THE BLUNT TRUTH: PERSPECTIVES FROM OUR FOUNDER
Written by Robert S. Marks, M.D.
Above all, this page is where I am placing content as I gather my thoughts and optimize this website. Most of what you read will be relocated to other sections of our website, edited, or removed.
Welcome to Texas Herb Center. I’m Robert S. Marks, M.D. I’m a dual board-certified pain management physician and anesthesiologist in Austin, Texas. I sit on the medical advisory board of Texas Original Compassionate Cultivation dispensary. Along with my wife’s support and organizational acumen, we founded and run Diagnostic Pain Center, Texas Herb Center, and Texas Herb Clinic. I have studied and given countless lectures on medical cannabis since 2012 and testified before the Texas Legislature during every session since initial passing of the Texas Compassionate Use Program. Each time, I’ve argued in favor of expanding Texas citizens’ pain management options.
Having discussed medical cannabis with thousands of healthcare providers, politicians, lawyers, professionals, and patients for over a decade, I will share with you my honest opinions on the topic. I created Texas Herb Center to provide a safe outlet for top quality, organic over-the-counter CBD products as well as to provide up to the moment information on CBD/Cannabis/Hemp and the state of medical cannabis legalization in Texas. Whether you are a patient of mine or just interested in learning, I hope my website is helpful to you. I’ll be blunt, direct, and candid. Tell your friends. Enjoy…
LIGHTING THE FIRE
In 2012, I lectured to an auditorium of doctors about medical cannabis at Texas Tech University’s International Pain Symposium. It was the first time I lectured about medical cannabis. It was my grand rounds presentation at the end of my pain management fellowship – the medical equivalent of a thesis presentation, highlighting the culmination of my findings from a year of extensive scientific review. A year prior, I thought it would just be interesting dinner party conversation, but the literature showed very compelling evidence that the cannabis plant had many profound benefits for the human body. In addition to Tetrahydrocannabinol (THC), which everybody had heard of, I extensively discussed Cannabidiol, more commonly known as CBD. Few in the room had heard of it. The evidence was overwhelming that the risk of use was low, and the potential physiological benefits were high.
As I flipped in rapid succession through a series of photos of famous people known to have used cannabis because they had enough “friends” (Mark Zuckerberg), “fame” (Snoop Dogg, Willie Nelson, Michael Phelps), “money” (Steve Jobs) and “power” (Obama, Bush, Clinton) to access cannabis, my lecture was abruptly ended by Dr. Prithvi Raj, an 80 year old highly respected professor and founding member of the Texas Pain Society. I had just shown the punchline slide of the series: a group of emaciated, cancer-ridden people in wheelchairs, and I stated: “but you can’t get it if you have the right disease.” I remember so vividly the sound being yelled out, “ok, we’ve heard enough.” I was the expert in the room, but Dr. Raj didn’t want to hear it. He didn’t want to believe it. It wasn’t mainstream. He stopped me from sharing the knowledge with an auditorium full of medical doctors. The audience was outraged, and I was asked to complete the lecture the following day. I did. If you want to see it, click HERE.
I knew at this moment that I had a long road ahead of me. Medically speaking, I knew that this was a tool that patients should be allowed to try; a tool for doctors to recommend for various conditions that was safer than or complementary to many pharmaceutical drugs. I had just witnessed one of the most highly acclaimed academic professors in the world opting to bury his head in the sand on the topic – and silencing an objective voice because it didn’t fit with his views. Since that day, I have felt an ethical obligation to get the message out. It was clear that there would to be extreme pushback in my quest to get patient access to safe quality cannabis/hemp-based products. It would take a lot of convincing. It was going to be a long road. But I welcomed the challenge.
STARTING PAIN MANAGEMENT PRACTICE DURING THE OPIOID EPIDEMIC
As a frontline public figure championing the furtherment of cannabis legislation in the state of Texas, I’ve always understood that cannabis was safer than many pharmaceuticals, especially opioids. When I first started my pain management practice in Austin in 2012, the opioid epidemic was atrocious. Physician jobs were offering incentive pay for lucrative urine drug testing, which heavily incentivized prescribing opioids. Almost every patient that would come in was already on chronic opioid therapy, usually very high doses, and everybody had the expectation that they would get more opioids. I always took issue with people being on chronic opioid therapy unless there was truly no safer viable option.
Patients frequently asked about cannabis, and I felt an ethical obligation to be honest with them. I was their doctor, after all, and I had sworn an oath to look out for their best interests. I was honest: I’d tell them that it was a lot safer than the medicine that they were taking, but it’s not legal in Texas. I was aware of the opioid overdose deaths are lower in states where cannabis is legalized. So are emergency room visits, opioid overdoses, and opioid prescriptions. In fact, prescriptions for a whole bunch of different types of medications have been lower in states where cannabis has been legalized – significantly and disproportionately compared to states where cannabis had not been legalized.
I created my pain management practice, Diagnostic Pain Center, because I wanted to practice medicine honestly and ethically. I didn’t want a boss pushing me to prescribe opioids or to push only the most profitable therapies. A doctor needs to put their patients’ best interests at the forefront. All I really care about is that my patients get better in the safest most effective way. I want them to know their treatment options just like I want to know my options when I’m a patient. Not everybody needs the same therapy.
Yet, most Texas doctors are still scared to discuss cannabis with patients. I have spoken with thousands of healthcare providers over the years. Few of them (very few) are privately opposed to patients utilizing cannabinoid products, however they’re too scared to come out and say it. Why? If you work for a hospital system, university, or a venture capital group owns your practice, you certainly don’t want to become controversial and contradict your employer’s stance. Many fear liability or scrutiny. Personally, I think that most are scared because they’re not educated on the subject.
I have gained extensive insight into medical benefits of cannabis by listening to patients tell me about their experiences. This is especially true as so many people are moving to Texas from California, where cannabis was just another tool in the medicine cabinet. We need more dialogue between patients and their doctors. If everybody asked their doctors about cannabis, and everybody shared their experiences with their doctors, they would realize how much support there actually is in the medical community. Please, I encourage you, ask all of your doctors about it. Get people used to engaging in the dialogue. Help me help Texas by helping Texas doctors help Texans.
MORE RESEARCH IS NECESSARY – BUT IS IT REALLY?
Quality studies in the United States are difficult to find. Pharmaceutical companies aren’t generally going to put a lot of money into cannabis because there’s not much return on an investment in a product that can be grown in somebody’s backyard. Furthermore, the government isn’t particularly keen on funding research for a drug that’s illegal federally. Much of the data comes from other countries, with limited data also coming in from states where it’s now legal.
Most cannabis studies say “more research is necessary” somewhere in their conclusions. I question this conclusion for cannabis differently than I would for a pharmaceutical drug because of its low risk profile. Evidenced-based medicine is a buzzword that gets a lot of attention these days, but it doesn’t always correlate with patient outcomes. Economics are considered, as are the risks of the variable within the study compared to the benefit provided. For example, chemotherapy drugs are horrible for the body but kill cancer, so they are recommended. Breast MRIs will find a lot more cancer than mammograms (and with zero radiation), and evidence shows it – but it’s not cost effective to do annual MRI screening & false-positives may be found, so they are not recommended. For cannabis as a medicine, given the risks are low, the data doesn’t need to be so highly compelling to overcome the drawbacks. People should be allowed to try it if it has any potential to help them.
To confound matters further, politics in any given region also impact the extent to which people are willing to publicly share their opinions on these matters. Most Texas doctors & healthcare providers are scared to speak out publicly or discuss cannabis with patients. But as the general public became savvier about cannabis and hemp-based products, and legalization of low-THC products deriving from hemp has taken place, these products became much more mainstream. So has the conversation. Let’s keep it going.
SAFETY (AND DRAWBACKS) OF TETRAHYDROCANNABINOL
Over time, the consensus has become consistent: Cannabis-based products are generally considered safe. Although it is often said that one cannot die of an overdose of cannabis, it still does hold drawbacks. This is generally because of Delta-9-Tetrahydrocannabinol (Δ-9-THC or usually just THC), the component of the cannabis plant that causes conscious psychological effects. THC is the component of the cannabis plant that gets people high. Although it probably won’t kill anybody, that doesn’t mean that it can’t still ruin somebody’s life. Higher levels of THC can impact memory, judgment, reaction time, and perception, which may impact relationships, academics, and work. It can also increase the risks of psychosis. For patients suffering from medical conditions, these drawbacks are often offset by the benefits patients get when using THC products. I fully support the use of high THC cannabis for medical purposes and am grateful to be involved in the development and implementation of the Texas Compassionate Use Program.
MEDICAL VS RECREATIONAL: FENTANYL & VALIUM VS CIGARETTES & ALCOHOL
One of the most common arguments I hear opposing medical cannabis legislation is that it creates a “euphoric effect” on the mind. They voice concerns that people should not drive while using it. The argument about driving and psychological effects is very reasonable when considering recreational cannabis. This is the context as to when we should compare it to alcohol and cigarettes, as recreational products provide no medical benefit for the body. They’re strictly used for recreation, so any harm they may do to the user is not balanced out by treating any kind of medical condition or symptom. Arguments pertaining to recreational cannabis should be kept completely separate from those pertaining to medical cannabis, as they are simply not the same thing. While I do see the economic & societal benefits and view federal recreational legalization of cannabis as a long-term inevitability, as a medical doctor I focus my discussion on the medical side.
If we’re going to talk about cannabis as a medicine, then it should be compared to other medications – not cigarettes and alcohol. Oxford dictionary defines medicine as a compound or preparation used for the treatment or prevention of disease. In this context, medical cannabis no different than dozens of pharmaceutical medications already available to the general public. How many medications can you think of, prescription or over-the-counter, that would heavily impair your ability to drive a car? Do NyQuil or Benadryl make you drowsy? What about Xanax or Valium? Tiger Woods said he didn’t even know he drove his car when he was taking Ambien! And people who take too much Fentanyl or other opioids may simply be found unconscious in the driver’s seat.
I cannot emphasize this enough: Medical cannabis is intended to treat medical conditions & symptoms. Doctors, including myself, consider “risk vs benefit” every day when reviewing options to treat patients. The debate in healthcare shouldn’t be “medical cannabis vs nothing” but instead “medical cannabis vs alternative medications / treatments.” Compared to the majority pharmaceutical medications, cannabis is less likely to cause drug-drug interactions and has literally never been known to have directly caused an overdose death. Many medications alter the mind, but you don’t see doctors lining up to prevent them from being available for patients. Just like with any other medicine, patients need to use it responsibly, and doctors need to prescribe it responsibly. And regarding a “euphoric effect,” I can tell you that a moment of euphoria may not be a terrible thing for people suffering enough to warrant the need for medical cannabis.
LOW THC CANNABIS – AKA HEMP – 100% LEGAL
If you remove the THC or keep a very low amount of THC in cannabis, patients can obtain many of the cannabinoid benefits from cannabis plants without “getting high.” Per federal and state government regulation, as long as the concentration of Delta-9 THC is less than 0.3%, the product is 100% legal. No prescription is necessary. This is because it is below the THC threshold that is likely to get people high. This is the reason that all of our products are available over-the-counter.
Patients frequently ask me where to get hemp-based CBD products. I can’t tell you how many times I’ve heard patients tell me that they picked up some CBD at a gas station, and it just gave them diarrhea. This is an unregulated industry. A company could add a tiny bit of CBD into a product that’s full of olive oil and sell it is a CBD product – and the user will simply assume that CBD doesn’t help them, not knowing they ingested too little for it to take effect. Don’t give up! Our products are responsibly sourced, organic, pure, high-quality and 100% legal. Every bottle has a QR code with laboratory data showing you exactly what is inside the bottle. Ours is the real deal.
EXPLOITATION OF THE HEMP LAWS: DELTA-8-THC VS DELTA-9-THC
The drug that makes cannabis federally illegal, classified as a schedule 1 drug per the Drug Enforcement Administration’s (DEA), is Delta-9-Tetrahydrocannabinol. It gets people high. But it is well known that hemp (cannabis with <0.3% Delta-9-THC) has many potential benefits in healthcare, cosmetics, and industry – and it has very high concentrations of CBD. When laws were established to allow for the federal legalization of hemp, a legal dichotomy was made between Cannabis and Hemp. The Federal Agriculture Improvement Act of 2018 (2018 Farm Bill) authorized the production of hemp and removed hemp and hemp seeds from the DEA’s schedule of Controlled Substances. Hemp products are specifically designated to not get people high, so there was no need for restrictions on purchasing hemp-based products. Cannabis legislation has been largely left up to the states (it’s technically still illegal federally) for the sake of medical and/or recreational purposes, and restrictions are imperative on cannabis-based products due to the mind-altering effects. Texas’s medical cannabis law is the Texas Compassionate Use Program.
Then some very savvy scientists came up with the idea to convert a CBD molecule to THC so people could get high from the legal hemp products. It couldn’t contain Delta-9-THC since that would make it illegal. But they realized that they could convert it to Delta-8-THC or Delta-10-THC, and it would get people high without technically being illegal. While it may not be legal based on the letter of the law, it is a definite strike against the spirit of the law. In its pure form, I suspect it’s effects on the body are similar to Delta-9-THC, but the chemical solvents and reagents used to create these modified products could be quite dangerous and often still end up in the final products. This is a completely unregulated product without required age limits or warnings on the products. My friend and professional colleague, Shawn Hauser, a partner at Vicente Sederberg (the law firm behind many US cannabis laws), wrote a very informative piece about this which you can read HERE. I highly recommend staying away. As Delta-8 & Delta-10 products became a thing, some people have started to advertise Delta-9-THC (the actual federally illegal product) by marketing the amount of <0.3% Delta-9-THC that was extracted from hemp.
To be very clear, I do not support the sale of Delta-8 or Delta-10 THC products, and I fully champion the Texas Compassionate Use Program (TCUP) for those who qualify for Delta-9-THC for medicinal purposes. In efforts to achieve responsible cannabis legislation, our laws should be followed in both letter and spirit. Despite Delta-8 & Delta-10 products being a multi-billion dollar industry, I will not breach the trust of our clients and my patients by irresponsibly exploiting such loopholes and selling them. You will not see these products at Texas Herb Center.
HELP ME HELP TEXAS BY HELPING TEXAS DOCTORS HELP TEXANS
We need more dialogue between patients and their doctors. If everybody asked their doctors about cannabis, they would realize how much support it has is in the medical community. Please, I encourage you, ask all of your doctors about it. Get people used to engaging in the dialogue. Help me help Texas by helping Texas doctors help Texans.