Dr. Arno Hazekamp, Board Member of Scientific Committee of International Association for Cannabinoid Medicine (IACM), Head of Research & Development for Bedrocan International and Ph. D from Leiden University has developed an advanced training course for incorporating cannabis as a medicine. Having experience as one of the world’s premiers cannabis researchers (16 published articles, 13 cannabis or constituent related [PubMed search, June 2012]), Dr. Arno has generously invested his knowledge to better educate the greater cannabis community using strong scientific basis as a rationale for efficacy.
Through the single week of intensive training, Dr. Hazekamp invites health-care professionals, intentional cultivators, policy enthusiasts and curious scientists the privilege of seeing cannabis through a broader lens. When offered the opportunity from James Shaw, Director of Arts District Healing Center and Union of Medical Marijuana Patients (UMMP) to travel to the Netherlands to meet with some of the world’s pioneers of cannabis research, the answer was an easy YES!
The week started off with a beautiful dinner, courtesy of the Masterclass program where I felt instantly inspired conversing amongst individuals who ran labs testing cannabis, cultivators with advanced grow operations & physicians feverishly studying the effects and relevant application associated with cannabis. Great conversation and new friends over a multiple course meal made clear the week was to provide ample value for my time, energy & finances invested.
We started off the week receiving a broad view of how the week would flow and discussed how the Dutch Medicinal Cannabis program works in the Netherlands. The Head of the Office of Medicinal Cannabis (OMC, described as an organization analogous to the US’s FDA) explained to us the process of how product development, government, research and oversight of the program were all individual components of making a successful program. We also received information about systems biology and the concept of reversing the drug approval process. Rather than deriving single molecules, presenting a hypothesis for therapeutics and evaluating its effect and safety, we evaluate a whole system (ie. plant) and test hundreds of variables simultaneously and study the observations. Analyzing the observations, we are able to predict outcomes and effects from individual components and pool data at a much more efficient rate. This new ideology of analysis excites me as we start considering how to evaluate complex plant systems for effects and synergy. Conversations about international politics, local “drug war” stigma, views from the National Police Force also shed some light about the unregulated structure of cannabis cultivation in the Netherlands. Where does all the cannabis go? How about the profits? This conversation seemed to strike a flurry of thoughts from both ends of the spectrum and shared some interesting perspective on a decriminalized cannabis policy.
We had the privilege of hearing one practitioner’s experience from the Netherlands with patients who widely uses high potency cannabis extracts from ethanol distillations. Cannabis extract was diluted with olive oil to make a solution simpler for dosing and administering. Overall the product sounds like one effective method of delivery: olive oil is quite susceptible to oxidation and overall would reduce the shelf life of the finalized product when excessively exposed to oxygen or with time. Heart-opening stories were shared with patient’s experiences having chronic diseases with poor quality of life shift into a more manageable reality. One story was of an elderly man who had severe Parkinson’s symptoms exhibited for numerous years. To my memory, the man was taking L-DOPA for several years and had uncontrollable tremors daily. This case report used one drop of cannabis oil daily and had found relief within 10 minutes even from his first dose; eventually the drop’s effect lasted for 24 hours at a time and the patient began doing yard work again!
Reviewing statistics about the subset population of individuals who have enrolled in the Dutch Medical Cannabis program (2003-2010) was quite intriguing. With 5,540 individuals, a 83% of older patients (41-80) and about 56% female, numbers showed immediate difference to the traditional CA cannabis model. About 86% of patients try 1 strain, 12% try 2 strains, and about 2% explore 3 strains of pharmaceutical strength cannabis flower. A total of 35,621 prescriptions were doled out over the program’s existence with a trend of slight increase each year. The average number of prescriptions per patient is 6.65 – from clinical observations, there are a good portion of patients who will try a prescription with cannabis and discontinue early-on in their trial. Number one indication for cannabis usage is pain.
Those unfamiliar to pharmaceutical studies received a hearty dose of information during our discovery of some trial presentations of pharmaceutical cannabinoid antagonists. Looking at objective measures, we were able to see certain indicators being affected (ie. heart rate) noting an effect with or without subjective experiences (ie. feeling high). Some insight was shared about how trials are ran by testing for dosing and effects in patients to minimize side effects while maximizing therapeutic efficacy. This information gives a strong parallel to how cannabis can be tested for individual disease states and indications pending a change of legal status.
Endocannabinoid System (ECS) was presented as an important endogenous process which can be tuned through the nutrients we ingest. Fatty acid amides may bolster the production to endocannabinoids (ECBs) ameliorating deficiency in ECBs in a subset of patients. Eating behavior, inflammation, smooth muscle function, cachexia and disease-related anorexia and metabolic syndrome are all examples of possible disease targets which can be shifted by focusing on nutrition and ECB development. The presentation illuminated the importance of present research assessing how endocannabinoid imbalances directly interface with disease etiology.
Perhaps one of the most curious opportunities of the trip was a visit to see a legitimate grow operation of pharmaceutical quality. Taking a trip via train to visit the headquarters of Bedrocan itself was a unique experience in the countryside. After a nice lunch in the small town, we transitioned through comfortable vans into a warehouse far away from any major hustle/bustle. In practice, the facility was considerably different than what one might imagine for an internationally known standardized grow-op.
The warehouse had been tested and optimized over decades of experimental tests to study how subtle variations lead to individual changes in final product. By keeping protocols & procedures consistent, Bedrocan has had the privilege of discovering how to keep a uniform product on the market for patients by shifting individual variables in a controlled environment. Through years of research, Tjalling Erkelens, CEO of Bedrocan has discovered that plant constituents can be predicted when clones of existing plants are grown out using tightly observed & repeated protocols. The facility was kept quite neat & orderly – the floor layout has been kept consistent for replication on a larger scale when the need arises. Hundreds of plants were found both in the vegetative & flowering rooms at varying sizes – nutrients, watering, temperature, lighting, room materials and humidity are all considered in Bedrocan’s consistency formula.
Bedrocan has developed a total of 4 pharmaceutical grade products for patient consumption. With a spectrum of products including both granulated & flowers, indica and sativa, high CBD and varied terpene profiles, Bedrocan has done its part in providing an assortment of medicines to the table for patients. Seeing the complex simplicity of Bedrocan’s operation allowed the observer to recognize the feasibility of how cannabis can be applied as a medicine on a much broader scale as laws shift internationally. Listed below in the appendix is a simple objective overview of the 4 Bedrocan products with some key characteristics highlighted.
Friday may have illuminated my personal favorite experiences of the week where the scientist in each of us was cultivated. We had the privilege of visiting Leiden University and a laboratory space where Dr. Justin Fischedick lead us through analytical testing of cannabis & terpenes. Dr. Fischedick has written multiple articles and in my mind, is “THE terpene expert”. One interesting paper Dr. Justin & Dr. Hazekamp wrote was labeled “Cannabis – From Cultivar to Chemovar”. The concept of this article was to create a more predictable system of analysis cannabis strains by active chemical constituents vs. present “indica vs. sativa” classification. This can predict therapeutic effects more clearly and rid the industry of the name-game where strains are grossly mislabeled to increase attraction in the market place.
Jorge Fernandez spoke with us about his product presently in development (MiniVAP, www.minivap.com), a portable medical vaporizer with variable temperature changes used for herbs & cannabis. He discussed practical application about inputting data regarding dose, schedule of use, product type to record usage and develop a system for patients & physicians to review to determine effectiveness of medication. All & all, I was very impressed with the application of the MiniVAP and look forward to the product being available in the United States.
In the lab we walked through rooms including NMR, GC-MS, LC-MS and discussed the application of each. Taking several strains of cannabis, we did ethanol extractions and did our own tests on heating cannabis and testing for acidic cannabinoids vs cannabinoids. We were able to predict cannabinoid levels and see how different dosage forms (ie. cannabis flowers vs. hash vs. extract) contained different constituents. Also neat, was viewing results on the graphs and predicting what the chemical constituents were. This whole experience was quite inspiring for me having a scientific background and wrapped up the week perfectly.
No detailed lesson can be complete without exploring the best of a community has to offer. Netherlands had much to provide visitors – the coffee shops varied in size, experience, quality of product and energetic environment. Having no specific interest for ingesting cannabis, the experience of initiating into coffee shops was of a cultural curiosity for me. As I traversed through the Netherlands in a few coffee shops, Dr. Arno’s article “An evaluation of the quality of medicinal grade cannabis in the Netherlands” (Cannabinoids 2006; 1(1): 1-9) jumped into my mind. This was a paper evaluating 11 coffee shops and Bedrocan/Bedrobinol qualities – including mold, aerobic bacterica, gram-negative/enterobacteria testing, cannabinoid profiles & cost. Cost analysis of the samples in cost (Euros) per 100 milligrams of THC was evaluated.
Personally, I believe some of the coffee shops I ventured into had dodgy practices of cleaniness (ie. hands into open bags under counter) and can attest to the results of the study. Simply put, some strains from some randomly selected coffee shops had failed USP/NSF/WHO standards and even less stringent guidelines while Bedrocan products adhered to USP standards at close to twice the price of coffee shops. Another added cost and barrier to some patients using pharmaceutical grade cannabis may be a physician visit (time) and added cost for consultation time. Not all contaminants are actually dangerous for the consumer; people with compromised immune systems, respiratory challenges and elderly should pay more heed to the quality of consumption. Higher levels of contaminates may be more likely to be dangerous to the end user.
Ultimately my experience in the Netherlands (and Amsterdam) was all kinds of awesome! I had the opportunity of hanging upside-down doing acro yoga in the middle of the Keukenhof Gardens, a famous Dutch Tulip garden with Dr. Arno. In general, people seem to live so freely and contemplate life, liberties and the pursuit of presence. Random conversations on a train were always intriguing and diverse – The Van Gough museum was stellarly modeled to be insightful and entertaining for the human eye experience. When visiting the city of Amsterdam, I can highly appreciate The Flying Pig Hostel, where the staff becomes family during your stay. Great hangout spots, Wi-Fi, interesting folk from all over the globe make it challenging to leave “the Pig”!
My experience with Dr. Hazekamp and his esteemed colleagues was overall an interesting experience through the realms of science, application and sustainability. For those seeking a development of cannabis knowledge, inspiration of scientific application, or a vacation with potential to expand your mental projections of possibilities, you can consider the Medicinal Cannabis Masterclass for 2013. Much appreciation to the Union of Medical Marijuana Patients (UMMP) for the generous sponsorship of the Masterclass course – May this newfound knowledge be invested into the future of applied plant medicine for generations to come!