If I had a nickel for every time a patient said to me, “Doc, give me the kind of weed that won’t get me high,” well, you know the rest.  Similarly, if I had nickels for every time I’ve had a medical colleague say, “medical cannabis is ok as long as it doesn’t get my patient high,”… The problem here is that both of these statements reflect and reinforce stigmatized and overly simplistic thinking that ultimately stands in the way of patients getting the care and benefit they need.  

I don’t recall any patient, or doctor, ever saying to me that benzodiazepines would be ok since they don’t get you high (and they certainly can). I don’t recall anyone criticizing SSRIs because they alter your mood – that’s the whole point – but it’s ok if it’s an SSRI and not so much if we’re talking about cannabis.

Many medications affect mood and cognition.  So do many illnesses.  Have you ever had pneumonia, the flu, a urinary tract infection, or diverticulitis?  These make you feel quite lousy and affect your judgement as well as your ability to drive.  So do the antibiotics that you might be given to treat some of these diseases.  Bactrim, Cipro, and Amoxicillin, just to name a few, all make you feel bad and affect your thinking negatively.  We take them because they ultimately make us better (and feel better).  Nobody gets worried about using those medications when they’re needed, despite their obvious intoxication. 

All medications have side effects.  In fact, since all medications alter basic biological function of an organism, they can be defined as toxins.  The difference between danger and benefit is in how they are used.  Within a specific range of dose and frequency, medications can be safely used for benefit (This is called the Therapeutic Index).  Outside that range, medications are either ineffective or dangerous. 

Cannabis and cannabinoid medications are no different.  Within specific ranges of dose and frequency cannabis can be useful and effective; outside that range we see trouble. 

Similarly, cannabis always comes with some modicum of intoxication.  It’s just a side effect of the THC contained in cannabis.  However, it’s that very same THC that causes the benefits for which we’re using cannabis. [As an aside, there may be use for other cannabinoids from cannabis that do not cause intoxication, like CBD, CBG, CBN.  However, those uses have yet to be proven in human beings despite the current popularity of some of those elements.]

Our goal then, with cannabis as with all medications, is to use it for the correct reasons, with optimal dose and timing, and within the context of appropriate follow-up care.  In taking this common medical, “less is more” approach we maximize the chances for benefit and minimize the risk of adverse effects. 

For example, cannabis is frequently touted as a treatment for anxiety.  In fact, we do have evidence that cannabis can help with anxiety.  We also have evidence that it can provoke anxiety.  How can it do both?  It’s all about the dose.  Low doses are effective, higher doses can backfire.  

Furthermore, timing is important too.  Common wisdom is that to treat anxiety with cannabis you use cannabis whenever you feel anxious throughout the day.  This is completely wrong!  Studies have demonstrated that day-time use for anxiety can decrease school and work performance, and can actually worsen anxiety.  The optimal approach is a low dose given in the evening, typically right before bed.  

What more is there to say?  If we can get benefit and minimize risk, we need to accept that utility for our patients, and also accept that this medication has side effects, including intoxication, just like all other medications.  

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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