Interview with Dr. Jordan Tishler
On February 21st, Dr. Jordan Tishler, will speak at Kahner Global's Cannabis Private Investment Summit in Fort Lauderdale, FL. This event gathers industry leaders and investors for a day of collaboration and networking
Dr. Tishler is a Cannabis Specialist. Through his training in Internal Medicine and years of practice as an Emergency Physician, Dr. Tishler brings his knowledge, reason, and caring to patients here at inhaleMD, and through his advocacy work at the local and national levels.Dr. Tishler graduated from both Harvard College and Harvard Medical School, trained at the Brigham and Women’s Hospital, and has spent many years working with the underserved, particularly our Veterans. Having treated countless patients harmed by alcohol and drugs, his observation that he had never seen a cannabis overdose lead Dr. Tishler to delve deeply into the science of cannabis safety and treatment.Dr. Tishler is also a parallel entrepreneur working for patients’ wellbeing in the corporate space, helping to elevate dosing and safety profiles of medication, and helping to establish best practice for bringing new Cannabis products to market.Dr. Tishler is a frequent speaker and author on a variety of topics related to the medical applications of cannabis. He is the President of the Association of Cannabis Specialists, and the Treasurer and a Board of Directors member of Doctors for Cannabis Regulation (DFCR).
Please tell us about your medical background?
My medical background is quite traditional. I went to Harvard College and then to Harvard Medical School. I trained in Internal Medicine at the Brigham and Women’s Hospital in Boston. I worked in emergency care for most of my career, the last 15 years at the VA.
Why did you decide to start a practice in the cannabis industry?
I got into cannabis medicine through my experience as an emergency doctor at the VA. So many of my patients where there for drug and alcohol problems, or even if they were there for other reasons, were complicated by alcohol and drug problems. I really became a de facto expert on care of these problems. When Massachesetts started considering cannabis as a potential medication, I recognized that I’d never seen anyone sick from cannabis! So I started to delve into the science.
It’s fashionable presently to say there isn’t enough research on cannabis. On the one hand, this is inarguable: we could always do with more research. However, this is true in all fields of medicine, including for example, cardiology. This does not mean that there isn’t good data now upon which we can make good decisions, and refine those decisions as we learn more. Research on cannabis has been ongoing since the early 1960s and has produced a whopping 26,000 plus studies. It is the most widely researched substance. Compare this to 5500 studies on alcohol.
After my rather skeptical deep dive into the science, I emerged quite convinced that under the right circumstances, cannabis is great medicine. As with all medicines, whether is works, is good or harmful, or creates intolerable side effects, it’s all in how you use it.
Ultimately, I recognized that very few of my colleagues knew much about cannabis. Further, they were supportive and curious about the benefits, but haven’t the bandwidth to get into the details, much less take care of patients using cannabis. This lead to the referral model of a Cannabis Specialist, which is the way I see things working well today. Co-management of patients is wildly successful.
To further the field and to raise the bar for patient care, I started the Association of Cannabis Specialists cannabis-specialist.org which I encourage people to learn more about.
What are some health reasons for why patients come to you? What are the most typical treatment you offer?
One of the unique aspects of cannabis as medicine is that it works on our Endocannabinoid System (ECS), a system only recently discovered. The ECS is really a meta-system affecting the action of many other systems throughout the brain and body. This makes cannabis good at treating many seemingly unrelated illnesses.
For examples, cannabis is good for pain control, nausea and vomiting, anxiety and depression, insomnia, and poor appetite. While there are many ways to use cannabis, contrary to current industry marketing, they are not all the same or interchangeable. Inhaled cannabis behaves differently than orally ingested cannabis. There are lots of self-serving marketing schemes out there to be wary of. Topicals just don’t work and tinctures can work, but are not sublingually absorbed. Pure CBD is largely placebo at the currently affordable doses and can interact dangerously with many common medications.
Do you believe cannabis has the ability to cure cancer or do you mostly offer it for pain relief?
Cannabis has been shown to kill cancer cells. This is very encouraging. However, it must be understood that this is is test tubes and mice only. Also it is specific to the type of cancer. So we are very, very far from any evidence that this is functional in humans. 92% of all drugs that look promising in animal studies fail in humans.
Great research is being done on this subject, but we’re just not there yet.
I do treat patients’ cancer if they request it, but always after a long discussion of the state of the research and after extracting a promise from them that they will continue their conventional, proven cancer treatment.
What do you believe will be in the future for medicinal cannabis? Do you see it disrupting the healthcare industry in a major way?
Right now the best cannabis medicine is whole plant or whole plant derived. We simply don’t know enough to really benefit from the many component chemicals in cannabis. The interesting thing about cannabis as medicine is that unlike all conventional medications which have one chemical ingredient, cannabis components don’t work as expected when isolated from the bunch. This is called the Entourage Effect - that the constituent parts interact to cause the expected result. This provides a novel challenge to both pharmaceutical development and governmental regulation.
I expect that we will ultimately get a handle on what all the parts do and how they work together. We will then be able to produce the parts needed and combine them to make even more effective medications. Further, this process will develop new techniques for developing medicines. How many potential medications have we not discovered simply because we’ve been looking for single chemical agents? The lessons from cannabis research will have far reaching effects on novel drug development beyond just cannabis medicine itself.
When do you recommend for someone to consider cannabis vs a prescribed drug?
Using cannabis instead of conventional medications depends entirely on what is being treated. For example, for pain control cannabis is as effective as opioids but vastly safer. While cannabis is largely considered a treatment of last resort, that is political thinking, and for pain control should be used prior to considering opioids.
Similarly, insomnia is the second most common complaint to healthcare in the US (after pain) and the medications that we have for insomnia are poor. Cannabis is wonderfully effective and should be first line treatment for insomnia.
On the other hand, cannabis for anxiety and depression is effective at low doses and for very mild symptoms, but for more severe cases SSRI or SNRIs are just better. Interestingly, however, cannabis can be used concomitantly to improve the effectiveness of the conventional medication and to counter some of the common side effects (for example, sexual).
As I’ve mentioned, cannabis can be a wonderfully effective medication by itself or in combination with conventional therapy, but like all medications it has risks associated and must be used in a controlled, thoughtful manner.
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