Cannabis medicines are boring.  There, I said it.  Sorry it’s not that exciting.  If you’ve fallen victim to all the hype going around about the vast array of cannabis products, you have my sympathy.  The misinformation is rampant.

The issue is that cannabis is a wonderfully effective medication for some people and some problems.  However, it’s just a plant and if you’re in the business of selling lots of product, you have to figure out a way to convince folks that yours is better or different from the other guys’.  It’s just not true, however.

Stick with me here and we’ll explore the types of medications that work and what we really need for medical treatment, and what’s just hype.

There are basically two types of cannabis medicine that we need for most medical problems: inhaled and orally ingested (eaten). 

Inhalation: Rapid and Short

Inhaled cannabis provides rapid onset of effect with relatively short duration of action.  It works in about 10-15 minutes and wears off in about 3-4 hours.  This is because inhalation allows rapid absorption of d9-THC and other cannabis chemicals through the lungs, and because d9-THC gets degraded rapidly by the liver.  This makes inhaled cannabis great for acute or episodic problems.  The classic example I give is a Migraine headache where we know that letting it progress leads to worsening pain, so there’s great value in rapid treatment.  However, if the treatment is successful, we’d like the medicine to wear off quickly so that we can get back to whatever we were intending to do that day. 

Please note how careful I’m being to say inhalation, not smoking or vaping.  I don’t recommend smoking because smoke contains many toxic chemicals as well as small particles of soot that are not good for your lungs or other body tissues.  It doesn’t make any sense to me to deliver medicine by a mechanism that itself is dangerous or harmful to the person we’re treating.  Similarly, “vaping” or using those oil-pens is not safe either.  Those pens just combust the oil so you’re not doing anything safer. 

When I say “inhalation” what I really mean, in practical terms, is flower vaporization.  How is that different from “vaping?”  I’m glad you asked.  While vaping creates toxins just like smoking does, flower vaporization uses a more sophisticated device with a computer brain that controls temperature precisely.  If we then set the device to the correct temperature (350’F, 180’C) we can be reasonably assured that we’re inhaling just the cannabis medicine, and not all those toxic products of combustion.

Oral Ingestion: Slow and Steady, Because It’s A Different Medicine

You’ve gotta love all those websites out there that say if you don’t want to smoke weed, just have a cupcake.  These are the same sites that talk about holistic medicine.  I don’t recommend cupcakes, or anything like that, because if we’re being holistic we need to recognize that most folks don’t need the additional calories in their day that come with cupcakes and brownies and the like.  Small little gummies are much more reasonable.

Remember that I did say we need some orally ingested medicine (aka edibles).  This is not because they’re not a good substitute for inhalation, they act completely the opposite!  Edibles are slow to work but when they do work, they work much longer (8-12 hours).  This makes them our “extended release” medicine.  They’re terrible for that classic Migraine, but perfect for ongoing, unrelenting pain.  

In fact, we know that treating chronic pain with inhaled cannabis can backfire.  Short-acting medications wear off too soon and the brain learns to anticipate the return of pain.  This pain anxiety can lead to worse pain and to over-use of the medication.  A nice, steady pain control is more effective and edibles are how we get there with cannabis medicine.  

For the nerds like me who are reading this, the key here is that edible cannabis is actually transformed in the liver from d9-THC to 11-hydroxy-THC, an entirely different chemical with different chemical behavior.  So, when we take cannabis orally it actually becomes a different 

Bunk Junk in Your Trunk?

What about all the other forms of cannabis that are available?  What about tinctures, concentrates, patches, lotions, suppositories and the like?  In short, I have very little use for them.

Tinctures are a liquid form of cannabis, usually in an oil solution.  It’s said that you place it under your tongue to get it to absorb, but this is false.  It’s only absorbed when you swallow it.  More importantly, it’s a liquid and really easy to dose incorrectly.  A gummy is just more reliable.  Either you took it or you didn’t.

Concentrates are, well, too concentrated.  They make great ingredients in edibles, but aren’t safe or necessary for direct consumption.  If you’re using a concentrate, the chances are you don’t need to, are driving (or have driven) your tolerance up too high, and would do better on a lower dose regimen.  Please reach out if this is you, and we can help get you on a more effective and safe plan.  

Topical treatments like patches, creams, and lotions are just crap.  Cannabis medicine will not go through your skin unless some pharmaceutical-level trickery is employed.  Current cannabis products don’t do this and if they did, they’d likely cause rashes and other side effects like conventional medications do.
The case for suppositories is interesting.  Many have asked me about using rectal suppositories for prostate cancer.  Others, about vaginal suppositories for menstrual pain.  In neither case does this make sense.  Despite our sensory perception that the routes of administrations are close to the body part they are supposed to treat, from a physiologic point of view they’re miles apart.  Reaching the uterus or prostate requires systemic treatment.

That’s Why I Said It’s Boring (But Effective)

As you can see, there is a lot of misinformation and hype out there, all aimed at making a sale.  When I think about what I need to properly treat my patient, again it’s boring.  I need a good flower vaporizer and the flower to go in it, and a well-made 5mg gummy.  That’s pretty close to it.

Consult with a Qualified Boston Medical Marijuana Expert Today 

Those considering using THC, CBD, or any type of medicine found in cannabis to help manage their condition should consider speaking to a trained medical expert who is knowledgeable about using cannabis therapeutically. Massachusetts medical marijuana doctor Jordan Tishler, M.D. sits on the faculty of Harvard Medical School and has years of experience helping patients treat pain and other ailments using cannabis. He and the team at InhaleMD stand ready to assist patients in determining whether medical marijuana is right for them. For more information, or to set up a virtual consultation with the team at InhaleMD, call us at (617) 477-8886 today.

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