Opponents to any legalization of cannabis have always insisted that allowing its use would lead to a increase of traffic accidents and avoidable deaths. With more states permitting cannabis use for medical as well as adult use, the worries over cannabis impaired drivers has drawn the interest of legislators and law enforcement. Some states have legislation which specifies a specific blood level of THC at which a person is considered impaired, just like the law does with blood alcohol levels. In some states which have a "zero tolerance" law, the presence of any trace amount of THC or even the non-psychoactive metabolites will be considered "pro se" evidence for driving under the influence. Its presence means you are guilty. There is no legal defense. Five states have pro se blood THC limits from 1 nanogram/ml to 5 nanograms/ml as the legal threshold of impairment.
"Edibles" is the catch all word for orally administered cannabis. Orally administered cannabis is different from inhaled cannabis in ways that give it certain advantages such as increased potency and a longer duration of effect. It also has some disadvantages which can make it a bit difficult to use..
The largest increase in growth of medical cannabis use is in people older than 55 years. From 2013-2014 it rose by more than half. Many people seem surprised by these numbers as this is the age group who have traditionally opposed to any legalization of cannabis. They grew up with the beginning of the war on drugs, Mrs. Reagan' "just say no" campaign, the ads showing an egg frying on an iron skillet as a metaphor for "your brain on drugs" and likely know someone" who" family has been ravaged by drug abuse.
Last week, I received a call from a patient I had seen for a medical cannabis consultation to use it in the treatment of his chronic pain issues. He did meet qualifying conditions in Arkansas and I provided his certification and advice on beginning medical cannabis, strain selection, routes of administration, etc. I returned his call with the hopes he had found my advice helpful and was on his way to improving his quality of life. Instead, it was yet another story of the stigma of medical cannabis affecting yet another pain patient..
As a patient becoming more informed and sophisticated in the use of medical cannabis, you may enter into the world of DIY edible production. I have been successfully recommending DIY cannabis tinctures for years in appropriate patients to take advantage of the longer lived effects, convince, discretion and economy they can provide. There is a legal issue with tinctures and medical cannabis in general which should be addressed.
Cannabis as a medicine seems quite new. With a majority of states now allowing its use, patients, many of their doctors, society at large and certainly to law enforcement and government are searching for information. The information available online is vast and often confusing. Much of it is incomplete, far too detailed and technical for most people to sort through, clever marketing or just plain wrong.
Medical cannabis patients are certified by a physician as having a qualifying condition. The patient is issued a card and then, too often is left to decide for themselves as to the best treatment. Dispensary employees are usually the cornerstone of giving patients advice on strains and how to use cannabis. Sometimes they are very good at giving recommendations. Sometimes, not so much.
Modern medicine treats disease with the drugs that are effective for the majority of patients, forgetting that we are all very different individuals. What is a good choice for one patient may be ineffective or cause side effects in another. Although most patients see some improvement in using cannabis, getting the best result is a bit more complicated...
I have seen patients without much knowledge or direction experience lukewarm results of medical marijuana. I have also seen those so-so results turn into remarkable improvement under the knowledgeable direction of a doctor that treats the individual patient using the correct combination/forms/amount of cannabis.
It is my hope to sift through all the noise, marketing, agenda driven studies, politics and stigmas encountered when one tries to be an informed medical cannabis patient. I want you to get the best result from medical cannabis you can.
Brian Nichol MD