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By Benjamin Liong Setiawan for Forbes
Medical cannabis is an area that has many question marks for some and for others has become an essential component of their medical treatment. I sat down with Steph Sherer, the Co-Founder and President of the International Cannabis and Cannabinoids Institute (ICCI), to help demystify medical marijuana and address some common misconceptions in this two-part series. Headquartered in Prague, ICCI is an international research and educational center for the advancement of cannabis and cannabinoid treatments. Sherer also founded Americans for Safe Access (ASA), which advocates on behalf of patients to ensure safe and legal access to medical cannabis.
The following interview has been edited and condensed for clarity.
Benjamin Liong Setiawan: How do you respond to people who think medical cannabis is just a way for people to get high?
Steph Sherer: The only people that regard medical cannabis use as an excuse for patients to get high have not used appropriately standardized products created from the plant or seen its benefits on a loved one.
Today most people in the U.S. know someone that cannabis has helped or could help. The stigma around medical cannabis is global and pervasive, but is built on facts that do not hold up when properly researched. Patient advocates globally are teaching society about the misconceptions and the benefits of cannabis-based medicines.
Setiawan: What led you to patient advocacy for the use of cannabis as a medical treatment?
Sherer: In 2000, during a demonstration, I was attacked and sustained a severe neck injury. After months of care, I was not healing. My head was on my left shoulder and couldn't move. I had neurological spasms and chronic pain. I would eventually be diagnosed with Multifocal Dystonia and Torticollis. My life was changed forever. Medical teams prescribed painkillers, muscle relaxants, and high doses of ibuprofen. I was sick, both from the disease and the medication which lead to gastrointestinal and kidney issues. After two years, to avoid kidney failure and early age dialysis, my physician took me aside and recommended that I explore medical cannabis. I naively thought medical cannabis was only for people with AIDS or cancer. This was the first time I considered cannabis as medicine. My personal experience is what ultimately led me to where I am today.
I have always been a student of social change and will continue to be. Through this journey, I have crossed paths with the next generation of patient-led civil rights activists. These activists were willing to commit federal civil disobedience daily to provide safe access to people like me, people who were willing to stand up against unjust laws in the courts, and people who were willing to fight for the welfare of others.
Setiawan: You founded Americans for Safe Access (ASA). Tell me more about that.
Sherer: Americans for Safe Access was born in 2002 from the idea that I needed to work with medical cannabis stakeholders to create an organization that would stand up for the rights of people like me, who were seeking safe access to it, and those willing to provide it. As a medical cannabis patient, it was my turn, my responsibility, and my honor. I started with what I knew, grassroots organizing.
The year I founded ASA, there were only 11 dispensaries in the U.S., all of which were in California, and most were in the Bay Area. These centers were defying federal law as well as state and local laws to provide access to medical cannabis. The success of cannabis therapeutics in my life came directly from the guidance I received from a facility member at University of California, Berkeley. Shortly after that, I relocated to the Bay Area to be closer to safe access.
I thought at that time it would only take a couple years to make this a reality. Here we are, 17 years later. While there has been so much progress, there are still so many people across the country struggling to receive safe access.
Setiawan: How is your role in ASA shifting?
Sherer: As ASA becomes an institution and pillar to the global medical cannabis movement, like any organization, we are preparing to be in the best shape possible to carry out the mission of safe access to medical cannabis. That is why I’ve decided to step down as the Executive Director and usher in a new leader that can be dedicated to the next phase of ASA’s advocacy.
In my new capacity, I will stay on as President, being deeply committed to fundraising efforts, as well as contribute to our strategic thinking and planning. With this new shift in my role, I will now have an opportunity to engage with people in a different way.
ASA will always be the foundation of my work. It led me to understand how critical it is for companies to think about the needs of patients in a transformative way.
This shift will better allow me to put this work to practice—working at International Cannabis and Cannabinoids Institute (ICCI) and Dioscorides Global Holdings (DGH), an investment firm that I founded with my friend and board member, Ben Bronfman. I am matching innovations with investments for companies and projects that are serious about creating medicines for patients.
We are working to ensure that the industry operates in an ethical and well-informed fashion, while putting patient needs first. The time to shift is now. We have made phenomenal headway with DGH, building a medical only portfolio, and ICCI. Having started in the advocacy space, I never had access to large amounts of capital. I am extremely prudent with our current investments and we are tracking to build a company that will soon be a pillar of the cannabis industry.
Setiawan: Are there any challenges with the current scope of research for medical cannabis?
Sherer: Cannabis is different in that there are hundreds of compounds in the plant. That is why it's so important for us to gain an understanding of how these compounds work together, and how they interact within our body. A better understanding of these combinations can inform the industry on how to cultivate and manufacture products that will have the desired effects on patients.
Because of the politicization of the plant, and the fact that the main source of research funds to this day has been through the National Institute on Drug Abuse (NIDA), a lot of the data available focuses on the harms of cannabis rather than the benefits. The studies that we have also aren't really replicable because a lot of the cannabis companies don't have standardized products.
Setiawan: What has ICCI done to improve the existing research model?
Sherer: In addition to providing clinical research services, ICCI also focuses on building a library of data and information that can be turned around to help educate researchers, doctors, and patients as we continue to discover and unlock what is going on when cannabis is used as a true medicine in the human body. That’s why the advances of Dr. Ethan Russo, ICCI’s Director of Research & Development and a pioneer within medical cannabis research, is so critically transformative. His focus on whole plant research rather than isolating specific compounds has opened a new understanding of how the various compounds mixed together in cannabis create better results in efficacy than single compounds, such as THC or CBD alone.
At ICCI we are using metabolome technologies to better identify the chemical make-up of cannabis and cannabis products. We are using fractionation technologies combined with tissue bots and artificial intelligence (AI) to connect cannabinoid and terpene combinations with efficacy. We are also using our AI tools to do retrospective studies to scrub through past research to see if we can identify cannabis efficacy. This isn't a definitive science. It won’t replace future clinical trials, but it can help inform the expansive search for connecting formulations to indications.
Setiawan: Some say that medical cannabis can be used to treat inflammation and gastrointestinal disorders. How does that compare to leading over-the-counter medications used for the same ailments?
Sherer: Within the human body we have a system of receptors that control the most important functions of life. Those functions are eating, sleeping, memory, relaxation, and regeneration—the building blocks of life. The most interesting thing about the cannabis plant, as it relates to the system of our bodies, is that “phytocannabinoids,” cannabinoids that come from the plant, mimic “endocannabinoids” that are produced in the human body.
When we compare the toxicity and side effects of over-the-counter anti-inflammatory drugs to cannabis use, what you will find is that the recommended dosage of OTC medications is much lower and only for a finite period due to the side effects. When studying whole-plant-medicinals such as cannabis, we need to talk about much more targeted formulations to properly compare over-the-counter drugs for chronic issues such as GI disorders and epilepsy. Consistency and proper dosage are what is needed.
Most chronic conditions include inflammation as a symptom of the disorder. If you must take medication every day for the rest of your life to treat a condition, addiction is not an issue. Safety and toxicity are your main concerns. As far as those who are using medical cannabis to deal with acute medical conditions, there is little risk of addiction. In fact, according to the Drug Enforcement Administration (DEA) withdrawal symptoms of ending cannabis use, if any, are akin to caffeine withdrawal.
Setiawan: How does standardization impact the retail landscape for recreational users and medical consumers?
Sherer: Research plays a role in normalization—from the creation of instruments and tools that can help measure and standardize cannabis products to high tech tools that guide the production and cultivation of cannabis products. At ICCI we are using AI technologies to help guide regulations at the agricultural level and through advanced product formulations.
Most commercial products for human consumption are standardized at some level. For the recreational industry, the focus weighs heavily on THC potency. Unfortunately, the lab infrastructure in the U.S. is not consistently testing for THC, and so it is still hard for consumers to depend on labeling for potency.
For medical cannabis patients, there is a long road to finding a product that works for everyone. Medical cannabis will become competitive with OTC pharmaceuticals when patients can rely on content and dosage information that is provided. The product will need to be scaled for availability and research companies must develop a more targeted formulation for efficacy.