Episode Transcript

Trevor:  Kirk, we're back.

Kirk:  Hey, Trevor, how's it going?

Trevor:  Good. Let's see if we can do this up front. I'm Trevor Shewfelt. I am the pharmacist.

Kirk:  I'm Kirk Nyquist. I am the registered nurse and we are up early in this morning because we are expecting our guest from Israel to join us during as we introduce him. So I found this gentleman through NORML as I have told our audience in the past. I have received NORML pushed emails and I read through them and I send out requests and about 20% of them get back to me. And this is a gentleman that got back to me about what three months ago and we've been sort of hitting back and forth finding a time and here it is we're going to find time to talk to him and I'm quite excited about it.

Trevor: Yeah so and and he will do a much better job but just let's prep the people a little bit ahead of time so Diabetic Neuropathy tell us up the real quick Coles Note's version of what it is and then we'll talk about what what he's trying to do about it.

Kirk:  I have seen this condition often in my clinical practice. It's defined as damage done to the peripheral nervous system and part of the central nervous system, but it's mostly the peripheral. What happens is that you lose sensation to the periphery, your toes, your feet, your hands, and you get pain because there's a pain that comes, but there's also a loss of sensation that comes. So it's very often that diabetics will get foot ulcers or sores on their feet due to poor fitting shoes or for whatever reason because their body has lost that fine sensitivity due to diabetes. and they get pain because of it.

Trevor: And like you said, that, and it can just hurt no matter what you're doing. Like they talk about it in the study, allodynia, which is, you know, even you rub a feather on your toe, hand, whatever, and your body goes, ow. And you know they talk about sciatic-like shooting pains. So it can be, aside from the obvious bad part about diabetic ulcers and not feeling, it can just hurt like a lot.

Kirk:  And Dr. Robinson has just joined us. Hello Sir.

Trevor: Perfect. Let's let him do that part.

Kirk:  We were just introducing you, as I said to you we have our recorder on sir, so good morning for us. How are you?

Dr. Dror Robinson I'm fine, thank you.

Kirk:  Could you please introduce yourself sir and let us know where you are?

Dr. Dror Robinson My name is Dror Robinson, I'm an orthopedic surgeon working in Israel at the Rabin Medical Center in central Israel.

Kirk:  Fantastic. I was just telling Trevor that I found your study through NORML, which is a magazine, an online magazine pushed from America. And I was trying to get ahold of you to talk about your study using inhaled cannabis to relieve people of their neuropathies.

Dr. Dror Robinson Yes, it's a it's small, relatively small one center study that just got published like in the last few months and it is a five year follow up study, which is the longest I am aware of in the literature. So most studies are like six weeks, six months, maybe one year, but this is a long term follow up study. And our results are quite interesting. First of all, the normal cohort that you follow with diabetes will worsen over time. The best drugs around can lower hemoglobin, glycated hemoglobulin by two percentage points or two and a half percentage points, that's the best. And actually, cannabis achieves this. So this is kind of amazing. Also, it goes a little bit against the notions that cannabis worsens diabetes control. So there are a couple of studies showing that recreational cannabis users are actually worse off regarding diabetes than people who do not use cannabis. But there is at least one large study that came from the University of Nebraska and Harvard showing quite amazingly that current marijuana use is associated with lower levels of fasting insulin, lower HOMA, IR, and smaller wave circumference. So this is a very important clue. It kind of shows you that cannabis is not a glucose lowering agent, but rather a metabolic intervening agent, changing the body metabolism.

Kirk:  That's very curious. So you're saying part of your results, you saw that your participants had lower sugar levels and you're saying this is marijuana, cannabis had an effect on that?

Dr. Dror Robinson Yes, cannabis actually lowers the blood spikes, the glucose blood spikes. And this goes against the basic notion what we call the munches, that people like to eat sugary stuff when they're using cannabis. Despite this munch or these cravings, people actually become better metabolically balance when they are using cannabis. This is a very distinct result of our study. It can be explained partially by the effect of what is called THCV, like victory, because THCV is known to decrease insulin resistance and known to improve insulin sensitivity in animal studies.

Kirk:  Is that one of the reasons why you removed medical cannabis users from this particular study? You're studying, talking about cannabis and diabetes is I'd like to get deeper into that. The study we got a hold of you for has to do with the pain management of neuropathies. And I noticed that when you did your sample, you removed people that were on medical cannabis. Is that because of this effect cannabis has on the homeostasis of sugar, I guess.

Dr. Dror Robinson Yes, we have a fairly small group, which is only 52 patients, because we were selective, we did not take anybody who used recreational cannabis. So this actually removed a lot of people because a lot people actually try recreational cannabis, but the advantage is that you really can show the effect because these people had diabetes before the study. They still have diabetes, but they are improved. So you can show that the cannabis is what did the effect.

Kirk:  That's why I pushed out to you. One of the observations I made in your study is that you were saying that the sample had A1Cs of 9.8, which from my practice seems a little low for someone that has chronic diabetes. Did you notice a decrease in the A1C over the five-year time you're with these individuals? Did you notice that by average everyone's A1C was lower?

Dr. Dror Robinson Yeah, it decreased about two percentage point from nine something to seven something. This is very amazing because in a typical diabetic cohort, you follow for five years, no matter what intervention you expect to see worsening.

Kirk:  Yeah.

Dr. Dror Robinson It will get worse, not better.

Kirk:  Yeah.

Dr. Dror Robinson So this is a very profound metabolic effect of cannabis.

Kirk:  Yeah, that's very much my experience. That's what startled me about your study is that not only did people get pain relief from the cannabis, but they also had, I don't know what the word, a regulation of their diabetes as well. It appeared from this small sample.

Dr. Dror Robinson Yes, actually diabetes is affected in a positive manner by cannabis. I think a lot of larger RCTs are needed to show what part of cannabis does the trick. We are all also only using inhaled cannabis. I'm well aware of the Negative image of a doctor that recommends his patients to smoke. It sounds horrible. But I think cannabis through the lungs acts very differently than cannabis which is taken orally or in another manner. And I think it might be a more neural effect or a different pain perception effect that actually improves the diabetes and you do not see it with edibles or with oils or any of the oral stuff.

Trevor: Dr. Robinson, Trevor, the other half. Can we just talk about the pain over the five years for your patients? We know in neuropathy for diabetes, it's painful. The current batch of medicine that we usually use only gets rid of pain about 50% of the time. We know they've got a bunch of side effects. Over the five year when people added on inhaled cannabis in your study for these 52 patients, what happened to their pain?

Dr. Dror Robinson Actually, the decreasing pain is like from about nine at the beginning to about two at the end of the study. So we see a very strong analgetic effect and we see major decrease in medications. So people do not require that much Lyrica or pregabalin, they do not really require as much Cymbalta, Duloxetine, and all the other drugs, which I think can be problematic. I think they have major side effects, which are difficult to manage. So if you can get rid of the opiates, if you can rid of the anti convulsions, it makes sense.

Kirk:  Did you, in your study, obviously you're focusing on inhaled cannabis rather than ingesting. When you were putting the study together, why did you choose to go with the inhaled form of administration opposed to edibles?

Dr. Dror Robinson I think Israel is mostly about inhaled cannabis. Like the percentage of inhaled versus other ones is about 90% inhaled cannabis. Only about 10% are oils. And I think it has to do with what kind of oils we have in Israel, because many of the oils that are used in Israel are not how I would have produced the oil, let's put it this way, there are many ways to extract cannabis. I'm not very happy with the industrial extraction processes that are used in Israel.

Kirk:  Actually, one of our, I guess it was our last episode, we interviewed a gentleman from Spain, Peter Vermeul, and he has a technique of removing the essence of the plant that retains the acid forms of the cannabinoids of cannabinoids. Have you heard of Peter's extraction methods?

Dr. Dror Robinson Yes I have, yes I have. But the issue is how much you extract and how costly it gets. It is very important to keep the acid forms. And the closer you have to a real plant, the better you are. So if you have a sophisticated technique that you can actually keep the acidic forms, that's fine. But unfortunately, it's not what we get over here.

Kirk:  If you were to improve upon the study with hindsight, what would some of the variables you may have removed or some of variables you would have added?

Dr. Dror Robinson Well, it should have been a multi-center study. This would have made it more generalizable. Also, we are a binational country. We have two large populations speaking different languages. I think this study did not include very many Arabic-speaking people. I think it is also very important. Otherwise, I think it's a fairly well-conducted study. Of course, you need a control group, but actually, we are talking about real-time, real-world data. Real-world, data, we do know what happens to diabetics without cannabis. So we are quite sure we do have the control of all the other people who do not use cannabis. So of course, for the scientific part, You would really want to have a control group, but for the ethical part, I'm not sure it's even ethical not to offer cannabis to people with severe diabetes.

Kirk:  That's a very curious comment. I was going to ask about your sample. The sample came in, they were non-cannabis users. You asked them to use cannabis as part of the study. And now that the study's over, have these individuals continued using cannabis? And also, did you notice if there was a a creep in use? Did they use more cannabis as time went on? Did they need more cannabis? Did the need a break during the five-year period? Did they need to take a two-week break from cannabis and then come back to it? Can you talk about their use of cannabis?

Dr. Dror Robinson Yes, actually, they start, according to regulation, with about 20 grams of inhaled cannabis per month. It's about 0.6 grams per day. And actually, it's only 10% THC at this stage. And only by the end of the first year, they started getting the 20 plus THC percentage. And usually by that time, they're using about 20 to 30 grams per month. So it means about one gram per day of inhaled cannabis. Still, because everybody is inhaling differently, you don't really have a dosage, so you don't really know how much is actually absorbed. You only use, you only know how much is consumed. You don't know how many people are getting inside their body. But the creep is not very high. Like the people ended up with about 45 grams after five years. So there is a creep, but it's not very fast. You don't need to go, in most cases, to very high dosages. We are currently working on a study with almost 1,000 patients that we started using cannabis on with low back pain. Which is another pain entity, quite common. So we have many more patients and this is like a 10 year follow up study. And I can tell you that most people do not creep much higher than 60 grams, which is about two grams per day. You only have a small percentage that actually need more. And you have about five to 10% that still need opiates and cannabis. Now, we did some studies to try to understand the demographics. While these people because they are a minority, and maybe they are not typical, and you can sort of demographically agnosticate them, like with some demographic data, you can say at the beginning what the chances are, that like after five years, the guy's going to use 90 or 100 grams per month, which is a large dose, like it's three to four grams a day. So. You can actually, we are trying to develop an index that is going to assist the doctor. Like give you the chances of the guy becoming heavy user. Again, I'm not sure what heavy user means. Is it really derogatory? It sounds bad, you know, oh, you are a heavy drug user. But actually, I am not sure they are performing any worse than other people.

Kirk:  In the five years period of time, you've directed people to use inhaled cannabis, like you said earlier, is contrary to what we do in the healthcare field. Did you do any x-rays or diagnostics of any changes to lungs due to the inhalation of carbon? Do we have any diagnostic of that?

Dr. Dror Robinson No we don't, no we don´t.

Kirk:  I'd be curious. I also asked you about any space in some of the people we've talked to. They have said that using cannabis medicinally, and in a sense you've used people, this is medicinal cannabis that you're providing, that they find that if they take a two-week space every year or whatever they do, they find they have a better, that cannabis has a better effect. Have you done any studies or heard of anything in that way? Taking the cannabis gap.

Dr. Dror Robinson Now we are in a regulatory loophole because you cannot really stop a license in Israel because once you stop it you have to start from the beginning. You cannot repeat the dose that the guy last used. Actually when you are talking you know just off the record and without any written evidence in the electronic files. Most people will tell you that they stop occasionally. For example, when they go abroad to a country that does not allow cannabis, they would stop. And this will improve the tolerance. So people are becoming less tolerant of cannabis and they are probably lowering the dose. But as long as cannabis is regulated as it is in our country, it's a problem. It's a problem to actually. You know, manage the prescription. I do not give the prescription I would like to give. Okay. I would love to have THCV like a victory, rich strains. We have excellent genetics in Israel, but there is no way to market them because actually everybody's looking at the percentage of THC. So nobody will buy a heavy THCV strain so this is like a crazy mountain

Kirk:  What are the laws in Israel then, in the sense, medicinally obviously, is there recreational cannabis in Israel?

Dr. Dror Robinson Officially not, unofficially of course.

Kirk:  Fair enough. Yes, okay. But obviously medicinal cannabis is allowed because there's a lot of studies that come out of Israel.

Dr. Dror Robinson Yes, medicinal cannabis is allowed. There are several indications. The most common indication is pain or chronic pain. The second most common indicator is PTSD, like post-traumatic stress disorder. And unfortunately, there are indications that you are not even allowed to study. For example, schizophrenia. Is cannabis bad for schizophrenic or is it good for schizophrenics? This is tricky because the ones who speak with schizophrenic individuals, many of them are finding solaces and less hallucinations with cannabis. So this is a very tricky point. Of course, there is a cannabis related psychosis. No doubt. You can cause a psychosis with cannabis. But actually many bipolar, many schizoaffective and many schizophrenics are using in an unofficial way, cannabis and are benefiting. So really it's a matter that because of the regulation, the level of research is not as good as we would like it to be.

Kirk:  I was interested in the whole plant medicine. I did, I actually went back to some of the literature that you cite for your study and found it interesting that one of the pieces was plant-derived medicines for neuropathies and comprehensive review and clinical evidence. I guess asking you a political question about cannabis. Why do you think with all the observational long studies we've seen, the anecdotal notes that clients give us, we know as cannabis researchers, we know that cannabis works. And we know that the evidence is that cannabis is helping people. Why do you think Western medicine Ignores it?

Dr. Dror Robinson I think like RFK, you know, the current head of the health ministry in the US is saying it's the pharma industry. Once cannabis could be patented or some cannabis derivative could be patented, I'm quite sure that attitudes will change, but I think there is a difference even opiates are not as good as the whole plant like opium is not as dangerous like the extracted milk of the poppy flower is not dangerous as fentanyl. But it cannot be patented so opium is a criminal offense but fentanyl is a drug that you can prescribe but i'm quite sure especially in your southerly neighbor there are a lot of fentanyl deaths. It's a dangerous thing.

Kirk:  There's a lot of deaths in Canada. It's actually a huge concern in Canada and we've done interviews with people that are using cannabis to decrease those deaths and it's really still tough to get that out to leadership. There's one more question I just noticed on my notes here about you're using inhalation of cannabis. Is it whole flower you using and are people accessing the flower themselves or are you providing them the flower?

Dr. Dror Robinson No, it's illegal to provide them the flower. I write so they go through pharmacy. And the flowers are really wrapped in very nice and colorful packages, but you cannot actually see what you are buying. So this gives it like a surprise bag appearance. You open it and you never know what you find inside. This is a very not natural way of selling cannabis. Cannabis should have been sold, you know, we are in the Middle East. It's nice to go to the bazaar and buy cannabis. And then you can see what you are buying, because the smell makes a difference. The shape of the flower, the color of the flower. They all interact and they all cause part of the effect. The is not only by THC it's and many components acting together.

Kirk:  So they're taking their medicine, their flower, from a pharmacy. I was just very recently in Spain, and Spain is selling cannabis at storefronts, but they're selling hemp products that have been dusted with THC-O and THCPs, which are derived cannabinoids from hemp. So I guess in a roundabout way, are you ensuring people are getting marijuana products or are they getting hemp products for your study when they go to the pharmacy and they get the pretty colors? Because in Spain, it's all nicely pretty colors and there's a bud, but inside it's not marijuana per se, it's a derived hemp product. So when your clients are getting their medicine, is it a marijuana product?

Dr. Dror Robinson Yes, everything is in Israel. Everything is not hemp. Hemp actually cannot be grown in Israel, so it's only THC which is derived from marijuana plant. And in Israel we really believe in what's called the entourage effect, so we try to be as close to the natural flower as you can.

Kirk:  But the flower that their clients are getting, has it been analyzed to say 10% THC? Is it so they know they're getting? No, okay.

Dr. Dror Robinson Like everything is analyzed but only unfortunately only three cannabinoids are analyzed it's THC CBD and CBN.

Kirk:  Okay.

Dr. Dror Robinson CBN is the tricky one because it's a little bit like aging of wine most CBN makes the effect of THC mellower so a lot of the people are actually aging their Cannabis. You age it for a few months and you get a better result.

Kirk:  Yeah, we refer to it as curing, curing. Do people grow their own cannabis? Are any of your sample using their own medicine?

Dr. Dror Robinson No, it's not allowed in Israel. Everything has to pass through a farm and on the one hand, it is a little bit like medication, so there is a lot of regulation and a lot of checking and a lots of diagnostics being made. So you know there are no fertilizers and there are not anything dangerous being sprayed on the plants. Everything is tested. On the other hand, we don't have the ability to grow our own, which I would love to have, but we don't

Kirk:  Very cool. Trevor.

Trevor: I don't know. Thank you for hitting on the... I thought it was interesting where I read the study that unlike a quote-unquote regular study, you didn't have really good control over what was in the cannabis. We can't say you know every... I think you had like 20% THC, less than 1% CBD, and but other than that you didn't t know the strain, you don't know how much THCV like victor was in there and yet you still got these good and results over five years. It was it was interesting that you know there wasn't we like you said closer to real world we didn't have as close uh monitoring of what the it was in the cannabis but we still got the good results over five years. I thought that was fascinating.

Dr. Dror Robinson Yes, I think a lot of it is the many strains of cannabis are working. And actually, there is a very strong social networking of patients. And if you are growing or importing something which is not good, people will know about it very fast. So the social network, so the good or the effective strains are being sold very fast. Once you see something is not being sold to very fast, you have to doubt if it's good. And actually there was at least one company that had a very bad crop, which was not effective. I'm not sure why, but it was not. And simply nobody would buy their products. And they stopped selling them. They're actually out of business now. So it's not all about the THC. It's a little bit about how you grow the plant, which is tricky. It is a tricky plant and you have to know how to grow it.

Kirk:  Is there any other message about your study you would like our listeners to understand?

Dr. Dror Robinson Well, first of all, I think it's important that diabetic people will know that this is an option. This is a therapeutic option. I'm not sure how many doctors in Canada and the US actually offer it. And I think, it should be offered. I think you should look at the retention rate. We have a 96% retention rate and it is unusual for people to come back. Actually, I work like in a private clinic, people actually pay for. Seeing me. So 96% retention is a lot. So people will not be retained unless it works for them.

Kirk:  So tell me what what came to your mind?

Trevor: Well, first, because, and it was, I enjoyed the conversation, don't get me wrong, but just, cause it was a conversation, not let, let's just, I'm going to do a quick recap of the study, jump in if I missed something. So he had 52 patients. And like you said, the amazing part about that is followed over five years. A five year study is a long time. Good, that's a good thing. So they had diabetic neuropathy. They had diabetes, they all had, he went through all the core morbidities. They all had heart conditions or peripheral vascular disease or people with diabetes. Diabetes leads to other stuff and they all had some of that. Their average age about 45, mostly male. Okay, so but they had pain, they They had, I don't want to say post neurologic, but they had diabetes. Nerve pain, diabetes nerve pain, neuropathies, and what they had over the five years is their pain control got better. Like you said, on the 10 point scale, it went from nine down to like two-ish, so pain control better.

Kirk:  That's amazing, really, that's amazing.

Trevor: That is amazing because as we sort of glossed over the current stuff that you get from my pharmacy, the the anti-convulsant like gabapentin or the anti uh like duloxetine which is an antidepressant or opioids, they work but only in half-ish of people with neuropathies. Neuropathies are hard treat. And so the fact that pain got better... And also we think about over five years you would expect sort of in general if you did nothing the pain get worse. That's just what we would expect. So that's good. The one that kind of blew my mind. So I'm glad you spent a little bit of time with them is their A1C got better.

Kirk:  Yes.

Trevor: So, so for what for the you for the non non medical people A1C like to think about it being sort of a three-month average of your blood pressure. It isn't it's measuring literally how much sugar is stuck on to red blood cells but it's think about it being like a three month average of of your sugar of your glucose and I got better which is again that's literally what we give people diabetes medication for is to make their blood so the fact that cannabis made A1C, this three- month average of blood sugar get better is stunning. And the last and maybe not unexpected from the other things we saw is they use less opioids. They use less of the other medications too but one of the ones we worry the most about is opioids because too much of it people die, it has a high addiction potential and and and. So better pain control, lower A1C and less opioids so that those are the three big outcomes. Now we have to talk about some of the problems we'll call it problems in quotes. It was a very small study, 52 people, not that much. Only one center. So again, in a perfect world, you have this done in multiple clinics over ideally multiple countries, but at least multiple parts of Israel. And it didn't have a control arm. Like there was no placebo arm. So that's, I'll talk about why some of those matter or not matter, but that's kind of a summary of the study. So people just sort of get back in their heads what we were talking about. Kirk, what were you thinking and then I'll talk more.

Kirk:  Well, I am, I'll use the word limitations opposed to problems. When you're looking at this study, it's the limitations of the study, but however... What I liked about the study, and I dug deep into this, like I said, I started reading some of the papers that referred to as part of the study's reason for existing. What I found fascinating was, and he said it, is this was real world. This is putting a situation together where you grab a sample of people and you obviously create a sample so that you have a measurable group of people to follow. And so then you give them this prescription to say we want you to consume X amount of cannabis your way And we know one of the biggest issues that the Western medicine has is that the client the patient is controlling the medication. This is not the doctor or the pharmacist saying take X medicine three times a day at this quantities and then we'll well titrate it or whatever we'll do. This is the patient, real world, taking control of the medicine and in the process of 97% following this criteria, over a five-year period, here's the result.

Trevor: I was just jumping quick on that just because yeah, if you read studies, there's always x number of people dropped out for whatever.

Kirk:  Oh, yeah. Yeah, yeah,.

Trevor: So so they started with 52 people. They ended with 50. Because two died, like, you know, yes. Yeah. You start with diabetics average age 45 fold them over five years. Sorry, having to die is not unexpected. So I, I would say we really this was a study that had damn near 100% follow through over five years to people didn't make it to the end of the five years.

Kirk:  So that's my observation. When I read the study and then now talking to him, I see a real world presentation of cannabis assisting people with a chronic disease that is costing them and society billions of dollars. So my god once again cannabis decreases the use of other pharmaceuticals and gives somebody better homeostasis which is what the endocannabinoid system is all about. So I see a real-world study and the problems the limitations I believe actually make this study stronger yeah we could have a more diverse group sure we could but really when it comes right down to it, I guess the only limitation I have is I'd like to know if there's any checks x-rays to see if the inhaled flower is causing systemic problems with lungs. I guess that would be my concern. But other than that, I think it's a brilliant study.

Trevor: No, it really was and I'm glad you hit on the inhaled, you know, most of the time when we talk about medical cannabis, it's an oral because it just is, well, a bunch of reasons. It was interesting. This was predominantly inhaled or sorry, all inhaled because main reason he claimed is that predominantly in Israel people inhale their cannabis. That's just the way it is, which is fine. I think that would be harder. North America you know there's just it is harder to inhale stuff you know be it cigarettes or vapes or cannabis like for example if I had diabetic neuralgia I'm a pharmacist it's minus 30 outside I'd have to go to the other side of the parking lot to inhale my medicine in the the day. I don't want to do that so it just I'm not saying but practically in North America, their inhaling stuff is not popular. So it'd be... And it was also interesting along those lines, so I'm all over the place, but interesting that it was inhaled. I don't know how well that moved to North America. But I did think it was interesting that he thinks pain control with inhaled, at least from his experience, was good and or better than oral. Well, true, not true. I think even he would agree we have to look into that more, but it was just interesting that was what came out of his study.

Kirk:  Well, I guess the way I look at it clinically, and that's the question I forgot to ask him, but I think he answered the question, how would you apply it clinically? I think you have to remember that from the perspective of administration, inhaled cannabis is for breakout pain, right? If I was using cannabis strictly for pain, which I have, actually, I have ingested a cookie that gives me, you know, eight hours of less pain. And if I find that I go and do something, I move my shoulders in a certain way, I'll go and have a hoot and I get breakout pain. So I guess in some ways, in the use, clinically using cannabis. Inhaled cannabis from for me would be breakout pain because it's immediate.

Trevor: Right. But that's not what he said. He said, because he said it would come and work right away, which is your breakout pain, which everybody understands gets in fast through the lungs, lasts about two hours. And his opinion, you know, learned due to the study was the inhaled was at pain control than oral. So that's good, that's interesting. You know, you go, okay, everyone do inhaled all the time. I'm just, that would be, I'm thinking ahead, that would, I think that would be difficult in North America.

Kirk:  Well, it'd be interesting if he was able to get x-rays of a few of those people to see if there's any effects. I mean, after consuming cannabis for five years, you would assume there'd be some effect on the small bronchi. I know there would be if you're consuming tobacco products and inhaled them deep, because, I mean they do talk about the inhaled cannabis goes deeper than the inhalable tobacco, but I don't know, I've seen some people smoke tobacco pretty deeply. Anyways, I really enjoyed this conversation. I'm so glad that he decided to join us, and again, another gentleman to keep on my storyboard.

Trevor: Absolutely. No, this was a great one. Thank you for finding Dr. Robinson and Dr. Robinson, thank you for agreeing to talk to us. I guess again, I've been Trevor Shewfelt, the pharmacist. You are.

Kirk:  I'm Kirk Nyquist, I'm the registered nurse and we are Reefer Medness, the Podcast. And in the last several episodes we have been in an international podcast getting some cool stories from around the world. reefermed.ca. We have a blog page we have everything transcribed we have all the research. This paper will be attached to this episode's page you find us on Spotify you find us in iTunes you find this all over the the web and if you like us please give us give us a five star rating. Push us on the friends.

Trevor: Yep, it's been another good one. Kirk, thank you very much.

Kirk:  Let your diabetic friends know that this episode is compelling to them and if you have any questions or stories just send them to us.