S4E55 Marijuana and MS

S4E55: Marijuana and MS – A Conversation with Dr. Mikhail Kogan

Bio:

Dr. Mikhail (Misha) Kogan, MD, ABIOM, RCST is a leader in the newly established field of Integrative Geriatrics. He is the chief editor of the first definitive textbook of the field entitled “Integrative Geriatric Medicine”, published by Oxford University Press as part of Andrew Weil Integrative Medicine Library series and is frequent speaker at a variety of international conferences on the topics of Integrative Medicine, Geriatrics, healthy aging, as well as medical cannabis. While Dr. Kogan’s main medical cannabis expertise is in treating older patients and palliating symptoms at end of life he also treats a wide arrange of internal medicine problems from chronic GI problems to cancers where use of medical cannabis can be very beneficial. In October 2021 Dr. Kogan, in collaboration with Dr. Joan Liebmann-Smith and Penguin Random Publishing House, published Medical Marijuana, Dr Kogan’s Evidence-Based guide to the health benefits of cannabis and CBD.

Dr. Kogan currently serves as medical director of the GW Center for Integrative Medicine, associate professor of medicine in the division of Geriatric and Palliative Care, and associate director of the Geriatrics and Integrative Medicine Fellowship Programs and director of Integrative Medicine Track program at the George Washington University (GWU) School of Medicine.

Dr. Kogan is also the founder and the executive director of AIM Health Institute, a 501(c)(3) non-profit organization in the Washington, D.C. metropolitan area that provides integrative medicine services to low-income and terminally ill patients regardless of their ability to pay.

Download the episode transcript here.

Questions:

Background

You have a diverse and impressive background, including integrative medicine, serving as an Associate Professor of Medicine at George Washington University, founder of a health nonprofit, and author. So cutting to the chase, what has gotten you to the place where you’re one of the leading medical experts on cannabis?
People have all sorts of associations with cannabis, mostly around its reputation as an illicit substance. Of course now it’s being legalized for recreational use in many places around the world. Can you speak to its use for medicinal purposes? What’s the medical backstory of cannabis?
Maybe we can shift to a little rudimentary chemistry and biology to understand how cannabis works medically. Can you provide a layman’s explanation of the human endocannabinoid system, how the cannabis plant interacts with it, and the difference between CBD and THC?

Dispelling Myths

There are a number of perceptions around cannabis and its use, and I wanted to see if we could validate or dispel some of them:

Firstly, is cannabis a gateway to harder drugs?

Is it safe to use? Are there side effects?
What about the argument about how effective it truly is for medical use? Can you speak to the efficacy ranges for cannabinoids?
Is there an evidence base to suggest cannabis is effective as a medical treatment?

Cannabis and MS

If we shift the focus to MS, can cannabis be helpful?
How does cannabis impact MS spasticity?
And what about using it for pain management. Does it alleviate pain that may be associated with MS?
So are there any downsides to using cannabis as part of an MS treatment regimen? Perhaps adverse interactions with DMDs?

Which cannabinoids should someone be taking to get an anti-inflammatory effect?
How do you prescribe or recommend the use of cannabis in your own medical practice? Maybe put another way, how does someone determine if they’re a good candidate to use cannabis medically?
The organization behind this podcast, Overcoming MS, is a big advocate of healthy lifestyle choices. How does cannabis fit with healthy lifestyle choice in your view, Misha?

The Future of Cannabis

What is the current research activity around cannabis? Anything we should be aware of down the pike?
What does the future hold for using cannabinoids for disease modification?
And lastly, your book. You’ve just released a new book called Medical Marijuana. There’s a link in the show notes for more information and where to buy it. Can you tell us a bit about the project, what it’s about beyond what the title implies, what kind of impact you hope it will have?
Thanks so much for being our guest on Living Well with MS, Dr. Misha Kogan. We are thrilled to learn about the amazing work you’re doing to help people navigate the intricacies and benefits of medical marijuana. And I encourage everyone to learn more about you and your work by checking out the links and more in our show notes for this episode. Thanks again, Misha.

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