Cannabis Can Enhance Sexual Function and Connectivity

Steps to Safely Intensify Libido, Intimacy & More with Dr. Jordan Tishler.

Medicinal cannabis has been studied and administered for health benefits like chronic pain reduction and chemotherapy-induced nausea. Compelling—while currently more limited—evidence shows that a small, controlled dose of cannabis can also improve sexual function in the four main domains: libido, arousal, orgasm, and bonding. The optimal medium to use is cannabis flower (to avoid harmful byproducts and have predictable effects) with a vaporizer that has proper temperature regulation and dose control. It’s also important to wait about 10-15 minutes between each inhalation because effects are delayed. Just one or two puffs has impact for most at the recommended dose, and more can be counterproductive. See more details in Dr. Jordan Tishler’s protocol below.

In this episode…

Episode Intro … 00:00:40
Cannabis Can Enhance Sexual Function … 00:07:38
Can Cannabis Cause Hormone Issues? … 00:12:09
Guidelines for Safe Cannabis Dosing … 00:16:33
Best Forms of Cannabis for Sexual Impact … 00:19:57
Monitoring Your Dose & Frequency … 00:27:08
Vape Devices Don’t All Give the Same Dose … 00:29:39
Considerations for Avoiding Toxins … 00:34:41
Is CBD as Beneficial as People Think? … 00:40:07
Research on Cannabis and Sexual Function … 00:48:26
A Starter Protocol for Cannabis & Sex … 00:53:39
How Does Cannabis Enhance Bonding? … 00:57:38
Episode Wrap-up … 01:00:03

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Episode Intro

Dr. Michael Ruscio, DC: Hey everyone, welcome to Dr. Ruscio Radio. This is Dr. Ruscio. Today I’m here with Dr. Jordan Tishler. We are going to be talking about something very interesting, hopefully—anyway, it is to me—which is the potential of medicinal cannabis to enhance sexual function and sexual intimacy, and explore this realm which we haven’t really discussed. So I’m very curious to launch into this conversation and to pick your brain, Jordan. Welcome to the show and thank you for being here.

Dr. Jordan Tishler, MD: Thank you for having me. I’m looking forward to it.

DrMR:  Let me lead by just sharing my experience with this. And then the next thing I’d like to do is just have you tell people a little bit about your background. But really quick, before we do that, I had noticed personally, with my experimentation with a combination of CBD and THC—I tried to experiment with cannabis to see if some of the Internet popularity you’re hearing about is something that I can correlate personally—there are certain areas that I’ve found it to be fairly effective for. I think I’ve shared in the podcast before, when I’m in a mode of workaholic-ness, a blend of THC with CBD can really shut me off, which has been helpful in that capacity.

One of the things I don’t know if I’ve shared on the podcast was, there have been a handful of times when I felt that with medicinal cannabis—and this does not happen with CBD alone, so I just want to clarify my experience for people, that this was a THC-CBD combination—the sexual intimacy and experience was electrifying. I mean, off the charts, absolutely on fire, which was pretty remarkable. But I had never heard that discussed anywhere else. I had heard about joint pain, sleep, anti-anxiety, anti-inflammatory benefits. So I thought, “Wow, maybe this is an experience that’s unique to me,” until I saw there was actually a company that makes a vaporizer pen specifically designed to help with arousal and with sexual connectivity. And when I saw that, I said, “Geez. There must be more to this, obviously, than just me having this somewhat unique experience.”

So we dug a little bit into this area. Jordan’s name came up as someone who has discussed this at length and has a fair bit to share here. So that leads us to our conversation today, which is one I’m very curious to hear your elaboration on, Jordan.

DrJT:   Well, I think that your experience is exactly what we would expect. I think that most people come into cannabis—whether it’s from a medicinal point of view or a recreational point of view—and have this ‘aha’ moment when they’re doing it and go, “Wow, this is amazing.” And there’s this long apocryphal tradition primarily discussed amongst women (because men don’t talk about anything, particularly with regard to sex… at least not honestly). But there’s this long oral tradition of discussion amongst the recreational population about using this stuff sexually. And there’s some really good evidence to support it at this point. And in my practice where I focus more on people who are having difficulties around sexuality, it’s been, to quote them, “A real game changer.”

DrMR:  That’s great to hear that. Again, I’m not alone in that observation. I’m sure that people are perking up a little bit because I know very few people who would not be interested in that proposition. And before we go a little bit more deeply into this conversation, tell people about your background, your practice, how you came to start using this in your office.

DrJT:   Sure. So what I typically say to people is, frankly, I come from a very traditional or conventional background. A billion years ago I went to Harvard College. And from Harvard College I went to Harvard Medical School. And then I trained in internal medicine at the Brigham and Women’s Hospital in Boston, which is another Harvard Hospital, earning me the affectionate badge of “Preparation H.” And then I went out into the world to practice medicine. And I gravitated towards emergency medicine, which I then practiced for about 20 years. The last 15 or so of those years, I was actually working for the VA.

And it was my experience in the ER at the VA that made me get into the interest of cannabis. Which is to say, as you might imagine, in the emergency room, I saw hundreds—if not thousands—of vets over the 15 years whose lives were really harmed by substances. Alcohol way more than any other substances, but other substances as well. And at some point when my state, Massachusetts, started talking about medical cannabis, I went, “Huh. It’s funny, I’ve never seen anybody sick from cannabis.” And I’ve seen so many hundreds or thousands sick from all these other things. Maybe I should look into this. Maybe there’s something there. As you might imagine, I went into my exploration in a somewhat skeptical fashion, as we doctors tend to do.

But after a couple of years of really digging into the medical literature, I came away pretty convinced. Convinced that it is a valuable medicine, that it needs to be done in a way that’s thoughtful, careful, and appropriately applied to each individual circumstance. And that we need to do things like figure out and control the doses so that we do this properly. So it can’t just be a willy-nilly thing, but in fact we can get a lot of mileage for people who are otherwise not getting what they need from conventional medications. And that led me to form my practice, which is called Inhale MD.

And the reason for that was really not because I wanted to be in private practice—that was never really on my agenda—but rather to be able to get around some of the federal roadblocks that were imposed upon these other major institutions. Certainly the VA isn’t touching this stuff. But even the Harvard hospitals, the private ones, are bundled up in all sorts of federal red tape around this. So what I’ve been able to do, then, is to work with my colleagues at these major institutions, because I have a private practice to whom they can send their patients. And that’s been very effective.

DrMR:  Gotcha. Certainly makes sense, getting yourself out of a bureaucratic situation to where you have a bit more freedom so you can explore. Obviously this is a little bit shrouded in taboo.

Cannabis Can Enhance Sexual Function

So how do you look at cannabis? Maybe the first simple statement: cannabis can enhance sexual function. It seems that there’s at least some veracity to that claim. But what’s your short elevator pitch regarding cannabis and sexual function and sexual intimacy?

DrJT:   I don’t think I have an elevator pitch version, but I will try to keep it short. I think one of the things that I realized when I started getting interested in cannabis specifically around sexuality was that, frankly speaking, what I needed to know had far less to do with cannabis and far more to do with sexuality. And in fact, when I write articles about this, I write about sexuality, and “Oh, by the way, here’s cannabis.” But the reality here is that what we need to effectively understand and use any medicine—but cannabis particularly—is to understand how sexuality works, and the differences between men and women.

And there’s a long literature stretching back to the 40s, but mostly the 60s, about how we think about this stuff. And really it can be broken down from a more modern perspective into four areas. There’s libido, or interest. Then there’s arousal—which is separate—which has more to do with the physiologic response, getting an erection, lubricating a vagina, that sort of thing. Then there’s orgasm. I think we have a pretty good definition of that. And then the fourth stage is satisfaction, or “was it good for you?” And along with “was it good for you?” is it good in terms of a bonding experience with your partner, and that sort of thing.

And so what’s really interesting is that then we step back and look at our conventional approaches to this. And frankly, we’ve got pretty close to bupkis. For men who have erectile dysfunction, which is that arousal phase, we’ve got a couple of medicines all in that phosphodiesterase-5 inhibitor class, like Viagra and Cialis. That works for that particular problem. It turns out that, amongst men, that’s only about 20% of men. And it tends to be the older men as well. But we don’t have anything to address libido. And we don’t have anything to address the issues around orgasm, either too swift an orgasm or difficulty achieving orgasm. And we don’t really have anything that enhances that intimacy.

And then if we look at women, we’ve got nothing at all. There’s one FDA-approved drug that tends to cause women to pass out, so we don’t use it very much. So we’ve got 51% of the population who may have issues around sexuality and we’ve got really nothing to address this with. And so then, enter cannabis. It turns out that cannabis works for both genders, and it works across all four of those domains. So if you have a man or a woman who’s not particularly interested in sex, but of course they’re in a relationship in which sex is potentially important and meaningful, then you have a conflict potentially. And using cannabis can stimulate that libido so that they can meet their partner in some middle ground.

Similarly, we see in men that small doses of cannabis can help with erectile dysfunction. And certainly in women, it can be relaxing and help with lubrication and muscular relaxation that’s involved in arousal. As you mentioned, cannabis can create very intense orgasmic experiences, for both men and women. And particularly it can also increase not just the intensity but the frequency, so that sometimes men can go more than once, and women can go… as long as they can go. But then the last factor, that intimacy or satisfaction, I think is where it’s really exciting, because it creates this bonding between the couple that may or may not happen organically. What’s also interesting is that we can see hormonal changes at the time that are provoked by the experience with cannabis, and not so much if you don’t have the cannabis on board. So we really get at all of the phases in a nice, neat package, in a way that no other medication can.

Can Cannabis Cause Hormone Issues?

DrMR:  Gosh, so a lot there to dig into. Let’s start with the hormonal changes, because this is something that I think men more often may read conflicting claims about on the Internet, conflicting with the statement that too much cannabis can enhance or elevate estrogen levels. Certainly that’s a concern. But how do you contextualize this? And is that maybe a misrepresentation of what the facts actually show?

DrJT:   Everything is in the gray areas in between, right? So the first thing I would say is that when we look at the utility of cannabis for the two genders, what we notice is that while it can be helpful for both, men are much more sensitive to the dosing. So there is an expression called ‘stoner boner,’ which basically is that if you use too much, you can’t really maintain the erection. I think that most of us who are male don’t think much about how much thought goes into getting and maintaining an erection. It’s unconscious thought. But if we disrupt the thinking, say, by taking a lot of cannabis and then having our heads orbiting Jupiter, not really focused in the moment with our partner, then things tend to wilt. So small doses for men are helpful, and larger doses are not so helpful.

To your question more specifically about the potential harms of use of cannabis, the first thing I would say is that cannabis is often touted as being completely safe. I think that there’s nothing in this world that’s completely safe. And if you overuse anything, it’s going to come back to bite you. That being said, I think with cannabis—compared to many other substances and medications—we have a bit more latitude than in other cases. What we do know is that prolonged use of cannabis can, in rare instances, increase estrogen levels. Not clear that that’s enough to make any difference. People start to worry about fertility issues. There are some studies that show men who are heavy cannabis users can have slightly decreased sperm counts, and (slightly more concerning) messed-up looking sperm. Meaning, they don’t develop normally and they don’t have their normal ability to swim the way sperm should swim. All of which is interesting in a test tube, but then what we really need to do is ask the practical question: do cannabis users actually have fewer children, or more trouble having children? And the answer appears to be no.

So what we have is what you can find in the lab versus what you find in the real world. And those things don’t match up entirely at the moment. I would say that when we think about sperm counts, most people make enough sperm that if they had a 10 or 20% detriment, it wouldn’t affect their fertility. There are certainly circumstances where that’s not the case, but those are minority situations. And I would certainly say to anybody who is using cannabis (now, I’m talking about men), “Look, if you’re trying to conceive, and you’re having trouble, then let’s get you off the cannabis and see if things get better.” But it wouldn’t be a foregone conclusion that this was necessarily the source of the problem. If we’re talking about women, you don’t want to conceive and you certainly don’t want to carry an infant while you’re using cannabis. There’s just too much unknown about this at the moment.

DrMR:  Sure. That’s incredibly well-said. It’s a point I’ve made on the podcast many times in different facets of healthcare, which is, if we see a change in a certain lab value, that doesn’t mean that that change in the lab value connects to a clinically significant impact in an outcome. So in this case, a change in estrogen levels may not lead to, as you very aptly put it, a change in fertility. So that may just be noise. It doesn’t really impact the signal of fertility, if you use the correct doses.

DrJT:   Yeah. It can be true that you’ve changed in estrogen level, but it doesn’t necessarily lead, as you say, to a particular outcome one way or the other. In other words, the lab isn’t necessarily wrong, it just doesn’t have any meaning in this context.

Guidelines for Safe Cannabis Dosing

DrMR:  Exactly. So, what are—and I know this may not be incredibly clear-cut—some guidelines to determine overuse? I’m assuming that these men that you’re discussing may have been using cannabis multiple times per week, as compared to maybe using it one to two times per week, to be considered acceptable. That’s just an arbitrary number I’ll throw out there. But how do we help someone know if they’re overusing, compared to using perhaps something more proximal to the correct dose?

DrJT:   Yeah, that’s a very interesting question…

DrMR:  You probably have the amount you’re ingesting, and then the frequency of ingestion. So that maybe complicates the case a little bit further. But any guidelines that you have, I’m sure our audience would be very appreciative of.

DrJT:   I think it really depends a bit on the circumstances. So if we’re using this stuff medically, I might be suggesting a greater frequency, not necessarily a greater dose. I find that people do well in the range of 5-15 milligrams of the THC component in general, almost regardless of what we’re treating. But the route of administration I think is very important, and the timing is obviously very important. So for some folks, we might be having them use it daily or even twice daily, say, if we were treating pain or something like that. But the studies were all done on recreational users. So there’s no basis for comparison because, in fact, there was no measurement of what they were using or how they were using it. It was simply, “Do use cannabis?” “Yes? Okay, fine. Let’s look at your sperm count.”

So what I think is we should probably be generally using as little as possible, within the bounds of using it properly to get the benefit we’re looking for. In essence, less is more. So if somebody is looking to have a sexual encounter two or three times a week, then that seems reasonable, and we can use a low dose to achieve benefit. And I wouldn’t imagine that that’s going to be a problem for fertility. And it’s certainly nowhere near what I would consider an abusive dose.

To think a little bit about the other end of the spectrum, we’ve got people who wake up in the morning and the first thing they do before their feet hit the floor is take a big hit of something, particularly if they’re using concentrate and doing things called dabs, which is a particular way of administering those concentrates that gives you a very high dose very rapidly. That’s been shown to generate some neurologic degeneration over a very short period of time, meaning like five years. Certainly we don’t want to be in that category. But that’s not relevant to a medical approach, or even to a thoughtful recreational approach. I think that behavior is pretty far off on the tail of “Please don’t do this.”

DrMR:  Yep. Absolutely. And I think your point is a good one, which is essentially, try to find your minimum effective dose. More does not mean better. In fact, more could be a bad thing. And I think alcohol is another good analogy. Not that alcohol is necessarily a medicine, but I think a small dose of alcohol, or a moderate dose of alcohol, can enhance someone’s extroversion. Too much of that and you will be falling out of your chair. So it’s finding that optimum balance.

Best Forms of Cannabis for Sexual Impact

You mentioned form. I believe some have speculated that you may have better sexual impact from an edible as compared to something that’s vaporized or smoked, but that could be complete hearsay. Do you have any thoughts in terms of the optimum form?

DrJT:   Yes, actually. There are three forms that get brought up, particularly in the context of sexuality. There’s inhalation, oral ingestion, edibles, that sort of thing, and then topicals get brought up a lot. Meaning, “Can I put the cannabis in a lube and apply it down there?” Let me actually start with topical, which I think is, generally speaking, not a great approach. And that’s because while there are cannabinoid receptors in our genitals, most of what goes on in sexuality actually occurs between the ears, not down there. So if we put the cannabis down there, frankly speaking, we’re missing 90% of the boat. There are reports of increased tactile stimulation using topical. But, again, it’s maybe a nice novelty, but it’s not really going to get us where we need to be.

The other thing to know is that it does take about 40 to 60 minutes for the cannabinoids to do anything down there. And I think that the vast majority of people would be well and truly onto smoking the cigarette and watching Netflix before 60 minutes have elapsed. Or put another way, I can’t imagine wanting to lube up an hour before you’re planning to have sex.

DrMR:  It kind of takes the spontaneity out of the moment.

DrJT:   Yeah, absolutely. So I tend to discount that approach. And so, if we’re thinking now about systemic, meaning either by inhalation or oral ingestion, then the issue is this: inhalation is very rapid. 10 to 15 minutes and it’s doing its thing, and then it wears off in three or four hours. Whereas the oral stuff is very slow and somewhat unpredictable in its onset. So it may be an hour or so, maybe even longer, for that stuff to kick in. Again, that puts a damper on the spontaneity. But the other thing is that, at least in the context of a partnered experience, you want both partners to get to the same place at the same time. And that’s very much not guaranteed when you use something orally, because the ingestion, the absorption, and the chemical reaction for each individual is going to be different. So really, when I think about partnered sexual experience, I tend to think about inhalation.

Lots of people talk about wanting to make romantic multi-course meals with cannabis infusions, etc. And to me, leaving aside the fact that I don’t think cannabis infusions taste that great, what I usually say is, “Look, make the meal. Let’s be romantic. But when it comes time to, either just before, or just after the meal, then vaporize cannabis to have that sexual benefit.” And I will say also that I think that not all vaporizing is equal. That if we really want to be most effective and safest, we want to vaporize cannabis flower (meaning weed) and not these little vape pen type things with the oil cartridges. Because while those are called vaporizers, they don’t actually control the temperature effectively. And as a result, they’re really combusting that oil and getting us the toxins that we would like to avoid.

DrMR:  Mm-hmm. Let me take one small step back for our audience and just make one clarifying remark. If you’re on the outside looking at cannabis and you haven’t experimented yet, you may have this picture in your head of a huge bong and some typified college stoner taking these massive puffs of smoke, which just seems very foreign and unappealing and almost hard to justify in any way. But when you’re using a vaporizer—either for flower, or a vape pen—you can really have a medicinal benefit from one small puff on one of these devices. And the amount of smoke is fairly minimal. The amount of odor is fairly minimal. So much of this is actually very clean and minimally theatrical, if you will. There’s not this big bong-like device with these huge plumes of smoke that you’re blowing out of your lungs. It’s actually fairly minimalistic, in terms of the intervention, and can be very clean.

And so I just want to paint that juxtaposition for people who might be picturing their college dorm room, a guy down the hall who is the typified stoner, wearing a tie-dye shirt, and having this huge bong in his room with a cloud of smoke. It’s a very different experience with more of this modern technology that we’re using. And also, when you’re not trying to get stoned out of your mind, the dosage is quite a bit less.

DrJT:   Absolutely. I think we’ve all been subject to a range of PR/propaganda, ranging from Cheech and Chong on up to Nancy Reagan and eggs in frying pans, and all that sort of thing. And unfortunately for those of a certain age and older, I think it’s very hard for us to get past and possibly we will never get past some of that internalized stigma. But the reality here is that, as you say, we’re using this in a calculated fashion, using devices that have been designed to be safe. And the idea is that we are getting just enough of this medication to do what we needed to do and not more. And we’re not going to drool on our shoes as a result of it. It’s not the way things are.

DrMR:  Exactly. A halfway decent analogy is actually of an inhaler. With some of these devices, it’s almost that clean, that sterile, and that minimalistic. So that may be a more befitting thing to picture in your head if you’re new to this and trying to justify the experiment to yourself.

DrJT:   I think that’s a very good point.

DrMR:  Thank you.

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Monitoring Your Dose & Frequency

Now, what about frequency? Certainly you alluded to this: maybe a few times a week may be okay. Is there a certain frequency at which people may want to be cautious to stay underneath, which may start directing them toward the border of overuse, from a sexual perspective? I think it’s different if you have this chronic inflammatory condition that you’re trying to quell. But more from the sexual endpoint, do you have any limits that you’d like people to stay underneath there?

DrJT:   You know, I think it’s less about the frequency per week, and more about the overall dose. So if somebody were using it two, three times a week, fine. If they were using it daily and it were helping, a part of it also is… what everybody would like is some sort of a definitive danger zone: “Don’t do this.” The reality is far more nuanced. What we have to do is say, “What is the level of the issue that we’re trying to address? And what level of risk are we willing to tolerate to achieve benefit?” The risk here is pretty small. If we’re talking about one to two puffs on a vaporizer, we’re talking about 5-10 milligrams of THC, assuming some things that are probably beyond the scope of our conversation today. But that’s a fairly small dose, compared to any recreational user. So if you are taking that 5-10 milligrams once nightly, all week long, and it’s benefiting you, then I think that’s reasonable.

Where it’s not so reasonable is if you’re taking six or eight puffs nightly, and then somehow it becomes in the morning too. And then after time it becomes in the afternoons. That snowball effect is problematic. And that’s part of the reason why I think you do this with some guidance from somebody like myself, to help you understand. Also because you see them back over time. On rare occasions I have turned to my patient and said, “Well, a year ago you were taking two puffs. And now you’re taking six puffs.” And then we have a conversation about being mindful about this, and gently trying to pare it back down towards the two puffs, rather than letting it escalate. I think that that’s a more nuanced answer necessarily than one would love to have, but that is the reality of it.

DrMR:  Sure. That’s very helpful, and also the remark that you made.

Vape Devices Don’t All Give The Same Dose

And is this a general approximation? I’m sure this could vary from device to device and from pen to pen, but if someone’s using a vaporizer device or a vaporizer pen, are they looking at roughly five milligrams per inhalation? Is that somewhat proximate?

DrJT:   No, not at all.

DrMR:  No? Okay, can you fill that in for people?

DrJT:   Yeah, sure. So I’ve seen devices put out as much as 20 to 30 milligrams per puff, particularly of these pen-type vaporizers. That one puff will knock most people on their tush, without question. And the other thing that’s challenging is, how do you tell somebody to take a partial puff? What’s half a puff? What’s a third of a puff? So for me, I’m happier with devices that actually put out less per puff. Because you can always take more puffs, but it’s hard to split hairs over a fraction of a puff.

So with the device that I tend to recommend to people, which is the Storz and Bickel Crafty—and by the way, I have no affiliation with them or conflict of interest, it’s just a device that happens to work really well—if you put cannabis with THC concentration of between 15 and 20% into it, then you can be assured if you take a full lung-full, that that’s between three and five milligrams. And basically the way you do that math is, you fill the bowl to full (which is a third of a gram in that particular device) and you figure out how many puffs it takes to exhaust it, and how many milligrams of THC was in there and just divide it out, right? That’s not real rocket science. But with that particular THC-level strain in that particular device, taking the puff in that particular manner, meaning, again, a full lung-full as opposed to a partial lung-full, then you can get a consistent response. So that’s what I teach my patients.

DrMR:  So the vaporizer device is called Crafty.

DrJT:   Crafty, yes. The parent company is called Storz and Bickel.

DrMR:  Gotcha. Okay, perfect. And then we’ll see if we can grab the link for that and include that in the notes for people. Those specifics are super helpful. Just to share some of my experience here, not that I am by any stretch an expert, but there is one company that I’ve liked called dosist, that has a very clean pen devoid of some of the plastics and fillers that you get in some of the vaporizer pens. And once you’ve pulled a certain amount of air through the device, it buzzes so that you have a consistent pull. So this way, instead of getting into the habit of gradually taking longer and longer inhalations, once a certain amount has been pulled through the device, it vibrates, it buzzes. And that tells you to stop and helps to try to standardize your dose, which I’ve found to be helpful. Especially if you’re getting more relaxed with this, I think it’s easier to take a longer pull, and maybe lose sight of how much you’re inhaling.

And it does make a difference. There is a notable difference, in my experience, between one puff and two. And that’s why I say, it’s not something where you need to be taking these huge bong hits as you may be picturing in your head. It’s actually a fairly small inhalation. And one, for me, has been enough to make a difference. Two, a little more. And when I get up to three or four, that’s when I’m getting put on my tush, as you’ve described it earlier. So just my perspective there too. Sorry, Jordan, anything that you want to add?

DrJT:   Well, I’ve not had the pleasure of actually dissecting a dosist pen, though it’s been on my agenda. My understanding is that if you follow the buzz, the vibration, then you’re getting about two and a half milligrams per puff, which is great. My concern around this particular device—well, all of these devices, again—is that they don’t make any specific reference to temperature. So while you may be getting the right dose of the medicine, you may be getting products of combustion because they simply don’t either have the technology, or make it clear to people at what temperature they’re vaporizing.

So I think if I had a chance to speak to the guys at the dosist company, I would ask them, what’s their temperature of vaporization? And could you make it more obvious to us, those of us who might be recommending or prescribing such a thing? That would be very helpful in terms of our understanding how it works and feeling comfortable with the device.

DrMR:  Okay. Well, we’ve been in touch with the people over there, so maybe I’ll see if I can connect you guys in the back end and get you an answer, to better give everyone an answer on that.

DrJT:   That’d be awesome.

DrMR:  Cool. So, more to follow there, guys, hopefully.

Considerations for Avoiding Toxins

And you also make a good point, which maybe we should clarify for the audience. Jordan, again, correct me if I’m wrong here, because I’m certainly a novice here in my understanding… you have a vaporizer pen, so the pen has this oil in it. And you also have these devices where you can put the cannabis flower and vaporize that, and that’s the Crafty device, I believe. You can also adjust the temperature of the heating with these vaporizers that you put the flowers in (the Crafty device), and that impacts the amount of medicine you get and also the combustion. I’m not familiar with all the nuances there, but that’s just something I want to paint for people, maybe to clarify some of the terminology. And Jordan, if there are any shades there you want to fill in, please.

DrJT:   Yeah, I think that that’s exactly right. For the oil pens, we don’t know what temperature they’re working at, so they may be burning things. There are also certain types of oils and additives that are just inherently bad for you. Medium-chain triglyceride, which is often coconut oil… when heated, you’ll be inhaling oil, and your lungs don’t like getting oil in them. There are terpenes, which are natural chemicals from cannabis, that are often added in addition to the cannabis oil to make this oily stuff runny enough that it works with the vaporizing device. And these can turn into carcinogens at relatively low temperature. There are some other additives, polyethylene glycol or propylene glycol, which are not used as much anymore, but also were things that turned into formaldehyde when heated. So there’s just inherently a bunch of problems that are associated with those oil pens.

In the flower machines, like the Crafty we talked about, you’re putting plain old ground-up cannabis into it, and they allow you to control that temperature exactly. In part, they’re bigger because they need a bigger battery, but also because they have a little microprocessor in them that allows them to actually measure the temperature at the point of vaporization (as opposed to either ignoring the temperature or estimating it based on some fancy math). So one of the things I like about the Crafty in particular is that you don’t have to change the temperature at all. It comes preset to an ideal temperature of 350 degrees Fahrenheit. Right out of the box, all you need to do is fill it and use it.

There are people who like to raise the temperature of their vaporizers because they think it makes them have bigger clouds, a more obvious, visible voluminous vapor. But actually that’s really not a good idea because, number one, more isn’t necessarily better. And number two, you’re getting everything you need in terms of the medicines at 350. So all you’re doing by raising the temperature is making the vapor hotter and less well-tolerated, and starting to generate some of those products of combustion that are harmful to us.

DrMR:  Oh, that’s great to know, because one thing that admittedly, on the user end, seems a bit intimidating is controlling the amount of heat with the adjustable vaporizer. So it’s nice to know that Crafty is preset to what may be the optimal amount of heat.

DrJT:   I always say, “350 like we were making cookies.” And everyone chuckles. It is in fact a set-it-and-forget-it.

DrMR:  Great. That’s really useful. I think the more we can do to make this user-friendly for our audience, the better. And I also want to ask you about the terpenes. So you’re going to get those with the flower also, because as I understand that, those are going to vary from strain to strain, from flower to flower. How are the pens perhaps exposing you to more? Do they concentrate the terpenes in the vape pen oils?

DrJT:   Essentially, yes. You’re going to get some terpenes with the regular cannabis. And that’s what we want, because we think that that may be influencing the things that people generate preference around. But what’s going on in the vape pen is they’re adding extra terpenes. So they’re saying, “Well, look, we can’t use some of these conventional chemicals like polyethylene glycol or propylene glycol, because they’re not very good for people. So what other chemical could we use that will help us make it a concentrate runny enough that it’ll work in the device?” So they hit on this idea of using terpenes, because the logic (which is flawed) goes, “Well, if the terpenes are already in cannabis, then if we can add more terpenes, it’s still the same.”

And the problem with that is a couple of things. The first is that it doesn’t get around the temperature issue. Whether you have a little terpene or a lot of terpene, you still probably need to control the temperature. Then the other thing is, if we think that these terpenes are in fact biologically active—meaning, limonene makes you upbeat, and myrcene makes you sleepy—then how do we know that more is not problematic? If a little is okay, how do we know that a lot is still okay? And I think that that’s very much up in the air. But the bigger issue in my mind overall is that of temperature control.

DrMR:  Gotcha. This is great. Very, very helpful.

Is CBD As Beneficial As People Think?

What about CBD? Obviously, I think it’s fairly tenable to claim now that CBD may be getting way ahead of itself, in terms of the claims that it’s making and the popularity that it’s receiving. I understand the allure. It’s non-psychoactive. But I am starting to think—and I don’t have a lot of details sussed out here just yet, but the inkling I’m starting to get is—you’re not going to be able to derive all the benefits from CBD alone that you would from CBD combined with THC. Now, what conditions benefit more from a combination rather than just CBD, I can’t say. I haven’t seen any data there. That’s just a hunch. But I’m curious what your thoughts are regarding CBD and how that interfaces into all of this.

DrJT:   Good and complicated question. I think your statement that CBD is getting ahead of itself is exactly right. And the bottom line here is that there’s a small raft of studies on CBD. Almost all of them were done in rodents. Very few in human beings. There are a couple of studies in human beings on anxiety, but none of them are long-term studies. They all look at single dosing. There’s this also one study on using CBD and acute psychosis in humans. But other than that, everything else has been done in rodents.

And what we know is that human beings are not rodents. It caused me to ask the question and go look up “What percentage of medicines that work for rodents fail in human beings?” You want to guess?

DrMR:  I’m so glad you’re about to give me this answer. 70%.

DrJT:   92%.

DrMR:  Wow.

DrJT:   Yes. Which really calls into question the veracity of any generalization from a rodent to a human being, not necessarily even related to cannabis.

DrMR:  100% agree. It’s a point I’ve made on this podcast many a time. Could not agree with that more.

DrJT:   So right now we’ve got all these claims being made, with very few studies in human beings. A few studies in rodents that are maybe not so applicable. But what’s interesting to me about the whole thing is that—whether we’re talking about rodent studies or human studies—what is consistent is the dose. It’s enormous. It turns out that the studies that have had positive benefits all use between 10 and 20 milligrams per kilogram. If you’re a mouse, that’s not that much CBD, because the thing weighs so little, right? But if you’re talking about an adult human, let’s say 70 kilos, you’re looking at 700 to 1400 milligrams of CBD a day. Well, first of all, that’s extraordinarily expensive.

DrMR:  That’s a ton. Yeah.

DrJT:   A ton, right. Plus nobody’s getting that. You go down to your corner Whole Foods, or you go down to your corner gas station and buy a little vape pen, and you might be getting five, 10, 20 milligrams total. So unless you’re going to basically suck on that vape pen, and drain it in a day… Think about it. That vape cartridge has, what, half a gram in it? That’s 500 milligrams. So you’d have to ingest the whole thing somehow.

DrMR:  And many of the CBD-only bottles are a couple of hundred milligrams at best usually. So that would be a whole bottle of CBD that costs like $100.

DrJT:   Exactly. It’d be more than that. It’d be several of those bottles, costing several hundreds.

DrMR:  I’m sorry, several bottles.

DrJT:   And no one’s doing that, right? So then you say, “Well, wait a minute. Why are all these people running around saying CBD is so wonderful, and all of these popular magazines want to write articles about it?” I think the answer is, it’s a placebo, right? That is to say, it’s a wonderful thing that you can do. And if you have the faith that it’s going to do something for you, then likely you will feel that it has done something for you. I’m not questioning the legitimacy of your feelings, but I am saying that they’re non-physiologic. And at least as a physician who’s looking to treat people in some demonstrably valid way, and perhaps as a society that likes to protect its people from spurious claims, then I think we need to really look at this.

I think CBD will turn out to be helpful to us someday, but probably not until we get a whole lot more of it available at a whole lot less price. And then we also probably have to think a little bit about the fact that CBD also can interact with conventional medications in ways that cannabis generally doesn’t.

DrMR:  My thinking here—and again, this is something that’s going to evolve as the evidence evolves—is CBD may have some merit for inflammatory disorders. There’ve been some people that have reported that CBD tinctures have helped with gut inflammation or joint inflammation, as two examples. But there have also been some patients who reported that same thing from cannabis flowers, where you have a combination. Could some of the people reporting benefit from CBD only be placebo? I think it could. I’ve seen enough where I lean in the direction of expecting the evidence to show a benefit for some inflammatory disorders. But again, I will modify that if the evidence at any point shows otherwise.

What I don’t think will happen is, we’ll see the same breadth of influence from the CBD alone as you will see from using the whole flower that has a combination of CBD, THC, and other compounds. And my personal experimentation has reflected this. I have not seen that sexual benefit by using CBD alone. In fact, I noticed zero sexually when using CBD alone. So my experience, I’m assuming, is going to be somewhat reflective of what the research will show as it advances.

DrJT:   Yeah, I think that’s right. There’s certainly zero literature on CBD for sexuality. Nor any real plausible reason to expect that it would be valid. But again, the thing is that if people are getting, say, a one-to-one vape pen (or whatever like that), then they’re getting a relatively smallish dose of THC, but within the therapeutic expected window. Whereas the CBD component is so far below that window, really what it’s doing is just diluting the THC. So I think that there are people out there that like these one-to-one ratios, because essentially, they can take more puffs on it before they become more intoxicated than they want. It doesn’t necessarily mean that the CBD itself is having an active role.

DrMR:  I think that’s dead-on actually. I know some people who’ve been experimenting, and one of the theories that I think I’ve voiced in this podcast is, a lower THC cannabis tends to be more well-tolerated by people. There are definitely some people who seem, at least in my experience, to be THC-sensitive. So they do better on a lower THC, but also higher CBD, strain. And I don’t necessarily think it’s because the CBD is higher. I think it’s because some people are overdoing it with THC. So you automatically throttle them from being able to overdo it with THC if you give them a much lower percent THC flower to use.

DrJT:   Yes. The flip side of that, however, is that they’re paying a lot. If you have a one-to-one, and the CBD isn’t really doing much except, say, throttling you as you said, then you’re paying 50% of the money for this, when you could just take one puff instead of two. And that gets into preference.

DrMR:  Yup. I think that’s really well-said. And I think it comes back to our earlier comment about trying to find your minimum effective dose. Don’t assume more is better. Don’t assume you’ve got to be taking tons of huge puffs in order to have the medicinal benefit. If you’re doing it the right way, it sounds like—and that’s something that I’m curious to learn more about, and get more evidence behind how healthy that pen is, as someone who’s been using it personally—with the Crafty device or the dosist potentially, you’re only looking at a couple of puffs, really. It’s not this process where you’re puffing on a pipe like Sherlock Holmes.

Research on Cannabis and Sexual Function

I want to ask you about the scientific documentation, as you just said. I haven’t seen any research looking at cannabis with sexual function, although I haven’t checked. But I have read some of the review papers. Now, the review papers may have had a skewed window looking more at things like neurodegeneration, rheumatic conditions, and inflammatory conditions, and may have just not looked for the sexual literature in their review. So what do we know here from a scientific perspective?

DrJT:   There’s a small but significant literature, mostly coming out of Britain. They have prohibition like we have. But interestingly, they’re the cannabis and sex powerhouse. And they’ve been a number of studies, from observational studies (for what they’re worth) on up to in-laboratory volunteer-group type stuff. One of the studies that I found most intriguing, many years ago when I encountered it, was, again, from a group in Britain, where they actually devised a device that was insertable that would measure sexual arousal. So basically, it looked at vaginal contractions and vaginal lubrication, and sent back some data to the computer. They took a group of volunteers, and they showed some video.

So they initially showed a news report, which, as you can imagine, didn’t really do much for people. And then they showed some pornography, which didn’t necessarily do that much for these women either. And then they gave them some cannabis. Actually, in that experiment they used IV THC, probably because that’s what they could get past their IRB, or Institutional Review Board. When they gave the cannabis, the news reports still did nothing, but suddenly the pornography was much more interesting. So it really showed that the THC administration changed outcome in terms of interest and arousal.

DrMR:  I think you have every guy perking up in his chair right now, about to mail-order some IV THC.

DrJT:   Haha! Thank goodness you can’t get IV THC!

DrMR:  Right. Great, well, I’ll send you a ping afterward if you have that reference. We’ll see if we can find it as well, but that would be fantastic to include in our notes. I’m assuming that’s available in PubMed or somewhere like that?

DrJT:   Yes. I’m sure that’s where I encountered it the first time. Send me an email, I’ll see if I can dig it up.

DrMR:  Awesome, that would be great. And that’s really a fascinating study.

View Dr. Ruscio’s Additional Resources

Okay, so like you said, there’s a small body of literature. But what you’re claiming is, it’s pretty compelling in terms of the findings that have been illustrated there?

DrJT:   Yeah. And I will also say that in my clinic, I have quite a number of couples who’ve come to me either primarily for sexual issues or for something else. I have a handful of women who came to me with their breast cancer, and thankfully they’re doing well from their breast cancer. And “Oh, by the way, doc, you know, this cannabis has really rejuvenated our sex life.” Cancer diagnosis and treatment really undermines one’s well-being—and in particular around sexuality—because there’s just so much stress, and so much that needs to get done. And then of course the cancer makes us anxious, the treatments make us sick, and all those sorts of things.

So the ability to not only treat those symptoms in the broadest sense, but then to be able to—almost as a side effect, but not really—help this couple regain their intimacy and connection… that’s why people go to medical school!

DrMR:  Yeah, that’s fantastic.

A Starter Protocol for Cannabis & Sex

Just a couple more questions here. I know that we’re coming up on an hour. Is there a starter protocol? If there’s someone listening to this, and it’s a couple, or one person in the couple who knows that the other would be consenting, is there a simple starter protocol that you would recommend people could begin with?

DrJT:   Yes. The first thing I would say is, think vaporization. For the safety but also for the immediacy. And then the second thing I would say is, if you’ve never done this before, then plan some time by yourself so that you can get used to the experience and sensations without needing to worry about your partner. Essentially what I’m saying is, carve out some protected time, where you’ll be alone and you can be comfortable. Then go into your private space (probably your bedroom), use cannabis and masturbate and see what that does for you. And get used to that and do that a few times before you then bring this into a coupled, or partnered, experience. As for the dosing, the old adage “start low and go slow” is exactly right.

There are websites which will tell you that the onset of inhaled cannabis is immediate. And that is not true. It is quick, but it’s still 10 to 15 minutes. And I say this because in 10 to 15 minutes you can take a whole lot of puffs, right? And you’ll be quite surprised when they all add up. So the idea here is, again, to be cautious. Fill up the machine. Turn it on. Take a puff. Wait 10 minutes, 15 minutes, see what that feels like. Then take another one if you feel like you need it. But really, be disciplined enough to do this very sequentially, so that you can figure out where that dose lies. Once you figure out that two puffs is perfect, then you don’t have to go one puff, two puffs. You can take two puffs, but at least you’re not dumping yourself in the deep end of the pool.

DrMR:  Mm-hmm. That’s really well-said because, you’re right, it’s not immediate. I learned that the hard way. And at least in my experience, when using an actual device where you smoke with a lighter, I felt that to be more immediate. Why I’ve heard that is, is the temperature is higher. And I don’t actually know if using a lighter is a higher temperature than using one of these vaporizers—and in fact I’m pretty sure it’ll be lower with a lighter—but in any case, in my experience, smoking a flower with a lighter and some kind of bowl device was much more of an immediate hit compared to the vaporizer. There did seem to be about a five to a 10 minute latency in my experience. And it’s important to account for that, as you’re saying. Because if you take one puff, and a minute or two later, feel nothing, and then you take another and another, you could really overdo it by the time that latency catches up and it all kicks in.

DrJT:   Yep. That’s exactly it. So when you smoke cannabis, you’re burning it and it’s around 950. Whereas if you’re vaporizing properly, we’re talking about 350. So it’s much lower with a vaporizer. Now, there’s another factor which is that there is one cannabinoid called THCV, or tetrahydrocannabivarin, which has a much shorter onset, and is a little bit more psychedelic-provoking. And that vaporizes at about 420. So we are deliberately avoiding that one cannabinoid a little bit when we vaporize down at 350. But in terms of the medicinal benefits we’re looking for, we’re going to get all of them at 350.

DrMR:  Gotcha. Great to know.

How Does Cannabis Enhance Bonding?

And then one of my final questions here is, how does cannabis enhance bonding? That’s something that I’ve heard and I’ve noticed myself, that you feel closer, more connected to the person both sexually and pre-/post-sex. And I’m wondering, do we see any of that documented in the literature and is there a proposed mechanism, maybe oxytocin potentiation or something of similar effect?

DrJT:   You said it. It’s oxytocin. I don’t know that I can tell you why, but what we do know is that when using cannabis post-coitally, people have increased levels of oxytocin circulating. We think that the oxytocin has some effect on that feeling of intimacy. There’s some hand-waving in there, but that’s what we know so far.

DrMR:  Gotcha. Great. It would make sense that oxytocin would be part of the mediator. And perhaps that is part of the reason why cannabis has some of the medicinal benefit that it does have. If people are using cannabis, let’s say for health condition x, and presumably many of these people in a given study are also going to be having sex, they’re probably going to be experiencing some of this oxytocin potentiation even though they weren’t trying to do that. And we’ve discussed some of Shelly Taylor’s work in the past, showing that when women are injured or unhealthy, they’re more reliant upon bonding in connectivity (and the ensuing oxytocin) than men are.

And as she terms it, when women are trying to heal, they require “tending and befriending” more. And oxytocin is a hormone that mediates that tending and befriending. So I wonder if part of the reason why people, and more specifically women (but I wouldn’t say it’s limited to women), are experiencing some medicinal benefit from cannabis for other healthcare matters is because, ostensibly, a number of them are probably also having sex. And that’s giving them even more potentiation of oxytocin, which physiologically seems to be an antecedent needed for women to heal. So just something interesting to ponder.

DrJT:   Yeah, that’s a very interesting thought. Hmm.

Episode Wrap-Up

DrMR:  Well, we’ve dug through a lot there. This has been an incredibly insightful conversation, as I thought it would be. So you already mentioned your website. Anywhere else you want to point people on the Internet? And please give the audience your website one more time.

DrJT:   Sure. One of the things that I do quite frequently is I do consultations virtually. So if somebody is in California or Arkansas or wherever, I can certainly be available to help them. So, go to my website, which is inhalemd.com, and you can reach me through there. There’s also a large library of articles that we’ve written to help you start the journey and understand what we’re talking about.

The other thing that I would suggest is that you check out the Association of Cannabis Specialists. This is a group that I started a little while back. It’s now an international group of clinicians focused on taking care of patients using cannabis. The URL there is cannabis-specialist.org. There’s lots of information there as well, and a listing of people who provide this kind of medical care. That’s pretty much it, I think.

DrMR:  Awesome. And any closing words you want to leave people with?

DrJT:   Mostly, I think people should have fun. So, go get a small amount of cannabis. Use it safely, use it carefully, and have lots of good sex.

DrMR:  Awesome. I love it. Yeah, it’s been a great conversation, Jordan. Really appreciate it. Super interesting stuff. And if anything noteworthy pops up, feel free to give me an email and we’ll have you back on to expand.

DrJT:   I think that sounds lovely.

DrMR:  Awesome. Thank you again.

DrJT:   All right, take care.

DrMR:  You too.