Starting Medical Cannabis Treatment
Many patients who are seeking medical cannabis as a treatment have little experience with the drug. With the older population experiencing the common pain problems which occur as we age and looking for alternatives to the usual treatments, medical cannabis is a safe and often effective option. Perhaps this is you. So you get a certification as having a qualifying condition from a doctor and receive a dispensary ID card. If you have never used cannabis or the last time you did was at a "Boston" concert in 1979, where do you start...
Medical cannabis is not a single thing. The huge number of different strains have been developed by selective breeding and cross breeding to obtain a certain effect which is the result of the mix of cannabinoids and terpenes present in the plant. Strain choice is very important in achieving the best results from medical cannabis both for maximizing symptom control and minimizing the side effects. When starting as a novice, minimizing side effects is the first step.
Novice medical cannabis patients first must become accustomed to the main side effect of cannabis- that of being "high". The euphoric effects that cannabis produces is from the THC. While many people find the effect pleasant, some find it as an anxiety producing experience which some people describing it as being somewhat "paranoid." Such experiences can discourage these patients from further considering cannabis as a treatment option. This can be avoided with careful strain selection and slowly building up tolerance to the side effect.
New to cannabis patients should start with a balanced strain of cannabis. A straight hybrid with a 1:1 ratio of THC:CBD is optimal as the high levels of CBD will counter some of the mental effects of THC which makes the possibility of paranoia lower. Look for the presence of THCV in the lab analysis as this cannabinoid also moderates the psychoactive effects of THC and helps with anxiety that may occur when beginning medical cannabis.
After picking and obtaining a proper starting strain, inhalation should be the first route of administration used. The very short time it takes from inhaling cannabis smoke or vapor to producing the effect and the perhaps hour the effects last are optimal for getting used to the medication. Edibles and other orally administered cannabis are a poor choice to start with as they are much more potent and longer lasting. They also can take from an hour to several hours to see the effect which makes it difficult to titrate to effect.
Titration is the slow administration of small doses to achieve the desired effect. In this case, the desired effect is to become tolerant to the side effects. Here is how to do your initial titration.
Begin on a day you have no obligations and will be at home for several hours. Use either a dry herb vaporizer or a small pipe ("one hitter") and have a puff of the cannabis. You will notice the effects in a minute or two. If it is a little "too much" as to how it makes you feel. don’t panic! Just relax and put on the Boston album- the effect will start to wear off within the hour. Then do it again. Continue to use the cannabis on day one every hour or two to get it in your system. Continue to use some cannabis daily. Over the course of a week or two you will become tolerant to cannabis' side effects.
Once you are no longer a novice but rather what I refer to as a cannabis tolerant patient, strains that may be more appropriate and other routes of administration can be explored. Remember, almost everyone experiences some improvement in their symptoms using medical cannabis. It is likely you will just on your "introduction" to medical cannabis. Getting the best results takes much more thought and effort. Don’t settle for better. Become informed, be your own advocate. Get the best possible results from medical cannabis possible for you.
Brian Nichol MD