\n<\/p>\n
Every five months Irvin Rosenfeld has gets a FedEx shipment, courtesy of the federal government, containing six metal canisters, each with 300 perfectly rolled joints of what today would be considered rather mediocre weed. But the quality of the government-issue reefer matters less than the fact that Uncle Sam has been supplying him with it regularly since 1982, when Rosenfeld won the right to smoke cannabis for reasons of medical necessity under the auspices of the federal government\u2019s Compassionate Investigational New Drug (IND) program. Rosenfeld smokes cannabis every day to treat a rare and excruciatingly painful bone disease called multiple congenital cartilaginous exotosis.<\/p>\n
<\/p>\n<\/figure>\n
A total of 15 patients with different incurable ailments would enroll in the Compassionate IND Program to study cannabis before it was officially shut down in 1992. As one of the last living IND participants, Rosenfeld remains a forthright and energetic medical cannabis advocate, a role he takes very seriously. His personal story is compelling. He has suffered with extreme pain for most of his life. At age 10, x-rays revealed more than 200 tumors sprouting from bones in his arms and legs. He would undergo a dozen surgeries and consume a steady diet of prescription narcotics and other pharmaceuticals. <\/p>\n
When he first smoked marijuana as a teenager at a social gathering, it was a revelation. Before long he realized that if he smoked cannabis every couple of hours, his pain eased and he didn\u2019t have to rely as much on doctor-prescribed muscle relaxants, opiates, and benzos to get by. Although he felt no euphoric effects from cannabis, the herb somehow kept his disease in check, inhibiting tumor growth and helping him live a decent life. A walking, talking refutation of the lazy stoner myth, he went to college, played sports, married his childhood sweetheart Debbie, and became a successful stockbroker.<\/p>\n
There\u2019s no doubt that cannabis helps Rosenfeld\u2019s condition, but it\u2019s not a cure. Though he has learned to live with his pain, at times its relentlessness makes him feel depressed, trapped in a lonely prison from which there\u2019s no escape. At least that\u2019s how it felt until one day in 2020, when Rosenfeld\u2019s pain management specialist, Dr. Michele Weiner, mentioned a potential jailbreak: ketamine.<\/p>\n
Ketamine, an FDA-approved \u201cdissociative anesthetic,\u201d has been around since 1962 when it was first synthesized by chemist Calvin Stevens. Employed initially as a tranquilizer in veterinary medicine, the drug was widely utilized during the Vietnam War for treating wounded troops. Ketamine kept injured soldiers conscious but cognitively disconnected from their pain, all while maintaining their vital functions.<\/p>\n
Ketamine\u2019s efficacy against pain is attributed to the drug\u2019s ability to induce a dissociative state. At high doses ketamine produces anesthesia; at lower doses, it relieves pain and causes hallucinations. \u201cSpecial K\u201d acquired a reputation as a party drug in the 1970s due to its psychedelic and mood-altering effects. Favored by fashionistas and Silicon Valley bros, it\u2019s still part of the recreational drug scene.<\/p>\n
At high doses ketamine produces anesthesia; at lower doses, it relieves pain and causes hallucinations.<\/p>\n
Some have attributed Elon Musk\u2019s erratic behavior of late to ketamine benders at parties. (He says he uses it to relieve depression \u2014 proof that money can\u2019t buy everything.) Although ketamine is potentially addictive and excessive use can cause liver damage, renal failure, and psychotic episodes, it\u2019s classified as a Schedule III controlled substance (along with anabolic steroids and some acetaminophen-codeine combinations), indicating a relatively low risk for abuse.<\/p>\n
Unlike LSD and psilocybin, ketamine has no natural source. Lysergic acid is present in ergot (rye fungus), psilocybin is a magic mushroom compound, mescaline comes from the peyote cactus, and for MDMA (\u201cecstasy\u201d) there\u2019s sassafras. But there\u2019s no natural correlate for synthetic ketamine, which works through different molecular pathways than the classic, naturally sourced psychedelics. Acid and \u2018shrooms deliver a full-blown psychedelic experience by binding to the 5-HT2A serotonin receptor, whereas ketamine confers its powerful dissociative and psychedelic effects by blocking the N-methyl-d-aspartate (NMDA) receptor, a glutamate ion channel that manages the ebb and flow of calcium inside the cell.<\/p>\n
By inhibiting the NMDA receptor, ketamine triggers the production of a chemical known as brain-derived neurotrophic factor (BDNF), which has been likened to \u201cfertilizer of the brain.\u201d The role of BDNF in adult neurogenesis (the creation of new brain cells) and neuroplasticity (the ability to reorganize neural networks and synaptic connections in response to injury and lived experience) is the subject of many scientific papers.<\/p>\n
According to a 2012 study by University of Bonn scientist Andras Bilkei-Gorzo: \u201cOn the cellular level, the cannabinoid system regulates the expression of brain-derived neurotrophic factor and neurogenesis.\u201d Subsequent reports by Brazilian investigators established that ketamine\u2019s central and peripheral painkilling effects are mediated by the endocannabinoid system. When scientists blocked the CB1 cannabinoid receptor, ketamine did not prevent pain. The same group of researchers also found that ketamine caused anandamide (one of two major endocannabinoids) to be released in certain brain areas. And when anandamide levels increased, so did ketamine\u2019s analgesic effect.<\/p>\n
\u201cCBD significantly augmented the activating effects of ketamine.\u201d<\/p>\n
Plant cannabinoids have also been shown to potentiate ketamine\u2019s painkilling properties. A 2011 report on \u201cThe interplay of cannabinoid and NMDA glutamate receptor systems\u201d examined \u201cthe interactive effects of cannabidiol and ketamine in healthy human subjects.\u201d The report concluded that \u201cCBD significantly augmented the activating effects of ketamine.\u201d Other studies have noted that CBD boosts endocannabinoid levels and CB1 receptor signaling by delaying the metabolic breakdown and reuptake of anandamide.<\/p>\n
CBD and ketamine are both neurogenic compounds, and this may factor into how they confer antidepressant effects. Impaired neurogenesis has been linked to clinical depression, substance abuse, and other mental health conditions. Ketamine\u2019s rapid antidepressant effects involve enhanced BDNF-induced (and cannabinoid-regulated) neurogenesis and neuroplasticity. The drug is currently being administered off-label for refractory depression at numerous ketamine clinics around the country.<\/p>\n
\u201cPain and depression share common biological mechanisms,\u201d explains Dr. Michelle Weiner, a double board-certified physician who specializes in interventional pain medicine, physical medicine, and rehabilitation. In addition to her clinical practice at five locations in southern Florida, Dr. Weiner is an Assistant Professor at Nova Southeastern University College of Osteopathic Medicine.<\/p>\n
Take a spin on her website and you\u2019ll find a group photo picturing Dr. Weiner and her team of practitioners, a bevy of Florida beauties who look as though they could\u2019ve been cast as the Real Housewives of Miami. There\u2019s a lot going on behind the glamor. When interviewed by Project CBD, Dr. Weiner\u2019s enthusiasm for her calling is obvious, her expertise backed by years of on-the-ground research and a vast knowledge rooted in pain studies and cutting-edge neuroscience.<\/p>\n
While building her practice, Dr. Weiner grew increasingly frustrated with the limited tools available beyond conventional pain pills and injections. When medical cannabis was legalized in Florida in 2016, she became one of the first licensed physicians to include it in her treatment plans. She found that cannabis was an effective therapeutic option for helping chronic pain patients, especially seniors, decrease their dependence on opioids.<\/p>\n
\u201cIt really changed my practice,\u201d says Weiner, who is a member of Florida\u2019s Medical Cannabis Advisory Committee. Weiner\u2019s experience as a cannabis clinician encouraged her to explore other mind-body healing modalities, including psychedelic drugs. Today she is vice president of\u00a0Mr. Psychedelic Law, a not-for-profit that advocates for responsible legal reform of psilocybin prohibition in the Sunshine State.<\/p>\n
Dr. Weiner\u2019s interest in ketamine began during a residency and training fellowship at the University of Miami. \u201cBack then we used ketamine differently than we do now,\u201d she says. \u201cWe\u2019d give patients a benzodiazepine sedative beforehand to tone down the hallucinatory experiences common with ketamine.\u201d But after learning of ketamine\u2019s potential as treatment for anxiety, depression, and PTSD, she changed her approach to encompass a dual-pronged focus on pain and mental health.<\/p>\n
\u201cEighty-five percent of chronic pain patients also suffer from depression,\u201d says Dr. Weiner. \u201cYou can\u2019t successfully treat pain without concurrently treating mental health.\u201d From her perspective, it\u2019s all interconnected: chronic pain adversely impacts how the brain functions, causing maladaptive changes in the central nervous system and weakening synaptic circuitry between brain regions \u2014 and these changes often lead to depression, according to a 2017 study published in the journal Neural Plasticity. Not only does it offer rapid relief from both depression and pain, ketamine also appears to refresh and reset neural circuitry.<\/p>\n
But the benefits of a single ketamine treatment are often short-lived (seven days on average for depression), and the drug may be contraindicated for certain conditions. Some people can\u2019t tolerate ketamine\u2019s intense hallucinogenic effects. Another major drawback: MediCare and health insurance companies don\u2019t cover ketamine treatments, so patients must pay out of pocket. For those who can\u2019t afford it, there are DIY at-home ketamine kits with medicine procured from less-than-reliable online sources, which is problematic.<\/p>\n
\u201cWhen used mindfully, ketamine, through its dissociative effects, allows patients a time-out from their pain.\u201d<\/p>\n
Ketamine treatment needs to be monitored by an experienced practitioner, says Dr. Weiner. Most of her patients come into the clinic once or twice a week for at least a month to receive ketamine by intramuscular or intravenous infusion, along with therapy sessions and lifestyle counseling for a better long-term outcome. Treatment is tapered off over time, and the benefits are maintained with occasional ketamine \u201cboosters,\u201d an approach backed by research. The goal is to relieve pain while helping patients learn new strategies for how to live with it.<\/p>\n
\u201cWhen used mindfully,\u201d says Dr. Weiner, \u201cketamine, through its dissociative effects, allows patients a time-out from their pain. Yes, it\u2019s temporary, but being able to take a break from intense pain also gives them a chance to see it from a different perspective. It\u2019s not who they are. It\u2019s not their identity. Ketamine disrupts the static and unproductive patterns with which patients deal with their pain and encourages the development of better life strategies. What we\u2019re really doing is teaching them resilience.\u201d<\/p>\n
Unlike Dr. Weiner\u2019s other patients, Irv Rosenfeld has her blessing to treat himself orally with ketamine at his own home. The fact that she makes an exception in Irv\u2019s case is a testament to her admiration and respect for Rosenfeld, who has been under Dr. Weiner\u2019s pain management care for many years.<\/p>\n
Every five days or so, when the pain in his bones gets really bad, Irv texts his wife Debbie before he drives home from work: I\u2019m doing ketamine tonight. Debbie knows to stay close by yet out of his way. In order to \u201cdo ketamine,\u201d Rosenfeld needs complete isolation and quiet. Once at his house in Fort Lauderdale, he will put on some classical music. Then he\u2019ll place one-and-a-half sublingual tablets containing a total of 300 milligrams of ketamine between his cheek and gum, sit down in a comfortable armchair, and wait for the portal to open. His flight from pain is about to take off.<\/p>\n
About an hour passes before Rosenfeld notices any effects. When they arrive, the feelings are both physical and emotional. He can see \u201cthe pain flow out and float far away,\u201d he tells Project CBD. Under the influence of \u201cforgetamine,\u201d existential agony and exhaustion are replaced by euphoric hallucinations lasting several hours with his eyes closed. \u00a0<\/p>\n
Rosenfeld accepts that the relief he gets from ketamine won\u2019t last beyond his solitary, three-to-four-hour sit-down sessions. But the knowledge that he can occasionally be whisked away from the Land of Pain is in and of itself transformative, nourishing his innate resilience and helping him tackle life\u2019s daily challenges.<\/p>\n
\u201cIt\u2019s a remarkable drug,\u201d he says with an obvious tone of gratitude. Just as pain has influenced the course of Rosenfeld\u2019s life, so has his outspoken activism, his efforts to get the word out about the therapeutic benefits of cannabis before most people knew much about it. And now he\u2019s also singing the praises of ketamine. Listening to him talk is uplifting, like getting a dose of medicine you really need.\u00a0<\/p>\n
Melinda Misuraca is a Project CBD contributing writer with a past life as an old-school cannabis farmer specializing in CBD-rich cultivars.\u00a0Martin A. Lee is the director of Project CBD. He\u2019s authored and edited several books, including\u00a0Smoke Signals,\u00a0Acid Dreams, and\u00a0The Essential Guide to CBD.\u00a0\u00a9\u00a0Copyright, Project CBD. May not be reprinted without\u00a0permission.<\/p>\n
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