"Here I was, a medical student, training to be a doctor, and thinking 'You are offering me POT? You want to make me a drug addict?'"
With over 16 years of experience practicing in New York and California, Dr. Junella Chin gives us practical advice on treating arthritis, migraines, and anxiety with cannabis. We also find out how this Bronx-native—for whom cannabis was stigmatized—found her way here.
In an industry begging for proper clinical research, finding an integrative-medicine doctor with over a decade of experience, is the Holy Grail. With three thriving practices coast to coast, including a free clinic for low income patients in NYC, Dr. Chin treats children and adults with a wide range of health issues.
The Highly: How did your interest in cannabis develop?
Dr. Chin: At 17 years old, I was diagnosed with ankylosing spondylitis, or AS, which is a progressive type of arthritis that affects the spine, pelvis, hips, and back. It causes extreme pain and stiffness. What ends up happening is your vertebrae essentially become crazy-glued together. Your spine starts to look like a bamboo stick and you literally can't bend it anymore. It usually happens in young adults. I tried physical therapy. I tried opiates, muscle relaxants, icing, nerve block injections, acupuncture. Everything under the sun. I left no stone unturned.
When I moved to San Francisco in the 90’s for medical school, I was really disheartened. The opiates were making me too drowsy, and I couldn’t retain any of my academic material. Here I am, training to be a doctor, with hundreds of doctors at my disposal, and I'm unable to fix this thing. It felt ironic that I couldn't find a solution to my own chronic pain. I was beyond frustrated and would tell the doctors, “I tried it all and I can't...don't hand me another script. Please. It doesn't work.” One day, an attending—a physician mentor—introduced me to the world of cannabis. He was this hippie-looking doctor and he had an integrative private practice where he was using medical cannabis to treat AIDS patients, helping increase appetite and reduce pain. I watched as his patients got better and better.
When I told him about my spine, he said, "Listen, I have this marijuana plant that can help you. It doesn't make you feel high. In fact, it will help you with the stiffness and the aching, and make you feel like you did yoga." I was mortified but desperate. Here I was, a medical student, training to be a doctor, and thinking "You are offering me POT? You want to make me a drug addict?" I grew up in the Bronx, where there was a huge social stigma around marijuana. Kids that smoked weed were either dropouts or involved in gangs. My attending gave me this little brown dropper bottle that smelled like a combination of alcohol, wet dog, and grass. We now know this is called a CBD-dominant formulation. But they didn't call it that back then.
To my amazement, I remember the feeling of, "Oh my God, this works." The stiffness, the numbness, the pain…it was getting better. [Ed.: Numbness of the extremities can be a symptom of AS.] My MRIs and X-rays were showing that the degenerative part of my disease was not progressing as quickly as it had been. I took it for a month at a time and was able to stay in school. So there I was, using this little weird bottle of marijuana, which had gotten me so much further than any of the opiates, muscle relaxers, or nerve block injections that the conventional doctors were giving me.
As I was learning allopathic medicine, I began questioning the conventional medical wisdom and assumptions. There are just so many gaps and holes in the field of medicine. I was determined to find better solutions. This really changed the trajectory of my life. I would not have been able to finish medical school and become a doctor had it not been for the CBD. I had an educational advantage being in California. They legalized medical cannabis in 1996. I was in the middle of a switch box, and was able to engineer my circumstances. It really was the best of both worlds. That's where it all began.
TH: How do you treat your AS now?
DC: Today I keep my AS in check with a CBD tincture taken about three days a week, and on days I know I will be doing something physically strenuous. But it’s not a silver bullet. I watch my diet and try not to binge on gluten, dairy, sugar or anything that will cause inflammation. Hot yoga is my other salvation. The CBD takes away the inflammation and makes my joints feel a little more flexible, and I make sure that I stretch it out and exercise. I can't say I'm a super-yogi, and can’t always finish the class, but that’s okay.
TH: Why does cannabis help with such an array of diseases? What's the common thread?
DC: If you boil it down on a pathophysiological level, inflammation is the final, common pathway for all chronic diseases. When you think of arthritis and chronic pain, you can also include diabetes, obesity, even high cholesterol. Other examples include fibromyalgia, autoimmune diseases, migraines, irritable bowel syndrome, Crohn's disease, and ulcerative colitis—the list goes on. All of these diseases have root causes in chronic inflammatory processes in the body. These diseases occur because inflammation precedes these diseases. Cannabis is both a pain reliever and an anti-inflammatory.
Note: Arthritis is the leading cause of disability in the United States. Because its part of the aging process, it can strike even those who have cultivated perfect habits and lifestyles.
TH:What proportion of arthritis sufferers do you see benefiting from cannabis?
DC: With arthritis, it depends on the co-morbidities. Are they obese? Do they have an artificial hip or artificial knee? When you tell someone who has had a bilateral knee replacement to go exercise, it's hard, because they're in pain. But when the patient needs to exercise to lose weight, this pain relief is vital—they can sleep better, move better, even start gentle activities. When there's that parting of the gray skies, they are able to integrate other types of wellness. Cannabis breaks up that storm. When you integrate cannabis and you get that pain to go into the back of your mind so it's not all-consuming all the time, then maybe you can take a 10-minute walk around the block. Maybe you can cut out some of the sugar and the simple carbs in your diet that are contributing to the inflammation in your joints. There's a dance that you have to do. The solution is not just cannabis, but cannabis could be the catalyst to help you drive that momentum into greater wellness.
TH: So cannabis opens the door for you to be able to do things the pain is preventing you from doing?
DC: The great thing about cannabis is, because it's cumulative, it's always working. I look at it not only as pain reliever. It's a very potent anti-inflammatory. I have one patient who took it for months and said he felt no difference. He said, "I feel nothing. I feel like maybe I'm a little looser, but I don't feel any pain relief." I instructed him to stop the cannabis use for 10 days and see what happens. In the span of that 10-day cannabis fast, he noticed that the stiffness returned. He said, “I can't even get out of bed, and I can't believe how much it helped but I didn't really notice it helping.”
TH: Can arthritis go away?
DC: Arthritis can go away because it's inflammation. But it depends on how severe it is, how old you are, and your joint health. Are you grinding bone on bone? Were you an extreme athlete, or is it minor arthritic pain? My ankylosing spondylitis improved so dramatically—I'm functioning with much less arthritis than I had as a teenager.
TH: What type of CBD do you recommend for arthritis? Is it internal or topical? Do you prefer extractions from cannabis or hemp?
DC: You just try it. You try them both. There are two different types of cannabis plants: hemp, which are low-resin, and drug or medicinal plants, which are high-resin. The problem with hemp is that it's a hyperaccumulator. It is basically a natural vacuum cleaner that sucks up pollutants and heavy metal toxins out of the soil. They plant it around toxic places like old steel mills, defunct factory plants, environmental spills, and accidents so it can suck up the damage that the pollutants did to the soil. Willow bark is another that does that. It's called phytoremediation. When you're buying hemp oil, the hemp CBD, you better hope that they tested it and removed heavy-metal toxins. I would recommend a reputable brand like Charlotte's Web for CBD from hemp if it's in a patients budget.
TH: What is the difference between high and low resin plants?
DC: You need a lot of the hemp plant to have a CBD-rich product. When you get to the high-resin medicinal plant, it is very rich in CBD and THC and other therapeutic cannabinoids and terpenes. That’s why I always recommend CBD-rich products made from only organic, whole-plant cannabis. These products have the best safety profile, and offer superior medicinal benefits. Some patients do great on a CBD hemp, like Charlotte's Web. Those are the ones that are like, "You know what? I went for a run, and I'm really sore.” Or, "I went indoor rock climbing, and I did a little too much." But my chronic-pain patients with neuropathy, fibromyalgia, reflex sympathetic dystrophy, or multiple sclerosis don't do that well with the hemp-derived CBD. If it doesn't, I say, "Don't give up yet. Let’s try a more highly refined CBD and THC-rich cannabis from the medicinal plant.”
TH: Do topicals make people high?
DC: Not if used locally. I do recommend topicals, but with topicals, you have to have a little THC in it. It can't just be CBD. The THC helps with pain.
TH: Do you need THC in ingestibles, especially for arthritis?
DC: Yes. If you do a CBD-dominant strain and there's just a little bit of THC in it, it helps jumpstart things.
TH: Is that the entourage effect in action? [Ed.: The entourage effect holds that different combinations of compounds in varying cannabis strains and formulations can enhance or alter THC’s psychoactive and medicinal properties.]
DC: Yes, exactly. The THC jumpstarts the CBD.
TH: Let's talk migraines. What causes one?
DC: A migraine is an inflammatory process and there’s always a reason for getting one. It could be from hormones, allergies, Lyme disease, or it could just be the weather. It’s very important to get to the bottom of it. I had a 17-year-old come in with chronic migraines. He medicated with a combo of marijuana he got from his friends and his doctor’s prescription. He still couldn't figure out where the migraines were coming from and therefore still had bad days and felt he was chasing his tail. We figured out it was the MSG that was in his food each day, whether from the cafeteria or when eating out with his friends. He cut out the MSG and had less migraine attacks.
TH: What is the best method for migraine sufferers to start medicating with cannabis?
DC: Many migraine sufferers know when it’s coming on—whether through auras or the shift in hormones or weather. There are also different psychosomatic things that can come with it, like anxiety. I like to start these patients with a vape pen. A two- to five-second inhalation, it'll relax them a bit, and they can usually head the migraine off the path so it doesn’t get worse.
TH: Does the vape contain THC, CBD, or both?
DC: Usually there's a little bit of THC in it, but not too much. [Ed.: The THC helps with pain. The CBD helps with inflammation.] I always like patients to have on hand a high CBD dominant and a THC dominant. That way they can play with it. Let's say you have a migraine coming on but have a deadline at work and need to stay focused and cannot be sedated or altered in any way. Then I suggest trying a little higher CBD to counteract the THC's psychoactive effects or the sedating effects.
TH: Do topicals work?
DC: I'm always the first to suggest a topical, like a salve. But with migraines, I find that it doesn't work as well unless there's chronic pain or joint pain involved. My Lyme disease patients, for example, have joint pain all over and musculoskeletal spasms. This acute pain triggers a migraine. In that sense, if they use a salve and apply it on the muscle and joints, it can work to prevent a migraine because we have treated the acute spasms early. With cannabis, there’s no hard and fast rules. The patient has to experiment.
TH: Anxiety seems to be the ailment plaguing our youth. What is anxiety and why is it so noxious?
DC: Let’s think about our nervous system. We have a sympathetic nervous system that balances out what is called a parasympathetic nervous system. The sympathetic nervous system is the primal instinct of our fight-or-flight response. We're running from a bear, we are in trouble, there's fear and danger. This also includes rushing to meet a deadline or fear of public speaking. The parasympathetic system is your relaxation mode—sex, digestion, and sleeping. In our fast-paced society, we don't have enough of that, so we are always in a sympathetic drive. If our body gets stuck in that sympathetic overdrive, we have a chronic level of anxiety all of the time.
Cannabis naturally increases the gamma-aminobutyric acid (GABA) receptors in the brain, and the GABA is the body's way of saying it's time to chill out. It's time to power down. Not everyone can do that on their own. Your body's supposed to self-regulate on its own depending on what circumstances are, right? When you're getting ready to do a presentation for a meeting, you're going to be in high sympathetic adrenal rush, but then when the meeting's over your body should be able to relax and you should be able to sit down at your desk and say, "Cool, I killed it. I knocked it out of the park." But if your sympathetics are always working, you can't relax. Your body can't self-regulate.
When a patient takes marijuana, it allows their body to balance out. Those receptors come flooding in. The GABA’s balance out the nervous system back to a calmer and more stable state to meet the challenges coming at you in life. It tells your body to reset. That's what Xanax does. That's what those benzodiazepines do, but they do it artificially.
TH: In your practice, what percentage of people suffering from anxiety do you think are helped by cannabis?
DC: It's easily 80 percent. I think that's what recreational users use it for. It's really to be happy, for relaxation. And what's wrong with that? When you use it for recreation, you're using it therapeutically. There’s nothing wrong with being a little happy and chilling out.
TH: Are there dangerous side effects for someone with anxiety?
DC: If you take too much THC and you go above your optimum therapeutic threshold, then it could make you paranoid. I see a lot of patients over 65. Some of them have never even tried cannabis. A lot of them will say, "I tried it as a kid, in high school in the ‘60's and ‘70's, and I totally tripped out. I got so anxious, and I felt my heart was going to come out of my chest.” That's THC. You took too much.
TH: What’s the best application for anxiety to start?
DC: Do it on the day or evening where it's your day off, and that way you can experiment. Try at least three different types of strains or chemovars before you give up, see which strain is best, and you can microdose around that. You can always experiment, but I always start them on a little bit of THC.
TH: Would you ever have them start on a sativa? [Ed.: Indica and sativa are both cannabis strains. Essentially, indica calms you down and sativa peps you up.]
DC: Sometimes patients do well with a sativa. It depends on where the anxiety stems from. I have some patients that have ADD, ADHD, and anxiety. It’s like they have this Ferrari as a brain, but have bicycle brake pedals. They just can't slow down. It makes them really anxious and unfocused. Sometimes taking a sativa-type in the morning, right as they are getting up out of bed, works well. By the time they get to work the body gets into the zone, and the cannabis helps them focus. It really depends on the patient.
TH: Would you ever start with an edible for anxiety?
DC: I don't like the edibles to start because it's hard to control and measure out how much you are actually consuming. You don't know how you're metabolizing it. It doesn't take effect until maybe an hour later because it gets processed through your liver and through the digestive enzymes of your stomach. I always recommend a tincture or a vape so you can control how much you take, and it works pretty quickly.
TH: What if something goes wrong and they surpass their optimal THC level and get anxious—or more anxious?
DC: I reassure them that it will go away. You'll be uncomfortable for a couple of hours. Try to eat something, take a nice shower, and just hang out for a little bit. We know that you went overboard, but you're not going to overdose.
TH: And for someone with anxiety, do you suggest any other ways they can help themselves with cannabis?
DC: Try taking cannabis before a yoga class, before meditating, before journaling.