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Healing with Cannabis Part 2

Wednesday, February 13, 2019 18:49

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After being a medical marijuana patient for over a year now, I’ve realized that many people I meet don’t know much about this medicine. Even the recommending doctors I went to, in New York and New Jersey, really don’t know much about marijuana –as a plant, as a “drug”, or as a medicine; those terms are not mutually inclusive. Many doctors are still not on board with cannabis used as a medicine and, like the federal government, consider it a Schedule I drug with no medicinal value. Many lawmakers and administrators of medical cannabis programs are no different. When I applied for the MMJ program in New Jersey, I had to essentially sign a legal document telling the state that I understand marijuana has “no known medical benefits…” So, the idea of marijuana as medicine isn’t truly integrated into some medical cannabis programs. Then, consider the idea of a plant as medicine for a traditional doctor who’s gotten used to handing out pills? That’s too esoteric for many of them.

#1 Find a cannabis certifying physician… hopefully a good one.

Finding a physician isn’t easy, but it’s easier now than it has been. Finding a good one– one that will do more for you than just certify that you have a condition that your state considers eligible to receive medical cannabis– is near impossible. Many will only certify you, and that isn’t bad, but it helps to have a doctor that can guide you. However, most won’t because cannabis is a Schedule I drug. Because of its listing at the federal level, doctors can’t give a proper prescription, only giving a basic recommendation. My doctor in NY just gave me a recommendation for any cannabis offered by the NY Medical Marijuana program. She didn’t give any other recommendation than that. My NJ doctor did essentially the same, recommending me for cannabis and allowing me the maximum quantity available in the NJ program, a whopping 2 ounces a month. (Which isn’t much, especially if you want to make homemade remedies like Rick Simpson oil).

My NJ doctor said: “How you use it is up to you.” On my subsequent visits, for his paperwork, he did ask me how I was using it: smoke, vape, or edibles. He didn’t want any other information than that. A good article from “Practical Pain Management” gives some other tips about medical cannabis and your healthcare provider.

It’s also a plus if the doctor that certifies you is one that actually understands cannabis as medicine. The NY doctor that ultimately certified me for the NYMMJ program was a pain-specialist who had been part of some NY state council on opioids. She only became certified to recommend cannabis in order to compare her patients’ experiences on cannabis, which she didn’t think was as effective as opioids. She said she was doing it for personal/professional research purposes. She and I did have a laugh when I asked if I was to be her guinea pig. But, that’s essentially what I was because she was convinced I would do better on opioids.

She wasn’t the first doctor I had seen in New York about cannabis either. The first one happened to be a neurologist I had initially seen almost 10 years ago, after I had had a mini-stroke, and he was one I had gone back to several times over the years. He was one of the many neurologists who had missed my epilepsy diagnosis. During the last round of visits, he wanted me to repeat all the tests I had had because he didn’t believe my diagnosis of epilepsy. He wanted me on another cocktail of anti-seizure medications in addition to yet another round of opioids. It didn’t matter that I had already done all that to no effect. Finally, after having a few tests and lots of turmoil, I confronted him, asking if he had any intention of ultimately recommending cannabis– even if I were to do the 6 months on new meds. He said no because he had no faith cannabis would work for me and he had no confidence in my diagnosis– and yet he was prescribing a cocktail of anti-seizure medications. Neither doctor gave me much assistance, though the pain management specialist did give me the certification.

I often tell folks when I speak with them about cannabis: if you don’t have a doctor that will even entertain the idea, then find one who will. It’s hard to do, especially considering insurance. But, if you want to try a medicine that can improve your life, then it’s worth the trouble. Try Leafly for help finding a doctor near you. Another resource is Marijuana Doctors.

Sometimes you’ll come across a doctor that does cannabis certification not because he or she believes in cannabis as a medicine, or because the doctor understands cannabis, but because it’s an easy money-maker. Cannabis certification can be expensive. So…

#2 Find a doctor that accepts insurance.

If you’re lucky, you can find a decent doctor that will accept health insurance and will drastically cut down on your out-of-pocket expense. Both doctors I got certified by accepted my health insurance for the visit. Not all do. Sometimes it’s also a measure of how reliable the doctor is and is an important thing to keep in mind depending on your state’s program. In NY, I only needed certification once a year, but in NJ, I need it every 3 months. If you use an online service, and there are several where you have an online visit with a physician in order to get the certification, or if you find a doctor who will only take cash for certification, then that’s a cost that will rack up as you move forward in the program. In NY, at the time I was certified, most doctors charged about $400 for a visit and online resources were similarly priced. A fair number of those NY doctors accepted cash only for the certification. As I said, the doctor I saw took my insurance, though had she not the cost would have been over $400. The NJ doctor charged far less, but ultimately took my insurance as well. Had he not, the first visit would have cost $125 and follow-up certification visits would cost $75. For a year’s worth of visits, had I paid out of pocket, it would have been comparable to the average cost of NY certification.

#3 Be your own doctor, your own cannabis advocate, and educate yourself.

This is perhaps the most difficult. Many people want a doctor to write a script, a pharmacist to hand them a pill that all they have to do is consume. It’s far easier for people to hand off control over their own health to doctors and Big Pharma. As more people are familiar with plant medicine, there’s more of an understanding about regaining that control over your own health and your own wellness regimen. I discuss this at length in the series “The Cure is You Dealing with Chronic Illness”, which ran for 7 installments.

This is particularly pertinent when regarding cannabis as medicine. (And, I’m a believer that “recreational” cannabis is actually medicine and folks who turn to cannabis for so-called recreation, are doing so because of a need to self-medicate, even if it’s only to “relax” or “unwind.”)

The NJ doctor I saw a full 180° turn in favor of medical cannabis because he saw how effective it could be for his patients. But, he confessed he had no understanding about the plant and no real knowledge about its medical use. He may take my insurance, but he does nothing more than recertify me every 3 months. After speaking with my current physician – as well as my mother’s lawyer, several assorted family members, and friends– I realized how much I’ve had to learn on my own about cannabis as medicine. After finally turning my mother into a cannabis patient, I realized how very intimidating cannabis can be for anyone coming to cannabis from a prohibition mentality. So, as I noted in my “Cure is You” series, educate yourself. Here’s my Crash Course on Cannabis.

There are several things to know about cannabis from the start.

Cannabis can be used to treat a variety of ailments.

Cannabis has different properties, comes in different types (called strains), and is consumed in several forms.

Cannabis has minimal side-effects, but there are side-effects, which sometimes depend on the form you use it in and the strain you’re using.

Because of our Endocannabinoid System, cannabis can be used to treat lots of conditions and research is being done all the time to expand our understanding of what cannabis can be used to treat. Researchers are also trying to understand how many conditions –from Parkinson’s to migraines– may be the result of a deficiency in our endocannabinoid system.

Cannabis contains compounds called cannabinoids. Of the myriad cannabinoids present in marijuana, most people are familiar with only two: THC (tetrahydrocannabinol) and CBD (cannabidiol). Research is promising regarding cannabinoids, pointing to CBD as a powerfulmedicine with anti-inflammatory, anti-seizure properties, as well as properties which protect the nervous system, work to combat tumors, and help improve mood. Both THC and CBD help pain, but THC also can help with sleep and appetite. But, in addition to THC and CBD, we have terpenes, fragrant oils present in all plants. The terpenes in cannabis have medicinal properties as well.

It’s the combination of cannabinoids and terpenes that give different strains different properties. Oh, yeah– and marijuana isn’t a one-size-fits-all plant. You can’t go into a dispensary and ask for marijuana. It would be like going into a wine shop and asking for wine. That sounds counter-intuitive. Of course you’ll get wine in a wine shop, but what kind? What variety? Where was it bottled? Are you looking for a sweet dessert wine or a dry chardonnay? Are you looking for a primo champagne or will a bubbly moscato do? Just as each grape has its own profile, each strain of marijuana has its own profile. One of the best resources for strains and their properties is Leafly.

But, since dispensaries and growers constantly experiment with cross-breeds, landraces, and specialty varieties of cannabis, creating new strains, Leafly doesn’t have everything.

Then, as if that’s not enough, cannabis can be consumed in various ways. I already noted in my previous part that different medical cannabis programs have different rules. Get to know what the rules are in your state’s programs. New York, at the time I was a patient there, prohibited any plant material from being in the product consumed by the patient. So, it was only available in pill or capsule and oil products, which would be vaped or used sublingually. Certain dispensaries offered variations, sublingual sprays, and at the time I left the program, my dispensary had plans on introducing topicals.

In states like New Jersey, where whole flower is permitted, that may be all you have access to: the flower. Many dispensaries in these states may not offer any other products except the bud in flower, shake, or pre-rolled joint (cigarette). If you’re going to a recreational dispensary, that’s a different story. The possibilities are virtually endless– smoke, vape, edible, topical are categories. If you’re going to smoke it, how: bong, pipe, joint? What are you going to smoke: flower, dab, shatter? If you vape, are you going to go for a vaporizer that uses whole flower or an oil? If you’re going to do an edible, how: tincture (Glycerin? Alcohol? MCT oil [medium chain triglycerides]?), gummy, brownie, chips, soda? Topical oil, liniment, lip balm, moisturizer? It gets a bit overwhelming. (Some helpful information about cannabis terms.)

I appreciate that my herbalism background along with my adventurousness in the culinary arts have been invaluable on this journey. If you don’t know your way around the kitchen and don’t know some basics about herbalism, cannabis can be daunting –which may be a reason so many people just smoke it. Smoking the herb is simpler. But, it’s debatable about whether or not smoking cannabis is as dangerous as smoking tobacco. Leafly has an interesting article about the controversy and gives some helpful information regarding the proper temperatures to vape at.

Aside from that, you’re left on your own. The dispensary agents –pharmacists and counsellors –are there to help you determine what strain and what form will work for you. But, you should have more than a passing idea of what you want and how you’ll use it before going into the dispensary.

When I went to my NJ dispensary, Garden State Dispensary,

I sat with a counsellor for an initial intake session. The counsellor was floored at how prepared I was. I had a notebook with scads of information about what strains I wanted to try. In order to prepare, I used the dispensary website and the MMP directory as a guide on what strains offered at Garden State Dispensary (GSD). Unfortunately both sites are sorely outdated. GSD has new strains in their daily menu but, despite my emails and social-media pleas, they have so far failed to update their website with information on these strains. Ditto for MMP, which lists strains no longer offered by GSD and has skewed information about THC and CBD ratios in each strain. While I was gathering my information, I often found myself cross-referencing strains, looking at what the dispensary had on offer, finding some guidance from the MMP directory, and then rounding out what information regarding uses and side effects from Leafly. When I went to the dispensary, I had a list of my ailments and which strains I thought would be helpful in tackling them. This list was an indispensable foundation in my cannabis regimen and helped me not be swayed by a pharmacist who I wasn’t sure could have been trying to push a particular strain that the dispensary needed to unload. (For tips about first time dispensary visits, check out Leafly’s article.)

The folks at GSD are really exceptional, despite their lack of website updates. The counsellors and pharmacists are there if I have a question. They’re pleasant, knowledgeable, and don’t push anything on customers. While I wish they offered more flower, what they do offer is top quality. I got a crash course on vaporizers and after discussing the idea with my counsellor, I opted to add vaping to my regimen. I also learned that if you use a whole flower vaporizer, you can save the material, called ABV (already-been-vaped bud) to make edibles. I use it to add some medicine to everyday food. In future installments, I’ll talk more about personal vaping.

But, keep in mind that all resources on cannabis strains, their medicinal uses, and their side-effects are anecdotally based. Meaning, Leafly, MMP, and any dispensary posting information about their strains gets their information from the people– and only customers that share their information. They gather anecdotal evidence, so it’s not like reading a pharmacist pamphlet that comes with your doctor’s prescription from your local pharmacy. That kind of information comes from studies, research, corporations, and FDA guidelines about the medication. No such information exists about cannabis. Partly because cannabis as a medicine is still being understood, partly because of the Schedule I classification, but mostly because cannabis as a plant isn’t something that can be patented the way the latest high blood pressure pill can be patented. Although, that is starting to happen.

And, you can’t rely on anecdotal evidence. My experience with Bubble Gum, a high THC strain, is case in point. Bubble Gum has really positive reviews on Leafly. It has great properties and hit several of my needs medicinally speaking. It was supposed to give a boost of energy. The counsellor cautioned me that it’s a high THC strain so it would make me feel like cleaning the entire house in one go. Not so. It put me to sleep. I got muzzy-headed and had the worst case of couch-lock ever. And, when I used some Bubble Gum infused coconut oil in a batch of brownies, I was stoned for about 30 hours, with the dizzy spins and the giggle fits. Luckily, I didn’t get any of the anxiety or paranoia I had experienced from my Jamaican brownie experience.

Last on the list are the side-effects. One problem I have with uneducated herbalists and mainstream views on herbalism is the notion that because you’re dealing with a plant, there aren’t any side-effects. This is false and dangerous. All medicines have side-effects. Cannabis is no different. Granted, the side-effects from many herbs, cannabis included, aren’t as devastating as those from pharmaceuticals, but still side-effects are possible. I want to caution you against just looking up “cannabis side-effects” because much of what you’ll get in an average Google search stems from prohibitionist websites and causes. There are lots of articles that hold to the old Reefer Madness mentality and use scare tactics.

Most cannabis patients experience dry mouth and dry eyes, but there are other side-effects including: anxiety, paranoia, dizziness, confusion, and headaches. There are some cautions about people with certain psychological disorders, like schizophrenia and bipolar disorders, taking cannabis. There are instances of THC psychosis in users of cannabis with very high levels of THC, but even the articles I found noting the links between cannabis and psychosis are dubious. Some were dated, others aren’t clear about their stance– are they prohibitionist? Still, it’s helpful to read up on this if you have a serious mental disorder that can be exacerbated by cannabis use. This is one of the better articles since it also points out that cannabis has shown promise in treating mental disorders. The information about cannabis inducing psychosis is unclear. What strain are they talking about? What dosage? What form? This is another reason a doctor’s guidance is necessary.

Stay tuned for recipes and vaping information.

Source: http://www.green-and-growing.com/2019/02/healing-with-cannabis-part-2.html

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