Episode Transcript

Rene: Well, hello there. Welcome back to Reefer Medness, the podcast. Today we're going to continue listening to a conversation that Trevor had with Dr. Vlad Gavril from Germany. And why don't we just have a listen to Vlad's introduction of himself before we continue.

Dr. Vlad Gueril: Like I'm a GP from Germany. And I'm listening to your podcast like every week whenever there's a new episode since almost half a year now. So like I said, I'm GP, but like I'm focused on the treatment with cannabinoids. I'm interested in it since almost six years now. But like I got my license three years back now and since then I'm prescribing also because before, of course, I was just consulting and I was not allowed to prescribe myself.

Rene:  And now here's Trevor as he continues his conversation with Dr. Vlad.

Trevor:  How about, I don't know if one comes to mind, but a really unusual case where, you know, I didn't know that cannabis would help for this and anyone come to mind as sort of an unusual, I can't believe cannabis helped this person, kind of patient that's come up lately.

Dr. Vlad Gueril: I just had a case on Friday, last Friday, I do a lot of telemedicine also, and I had a video call with a patient from Munich and in the south of Germany, also there, cannabis like it's really like, you know, in Germany in the South, it's where beer is from. So in there,

Trevor:  Bavaria.

Dr. Vlad Gueril: They're in Bavaria. Yeah, exactly. So he was like a 59-year old, like a guy who was doing a lot of trading and because he was doing trading also, like in America and Australia and so on, also he developed insomnia and like he started the conversation with telling me, I'm just here because of friend of mine. And I said, okay, well, but how can I help you? Like, and then he told me about like insomnia, which was like ongoing for years. Sometimes worse, sometimes got better in fun. He tried Benzo and fun, like he was like addicted to them. And he told me he will never take those again. So I told him, well, you are at the right person here, because I believe that with cannabis, we can do better than with Benso and fun. He told me like he doesn't want to smoke. He never smoked like cigarettes and so on. So I told him, okay, then we have the option of oil and way better because also a lot of patients who come to me with insomnia, they use cannabis before many of them. And they know with cannabis, of course, you can like reduce the time that it takes you to fall asleep. But because we are the inhalation route, the duration of the effect lasts for like, let's say two to three hours. And when you've got a bit of tolerance and even less. So I tell my patients, of course, with cannabis, you can reduce the time for you to fall asleep. But then after two hours, three hours, you will be awake again. And then it will be hard again for you to fall back and sleep. So that's why I do a combi therapy, basically. I tell them, take something to inhale for you fall into sleep faster. But then for sleeping through the night, you will use an oil because the oil takes much longer for the effect to put on test, but then it lasts like four to eight hours. Like that's what the literature we have here. And like I told him too, and like he was really reluctant. Yesterday I got an email from him and he was like, thank you, you're my king. They're like, I love you and so on. I can finally see it again. I'm so thankful. Thank you. Thank, thank you. And in the beginning, he was totally reluctant. He just like made an appointment because a friend of his who also was like suffering from insomnia, he came to me. But insomnia is something that we know, like that we can treat with cannabis. Like in my opinion, everyone who like maybe smoked when he was a student or whatsoever, he knows that cannabis can put you to sleep. If you have the right terpenes also. But like cases where like I was really mind blown are like of course cases where the patients were not able to go to work anymore because of the pain. They were like really like stuck in bed. They barely could walk. With my to like basically they are my bosses. We do also like house visits, you say also in English. We go to them to their apartment, to their house. And we had one patient, he was like, he wasn't able to come to our like office. He was not able to and within we started like he had like pregabalin; he had all the drugs. That you can imagine and then we started him on cannabis and after like it took some time But after two months he was able to walk again properly without any pain So this for me, of course, it's one in like let's say 100 cases, but for me everyone counts So even if it's just the one I'm happy for him because it changed his life. He went back to work. He is not dependent anymore on the money that he is getting from the government. His quality of life is way better. It's amazing how you can change a patient's life.

Trevor:  And that's amazing. But on your pain patients, like your guy on the pregabalin do you find when they start using cannabis for pain, they start losing less of their pregabalin and less of opioids, and does the other medication end up becoming less?

Dr. Vlad Gueril: For sure, not all of them. For sure. But some of them, yes. For example, a friend of one of my brothers, my brother is a roofer. So of course, when you work like as a roofer, like then after some years, you will have the chronic back pain and so on. So he had like I think on three different levels he had herniated disks. And a lot of pain. And he was put on opioids starting with the age of 20 and really heavy doses, even like they exceeded the maximum doses. So in my opinion, the doctors made him addicted to opioids, like he was to Oxycodone. And with time, like after six months, we were able to taper off the opioids completely. So he's without.

Trevor:  Yeah, all the way off.

Dr. Vlad Gueril: Yeah, all the way but with many, and this is also an important thing to say with many patients, you tried with cannabis and there's no benefit at all. It also has inspired a lot. So this is also like in the discussion in general, like, you know, like I listen to a lot of podcasts, I go to conference and I only see black and white. So in my opinion, we have to make ourselves like honest again and transparent and tell patients it's an option, but it doesn't work for everyone.

Trevor:  That's a good message. Yeah.

Dr. Vlad Gueril: Yeah. Why I try with many patients is because if you take the side effects and you compare it to, for example, for chronic pain with opioids and for long-term use of opioids, The side effects with cannabis, if you use it properly, are really really low. Plus, it's super easy to get patients off of cannabis. There is no, how do you call it, with opioids, the withdrawals.

Trevor:  Withdrawals.

Dr. Vlad Gueril: Yeah, like these you have, of course you have them. With a lot of patients that use cannabis recreationally, and they used it like they misused it to be honest. There you can have like if you just cut the cannabis, then like yeah, for the first days or even weeks, it will be really hard for you to sleep properly. You will have maybe also sweat, night sweat and so on. But if I get patients of cannabis, which were like really good with the dose and so on. They are really good. How do you say if a patient gets the right dose and so on, we have the germ.

Trevor:  Yeah, the right dosage. The right dose, the right dose.

Dr. Vlad Gueril: Then it's really easy to take them off of cannabis.

Trevor:  Any withdrawal symptoms. This has been fascinating and I'm really glad we got in contact over LinkedIn and you agreed to, you know, pick a time of day when we were both awake to talk about this. I'll go to my usual last question. Is there anything that you think our listeners should should hear about? Any question I missed? Anything you really want to talk about before we before we let you go?

Dr. Vlad Gueril: Yeah, like I said, like to talk also about the bad side of cannabis. Of the misuse. This is really important to me. But also to ask your doctor, ask your doctor, asked him if he can reach out to a doctor who knows about cannabis already, if he or she doesn't know about it. There are like these associations that we have in Germany by now, which you can reach to. And it's hard to find a doctor, but there are doctors. And you can also do telemedicine, which is like... Okay, in Germany by now, let's see for changes. But also like for doctors, I want to say, just have in mind that cannabis can be an option. And if you don't know about it, check for like colleagues like me or others, there are many others who know a lot about cannabis, because in my opinion, you want to do the best for your patient. And sometimes the for your patient can be cannabis.

Trevor:  Dr. Vlad, it was really good to meet you. And again, thank you very much.

Dr. Vlad Gueril: Thank you for the opportunity. Thank you.

Trevor:  Kirk, I love my chat with Dr. Vlad. One of the things that leapt out for me is he, like all the other docs we talked to, he didn't start because a patient came to him. He sort of got interested in cannabis because a friend who had a wholesale cannabis company started telling him about all the cool stuff that cannabis could do, and then he started looking into it. So a different route in than we usually hear about.

Kirk:  Yeah, you know, that's very true. And how he learned to about cannabis was by getting into the international scene and calling people up and talking to people. Whereas what we've learned in the past from many of our practitioners that go back to the early aughts is that they were learning from patients. Whereas this gentleman, and thank you very much for contacting us, he went off and talked to the medical researchers. Godfathers.

Trevor:  Yeah, he just called up Dr. Professor Mishulam. He mentioned Dustin Sulak, just not really a plug, but we'll do it anyway. I have Dustin Sulaks book here, one of them. I've heard him talk a few times at CannMed events. So yeah, he's just, you know, gone on a Zoom call with some of the big names in cannabis. I'm sure he did other research too, but I just, we learned through and he was too.

Kirk:  Yeah, so but it's kind of cool. This is a Germany, this is a Germany centric story. And Germany is now and this is what we need to see what we're talking about. Germany is one of three European countries that is technically legal for recreational cannabis, but they've done it in a unique way.

Trevor:  Well, and he would disagree, as I did ask him that, that he called it partial legalization in April 2024. So before that, you'd need a controlled drugs prescription to get it, like you would for, you know, fentanyl and hydromorphone and other opioids in Canada. We call it M3P here, but a controlled drug's prescription from the doctor. And 2024, you now just need a regular prescription from any old general practitioner and you can get cannabis with that, but when I asked them there really isn't a walk down to a local rec shop without any pieces of paper and buy cannabis that wasn't really a thing. But you did find that there does seem to be some Social clubs.

Kirk:  Yeah, well, like, like always, you know, a lot of our guests just send me into rabbit holes and according to Wikipedia, cannabis in Germany quote unquote "cannabis in Germany was legalized for recreational use by adults 18 years and older April 1st 24." I've gone to several different sites on the internet. How to buy weed in Germany through cannabis clubs and so I think what Germany has done from what I've read is that it is legal to grow cannabis. You can grow up to three plants and he mentioned that. And you can get cannabis from medicinal prescription and we talked about that. But in the rec market, I guess what they've done is that they haven't made it easy to get cannabis. So you have to join a social club to get your cannabis legally and I guess I mean, we've said this a thousand times. We believe, you know, 99.9% of the people that consume cannabis are doing it for a medicinal reason, but they call it a rec market because it's so, it's not, the police don't bother you. So. The other thing that's unique about Germany is you have to live in the community. You have to live in Germany, I think it's up to six months or a period of time before you can go to the social clubs and get cannabis. So tourists can't do this. Unlike I guess what I did in Spain, no one told me I couldn't do it and nobody said even perceived that I could not do it. But I guess in Germany I wouldn't be able to go to go the cannabis clubs and stories or maybe I could go but I wouldn't be allowed to consume cannabis. So tourists can't consume cannabis you can't go there and have a cannabis holiday Um, but I guess.

Trevor:  But on something completely different, because pharmacist here, I thought it was cool that people are going into a pharmacy to get their cannabis. You can have it delivered, that was cool, but also cool, maybe not surprising. You don't stand in the spot that you get your cholesterol pill and your antibiotic and also get your cannabis. It seems to, because of stigma, seems to be in literally a separate part of the pharmacy. So I'm picturing a divided pharmacy or maybe. One door for regular prescriptions and another door for your cannabis, but it does seem like, he said it seems to be separated, which, still better than what we had here.

Kirk:  Yes, well, yeah, yeah. I mean, cannabis, and how we perceive cannabis and how this plant, how this plan is just so, how people are just so afraid of it. And I shouldn't say people, how governments are just afraid of that, you know? Again, Wikipedia, we've got Czech Republic, Georgia, Germany, and Luxembourg, and Malta are the European countries. Malta's not in Europe, though. So we've four European countries that are now legal for the quote-unquote rec market. But again, there's nuances to it in the sense of going to Germany. Yeah, so is there anything specific? Like obviously they're pharmacies, they get it from pharmacies?

Trevor:  Yeah, a couple things. One, you know, not surprising because, you know, people are people. Like, one of our previous guests, and I've heard him talk now a few times in public talks, Dr. Blake Pearson talks about an unhappy triad of the types of people who come to his practice to get cannabis, and it matched perfectly with Dr. Vlad. So, Dr Vlad was saying, you know chronic pain, insomnia, and anxiety depression, that combo. Maybe, again, not surprised, maybe I was hoping that in Germany they were going to all come in for MS or something, but you know, it's not, but no, it was the chronic pain, can't sleep, and depression, anxiety is the reason they're there. Again, not surprising, German insurance companies don't like paying for vaped cannabis, but they will pay more often for oil. And then one that I just kind of blew my mind a little is you can't, according to Dr. Vlad, you can't really smoke a joint in Germany, like combustible, pot, or tobacco. There's not a lot of smoking, so they write right on their prescriptions to vape, not smoke. Again, he says, I won't call vaping safe, but it's certain safer than smoking because to avoid those tricyclic hydrocarbons. The stuff you get from burning, you should get way less of it from vaping, so.

Kirk:  You're talking vape flowers, right? You're talking about flower vaping.

Trevor:  He was talking about Yep, buying flower and vaping it. Um another one that I like because he he stresses the endogenous endocannabinoid system so instead of the five dollar word. Your body produces cannabinoids and it uses it for you know keeping your body in good balance um he talks about when you when after he's prescribed an exogenous a a flower or a oil that you after it's helping you get more in balance that you've got to use your endogenous your internal cannabinoid system to to do stuff. So you said you know once you sort of feel a little better and want to get off the couch from your depression then you still have to go for that run or walk to have the exercise help out your endocannabinoids system you still have to now eat well to help your endocannabinoids. I like that he was trying to balance exogenous or outside cannabinoids with what your body was producing anyway by, you know, stressing things like exercise and diet, oh and meditation, he threw out meditation.

Kirk:  I think the word he used was engaged. Yeah. I think that's what stood out for me as well is that his practice is to engage the endocannabinoid system, which I find interesting because I have always been, I mean from the get-go when I first discovered cannabis as a teenager, cannabis has always been an active thing for me. I would go bike riding as a kid. I'd go hiking in the Sooke Hills or up Mount Doug in Victoria. I would to the beach. I was always moving. Those people, like I had friends that, you know, we'd go into their, into the basement of their house and their parents were pretty liberal, and we would hotbox a bedroom, and then people would sit around and listen to music, and, yeah, okay, this is good, but, but let's do something now. And that captured me when you said engaging, because for me, I was never a lay around listening to Pink Floyd guy, you know, never was.

Trevor:  Another one and I really and probably not surprising coming from a clinician instead of a researcher He said, you know when he listens to cannabis podcast or goes to conferences It seems to all be black and white, you. Know this works fantastic. This works great He said you got to remember it just doesn't work for some patients and you know to tell them ahead of time You know, we are going to try this for you your chronic pain And here's the reasons why I think it might work and you, know, here's a risk benefit, which is all good. But you know, it might not, we might not have to try something else. So he said, I've definitely had patients, I tried cannabis for, didn't do a thing, we had to try somebody else. So I think that's good. In some ways, it's just like every other medicine, it's gonna work for some people, not for others, and you know it's not magic, and I like that. But he did say the nice thing, sort of on that risk benefit thing, is if it doesn't work, unlike Opioids and benzos really easy to come off of you know There's there's none or minimal withdrawal effects unlike opioids of benzodiazepines Which can have serious withdrawal effects, and you know if it's not working It takes us a little bit of time and effort to get somebody off off of it safely and for them to be comfortable

Kirk:  I'm smiling at you here, Trevor, because you use a phrase that I want to push back on. And that is like cannabis is like any other med. It's not. That's the whole point. It's like any med. And I know from a pharmacist's perspective, you're looking at it. I get it. I get. But this is the whole unique thing that frustrates the Western concept of medicine is that it's not, I mean, it- You know, one flower may not work for you. I think I said to you, a while back a friend of the show gave me some genetics. Uh medical genetics and I was growing it without any feedback on what this stuff was and so I grew some plants and and some of the plants I grew you know I I like my flower I've said that many times I'd go out and have it and you know i'm I'm waiting for i'm waiting for the intoxication I'm waiting for I’m waiting for that THC whatever and i'm going what this this this this is garbage you know but it but it's not because more than likely It's a very high CBD cultivar. So what I've done, you know, as I go out and again, it's so expensive to send your cannabis off and get it to get it, to get an analyze that a lot of growers don't. And I tend to be that guy now. But what I come to understand about these plants as a grower and, and using this and these, I know that that particular cultivar, which I have in a jar in my, in my in my cold room, is I use that for the rubs now, for the creams, and I mix it in with some of the other ones. So I know I'm getting a multi-cultivar mixture, which is what Dr. Goldstrich talked about. And I use it, I use the particular cultivar specifically for my medicinal use of cannabis, whereas I have some other cultivars that, whoa, this is dynamite, and that might my recreational cannabis, you know.

Trevor:  Yeah, but just because it can have, you're saying, you know, if they pick the right cultivar, right strain, and we're not minimizing that, but there's going to be people who it just doesn't work for. There's no, they even try a hundred cultivars and it, you, know, this is not the medicine for them. And, and I think that's important for people to realize cannabis isn't magic. It's not going to work for everybody, for every condition for all the time. And I think it's just good to have out there. And the the last one was that just an Eric story for those of you who haven't heard about my son in a little while. So Eric, currently unemployed, but will be employed again. He works in refrigeration. So one of the companies he worked for recently, they fix hockey rinks. He's been all over Northern Ontario and Manitoba looking at hockey rink and putting in new piping for the refrigerant that. And he came home end of March for my wife's birthday. We were all out for dinner and he saw a van of one of the companies he used to work for and was looking around to see if he recognized the person and he did. The guy's name was Scott apparently. The company was Berg and the guy was Scott. He said oh do you want to say hi? No I don't like Scott. All right why don't you like Scott? Well Scott thinks everything German is the best. Everything German's the best. He wants to retire and go to Germany. Everything in Canada is shit. It's awful. Everything German's the best. So Eric, you know, mentioned that his grandmother was from Germany. And he couldn't, apparently Scott would then quiz them about what town his grandmother grew up in and Eric couldn't remember. So after that, not only was Eric, you know a useless Canadian kid, he was a fake German because he didn't know what town it was. So Scott, Eric's grandmother's from Seckendorf. That's in Bavaria, which Dr. Vlad was talking about, the beer part of Germany. Years ago when we visited Doris's family in Hamburg, they kept apologizing to me for the beer, which was fantastic, but it's so much better in Bavaria. So yeah, it's just interesting that one of Dr. Vlad's patients was in Bavaria, talking about beer and sort of related to Eric, the fake German. Whose grandmother really is German and really did grow up in Seckendorf, Scott. Anyway, just thought I'd throw that out there Scott from Berg happens to be listening to this episode. Ha ha!

Kirk:  So this was good.

Trevor:  I really liked that one. Any, any other things you want to talk about? Dr. Vlad and his practice and...

Kirk:  No, what I got out of this is we had a general practitioner, what they call medic, Dr. Medic in Germany contacted us and thank you very much for doing that. And I guess we're open to others. I mean, we know that people are listening to us from around the world. We see that in our stats. And we know our audience is dedicated because we have a very steady number of downloads every month. So there's a lot of you out there that are listening and we thank you. Call us. Tell us a story. I mean, we seem to be getting a little bit of an international buzz going here. We've got stories from Australia. Stories from Germany, stories from Morocco, stories from Spain, Britain, and so thank you very much. We're Reefer Medness The podcast you find us at Reefermed.ca. I ask everybody to go to our webpage because it's a searchable webpage. You can you can learn from our webpage and what if you are somebody that's just discovered us? The web page allows you to search by topic and interests opposed to just starting at episode 1 or episode 170, you know. You can go back and really dial down to what your interest is.

Trevor:  No, it's been another good one. Dr. Vlad, again, thanks for reaching out to us. We'll talk to everyone next time. Yeah.

Kirk: Peace and love. See you next time.