C
crowman
Guest
"We are not physicians or pharmacists. This material is provided solely because there is virtually no information provided to medicinal marijuana patients in California concerning the dosage, purity, potential side effects and drug interactions associated with medicinal cannabis use. This information is not intended to be prescriptive and has not been approved by the FDA, NIDA, or anyone that owns a mug with initials on it.
Dosage - Inexperienced users of medicinal cannabis often use more cannabis than needed to address their symptoms. Because cannabis is relatively nontoxic, overdosage is very common. Some ill-informed recreational users have promoted the dosage strategy that “more is cooler” and this ignorance has spread to some medicinal cannabis patients. The key to intelligent medicinal cannabis dosage is to use only enough cannabis to address their symptoms. A recent study confirms that there is a “sweet spot” for medicinal cannabis dosage. Patients in the study that consumed too small a dose received no relief of their symptoms, while patients who overdosed also achieved no relief. Exceeding the “sweet spot” dosage point is a waste of medicine.
Titrating (adjusting) the cannabis dosage seems easiest for patients that choose to smoke cannabis, even though smoking cannabis presents its own specific health issues. One method is to take a single deep inhalation of .1 gram of smoked cannabis, then wait five minutes to gauge the effect of this dose. Holding the smoke in the lungs does not increase the amount of THC that will be absorbed through the lungs, but does increase the amount of toxic tars that will coat the lung passages. Many patients who take large inhalations of smoke and hold their breath subsequently develop chronic lung irritation. With “creeper” strains of cannabis, which have a slower onset of effects, the patient may wish to wait fifteen minutes to assess whether effective dosage has been achieved.
When vaporizing cannabis, it is easier to overdose than when smoking, since the lack of irritation, in comparison with smoking, makes it more likely that too much of the vaporized cannabis ingredients will be inhaled. This lack of precision can be adjusted by carefully weighing the amount of cannabis to be vaporized and using only familiar cannabis strains. Take a single inhalation of vaporized cannabis, exhale and wait five minutes. “Creeper” strains of cannabis are not as easily vaporized, since they require a higher temperature, though precision vaporizers such as the Volcano and Vapezilla can be used effectively with these strains.
Eating cannabis is by far the most difficult method by which to achieve precision dosage. This is made more difficult when using readily available “edibles”, since there is no standard formula for dosage. “5x”, “10x” and other dosages found on “edible” packaging are absolutely meaningless and completely unreliable. To effectively consume cannabis orally requires the presence of a fat to help digest the active ingredients found in cannabis. Additionally, the cannabis should be heated for five minutes at 350 degrees F, to convert the active ingredients so that they can be absorbed through the digestive tract. Thorough heating also kills any harmful bacteria that might be present on the raw cannabis.. Selecting the appropriate dosage of cannabis to be consumed orally is a process of trial and error, though there are a few techniques that might help. First, use a specific strain to prepare the edible preparation, since there will be less variance in cannabinoid content. Second, use the same kind of oil or fat to distribute the active cannabis ingredients throughout the edible mixture. Third, use the same exact amount of cannabis each time you prepare the edible mixture. Fourth, wait four hours after consuming the edible mixture before assessing whether you’ve achieved the correct dosage. Lastly, always keep notes on your dosage. Consistency is the key, though there will always be some variance with the effects of orally consumed cannabis.
Purity - Raw herbal cannabis may be contaminated by bacteria, molds, fungi and viruses. The average microbial counts found on raw cannabis vary, though these counts can be significant and can pose a health threat to patients. Some bacteria found on raw cannabis may cause gastrointestinal illness. Additionally, the small cystolith hairs found on the stems of raw cannabis can severely irritate the human digestive tract.
The bottom line: never eat raw cannabis.
Mold and fungi infestation found on some contaminated cannabis can pose a health risk to patients using cannabis. Mold growth is common on cannabis grown indoors. Patients should learn to recognize the more common molds found on contaminated cannabis. The most common mold infestation on cannabis is mildew. Mildew often appears on the tiny sugar leaves that surround the bud and appear as bright white trichomes (”hairs” or “crystals”), similar to the actual transparent milky or amber trichomes found on the flower surfaces of healthy cannabis. Unscrupulous cannabis growers often attempt to conceal mildew infestation by trimming back these leaves. Close visual inspection of cannabis flowers can usually reveal any mildew contamination. The health repercussions of consuming mildewed cannabis are unknown, but caution is certainly advised.
Very rarely, cannabis can be contaminated by aspergillus mold. Aspergillus can produce aflatoxins, which are extremely toxic and responsible for the only death in the US directly attributable to contaminated cannabis. Aflatoxins are not destroyed by heat and can be inhaled by cannabis smokers. Aspergillus mold can grow on cannabis cured in paper bags, so-called “sweat curing”. Cannabis should never be cured or stored in moist conditions.
Concentrated forms of cannabis, including hashish, oils and tinctures, present their own set of contamination risks to patients. Medicinal concentrates are typically made from byproducts of the process of manicuring cannabis flowers. The collection and storage of these byproducts is often unsanitary, while the actual methods by which many concentrates are produced, often introduces new contaminants. Hashish and kif are made by separating the trichomes from underlying plant material. Traditionally, this process was achieved by dry sieving the cannabis through fine screens to collect the trichomes. In recent years, water trichome extraction methods have been introduced that greatly increase the likelihood of mold contamination in these concentrates. Almost no hashish available to patients is free from mold contamination. Oils and waxes are usually made by extracting the active ingredients from cannabis by using solvents or compressed gases such as butane. Often these solvents and gases contain extremely toxic and carcinogenic substances that remain in the concentrates after the extraction process. The bottom line is that patients that choose to use concentrated forms of cannabis are at greater risk of exposure to dangerous contaminants.
Side effects - Speak with your physician if you experience any side effects from cannabis use.
The physical side effects of cannabis use may include:
Tachycardia - rapid heartbeat
Dry mouth
Dizziness
Orthostatic hypotension - dizziness or loss of consciousness when standing or sitting up while medicated on cannabis.
Headache
Insomnia
Increased sensation of heat or cold in extremities
Red or burning eyes
Muscle weakness
Irritation of airways in cannabis smokers
Cognitive impairment - long-term use of cannabis does seem to effect cognition (ability to think), but any cognitive impairment arising from cannabis use appears to be reversible.
The psychological side effects of cannabis use may include:
Anxiety
Lethargy
Confusion
Panic
Reaction time
Many of these side effects are dosage dependent and can be reduced by ingesting smaller doses of cannabis.
Contraindications - Patients with the following illnesses or disorders should discuss these conditions with their physician before using medicinal cannabis.
Heart disease, arrhythmia, or angina
Acute high blood pressure
Pulmonary disease - smoking cannabis is not recommended for these patients.
Schizophrenia
Immune disorders
Pregnancy and breast-feeding - Use of cannabis during pregnancy and breastfeeding is not recommended. Children exposed to cannabis during the mother’s pregnancy have been shown in certain, but not all, studies to score lower on cognitive function examinations. The active ingredients in cannabis are present in breast milk.
Dependence - Over time, medicinal cannabis users can become physically dependent upon cannabis. Cessation of long-term cannabis use can produce mild withdrawal symptoms including restlessness, irritability, insomnia and, rarely, nausea.
Tolerance - Many patients claim to develop a tolerance over time to medicinal cannabis that requires these patients to increase their dosage. In our experience, we feel that most cannabis tolerance issues are myths. It has been shown in research studies that overdosing on cannabis reduces its effects. Most tolerance is caused by overdosing. Many cannabis users believe that tolerance can be avoided by switching among cannabis strains, which is another myth. The variations in the effects of different cannabis strains are caused by the different ratios of cannabinoids and pharmacologically active essential oils found in each cannabis strain. The variance in these essential oils is one of the primary causes for why different cannabis strains produce individual effects. It’s possible that certain essential oils in cannabis lose their effectiveness when taken continuously over time, but this has not been proven in research studies. The only way to reduce so-called “tolerance” is to reduce dosage.
Drug interactions - When taken orally, the active ingredients in cannabis can interact with enzymes in the body to increase or decrease the effect of cannabis. Special caution should be used when taking oral cannabis with the following drugs. The interaction of smoked or vaporized cannabis with these drugs is unknown, but caution is advised.
The following drugs can increase the effects of oral cannabis.
Clarithromycin (Biaxin) - antibiotic
Erythromycin (Robimycin, Ilosone, Acnasol) - antibiotic
Itraconazole (Sporanox) - antifungal
Fluconazole (Diflucan, Trican) - antifungal
Ketoconazole - antifungal
Miconazole (Monistat) - antifungal
Diltiazem (Tiazac, Cardizem, Dilacor) - high blood pressure, angina
Verapamil (Calan, Veralan, Isoptin) - cardiac arrhythmias
Amiodarone (Cordarone) - cardiac arrhythmias
Ritonavir (Norvir) - HIV protease inhibitor
Isoniazid (Nydrazid, Rifamate) - tuberculosis treatment
The following drugs can decrease or interfere with the effects of oral cannabis
Rifampicin (Rifampin, Rifadin, Rifater, Rimactane) - antibiotic
Carbamazepine (Tegretol, Equetro, Carbetrol) - anticonvulsant
Phenobarbital - sedative, anticonvulsant
Phenytoin (Dilantin) - anticonvulsant
Primodone (Mylosine) - anticonvulsant
Rifabutin (Mycobutin) - MAC disease
St. John’s Wort - herbal antidepressant
Additionally, cannabis (smoked, oral, or vaporized) increases the effects of alcohol, benzodiazepines (Valium, Xanax, Restoril, Librium, Ativan, Lorimet, Halcion, etc.) and opiates (morphine, Fentanyl, codeine, etc.).
Because THC is strongly bound to plasma proteins, caution is advised when taking other medications that are also strongly bound to plasma proteins.
Please take the time to discuss the information provided with your physician. Medicate smart."
Dosage - Inexperienced users of medicinal cannabis often use more cannabis than needed to address their symptoms. Because cannabis is relatively nontoxic, overdosage is very common. Some ill-informed recreational users have promoted the dosage strategy that “more is cooler” and this ignorance has spread to some medicinal cannabis patients. The key to intelligent medicinal cannabis dosage is to use only enough cannabis to address their symptoms. A recent study confirms that there is a “sweet spot” for medicinal cannabis dosage. Patients in the study that consumed too small a dose received no relief of their symptoms, while patients who overdosed also achieved no relief. Exceeding the “sweet spot” dosage point is a waste of medicine.
Titrating (adjusting) the cannabis dosage seems easiest for patients that choose to smoke cannabis, even though smoking cannabis presents its own specific health issues. One method is to take a single deep inhalation of .1 gram of smoked cannabis, then wait five minutes to gauge the effect of this dose. Holding the smoke in the lungs does not increase the amount of THC that will be absorbed through the lungs, but does increase the amount of toxic tars that will coat the lung passages. Many patients who take large inhalations of smoke and hold their breath subsequently develop chronic lung irritation. With “creeper” strains of cannabis, which have a slower onset of effects, the patient may wish to wait fifteen minutes to assess whether effective dosage has been achieved.
When vaporizing cannabis, it is easier to overdose than when smoking, since the lack of irritation, in comparison with smoking, makes it more likely that too much of the vaporized cannabis ingredients will be inhaled. This lack of precision can be adjusted by carefully weighing the amount of cannabis to be vaporized and using only familiar cannabis strains. Take a single inhalation of vaporized cannabis, exhale and wait five minutes. “Creeper” strains of cannabis are not as easily vaporized, since they require a higher temperature, though precision vaporizers such as the Volcano and Vapezilla can be used effectively with these strains.
Eating cannabis is by far the most difficult method by which to achieve precision dosage. This is made more difficult when using readily available “edibles”, since there is no standard formula for dosage. “5x”, “10x” and other dosages found on “edible” packaging are absolutely meaningless and completely unreliable. To effectively consume cannabis orally requires the presence of a fat to help digest the active ingredients found in cannabis. Additionally, the cannabis should be heated for five minutes at 350 degrees F, to convert the active ingredients so that they can be absorbed through the digestive tract. Thorough heating also kills any harmful bacteria that might be present on the raw cannabis.. Selecting the appropriate dosage of cannabis to be consumed orally is a process of trial and error, though there are a few techniques that might help. First, use a specific strain to prepare the edible preparation, since there will be less variance in cannabinoid content. Second, use the same kind of oil or fat to distribute the active cannabis ingredients throughout the edible mixture. Third, use the same exact amount of cannabis each time you prepare the edible mixture. Fourth, wait four hours after consuming the edible mixture before assessing whether you’ve achieved the correct dosage. Lastly, always keep notes on your dosage. Consistency is the key, though there will always be some variance with the effects of orally consumed cannabis.
Purity - Raw herbal cannabis may be contaminated by bacteria, molds, fungi and viruses. The average microbial counts found on raw cannabis vary, though these counts can be significant and can pose a health threat to patients. Some bacteria found on raw cannabis may cause gastrointestinal illness. Additionally, the small cystolith hairs found on the stems of raw cannabis can severely irritate the human digestive tract.
The bottom line: never eat raw cannabis.
Mold and fungi infestation found on some contaminated cannabis can pose a health risk to patients using cannabis. Mold growth is common on cannabis grown indoors. Patients should learn to recognize the more common molds found on contaminated cannabis. The most common mold infestation on cannabis is mildew. Mildew often appears on the tiny sugar leaves that surround the bud and appear as bright white trichomes (”hairs” or “crystals”), similar to the actual transparent milky or amber trichomes found on the flower surfaces of healthy cannabis. Unscrupulous cannabis growers often attempt to conceal mildew infestation by trimming back these leaves. Close visual inspection of cannabis flowers can usually reveal any mildew contamination. The health repercussions of consuming mildewed cannabis are unknown, but caution is certainly advised.
Very rarely, cannabis can be contaminated by aspergillus mold. Aspergillus can produce aflatoxins, which are extremely toxic and responsible for the only death in the US directly attributable to contaminated cannabis. Aflatoxins are not destroyed by heat and can be inhaled by cannabis smokers. Aspergillus mold can grow on cannabis cured in paper bags, so-called “sweat curing”. Cannabis should never be cured or stored in moist conditions.
Concentrated forms of cannabis, including hashish, oils and tinctures, present their own set of contamination risks to patients. Medicinal concentrates are typically made from byproducts of the process of manicuring cannabis flowers. The collection and storage of these byproducts is often unsanitary, while the actual methods by which many concentrates are produced, often introduces new contaminants. Hashish and kif are made by separating the trichomes from underlying plant material. Traditionally, this process was achieved by dry sieving the cannabis through fine screens to collect the trichomes. In recent years, water trichome extraction methods have been introduced that greatly increase the likelihood of mold contamination in these concentrates. Almost no hashish available to patients is free from mold contamination. Oils and waxes are usually made by extracting the active ingredients from cannabis by using solvents or compressed gases such as butane. Often these solvents and gases contain extremely toxic and carcinogenic substances that remain in the concentrates after the extraction process. The bottom line is that patients that choose to use concentrated forms of cannabis are at greater risk of exposure to dangerous contaminants.
Side effects - Speak with your physician if you experience any side effects from cannabis use.
The physical side effects of cannabis use may include:
Tachycardia - rapid heartbeat
Dry mouth
Dizziness
Orthostatic hypotension - dizziness or loss of consciousness when standing or sitting up while medicated on cannabis.
Headache
Insomnia
Increased sensation of heat or cold in extremities
Red or burning eyes
Muscle weakness
Irritation of airways in cannabis smokers
Cognitive impairment - long-term use of cannabis does seem to effect cognition (ability to think), but any cognitive impairment arising from cannabis use appears to be reversible.
The psychological side effects of cannabis use may include:
Anxiety
Lethargy
Confusion
Panic
Reaction time
Many of these side effects are dosage dependent and can be reduced by ingesting smaller doses of cannabis.
Contraindications - Patients with the following illnesses or disorders should discuss these conditions with their physician before using medicinal cannabis.
Heart disease, arrhythmia, or angina
Acute high blood pressure
Pulmonary disease - smoking cannabis is not recommended for these patients.
Schizophrenia
Immune disorders
Pregnancy and breast-feeding - Use of cannabis during pregnancy and breastfeeding is not recommended. Children exposed to cannabis during the mother’s pregnancy have been shown in certain, but not all, studies to score lower on cognitive function examinations. The active ingredients in cannabis are present in breast milk.
Dependence - Over time, medicinal cannabis users can become physically dependent upon cannabis. Cessation of long-term cannabis use can produce mild withdrawal symptoms including restlessness, irritability, insomnia and, rarely, nausea.
Tolerance - Many patients claim to develop a tolerance over time to medicinal cannabis that requires these patients to increase their dosage. In our experience, we feel that most cannabis tolerance issues are myths. It has been shown in research studies that overdosing on cannabis reduces its effects. Most tolerance is caused by overdosing. Many cannabis users believe that tolerance can be avoided by switching among cannabis strains, which is another myth. The variations in the effects of different cannabis strains are caused by the different ratios of cannabinoids and pharmacologically active essential oils found in each cannabis strain. The variance in these essential oils is one of the primary causes for why different cannabis strains produce individual effects. It’s possible that certain essential oils in cannabis lose their effectiveness when taken continuously over time, but this has not been proven in research studies. The only way to reduce so-called “tolerance” is to reduce dosage.
Drug interactions - When taken orally, the active ingredients in cannabis can interact with enzymes in the body to increase or decrease the effect of cannabis. Special caution should be used when taking oral cannabis with the following drugs. The interaction of smoked or vaporized cannabis with these drugs is unknown, but caution is advised.
The following drugs can increase the effects of oral cannabis.
Clarithromycin (Biaxin) - antibiotic
Erythromycin (Robimycin, Ilosone, Acnasol) - antibiotic
Itraconazole (Sporanox) - antifungal
Fluconazole (Diflucan, Trican) - antifungal
Ketoconazole - antifungal
Miconazole (Monistat) - antifungal
Diltiazem (Tiazac, Cardizem, Dilacor) - high blood pressure, angina
Verapamil (Calan, Veralan, Isoptin) - cardiac arrhythmias
Amiodarone (Cordarone) - cardiac arrhythmias
Ritonavir (Norvir) - HIV protease inhibitor
Isoniazid (Nydrazid, Rifamate) - tuberculosis treatment
The following drugs can decrease or interfere with the effects of oral cannabis
Rifampicin (Rifampin, Rifadin, Rifater, Rimactane) - antibiotic
Carbamazepine (Tegretol, Equetro, Carbetrol) - anticonvulsant
Phenobarbital - sedative, anticonvulsant
Phenytoin (Dilantin) - anticonvulsant
Primodone (Mylosine) - anticonvulsant
Rifabutin (Mycobutin) - MAC disease
St. John’s Wort - herbal antidepressant
Additionally, cannabis (smoked, oral, or vaporized) increases the effects of alcohol, benzodiazepines (Valium, Xanax, Restoril, Librium, Ativan, Lorimet, Halcion, etc.) and opiates (morphine, Fentanyl, codeine, etc.).
Because THC is strongly bound to plasma proteins, caution is advised when taking other medications that are also strongly bound to plasma proteins.
Please take the time to discuss the information provided with your physician. Medicate smart."
