Guide to using medical cannabis
Cannabis is a flowering plant that has fibrous stalks used for paper, clothing, rope, and building materials leaves, flowers, and roots used for medicinal purposes, and seeds used for food and fuel oil. Cannabis leaves and flowers are consumed in several forms: dried flower buds or various types of concentrated, loose, or pressed resin extracted from the flowers or leaves through a variety of methods. Once mature, the plant’s leaves and flowers are covered with trichomes, tiny glands of resinous oil containing cannabinoids and terpenes that provide physical and psychoactive effects.
100+ different types of cannabinoids and terpenes.
Concentrations or percent of each type of cannabinoid ranges widely from plant to plant and strain to strain.
The first identified and best-known cannabinoid is THC (delta-9-tetrahydrocannabinol). THC has the most significant psychoactive effect of the cannabinoids. The ratio of THC to other cannabinoids varies from strain to strain. While THC has been the focus of breeding and research due to its various psychoactive and therapeutic effects, non-psychoactive cannabinoids have physiologic effects that can be therapeutic.
- Cannabidiol (CBD) relieves convulsions, inflammation, anxiety and nausea—many of the same therapeutic qualities as THC but without psycoactive effects. It is the main cannabinoid in low-THC cannabis strains, and modern breeders have been developing strains with greater CBD content for medical use.
- Cannabinol (CBN) is mildly psychoactive, decreases intraocular pressure, and seizure occurrence.
- Cannabichromene (CBC) promotes the analgesic effects (pain relief) of THC and has sedative (calming) effects.
- Cannabigerol (CBG) has sedative effects and antimicrobial properties, as well as lowers intraocular pressure.
- Tetrahydrocannabivarin (THCV) is showing promise for type 2 diabetes and related metabolic disorders.
In addition to cannabinoids, other cannabis plant molecules are biologically active. A few other molecules known to have health effects are flavonoids and terpenes or terpenoids (the flavor and smell of the strain). Cannabinoids, terpenoids, and other compounds are secreted by the glandular trichomes found most densely on the floral leaves and flowers of female plants.
Understanding Your Medicine
Different people have different experiences. One individual may feel stress release, while another feels over-stimulated and stressed, while another feels energized and on-task. There are many factors that impact the effect:
- Amount used (dosage)
- Strain of cannabis used and method of consumption
- Experience and history of cannabis use
- Mindset or mood
- Nutrition or diet
- Types of Cannabis
Though cannabis is biologically classified as the single species Cannabis Sativa, there are at least three distinct plant varieties: Cannabis Sativa, Cannabis Indica, and Cannabis Ruderalis, though the last is rare. There are also hybrids, which are crosses between sativa and indica varieties. Cannabis used for fiber is typically referred to as hemp and has only small amounts of the psychoactive cannabinoid THC, usually less than 1%.
Genetic “breeders” of the cannabis seed have developed thousands of different strains of cannabis from these three varieties. There are marked differences between sativa, indica, and hybrid. Today, we mostly find hybrids. It can be difficult to find pure indica or sativa.
All types of medical cannabis produce effects that are more similar than not, including pain and nausea control, appetite stimulation, reduced muscle spasm, improved sleep, and others. But individual strains will have differing cannabinoid and terpene content, producing noticeably different effects. Many people report finding some strains more beneficial than others. For instance, strains with more CBD tend to produce better pain and spasticity relief. As noted above, effects will also vary for an individual based on the setting in which it is used and the person’s physiological state when using it.
In general, sativas and indicas are frequently distinguished as follows:
The primary effects are on thoughts and feelings. Sativas tend to produces stimulating feelings, and many prefer it for daytime use. Some noted therapeutic effects from use of Sativas:
- Increased sense of well-being, focus, creativity
- Reduces depression, elevates mood
- Relieves headaches/migraines/nausea
- Increases appetite
Some noted Side-Effects from use of Sativas
- Increased anxiety feelings
- Increased paranoia feelings
The primary effects are on the body. Indicas tend to produce sedated feelings, and many prefer it for nighttime use.
Some noted Therapeutic Effects from use of Indicas:
- Provides relaxation/reduces stress
- Relaxes muscles/spasms
- Reduces pain/inflammation/headaches/migraines
- Helps sleep
- Reduces anxiety
- Reduces nausea, stimulates appetite
- Reduces intra-ocular pressure
- Reduces seizure frequency/anti-convulsant
- Some noted side-effects from use of Indicas:
- Feelings of tiredness
- “Fuzzy” thinking
Strains bred from crossing two or more varieties, with typically one dominant. For example, a sativa-dominant cross may be helpful in stimulating appetite and relaxing muscle spasms. Crosses are reported to work well to combat nausea and increase appetite.
The dried flower or bud from the manicured, mature female plant is the most widely consumed form of cannabis in the U.S. Elsewhere in the world, extracts or concentrates of the cannabis plant are more commonly used. Concentrates are made from cannabinoid-rich glandular trichomes, which are found in varying amounts on cannabis flowers, leaves and stalks. The flowers of a mature female plant contain the most trichomes.
Many methods are used to separate the trichomes from the plant:
- Sift the cannabis flower and/or leaves through a fine screen either via a mechanical/motorized tumbler or by hand. Called “dry sift.” What passes through the screen is primarily the oil-rich glandular heads.
- Roll the cannabis flowers between the fingers to rupture the trichomes and collect the resin that sticks to the fingers. Called “finger hash.”
- Submerge cannabis leaves in ice water and agitate mixture to solidify trichomes. Filter mixture through series of increasingly fine screens or bags. Dry the trichomes and press into blocks. Called “bubble hash.” This method has increased yield.
There are other ways to separate the trichomes from other plant material, such as butane extractions, but consult your local medical cannabis laws concerning restrictions on certain types of preparations and use caution as some methods can create serious combustion dangers.
Kief is a powder made from trichomes removed from the leaves and flowers of cannabis plants. Can be compressed to produce cakes of hashish, or consumed (typically smoked) in powder form in a pipe or with cannabis bud or other herbs.
Hashish (also known as hash or hashisha) is a collection of compressed or concentrated resin glands (trichomes). Hash contains the same active cannabinoids as the flower and leaves but typically in higher concentrations (in other words, hash is more potent by volume than the plant material from which it was made).
- Hashish usually is a paste-like substance with varying hardness. Good quality is typically described as soft and pliable. It becomes progressively harder and less potent as it oxidizes and oil evaporates.
- THC content of hashish ranges from 15-70%.
- Often smoked with a small pipe. Can be used in food, in a hookah, vaporizer, mixed with joints of cannabis bud or aromatic herbs.
- Color varies from black to brown to golden or blonde. Color typically reflects methods of harvesting, manufacturing, and storage.
MYTH: The effects from smoking hash are different.
FACT: The effects of hash vary in the same way strains of cannabis do. This stems from differences in potency of hash and the regional variations between cannabis strains used for making it.
Hash oil is a mix of essential oils and resins extracted from mature cannabis foliage through the use of various solvents such as ethanol or hexane. The solvent is then evaporated, which leaves the oil. Hash oil tends to have a high proportion of cannabinoids—a range from 30 to 90% THC content can be found.
Can be smoked with a specialty pipe (specifically for hash oil or hash), with a vaporizer, with cannabis bud in a pipe, joint, or added to food.
Cannabis can be ingested or eaten when added to cake, cookies, dressings, and other foods. It can also be brewed into a tea or other beverage. To be effective, cannabis and its extracts or concentrates must be heated in order to convert the cannabinoid tetrahydrocannabinolic acid into active THC.
Digestive processes alter the metabolism of cannabinoids and produce a different metabolite of THC in the liver. That metabolite may produce markedly different effects or negligible ones, depending on the individual. Onset of effects are delayed and last longer due to slower absorption of the cannabinoids.
Cannabinoids are fat-soluble, hydrophobic oils, meaning they dissolve in oils, butters, fats and alcohol, but not water. Processes using oil, butter, fat or alcohol can extract the cannabinoids from plant material.
Various forms of converted cannabis can be used for edible medicating. Each can be made from cannabis flowers, leaves of concentrates such as hash. The potency of the edible will depend on the material used in making it and the amount used. Edibles made with hash will be stronger than those made from leaf trim.
Cannabis Oil (cannaoil): is cooking oil infused with cannabinoids. Various means to extract include heating the oil and cannabis mixture at low temperature in a frying pan or pot, double boiler, or slow cooker then straining out the plant material. Can be used in any recipe that includes oil and that doesn’t go over 280 degrees Fahrenheit (evaporating point). Think cookies, cakes, candies, and other food items.
Cannabis butter (cannabutter) is butter infused with cannabinoids. Heat raw cannabis with butter to extract cannabinoids into the fat. Various means to extract include heating the butter and cannabis mixture at low temperature in a frying pan or pot, double boiler, or slow cooker then straining out the plant material. Can be used in any recipe that includes oil and that doesn’t go over 280 degrees Fahrenheit.
Tinctures use ethanol alcohol (e.g. pure grain alcohol, not rubbing alcohol) to extract the cannabinoids. You use droplet amounts, and it is absorbed through the mucous membranes in the mouth.
Sublingual sprays is another way of using a tincture. Use ethanol alcohol to extract the cannabinoids. You use a pump to spray cannabis-alcohol solution under your tongue.
Liquor may be infused with cannabinoids. Best to cook stems and leaves into brandy or rum. Can be added to coffee and other beverages.
Cannabis Topicals (applied to the skin)
Cannabinoids combined with a penetrating topical cream can enter the skin and body tissues and allow for direct application to affected areas (e.g. allergic skin reactions, post-herpes neuralgia, muscle strain, inflammation, swelling, etc.).
- Cannabinoids in cannabis interact with CB1 and CB2 receptors that are found all over the body, including the skin.
- Both THC and Cannabidiol (CBD) have been found to provide pain relief and reduce inflammation.
- Topical cannabis use does not produce a psychoactive effect, which is different from eating or inhaling the medicine.
Different types of cannabis topicals include:
- Salve: cannabinoids heated into coconut oil combined with bees wax and cooled. Rub directly on skin.
- Cream: cannabinoids heated into shea butter combined with other ingredients and cooled. Rub directly on skin.
Topicals may produce anti-inflammatory and analgesic or pain relief effects.. Research has to date been limited to studies on allergic and post-herpes skin reactions and pain relief. Anecdotal reports on topical treatment efficacy include:
- Certain types of dermatitis (including atopic) and psoriasis
- Balm for lips, fever blisters, herpes
- Superficial wounds, cuts, acne pimples, furuncles, corns, certain nail fungus
- Rheumatism and arthritic pains (up to the 2nd degree of arthritis)
- Torticollis, back pains, muscular pains and cramps, sprains and other contusions
- Phlebitis, venous ulcerations
- Menstruation pains
- Cold and sore throat, bronchitis
- Asthmatic problems with breathing
- Chronic inflammation of larynx (application in the form of a Priessnitz compress)
- Migraine, head pains, tension headaches
- Pharmaceutical Cannabis or Cannabinoids
Pharmaceutical cannabis or cannabinoid drugs are those that have been standardized in composition, formulation and dose. That means you always know exactly what and how much you are getting with each pill or spray. These are drugs which have been developed to meet regulatory requirements for prescribing by physicians.
Dronabinol (Marinol®) is a prescribed capsule classified as a Schedule III drug used to treat nausea and vomiting caused by chemotherapy and loss of appetite and weight loss in people who have acquired immunodeficiency syndrome (AIDS). It is a synthetic version of THC suspended in sesame oil and does not contain CBD (cannabidiol) or other cannabinoids.
Sativex® is a prescribed oromucosal (mouth) spray to alleviate various symptoms of MS and cancer, including neuropathic pain, spasticity, overactive bladder and other symptoms, depending on the country. Derived from two strains of cannabis, the principal active cannabinoid components are THC and CBD suspended in ethanol. Each spray of Sativex® delivers a fixed dose of 2.7mg THC and 2.5mg CBD.
How Can I Use Cannabis More Safely?
Adjust the way you use cannabis. One of the great aspects of cannabis is that there are many ways to use the medicine effectively.
Ingest via Eating
This is one of the safest ways to consume your medication, but understand that the effects from eaten cannabis may be more pronounced and onset of the effects will be delayed by an hour or more and typically last longer than inhalation. Using edible cannabis effectively will usually take some experimentation with particular product types and dosage. Digesting cannabis also metabolizes the cannabinoids somewhat differently and can produce different subjective effects, depending on the individual.
Use small amounts of edibles and wait 2 hours before gradually increasing the dose, if needed. Take care to find and use the right dose-excessive dosage can be uncomfortable and happens most often with edibles.
Try cannabis pills made with hash or cannabis oil or ingest via Tinctures/Sprays
Find your ideal dosage to enhance your therapeutic benefits. Start with no more than two drops and wait at least an hour before increasing the dosage, incrementally and as necessary.
Apply via Topicals
This is one of the safest ways to consume your medication and may be the best option for certain pains or ailments. Rubbing cannabis products on the skin will not result in a psychoactive effect.
Inhale via Smoking
Because the effects are noticed or felt quickly, this is a good way to get immediate relief and find the best dose for you. Research has shown that smoking cannabis does not increase your risk of lung or other cancers, but because it entails inhaling tars and other potential irritants, it may produce unpleasant bronchial effects such as harsh coughing.
Smoke as little as possible. Try 1 to 3 inhalations and wait 10 to 15 minutes to find the right dosage. Increase dosage as necessary.
Take smaller, shallower inhalations rather than deep inhales. Holding smoke in does not increase the effects; studies show that 95% of the THC is absorbed in the first few seconds of inhaling.
If consuming with others, for health reasons, try not to share the smoking device. If sharing, quickly apply flame to the pipe mouthpiece or wipe with rubbing alcohol to kill germs.
To avoid inhaling unnecessary chemicals, use hemp paper coated with beeswax to light your medicine rather than matches or a lighter.
Inhale via Vaporizer
This is the safest way to inhale your medicine because it heats the cannabinoid-laden oils to the point where they become airborne vapors, without bringing the other plant material to combustion, drastically reducing the amount of tars and other chemical irritants that you otherwise would inhale. Vaporizers also emit much less odor than any type of smoking.
Invest in a tabletop Volcano brand vaporizer or a hand-held vaporizer (such as vaporPlus). Construct your own vaporizer if you can’t afford to buy one.
Inhale via a Pipe/One-Hitter/Steam Roller
Use a glass, stainless steel, or brass pipe; avoid wood or plastic pipes. Glass one hitters, tubular pipes that contain a single dose, are the most economical devices.
Inhale via a Bong/Water Pipe
Don’t use a bong or water pipe regularly. The water absorbs some of the THC and other cannabinoids, and you can inhale water vapor or water drops into your lungs.
Don’t use a bong made from plastic, rubber or aluminum that can produce harmful fumes when heated or melted. If you do use one, change the water frequently to limit exposure to germs and viruses.
Know Your Variety
Cannabis comes in many varieties, roughly divided between Sativas that originated near the equator and Indicas that come from northern latitudes, though modern breeding programs have created a wide range of hybrids. Each variety has its own cannabinoid and terpene profile and subtly different effects. Whether you use Sativa-dominant, Indica-dominant, or a Hybrid it makes a difference.
- Take note of what effect each variety produce for you (therapeutic and side effects); keeping a log can be helpful.
- Use higher potency cannabis so you use less medicine. Concentrates can be useful, particularly if you need higher doses.
- For concentrates, use a glass pipe made for cannabis concentrates.
- Experiment with high CBD strains, particularly for nausea, appetite, and pain.
- Take a medicine vacation occasionally. While cannabis does not produce tolerance in the way opiates do, reducing or ceasing cannabis use can yield enhanced effects when restarted. Either reduce or stop for however long it feels comfortable for you.
- Change the variety if the one you’re using seems to be losing its effectiveness.
- Whenever possible, choose organic cannabis products. Never consume cannabis that has been treated with pesticides.
Think About Drug Interactions
No significant interactions between cannabis and other drugs are known at this time, though research indicates cannabis enhances the effects of opiate painkillers. Little is known about the interaction of cannabis and other pharmaceutical medications, but it is important to consider any complementary effects.
Talk to your doctor or find a doctor who you can talk to about medical cannabis. Some studies show interactions with barbiturates, theophyline, fluxetine, disulfiram, sedatives, antihistamines, etc.
A synergistic effect can occur with alcohol use; limit mixing the two.
Consider Safety. For yourself and your community.
Indicas can cause drowsiness-avoid driving or operating heavy machinery when using your medicine.
Don’t consume cannabis and drive. Cannabis use can impair motor skills. Find a safe environment to consume your medicine. Wait at least 1-2 hours after you medicate before getting behind the wheel.
Managing medicine costs
If paying for your medicine is an issue, try a few of these tips.
- Track your costs to get an accurate picture of your spending on cannabis.
- Take a “grow your own” class and explore growing your own medicine or work with a small group of patient cultivators.
- If you access your medicine through a dispensary, use discount cards or investigate other ways to receive free or discounted medicine (like a low-income program, sliding scale program, activism volunteer)
- Store your medicine properly to maintain quality over time. Airtight glass jars kept in a cool dark space work best.
Keeping a Cannabis Log
To establish an optimal treatment regime with cannabis, you will need to balance the effects of different strains, doses, and methods of ingestion. It may be helpful to record your therapeutic relationship with cannabis on an ongoing basis. One method is through keeping a cannabis-use log that captures your experience, including thoughts, feeling and behaviors. Periodically reviewing the log can help both you and your doctor make decisions about what works best.
To start, keep a detailed log, as described below, for at least one week. Once you’ve got a week’s worth of information, complete the self-assessment worksheet that follows. This worksheet will help you better understand many things about yourself, including: your ailments and symptom patterns, your treatment behaviors, and the efficacy and side effects of the cannabis medicines you use.
In keeping a medication log, try to keep things standardized, and be as consistent as possible. Here are some logging tips on useful information to collect:
- Date/Time: Record every time you consume cannabis with the current date and time of day.
- Amount: The amount of cannabis used (gram estimate or other consistent measure).
- Strain: The name, strain or variety of the cannabis strain or variety of cannabis medicine used. If you don’t know the name, write a detailed description of the medicine.
- Code: Strains are generally described as Indica, Sativa, or hybrid. You may want to code your entries: I=Indica, S=Sativa, S/I=Sativa-dominant Indica Cross, and I/S= Indica-dominant Sativa Cross.
- Type is the form of cannabis consumed: dried bud flower (most common), concentrates, tincture/sprays, edibles/drinks or topical. You may want to use: F=flower, C=concentrate, T=tincture/spray, E=edible, TO=topical.
- Cannabinoid Content: refers to the percent of THC, CBD and/or CBN. If you have this information available to you, write down percentages of each cannabinoid. If you’re using edibles or similar, a description of potency and preparation is helpful.
- Mode: Write down how you used your medication. Either inhale via S=smoke or V=vaporize, E=eat/digest, T=tincture or spray, TO=topical.
- Therapeutic Effects: List any positive effects you experience (physical, mental, social, behavioral, etc).
- Negative Side Effects: List your negative effects
- Timing: How quickly did you experience the first therapeutic effects? When did you feel the peak of relief? When did it start to noticeably dissipate? How long until effects were gone?
- What prompted your cannabis use? List the specific factors that told you it was time for medicine, as well as the general symptoms or conditions being treated (e.g. pain, nausea, anxiety, etc.
- How did you feel (mindset)? Record your mood and feelings before and after you used cannabis.
- Where were you (setting)? Were you at home, at a collective, in your office? Sitting, standing, lying down?
- Who were you with? Were you by yourself, with a friend, a large group, among other cannabis consumers, etc?
- What were you doing? Just before you used cannabis, what was going on? What were the activities or circumstances leading up to it?