A FEW GENERAL NOTES
- Medical Cannabis (and its derivatives) can be used as a preventive therapy and/or an analgesic. It is effective therapeutically at a wide range of doses (see Pt. 10 – Dosing).
- A high-quality Full Spectrum CBD extract is a good starting point for cannabis naive patients. THC is often introduced slowly for evening use due to its psychoactive effects.
- It is helpful to introduce a High CBD – Low THC option, a balanced (1:1) option and a higher THC option.
- There are many forms (and delivery methods) of cannabis to try. Each will have varying speeds of onset (10mins-2hrs), durations of action (1-24hrs). Some may notice Improvements within an hour of medicating, while it takes 2-3 weeks for others to notice positive effects.
- Starting slowly is the key to success with any method. Keeping a journal is immensely helpful during this initial trial and error phase.
- Many patients’ needs necessitate the use of more than one type of cannabis and will need to try several in order to learn what is most effective for them.
- As with any type of medication, patients must use their medical cannabis responsibly. Keep your medication out of the reach of children and do not drive impaired!
- There is a great deal of stigma and misinformation surrounding medical cannabis. One must advocate for themselves and educate those around them. If your doctor has recommended medical cannabis, it should be regarded as a legitimate form of medication, equally valid as anything else in your treatment plan.
1. THC, CBD, RATIOS & TERPENES
- CBD is known for its anti-inflammatory, anti-seizure, anti-anxiety & analgesic effects. It is most well known for being the non-psychoactive Yin to THC’s Yang.
- THC is known for being the cannabinoid that produces psychoactive effects (aka it’s the one that produces a “high”). It is often vilified and dismissed due to its recreational use, and many patients avoid it due to stigma and fear. THC is a potent pain reliever, anti- emetic, neuroprotectant, sleep aid, PTSD treatment, appetite stimulant, anti- inflammatory, bronchodilator, anti-convulsant, anti-tumor and more. Don’t be afraid of THC… just take it slowly.
- CBD products are not all created equal! Source, extraction method, quality, potency and price will always vary. Always choose FULL SPECTRUM extracts over CBD Isolate. Question any product that is marketed as “Pure CBD”, “99% Pure CBD”, etc.
- THC and CBD work better together! Look up the “Entourage Effect”. Learn why whole plant medicine is more effective than isolated compounds (i.e. Pure CBD). The real purity lies in a full spectrum extract, which preserves as many cannabinoids and terpenes as possible.
- Terpenes – these oils are responsible for the various scent and flavor traits of a strain, but also for the synergistic effects they have with the plant’s cannabinoids. They are responsible for many of the characteristics you often hear attributed to species type (i.e. Indica, Sativa, Hybrid).
- The ideal cannabinoid ratio will vary from person to person. A 1:1 ratio of CBD:THC is effective for many, but one must still pay attention to the mg dose on the label (strengths will vary).
2. STRAIN NAMES; INDICA VS. SATIVA
- You might hear that Sativa strains have an uplifting, more cerebral effect while Indica strains are relaxing, calming and better for sleep. These are outdated comparisons, so don’t give them too much weight. Recent studies suggest that these characteristics actually have more to do with terpenoids than species type!
- OG Kush, Gorilla Glue, Blue Dream… Strain names are fun but they don’t actually mean anything. The traits of your “Pink Kush” can vary greatly from those of your cousin’s Pink Kush down in Florida! Indoor/outdoor growth, soil type, weather conditions, growing techniques, etc. There are countless variables that contribute to the traits/effects of a strain. It is far more important to note the strain’s THC:CBD content and terpene profile than the name it was given.
3. HAVE PATIENCE, MANAGE EXPECTATIONS
- This is a process, not a quick fix! Cannabis is a very effective tool for symptom management… but it is not a cure.
- Be patient with the process, it takes time. If something isn’t helping or it exacerbates your symptoms, lower the dose or discontinue and move on. Purchasing small quantities is a good idea in the beginning.
- Do not get discouraged if something isn’t helping! Keep trying different things.
4. DO YOUR RESEARCH!
- Empower yourself to make educated choices. Read articles from several sources.
- Very important: learn what is legal and what is not. Don’t rely on an online retailer to tell you. Hemp CBD legality is a very complicated issue in the United States.
- Become a legal patient within your state’s medical cannabis program and stay within those laws. Know your rights as a patient. A great resource for this is https://www.safeaccessnow.org/
- Educate yourself on the plant itself and its history of use in medicine.
- Familiarize yourself with dosage and how to read labels.
- Engaging in support groups (both online and in-person) is a great way to learn from others who are medicating for the same conditions. Ask lots of questions!
5. TRIAL AND ERROR, TRACKING
- Medicating with cannabis is a continual process of trial and error. Each person’s metabolism and neurotransmitters react differently, so what works for one person may not work for another. It is very hard to predict what will work for you.
- TRACK your progress as you go! Make notes before and after everything you try. You may find that your pain responds to one thing and your anxiety responds to another. This will help you learn what works for you and at what dose! There are fantastic apps for this, like Strainprint.
6. TYPES OF CANNABIS AND DELIVERY METHODS
(Please note that legality, access and availability issues may reduce the number of options available to a patient.)
- Forms of Cannabis Include:
- Dried Cannabis (Bud/Flower), Extracts (Oils, Tinctures), Concentrates (Shatter, Hash, Bho, Wax, etc.)
- Delivery Methods Include:
- Inhilation (Smoke, Vaporization of Flower or Oil); Sublingual absorption (Oil, Tincture, Oral Sprays, Wafers, Mints); Oral ingestion (Capsules, Edibles, Infused Drinks); Topicals (Cream, Salve, Bath Salts); Transdermals (Patches, Cream); Dabbing (Vaporization of Concentrates); Internal absorption (Personal Lubricant, Suppositories)
- Each patient’s individual needs and preferences will help determine what type of cannabis and which delivery method suits them best. Speed of onset, duration of action, dosage, tolerance, preference and bioavailability may factor into one’s choice.
- Bad tasting oil? Many extracts taste quite bitter. The best way around this is to purchase a bag of empty capsules and fill them with your oil!
- Tricky Terminology: All Tinctures are Extracts, but not all Extracts are Tinctures! Many companies use the terms interchangeably which can be confusing, but Tinctures are traditionally alcohol based. Most oral extracts available are oil based.
- Vapor is not Smoke! Lighting cannabis on fire is called combustion, which creates smoke filled with toxic carcinogens that are harmful to your lungs. Vaporization heats the cannabis just enough to release the plant’s active compounds. This is the more efficient delivery method of the two, since combustion actually burns off many helpful cannabinoids.
- Note that sublingual oil and vape oil (vape juice, e-juice etc.) are two different things! Inhaling sublingual oil (coconut, MCT, olive etc.) can lead to lipid pneumonia, so make sure you have the correct product for your needs.
- DIY! No access to _? There are many recipes online that can help you transform your cannabis at home. Infuse your own oil, bake your own edibles, mix your own topicals, etc!
7. SHOPPING FOR MEDICAL CANNABIS PRODUCTS
(Please note that “Dispensaries” can be a legitimate provider of medical cannabis or an illegal operation depending on where you live!)
- If you must purchase CBD online, shop critically. Learn how to distinguish a quality product from one that is weak and ineffective. Don’t fall for marketing gimmicks and scams.
- Look for companies that cultivate their own cannabis/hemp and control production from “seed to finished product”.
- Try not to choose a product based on taste alone. Fun flavoured CBD oils are not always a good choice. Artificial flavours and fillers can be signs of a weak or low quality product.
- There tends to be more selection online, but this comes with a much higher risk in terms of quality/scams. There are good products online, you just need to know what to look for.
- Online products are often not regulated, tested for cannabinoid/terpene levels or subjected to any sort of quality control. Their legality should also always be questioned.
Titrating aka Start Low, Go Slow
- There is no one-size-fits-all dosage for any one condition or type of patient. The best way to approach dosage is to “Start Low and Go Slow”. This goes for all cannabis products, including CBD.
- A patient’s sensitivity to THC can help determine a starting dose. Many respond well to taking small doses over the course of the day. Slowly increase the dosage one step at a time until symptoms improve.
- Potential short-term side effects can include: euphoria, heightened senses, confusion, drowsiness, cognitive impairment, memory loss, increased appetite, anxiety or paranoia.
- “Microdosing” with as little as 2.5 mg THC may help with symptom relief and side effects.
- Where to start:Oil: Aim for 5mg of CBD to start. 2-5mg for THC. Wait 2 hrs before judging the effects. Dried flower: Just a “puff” or two to start, preferably from a vaporizer. Wait approx. 10 mins before judging the effects and take additional puffs as needed.
- Average daily dose of CBD:Anywhere from 20-50mg. Epilepsy and cancer patients may take up to 200mg CBD/day.Average daily dose of THC: varies considerably. Knowledge of tolerance is key. Beginners may stay under 10mg, while experienced patients may require 50mg-300mg for breakthrough pain. THC concentrates (shatter, distillate, etc.) are an efficient way to attain these high doses while consuming a very small amount of product.
- You cannot “overdose” on cannabis, but you CAN take too much THC for your tolerance level which can be extremely unpleasant. If this happens: stay calm, drink water, eat food and try this Pro Tip: Keep some CBD on hand at all times. It mitigates the psychoactive effects of THC and can lower your anxiety!
For more information, permission to reproduce or help applying these tips to Migraine and Headache disorders, please contact: Jodie Epstein firstname.lastname@example.org 416-566-4898