Ansiedade, Insônia e Dor: por que a Cannabis funciona de forma diferente em cada pessoa?

[00:00:01][music] [music] [music] Good evening, welcome to another live stream from the Cannabis and Health portal.

[00:00:29]First of all, I'm Gregório Ventura, editor and journalist for the Cannabis and Health portal. These are the first announcements here on YouTube. Please subscribe to our channel here, give us a thumbs up, give our video a like so that this video, this content, reaches as many people as possible. Today we're going to address a topic that raises questions for many people. If you've ever taken the same cannabis-based product as a friend and experienced a completely different effect, today we're going to understand why this happens. And for this conversation, we will be joined by Dr. Vinícius Mesquita. He is a general practitioner and prescriber for over 5 years, working exclusively in the area of medicinal cannabis, with in-depth clinical experience in different physical and mental health contexts. She has a solid track record in managing neurological, psychiatric, painful, and inflammatory conditions, always based on scientific evidence and responsible clinical practice. It has already treated more than 1500 patients, including children, adults, and the elderly, developing individualized protocols, providing longitudinal follow-up, and making continuous therapeutic adjustments.

[00:01:40]Dr. Vinicius, it's a pleasure to have you here. Thank you so much for taking a moment out of your schedule to talk to us here at Cannabis for Health.

[00:01:49]Thank you, Gregory. Goodnight.

[00:01:52]Thank you for the invitation. It's a joy to participate in this discussion again and, above all, to clarify that cannabis treatment isn't just about choosing between CBD or THC, right? We are talking about a pharmacological intervention that is complex, dependent on the diagnosis, the organism, the medications the person is already using, and the goals of each patient. And today we're going to try to transform this whole discussion into a simpler conversation, reduce the complexity, and bring clearer information closer to the patient.

[00:02:30]Thank you so much for sharing your knowledge here with us at Cannabis for Health. This is a very complex issue, because many people may abandon treatment thinking it does n't work, when in fact it requires continuous follow-up, attention, and monitoring to make adjustments and everything else that is necessary. So, to begin our conversation, Dr. Vinícius.

[00:02:53]Before we begin our chat, I'm going to ask everyone watching us online to interact with us here in the chat. If you want to send a question, if you want to ask Dr. Vinícius Mesquita any questions, take advantage of the fact that we're saying goodnight and tell us where you're calling from so we can mention it here in our live stream. To begin our conversation, Dr. Vinícius, I'd like us to start by talking about an introductory topic, right? We need to talk about how cannabis works differently from person to person. It's important that we talk primarily about the endocannabinoid system, which is fundamental for us to understand how cannabis-based medications interact and bring about therapeutic effects in treatments. So explain, please explain to us, how cannabinoids interact with the system and how they can also interact with other medications.

[00:03:53]Well, the endocannabinoid system is a system that regulates the body itself.

[00:03:59]He seeks to bring about homeostasis, that is, the balance of the body itself. And it received this name because of its close relationship with phytocannabinoids.

[00:04:16]So, some components of the endocannabinoid system, which is a part of the human body, interact with chemical substances produced by this plant, cannabis sativa, commonly known as marijuana. And then this interaction occurs in the body along the central nervous system, the autoimmune system, and produces modulations that will impact mood, sleep, pain, memory, anxiety, appetite, inflammation, and stress.

[00:04:55]There are several parts that are affected due to this intersection between the central nervous system, the autoimmune system, and the endocannabinoid system, which is this great conductor, this great regulator.

[00:05:11]And then CBD and THC are able to directly activate these receptors that make up the endocannabinoid system called CB1, CB2, and THC. preferably CB1. This can produce some states such as analgesia, relaxation, altered sleep, reduced nausea, and adverse side effects, like any medication. CBD has a different pharmacology, and therefore it doesn't work by simply occupying a receptor in the same way that THC does. It acts indirectly on the endocannabinoid system, influencing other targets and potentially interacting with other medications, in the same way as THC. And this interaction can occur in a few ways, mainly two. The first is that two medications will produce similar effects and those effects will be added together. So, for example, there's a sedative effect, increasing sedation, such as, for example, benzepine, antihistamines, alcohol, which can increase drowsiness, worsen drowsiness or sedation, which is worse, or lead to some slowing down or risk of falling. And the second way the interaction occurs is in how these various substances are metabolized by the liver. So, these enzymes that are recruited to metabolize so many medications that are already in use, such as CBD and THC, can lead to the emergence of compounds or the accumulation of certain compounds that increase the risk, especially anticoagulants, anti-compulsives, immunosuppressants, and medications where a dose is very specific to cause intoxication; it cannot vary much, it has to be very well controlled. If it gets too high, it can lead to poisoning.

[00:07:27]If it is not used in the correct dose, it will not have the desired effect. So, this means that this combination isn't necessarily prohibited, but we need to know the complete list of these medications in order to cautiously monitor clinical effects, continue follow-up with laboratory tests, certain substances can be measured in the blood through direct examination, laboratory tests, and this monitoring requires a professional perspective, medical follow-up. Yes, doctor, excuse me for interrupting you, but you also mentioned the issue of laboratory tests, right? So, in this topic that we're discussing here in the live stream, which is the different reactions to treatment with cannabinoids, explain to us the importance of these laboratory tests, the importance of these follow-ups, and how these tests can help to avoid these fluctuations and ensure that the therapeutic effects are fully achieved.

[00:08:41]Yes, many substances can begin to accumulate in the body, especially lithium as a mood stabilizer, anticonvulsants, valproic acid, sodium valproate, immunosuppressants, and tacrolimus. So, throughout the treatment, it 's sometimes necessary to request laboratory tests to analyze how the substances being used by the patient are interacting.

[00:09:20]And it can happen that in this queue of metabolic preference, CBD jumps the queue and has a preference, a greater affinity with the receptor that will metabolize it and be metabolized first in place of another substance, and that substance accumulates. And then a laboratory test done at the appropriate time can detect this alteration, which can often be silent and not cause any direct effect in a short period of time, but which is desirable to adjust, usually by reducing that other substance. And that's where happiness often lies in finding a good response, even with smaller, optimized doses, sometimes even with these lethal products allowing for deprescribing. And then, in a situation where medication is sometimes taken in a polypharmacy regimen or with a heavier prescription, a better result can be achieved with fewer medications.

[00:10:38]Anything can happen in these scenarios, but that's the main explanation.

[00:10:45]Nice. And I wanted to take advantage of the fact that you were talking about such a complex subject, right? It's a matter that requires a lot of care, isn't it? A great deal of attention is needed to ensure the well-being of the patients. So, I wanted to take this opportunity to remind you that we've included a link to our scheduling platform in the video description. There you can schedule an online consultation with Dr. Vinícius de Mesquita, get all your questions answered, and understand how cannabinoid treatment can work for you. This individual assessment is fundamental. So, we've put it here, we're not going to put it in the chat either, but the link to our scheduling platform is also in the description of this video. And to talk, doctor, about this topic of variation, how cannabis works differently in each person, it's important that we start by addressing the main health conditions that cannabis treats today, right? What people are looking for motivates them to seek treatment with cannabis-based medications. So, we wanted to start with the topic of anxiety and we wanted to ask you, to clear up this doubt for our readers. How do cannabis-based medications, whether based on CBD, THC, or a mixture of both, work on anxiety mechanisms?

[00:12:13]Well, anxiety is not produced or controlled by a single neurotransmitter or a single brain region. It will involve networks related to threat detection, memory, anticipation, fear control, emotional memory, and the physical stress response.

[00:12:41]So, the endocannabinoid system participates in this regulation; it influences this communication between parts of the brain, such as the prefrontal cortex, amygdala, and other areas that will help the body identify the threat and then end this response when the danger has passed.

[00:13:07]So CBD is studied for this indirect action that influences how serotonin-related receptors modulate neuronal excitability, that is, how much stimulation a neuron needs to fire and process stimuli that the brain interprets as threatening and that will increase stress. This doesn't mean that CBD will directly increase serotonin, but rather act as an antidepressant.

[00:13:44]Pharmacology is more complex, and the effects will vary depending on the dose, composition, frequency of use, or type of disorder.

[00:14:00]Speaking of CBD, THC can act in a different way, activating certain receptors to reduce tension and facilitate relaxation in some people, especially at low doses.

[00:14:20]It is possible that this effect can be modulated and adjusted, starting with low doses and adjusting as needed, without exceeding a point that, like many medications, can lead to adverse side effects, including increased anxiety. And it's very similar to various types of antidepressants in that it's a medication meant to reduce anxiety, but often ends up triggering anxiety, hence the need for this monitoring to individualize the treatment and find the right combination that will balance CBD and THC in this interaction, where one reduces the side effects of the other.

[00:15:15]Acting together as a team and striving for the best outcome, good symptom control, while acknowledging that side effects and adverse effects are possible along the way.

[00:15:29]And in your clinical practice, doctor, you just talked about this relationship, right, of a little bit of THC plus CBD. In your clinical practice, for anxiety, you'll generally prefer CBD or THC, whatever you find works best, broadly speaking.

[00:15:49]Well, it 's almost a consensus. Speaking of anxiety, there is concern about the side effect that THC can cause of increasing anxiety. This has a pharmacological justification.

[00:16:06]But THC, even in low doses, often within the limits established by regulations, can produce relaxation, facilitate sleep, reduce tension, and alleviate symptoms associated with pain. And it's a track that needs to be sought out. It's a search, really, into the composition between CBD and THC. Hence the relativity of what constitutes a low dose.

[00:16:47]The THC content on the bottle is given as a percentage, which is a relative measure, not an absolute one. So you notice that each component will have a concentration relative to that component, 0.2% referring to something. And then there's the difficulty in standardizing the presence of generic drugs; these are challenges aside, which makes professional knowledge of each composition even more important, as well as analysis certificates to know the proportion between CBD and THC, and the reassurance that THC in a low dose is very welcome even for anxiety, and full-spectrum drugs are very welcome for reducing anxiety.

[00:17:48]Nice. I wanted to take a look at our chat now, we asked people to say where they were calling from, and people are responding here, see? A big hug to Rafael from Teresópolis, Paula Fonseca from Sinop, Mato Grosso, and Jéssica Batista from Jundiaí. Hello, good evening to Miriam, to Mabeles, to the web design sites 6526.

[00:18:14]Let's go, let's move on. So, we've talked quite a bit here about anxiety, and we can now move on to another health condition that also leads many people to seek treatment with cannabinoids, right?

[00:18:27]Insomnia, sleep disorders in general. Insomnia is the most prevalent sleep disorder, but difficulty falling asleep, or problems that arise at bedtime, is a broader category. So I wanted to ask, doctor, how do cannabis-based medications help patients with sleep disorders beyond insomnia, including sleep apnea or other disorders?

[00:18:54]They can certainly help patients with sleep disorders. And we need to identify what that disorder is that's present. For example, in people with pain, anxiety, and symptoms that prevent sleep, improving this underlying condition can indirectly improve rest.

[00:19:16]And in other cases, phytocannabinoids can directly affect how long it takes for a person to fall asleep, how many times they wake up during the night, or their perception of sleep quality.

[00:19:33]THC can reduce the time a person spends in bed and falling asleep. And that's where our responsibility lies: adjusting the dose to avoid, for example, causing discomfort, cognitive impairment, or problems the next day after a certain dose. But we adjust that according to each individual response, observing and gradually increasing the dose.

[00:20:03]CBD will not act as a sedative; it will not induce drowsiness in a way that leads to sedation. In some people, this can lead to relaxation, while in others the effect may be neutral or even leave the person in a more alert state. Hence the need for individualized dosing and individualized monitoring to observe the outcome and intervene appropriately, making adjustments. The effect can sometimes be paradoxical. It acts one way with one person and in another it acts in a completely opposite way. And then the same product was shared by a family member, by a neighbor, with completely different results. And sometimes people think: "Oh, what is this? It doesn't work, or what is the other person feeling that I can't feel the same way?"

[00:21:02]Several difficulties can be inherent to this type of observation in the composition, in the patient, in the symptom, that is, a total individualization, and often only observation is what will lead to certain conclusions.

[00:21:24]You spoke about a very important topic, doctor, which is the next day, right?

[00:21:28]Especially for those who have sleep disorders, if you wake up, sleep poorly, wake up poorly, the whole day is compromised. So, I wanted to ask you if treatment with cannabinoids prevents this drowsy state, the drowsiness the next day, if it's possible to fix this, if it's possible to correct this when this problem appears, if it's possible to make an adjustment to improve this issue? Look, it 's not common for phytocannabinoids to leave a person drowsy until the next day. They don't have that effect. It's different from other substances that can, depending on the time of day, cause drowsiness. The text discusses the effects of cannabis products on sleep, suggesting that some people might sleep for hours and hours longer than usual. It explains that cannabis products don't cause this problem, and that depending on the underlying issue, even using the same substances the following day won't produce the same drowsiness as taking them at night. The text also notes that many people experience the dual effect of taking the same substance at different times of day, resulting in different reactions. The text then suggests seeking adequate pain or spasm control and using certain doses of CBD or THC to avoid drowsiness the next day, while still achieving a good night's sleep. Finally, it notes that during a consultation, the assessment is important to understand the root cause of the insomnia and how it can be resolved. The text suggests that the problem might be resolved immediately or require further investigation. In that case, certain substances, even if they induce drowsiness, might not be the answer, maintaining non-restorative sleep.

[00:23:51]What's being harmed, and if not addressed properly, will increase the long-term risk. So that 's the importance.

[00:24:02]Now, still talking about sleep disorders, a topic we really like to address in cannabis and health, right? We'd like to discuss minor cannabinoids, especially in recent years, with the emergence of cannabinoid CBN. Products rich in this cannabinoid have also been widely used in the treatment of sleep disorders. I wanted to know if you have experience prescribing this type of cannabinoid and what you observe in practice with patients with insomnia?

[00:24:35]Perfect. CBN is a cannabinoid derived from the oxidation of THC. So, over time, THC converts into this substance which has a different action profile and therefore doesn't cause the same type of psychoactive effect as THC.

[00:24:57]Hence its use at night due to this effect of inducing drowsiness without causing the same discomfort, the same side effects that some people may experience with THC. It's very interesting.

[00:25:14]In certain cases, of course, we will do... Treatment optimizations involve using phytocannabinoids in a series of steps, adjusting doses, and creating a comfortable environment for introducing certain substances.

[00:25:33]Throughout these investigations, a more direct shortcut to sleep has often been CBN, which is safer, with fewer side effects and adverse reactions, or fewer dose-dependent surprises. So, all phytocannabinoids are important; they all have their therapeutic effects. CBN has certain advantages for certain indications that can outweigh this effect and often be preferred depending on the patient's profile, achieving an effect in reducing the time it takes for a person to fall asleep and, for example, reducing nighttime awakenings.

[00:26:33]Often, THC can cause tachycardia, which can wake a person up with a racing heart during the night. This can sometimes happen as a side effect. With CBN, this risk is even further reduced.

[00:26:50]Great. And now I'd like to ask about a population that also has the potential to benefit greatly from the medicinal use of cannabis, which is the elderly. People in their third age... Older adults often experience sleep problems, their bodies are undergoing transformation, and I wanted to know if there are any extra precautions, any special care in the treatment of sleep disorders for elderly people using cannabinoids.

[00:27:19]Certainly, this is a profile where we should avoid certain situations at all costs, and one of them is falls.

[00:27:30]Any alteration in the prescription for elderly people will lead to a potential increase in certain risks, and the risk of falls is the biggest alarm of all. So, whether it's introducing a cannabis product, or changing blood pressure control medications, which many patients may even neglect, leaving them without proper monitoring by a specialist, a cardiologist, but also the use of certain medications that become part of a routine, such as eprazole, medications that the patient sometimes uses once and continues indefinitely.

[00:28:18]And then this generates situations where many patients are using three, four, five types of medication, all for the same organism to metabolize, for the same liver to metabolize.

[00:28:33]And in this situation, the risk can sometimes be cumulative. So, sometimes, using a diuretic, uh, medication that will alter... In blood coagulation, factors can both hinder and increase, decrease, or improve it. So it's important, it's fundamental to have this complete list to weigh each component of this equation. It's an equation where each factor has its importance, it has to be known, it has to be predicted in these unfoldings, in these consequences. And this individualization is a very original factor in the monitoring with cannabis products because of the possibility of adjusting compositions.

[00:29:30]Traditional medicine doesn't address this type of reasoning. Medications are standardized, a 500 mg tablet will be practically the same for everyone. A child makes an adjustment, but there's no way to alter it or a reference point to alter it in the same way as is found within cannabis products, whether the phytocannabinoids are larger or smaller. And these are complexities that are constantly being refined, scientific advances that continue to happen, situations that the doctor needs to be very up-to-date to keep up with.

[00:30:16]Going back to our chat, Rafael from Teresópolis, my fellow countryman, sent this here, look, he sent this here in our chat. Do the treatment for Anxiety and depression: I use high-spectrum CBD oil in the morning and a 1:1 ratio with THC at night, combined with fluvoxamine malate. Physical activity also helps a lot. Wow, that's great, Rafael. Explain to us how you arrived at this combination.

[00:30:45]This combination might work really well for you, right? Or it might not work for me, for the doctor, maybe another combination would be better. Explain to us how you arrived at this very interesting combination. And the doctor also explains if there are any interactions with the medication he says he uses.

[00:31:06]Well, certainly the liver is metabolizing both fluvoxamine and phytocannabinoids and other substances that he continues to ingest through food.

[00:31:19]And that's where this monitoring really comes in, because CBD will have a different effect than THC; the perception can change both when used alone, in the case of using it alone, but also with a full-spectrum oil or together with THC in a known proportion.

[00:31:44]The one-to-one ratio doesn't provide complete information either. In the same way that The percentage notation is relative, not absolute.

[00:31:59]Therefore, more information is needed for certain conclusions, but in general, the combined use of CBD and THC enhances the therapeutic effects of each and reduces adverse side effects. So, excellent. That's good. I really liked this composition and congratulations.

[00:32:28]And Maria José from Curitiba also came here. Good evening, Maria José. She asks if it's also indicated for depression. We've already discussed this here, right, talking about sleep disorders, talking about anxiety, whether cannabis- based medications are also indicated for depression.

[00:32:48]Well, the endocannabinoid system has a different part from the parts where antidepressant medications act. And it's complicated to talk about it in certain terms, because treatment for depression is generally related to major depressive disorder, which may include depressive symptoms among its various symptoms. So, depressive symptoms can be present in this nozological entity, in this pathology, in this disease, in this disorder that is major depression, as well as in any other "Illness, right? And then cannabis products have an action, I wouldn't say antidepressant in the classic sense of what is understood as an antidepressant effect, but rather an activating, awakening, motivating effect, that increases interest, increases pleasure, increases curiosity in various situations, at various ages. And then it becomes very difficult to say in the classic term an antidepressant effect, but certain cannabis products can have this activating effect and that could be an explanation for this duality of action, acting one way in the morning and acting another way at night.

[00:34:32]Rafael answered us here, we talked a little about his routine, he said yes, that it's a very personalized treatment and that's fundamental. The close monitoring by the doctor, the psychiatrist, the health professional is fundamental for the success of the treatment. He brought more details here for you to comment on, Dr. Vinícius, look, high CBD at 20% in the morning and the oil at 1 to 10% at night. Follow the doctor's instructions."

[00:35:00]Raquel, and we're adjusting the dosages according to my own experience. I'm studying and discussing it with the doctor.

[00:35:06]This open dialogue, this frank communication between the patient and the healthcare professional, is very fundamental, isn't it, doctor? How do you see this relationship and this exchange? What is the most frequent follow-up you recommend in these cases?

[00:35:21]Absolutely. Well, this attentive observation allows them to identify any need for early intervention, whether it's adjusting the medication, increasing or decreasing it, adding another phytocannabinoid, or adding some other medication.

[00:35:44]So, it's a refinement that is fundamental to obtaining the result. And this treatment with cannabis products requires this individualization, this personalization that is being increasingly incorporated into various areas of medicine.

[00:36:05]Lifestyle medicine, integrative medicine, are forms of complete vision of the patient, holistic and integral, not in a mystical sense, but in the sense of observing the body as a whole, the habits, the patterns.

[00:36:27]And I take this opportunity to remind you that Dr. Vinícius de Mesquita is on our cannabis health scheduling platform. You can easily schedule a consultation with him in just a few clicks and receive a complete, individual assessment from Dr. Vinícius de Mesquita to find the most effective and safest treatment for your case. Each case is unique and deserves a detailed analysis. So, we'll put the link to our scheduling platform here in the YouTube chat, and you can also click and access the cannabis health scheduling platform below in the video description. It's crucial to have close monitoring when you're undergoing treatment with cannabis-based medications, and especially it has to be with an experienced person, someone accustomed to this type of therapy, like Dr. Vinícius de Mesquita, who is here with us today. To continue with our program, doctor, we're going to talk about another motivation for people to seek cannabis treatments, which is pain. Various types of pain bother people, especially chronic pain.

[00:37:40]And the treatment Pain has been one of the most prevalent and common reasons people seek treatment with cannabis-based medications. What type of pain? In your clinical practice, what type of pain is most prevalent? People usually prefer to seek treatment for what type of pain?

[00:38:01]Ah, generally, muscle and joint pain. And there, lower back pain has the highest prevalence and frequency. And comparatively, it's even greater than neuropathic pain. Thankfully, neuropathic pain, which is related to some injury due to diabetes or trauma.

[00:38:34]Even this musculoskeletal pain, muscle pain, can have excellent results with cannabis products.

[00:38:42]So, certain pains will require certain more specific phytocannabinoids. And then we can segment according to each type of pain, as I said, musculoskeletal pain in one way, neuropathic pain in another.

[00:39:03]And we will modulate according to each type of pain. And the benefit is observed according to this segmentation. Not all patients will respond in the same way. The composition is the same.

[00:39:19]And then the THC can have an adjusted proportion to produce a reduction in pain, with a more direct analgesic action.

[00:39:30]But on the other hand, let's say, it can cause dizziness. And that's where the individualization of treatment arises, the need for this monitoring, this close doctor-patient relationship.

[00:39:45]Often, acute pain has an origin that is, let's say, called nociceptive, and it's also very common in fibromyalgia.

[00:39:57]And then certain compositions won't have the expected result. That's another point where cannabis products may seem to be failing. So, a person has a condition, has an excellent result in skeletal muscle pain, wants to share that with everyone, recommends it, the person goes there, uses it, and doesn't get the result. So, there has to be this particularization of pain to adjust the composition for fibromyalgia.

[00:40:30]A certain composition is more suitable.

[00:40:32]Fibromyalgia pain has a certain characteristic. Diabetes pain has another characteristic.

[00:40:39]Repetitive strain pain, another characteristic. And then we adjust the composition for each of them to have a result and say: "No, cannabis works for..." "Pain." Generally speaking, yes. And we're going to look into how to make that effective, how to make that happen.

[00:41:02]Great. We've already had some questions about pain in our chat.

[00:41:07]Jessica, from Jundiaí, asked about the use of cannabis-based medications for endometriosis.

[00:41:16]Are there indications for relieving endometriosis symptoms with cannabis-based medications?

[00:41:24]Yes, definitely.

[00:41:27]Endometriosis will be addressed both in terms of pain, pain reduction in a direct analgesic way or indirectly by reducing inflammation, in the search for homeostasis, the body's balance, regulation of the menstrual cycle, direct and indirect ways, more or less specific, that will show the result. And then yes, the indication of cannabis products for endometriosis is not something directly like the first indication, but inserted in this context of analyzing the patient's phenotype, what they are observing in terms of symptomatology and how the pathology has its physiology described, its alterations. It is possible that a cannabis product will have this result of having a better Control in various cases is varied, right?

[00:42:40]We're talking here in the live stream about anxiety, insomnia, pain, which also applies to endometriosis, but it's not just pain that's present in endometriosis, which can be adjusted and improved with cannabis products.

[00:42:57]Great. And also bringing up another painful condition here, Gabriela, she talked about headaches. Uh, she had previously commented on migraines. For these cases of headaches and migraines, do you also see possibilities for therapeutic effects with cannabis-based medications?

[00:43:20]Yes, yes. And it's very important, as I always emphasize, to get to the root of the problem, what's causing it?

[00:43:28]Is this headache actually a migraine, a headache that has another mechanism, is it tension-related, muscular, or is it dehydration, lack of water, or caffeine addiction?

[00:43:48]So, a little bit of everything has to be observed because it's a symptom very much shared with various pathologies, right? Migraines.

[00:43:57]Classically diagnosed and treated, cannabis products wouldn't be a first-line option, but it's common for patients, even those with a confirmed diagnosis and undergoing specific treatment, to still not find good results. And traditional medicine often doesn't know what else to do. In this context, cannabis products can continue to surprise and deliver different results, something that each specialty might not consider necessary to optimize specific treatment.

[00:44:40]Cannabis products can achieve this through modulation of the endocannabinoid system, either through a more direct action on symptoms or through modulation that provides homeostasis, rebalancing the organism.

[00:44:59]So, migraines can be approached and studied in various ways, but I would say that cannabis products do show good results in treating migraines.

[00:45:13]Now, speaking of pain, not only headaches but other types of pain, what combination do you see working best?

[00:45:25]Is it more CBD, more THC, etc.? What is the combination that usually works? Of course, always, understanding that fine adjustments will sometimes be necessary.

[00:45:37]Well, it's very common that prescribing CBD alone isn't adequate for the pain, just as THC alone doesn't produce results. And in this process, fine-tuning is necessary, as you said, right?

[00:45:59]Creating a suitable environment to deal with certain effects that are possible, expected, can be tolerated, and can be adjusted according to each case. And the composition of the cannabis product will dictate this rhythm.

[00:46:25]The affinity between the phytocannabinoid and the receptor is unique to each individual. So THC has a certain affinity that CBD doesn't. And the composition needs to be adjusted accordingly.

[00:46:48]So if THC binds very easily to a certain receptor, it's necessary to overcome that with CBD. And in this process, adjusting the dose successively, increasing it slowly, moving towards finding a dose that more effectively controls the pain with an optimized dose, mainly of THC, based on the possibilities that CBD provides. To reduce side effects and adverse reactions. So, each case is specific, but it is entirely possible to live with pain in a different way through the use of certain phytocannabinoids. I would n't say to eliminate pain completely, right? In certain cases, yes, that 's not the reality for everyone. sound alive. Sharp, excruciating pains, pains of cancer origin.

[00:47:59]Neuropathic injury due to diabetes, post-stroke injury, phantom limb pain, trigeminal neuralgia, various conditions in which pain is a condition that practically makes normal life incompatible.

[00:48:23]And although it doesn't eliminate addiction entirely with cannabis products, it allows a person to have an active life, return to a routine with leisure time, spend with family, engage in physical activity, and take other actions that will naturally produce the substances our body produces to generate this well-being. Okay? And in convergence, everything combines to achieve the result: controlling pain, using cannabis products and the body's own products, such as endorphins, which provide our own hormonal stabilization and homeostasis.

[00:49:13]You mentioned hormonal balance, and a very interesting question came up in our chat about menopause. This is Sandra Cristina Salgado who sent this: "Good evening, I'm from São Paulo, I'm going through menopause, I've been on hormone replacement therapy for 5 years, but it has n't solved my sleep problem. I always wake up at night, I can no longer sleep deeply." It would be suitable for use, recommended use. So, in that case, you would indicate that she's already undergoing hormone replacement therapy for quite some time, and sleep continues to be a problem for Sandra. Do you think that cannabis-based medications could be a useful tool in her case?

[00:49:59]Well, it's in this quest for homeostasis, without a doubt. So this rebalancing that the body acquires after modulating the carbabinoid system is something that can bring about a different result, especially in her view, given that she has been on treatment for a long time, doing this hormone replacement, and knowing that the composition will alter the outcome.

[00:50:26]So, it may indeed have an indication for use, and over time, optimization and adjustment can lead to certain more specific phytocannabinoids. We were talking to Rafael, right? Rafael, thank you very much. He shared a bit about his treatment with us here during this live stream, and now at the end he mentions that THC is very important to him. He wrote: "I feel that THC is very important to me, but at the same time it requires more attention to its use."

[00:51:01]It's mainly about everything we've been talking about and bringing up here today, right, doctor, that THC can cause some adverse, uncomfortable effects, and CBD is there to help make that adjustment. Thank you so much, Rafael, for sharing your treatment with us. Yes, and it also ties in very well with the theme of our live stream, which is the individualization of treatment, showing how something that works for one person may not work for another. In your case, THC is proving very important.

[00:51:34]Here we also have another colleague who came to the site in the chat, he says: "I've been using CBDF Spectrum for over 3 years for anxiety. At the time I was using this italopran and little by little I was withdrawing it. I increased the number of drops while decreasing the number of CBD drops. And it's working really well. Thank you very much, Zé. It's very, very cool to understand that you can reduce the amount of italopran a little and increase the number of drops and it's working better for you. You, Dr. Vinícius, do you usually encounter these cases in your practice where the patient is taking this italopran and needs to make this transition from one medication to another, to cannabinoids?

[00:52:23]Yes, it's frequent with various antidepressants, not just italopran, but sertraline, desgrenofaxine, fluoxetine.

[00:52:35]We will always be looking for the lowest doses that have the best effect, the smallest amount of medication. And in this search, it's frequent that we Note that certain medications sometimes become less necessary. So, it can be a good time to consider how an adjustment might impact your treatment, perhaps renewing an established regimen that wasn't yielding good results, even temporarily, without implying any superiority.

[00:53:16]It's perfectly possible to reduce some medications while maintaining good symptom control. Similarly, combining medications can sometimes offer advantages over using each medication individually.

[00:53:32]Great. I hope you enjoyed this and can share your experience with us, friend Zé Oliva, Dr. Vinícius Mesquita. We're nearing the end of our live stream.

[00:53:49]We're almost at 50 minutes into the conversation. Thank you again for sharing some of your experience with us. Now, the microphone is open for you to send a message to our viewers. Send your thanks in our chat. And Dr. Vinícius, to conclude, tell us... What would you say to patients to convey this image of patience, this hope that the treatment will be effective, but that they need to be careful and have follow-up care?

[00:54:26]Look, it's very difficult to compare cases, even between people from the same family. So, sometimes the patient arrives with an expectation, having already tried, tried in various ways, and it didn't work.

[00:54:48]Cannabis always has a message, I would say, of hope that it's possible to have a different result, even if treatment has been stagnant for a long time without yielding the same results. When you start interfering with this other part of the human body, which is the endocannabinoid system, it's possible that other results will occur, results that are often not even expected by the doctor who was already following these established cases. So, it's always an opportunity to have a different result, to have hope for a sometimes better result, something sometimes unexpected, but in a positive sense. That's the happiness. The surprise is usually always positive, and the path of adjustment tends to have positive surprises and recoveries over time. Sometimes the patient wasn't expecting it, wasn't counting on it anymore.

[00:55:58]And speaking generally, considering the various particularities of each pathology, but also at different ages, at each moment, whether in childhood with the acquisition of new skills in autism, for example, or in post-stroke recovery, sequelae of stroke, sequelae of spinal cord trauma, dementia, neurodegenerative processes, or the performance of healthy adults, their concentration, focus.

[00:56:49]So, it's a plant that, let's say, has served humanity since the beginning and at all ages, always positively, always with great joy.

[00:57:03]Great. Yes, in fact, it's a very old use, a very traditional use that is returning, is returning now, returning with new technologies, with more sophisticated products, with techniques and ways of monitoring the patient, especially the tests, which you mentioned at the beginning of our live stream, which are fundamental to monitor liver function, to monitor the medications and substances circulating in the blood so that the treatment... Bring well-being, right?

[00:57:37]Bring quality of life.

[00:57:40]Perfect.

[00:57:41]So, Dr. Vinícius Mesquita, I am very grateful for your presence here on our live stream.

[00:57:48]To conclude, I recommend that everyone watching click on the link below to schedule a telemedicine consultation with Dr. Vinícius de Mesquita. And doctor, I hope to see you here in a future live stream where we can have a chat as great as the one we had today, a productive conversation with so much content, where we can also answer questions. I believe everyone had many questions answered in our chat, and here's my hug, doctor. Have a good night, have a great week now, World Cup week.

[00:58:29]Good night, thank you very much for the invitation.

[00:58:31]I am available. Regarding various Cannabis topics, I like to discuss them all and I am available to chat more.

[00:58:41]And to finish, I ask you who are watching to subscribe to our channel, subscribe to the Cannabis and Health channel on YouTube.com Please continue following us on our other social media platforms as well, on Facebook, Twitter, and especially Instagram and LinkedIn. We also ask that you share this live stream with your friends, relatives, and everyone you think could benefit from cannabis-based treatments.

[00:59:08]Good night!