Know Your Medicine…Duke City Fitness & Wellness believes that all patients should receive the highest quality medicine to fit their specific needs. This section provides the medical cannabis patient a complete overview of all aspects of using medical cannabis and types of cannabis medicine.
Medical cannabis: or medical marijuana can refer to the use of cannabis and its cannabinoids to treat disease or improve symptoms; however, there is no single agreed upon definition
Cannabis Strain: a genetic variety or varieties of medical cannabis; Indica, Sativa, Hybrid, & Ruderalis.
Indica Strains: are sedatives/relaxants and are effective for treating the symptoms of medical conditions such as anxiety, chronic pain, insomnia, muscle spasms and tremors. Indicas have a higher level of cannabinoids than sativas, which results in a sedated body-type stone. Because indica strains may cause feelings of sleepiness and heaviness, many patients prefer to medicate with this type of cannabis at night. And many dispensaries will color code its strains on menu’s & list all Indica Strains in Purple or Blue.
Sativa Strains: are more of a stimulant, and are effective in appetite stimulation, relieving depression, migraines, chronic pain and nausea. Sativas have a higher level of THC than indicas, which results in a psychoactive and energetic mind-high. Because sativa strains may cause feelings of alertness and optimism, many patients prefer to medicate with this type of cannabis during the day. Typically Sativa will be color coded in a Red Color.
Hash Plant Strain: This Indica Dominant Strain type of the precious Afghani (Indica), is descended from one of the finest hash-making cultivars ever brought from the Hindu Kush (Indica) to the west. Cannabis strains known generally as hash plants are found throughout the countries that border these mountains, but very few have the pedigree of this Hash Plant – a living definition of the stocky, chunky, beautifully sticky Afghanica genotype. The direct ancestor of Hash Plant was developed in the Northwest USA and came to Holland.
Probably the most known cannabinoid found in cannabis is THC. This psychoactive cannabinoid is responsible for producing the sense of euphoria associated with cannabis consumption. However, more recently CBD has also been gaining in popularity particularly for medical applications. And a lot of dispensaries will color code strains dominant in CBD with Orange.
CBD: has a wide potential for treating many conditions including:
Schizophrenia – due to the anti-psychotic nature of CBD, this compound could pave the way for new schizophrenia drugs. This is might be because CBD may stabilize disrupted or disabled NMDA receptor pathways in the brain.
Seizures – CBD has shown to be very effective in treating epilepsy. While there aren’t currently “accepted” treatments as of yet, for some patients such as Charlotte Figi, this compound has been the difference between life and death.
Nausea – CBD is an antiemetic, meaning it reduces nausea and vomiting.
Inflammation – CBD is also an anti-inflammatory agent.
Cancer – As well as THC, CBD is an anti-tumoral agent and can be used to treat certain types of cancer. For other cancers, THC works better such as Prostate Cancer.
Pain Relief – 60% of patients use cannabis for pain relief. This is due to the fact that THC activates pathways in the central nervous system and in turn blocks pain signals being sent to the brain. Particularly useful for neuropathic pain, THC has provided relief for thousands of patients around the world.
PTSD – ‘Short Term Memory Loss’ was considered a ‘bad thing’ for quite some time, that was until a deeper understanding of Post-Traumatic Stress Syndrome was unveiled. To simplify what happens with PTSD, the patient is ‘stuck’ in a looped memory of a past trauma. THC helps interrupt these loops allowing the patient to deal with the trauma.
Nausea – THC has been available for nausea in pill form since 1980+. This has been used to treat nausea induced by chemotherapy and is one of the few pills containing THC that is legally available on the market.
Appetite Stimulation – Another benefit of THC is stimulating appetite. Patients undergoing chemotherapy have found that THC helps stimulate their appetite regardless of the nauseating effects of chemo. Studies have also suggested that it could be a potential treatment for anorexia.
Asthma – Since the 1970’s, researchers have known that THC improves the breathing of asthmatics. While attempts to make a suitable inhaler has been largely ignored due to the staunch rules against cannabis, people believe that modern day vaporizers could suffice in providing relief to medical patients suffering with asthma.
Glaucoma – Similar to Asthma, the beneficial effects of THC on Glaucoma has been documented since the 1970’s, many Americans have been using THC to treat their glaucoma.
Insomnia – Another medical benefit of THC relates to sleep. While preferably Cannabis indica is used in this treatment, many Americans have found relief in cannabis for cases of insomnia. These studies date back to the 1970’s.
There are plenty more effects of THC on the human body, however this shows that THC should not be demonized as it has been over the past few decades. The medical efficacy of this compound is yet to reveal the totality of the benefits to the human condition.
Medical Cannabis is most often obtained from stores called LPNN’S or Dispensaries. The dispensary experience is unique: you are both a customer in a retail store and a patient looking for medical treatment guidance. Dispensary employees and owners try to ensure the best customer service experience they can – they don’t want to waste your time or money, nor do they want you to suffer needlessly. All medical marijuana dispensaries require patients to have a current/valid state-issued MCP Card and for of National or State ID to enter the store and make a purchase. Key things to know about the dispensary shopping experience are:
Product availability will vary between stores.
Prices won’t be the same at every dispensary.
Dispensaries have their own unique varieties of cannabis plants and cannabis products.
Despite a dispensary owner’s best efforts to keep costs manageable, medical cannabis products can be quite expensive. Prices are based on factors such as cost of procuring product and sales taxes. Like any other retailer, dispensaries compete with each other by offering discounts and specials.
The person working behind the counter at a dispensary is called a patient consultant, peer educator, or budtender. A typical job description for a patient consultant look something like this:
“… experience in retail sales. Possession of, or willingness to obtain, a comprehensive understanding of medical cannabis and its various applications for patients is essential, as is eagerness to learn, … (Budtenders) should be comfortable troubleshooting patient questions and concerns, have meticulous attention to detail, and be personable and honest in all interactions.”
How to Talk to Your Patient Consultant
A patient consultant is a de facto caregiver; this makes clear, accurate communication quite important. Even a small misunderstanding could result in recommending the wrong type of product for your condition or an incorrect dosage.
This is significant because nailing down the perfect cannabis regimen takes a lot of trial and error. Part of the goal is to minimize any potential unpleasant experiences, particularly allergic reactions or side effects with other medications.
When you first approach a patient consultant they will ask you a few “starter” questions to get an idea of what you’re shopping for:
What effect are you looking for?
What strain are you interested in?
How do you want to consume?
If you have little or no experience with cannabis, these questions can confuse or intimidate you. This in turn can affect how you discuss your needs. The answers they’re looking for are designed to narrow down the choices of products to only those that work for you.
Finding what works best not only takes patience and trial and error, but is compounded by the sheer amount of medicinal possibilities and combinations. Everything from methods of ingestion to cannabinoid levels to strains and much more make for near-countless options.
Corinne Malanca, co-founder of United Patients Group, has these tips for communicating your needs clearly:
Describe the symptoms you want to address – Malanca says it’s best to describe your needs in “specific, yet general terms.” For example, instead of outlining your condition in overwhelming detail, try, “My fibromyalgia causes aching pain in my arms and neck that gets worse at night.”
Describe the TYPE of relief you’re looking for – Instead of “I need muscle pain relief” try “I want to calm the throbbing pain for around 8 hours so I can sleep.”
Introduce the question – Malanca suggests phrasing your questions in a way that the budtender can safely answer. For example, “Of all the people you see in my situation…”
Finally, when consulting with a patient consultant, take a few minutes to ask them about themselves and their experience. Get an idea of how many medical patients they work with, and the type of training they’ve gotten.
Usage Techniques For Medical Cannabis
There are many ways to ingest medical cannabis, and patients may find that one method is more effective than another for their specific needs. The effects often vary with each method, sometimes affecting the length of time it takes for the herbal medicine to take effect, or the length of time that it remains effective. Each patient should find which manner is best for them.
1. Smoking Medical Cannabis
Historically, the most traditional form of ingestion is smoking the dried flowers or leaves of the cannabis plant. Hash and kief are also ingested this way. Cannabis can be smoked through a pipe, rolled into a joint (or preroll), or smoked using a water pipe (bong).
For most patients, the effects of smoking dried cannabis are felt almost immediately, but soon begin to diminish. Depending on the individual patient, and the cannabinoid content and potency of the cannabis strain, effects wear off almost completely within 90 minutes to 4 hours. Regularly smoking any plant material, including cannabis for health reasons, can have a negative impact, which is why we recommend patients use vaporizers or edible forms of medicinal cannabis whenever possible.
2. Vaporizing Medical Cannabis
A vaporizer is a device that is able to extract the therapeutic ingredients in the cannabis plant material, called cannabinoids, at a much lower temperature than required for burning. This allows patients to inhale the active ingredients as a vapor instead of smoke, and spares them the irritating and harmful effects of smoking. Those patients who are used to “smoking” cannabis may not feel like they are “getting anything” at first because it does not “burn” the throat. It is advised to use caution and wait a few minutes to feel the full effects. Many patients say that half as much herbal medicine will provide twice the effect when vaporized.
3. Edible Medical Cannabis
Cannabis can be infused into butter or oil that is then cooked in food. Edibles, as they are typically called, usually take longer to take effect than smoking or vaporizing, often 20 minutes to an hour or more. Doses can be difficult to judge, so it is recommended to eat only small portions of edible medical cannabis at a time, and wait at least an hour to assess its effects so you do not over-medicate. Edible herbal medicine will kick in significantly faster if eaten on an empty stomach. In general, the therapeutic effects from eating cannabis last much longer than other consumption methods, often up to four hours or more, and then slowly begin to wear off. Many patients report that this method provides more of a relaxing body effect than the cerebral high that is often accompanied with vaporizing and smoking.
4. Topical Medical Cannabis
Topical herbal medicines are applied directly to the skin or muscles. They include lotions, salves, balms, sprays, oils, and creams. Many patients report they are tremendously effective for skin conditions like psoriasis, joint diseases like rheumatoid arthritis, migraines, restless leg syndrome, some spasms, and everyday muscle stress and soreness. However, unlike smoking, vaporizing or eating the medical cannabis, topicals are completely non-psychoactive—you could take a bath in them, and never get high.
5. Tinctures (Medical Cannabis Concentrate)
A tincture is a concentrated form of medical cannabis in an alcohol, coconut oil, or glycerin solution. Tinctures are highly concentrated and require careful dosage levels, starting out small and waiting to feel the effects before adding more. They can be taken under the tongue or mixed into water or other beverages.
Eating Cannabis for Cancer, Aids, Chronic Pain and Other Medical Conditions
Eating cannabis can be an excellent alternative to smoking, especially for patients who would like to use the herbal medicine but do not want to ingest smoke. Here is some information that you should be aware of and may find helpful. Many members use edibles as a sleep aid, consuming about an hour before bedtime for a sounder sleep.
Food-based cannabis medicines affect patients differently than inhaled methods like smoking or vaporizing.
Eating too much medical cannabis can cause extreme drowsiness, dizziness, inability to concentrate, diminished ability to focus, rapid heartbeat, increases or decreases in blood pressure, need for sleep, and feelings of euphoria.
How can you ingest cannabis medicines safely?
Learn to manage your dosage effectively…
1. Begin with a ¼ of a “dose” or small portion of herbal medicine.
2. Wait for at least one hour and analyze the effects.
3. If necessary, consume another ¼ dose or small portion.
4. Wait for at least one more hour.
5. If necessary, consume part or all of the remaining herbal medicine.
Do not operate heavy machinery, motor vehicles, boats, or motorcycles while taking edible medication. Do not use if you are pregnant, nursing or caring for an infant. Be aware of your surroundings and possible hazards, and prepare for your needs before taking medication.
Remember: Edibles can vary greatly in potency. Products often contain multiple doses or lesser doses of medicine. Weight, metabolism, and eating habits can alter dosage effects. Eating medical cannabis on an empty stomach can intensify effects. Learn dosage management that works for you when ingesting herbal medicine.
If you feel you have eaten too much of a food-based herbal medicine, do not panic, your symptoms will subside within a few hours. Remain calm. Stay hydrated and eat food to help symptoms pass.
Edible medical cannabis is safe and will not cause any long-term toxicity.
A Matter of Privacy
In a dispensary, there will almost always be other people standing a few feet from you when you step up to talk with a budtender. If you aren’t comfortable talking about your needs with other people nearby, ask if you can talk with someone in a quiet spot away from the other patrons. A sensitive, experienced patient consultant will honor this request in a heartbeat. There’s no need to feel awkward asking. Records of your initial medical cannabis evaluation are protected by HIPPA, the federal law covering privacy for health records. However, discussing your condition and needs with a patient consultant are not protected since a patient consultant isn’t a licensed medical professional. Anything you share is at your discretion.
How to Educate Yourself
As you can see by now, patients must do a good deal of research before (and during) their medical cannabis journey.
The internet will become your second home when you’re researching medical cannabis. There is a large amount of information out there, and many reputable organizations have compiled comprehensive sites to guide you.
The resources referenced here aren’t the only places you can find information, but they are kept up-to-date and are easy to understand.
Resources: The Cannabist, Mary’s Medicinals, Leafly
Conditions and medical cannabis uses
Resources: United Patients Group, Cannabis Patients Alliance, CannaSOS,Medical Jane, PubMed
Resources: Project CDB, Medicate Mate app, Reset.me
Sometimes patients are immobile or are too sick to go to a dispensary. This includes children with severe epilepsy (who are legally too young to enter a dispensary anyway), adults with cancer, or other physically debilitating or terminal illnesses.
In other cases, a patient might have access to a dispensary but their needs require deeper knowledge of medical conditions, specialized cannabis products and dosing.
In situations where you do need to dive deeper, here are other practitioners who can give medical cannabis guidance:
1) Care Consultants
Care consultants are independent advisors knowledgeable in the complete process of treating severe illnesses with medical cannabis. They provide broad information on cannabis for specific conditions, but not specific medical advice.
A caregiver is someone that you have designated as your single resource for personalized care. A caregiver can grow cannabis for your personal use and purchase products on your behalf. Laws regarding how much product a caregiver may have, how they buy for a patient, etc. vary from state to state.
Cannabis nurses are trained RNs who have advanced knowledge of medical conditions and have extensively researched medicinal cannabis. These nurses can’t give specific medical advice, but they can give you in-depth, medical explanations of how cannabis works in your body for a wide range of conditions.
Consultants and nurses can’t sell product directly, but they can advise you on the best methods of obtaining the right product for your specific needs.
Is It Worth It?
At this point, you could easily think that pursuing medical cannabis puts too much burden on the patient and may not be worth all the effort. If you’re expected to know exactly what you want and how to use it before you come to the store, how is a dispensary anything more than a 7-11 for weed?
Taking control of your own medical care is always worth the effort. No one in a dispensary intentionally shifts an undue burden to the patient, sells you the wrong thing or gives you inaccurate information. It’s simply a fact of life that the sparse amount of information about medical cannabis currently available from MDs requires you to learn as much as you can on your own.
As the industry grows along with advances in cannabis research, expertise will improve at all levels of caregiving. Patients play a tremendous role in this growth by communicating fully with their providers and giving honest feedback as to what works for their condition.