A Beginner’s Guide to Legal Medical Cannabis
Colorado is currently the nation’s leading cannabis industry. Legalization of both recreational and medicinal cannabis has attracted a variety of people to the state. While many come to partake in recreation use, there are a large number that are enticed by the medicinal properties of the plant and come seeking a treatment for a variety of ailments. Unfortunately, the foreign word jumble of strains, acronyms, and delivery methods that are commonly found in a dispensary often overwhelms those new to legal medical cannabis.
Cannabis is a flowering plant that comes in two main strains, cannabis sativa and cannabis indica. Once the plant is mature, it is covered in resinous glands called trichomes. These trichomes contain compounds known as cannabinoids and fragrant oils called terpenes or terpenoids. The first identified, best known, and most psychoactive cannabinoid is THC. CBD or cannabidiol is another well-known medicinal cannabinoid that does not have the psychoactive effects of THC. In all, there are more than 85 different kinds of cannabinoids that are currently known.
Hemp, on the other hand, is a type of cannabis sativa that is bred predominantly for its fibrous stalk and seeds. Each flowering plant, be it a sativa or indica strain has a unique combination of cannabinoids and terpenes. The vast amount of these combinations is only half the story, however. Our body naturally makes compounds similar to the cannabinoids known as endocannabinoids. These chemicals have corresponding receptors called CB1 and CB2 receptors that are found throughout the body and the brain. This network of receptors and compounds is collectively known as the endocannabinoid system. To simplify, this system is thought to generally mediate the health and stability of a variety of functions of the body and brain. When the cannabinoids from the cannabis plant are taken into the body, the endocannabinoid system is activated in a variety of ways that modern science is just starting to understand.
The way the different strains, cannabinoids, and terpenes interact with our endocannabinoid system is fairly complex. Modern medicine has a tendency to think about drugs and therapeutics in a reductionist way. For example, we know penicillin comes from a fungus and we can extract the drug from the fungus, however consuming the whole fungus would not offer any additional benefits and would likely be dangerous. Cannabis is not the same, and follows a concept known as “whole plant medicine.” The “entourage effect” is the interactive synergy between the different cannabis compounds and the physiologic effect they have on the body.
Simply creating a synthetic THC such as the drug Marinol that is used for cancer-related nausea fails to take this into account. Different combinations of terpenes and cannabinoids can have a wide-ranging physiologic effect. Some compounds are inhibiting, while some are activating to the endocannabinoid system. In a simple example, a strain with a high concentration of THC with a moderate concentration of CBD will not be as psychoactive if it only had the THC alone. This is also an important point when considering cannabis for pain management. Typically different ratios of THC/CBD and other cannabinoids will have different effects for a variety of conditions.
Hemp, although potentially high in CBD, does not contain THC and some of the other cannabinoids possibly needed to induce the entourage effect. Ultimately, it is advised that if you are seeking out cannabis for its medicinal properties to consult with a clinician well educated in cannabinoid medicine. It can also be very helpful to keep a journal to document the different effects that the various combinations of cannabinoid compounds have on you.
Besides having an appreciation for the cannabis varieties and the possible medicinal effects, it is important to have an understanding of the different ways to consume cannabis. Deciding on a delivery mechanism greatly depends on how quickly or how long you are seeking relief. Inhalation mechanisms will deliver a faster onset but will be shorter lasting.
Vaporizing is becoming the preferred method of inhalation and is thought to possibly be healthier than smoking. Smoking or combusting cannabis uses high heat. This heat, in combination with burnt particles, is postulated by some in the medical community to have to adverse health effects on lung function 2. Vaporizing, however, uses sub-combustible temperatures. The hope being that only the cannabinoids and supporting compounds are inhaled. Edibles, capsules, and tinctures provide longer lasting relief, but these methods may also take several hours to take effect. To achieve immediate and long-term dosing there is a method known as “stacking” in which you take two methods at the same time. Vaporizing and an edible together could provide immediate and longer duration relief.
In regards to dosing cannabis a couple simple rules are advised. The first is to start low and go slow. This is especially true for those new to cannabis. Some of the concentrations on the market are quite high and can result in undesired side effects. Edibles and tinctures are often more reliable to measure dosing as opposed to inhalation, which can be hard to measure given the variability in the amount of each inhale, time in lungs, etc. It is often found in cannabinoid medicine that experienced users have exceeded their therapeutic dosage window and actually reducing their dosage can have a greater therapeutic effect. As previously mentioned, keeping a journal is highly advised to finding not only your optimal cannabinoid combination but dosage as well. For more information about safe cannabis use and advocacy check out the group Americans For Safe Access at SafeAccessNow.org.
Hazecamp, A. (2013). The medicinal use of cannabis and cannabinoids—an international cross-sectional survey on administration forms. Journal of Psychoactive Drugs, 45, 199-210. 2Smoking Marijuana and the Lungs. (2017). American Journal of Respiratory Critical Care, 195, 5-6.
DISCLAIMER: The information in this article is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information contained in this article is for general information purposes only. Always consult a doctor before making any health changes, especially any changes related to a specific diagnosis or condition.