When it comes to using Medical Marijuana today, one may be pleased to know that you don’t have to smoke it and you don’t have to get high anymore. When I mention this to my baby boomer patients that they can find relief from pain, anxiety, seizures, Parkinson’s, migraine, PTSD, and uterine pain, just to name a few, they are absolutely relieved to hear that. They are not interested in getting high or inhaling smoke. “Back in the day”, one was limited in consumption choices. Inhale it into your lungs through your airways and feel the hot burning smoke, a cough sometimes, then the particles from the paper or leaf deposit on the lung tissues (doesn’t sound like fun at all).
I applaud them. Now some persons do want to only use it for the psychoactive effects (getting high) and some only want to smoke it (or vape it). There are the connoisseurs of fine marijuana with the expertise about its color, shape of buds, smell, smoke and their medical condition. If you used marijuana in the 60’s or early 70’s, you probably over consumed it and became very intoxicated and had to just go to sleep for a while until it wore off. That psychoactivity, or getting stones, may have been so strong that you vowed to never try it again. Fast forward 40, 50 years and you still feel the same. You have the same anxiety and aversion to it. No way will you get close to that marijuana again you promised yourself.
I am here to ask you to give this natural, and in my opinion, sacred herb a second chance! There are now multiple ways to get the active therapeutic plant cannabinoids (CBD, THC) into your systems circulation. When you go to the dispensary ask the “Bud-tender” (not bartender) about marijuana infused oils. With this you can put drops under your tongue where it will be absorbed into your blood. Or ask for Lozenges which you may suck on, chew, or break it into pieces. You may purchase infused mints. This is nothing new, but you can mix the dry leaf into brownie mix, cookie mix, regular butter, cocoa butter, and many more foods. You may buy (or make it yourself, my recommendation) creams, salves, or lotions. These you do not have to combust (or light up). These are the healthiest ways to consume MMJ.
So we have established that one doesn’t have to smoke marijuana if you choose not to. But what about getting high?
What do you get from this plant as a human: “THC and CBD “(or some variation of them). That’s it. Most CBD goes to the body (not getting you high) and the THC goes to the brain (correct, getting you high). NOT getting high is now an option. (Unless getting high is your choice). If you use CBD with a tiny bit of THC (less than 0.3) as seen in hemp, you will absolutely not get high- absolutely impossible! It just won’t happen. CBD is not psychoactive. You can get CBD online, or through some pharmacies, doctor’s offices, dispensaries, smoke shops, you name it. The dispensaries carry CBD with a ratio of CBD: THC know as a hybrid (my recommendation). One can make or buy topicals too. These rarely penetrate deep enough to get to your circulation. It penetrates to the CB2 receptor layer in the skin. Salves rubbed on the sore spots, arthritic joints, itch from insect bites, psoriasis, can give you relief with one or repeated applications. It takes about five applications to reach a constant level in the local area.
“Did you know the federal government owns a Patent related to cannabinoids and grows cannabis for patients?”
Cannabis is only approved federally for investigational use. Cannabis is not approved by the FDA for any condition. Cannabis is a Schedule 1 drug by the Drug Enforcement Agency. However, on the state level, in a growing number of states, Marijuana is legal (within that state) for a variety of purposes. These purposes may be approved for recreational use or for medicinal use. In 1996 California legalized marijuana for medical purposes. Now in 2020, 33 states have legalized cannabis in some form.
Most have seen pictures of the cannabis plant with its 7 long slender leaves, its’ long trunk and stems, and its flowers or buds. Some have caught a whiff of the pungent (to some) aroma. It was combusted or in its non-activated raw form. But it is the chemical reactions inside the plant that is the substance of the sometimes “funny” stories one might hear. That paranoia or giddiness or the near immediate pain or nausea relief are all caused by something happening inside the plant material. Boring to some, fascinating to others, whatever the case, knowing the mechanism of action shows how far we have come in understanding the science of cannabis pharmacology.
“So what?” you say. Well did you know that when you want to use cannabis to relax and maybe help you sleep we can now give you a type (strain) of cannabis that is specifically for sleep and not for keeping you awake? Say an “INDICA”. What if you felt exhausted from work all day, or just tired of being tired? There is a strain that you may consume that will give you a boost of energy that may last the whole evening or day (I am not talking about a manic type of energy). In a way it’s enough energy to boost you to your natural genetically predetermined energy level or set point, no more. Oh, and there are no side effects in most cases. One would call that a type “Sativa”. If you re-read this paragraph, you will know nearly more than half of what you need to know about the chemistry of cannabis. Okay, not exactly, but a lot more than you knew.
A Little Chemistry (Feel free to skip ahead to topics of your interest)
A video is worth a thousand words so check out this YouTube video:
-Visualization of the endocannabinoid signaling system on YouTube (May 12, 2012) an informative animated video.
“The Endocannabinoid System (ECS) seems to be essential in most, if not all, physiological systems. The ECS is essential to life and it relates messages that affect how we relax, eat, sleep, forget and protect.”
Vincenzo Di Marzo, PhD (taken from University of Sciences, 2019)
If THC from the marijuana plant works inside our bodies, then what in us does this plant derived chemical stick to internally to cause a reaction in us. The tongue, the lungs, the stomach or intestines, the brain, the nerves or the bone? The answer is: all of the above! If THC is the key then we must have a lock or receptor. But, if we already have the lock, then why do we have a lock for something that we cannot already make for ourselves and be self-sufficient? Do we really need to go around picking plants and burning them and inhaling the smoke? Doesn’t sound like a very good design? We should already have a key (or chemical) that we are born with. We did find a chemical in 1983. We found that naturally occurring chemical, like the THC (the external key) from the plant floating around in our bloodstream already. We called it ANANDAMIDE. The first cannabinoid, a name given to all the chemicals like THC, because more cannabinoids were to be discovered later. Just like the discovered body systems already known to us like the circulatory and endocrine systems, a previously unknown body system that we possessed already came to light- our scientists had discovered an unknown system.
“Anandamide was the first, naturally occurring endogenous cannabinoid, or Endocannabinoid. It was found by Dr. Raphael Mechoulam as well as NIMH researchers William Devane and Dr. Lumir Hanus around 1983.”
“A history of Endocannabinoids and Cannabis”
To summarize, we know that our bodies use THC from the plant cannabis. We know that we make nearly an identical chemical in our bodies – annadimide. Both exogenous and endogenous (outside made and inside made) chemicals cause (previously discussed above) reactions in our bodies. We should also know that THC is not the only chemical or cannabinoid found in plants. There are others. Taken together we are better off knowing exactly what it is from the plant that we use.
A few cannabinoids that we know of:
Theses cannabinoids, we believe, cannot work without the help of other chemicals called TERPENES. Think of a puzzle, doesn’t work unless all the pieces are there. Terpenes complete the picture or allows the bodily reaction to happen. A few terpenes:
USING MEDICINAL MARIJUANA
When headed out to the Dispensary to purchase medicinal marijuana, will you have an idea of what to get for your particular ailment? Any information that you will need is easily gotten from your physician or the bud-tender.
“Cannabis has been employed medicinally throughout history, but its recent legal prohibition in the 1940’s through about early the 1990’s, its’ biomedical complexity and variability, quality control issues, previous dearth of appropriately powered randomized controlled trials, and lack of pertinent education have conspired to leave clinicians in the dark as to how to advise patients pursuing such treatments.”
Drs. MacCallum and Russo, 2018 (From University of Sciences, 2019
First one has to get the marijuana chemicals out of the plant and into our bodies. There are several common and /not so common ways to do this. So, what is the best way? Most of us know about smoking it. But some of us may not have thought of eating it, rubbing it on our skin, suppositories, patches, turning it into a vapor and inhaling it.
“You don’t have to smoke marijuana and you don’t have to get high anymore”
Does it really matter how we get it into our bodies? It does if one uses it for medicinal purposes. Say it has been prescribed to you for stress/anxiety or for a situation you encounter that has you rattled and you want to calm down. The quickest way would be to smoke or vape it. You could feel relaxed and stress free in a matter of minutes. But if you decided to, say eat a cannabinoid infused gummy bear, it could take as long as 40 minutes up to an hour or two before you feel relief from stress. Edibles will last for 8 hours in the body where smoking or vaping cannabis will last about 3 hours. The method which we consume it will determine how quickly or slowly it will begin to work initially, manner of consumption will determine how long the effects will last on a conscious or unconscious level. Perhaps the intensity of those effects and from an economical level the manner of consumption will determine how long the quantity purchased will last (medicinal marijuana can be expensive).
Inhaling the smoke or vapor into the lungs??
Imagine holding a small unlit cannabis bud. Inside every part of that bud are tiny molecules and compounds that you want to pull out of it. Think about a tea bag, one knows that inside the tea leaves are chemicals that leach into water when the tea is immersed- that which one cannot see directly. There are ways to get those chemical out of the cannabis bud and into the body. By heating the bud, chemicals begin to move from inside to outside into the air surrounding the bud. If one heats the bud, to the point just before it catches fire, a vapor will emerge, similar to sniffing perfume when the bottle is left open. Purse your lips and suck that vapor into your mouth. It will travel deep into the lungs, then through the walls of the lungs into the blood circulation. From there it travels to different parts of the body. In fact, it will travel to every part of the body eventually. Enough heat will agitate the inner chemicals of the bud to the point where they will escape the plant material. This process is called “VAPORIZING” or “VAPING”. Of course one cannot actually see vapor but one can see smoke. If you want smoke you’ll have to heat the bud to the point of combustion, or commonly known as “smoking”.
Using the same process as above, with perhaps different accessories, or a rolled cigarette or pipe, one combusts the bud or raises the temperature above 450 degrees Fahrenheit which will cause a flame. The bud burns, smoke emerges, and one inhales the smoke into the mouth and lungs. The smoke contains the chemicals that are released from the cannabis. These chemicals travel through the walls of the lungs and into the circulation and entire body eventually.
In the United States, marijuana was not widely used for recreational purposes until the early 1900s. Immigrants from Mexico to the US during the tumultuous years of the Mexican Revolution, brought cannabis with them to the US which they had used medicinally, thus the introduction of the recreational practice of smoking marijuana to the American culture. Massive unemployment and social unrest during the Great Depression stoked resentment of the Mexican immigrant and public fear of the “evil weed.” As a result, and consistent with the Prohibition Era’s view of all intoxicants, 29 states had outlawed cannabis by 1931.
Marijuana, HISTORY.COM . Oct 10, 2019. May 31, 2017
Which is best? Smoking or Vaping?
As a physician, I would recommend against putting anything into your lungs except air: with the exception of medicine recommended by a doctor. If you can see smoke then something makes up the smoke. Smoke contains particles from whatever is burned or combusted. These tiny particles settle onto the walls of the lungs and cause irritation and also changes in the tissue. What helps to remove the particles from the walls of the lungs? Coughing and mucus, which is produced by the walls of the lungs, mixes with the particles and is coughed up and out. Not a big problem unless it occurs over and over again. This chronic coughing and expelling of mucus is called “BRONCHITIS”. Yep, smoking marijuana can be a blast, but there is always a cost (with the good comes the bad.. one cannot separate the front and back of a piece of paper). No worries though, the cough will/should resolve when the smoking stops.
So vaping is better, right? Nope. The heat from the smoke and chemicals that may be mixed with the vape oil or flower or some chemical reaction of the body with the process of vaping will cause BRONCHITIS as well. But with the judicious use of vaporizing or smoking, the side effect may not become severe enough to cause bronchitis. This is not medical advice, but some may take small puffs and not inhale too deeply. Or not use cannabis as often.
A newer way to get cannabis or marijuana into your body’s circulation- Just Eat It!
“If you and I ate a cannabis infused gummy bear at the same time, would we feel the effects simultaneously? Yes and no. The human body metabolizes marijuana at different rates. So a gummy bear (or whatever edible you choose) may affect you within 30 minutes but may affect me in 2 hours.” (If I were one to use psychoactive substances, which I am not)
As opposed to smoking or vaping cannabis, when one eats it, the onset of action or effects occur more slowly. It takes about 20 minutes to 2 hours before one feels it or knows that it is working. This delay has caused persons to take one, and then to take an extra one, or to take more than is recommended because they believed that it was not working or was not strong enough. They would end up having to go to bed and ride it out. Having a high fat meal in ones tummy will help with absorption and maybe the duration of effect. Smoking cannabis is known to last for about 2 to 3 hours. However, eating cannabis can last from 4 to 8 hours per dose. It is important to know the dose of the product you are eating. Once it is eaten it cannot be taken back. Most edibles are 10mg doses. That is a normal starting dose. Wait at least 2 hours between doses. If someone gives you a brownie or a cookie infused with cannabis, be sure to know the approximate dose per square or cookie.
One may chew it, suck a lozenges, place drops under the tongue or spray (more ways may be forthcoming). Sublingual may have a quicker onset of action- Say about 15 minutes until effects are felt (as in oil drops or extracts).
Huestis: MacCullum, Russo.
Briefly, when cannabis enters the body it is broken down by the liver and leaves the body by the urine and feces. But all of the parts (or metabolites) of the cannabis leaves the body right away. It will slowly leach out of the body over a period of several days to weeks. This depends to a great degree on the amount of fat one has in the body. The body slowly releases the byproducts in the urine, saliva, and blood. Cannabis does cross into the fetus in pregnancy.
I was interested in CBD before it became popular. Curaleaf, a national franchise now has products for sale in pharmacies; they are, of course, CBD only products. Check out the Oils, Salves, and Topicals. Doctors’ offices are now recommending topicals.
What is a topical? Topicals come in lotions or ointments. One can apply these directly onto the skin just about anywhere on the body’s surface. One can easily make them from household extract products (oils). They are favorites because of their fast action on pain relief, inflammatory conditions such as poison ivy, psoriasis, or fever blisters as examples (not medical advice). The best part for us baby boomers, with no interest in getting high, is that there are typically non-intoxicating effects which allows patients to enjoy the plants therapeutic effects without attendant psycho-activity. If making one’s own products or purchasing them, they may come with, or you may add, essential oils or other topical medicinal or edible ingredients (I like to use cocoa butter).
“Psychoactive drugs or chemicals that acts on one’s mental state, is a chemical substance (THC) that acts primarily upon the central nervous system where it alters brain function, resulting in temporary changes in perception, mood, consciousness and behavior.”
Most know of the chemicals in cannabis is THC and CBD. There are more, but let’s go with these for now. CBD is probably imperceptibly psychoactive (but you will never feel heady) such little psychoactivity that we usually say that CBD has no psychoactive. THC on the other hand is psychoactive. Imagine a mountain where the bottom is where CBD lives the top is where THC lives. They both do not always stay at their locations but intermingle with each other somewhere along the slope. One will find any ratio of CBD: THC or THC: CBD together anywhere along the slope of the mountain. Imagine the mountainside with cannabis plants growing from the bottom CBD and the top is where THC grows. These plants will have many variations in ratios of CBD: THC or varying amounts of psycho-activity. The bottom plants will have CBD plants. CBD is an energizing and yet anxiety relieving plant- a “pick me up” if you will. This plant has next to zero psycho-activity in contrast to the THC containing plants which has strong psycho-activity.
Any cannabis with a predominance of CBD or CBD like effects is a Sativa. As you now know, there may be minuscule psycho-activity effects. This means that if one wished to not get high or is averse to psycho-activity, then a sativa is the one for you. But, genetic drift does occur and that is why nothing is pure.
Any cannabis with a predominance of THC may be termed an INDICA. This is not a 100% accurate statement but for our purposes at this point it will suffice. Indica cannabis plants are the darling marijuana plant. However, it is losing its dominant position in the world of cannabis using humans mostly because most humans do not want to feel high. (The 60’s are over baby)
Hybrids are what stand between the sativa and the Indica. Sativa + Indica = Hybrid. Hybrids are the up and coming favorite when it comes to choosing a cannabis plant. Hybrids are not extreme at the bottom or at the top- they are somewhere in between. Hybrids can be found halfway up the slope of the mountain. Sativa, Hybrid, or Indica are not pure. There are always some of each cannabinoid in all cannabis plants. But generally we may discuss only the three strains.
A CBD dominant may have a ratio of 1:20 (THC: CBD). A THC dominant may have 16:1 (THC: CBD). A hybrid may have any ratio, even an equal ratio 1:1, 4:1 etc. There are variations on this, but let’s just go with this for now. Dispensary packages are labeled with the chemical make-up of cannabis. Unfortunately, you will need a PhD. to read the label). The above are the basic categories of the products one finds in the dispensaries. Despite the hundreds of products you will see on display there are only three broad categories: Sativa, Hybrid, and Indica.
Considering how much to use
“Doc, I am from the 60’s. I was at the first Woodstock. I have been using “weed” since you were in diapers!”
Patient of Dr. Brunson
It is difficult to determine “how much” cannabis to use per sitting. For example, Tom and John were sitting on a couch smoking a marijuana cigarette. After one small puff Tom said “let’s go clubbing”. John said “no, I feel paranoid I need to go home where it’s safe and people can’t watch me”. They had two different reactions with the same marijuana cigarette. The psychological effects of cannabis can differ between individuals. Tom experiences a good and rewarding feeling where John experienced paranoia, and rarely may be at risk for the development of psychotic thinking or it may make schizophrenia worse if he had suffered with it already.
For some, marijuana causes a rewarding high and for others, it can produce serious psychiatric side effects. Why is that? Certain, deep areas of the brain react to cannabis differently, so everyone will have different experiences- almost polar opposite experiences.
“Until now, it was unknown which specific regions of the brain were responsible for these highly divergent effects of marijuana.”
Steven Laviolette, Ph.D.
Professor Laviolette found, in the brains of rats, that THC can produce highly rewarding psychoactive effects in the region called the NUCLEUS ACCUMBENS. This region of the brain is responsible for the rewarding effects of marijuana (a word of caution, this is the major addiction producing area of the brain, where morphine causes its effect). The other part of the nucleus accumbens causes the adverse effects (John wanted to just go and be by himself). To summarize, we have discovered why some people have a positive experience and others have a negative experience. Reward and aversion are produced by anatomically distinct areas of the brain and these areas are genetically predetermined, genetic variations leading to differential sensitivities of the nucleus accumbens. Since we are all genetically predetermined to be different, we all may need differing amounts of cannabis per dose. The best advice (this is not medical advice) is:
Start low and go slow or just a little bit
Start off with a very small puff. Increase over a period of time until you find an amount that you are most comfortable with it. Increase up to the most effective dose for your particular tolerance or for your medical problem. Why is this? There are receptors throughout the body waiting to receive the cannabinoids. If they are overwhelmed by using too much initially they will, in a sense go to sleep, and not be available to work for you for a while. This is called “down-regulation”. We want our receptors to remain more “up-regulated”. So “less is more”.
Is it a strong strain which may have a high percentage of THC or a milder one without much THC? What matters is how much THC or CBD you have in your cannabis. One may have a predominant THC level while the other strain may have a predominance of CBD. Yet, another strain may have a combination of both. The package should have some information on how much of each is in your strain. Remember, the THC is what gets you headiness or a high or is psychoactive. The CBD does not get you high or is not Psychoactive (again, you don’t get high from CBD). On the container should be ratios. The dominant cannabinoid is always first. That is what it is called too. Indica (if THC is first, etc.) The ratio may be indicated by a percentage as well (THC – 5.123%). No one can tell you how much to take. You will need to just try it at varying doses. You may want a “sub-psychoactive” dose. So start low and go slow.
It is safe to start with 1-2 mg. The older you are, the lower the dose you may want to start with (1mg). For liquid tinctures or extracted oil use just a few drops at first then increases tolerated. You may not want any psycho-activity initially as you start. Wait awhile before re-dosing (one drop then wait 90 minutes).
For my baby boomer patients, I advise them to start off using cannabis just before bed. Then every-other night or so dose an hour earlier for a few nights. This way you will slowly get used to cannabis effects in the evenings then eventually start trying it as early in the day as you like. If you feel too heady just go to bed.
You may start with a little more CBD dominant strains because you normally do not have to worry about getting high or too much psycho-activity. You can use once daily dosing then twice daily dose. Wait about 2 weeks between doses. Don’t take with food- use alone. There are innumerable websites that will teach you how to dose. They are designed just for beginners use.
Lozenges: 5 or 10 mg candies. Eat a little piece of one before bed then increase the amount. Lozenges are usually strong and have a large amount of THC. The THC will put and keep you asleep for 8 hours. The mints are similar in effect.
Oils: This is measured in drops. Start off with just a few drops. If the oil is weak you may need more drops. Try to get 1000 mg bottles. You may purchase up to and above 5000 mg.
Topicals: These can be oils, butters, salves. These will penetrate the skin and not get to the brains psycho-activity areas. So you don’t get high. You will become relaxed or sedated.
If dosing is not clear to you, you may speak with your dispensaries Bud-tender.
Opinions are of the author.
- University of the Sciences, Pennsylvania Department of Health 5/2019
- Cannabidiol (CBD) Critical Review Report. Word Health Organization, Geneva, Geneva June 2018
- Journal of Basic and Clinical Physiology and Pharmacology 2016;27(3).
- British Journal of Pharmacology 163: 1344-1364.
- National Academies of Sciences, and Engineering, and Medicine. 2017
- purekana.com. What is the Endocannabinoid System?