Medical Marijuana Basics

How does cannabis treat medical conditions?

The active chemical compounds in medical marijuana are called cannabinoids, and they are secreted by marijuana flowers. The two most well-known cannabinoids are THC (tetrahydrocannabinol) and CBD (cannabidiol), although dozens exist.

Cannabinoids affect receptors in your brain and body, causing the reactions that may provide therapeutic relief. Different strains cause different reactions, but some of the positive short-term effects of medical marijuana can include:

  • Relaxation
  • Pain relief
  • Hunger
  • Drowsiness and sedation
  • Reduction in anxiety
  • Energy
  • Reduction in inflammation
  • Improving moods

Cannabinoids can also come with a host of less therapeutic effects. THC has psychoactive properties that can cause you to feel euphoria, but also anxiety, paranoia, dizziness, etc. CBD tends to balance out these effects. Each plant will have a different ratio of THC to CBD, with different amounts of each cannabinoid total, and these measurements can influence your experience. Every person is unique; your best bet is to try different treatment options until you find what works for you.

Is cannabis safe?

According to The Drug Abuse Warning Network Annual Report, published by the Substance Abuse and Mental Health Services Administration, there has never been a recorded death from marijuana use. [ 1 ] In 1988, Francis Young, a Drug Enforcement Agency Chief Administrative Law Judge, concluded that “In strict medical terms marijuana is far safer than many foods we commonly consume.... Marijuana in its natural form is one of the safest therapeutically active substances known to man. By any measure of rational analysis marijuana can be safely used within the supervised routine of medical care.” [ 2 ]

As for the effects of long-term cannabis use, in 1999, the Institute of Medicine published a report titled Marijuana and Medicine: Assessing the Science Base, [ 3 ] that broke the issue down into two parts: the effects of long-term smoke inhalation, and the long-term effects of cannabinoids on the human body. Their verdict: "Marijuana is not a completely benign substance. It is a powerful drug with a variety of effects. However, except for the harm associated with smoking, the adverse effects of marijuana use are within the range tolerated for other medications.” In other words, the act of smoking can still cause harmful effects, even if marijuana is a safe medical treatment. You do not need to smoke cannabis to receive its therapeutic effects.

Medical marijuana shows particular promise as a replacement for opiates for the treatment of pain. The Center for Disease Control reports that between 1999 and 2015, 183,000 people have died from overdoses related to prescription opioids. [ 5 ] In contrast, there haven’t been any credible medical reports that indicate cannabis has caused a single death.

How to Consume Marijuana

Although smoking may be the most well-known method of marijuana consumption, it’s by no means the only way to go. With countless new products released in a booming market, there are more options than ever for how to find relief.

Here are the four primary methods of marijuana use:

  • Inhalation: Smoking and vaporizing; ingesting through the lungs
  • Edibles: Using cannabis oil in foods, drinks, or pills; ingesting through the digestive system
  • Sublingual Tinctures: Using cannabis products that dissolve in the mouth; ingesting through the mouth’s permeable membranes
  • Topicals: Applying cannabis-infused products to the body; ingesting through skin absorption
Inhalation

To many people, this is the classic method of consuming marijuana, using pipes, joints, or vaporizers. Inhalation has an immediate effect on the body, allowing for quick and personalized dosing that takes effect within 10 minutes and dissipates over the next 30-60 minutes. [ 6 ]

Both smoking and vaporizing cannabis are easy and popular methods of consumption. However, smoking may carry its own risks, and vaporizing is considered safer and recommended more by doctors. [ 7 ]

When you inhale cannabis smoke or vapor, the THC is absorbed into the blood through the lungs, where it makes its way directly to your brain. Concentrations peak in your blood within 5 to 10 minutes. Compare that to the effect of edibles, where THC must first be metabolized by the liver, and converted to 11-hydroxy-THC. [ 6 ] This compound takes longer to create, but is particularly adept at crossing the blood-brain barrier, which can cause a more intense high.

Because inhaling marijuana takes effect and tapers off more quickly than with edibles, new users often find that smoking or vaporizing allows them the most control over their dosage and experience.

Edibles

Like any other kind of culinary herb, marijuana can be used to infuse oils, or extracted and added to everything from candy to butter to salad dressings. Ingesting marijuana through edibles can be a creative and delicious alternative to inhalation, although the way your body processes it is very different.

Before the THC in marijuana-infused products can reach your brain, it first must be processed by the liver, where it is turned into 11-hydroxy-THC. This compound is efficient at crossing the blood-brain barrier, resulting in a more intense and long-lasting high. Because edibles take the long route to absorption, they can take from 30 minutes to two hours to take effect. The peak usually comes in around four hours, and the high typically lasts for several hours after. [ 6 ]

For patients with chronic, debilitating conditions, edibles can allow you to take fewer doses of medical marijuana, and have steadier relief throughout the day. [ 8 ] The downside is that each batch of infused product can affect the body differently, which means trial and error is necessary to get the dosage right.

If you’re new to edibles, patience is key. Start with a small dose and weight the effects over several hours. Because edibles can cause a more intense and long-lasting high, ingesting too high a dose can throw off your whole day. Better to have slightly too little and increase the dosage next time, than start with way too much and have a bad experience.

Sublingual Tinctures

Medical marijuana can also be ingested orally, but unlike edibles, tinctures bypass the digestive tract. These products are absorbed through the walls of your mouth, directly into your bloodstream, where they head to the brain. Tinctures act quickly, like smoking or vaporizing, but without any inhalation-related health risks. Marijuana extract is suspended in a carrier, like alcohol, vinegar, or glycerol. A few drops of tincture are held under the tongue, where it’s absorbed. If accidentally swallowed, there are no ill effects--it just gets processed like an edible, needing to be metabolized by the liver before taking effect. [ 9 ]

Topicals

Topicals are cannabis-infused ointments, lotions, oils and patches that are used for treatment of pain and discomfort. Just like a salve you’d get from the drugstore, topicals are applied to specific areas of the body, where the cannabinoids are absorbed through your skin. These products don’t cause psychoactive effects like the other three methods of ingestion, which makes them perfect for people seeking cannabis-infused therapy without the high.

Topicals work by tapping into the natural cannabinoid receptors throughout the body. The network of receptors in your skin are called CB2, and topical treatments only penetrate to this level, rather than being absorbed into the bloodstream. That’s why topical treatments are great for localized relief without psychoactive side-effects. [ 10 ]

How will I feel when I consume cannabis?

There are a lot of factors that will influence how you feel when you ingest marijuana, and there is no guarantee that you’ll have the same experience as someone else, even with the same products.

Every strain of marijuana, every batch of product, every type of consumable is different. Some strains give a relaxing effect; others provide energy. Some may cause paranoia or anxiety, while others are useful in treating anxiety.

The best place to start is with the strain. With the guidance of your designated dispensary, identify how you want to feel. Are there particular symptoms you’re trying to treat? Let your dispensary advise you on what strain suits your needs best.

Then, identify whether you’re looking for long-lasting relief or the ability to dose more precisely. Edibles are great for treatment that lasts several hours, but it can be tricky to get the dosage right, and easy to overdo it. Smoking, vaporizing, and tinctures provide quick uptake and relief, with the ability to add a little more and get the dosage just right. But they also wear off faster.

Topicals provide localized relief without being absorbed into the bloodstream, so they can be an excellent choice for treating local pain, with or without the addition of marijuana you take internally.

After your first trip to the dispensary, it’s up to you to track your response. You may find that a particular strain disagrees with you, and choose to try something similar with a more balanced THC:CBD profile. Even if a specific product works great for a friend, your individual chemistry will influence your reaction--which means tracking your own journey is the key to finding what works long term.

What is a strain of cannabis? What do Indica and Sativa mean?

In the same way we cross-breed apples to create new varieties, marijuana has been cultivated for so long that there are hundreds of different strains. Indica and Sativa are two primary species of marijuana plant that create different effects on the body. Indica is generally known to produce a calming, relaxing effect, and is good for anxiety, pain relief and insomnia, while Sativa is known for producing uplifting energy and creativity, and is good for depression and fatigue. [ 11 ]

Hybrid strains combine these two species in different proportions. They’re created by cross-pollinating plants by hand to propagate offspring with the desired effects. Cultivators can cross-breed cannabis plants to create strains with high THC, a more balanced CBD ratio, or to enhance the effect of specific terpenes, etc.

You may recognize strain names like Purple Kush, Acapulco Gold, Girl Scout Cookies, etc. Strains have colorful names to help differentiate them, but across states, cultivators and dispensaries, and even batch numbers, strain names are arbitrary. What matters more than the name of a strain is the information about each batch, like how much THC and CBD it contains, the ratio between the two, and its terpene profile. The information is required to be on the back of all medical marijuana packaging, and will help you choose which strain and batch will suit your symptoms best.

Sources

1 Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits [PDF] 2 United States Department of Justice; Ruling in the matter of Marijuana Rescheduling Petition [PDF] 3 Medicine and Marijuana: Assessing the Science Base; Joy, Watson and Benson [PDF] 4 Americans for Safe Access: Cannabis Safety 5 Centers for Disease Control and Prevention: Prescription Opioid Overdose Data 6 Leafly.com: Ingest or Inhale? 5 Differences Between Marijuana Edibles and Flowers 7 Medicine and Marijuana: Assessing the Science Base; Joy, Watson and Benson [PDF] 8 TheDailyBeast.com: Smoke vs. Snack: Why Edible Marijuana Is Stronger Than Smoking 9 UnitedPatientsGroup.com: Sublingual Delivery vs Oral Ingestion Methods for Cannabis 10 Leafly.com: What Are Cannabis Topicals and How Do They Work? 11 Leafly.com: Sativa vs. Indica vs. Hybrid: What’s the Difference Between Cannabis Types?