Risk of Smoking

Why do I generally recommend against smoking?  Smoking exposes us to a wide array of nasty chemicals from the combustion of the plant material and terpenes.  Most of these nasty chemicals are known to promote cancer, heart disease, high blood pressure, and lung disease.  The overlap in nasty chemicals between cannabis smoke and tobacco smoke is impressive.  Hence I recommend avoiding these when we can.

Interestingly, and in full transparency, cannabis smokers don’t seem to get the same emphysema and lung cancers that we see with tobacco smokers.  You may have heard of the study that Dr. Donald Tashkin at UCLA started back in 1980s following recreational cannabis smokers that has amply demonstrated these differences.  Nonetheless, we clearly don’t understand why these differences should exist given the similarities in the nasty chemicals in both that we’ve already discussed.  Perhaps there are some chemicals in cannabis smoke that mitigate the negative effect found in tobacco smoke, but that seems less plausible.  Perhaps we just aren’t looking at the right harms and cannabis smokers do get something bad from these nasties.  We just don’t know.  Again, this is why I recommend avoiding the avoidable exposure. 

Risk of Dosing

Inhalation as a method of cannabis use poses some risk itself due to dosing effects.  Whether we’re talking about smoking or vaporizing flower, there is a tendency for users to not focus on their dose.  When I teach patients to use cannabis via a flower vaporizer, I teach them to take a “puff” in a specific manner that leads to a consistent dose per puff.  Nonetheless, even if the dose per puff is known, it requires the user to pay attention to how many puffs they take.  This is easily done for many, but for some it is just too easy to not pay attention and puff away.  Very quickly this can lead to taking much more cannabis than intended.  This becomes problematic as higher doses push up tolerance, which then lead to using a still higher dose, and this can escalate the dose ever higher.  At some point these ever higher doses lead to down-regulation of endocannabinoid receptors, malfunction of the Endocannabinoid System, dependence, and even addiction. 

The best way to avoid this vicious cycle is, of course, to use the flower vaporizer with care and to respect your dose.  Counting puffs is not that difficult. 

Bong vs. Joint for Dosing

If someone is hell-bent on smoking (and this article really shouldn’t be used to justify that), the bong does present a better option than the joint. 

When you smoke a joint, you watch much of the smoke spiral off into the universe, lost from being available to help you.  Estimates of how much that may be vary and are not well documented.  However, it appears to be somewhere between 50-70% is lost to the “side stream” meaning into the ether.  This makes understanding how much you’re actually taking in very difficult.  You can do the math, but it’s woefully imprecise. 

Furthermore, most patients and cannabis users are quite cost conscious, so losing >50% of your medicine seems like a dramatic, avoidable waste of money. 

Bongs are different.  Not only do they trap the smoke in a container so that it is not lost when you stop inhaling, and that smoke remains available in that container when you resume inhaling, but they generally don’t stay lit when you cease the inhalation.  This means that much less is lost to the side stream.  It appears that the loss is about 10% – meaning that you get to use about 90%.

Since bongs are so much more efficient, we can do dosing much more precisely.  To do this we start with the dose we need, back calculate how much cannabis needs to go into the bong, and at 90% retention, we have a good idea what you’re getting.  Let me give you an example:

If your dose is 10mg THC, and you buy a 20% THC strain, then 50mg of cannabis equals 10mg THC (here’s the math – 10/0.2 = 50).  You can do the same math with odd percentages too.  If the strain has 17.3% THC, then the 10mg THC dose is 10/0.173 = 57.8mg cannabis.

So if you put 57.8mg of 17.3% THC cannabis into your bong and smoke it, you’ll be getting about 9mg THC which, as they say, is close enough to 10mg for rock and roll. 

Vaporizing is Best

In the end, there’s really no good reason to smoke cannabis.  It’s really an unnecessary risk when you consider that you’re using cannabis as a medicine.  Dosing is really important too, for all the reasons I’ve given above.  So if you must smoke, then a bong at least allows control of dose.  It’s up to you to follow the math (I’ll be happy to help) and to stick to the dosing and timing we discuss in your care plan. 

Consult with a Qualified Massachusetts 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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Read on to learn about two of the most important differences between taking marijuana orally (edibles), and inhaling marijuana (which may involve using a pipe, marijuana cigarette/joint, flower vaporizer, or vape pen).

Smoking or Vaporizing Marijuana vs. Eating Cannabis Edibles

There are clear differences between inhalation (smoking, vaporizing, or vaping) and orally consuming marijuana.  The method of ingestions influences dosing accuracy, time to onset, and duration of benefit. Before using cannabis, you need to know about what to expect from each method of administration.

For acute or episodic problem like a Migraine headache, I generally recommend vaporizing whole cannabis flower as the ideal method of use.  Vaporizing whole cannabis flower is safer than vaping cannabis-infused oils, which have been shown to really be combustion as well as containing heavy metals that are unsafe for human consumption.  Edibles, on the other hand, have really completely difference use cases:  due to the delayed onset, but longer duration of action, they are best used for chronic problems like back pain or arthritis.

Difference #1: Onset and Duration

“Onset time” is how long it takes before the cannabis takes effect. Duration of action relates to how long the benefit lasts after the drug starts to work.  The specifics of your illness will dictate which method is best suited to get you relief.

If you’re using marijuana to treat acute or episodic problems like nausea, you’ll need rapid onset time. When you vaporize (or smoke) cannabis, you begin to feel the effects rapidly (about 10-15 minutes) as THC and other cannabinoids are quickly absorbed into the bloodstream. However, the effects last only about 3-4 hours, which is fine for some issues like a headache where the problem will be resolved when the medication wears off, but not ideal for ongoing problems.

Edibles, on the other hand, take effect much more slowly, due to the way they are absorbed and metabolized, typically about an hour (much like conventional medications).  In fact, because the THC is metabolized first by the liver, we’re actually getting treatment with a slightly different medication.  If you’re using marijuana to treat pain or other ongoing medical problems, this is ideal as the benefits last longer (about 8-12 hours).

Difference #2: Dosing Precision

While cannabis dose can be estimated and controlled when using it by inhalation, using it by oral ingestion is just easier and the dose more precise.  With inhalation, dose estimation requires putting a known percentage THC flower into a vaporizer, taking puffs in a specific manner, and counting the number of puffs taken.  On the other hand, taking a 5mg gummy is as easy as it sounds, and furthermore, the dose per gummy is stated on the package and tested for accuracy prior to sale.

While inhaled cannabis is useful, and necessary for acute or episodic problems, like for example a Migraine headache, attention to dose and number of puffs is paramount.  It is, unfortunately, all too easy to ignore dosing and take mindless puffs, leading to getting much more THC than needed or anticipated.  This can lead to tolerance, dose escalation, dependence, and even developing an addiction.  Edibles generally don’t share this risk as it’s just less likely anyone would take mindless and excessive numbers of gummies.

Medical marijuana dispensaries use finely-calibrated, industrial-grade professional equipment, to achieve accurate dosing for marijuana edibles.  It is a challenge to do this at home, which is why you shouldn’t try to make your own edibles at home.

Ask a Massachusetts Marijuana Doctor if Cannabis is Right for You

At Inhale MD, we are committed to bringing cannabis education and awareness to people across the United States. Our founder, Jordan Tishler, MD, brings to the practice his background as a leading expert and innovator in cutting-edge cannabis therapies. Our vision is to make using cannabis safer and more effective by providing personalized guidance based on the latest research and medical developments.

Using secure technology, our online telemedicine conferences bring expert care into the comfort and privacy of your living room.  To schedule an appointment and learn more about whether a cannabis care plan is right for you, contact Inhale MD online, or call today at (617) 477-8886.

The post What is the Difference Between Eating and Smoking Marijuana? appeared first on Massachusetts Medical Marijuana Doctors: Inhale MD.

Still, we have ample experience that whole cannabis behaves differently from synthetic THC available as an FDA-approved pharmaceutical called Dronabinol.  This could be simply because the synthetic THC is structurally different from plant-derived THC, but has also lent credence to the idea of the Entourage Effect (more properly called the Entourage Hypothesis).

According to the concept of the entourage effect, each of the compounds in the cannabis plant works together with the other compounds to create an effect in the user that is greater than each of the compounds alone. Continue reading from our Massachusetts medical marijuana doctor to learn more about how the entourage effect might work and what it means for medical marijuana patients.

Understanding Cannabis’s Entourage Effect 

The theory behind the entourage effect says that combining the compounds in the cannabis plant creates an outcome that is different than the effect of a single compound consumed by itself.  Essentially, the entourage effect claims that the components in both types of cannabis plants, marijuana and hemp, are greater than the sum of their parts. The compounds act synergistically to draw additional effects out of each component present in the plant.

The entourage effect has led many experts in the cannabis industry to advocate for a holistic, whole-plant approach regarding cannabis products. Instead of isolating one ingredient or compound in the cannabis plant for the patient to use, proponents of the entourage effect recommend using several components that can interact with each other in the patient’s body to create the effect that is most beneficial to their health and well-being.

The cannabis plant is comprised of more than 480 natural components, only about 140 of which are cannabinoids. Cannabinoids are the compounds unique to the cannabis plant and include the popular compounds tetrahydrocannabinol (THC) and cannabidiol (CBD), as well as cannabigerol (CBG), cannabichromene (CBC), and cannabielsoin (CBE).

There is a wide variety of other compounds present in the cannabis plant that could play a role in the effect that marijuana has on a user. Terpenoids, for example, are the compound that give each strain of its marijuana its individual flavor and smell. There are about 120 different terpenes present in the cannabis plants, each of which might interact with the other compounds present in the plant. Other compounds include lactones, steroids, flavonoids, and other elements.

What the Cannabis Entourage Effect Can Mean for You

A recent study that reviewed the evidence for the entourage effect concluded that the concept remains reasonable and that there is some evidence to support this idea, but that it was in no way proven.  So, more research to come.

In the meantime, as we focus on treatments with the most health benefits of cannabis possible for you and your health,  it’s important to pay remember to aim for whole-plant products.  These products are often called “full spectrum”, which means the product contains most of the compounds found in the cannabis plant, including an array of cannabinoids, terpenes, vitamins, fatty acids, proteins, and more. These products are most likely to help users deal with many common ailments, including inflammation, chronic pain, anxiety, depression, epilepsy, and multiple sclerosis.

Consult a Massachusetts Medical Marijuana Doctor

The experts at InhaleMD would like to help patients understand the entourage effect and how it can affect their use of medical marijuana products. If you would like to learn more about how you can utilize the entourage effect to make the most of your own medical marijuana use, get in touch with the Massachusetts medical marijuana doctors at InhaleMD as soon as possible. Call (617) 477-8886 today.

The post What Is the Cannabis Entourage Effect and What Does It Mean to Me? appeared first on Massachusetts Medical Marijuana Doctors: Inhale MD.

You can imagine a very unfortunate scenario in which somebody starts using cannabis to treat their anxiety, but gets bad advice on how to do so which leads to their using cannabis excessively which leads to more anxiety. Needless to say, then they use more cannabis which leads to more anxiety and now we have a vicious cycle. This is exactly what we need to avoid.

The key, then, is to avoid the pitfalls that are so commonly seen and repeated in the cannabis using community. This means careful attention, again, to dose and timing.

The Effect of Cannabis on Anxiety

Cannabis works by interacting with our internal signalizing system called the Endocannabinoid System.  This system is responsible for a wide range of processes including mood, sleep, pain, memory and others.  It interacts with other important systems like the serotonin, dopamine, glutamate, and opioid signaling pathways. 

Using cannabinoids judiciously can strengthen the functioning of these systems, but improper use can undermine the balance between all these important functions and create a downward spiral. 

Long-term Studies

Most of the science about cannabis for anxiety is deeply flawed.  This is largely due to the legalities impeding proper study which has led to studies that do not appropriately account for dose and timing.  In sorting through the vast number of these studies, it’s critical to evaluate the methodology to see if there is any attention to these important factors. 

Naturalistic studies have demonstrated that excessive use of cannabis can lead to decreases in school/work performance.  Day time use of cannabis has been implicated in this dysfunction as well.  Similar research has demonstrated that excessive use can worsen both anxiety and depression, leading to that vicious cycle mentioned above.  

More recent studies have shown two interesting phenomena:  lower doses are more effective and do not seem to provoke worsening anxiety, and that dosing around bedtime avoids day time use and provides benefit throughout the next day.  The meaning of these observations is that low-doses can be helpful, and less likely harmful, and that the effect of cannabis on anxiety isn’t directly tied to being intoxicated (being stoned).  In fact, the intoxication can be fully viewed as a side-effect to be best slept off overnight. 

Comparison to Conventional Medications

It’s also clear that the benefit of cannabis for anxiety and depression is fairly weak.  It is perhaps similar to a starting dose of an SSRI.  Some people do get the benefit they need at those starting doses of conventional medication, and so low-dose cannabis may be an alternative for them.  However, most people will need more of that conventional medication and for them cannabis is not a good substitute.  

Importantly, this is not an either/or situation.  Cannabis can be used safely and effectively as an adjunct to conventional medications providing both some additional effectiveness for the treatment of the anxiety, and also helping to undo some of the negatives that come along with conventional anxiety medications (like ennui, and various sexual side effects).

Seeking Help

As we’ve discussed, the dose and timing of that dose is critical to safe and effective treatment of anxiety.  Furthermore, we’ve noted that for anxiety and depression, more than for other conditions, the approaches to treatment being discussed among lay-people are incorrect and likely to create that vicious cycle of ever-increasing anxiety.  To avoid those pitfalls, dose and timing are the crucial elements, as is getting proper medical guidance and follow-up.  

Your healthcare shouldn’t be a DIY project like painting the spare bedroom or washing your car.  The consequences of getting it wrong are far worse and long-term.  Please seek real medical care. 

Consult with a Qualified Massachusetts 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.

The post Effects and Risks of Using Medical Marijuana for Anxiety appeared first on Massachusetts Medical Marijuana Doctors: Inhale MD.

What is a Seizure?

In order to understand what a seizure is, we need to discuss epilepsy and what it entails. According to the Centers for Disease Control and Prevention (CDC), “Epilepsy is a disorder of the brain that can cause seizures… Epilepsy can affect people in very different ways… because there are many causes and many different kinds of seizures. Some people may have multiple types of seizures or other medical conditions in addition to epilepsy. These factors play a major role in determining both the severity of the person’s condition and the impact it has on his or her life.”

As stated above, epilepsy can be caused due to different brain conditions that directly affect a person’s life. Although the specific underlying causes of epilepsy are unknown, the following are commonly associated with this debilitating illness:

• Head Injuries and Traumatic Brain Injuries (TBI)
• Strokes
• Brain Tumors
• Meningitis
• Encephalitis

Types of Seizures Caused by Epilepsy

Seizures are generally divided into two main categories known as “Generalized” and “Partial” seizures. Generalized seizures happen as a response to electric impulses produced throughout the entire brain. Different from generalized seizures, partial seizures are caused by electrical impulses originating in a specific or focused part of the brain.

Both categories contain subcategories of seizures. For instance, examples of generalized seizures include:

• Absence: Also known as “petit mal,” this type of seizure causes a short period of blank staring, affecting a person’s awareness. During this moment or lapse of time, the person may not be aware of what is happening around him or her.
• Myoclonic: The myoclonic seizure can cause the sudden movement or jerking of a muscle or group of muscles. Many people suffering from this debilitating condition will suffer from sudden movements of muscles on both sides of their body.
• Clonic: This type of seizure involves the sudden movement of muscles, accompanied by muscle stiffness and rigidity.

Examples of partial seizures include:

• Focal Aware Seizures: This type of seizure begins on one side of the person’s brain and the individual experiencing the seizure episode has no loss of awareness.
• Focal Impaired Seizures: Also known as “complex partial seizures,” focal impaired seizures cause the person to be unaware of what is happening, as opposed to focal aware seizures.

Common Epileptic Seizure Medications

Medications available to treat epilepsy are known as “Anti Epileptic Drugs,” or AEDs. AEDs are divided into two categories depending on the type and severity of the epilepsy. These categories are:

• Narrow-Spectrum AEDs: This type of medication is exclusively designed to treat epilepsy that originates in a specific part of the brain, and is not meant to treat every kind of epilepsy. It is always wise to consult a physician who can properly diagnose your type of epilepsy and if narrow-spectrum AEDs are best for you. Some common AEDs include:
  • Clobazam
  • Diazepam
  • Gabapentin
  • Pregabalin
  • Vigabatrin
• Broad Spectrum AEDs: Different from Narrow-Spectrum AEDs, Broad-Spectrum AEDs are designed to treat epilepsy that surfaces in multiple parts of the brain, hence the term “broad.” As stated before, in order to know what type of medication is more appropriate for you, consulting your physician is of utmost importance. Examples of Broad-Spectrum AEDs include:
  • Clonazepam
  • Clorazepate
  • Lorazepam
  • Topiramate
  • Valproic Acid

Medical Marijuana as a Treatment for Seizures

As shown above, epilepsy is commonly treated with prescription medications. However, many people may wonder if there is an alternative method that can help to reduce the symptoms commonly associated with this debilitating illness – particularly patients whose epilepsy does not respond to, or is not significantly improved by, conventional treatment methods.

Recent studies suggest that the use of cannabis can help to alleviate epileptic symptoms. For instance, a study published by the Journal of Epilepsy Research, which analyzed the results of three therapy trials involving purified CBD (one of the most researched components in cannabis), found the following of patients with different epileptic syndromes: “For the first time, there is now class 1 evidence that adjunctive use of CBD improves seizure control in patients with specific epilepsy syndromes.”

How Does Medical Marijuana Treat Seizures?

In order to understand how medical marijuana works, it’s important to understand cannabis itself. It’s also important to understand that medical cannabis is not a “miracle cure,” and it has not been proven to cure epilepsy. However, medical cannabis has some properties that can help – alongside your treating physician’s recommended medication – to alleviate symptoms associated with this disease.

Cannabis has more than one hundred components. The most researched are tetrahydrocannabinol (THC) and cannabidiol (CBD), which was used in the aforementioned study. THC is the psychoactive component found in cannabis that is most associated with the commonly-known “high.” CBD, on the other hand, has no psychoactive effects. While many of marijuana’s medical benefits are strongly attributed to THC, CBD can also act as anti-inflammatory and anti-anxiety agent.

It is precisely the latter which has the potential to treat epileptic seizures. This is because our nervous system contains what is known as the “endocannabinoid system.” Our body produces its own set of natural cannabinoid receptors, which is why components found in cannabis affect our feelings, sensations, and functioning. When cannabis “activates” the endocannabinoid system, it disrupts the abnormal brain signaling that causes seizures. As another study published in the Handbook of Experimental Pharmacology notes, “[E]ndocannabinoid signaling limits abnormal network activity as a central component of the synaptic circuit-breaker system…”

One of the staple cases that showed medical cannabis can help treat seizures is the Charlotte Figi case. Figi, a resident of Colorado, suffered from continuous seizures. After many attempts at treating the girl’s condition, her parents decided to give her medicinal cannabis high in CBD. To their surprise, the girl’s seizures were reduced from 300 grand mal seizures per week to only two or three seizures per month.

While this case can illustrate medical cannabis’ ability to help treat seizures, it cannot be taken as the one and only case to follow if you suffer from this condition. Always make sure to talk to your physician and receive the appropriate guidance to see if cannabis can help you alleviate your illness’ symptoms.

Medical Marijuana Doctor Serving Massachusetts

There are many people in the United States who suffer from epileptic seizures. While using medical cannabis will not cure this illness, it might provide assistance in alleviating its symptoms. You should always – we cannot stress this enough – consult with your treating physician to see how medical marijuana can help you.

If you wish to learn more about the benefits of medical marijuana, contact Inhale MD online, or call us at (617) 477-8886. We are conveniently located in Brookline and Cambridge, serving residents from the Boston area and beyond. We also offer confidential online sessions.

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What Is Cannabis Oil?

Cannabis oil is, to put it simply, the oil derived from the cannabis plant. There are two types of cannabis plants — hemp and marijuana — and each can have oil extracted from it. The main difference between hemp and marijuana plants is the level of tetrahydrocannabinol (THC) content. THC is the psychoactive substance that creates a feeling of being high.

Hemp plants contain a low amount of THC (no more than 0.3%) while marijuana plants have a much higher amount of THC, typically between 5% and 15%. However, both plants have similar amounts of cannabidiol (CBD). Since the two varieties of cannabis plant have different THC levels, the oil from each plant will have slightly different effects on users. Talk to your doctor before incorporating cannabis oil into your lifestyle.

Types of Cannabis Oil

Different oils can be derived from the different varieties of cannabis plants, hemp and marijuana. Oils derived from cannabis plants will have different levels of the two main compounds found in cannabis plants: THC and CBD. While certain oils can have both in differing ratios, THC and CBD are the two main types of cannabis oil that are available to consumers.

In the past few years, CBD oil has begun to receive more attention and is now accepted as a mainstream option for soothing the symptoms of certain conditions. CBD is appealing to many users because, although it is derived from marijuana (and hemp), it does not have any of the psychoactive effects commonly associated with cannabis.

Since there are no psychoactive effects associated with CBD oil, it only creates a calm, peaceful effect on those that use it. CBD oil works by interacting with the receptors in the endocannabinoid system, which are found in the nervous system, the digestive system, the brain, and throughout the body while positively impacting the functions of serotonin receptors and the hippocampus.

CBD is popular with consumers because it has proven to be beneficial for a variety of ailments. Firstly, using CBD to treat anxiety and other anxiety-related conditions including post-traumatic stress disorder, social anxiety, panic disorders, or moderate depression is extremely frequent. Also, CBD for chronic pain relief is another common use. CBS oil can reduce inflammation and speed up the healing process for damages muscles. It is also known to be an effective treatment for epilepsy, as well as other conditions such as Parkinson’s disease, Huntington’s disease, and glaucoma.

THC oil is the other type of oil that can be derived from cannabis plants. It has psychoactive effects, which means that it is responsible for the feeling of being “high” that is commonly associated with marijuana. It affects the brain by interacting with certain neurotransmitters.

THC oil can induce a sense of relaxation in users, as well as altered senses of sight, smell, and hearing, and increased levels of hunger. For these reasons, it is commonly used by people dealing with the negative side effects of chemotherapy, which include depression and anxiety, pain, and loss of appetite. THC can also be used to deal with the pain and discomfort brought on by other conditions such as multiple sclerosis, HIV/AIDS, spinal injuries, digestive issues, and substance abuse disorders.

How to Use Cannabis Oil

CBD oil and THC oil can be consumed in many ways, depending on what suits the needs of the individual. The following are ways that cannabis oils can be consumed:

• Sublingual tinctures – You can take cannabis oil by placing a few drops of an oil tincture under your tongue and keeping it there for 30 seconds before swallowing. Oil tinctures are made by soaking the cannabis flower in oils or alcohol for an extended period of time.
• Ingestion – Another easy way to consume cannabis oils is to ingest them in the form of an edible or other food or drink product. There are many delicious edible products on the market (including easy-to-eat gummies, candies, and mints), though it’s also possible to make edibles at home using cannabis oils. This method takes longer to work but provides longer-lasting effects.
• Topical application – Applying CBD or THC oils in a balm or lotion is another way to consume them, though the efficacy of this method is questionable at best.
• Inhalation – Breathing in vaporized cannabis oil is the quickest way to consume it, and it produces an almost immediate effect. However, this method is also the most likely to cause irritation of the lungs.

Get in Touch with a Boston Medical Marijuana Healthcare Professional Today

If you would like to learn more about how to how can use cannabis oil or any other cannabis derivative, such as THC or THC-A, you are encouraged to contact Boston medical cannabis expert Dr. Jordan Tishler for more information. To schedule a consultation with Dr. Tishler and the team at InhaleMD, call (617) 477-8886 at your earliest convenience.

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