From the sixth floor of a nondescript office building whose parking lot straddles the District of Columbia–Maryland line, Patricia Frye, MD, runs her practice: Takoma Park Integrative Care.
But that name obscures Dr. Frye’s real claim to fame: She is an independent physician-consultant specializing in cannabinoid medication for conditions ranging from autism and neurodegenerative disorders to anorexia, gastrointestinal illness, and severe cancer pain. Born and raised in Washington, DC, she is also the author of the highly acclaimed book The Medical Marijuana Guide: Cannabis and Your Health.
The Road to Cannabis Medicine
Interviewed at her clinic, Dr. Frye said even she is surprised by the path her career has taken.
“I had gone to college because I wanted to be a doctor, but then like a lot of females at that time, I started to question my ability,” she told AJEM. Following her medical education and pediatric residency at University of Maryland in Baltimore, Dr. Frye trained in anesthesiology at Baylor College of Medicine in Houston, Texas, and eventually obtained licenses to practice in Maryland, Virginia, Nevada, California, and the District of Columbia.
“In 2015, I started looking for a telemedicine job,” she recalled. “I was offered one by a company in San Francisco called HelloMD doing medical marijuana evaluations. I spent my days talking to patients in California, and that totally dispelled any preconceived notions I had about who uses marijuana. I talked to grandmas, computer programmers, and people on disability.”
Within a year, Dr. Frye evaluated more than 5000 patients.
“I was amazed at the improvement these patients experienced once they moved from pharmaceuticals to cannabinoid medicine,” she said. “I realized that this is a pretty amazing plant, and that people should know about it and have access to it.”
Dr. Frye researched the plant and its physiological effects extensively, and subsequently became professionally certified in cannabis science and medicine by the University of Vermont School of Medicine and joined the Society of Cannabis Clinicians, where she chairs the Education Committee. She also co-chairs the Maryland Medical Society’s Medical Cannabis Task Force. On May 17, 2023, she gave the commencement speech for the University of Maryland School of Pharmacy master’s program in Medical Cannabis Science and Therapeutics.
Building Confidence in Cannabis, One Patient At a Time
Dr. Frye initially opened her practice, Takoma Park Integrative Care, in December 2015. About 85% of her patients were adults and she saw about 25 to 30 patients per week with the help of an assistant. During the COVID-19 pandemic, Dr. Frye switched to a telemedicine practice, working alone, and seeing about 5 to 6 patients per day, 3 to 4 times per week. She noted that her patient volume has decreased significantly since the District of Columbia changed regulations to allow patients from any state to “self-certify”. She now sees about 25 to 35 patients per month. Initial visits last about an hour and return visits are about 20 to 30 minutes.
“I provide patients with a written summary of what I think will help them based on their dispensary menu. I like to see patients return in 6 to 8 weeks to suggest changes in the event they are not yet experiencing adequate symptom relief. I also spend quite a bit of time going over sleep, nutrition, and other lifestyle changes that will upregulate their endocannabinoid system and microbiota,” said Dr. Frye.
The majority of patients (about 80%) in her practice are referred to her—48% from physicians and 32% from relatives or friends. The most common medical conditions she sees (in order) are chronic pain, anxiety, insomnia, autism, stress, dysthymia, and neurodegenerative disorders.
“By virtue of the fact that patients are scheduling an appointment with me, it means that they have already considered cannabis, or it has been presented to them by their physician or family member. Once I explain that there is an endocannabinoid system, how cannabis works, and it can be used with or without the impairing effect—which for some patients is a benefit—most patients feel very comfortable trying it,” said Dr. Frye.
Recently, she has seen an uptick of patients under twenty-one years of age—which comprises about 10% of her practice. Dr. Frye expects her adult patient practice volume will soon decline due to the legalization of adult-use cannabis in Maryland as of July 1, 2023.1 “My established patients have been well-educated and may opt to forego recertification, although physicians may continue to refer.”
Dr. Frye Explores the Role of Cannabis in Treating Autism
A focus of Dr. Frye’s work is with children, particularly those with autism spectrum disorder (ASD) or severe behavioral issues. As a board-certified pediatrician, she is familiar with the FDA-approved pharmaceuticals doctors use to treat autistic children.
“The problem is that none of [the currently approved medications for pediatric ASD] address the core symptoms of autism, which are problems with social interaction, expressive language, and repetitive behaviors that negatively impact their quality of life,” she said. “As a pediatrician and as a mother of an adult child who’s on the spectrum, I’ve seen the issues these pharmaceuticals cause in terms of adverse effects and lack of efficacy.”
She pointed to recent research exploring the potential role of neuroinflammation and impaired anandamide signaling in ASD, which provide support for therapeutic targets involving the endocannabinoid system.1,2
“There are studies showing that patients with autism have neuroinflammation and low levels of anandamide as compared with neurotypical controls. The researchers were able to accurately predict which subjects had autism based on the anandamide levels. It was also noted that anandamide levels correlated with the severity of symptoms—the lower the level, the more severe the expression. It is critical to consider a therapeutic that will be effective in addressing the symptoms that negatively impact their quality of life.”
The ability of cannabidiol (CBD) to indirectly raise anandamide levels has been known for the past decade.3 Additionally, cannabigerol (CBG)—which has become more widely available in the past couple of years—potentiates the anti-inflammatory effect of CBD.4
“[CBD and CBG] interact with the GABA [gamma-aminobutyric acid]–glutamate system, which is not in balance in most of these patients with extreme irritability, anxiety, and aggressive or self-injurious behaviors. That combination of CBD and CBG has been working quite well with the majority of patients that I see, which is perhaps due to CBD and CBG modulation of the GABA/glutamate system.5,6
Cannabis Medicine Goes Mainstream
Some 35% of autistic children also have a seizure disorder,7 such as Dravet syndrome, tuberous sclerosis, or Lennox-Gastaut syndrome. In June 2018, the FDA approved Epidiolex (oral CBD) for Dravet and Lennox-Gastaut syndromes, marking the agency’s first-ever endorsement of a purified drug substance derived from cannabis.8 From Dr. Frye’s perspective, the new drug has made a difference in the treatment of pediatric seizures.
“I was seeing the treatment-resistant patients, basically, those [who] were referred to me who might be on 3, 4, 5 different anticonvulsants, and they were still seizing,” Dr. Frye said. “But I don’t see as many seizure patients now as I did prior to Epidiolex being FDA-approved.”
Opioid Epidemic Sparks Change in Attitude Toward Cannabis
Restrictions on cannabis have loosened dramatically since Dr. Frye began her career. As of July 2023, 40 states allow medical cannabis and 23 states permit adult-use cannabis. Medical and recreational use is allowed in the District of Columbia, except on federal property.
Dr. Frye attributes this change of attitude mainly to the opioid epidemic. “Doctors were seeing skyrocketing numbers of addictions,” she said. “A lot of patients started learning about cannabis—probably from friends and family—investigated it, tried it, and found out that it worked as well, if not better, in treating their chronic pain. From there, the acceptance of cannabis as a therapeutic grew exponentially.”
With loosening of restrictions, Dr. Frye is hopeful that resources supporting medical education and research will change too. “I’m hopeful that with this relaxing of some of these barriers, medical schools will start to open their eyes, start teaching the endocannabinoid system to medical students, and fund research within their institutions.”
To hear more of AJEM’s interview with Dr. Frye, please listen to AJEM Live.
- Maryland Cannabis Administration. Adult-use cannabis sales in Maryland begin July 1. Accessed July 16, 2023. https://mmcc.maryland.gov/Documents/2023%20_PDF_Files/News%20Release/Adult-Use%20Cannabis%20Sales%20in%20Maryland%20Begin%20July%201.pdf Su T, Yan Y, Li Q, Ye J, Pei L. Endocannabinoid system unlocks the puzzle of autism treatment via microglia. Front Psychiatry. 2021;12:734837. doi:10.3389/fpsyt.2021.734837
- Karhson DS, Krasinska KM, Dallaire JA, et al. Plasma anandamide concentrations are lower in children with autism spectrum disorder. Mol Autism. 2018;9:18. doi:10.1186/s13229-018-0203-y
- de Almeida DL, Devi LA. Diversity of molecular targets and signaling pathways for CBD. Pharmacol Res Perspect. 2020;8(6):e00682. doi:10.1002/prp2.682
- Mammana S, Cavalli E, Gugliandolo A, et al. Could the combination of two non-psychotropic cannabinoids counteract neuroinflammation? Effectiveness of cannabidiol associated with cannabigerol. Medicina (Kaunas). 2019;55(11):747. doi:10.3390/medicina55110747
- Cifelli P, Ruffolo G, De Felice E, Alfano V, van Vliet EA, Aronica E, Palma E. Phytocannabinoids in Neurological Diseases: Could They Restore a Physiological GABAergic Transmission? Int J Mol Sci. 2020 Jan 22;21(3):723. doi: 10.3390/ijms21030723.
- Horder J, Petrinovic MM, Mendez MA, Bruns A, Takumi T, Spooren W, Barker GJ, Künnecke B, Murphy DG. Glutamate and GABA in autism spectrum disorder-a translational magnetic resonance spectroscopy study in man and rodent models. Transl Psychiatry. 2018 May 25;8(1):106. doi: 10.1038/s41398-018-0155-1.
- Practical Neurology. Epilepsy and autism. Accessed July 16, 2023. https://practicalneurology.com/articles/2020-oct/epilepsy-and-autism#:~:text=Comorbidity%20of%20epilepsy%20and%20autism,have%20epilepsy%20and%20vice%20versa.&text=The%20high%20rate%20of%20comorbidity,genetic%20and%20microstructural%20brain%20differences.
- FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. FDA news release. June 25, 2018. Accessed May 25, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-comprised-active-ingredient-derived-marijuana-treat-rare-severe-forms