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Your medical cannabis question page

How can cannabis help with someone who has suffered a stroke?

*A stroke is a very serious medical condition requiring immediate and proper medical care, usually resulting from either a ruptured (hemorrhagic) or blocked (occlusive) blood vessel in the brain.  Quick and proper treatment is essential with time being of the essence, as tissue destruction worsens with elapsed time before appropriate medical treatment is initiated.

*There is some evidence that cannabis may be useful for individuals who have suffered a stroke, and this is in terms of neuroprotective therapy post-stroke.  Sinor and colleagues have demonstrated that both AEA and 2-AG (the bodies own endocannabinoids) may play a role in increasing cell viability in cerebral cortical neurons cultures which have been subjected to 8 hrs. of hypoxia and glucose deprivation - similar to what occurs in a stroke.  Also, the same protective effect occured with conditions that mimic ischemia, or conditions causing a limited blood supply, also things that occur in and after a stroke.  This effect occurred at very low levels of cannabinoids - at the nano molar level of concentration, and was unaltered by CB1 and CB2 antagonists.  This implies the effect is not mediated thru these receptors, but due to another cause. These results indicate the benefit for cannabinoids as a therapeutic role in preventing ischemic induced cell damage of brain tissue.

*More recent studies also indicate that cannabinoids, and perhaps CBD help to stimulate the formation of new neurons in the rat hippocampus.  Some findings also suggest that cannabinoids can decrease cortical GABA levels, and this in effect reduces the neurotoxicity sometimes associated with excessive GABAergic activity.  The  CBD in cannabis is helpful as well - in this fashion: Cannabidiol (CBD) is able to function as an anti-oxidant and neutralize superoxides that can be toxic.  Also, CBD can help increase the body's own cannabinoid response by inhibiting the enzyme that inactivates AEA and 2 AG, thus allowing these endocannabinoids to have longer duration of protective action.  All in all, stroke victims require adequate and extensive medical care, but once stabilized can feel safe in using cannabis, with a possible benefit for future neuroprotection.

Can cannabis help with IBD and Crohn's disesase?

*Crohn's disease and Inflammatory Bowel Disease (or IBD) are quite possibly aided by the use of medical cannabis.  It causes inflammation of the digestive tract, and associated abdominal pain, weight loss, fatigue, severe diarrhea, and malnutrition. Keep in mind that IBS (Irritable Bowel Syndrome) is a different disease, usually not chronic, and characterized by cramping and muscular dysfunction.  Both of these diseases may be aided and targeted by the components of cannabis, both cannabinoids and to a lesser extent the terpenes.

Many Crohn's patients may seek cannabis approval because they have already discovered the benefits of medical cannabis and derivatives, and have seen that it can alter the course of their disease.  Basically not a cure, but can ameliorate and help some of the symptoms of the disease - patinets report an improvement in pain in the gut, nausea, vomiting, fatigue, depressed mood and activity level.  The well known effect of most cannabis (except high THCV strains) is to increase appetite and facilitate eating. The large number of CB2 receptors in the gut and digestive system allow for moderation and regulation of digestive processes by exogenous cannabinoids.

For similar reasons,  some patients with ulcerative colitis (separate disease from Crohn's) may benefit from cannabis.  Usually ulcerative colitis only affects the colon, not the entire digestive tract as in Crohn's.  However, they should receive standard medical care first and perhaps use cannabis to mitigate symptoms, not as a substitute for treatment.  Likewise, due to the relaxing of the bowel musculature and regulating peristalsis, cannabis may help in IBS - Irritable Bowel Syndrome.  Strains with ample CBD may be required, and perhaps even sublingual tincture of CBD alone may help, with no THC.  Cannabis is a well known an effective anti-emetic and anti-nausea agent, and typical strains increase appetite and facilitate eating.

Safe to use, patients with digestive disease who have received proper medical care first, can feel comfortable using cannabis to alleviate symptoms under the supervision of their certified cannabis provider.

Does cannabis treat anxiety? How does it work to do that?

*Anxiety usually encompasses a general anxiety disorder, obsessive compulsive disorder (OCD), panic attacks, PTSD, or social stress situation.  Medical cannabis can be useful in certain types of anxiety disorders, and under proper supervision and guidance can be a useful tool of therapy.  However, it must be used with caution, particularly because of it's possible anxiogenic side effects (predominantly due to the THC content), and because most patients will already be taking previous medication for anxiety. In the former case concerning THC content, it is advisable to start with a low amount, and always balanced by CBD in the proper ratio, and this can be determined by careful experimentation... a ratio of THC:CBD of 1:2 is a good starting place. Pure CBD alone can be beneficial for anxiety, but CBD is more therapeutic when combined with some THC as well, although the THC content should start low and increase incremental.  Too high of a THC dose can easily result in a panic attack or severe anxiety, which would then make cannabis contraindicated. Therefore dosing is critical, and steps must be taken to insure and adverse reaction never occurs. Start low and go slow is the key, cannabis works over weeks and months, takes time to learn how to best use it for your specific anxiety needs.

Patients seeking relief from anxiety also typically use prescription medications to treat their symptoms.  Occasionally,  they are ineffective or can cause adverse side effects totally undesired. Some work well, but in many cases people eventually want to stop taking them.  They may have helped as was their purpose, or the side effects may have been too much to bear - and patients want to quit taking them.   Always please seek professional guidance before using cannabis if you are already on existing medications.  Several interactions can occur between the Rx meds and cannabis that must be considered.  While it can, and has been used, for thousands of years to regulate mood, it's use for anxiety has been proven in many cases.

The correct strain of cannabis, dosage, and terpene content is also a factor in addition the THC:CBD ratio.  The terpenes linalool and beta myrcene may be useful in treating anxiety , and perhaps low pinene and limonene content as these tend to stimulate rather than relax. If too much THC results in anxiety or panic attack - please do not call the hospital, but wait it out in a comfortable setting. Drink some water, perhaps ingest a CBD capsule, or use a peppercorn under your tongue.  Usually 20 minutes will be all that you need to feel better. Some patients could use a low of valium or xanax in case of an adverse reaction, or take a small sip of alcohol. Cannabis if used in the proper fashion and supervision should not cause this response.

If used properly and with conseling to control unwanted anxiety,  a good technique for ingestion of cannabis could be vaporizing for a quick response, but more general control should be achieved perhaps with a daily dose of synergistic cannabinoids in pill form, or a sublingual tincture.  Dermal patches and extracts are also a possibility, as well as edibles (currently not available in Maryland).  Keep in mind that other meds could cause a drug interaction with cannabis that is adverse (although unlikely), and that if you also stop taking prescription medications it could itself stimulate anxiety by this action alone. Some medications may also have slight withdrawal symptoms when you stop,  and medical cannabis during this time has helped some to transition off pharmaceuticals, and to stop taking them entirely. So, if you are using medical cannabis for anxiety and also weaning of pharmaceuticals, some negative effects may be attributed to the decrease dose of the pharmaceutical (like a withdrawal effect) and not due to the effect of the cannabis. 

The bottom line is to be cautious, go slow and low dose, select your strain, dosage and ingestion technique carefully and be prepared to experiment and be patient. Always consult with your health care specialist and inform him if you are using cannabis along with your other therapy. Since it is a valid treatment, and more accepting as a therapy do not be afraid to discuss it with your doctor.

*Please note that these articles reflect the belief and opinion of the author and are not recommended as a substitue for professional medical care. The information herein is not intended to serve as medical advice nor is it intended to to replace the care of a licensed physician. Please consult your personal physician or specialist to help in your care. The information presented here is not exhaustive, and each patient requires special consideration and to do their own research, and discuss the use of cannabis with their doctor*

Is cannabis safe to use? 

Studies have shown that cannabis is very safe and does not lead to death even in extraordinarily high doses which are not possible with any ingestion technique or amount.  It is habit forming and can be abused, but not truly addictive. It certainly can also cause unwanted side effects similar to any drug, so must be used properly, also just like any other drug it depends on dosage, strength and route of absortion. It can cause mental confusion, dizziness, anxiety, feeling of unease or impending doom, and other undesireable effects. However, it does not cause respiratory depression or death as do some narcotics. There are few drugs that have the safety of cannabis, if any....

Will Cannabis help for Rheumatoid Arthritis?

*Rheumatoid arthritis is a long term autoimmune disease that affects primarily the joints. It can result in painfull, tender, or swollen joints. The pain and stiffness often get worse with rest. Other conditions also accompany the disease including inflammation around the heart or lungs, low red blood cell count, fever or low energy.

Cannabis plants all possess varying compounds, both cannabinoids and terpenes, that aid in combating inflammation and pain to some degree.  Also noteworthy is the immunomodulatory effect of CBD in cannabis, as well as anti-inflammatory effect and alteration and reduction of pain. For this reason, it may be useful in some individuals who have osteo-arthritis, rheumatoid arthritis, or other forms causing inflammed joints, swelling, and pain.  Cannabinoids have also been shown to counteract oxidative tissue damage. 

In terms of specific strains, look for strains that have CBD, CBC, CBN, and THC (or THCV THCA).  It may also be beneficial to include the terpene pinene as well, as this is anti-inflammatory and can increase alertness. This terpene is also found in rosemary, pine, parsley, and basil.  The strain Trainwreck or Bubba Kush may be a good one for this disease, but there are certainly others. 

Arthritis was possibly one of the earliest uses of cannabis where it was employed as a treatment.  Together, the THC and CBD activity can reduce cytokine activity which is responsible for the joint destruction in arthritis.  Cannabis is most likely described as moderately effective in arthritis, and other treatment modes and meds still may be needed.  As well as direct reduction of inflammation, the cannabis can also act as a pain distractor mentally and allow greater freedom and ability to live more comfortably with the pain.  THC has been reported to have twice as much anti-inflammatory activity as hydrocortisone. The CB2 receptor, which is stimulated by exogenous cannabinoids, ie THC, is involved in the modulation of  immune function and this may help in the arthritic autoimmune disease.

As far as dosage, start with 5 mg of THC in your product and work your way up as needed.  Please make sure you are also getting CBD as well in equal or greater amounts if possible.  The strain Cannatonic is high in CBD and can be used for it's anti-inflammatory properties, whereas high THC strains work better as a distraction and also to synergize with the CBD.  All- in -all some patients report beneficial use for their arthritis, and others do not receive as much benefit. It may take time, weeks or months, to achieve the proper dose and strain to provide the most relief, and experimanting with technique, dose, and strain is important.  Topical creams or lotions may be effective to spot treat hot spots and flare ups of pain.  Dermal patches can also be considered, as well as edibles or tinctures. Vaporizing can provide a more immediate effect, but not as long lasting or potent as oral ingestion. 

 

Can cannabis help insomnia?

*Insomnia is the inability to fall asleep or maintain sleep. Other sleep disorders include sleep apnea and waking up too early, when additional sleep time is desired.  Because cannabis is a mild sedative it is often helpful in improving sleep patterns, but also has been shown to limit REM sleep and dreaming.

The successful treatment of sleep disorders with cannabis medicines is dose and ingestion technique dependent, affected by the THC:CBD ratio, the terpenes present, and the proper time of the dose. Most of the effects of cannabis usually occur in a sequence - onset phase, excitation phase, stationary phase, reduction phase, then sedation phase. For this reason, please allow about an hour for the sedating phase to occur, so time your dose. Ingestion imediately before sleep may be counter productive. 

Patients whom are kept awake by pain have also shown to have better sleep and more comfortable nights with the proper use of cannabis. Also there is a lack of any significant hangover effect the next morning, unlike the majority of over the counter or prescription sleep aids. Tolerance has been either a non factor or too insignificant to be a problem, and increasing doses are not needed over time. 

THC produces residual sedation, and low doses of CBD can stimulate and be wake producing. However, CBD may help prevent anxiety which may make it easier to fall asleep. CBN is also a sleep inducing cannabinoid, and present in older oxidized and aged cannabis.  

Very effective for sleep, the correct use of cannabis can eliminate the need for stronger medications and their negative side effects of addiction, habituation, and tolerance. Choose a balanced indica strain, with THC, high CBN, the terpenes linalool and myrcene, and ingest about 60 minutes before desired sleep.

SOME RECENT STUDIES INDICATE THAT SINCE CANNABIS INHIBITS STAGE FOUR, OR REM SLEEP, IT MAY BE AN AID IN SOME PATIENTS WITH SLEEP APNEA. TYPICALLY, SOME APNIC EVENTS OCCUR ONLY IN STAGE 4, SO BY PREVETING THIS DEEP PHASE OF SLEEP SOME BENEFIT MAY BE OBTAINED LIMITING THE APNEA.

How does Cannabis control Pain?

Cannabis has been used for thousands of years to control pain, but the recent development and usage of pharmaceuticals for pain, both opioid and non-opioid, has led to decreased use of cannabis by developed societies for the control of pain. Many current pain meds are quite effective, however the chronic and habitual use of opioids has led to a serious problem which now has to be addressed. Chronic use of other seemingly innocent over the counter pain medications can also lead to health issues involving the liver, kidneys, stomach and nervous system. Many Americans and people around the globe are looking for an alternative safer medicine to help control pain. Cannabis is perhaps a safer more natural choice. The drawbacks are related to it's possibly anxiolytic effect, and psychoactive side effects, which most users actually find enjoyable.

Neuropathic pain is defined as pain that originates in the nervous system itself and not from an outside agent or injury. An example is the pain with multiple sclerosis, or diabetic neuropathy, or spinal cord pain. Proprioceptive pain is the pain caused by an injury or surgical insult - ie wisdom tooth extraction, or getting your finger slammed in a dooor. Cannabis works best for neuropathic pain, both by reducing inflammation, and by altering the synaptic transmission of neurotransmitters at the site of the synapse. 

The exact type and location of the pain may dictate a certain type or strain of cannabis and ingestion technique and dosage for the maximum effect.  Also, it is important to note that cannabis can synergize with other pain medications (ie narcotics), therefore requiring a lower dose of the narcotic for the same therapeutic effect. Tylenol, for example potentiates and synergizes with cannabis as well. Many patients are seeking to "get off opioids" and seeking a safer altenative by using cannabis, however considerable effort and will power is still required, but cannabis has been shown to lessen the effect of opiate removal and withdrawal. These patients may require very high doses of CBD (in the order of hundred's of milligrams) in order to help them to remove narcotics from their system.

 Chronic pain is more targeted by cannabis verses acute pain.  Results are experienced differently than by, for example, taking a narcotic which has a more intense and dramatic effect on pain relief. However, with proper experimentation and dosage, cannabis can be quite effective for a wide variety of pain and greatly help reduce other pain medications or eliminate their use entirely. Of course, pain perception and response to treatment is widely varied and everyone responds in a different way. For some, cannabis may not work or exagerate the pain. Both THC and CBD are required in strains that are used for pain, so in addition to the therapeutic effect of the CBD on the pain receptors, the psychoactive or mental effects from the THC can allow the pain response to dissipate. Severe pain can be all encompassing and embrace your mind and body, and cannabis can help to break apart the cycle of pain mentally and be a good distractor for pain.

 Some types of chronic pain treated by cannabis may be related to digestive pain, bowel pain, muscle pain, inflammatory pain, skeletal spinal pain, headache type pain, neuropathic pain, multiple sclerosis pain, or pain from neurodegenerative diseases or illnesses. Most patients report a reduction in pain overall once their specific dosage and administration techniques are achieved, and this can take a few weeks so be willing to experiment during this time with strains and THC:CBD ratios, etc.... Other patients report a relatively dramatic improvement in pain reduction thru the use of cannabis and eliminate or reduce other pain medicines, including narcotics. These patients it is noted are also highly motivated and may be doing other things to get healthier as well including diet, exercise, and lifestyle changes. There have also been some who have not benefitted from using cannabis for pain and in this case they should not use it but try something else... The bottom line...decide for yourself if it works by using it, but only under the guidance of an experienced provider. Maybe you can join the thousands of patients around the world who use it effectively to control pain due to a wide variety of conditions and ailments.