The Cannabis Expert: The Painkiller Alternative for Chronic Pain, Endometriosis & Migraines

0:00Cannabis that people are buying on the streets without a prescription. And we showed that up to 90 % of those samples were contaminated by potentially harmful mold, fungi, yeast. Why is no one talking about this? Today on the show. Dr. Simon Erridge is a medical doctor, research fellow at Imperial College London, and one of the UK's foremost experts in medical cannabis. It's much more common in the UK to be prescribed medical cannabis through a private clinic for conditions. most commonly chronic pain but also maybe mental health conditions or other neurological conditions to access medical cannabis here in the uk you need to have a diagnosed condition and you need to show that you have failed licensed treatments and the people that we have done research with on that have shown improvement opioids why is that so much more widely available because it is very addictive right in the uk we're one of the highest prescribers of opioids per capita in the world i think really yeah more than america but how does cannabis actually help in our bodies and minds maybe both with chronic pain like what's it doing really what they're doing is is they work at three different levels really what they can do is modulate the transmission from let's say you have pain in your arm how it goes along your arm along to the spinal cord the second thing it does is it affects how those signals are going up and down and then finally that sort of emotional cognitive manifestation of pain.

1:27So do you think we'll have a similar relation to it in some states in America and Canada and Amsterdam? Do you think it will become legalized here?

1:40Guys, I have written a book and I've just heard it's a Sunday Times bestseller, which is very exciting. Now it's called Healthy Shouldn't Be This Hard because truly that is the reason why I really started this show. Healthy really shouldn't be this hard. And the one thing that I found from all the years of being in the well-being space and working as a nutritionist and interviewing incredible people is that there is one vital step that is missing in our health information, us and ourselves and being self-compassionate, treating ourself as we would a best friend seems to be fully overlooked and maybe even seen as soft but this book is going to help you re-explore that and realize there is so much science behind just how we think shapes every cell in our body shapes our physiology how we metabolize food how we respond to food and even the choices that we make so if you want to know more this book quite literally might change your life so head to the show notes where i put the link you can head to amazon or any good bookstore and you will be able to buy healthy shouldn't be this hard and if you do i'd love to know what you think simon medical cannabis quite a big opening for many people listening to this i want to start with like why should someone listen to this episode about medical cannabis and not just think that it's something about getting high that they might associate cannabis with like why does someone need to listen to this episode I think that's the most important thing like what you just mentioned there is that the the core differences between what people's conceptions may be around cannabis and what medical cannabis actually is so what is medical cannabis then medical cannabis is derived from the cannabis plant as we all are aware of but it's manufactured and prescribed in a legitimate regulated way for diagnosed health conditions.

3:26I think that's really important between the distinction between help trying to help someone with this plant versus potentially the recreational uses that can also be obtained from it. Okay so before we even like get into medical cannabis like how did how did you get into into this world like how did you start researching so you've done so many research papers around this like what was your entry point? Yeah, so my entry point came from my background as a medical doctor and a researcher at Imperial College London. And I was working in a lab that was set up around cancer and chronic pain and inflammation.

4:06And around the time I actually joined the lab in 2018 was around the same time as the change in legalization around medical cannabis here in the UK. not only did that mean that medical cannabis was able to be prescribed for the first time but what people probably don't know as well is it actually helped to open up the doors for research and one of the core reasons why we potentially haven't moved forward as much as we would have liked is we had so many years of prohibition where we haven't been able to do that research on the cannabis plant things still aren't perfect now but it was kind of an almost a perfect coming together of a point in my career and the things that I was interested in studying and also what we may be able to do with the cannabis plant and that sort of came as a natural fit.

4:53I mean it's interesting because there's a class b drug here isn't it in the UK but I think about America because we have so many American listeners on the show in New York and in LA and you've got Canada, you know, they're all now legalized. There's certain states that are legalized in America. Why do you think we haven't got that part here yet in the UK? Because Keir Stump's pretty strong about not legalizing it. Yeah, I think it, I mean, it's, I mean, America is a massive hodgepodge of different rules and regulations. Hodgepodge, the Americans will like that too. Of different rules and regulations.

5:30You have some states where there's no medical access even and where you have some where there's really liberal rules around recreational and medical and at the federal level it's still illegal for all uses so you can't even if it's legal in two states you couldn't fly for instance between the two states with your medical cannabis because it's federally legal so it's really a complex system in America. Canada much more straightforward you had the legalization for medical reasons in the early 2000s and in the much more recent legalization for recreational reasons in the 2010s. I think where we are here in the UK, I think Europe is probably more cautious as a society anyway.

6:13But I think in many ways, we're actually in the perfect situation to take the change in legislation around medical cannabis, the awareness of its medical therapeutic properties, and almost having this period of time before there is any change around recreational use or adult use, whatever you want to call it. We have this perfect ground now where we can actually do some really good medical research to hopefully prove where medical cannabis can be used appropriately. Because as many people, listeners in the United States, in Canada will see, the liberalization of recreational use has almost come at the detriment of medical it's deprioritized research into medical use deprioritized um sort of the initiative to drive forward access through insurers or in the uk on the nhs and so i think that is a really um although i i don't know um what goes on inside keir starmer's head i'm sure um you know many things are going on inside his head and I wouldn't suggest that I want to be inside it but at the same time I think no matter what he is thinking or whatever other political parties are thinking we have a really good opportunity at the moment to try forward medical research for the benefit of patients.

7:37So people listen to this and they're like well I don't know this isn't available on the NHS this is only available I'm going to say privately right now is that correct or is it available on the NHS? There are some distinctions. So there are three different types of the medication that are available on the NHS, but for really specific circumstances. What are they? So people probably are most familiar, in the UK at least, with the campaign around legalization for children with childhood epilepsy syndromes. Okay. So people can access CBD only medication for three specific epilepsy syndromes of childhood.

8:17There's also medication that's available for spasticity associated with multiple sclerosis. So that's when the muscles and the joints have much increased difficulty in opening and closing. And then the third is chemotherapy-induced nausea and vomiting, so sickness around having chemotherapy for cancer. But that's really small. we're talking about hundreds to maybe low thousands whereas um the it's much more common in the uk to be prescribed medical cannabis through a private clinic um for conditions most commonly chronic pain but also maybe mental health conditions or inflammatory bowel disease or other neurological conditions okay so you obviously had you got into this more when the research opened right in 2018 was there like an infliction point where you saw something within your own research where I don't I don't know just like an alarm bell went off and you were like why is no one talking about this yeah I think I think the the really interesting things with our research that we have shown is that to act to actually to scale it right back to access medical cannabis here in the uk you need to have a diagnosed condition and you need to show that you have failed licensed treatments so for someone with chronic pain they've gone to their gp or specialist they've tried in most cases everything that they've thrown at them or the majority of things they've thrown them nothing has worked and then they have transitioned on to medical cannabis and the people that we have done research with on that have shown improvement and the real you know delightful thing to see for those people is you know that they've been suffering with chronic pain in many cases for years it's affected their jobs their livelihoods their social lives their economic lives and then you've you know we've been able to do some thing clinically in order to be able to you know provide access to medical cannabis but then also do the research to show how it's affected their day-to-day lives.

10:23So can you just maybe give us a picture of the patient that walks through your door? Because I think at the moment for many people, this might feel quite abstract. Yeah. So can you just give me like a really clear shot of someone who's coming to see you, like your typical patient? Yeah. So our typical patient, one in two patients are being prescribed for chronic pain. So they are a typical patient. The most commonly they would have been to see their their gp they've been tried on opioids gabapentinoids other pain medications they've tried that most of the time for years it hasn't benefited them or they've had awful side effects from those medications and they're just seeking relief from their symptoms and those are the people that we're seeing and so they come and see us um i was going to say walk through our door but but the vast majority is online nowadays.

11:14They see us and, you know, we have a consultation to figure out whether medical cannabis is right for them. I attended TED earlier this year and I found myself in conversations with the founders of NoWatch. You've probably seen me wear something on my wrist and lots of you have messaged me asking me what this is. It looks like a classic watch, but it's actually quietly tracking something much more meaningful, your autonomic nervous system. This is the system that governs everything from how you respond, from excitement to anxiety, calm to overwhelm. Most wearables just give you a score, but if you're anything like me, that score can sometimes make you feel worse, like you're already behind before your day even begins.

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12:40You mentioned something really interesting there, opioids. Now, I don't know if anyone's watched or you've seen Dope Sick that's listening. Yeah. I know there's many documentaries around the opioid crisis in America especially. And I know there's quite a few. That's the one that I saw and it really shocked me when I watched that documentary. I just kind of, I didn't realize how big the problem was in the States and how, you know, that's obviously what they deliver for chronic pain when they made that kind of smiley face. They were given hospitals and say, like, great. Like we see at airports. Exactly.

13:17Yeah. Like how good is a water filter? I was happy with that. And I think that really shocked me being English. Now, people who listen to this in the States might be like, it doesn't shock me at all. I see it every day. It's destroyed families. It's so interesting because obviously we prescribe it here, but we are quite strict and regulated with how we prescribe opioids in my view, but you could completely tell me I'm very misinformed here. But I just know that if you've ever tried to get opioids for something, people are like, they're very addictive and we only wanna give you a small dose. But a lot of people are put straight onto opioids, right?

13:52For their chronic pain. So why is that so much more widely available? because it is very addictive, right? Than cannabis. I'm just trying to like understand the weighing up of the options here. Is cannabis maybe as dangerous as opioids? More dangerous? Addictive? Like what's your take on why we seem to favor opioids to support chronic pain rather than cannabis? Yeah, so I think, I mean, taking all that in conjunction, actually in the UK, we're one of the highest prescribers of opioids per capita in the world. Really? More than America? Not more than America, but we are certainly one of the biggest in Europe and globally top five.

14:33Wow. But luckily since 2018, when some new guidance came out, things have started to trend downwards and people are more aware of the harms of opioids. So I think that's helped. But the problem is, is we haven't always had something to substitute it with. I think a lot of times when you're a patient, you're a doctor, someone is suffering in front of you, trying to reach for anything to help them. And I think that's often what happened, even though the evidence base for opioids hasn't been good in terms of how it affects chronic pain. In terms of weighing up, is one more harmful than the other?

15:08I think lots of people go to sort of the illicit use of both. But what we have is studies where you've looked at the medical use of cannabis and the prescribed opioids. And when we see them compared head to head in some of our best research to date, we see that people who are prescribed medical cannabis are less likely to stop taking it because of the side effects and they're less likely to have serious side effects because of the medication. So, you know, I'm not suggesting that medical cannabis is a panacea. There aren't potential harms. But when we compare them head to head, it certainly seems like medical cannabis is slightly safer for some patients.

15:49so how does it work with chronic pain like how does cannabis with what i associate with amsterdam and going there um you know because i think when you're younger and everyone goes to amsterdam it's all this cannabis is like all free and being a uk citizen you're like this is mad um that's kind of before this podcast like how i would have thought about it and then and actually that's why i spoke to professor david nutt on here and he's done a lot of work within this sector as well um and he has always fought for it to be legalized and not a class b drug as well as psychedelics um as well for mental health treatment and things like anorexia nervosa but how does cannabis actually help in our bodies and minds or maybe both with chronic pain like what's it doing yeah so i guess people are most familiar with the the two major compounds you find in cannabis that's thc tetrahydrocannabal and cbd cannabidiol really what they're doing is is they work at three different levels really what they what they can do is modulate the transmission from let's say you have pain in your arm how it goes along your arm along to the spinal cord the second thing it does is it affects within the spinal cord how those signals are going up and down and then finally that sort of emotional cognitive manifestation of pain we always you know maybe many of us think about pain as just being a kind of physical sensation but it really is an emotional one cognitive one you know you think of times when you've been in pain but someone's been able to make you laugh or smile and it kind of helps to just at least take some of that pain away medical cannabis is is working across those three different levels to have an effect on on on an individual's pain levels.

17:38Okay, so you just mentioned two things there. One was CBD. That had a massive boom about five years ago, I think. Everyone was making CBD drinks and like the CBD that you put under your tongue. I have no idea where the legalization is on that now. But is it THC, the one that can make you high and the CBD doesn't make you high? Am I right in saying that? Yes, you're right in saying that. So CBD is non-intoxicating. I wouldn't recommend this, but you could take as much of it as you wanted and you would never get an intoxicating effect. Whereas THC has that potential. I think the key thing, you know, you mentioned about the misconceptions at the beginning of the podcast is when we're prescribing for medical cannabis, we start off with that THC level low so that it's not causing that euphoria, cognitive impairment, etc.

18:31And we slowly titrate it up over time to reach a level whereby you're getting that clinical effect. But a patient has developed tolerance to maybe those adverse events. So, yeah, it's between those two that's kind of having the effect when someone takes medical cannabis. Because the CBD, people can go and buy that now from the shop. Is that right? That is correct. But I think there's two key distinctions. Right. One is there's been studies shown of CBD that you buy on the high street, online, wherever you're able to obtain the wellness CBD products from. Often they don't contain as much or more CBD than they say they do.

19:06They may contain other contaminants that you're not necessarily wanting to take at the same time. Essentially, they're regulated as a food product. So the margin for error on everything that's contained in it is much wider. Whereas CBD, when it's in medical cannabis, it's a medicine. And so therefore, the appropriate regulations are in place to make sure that, you know, a specific amount is prescribed and you get exactly what is in that product. So someone's saying like these drinks with CBD and do you think they're going to be having much more effect? Or do you think they're mostly for a claim because there might be quite small amount of CBD?

19:44And I mean, what like how much do you really need to have an effect? Yeah, and I think this is why there was quite a lot of guidance from the Food Standards Agency, particularly around in food products. When you're taking it in a food product, you have no idea how that food product is affecting how much you're absorbing it. Often you need to improve the absorption of medical cannabis. Ideally, you take it in a fatty meal. And one of the most common ways in which you take medical cannabis is as an oil. and we would suggest people hold it under their tongue for five ten minutes to have better absorption we actually absorb it really poorly through our guts and so therefore actually if you are taking it in a drink a food product whatever it may be actually if it particularly if it's not a particularly fatty food product probably doesn't you know you're having a small amount it's not absorbed particularly well and you're probably not having that much of an effect So how much would this cost for someone then who is maybe thinking, well, I've gone through all of these routes that Simon's just mentioned, you know, like what is the cost of going on medical cannabis?

20:51Yeah, so the costs really vary depending on the condition and what may be prescribed. But typically appointments may cost anywhere in the region of 10 to 50 pounds, depending on which clinic you go through. In terms of the medications, yeah, like I said, it's a broad spectrum going from sort of low to mid hundreds of pounds per month. I think that's what makes me feel sad I mean I'm sure it does for you as a clinician as well maybe seeing people actually having these advantages and effects that helps improve their chronic pain I mean there's nothing worse than when you're in pain the whole time and knowing that actually this is really only accessible for kind of people that have a good income yeah I mean it's it's a bit of a paradox really because I work for a private medical cannabis clinic, Pure Relief, but I see it as my objective to make my job almost like obsolete and make it available on the NHS if the research shows that that's appropriate.

22:02And I hope, you know, thankfully for my employment, it will take probably a long time to show this, but I hope that in the future, we're at a point whereby we can say, you know, for all of the indications where medical cannabis is prescribed this is exactly where it should fit into someone's treatment regimen and this is where it should be appropriate on the nhs but at the moment everything is just categorized as it's you know a treatment of last resort um and so i'm hopeful in the future we will we will get to to there we'll get there most wellness products are built for someone with four hours sleep to spare and a cold plunge in their garden dion is built for the rest of us.

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23:18Grounded is launching very soon and you can shop both at diome.co. That's d-i-o-m-e.co. Use code Sarah20 for 20 % off, whether you're buying once or subscribing. How many research papers and studies have you done around this? I think I've got over 80 publications on medical cannabis today. Which was the most surprising results to you? What was the thing where you were like, wow, this is incredible that we had this result or surprised you potentially? That's a really good question. I think we've talked about the clinical side. I think one of the really interesting things that we looked at was maybe not so much the medical side, but we looked at contamination of illicit cannabis.

24:03What's that? So cannabis that people are buying on the streets without a prescription. We looked at samples that had been seized from police forces across the UK. And we showed that up to 90 % of those samples were contaminated by potentially harmful mold, fungi, yeasts. Some were even contaminated by bacteria like E. coli, salmonella. and we also showed that some were also contaminated by like heavy metals like lead not at really high levels but certainly if you were taking it regularly over a long period of time enough that potentially could be harmful and so i think that's that's the other flip side of it is that we know that a lot of people who can't access it for cost reasons they're not even aware that medical cannabis exists but are still like accessing it through a black market route are really putting themselves potentially at risk unknowingly by the by the contamination of illegal cannabis wow that's a really good point that you raise because i think the the fear on people hearing a conversation like this right and we haven't gone into all the areas and the studies of what you've seen of different health conditions yet but it is you know because it can be expensive the easier route is to go black market.

25:25And I've seen that now loads with peptides, you know, people getting them from China, GLP-1s, if you're not doing it via the doctor and getting it on the dark web, any type of drugs, you know, it's so much sometimes easier as a solution to be like, well, I've heard this, well, I'm gonna maybe not get it from a regulated source. What's like your biggest worry there with people? I think I think you know my biggest worry is that people are placing their health in the hands of people who don't care about it drug dealers gangs whatever it may be whereas if you go to a regulator source you're seeing a doctor someone who's trained to look after you not only with you know from a medical point of view but emotionally like most doctors the vast majority that I've come across are very good people and want to do right by you and so I think you know That's the most important thing when people are trying to weigh up those two options.

26:23And in some, you know, in some instances, you know, the cost may be comparable. It's not as if illegal cannabis is, you know, ridiculously cheap either. And so when you're trying to weigh those up, I think that's really important to make a decision on. Is it addictive, cannabis? So there is a potential that cannabis can be addictive, like any substance that has the potential to cause that euphoria, that high that we've talked about. Again, I think this is another important point by going through a regulated route whereby you're being prescribed a controlled amount of the medication. There are limits about how much you can be prescribed.

27:00You're seeing a clinician who can monitor for those effects over time. If you're going through an illegal route, that's not necessarily the case. Whereas within medical cannabis, that's something that we take really seriously and monitor for the effects of. Because I'm just thinking about that with opioids, right? Because you can still be, maybe should be talking more about the European side than the American side, but you are normally prescribed to specific dose. So people might also be going, oh, that's what the doctor does for opioids. But I still think you can get very, very hooked on opioids.

27:34yeah so I so I think with with medical cannabis what we we certainly see in our clinical practice is that very few people do end up you know developing a tolerance to it compared to opioids like comparing again comparing head to head much less of that addictive potential to it but it's obviously important we have the right safeguards in place as well in addition to knowing what we know about how the plant works so one of the things that I found so you sent me lots of research papers that I looked across and one thing that I think I've heard a lot of people suffer with and I'd be interested on our listeners to know what their journey's been like with this health condition but it always feels like the one that there's never a solution for um apart from more alternative medicines like acupuncture and things like that is migraines now migraines are not obviously just a headache they are like debilitating yeah and i know so many different people that have suffered with migraines and they're always like i've just gone on this lifelong journey and never fully understood like how i get rid of a migraine a lot of people say like i feel it i feel it coming but like i don't know what to do to stop them yes um you've shown that medical cannabis is potentially one option like how tell me how does that work i mean i think so the good news is is in addition to medical cannabis we have more preventative options than we've ever had in migraine like the the field around migraine is changing um quite quickly um but in terms of like focusing specifically on medical on medical cannabis for migraine i completely agree it is really debilitating and there's there's two sort of ways in which people are using medical handlers a bit like the medication triptans that many people who suffer with migraine may be familiar with where they're both used for both preventative but also when the attack happens and so we really see that during an acute attack for example you have those sort of more acute pain relieving effects when we're looking at more sort of the chronic preventative type effects, we're less sure as exactly why that may be happening.

29:48In someone with migraine, we think that this probably comes from the fact we don't really also understand terribly well why someone develops migraines and what's happening. But we think it may be due to a couple of phenomenon, such as changes in the way that the blood vessels dilate in the brain. And secondly, how electrical signals get passed along the brain to cause those kind of sudden migraine attacks or headaches. And so again, I think medical cannabis, when it's been used as preventive, is addressing those two things. But I think not only do we need more research about how medical cannabis works to really truly understand that, we also need some more research on how, you know, what is migraine?

30:31How is it happening? Because we're still so far behind the game on that as well. so would you then say because it's preventative people then just take a dose every day to reduce the to reduce the possibility of you getting a migraine you don't take cannabis when you feel migraine coming on so so you would probably um do a bit of bit of well i say a bit of both you would do both um in that you would yeah take take something every day to to keep keep it at bay but then if you did um you know have a migraine attack have something available so that you're able to take something acutely when you feel the symptoms start to come on.

31:07Right okay it's fascinating because I just feel like so many people have suffered and when I looked at the paper it showed that women were less likely to see improvements than men but also I feel like migraines seem to predominantly affect women more so like what's going on there? Yeah no it's I mean it's really it's really fascinating I can't really explain necessarily that finding but what we do know particularly around how medical cannabis works and the major compounds of CBD and THC that we touched upon they interact with something called our endocannabinoid system so these are a series of receptors and molecules that are found predominantly in our brain and spinal cord but right throughout the body in our immune system our skin our gut and we know that there are differences between men and women that are regulated by estrogen as to how much of that system is upregulated or downregulated at any one time.

32:05And so we do see actually right across the research base that we've looked at, a sort of sex specific differences. And normally what we tend to see actually, and which is why I can't necessarily explain the migraine result, is that women interestingly tend to report a greater improvement, but they're also more likely to report side effects from the medication. And I think that that may be due to the fact, like I said, they're more likely to have an upregulation in these receptors. So they're just a bit more responsive. And so our doctors kind of work with that to maybe be a bit more gentle in starting the medication at a lower dose and titrating it a bit more gently, rather than, you know, with a male patient, just you know going at potentially a more standard dose women and hormones it's honestly the bane of our lives i'm gonna have to tell you i mean i mean you may be speaking to the wrong person but i i mean i agree i think you know it's it you know it it's really vogue at the moment to really be talking about women's health but i hope that it goes from just being a moment to being something that is like a movement yeah because women have for centuries been on the back foot in terms of medical research around all aspects of medical care um and we're just really playing catch up um but i'm hopeful that now now people are realizing that that is you know a fact and hopefully we continue to improve that over the time but certainly you know within our medical cannabis research we all continue to try and look at that as much as we can i'd be interested to know about because obviously you're saying estrogen potentially then is why it plays a role in this system that you just mentioned that i'm not going to be able to pronounce eco cabin endocannabinoid endocabinoid system um many people are like never heard of that before but i think it's really interesting that maybe potentially i would want i would love to know more about like whether it's perimenopausal women, menopausal women, women of younger age, like, because obviously our estrogen flexes, right?

34:16And it drops as we go into menopause. So I'd be really interested to see, like, how the cannabis then works from different women at different life stages. Yeah. So we haven't, we haven't, that's a really, I mean, that's setting off some ideas for some potential research projects down the line. But certainly it, what we, what we do know is that oestrogen tends to upregulate those receptors so what we anticipate from what we're seeing in our our research is it is that effect that's driving those outcomes but at the same time that's that's you know really interesting and you know you could even you know look at the the fluctuations of oestrogen during the menstrual cycle even um and and and see actually the sort of daily fluctuations and how that affects things i think that the difficulty we would find there is you probably have the effects of changing hormone levels during the menstrual cycle on potentially the condition itself and then the medication um but yeah that's a good idea i think that's something for me to take away yes please please do more research into women's health well that brings me so nicely it lines me up so perfectly for my next part which is endometriosis yes so this is like chronic debilitating pain for so many women and it affects 176 million globally obviously women globally because men don't have this um it's so undertreated and it's such an under-researched area and so many women suffer and so many women also get dismissed for this when they go to their doctor right a lot of them would just say you've got a heavy period and send them away and women like can suffer it can take years yeah yeah for a woman to get a diagnosis around over eight years in the uk wow that is really sad do you see a lot of women coming to you with endometriosis to be treated yeah yeah we see it we see as part of our chronic pain group yeah quite a really sizable amount of women can you tell me about how well basically how this works with them and like any patients that have seen results yeah so i think with endometriosis you typically have two types of pain you have your cyclical pain during the menstrual cycle as the lining of the uterus sheds you essentially have shedding of these endometriosis deposits which are typically found deep in the pelvis they may be on the bladder on the uterus on your bowel in some rarer cases even as you know far-fledged as the lung yeah and so you have when you know when you when a woman has their period at the same time they will have shedding of this lining causing pain but also what then happens is is because you have essentially bleeding and shedding in the pelvis in the gut then start to develop scar tissue and so women will often also have continuous pain right throughout the month doesn't matter about their cycle because you know their gut is trying to move food through the bowel as it should do but it's stuck together or you know whatever whatever other bodily function you want to you know appropriate there may be some effect of endometriosis more chronically and so really again it's about sort of addressing those those two things the cyclical pain um maybe a bit more difficult often in treatment of endometriosis you're talking about sort of hormonal contraceptions or or other things but with medical cannabis you can obviously um use that for the well you could use it for both but the chronic pain certainly that a woman may experience right throughout um her time and really sort of adjusting the medication according to you know what specific types of pain she may be suffering with so is it the fact that the medical cannabis directly treats the pain response but you also will have to still treat the effects of endometriosis at the same time so it doesn't like reduce the bleeding it doesn't make endometriosis any less worse i don't know it's or am i thinking about that wrong can it do both no so so um so it's it's more about the pain it's that thank you for helping me clarify that so it's more about the pain itself it won't take away the endometrial deposits it won't stop them from shedding um but you know there's so much more work that we have to do around that we know that lots of people um who have endometriosis go through keyhole surgery to remove them but a significant portion of those those women will go on to actually have them just recur down the line anyway and so it's about having maybe we're working more towards the symptom relief side of things but you know there needs to be a concurrent piece where we're looking to reduce people developing endometriosis and if they do treatments to help reduce the burden of endometriosis itself.

38:55Because you just study on this, this is the one that I looked at on end because I was really surprised that, you know, thinking about medical cannabis and endometriosis, but obviously it doesn't surprise me now realizing obviously it's helped treat chronic pain. But nearly half of the women in the study were already on opioids when they when they came obviously that says a lot in itself what happened at the end of the study that you did around endometriosis like what was the outcome with medical cannabis versus the ones that were on opioids as well the ones that were on opioids as well um so sorry do you mind just rephrasing that so in terms of what was the difference between those on opioids and those who were not on opioids what was the outcome of the study because i know that some of them were already on treatment when they came to see you on the study yes sorry i understand that so what we saw is there was a reduction in the amount of opioids that were prescribed for those individuals who were on it at the beginning of the study so i think not only are we showing that you know that the pain has reduced over the time course of that study but also there was a reduction in the amount of opioids that they were prescribed and i think particularly people who have um you know women who have endometrial deposits on their bowel they often get constipation things of that nature so being able to take them off a medication that potentially can cause really nasty GI side effects is you know another positive as well yeah huge I think we forget like how well hopefully we don't in the show because I talk about it all the time but just how interconnected the body is yeah you know and I think about different people in my life that have got different conditions and it's not just you know whether it's a bad spine or whatever that then affects like their hands and their legs and their feet and all of these different symptoms that then kind of show up, as you said.

40:41Like I also know that so many women that have problems with their whim or whatever, they also get really bad like gastro effects at the same time. And so it's like a compounding effect. No, of course. I have one small ask while you're watching this show. If you're enjoying it, please hit subscribe on whichever platform you're listening on. This really, really helps the show more than you can realize. It helps people that have never listened to the show before come across it and see all the incredible episodes that we have with the amazing guests. So if there's one small favor today, if you're not already a subscriber, please do subscribe.