We’re all unique, with our own needs, desires, and body chemistry. There is no one size fits all when it comes to using medical marijuana for treating chronic pain. Each of us will respond somewhat differently to the variety of available products and methods for consuming MMJ. In this chapter I’m presenting you with a multitude of options along with their advantages and disadvantages. From this information you should be able to choose at least one or two methods with which to begin the process of relieving your pain. If you’re not satisfied, then try another until you are comfortable with the one you’ve chosen.
Whatever option you choose, remember to rotate the strain of marijuana you’re using (if vaporizing or smoking) or the MMJ product, and to not use the same one every day. It’s most effective to have three or four different strains or products available, and don’t use the same one for more than three consecutive days. Otherwise you might develop some degree of tolerance, and it will be less effective for pain relief.
Smoking marijuana gained popularity with Americans shortly after the Mexican revolution in the 1920s, with the influx of Mexicans who did it recreationally to relax. Due largely to its convenience and rapid onset, smoking remains the most popular method of administration.
Although smoking is by far the most frequently used method, it is certainly not the healthiest way to use marijuana. Smoke is a major irritant to the sensitive mucous membrane lining the entire respiratory tract—nose, sinuses, and lungs. Chronic irritation can lead to inflammation, which in turn causes swelling and a narrowing of the airway. As a result less oxygen is obtained with each breath, and oxygen is our most critical nutrient for optimal health.
Coughing is an immediate response to the irritation from the smoke. However, if you are someone who has preexisting chronic inflammation of the mucous membrane, such as chronic sinusitis, allergies, asthma, or chronic bronchitis, smoking will to some extent increase the inflammation, which in turn can cause increased congestion (nasal, head, or lung), postnasal mucus drainage, cough, possible allergy symptoms, fatigue, and irritability, along with greater susceptibility to infection. In those people with a predisposition to sinus or allergy problems, this increased inflammation can also precipitate a sinus infection or an allergy attack. I found this to be the case during the late 1970s when I would often develop a sinus infection within twenty-four to forty-eight hours following my weekly Sabbath ritual of smoking marijuana.
From early childhood my radiologist father had made me acutely aware of the health risks of smoking cigarettes. He would bring home chest X-rays of patients he had diagnosed earlier that day with lung cancer, and after dinner he would set his view box on the kitchen table, put up the X-ray, and point out the lung tumor. I remember asking him, “Why did this person get lung cancer?” And his response was always the same: “He was a smoker.” This was in the mid-1950s, nearly ten years before the surgeon general required a health risk warning on all cigarette box labels in 1964.
Then I’d ask, “What will happen to him?” “He’ll die. There’s nothing we can do for him” was my father’s grave response. He seemed not only truly forlorn for the terminal fate of the patient, but genuinely sad that his beloved medical profession was unable to do anything to help save him. His message to me was conveyed loudly and clearly: “Smoking is a really bad thing to do.” During the past sixty years, other than smoking marijuana, I’ve strictly adhered to his advice.
Until my sinus problems began around the age of thirty, I thought smoking marijuana once or twice a week was relatively harmless. It was a revelation to me that smoke even at this frequency can increase inflammation enough to cause sinus infections. This is especially true when there are other contributing factors present, such as stress, a weakened immune system, or exposure to cold viruses.
The air most Americans are breathing, both outdoor and indoor, is already polluted. We don’t need to add another pollutant by smoking anything, whether it is a cigarette or a joint.
Although it was not well known in the 1950s and early ’60s, today most Americans are well aware that tobacco smoke contains carcinogens that can cause lung cancer. But surprisingly, several major population studies have shown no link between marijuana smoking and a higher risk of lung cancer. In fact, a Jamaican study showed that regular users of marijuana had a lower risk of cancer than nonsmokers!
Both cigarette and marijuana smoke contain carcinogens, but the anticancer properties of several of the cannabinoids, especially THC and CBD, prevent the promotion of lung cancer. To lend greater clarity to this important subject, research has shown that nicotine, the active and highly addictive ingredient in tobacco, activates an enzyme that converts certain chemicals in tobacco smoke into a cancer-promoting form. Conversely, THC inhibits this enzyme from activating the carcinogens found in marijuana smoke.
However, this does not mean that smoking marijuana is risk-free, especially for people suffering with chronic pain, or for current or former sinus, asthma, or allergy sufferers. In the vast majority of cases of chronic pain, there is some degree of underlying inflammation. Smoke contains toxins created from combustion, and when they are inhaled and enter your bloodstream, they can potentially increase inflammation in any part of the body where inflammation already exists (e.g., arthritic knees or hips). This is in addition to the increased inflammation resulting from direct contact of the smoke and heated air on the mucous membrane lining the respiratory tract. Several of the cannabinoids have an anti-inflammatory effect and can diminish this response, which is another reason marijuana is healthier smoke than tobacco, but it’s still smoke. And with smoke there are risks that can and should be avoided by chronic pain patients, especially those suffering with migraine headaches. Smoke is a potential trigger for migraine.
Another potential risk from smoking marijuana is respiratory infections, such as sinusitis, bronchitis, and pneumonia, resulting from contamination with bacteria and fungi. In Colorado, surprisingly after nearly seven years of legalized medical marijuana, required microbiology testing for MMJ has not yet been enforced. I have recently heard from a microbiologist who runs a marijuana testing facility that following preliminary laboratory tests performed by the state, it is estimated that as much as 70 percent of the marijuana in Colorado will have tested positive for the aspergillus fungus. (This finding has not been officially confirmed.) In a person with a weakened immune system, this can cause a serious lung condition called aspergillosis. It is not the fungus itself but the spores of aspergillus that cause the damage, and the spores cannot be destroyed by fire.
I have not smoked marijuana in more than five years. Whether it’s a joint (marijuana “cigarette”), pipe, bong, or water pipe, there’s combustion, and smoke is always a by-product. Given the potential health risks, and as a former sinus sufferer, I prefer a much safer alternative for inhaling the flower and obtaining an immediate effect . . . vaporizers.
Advantages of smoking: Immediate and possibly stronger effect (for some people) than with a vaporizer; allows user to choose most effective strain from among a wide variety of strains of flower; for veteran “pot smokers” the aroma (conveyed by terpenes) is more evident.
Disadvantages of smoking: Most unhealthy method of administration (causes inflammation and greater susceptibility to infection), especially to the respiratory tract; smoke produces an odor that may be offensive to others and makes it more difficult to be discreet while using. Smoking provides the shortest duration of action—two to three hours.
Vaporizers are essentially miniature “ovens” that heat but do not burn the marijuana, at temperatures ranging from 360 to 420 degrees Fahrenheit. There is no flame, and no combustion, and therefore none of the toxins that accompany marijuana smoke. This allows the user to inhale only the psychoactive and medicinal cannabinoids within the specific strain being vaporized.
There is a vast difference in the quality of “smoke” that one receives when marijuana is vaporized versus when it is smoked. Approximately 88 percent of the combusted smoke gases contain non-cannabinoid elements, most of which provide potential health risks. Conversely when one uses a vaporizer, the smoke (actually a thick vapor) and gases that are inhaled consist of approximately 95 percent cannabinoids, which are largely medicinal.
Vaporizers can be purchased in a wide variety of shapes, sizes, and prices. Although most vaporizers that accommodate only the marijuana flower are in the $200 to $500 range, the one I personally use and recommend to patients, the Fully Alive Vaporizer® (formerly the Wulf-LX), sells for $95 (see Resources). The Volcano has for several years been regarded as the “gold standard” of vaporizers, and it retails for more than $500. Having used one on three different occasions, I consider it the best example of effective marketing I’ve ever seen. It’s simply not worth it. And since expense is a deterrent to using a vaporizer for many medical marijuana patients, I would like to make it clear that it is not necessary to exceed $100 to purchase an excellent vaporizer.
Even though to veteran “pot smokers” the effect derived from vaporizing may not be quite the same (many tell me without specifics, “I don’t like it as much,” while others have said, “It doesn’t smell the same”), I can assure you that for inhaling the medical marijuana flower and obtaining an immediate medicinal effect, vaporizers work quite well. In fact, inhalation (smoking or vaporizing) is the only method of administration that conveys almost immediate pain relief.
It does help when using a vaporizer to keep in mind these guidelines:
• The optimum temperature for vaporization is 375 degrees—at this temperature there is little or no visible “smoke” (it’s actually a thick vapor); a good quality vaporizer allows you to set the exact temperature. If you find 375 degrees to be too harsh, I’d suggest a setting of 360 degrees, but you may need to take additional inhalations at this temperature to obtain the desired effect.
• Use a grinder to break the flower/bud into small pieces (rather than crumbling it with your fingers) before placing them in the vaporizer chamber; preferably a grinder with three levels and a screen separating the second and third levels to capture the tiny particles of kief. These are the resin glands that contain the cannabinoids and terpenes that make each strain of cannabis unique. Once you’ve collected a moderate amount of kief at the base of the grinder, these can then be sprinkled into the chamber of the vaporizer along with the flower to obtain an enhanced effect. The use of a grinder enables you to maximize the effect of vaporizing while avoiding wasting any part of the plant.
• For every one hit or inhalation of smoke (if you were previously a smoker), you should do two hits on the vaporizer; four to six inhalations (the equivalent of two to three hits of smoke) is nearly always sufficient to feel the desired effect. If you tend to be someone who is especially sensitive to most drugs, then start with only two or three hits. Your final inhalation can be immediately after you’ve turned off the vaporizer, since there is still vapor available.
• To make vaporizing more gentle and less irritating to your lungs, do not take an excessively deep breath or hold your breath at the end of each inhalation. Breathe normally and take your breaths in fairly rapid succession. The longer you wait between hits, the more “cooked” the marijuana will be, the thicker the vapor you’ll be inhaling, the more visible the vapor that you will exhale, and the more irritating it will be to your lungs.
Most people will notice the medicinal or psychoactive effect within two to five minutes. And with both smoking and vaporizing it will typically last for two to three hours. Although the other methods of administration require more time before you feel the effect, they do last longer than with inhalation. The other benefit is that these methods do no harm to your respiratory tract. For those medical marijuana patients with even mild or moderate chronic inflammation of the respiratory mucous membrane, 375-degree air is still an irritant and can increase inflammation, albeit not nearly to the same extent as smoke. My recommendation to these patients is to avoid using a vaporizer as long as you still have inflammation (you’ll know you’re inflamed by virtue of your symptoms—nasal congestion, cough, excessive mucus); or set the temperature at 360 degrees, and see how you react.
For those patients with chronic pain and sleep problems (the pain often awakens them), without any inflammation of their respiratory tract, the following vaporizing techniques can be quite helpful:
• Shortly before bed, vaporize at 375 degrees a strain that you’ve found to be effective for pain and sleep (e.g., a strong indica).
• After you’ve finished vaporizing do not empty the chamber, but raise the temperature setting to 395 degrees and then turn the vaporizer off.
• Place the vaporizer within reach, on your nightstand by the bed, before going to sleep.
• If after three to four hours you awaken with (or without) pain, you can turn on the vaporizer and take two to four hits at 395 degrees. Even though you are using the same leaves you’ve previously vaporized at 375 degrees, it will still work quite well for relieving your pain and making you sleepy. This entire process will have taken just a few minutes before you’re back to sleep. And since the vaporizer is already loaded, with the temperature at the appropriate setting, there’s no need to get up out of bed or even to turn on any lights.
This technique illustrates an additional advantage of using a vaporizer that allows you to set the temperature. You’re able to use the same leaves more than once, which is extremely helpful for people who have problems with both falling and staying asleep. You can more easily get a good night’s sleep with minimal interruption. Since medical marijuana is not inexpensive, if you’re interested in saving money and did not need to use the vaporizer a second time during the night, you can use it the following night without refilling it with fresh leaves. Keep in mind, however, that there is more “smoke” (thicker vapor) at the higher temperatures and a greater likelihood of stimulating a cough. I only recommend this method if you have a healthy respiratory tract. And if so, it’s possible to use the same leaves a third time by raising the temperature another 15 to 20 degrees, to somewhere between 410 and 415.
Another money-saving tip for those with healthy respiratory tracts is the possibility of smoking the leaves that have already been vaporized, or even better, you may use them for making edibles.
Advantages of vaporizing: Immediate effect with little or no smoke, odor, or damage to the respiratory tract; allows user to choose most effective strain from among a wide variety of strains of flower, to determine optimum dose (number of inhalations or “hits”) for pain relief, to save money by re-vaporizing the same flower more than once (only with a healthy respiratory tract), and to use the vaporized leaves to make edibles; with no smoke or odor the user can be more discreet.
Disadvantages of vaporizing: Can be somewhat irritating to those with preexisting inflammation of respiratory tract; weaker aroma and terpene effect. Vaporizers that accommodate only oil cartridges greatly limit your choice of specific strains. Duration of action is only two to three hours.
As I’ve mentioned, smoking is unhealthy for anyone. And if you’re a sinus sufferer, have serious nasal allergies, asthma, chronic cough, or any other respiratory problem, it is best to avoid vaporizing as well. However, I do understand the difficulty of stopping an enjoyable habit, even though there are a number of other healthier options for using marijuana.
As I explained in the Introduction to this book, very often a health crisis can become a gift. In 1980, I was diagnosed with chronic sinusitis and told I would have to live with it. Although I rejected that prognosis and was determined to cure the condition, I also recognized that I’d have to stop smoking marijuana in order to achieve my goal. This grievous loss of one of my life’s greatest pleasures served as a powerful motivator for the development of the holistic Sinus Survival program and the writing of a book that quickly became a bestseller.
Prior to 1980, I rarely smoked more than twice a week. But even at that frequency I often developed a sinus infection within a day or two after smoking. If my treatment program worked, then I’d be able to smoke (no more than two or three hits) without getting a sinus infection. This benchmark became a primary measure (although certainly not the only one) of my progress in healing my sinuses.
I stopped smoking entirely for more than a year, and allowed my body to heal the mucous membrane, at least to some extent (living in Denver, I was still breathing polluted and dry air). At the same time I made other changes with regard to diet and nasal hygiene practices. Through a trial-and-error process I gradually reintroduced smoking back into my life. Smoking marijuana provided an excellent method for both challenging and evaluating the health of my inflamed mucous membrane. As a result it was instrumental in helping to develop a highly effective method for treating and preventing sinus infections, especially in high-risk situations. The method’s success, however, was quite limited with smokers of cigarettes (those who smoked at least one half to one pack per day). I finally made the cessation of cigarette smoking a requirement before agreeing to help chronic sinusitis patients implement the holistic medical treatment program.
If you have a respiratory condition, are in the habit of smoking medical marijuana daily or more than once a day to treat your chronic pain, and are unable or unwilling to stop smoking, in spite of the many healthier options presented in this chapter, I suggest utilizing the following components of the Respiratory Healing program to prevent infection and mitigate inflammation whenever you smoke or vaporize:
• Saline nasal spray: Preferably one that contains anti-inflammatory and anti-infective herbs, such as the Sinus Survival Nasal Spray (containing aloe and berberis): two sprays in each nostril just before smoking, and again within fifteen to twenty minutes after smoking. This will lessen inflammation and reduce risk of infection, while cleansing and moistening the mucous membrane. The most effective way to spray is to tilt your head slightly forward, tilt the head of the spray bottle toward the outside of each nostril (not towards the septum dividing your nostrils), and gently inhale as you spray. Sinus Survival products are available online (see Resources).
• Peppermint oil: Use immediately following the nasal spray; place a few drops on your index (first) finger, touch this finger to your thumb and then swab (with both finger and thumb) around the outside of both nostrils. This will stimulate blood flow to your mucous membrane, increase absorption of the medicinal herbs that you just sprayed, and act as a decongestant. Available at health food stores or as Sinus Essentials oil online (see Resources).
• Steam inhaler: This may be the single most effective method for protecting your mucous membrane. It should be used shortly (within twenty to thirty minutes) after you’ve smoked. Add filtered water to the cup at the base of the steamer, and after it begins steaming, add two to three sprays of a highly medicinal eucalyptus oil, for example Sinus Survival Eucalyptus. (Eucalyptus oil acts as a potent anti-inflammatory, but less than 2 percent of the approximately seven hundred species of eucalyptus are truly medicinal.) Then add a few drops of peppermint oil and tea tree oil to the steam. Sit with your nose and mouth close to or touching the plastic hood of the steamer for at least fifteen to twenty minutes. Be aware that the eucalyptus oil might initially stimulate a cough, but that will rarely last for more than a few seconds. Studies have shown steaming to reduce inflammation and nasal congestion, an ideal balance to smoking, which increases both. Tea tree oil can help to kill viruses, bacteria, and fungi. Steam inhalers are available at most pharmacies; and Sinus Survival Eucalyptus, Tea Tree, and Peppermint oils for steam therapy are available online (see Resources).
• Nasal irrigation: For those with chronic sinusitis, it is very helpful to irrigate your nose and sinuses immediately following the steaming. The most effective irrigating device is a pulsatile irrigator called SinuPulse, which utilizes the same technology as the Waterpik device for teeth. Studies have shown pulsatile irrigators to be the only devices capable of removing biofilm, a thick coating of mucus typically found on the surface of a chronically inflamed mucous membrane. SinuPulse can be purchased online (see Resources) and other irrigators are available at most pharmacies.
• Diet: Avoid inflammatory (acidic) foods, especially milk and dairy products, alcohol, caffeine, and sugar (see Acid/Alkaline Food Chart in Chapter 5). Be conscious of drinking lots of water after smoking or vaporizing, to counter the dryness of the mucous membrane triggered by marijuana, as mentioned previously in Chapter 3 (question 8 “side effects of THC”).
• Anger: Avoid smoking marijuana if you’re angry. The emotion of anger, especially if it’s repressed, can significantly increase inflammation.
• Don’t hold your breath: Breathe normally to avoid prolonged exposure of the mucous membrane to smoke and heated air.
• Purchase only marijuana that you know has undergone microbiology testing: This will help to avoid bacterial (e.g., staph) and fungal (e.g., aspergillosis) infections.
Even though these suggestions will all help to significantly mitigate inflammation and help prevent infection of the respiratory tract, they cannot completely eliminate the negative effects of smoking. You will do a much better job of self-care if you choose one or more of the following methods of administration while you’re healing your respiratory tract.
Tinctures are one of many forms of marijuana concentrate. However, I will cover them separately in this section, because they deserve more attention, and the other commonly used concentrates in the following section.
In the very near future, I expect to see cannabis tinctures and other forms of trans-mucosal delivery systems—including intra-nasal and sublingual (under tongue) sprays and drops in addition to sublingual and oral (dissolve in mouth) tablets—become the preferred and most recommended method (by physicians) for administering medical marijuana. Scientific and technological advances in the modern age will provide us with the most potent pain-relieving cannabis tinctures and other trans-mucosal delivery methods ever produced. The majority of doctors and their medical marijuana patients will rely on tinctures (and the soon-to-be-released trans-mucosal products) to provide rapid onset of action; improved dosing, safety, and effectiveness; and a convenient means of administration.
Tinctures are not new. The fact that cannabis was administered as a tincture in several of the most popular medicines for nearly a century (beginning in the mid-1800s) has been largely forgotten. Until cannabis was declared illegal in 1937, tinctures were the only type of cannabis medicines in the U.S. The word marijuana and the practice of smoking the cannabis plant came to America from Mexico. It was brought here by the thousands of immigrants who arrived in the U.S. during and following the Mexican revolution (1910–1920). Americans were not familiar with the word marijuana or the practice of smoking the plant, but they were well aware that cannabis was the key ingredient in many of their most popular medicines, especially those used for treating arthritis, migraine, menstrual pain, neuralgia (nerve pain), and depression.
Tinctures are liquid concentrates typically produced via alcohol extraction. They are extractions of whole plant cannabis (usually produced from the flowers and trim leaves), containing all of the cannabinoids and terpenes in the specific strain from which they were extracted. They are relatively easy to make and inexpensive.
Tinctures are absorbed both sublingually and through the oral mucosa (tissue lining the mouth). Titration or dose control is easily achieved by the number of drops patients place under their tongue, where the medicine is rapidly absorbed into tiny blood vessels and quickly transported to the brain and body. A minimum of two to three minutes of holding the tincture under the tongue is generally recommended. That will work, but I’ve found that for more complete and faster absorption and a subsequent stronger peak effect, it’s helpful to keep the tincture in your mouth (sloshing it around and letting it sit under and surrounding your tongue) for a much longer time frame. I’ve found that ten to fifteen minutes is optimum. When the tincture is held for that length of time, the psychoactive effect can sometimes begin within twenty to twenty-five minutes of inserting the drops.
Rapidity of onset is especially important to those patients suffering with migraine headaches. As you’ll learn in Chapter 8, although MMJ is highly effective for preventing and relieving a migraine headache, in order for it to do its job, it has to take effect within the brief window between the aura (early warning) and full-blown headache.
It will often take between thirty and forty-five minutes before patients begin to notice the effects of an MMJ tincture, and an additional forty-five to sixty minutes before they reach their peak. This maximum effect can then last for another four to five hours. It takes less time to begin feeling it, and the maximum effect is stronger and lasts longer, if you have an empty stomach and/or engage in moderate exercise (for at least twenty to thirty minutes) preceding its administration. Total duration of the medicinal effect of tinctures is four to six hours.
If after ninety minutes patients are not experiencing the desired effect, I instruct them to add more drops, and wait to see how the stronger dose is working. This method of individualizing the dosage (called self-titration) clearly distinguishes cannabis tinctures from pharmaceutical drugs, which are most often prescribed in a one-size-fits-all fashion. The opportunity for patients to easily determine the optimal dose for their unique body and their specific condition makes tinctures the ideal self-care medicine.
Tinctures can be flavored for better taste. They are best stored in dark bottles in the refrigerator. Since tinctures average about 75 percent ethanol, there is little worry of bacterial or other biological contamination. For those who wish to avoid alcohol, a California company, Yolo Botanicals, sells Prana Bio Medicinals, providing patients with alcohol-free, sugar-free tinctures. Prana Bio Medicinal products are formulated from a variety of pure plant CBD-rich and THC-based cannabis strains with specific ratios and terpene profiles, divided into categories called P1 (THC:THCa), P2 (3:1 CBD), P3 (1:1 CBD), P4 (CBD:CBN), P5 (CBD:CBDa), available in capsule, sublingual, and topical delivery methods. P1 thru P3 are available in activated (with THC) or non-activated (without THC) formulas, offering patients options between a psychoactive or non-psychoactive therapy. Prana’s unique tinctures are infused in pharmaceutical-grade fatty acids. This not only eliminates the need for alcohol or ethanol, but greatly increases their bioavailability. Since marijuana is fat-soluble, the rate of absorption for these tinctures is far superior to that for others.
I was most impressed with the analgesic and sleep-inducing effect P4 had on my shingles pain. However, it became unavailable in Colorado and I was unable to continue using it.
I believe we will soon see a rapid development of cannabis tinctures, as the weaknesses of the other methods of administration become more apparent. I’m excited about the wide of variety of trans-mucosal delivery systems that will soon be available, in addition to the sublingual drops and sprays currently available. There will also be more tinctures not using alcohol as their extraction method. Current tinctures include:
• 1:1, 2:1, 3:1, 6:1, 20:1/CBD:THC—Each of these tinctures is excellent for relieving pain, and the 20:1 is best for sleep and pain, with a minimal psychoactive effect. (A Boulder-based company, marQaha, recently created a new tincture made from the Harlequin strain with CBD:THC of 1:1. I believe it is currently the strongest analgesic of all tinctures, besides producing a pleasant high.)
• THCa—Not psychoactive, and possibly the most potent anti-inflammatory of all cannabinoids. It closely parallels the effect of THCa obtained from juicing raw cannabis leaves, which makes this tincture the most practical and therapeutic method for obtaining THCa. It’s more effective than the transdermal patch, and raw cannabis leaves are not readily available. Since it’s not psychoactive, it can be used in conjunction with any of the other tinctures or other methods of MMJ administration. This combination can offer great relief for patients suffering with highly inflammatory conditions such as rheumatoid arthritis or Crohn’s disease.
• CBD/CBN with low THC—These are ideal for reducing pain and promoting sleep.
• CBD tinctures—From either hemp or marijuana, they are not psychoactive and the latest research reveals these to be most effective for reducing anxiety and some seizures, and moderately (at best) helpful for relieving pain or enhancing sleep. I’m familiar with an excellent CBD hemp oil (no THC) combined with phospholipids (liposomes = healthy fats), available through Quicksilver Scientific in Lafayette, Colorado.
Advantages of tinctures: Most convenient, safest, and most consistently reliable method for determining optimal dose, referred to as self-titrating. They have a longer duration of action than smoking or vaporizing. Tinctures are the most conducive method for creating unique formulas and combinations of individual cannabinoids, especially CBD, THCa, CBN, and THC. Of the non-inhalation methods, tinctures are among the most consistent or homogenized dosed formulas—i.e., they are more uniform throughout. This means that each drop of the tincture has approximately the same amount of CBD, THC, or any of the other cannabinoids as every other drop. The lack of homogeneity is a significant problem with edibles. It is not surprising that a century ago, tinctures were the only method of administering cannabis medicine.
Disadvantages of tinctures: Limited selection, with most medical dispensaries having relatively few choices of tinctures for sale. Most tinctures contain alcohol.
Cannabis concentrates include any cannabis product produced through an extraction process. Solvents such as butane, CO2, and ethanol strip compounds from the cannabis plant, leaving behind a product with cannabinoids packed in every drop. Some types of extracts, such as shatter and wax, test as high as 90 to 95 percent THC (three to four times higher than the strongest sativa strains of flower), while others are rich in non-psychoactive compounds, most often CBD. But it is the extremely high THC content that makes these concentrates such a potent and high-risk medicine. Although they are classified as concentrates, tinctures as whole-plant extracts do not have nearly as high a concentration of THC as shatter and wax. These stronger concentrates are typically consumed through dabbing (see below) and vaporizing.
There is also a significant safety issue with the production of extracts, but this can be minimized with the use of a professional extractor and other more sophisticated equipment. Butane is highly flammable and mildly toxic. Before purchasing, check to confirm that the butane hash oil (BHO) is lab tested for purity, as improperly purged BHO may contain traces of butane, which should be avoided. The other extraction methods, such as CO2 or ice-water extraction, are much healthier and safer, and reduce or remove the possibility of explosions.
The oldest and most familiar form of concentrate is hash or hashish, a cannabis product made by compression of the plant’s resin. The powdery kief that coats the cannabis flowers can be collected (as described above with a grinder in the “Vaporizing” section) and pressed together to form hash, or solvents like ice water or ethanol may be used to more effectively strip the plant of its cannabinoid-loaded crystals. Though not as popular or as potent (nor does it have the potential risk of rendering the endocannabinoid receptors ineffective) as the other cannabis concentrates, hashish remains a staple of cannabis culture around the world. It is typically smoked, and is not conducive to vaporizing.
Butane hash oil (BHO) is a high-potency concentrate that has been extracted from the plant using the chemical butane. Butane is convenient and widely available, making it ideal for this process. However, butane is also a mildly toxic chemical (found as well in common scent and flavor extracts), highly flammable, and can be dangerous to work with. For these reasons, many dispensaries are switching to CO2 as the preferred method of extraction. It is healthier to inhale or ingest and safer to work with.
Hash oils are available as sativa, indica, and hybrid; as well as in a variety of CBD:THC ratios. BHO or CO2 hash oil is a thick, dark brown, sticky substance most often dispensed in a syringe. The recommended dose is an amount approximately the size of one grain of rice. (Start with less if you are someone who is particularly sensitive to drugs.) It can either be vaporized (only with vaporizers that can accommodate oil) or ingested. I recommend the latter since its duration of action is more than twice as long (six to eight hours) as vaporizing (two to three hours). In addition, vaporizing the oil requires a much higher temperature than the flower (440 degrees Fahrenheit versus 375 degrees) and is therefore more harsh on the mucous membrane lining the respiratory tract.
I suggest eating it with a fatty food—e.g., avocado or peanut butter—since marijuana is fat-soluble and this will allow for more rapid absorption, sometimes as quickly as thirty to forty-five minutes. Otherwise it might take one to even two hours to feel a strong therapeutic effect. Since the oil is so sticky, it helps to push it out of the syringe onto a relatively hard surface, such as a cracker, and then you can scrape off the remaining oil at the opening of the syringe onto the cracker. After the dose of oil has been dispensed, then add your fatty food, and eat all of it. I don’t recommend eating a sizable meal along with the oil, unless it’s an especially fatty meal. A big meal will significantly delay the onset of the hash oil.
In 2003 a man named Rick Simpson treated his skin cancer using a homemade remedy made from cannabis. When he soaked the cannabis in pure naphtha or isopropyl alcohol, the therapeutic compounds were drawn out of the plant, leaving behind a tar-like liquid after the solvent fully evaporated. Also known as Phoenix Tears, Rick Simpson Oil (RSO) can be orally administered or applied directly to the skin. There are several dispensaries currently selling their own versions of the oil, some of which are high in THC while others contain only minimal amounts, along with a relatively high percentage of CBD.
Since THC and CBD both have anticancer properties, the most effective oil for treating cancer combines the two, with significant amounts of both. RSO is considered to be the most effective MMJ product for treating cancer, both ingested and applied topically to skin cancers. (This treatment should be used as a complement to conventional cancer treatment.) The most frequent complaint expressed by patients ingesting RSO is that “it makes me too high.” I recently heard from a patient who has been administering the RSO in rectal suppositories (he fills the capsules himself from the syringe he purchases at the dispensary), and the psychoactive effect is greatly diminished.
Although RSO can be produced in a variety of ways, it is traditionally done with an alcohol extract. Dispensing and dosing are similar to what I’ve described for CO2 hash oil above.
These concentrates are derived from and considered a subcategory of hash oil. The primary differences between hash oil, shatter, and wax are the consistency of the end product following the extraction process and the concentration of THC. Shatter and wax can have a far greater THC content than hash oil, with as much as 95 percent (or more).
Shatter, with its flawless amber transparency, has a glass-like appearance. Heat, moisture, and high terpene content can affect the texture of the hash oil, turning it into a runnier substance that resembles sap (hence the commonly used nickname sap). Oil with a consistency that falls somewhere between glassy shatter and viscous sap, is often referred to as pull-and-snap.
The name cannabis wax refers to the softer, opaque oils that have lost their transparency after extraction. Unlike those of transparent oils, the molecules of cannabis wax crystallize as a result of agitation. Light can’t travel through irregular molecular densities, thus leaving a solid non-transparent oil as the end result.
Just as transparent oils span the spectrum between shatter and sap, wax can also take on different consistencies based on heat, moisture, and the texture of the oil before it is purged (the process in which residual solvents are removed from the product). Runny oils with more moisture tend to form gooey waxes often called budder, while the harder ones are likely to take on a soft, brittle texture known as crumble or honeycomb. The term wax can be used to describe all of these softer or solid textures.
Both shatter and wax are typically inhaled through the process of dabbing. A dab refers to a dose of concentrate that is heated on a hot surface, usually a nail, and then inhaled through a dab rig. This method of administering shatter and wax makes dabbing the fastest and most efficient way to relieve pain, and to also get very high. This fact has triggered valid concerns regarding dabbing and the use of shatter and wax.
I do not recommend the use of shatter or wax, except under the most extreme circumstances—i.e., the most severe pain (8 to 10). Even then, it is not necessary. I suffered with shingles pain at a level from an 8 to a 10 for nearly two months. Vaporizing hybrid and indica flower, taking tinctures, ingesting edibles, and applying transdermal patches were enough to reduce the pain to tolerable levels and allowed me to function reasonably well.
Advantages of concentrates/extracts: The greatest benefit of concentrates is that they provide a powerful dose of medicine to those who truly need it, especially for severe pain and, with Rick Simpson Oil/Phoenix Tears, for treating cancer (in conjunction with conventional medical treatment). The safest way to use concentrates is to ingest CO2-extracted hash oil or RSO. This method also provides the longest-lasting pain relief. Patients dealing with acute severe pain, a flare-up of chronic pain, or extreme nausea report that dabbing can be the most effective way to get immediate relief. I’ve also heard from a few patients with migraine headaches that if they are unable to vaporize flower during the initial window between the early warning and the onset of pain, and they’re left with intractable disabling pain, dabbing can relieve it. Once a migraine begins, this seems to be the only method of delivering marijuana capable of significantly reducing the pain.
Disadvantages of concentrates/extracts: With increased use of high-potency concentrates such as shatter and wax, we are recognizing previously unknown risks. As a result of their efficiency in relieving pain, there is a great temptation to use these concentrates on a daily basis, and subsequent dependence, abuse, and addiction are often the result. When shatter and wax are consumed daily, at the very least it results in developing a tolerance and a significant reduction in the therapeutic effect. At worst, it can cause the “burnout” or destruction of the endocannabinoid receptors and can render them inoperable. If this occurs, then marijuana delivered by any method of administration will have no effect.
I’ve seen two patients with severe chronic pain have this happen, and it’s very sad indeed. They’ve had to return to using the prescription narcotics they had weaned themselves off months and years earlier through the use of medical marijuana. The good news is that although it might take several months of complete abstinence from all marijuana for the receptor cells to rejuvenate, the body is capable of recovering.
Dabbing, not surprisingly, is most popular with consumers in their twenties. As stated previously, high-THC marijuana products can be damaging to a developing brain. There’s nothing higher in THC content than shatter and wax. This fact leads to another liability of dabbing and inhaling these “super-concentrates.” They are responsible for cannabis abuse, and for the first time it is now possible to overdose on cannabis. For this reason, and their potential for addiction, shatter and wax have been referred to as the crack cocaine of cannabis. While they are still not lethal, taking too many dabs can lead to extremely uncomfortable highs and, in some cases, passing out. Although they relieve the pain, they often render the user unable to function. Marijuana has been considered an extremely safe medicinal herb, but the overuse of these high-potency concentrates could be undermining this message of safety. In addition, there have also been reports of more intense withdrawal symptoms for dabbers, but that information is still limited.
The concentrates are in need of more research, and rapidly advancing technology in this field will likely (and hopefully) result in less dabbing. While there is great potential for the use of shatter and wax in treating severe pain, at the present time I do not recommend using them. But if that is your choice, I advise using them with utmost caution, and only for the most severe pain.
Edibles are food infused with cannabis. They can be purchased in a wide variety of shapes and sizes, including cookies, gummies, cakes, hard candies, chocolate bars, and beverages. Depending on the strain(s) of cannabis used to make them, there are sativa, indica, and hybrid edibles, producing effects much like those described in Chapter 3 for each of these three types of marijuana flower. There are also high-CBD/low-THC edibles that are effective for treating anxiety, pain, and insomnia.
Since edibles are absorbed through the gastrointestinal tract, there are a number of variables that can impact their rate and degree of effectiveness. What, when, and the amount you have eaten prior to or along with ingesting an edible will influence its rate of onset. The condition of the tissue lining the bowel, your weight, and your metabolic rate are additional factors affecting absorption. Rich and dense products such as brownies or chocolate also take longer to digest, which means it will take longer for you to feel the effect. On the other hand, infused drinks begin to work much faster.
As previously mentioned, marijuana is fat-soluble and is therefore absorbed more quickly if you eat it with a fatty food. I suggest not eating a big meal, but some food (including fat) is preferred over an empty stomach.
Given all of these variables, the onset of action of an edible can take from forty-five minutes to two hours.
Advantages of edibles: Edibles provide a discreet and convenient way to consume cannabis, particularly for those chronic pain sufferers looking for an alternative to smoking or vaporizing. They are economical, especially if you make your own. This entails a relatively simple process of first making cannabutter (made by heating butter along with marijuana and then straining out the leaves). You will need sufficient plants and the specific strains that you have found to be helpful for relieving your symptoms. You can either purchase these strains from a dispensary or buy the seeds and grow your own plants.
Other than avoiding inhalation, perhaps the greatest benefit of edibles is their duration of action. Depending on the dose, the therapeutic effect can last from four to twelve hours, but on average, you can usually count on six to eight hours of relief. In addition to lasting longer, for some patients the effect can also be more intense than with smoking or vaporizing.
In many cases of inflammatory bowel disease, such as Crohn’s and colitis, and even with IBS, edibles seem to be the most effective method of administration.
Disadvantages of edibles: Many medical marijuana patients have had unpleasant and uncomfortable experiences with edibles because they “took too much.” When this occurs, the advantage of a long duration of action becomes a distinct disadvantage. You might feel heightened anxiety and unable to function for a significant part of a day. Signs of an edible overdose may include paranoia, lack of coordination, and hallucinations. Some have described this experience as similar to having taken a hallucinogen or being on an “acid trip.”
If you feel like you’ve overdosed, don’t panic. Remember, the symptoms will subside within a few hours. Stay calm and hydrated and eat food. Those who have suffered through such an experience are unlikely to want to try an edible a second time.
This has been a common problem with edibles (officially described in the cannabis industry as manufactured infused products—MIPs), which can occur as a result of inconsistency of dosage, the lack of homogeneity in the product (cannabinoids are not evenly distributed), and the accompanying unpredictability of their effects and especially of their response time. These overdose incidents typically occur because the consumer isn’t feeling any effect in thirty or forty-five minutes, becomes impatient, and decides to ingest more.
In Colorado, recently revised limits on THC content and new regulations regarding packaging and dosing instructions have helped considerably in decreasing the incidence of overdosing with edibles. State laws now require that total milligrams of THC and number of servings be included on packages. In Colorado, one package cannot have more than one hundred milligrams of THC, and one serving can constitute up to ten milligrams of THC. It is easier to discern the amount that constitutes one serving of some edibles than of others.
Each of us will react a bit differently, and your reaction to the same edibles may vary from one time to the next, depending on the previously described variables. If they’re using a particular edible for the first time, I strongly advise patients to start slowly, with a relatively small dose (preferably half the recommended dose on the package) and wait at least an hour (or more) to see how they react before taking a bit more.
For the uninformed consumer, ingesting an edible for the first time can pose a problem. Since medical and recreational marijuana have become legal in Colorado, emergency room visits for marijuana overdose have seen a significant increase. Nearly all of these patients, many of whom are young children, have ingested an edible. This illustrates another liability of edibles for medical marijuana patients with toddlers in the house. The edibles must be kept out of reach, and it must be made clear to the child that they are medicine, not candy.
If edibles are used appropriately, each of these liabilities can be mitigated, and for many chronic pain patients edibles can be quite helpful, in spite of being somewhat unpredictable.
Tablets and capsules can be regarded as similar to either tinctures, edibles, or concentrates, depending on the specific product. There are sublingual tablets that dissolve quickly under the tongue and can be absorbed within a few minutes and begin to take effect within twenty-five to thirty minutes. Similar to tinctures, their duration of action is four to six hours. This delivery method is a recent addition to the rapidly expanding list of MMJ products. The one with which I’m most familiar is the line of MED-a-mints, available in sativa, hybrid, and indica sublingual tablets. They work well (especially the indica for sleep, the hybrid for pain, and the sativa for migraine), are absorbed quickly, and have a pleasant mint flavor. The manufacturer is planning to introduce a line of high-CBD MED-a-mints sometime in 2017 (see Resources).
There are also tablets that are swallowed, and as such, similar to an edible. They can take forty-five to sixty minutes to begin working and can last as long as six to eight hours. The line of Stratos tablets is available in sativa (called Energy), hybrid (Relax), and indica (Sleep), as well as two new high-CBD tablets (15:1 and 1:1/CBD:THC). I’ve seen excellent results with patients who have taken the indica for sleep.
Some dispensaries sell capsules containing hash oil as a more consistent and convenient way of delivering (ingesting) and dosing the oil, rather than dispensing it via a syringe. A few dispensaries now sell CBD oil (containing no THC) in capsules in strengths of 10, 25, and 50 mg. CBD capsules are also available online (see Resources).
There are also a few dispensaries that have oil-filled rectal and vaginal suppositories. The rectal suppositories begin working within ten to fifteen minites, can last from four to eight hours, and, in some cases, will significantly minimize the psychoactive effect. To learn more about the administration of rectal suppositories visit http://phoenixtears.ca/dosage-information/.
Advantages of tablets and capsules: I’m hopeful that the sublingual tablets will provide an effective option for preventing migraine headaches. Other than smoking, vaporizing, and to a lesser extent, topicals, the sativa or hybrid MED-a-mints are the only other current delivery method that can potentially work quickly enough to knock out the headache before a full-blown migraine puts you out of commission. And they are much more convenient than those other methods. However, their effect is dependent on the length of time between the early warning or aura of an imminent migraine and when the pain actually sets in. If this window is less than twenty-five to thirty minutes, it will not be as effective as vaporizing.
Both sublingual and swallowed tablets are the most convenient and consistent delivery method available. They are also an excellent option for travel, since the majority of patients have concerns about the legality of marijuana in other states and countries. Traveling with tablets and capsules allows you to be much more discreet. Most people with chronic pain are comfortable with taking pills, and these MMJ tablets are as close as we’ve come to approximating the pharmaceuticals in both form and consistency. The dosage on the label is exactly what you’re getting in each tablet.
Disadvantages of tablets and capsules: As with edibles, there is a risk of taking too much. Since each of us will have a somewhat different reaction, I suggest starting gradually with a low dose, waiting at least two hours to evaluate the effect, then deciding if you need more. The sublingual mints are scored tablets, so they’re easy to break in half.
Vegetables are defined as “any plant cultivated for food, edible herb or root.” Cannabis has been referred to as the “most important vegetable on the planet” because it can strengthen the function of your immune system, provide anti-inflammatory benefits, and improve bone metabolism and nerve function, as well as inhibit cancer cell growth.
Some vegetables may be eaten raw, while others must be cooked in order to be edible. When certain fruits and vegetables are heated, they lose a majority of their beneficial enzymes and nutrients. Cannabis is no different. As an edible herb, it is technically a vegetable, containing many of the same nutrients as other leafy greens (such as fiber, iron, and calcium). But its raw leaves are also filled with beneficial cannabinoids, particularly THCa, CBDa, and CBG (described in Chapter 3). As such, juiced cannabis is a nutritionally dense, very potent medicine without the psychoactive effects one would normally experience when heating the plant.
THCa and CBDa must be heated in order to produce THC and CBD. However, according to Dr. William Courtney, a dietary raw cannabis specialist and a strong proponent of the plant’s medicinal benefits, “you are actually walking away from 99 percent of the benefits cannabis provides when you cook or smoke cannabis.”
Additionally, the body is able to tolerate larger dosages of cannabinoids when cannabis is consumed in the raw form. Your body can only absorb approximately ten milligrams of THC at a time when you smoke cannabis. According to Dr. Courtney, “If you don’t heat marijuana, you can go up to five or six hundred milligrams and use the plant strictly as a dietary supplement by upping the antioxidant and neuro-protective levels which come into play at hundreds of milligrams of CBDa and THCa. It is this dramatic increase in dose from 10 mg of psychoactive THC to the 500 mg to 1000 mg of non-psychoactive THCa, CBDa, and CBGa that comprises the primary difference between traditional medical marijuana treatments and using cannabis as a dietary supplement.”
The FDA has recently approved a tolerable CBD dose of 600 mg per day as a new investigative drug. This makes the medical potential of drinking the juice containing 600 mg of CBDa far greater than when you heat cannabis. Considering that CBD percentages are typically below 1 percent in most strains available in dispensaries, it is nearly impossible to smoke enough in one day to ingest a 600 mg dosage of CBD.
If you’re interested in juicing marijuana, Dr. Courtney recommends that patients juice fifteen leaves and two large (two to four inches long) raw buds per day. Raw buds are flowers harvested when the THC glands are clear (rather than amber). Be aware that this juice is highly acidic and has a bitter taste, and should therefore be diluted either with water or preferably with another type of vegetable or fruit juice (a ratio of one part cannabis juice to ten parts other juice is recommended). Both organic apple and carrot juice are popular choices. There are many good recipes for juicing online.
Split the juice drink into three parts and drink one with each meal, or store it for up to three days in a tightly sealed container in the refrigerator.
Advantages of juicing: An excellent and discreet method for deriving both the health and medicinal benefits of cannabis without the psychoactive and other negative effects of smoking or vaporizing. Juicing is especially effective for inflammatory conditions such as osteoarthritis, rheumatoid arthritis, colitis, Crohn’s, and other autoimmune conditions.
Juicing cannabis is also a good preventive medicine, infusing the body with vitamins, minerals, and phytochemicals—natural compounds occurring only in plants that can aid human health by guarding against chronic illness. There are an abundance of phytochemicals in every healthy fruit and vegetable, and they convey antioxidant and even anticancer properties.
Disadvantages of juicing: Juicing requires raw, freshly picked, and properly grown cannabis free of any pesticides or other microbiological contaminants. Unless you grow your own plants, this is not easy to find. A few dispensaries do provide fresh cannabis for juicing, but not many. Marijuana that has been dried and prepared for smoking is not suitable for juicing.
Topicals are cannabis-infused products that are absorbed through the skin for both localized and generalized relief of pain, soreness, and inflammation.
These include creams, lotions, balms, sprays, and oils. Because they’re non-psychoactive, localized topicals are an excellent choice for patients who want pain relief without the psychoactive effect associated with most of the other delivery methods, including the generalized topicals.
Localized topicals are applied directly to the skin covering the area of pain. Their primary active ingredients are CBD, THCa, and CBC (non-psychoactive potent anti-inflammatories), as well as other cannabinoids. They often contain other ingredients, such as arnica (a homeopathic remedy for pain and inflammation) and essential oils to enhance pain relief, such as cayenne, peppermint, wintergreen, and clove. They work by binding to the network of CB2 receptors found throughout the body. These receptors are activated either by the body’s naturally occurring endocannabinoids or by cannabis compounds known as phytocannabinoids (e.g., THC, CBD). Even if a topical contains active THC, it’s usually a very small amount and won’t induce the psychoactive effect.
A localized topical I’ve found to be one of the most consistently effective for relieving my patients’ pain is Apothecanna Extra Strength. It’s a double strength moisturizing body cream with anti-inflammatory plant extracts, containing CBD, arnica, peppermint (cooling and anti-inflammatory), and juniper (antiseptic and antirheumatic). Apothecanna Extra Strength provides fast-acting relief from pain and inflammation, in addition to moisturizing and cooling dry and irritated skin. It can be applied directly to sore muscles and painful joints or used as a full body massage.
I always recommend this topical to patients with arthritis, postoperative pain, and chronic pain resulting from serious injuries. I’ve known several patients who have used Apothecanna to successfully treat their migraine headaches by applying it to both temples and forehead, just between the eyebrows. I’ve not heard that about any other topical.
I’ve also seen several women who have successfully treated their menstrual cramps by applying Apothecanna cream to their lower abdomen/pelvic area, directly over their uterus. It was initially quite surprising to me that this topical has the capacity and potency to penetrate deeply enough to pass through several layers of body tissue, including the skin, fat, and abdominal muscles, to reach and then be absorbed into the uterine muscles where it relieves the cramping.
Another highly effective localized topical is Mary’s Medicinals CBC Transdermal Compound. This is the first topical cream on the market that isolates the cannabinoid CBN (well known for its analgesic properties). Immediate benefits include relief from inflammation of the joints and skin irritation, as well as antibacterial properties. These two localized topicals have frequently been reported by my patients to work extremely well for pain relief, but there are a number of others, especially Restore Relief (from Restorative Botanicals), with similar pain-relieving properties, containing cannabinoids along with other analgesic and anti-inflammatory ingredients.
High-CBD hash oils are another effective topical option, especially for killing cancer cells when applied on a daily (or twice daily) basis directly to the skin cancer, whether it’s a melanoma or a basal or squamous cell carcinoma. (A study that was published in the Journal of Clinical Investigation in 2003 found that the cannabinoids in marijuana stop the growth of skin cancer cells.) However, with any of these skin cancers, the topical should be used as a complement to conventional cancer treatment. They’ve also been helpful in treating psoriasis, eczema, and other forms of dermatitis. Although I’ve not worked with any patients who have tried it, I would recommend it for treating actinic keratosis, considered a precancerous lesion, and warts as well.
Cannabis-infused massage oils containing cooling menthol or peppermint are excellent topicals to use both prior to and following a strenuous workout or for sore and aching muscles in general.
Advantages of localized topicals: They provide pain relief where you need it most, without a psychoactive effect. They are effective, convenient, discreet, and can be used any time of day, especially while working. Their effectiveness—without getting high—makes them the preferred daytime medical marijuana product for many of my chronic pain patients, especially those with neck, back, and joint pain.
Disadvantages of localized topicals: They are expensive and their duration of action is relatively short, approximately two hours. This results in frequent reapplication, and if the topicals are used daily, containers are emptied rather quickly.
Generalized topicals differ from localized as a result of the cannabinoids being absorbed directly into the bloodstream (they’re applied to the wrist) and therefore affecting the entire body.
The generalized topicals I recommend to patients are Mary’s Medicinals Transdermal Gel Pens and Mary’s Medicinals Transdermal Patches. There are four types of the unique five-inch, cylindrical transdermal pens. Each of them releases a 2 mg dose of CBD, or CBN, with a THC Indica–THC Sativa, turn-click system. The gel is applied to the forearm and is distinguished from other topicals in the fast and complete absorption of the compound into the bloodstream. Patients with generalized pain, such as fibromyalgia, seem to benefit most from the pens.
There are several varieties of the two- by two-inch-square adhesive transdermal patches: CBD, 1:1/CBD:THC, THCa, indica, sativa, and CBN. They are the first of their kind on the market and use the unique delivery method of venous absorption. Patients are instructed to apply them to either their wrist or ankle, where the skin is thin and the veins are close to the surface. Patches can be worn for up to twelve hours of continuous effect. If the patient no longer wishes to feel the effect for whatever reason, the patch can be removed and the effect will dissipate within approximately one half hour.
I’ve had good results with the 1:1/CBD:THC for pain relief, the THCa patch for inflammation, the CBN for sleep and pain, and the CBD for reducing anxiety. Patients who are interested in consuming either an indica or a sativa will usually prefer other delivery methods, especially vaporizing flower.
Advantages of transdermals: Pain relief without inhalation and duration of action (ten to twelve hours), especially with the patches, are the primary advantages. The 1:1/CBD:THC has been an excellent choice for many of my elderly patients with chronic pain, especially those with arthritis. They do not want to inhale, and the psychoactive effect with the patch seems a bit milder, with a slower onset, than with the other delivery methods. The patches are also useful for terminal patients and hospice care. Both pens and patches are convenient and discreet.
Disadvantages of transdermals: Not as effective for severe pain as most of the other delivery methods. They are expensive.
• • •
As you can see from both this and the preceding chapter, there are a great many available options for consuming medical marijuana. The challenge is to find the best combination of MMJ product and delivery system to meet your specific needs, and one that works in harmony with your unique body, without causing discomfort. In these two chapters, I have provided you with sufficient information to make well-informed choices to begin the process of selecting the delivery method(s) that works best for you. This might entail a brief (two- to three-week) period of experimentation. I suggest you try several of these methods at least twice while varying the dose of the MMJ to determine the ideal formula for you. With a multitude of options for pain relief and relatively few adverse side effects with short-term daily use, I’m confident you will be successful. Enjoy the process!
• • •
Now that you’ve read Part I, consider yourself a knowledgeable patient and well prepared to begin using cannabis as medicine. Part II will assist you in the process of integrating this knowledge into a holistic treatment program for significantly relieving your pain and treating your specific chronic condition. And if you choose to go further, Part III will reveal how this remarkable herbal medicine can help you to further address the causes of your dis-ease and heal your life.