD. A novel therapy may soon include CBD in exposure therapy for those with phobias. Profoundly, CB1 receptors are integral for “extinction”, an important process for PTSD and chronic anxiety. “CB1 receptor stimulation with THC enhances fear extinction in humans, which warrants further investigation in post-traumatic stress disorders and chronic pain.”11 Chronic pain states are also neuronally interrelated with those of high stressed states and both can further benefit from cannabinoid therapy. We are learning that the perception of pain and the emotional response to a traumatic event are (synaptically) important, perhaps just as important as the actual pain or event itself. Anxiety, fear, and even states of depression are natural and healthy when they are proportionate to the event. When these states are chronic and disproportional with the event cannabis can help to “reprogram” how we interpret our reward processing, how we derive pleasure from interacting with stress, or how we emotionally encode our responses to them. Clinical data also suggests endocannabinoids and CB1 receptors may attenuate anxiety and depression. Increased endocannabinoid signaling has been found to decrease depression and anxiety symptoms. Deeper within this molecular system... There are two integral receptors that we have identified so far: the CB1 and the CB2 receptors. As Scientist Ruth Ross explains in her Ted Talk “Demystifying the Endocannabinoid System.” A cannabinoid such as THC or Cannabidiol, simply speaking, is like the key, and the CB1 and CB2 receptors in our body are like the locks. Unlocking certain receptors has certain effects. One endocannabinoid could target a CB1 receptor to alleviate pain from a slipped disc. Another exogenous cannabinoid, like a CBD extract, could reduce inflammation by binding to a CB2 receptor in your immune cells. Our pathology and physiology are influenced every day by our own body generating endocannabinoids. Scientists are beginning to postulate that the main role of the ECS is to maintain homeostasis. Depending on which endocannabinoids and receptors are used, your body can respond to a plethora of attacks or problems to maintain homeostasis. Learning about cannabis and the world of the endocannabinoid system has allowed us to understand diseases that are linked to this impressive system. We now understand more than ever about neurodegenerative diseases such as Alzheimer's and MS because we now better understand the ECS. This has come full circle as we now are beginning to witness cannabis helping with diseases that are related to the very system it helped discover. Recently scientists have linked neurodegenerative diseases to inflammatory diseases. Cannabis is renowned as inherently anti-inflammatory and has “been found to modulate analgesia and anti-inflammatory pathways and provide neuroprotection among other functions”2 The ability of cannabis to quell the “cytokine storm” is currently of extreme interest to scientists as cytokine suppression is very important for autoimmunity, and currently relevant to our urgent global health issues. We do know the CB2 receptor plays the starring role in cannabinoid regulation of the immune and inflammatory systems. Promising results are also developing for neurodegenerative diseases which result in millions of deaths worldwide and diminished quality of life for far too many. The neurodegenerative processes of these disorders take place in the central nervous system. When CB2 receptors are activated in microglial cells they produce anti-inflammatory cytokines and inhibit pro-inflammatory cytokines. This is huge evidence for utilizing cannabis to fight neurodegeneration. Decreasing inflammation actually protects your neurons. Being able to control the immune response with MS or AD is pivotal in treatment. Cannabinoids have also recently been attributed to decreasing oxidative stress and helping with the integrity of the blood-brain barrier, again crucial for neurological health. Cannabis can bring profound change to the health of countless individuals. The now-famous “Charlotte’s Web” cannabis strain was specifically cultivated by cannabis growers for a girl named Charlotte who suffered from constant seizures but found significant relief from the strain’s medicinal properties. This treatment is now a common cure for patients (who have access to the appropriate cannabis) suffering from epilepsy and demonstrates how the medical cannabis community can bring change by understanding the plant itself. Charlotte’s Web was grown to have a high CBD content relative to THC. Interestingly the plants that were grown purely as CBD plants did not offer the therapeutic effects as did Charlotte’s Web, which contained small amounts of THC. This points to the importance of the synergistic effects between THC and CBD… AKA the entourage effect. Expanding implications of endocannabinoids… There are even CB1 receptors located in the basal ganglia and hypothalamus, which when stimulated, help regulate appetite and gastric motility.1 The medical uses of this discovery have far-reaching implications. Appetite excitation has been exploited by drug companies to help cancer patients struggling with appetite, wasting syndrome and nausea. Appetite suppression via cannabinoids has constant attention considering obesity issues in the U.S. and globally. One drug, Rimonabant, blocked CB1 in the hypothalamus and effectively proved weight loss, however during clinical trials negative side effects resulted as CB1 was also blocked throughout the body “including those brain regions where the endocannabinoid system regulates emotion and vomiting reflexes, among others.”9 and the negative effects (e.g. nausea, depression, even suicidal ideation) caused the product to be halted. Unfortunately, the drug Rimonabant was not successful in the way it blocked CB1 receptors (general CB1 inverse agonism). This shows we must do more research and dial in the receptor’s activity and find more acute methods to get the results we need without such ancillary negatives. Studies are ongoing and many focus on THCV, a cannabinoid sought after for its satiation and anti-munchie effects. The hunt for the perfect “diet weed” is intense. The future is bright as further drugs are being developed and might hold promising results concerning obesity. Unfortunately, decades of detrimental misinformation and negative cultural stigmas have stagnated medical research and are still hampering our scientists and doctors today. Panic led to the misclassification of Cannabis as a schedule 1 drug. With the Controlled Substances Act of 1970, signed in by Richard Nixon, the Federal government categorized cannabis as a Schedule 1 substance, considering it to have no acceptable medical uses. Thankfully science has pushed us to the truth; Cannabis is extremely beneficial medicinally and has exponentially low to non-existent toxicity levels compared to other legal drugs (caffeine, tobacco, alcohol, etc.) “With the discovery of the ECS, scientists and researchers have been petitioning to remove the cannabis Schedule 1 drug restrictions so medical research can more easily be done. Current research is studying the effects of exogenous cannabinoids in treating symptoms of epilepsy, HIV neuropathy, chemotherapy-induced nausea, anorexia, multiple sclerosis spasticity, chronic and neuropathic pain, glaucoma intraocular pressures, and asthma-associated dyspnea. The FDA has recently approved a study on the effect of medical cannabis on treating military veterans with post-traumatic stress disorder."1 Self-checks, methods of consumption, and the future... As young cannabis connoisseurs, (before legalization and access to all the many different strains of cannabis we see today) friends and I noticed different types of herb had different effects. One particular strain with a lot of red hairs made us euphoric with a heavy body high while a potent yellow strain was very psychoactive, creative, and energizing. We also learned that this medicine wasn't for everybody. The interaction of cannabinoids and our ECS is individually unique and we are still learning how exactly certain strains and their terpene profiles affect us. Sometimes it is important to do a self-check. Ask yourself “how does this medicine affect my body, or alleviate this or that?” or “Does eating a THC edible provide better migraine relief than that transdermal patch?” for example. Our bodies and collected anecdotal evidence should not be ignored and can help point us to the right method of medication. What also affects us and the ECS are the methods of cannabis consumption. Primarily you have inhalation or some form of ingestion. Topicals, transdermals, suppositories, etc. are less common but of equal importance. Each method has varied uses and effects: Inhalation is better for self titrating THC to blood levels and can be better for those who need a fast onset, such as nausea. Inhalation is often easier to predict oncoming effects and gives the patient more control of how much is needed, kicking in usually takes 20-40 seconds, and effects only last 10-40 minutes. Not being dependent on how much you have eaten that day or how long it might take to fully enter your bloodstream, cannabis patients accustomed to inhalation often become good at detecting their correct dosage of THC. Ingestion can be a great method for slow onset and steady delivery of medication. With the perk of being more discreet, ingestion is a practicable option for those who enjoy not having to re-medicate more regularly. For some, edibles are a great way to keep constant relief from chronic pain or anxiety. For others, ingestion can be less predictable and too long-lasting (up to 8 hours). Contacting a qualified cannabis doctor to receive the best medicine for your needs is a great idea. A cannabis doctor will help ensure you are not taking contraindications and they will give you recommendations for the best strains and products. You may ask “why medicate with cannabis?” or “why modulate these receptors with cannabinoids if the ECS works perfectly fine on its own?” Well as humans we are genetically variating, none of us have identical brain chemistry and sometimes even our receptors are not working perfectly fine. We have developed medicine to improve our livelihoods. For many, modulating our ECS may enhance our quality of life, elevate our mood, and improve cognition or overall health, the list continues to grow into the future with our finding of the many keys hidden in this beautiful plant and the many amazing locks hidden within ourselves. Written By Gregory Sondrol© - Cannabis Contributor 05/01/22 References: 1. Jarvis, Sabrina; Rasmussen, Sean; and Winters, Blaine, “Role of the Endocannabinoid System and Medical Cannabis” 2016. Student Works. 192. 2. Aggarwal S, Carter G, Sullivan M, ZumBrunnen C, Morrill R, Mayer J. Medicinal use of cannabis in the United States: historical perspectives, current trends, and future directions. Journal of Opioid Management. May 2009;5(3):153-168 3. Di Marzo V, Bifulco M, De Petrocellis L. The endocannabinoid system and its therapeutic exploitation. Nature Reviews Drug Discovery. 2004;3(9):771-784. 4. Lu H, Mackie K. An introduction to the endogenous cannabinoid system. Biological Psychiatry. April 2016;79(7):516-525. 5. Charytoniuk T, Zywno H, Berk K, et al. The Endocannabinoid System and Physical Activity-A Robust Duo in the Novel Therapeutic Approach against Metabolic Disorders. Int J Mol Sci. 2022;23(6):3083. Published 2022 Mar 12. doi:10.3390/ijms23063083 6. Iannotti F.A., Di Marzo V. The gut microbiome, endocannabinoids and metabolic disorders. J. Endocrinol. 2021;248:R83–R97. Doi: 10.1530/JOE-20-0444. 7. Mayoral L.P.-C., Andrade G.B., Mayoral E.P.-C., Teresa H.H., Socorro P.C., Francisco J.R.C., Héctor A.C.-F., Cruz M.M., Santiago A.D.P., Alpuche J.J., et al. Obesity subtypes, related biomarkers & heterogeneity. Indian J. Med. Res. 2020;151:11–21. doi: 10.4103/ijmr.IJMR_1768_17. 8. Meccariello R. Endocannabinoid system in health and disease: Current situation and future perspectives. Int. J. Mol. Sci. 2020;21:3549. doi: 10.3390/ijms21103549. 9. Alger BE. Getting high on the endocannabinoid system. Cerebrum. 2013;2013:14. Published 2013 Nov 1. 10. Vasincu A, Rusu RN, Ababei DC, Larion M, Bild W, Stanciu GD, Solcan C, Bild V. Endocannabinoid Modulation in Neurodegenerative Diseases: In Pursuit of Certainty. Biology (Basel). 2022 Mar 14;11(3):440. doi: 10.3390/biology11030440. PMID: 35336814; PMCID: PMC8945712. 11. Zieglgänsberger, Walter & Brenneisen, Rudolf & Berthele, Achim & Wotjak, Carsten & Bandelow, Borwin & Toelle, Thomas & Lutz, Beat. (2022). Chronic Pain and the Endocannabinoid System: Smart Lipids – A Novel Therapeutic Option?. Medical Cannabis and Cannabinoids. 5. 61-75.

Cannabis Doctors of New York offers a statewide directory of licensed medical marijuana dispensaries where pharmacists will assist you with the process of purchasing cannabis products. Many offer home delivery options. If you are a patient of Cannabis Doctors of New York, please inquire about our full directory which includes information about the availability of handicap accessibility, kosher products, vegan products, and types of consumables offered by each company based on location. Please remember, you must complete the certification process, as well as yearly renewals, in order to obtain medical marijuana. You will present your medical marijuana card each time you visit a dispensary. You may only use your medical card in the state of New York. Yearly renewal of your certification is required by law. Certification and renewal is simple, at CDONY we guide you through the entire process. NEW YORK STATE MEDICAL MARIJUANA CARDS "Registered patients can buy medical cannabis products from dispensing facilities operated by registered organizations across New York State. Not all registered organizations sell the same types of medical cannabis products including seeds or plants for home cultivation. Please contact the registered organization directly to learn more about the products they have available. Registered organizations handle all aspects of delivery. Contact registered organizations to learn about delivery areas and possible fees. Find a dispensing facility near you." - Office of Cannabis Management 2/4/2023 New York State OCM Licensed Medical Marijuana Dispensary Directory: Before visiting any of the New York State Marijuana Dispensaries, you must first obtain your Medical Marijuana Card. Cannabis Doctors of New York can provide you with a same day certification and access to your New York State MMJ card. We provide concierge service, guiding you through the process and recommending products tailored specifically to your health needs.Looking for more info? Try New York State Department of Health.

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