FM Talk 1065 Podcasts
Sweet Home Cannabama 9-16-24 guest Dr. Brent Boyett, addiction and cannabis
(upbeat music) - It's time for Sweet Home, "Cannabema", a show that'll answer all your questions, provide accurate information, and dispel the myths of cannabis, and have your specific questions answered by emailing jennifer@cannabema.com, or text or call 3430106. And now, for all things cannabis in Alabama, here's your host, Jennifer Booser. - Welcome to the show, everybody. I'm your host, Jennifer Booser, owner and founder of "Cannabema" in downtown Mobile. We are located at 558 St. Francis Street, right there in downtown, and we're open seven days a week. So, definitely come and see us. Our phone number is 251-255-5155. Our website is canabema.com, and you can find us on Sweet Home, "Cannabema" pages on Facebook, Instagram, we are now official on X. So, they are cannabis friendly, we hear, so we're kind of scooting over there. Since Facebook doesn't appreciate us very much. (laughing) A little bit of current event news. I know last week I talked about how California and other states were starting to join this executive order club, and the only news that we have since then is out of Missouri. Thanks again to John Grady, to Brooklyn Hill, and the Missouri Trade Association for keeping us informed. Over 50 businesses have been hit, and this is of last week. Over 50 businesses were hit, and even though they were not mock skittles and lifesavers and things, like their governor is accusing us of selling, their products were being embargoed and even destroyed, they were pouring bleach on these people's product. They had removed it from the shelves to be compliant with the order while they go through the legal issues, and they boxed it up, put it in the back room. We had a product one time that got recalled, and it was a newer product, and it got recalled. We pulled it off the shelf. They said, "Stick it in a box with the name on it, and we'll send you a label eventually to get it back, and you'll get your money back." And instead of allowing them that, they were pouring bleach on their products and destroying thousands and thousands of dollars worth of products in all of these businesses all over the state. And the worst offense by the state, the DHSS, I believe is what it's called in Missouri, is on 9/11, they hit a VFW, and they harassed these no children allowed establishment for veterans on 9/11. Possibly people were in there that day or patronized this VFW and supported that were, you know, in war during that time that went to help rescue or went off to the Middle East after that, you know, and they went in and they harassed them and treated them less than, and it was, you know, they even said, if it had happened on the 10th or the 12th, it wouldn't hurt so much. But it was wildly inappropriate and offensive, especially to the veteran communities in Missouri who are part of the hemp industry. And there are a ton of awesome veterans that are in the hemp and cannabis space. So I do know that the Missouri Hemp Trade Association has now filed for a TRO that will be heard in court tomorrow. And like I said, we don't have any other updates from California or Tennessee. Nothing new has happened with Boro Hemp here in Alabama. And so we're gonna move on to tonight's topic. I'm really excited tonight. We have a very special guest. And his name is Dr. Brent Boyette. He is an addiction medicine specialist from Hamilton, Alabama. Dr. Boyette works at the Neuroscience Institute at North Mississippi Medical Center in Tupelo, Mississippi. Dr. Boyette, welcome to the show. - Thank you so much. It's good to be with you. I'd appreciate the opportunity. - Absolutely, I wanna read this disclaimer and then we'll get into your bio. But for the listeners, we've posted this on the live stream as well. The information provided on this radio program is for general information and educational purposes only. While our guest is a qualified physician, the content discussed on this show should not be construed as personalized medical advice, diagnosis or treatment. Always seek the advice of your own physician or another qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you heard on this show. The views and opinions expressed by the guest are their own and do not necessarily reflect the views of the radio station or its affiliates. So we got that out of the way. Everybody knows. We tell people that in the store. If you're on medication or you're coming to speak to some condition specifically, you always, always, always want to talk to your doctor about adding a cannabis product of any kind, whether it's CBD, THC, I'll always talk to your doctor. We have a bright yellow sign at the register. Do not take this as medical advice. Go and talk to your doctor. So we wanna make sure to make that clear Dr. Boyette wanted to make sure that that was clear. So let's talk about your bio, Dr. Boyette. So Dr. Brent Boyette is, let's see, let's all these letters. We were giggling about what some of these letters meant. DMD, D-O, and this one's my favorite. I need you to explain it. D-F-A-S-A-M, it's a distinguished, go ahead. - Yes, there you go. Yeah, distinguished fellow through the American Society of Addiction Medicine. - Nice, oh, right. So Dr. Boyette is a distinguished professional with a unique background in both dentistry and medicine. He first earned his doctorate in dental medicine and practiced dentistry on the weekends while pursuing his doctor of osteopathic medicine. And this dual expertise allowed him to establish a multidisciplinary practice in Hamilton, Alabama, where he seamlessly integrated both fields. In 2018, Dr. Boyette became board certified in addiction medicine, recognizing the growing need for specialized care in this area. He decided to stop practicing dentistry and dedicate his career to addressing behavioral and emotional disorders. His approach focuses on the bio, sorry, bio psychosocial model. That one tripped me up. (laughs) And contingency management, ensuring comprehensive and effective treatments for his patients. Dr. Boyette's commitment to behavioral and emotional disorders and his innovative treatment methods have made him a respected figure in the medical community. His work continues to make a significant impact on the lives of those struggling with these disorders. People like me. Again, welcome to the show, Dr. Boyette. - Thank you so much. I appreciate it. It'll be here. - Well, let's get on into it. How did you become interested in addiction medicine? You were doing dentistry and dental surgery, right? We spoke about that and then osteopathic medicine. What kind of made you decide that addiction needed to be faced? - Well, Jennifer, I'm an Alabama native. I grew up in Northwest Alabama with a small town called Seliget, Alabama. - Oh, wow. - And I went and became and got my dental degree through the University of Alabama Birmingham and was really attracted to the medicine science industry. I enjoyed the end of the theology. I enjoyed just the broader approach. So I finished dental school in 1994 and then went straight into osteopathic medical school. In the four years of osteopathic medical school, finished that in 1998 and did a family medicine residency through the University of Mississippi. And I finished that in 2001. And my plan was to come back to Northwest Alabama, the area where I was raised and to basically serve the people there. And I've been going for about 12 years. And so when I returned after my education, this was not the home that I had left. And this was right around the turn of the century, 2000, 2001. And what I came back to was a community that was devastated by the primarily the misuse of prescription medications, namely opioids and benzodiazepines and other controlled substances. - Right. - And so what I found was that it not only affected the health of our people, but it also affected the psychology, the reality, and ultimately the entire social fabric. - Right, families, jobs, being able to stay out of jail, maintain your debt, all those things, every aspect of life has affected by that. - Absolutely. And I saw it in the community. So when I was practicing in the dental office, I saw it when I was practicing in the family medicine office, I saw it. I did some emergency medicine work, I saw it in the ER. So, I began to try to figure this thing out and begin to study behavior. And it really was fascinated by the science of actually cognitive behavioral approach to pain and pleasure. - Right. - And actually with what it boils into. - Dopamine, yes. (laughs) - Dopamine, yeah, exactly. So I always just explain that this addiction medicine is the field of medicine that helps patients establish and maintain a functional balance in their perception of pain. - Right. - And when we can do that, then the drug use takes care of itself. And so that's one of the keys is that we have to pay attention to the fact of consciousness and what compels a person to engage in a dysfunctional behavior like drug abuse. - Right. And when you said when you returned home, you live up near Walker County, which anybody who knows anything about the opioid crisis in Alabama knows that Walker County is probably the worst county as far as the amount of drugs, the prescription drugs, specifically that come in and out of that area of Alabama. - That's exactly right. Walker County, Marion County, Franklin County, as a matter of fact, Harvard issued a report that looked at opioid prescribing per congressional district in the United States. They found that the number one congressional districts in the entire country, in the entire United States for per capita opioid prescribing, was Alabama Congressional District 4 War, which is Robert Aderholt's District. - Wow, wow, when we come back from the break, we're gonna talk with Dr. Voyette some more about addiction and cannabis. Stay with us. (upbeat music) - Welcome back to "Sweet Home, Alabama." Now with all the information you want about cannabis, here's your host, Jennifer Booser. - Welcome back, everybody. I wanna give a special shout out to my friend Sonia in Tuscaloosa, who's awesome commercial we just heard. That's my favorite commercial I've ever gotten to record. But Facebook deleted her business page just like mine, but they then deleted her personal page and she's been on Facebook for since like '08. And so she's having to recover from that. So yeah, make sure you look up freedom wellness is her new page, freedom wellness on Facebook. I'm sure it's Instagram as well. Anyway, they just don't like us, I told you. So tonight we're talking with Dr. Brent Booyette, who is an addiction medicine specialist from Hamilton, Alabama, and he works at the Neuroscience Institute at North Mississippi Medical Center in Tupelo. Doc, how did you become so interested in chronic pain once you saw that everybody around, all the community around you was being destroyed by these opiate prescriptions and benzo prescriptions. What made you decide to focus on chronic pain? - Well, chronic pain drives a lot of addiction. In fact, I always just say that at the root of addiction, there's always pain. And so whether that be physical, emotional, but usually a combination of both. - Right. - So physical and emotional pain affect each other bi-directionally. - Absolutely, absolutely. - And so in order to just focus on the behavior and not to focus on the underlying compelling conscious problem that drives the behavior is kind of shortsighted. - Right. - And that's kind of, the whole point is to change the consciousness and that can change the behavior. And so, you know, going to the root of that pain, whether that be emotional pain, physical pain or a combination of both, is essential for recovery and maintenance of recovery. - Right, I posted something the other day that said trauma is actually the gateway drug. Because for me, I had a physical pain issue, injury, but I also had lost my son and wasn't handling it well. And those two things created a perfect storm because when you are emotionally distressed and traumatized, it exacerbates your ability to feel the pain and it definitely tamps down your body's natural ability to combat that and give you what you need to cope with it. And when you, for me, my first experience with that was I had a bulging disc in my neck and I was deeply grieving six months after my son died. And when I took the pain pill, the noise in my head stopped and the deep ache in my chest stopped and the world got quiet and I could interact with my husband like a wife should and I could interact with my son like a mom should and wow, this was great. And I would do that occasionally when it got too much and then it got to be every day. And then it was, and it's this roller coaster, but it definitely was rooted in emotional pain that exacerbated over a long term my chronic pain because I was a chronic pain patient since the age of 15. But definitely that was the perfect storm, the emotional turmoil and the crushing of my spirit over that while I was also enduring the physical, you know, explosion of my insides and surgeries and all those things and learning to live again. I mean, one begets the other and vice versa. - I just got a little eye. As a matter of fact, adverts childhood events and there's actually a score to grade adverts childhood events which can include abuse and neglect and other types of things. But that is just as good, if not a better predictor of back pain as pathology on the MRI between degenerative distancing which is not necessarily that good of a predictor effecting. - I have that, wow. Oh, wow. Okay, so let's keep going. How did you become interested in cannabis as medicine? - So I will tell you this. I came into cannabis kind of accidentally. I have, you know, built my career and then focused my career in addiction and the pains that lead to these self-destructive behaviors. But I had the opportunity to go and take over a program that was previously managed by anesthesiology and it was the medical pain management program at North Mississippi Medical Center. And I knew that legal cannabis was coming to Mississippi. And so I felt, you know, I felt compelled to become educated in the cannabis as much as I could and to introduce cannabis as a treatment option in the North Mississippi Health Center as scientifically and as responsibly and ethically as possible. And that's what we saw to do. And so I've been studying cannabis for the last three to four years and I have been actually working with medical cannabis for the last two years in my clinical practice. And I will tell you this, I was a skeptic of cannabis. - I was too, I was too, I turned it down, I was too. - Yeah, I was, I was, I have seen cannabis use disorder and particularly in adolescents and young individuals. But there is a concern in cannabis and cannabis misuse. - Right, however, there are arguably more concern with the medications that we have become, in my opinion, far too comfortable prescribing, which are benzodiazepines and opioids and these kinds of things. - Absolutely, well, my son at 16 was prescribed opioids because he broke his ankle and his leg and tore all the ligaments, had to have surgery. And I was terrified because here I was, what, two years clean. From that bondage and I know my dad died of an accidental overdose of pills. And I'm like, I can't allow this to happen to my son. And it was terrifying that they were so casually, I mean, he had a major surgery, but I remember being 15 and having migraines and they would give me lore tabs and I didn't, I got in trouble at school one day for scratching my nose too much 'cause I was high as a kite. I was 15, you know? And I know that oxycodone was approved for use as young as 11. So it's crazy. - The truth of the matter is, the truth of the matter is with regards to pain management, particularly chronic pain management, we just did not have that many tools in the toolkit. - Right. - I mean, it's opioids and other types of things. - Right, sedating people and then becoming vegetables and addicts, that's all there is. - That's exactly right. And so we needed more to this. And cannabis just turned out to be a very effective tool, not for everyone, but it certainly has become a valuable tool in my toolkit in managing chronic pain. - Right, right. Well, so what do you think the benefits of cannabis are compared to those other treatments? I mean, I know from my experience as a patient, what I think and then as an educator and doing this and being part of the industry, what I've learned, but I would love for the listener to hear, what do you think the benefits are compared to opioids? - Yeah, I think that there are several, a couple of things in the clear and obvious ones are the lack of respiratory depression associated with cannabis. - Yes. - You know, there's good evidence to suggest that humans have kind of coevolved with the cannabis plant to the point that human beings have a relatively low CD1 receptor density in the brainstem, which is responsible for respiratory drive. - Right. - So unlike opioids, - Which is why an opioid would make you stop breathing, is that brainstem location, when you get too much, it depresses your breathing till you stop breathing. - That's correct. - That's how my father died, yeah. - The brainstem of the Rossovita Bedoule and the parents are great, which are parts of the brainstem are chopped full of opioid receptors. And the more, the higher plasma concentration of an opioid, particularly a full agonist opioid, the greater the respiratory drive is depressed and subsequently death occurs. And so that's one thing, but here's another thing. In an addiction medicine specialist, I kind of live in the world of receptor dynamics. And so you've gotta keep in mind that these neurons that we have in our brain all have receptors, G-protein receptors on them, and we use these receptors to basically hijack these, with opium, we're hijacking beta-endorphin receptors. With cannabis, we're hijacking an antibiotic to AG receptors. There's CB1 and CB2 receptors. - Right. - But I'll tell you if yes, and this is anybody that understands molecular biology will agree with this, that when you stimulate a G-protein receptor, if you can use a partial agonist ligand, which is much gentler on the receptor compared to a full agonist ligand, you will destroy much fewer receptors. And as a result, you wind up not having receptor damaged in downregulation and subsequently. Interestingly enough, delta-9 THC is a partial agonist ligand at the CB1 receptor. And so therefore it's- - I can't hear. Sorry, Doc, I can't hear you. - I think we're losing the signal. - It sounds like it. - We're not getting him on the air. - Doc, are you there? - Get him on the air. - Okay, we can't hear you on the radio. I'm not sure, I'm not sure. - It sounds like it's phone signal. - It sounds like your phone signal is breaking up on your phone. That's okay, our audience is- - We're really good to- - We're about to go to commercial break anyway. - Okay, you're gonna be better? - Oh, yeah, you're gonna be better. - Yes, okay, we got you back. It's got a little bit of an echo, but we're about to go to commercial break in a minute and we'll just fix that right up. - Okay. - All right. - I'm good from here. - How much time do we have before the break? - About 45 seconds. - Okay, well I do know, I will say, if you can hear me clearly, that I'm interested in definitely agree with you on the lack of respiratory depression being a huge plus for the plant because we know that benzos and opioids and even muscle relaxers like somas, I know that that's what they used to give me. Those will slow your respiratory activity until you basically stop breathing. That's how my father died probably 14 years ago now is an accidental overdose. He went to sleep and he never woke up. And I kept using for five years after that and I am not proud nor am I saying that lightly, but that's the grip that these things have and what he's saying about the mass of opioid receptors in those parts of the brain. Those, I think, they say two years before the brain goes back to normal activity. When we come back from the break, we're gonna talk more with Dr. Boyette. Stay with us. (upbeat music) - Welcome back to Sweet Home, Alabama. Now with all the information you want about cannabis, here's your host, Jennifer Booser. - Welcome back to the show, everybody. Tonight we're talking with Dr. Brent Boyette, who is an addiction medicine specialist. He is also an active medical cannabis doctor in Mississippi, so if you're listening in the Mississippi Gulf Coast area, look him up, look him up. Might be somebody worth visiting. I know that there are a lot of doctors in Mississippi and kudos to Mississippi because we here in Alabama like to think we're better than them, but they've, I mean, they've had their hiccups. Don't get me wrong, that whole one typo throw out the bill thing, that was low. And I know they've had their hiccups, but their program is really helping people and Alabama, we're just so in each other. So for those of you in Alabama who are anxious to talk to someone or hear from someone who does this currently right next door in Mississippi and some of y'all up near Tupelo might not mind the drive just to get some advice, but know where these experts are. We wanna get you this information. Dr. Boyette, let's go back to the benefits of cannabis compared to other therapies. We talked about the lack of respiratory depression and then the receptor dynamics before your earbud went out. So let's continue to talk about that. - Sure, the receptor dynamics piece is really important too because that is the core of addiction. And that basically means that anytime that we overstimulate a receptor group in the case of opioids, we're overstimulating new receptors and dopamine receptors which are very dynamic receptors. We damage these things, build up a beta arrestin that build up on the receptor and block signal transmission causes a deafness of the function of that receptor group. So not only do we get a decent sensation to exogenous opioids like oxycodone or hydrocodone but we become resistant to our body's own endorphins which are naturally natural pain relieving mechanisms. Cannabis on the other hand is significantly less damaging to their receptors because Delta 9 THC is a partial agonist ligand. And that just basically means that it does stimulate the receptor but it does it in a much gentler fashion than any full agonist ligand. Full agonist ligand in the CD1 receptor class would be something like spice. And that is harmful and causes damage. - Of course, but that's not natural, naturally grown cannabis. That is some kind of biomaterial sprayed with chemicals, am I right? - That is correct, yeah, that's correct. You know, cannabis, which is a phytocannabinoid is a gentler approach. Now, let me say this that higher doses of cannabis and you can overcome the sealing effect of the partial agonist activity by crazy doses. So, you know, in moderation is best. Having said that, it is certainly safer in a lot of ways than the medicines that we have been using, like benzodiazepines and opioids. - Right, which shouldn't even be used together, right? - Right. - I remember when my father died, my pain management doctor across the Bay gave me a low dose of Xanax or something 'cause I was very upset. And when I went to fill both prescriptions, the pharmacist wouldn't fill it without speaking to my doctor because he's like, yeah, you can die if you take these together. I'm like, oh, well, I was just a little sad, you know? It's crazy, of course he went to prison, so. (laughing) - It's a combination of respiratory depressants, but they're even much more than that because benzodiazepines cause a dopamine release through the GABA system, whereas opioids cause a dopamine release in the opioid system, but they both overstimulate those dopamine receptors, causing a dopamine receptor down regulation, and in a very real sense, addiction is dopamine resistance in the same way that type 2 diabetes is insulin resistance. - Right. - It just takes more and more dopamine and more and more beta and dorphin to achieve the same effect. - Right, which is why I went from taking a 7.5 milligram lore tab to 60 milligrams of oxygen one time because my body got so accustomed to it, I needed more and more and more, and that's why I started running out of pills and going through withdrawal every month, and it was a horrible cycle, but even though at the end of the two-week cycle of withdrawal, I would still go and get those dad gum pills because I just, I still felt so bad. And I needed that, and as many times as I said, I'm not going back, I went back every time until the last time. And then I knew I had to tell the doctor, do not give me this, I am abusing it. So he would legally know not to give it to me. I knew I had to cut myself off. That was the only way I was gonna succeed. I was not gonna wean myself, I was not gonna do it. I hadn't played by the rules so far, wasn't gonna start, you know? But, and it was absolute hell on earth. You take that out of the brain after 10 years, and your brain's like, okay, well, we don't play this. And it just like your whole body hates you for a long, long time. That's true, Jennifer, the condition you're describing is well known, and it's called opioid-induced hyperalgesia, O-I-H, and it's a well-known phenomenon. And what this really means is with chronic and long-term use, opioids can actually amplify and perpetuate the very symptoms they intend to treat. - A thousand percent true. - Absolutely, and so because of this reason, there's currently a $55 billion class action settlement being paid out by the pharmaceutical industry for the brain damage caused by prescription opioids. - Wow. - And, and so, I mean, that's being paid out the state of Alabama is getting hundreds of millions of dollars. - Well, maybe I ought to look into that 'cause three of my doctors in Alabama went to prison, both sides of the bay too. Whoa, Mobile and Boa County. - It is true, and that's the situation. Over time, a person gets caught up in a cause and effect, the way that essentially says, do I take opioids because I'm in excruciating pain, or am I in excruciating pain because I take opioids? Yep, one begets the other, and I told you this earlier that for me, I, you know, I white knuckled it. And then God delivered me from that craving at about three week mark, but my body still had to get back to normal. I had to learn how to pick myself up off the floor and literally survive 30 minutes at Walmart. And, you know, but two months, three months maybe, I had less pain after three months without the opioid, as I did taking 60 milligrams, you know, every three hours. So that told me this was, 'cause I had read that, but I didn't believe it, but sure enough, I was like, man, I gotta admit, this is true, I have less pain now than I did when I was eating that like candy, and I told myself I needed it. So there's definitely light at the end of the tunnel. I mean, I'm 10 years clean next month, and, but cannabis has been a big part of that. And that's why we wanted to have you on. What about, besides the receptor dynamics, was there any other points you wanted to make about the benefits compared to other therapies? Well, I do think that there are other benefits that cannabis offers besides just analgesia or dopaminergic- Well, yeah, you could replace your anxiety. I did, I replaced anxiety medicine, antidepressants and sleep medicine, which that's what we hear the most, is anxiety pain, sleep, anxiety pain, sleep, or a combination of those things. You know, I think what makes physicians so uncomfortable with the concept of cannabis is a couple of things. First of all, we were taught almost nothing about this in medical school. The endocannabinoid system, the receptors were only discovered in the 1990s, and they're activating ligands that were discovered in the late 1990s. And most of that research was done in Israel and not in the United States, because cannabis has been locked behind a vault of prohibition for the last decade. Right, yes, we've, we know all about Dr. Rafael Machulum and his research. Absolutely. So, so, you know, incredible science has been difficult to get in the United States. Right. And secondly, cannabis, most medications that physicians are comfortable with and familiar with are monomolecular. It's one molecule that's doing one particular thing, sometimes a combination of two molecules. Right. It's usually a pretty simple pharmacology. In cannabis, it's multi-molecular. The onterrhage effect. Terrhage effect is exactly right. Yes. In talking about dozens, if not hundreds of medicines of different drugs that have different molecules, that can have clinical effects. Right. Even some molecules in the cannabis plant can enhance or inhibit other molecules. So, it's very complicated. The analogy that I use to describe this to patients is I say that most medicines are monomolecular in that they are like a violinist standing on a stage playing a violin, whereas cannabis is like an entire orchestra playing together. Yes. And so, in order to understand how to manage medical cannabis, you have to understand each individual musician playing in the orchestra. And each, any, any instrument. There's so over 400 compounds in the plant. And you're right. We talk about terpenes and flavonoids. And those are, I think I've read around 100 different terpenes in different proportions. Flavonoids, 148, I believe cannabinoids that we know of. And that's a ton of different ratios. And that's what makes up the different strains. Is the percentages of the different terpene profiles and stuff. And I love the plant because it's as unique as we are. There's no two of us the same. And that's what I think makes cannabis such a great medicine. When managing cannabis, I believe it's really important to pay attention to the content analysis of each product that you purchase. Because as you've mentioned, even though you can have genetically identical plants through a cloning process and other types of technologies, even the growing conditions. Right. One corner, yeah, one corner gets more sun or more rain or something can happen and each plant can be different. That's right. Just like humans where we are products of both nature and nurture, cannabis plants are products of both nature and nurture. And so the content analysis can be very much affected by all of these factors. Right. And so for instance, not all cannabis is the same. And so if you are trying to treat, let's just say seizure disorder, you might want to use a cumivar that is higher in CB-DV, which is shown to have anti-elastic properties and raises seizure threshold. If you were trying to treat nausea, you might want to have a cumivar that is higher in THCA, tetra-benavinalic acid, which has 30 times the anti-ametic effects of just delta-98. Really, I did not know that. That's amazing. I knew it was good for nausea, but not that good. That's amazing. Yeah, it's much better. So CBG can have antimicrobial effects and anti-inflammatory effects, beta mercy, the common terping that is found in cannabis can have muscle relaxation effects can be quite beneficial in muscle spasms. However, it may also cause couch loss, which is an unwanted side effect in some cases. Hey, hold that thought. Hold that thought. We got to go to a break. We'll be right back with Dr. Boya. Stay with us. (upbeat music) - Welcome back to Sweet Home, Canada. Now with all the information you want about cannabis, here's your host, Jennifer Buser. - Welcome back everybody. We're here every Monday night at seven o'clock right here on FM Talk 1065 and live streaming from the Sweet Home, Alabama pages on Facebook, Instagram, and now on X. Bunch of other pages, thank you to the groups and the people that allow us to stream from their pages within the hemp and cannabis industry and the advocacy community. There's a bunch of them. And so tonight we're talking with Dr. Brent Boya from Tupelo, Mississippi's Neuroscience Institute at North Mississippi Medical Center and Addiction Medicine Specialist from Hamilton, Alabama. Dr. Let's get into, you wrote a white paper about medical cannabis. And one of the things that struck me as interesting that I have actually seen in the store is something called Operate Conditioning. Explain what that means. - Operate conditioning is another name for Pavlovian conditioning. And you may remember this from-- - Pavlov's dog. (laughs) - Pavlov's dog, exactly. - I think that's freshman year of college 101 psych. (laughs) - That's exactly right. So Pavlov famously had tubes in dog's necks. He was studying dog saliva. And he noticed that dogs would begin to salivate when the lab technician who fed the dogs came into the room. And he recognized that as a response to a stimulus. And so he wound up ringing the bell, give him a dog a food treat, ringing the bell, give the dog a food treat. After a while, the dog becomes conditioned to the ring in the bell. He associates that sound or that stimulus with the reward it's about to come. - And he salivates, yeah. - And he salivates. And so what we know about Operate Conditioning, and this is one of the pillows of addiction itself, is that, you know, for instance, nicotine. You smoke a cigarette, you suck smoke into your lungs, you get a nicotinic receptor activation treat, and it's a good boy, good boy, good boy. And you learn to, every time that you inhale, smoke that you're going to immediately get a reward. - Right. - And subsequently you fall in love with the behavior. - Right. - You feel compelled to smoke cigarettes. Why do you smoke those cigarettes? You say, I don't know, I just feel compelled to do that. - I've always wondered why, 'cause I've been a smoker, and I always wondered why do people always smoke right after meals? Like, it's like, nobody tells you that's a rule, but immediately after a meal, you want to smoke. And it's like a universal rule. I've never met anybody that did not agree with that. And that's weird to me. - Well, I think it feels the deal on pleasure. In other words, you know, no pleasure is complete until those nicotinic receptors are activated. - Right, good meal, good meal, it's good, but it's not perfect until I can get outside in the parking lot and burn one. - You know what the weird difference in cannabis and cigarettes is that most people that I know that smoke cannabis have to smoke before they can eat. - Instead of after. - Well, yeah, and you know, a certain chemo bar, certain cannabinoids are appetite stimulants. - Right. - There are some that are appetite depressants, and so, you know, that's like, for instance, THC, V has been found to be an appetite suppressant in an energy booster. But with regard to the operate conditioning, the faster the reward following the dosing behavior, the more reinforcing the dosing behavior becomes. So for instance, the reason why smoking is so much more addictive than just say putting on an nicotine patch and wearing it, it's because of the rapid reward that occurs. - Right, that brain, that blood brain barrier pass that's just almost instantaneous. - That's exactly right. So if, you know, Pavlov would ring the bell and wait an hour and a half to give the dog a treat, the dog would never fall in love with the ring in the bell. - It would just be a sound that he heard every day at two o'clock. - That's exactly right. And even in dog training, you know, we take advantage of this. I'm kind of a hobby dog trainer myself. And so when a dog gives me the behavior that I want, I'll say sit. And as soon as the dog's butt hits the ground, I will mark that behavior with a clicker. Click, click, click, click, click, click. And as soon as I can get to her, I'll give her a treat, but I'm marking that behavior. So that's the thing about inhaling smoke, are the rapid reward. You're marking that behavior and immediately you get a treat, whether that be nicotinant receptor activation or in the case of cannabis, CB1 receptor activation. - And that's why people also will smoke, even smoke pills and smoke, smoke other drugs, yeah. - Exactly. Yeah, the faster they don't set up a reward, the more reinforcing the dose of behavior becomes. Crushing snort for opioids is faster than swallowing the pills or shooting them and is faster than that and so forth. So we, when we brought cannabis to North Mississippi and we wanted to do it in a medical or ethical way, we decided that we would not certify for any inhaled routes of delivery for a couple of reasons. Number one, there's evidence to suggest that smoking in any form is harmful to your load. - It is combustion, it is combustion. - Yeah, and secondly, even with the vapes, there had been problems with some of the lymphophilic components like vitamin E that have caused lung damage and so forth. And then thirdly, and there's the evictionologist, I think this is incredibly important, I want to delay the reward following the dosing behavior. - Yes. - In other words, I would like, it's actually a good thing that it takes swallowing cannabis 30 minutes or two hours to kick in and work because there is significantly less chance of compulsive misuse. - Right. - When I, when I tell my patients, I want you to use cannabis therapeutically. - Right. - Not compulsively. - Right. - And a way to avoid compulsive use is to delay the onset of reward temporarily. - I see this a lot and that's why I wanted to bring this up because when I am trying to give people information about methods of consumption, how they work in the body, bioavailability, so that when they come in and buy something, they know how to correctly use it. I have the hardest time talking, excuse me, talking to people who only smoke or vape. They don't want nothing else. Even if I'm explaining how a micro dose, several times of a day is not as good as a macro dose twice a day and here's why and all the, they don't care. They want that instant gratification and they will, to their own detriment, skip over an oil or a capsule or an edible that will take more than three seconds to get to the brain and affect them. But what they don't like, we have to say, when you inhale your micro dosing, it hits you fast, but then it wears off fast and for people like me with chronic pain, I would have to hit that sucker once an hour at least and that's no way to live. And then again, the lung damage. Why not find, you know, we tell people you start low and you go up until you find what works for you and then you stop there because more isn't more. More is just more money and is addicts. Everybody that's been an addict thinks more is more. And that's another battle. But the operative, the operative conditioning, I see that because people who like that instant gratification, they cannot be talked out of it to their own detriment. - Well, they've got a word for it, it's called the hit. You know, the hit off of Marlboro cigarette or the hit off of crushing the store in your oxycodone or injecting your oxycodone is a hit and that's a treat. And that's a reinforcing behavior. And so we want to avoid the hit. We want the pain relief to be gentle and slow and not hit you like a freight train. - Yes, I agree. I agree because there and that's a whole other conversation. We were about out of time. Thank you, Dr. Boyette for your time and for sharing with the listeners tonight. - You have anything you want to leave us with? - Just the fact that cannabis is a complicated, a multi-molecular medication and your physician should be understanding the entourage effect, understanding that CBD may block sedating effects, CBN may enhance effects. There's a lot to unpack about cannabis and your physician needs to be educated in the way to conduct the orchestra. - Yes. - That's the key. - Yes, I love that we both use a different version of the same analogy for the endocannabinoid system as a symphony or an orchestra because that just made sense to me and that's how I teach my customers. So I appreciated that. We thank you so much again for your information and you can find out more about Dr. Boyette at the Neuroscience Institute at North Mississippi Medical Center website. And Dr. Boyette, are you on social media? I am on social media, I am also on Dr. Brent Boyette.com and I also have a couple of books on Amazon. One is called Healing or Harming by Brent Boyette and the other is called Move Beyond Pain and both of these are on Amazon. - All right, all right, that's awesome. Thank you so much. Thank you to our listeners. Join us here every Monday night at seven o'clock and come see us at Canobama where they're seven days a week, even on Sunday from noon to five. And of course, 24 hours a day, we're on our website and on social media so that you can find us. You can, we're gonna be celebrating National Recovery Month. I don't even think I mentioned that. But next week, we're gonna hear from my good friend, Mr. Waxey Brown. Thanks for being with us tonight. God bless and good night. (upbeat music) (upbeat music) (upbeat music) (upbeat music)