Establish a solid understanding of the basic concepts and treatment options of medical cannabis.
Cannabis is a flowering plant which has many wonderful uses: its seeds are a healthy source of nutrition; its stalks can be processed into paper, clothing, rope, and construction materials; its leaves, flower, and roots can be harnessed for medical uses.
The plant has unique male and female forms, with the females being the party which grows flowers. Its flowers are commonly referred to as buds or colas. There are multiple buds per plant, with the central and largest bud being commonly referred to as the apical bud. The buds are most commonly used for human consumption.
Upon closer inspection, the buds will look as though they are coated in small clear or white colored crystals. These structures are commonly referred to as trichomes. Their purpose in nature was to help the plant defend itself from predators and the elements. Packaged inside these structures, shaped like stalks with mushroom like heads, are the terpenes, and cannabinoids like THC and CBD. Terpenes are the chemicals which produce the intense smells of cannabis.
CANNABIS AS MEDICINE
Documents found through the course of history dating back to 2900 B.C. clearly demonstrate the presence of cannabis alongside humankind for thousands of years. Throughout this time cannabis was cultivated for medicinal purposes. Cannabinoids are the chemicals found almost exclusively only in cannabis which are mainly responsible for its medicinal effects. The two most well known cannabinoids are surely THC and CBD. Cannabinoids interact with the human body via receptors located throughout the human body – together as a whole this network of receptors is named the endocannabinoid system.
There is a quality body of scientific work which supports the use of cannabinoids as medicine. In fact there is so much evidence that cannabinoids have been artificially synthesized and subsequently approved by the FDA for diseases like MS and cancer (Sativex, Marinol, and others). THC and CBD have been shown in studies to provide relief for pain, nausea, sleep and stress disorders, as well as anxiety, inflammation, and epilepsy. In total the cannabis sativa plant contains over 85 cannabinoids, and every day new research is released which shows how these chemicals can be used to treat a wide range of illnesses. However, some recent studies have also shown a possible link between cannabis use very early in life (under 18 years of age) and a negative impact on brain development. Without a doubt, more research is needed to understand the impact cannabis use can have on the human body.
One of the most important aspects of modern day medical cannabis to understand is that patients no longer need to smoke cannabis, or ingest some orally administered edible/liquid product which has an unknown potency. Just like traditional modern medicine, cannabis dosages can be precisely measured and delivered. Recent advancements in processing equipment and techniques have allowed the integration of pills, gelcaps, and tablets into the cannabis marketplace. These products contain precision dosed amounts of the chosen active ingredient(s) i.e. 5mg of THC and 10mg of CBD – this is a leap forward in the integration of cannabis into the active pharmaceutical arsenal.
WHAT IS A CANNABIS STRAIN?
A strain is a unique genetic variant of cannabis. Most cannabis strains are classified as either Cannabis Sativa or Cannabis Indica, two variations of the same species of cannabis. These two families of cannabis strains tend to have different effects on the patient, as discussed in the next section below. We are seeing in today’s medical cannabis marketplace the blending of these two types into what is called a hybrid, and contains traits from both its sativa and indica parents.
Throughout the years, numerous hybrid strains have been born through the genetic cross-breeding programs which were intended to develop plant profiles which inherited the best qualities of each parent strain. Just visit a legal cannabis dispensary and you will be amazed to see the wild assortment of strains that have been created over the years, drawing from a world-wide genetic pool of cannabinoid profiles.
INDICA AND SATIVA
Form and Structure:
Indica plants tend to be short and bushy, while sativa varieties are tall and wide. The leaves of indica varieties are broad and wide, with sativa leaves having thin and elongated pointy leaves. It is important to note that it is not always easy to identify a plant solely by its overall profile or the appearance of its leaves. The variations between indicas and sativas are due primarily to their different geographical regions of origin. Indicas call the mountainous regions of Asia and the Middle East home. In contrast, sativas call the equatorial regions of the planet home.
The efficacy, or effect, of indica and sativa strains is respectively quite different. A pure sativa will likely have a powerfully uplifting and energizing effect. Sativas can encourage increased focus and productivity – making them the choice for daytime use. However, sativas can be so mentally expanding that some patients feel their mind is racing too fast and feel anxious or paranoid.
Indicas generally promote relaxation and overall calmness. Many think indicas are very beneficial for pain relief, anxiety, and sleep disorders. Strong indicas may not be the ideal option for morning or daytime use, as the strong relaxing effects may hinder productivity. Going along the same line of thinking, consumption of a sativa may not be ideal for evening use.
With that in mind, these expectations are at times discussed without making note of the finer points in the differences. The two types of chemicals found in cannabis which hold the majority of the influence on the effects are the cannabinoids and the terpenes. In this way of thinking, cannabis strains are the sum of their smaller parts which are passed through from generation to generation through the family line.
As noted earlier, hybrids are simply a mix of sativa and indica, providing both good and bad qualities of each type. Hybrid strains in which the indica family dominates are commonly referred to as indica-dominant. Conversely, strains which are mostly sativa are sativa-dominant.
TYPES OF CONSUMPTION
In today’s medical cannabis marketplace there exists a wide variety of consumption methods. Traditionally, the most common consumption method is smoking in either a pipe-type instrument or rolled in paper. Oral ingestion (eating cannabis infused foods or liquids) has also been a common consumption method in many cultures.
Recently advancements in extraction technologies have allowed for new forms of concentrated resin, along with concentrated forms of cannabis oil which can been ingested orally. These concentrates can be made mixed into topical lotions and applied to this skin, or also vaporized and inhaled. Smoking is by far the only method available in today’s new world. Patients have access to pills which contain precision amounts of medication, i.e. a pill with 5mg of THC and 5mg of CBD.
Here is a quick rundown of the most common forms of consumption and the cannabis forms for each:
Inhalation – smoke or vapor which is inhaled and absorbed into the bloodstream via the lungs (joints, pipes, and vaporizers).
Ingestion – the oil extracted from the cannabis plant, containing both the cannabinoids and terpenes, can be ingested as-is, or combined with any solid or liquid food and ingested as an infused product. The oil can also be processed into pills, gel caps, and tinctures.
Oral absorption – often the extracted oil is combined with another medium to act as a vessel. The resulting product is kept inside the mouth while it is absorbed by the skin under the tongue and inside the mouth(mints, lozenges and breath strips).
Topical – the extracted oil is combined with a topical product that is applied directly to the surface of the skin(lotion, ointments and transdermal patches).
THE EFFECTS OF CANNABIS
The effects of cannabis will be unique to each individual. Different strains and methods of consumption gives patients different results. Furthermore, new patients typically experience different effects and more experienced patients.
Results will vary – with some patients not feeling anything at all the first time they medicate. For the majority of the time, the experience tends to be mostly relaxing and slightly euphoric. Some patients feel more outgoing and social, while other patients find cannabis makes them tired, anxious, or even paranoid.
It is critical that patients proceed with consuming medical cannabis with caution and respect for its powerful efficacy – the rule to never forget is start low and go slow. Wait and see how the initial dose affects you before increasing your dosage amount. Keep written track of your dosing records, type of products used, and the effects you felt – this will help you be more able to clearly comprehend how cannabis can work best for you.
CAN I CONSUME TOO MUCH CANNABIS?
Cannabis is no different than any other substance which has a physiological effect on the human body, it is possible to over-medicate. However, it is important to note that cannabis is unique and unlike other medications prescribed for treating pain and other conditions approved for the program, it is extremely highly unlikely that an otherwise healthy individual would consume a lethal dosage. This is mainly because the cannabinoid receptors, unlike opioid receptors, are not located in the brain stem areas which control automatic bodily functions like respiration and cardiovascular function. In the 5,000 year long history of cannabis, throughout its use by hundreds of millions of people for both medicinal and recreational purposes, there has not been one single credible documented case of anyone fatally overdosing on cannabis.
There is a test named the LD-50, which is used to determine and quantify the toxicity of a product. This rating indicates at what specific dosage 50% of test animals receiving a drug will die as a result of drug induced toxicity. For example, the LD-50 rating for aspirin is 1:20. In layman’s terms that means that is the recommended dosage is two pills, a person would need to consume twenty times that amount to cause death. For Valium it’s 1:10 and for some cancer medications it can be as low as 1:1.5.
It is estimated that the LD-50 for cannabis would be between 1:20,000 and 1:40,000. The resulting math would calculate that a person would need to ingest twenty to forty thousand times the single serving size to result in death. The study which measured these amounts referenced 0.9g as a single serving, which was that they expected one typical joint to weigh. Using the LD-50 ratio for cannabis, a patient would need to consume roughly twenty to forty thousand joints, or about 1,500 pounds of cannabis within 15 minutes to result in death. In short, it would take an unrealistic amount of cannabis consumption for an otherwise healthy person to experience cannabis-induced death.