Daily use of cannabidiol (‘CBD’) oil may be linked to lung cancer regression
It may be worth exploring further the use of cannabidiol (‘CBD’) oil as a potential lung cancer treatment, suggest doctors in BMJ Case Reports after dealing with a daily user whose lung tumour shrank without the aid of conventional treatment.
The body’s own endocannabinoids are involved in various processes, including nerve function, emotion, energy metabolism, pain and inflammation, sleep and immune function.
Chemically similar to these endocannabinoids, cannabinoids can interact with signalling pathways in cells, including cancer cells.
They have been studied for use as a primary cancer treatment, but the results have been inconsistent.
Lung cancer remains the second most common cancer in the UK. Despite treatment advances, survival rates remain low at around 15% five years after diagnosis. And average survival without treatment is around 7 months.
The report authors describe the case of a woman in her 80s, diagnosed with non-small cell lung cancer. She also had mild chronic obstructive pulmonary disease (COPD), osteoarthritis, and high blood pressure, for which she was taking various drugs.
She was a smoker, getting through around a pack plus of cigarettes every week (68 packs/year).
Her tumour was 41 mm in size at diagnosis, with no evidence of local or further spread, so was suitable for conventional treatment of surgery, chemotherapy, and radiotherapy. But the woman refused treatment, so was placed under ‘watch and wait’ monitoring, which included regular CT scans every 3-6 months.
These showed that the tumour was progressively shrinking, reducing in size from 41 mm in June 2018 to 10 mm by February 2021, equal to an overall 76% reduction in maximum diameter, averaging 2.4% a month, say the report authors.
When contacted in 2019 to discuss her progress, the woman revealed that she had been taking CBD oil as an alternative self-treatment for her lung cancer since August 2018, shortly after her original diagnosis.
She had done so on the advice of a relative, after witnessing her husband struggle with the side effects of radiotherapy. She said she consistently took 0.5 ml of the oil, usually three times a day, but sometimes twice.
The supplier had advised that the main active ingredients were Δ9-tetrahydrocannabinol (THC) at 19.5%, cannabidiol at around 20%, and tetrahydrocannabinolic acid (THCA) at around 24%.
The supplier also advised that hot food or drinks should be avoided when taking the oil as she might otherwise feel stoned.
The woman said she had reduced appetite since taking the oil but had no other obvious ‘side effects’. There were no other changes to her prescribed meds, diet, or lifestyle. And she continued to smoke throughout.
This is just one case report, with only one other similar case reported, caution the authors. And it’s not clear which of the CBD oil ingredients might have been helpful.
“We are unable to confirm the full ingredients of the CBD oil that the patient was taking or to provide information on which of the ingredient(s) may be contributing to the observed tumour regression,” they point out.
And they emphasise: “Although there appears to be a relationship between the intake of CBD oil and the observed tumour regression, we are unable to conclusively confirm that the tumour regression is due to the patient taking CBD oil.”
Cannabis has a long ‘medicinal’ history in modern medicine, having been first introduced in 1842 for its analgesic, sedative, anti-inflammatory, antispasmodic and anticonvulsant effects.
And it is widely believed that cannabinoids can help people with chronic pain, anxiety and sleep disorders; cannabinoids are also used in palliative care, the authors add.
“More research is needed to identify the actual mechanism of action, administration pathways, safe dosages, its effects on different types of cancer and any potential adverse side effects when using cannabinoids,” they conclude.
Medical use of cannabis
The Therapeutic Goods Administration website has patient information and guidances to assist health professionals who choose to prescribe medicinal cannabis in Australia.
Key messages and recommendations
- In Australia, medicinal cannabis refers to a range of quality assured, pharmaceutical cannabis preparations, for the relief of a medical condition and must be prescribed by a doctor. It should be taken as prescribed.
- Existing published evidence does not support the use of medicinal cannabis for therapeutic indications relating to treatment or cure of cancer.
- There is limited current evidence that medicinal cannabis or cannabinoids are effective at inhibiting tumour growth, or to treat or cure cancer in humans. In addition, there is no current evidence that medicinal cannabis or cannabinoids reduce risk or prevent cancer occurrence.
- for relieving nausea and vomiting in patients undergoing chemotherapy;
- as an analgesic in patients experiencing pain;
- as an appetite stimulant for patients experiencing weight loss and muscle wasting.
Managing conditions induced by cancer and cancer treatment, especially in patients with advanced cancer who have responded poorly to conventional relief options, is a significant concern for cancer patients and their doctors. There is increasing interest, both internationally and in Australia, in the opportunities to use cannabis in cancer care, particularly to relieve side effects of cancer treatment. However, there is currently limited evidence to support the quality, safety and efficacy for use of cannabis in standard care.
Cannabis, also known as marijuana (and colloquially as grass, pot, weed, hash etc.), is made from the dried flowers and leaves of the Cannabis sativa plant. Cannabinoids are chemical compounds found within cannabis which act upon cannabinoid receptors in the body. Cannabis contains over 500 distinct compounds, of which at least 144 are cannabinoids.  .The two most abundant and researched cannabinoids are Tetrahydrocannabinol (THC) and Cannabidiol (CBD)
THC is the primary psychoactive component of cannabis, with the therapeutic use of THC complicated by its psychoactive side effects. In recent years, interest has increased in the potential use of non-psychoactive cannabinoid compounds such as CBD and other cannabinoids to alleviate chemotherapy induced illness.
In Australia, medicinal cannabis refers to a range of quality assured, pharmaceutical cannabis preparations, for the relief of a medical condition and must be prescribed by a doctor.   It should be taken as prescribed. Unregulated cannabis contains unknown concentrations of cannabinoids and may expose patients to harmful pesticides, fungicides and bacteria. Cannabinoids used in medicinal cannabis products can be derived naturally as extracts from the cannabis plant, such as nabiximol which is a chemically pure 50:50 mixture of THC and CBD; or produced synthetically in a laboratory to mimic or produce similar effects, such as dronabinol and nabilone which contain synthetic THC.  Several clinical trials are currently underway in Australia investigating the efficacy of cannabis in a medicinal form, and its use in specific cancer care indications, including symptom management for loss of appetite, nausea, insomnia and pain. Animal and human studies are currently being conducted to evaluate the potential for anti-cancer effect for some cancers.
Legal and regulatory implications
In Australia, cannabis and its products are regulated under various federal and state laws. Cannabis is encompassed by law under the Narcotics Drugs Act 1967,  and the Therapeutic Goods Act 1989,  and compliance is required with Customs (Prohibited Imports) Regulation 1956.  These controls ensure that practitioners prescribe according to current recommended indications using either the Special Access Scheme or as Authorised Prescribers or access via a clinical trial.  The Standard for the Uniform Scheduling of Medicines and Poisons is a Commonwealth legislative instrument consisting of decisions that classify different medicines and poisons into ‘schedules’. It is implemented through state and territory laws which may impose additional restrictions on the use of cannabis.
Australia is a signatory to two United Nations international agreements relating to the use of cannabis for medical purposes: The Single Convention on Narcotic Drugs (1961);  and the Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances (1988).  The agreements aim to ensure the availability of controlled substances for medical and scientific purposes, and to combat drug misuse through coordinated international action, including drug trafficking. The Single Convention on Narcotic Drugs was implemented to limit possession, use, trade in, distribution, import, export, manufacture and production of drugs exclusively to medical and scientific purposes.  The Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances listed additional behaviour and mood-altering drugs to the Single Convention on Narcotic Drugs and distinguished between drugs which are totally prohibited and those, such as cannabis, which have the potential to be used for restricted medical purposes.  Australia must uphold its commitment to these agreements when considering the use of medicinal cannabis.
Evidence-base for medicinal use of cannabis
The purpose of this Position Statement on Medicinal Use of Cannabis in Cancer is to present the existing evidence of the effect and application of therapeutic preparations of cannabis in the human population. Therefore, it purposefully excludes evidence from pre-clinical trials, studies relating to cannabis and the endocannabinoid system, and research currently being conducted and therefore without results to publish. However, evidence from early phase studies, review papers utilising a wide range of research,  and pre-clinical studies,   indicate potential for medicinal cannabis to relieve effects of cancer and chemotherapy. Future evidence will be considered and incorporated into this Position Statement as available.
Existing published, peer-reviewed evidence does not support the therapeutic application of cannabis in cancer care. However, when symptoms are deemed refractory, a doctor on behalf of their patient, can request access to medicinal cannabis products to relieve pain associated with cancer symptoms and side effects of cancer treatment through the TGA Special Access Scheme or an Authorised Prescriber or an available clinical trial. This evidence to support this request is summarised below.
These conclusions were assessed against evidence summaries produced by the Commonwealth Department of Health to inform the Therapeutic Goods Administration (TGA) medicinal cannabis guidance documents for the use of medicinal cannabis approved via the Special Access Scheme in Guidance for the treatment of palliative care patients in Australia, and Guidance for the prevention or management of refractory chemotherapy induced nausea and vomiting in Australia. 
Historically, across the international research community, research into the use of cannabis in cancer and cancer care has been predominately conducted in vitro or in vivo using animal models. Studies using humans are entering the peer reviewed literature, however these remain limited. To date, and particularly reflected in the evidence available to inform this Position Statement, most human studies within existing published literature frequently compared medicinal cannabis prepared as a therapeutic product, either in its natural form or synthetic, with a placebo or used a comparator drug either not considered standard of care or indicated for the effect. The different comparator drugs used, and lack of significant results makes it difficult to draw conclusions from the evidence on the efficacy of medicinal cannabis. Additionally, many studies had high drop-out or non-completion rates by participants. The poor feasibility of the studies restricts accurate insights into effectiveness and potential population prescribing because, understanding the characteristics of who will benefit from the products are limited, resulting in inconclusiveness.
Prevention of cancer
There is no evidence that medicinal cannabis prevents cancer. Most studies investigated the role of cannabinoid receptors, CB1 and CB2 in cancer prevention, not the effect of cannabis itself.
Impact of cancer growth
There is limited, low quality evidence available on medicinal cannabis promoting or reducing cancer growth. One in vitro study investigated the impact of CBD and the synthetic cannabinoid WIN-55,212 in inhibiting prostate and colon cancer cells.  CBD was found to be more effective in inhibiting growth among both types of cancer cells, compared to WIN which only inhibited prostate cell proliferation.  This is a field of current research nationally and internationally with no results to report to support the use of medicinal cannabis in control or prevention of cancer.
There is also currently no evidence of the comparative effectiveness of medicinal cannabis, containing either natural or synthetic cannabinoids, compared to standard cancer treatment.
There is currently no evidence that medicinal cannabis, containing either natural or synthetic cannabinoids, can treat or cure cancer or inhibit cancer growth.
Management of cancer symptoms and side effects from cancer treatment
Most of the research into the clinical application of medicinal cannabis has been in the management of common side effects induced by cancer treatment, usually chemotherapy. Evidence indicates that medicinal cannabis may provide a limited benefit for people affected by chemotherapy-induced nausea and vomiting, although the quality of these studies restricts the ability to translate this into practice.
Chemotherapy-induced nausea and vomiting
Several studies assessed the efficacy of medicinal cannabis on alleviating chemotherapy-induced nausea and vomiting as a single indicator.         All reported that synthetic THC based medicinal cannabis was more effective than either prochlorperazine (an antiemetic and antipsychotic drug which works by changing the actions of chemicals in the brain),    no treatment,  or non-concurrent comparison groups.    A statistically significant difference was found in one study, which compared dronabinol and prochlorperazine in combination to single agent (dronabinol or prochlorperazine). Study drop-out rates were greater than 10% and in five out of eight patients this was due to adverse events, compromising study validity. 
Most studies assessing the efficacy of medicinal cannabis in improving chemotherapy-induced nausea reported that synthetic THC based medicinal cannabis was more effective than a comparator drug,        or placebo treatment,   except for one which compared nabilone to prochloraperazine.  Another study reported that naturally extracted THC was more effective at improving chemotherapy-induced nausea compared to prochlorperzaine.  While these studies had relatively small sample sizes, five concluded that medicinal cannabis was significantly superior to a comparator. These were compared to oral procholorperazine,     and ondansetron, which blocks serotonin that causes vomiting.  A combination of small sample sizes and incomplete data in these studies possibly impacts the representativeness and conclusiveness of the findings.
All studies which assessed the efficacy of medicinal cannabis in improving chemotherapy-induced vomiting concluded that synthetic THC based or naturally extracted THC based medicinal cannabis was more effective than a comparator drug,          or placebo treatment.    Although the majority reported that the results were statistically significant,         sample sizes were small, ranging from 19 to 114 participants with drop-out rates greater than 10%, often because of incomplete treatment. In addition, variations in the administration of drugs makes it difficult to compare studies and their effects.
Radiotherapy-induced nausea and vomiting
Only one study assessed the efficacy of medicinal cannabis (oral levonantradol) on radiotherapy-induced nausea and vomiting and found that levonantradol was no different to the drug oral chlorpromazine. 
Four studies measured pain outcomes in patients who had cancer pain that was unalleviated by opioid therapy.     These studies concluded that Sativex, a commercially developed nabiximol containing a combination of THC:CBD and taken as a self-titrated spray was superior to a matched placebo or no treatment. However, an article that published two studies, found in the second study, that Sativex was no better than placebo at improving pain in patients who had previously responded to Sativex.  In a similar population, a study that assessed the effectiveness of nabiximol at improving pain, sleep and quality of life outcomes concluded that improvements were non-significant compared to a matched placebo. 
Among patients with chemotherapy-induced neuropathy pain, nabiximol, as a spray, appeared to be more effective than a placebo in improving neuropathy pain and quality of life outcomes.  Quality of life outcomes assessed included physical and emotional health problems (i.e. anxiety or depression), such as the ability to complete work and/or daily activities. 
Five studies assessed appetite changes among cancer patients who had reported a loss of appetite or weight.      Of these studies, two found that synthetic THC medicinal cannabis products, oral nabilone,  or oral dronabinol,  were more effective in improving appetite compared to a matched placebo. Another study found that oral megestrol acetate, a non-cannabinoid comparator drug, was significantly more effective than oral dronabinol for improving appetite and promoting weight gain.  Four also assessed quality of life,     but only one concluded that medicinal cannabis (oral dronabinol) significantly improved quality of life compared to a matching placebo.  The measurement of quality of life differed across studies, some utilised scales and others questionnaires, which may have affected the comparability of results.
Best practice management of cancer symptoms and side effects of cancer treatment
To support doctors who wish to prescribe cannabis-based therapeutic products not approved, the TGA released a set of clinical guidance documents across a range of conditions to support informed decision making with their patients.  These guidance documents provide advice on the use of medicinal cannabis in the treatment of palliative care patients in Australia, and for the prevention or management of nausea and vomiting in Australia. In addition, the Australian Centre for Cannabinoid Clinical and Research Excellence have developed NSW Cannabis Medicines Prescribing Guidance ‘to provide interim information to support NSW medical practitioners in prescribing cannabis medicines to patients for conditions where cannabinoids are perceived to have some benefit ‘. 
Medicinal cannabis is not a recommended treatment option in the Multinational Association for Supportive Care in Cancer (MASCC) and European Society for Medical Oncology consensus Guidelines on the Prevention of Chemotherapy and Radiotherapy Induced Nausea and Vomiting,  or the Australian eviQ clinical resources for the Prevention of chemotherapy induced nausea and vomiting,  and Management of radiotherapy induced nausea and vomiting.
Access to therapeutic products in Australia
In 2016, the Australian Government amended the Narcotic Drugs Act 1967,  enabling the cultivation of cannabis for medical and research purposes. The Office of Drug Control, within the Commonwealth Department of Health, reviews applications and administers licences and permits for the cultivation, production and manufacture of medicinal cannabis therapeutic products. The Office of Drug Control does not have powers to authorise the prescription, administration of, and patient access to, cannabis. Patient access to cannabis for medicinal or research purposes requires both Commonwealth government review and state or territory health authority approval, as well as standard research ethics and governance review for use in human research.
In Australia all authorised therapeutic substances are required to prove a high standard of safety, efficacy and quality, and demonstrate clinical effectiveness against standard treatment prior to use. Neither cannabis and cannabinoids, nor their synthetic forms have been approved by the TGA for a cancer-related therapeutic indication in Australia. The nabiximol, Sativex has been assessed as demonstrating safety, quality and efficacy for the ‘treatment, for symptom improvement in patients with spasticity due to multiple sclerosis who have not responded adequately to other anti-spasticity medicine who demonstrate clinically significant improvement in spasticity related symptoms during an initial trial of therapy ‘.  This efficacy does not as yet translate to other indications.
Cannabis, including seeds, extracts, resins and the plant, and any part of the plant , is typically a Schedule 8 controlled drug.  Schedule 8 controlled drugs are substances that ‘ should be available for use but require restriction of manufacture, supply, distribution, possession and use to reduce abuse, misuse and physical and psychological dependence ‘.  However, as the Standard for the Uniform Scheduling of Medicines and Poisons is implemented through individual state or territory drugs, poisons and controlled substances legislation, additional restrictions to access may be applied. Cannabis-based therapeutic products, dronabinol, nabilone and nabiximol are listed as Schedule 8 controlled substances.  Cannabidiol is listed as a Schedule 4 prescription-only medicine where it comprises 98% or more of the total cannabinoid content of the preparation and where other cannabinoids in the preparation are naturally found in cannabis and make up less than 2 percent of the preparation’s total cannabinoid content. Schedule 4 substances are ‘substances, the use or supply of which should be by or on the order of persons permitted by State or Territory legislation to prescribe and should be available from a pharmacist on prescription ‘. 
On 15 December 2020, the TGA announced that it would down-schedule certain low dose cannabidiol preparations from Schedule 4 (Prescription Medicine) to Schedule 3 (Pharmacist Only Medicine) under the Poisons Standard. As of 1 February 2021, low-dose cannabidiol products containing up to a maximum of 150mg/day for use in adults will be allowed to be supplied over-the-counter by pharmacists without a prescription. Only low-dose cannabidiol products approved by the TGA and listed on the Australian Register of Therapeutic Goods that comply with specific packaging and dosage requirements under the Poisons Standard can be supplied.
Access to Schedule 8 substances unapproved in Australia can be sought through either the TGA’s Special Access Scheme, Authorised Prescriber initiative or through a clinical trial.  For the first two pathways, applications are assessed by the TGA on a case by case basis and require a doctor to agree to prescribe and monitor the use of the unapproved product. There is also an option for a product to be imported into Australia using Special Access Scheme Category A.  Cannabis and cannabis-based products are excluded from personal importation under the Therapeutic Goods Regulations 1990,  because cannabis is a prohibited substance under the Customs Act 1901.  A medical practitioner licensed under the Customs Act to import medicinal cannabis can do so on behalf of their patient through the Special Access Scheme. Patients must fund the cost of the product as no medicinal cannabis products are currently subsidised by the Pharmaceutical Benefits Scheme.
‘Weed the People’ Explores Medical Marijuana for Kids With Cancer
M arijuana, both medicinal and recreational, is growing more mainstream. Medical marijuana is now legalized in a majority of states, and 62% of Americans support legalizing it outright — but in the political realm, the plant has long been controversial.
Now, a new documentary called Weed the People, which opens in some theaters in October, explores the potential of medical marijuana for childhood cancers and the regulatory hurdles facing people who want to use cannabis. The film, which was executive produced by former talk-show host Ricki Lake, follows five families using cannabis oils to treat pediatric cancers. Some of the children used cannabis alongside treatments like chemotherapy, while others turned to the drug after conventional treatments had failed.
Lake became interested in medical marijuana when her late ex-husband, Christian Evans, began researching cannabidiol (CBD) — a compound in marijuana that does not cause a high —for his own health issues, including chronic pain and ADHD. (Evans died by suicide last year.) The two met a young girl with a tumor disorder whose family was desperate to get her off chemotherapy, and they helped connect her with a doctor who specializes in medical marijuana. Lake and her production partner, director Abby Epstein, were inspired to find other families in similar situations and tell their stories on screen. They made Weed the People to explore the potential of medical marijuana, and the regulatory challenges families and researchers must overcome to use it.
“I want to get people seeing it as a medicine, seeing what it was able to do for these children, and fight for this medicine to be available to everyone who needs it,” Lake says. “It’s a human rights issue.”
The film paints a rosy, anecdotal picture of the effectiveness of cannabis oils; some of the children featured had their tumors shrink substantially or disappear entirely, even if they were using cannabis oils in place of chemotherapy and other conventional treatments. “You can’t say the ‘cure’ word,” Lake says, “but how else do you explain it?”
But the concept is far from proven and could even be dangerous. While there is some evidence that marijuana can ease chronic pain and chemotherapy side effects, the American Cancer Society (ACS) warns that “relying on marijuana alone as treatment while avoiding or delaying conventional medical care for cancer may have serious health consequences.” And while some studies have shown that compounds in marijuana can slow growth of or kill tumor cells in animals or lab dishes, evidence in humans — particularly around marijuana oils — is lacking, the ACS says. While conventional treatments like chemotherapy are still the standard, pediatric cancer providers are increasingly voicing their support for the use of medical marijuana, particularly in palliative or end-of-life care when other treatments may not be necessary.
More research is needed to learn about the potential effects and limitations of cannabis-derived medicines for both adult and pediatric cancers. As the families and experts in Weed the People see it, this lack of evidence is precisely the problem — and it’s exacerbated by current regulations around medical marijuana.
Marijuana, like heroin and LSD, is classified by the Drug Enforcement Administration (DEA) as a Schedule I drug, meaning it has “no currently accepted medical use and a high potential for abuse.” But in June, the FDA approved the first drug derived from marijuana, a purified version of CBD called Epidiolex, for kids and adults suffering from two rare forms of epilepsy; the DEA then rescheduled Epidiolex (but not CBD as a whole) to schedule V, the lowest restriction classification for controlled substances. Researchers who wish to study cannabis need a Schedule I drug license and must submit to background checks and site visits from the DEA.
The DEA also only permits one institution, the University of Mississippi, to grow marijuana for study, though DEA spokesperson Melvin Patterson says it is planning to grant additional licenses to other growers, which would “increase access to marijuana for researchers, potentially increase the number of available strains for research, and may foster additional research on marijuana.”
This means scientists are limited to studying only the products and formulations available from the University of Mississippi, which doesn’t include popular consumer products like vapes and edibles, says Dr. Jeff Chen, director of the University of California Los Angeles Cannabis Research Initiative. “At my office at UCLA, I look out my window and I can count two dispensaries that I can see,” Chen says. “We can’t touch that cannabis—not even to understand what’s in it.”
As a result of these challenges, many families who wish to use cannabis, including those in the documentary, are forced to buy it from sources outside the conventional medical system, and must trust that what they’re using is safe. “I just find it absolutely staggering to accept that in this day and age, with the billions of dollars that are spent on cancer research, the medicine we were relying on was made in somebody’s kitchen,” says Angela Smith in the film, whose son, Chico, uses cannabis oils to treat his soft tissue cancer.
Chen, who was not in the film but shares its frustration with current marijuana regulations, became swayed by the medical potential of cannabis compounds early in his career, when he encountered a young patient with epilepsy whose parents were treating her with CBD. Unfamiliar with CBD, Chen and his colleagues almost called Child Protective Services to intervene—until Chen looked into the compound further and saw how much he didn’t know.
“That’s when I realized that science had completely left cannabis in the dark,” Chen says. “It was time for science to step up and really to push on this issue. I felt a duty.” Today, Chen works to understand the health benefits and risks of marijuana and its many compounds, including CBD.
The film also touches on funding challenges associated with marijuana research, an impediment Chen has encountered with his own research. While the government does fund some marijuana research, Chen says the “vast majority” of federal dollars go toward understanding the harms of cannabis, not the potential benefits. Researchers who wish to study how marijuana may improve treatment for conditions ranging from cancer to chronic pain are largely left to find the money themselves, Chen says.
These roadblocks have led many researchers, including those quoted in the film, to call for looser marijuana scheduling, but the DEA denied two such petitions in 2016. Dr. Igor Grant, director of the Center for Medical Cannabis Research at the University of California San Diego, who was not in the film, agrees that current regulations have made research more difficult, and says marijuana probably doesn’t belong in schedule I. But he says he doesn’t believe that the government is actively trying to stifle cannabis research, as many people—including some in Weed the People—have alleged.
Grant says there’s some evidence that the barriers are becoming fewer. His lab recently made history by importing research-approved marijuana from Canada, a move that suggests U.S. researchers may soon have greater access to the plant. That access, combined with lighter regulations from the government, could open new doors, Grant says.
“You would have to both reschedule it and increase the availability of manufacturers,” he says. “This could be a joint effort between states, manufacturers, academia and federal [regulators].”
This type of collaboration is crucial, Lake says, and she hopes her documentary will garner public support for it. “I’m really hoping to reach the people who really have this idea that this drug is bad,” Lake says. “It’s a matter of just changing mindsets and having them fight to have access to this plant. I do believe change is coming.”