Medical Marijuana: How to Choose, How to Use

From little information to an overload of information online, it is easy to imagine that most people living with pain, their family members, and caregivers will be overwhelmed about whether or not cannabis is a viable pain relief option.

First of all, it is very important to have an honest discussion and make an informed decision, in partnership with your healthcare provider. Individuals may have different medical conditions that co-exist with any particular pain disorder, and that may affect the choice and the delivery method for cannabis. All involved should not only understand the different types (strains) of medical grade cannabis that exists, but also the delivery systems available.

Additionally, you need to know the typical effects of medical marijuana as well as side effects that could occur. For example, someone with a past brain injury asked me a thoughtful question, “Will cannabis fry my brain?” Another person living with asthma, expressed concerns about cannabis effect on the lung if inhaled through vaping. Concerns like these will impact your decision – how to choose, how to use, or even if to use. Let’s discuss these issues.

First of all, there is no single, clear answer right now. As stated in a previous blog, Pot for Pain Relief? What the Research Gurus Say…, research findings are limited, though promising. Doing your homework is essential.

How to Choose

According to Marijuanadoctors.com, there are thousands of strains of cannabis that exist. Most fall into three categories: indica, sativa and hybrid. There are others such as cannabis ruderalis and industrial hemp; which are not well studied.

• Indica: more sedating, comes in a variety of flavors and contains high levels of resin. Can come in pure and blended forms. Indica strains are grown in harsher climates like the middle east, Northern Africa, and Nepal. Commonly prescribed for the following conditions:
  • Pain Relief
  • Anxiety and Stress Disorders
  • Seizure Disorders
  • Muscle Spasms
• Sativa: more stimulating and energizing, it may increase creativity. It also comes in variety of fruity-sweet to earthy flavors. Sativa is grown in the far east, South America and Mexico. Used, but not commonly prescribed, for the following conditions:
  • Depression
  • Improved focus & creativity
  • Mood Elevation
  • Insomnia

Note: Pure sativa can induce irregular heartbeats and paranoia.

• Hybrid: typically a mix of indica and sativa; strain’s are mixed for positive properties and preferred characteristics. Growers (also called breeders) are diligent in creating a variety to address the desired effects both by recreational and medical consumers. Therefore, most medical cannabis is hybrid, meaning hybrids are typically a combination of seeds from different countries worldwide where marijuana can successfully grow. Hybrids can be used for:
  • Elevating Mood
  • Energizing Activities & Productivity
  • Decrease social anxiety
  • Improve motivation
  • Conquer social anxiety
  • Motivate your mind
  • Decrease fatigue
  • Pain relief
  • Lift depression
  • Improve appetite
  • Decrease nausea and improve digestion
  • Sleep aid

Strains can be used in combination, such as with depression or fatigue. Sativa could be recommended for daytime use. For insomnia and pain, Indica might be suggested to be used at night. These strains often have unique names, such as:

• Lemon Haze (Sativa): Happy, euphoric and uplifting; helps with anxiety, pain, lack of appetite
• Jack Herer (Sativa): Cerebral, energetic and creative; helps with depression, fatigue, nausea
• Blue Dream (Hybrid): Relaxed, sleepy, pain relieving and social; helps with headaches, inflammation, muscle spasms
• Blue God (Indica): Pain relief, increased appetite and a relaxed state; helps with insomnia, stress, pain.

Medical quality stains should contain more CBD (cannabidiol), which has therapeutic effects, than THC (tetrahydocannibidiol); THC has psychoactive properties which causes the “high” preferred by recreational users.

How to Use

1. Smoking is the most well-known delivery system, where dried leaves are either rolled into small cigarettes (doobie, joint, reefer), or placed in a pipe or bong (water pipe), which is lit and smoke is inhaled.
2. • Advantages: smoking provides fast-acting relief from pain, nausea or other symptoms, the regulation of dosing is easy, lower cost and little need for leaf processing therefore more pure.
   • Disadvantages: smoking is not the best option if you have asthma, frequent respiratory illnesses, chronic bronchitis, COPD or lung cancer. Also, it must be said that many healthcare providers are not in favor of encouraging inhaling smoke into the lungs for any reason. Tar and other waste products inhaled into the lungs and throat, can irritate and dry the protective mucous membranes, increasing the risk of infection. And, the smell of cannabis smoke is noticeable and considered offensive to some.

2. Vaporizing or “vaping” is a popular way of inhaling cannabis (as well as tobacco); this involves preheating a vaporizing device to recommended temperature, inserting a small amount of cannabis flower into the “vape” and then inhaling.

1. • Advantages: vaporizing cannabis provides instant relief (like smoking), keep in mind the time factor required to heat up the vaporizer. Vaping does not irritate the mucous membranes of the throat and lungs as much as smoking.
   • Disadvantages: vaping devices tend to be costly; the process of vaping for the inexperienced can be challenging or awkward as well as the intense effects for those not sure what to expect. The smell of cannabis smoke is less yet still present.

3. Edibles: cannabis is added to typical dessert favorites like brownies, cookies, candies, ice cream, and chewables (like gum). This can be a preferred way to ingest for children and older adults.
   • Advantages: edibles are a pleasing way to ingest cannabis, especially for those who prefer not to inhale smoke; no special equipment is needed and no smell of smoke is present.
   • Disadvantages: edible forms take more time before the cannabis effect is noticeable; therefore dosing can be more challenging. Once the effect is felt it can be more intense than anticipated. Like any oral medication, it should be kept out of reach of young children and pets to prevent accidental ingestion.

4. Tinctures: form of cannabis dissolved in alcohol that can be placed on the skin or taken by mouth by placing drops under the tongue or adding to a cup of hot beverage; sometimes comes in spray form. Requires gradual dosing to avoid taking too much, too soon (rule of thumb: start low, go slow)
   • Advantages: faster acting than edibles, yet slower than inhaled; mild taste; easy to administer or take.
   • Disadvantages: less costly when small doses required, more costly with higher dosing requirements.

5. Oils/Concentrates: concentrates of cannabis infused into cooking oils, similar to olive oil or coconut oil, which is then cooked into foods.
   • Advantages: can be easily be added to favorite meals and desserts; can be used with individuals, like those with Alzheimers, who cannot understand its use or would resist taking other forms of cannabis or medications of any kind.
   • Disadvantages: similar to edibles.

6. Topicals: lotions, creams or patches applied to the skin; most commonly used for pain disorders, where the topical can be placed over the area of pain, such as: arthritis, fibromyalgia (trigger points) and musculoskeletal pain.
   • Advantages: lotions/creams provide fast onset, and short lived relief compared to patches that give slower onset yet longer relief. Some individuals use a combination of creams/lotions and patch application to maximize onset and length of effect.
   • Disadvantages: local allergic reaction to patch adhesive/material or binding agent in cream/lotion has been reported.

7. Other forms (less commonly used): Suppositories, capsules, juicing (cannabis infused beverages), eating plant leaves.

Just like any pain relief option, cannabis may work as a key component of one person’s pain tool kit and not for another.It is not a one size fits all treatment option. This is an option that should be discussed with your healthcare provider before seeking out a licensed marijuana prescriber and dispenser. If you are currently taking opioids for pain relief, find out if you will be required to taper off before cannabis is started.

Before having a discussing with your healthcare provider, be sure you have done your homework. Check laws and regulations on medical marijuana in your state and community as they vary. Some other areas to address are:

• Will medical marijuana affect your ability to work and perform expected duties?
• Will your job be secure or is there a risk of job loss if medical marijuana is legally prescribed?
• Is there a risk of losing work-related security clearances due to medical marijuana use?
• What do you need to know if you travel across state lines or outside the U.S. while using medical marijuana?
• What are the purchasing rules and restrictions if you travel for business or recreation out of state or outside the U.S?

The bottom line: choose and use wisely.

I invite you to share your thoughts on our discussion board. I would love to know your questions, concerns, tips or experiences.