Why would a Harvard-educated physician leave behind traditional medicine and create a practice that helps patients use cannabis to help alleviate symptoms associated with stress management, insomnia, and human sexuality? We are going to find out today in this interview with Dr. Jordan Tishler.
[0:57] – Dr. Jordan’s background
[5:18] – Dr. Jordon talks about being an ER doctor
[7:53] – What is Inhale MD
[19:36] – Educating other MDs about cannabis
[26:03] – Jordan talks about his most common cannabis treatments
[32:43] – Jordan talks about cannabis dosage
[34:16] – Cannabis helps sexual dysfunction
[42:39] – Common concerns patients have about using cannabis
[45:57] – Dr. Jordan talks about starting a cannabis practice
[47:36] – Jordan answers some personal development questions
[50:55] – Contact details
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Why would a Harvard educated physician leave behind traditional medicine and create a practice that helps patients use cannabis to help alleviate symptoms associated with stress management insomnia and human sexuality? We’re going to find out the answer today in our interview with Dr. Jordan Tishler. Dr. Tishler, welcome to CannaInsider.
Jordan: Oh, well thank you for having me. Pleasure to be here.
Matthew: Give us a sense of geography. Where are you in the world today?
Jordan: Today I’m in my home which is in the Boston area.
Matthew: What is your educational and professional background, and what brought you to focus on cannabis?
Jordan: I have a very sort of traditional educational background. I went to Harvard College way back in the day. Then to Harvard Medical School, something that we affectionately call Preparation H. Subsequent to that I trained in internal medicine at the Brigham Women’s Hospital here in Boston. So my background is very traditional in that regard. After I finished training I have worked in various emergency and urgent settings and spent 15 years in the emergency for the VA hospital here in town. And actually ironically, given the federal position on cannabis, it was in fact working for the VA that led me to the interest in cannabis.
When I worked in the emergency department I saw so many veterans who were dramatically harmed by substances, primarily alcohol as a matter of fact, but then to a lesser degree substances like benzos and opiates who have certainly entered into the national discussion. So over 15 years of treating folks with these either as sort of a primary problem or complicating whatever their more routine medical issues were it sort of became a defacto expert in the treating of these illnesses. And that coupled with in the year 2012 Massachusetts started this ballot initiative, actually passed the ballot initiative to legalize cannabis for medical use sort of led to this aha moment where I said, you know, I’ve seen all these guys who have been so harmed by these various substances and yet in all these years I’ve never seen anyone sick from cannabis.
If it’s not harmful like these other medications or at least not evidently so, then maybe there’s something to this medical idea at least worthy of exploration and that sort of led me to delving into the medical literature. It’s very popular at the moment to say we don’t have a science. We can’t do this and that’s just bologna. The reality here is that we have over 26,000 studies in the medical literature on cannabis making it one of the most researched topics ever. Now in fairness not all of those studies are all that well done. Most of them were designed to look for harms caused by cannabis, but the remaining swath of them that is actually fairly compelling. And the more research we do get the more compelling it is.
So, after a couple of years of digging through this pile of science, then I started reviewing in a rather skeptical manner. I ended up being fairly convinced that we had some pretty good data on this, and we have a pretty good starting point on how to do it. People always say well don’t we need more data. I always say, well of course. Who would every argue against more data. I mean even in fields that are very advanced like cardiology we continue to do studies all the time because we want to explore and learn and refine our abilities and our techniques. And I think where we are with cannabis is of course we want to do more studies. We’d have to be brain dead to argue against that, but it doesn’t mean that we don’t have enough science now to be making meaningful use of the plant and its derivatives that we now. And of course we will refine our understanding and our techniques as we go forward.
Matthew: Now you mentioned you were an ER doctor. Any interesting stories? What’s it like to be an ER doctor day to day? That seems like it would be a lot of wild ups and downs, exhilarating and then bleak soul crushing sadness. What’s it like?
Jordan: That’s a good question. There’s definitely moments that are like that, but as with everything most of the reality doesn’t make a good television series. If you go back in the day and you think about ER the television show, that was bananas all day long. It’s just one gunshot wound after another after another, and reality thankfully is not that hectic or that bleak. But there are certainly many stories that I could tell, most of which I think would probably repulse your listeners. From the time that I had to resuscitate somebody in a bathroom stall to the times that I ended up covered in various bodily substances. There’s some reality to its being an unusual profession. Let’s put it that way.
Matthew: Yeah I would imagine people put themselves into a lot of weird situations. I know as a kid I had another kid shoot a bb in my ear from 20 yards away. It was like the perfect. I mean I still can’t believe he shot it in. It went directly in my ear, and then I had to go to the ER. The doctors were using suction and these long weird shaped tweezers, and I was like ER doctors just have to be really creative coming up with different ways to solve problems.
Jordan: Yeah. There’s a certain cowboy mentality that persists in the emergency department, more so than other fields of medicine. Because you’re right, we see all kinds of weird stuff and have to kind of figure out the best way to make people as well as possible. Does that ear work for you now?
Matthew: Still works.
Jordan: Okay well you’re a lucky man.
Matthew: Remarkably no problem, resiliency. I mean most of the impact hit the outer ear and then it was like a bank shot in.
Jordan: Yes. And there’s a reason why our ear canals are not straight. I mean it’s to keep things out. While everyone goes eww when we start talking about ear wax, it’s there for a reason. It’s not just sort of icky.
Matthew: Yeah it keeps things out. Keeps little insects from crawling in them. Gets them kind of stuck, yeah. I’ve started a separate podcast just about ear issues in my bb experience. I’m just kidding about that. Tell us more. What is Inhale MD? What is that?
Jordan: I was telling you about the saga of how I came to be interested in cannabis medicine. Sort of the second part of that story is that once I had kind of learned enough about this to be convinced that this was something that should be available to patients, then I started taking a look around at the landscape and said, obviously I worked for the federal government so that’s not going to happen. Though I’ve certainly applied a fair amount of pressure both locally and in Washington to try to help that along. But then I started looking at the private institutions that I knew well, like the Brigham Women’s Hospital, Mass General and those places, and what I realized is that even private institutions get so much of their funding from the federal government, both in terms of being paid through Medicare, but also paid for the support for their residents through NIH and then the research money from NIH.
I mean the federal government really funds the vast majority of any hospital’s budget. And as a result, they set policies that are in line with federal policy. Obviously, that makes sense, but it meant that very few of my colleagues knew the things about cannabis as medicine that I knew, but perhaps even more importantly those institutions were going to be in a position of saying we’re just not going to go there yet because it’s federally illegal. At that point, I said how do I make this available? How do I get this to work, and I thought, I never really sat out to be in private practice. But a private practice is not constrained by the policies of the institutions. So, what I’m going to do is I’m going to set up a private practice where I can see the patients, but I’m then going to go back into these major academic medical facilities where they know me and I’m going to be like, hi it’s me. You know me. I’m not a quack and I haven’t lost my mind. Here’s a lecture on why I’m doing this and what the data are, and it’s been a phenomenally successful approach because at least here in the northeast my colleagues have been wonderfully receptive. Very curious, very open-minded about this. They know that they don’t know.
So, they’ve been interested and eager and also very grateful that they don’t have to take it on themselves. One of the things that’s sort of a misunderstanding in the cannabis advocacy world, and this is sort of an outgrowth of the beginnings of medical cannabis in the middle 90s in California, is this idea that a physician is going to just say yes or no without really knowing much about cannabis as medicine, or that they’re going to somehow shoehorn all of this new information into their already short jam-packed 15 minute visit with their patient. If you could imagine, most primary care practitioners have 10 to 15 minutes with a patient to cover everything. Head to toe, inside to outside, things that are going on now, things that are on the patient’s mind, preventative care issues, whatever it is. You got to do that in 15 minutes. It’s an undoable combination.
Now you want to add cannabis into it which is something that the doctor doesn’t know that much about, the patient doesn’t know that much about and things are not cut and dry like they might be, take these pills. It’s a setup for it not happening. In my clinic I said, that’s fine. You don’t need to understand all this stuff. Know enough that you (audio cuts) and you need to know enough that you don’t think you’re berzerk. That’s worked really well. So, I spend an hour with that patient at the first go around. And I’m talking about only cannabis care and their illness and not worrying about helmets and seatbelts and all those other things that the primary care folks deal with. It works very well in that way. And so I’ve sort of defined my model and the model that I’m trying to sort of get others to adopt as cannabis specialist.
Jordan: Let’s put it this way. If I really knew the answer to that, I would at least be the head of Health and Human Services, if not perhaps President of the United States, not either of which is jobs that I really want. I think that there are massive problems with our healthcare system. And many of the things that actually make our healthcare system as difficult as it is are things that are not really obvious. We have some of the broadest health problems compared to many other nations. We have a very economically diverse population compared to many other countries. We also do almost all of the research, particularly drug-related research and development as well as technology development for the rest of the world.
There are ways in which some of these other countries that you’ve mentioned, for example, Canada, are sort of drafting off us. I don’t personally find that a problem. Conceptually it’s just a problem when our system is having as much trouble as it is and we’re sort of trying to continue on supporting not just our own country but the world by extension. I’m not suggesting again that we should be somehow undermining world health. That’s not my point at all but simply to understand that the issues that we face are large and even broader than some of the stuff that we’re aware of. You went back a few sentences ago and said you never spent this much time with a doctor. I think that almost all physicians would be overjoyed and really excited to be able to spend half an hour or an hour sitting and talking with their patients.
Most physicians went into this field because they like taking care of people, and they like people. They like to talk to people about what’s going on and figuring out ways to figure out what the problems are and how to fix them if they can be fixed. We’ve just generated a system that is the financial factors require that you see patients more frequently than is medically feasible. That leads to physicians being burnt out and feeling miserable and suicidal. We know that physician burnout is amongst the highest in the nation and that physician suicides are, I don’t know the actual numbers off the top of my head, but they’re huge. As well as physician substance abuse problems and these are all related to the fact that they’re overworked and frankly underrespected and I don’t necessarily mean by the population. I mean by the people who are running the healthcare system.
If we could get to a position where physicians and their patients could be working together without so much intrusion from the financial and management side of things, I think we could make a system that was a lot better and it’s part of why I structured my clinic the way I did was I said look, what does it take to get the patients what they need. Well at least for the first visit it really requires an hour between asking them about what’s going on and talking about their experiences and then going through a packet of material that I want them to understand and teaching them about cannabis and how to use it and what the pitfalls are and who’s out there that’s going to try and misguide and twist their arms and all of that. And then sort of toward the end we actually boil that down to what looks like a prescription. These are the things that it takes and it just takes an hour.
If there were a lot more price pressure, I probably wouldn’t be able to do it. I also have a bunch of employees whose livelihoods and therefore their quality of life is dependent on my being able to pull all of this off.
Matthew: It’s amazing, when I do interact with people in the medical profession how much more enjoyable it is for both sides when we skip the insurance company layer where we just say, you know what can we just have a private transaction between us. We’ll agree upon some rate and I’ll just pay you cash. Everybody seems more relaxed. We know that the motivations of both parties is direct instead of having, well my insurance company says this and we need to look up this code and will I get reimbursed. All of those are taken out and the relationship is rightly restored between patient and doctor and I just feel like that’s so much more natural. And then what I’ve seen happen too is if I say I can pay cash, somehow the price always comes down compared to the quoted price. Like if you’re going to pay me cash right now. What does that say? That says there’s unnecessary layers there that are not serving a function for the value between the patient and the doctor. That’s the feedback I feel like the system is telling me when I create that direct relationship. What do you think?
Jordan: I think you’re on the money. If you take the case, which you would exemplify and people who earn a fair amount of money would exemplify a direct relationship. As you describe it, I think that that model works wonderfully. Just for comparison sake, when I sat down and tried to figure out what I would charge, I took a bunch of plays out of different playbooks. I charge an annual fee. The reason I did that is because I wanted patients to feel like they could come back to me either by email or telephone or in the office as needed without worrying that they were going to get hit with another fee. So, it’s an annual fee and it includes the first visit of the year and a midyear visit and whatever else we might need.
Capitation, that’s what that model is called. When I thought about the number of dollars I actually try to figure out what it is that other institutions were charging. The Brigham Women’s Hospital for the kind of visit that I am emulating or approximating there, their effective rate is $2,600 an hour. That is billed to the insurer and then they get pennies on those dollars. So, there is this weird dance where it’s like you write down - if you went to Midas Muffler and you got a muffler and they said that will be $600, you wouldn’t say, I’m going to pay you 9 cents on the dollar. You give them a credit card and you them $600. There’s this weird thing in the insurance world that’s like, you told me that your price is X. We’re going to give you a fraction of X and you’re just going to be happy with that. That’s nuts, but then, of course, you’re going to bill higher so you get a proportional fraction and then they try to cap how much you can bill.
It’s just a nutty system, and really what people should be doing is saying this is what I cost. Take it or leave it. And if everybody leaves it, then I got to reduce my price, but the problem and where the simplicity of that free market stuff gets muddled up is that we only look at sort of a constrained relationship between a doctor and a patient in an office visit where that particular patient happens to be able to afford some reasonable rate. There are many many Americans who can’t afford anything even if it were reasonable by some measure. So, that’s another population that we have to look after. Then there’s the question of what happens when you land in the hospital, a catastrophic illness.
The reality here is that those become 10s to 100s of thousands of dollars very very quickly and some of that is that inflation that we were just kind of talking about that gamesmanship. But some of it is if you have a big building with a lot of staff and a lot of medicines and a lot of technology, it just costs a lot of money. So there are probably shaving that could be done by a system that we’re less full of the bologna, but on the other hand I think even if you shaved off all that bologna, you’d still be left with a price tag that was out of both people’s reach and then you get into how do we cover that cost. Will we use insurance? And insurance is again a risk pool where people who are using less pay for those who use more on the sort of contractual or social idea that when those people were paying less grow older and become people who are needing more, then there will be money in the kitty to cover them. That becomes just an extraordinarily complicated math problem.
Matthew: I agree. I don’t think there are any easy answers. I’m glad that Chase Bank, Amazon and Berkshire Hathaway, I think that it’s a good idea that they have almost a million employees and they’re going to create their own kind of cutting-edge technological co-op to see where and how they can bring down costs with that sample size and what works and what doesn’t.
Jordan: I think they’re going to get their heads handed to them.
Matthew: They might. Then again, Amazon does seem to have an incredible track record of doing incredibly complex things at scale logistically. So, I don’t know.
Jordan: Yeah. Let’s put it this way. Those three companies, I don’t know about Chase, but certainly Berkshire and Amazon, if this can be pulled off entirely in the private sector, those are the guys who are likely to do it, especially if they are smart about it, which they tend to be, which is then to hire some people who have been at this for a while in other settings to kind of help plan it out rather than really just try to drum it up out of thin air. But I have the feeling that even with a million people and that intelligence, etc, it’s just such a complicated issue that I think it’s unlikely to be solvable in any simple fashion and throwing money at this has not worked many times over.
So, I don’t know. I think it will be interesting to see how it goes. I wish them the best of luck because even if they don’t succeed, maybe we can learn some stuff from this process that will help with the next iteration. It’s just an insanely complicated process.
Matthew: It is. It really is. And we could go on and one about, but let’s pivot back to cannabis here. Can you tell us about the most common treatments you find yourself suggesting to patients, and then how they implement those suggestions day to day?
Jordan: Sure, before we even get into the most common treatments, let’s talk briefly about the most common issues that come up, meaning what are people coming to me seeking care for. By far, the number one complaint is pain and the pain can be from many different things. It could be from a degenerative disease in your back. It could be from various neurologic disorders. It could be from cancer. So, pain is a broad category, but that is the number one thing that people come to me seeking care for. The interesting bit about that to me is that pain is the number one presenting complaint of Americans to their doctors across the board, but it is also the number one complaint where people say, we are just not doing a good enough job.
That really I don’t think surprises many of us in so far as it turns out that we don’t have a lot of tools. In fact really only three choices. There’s Tylenol which lives in a class by itself. And for some things and for some people can be very helpful but not for everything and not for everyone. Then you have this class called non-steroidal anti-inflammatories, which is the long way of saying things like Motrin or asperin. There are a bunch of other medicines in that category, and again they’re helpful for some things but not for everything and not for everyone. And there are reasons why people can’t take one or both of these two things. Then if you ruled those things out because they either didn’t work or you can’t take them, the only other choice is opiates and that’s it. End of the line.
We know we don’t want to go there. So, we can get very bent out of shape about the poor job that medicine is doing controlling pain, but we really don’t have a lot of tools. And then cannabis becomes sort of the fourth leg of this chair for the moment. So, this is why I’m seeing a lot of it. The reality is is that what we know at this point is it for chronic pain, meaning pain that’s ongoing more than three months. Opiates aren’t a very good treatment. Leaving aside their risk, they just don’t do a super good job of controlling that pain. It turns out in head to head studies that cannabis isn’t any better. That is to say, both are mildly or moderately effective but not brilliant. But on the other hand, cannabis is much much safer.
So, to me when I look at this and I say I have two equally, if not perfectly effective agents to treat pain, one is dangerous and one is safer. Which one should we choose? I would personally choose a safer one. I think that’s what we might call a no brainer. We sort of got all this political and social overlay here that we’re sort of having to navigate our way through while we’re getting back to something that’s a little bit more rational.
The second most common complaint I see is insomnia. It turns out that across the nation insomnia is the number two complaint to doctors, and again the number two complaint where patients tell us, the things you’re giving us aren’t working really well. When it comes to treating insomnia again, we have a fairly limited number of options. You’ve got things like Benadryl which for young people is actually modestly effective and generally fairly safe, but isn’t super safe in the elderly. Can cause people to fall over and hurt themselves. It can prevent me from being able to urinate. Then you got stuff like Ambien which works reasonably well for some people, but for other people cause a significant hangover the next morning. Then you got things like benzodiazepines like Valium or Ativan and stuff like that, which again work, but can create that hangover and also can create dependence which by the way you can get from the Ambien as well. But the bottom line is at some point you have to ask what’s the risk/benefit profile and we’re worried that the benzos risk is significant and probably underappreciated.
So, again, enter cannabis, which is I think of all the things cannabis does well, treating insomnia I think is the thing it does best. And very very small amounts before bedtime can really be very restorative. One thing I would also add is that there’s a pretty wide divergence between my experience with treating patients. Let me rephrase this another way. Patients tend to come to me sort of in one to two categories. People who have never used cannabis or maybe they tried it back in the 60s or 70s but not since. So they’re functionally naïve to the substance. Then there’s this other smaller group who are people who are coming to me sort of already using it.
What’s interesting to me about this is it’s much easier for me to deal with the folks who are not using it and to get them started and to help them land at a very functional and very low dose that has good outcomes. The folks who come in already using by and large are using way more than I find is necessary for people. Largely because they’ve gotten into it either from a recreational point of view or on the advice of or with the guidance of people who are more recreationally oriented and that tends to mean that they’re using much higher doses. And with higher does comes greater tolerance, greater dependence, and greater side effects so that it becomes better for their health if I can kind of talk them into sort of ratcheting it down, but that’s oftentimes a harder sell.
Matthew: I know what you mean. Now you mentioned dosaging and just so people get a sense, what dosages do you find yourself prescribing the most that you consider a medicinal dosage?
Jordan: It’s funny you ask that question because a lot of people in the field will hear what I say and they’ll call it a microdose. I’m thinking, no, that’s not a microdose. That’s a dose. If you want a microdose, we’re talking about things that are even smaller than what I’m talking about. We can talk about micro-dosing but that is its own thing. When I’m thinking about treatment type doses I’m thinking about sort of 5, 10, 15, maybe up to 20 mg of the THC component from whole plant cannabis. So, we’re talking about again fairly small quantities. As opposed to sort of on the recreational side where people might start at 20 but more typically be taking anywhere between 40 and 100 mg and there certainly people who are way beyond that who are taking many hundreds of milligrams over the course of a day.
That’s just not a place that I found my patients need to be. It comes with some risk and baggage if you get up in that range.
Matthew: One thing that we don’t talk about a lot or hear a lot about is sexual dysfunction and how cannabis can be used to treat that. What can you tell people that are not even familiar that that’s something that goes on using cannabis for sexual dysfunction? Maybe you can talk a little bit about sexual dysfunction in general.
Jordan: In that relationship between two people the method of use becomes all that much more important. So, you asked me to talk a little bit about sexual dysfunction. Sexual dysfunction is a very broad category of issues in both men and women. Certainly Hollywood has made a big deal out of sexual dysfunction in men regarding difficulty getting and maintaining an erection, and we have a class of medicines out there that treat erectile dysfunction, but that’s all we’ve got from male sexual dysfunction. The Viagra and Cialis of the world don’t do anything for women.
When we think about male sexuality we don’t really tend to discuss the fact that men may have other problems that don’t have anything necessarily to do with erections and having to do with libido. In particular, I think the common misconception is that all men are horny all the time, but the reality is that up to 30 percent of men actually have low libido and that presents issues with their partners and also for their self-esteem and such like that. Then there are a number of other issues around male sexuality, but then turning our attention to female sexuality, which obviously we’ve come to understand over the last 40 years is a complex set of interactions that need to happen in the proper cascade in order for things to go well.
Having to do with interest, libido or more mechanical things like arousal which is more about lubrication and relaxation. Then around orgasm, which is a problem for some women. And even for both genders in that sort of final phase where there is a bonding phenomenon. It turns out we’ve got this one class of medicines that work for erectile dysfunctions but otherwise, we’ve got no treatments for sexual dysfunction at all. Well, I should say no medical treatments. I mean obviously there’s couples counseling and there’s more of that psych/social approach, which I don’t mean to discount at all. I think that’s hugely important, and couples therapy is the best thing since sliced bread for many people.
That all being said, it would be lovely to have some level of pharmacological intervention that makes people’s lives better, and cannabis really kind of fits this bill. It works in both men and women and it can address many of the areas of dysfunction or difficulty that we’ve just kind of talked about. It’s very important to understand dosing when it comes to sexuality. Women, generally speaking, can kind of get away with being a little bit more loose with the dosing, but men have to be very meticulous about it because if you get too much, you just sort of stop performing if you will. When I often say, slightly glibbly in talks that I give is that it’s very hard to sort of keep going with the mechanics of sexuality if your head is orbiting Jupiter. That there’s a certain physical repetitive motion that you have to concentrate on doing. And if you’re too far gone, it just doesn’t work.
There’s this expression from the old days called stoner boner, which was men would have trouble maintaining the erection. And I think that’s, all funny names aside, it’s true because maintaining an erection requires a certain amount of concentration. You have to stay in the here and now and if you get too much cannabis you kind of wander away. But interestingly there is a sweet spot where in fact it enhances erections. It enhances tactile sensation. It decreases anxiety and over increases the intimacy and the ability to kind of be together in that moment and have that relationship move forward. So, again, dosing is everything.
The other thing is going back to the routes of administration stuff. If you are with your significant person and you want to have an intimate relationship, you need it to be in sync. You need to be interested at the same time, both of you. If that is out of sync, then that becomes problematic. A lot of the discussion out there on the web about cooking this gourmet five-course cannabis related meal for you and your partner is all very romantic, but I’m not sure it’s very effective because sure cook a five course meal, but I don’t think I’d put the cannabis in the meal. When it comes time to either enjoy the meal together or after the meal when we’re starting to think about the bedroom, that would be a time to use inhaled cannabis because it works not only quickly but within a synchronous timeframe. You’re both going to get the effects of the cannabis fairly simultaneously and be at the same stage of that arousal process together using it that way. Whereas with the food because it takes longer and because it behaves erratically from person to person and moment to moment, you just don’t know it’s going to click for both of you at the same time. Not to mention do you really want to wait an hour or two hours after the meal? Is that part of the plan? I suppose it could be, but it’s not a lot of spontaneity which something people talk a lot about.
Similarly, there are products out there now like lubricants and stuff like that now have cannabis in them with the idea being that you use this in the foreplay to enhance the sexuality or the sexual experience. There’s little doubt in my mind that those compounds or those products enhance things locally, meaning at the level of the vulva or the penis to enhance the sensation. But when we’re really thinking about the broader category of sexual difficulties, in particular, we need to remember that 90 percent of what goes on in a successful sexual encounter occurs above the neck. We are sensing beings and feeling beings and all of those things which happen between our ears have far more to do with sexuality than what’s going on at the genitals, which is sort of just kind of where the friction happens.
So those products that are applied topically locally, meaning down on the genitals are really missing the vast majority of where the action needs to happen. So in these cases I think systemically administered, meaning taking the medicine not just locally but into your entire body is really the only way to kind of get what we need out of it.
Matthew: I know common questions and concerns for patients are how can I use cannabis without getting high. Also how do I manage the side effects of cannabis? What’s your answer to patients that have those questions?
Jordan: Good question. The first is I would say there isn’t a cannabis that doesn’t get you high, or that cannabis which doesn’t get you high isn’t going to work for you. So, that gets the second question which is and therefore in the non-recreational concept, meaning in the medical concept, that high or intoxication is a side effect, and we need to manage that. Just like we would manage side effects from any conventional medication. If we’re talking about the sexuality stuff that we were just talking about, then we’re anticipating and using that intoxication for our purpose and taking advantage of it.
Again, it’s a dosing thing. A little is helpful and a lot may just be too much. And if we’re thinking about it, then that is not a problem. But if we’re careless, then it can become a problem. Similarly, when we are thinking about the treatment of all the other stuff that we were talking about, dosing and timing become extremely important. If you have episodic pain, you don’t want necessarily to be intoxicated all the time. So, again that’s a reason to get those edibles with their long mechanism of action. Not the right idea. If you are fine most of the time and occasionally you get a horrible migraine, you need relief now and you also want relief that lasts only as long as you really need it to last and then it should go away and you should be back to normal.
Similarly people with anxiety disorders cannabis can be extremely helpful, but for most people who come into using cannabis for anxiety through the sort of recreationally guided paradigm, they tend to use a lot of cannabis sort of all day long, and that turns out to be not the best way to do it and that smaller doses in the evening can be just as effective and don’t require intoxication during the day while you would be out doing the things you need to get done. Again, timing, dosing and some I to lifestyle. When does this happen? What do you have to do? What are your responsibilities? All those sorts of things factor into the dosing and the timing.
Matthew: That makes sense. If there are other medical professionals listening, and I know a lot on the West Coast have contacted me and they’re saying I want to build a practice like Dr. Tishler and build a community, get patients and really start off on this new cannabis medical journey. Do you have suggestions on how to be successful doing that?
Jordan: Sure. The first thing I would suggest is throw away everything that you think you know about cannabis from anything that you’ve read that wasn’t a decent study. The second thing is I would say go to Pub Med and just start reading and reading. That being said, that’s really the starting point. The next thing I would say is we don’t practice in a vacuum and the more we communicate with each other and particularly with colleagues who are interested in science and evidence-driven medicine the better. Because I found that that was not something that was readily available, I started one. So, we now have an international organization called the Association of Cannabis Specialists, and I would urge people to come and check out the website and contact us and get to know us.
The website is www.cannabis-specialists.org. Of course, people can always email me directly and ask me questions.
Matthew: I like to pivot to some personal development questions to help listeners get a better sense of who you are personally. With that, is there a book that has had a big impact on your life or your way of thinking that you’d like to share?
Jordan: Now that’s a really good question, and I don’t have a great example. There are so many to choose from that I don’t know that I can pin one down that would be helpful to your listeners.
Matthew: How about is there a tool that you use daily or weekly that you consider helpful to your productivity or effectiveness, either personally or as a doctor?
Jordan: The biggest tool that I use in terms of treating patients are a couple of vaporizers. Which is to say that so much of what we’ve talked about today is about inhaling the medicine but also the dosing. So, a lot of my physician colleagues will put forth the concern, how do I know how much people are getting and how do I make sure that it’s the right amount if we’re talking about smoking this stuff? So, the first thing I would say no, we don’t want to be smoking the stuff because we’ve got really good data that cannabis smoke doesn’t cause lung problems, but the research there is not done. We need more research there before we can say it’s truly different, but vaporization is the way to go because what you’re doing in that setting is you’re heating the cannabis to a temperature where we can get the medicine as a vapor but there’s no combustion. So, there’s no smoke.
Using well crafted vaporizers and a particular inhalation technique that I teach my patients, which by the way isn’t rocket science, I can tell how many milligrams of cannabis or THC they’re getting per puff, per inhalation and that allows me to know what they’re getting and how to compare that against other patients or against their own progress. So, the vaporizers that I use, two of them in particular that I recommend to people, one is the Stores and Bickel Crafty, which is a small handheld unit. There’s another one by a company called Boundless that makes a version called the CFX, and the CFX is a fine machine. It’s principle advantage, however, is it’s less expensive than the Crafty. I think the Crafty is sort of the cream of the crop at the moment. I’m actually working with a number of companies on developing better vaporizers, ones which can deliberately deliver specific know doses, a metered dose vaporizer. Those are not entirely to market just yet.
Matthew: You did mention how to get a hold of you, but if you could repeat that one more time, your website and your email or any way to get in touch with you that’d be great.
Jordan: My website is www.inhalemd.com and you can email me directly at firstname.lastname@example.org. And if you’re interested in checking out the Association of Cannabis Specialists, that’s www.cannabis-specialists.org.
Matthew: Well, Dr. Jordan Tishler, thanks so much for coming on the show today and educating us. We appreciate it.
Jordan: Thank you. It was great. Lots of fun.