As the Medical Director of the DENT Neurologic Institute, Dr. Laszlo Mechtler’s credentials in the world of medical cannabis run deep. Serving over 15,000 patients, DENT has become one of the leading medical cannabis research & treatment facilities in the country. Dr. Mechtler was kind enough to sit down with CannaBuff’s own Geoff Brown for a discussion about medical cannabis. While his path into medical cannabis was indirect, his insights and knowledge on the topic have helped put DENT on the forefront of this budding industry with enormous potential.
Geoff Brown: What do you think about how hemp-derived cannabidiol products are regulated in NYS?
Laszlo Mechtler: As a whole, NYS has done a better job than most states and even the federal government when it comes to regulating cannabis products (hemp-based CBD and marijuana). If you look at the rules and regulations NYS has put together, they tend to be well thought-out and focused on consumer protection. Now are they perfect? No, not by any means, but they offer guidance to an industry that is largely self-regulating.
GB: What can you share with us about the research you’re involved with regarding CBD and/or medical cannabis at the DENT institute?
LM: Since the NYS medical cannabis program came online in 2016, we have built one of (if not) the largest physician directed medical cannabis clinics in the country with more than 15,000 patients. The sheer size of our clinic affords us the ability to study many different disease states and conditions. Our studies have included Migraine (the second most debilitating disease globally), Neuropathy, Trigeminal Neuralgia, Glioblastoma, Parkinson’s, Multiple Sclerosis, Anxiety, Depression, Cannabis use in those over 75, Treatment outcomes between different races, as well as several others which are ongoing. The overarching theme for each one of these studies has been when used appropriately under the guidance of a qualified medical professional not only is cannabis therapy efficacious, but many times allows one to reduce their consumption and/or transition off of standard pharmaceuticals (many of which come with a host of negative side effects). I would also be remiss if I did not mention we have engaged with a number of research collaborations with very large companies in the space to research their products and further legitimize the plant as a medical treatment.
GB: What’s your take on vaping cannabinoid products? Is it safe? Or do we need to know more before we can determine that?
LM: Let me first say, as an oncologist and the Chief of Neuro-Oncology at one of the country’s top cancer hospitals, it is difficult for me to endorse the smoking and/or vaping of any product. Over my 30-year career I have counseled patients on how to stop smoking tobacco due to the well documented and studied health risks. That being said, due to the federal status of cannabis, we have not been able to sufficiently study smoked or vaped cannabis products. As such, we do not have enough data (short or long-term) with necessary scientific rigor to state whether or not use of smoked or vaped cannabis products are safe. This is something that has been highlighted by two recent events: the vaping epidemic (this was ultimately tied to tainted products which in part stems from poor regulation at the federal level), and the ongoing COVID-19 pandemic which is a respiratory illness which we know is more likely to affect those that smoke. Therefore, if one smokes or vapes cannabis products, my recommendation has been to change to other 3rd party tested products such as tincture or capsules.
Now, will I recommend vaped cannabis products to a certain subset of my patient population? Yes, due to the pharmacokinetics of this modality, given its rapid onset vaped products can work well for those that need an abortive for immediate symptom relief lasting (2-3hours). Though other modalities are preferred for prophylactic (preventative) treatment as they come with longer half-lives (6-8 hours). However, no matter what cannabis product is used, it must be 3rd party tested and come from a reputable source. In closing, we need more research before we can determine if vaping of cannabis is safe. Which should not come as a surprise, as we need more research to unlock the full potential of this plant in general.
GB: A lot of patients are turning to CBD and medical cannabis in hopes that they’ll use these products to transition off of their prescription meds. Is this a safe expectation for the public to hold? Or do you think the dialogue around CBD and medical cannabis should change to be more conservative regarding possible medical benefits?
LM: On a daily basis patients come to the DENT seeking to transition off their prescription medications mostly due to negative side effects. For many patients cannabis products present a viable option to reduce one’s consumption of traditional pharmaceutical interventions. While we do routinely assist patient’s transition off medications such as opioids, each case is unique and needs to be treated as such. Cannabis is not a panacea and for some individuals is not a viable option. While in some cases we see upwards of 50% of a patient population completely discontinuing their standard prescription medication, it is much more reasonable for one to anticipate being able to reduce their consumption of medications (oftentimes by significant amounts) which in many cases addresses the associated side effects. However, it is vitally important that one talk to a qualified member of their care team before making any treatment decision.
GB: What has been your experience at the DENT with patients using CBD and/or medical cannabis to try and transition off of prescription drugs like benzodiazepine and opioid medications?
LM: In my clinical experience, cannabinoid products have helped many patients dissatisfied with their current treatment regimen. My team and I have assisted countless patients to successfully reduce their consumption of conventional pharmaceuticals, and in many cases completely discontinued these prescriptions entirely. When we conduct our research studies this is something that we watch closely, for example, in our chronic migraine population 56% of opioid users reported dose reductions of which almost half were able to discontinue opioids entirely. In a different study, we evaluated the ability of those suffering from comorbid anxiety and depression to reduce consumption of benzodiazepines and/or SSRIs. We found that 35% of those using Benzodiazepines were able to decrease consumption of which 55% discontinued consumption entirely. With regard to SSRIs 16% of patients reported being able to decrease their consumption of which 75% discontinued this medication entirely. That being said, this is only a small sampling of the conventional pharmaceuticals our patients have been able to reduce intake of or transition off of. Once again if a patient is dissatisfied with their current treatment regimen and would like to explore cannabis therapy, I would recommend that they consult a knowledgeable member of their care team before making any treatment decisions.
GB: Do you have any concerns about the legalization of cannabis for adult-use?
LM: As a physician I have a number of concerns with the adult-use legislation that was recently passed. First, medical providers and medical societies have been largely excluded from talks surrounding medical and adult-use legislation. In my opinion this is a mistake. If we truly want to legitimize this plant as a medicine, medical providers and medical societies need to have a seat at the table. Second, I am concerned that the legislation will negatively impact the medical program. In its current form the medical program is cost prohibitive to many patients (40% of my patients report the program is cost prohibitive) which may cause them to self-medicate via the adult-use program which will most likely be less expensive. I also am concerned about home-grow as cannabis plants are hyperaccumulators meaning that they absorb toxins from the soil such as heavy metal, insecticide, etc. Now if you allow people to grow plants at home and the plant is not being tested, you could potentially have consumers ingesting things such as lead which presents as a substantial health risk. Lastly, the health ramifications of smoking cannabis are largely unknown, yet we are going to allow that. Just to add context to this, several studies have been conducted evaluating the differences between smoke cannabis and traditional cigarettes, and it was found on average cannabis produces 4 times the amount of tar. That being said many parts of the legislation are open to modification and I am hopeful that the proper provisions will be put in place to protect Cannabis consumers in NYS.
GB: What first sparked your interest in cannabis-based medicines?
LM: This surprises a lot of people, but I got into cannabis by duress. When New York first rolled out the program, I had no intention of certifying patients for cannabis as everything I was taught to that point indicated cannabis had no place in a medical practice. Though being the largest neurological institute in the country and 10 out of the 11 qualifying criteria being purely neurologic, we were receiving more than 500 calls per day. After a week my team and I knew we had to do something so we opened the clinic and I read everything I could regarding the use of cannabis in medicine. While initially skeptical I began to see this plant change the lives of patients I had been treating for years. I’m talking patients that were on high dose opioids for poorly controlled pain, those that were in wheelchairs because it was too painful to walk back to the clinic in a walker and then a cane. Each time these patients would hug me and say you changed my life, but in reality it was this plant. It is seeing this transition in my patients time and time again that has changed me from a skeptic to an advocate, and drives me to legitimize this plant as a medicine.
GB: What does the future look like for you in regards to DENT cannabis?
LM: In my opinion the future looks very bright for the DENT Cannabis Clinic and Research Center which continues to grow on a daily basis. While we are yet to see how the adult-use legislation will affect our medical cannabis clinic given the amount of research that is needed to unlock the true potential of this plant I am confident we will be part of many exciting advancements in the years to come.
More about Dr. Mechtler
Dr. Laszlo Mechtler is Professor of Neurology and Oncology at the State University of New York at Buffalo. He is UCNS certified in Neuroimaging, Neuro-Oncology and Headache Medicine. Dr. Mechtler is the Medical Director of the DENT Neurologic Institute. His training includes institutions such as MD Anderson and the State University of New York at Buffalo. He is a past president of the American Society of Neuroimaging (ASN) and the Hungarian Medical Association of America (HMAA). He was the guest editor of the 2009, 2014 and 2020 editions of Neurology Clinics on ‘Neuroimaging”. He served on the Executive Committee for BrainPAC through the American Academy of Neurology (AAN). He also serves as the Medical Director of Jushi, Inc. Dr. Mechtler has published some of the first major retrospective research trials on Medical Marijuana in Headaches and other neurologic disorders. Dr. Mechtler lectures both nationally and internationally and is recognized as a leader in the fields of Neuroimaging, Headache Medicine, Neuro-Oncology, and Medical Cannabis. He is the Director of the DENT Cannabis Clinic, which has more than 15,000+ patients certified through the NYS MMJ program and continues to grow each day. Dr. Mechtler is also the Founder/Medical Director for the MIND Institute in Budapest Hungary which opened in Fall 2020.
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