Medical cannabis treatment is NOT one thing!! There are myriad cannabis strains and many modes of administration. You will need to EXPERIMENT to find out what works best for you! These notes are intended to help you do that. If you need more help, I am a Chronic Pain Coach, certified by Michael Moskowitz, MD, MPH, and I hold a Certificate in Cannabis Science from the University of Vermont. If you have a medical cannabis recommendation from a doctor, I can work with you as you find the treatment that best serves your needs.
- I’m serious about this one: you need to ask your doctor if you are a good candidate for medical cannabis treatment. I am a huge fan of medical cannabis. It is very safe, which is to say that no one has died simply from ingesting it. That said, some people absolutely should NOT use medical cannabis, so ask your doctor!
- You should be aware of the laws in your state or country. You can check this site for up to date information: https://norml.org/legal/medical-marijuana-2
- Find a reliable cannabis dispensary, one that can tell you both the ratio of the two most prevalent cannabinoids, CBD and THC, and their concentrations, in each product. You are also looking for a dispensary that carries high CBD products with a CBD:THC ratio of at least 15:1.
- There are over 100 cannabinoids in the cannabis plant, (and some terpenes and flavonoids too). Many have beneficial effects. The two we hear about most are CBD and THC, (THC being the psychoactive component of cannabis). Researchers have identified what they call an “entourage effect” when a variety of cannabinoids are taken together using the whole plant, so using a variety of strains in your treatment is often better than just one strain. You are looking for a “broad cannabinoid profile.”
- Modes of Administration: There are many ways to use cannabis—smoking, vaping, topicals, edibles, tinctures, etc. For the sake of simplicity, when treating chronic pain, I’d suggest starting with alcohol based tinctures. Typically, tinctures last about 8 hours in the system.
- Generally speaking, you should begin using a new cannabis product when you have some free, relaxed, time to gauge the effect.
- Generally speaking, start taking cannabis in the evening, adding a morning and then perhaps, an afternoon dose once you know how you tolerate it.
- Generally speaking, for pain, I would suggest you begin with strains of cannabis that are high in CBD and low in THC. (A ratio of at least 15:1—CBD:THC) THC is psychoactive; CBD is not.
- Generally speaking, when you begin using a new cannabis product, start with a low dose, (5 drops of a given tincture for instance), and increase the dose each day until you experience a beneficial effect. Optimal dosing is difficult to predict because each patient can be very different. For some, 10 or even 5 drops of a tincture might be enough, for others 60 drops are required. The point here is that you need to experiment with different strains, combination of strains, and doses. You can take something different at night than you do in the day. You are trying to find your optimal treatment and yours can be very different from a friend’s. EXPERIMENT!
- THC is not bad. In fact, because of the entourage effect, you may need a bit of THC in your “cannabis diet,” to get the optimal effect. Assuming you don’t want to feel the psychoactive effects of cannabis, there are ways to get some THC into your system without experiencing the high.
- You could try a few drops of a higher THC strain, 4:1, before bed.
- You could try vaping a 7:1 strain for “breakthrough pain” during the day.
- There is some evidence that high concentrations of CBD counteract the psychoactive effects of THC. Experiment!
- You may have heard about Indica strains and Sativa strains of cannabis. Common wisdom suggests that Indica strains offer a “body high,” and are good for situations where you need to be calm—sleep for instance. Common wisdom suggests that Sativa strains offer more mental stimulation. That said, recent studies have shown that the cannabinoid profiles of both these classes of cannabis range the whole gamut. While this calls the common wisdom into some question, I’m still apt to follow it.
- You can also use a high THC alcohol based tincture as a topical treatment without any discernable psychoactive effects. The results can be amazing! Roll it onto a painful area, but not on an open wound. (Note: topical treatments will show up in a urine drug test.)
- If you experience unwanted side effects with any product, just back off the dose until the side effects are tolerable.
- Keep this in mind . . . most cannabis products do not have a fixed cannabinoid profile because the cannabinoids change over time, especially when exposed to light or heat.
- These guidelines are intended to help you get started. Eventually you may want to experiment with capsules, edibles and more, or you may just want more information. I would suggest Medical Cannabis; a Guide for Patients, Practitioners, and Caregivers, by Michael Moskowitz, MD, MPH. Moskowitz is a pain specialist. His book offers both theoretical and practical information. (Available on Amazon)
You may download these guidelines in a booklet format below and feel free to distribute it, in its entirety, for free. (Print two-sided, “short-edge binding.)