Ethan Russo: “Cannabis is much less dangerous than most conventional drugs”

Neurologist and researcher in the field of psychopharmacology, Ethan Russo has been a leading figure in medical cannabis research since 1996. He has written seven books on cannabis and medicinal herbs and published over 50 scientific articles in the fields of neurology, pain management, cannabis and ethnobotany , having provided training in more than 30 countries. Ethan was in Portugal in 2018, invited by PTMC – Portugal Medical Cannabis, to clarify the medicinal potential of cannabis and debunk some myths.

Founder and CEO of CREDO Science, in 2020 Ethan teamed up with lawyer and scientist Dale Hunt, and botanist Robert Clarke to launch the Breeder's Best, a company focused on licensing intellectual property in the cannabis industry. With a degree in psychology from the University of Pennsylvania and a degree in medicine from the University of Massachusetts, he began by working in pediatrics and was a clinical neurologist for about 20 years before joining the ICRS – International Cannabinoid Research Society (International Society for Cannabinoid Research) and the IACM – International Association for Cannabinoid Medicines (International Association for Cannabinoid Medicines), also being part of the Scientific Council of American Botanical Council (American Botanical Council).

He was Medical Director of Phytecs, a biotechnology company investigating the human endocannabinoid system (ECS), medical consultant at GW Pharmaceuticals, having supervised the clinical trials of the drugs Sativex and Epidiolex. He was director of research and development at ICCI — International Cannabis and Cannabinoids Institute and is president of the Scientific Council of Endocanna Health, a North American biotechnology company specializing in endocannabinoid DNA testing and precision cannabinoid formulations. 

What sparked your interest in studying the medicinal applications of cannabis? How did you discover the plant?
In 1990, after seven years of clinical practice in neurology, I felt that I was giving more and more toxic drugs to many of my patients, with less and less benefit. So I revived an old interest in medicinal plants, which took me to the Amazon rainforest in Peru to study the indigenous flora used by the Machiguenga people to treat migraines and other ailments. When I returned in 1996, I quickly became involved in the cannabis controversy. The incredible history of cannabis as a medicine, as well as the abundant publications on its benefits, captured my imagination and made it the center of my career. Although I had known cannabis long before, I came across it professionally in 1980 when I was a neurology resident, and I met a man at Seattle Veterans Hospital who mixed cannabis into his pipe tobacco as a treatment for myasthenia. serious. Thanks to that, he practically avoided hospital admissions. Later, even in the 1990s, about a third of my MS patients used cannabis successfully for pain and spasticity, as well as a wide variety of other ailments: migraines, chronic pain, Parkinson's and Huntington's diseases. , and even epilepsy.

How would you explain medical cannabis to a patient who has never heard of it?
Cannabis is a medicinal plant whose use by humans dates back to times before documented history. As a herbal remedy, it contains a combination of ingredients that together stimulate its activity (synergy) and produce a versatile therapeutic agent for many diseases in which conventional medicines fail. In part, this is because cannabis works on the endocannabinoid system, an innate regulator of bodily functions that serves to maintain homeostasis (a desired balance of physiological functions).

What discoveries have you made in your latest research or what are you focusing on now?
We recently discovered the genetic basis of cannabinoid hyperemesis syndrome. The article is now being considered for publication. We are also publishing the findings of a very large survey of people using products predominant in cannabigerol (CBG) to obtain benefits in pain, anxiety, depression and other conditions with an apparently very safe side effect profile and no evidence of dependence or withdrawal. We have also developed a new solvent-free extraction technique for cannabis that preserves the profile found in the fresh plant. We are trying to make cannabis safer and better. 

Last year he said that one of the main problems in the cannabis industry is the lack of diversity of chemovars. Why?
Selective breeding remains an important priority. We are always looking for better genetics that express the “minor cannabinoids” and then investigating their use. This will become easier as laws change internationally.

In Portugal there are still many doctors and psychiatrists convinced that cannabis causes psychosis or schizophrenia. What do you have to say about these convictions and what is your experience as a neurologist?
Cannabis is like any other medicine. It has side effects, but they are well-researched and well-known, and in this case, they are entirely preventable. There is an abysmal difference between smoking cannabis recreationally, when the intention is to produce psychoactive effects, and using cannabis therapeutically, by administering it unsmoked in doses that are used to control symptoms. In fact, cannabis is far less dangerous than most conventional medicines and does not cause schizophrenia in individuals who do not have a prior predisposition to this disorder. Furthermore, there is no single dose of cannabis that can cause death, unlike opiates, as there are few cannabinoid receptors in the respiratory centers of the brainstem, and it has a remarkable margin of safety when proper preparations are used properly.

In his 2011 publication in the British Journal of Pharmacology, “Taming THC”, he stated that, to date, many cannabinoids, terpenoids and flavonoids remained unstudied. Do you think this situation has changed in recent years? How?
It hasn't changed as quickly as it should! I continue to research and write about this topic. We currently have a study starting in the US with Ryan Vandrey of Johns Hopkins University, funded by the National Institutes of Health, which we hope will provide evidence of the synergistic contributions of terpenoids to the effects of THC.

Ethan Russo at Lisbon Medical Cannabis 2018 – Photo: Renato Velasco

How important are the synergistic effects of cannabis and how might they impact medical advances in the future?
The synergy of cannabis ingredients can have two benefits:

1) Stimulation of a desired activity, such as combining two or more analgesic ingredients to reduce pain and inflammation (eg THC + CBD + Caryophyllene);

2) Certain terpenoid components reduce the side effects of THC. A good example is the ability of Alpha-Pinene, an acetylcholinesterase inhibitor, to reduce the impairment of short-term memory produced by THC. These types of formulations may prove to be better cannabis-based medicines.

In your opinion, what is the ideal scenario for a country that has just legalized medical cannabis? Do you think that it is enough to sell cannabis as a medicine in pharmacies or should the entire plant also be made available?
Various approaches should be developed. While I continue to believe that prescription cannabis medicines are necessary in many situations, there will always be room for well-grown and produced herbal preparations.

Do you think that patients should be allowed to grow their own cannabis, under medical advice?
Yes. Patients who are physically able to grow their own cannabis show signs of benefiting greatly from this activity and the ability to help themselves. Given the complexity of the ECS (endocannabinoid system), cannabinoids (both endogenous and exogenous), and the countless interactions in which they participate or processes that they modulate, it can be said with certainty that a particular branch of medicine, pharmaceuticals or even a new exclusive branch emerges to be included in higher education programs. 

Ethan Russo with Raphael Mechoulam and Yehiel Gaoni – Photo: DR

How should cannabis education be addressed in the future?
Cannabis-specific education is currently available from a variety of sources, such as Americans for Safe Access, The Answer Page, and the Society of Cannabis Clinicians. Cannabic Doctors). Unfortunately, education on cannabis and even the endocannabinoid system is woefully inadequate in medical schools around the world. That needs to change. Certification of knowledge of cannabis as a medicine is already available and is mandatory in certain areas in order to be able to recommend or prescribe it.

How is easier and safer access to cannabis achieved? What are the paths that the industry and patients should follow?
We need new and enlightened politicians who realize that cannabis is a solution to many problems and that it should not be considered just a problem in itself. The industry needs better regulation for consumer education and safety.

How do you envision cannabinoid-based medicine in the next 20 years?
As cannabis drugs become more available, there will be increasing recognition of their value in many types of refractory diseases. Attitudes will slowly change as people and politicians become aware of its safety and as the benefits of this safer drug become evident. With cannabis clinical trials, the best is yet to come!
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Interview: Laura Ramos
Translation: João Vasconcelos
Photography: Renato Velasco

This interview was published in #2 of Cannadouro Magazine