Medical Marijuana – What You Need To Know
*Cannabis use for cancer patients, otherwise referred to as Medical Marijuana; what you need to know can be hard to find. Cannabis use in cancer care in Massachusetts is of interest to most cancer patients. Almost all of our clients however report they are not given guidance on access and use. To combat this void, The Healing Garden invited Katherine Connelly, a patient care services representative from Compassionate Care, Inc., the medical cannabis dispensary in Ayer, to answer questions. Prescribing physicians will warn against gaining your knowledge base through a dispensary. In order to gain expert advice, the Healing Garden attended Emerson Hospital’s grand rounds presentation delivered by Dr. Staci Gruber, the Director of the Cognitive and Clinical Neuroimaging Core at McLean Hospital’s Brain Imaging Center and an Associate Professor of Psychiatry at Harvard Medical School. Dr. Gruber reiterated much of the information delivered by the representative of the Ayer dispensary.
Medical Marijuana – The Basics about Cannabis
First, here are some basics about Cannabis. Cannabis contains two properties: THC and CBD. The psychoactive, euphoric, “high” experience comes from THC. The anti-inflammatory, anxiolytic (anti-anxiety), anti-seizure, pain relieving and reduction in movement disorder effects come from CBD. Cannabis products will have some ratio or percentage of THC and CBD. A prescribing doctor will help advise which ratio will best address certain symptoms. Using a product that has some percentage of both (rather than just CBD), has proven to be most effective. Another piece of basic information about medical marijuana is that there are two main species. Sativa is the species that is energizing, uplifting and will have a cerebral effect. Indica, is the species that is sedating, relaxing and has a body-based effect.
The last basic area of medical marijuana use is form of uptake. There are edibles, smoking, vaping, tinctures, and lotions. The general recommendation is to start with a tincture or vaping. Vaping is done through a vape pen that heats the cannabis flower or cannabis oil. Vaping allows for effect within 10-15 minutes, can be taken additionally as needed, and lasts 3-5 hours. Tinctures are dosed under the tongue and takes effect within 20 minutes. Tinctures can be taken additionally as needed, and last approximately 2 hours. Smoking is the least recommended form of use, as it causes exposure to carcinogens through the process of inhaling the burned papers. Edibles, another alternative, take effect after 90 minutes to 2 hrs. Edibles have a longer lasting effect of 6-8 hours however they have and higher potency and they are processed by the liver; concerning for those with other liver issues. Also, new users of edibles risk ingesting too much, when the delay in active effect is assumed to be a lack of ingesting ‘enough’. A prescribing doctor, Dr. Jordan Tishler, interviewed through WBUR’s This Moment in Cancer, stated that lotions and topicals are not effective as cannabis cannot penetrate the skin; however, anecdotally, many Healing Garden clients have reported relief from neuropathy through use of cannabis lotions. Salves and lotions massaged into the skin take 30 minutes to kick in and lasts 5-6 hours.
Medical Marijuana Product Usage Recommendations
There currently is no standard protocol/product usage for cancer patients. This is due to several reasons. 1) There is a lack of research. 2) Each individual naturally has a unique Endocannabinoid system. This is a regulatory system that exists in every mammal which functions to stabilize the body. Therefore, each person will have a different response to cannabis.
That leaves cancer patients with the decision of whether or not to go through the process of accessing medical cannabis, especially as it will be through trial and error as to how to determine the best product with the right ratios of THC to CBD to relieve their symptoms… and that process is very expensive. The process: 1) Physician Appointment (generally $200), locate and make an appointment or wait as a drop-in at a prescribing physician’s office; 2) Certification Card ($50), sent in by prescribing physician, may take up to 3 weeks to obtain; 3) Cannabis cost rage ($50-$300) -quite expensive especially when having to go through trial and error to see what works; and 4) Renewal ($250), yearly fee of physician appointment and card. The Compassionate Care, Inc. dispensary has a discount for veterans, those on MassHealth, or those on Social Security Disability.
The good news, however, is that cannabis is highly effective for many symptoms experienced by cancer patients, and it is likely that many different THC/CBD ratios and products will generally be effective, it is more a matter of learning which are more effective than others. The research as demonstrated by Dr. Staci Gruber through Marijuana Investigations for Neuroscientific Discovery (MIND) is astounding—medical use of cannabis shows significant improvement in sleep, anxiety, depression, quality of life, and pain—all primary symptoms for cancer patients. In one of their more recent studies, the use of pharmaceutical drugs reduced by the following:
Opiods -47%, Benzodiazipines -46%, Anti-depressants -22%, and Mood Stabilizers -28%. Dr. Jordan Tischler, in his interview at WBUR’s This Moment in Cancer, comments that with opiates, for example, “Cannabis and opiates for moderate to severe pain really study out as being equally efficacious — neither of them are super good. But the cannabis is much safer… if you start with cannabis, maybe you don’t need to get to the opiates, or if you do you need to get opiates, we have really good data that you need a lot less. If used together, you typically use only 20 percent of the amount of opiates you would have otherwise needed. With opiates, your risk goes up every time you increase [the] dose by a milligram. If you have someone who would need 100 mg of opiates, if you cut back to 20 mg, you’ve saved them 80 percent of the risk of the opiate. That’s huge.”
Medical Marijuana -What are the Cognitive Risks?
One of the major questions posed by Healing Garden clients is what is the effect of medical cannabis on cognitive functioning? Research at MIND demonstrated that use of cannabis causes significant neuro-cognitive deficits if used during the time of brain development (ages up to 25). However, later onset use (ages past 25) demonstrates very little difference between control groups (non-cannabis users) and medical cannabis users (use of 5-7 times/wk, several times a day). Moreover, for ages 50-64, cannabis use demonstrated an increase in cognitive function, surmised as a result in improvement of endocannabinoid systems along with improvement in pain, mood, sleep and quality of life.
For further information, a few recommended sites are as follows: http://drstacigruber.com/mind/, https://www.ncbi.nlm.nih.gov/pubmed/?term=medical+marijuana+cancer, http://www.wbur.org/commonhealth/2018/01/10/marijuana-weed-cancer, https://www.leafly.com/
Written by Brianne Carter, LICSW
*Cannabis is the Latinate plant name, used instead of “Marijuana” which a term derived from racist origins with the purpose to denigrate Mexicans and Mexican-Americans.
*All information provided in this article is exempt from being considered a medical resource. Readers will follow information provided in this article at their own risk.
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