Medical Cannabis 101
By Andrew Kuebbing, California Cannabis Advocates
Trying medical marijuana for your condition can be a daunting prospect—maybe you had a bad experience in the past, or maybe there’s just too many options and you don’t know where to start.
Cannabis medicine doesn’t have to be confusing, and with a few simple pieces of knowledge you can feel much more confident about taking charge of your health care.
The Myths of Cannabis
Let’s start with a few of myths about cannabis that have hung around long enough—like cannabis kills brain cells, causes lung cancer or depression—all myths. Even old sayings like “gateway drug” have been proven untrue. As more and more is understood about the biology of addiction, researchers have come to understand that cannabis is not addictive in any traditional sense, especially when used as medicine. In a recent paper, it was actually revealed that 87% of cannabis patients have used cannabis to replace prescription pills, alcohol or illicit substances.
For many patients, using cannabis as part of a wider health and living regiment is the best way to get the most out of the medicine. With new dosed and CBD-rich options, patients are able to experience the healing and anti-inflammatory benefits of cannabis without any effect on their cognition during the day. CBD-rich medicines have also shown promise for slowing or even reversing the cognitive decline associated with Alzheimer’s disease. The federal government’s current stance on cannabis means that state-qualified patients can use cannabis medicine without fear of arrest or prosecution.
What You Need to Know about Therapeutic Marijuana
With just a few basic pieces of knowledge, you’ll be just as informed as the “budtender” at your local dispensary (and don’t let them fool you into thinking any different!).
Let’s start with indica and sativa. For medical patients, especially those new to the medicine, it’s not as relevant as it used to be. If those are your only choices, pick Indica, but those shouldn’t be the only choices.
To give a brief synopsis, indica and sativa are subspecies of cannabis, developed over generations in vastly different climates in around the world, using a multitude of terpenes to repel different pests in exotic locales. Sativa developed in tropical climates, with a long growing season and ample sunlight, giving them their sweet smells, thin leaves, long growing season and towering heights. Indica is the opposite, having developed in mountainous regions, it adapted to a shorter growing season, colder climates and less sunlight. The original “strains” of cannabis were basically the choice varietals from growing regions around the world, transported as seed—various Mexican sativa, Afghan indica, Indian Kush indica, Thai sativa, etc. Over the last 100 years, especially the last 40, they have been extensively hybridized in the West, leading to the multitude of strains you see at any dispensary. But don’t be fooled by names, new genetic testing has revealed that many strains are surprising similar or mislabeled.
The most important piece of information for new patients is the ratio of CBD:THC. CBD is most effective for inflammatory conditions, as well as anxiety and seizure control, while THC is more effective for pain and nausea. Individual dosing can vary across ratios, but the safest and easiest way to titrate is start with a high CBD ratio (15:1 or above) which will be generally non-psychoactive, helping inflammation but not really improving pain, nausea, or spasticity as much. Then, as you feel comfortable, add in small amounts of THC, increasing the ratio slowly until you reach a dosage that is comfortable for you. This process is called titration.
Consider your Return on Assets (ROA)
Now you’re probably thinking, “Ok, it sounds easy enough, but how do I know how much of the joint to smoke?” My answer is, “You don’t have to smoke!”
It’s actually easier to titrate your ratio (see above) and accurately dose your medicine if you don’t smoke! With an edible oil or sublingual sprays, you can measure your dosage through milligram or weight, through the scientific miracles of lab testing. Concentrated oils are the most potent type of cannabis medicine—usually somewhere between 400 and 900 milligrams of cannabinoid per gram. Ethanol and “Distillate” or “clear,” are prepared to be ready for oral consumption, sometimes CO2 oil is as well. These products are the least expensive per milligram of medicine, but it is difficult to use in small doses, making it easy to waste.
For new patients or those seeking a more comfortably dosed experience, extracts are available which combine concentrated cannabis oil with an inactive carrier oil such as coconut oil. This allows for a cannabinoid concentration between 15 and 25 mg/mL, making it possible to dose 5-10 mg increments in a spray or dropper. A major benefit of an extract over a concentrate (or a food edible) is that the medicine absorbs through the mouth, meaning it takes effect faster (5-20 minutes vs 45-60 minutes) and requires a slightly lower dose because it avoids the stomach acids.
Even a sublingual extract is not fast-acting enough and without enough kick for many patients, which is why vaping and smoking continue to be a mainstay of cannabis therapy. Taking the medicine through the lungs results in almost instant relief, which makes titration simple—just stop when you feel better.
Ok, so how do I get it?
This is a loaded question, as it will be different in every state. I live in California, where the law recognizes that cannabis can help many conditions and there are doctors who specialize in writing cannabis recommendations for patients—making the process the easiest in the country.
There are some constants around the country you can use to get started. Every program is state-level and states generally do not allow reciprocity with other state programs. Check with your State Department of Health to find out the qualifying conditions and rules in your state. Every state except California requires registration with the state to be a valid patient (and this information is all protected by HIPPA).
Once you have your state-required paperwork you’ll be able to visit a dispensary or, depending on the state, grow your own cannabis at home. Growing quality cannabis can be a lot of work, but if time is no issue it should save you money overall, especially if you have the space and climate to grow outside.
A Final Note on Cannabis
Cannabis is still considered a Schedule I drug by the Federal Government, meaning it has no medical value and a high potential for abuse. Despite this, the Obama Administration has allowed state-level medical marijuana programs to continue generally unimpeded. This leniency under the law could be stopped by a future presidential administration. Until cannabis is removed from the federal schedule of drugs we are all suffering a great injustice, as patients in many states risk their freedom to access the medicine.
About the Author:
Andrew is a lifelong progressive and longtime community organizer. He graduated from the University of Maryland with a degree in history and a focus in political science, and has applied that perspective to the culture surrounding cannabis. He has worked in the cannabis industry as a consultant, quality and production control manager, caregiver, patient access director, collective operations manager, and community organizer. He believes in access to self-directed health care and has fought for his own health through the biomedical arena. He is a medical cannabis patient in the state of California.
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