Alex Capano

I get asked a lot why I wanted to focus on cannabis and, to be honest, I just felt like I was on a bit of a hamster wheel, and I was more ambitious than that. There was no upward mobility and that was really frustrating to me. Cannabis is such an exciting, emerging therapeutic area. There’s a lot of work to be done and a lot of people are really apprehensive to even research it because of the stigma, but I don't care about that. So I felt like, hey, here's a field where I can channel my ambition, but also really advance the science and help people gain access. And then, through that science, influence policy. I would hear these success stories from patients all the time—and I would observe them—and I felt like, okay, this is really important, people need access. I can help close that gap.

It’s certainly a major social justice issue, too. About once a week, I would go to juvenile detention centers to do sexual and reproductive health consultations and it was so obvious to me that there was a huge disparity in people of color being incarcerated from such a young age because of cannabis. I think that if we can get some research out there and have people using it appropriately, safely, and easily, then we can keep people out of detention centers and improve their health overall.

Rarely, rarely did I ever have a Caucasian patient in the detention center. From a demographic perspective, the kids were overwhelmingly people of color. And certainly Caucasians use. I mean, white Americans use cannabis at the same levels as people of color, if not higher. But the incarceration rate for people of color is four times—or I think the ACLU says 3.7 times—as high.

I learned that these kids would get caught smoking weed and then they were in the system, and that was something really difficult to get out of. They’re 12, 13, 14 years old the first time they come in, and maybe their parents are working double jobs or not as engaged as they should be so they miss their follow-up court date. So they’re sent back. And sent back. And sent back. These kids didn’t do anything that most teenagers aren’t doing. But now they have really low chances of finishing high school, let alone going to university. I would see these huge files next to kids who just wanted to go back home, and most of them hardly did anything wrong. They just were being teenagers.

There was one young woman, who was, gosh, probably 14, and had experienced a lot of abuse. She had textbook PTSD and the psychiatric medication she was on had really debilitating side effects. At one point she was self-medicating with alcohol, which was really dangerous for her health. But she found that cannabis really helped her PTSD, so she would use, but not even very frequently. It helped her function. And she was thrown into juvenile detention center for it because it wasn't legal, and that exacerbated her PTSD much, much more.

At the time, medical cannabis was not yet legalized in Pennsylvania, so I would just try to help her with other coping mechanisms and also explain that I didn't judge her. Now, luckily, we do have an active program and PTSD is a qualifying condition. So I have a lot more latitude to say, hey, I'm gonna get you plugged into this network so that you're not gonna get in trouble for it.

There are definitely issues with high THC and frontal lobe development in adolescence, but there’s still an opportunity for appropriate use. And I think—at least as far as harm reduction goes—it’s a much safer alternative than some of the other options.

Identifying safe alternatives for opioids is also a huge life goal of mine. I know every city and every town feels the epidemic right now, but living in Philly and growing up around here, it's surrounded my life as long as I can remember. I’ve lost friends and patients to opioids. I’m fed up and furious that we aren’t exploring all alternative options. Addiction is very complex, but in my experience, cannabis may be a major part of the solution. This is all rooted in scientific evidence, as well as clinical (and personal) observation. That’s why my first initiative at Ananda was executing a study on opioid reduction, and that data will be analyzed in the coming weeks.

I’m someone with anxiety—I’ve always had it. And when I was younger, whenever I tried smoking weed, it made my anxiety worse. THC can really induce that for me. So it took me a while to not be scared of CBD and realize that it could actually counteract my anxiety. I really like a 5:1 or 10:1 ratio of CBD to THC. That’s ideal for me. And even though I do have one of the qualifying conditions for Pennsylvania’s medical cannabis program, I don’t need to use it because you can get that sort of ratio from a hemp-derived oil.

I take CBD about two hours before bed every night. And sometimes I take it during the day, if I’m having more anxiety or if I'm going to the beach or just chilling out. It's a really nice alternative for me, especially if I don’t want drink because then I’ll feel dehydrated and terrible. I can get that rest and relaxation from a CBD oil. And I do think that the other cannabinoids like CBN and CBG are really important.

I just feel like there's so much hyperbole around CBD. I've never seen something be so hotly debated. On the one hand, you have claims that it’s the devil's jazz cabbage; that it’ll cause reefer madness. On the other, you have people acting like it’s some magic potion that's going to cure everything for every person. It’s frustrating because the truth is in the middle. We should just talk honestly and openly about what CBD can do, and what it can't do. That said, on the spectrum of things that are dangerous, it’s low. Really, really low, especially compared to alcohol and other drugs, including a lot of prescription ones.

The other thing that’s frustrating is so many people saying, “We don't have any research.” And there certainly is a lack of high quality, randomized control trials that influence practice and policy in medicine. Maybe there hasn't been a huge human, randomized, double-blind, placebo-controlled trial that shows cannabinoids’ efficacy in anxiety or pain or whatever. But 99% of my time is working in medical cannabis and I observe it every day. I see it in practice every day. I see people’s quality of life improving in profound ways. So I understand that we need more research, but just because it’s not out there doesn't mean it doesn't work. And there’s also a lot of red tape, so we're not even able to do the research.

I think CBD should be a first-line option for a lot of different conditions. The safety profile’s really excellent. You can’t overdose on it. You can’t get addicted to it, and you can’t withdraw from it.

I recently had a veteran who couldn't sleep. He had severe insomnia since he returned from combat. I was trying to get him to try this, and to try that, but he was really resistant. Finally I said, “Look, just try it, and if you don't like it, fine. I’m gonna give you a sample so you didn't waste any money.”

The next day he came in and he looked like a different person. He said, “I slept through the night for the first time in four years.” You could just see that he didn't have the same exhaustion. I've been following him since and he sleeps. And because he sleeps, his pain’s better, his mood’s better. He was unemployed and on disability, but now he has a job. He went off some other medications he was taking. That was really cool.

If you're taking CBD for sleep, I recommend taking it one to two hours before bed. This isn't Ambien; it's not going to shut down parts of your brain and make you pass out or have no memory and do really weird stuff.

I certainly prefer taking a tincture under the tongue because one, it’s going to have a more rapid onset, and two, it doesn’t go through something called “first pass metabolism.” It goes directly into your bloodstream, so you get more bang for your buck.

When you take something like a capsule, or if you drink it in a coffee, it’s going to go through your GI system and you'll lose some of the active ingredients. Plus you’ll have a delayed onset and put stress on your liver. We need to take care of our livers, so I’d rather people not use it that way, if possible. Why not just take it under your tongue, have a more rapid onset, not lose any of the active ingredients and waste your money?

I think terpenes are finally starting to get their day in the spotlight. I hope they are, because they’re really important and have nutritional and potentially therapeutic benefits. They’re found in plants, fruits, and vegetables, but we can really consider them cannabinoids because they interact and modulate the endocannabinoid system. A friend of mine actually did some research on dental pain and found that CBD was really effective for it, but beta-caryophyllene, which is a terpene, was just as effective.

Some people are more sensitive to energizing terpenes than others, so sometimes I’ll get reports of a racing heartbeat or something that actually made someone a bit more jittery. And that’s not because of CBD or other cannabinoids, it’s the terpenes or the terpene blend. Certain terpenes are energizing, while others are more sedating. So when you change them, you can eliminate that feeling.

When you’re making a formulation, you have to figure out what you’re looking for, and then do a little research on the cannabinoids that may be most beneficial. Regardless of what you’re consuming, you want it to be full spectrum. To me, “full spectrum” means more than just two cannabinoids, because there's going to be more than two in any decent plant that's grown well.

So for example, if you have higher levels of CBN, that’s great for sleep, whereas a cannabinoid like THCV is going to be better if you’re using a product for weight control or going for a run. That’ll be more energizing and actually decrease your appetite a little bit. The evidence is kinda mixed about CBD, though: it does appear to be anti-nausea but doesn't help people necessarily eat more or eat less.

As far as terpenes go, myrcene is a really, really, really good one for sleep. The same thing with linalool. With Dusk, we looked at terpenes that interact with cannabinoids like CBD and CBN, and highlighted effects like anti-anxiety, relaxation, and even muscle relaxation.

It's not just helping someone get to sleep and stay asleep, it's also about helping people with their anxiety and pain—or anything that might be keeping them up. The terpenes in Dusk have those properties. And that's been established in scientific literature since like the '70s. Honestly probably before that. We know more about terpenes than we do about cannabinoids.

You don't need a lot of CBN to get the effects of it, but there's really limited research on it. You know, if we're gonna argue about limited research on CBD, CBN is really far behind. But I think it’s the up-and-coming molecule of the day.