Let’s face it, we all know someone, or many someones, who use cannabis. Maybe it’s a friend, or cousin, or your kid. Maybe it’s your sister, the nurse – surely she knows. Whoever it is, the likelihood is that they are free with their advice, but sadly, not very knowledgeable of the medical facts. As it turns out, much of the common cannabis knowledge is just medically wrong. This wrong advice can come back to haunt you so let’s look at some of the bad advice that’s out there.
Start Low and Go Slow
This is a common refrain in the cannabis world. On the surface it seems like good, common-sense advice. Who could argue with this? I guess that’d be me.
As with most things in medicine, the devil is in the details. What does it mean to start low? Is low 1mg THC, 5mg THC, 50mg THC? The answer is that it depends. 50mg is not low by any standard, but 5mg is low enough for most people to start. Of course, there are some people for whom 5mg might not be low enough and only a thorough assessment of their situation will determine where to start them.
While we’re starting low, how often is low? Even if it’s clear that, say, 5mg is low enough, should someone take it daily, nightly, twice or three times a day, or whenever they want? The frequency of administration will be just as important to the outcome as the dose itself. Five milligrams 3 times a day is very different from once a day!
Certain illnesses will require dosing multiple times a day. For example, treatment of chronic pain. On the other hand, treatment of anxiety and depression would likely be made worse by administration on that schedule, and should be addressed with only once nightly dosing.
So, you see, “start low” just isn’t specific enough to be good medical advice. Similarly, what does “go slow” really mean?
If you need to increase your dose, how quickly should you do that? For that matter, how sure are you that you should increase the dose? And, what is the upper limit? It’s not clear that the cannabis world understands that there is such an upper limit.
All medicines have certain properties that affect the answers to these questions. For examples, you should usually not increase your medicine just because you aren’t “feeling it”. A more appropriate and sophisticated medical approach depends on what we’re treating and assessing the benefit to that. If you did need to increase the dose, taking time at the lower, less effective dose is still beneficial because your body and mind are adjusting to the medication. Going from 5mg to 10mg after a week on 5mg is going to be a whole lot smoother than jumping up after only a day or two.
While therapeutic ranges for cannabis are less well defined than for conventional medications, there is still a range that can be defined as more effective and safer than “whatever”. In general, my experience is that 10mg per dose is an average and that 20mg per dose is a general upper limit, though that has exceptions too. Since cannabis can be addictive, I would never leave a patient to increase their dose with no limits and no follow-up guidance. That’s just not good medicine. In fact, I’d say you shouldn’t take advice from anyone, MD or not, who isn’t going to follow you and be there for additional guidance and to help if things go awry.
Everyone Is Different
On some level this is a no-brainer. Of course we’re all different, we’re individuals. Yet, on a deeper level this statement isn’t very helpful and, frankly, appeals to our narcissism. In our need to feel important, we’re discarding all the information and guidance that we can glean from the science and experience of other people.
Furthermore, this statement is often used to dismiss guidance from knowledgeable practitioners, like me, who are trying to help patients based on that science and years of clinical experience.
Such statements are also often used to denigrate conventional medicine and physicians. You know, we’re all in the pocket of “big pharma” and only apply “cookie-cutter medicine” for all patients. Whereas, of course, cannabis is “personalized” medicine.
In essence, however, these statements play into the hands of an industry that would like you to f-around with your cannabis medication, buy lots of different products, use them willy-nilly, and ultimately develop tolerance, dependence, or even an addiction. All of those suit their bottom-line just fine.
Cannabis is Safe. It’s Natural.
People often come to me saying they want to use cannabis for such and such illness, “because it’s more natural” than whatever conventional medication they’re on or were recommended. To this I usually reply, “cobra venom is all natural too, but it doesn’t mean that it’s any good for you.” In reality, the idea that natural things are good and human made things are bad is just BS. I often say, “I don’t care if it comes from a plant, or a plant in New Jersey”. It’s all chemistry. It’s either used wisely or its not.
Similarly, it’s really untrue to say that cannabis is safe. The comparison is often made between cannabis and opioids, or cannabis and alcohol, and while cannabis is likely safer than either of those two substances, the key word here is “safer” not safe. Anyone telling you cannabis is safe is trying to sell you cannabis products and hoping you’ll develop problematic use. Anyone recommending that you use cannabis should be discussing the real risks as well as possible benefits.
Maybe I Should Just Avoid Cannabis?
Please don’t let this discussion and the misdeeds of the cannabis industry deter you from seeking medical care for your illness(es). The point is that cannabis is relatively safe, can be very effective for certain problems, and most importantly, if used with the guidance of someone who knows what they’re doing and doesn’t have skin in the game of selling you products, is most likely to be beneficial while minimizing the risk.
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.