Cannabis Components, Safety, and Usage
Cannabis may be one of the safest drugs known to humans. There have been no reported deaths from its use, whether from overdose, allergic reaction, or adverse reaction when taken with other medications. Physical addiction is rare, and cannabis can be used to help patients wean off of addicting medications such as narcotics and benzodiazepines. Cannabis can replace prescription drugs for sleep, pain, and anxiety, which have become a leading cause of death in the United States. It can also treat withdrawal symptoms. In our practice, we’ve found cannabis to be an ideal “exit drug.”
Cannabis has been used medicinally for over 5,000 years and was recommended by doctors in the United States until powerful entities lobbied to make it illegal in the 1930s. It became a schedule 1 drug—considered highly addictive and without therapeutic value—in the 1970s. No other plant or pharmaceutical medication can come close to matching cannabis' safety and therapeutic profile.
Strains may be indica-dominant, sativa-dominant, or a hybrid of the two.
Sativa is known as a daytime strain. Sativa strains may have high levels of THC that, when activated, creates a “high.” In addition to its therapeutic value, it can be used for recreation and creativity. Strong sativas may sometimes cause anxiety or paranoia, especially in patients prone to these conditions. (High-CBD strains help reduce anxiety.)
Indica is known as a nighttime or “couch lock” strain. Indicas create a heavy, body-relaxing effect and are often used for sleep and pain reduction.
Cannabinoids and Terpenoids
The cannabis plant contains approximately 100 cannabinoids and 100 terpenoids, the terpenes that give it its distinctive aroma and flavor. Terpenes modulate the effect of cannabinoids. Terpenes are the reason that indicas and sativas with similar cannabinoid profiles can have different effects.
As you can see in the following chart, cannabidiol (CBD) has more therapeutic value than any other part of the plant. CBD is a non-psychoactive cannabinoid and may actually reduce THC’s psychoactive effects. CBD effectively treats many conditions, but it must be combined with the other cannabinoids (such as THC) and terpenes to have full therapeutic value. This is called the “entourage effect.”
Using Medical Cannabis
Inhaling is your fast-acting medicine. You feel the effects immediately, and they last for about two to three hours. It’s the best solution when you want immediate relief or don’t want a long-acting effect.
We recommend using a vaporizer rather than smoking because smoking is harsh on lungs and throat and can impede lung function. A vaporizer allows for immediate absorption of cannabinoids while minimizing smoke, odor, congestion and carcinogens. We recommend portable, battery-operated flower vaporizers with temperature control. The PAX 2 is the best flower vaporizer we’ve found to date, and it comes with great customer support and a 10-year warranty.
Oil, wax, and shatter-based vaporizers are discreet and convenient but can have significant negative effects (lack of temperature control, few varietal choices, increased tolerance, contaminants). We advise caution around dabbing, which can over-saturate receptors causing a very high tolerance and rendering cannabis less effective while increasing potential abuse.
Ingesting cannabis is your long-acting medicine. It can take an hour or more to take effect, and the effects can last as long as six to eight hours.
When you ingest cannabis, you convert delta-9-THC to 11-hydroxy-THC in the liver, leading to longer and stronger effects.
Edibles come in a variety of forms and can be purchased from dispensaries or can be made at home with cannabis-infused butter or oil.
When using edibles, always start slow! We recommend using a quarter to a half of the dose recommended on the product package, then increasing your dose if necessary. Try edibles on a day when you have nothing to do and can stay home.
Give it at least 90 minutes to feel the effects. If you still don’t feel the desired effect, don’t take more! Eat a snack, something with a little fat or oil (cannabis is fat soluble), and see what happens. If you still don’t feel anything, take the other half or quarter dose.
Edible cannabis can be very strong, and the effects aren’t always consistent from dose to dose. Stomach acids, intestinal absorption, and liver metabolism affect results. Food ingested before or after a medicated edible can influence how strong or weak the effects are for you. Your personal metabolism also plays a part in how edibles affect you.
These follow the same metabolic process as edibles.
Care must be taken to start low and gradually increase your dose over time, as tolerance permits.
Capsules can be taken at regular intervals, and CBD-dominant capsules may have minimal psychoactivity.
Cannabis hash oils can be inhaled or taken orally.
Hash oil is stronger than flower because it’s concentrated. You’re more likely to build up a higher tolerance when you use oil instead of flower. We always recommend flower rather than concentrates unless your condition warrants stronger medicine.
Concentrated cannabis, often in glycerin or alcohol, is your intermediate-acting medicine with a less than 30-minute onset.
Tinctures are a great alternative to smoking or ingesting. Simply put a few drops under the tongue and allow it to absorb into the blood vessels (one to two minutes), then spit it out or swallow it. Be aware that if you swallow the tincture, it will have a dual effect as an edible.
To figure out your tincture dose, check the bottle. As an example, if it has 0.5mg of THC per drop and you want 10mg, take 20 drops. By counting drops, tinctures allow for precise dosing.
Like tinctures, sprays are relatively fast-acting and typically sub-lingual, offering a very precise delivery system.
Sprays are a great option if you prefer not to inhale.
Salves, liniments, and massage oils can be used locally on joints and other areas of localized pain. Topical cannabis is very effective for muscle spasms and local areas of inflammation like those found in arthritic conditions.
Topical concentrated oils have been used to treat skin conditions including basal and squamous cell carcinoma.
We recommend massaging the medicated salve into the area in spasm or pain, applying heat, then giving it a few minutes to absorb.
Topicals are great used alone or in combination with systemic cannabis.
It is not common to have psychotropic effects from salves and topical oils.
These are relatively new on the market and are being perfected for absorption and skin reaction. They are generally placed on the wrist or dorsal part of the ankle for systemic absorption and may last up to six hours.
Not everyone absorbs medication from patches the same. The patches come in a variety of cannabinoid blends, usually in 10-mg dosages.
A transdermal cream that can be rubbed into the wrist acts similarly to the patch. It is usually 2mg per squirt.
The Endocannabinoid System
Six hundred million years ago, sea squirts developed the endocannabinoid system that today’s humans have inherited. Our bodies produce cannabinoids (endocannabinoids) and receptors that they attach to, in a system that provides balance and homeostasis in the body. Phytocannabinoids, plant-based cannabinoids with the same chemical structure as endocannabinoids, came into existence about 25 million years ago. Like endocannabinoids, phytocannabinoids bind to human receptors to provide balance and homeostasis.
Science is finally emerging that explains how cannabis can enhance physical, emotional, and spiritual wellbeing. The plant’s magic can be broken down into two words: symbiosis and balance. Cannabinoids are neuromodulators that provide balance within the synapse—the space between neurons—by traveling retrograde. When the body is in hyper mode, cannabinoids slow things down. When it’s in hypo mode, they speed things up.
The cannabis plant has approximately 100 different cannabinoids. The two most studied are tetra-hydro-cannabinoid (THC) and cannabidiol (CBD), which work symbiotically to improve human health, wellbeing, and balance.
Because the federal government classifies cannabis as a schedule 1 drug, considered to be highly addicting and without medicinal value, the FDA has not allowed double-blind, placebo-controlled studies in the United States. This is unfortunate, because cannabis has low addiction potential, is nontoxic, and has been shown to be a significant medicine. The DEA recently decided to keep cannabis in this category but is allowing more university centers to grow cannabis for performing studies.
A mountain of anecdotal information, based on actual patient experiences, indicates that cannabis is a highly effective medication for a wide range of disorders. We’re beginning to see the results of in-vitro, animal, and human studies throughout the world, and we’re about to embark on major breakthroughs in cannabis use. Cannabinoids offer great promise in protecting the brain, which could help treat neurodegenerative diseases such as senile dementia and Alzheimer’s. We’re already seeing the benefit of cannabinoids in treating a variety of types of cancer, autoimmune diseases, and seizure disorders, to name a few. THC and CBD are effective in relieving pain, inflammation, and spasm, allowing patients to wean off of opioids and benzodiazepines.
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For more information, watch our video series on cannabis and functional medicine!
Medical Cannabis Education