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How to use Cannabis? A Physician's POV

How to use Cannabis? A Physician's POV

 How to Use Cannabis…In our previous article, we went over a few reasons of why using medical cannabis, being such an interesting topic we are going to dedicate this whole article to give as much information on how to use it safely. If you happen to live in a place where medical Cannabis is legal this process will be easier for you and the best place to start is at your local compassionate Doctor office to obtain a medical cannabis license. The next step is to go to the cannabis dispensary or clinic, if this is your first time here you will probably be impressed and even fascinated with the incredible amounts of flowers, tinctures, edibles and concentrates available, at first it might cause you a little anxiety but don’t worry this is where this article comes handy.
Cannabis exists in nature mainly in 2 forms: Indica, Sativa and there is Hybrids or both; each one has a different THC: CBD ratio and different levels of activity in the CB1 and CB2 receptors inside the body as well. Currently, there are over 500+ Cannabis strains, they all have a specific fingerprint (ID) which gives you the THC, CBD concentrations and Terpene profiles of each one, in example: one of my favorite strains in Portland, Oregon is Durban Poison  (Sativa) THC % 16-25 CBD% 0-0.2% Terpenes: Linalool, B-myrcene, A-Pinene, B-Caryophyllene. You will also notice that besides the classic flower, cannabis comes in many presentations and forms of administration among the main ones we have: concentrates, edibles, sublingual and topical; so where and how do we start?
The first thing I want you to recognize is why are you seeking cannabis as medicine, do you have a specific medical condition? or are you curious to obtain the amazing overall health benefits of adding it to your life? Wherever you are in this spectrum, it is always a good idea to learn more, as knowledge is power. In my opinion like any other medication, the ideal prescription with cannabis should be always customized to specific patients needs, adjusted according to tolerance and clinical evidence of improvement. Giving as much information about your medical history or current illness to the Cannabis team is always helpful in order to choose the right strains, dosing, and forms of administration that suits you.Now that you have your prescription with you, what do you do with it?
Most people will advise you to “roll a joint and burn it” and although this is probably the most common and ancient form of using cannabis; is not necessarily the healthiest one, as we all know there is harm to our body when we smoke. This is mainly due to a byproduct of combustion named benzene; which is released when we reach temperatures above 392 Fahrenheit degrees (200 Celsius) like when we smoke, for that reason I always recommend vaporizing over smoking; nowadays there are numerous vaping devices with temperature controls that make this task a no-brainer.
Ingesting cannabis it is also a very popular way of use, most of you probably have heard about the famous Cookie power or space brownies. This method requires absorption through the gastrointestinal system which takes approximately an hour to be in full effect,  it can be 3-5 times more psychoactive than inhaled cannabis and it will last longer in your system. When using this method It is very important to differentiate, as we explained in our first article active (cooked) cannabis from inactive (raw) cannabis that is ideal for juicing and salads and has no psychoactive effects.Sublingual administration is also very popular for tinctures and concentrates, in this case, the medication will be held under the tongue for approximately 90 seconds as here there is mucosal plexus that promotes a fast absorption, it has the advantage of bypassing the digestive system so it can reach the bloodstream and endocannabinoid system faster. Also, there is topical administration will mostly consist of patches, ointments, and creams, most of them have only localized action with little to none systemic or psychoactive effects.
Dosing cannabis is definitely not rocket science, here are a few recommendations to keep in mind for the first timers; the golden rule is to start low and go slow, this is mainly because every person will respond differently to the same dose. For an average 70-80Kg person I will suggest to start with a 5mg Edible or 0.25g (1⁄4 gram) of dried cannabis flower and aiming to choose a high CBD low THC strain to minimize psychoactive effects. In more practical setting grind a little bit of,  flower set it in your vaporizer at less than 392 degrees, inhale and wait… Do not take another dose for at least 7 min remember we are going to go slow until we find our therapeutic window, which is defined by the minimal amount of cannabis necessary to provide an improvement of symptoms or complete relief. I will also recommend to document your experiences and always have the company of another adult preferably in a quiet and relaxed setting where you don’t have to deal with any major responsibilities.
Unlike most pharmaceuticals in the market, the potential side effects, adverse reactions, addiction potential and even cost is much lower when using cannabis as medicine. Some of the cannabis main side effects are dry red eyes, increased thirst and hunger, anxiety, and paranoia. It is also important to keep in mind that only THC has psychoactive properties, most of this undesired side effects are dose-dependent and related to THC another reason to always choose high CBD low THC strains and to remember the golden rule start low and go slow on your first attempts. There is no life-threatening reaction or death by overdose described in the literature when using medicinal cannabis alone. Nonetheless, if you were to find yourself in an uncomfortable that is out of your control situation please do not hesitate to call 911 or go to the emergency department.
Other considerations to take home when using medical cannabis: first It is not intended to replace your current medicine, but to offer a natural alternative that could aid your current condition and improve your quality of life. Second when choosing your cannabis please read the labels carefully and also look for organic, clean, green certified products if able. Third but not least important always consult with your primary care Physician prior to the use of cannabis. I hope this information was useful to you if you have further questions or would to share your experience do not hesitate to reach out or schedule a consultation with me.
Dr. Divo
Lifestyle & Cannabis medicine
References:
Cannabis Pharmacy, the practical guide to medical marijuana. 2014. Michael Backes.
The Journal of cannabis in clinical practice, spring 2010. J H. Miles.
http://www.cnn.com/2013/08/07/health/charlotte-child-medical-marijuana/index.html
Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in a migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions?  Russo EB.Neuro Endocrinol Lett. 2008 Apr; 29(2):192-200.
http://www.biology-online.org/dictionary/Homeostasis

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