So thank you so much for taking the time. I know you're super busy. I just want to say I'm really happy to have you on-board doing this. We have worked a little bit together in terms of research, but I've also heard fantastic things in terms of your patients. They have nothing but great things to say about you. I thought it'd be great to get a perspective of somebody who's in the front lines in terms of patient care, but also interested in the research. I thought you would have some unique things to say about what we're seeing here in Colorado in terms of cancer patients and cannabis. So maybe just to jump in here. If you can maybe say a word about what you're seeing in terms of the number of patients who are using cannabis and maybe what kind of cancer patients you typically see- So I'm going to ask you a question first, because I can't remember. So when did recreational cannabis become legal and when did medical cannabis become legal in Colorado? So rec was 2014, and I believe medical was- It was earlier. Or as much earlier, so. I think it was like a year earlier. Yes. So here's the funny story. So for one year, when medical was legal and before recreational was legal, the most common question I got asked was, my grandson wants to know if I can have medical marijuana. As soon as recreational became legal, that question disappeared. For about a year, it was this novelty and clearly everyone's like, "Granny, go get the marijuana." So that was just kind of noise. It really, I think, emphasized the importance of doing a medical assessment when recreation was pulled out of the equation, because you don't get all these people who have fake conditions. So I treat lung cancer. It's the second most common serious cancer that affects both men and women, but it's the number one cancer killer of both men and women. It's a very serious disease. My guess is somewhere between 30 and 50 percent of patients have at least tried marijuana. Now we can capture the ones who are official, because they come in they asked me, we fill out a form, and they get a thing that looks like a driver's license, so they then are listed. I'd say they have cancer, and then they can go into the dispensary and they can get it at a somewhat reduced price. That's really the advantage that they get. But there's a whole bunch of people who just can't be bothered with that and just go and buy the same stuff, but they paid the recreational fee, or they borrow it from other people. But it's incredibly common. Interesting. Do they talk much about what they're using it for? It's interesting. I think some people are kind of like, this is a panacea and it must be amazing. At least when they have the conversation with me, and we try and encourage an open conversation, because it's not illegal now. It's much easier to just say you're taking this. Again, if you don't ask, you don't find out. There is no doubt that it can work on some symptoms. So I have definitely seen people come down on that opioid painkillers. I've seen it worked on anxiety, I've seen it worked on insomnia, I've seen it worked on anorexia, and it can work on nausea as well. The reason I believe that it's like any drug. It doesn't work in everybody. I'd have some patients who are incredibly skeptical. I remember one was an ex-narcotics police officer, and the idea that he might actually take marijuana was the worst thing he can imagine. Yet, he came down on his doses of painkillers, because he didn't like taking opioids either. It clearly worked for him. It was like he was set up not to have a placebo effect, getting that plenty worked. There's a whole bunch of people who believe it's an anti-cancer treatment, and I don't really buy into that. My evidence on that is there's definitely a few people who say, "I'm just going to try the marijuana every single one of them progresses." Right. Yes. We actually had a little bit of conservation about this in the class too. That can be the downside on all of this right around. People, they get this information on the Internet, especially if they stopped their treatment or they don't show up to see their oncologist thinking that, oh, I'm going to take care of this stuff." There's a special concentrator or whenever, there's oil, and that can be obviously a negative. On the other hand, the symptomatic relief, the things you're talking about obviously could be a positive. Yes. This is just a drug, if I say, "Look, I've discovered a new painkiller." You go, " Great." It'll work for some people but not others. Right, exactly. Speaking of which, in terms of the differences, we're working with some and then others. People, are they taking all different kinds? Do you see any patterns or what people are doing? I don't even know how to describe what they're taking and that's the problem. This isn't a standardized preparation. It's a natural product. There's no guidance in terms of what they take, how much they take, how they take it. One of the interesting things is, the oils are quite popular because they're highly titratable. You can totally control, at least how much you take, because the other factors are, how do you as an individual handle that, the pharmacokinetics, we don't know. There are some people who even just when you still take the oil, some people drop it in the water and take it, others rub it on their gums. They report a shorter, what's called Tmax, the time it takes for them to get that effect. If you're nauseated, and swallowing stuff isn't good, rubbing it on your gums is quite a nice way to take it. Right. That's actually a good point actually. Obviously, inhaling is not useful at all. Right? Yes. I try and ask people not to do. I mean, I had lung cancer, but I'd much rather it some edible. Right. It makes total sense. Is there ever any or is it ever interfere with the person's adherence to their treatment regimen or is it soon to be co-exist just fine with regular search in a regimen? So I think if you were a little bit off the beaten track beforehand, you don't get any closer to the beaten track, just because you're taking marijuana. But I think if you're a pretty rule-following person, but you don't suddenly become Shaggy out of Scooby-Doo just because you take some medical marijuana. Yeah. Then any sort of pattern in terms of CBD versus THC that you see in parts of Europe? Most of these people are not getting any kind of guidance. They're getting guidance from the guy in the dispensary. They may know what works for them, but not necessarily really what's going to work for the symptoms. I think the analogy is it's a bit like going into a liquor store and saying, "I'd like some alcohol, please." You go, well what do you want?" You go, "I don't know. What do you recommend?" That's the level of advice that people are currently getting. Right. It seems to me that that's a place where we really need to do more work. I mean, people shouldn't be flying blind like that. I think it's such a disservices to patients. It's up to them to figure it out. Its up to them to experiment. Obviously, we're trying to do some research. But until now, there really hasn't been much to go on. Right? Yeah. I realize you and I are preaching to the choir on both sides of this call. I mean, if we can't figure this out in Colorado, we are totally missing out on opportunity. It'll get federally legal at some point, I'm sure. But wouldn't it be wonderful if we could be the leaders in terms of figuring that out? Yes. No, I completely agree, 100 percent. When you talk to others, especially talking to people from other states and talking to people and the physicians, and people who are doing medical research, they want to put it in this box, that's the typical kind of RCT medication trial, right? Yeah. Of course, it doesn't fit in that box, because you just mentioned so many different things going on all at once. I think we obviously need to think outside the box. That's what we need to do. Well, we got lots of chunk. We got the whole favorably illegal issue. But then we've got the fact that this is so, maybe not freely available, but fairly easily available. Whereas how are you going to constrain what's almost taking when there will compose the dispensary. Right, exactly. As you said, they can go in and every person is going to give a different advice. There's no consistent advice dispensary about them. So imagine we were doing a study of coffee, and I said, "Well I'm going to give you government issue coffee, but just don't take any other coffee." You just know people would be going to Starbucks. Absolutely, I would for sure, and government coffee too. So, yeah. Cool. Well, anything that you want to talk about, anything that still surprise you in terms of how this has evolved over the last year or two? You and I have talked about this. I mean, I think we are just scratching the surface of this. Afar from just basic high THC or high CBD, some kind of cognizant. But the whole issue about what dose do you take, how do you take it? That whole thing about, do you put it on your gums? Do you swallow it? Do you rub it on your skin? I mean, all of these things. I mean, it's so right for a research. It's like the most basic pharmacology. Totally. There's one thing I want to ask you about it, because I haven't really touched too much on Palliative care. Obviously, especially when you're dealing with elderly and late-stage cancer, they have a role to play there too. We're talking about symptom relief in terms of people who had just began the treatment, people who are at the end of their treatment. I don't know if you can comment on that knowledge. So interesting. So Palliative care, I don't know if you can still tell from my accent, but I'm British. But Palliative care started in Britain. There, it was very much set up, initially as a separate thing, you went to the hospice and you weren't contaminated by a treatment, and then gradually it re-introduced itself so it could overlap with standard of care treatment. So you'd be getting symptom control and anticancer treatment at the same time. Amazingly, the USA is doing the same thing. It's just taking about 40 years later to do it. We are slowly bringing Palliative care back in to be compatible with active anticancer treatment. Those guys that we totally tried to integrate back into our time here is going really well here. Medical marijuana should be in the armamentarium. It's a great question. I actually haven't spoken to them about it, but I think I should do. It makes all sense. Well, great. Well, I want to say, again, I think we have burned through our 15 minutes there. But thank you so much for taking the time. Oh, my pleasure. I think again people, I know that the students appreciate it. They really do like to hear from people who are on the front lines, and sure they're going to appreciate what you had to say. If you get involved in your research, shouldn't they? Definitely they should. They asked me about the topic. It's essential because obviously they're 20-21 year olds. We all have family members who had been touched with cancer, or Parkinson's, or something. I think they recognized the importance of this in terms of understanding the health implications. So, yeah. I'm sorry. I know we're running out of time. But this is the key thing. So you want them to make sure that people who could benefit from it are appropriately benefited, but not raising the hope inappropriately when saying,oh, you have to be on this, well maybe don't. Absolutely. No, I think it's very true. Especially when we interview obviously with CBD. There's so much type of CBD right now and still a little research. So no. I think the adjusting of expectations is really important. We definitely had some conversations in class about this already in terms of thinking about the harms and benefits and trying to modulate expectations. But like you said also, if there's some benefits and if the harm is pretty low, which of course, for all these patients, the risk size is pretty low, there's definitely some potential for some benefits. Although it's not a silver bullet and a cure all, by any means, right? Yeah. But yeah, I think that's a really good point. All right. Good talking to you. Yes. So thank you very much, Ross. You have a good day. Thank you. I'll be in touch soon. Okay. Bye. Okay.
