Hamartia is a Greek word, translating “to miss the mark, or err,” in Christianity and archery it means “to sin.” The last time most of us heard the term was likely in school, reading the classic Greek tragedies. Often, the character’s most compelling virtue is their most tragic flaw. In The Bible, Sampson’s long hair gave him great strength which was his best virtue. His love for Delilah was the flaw that lead to him losing his hair and therefore his strength when she had his head shaved. His hair was a virtue as well as a flaw.
Cannabis, being an inanimate object, can not have a flaw exactly like those in literature; however, it has a virtue patients who use medical cannabis know quite well and a very tragic flaw most patients continue to suffer without even knowing.
The most prominent virtue of medical cannabis is how it safely helps relieve some symptoms for the majority of patients treating a very wide variety of conditions. A recent survey showed that ~90% of patients who use cannabis to treat a medical condition claim “some” improvement in symptoms. People skeptical of the medical benefits of cannabis often ask the very fair and insightful question: “how can one medication work for so many different conditions?” The answer, of course, is the systems being affected by phytocannabinoids (cannabinoids derived from plants) are modulated through the ubiquitous endocannabinoid system. The endocannabinoid system basically consists of endocannabinoids (cannabinoids made in the body), receptors (sites to which endocannabinoids and phytocannabinoids bind to and exert effects) and enzymes (that break down endocannabinoids). The endocannabinoid system is structured to keep the body in a state of equilibrium or homeostasis; it keeps all of the body’s interrelated systems optimally “tuned” to ensure the survival of the organism. With cannabinoid receptors being located throughout the body and involved in regulating almost all of its processes and systems (mood, movement, appetite, sleep, pain pathways, inflammation, metabolism, etc.) it is no surprise administered phytocannabinoids, which can effect all three aspects of the endocannabinoid system, have so many effects. The fact they are overwhelmingly positive effects for most patients, that it is easy to achieve some improvement in symptoms and is a usually very safe, well tolerated medication are tremendous virtues of medical cannabis. It is the virtue most medical cannabis patients experience and use to their advantage.
The Tragic Flaw
The survey showing that the vast majority of patients using medical cannabis experienced some symptom relief seems like a big affirmation as to its effectiveness. It did not matter what the patients used- a gummy bear from a dispensary, smoked cannabis grown at home, a joint off the black market, most patients had an improvement in their symptoms. This is something almost all patients I see for medical cannabis consultations who have used cannabis report. A wonderful thing as most people see it and that is where most patients stop. They found that smoking cannabis relieves some symptoms, are glad they found something that helps and plan on continuing their current treatment. Therein lies the tragedy. Close attention to the presence and ratio of cannabinoids and terpenes in a particular chemovar (local strain), dose, methods and routes of administration, even the timing of cannabinoid use can change “some” improvement in symptoms into a tremendous improvement in the quality of one’s life. A little symptom improvement using medical cannabis is easy for almost anyone to achieve. Obtaining the best possible results is a bit more complicated.
Although I suggest cannabis has a fatal flaw, it is really our own hamartia which interferes with using medical cannabis effectively. We all want fast, easy remedies for whatever ails us. Cannabis often provides such. We have low expectations for achieving relief of symptoms, after having failed many of the treatments prescribed by western medicine before trying medical cannabis, so that any improvement is seen as fantastic. Our own experiences set the bar for “success” low and using any cannabis often surpasses previous results. The need for putting in the time and effort in achieving better results using medical cannabis is unappreciated and the opportunity for better results missed. The virtues of cannabis exploit our own hamartia.
Cannabis’ biggest virtue- the relief it easily provides the vast majority of patients is indeed its tragic flaw. Far too many patients settle for some improvement, missing out on the potential dramatic difference in their life thoughtful cannabinoid use could have provided. Other patients try strain after strain with little direction, looking for one which will be more effective than the others they used. They are like novice archers hitting different areas of the “target” but finding that they are still “missing the mark.”
The expert archer takes the target, its distance away, windspeed and direction, bow choice, arrow choice, etc. into account before drawing down. He also understands that it will require experience to hit the mark regularly. Just like an archer wanting to hit his mark on a target, a medical cannabis patient looking to sin less has much to consider. The target (symptoms and underlying condition), distance away (severity and duration of symptoms), windspeed and direction (coexisting conditions, medications used, experience using cannabis, etc.), bow choice (routes and types of administration, timing of doses), arrows chosen (cannabinoids and terpenes) all need to be considered if one is to hit the mark- optimal symptom control, rather than just “landing an arrow” on the target. It will also take some experience to hit the mark consistently.
Achieving the optimal response using medical cannabis, just like becoming a skilled archer, requires much from an individual. Education is paramount. A basic understanding of your conditions and symptoms, consideration of other conditions present as well as medications and experience using cannabinoids and a basic knowledge of how the endocannabinoid system effects these conditions will direct the choice of cannabinoids + terpenes. The type of symptoms, intensity, frequency, duration and other considerations direct dose, routes and types of administration as well as timing of doses.
You have already started on the journey to achieving the best possible results from medical cannabis by taking the time to read this article and possibly learn something new about cannabis. Don’t continue to suffer the easily obtained virtues of cannabis. Make it a priority to learn about your specific conditions and how cannabinoids may help. Learn about the endocannabinoid system, the individual cannabinoids, terpenes and the all important entourage effect. Decide on a specific treatment plan to try based on what you learn and stick to it for a couple weeks. Keep a journal of your progress and responses to the specific treatments you try, modify the treatment based on your response. Don’t let your use of medical cannabis be like a novice archer on the range, just landing arrows on the target anywhere, if at all. Hit your mark.
Brian Nichol MD