 I'm happy to have you here. It is an honor for me to be speaking at the San Francisco Public Library. Insomnia has been an issue in my life for many years, and it was a big problem. And I think, okay, anyway, and I retired, I retired a little earlier than I was actually planning to retire because I couldn't get enough sleep, and it was just too hard. I mean, I think that really impacted my ability to do my job, and I decided that, you know, if I wasn't working, I wouldn't have to worry about what time in the morning I got up, so that was the main reason that I retired earlier. And if I had known about medicinal marijuana, if I'd been able to use it or had started using it earlier, I think that I could have continued working for longer. So after that technology meltdown I swore I would never do this again. But if I'm a sucker for anything, it is authentic, non-commercial stories that help shed the light and guide the way for others. So it's hard to stay holed up in my office when patients themselves find this medicine so compelling of a positive experience. So I'm back, fingers crossed for technology to talk about cannabis and aging. So in 2017, a groundbreaking report came out commissioned by the National Academy of Sciences called the Health Effects of Cannabis and Cannabinoids. This is the first report ever to review the current scientific literature on the positive health effects of cannabis. It was commissioned by the National Academy of Sciences and included an expert panel too from the Bay Area, Dr. Donald Abrams, Chief of Oncology at San Francisco General, and Dr. Stephen Sidney of Kaiser Permanente. The expert panel concluded that there is indeed scientific evidence of the medical effectiveness of cannabis for a number of medical conditions. So no physician who is grounded in the medical literature can deny the value and benefit of cannabis for a variety of conditions. So for those of you in the audience who are met at the mere mention of marijuana by your healthcare professional with disdain, skepticism or ignorance, remember this report, the National Academy's Health Effects of Cannabis and Cannabinoids, and asked them, have you by chance had a chance to read this report? It's available free online. Another conclusion of the report is that there is very limited research on the usage and health benefits in the over 50 set, causing what's called a research gap. This is because cannabis research is limited by the policy that preceded it. A policy that strictly limited research to design only to show the harmful consequences and risks entailed in cannabis use, particularly in those thought to be abusing it, which were us, the baby boomers, adolescents, teenagers and young adults then, not the middle aged and beyonders that we are now who wonder if we should be using it. So physicians only informed by the scientific literature will not be guided by a wealth of positive experiences among those 50 years or older who have been using it medicinally for years. For over 18 years, I have had the pleasure of working with these patients as a clinical cannabinoid specialist, a fancy term for an evolved medical marijuana doc. And I've had over 13,000 patient visits from patients mostly not exclusively over the age of 50, including many octogenarians and a few centenarians. I had to practice that word. Folks over the age of 100. And I'm happy to be here tonight to share with you the experiences of the over 50 set and the scientific literature that has informed my knowledge of cannabis and aging. The questions most of my patients ask over 50 are, can cannabis help me with insomnia, anxiety or pain? And then is it true the cannabis legends as a cure, cancer, Alzheimer or slow aging? So I'm going to be answering those questions tonight bookended by the basics of medicinal cannabis and what I hope will be 10 takeaways from tonight. But before I go through the contents of the talk, I want to answer two questions that probably people here are too polite to ask. Who am I? And what am I peddling? I am a California trained medical physician trained in conventional medicine who left California after completing their residency in 1990 and returned in 2000. That was four years after passage of Proposition 215, California's groundbreaking legislation allowing for the legal medicinal use of cannabis to those with medical marijuana recommendations. And I began meeting patients like this. And I began to have horrible dreams with it. It was just awful. And I didn't even realize that that's what it was until I spoke with someone and they had taken the same sleeping aid and told me that that was a common side effect. So I went to the neurologist I was seeing and asked him and he said, well, yeah, but I have something else that might really help you. So I tried a common, it was again a common sleep aid, which was a sleeping pill. Was it a prescription pill? Yes, both of those were prescription, that one and the one I'm speaking about now. And that one, I had a hard time when I'd get up in the morning and tell a woman, don't be. And I didn't like the idea of perhaps becoming very dependent on it. So because of Proposition 215, patients like this had the option of a non-pharmaceutical, non-synthetic drug. It has helped me immensely and that I feel that it's a very safe alternative to a lot of very strong medications and pharmaceuticals. And I am just so, I feel so lucky that I'm able to use it. So in 2000, I began meeting patients who were refusing their refills on prescriptions I had doled out for years, Ambien, Halcyon, Valium, Flexaril, Prozac. And these patients were turning in their pharmaceuticals, opting for cannabis instead. And what they had essentially done was a comparison of pharmaceuticals versus cannabis. For the effectiveness, was it alleviating their symptoms? For its side effects and its risks, was it safe to use and did it make them feel better or worse? For its affordability, could they pay for the drug? And finally, for its accessibility, were they able to acquire it? And over and over again, patients were finding that cannabis suited their needs better than pharmaceutical. Because this comparison so often favored cannabis for a number of common medical conditions, today I am still a conventional medicine doc who no longer prescribes pharmaceuticals. Instead, I try to help patients harness the medicinal properties of cannabis to meet their medical needs. And just as patients are grateful for the opportunity to use cannabis, I would just like to make a shout out to those who passed Proposition 215, many of whom are pictured there, because they brought the evidence of the transformative power of cannabis right to my doorstep by allowing patients to experience it. Thank you. And what am I peddling? Cannabis is a multi-gazillion dollar industry. Most people who occupy the public space talking about cannabis have a product or a service to sell. I am here in a public service mode peddling much with the library pedals. Knowledge and stories to help you give pot a chance. So let's start with the knowledge part. Just as you shouldn't go out and drive a car if you don't know how to operate the pedal, the brake, and the steering wheel, you shouldn't take your pod out for a spin until you know the basic mechanics of the drug. And that is, where does your drug come from? What are its main medicinal components? And how do you get it into your body? There are two sources for medicinal cannabis, hemp and marijuana. Hemp is not grown for its medicine. It's grown for its strong fibers, which are used to create rope, fabric, and paper. But today it is also used for medicinal products. And the reason why, it's cheaper. Keep is good, but there might be some hidden costs that you should be aware of. Most CBD products not sold in dispensaries are not lab tested. They are bio accumulators of heavy metals, often passed on in the product. And they are absent, the full compliments of properties present in marijuana that many believe are contributing to their medicinal effect. Lab testing matters. A study done in 2017, published in the Journal of the American Medical Association, found 70% of products had mislabeled CBD contents and concentrations on their labels, and 20% had THC that was not listed on the label. So you don't have a reliable source of either medicine because you don't have the actual concentrations reliably reported. For those reasons, I specifically work with cannabis medicine derived from marijuana. And when I talk today about cannabis medicine, I'm going to only be referring to marijuana derived medicine because the broader term cannabis is now being adopted by the medical community as a more medicinally oriented rhetoric. So before I jump into the components of cannabis, I just want to step back for a second and give an historical context. And that is medicinal cannabis is not new. American physicians have been prescribing cannabis since the 1850s and it's been a part of the fabric of medicine in multiple cultures in Asia for millennia. In fact, before cannabis was banned here, it was in 40%, 40, 40, almost half, of all pharmaceutical products recommended by physicians. And it was indicated for use in over 100 conditions. Back then, not much was known about what gay cannabis is medicinal properties. The only thing that was known is it worked for a lot of things. Today, we know a lot more about what makes cannabis medicinal. This is a close-up of the cannabis marijuana flower and this is a further close-up of the flower also referred to as a bud, a modified 100-fold so that you can see these little oil-filled organelles called tricomes. These tricomes contain 500 different constituents and the medicinal focus currently is on two of them, THC, tetrahydrocannabinol and CBD that I'm going to be talking about tonight. But they also are components, there are components called terpenes that are drawing increasing interest and I think there will be increasing evidence of how they contribute to the medicinal effect. Tetrahydrocannabinol is the component of cannabis that it was responsible for in high doses getting people high. It is psychoactive. The receptors for it are all located in the brain and its effects on humans are analgesia. It's a painkiller, soporithic helps put you to sleep. It's an anti-anxiety, anti-depressant, appetite enhancement, anti-nauseant and anti-convulsant. That's THC. CBD receptors are all over the body. Virtually every organ has abundant CBD receptors although few are found in the brain and almost every cell binds with it and its effects on humans are non-psychoactive because it doesn't have very much activity at the level of the central nervous system. But it has all the same properties as cannabis but it also has additional ones. It is anti-inflammatory, anti-bacterial. It relaxes blood vessels and is also known to help with bone formation and increasing the rate of fracture healing. So a question that I often get is THC and CBD. Which one is right for me? So now that I've covered two components of driving this machine, the source, THC and CBD I want to look at three patients, one with insomnia, one with anxiety and one with pain and see what worked for them and what mode of administration did they find most helpful. So here's a real patient whose name and picture has been changed who came in to see me with insomnia, pain and anxiety. And she was 89 years old and she had previously used many of the medications that I had previously doled out antidepressants, benzodiazepines and sleeping medication and was currently on a anti-anxiety. And she lived alone, she didn't have any cannabis experience previously and she's like many patients, she came in with a short laundry list of her hopes for cannabis and I said, which is most important to you because it's hard to do a shotgun approach to multiple symptoms you want to focus on one symptom first and she said sleep. So I am not unfamiliar with seeing sleep problems in the over 50 set. It's very common amongst the elderly, 42% of people over 65 have problems falling or staying asleep and for many particularly women, the sleep problems begin much earlier around the perimenopausal phase in the four days. So the current estimate of difficulty sleeping amongst the over 65 age is 42%. My suspicion is that you would see about that same rate if you backed it up to the 50 year olds. So she came in on the recommendation of her daughter-in-law. Many patients who are coming to see me are being sent in by their children and she opens up her purse and she says this is what my daughter-in-law gave me to take for sleep and she had a bag of CBD candies. Candies are what are called edibles, they're eaten, that's how the medicine is administered and it's one of four ways to get it into your body. The other three are inhalation through your lungs, sublingual under your tongue and then topical through your skin. So most patients that I see are not keen on inhalation and before I turn to the other modes of administration I just want to sort of set the record straight about inhalation and that is inhaling cannabis flowers is perfectly safe. That was one of the other findings of this report. Smoking marijuana does not cause lung cancer. It is safe to smoke the bud. But here's the problem with smoking the bud. So this is a Dunesbury comic who I guess was famous for doing cannabis related strips and these are two characters who are dropping off a stash to a friend and they remark by now the old girl should be feeling some relief. Oh yeah, does she know how to spark up? Does she have the technical know-how? Golly, I forgot to ask. And then the patient holding what looks to me like a joint says, so which end do I snort? Ah, she didn't say. In fact, inhaling today is more complicated than ever and the reason for that is that the medicine is so powerful that the amount that you need to use is so small. So that is a typical starting dose and since it's hard to get a sense of how small that is I usually demonstrate with my baby finger but you can't see it from there so I will say it is probably about the quarter of a size of a pea. So learning to inhale itsy-bitsy, teeny-weensy amounts of cannabis is, believe it or not, a multi-skill process. And so I typically do not recommend inhalation as a starting point. To provide patients with a technical know-how to use cannabis effectively through inhalation I actually offer an inhalation 101 class free to my patients. I never thought I would be doing that in my career but it actually is a highly informative experience that has transformed the life of many of my patients. But it's not a beginning starting point. What I typically recommend to my patients is sublinguals underneath the tongue. They're readily absorbed within minutes, typically lasts for four hours and are one of the most controllable forms of administration. Edibles, ingestibles are my least favorite form of administration and the reason why is because the onset is highly variable 20 minutes to six hours depending on what else is in your stomach and your rate of gastric emptying which is just determined by your genetics and by your age. You actually waste about 80% of whatever you ingest ends up in the toilet bowl and before you even hit your system it's metabolized by your liver into a more sedating, more psychoactive, longer acting product. So it's a very difficult beginning step to start with. And topicals don't work for sleep. Topicals are just for pinpoint areas. So sublinguals is typically what I recommend to my newbies but she came in with a bag of CBD candies. Intent on using them with the full support of her family so I am not one to knock a person off their starting block so I say, okay, if that's what you want to start with we will start with edible CBD. So getting people to use CBD is like getting people to watch cat videos. Everybody's willing to do it. It's non-psychoactive. It's gotten very good press. There's a recent drug that's been approved by the FDA that is a cannabis CBD medication that has gone through all the FDA trials for control of seizures. It's easily accessible, you can get it into dispensaries and it's a good starting point. So I go over the beginning dose of CBD so you should always, the mantra for newbies, start low and go slow. Beginner starting dose depends on the root of administration. I've listed them here. For those of you who are interested in having these numbers they're on my website free of charge on an online guide so you don't have to fear that you won't have access to them again. So in my practice I actually give patients a treatment plan that has the name of the product, how you take it, what you should start with, what time of day you should take it and then how you should slowly increase your dosage. And I also tell people that you have to record your usage in order to really understand what's working for you. You can buy cannabis diaries or you can make them yourself. You simply want the date when you took it, the dosage, the time, the intention and the effect. So I explained to her that once she has reached a dose of approximately, for her she was doing an edible, approximately 50 milligrams and she wasn't getting an effect that she's probably not going to want to pay the amount of money it would take to continue going up to high dose CBD. The effects of CBD are dose dependent. The more you take of it, the more of the effect you get. However, at 100 milligrams of CBD, which is sometimes what is needed for sleep, you're paying $20 a night before taxes. So it's unlikely that that will be sustainable for her. So even though there's no upper limit and there's no adverse consequences for most patients, it becomes prohibitively expensive. So I explained to her once you reach that threshold, it might be time to consider THC. And when I mentioned the word, it's as if I have yelled fire in the office. Baby bloomers, fear and loathe THC. And the most off spoke words in my office are, I don't want to get high. So do you need to get high in order to get the benefits of THC? Absolutely not. It's all about the dose. And so I explained, start low and go slow. And if she is not finding the CBD to be effective after 50 milligrams, I say, you know, give a milligram of THC a try. So off she goes, candies and hands, and I see her back a month later and I say rather sheepishly, how are you sleeping? And she says, like a baby. And I said, really? How much CBD are you using? She says CBD, THC. How much THC are you using? 2.5 milligrams. I said, really? What product are you using? And she whips this product out of her purse. A five milligram micro tab of THC. And I said, this is five milligrams of THC. And then she whips a pill cutter out of her purse. And she says, I snip them in two. So the point of this is twofold. One, finding relief through cannabis is not like taking a pill. It is a process. There are many pathways to success, but the process is essentially the same. Start low, go slow. And where you start might not be where you end up. For many, CBD is a gateway drug to THC. For sleep, most patients need THC. But few patients are willing to start with it. For some, but it's really the minority, CBD alone works. Usually when it's caused by anxiety. And a methodical approach will determine what THC or CBD is best for you. LT came in to see me with new onset anxiety and insomnia, which she had never had before. She was a typical Berkeley patient. She had used acupuncture, Chinese, Tibetan herbs, essential oils, and homeopathy in the past. She had had several panic attacks within the last week and was even reluctant to leave the house to come and see me. And had I seen this patient 10 years previously, I would have immediately prescribed something like lorazepam or valium. Had I seen this patient five years previously, I'm not sure I would have had anything to offer her. Because there were no reliable CBD products sold at dispensaries. But by 2012, there was lab-tested, marijuana-derived, sublingual CBD products on the market. This patient was, like many patients, extremely functionally impaired by her anxiety. 15 to 20% of the elderly who suffer from anxiety are functionally impaired. 40% of those with a chronic medical condition, age 65 or older, also suffer from anxiety, but it is not as functionally impairing for them as their primary illness. So accustomed to homeopathy, she was very open to sublingual CBD drops. So for anxiety, I have to say, it is a game changer. Patients are not afraid and have no loathing, no stigma associated with CBD. It's not psychoactive. And it alone is often effective for cannabis-naive patients that haven't used cannabis since their college days, patients. So I gave her a treatment plan that, once again, started low with CBD, gradually ramped her up to 15 milligrams, spread out three to four times a day. And she came in two weeks later with a dramatic response. For many patients, especially from those suffering from primary anxiety, not secondary to other stuff, it is effective in and of itself. So for patients who take occasional benzodiazepines, lorazepam, adavine, they can stop using them. And for other patients who are on chronic benzodiazepines, they can go back to their prescribing physician and gradually wean themselves off. There's another kind of effect that I'd like to describe, because the incidence of chronic panic attacks and anxiety is smaller 20% than the incidence of the kind of anxiety that accompanies medical conditions, like chronic pain, depression, or cancer. And that is that patients who use CBD oftentimes don't realize the benefit they're getting from it for anxiety until they stop using it. And then they revert back to their pretreated experience. So it does have a more subtle contribution to chronic anxiety that once patients become cognizant of, are very appreciative for. So how to figure out if CBD alone will help you? It's simple. Follow the process. Start low and go up slow. Use sublinguals. Get up to 15 milligrams a day, spread out through the day, and see if that is helpful. Sublingual, again, is the easiest starting point. The low dose you should hold in place for three days, about 2 milligrams sublingually, and then go up slowly, increasing about 1 to 2 milligrams a day and recording your usage. And now on to pain. So pain comes in many varieties. There's back pain, neck pain, large joints, hips, knees. A lot of folks suffering from headaches. Abdominal pain from a lot of inflammatory bowel diseases I'm seeing, neuropathic pain from diabetes or unknown causes. Pain related to Parkinson's or multiple sclerosis, which is spastic pain, post-operative pain, and post-stroke pain. So 65%, 53% of 65-year-old or older have some kind of a bothersome pain. And the likelihood that you'll have pain only increases with time. The older we get, the more likely we're going to hit this. So I am seeing a patient, a kind of patient that I am delighted to be seeing. And that is the pre-op patient before the surgery. And I've seen pre-op hip, knees, back, and abdominal surgery patients. And they're determined to get off their post-op opioids as quickly as possible. And the traditional painkillers, non-steroidal anti-inflammatories and opioids are coming under increasing scrutiny by patients themselves. And she knows all too well the effects of opioids. She is used among other modalities, norco, flexural, and ibuprofen. And what she fears the most is constipation, which is well worth fearing. It is not only painful, but can lead to emergency medical needs. But opioids are responsible, as you all know, for much worse. The CDC just released its latest figures. 72,000 deaths in the U.S. last year from opioids alone. In states in which medical marijuana has been approved, the rate of prescriptions for Medicare patients for conventional painkillers has gone significantly down. So, does cannabis alleviate pain? Mild pain, some patients, can get relief with CBD alone. Moderate pain, CBD and THC are necessary, they're synergistic together. Severe pain, like post-op pain. CBD and THC can supplement other painkillers and reduce the desire for opioids. But usually, cannabis alone is not sufficient to control severe pain. So the route of administration I recommend to pre-op patients is sublingual, because it's the easiest to control and the easiest to begin for a newbie. And knowing that she's going to have severe pain after her replacement, I know that she's going to need THC. And so these are the starting doses of THC, in her case one milligram, sublingually. The dosing with THC is considerably different than CBD. So THC is a Goldilocks effect. And that means you take too little, you don't get any relief. You take just the right amount and your mind no longer is riveted by the pain. You can focus your mind on something else. You take too much, and unlike CBD where you continue to have the same benefits, you get a paradoxical effect. Number one, your pain can actually increase if you overshoot the THC mark. Number two, you easily can experience anxiety. And the other two are dependent on a much higher dose, which is that you feel stoned, out of control, paranoid, and then from there it gets worse. So what is important is before you have your surgery, you need to figure out about where is your sweet spot. And one of the good things about hip pain is you have pain before you have the surgery and you have pain after you have the surgery. So you have something to work with. So to find your sweet spot, the mantra is the same. Start low, go slow. If you're cannabis naive, you want to start your THC with a little bit of CBD. It will lessen the cognitive shifting you get. And you don't have to have your CBD in the same medicine. You can get your CBD from a different source. You don't have to worry about what ratio is right for me. You can have a THC medicine. You can have a CBD medicine. You should record your usage. I really like it when patients give me a couple of weeks before their pre-op because usually everyone can find their sweet spot in two weeks. And one of the great things about cannabis, it's safe to mix at these doses with any medicine. There is no question that a head-to-head comparison between nonsteroidal anti-inflammatories and opioids reveals that cannabis is safer and better tolerated than all conventional analgesic drugs. You should stop it 24 hours before anesthesia. You can take it with your narcotics. And you should expect few, if any, unpleasant side effects. So before I move on to the three cannabis legends, I would like to sum up because after I gave this talk at the Park Branch last week, a person who was in the audience said to me, so what product do you recommend for a headache? And I realize that I've tossed out so much information that it's really hard to distill it so patients really know what a good starting point for them is. So I'd like to try to offer you a distillate. So if you're wondering in the audience what you should start with, I'm going to try to encapsulate it. There is no size fits all answer, but for both CBD and THC, start low, go slow, be methodical. Sublingual administration is by far the easiest and most economical compared to edibles. If you are cannabis naive, which means you have not used cannabis since college, CBD is probably the right starting point for you. If you are experienced and are comfortable with THC for insomnia, your first step should be THC. Even if you're experienced for anxiety, you should just give CBD a run and see whether or not it alone helps you with your anxiety. And for mild pain, there have been some patients, even experienced patients who get alleviation with CBD alone. But if you're an experienced user and are having moderate to severe pain, you want a product that has both CBD and THC. So three cannabis legends that people ask me about, cancer, Alzheimer's, and aging. So cannabis is an amazingly potent anti-carcinogen, which I didn't know until I went to someone's talk who was making all these claims. And I said, do you have any references? Do you have any references? Do you have any references? And in fact, there's been about 1,600 articles looking at its anti-carcinogenic properties in cell cultures and mice. The first report came out in 1975 that found that THC inhibits growth of lung cancer cells. But there was no further research because the federal government wouldn't support that kind of research. Since the 90s, there has been a significant increase in the studies examining marijuana's anti-carcinogenic properties. But all that research has been limited to cell cultures and animal models. However, it is by everyone's estimation extraordinarily promising. It suggests that cannabis may reduce tumor growth, inhibit metastatic lesions because the cells don't have the motility, and selectively kill cancer cells, alleviating the sheer volume of cancer burden. But there has been no scientific study demonstrating marijuana cures cancer. So should you use cannabis for cancer? Not as your primary treatment if other proven options are available. But you should use it in conjunction with those others because of its anti-carcinogenic effect. It has been shown to be synergistic with other chemotherapeutic agents. And because it can be very powerful for symptomatic relief, especially nausea and appetite loss, as well as for mood enhancement. Anxiety, nausea with chemotherapy are concomitant. They're frequently seen in conjunction with cannabis. And for one of my patients, Kimo was his gateway drug to cannabis, which he found enormously powerful in transforming his anxiety pre-Kimo into a peaceful, grounded, and he called it his sanctuary space. So what about cannabis and Alzheimer's? Cannabis does not cure Alzheimer's, but there is cell evidence that it may retard its progression or delay its onset by preventing plaque being laid down in the central nervous system. THC itself does cause what's referred to as reversible memory loss. You remember less when you're on THC, sort of the Cheech and Chong effect than when the THC wears off, but it's completely reversible. What has been found and is being explored more and more is a lot of times patients with dementia have extraordinary agitation and anxiety. And they're often placed on very strong medications in order to deal with the behavioral consequences of that that feeling and cannabis can alleviate the agitation and anxiety in many patients. So does cannabis slow aging? There's no proof, but there's some very intriguing evidence. A group of elderly subjects were given ultra-low-dose THC for weeks and compared with untreated juvenile, juvenile subjects in a time trial maze for a delectable edible. And the group treated, the elderly treated, outran the juveniles who were not treated each and every time significantly. That's good news for the mice amongst us, which the subjects were. And for us baby boomers, one more hopeful signs of the opportunities that may or may not lie ahead in cannabinoid medicine. Before turning it over for your questions, I want to go over what I hope will be your takeaways. And that is know the basics of your cannabis, know where it comes from, what THC and CBD, what they do medicinally and what starting doses are and what your opportunities are for getting it into your body and the differences amongst them. I recommend starting with sublingual products. I think they're the easiest to use. And I am a physician who looks at the scientific literature. So I highly recommend that until there is proof of their safety, not to use vape pens, which are distillates. And that is because there is no long-term data on their safety and lungs are highly mutagenic and you don't want to expose them to anything that doesn't have a proven track record for not causing cancer, which cannabis has the flower itself, it has passed the test of time. Start low and go up slow. Do not rely on dispensaries for information. Dispensaries are where you should get your medicine, not where you should get your advice. I cannot tell you how many times I have seen cannabis patients walk out of dispensaries with $200, $400 worth of products, all of which are wrong for them. There are two weak links in the system. One, the medical community that fails to provide comprehensive treatment plans, including product and dosing, so patients can get the medicinal benefits of cannabis without any safety risk. The second is the cannabis industry that tries to fill the gap like a used car salesperson. Someone comes into a used car shop and says, which car is best for depression? And they'll be sold the only convertible on the lot. Dispensaries are not where you should get your advice. It is where you should get your medicine. This is how the dispensaries hope to engage the Over 55 crowd. This was a posting from yesterday, engaging the Over 55 crowd in your marijuana retail dispensary. And this person doesn't look like she's going after insomnia relief, pain relief, or anxiety relief. This patient looks like she's been given the opportunity to smoke an unspecified amount because she's smoking a joint. And the key word here is if you're not engaging the Over 55 crowd, then you're missing out on profit. Here is the secret that few dispensaries are willing to discuss. For the medicinal benefits of cannabis, you need very little product. And dispensaries turn a profit by selling you very high product. And that means that they are really specialists in getting high. The more THC they sell you, the more product they sell you. This joint usually has anywhere from a half a gram to one full gram. That amount of medicine, a half a gram, is 50 medicinal doses in the technique of actually getting a 2 milligram dose. So the dispensaries are geared towards profit. Profit means high dose product, which usually is not necessary for medicinal relief. Be methodical. Record the date, time, and intention of the medicine that you take. So not only do patients get a lot of products they don't need, they oftentimes don't record their experiences with the products that they get. Without the personal data on the effect, there is no way for experience to guide the process forward. So if you're going to use it, record when, how much, and what the effect is of the dose that you're taking. You don't need to and shouldn't alter any of your long standing other medications when you're beginning cannabis. You only want one ball in the air at a time. And if possible, I know this is sort of counterintuitive, use it before you need it. Get accustomed to cannabis because it is an invaluable tool in your toolkit as you get older. And remember you don't need to get high to get the medicinal benefits of cannabis. It's all about the dose and for most patients, less is more. And finally, continue to educate yourself. I have a tightly curated list of resources on my website including an online guide for new patients that's free of charge that goes over all of the basic information as well as starting doses and a few do-it-yourself websites on dosing both for inhalation and for inhalation sublingual and for edibles. And finally, I was telling one of my patients that I was going to be speaking on the topic of cannabis and aging to which she said, I can't imagine aging without cannabis.