Cannabis Doctor Reveals ALL (Part 1)
Learn the truth about microdosing, cannabis law, and more from Dr. Deb Kimless
Editor's Note: We are thrilled to bring you this exclusive interview with Doctor Deb Kimless.
The following has been edited for clarity and readability, but the full version is available for members of the New Vitality Center.
Dr. Deb Kimless: My name is Deb Kimless. I am an anesthesiologist, pain medicine board-certified physician, and recently board certified from the American Board of Lifestyle Medicine.
I practiced conventional medicine for years until I started investigating both whole food diets as an important foundation for health as well as medical cannabis.
I am the medical director for a medical cannabis company in Maryland, and I serve as control head for formulation companies around the country, and I run clinical trials.
I started as an allopathic, or traditional, trained doctor, sort of disease process-oriented. You have a disease, here's your pill, and that's it. And so I sort of switched my life around from looking at that; now I approach patients looking at establishing a foundation through wellness, diet, exercise, and then medical cannabis. And then if we have to: pharmaceuticals.
Clear Health Now: And your change was inspired by a sad experience with a family member?
Dr. Kimless: My mom sadly died a horrible death because she was given a pharmaceutical drug, taken as directed, followed written prescription, filled at a pharmacy, and encouraged by me, her daughter.
And it was for osteoporosis, which she didn't have. But they thought maybe if she took it, it would prevent her having it. And so sure enough they did make her bones very dense but what we didn't think about was how does that happen? What's that mechanism of action? And it reduces the amount of turnover in her bones and it made her bones fragile. And she literally shattered to death.
CHN: We’re so sorry to hear that.
Dr. Kimless: Thank you. But what's even crazier is as this was happening and they were trying to rebuild her with surgery, my mom always had a paradoxical response to traditional pain medicines.
Opioids made her crazy and enhanced her pain, and on the day that she died where her pelvis spontaneously shattered, she looked at my dad and said, "Make this stop." And he looked at me and what was I going to do? And my partner said, "Try medical cannabis. It's what they do in Israel." And he's Israeli.
My reaction was, "What does that even mean, medical cannabis. It sounds like an oxymoron. That's crazy." Sadly, with my mom, I didn't have the opportunity to even see if it would work for her or not. This was 2013, when the medical cannabis industry was still in it's infancy and it still kind of is anyway, and so I made it my mission to study everything I could to understand whether or not this was a real option, or just a legal reason for getting high.
And so I went to Israel and I met with the lead scientist there. I went to the Netherlands to study in a master class with science researchers from all over the world because they have a national program and they offer this opportunity.
So I studied and continued to study and decided that I can affect a change in a global way in memory of my mom so that hopefully nobody else goes through what she had to go through.
CHN: Well, that's certainly inspiring. We imagine the legal situation was catching up to you around the same time? In America, at least.
Dr. Kimless: Yeah, I entered into the cannabis world just as everybody else was sort of trying to figure out how did this work? What did the science say and different states, now that we're acknowledging that even though federally it's still illegal as a Schedule 1 drug, states were legalizing it as a highly regulated industry.
CHN: And it sounds like your approach coming from a mainstream scientific background maybe you were able to see it dispassionately?
Dr. Kimless: I think it's fair but I think what might be even more fair is I came from a totally "just say no" era. I was taught that cannabis makes you dumb and kills brain cells and "this is your brain on drugs" and they show that fried egg.
And I believed it. I thought that was to be true. So for me to change 180 degrees is huge.
And again, back to my allopathic training roots, the only time cannabis was ever mentioned was if THC tested positive in urine and people would sort of turn their nose at the patient and say they were a pothead or whatever the epithet that was thrown at them.
So I think I came in extremely skeptically, coming from "just say no" to "you've got to be kidding me, of course this is a medicine."
And yes, some cannabis constituents can cause intoxication, but of the 400 chemicals that make up this plant, all of them have medicinal bioactive properties when used appropriately.
CHN: And how do you compare the harm profile of cannabis to many pharmaceuticals, like the one you mentioned your mother unfortunately had?
Dr. Kimless: So the risk profile, everybody has to weigh the risk benefit profile for everything that we take. If we're talking about a kid with a developing brain, we don't want our children's brains to be exposed to anything that could potentially interfere with its growth and development, be it alcohol, tobacco, bad food. You know those things adversely affect everyone.
But when you look at the overall risk factors for cannabis compared to other options, the risks are very small.
CHN: What do you think an appropriate age limit for cannabis would be?
Dr. Kimless: So it depends what we're talking about.
If we're talking about adult use and not medicinal use, like instead of drinking a glass of wine at night, which does have harmful effects...
Studies I think have said that brain development continues through age 26.
Now, if you're talking about a child who has cancer and is going through chemotherapy and can't eat and has wasting syndrome, I think we do whatever it takes to save this child and improve this child's life.
So I think you have to work on the reason for taking it, what's the rationale? And then deciding what happens and how you dose, what you give that person.
CHN: That makes a lot of sense. And it sounds like we need to be careful to distinguish between recreational and medical use?
Dr. Kimless: Well, I don't even like to use the term recreational because if I see a kid, a young child smoking anything, or drinking alcohol, I say... I would say first that child is self-medicating, and then we have to figure out the root cause.
CHN: Sure, and it sounds like so, you think maybe in the recreational world, it may actually be less harmful than a glass of wine at night?
Dr. Kimless: So that's a really tough question. We have a biologic system called the endocannabinoid system. And basically it's in charge of physiologic function and physiologic balance.
And so if you are completely balanced, taking something to throw you off balance is probably not a good idea, right? For anything.
However, if I'm looking at the risk benefit ratio of alcohol and the number of deaths ascribed to alcohol per year, which I think the NIH had just published 88,000 people died this past year from alcohol-related deaths, none from cannabis, I would say that cannabis wins over alcohol.
CHN: And your work has mostly been on the medicinal side and the research side?
Dr. Kimless: So I have many touch points, including cultivation because I really enjoy all aspects of medical cannabis. As I said before, I went around the world and studied all the points of what goes on. So for cultivation I help with genetics, for processors I help with formulation.
And for other companies, those that want to run clinical trials, I love to do that as well.
CHN: So it's multidisciplinary. There's elements of horticulture and botanicals and obviously medicine and genetics.
Dr. Kimless: And it's complicated, and the more that we know, the more difficult and complicated it becomes because this has been a Schedule 1 drug under wraps for decades.
And so we really haven't had the opportunity for the Department of Agriculture to come in and look at the genetics of something the way they would look at it for traditional crops.
Or which crop protection agent should be used and what's safe? Because we've never had that luxury of studying it, you know?
CHN: Right, so you talked about your own remarkable transformation with medical cannabis. What about other doctors in the broader medical community? Are they coming around?
Dr. Kimless: So another thing that I enjoy doing is giving talks, sharing my knowledge with my colleagues. And so I say back in 2014, 2015, when I started the speaking tour, it would be like a third, a third, a third.
A third is yes, I accept, now educate me so I understand why that makes sense.
A third says, "Okay, I'm cannabis curious and talk to me."
And a third is very dogmatic, saying, "I grew up in a 'just say no' era, this is garbage and we're gonna kill all the people and make lazy stoners."
And so maybe that last third is slowly coming around a little bit. It's hard to tell. You don't try to convert anyone, you just try to educate them so that they have knowledge.
And as the states legalize, and the World Health Organization now is looking to reassign or at least talk about reassigning the cannabinoids to a different schedule, I think my colleagues are going to have to ultimately embrace the knowledge.
CHN: And there's a lot to know! You mentioned that there's over 400 chemicals involved?
Dr. Kimless: All plants have lots and lots of bioactive ingredients in it. And this plant isn't any different. So yes, there's over 400 bioactive molecules in this plant.
About 100 of them are cannabinoids, about 100 of them are terpenes. You have flavonoids, there's other antioxidants and other chemicals just like in any other plant. And all of them work together harmoniously to have medicinal and helpful benefits.
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CHN: And there are different varieties of cannabis that might have different combinations of chemicals. Some that may be good in one situation but not another?
Dr. Kimless: Yeah, so you're right, cannabis is sort of like humanity — it's a multitude of things. We're all people, but we're all different, same thing.
And so their constellation of chemicals vary and of course with breeding and cross breeding, those things vary all the time. And then what makes it vary even more is where it's grown and how it's grown.
Is it growing outside? Is it growing indoors in an industrial warehouse? Is it growing in a greenhouse? What nutrients were you feeding it? Changes its chemical composition, which makes it really complicated and incredibly exciting.
With greenhouse grows, you capitalize on the efficiencies of using energy from sunlight for photosynthesis. And in an indoor grow, it's kind of an all-consuming energy because of lights that you have to use for the growth of this thing.
But I don't think that matters. I think what matters is how it tests so that you understand whether there were pesticides that could be potentially harmful or heavy metals.
And also understand what the constituents are that you're ingesting because just like we're all different, as you aptly put, the cultivars or the strains are different. Some may work well, and if they do you'd like to be able to repeat it.
CHN: Sure, and how about delivery mechanisms? There are a lot of different ways, from edibles to sprays to vapors.
Dr. Kimless: All of those modes of administration are important depending upon what you're looking for and what you need to have done. So, when the plant grows naturally, it's in what's known as its chemically raw form, or acid form.
And when you heat it, so time and temperature, when you ignite it you convert that acid form to its chemically neutral form and that chemically neutral form is when the one or few chemicals that cause intoxication is TCH can actually give that intoxicating effect.
So if you want, if you're a cancer patient and you want both the raw form of the plant and the heated form of the plant, smoking or vaporizing it would not be good for you because you're now changing that chemical composition for all neutral.
If you're a pain patient, who has horrible spasms that are episodic and occur without warning? Then inhalation may be the way to go for you because the onset of action is incredibly quick.
So it depends on what you're trying to treat or to help, that will determine the mode of administration versus the cannabinoids that you want and the terpenes that you want and what makes the most sense.
CHN: So what would offer the best effect for a cancer patient? What mechanism of delivery?
Dr. Kimless: Again, it depends. So if a cancer patient has nausea, inhalation or sublingual dosage administration form may be the way to go because it's pretty rapid onset. If the cancer patient has pain from metastases and is suffering terribly, both an inhalation or sublingual and then something that's longer acting so that they can get a good night's sleep and don't have to get up in the middle of the night and re-dose could be useful.
So, again, we have to tailor this to the individual patients to determine what is right for them.
CHN: Sure, and I guess that's some of what your work specifically and personally is on is figuring these things out.
Dr. Kimless: It's the art of medicine. So it's the art of cannabis. You sort of get an understanding that certain things seem to work well with some people and certain things seem to work well with other people. And then you try to figure out what's the common denominator between those groups of people?
The beauty of this is that the risk of this medicine is very low versus the potential benefit. Trying different things could be a long process but is not necessarily a dangerous one.
CHN: And this is where a doctor can be very useful, guiding people through this process?
Dr. Kimless: Well, you know it's interesting because there are many, many people out there, doctors or allied health professionals or even people working in the dispensaries that have a lot of knowledge.
Sadly, because this was underground for so long, there's not as many traditionally trained physicians out there that could offer this advice. A lot of patients are experimenting on their own and trying to figure it out, which is why the clinical trials that I'm involved in are really important.
Because the more information which you get and share, the clearer and easier this process becomes.
CHN: To some degree, it depends on the state someone's in or even the country because of the patchwork legal status...
Dr. Kimless: And that's real frustrating.
I believe this is a human rights issue because I think there's no longer any question as to whether or not this is a medicine.
In 2003, our U.S. government had a patent on the neuroprotective and anti-inflammatory effects of cannabinoids.
So how is this still a Schedule 1 drug? It doesn't make sense to me.
And meanwhile, tobacco is freely purchased pretty much anywhere.
CHN: Right, and it's pretty uncontroversial at this point to say tobacco has a much worse risk profile than cannabis.
Dr. Kimless: I mean, it shouldn't be controversial for sure.
Tobacco should be a Schedule 1 drug and nobody should be making money from it. It should be a terrible thing.
Although prohibition never has been a positive, whenever you have prohibition, there's always things around it and definitely destruction in its wake.
So I'm not recommending that, but what I'm suggesting is cannabis as a Schedule 1 drug in this country is absurd. In any country it's absurd.
CHN: Tobacco's availability may speak to the power of their lobby and what we've heard from some people is that we will get significant change in cannabis law because now there's business interests that could have a lobby similar to tobacco. Does that ring true to you?
Dr. Kimless: I completely believe that as larger business and more traditional businesses enter into the cannabis market, there will be a lot more legislative change because they've got dollars backing it up.
CHN: This has been fascinating. What we'd like to do now is give some practical takeaways to our readers.
Dr. Kimless: Wouldn't that be nice? Again, because of the legal issues, you have to unfortunately search your own state's laws and regulations so that you don't end up in jail for involving yourself in a federally illegal substance.
And then follow along with what those rules and regulations are. Every state has qualifying conditions as to which condition can be allowed for treatment of medical cannabis.
Everything is so varied and changed, again, it's a human rights issue. It tells me that your ability, your access to medicine is based on your zip code.
CHN: So even from state to state it'll vary what's acceptable medically. In one state knee pain may be acceptable and in another state it may not be.
Dr. Kimless: Yes. Because there's, what, 30 states that have approved, like the District of Columbia approved some sort of cannabis program, but what could be CBD only. That could be a low-THC only state. That could be everything but you can't have flowers, you can have extracted oils.
Or you could have anything you want, or you can't have an edible or put it in a food. Which I don't love edibles anyway when it comes in a food.
Because one, I think it's crazy to put something that's very bitter in a food that now you've sweetened it and put junk into it, since I'm sharing my lifestyle medicine roots here.
But anyway, there's no cohesiveness. There's no cohesiveness in lab testing. Even within a state. They have rules and regulations what the benchmarks are but they don't have consistency and regulation as to how those labs should be testing.
Even the regulators for some reason are not regulating across the state when they can't. So they allow for inconsistencies. So one lab may use one method, and you get X, Y, Z percentages of cannabinoids or whatever. And another lab uses another method and it's totally different and it could be the same sample.
I still want to promote access to patients. Sort of like we didn't understand how digestion worked but people still ate. I want people to have access.
I don't want people to misunderstand and think it comes to a screeching halt until we've knocked out all the elements that need to be adjusted. And I am excited that there are laboratory tests for this because prior to 2014, 15, not a lot of states mandated it.
And every state tests for different things. Some just test for potency, other people test for microbials. Other people test for heavy metals, not all the heavy metals are the same. So it would be great to de-schedule it so that we could have the opportunity to have countrywide standardization. Just like any other medicine. Like this should not be looked at like, "Oh my god, this plant gets you high." It's got these medical benefits, it should be "This plant has tremendous medical benefits. And if used in a certain way, with a certain constituent included, can be intoxicating."
CHN: Is there any sort of resource you'd recommend people start with, maybe your own website where they can get some more information?
Dr. Kimless: So there are some websites that you can look into. Americans for Safe Access has a website that's very good.
I hate to endorse one thing over another and that's my struggle because there's a wide range out there.
There is a book called Cannabis Pharmacy, which is a pretty easy read that explains the endocannabinoid system.
CHN: Thanks a ton! Looking forward to part two, where we delve into the mysteries of CBD, cannabis for pet health, and much, much more!
This is part 1 of a multi-part series. Check back for part 2 coming soon!