|You've decided to take the plunge and try medical cannabis | “Now What?”
STEP 1 - Get Recommendation
If you are a resident of the State of California, have a valid state-issued Driver's License or ID card, and have a condition which may be helped by medical marijuana, you are qualified. Proposition 215 lists cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, and "any other illness for which marijuana provides relief". Physicians have recommended marijuana for hundreds of indications, including such common complaints as insomnia, PMS, post-traumatic stress, depression, anxiety, epilepsy, asthma, arthritis, and substance abuse harm reduction.
Finding a Doctor
Most patients go to a doctor who specializes in cannabis recommendations, since they generally have a system in place to provide 24 hour verifications online or over the phone (even though you have the original, physical copy, dispensaries and delivery services will also need to confirm that it is indeed valid). You can, of course, get a recommendation from your primary care physician.
STEP 2 - Select your Method
Inhalation offers the fastest relief, and is the most popular method of consumption. This includes both combustion (pipes, bongs, joints) and vaporization. While studies have shown that even decades of smoking cannabis is not associated with higher risks of lung disease, it is still not the healthiest alternative. Vaporizers work by heating the smoking substance to a temperature hot enough to vaporize the plant material but not burn it, which releases the cannabinoids and terpenes without the harmful tars and carbon monoxide of combustion. The biggest drawback to this method is its complexity -- this category includes everything from the simplest e-cigarette to the most elaborate tabletop unit, along with the daunting array of attachments, accessories, and options they offer. Don't let this discourage you! You can arrange a private, in-home new patient consultation and we can show you how everything works.
Oral / Mucosal
When patients need a more discreet method, or cannot tolerate inhalation, the next quickest route to relief is through the mucous membranes of the mouth. Tinctures, hard candies, sprays or strips, and gum all fall under this category. The longer the medicine is retained in the mouth, the more will be absorbed through the sub-lingual and buccal surfaces (under the tongue and inside the cheek, respectively); like inhalation, the medicine passes directly into the bloodstream. Still, some of it will be swallowed, and swallowed medicine must be digested before the effects are felt, so the rule to wait at least an hour and a half still applies.
Ingestion refers to cannabis that is absorbed through the digestive tract, which changes both the duration of the effects, and the effects themselves (more on that later). It will last much longer, but it could take an hour or more to be felt; it is very important for new patients to start out with a low dose and wait for the full effects before increasing the dose. Too much THC can be an unpleasant experience, causing disorientation, anxiety, paranoid thoughts, and a very, very dry mouth. You can't overdose and you won't do any lasting damage, but it isn't any fun. For new patients, experts recommend a very small (5 - 10mg) dose. Since cannabis interacts with the body's endocannabinoid system, you may require less, or substantially more, to treat your symptoms but we urge you always to err on the side of caution, and keep in mind that the rate of absorption and the duration will be different on an empty or full stomach. In spite of all these variables, once you have established what works for you, ingestion allows for precise dosing and predictable results.
Transdermal / Topical
Topical cannabis preparations work locally, without any intoxicating side effects. THC has antibacterial, anti inflammatory, anti-cancer and immune-modulating properties, and is lipophilic, which means that it can be dissolved into a fat-soluble substance and readily enter cell membranes. Topical preparations include balms, lotions, ointments or alcohol-based solutions. Very little research has been done on this method, but at least one study found that nerve and mast cells in human skin contain cannabinoid receptors. Anecdotal evidence suggests that topical cannabis is excellent for skin irritation and itching, rashes, allergies, sunburn, psoriasis, eczema, bruises, sprains, and arthritis. There are reports of patients having positive results with topical applications of undiluted cannabis oil on skin cancers. While this is encouraging, we urge our patients to evaluate such claims with a healthy dose of skepticism, especially if they tell you that you can treat your cancer at home with nothing but cannabis. We recommend that you find a doctor who is knowledgeable about current cannabis research, and work closely with them to incorporate cannabis into your treatment regimen.
STEP 3 - Learn Cannabinoids
In pharmacology, a drug is a chemical substance used in the treatment, cure, prevention, or diagnosis of disease, or used to otherwise enhance physical or mental well-being. These substances are defined in precise terms and prescribed in exacting doses; whole plant medical cannabis is a far more complex entity. Whole plant cannabis contains hundreds of compounds, which differ from strain to strain and even from batch to batch. Cannabinoids including THC, CBD, CBG, THCV, CBN, and CBC may be present in varying concentrations, along with terpenes and flavonoids which are responsible for the taste, smell, and many additional therapeutic effects. There is cannabis that will make you hungry, and cannabis that will curb your appetite and help maintain blood sugar. There is cannabis that fixes anxiety, and cannabis that causes it. Most of these differences are accounted for by the varying concentrations of cannabinoids and terpenes (and the ratios between them, since they often work synergistically), and the rest are unique to each patient's own body chemistry. We've included our Cannabinoid Reference Chart down at the bottom of the page (it's also available under the Resources tab). We encourage all of our patients to learn about the fascinating science of cannabis. Following are three of our favorite sites for well-researched information. Leafly in particular is an excellent reference for patients considering which strain will work best for them, as they collect detailed strain reviews and aggregate the data in an engaging and informative reference. Project CBD is a fantastic resource covering much more than just CBD, and Medical Jane's Cannabis Classroom does a great job of making research understandable to the layperson.
STEP 4 - Try Different Formulas
If you have never used cannabis before, we recommend that you start off slowly and cautiously, and that you set aside some time when you don't need to drive or operate dangerous machinery, in order to gauge how it affects you. Inhalation methods are felt immediately, but will build over time, generally peaking anywhere between 5 - 20 minutes after the first dose. Be especially careful with edibles, which can take up to two hours for you to feel the full effects, and if you overdo it, you may have an unpleasant experience -- if that happens, though, there's no need to worry, cannabis is extremely safe and cannot kill you. To minimize undesirable side effects, try strains or products with more CBD and less THC. Although extremely rare, cannabis allergies do exist. They are difficult to pinpoint, because doctors can't get cannabis to perform the usual allergy tests, but if you experience any allergic reaction, discontinue the medication and let your doctor know.
Keep a Dosage Diary
A dosage diary can be as simple or as detailed as you make it. When you try a new medicine, give it a page in your notebook, and record the category (Indica/Sativa/Hybrid), dosing method, cannabinoid percentages, strain genetics and growing conditions, smell, taste, and appearance -- you may not always be able to find that strain again, but the more you know, the better you can find something equivalent.
Try Different Strains / Cannabinoid Ratios
If at first you don't succeed, don't give up! Remember medical cannabis is not one single drug, but a robust pharmacopoeia with a huge variety of options. If you had any adverse psychological reactions (dysphoria, paranoia) you should try strains with more CBD and less THC. If you suffer from glaucoma, try strains high in CBG; if you get the munchies and eat too much, try strains high in THCV. Different strains feature different terpene profiles as well, so two flowers with the same ratio of THC to CBD might affect you differently. This is where your medication diary really shines! Making a note of what helps, you may find that they always smell of lemons, or always have purple hairs. This will help you identify medicine that is going to work for you, even if it's a strain you haven't heard of before.
Try Different Methods of Absorption
If you've been vaping, try edibles -- or visa versa. There are more differences between ingested and inhaled cannabis than the duration of effects. As you progress on your medical cannabis journey, keep in mind that it is one of the safest drugs in existence -- aspirin and Tylenol are more deadly than marijuana! It might feel strange to be "experimenting" with medicine, but as long as you're not doing any harm (and you're not), this method empowers you to take an active role in your treatment.