Cannabis is a medicinal treasure trove waiting to be discovered.
—Dr. Raphael Mechoulam, an Israeli organic chemist, professor of medicinal chemistry at the Hebrew University of Jerusalem, considered the “father of cannabis science” (b. 1930)
More than one in three American adults, 35 percent, were given painkiller prescriptions by physicians in 2015, according to a 2016 report from the Substance Abuse and Mental Health Services Administration. Many of you reading this book were among them. The report also indicates that during 2015 more adults used painkilling prescription drugs than used cigarettes, smokeless tobacco, or cigars combined!
Although these drugs are highly effective for relieving severe acute pain, such as that from serious injuries or postoperative pain, when used for longer than three months to treat chronic pain, they are often addictive, cause a multitude of unpleasant side effects, and are sometimes deadly. In 2014, opioids killed nearly 19,000 Americans. That’s greater than the total number of Americans murdered that year (15,809). Since 2000 more than 165,000 people have died from prescription pain relievers. These grim statistics indicate the lethal risk and stunning ubiquity of opioids in modern American life, as well as the dramatic increase in the prevalence of chronic pain.
It is extremely frustrating that despite a few good studies demonstrating the effectiveness of cannabis for relieving pain, the Drug Enforcement Administration (DEA) refused to reduce restrictions on marijuana use, maintaining its status as a Schedule l controlled substance.
This decision seems to many of us in the medical community to indicate that the DEA is strongly aligned with and protective of the pharmaceutical industry, whose profits are in the billions from opioids alone. When combined with sales of anti-anxiety drugs, sleep medications, and antidepressants, all of which are frequently prescribed to chronic pain patients (most of whom are able to reduce or eliminate pain with medical marijuana), these statistics make it understandable why the drug companies feel so threatened by this remarkable medicinal herb.
In twin studies published in 2016 and April 2017, researchers found that Medicare and Medicaid prescriptions for painkillers, antidepressants, and anti-anxiety medications dropped sharply in states that legalized medical marijuana. The study’s authors estimate that because of the reduction in prescribing rates, a nationwide medical marijuana program would save taxpayers about $1.6 billion on Medicare and Medicaid prescriptions annually. Although data include only prescriptions under Medicare and Medicaid, given the totality of the evidence, it seems reasonable to assume that similar patterns hold true for patients on private insurance plans.
Doctors in the Society of Cannabis Clinicians have been reporting for many years that chronic pain patients with access to cannabis reduce their use of opioids by 50 percent on average, and many quit opioids altogether. In my practice, although I don’t have an exact figure, I would estimate that the majority are able to stop opioids completely.
By responding to frequently asked questions posed by my patients, I will serve as your guide to the safest and most effective ways to use medical marijuana to relieve your pain and enhance your quality of life.
1. Is marijuana safe?
Yes, it is extremely safe when used appropriately. The greatest health risks of marijuana can be prevented by the following:
a. Avoid smoking any strain of flower or concentrate.
Irritation and chronic inflammation of the mucous membrane lining the respiratory tract (nose, sinuses, and lungs) are side effects of smoking. These effects are not specific to high THC content but are true for any strain of cannabis that is smoked, and is similar to the effect of smoking cigarettes. This health risk, resulting from direct contact with the smoke, also occurs, but is not as severe, with vaporizing concentrates—e.g., hash oil, wax, and shatter (See Chapter 4). The smoke is generally more harsh (i.e., it produces more “smoke” or visible vapor) than vaporizing the marijuana flower. Although still present to a minimal extent (resulting from dryness and increased urination), the risk of irritation and inflammation to the mucous membrane is even less significant if you ingest a high-THC product such as an edible, a tincture, or hash oil. The increased inflammation from smoking can become a contributing factor in chronic sinusitis, nasal allergies, a chronic cough, chronic bronchitis, and lung cancer. These risks appear to be proportional to the amount of cannabis use and the user’s predisposition to developing these problems. Smoking poses the most significant physical risk of cannabis. This is a chronic adverse physical effect I’ve observed from nearly four decades of focusing on the treatment of respiratory conditions.
b. Avoid using any high-THC marijuana product on a daily basis.
The following documented adverse effects are chronic and result from marijuana with relatively high THC content that has been smoked daily, unless otherwise stated.
• Several studies indicate a link between cannabis use and psychosis or schizophrenia. (Psychosis is defined as a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality.) This probably represents a causal role of cannabis in precipitating the onset of schizophrenia and psychotic episodes. The risk is significant and was most prevalent in adolescents who began smoking in their early teens and continued into early adulthood. The studies also demonstrated that those who persisted in using cannabis reported more persistent psychotic symptoms than those who stopped using cannabis. Psychosis is a major problem, and is by far the most serious (mental) health risk of chronic marijuana use (specifically, high-THC strains).
• A large body of evidence demonstrates that cannabis dependence, both behavioral and physical, does occur in 7 to 10 percent of regular users, and that early onset of use (adolescence) and especially daily use (of high-THC strains) are strong predictors of future dependence.
• A small but growing body of evidence indicates a significant link between daily use of cannabis and depression, memory loss, cognitive impairment (including the inability to discriminate time intervals and space distances), and information processing. Depression is associated with low dopamine (a chemical in the body responsible for feelings of pleasure) levels, and chronic use of marijuana causes the brain to reduce dopamine production.
• One study showed a connection between cannabis and impaired performance (decreased accuracy and increased response time) on serial addition/subtraction and digit recall tasks. The results of this study suggest that marijuana can adversely affect complex human performance up to twenty-four hours after smoking. If you are smoking on a daily basis, then, performance remains impaired.
c. Adolescents and young adults should avoid using any high-THC marijuana products on a daily basis. The brain is still developing into the mid- to late twenties.
This is by far the highest risk group for significant adverse mental health effects, including schizophrenia, abnormal psychosocial development, poor educational outcomes, dependence, and an increased risk of using more harmful and addictive drugs. Education regarding these risks is essentially the only effective preventive measure.
d. Avoid high-THC marijuana products if you have a heart condition.
THC increases heart rate, and can also cause postural hypotension (a significant drop in blood pressure when changing positions, e.g., from sitting to standing). But marijuana’s cardiovascular effects are not associated with serious health problems for most healthy users. Cannabis has occasionally caused heart attacks and strokes, but only in people with preexisting cardiovascular disease.
e. Avoid high-THC marijuana products if you are prone to higher levels of anxiety.
Psychologically and emotionally, THC may induce unpleasant reactions such as anxiety, disconnected thoughts, panic reactions, disturbing changes in perception, paranoia, delusions, and hallucinatory experiences. This is especially true in people who already have a predisposition toward higher levels of anxiety.
f. Other health effects include:
• Within twenty-four hours of using a high-THC product (after the psychoactive effect has dissipated), most people will experience some degree of irritability, fatigue, and possibly mild depression. This is to some extent a “rebound” from the euphoria and energizing effect of THC, along with a compensatory reaction of the brain to reduce dopamine release.
• Marijuana causes dry mouth, nose, and eyes, due to decreased blood flow to the periphery of the body and increased blood flow through the kidneys, resulting in increased urination. Drink lots of water to counter this drying effect.
• Marijuana can also increase urinary obstruction in men over fifty with preexisting BPH (benign prostatic hyperplasia). This results in increased urinary frequency and urgency.
There have been rare cases of someone committing suicide after eating far too much of an edible, however researchers have not found even one death directly attributable to marijuana.
Although the risk of schizophrenia is not great, I’ve seen how devastating it can be to both the afflicted person as well as his or her family. One of my patients described in detail the story of her twenty-two-year-old daughter who had been a perfectly healthy, bright, and highly functioning adolescent and young woman until shortly after graduating from college. Within the space of three to four weeks her mental health rapidly deteriorated to the point where she lost touch with reality, suffered a severe psychotic episode, and was admitted to a psychiatric hospital.
There was no family history of schizophrenia, but after hearing more of her history, I was able to speculate on the multiple factors contributing to her illness. It cannot be proven, but I strongly suspect that this was a case of cannabis-induced schizophrenia, triggered by a series of traumas throughout her life.
Although in this case there were other notable factors in addition to the daily use of sativa (high-THC) strains, who among us did not experience major emotional stress at some point during late adolescence and early adulthood? It’s easy and quite tempting for a young person to avoid confronting these issues and doing the difficult emotional work, while making problems “disappear” by smoking marijuana. But after this temporary euphoria dissipates, adolescents are right back where they started, with possibly even worse anxiety and depression.
Even though this same reaction can also occur in older adults using high-THC products as an escape from feeling painful emotions, the fragility of the developing adolescent brain makes psychosis from cannabis a far greater concern. In this younger age group, if a high-THC strain is smoked daily with the intention of quickly relieving emotional pain, it can potentially become a serious problem. Schizophrenia, a form of psychosis, is undoubtedly the greatest mental health risk of THC.
2. Is marijuana addictive?
Any substance or behavior that affects the “reward system” of the brain, including food, sex, and even television, and directly or indirectly affects dopamine metabolism, has the potential for dependence and possible addiction.
Although popular belief implies otherwise, marijuana can be addictive. Marijuana use can lead to the development of problem use, known as a marijuana use disorder, which in severe cases takes the form of addiction. To avoid misunderstanding, it is important to distinguish addiction from chronic use, problem use, recreational use, and medicinal use.
According to the American Society of Addiction Medicine, addiction is defined as “a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social, and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
“Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.”
Marijuana differs from far more addictive drugs, such as cocaine and heroin, because these have a more pronounced ability to affect this reward system more quickly, and there are increased potency and lethality associated with the side effects of cocaine and heroin, including respiratory depression, hypoxia, cardiac arrest, overdose, and death.
In 2014, 4.176 million people in the U.S. abused or were dependent on marijuana, and 138,000 voluntarily sought treatment for their marijuana use. Research has clearly demonstrated that people who begin using marijuana before the age of eighteen are four to seven times more likely than those who start as adults to develop problem use. Dependence becomes addiction when the person can’t stop using marijuana even though it interferes with his or her daily life. Studies suggest that 9 percent of people who use marijuana will become dependent on it, and this rises to about 17 percent in those who start using in their teenage years. These are similar to the number of people that can become addicted to other drugs such as alcohol, cocaine, or opiates. Addiction can cause a host of problems in daily life, especially maintaining a job or relationships.
Although marijuana is less harmful than alcohol, cocaine, and opiates, any drug that affects the brain reward system in the vulnerable individual can lead to problem use, dependence, and in severe cases, addiction. In most cases of addiction, it is not the drug, but the user of the drug that is the major contributor to causing addiction. Careful attention to an individual’s mental health history, such as a diagnosis of addiction, depression, anxiety, or a mood disorder, or a family history of addiction, should serve as a warning to the possibility of marijuana being a potential problem. Does the benefit outweigh the risk? These factors need to be taken into account before beginning daily cannabis use for chronic pain, and should be discussed with your physician.
Behavioral support has been effective in treating marijuana addiction. No medications are currently available to treat it.
Marijuana potency has steadily increased over the past two decades. THC content increased from 3.7 to 7.5 percent in the early 1990s to 9.6 to 16 percent in 2013. With the advent of THC concentrates, such as shatter and wax (see Chapter 4), the addiction potential of marijuana has increased considerably. The highest-potency marijuana flower available today contains at most 25 to 30 percent THC. But the concentrates can contain up to 95 percent or more THC. The effect is so intense and the addiction potential so much greater that they have been described as the “crack cocaine of marijuana.”
Researchers do not yet know the full extent of the consequences when the body and brain (especially the developing brain) are exposed to extremely high concentrations of THC or whether the recent increases in emergency department visits by people testing positive for marijuana are related to rising potency. I believe the risk of dabbing and the use of strong concentrates, e.g., shatter and wax, far outweighs their benefit, especially in late adolescence and early adulthood. I strongly advise my patients to avoid them.
3. Can I use marijuana and go to work?
There are many variables to consider in responding to this question. Your degree of pain, your level of functionality with the specific marijuana product you’re planning to use, the nature of your work, and your employer’s rules and regulations are some of the primary considerations.
Each of us is unique and will respond a bit differently to marijuana. As you’ll learn in question 5, the marijuana products most effective for relieving pain are not strongly psychoactive, and the effect of the THC in them is mitigated by both CBD and the pain itself. Many of my chronic pain patients, especially those who are self-employed or who work from home, are able to function and perform their jobs well while medicating with marijuana. The majority of those employed outside the home, however, refrain from inhaling or ingesting medical marijuana during work hours, and wait until they leave their workplace.
Those who do use MMJ while at work will often use either a topical cream (see “Topicals” in Chapter 4) without any THC (and no psychoactive effect), or a high-CBD tincture or hash oil with minimal amounts of THC. A transdermal patch is another possibility (see Chapter 4). It’s discreet, and if you find it’s adversely affecting your job performance, you can peel it off and the effect will dissipate within a half hour.
I suggest you test yourself on the weekend or a non-working day by taking the product you’re considering using during work and seeing how it affects you. If it’s too strong—i.e., too psychoactive—then try a smaller dose. Tinctures provide an excellent method for determining your ideal dose.
4. Can I drive a car while under the influence of marijuana?
There is an increased risk of motor vehicle accidents, although this risk is not nearly as significant as with alcohol. Drivers under the influence of marijuana were found to drive more slowly, while those intoxicated with alcohol drove faster. This risk can be prevented by simply avoiding driving within three to four hours after smoking or vaporizing.
5. Do I have to get high to benefit from medical marijuana?
The short answer is NO. But to relieve chronic pain, this medicine is most effective when there is some THC present.
There are a small minority of patients who would prefer not to experience any psychoactive effect, commonly referred to as getting high. I’ve been told emphatically by a few patients who were applying for a new medical marijuana card and had little or no prior experience, “I don’t want to get high.” Some of these people had used marijuana recreationally years before and had an unpleasant experience, resulting in high anxiety or paranoia, and never used it again. Others were simply afraid of the unknown or of “being out of control,” and were aware that it’s because of the psychoactive effect that marijuana had been deemed unsafe and still remains federally illegal. Although these are valid concerns, once patients are better informed about the quality and consistency of medical marijuana products and how to best use them for their specific problem, and have a better understanding of what an altered state of consciousness is and how it can be used beneficially, the majority of them are willing to try the treatment.
The psychoactive effect is generally only a “problem” with high-THC strains of marijuana, which are too strong for many people and not recommended for treating chronic pain. I’ve also noticed that when patients use products containing significant amounts of THC (20 to 25 percent THC) for treating more severe pain—i.e., above a pain level of a 5—the psychoactive effect is somewhat mitigated. You will not feel as high as if you had taken this same product at a time when you were experiencing little or no pain.
Researchers have not yet been able to explain how it occurs, but it’s evident that THC activates and significantly enhances the analgesic effect of CBD (cannabidiol), considered the most potent pain reliever of all the cannabinoids. CBD is not psychoactive.
We now have the benefit of more than twenty years of accumulated data from clinical experience and feedback from MMJ patients, along with increasingly more accurate laboratory analysis. What we’ve found is that high-CBD products with negligible amounts of THC will relieve pain, but not as dramatically as those with a higher THC content. However, these same products are more effective for reducing anxiety than those with higher amounts of THC. In those people who are normally more anxious, THC will often increase their anxiety and possibly keep them awake at night. And as most of you are aware, when you are more anxious or sleep deprived, your pain is worse.
When CBD is combined with THC, which is the case with the most effective medical marijuana products for relieving pain, it will significantly reduce the psychoactive effect, but the effect will not be eliminated. If you’ve been taking prescription opiates for pain, you will most likely be able to reduce your dosage by using high-CBD products. But eliminating these drugs entirely, as most of my chronic pain patients have been able to do, will usually require a medical marijuana product with significantly higher amounts of THC—e.g., those with a CBD:THC ratio of 1:1, 2:1, or 3:1. And, as a side effect, you will to some extent get high.
The psychoactive effect can also be reduced by taking citicoline, a popular brain supplement, before using an MMJ product with a significant amount of THC. One of the main benefits of citicoline is that it increases the level of acetylcholine within the brain. This is a neurotransmitter that plays a vital role in the development and formation of memory and a number of other cognitive processes. Citicoline can be found in most health food stores.
For those patients with chronic pain who remain steadfast in their resistance to experiencing even a mild high, the psychoactive effect can be avoided by taking CBD-hemp oil containing almost no THC (I’ll explain more about this in question 11). But be aware, it is not as effective an analgesic as those products containing THC.
Given all of these variables, determining the right product and dosage for you will entail a brief process of experimentation to see how you respond and how much of a high is acceptable to you.
6. What is THC?
THC (delta-9-tetrahydrocannabinol) is the first-discovered, most psychoactive, and best known of the more than eighty cannabinoids found in cannabis. Since it binds to the CB1 receptors found predominantly in the brain, THC produces what patients refer to as a “head high”—i.e., it primarily affects your mind, rather than your body. Recognized and appreciated most for its pleasurable psychoactive effect, THC also contains a great number of holistic (whole-person) medicinal benefits. These include:
• Happiness
• Increased energy
• Sensory enhancement
• Pain relief
• Anti-emetic effects (reduces nausea and vomiting)
• Anti-cancer effects
• Anti-inflammatory effects
• Appetite stimulation
• Relief for glaucoma and autoimmune disorders, especially multiple sclerosis
THC when isolated and used alone is mildly effective for relieving pain. A good example is the prescription drug Marinol, which consists only of synthetic THC. But when inhaled or ingested in its natural state in combination with other cannabinoids and terpenes (organic compounds found in cannabis, many with medicinal properties—see question 10 below), THC can become a far more powerful analgesic. This is referred to as the entourage effect.
Prior to the legalization of medical marijuana in California in 1996, marijuana was used almost exclusively for getting high, and nearly all of the available illegal marijuana had a high THC content, although not as much as we find today. These plants contained very little CBD, and were therefore lacking in many of the therapeutic benefits found in our currently far more sophisticated cannabis medicine chest.
7. How do you know if you’re high, and how can it help you if you are?
The THC in marijuana blocks inhibitory neurotransmitters (brain chemicals) whose purpose is to block the release of dopamine, a neurotransmitter responsible for producing feelings of pleasure. This allows an unmitigated flow of dopamine and subsequent feelings of intense pleasure, a major component of the psychoactive effect.
Many of my chronic pain patients have reported to me, “I’m not really sure if the THC is doing anything directly to relieve the pain, but it sure takes my mind off of it.” And therein lays the essence of the psychoactive effect of THC. Getting high simply means a higher level of consciousness, frequently accompanied by higher levels of happiness and energy (patients often report, “I can get a lot done while I’m high”). With intention, it can shift you into an experience of the spiritual properties of cannabis. This translates into a deeper awareness of: your body (Where does it feel restricted, uncomfortable, or painful?); your thoughts and beliefs (What critical, limiting, or negative messages do I repeatedly give myself that often precipitate higher levels of anxiety, which then increase the pain? What creative ideas come to mind that excite and inspire me?); your emotions (What am I feeling? What thoughts, situations, or images trigger fear, anger, sadness, joy, or pain?); your surroundings (What inherent beauty in my environment have I been overlooking?); the people with whom you share your life (Who consistently causes me pain and depletes my energy, and from whom do I feel support and acceptance and feel energized?); and your soul (What warms my heart, feels nurturing and compassionate, elicits joy, or feels like fun?).
For at least a couple of hours of expanded awareness, if it is your intention to do so, it is possible to step back from your pain, to see yourself and your life while experiencing your present reality from your soul’s perspective. This is called witness consciousness.
Many spiritual teachers define soul as your true or higher self, or your connection to God. However you describe it, under the influence of cannabis in a somewhat altered state, and if it is your desire to do so, you can gain a greater measure of soul awareness. You experience soul as separate from, yet interwoven with, your body and mind, and it serves you as a nurturing guide in the practice of self-compassion. This realization alone can be profoundly healing.
The experience of being high can also be quite pleasurable. If you allow the space for this life energy to flow (some alone time is recommended for this), it can be a sensory delight, encompassing a heightened sense of vision, hearing, smell, taste, touch, and intuition. Enhanced creativity, playfulness, and laughter are often part of a psychoactive experience. If shared with a spouse, partner, or lover, it will often deepen your heart connection. It is not frightening. You are simply expanding the breadth and depth of your awareness. Instead of your usual state of doing and thinking, this is a state of relaxed vitality that shifts you into more of a being and feeling mode. Don’t worry, you won’t turn into a vegetable and stop doing and thinking. But at least for two to three hours you will have a better understanding of the term “human being,” and what is needed for you to lead a more balanced life.
This is a very brief explanation of why THC can potentially be such a powerful and pleasurable holistic medicine as well as a sacred herb, one that has been used for thousands of years as a catalyst for spiritual awakening. I’ll present this subject in more depth in Chapter 16, “Cannabis as a Sacred Herb.”
These therapeutic and pleasurable effects I’ve described for THC are not experienced by everyone who uses it. I have spoken with several patients, probably less than 5 percent, who do not find THC and the psychoactive effect to be pleasurable or energizing. Some have mentioned fatigue as a side effect, and others feel anxious or even a bit depressed.
Remember that each of us is unique and will therefore react somewhat differently. There are also the variables of strain specificity and dosage. What are you using and how much did you take? I recommend at least a two- to three-week trial period to accurately determine whether MMJ is beneficial for you.
8. What are the side effects from THC?
The physical effects (other than psychoactive) of THC result in part from its properties as a central vasodilator—i.e., it dilates or opens the arteries flowing through the brain, heart, and kidneys—and a peripheral vasoconstrictor—i.e., it constricts or narrows blood flow to the periphery of the body, such as the skin, fingers, toes, and even your nose and eyes.
What you’ll notice if you pay attention to what’s happening to your body and mind shortly after using an MMJ product with a high THC content—e.g., a sativa strain of flower or a high-THC tincture, edible, or concentrate—are the following acute effects:
• The experience of getting high—from the heightened flow of dopamine and increased arterial blood flow to your brain, which in turn allows for more of the THC to interact with the CB1 receptors in the brain (you will often lose track of time)
• Increased heart rate—from increased blood flow to your heart
• Increased urination—from increased blood flow to your kidneys
• Increased thirst and dry mouth, nose, and eyes—from increased urination together with decreased blood flow to your mouth, the mucous membrane lining your nose, and your conjunctiva (the surface or outermost layer of your eyeball)
• Increased appetite
• Increased tendency to sunburn—because of decreased blood flow to your skin making it more vulnerable to the sun, even if you have a dark complexion
To maintain comfort and to counterbalance these effects, while maximizing the healing benefits of THC, I recommend doing the following:
• Drink lots of water and make sure you have convenient access to a bathroom.
• Avoid strenuous aerobic exercise in order to prevent tachycardia (abnormally rapid heart rate)—mild to moderate exercise is usually fine.
• Use a saline nasal spray and appropriate eyedrops for dry nose and eyes.
• Apply sunscreen and use sunglasses if you’re outdoors.
• Give yourself at least two hours of alone time and include journaling as part of the experience, unless you’re with others who are using marijuana recreationally.
9. What is the difference between the sativa and the indica strains?
In 2017, the major classifications of marijuana flower (also known as weed or bud) are sativa, indica, and hybrid. (However, I believe this classification system will change in the near future, as we learn more about terpenes and their therapeutic effects.) Sativa strains tend to be more energizing and mind-stimulating, while the indicas are more for relaxing, for a body high. Sativas are tall-growing, gangly plants, with very narrow leaves; and indicas are shorter, bushier, stay lower to the ground, are better able to survive colder weather, and are more productive.
The sativa or indica designation can also indicate the dominance of each specific strain with respect to THC. As a general rule (and there are exceptions to every rule), sativas have higher amounts of THC (from 5 to 30 percent) than are found in indica, while indica strains typically have lower amounts of THC and a higher CBD content than you would usually find in a sativa.
However, every strain of marijuana, regardless of its dominance as either sativa or indica, is to varying degrees, a hybrid. This means there is always a combination of several cannabinoids (and terpenes) present. For example, every indica strain has some THC present, and depending on the amount, you may experience some degree of psychoactivity. But when a strain is labeled as “hybrid,” it generally means it is relatively close to a 50:50 or 60:40 ratio.
The degree of dominance is typically noted by a ratio of sativa:indica (in S-dominant strains) or indica:sativa (in I-dominant strains), which is often clearly marked on the labels of the jars in which the plant is stored on the counter of medical marijuana dispensaries. A plant with a ratio of 70:30 or higher (S:I or I:S) is considered to be either sativa or indica, whichever is the 70 percent component, and is no longer labeled a hybrid.
However, these ratios can vary for the same strain. For example, a popular sativa strain is Golden Goat, which usually has an S:I ratio of 70:30. But depending on where and how it was grown, and the laboratory in which it was tested, there are also strains of Golden Goat that are 60:40/S:I. Although there are discrepancies, nearly all strains with the same name will remain in their category of dominance (either sativa or indica) and test very close to the same ratio (as this example demonstrates), whether they are grown in Colorado, California, or another state. For this reason, it is very helpful to pay attention to the name of the specific strain you’re using and make note of how it affects you. As you will soon learn, given the complexity of the herb, no two sativas or indicas will have exactly the same effect, even if they are the same ratio.
10. What are cannabinoids and terpenes?
Medical and recreational marijuana, as well as hemp, all stem from the same plant—Cannabis sativa. A highly complex herb, cannabis is home to at least eighty different cannabinoids and more than one hundred terpenes. Each strain of marijuana has a unique combination of cannabinoids and terpenes, and will therefore affect each of us a bit differently. As research continues, the number of identified cannabinoids and terpenes is likely to increase. Each of these substances found in marijuana, the flower of the cannabis plant, has multiple properties, the majority of which are still unknown. However, of those cannabinoids that have already been identified and studied, nearly all have been found to be medicinal. Even less is known about terpenes, but this is rapidly changing and the study of these aromatic chemicals is the next frontier of cannabis research.
There are approximately twenty thousand terpenes in the plant kingdom, but very little is known about their medicinal effects. However, due to their presence in cannabis, they have been the focus of recent research. In 2016, some researchers concluded that the terpenes may be the critical ingredient determining whether the strain is indica or sativa, and not the amount of THC. However, more research is needed before a definitive conclusion is reached. But from the findings that have already been documented, the terpene myrcene seems to have the most powerful impact on the ultimate effect of the different strains of marijuana. In addition to its being described as a potency multiplier, myrcene can also help to determine whether the strain is sedating (indica—if it contains more than 0.5 percent myrcene) or energizing (sativa—if the strain contains less than 0.5 percent myrcene). We also have learned that several of the terpenes serve as both a complement to the medicinal cannabinoids and to some extent an enhancement to the psychoactive effect.
The most distinctive quality of terpenes is their odor, which imparts a beneficial aromatherapy effect to the user. For example, the terpene limonene has a citrus odor, which can elevate mood, reduce anxiety and heartburn, and be used as an antifungal, antibacterial, and anticarcinogenic agent.
It will take additional funding and several years of cannabis research before we definitively determine the beneficial qualities of each of these approximately two hundred chemical compounds. Currently, laboratory analysis of the medical marijuana sold in the majority of dispensaries includes neither the terpene content nor many of the cannabinoids that are present in very small amounts. Only those cannabinoids with the highest content and known medicinal effects are measured.
Of all the cannabinoids that have been identified, THC and CBD are the two with which the public, dispensaries, and researchers are most familiar and for which we have the most information regarding benefits and health risks.
11. Is CBD a good choice for me?
CBD (cannabidiol) is not psychoactive but is currently among the most medicinal and safest of all the cannabinoids. Studies, together with clinical experience, have demonstrated the following therapeutic properties:
• Analgesic (pain-relieving)
• Anti-inflammatory
• Anxiolytic (reduces anxiety and helps relieve post-traumatic stress disorder—PTSD)
• Sleep-inducing
• Antiemetic (reduces nausea and vomiting)
• Muscle relaxant (reduces muscle spasms associated with multiple sclerosis, paralysis, and cerebral palsy and the tremors of Parkinson’s)
• Anticonvulsant (decreases both frequency and intensity of seizures in both children and adults)
• Antipsychotic
• Improves blood circulation
• Lowers blood pressure
• Antidiabetic (lowers blood sugar)
• Helps relieve autoimmune disorders
• Stimulates bone production
• Antioxidant (helps relieve the severity of symptoms with neurodegenerative disorders, such as MS and Parkinson’s)
• Antibacterial
• Reduces prostate enlargement and frequency of nighttime urination—not scientifically documented but consistently observed by myself and several patients
There is no other medicinal herb, or pharmaceutical drug, that possesses such a wide array of therapeutic applications. Many patients refer to the effects of CBD as conveying a body high—i.e., a feeling of deep physical relaxation without an altered mental state. The fact that it is perfectly safe makes it a highly appealing medicine. A 2011 review published in Current Drug Safety concludes that CBD “does not interfere with psychomotor and psychological functions” (as does THC). The authors add that several studies suggest that CBD is “well tolerated and safe” even at high doses. Most of this evidence comes from animals, since very few studies on CBD have been carried out in human patients.
Numerous studies suggest that CBD also mitigates the THC high, reducing both memory impairment and paranoia. And as with THC, CBD has been found to present no risk of lethal overdose.
Tolerance, which means that higher doses are required to achieve the same benefits over time, often occurs with products containing higher amounts of THC, but not with CBD. In fact, there appears to be some reverse tolerance in that users can reduce the dose of CBD by 50 to 75 percent while maintaining the same benefits. In addition, CBD appears to reduce the tolerance of opioids and other drugs, meaning a decrease in those drug requirements. The mechanism appears to be the modulation of opioid receptors rather than any change in drug levels of those substances. Also observed with CBD are reductions in addictive symptoms from opioids, as well as reductions in withdrawal effects for opioids, nicotine, and benzodiazepines.
A pharmaceutical version of CBD was recently developed by a drug company based in the UK. The company, GW Pharmaceuticals, is now funding clinical trials on CBD as a treatment for schizophrenia and certain types of epilepsy. It would certainly be ironic if it were found to be effective for treating schizophrenia, which, as I’ve previously mentioned, can potentially be the most harmful side effect of THC.
What I’ve learned during the past six years, from listening attentively to my patients’ stories and obtaining feedback from conscientious dispensary personnel and cannabis clinician colleagues, as well as from treating my own case of shingles, is that the combination of the cannabinoids CBD and THC is the safest and most potent pain-relieving medicine in existence.
CBD acts as an ideal complement to THC, creating a synergistic therapeutic effect. Together they serve as a powerful analgesic with a reduced psychoactive effect. The THC appears to activate the CBD, enhancing its analgesic effect. This explains why the products (e.g., tinctures) with a CBD:THC ratio of 1:1, 2:1, or 3:1 are most effective for pain. Though they aren’t exactly comparable to 1:1/CBD:THC, strains of marijuana flower with a ratio of 50:50 or 60:40/indica:sativa or 60:40/sativa:indica have a similar high pain-relieving potency. The ratios of CBD:THC or indica:sativa are found on the labels of most MMJ products.
Although it is most frequently used for pain relief, reducing anxiety, and relieving insomnia, CBD has received a great deal of publicity in recent years as a result of its anticonvulsant properties, especially in children. In an August 2013 CNN broadcast, Dr. Sanjay Gupta reported being a skeptic about medical marijuana until he saw the evidence regarding the effectiveness of CBD for dramatically reducing seizures in children. This report resulted in numerous families moving to Colorado to gain access to high-quality CBD for their children with severe and disabling seizure disorders (often with more than one hundred seizures per day).
In my practice, by far the most frequent uses of CBD are for treatment of chronic pain, insomnia, and especially anxiety. Since the focus of this book is on chronic pain, both physical and emotional, I will not be discussing CBD’s application in treating seizures, other than to report that it appears to be highly effective in reducing the frequency and intensity of seizures for both adults with epilepsy and, especially, children with the most severe and incapacitating seizure disorders.
I have personally seen very few patients who have used CBD alone (without any or with less than 1 percent THC), who have found it to be as effective an analgesic for chronic pain as when it is used in conjunction with some THC. Although not as strong, it still relieves pain and has been reported to work well by a growing number of clinicians and patients (including many former and active NFL players).
With the rapidly increasing demand for CBD, growers have been developing a number of new high-CBD strains of both indica and sativa. In addition to Harlequin and Cannatonic, which have been in existence for several years, other examples of high-CBD strains are: Charlotte’s Web, Otto, Haley’s Hope, Lucy, Cannatsunami, Strawberry Cookie, and Remedy. These strains (and there are many more) are often used to make high-CBD tinctures, oils, edibles, topicals, and transdermal patches; or they can be vaporized or smoked.
12. What specific strains are best for relieving pain?
As the medical marijuana industry has grown, it has rapidly been adjusting to meet the increasing need for more effective pain products (i.e., higher amounts of CBD combined with THC). As a result, marijuana growers have developed a multitude of new strains, many of which are approximately 50:50/S:I, but some of which are 60:40/I:S (indica-dominant) and 60:40 or 70:30/S:I (sativa-dominant). I have listed the most effective strains for relieving pain below.
Pay close attention to the strains you use and maintain a record of their impact on your pain and anxiety (sativas have a tendency to increase anxiety, and indicas to reduce it). For example, if your pain is reduced from a 7 to a 3, you can very simply make a note such as Harlequin: Pain ↓7 →3; Anxiety ↓5 →2 (you can use the “MMJ Log” in the Introduction to Part II to record your reactions). In doing this you can easily determine which strains work best for you, while also rotating the most effective strains. It is important to rotate three or four different strains (don’t use the same one every day) to avoid developing a tolerance to one strain.
I’m not sure where the names of these strains came from, but they are certainly easy to remember. Here are some examples of the most effective, popular, and available hybrids (all are close to 50:50/S:I) for pain. The names are universal, and the strains should be similar regardless of the state in which they’re grown.
• Agent Orange
• AK-47
• Biodiesel
• Blue Dream
• Don Shula
• Gorilla Glue
• Harlequin (in addition to being 50:50/S:I, it also has a very high CBD content; one of the most effective MMJ products for quickly relieving pain)
• Lemon Kush
• Mango Kush
• Pineapple Express
• Sage
• Skywalker OG
• Trainwreck
• White Widow
Among the indica-dominant 60:40s and 70:30s are:
• Afghan Kush
• Banana Kush
• Blackberry Kush
• Blueberry
• Bubba Kush
• Ghost OG
• Girl Scout Cookie
• Lucy (a 70:30 indica, especially high in CBD)
• Master Kush
• Northern Lights
• OG Kush
• Purple Kush
• Tea Tree
Included in the sativa-dominant 60:40s and 70:30s are:
• Bruce Banner
• Chem-4
• Chemdawg
• Chocolope
• Durban Poison
• Golden Goat
• Headband
• Jack Herer
• Lemon Haze
• Maui Wowie
• NYC Diesel
• Red Dragon
• Sour Diesel
• Super Silver Haze
This is by no means a complete list, and the availability of these hybrids depends on the dispensary. What these strains all have in common is their effectiveness for quickly relieving pain. Depending on your sensitivity, some of the sativas might make you too high or too anxious, while some of the indicas may cause you to feel too sleepy during the day. However, if you’re keeping a record of what strains you’ve used and what effect they had on you, you will be able to choose the appropriate strain. It’s best to initially test a new strain at a time when you have two to three hours in which you are relatively free from any work-related or personal responsibilities. Remember to rotate several strains (three or four similar potency strains) and not use the same strain for more than three consecutive days, to avoid developing a tolerance. It’s also helpful for health reasons (especially if you’re smoking), and secondarily to lessen tolerance, to periodically vary the method of administration (see Chapter 4).
The ratio of each of these strains may vary to a minimal extent depending on where and how it was grown. For instance, one of the most popular strains of marijuana in Colorado is Blue Dream. Generally considered a 50:50 hybrid, on occasion it will test as a 60:40 sativa-dominant strain.
All strains of indica flower are to some extent hybrids—i.e., they always contain both CBD and THC, but usually with higher amounts of CBD and lower amounts of THC than are typically found in sativa strains. This is the reason most indica strains are more effective for relieving pain than the stronger sativas—i.e., those above an S:I ratio of 60:40. CBD reduces both pain and anxiety, and as most of you are aware, the greater your anxiety the higher your pain level. The higher THC strains tend to increase anxiety.
Those patients suffering with chronic pain who can tolerate only a mild psychoactive effect should use only indica strains of 70:30/I:S or higher. In most instances, this will provide them with higher CBD content along with enough THC to activate the CBD and produce only a mild high. Although these strains will reduce the pain, they are not quite as effective as those with a higher percentage of THC.
I also recommend these stronger indica strains for treating anxiety and insomnia, since THC can potentially increase anxiety and keep patients awake. With higher CBD accompanied by minimal amounts of THC—i.e., the stronger indica strains—anxiety is diminished and sleep enhanced. Those strains most effective for anxiety, depending on its severity, have an indica:sativa percentage ratio of 70:30 or 80:20. For sleep and severe anxiety, I recommend the strongest indicas, those with the least amount of THC, 80:20 or higher, and sometimes a 70:30 if it’s high in CBD content, e.g., Lucy.
Besides those that involve vaporizing or smoking the flower, there are a number of other high-CBD products, such as tinctures, concentrates, edibles, tablets, and transdermal patches, that are also highly effective for relieving pain. I’ll be discussing these in greater depth in the following chapter.
Patients with PTSD and high anxiety levels are able to use the heavy indicas and high-CBD products during the day without getting sleepy. But if you are not someone prone to higher levels of anxiety, the 80:20 and even 70:30 strains might make you feel a bit sedated if used during the day. I’ve heard many of my patients refer to this feeling as “couch-lock,” and they complain “I can’t get anything done.” This may be the only significant adverse effect of CBD. But it is easily avoided by not using a strong indica or high-CBD product during daytime hours.
CBD, when used alone or with minimal THC, is a mild to moderate pain reliever. For those chronic pain patients who do not want to feel any psychoactive effect, there are currently several options of CBD oil with less than 1 percent THC. These might be labeled 20:1 or 25:1/CBD:THC if obtained in an MMJ dispensary, or have no mention of THC if purchased as “CBD hemp oil” in a retail store or online.
13. Is CBD legal?
The answer depends on where it originated. Cannabidiol (CBD) comes in two main forms and is grown for different purposes. CBD can be produced from medical marijuana plants or from industrially grown hemp plants. As I mentioned in Chapter 2, question 1, both are varieties of cannabis, but they are grown for different purposes, and each one comes with its own legal status.
The medical marijuana plants are grown to be high in CBD, and they have varying amounts of THC. The CBD oil derived from these plants is regulated by the same state laws governing the use of medical marijuana, and is sold only in MMJ dispensaries.
The FDA considers hemp oil (and its derivative CBD) that comes from industrial hemp plants to be a dietary supplement (not a medication). Therefore, if you live in the U.S., this means you don’t need a prescription and can legally purchase and consume CBD from hemp in any state. This CBD oil also has the added benefit of having virtually no THC (less than 1 percent). You cannot get high with CBD hemp oil, and these products can be purchased at several sites on the Internet or in some retail stores. They work quite well for treating anxiety and seizures, less so for sleep disorders, but are not as effective for relieving pain as those derived from marijuana, which has greater amounts of THC.
On December 14, 2016, the Drug Enforcement Administration (DEA) added a notice to the Federal Register that quietly informed the public it had established “a new drug code for marihuana extract.” The DEA’s argument was that the agency was entitled to regulate CBD oil because all extracts contain trace amounts of THC, the active ingredient in cannabis, which remains illegal at the federal level.
Establishing this new drug code is, effectively, the first step toward classifying CBD oil alongside cannabis under the Controlled Substances Act. This act classifies cannabis as a Schedule 1 substance, alongside drugs like heroin that are addictive and considered to have no practical medical benefit.
However, legal experts and advocates for hemp doubt that the DEA has the mandate to easily reclassify CBD oil. But if they are somehow successful in classifying CBD as a Schedule 1 drug, which I doubt they will be, then a pure CBD product (tincture, topical, or oil) could only be legally obtained from a medical marijuana dispensary.
By placing CBD in the same category as heroin makes no rational sense. I hope ongoing research and attention to existing data help to remove CBD (and marijuana) from any consideration as a Schedule 1 drug.
14. Are there other cannabinoids besides CBD and THC that can help relieve pain and reduce inflammation?
Yes, there are several others that have been isolated and are available in some dispensaries:
• THCa—Tetrahydrocannabinolic acid is not only a tongue-twister but also the acidic precursor to THC. In the live cannabis plant, THCa is the most abundant cannabinoid, while THC is present in only minute quantities. After cannabis is harvested, THCa begins to naturally convert to THC. It also converts to THC when burned, vaporized, or heated for a period of time at a specific temperature.
THCa is not psychoactive, and it appears to be the most potent anti-inflammatory of all the cannabinoids. It also inhibits cancer cell growth, reduces muscle spasms, and enhances sleep. THCa interacts with the endocannabinoid system, but not with the CB1 receptors (in the brain).
Patients often prefer THCa to CBD or THC for long-term use, since it’s not psychoactive and it’s more therapeutic for reducing inflammation. It has been isolated and can be administered by itself via a tincture (preferred) or transdermal patch or with other cannabinoids by juicing. I discuss each of these delivery methods in the following chapter.
• CBN—Cannabinol is primarily a decomposition product, and is produced when THC is exposed to heat or light. It can also be found in old dry marijuana leaves that have been stored for years. Very little CBN can be found in live cannabis. It is mildly psychoactive, with approximately 10 percent the psychoactivity of THC.
CBN is an excellent analgesic, anti-inflammatory, and sleep enhancer; it also reduces muscle spasms and can help glaucoma. At the present time, it can only be administered alone, via capsules or a transdermal patch. But when your marijuana is smoked or vaporized, you are most likely inhaling some CBN along with THC and many other cannabinoids.
• CBC—Cannabichromene is not psychoactive. It is an excellent anti-inflammatory, which therefore makes it a good analgesic. Many patients have experienced considerable pain relief from applying a topical CBC salve to the skin covering their painful joint, back, neck, or shoulder. Other than the topical, CBC cannot be administered as a single isolated cannabinoid. However, most medical marijuana products do contain small amounts of CBC.
• CBG—Cannabigerol is not psychoactive and is commonly found in large quantities in hemp fiber. It is known to be an effective anti-inflammatory, as well as an anticancer and blood pressure–lowering agent, a bone stimulant, and an antibacterial. Recent research indicates that it may eventually prove to be even more medicinal than CBD. There are currently very few MMJ products with high-CBG content. I know of only one indica strain, a 70:30/I:S, Permafrost, that fits this description.
• CBDa—Cannabidiolic acid is the acid, or precursor, form of CBD. It is a strong anti-inflammatory, antiemetic (relieves nausea and vomiting), antibacterial, and anti-proliferative (prevents the spread of cancer cells). Similar to THC, CBD, and THCa, CBDa helps to reprogram cancer cells, causing them to shrink in size.
The best way to administer CBDa is ingesting raw cannabis flowers and leaves through juicing, since it is only prevalent in cannabis that has not been heated (e.g., smoked or vaporized). However, once heat has been applied and it is converted to CBD, it still provides all of the therapeutic benefits conveyed by CBD.
15. What are the most common terpenes?
• Myrcene
Aroma: Musky, cloves, earthy, herbal with notes of citrus and tropical fruit (it’s in the same family as turpentine).
Therapeutic effects and benefits: Pain relief, anti-inflammatory, antidepressant, relieves muscle tension, aids in sleeplessness, antioxidant, anticarcinogenic, sedating “couch-lock” effect, relaxing
Also found in: Mango, lemongrass, thyme, hops
* High-myrcene cannabis strains: Pure Kush, El Nino, Himalayan Gold, Skunk #1 (all are indica strains)
• Caryophyllene
Aroma: Pepper, spicy, woody, cloves
Therapeutic effects and benefits: Anti-inflammatory (especially good for arthritis), aid in autoimmune disorders, relieves ulcers, gastro-protective
Also found in: Black pepper, cloves, cotton
* High-caryophyllene cannabis strains: Hash plant
• Limonene
Aroma: Citrus
Therapeutic effects and benefits: Elevated mood, stress relief, antidepressant, antifungal, antibacterial, anticarcinogenic, dissolves gallstones, may treat gastrointestinal problems such as heartburn
Also found in: Peppermint, fruit rinds, rosemary, juniper
* High-limonene cannabis strains: OG Kush, Super Lemon Haze, Jack the Ripper, Lemon Skunk
• Linalool
Aroma: Floral, citrus, candy
Therapeutic effects and benefits: Antianxiety, antidepressant, anticonvulsant, anti-acne, sedation
Also found in: Lavender
* High-linalool cannabis strains: G-13, Amnesia Haze, Lavender, LA Confidential
• Alpha-Pinene, Beta-Pinene
Aroma: Pine
Therapeutic effects and benefits: Alertness, asthma relief, antiseptic, memory retention, counteracts some THC psychoactive effects
Also found in: Pine needles, rosemary, basil, parsley, dill
* High-pinene cannabis strains: Jack Herer, Chemdawg, Bubba Kush, Trainwreck, Super Silver Haze
* Not every batch of any given strain will have high levels of these terpenes, as they are subjected to variable growing conditions. The only way to be sure is through a lab’s terpene analysis.
16. Why is the discovery of the endocannabinoid system so important?
The strongest evidence supporting the use of cannabis as medicine is that it reduces chronic pain. Both in Colorado and California, more than 90 percent of medical marijuana patients are suffering with chronic pain. But due to marijuana’s illegality it has taken the scientific community many years to overcome its resistance to doing the research and beginning to unravel the mystery of what the plant consists of and how it works (if used appropriately) to relieve pain; reduce inflammation, anxiety, and seizures; stimulate appetite; relax muscles; kill cancer cells; and enhance sleep and feelings of well-being.
Dr. Raphael Mechoulam, an Israeli organic chemist, considered the “father of cannabis science,” has spent a lifetime studying cannabis. It struck him as odd that even though morphine had been extracted from opium in 1805 and cocaine from coca leaves in 1855, scientists had no idea what the principal psychoactive ingredient was in marijuana. In 1964 he and his research team discovered the highly psychoactive THC, and later also elucidated the chemical structure of CBD, currently considered the most medicinal cannabinoid.
In 1992 Dr. Mechoulam’s ongoing research led him from the cannabis plant itself to the inner recesses of the human brain. That year he and several colleagues made an extraordinary discovery. They isolated the chemical made by the human body that binds to the same receptor in the brain that THC does. Mechoulam named it anandamide, from the Sanskrit for “supreme joy,” and referred to it as an endocannabinoid—i.e., originating from inside the body.
Since then there have been more than twenty-one thousand studies and articles that have appeared in scientific publications in the U.S., an average of more than two per day, on the subject of either cannabis or cannabinoids (but relatively few focused on cannabis and pain relief). Not only has this scientific investigation documented a great many healing benefits, but it has also uncovered several other endocannabinoids (a total of five have been identified) and their receptors (CB1 and CB2) comprising the endocannabinoid system.
Many of these researchers have concluded that this previously unknown physiologic system (physiology = the branch of biology that deals with the normal functions of living organisms and their parts) is a key component to establishing and maintaining human health.
Scientists now recognize that endocannabinoids interact with a specific neurological network—much the way that endorphins, serotonin, and dopamine do. In fact, exercise has been shown to elevate endocannabinoid levels in the brain. In an October 2015 study in Germany, researchers concluded that although exercise raises the blood levels of both endorphins and endocannabinoids, it is the endocannabinoids that are solely responsible for runner’s high (previously thought to result from the endorphins), and they also significantly contribute to the analgesic effect of endorphins (the body’s natural opiates).
I found this to be the case whenever I went for a hike during the peak of my bout with shingles. Pain reduction was both dramatic and consistent even without the use of medical marijuana. It worked every time, typically occurred within the first ten to fifteen minutes, and was maintained throughout the duration of the hike. Pain reduction was even greater when I did use marijuana during exercise. But I reserved this use for less strenuous exercise, since it can increase heart rate.
Fueled by the added anecdotal and clinical study reports of potential benefit, advances in understanding of the endocannabinoid signaling system upon which cannabis acts, as well as growing public acceptance that cannabis should be available as a medicine if a physician recommends it, a number of compelling studies have been published in recent years.
Research has revealed that the endocannabinoids are chemically very similar to the cannabinoids found in cannabis, and bind to the same receptors. The mechanism initiating the specific function of each cannabinoid (whether it originates within the body or from cannabis) occurs as it attaches to an endocannabinoid receptor, comparable to a key being inserted into a lock.
These receptors are found throughout the body: in the brain (primarily the CB1 receptors that interact chiefly with THC), organs, connective tissue, glands, and immune cells. CB2 receptors are predominantly found in the immune system and appear to be responsible for analgesic, anti-inflammatory, and other therapeutic effects of cannabis.
In each tissue, the endocannabinoid system performs different tasks, but the goal is always a steady-state or homeostasis (defined as the maintenance of a stable internal environment despite fluctuations in the external environment). Endocannabinoids promote homeostasis at every level of biological life, playing an important role in such basic functions as memory, balance, movement, immune health, and neuroprotection; reducing pain, inflammation, and anxiety; and inducing sleep and killing cancer cells. Reduction in endocannabinoid levels and/or changes in the CB2 receptors have been reported in almost all diseases affecting humans, ranging from cardiovascular, gastrointestinal, liver, kidney, neurodegenerative, psychiatric, bone, skin, autoimmune, and lung disorders to chronic pain and cancer.
Endocannabinoids are also found at the intersection of the body’s various systems—e.g., nervous, digestive, cardiovascular—allowing communication and coordination between different cell types. At the site of an injury, for example, cannabinoids can be found decreasing the release of activators and sensitizers from the injured tissue, stabilizing the nerve cells to prevent excessive firing, and calming nearby immune cells to prevent release of pro-inflammatory substances. Three different mechanisms of action on three different cell types form a single purpose: minimize the pain and damage caused by the injury.
The endocannabinoid system, with its complex actions in our immune system, nervous system, and all of the body’s organs, is literally a bridge between body and mind. By understanding this system we begin to see a mechanism that explains how states of consciousness can promote health or disease by bringing us into a state of balance and harmony. Other than hormones and the endocrine system, there is nothing else in the human body comparable to the multifaceted endocannabinoid system.
As a former biology major in college, with a fascination for the miraculous organism of the human body my entire adult life, I find this information to be quite remarkable. It strongly indicates that endocannabinoids are vital to the optimal functioning of the human body.
17. How can marijuana aid end-of-life care?
Marijuana can be extremely helpful for people in hospice care or at home with a terminal condition. It can relieve pain, decrease nausea and vomiting, improve appetite, and help increase energy. Depending upon what therapeutic effect is most needed, the primary caretaker will determine which MMJ product to administer.
For easing pain and increasing energy I suggest using the 1:1/CBD:THC patch. For agitation and mild-moderate pain, you can try the CBD patch (no THC) along with the THCa patch for reducing inflammation (they can be used together). If sleep is a problem and there is pain as well, I would choose the CBN patch. (I discuss this method of administration in the following chapter.) Neither CBD, THCa, nor CBN are psychoactive. Different restrictions apply to the use of MMJ by hospice personnel in each of the twenty-eight states in which it is legal. If hospice is not permitted to administer it, then I would consider doing it yourself if you’re comfortable doing so, and if you are the primary caretaker.