As a physician you constantly read, weighing research with advertised products and remedies. With marijuana, we have limited research due to federal limitations and previous interest and investment. Giving patients' access was originally not my idea. Many people know that I was approached in 2014 by an HIV+ positive gentleman who said he was "over Percocet" and demanded cannabis access. In previous presentations we've also mentioned that the HIV epidemic had a role in bringing forth medicinal cannabis to the forefront after decades of popular recreational usage. Back then I agreed to look into it and I did, I found no reason (beside administrative ones) to offer it to my patients. I do not see myself as the gatekeeper or the conscience of who should use medicinal marijuana or not. I use my clinical judgment to say that this is appropriate or not. It is a clinical tool. Particularly as it pertains to pain relief, as a medical community we are aware of our limited options. We must make a concerted effort to do better and more, particularly in communities of color.
Things to note, there was a study that showed the rate for suicide as an adult is higher for teens that have used marijuana than not. However I get approached by many parents to say that 'my teen is ALREADY using and what is next.' I agree the politico-socioeconomic and safety aspects lie on the side of medicinal cannabis in teens without severe and high risk of suicide, schizophrenia, schizoaffective, or severe bipolar. This is why we require more thorough records and at least a psych evaluation for children - for the patient's benefit.
All in all, our goal at Smart Cannabis MD is to give guidance and education that leads you in the right direction. That's why family is always welcomed onto our Zooms. We hope that with any full cannabis legalization, we hope education becomes a part of the process. This is imperative. I hope you all find our education sessions and information valuable in your cannabis journey. Education will remain our priority.
Check out the excerpt from the article.
Physician Glenn Rosen of Parkside Family Medicine in Germantown sees a lot of value in medical marijuana but generally avoids recommending it to patients with severe psychological problems, such as extreme bipolar disorder or schizophrenia “because you could potentially induce a psychotic episode. I also don’t think you’d want someone who has mania to an extreme to be involved in the program.” Rosen won’t recommend marijuana to younger patients who have early onset depression. And he screens for certain drug use. “If anything, there are certain medications you’re trying to get people off. If someone is on a benzo[diazepine] or an opioid, your hope is to get them into the program and get them off those other drugs and get them on a medication that’s a lot safer.” He is also cautious about recommending marijuana for teenagers due to potential effects on the developing brain. “No one can speak on any expert level on the long-term effects, but the same goes for Adderall or Ritalin.”
So generally start slow and try varieties of cannabis that have low levels of the psychoactive compound called THC, advises Sisley and other cannabis health experts.“You don’t need a high-potency product,” said Ryan Goodchild, director of education at TerraVida Holistic Centers, a chain of marijuana dispensaries in Sellersville, Malvern, and Abington.More nuanced products are favored by patients and consumers with years of cannabis experience.Going for a cannabis variety with the highest percentage of THC can be akin to guzzling straight 151 proof rum. You’ll feel it, but it won’t necessarily feel good. “My staff gets frustrated when people think THC is the be-all and end-all of good marijuana,” he said. “It’s not. It’s more complicated than that.”
There’s another myth that cannabis experts would like to dispel for both cannabis newcomers and old heads: the alleged effects of the varieties called “indica” and “sativa.” “The rule of thumb used to be that indica was more relaxing and sativa more stimulating,” said Andrew Atterbury, chief pharmacist at Ethos Medical Marijuana Dispensaries in Philadelphia and Montgomeryville. “The rhyme was that indica would put you ‘in da couch,’ ” Atterbury said. “But there’s been so much crossbreeding that those descriptions have become mostly useless. They primarily define the plant’s morphology or shape. Moving outside those categories can be more helpful.” Finding the right ratio of THC to CBD is what patients need to determine first. CBD, also known as cannabidiol, is another compound found in marijuana.
THC is thought to block the perception of pain, Goodchild said, while CBD is believed to reduce inflammation and anxiety. Some strains are turbocharged with extraordinary amounts of THC and have negligible amounts of CBD. Others offer a more balanced one-to-one ratio. “Strain names can be worthless,” said Sisley, who serves as principal investigator at Scottsdale Research Institute.
“For instance, a strain called Blue Dream pulled from 10 different retail outlets can be wildly different because the genetics vary,” she said. “That’s why you want to stick with the biochemical profile of the material” noted on the label.
Every marijuana product sold in Pennsylvania and New Jersey is required to be labeled with the proportions of THC, CBD, and other notable molecular compounds.
A dispensary pharmacist, or a salesperson called a “budtender,” can help patients navigate those products. Still, looking for the best strain may prove futile.
“The ’best strain’ may be the only strain that’s available at your local dispensary,” said Atterbury of Ethos. “It’s slowly getting better, but there remains a problem of supply meeting demand. So what we sell most is what we have available.”
Terpenes, dozens of molecules that give cannabis its distinctive rainbow of aromas, can boost efficacy through a phenomenon called “the entourage effect.”
Limonine, a terpene which carries a citrusy scent, is considered “energizing.” Myrcene, which produces a skunky or diesel odor, contributes to a more relaxing “couch-lock” feel.
To find the most effective product for them, patients should keep a journal, said Goodchild of TerraVida.
“Many of the strains have a strong effect on [disturbing] short-term memory, so it’s important to note how quickly they take effect, and how long they’re effective for,” he said. “Record how the strain affects you at different times of the day and how it affects your mood.”
Most important, start slow. Patients can choose products they can inhale — usually flower — an oil to place under the tongue, a pill, or salve. Buy — and try — small amounts first.
by Sam Wood, Posted: August 24, 2020 - 5:02 AM