I just changed my music playlist to the one that’s all my music PLUS all my holiday music! 11/1 is a big deal for me. The winter holiday season is here!

Which is hilarious and feels kind of stupid because I’m in Florida and today’s high will be 85 (just like all last week and all next week)

And maybe that’s why I embrace it so hard?

But I like it, so I’m not trying to get to the root of this and change. No way. And my family just takes it as one of my quirks.

• I have holiday print batik napkins to sew!
• Reusable gift bags from old flannel shirts to make!
• Yummy holiday treats to bake!
• And felt ornaments to make with my kids!!

And you can be sure I’ll do it all because I’m working on a marketing course for my private practice so I’ve gotta have some enticing ways to procrastinate!

One of my joys in life is reading magazines. I know they’re kind of gone now but I get the Apple News app (yup, just keep taking my money Apple) and can peruse all the different styles of holiday themed issues from needlecrafts (which I don’t even do but the stuff is soooo cute!!) to Southern Living to BHG (my longtime favorite since I was a teen! Yes, I skipped makeup and doubled down on curtain lengths and area rug trends 🙄).

And of course, Martha Stewart’s Living.

I’ve never made it to Martha’s level of anything (I’m more a Women’s Day "light" kinda gal) but wow is she just an incredible force of nature and in her 80's! Just Wow.

I hear there’s a documentary about her that just came out on Netflix and I think I’ll save some mini Twix and a spot on the couch for myself this Saturday night to catch up!

So onto the point already.

Medical cannabis. CBD. THC.

Even Martha Stewart (a little Snoop influence maybe?) is in on the CBD action! She has her own line of upscale CBD wellness products that look perfect in her magazine or on a well curated guest bedroom nightstand.

Although I’m not for or against any of this, I’ve been waiting for the mind boggling, definitive research to come out so I can take a stronger stance and inform people with real data.

And… we’re still not there yet!

I’m not very politically minded (although I voted early!) but there’s a LOT of money to be made in this area of CBD/THC/cannabis that doesn’t care about the research at all (and may even see it as a detriment if there isn't clear solid support in favor of cannabis).

I’ve done some reading and CMEs on this topic recently and I want to share what I learned. And what we think we do and don’t know about this topic.

​There are 3 FDA approved cannabinoids for medical use:​

• Dronabinol (Marinol) which is oral THC
• Nabilone (Cesamet) THC analog

Both are for nausea/vomiting associated with chemo or appetite stimulation in wasting illnesses (i.e. AIDS)

• And cannabidiol or CBD (Epidiolex) which is sublingual CBD indicated for 3 epilepsy syndromes

​Here's another great article from NIH​

• All of these are controlled substances

Other interesting bits:

• Medical cannabis doesn’t have a single, recognized definition!! Which makes all the other stuff (like doing randomized controlled trials) really difficult to do, interpret, and compare!!
• The actual cannabis plant has hundreds of potentially active compounds besides THC and CBD; a combination may prove more effective than a single compound alone i.e. CBD helps to minimize the hallucinations that can be brought on by THC
• THC can cause euphoria (good for pain), CBD doesn’t have an associated high (better for seizures and anxiety)
• There are many possible ways that these compounds work and different systems they impact (but we don't have it all figured out yet)
• ​The laws in states differ which can complicate the matter (the link is a cool interactive map!)
• Doctors don’t write prescriptions per se, they provide a certification to endorse the use of cannabis for a certain patient and condition who then gets what they need (hopefully) from a dispensary
• But 70% of what patients get is not exactly what they order!!!

CBD myths:

• There is NO evidence for help with sleep (THC or CBD) which I was shocked to find out!
• CBD creams are NOT absorbed into the bloodstream so they're really not any better than OTC creams (just way more expensive)
• Companies claim that these products will help just about everything (but they really won't)!
• CBD CAN'T convert to THC. If you get a positive drug screen it's because you didn't get what you thought you bought (see above 70% stat)

There are a bunch of MH conditions where it could be helpful but there just aren’t enough good quality studies for me, personally, to say "Yes, do this!"

Right now I don’t usually suggest it as an option to my patients. And I don’t certify anyone or write any prescriptions at this time.

But if someone has questions we talk about it. And we talk about why this may seem like a better option than other approved treatments. And then we try to figure out how we’ll assess if it’s helpful!

Some people want to feel better so badly that the placebo effect can be hard to parse out. I generally tell people if it’s helping and not causing any problems elsewhere, then great! But if not, maybe take a break and we’ll try something else.

I am very clearly not an expert here at all. But I found some of these tidbits pretty interesting and hopefully you learned something new too!

Here are some mega resources if you really want to dig in (I have not gotten very far at all!):

• ​Cannabis Policy Impacts Public Health and Health Equity​
• ​The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research​

And here’s a paper with some good info too:

• ​Medical Cannabis for the Primary Care Physician​

I like Martha’s taste in a lot of things. Not sure that I’m in the market to try her CBD gummies anytime soon but it’s nice to know I can have a gourmet experience if I want one! (how about tangerine, pomelo, and yuzu; yum?)

Cheers to healthy brains,

Dr. B

Jess Beachkofsky, MD

Your friendly, online psychiatrist!

P.S. Please let me know stuff on this topic if you’re an expert! Or share positive (or negative) experiences from patients or clients. I love to hear stories that may help inform what I do (with data too of course!)

P.P.S. Anyone have a holiday decoration or treat that I MUST know about? Share that too! Before it gets too late in the season and I have to actually do my marketing homework