MEDICAL MARIJUANA DEMYSTIFIED
CANNABIS EXISTED ON this earth long before we did. One of the oldest cultivated crops, it has proven to be a resilient and extremely versatile plant. Not only can it be used to create useful material goods, but it can also aid in the treatment of cancer, Alzheimer’s disease, posttraumatic stress disorder (PTSD), multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), nausea, HIV and AIDS, Crohn’s disease, glaucoma, epilepsy, and a growing list of other health conditions. While new research continues to emerge on an almost daily basis, there is still a long way to go to fully understand the many benefits of this amazing plant.
A POPULAR NEW PRESCRIPTION
“The evidence is overwhelming that marijuana can relieve certain types of pain, nausea, vomiting, and other symptoms caused by such illnesses as multiple sclerosis, cancer, and AIDS—or by the harsh drugs sometimes used to treat them. And it can do so with remarkable safety. Indeed, marijuana is less toxic than many of the drugs that physicians prescribe every day.”
—Dr. Joycelyn Elders, public health administrator, former US surgeon general22
Between 1987 and 2014, the percentage of people who believed marijuana to be “morally wrong” fell from 70 percent to 35 percent.23 This drastic shift in public opinion has been one of the biggest catalysts in the pro-legalization efforts. A 2013 poll found that 77 percent of the overall public believed cannabis to have legitimate medical uses.24
Just 10 years ago, cannabis was an underground drug and the primary focus of the Drug Abuse Resistance Education’s popular “Just Say No” campaign. There was no recognized medicinal use, and it was a prominent target in the war on drugs. While marijuana is still classified as a Schedule I drug and is federally illegal, the states that have instituted a medical or recreational market have created a haven for its use and decriminalized the drug. The approved criteria for medicinal usage differs slightly state by state as presented in the previous section. As new studies emerge, new criteria and conditions are added to the approved list for medical usage. In California alone, 5 percent of the population uses medical marijuana, and that number is continuing to increase.25
Current research on marijuana’s efficacy is ongoing, and newer, more potent strains continue to be developed. In other words, the marijuana that people smoked in the 1960s is not what you will find on the market today. As investors pour money into this booming market and cultivators experiment with growing techniques and crossbreeding, marijuana continues to change in potency and strength. NORML fiercely scours new publications and research for unbiased, well-run studies, surveys, and experiments that provide new information on marijuana. To keep up to date on all future research and findings, we suggest that you subscribe to NORML’s newsletter. You can also check out the list of reputable sources here as well as the NORML webpage: norml.org/library/recent-research-on-medical-marijuana. Also, consider giving the book Stoned: A Doctor’s Case for Medical Marijuana by David Casarett, MD, a read.
If you are interested in treating your own condition with medical marijuana, it can be hard to know where to start. Talk to a trusted doctor who knows your healthcare history, if possible. Being able to show an existing doctor–patient relationship and history of a particular condition may be required for your state’s medical marijuana program.
If you don’t have an existing relationship with a physician, talk with your NORML community for recommendations. Always check if a particular doctor is covered by your health insurance provider. A good physician should be open to hearing about any alternative healthcare treatments you are interested in pursuing. If a physician brushes off your inquiry or denies it for personal reasons, seek a second opinion.
When you want to bring up the subject of cannabis with your doctor, bring your state’s medical marijuana guidelines and list of approved medical criteria. Also bring along some research relevant to how medical marijuana can treat your health condition. If you already have your marijuana medical card, check out chapter 3 for practical information about finding dispensaries and figuring out the delivery method that is best for you.
“I am very glad to hear that the Gardener has saved so much of … the India Hemp … The Hemp may be sown anywhere.”
—George Washington, first president of the United States, in a letter to his farm manager, William Pearce, in February 1794
The amazingly useful cannabis plant has been growing on this planet long before humans learned of its benefits. Outside of its medical and recreational usage, cannabis is used to make textiles, rope, fiber, paper, biofuel, and food. In fact, the word canvas comes from the root word cannabis. As its common nickname weed might indicate, this plant can be grown just about anywhere as long as it is exposed to a consistent temperature that is not too cold and has adequate light and food.
Cannabis is a flowering plant that includes at least three species: sativa, indica, and ruderalis. (Sativa and indica are the species profiled in this book; ruderalis is not commonly grown in the United States for medicinal purposes.) The plant is an annual, meaning it completes its life cycle within one year. It is also dioecious, meaning that male and female organs are found on separate plants, although some plants can become hermaphroditic under certain conditions. The female plant produces the flower, or the buds, as they are known in the cannabis world. The flowers are the richest source of the chemical compounds in cannabis, so the males, which produce the pollen, are generally used just for breeding purposes.
On average, a Marijuana plant takes 3 to 4 months to mature for harvesting. After harvest, the flowers are prepared for their intended use, whether it be via smoking, vaping, ingesting, or topical application. If the plant is going to be smoked, the bud will be dried and cured before it is ready. If you’re going to use a vaporizer, you will use ground-up, dried buds or an oil concentrate (extraction) made from the cannabis buds. Many people prefer vaporizers because there is no harsh smoke; the vapor is generally cool and easy on the lungs. If you intend to use the cannabis for cooking, the buds are generally cooked in butter or oil. As they cook, tetrahydrocannabinol (THC) and other cannabinoids are released and attach to the fat in the oil or butter. Cannabinoids are the active chemical compounds in Marijuana. Tinctures can be made for oral ingestion by steeping the cannabis in alcohol or vegetable glycerin. For easy recipes and remedies you can make at home, go to part 3 of this book.
Cannabis goes by many names; the most common are Marijuana, hemp, and hash. Names for cannabis are always changing. Throughout its history, it has been known by a wide range of interesting slang terms such as weed, grass, dope, bud, pot, maryjane, skunk, schwag, kush, wacky tobaccy, bhang, dank, herb, reefer, chronic, weird, sticky-icky, cheeba, ganja, and Aunt Mary (a personal favorite of ours). As you’ll soon discover, the various strains have some interesting names as well.
The Parts of the Plant
Marijuana plants can be male, female, or both. Females produce the flowering buds, while males produce pollen. When pollinated, the female will produce seeds. This also reduces the quantity of buds. Males are isolated or destroyed unless breeding or seed production is the goal. Fan leaves extend off the stem up until the main cola, or terminal bud. The bud, or calyx, has the highest concentration of trichomes. Trichomes are resin-filled glands that contain THC.
People primarily use the bud for medicinal purposes. You can also use shake, or small pieces of bud. The iconic fan leaves are the least potent and generally aren’t used. Small leaves close to the buds, called sugar leaves, are useful in extractions. Just like buds, they are coated in trichomes. The stem isn’t very potent, but it does contain cannabidiol (CBD). The stem is used in commercial hemp production.
Popular Uses of Cannabis
When most people think of Marijuana, they think of its recreational use. But ancient records also point to industrial, medicinal, and ceremonial uses of Marijuana by many cultures throughout history. The same range of applications for cannabis continues today.
Industrial Hemp, a nonpsychoactive variety of cannabis, is made from the stalk of the plant. It’s a renewable resource used in thousands of products. Considered the world’s oldest domesticated crop, it can be used to make paper, rope, fabric, biofuel, beauty products, and food. Cannabis came to the New World on the Mayflower—hemp fiber had been used to make the ship’s sails and ropes, and hemp seeds were in the cargo. The colonies were actually required to grow hemp because of its necessity to everyday life. In fact, the Declaration of Independence and Betsy Ross’s American flag were both made of hemp. In 1970, the Controlled Substances Act banned all forms of cannabis, even hemp, by classifying it as a Schedule I controlled substance. However, the Agricultural Act of 2014 made it possible for states to regulate their own hemp legislation. States such as Kentucky, Colorado, and Oregon are already growing this renewable, sustainable, and versatile product.
Ceremonial The use of cannabis in a ceremonial and spiritual context dates back many thousands of years. In India, a drink of cannabis, milk, nuts, and spices was consumed at the Hindu festival Holi to celebrate the god Shiva, who, as legend goes, created cannabis from his own body. Taoist texts from the fourth century mention using cannabis in incense vessels for meditation and spiritual needs.8 Ancient German pagans associated cannabis with Freya, the goddess of love. It was believed that Freya lived in the flowers of the plant, and by ingesting them, one possessed Freya’s divine powers.9 In modern culture, the Rastafari movement has embraced cannabis as a sacrament and consider it to be the tree of life. Anecdotally, many people today use cannabis for meditative purposes.
Recreational Marijuana is the third most popular recreational drug in the world, just behind alcohol and tobacco. In the United Sates, the percentage of people who report smoking Marijuana has doubled over the last decade. While many of these people are using cannabis for medical purposes, most are recreational users. That means they use cannabis for its psychological and physical effects, which include relaxation, euphoria, introspection, and creativity. Four states—Washington, Oregon, Colorado, and Alaska—along with the District of Columbia have legalized the recreational use of Marijuana. A 2015 poll revealed that 58 percent of Americans believe Marijuana should be legal, the third year in a row that the majority has been in favor of legalization.10
Medical One of the oldest written records of cannabis use dates back to 2700 BCE in China, in the form of an ancient healing book. The ancient text indicates the use of cannabis in treating a number of disorders, including rheumatism, gynecological disorders, and absentmindedness.11 In the late 1800s, cannabis became available at drugstores across the United States in liquid and hashish form. In fact, an 1862 edition of Vanity Fair advertised a hashish candy for the treatment of nervousness, weakness, confusion, and melancholy. “Under its influence all classes seem to gather new inspiration and energy,” it boasted.12 When we talk about Marijuana in this book, our focus is on its use to treat or prevent a wide range of health issues, from reducing nausea and stimulating appetite to relieving pain and easing muscle spasms … and much more.
In 2015, there are 23 states plus the District of Columbia with medical Marijuana programs. A person must apply for a medical Marijuana card with records of an approved illness from a physician recommending cannabis as a treatment. See the Medical States section (here) for a list of states with medical Marijuana programs. Doctors can’t legally “prescribe” cannabis, as it is still classified as a Schedule I drug, but they can recommend its use.
THOUGHTS AND EXPERIENCES
For the last six months my dog has been eating dog biscuits made with Marijuana. We give her one in the morning and another in the late afternoon. They cost about 50 cents a biscuit. The vet suggested we try her on Marijuana because she is allergic to the pain-relieving pills made for dogs. When we rescued her, we knew she had bad hips and was already starting to have trouble walking. But her condition got bad fast, and we were so upset to discover that the traditional medication made her sick. The biscuits have been working very well; in fact, the difference is huge. I might try to make the biscuits myself after doing some research. I have never tried Marijuana, and I can hardly believe that my dog is the one in the family uses it. —Richard S., Oregon
The Naming of a Strain
Once just referred to as “bud,” the list of commercially available strains today is huge and increases with each new harvest. Every strain originates as a unique plant that is crossbred over many generations. Some names describe the genetics and effects of the plant, while others are feats in pure creativity. Don’t be put off by some of the strange names. It isn’t the name of the strain that matters, but the beneficial effects the strain can impart. There is really no way to verify that a strain you are purchasing actually originated from the source plant, but reputable dispensaries will make an effort to ensure the authenticity of their products and label them appropriately.
When you enter a Dispensary, you’ll generally notice three main categories of cannabis: sativa, indica, and hybrid. Hybrids can be further categorized into sativa-dominant hybrids, indica-dominant hybrids, or split hybrids. Until very recently, it was believed that sativas have energizing, uplifting effects, indicas impart more relaxing, full-body therapeutic experiences, and hybrids create observable effects that fall between the two.
But when it comes to the efficacy of medical Marijuana, there is an emerging school of thought that believes the classifications of sativa, indica, and hybrid are not as important as we have come to believe over the past several decades. In fact, some contend that the differences we experience between sativas and indicas are a result of the placebo effect and confirmation bias. “The data shows that indica and sativa is just morphology,” said Jeffrey Raber, PhD, in an interview with LA Weekly. “It’s a misperception that indica will put you to sleep or that sativa is more energetic.”13 In an analysis of 494 flower samples, Dr. Raber found no evidence that strains labeled indica and strains labeled sativa were chemically distinct entities.14
Nevertheless, in today’s Marijuana market, cannabis plants are still largely classified as indicas, sativas, or hybrids, and as new consumers, you’ll need to be familiar with the way cannabis strains are presented. Because of this, we follow conventional indica, sativa, and hybrid classifications when we walk you through profiles of various strains in part 2 of this book.
It is also important to be aware that some growers and sellers may accidentally or even purposely mislabel a strain with a more popular strain name to increase sales and revenue. (Yes, some strains are more expensive than others.) Additionally, the same strain between two growers may have widely differing observable effects, due to variations in climate, soil, light, and food. When picking out a strain to try, remember that you cannot accurately base your selection solely on the indica, sativa, hybrid classification or the individual strain’s name. Instead, it may be more helpful to focus on other ways of identifying the strain’s benefits, such as the breakdown of chemical compounds found in the strain.
The emerging thought today is that the range of effects produced from different cannabis strains comes down to the levels of cannabinoids and terpenes, the chemical compounds found in the plant’s resin secreted by the trichomes. “There are biochemically distinct strains of Cannabis, but the sativa/indica distinction as commonly applied in lay literature is total nonsense and an exercise in futility,” reported Ethan Russo, MD, a world-renowned cannabis researcher, in a recent interview with the journal Cannabis and Cannabinoid Research. “It is essential that future commerce allows complete and accurate cannabinoid and terpenoid profiles to be available,” advises Dr. Russo.15
The best-known cannabinoid in cannabis is tetrahydrocannabinol (THC), the compound responsible for the plant’s psychoactive effects. However, it’s merely one of an estimated hundred compounds that we know of. Quickly gaining popularity is cannabidiol (CBD), a nonpsychoactive compound that possesses anticonvulsant, anti-inflammatory, and antianxiety properties and actually counteracts the high from THC. Current medical research is focusing on CBD in the treatment of epilepsy, Crohn’s disease, PTSD, and multiple sclerosis. Cannabigerol (CBG) is also growing in importance. CBG has been shown to kill cancer cells and inhibit tumor growth, and may help treat glaucoma and inflammatory bowel disease.16
Although recent research has focused on the cannabinoids of Marijuana, terpenes are the next frontier. Like cannabinoids, terpenes are oily compounds secreted from the trichomes of the plant. They give different cannabis strains their distinct smells. Unlike the marijuana-specific cannabinoids, terpenes can be found throughout the natural world in our fruits, vegetables, herbs, and spices. We already consume them every day (black pepper, anyone?). There are more than 200 different terpenes found in cannabis, and the terpene profile of a particular strain is thought to play a role in that strain’s effects. For example, myrcene is a terpene found in many strains and is known to be a sedative, muscle relaxer, and painkiller. It is also used for its anti-inflammatory effects. In addition to Marijuana, it can be found in sweet basil, thyme, lemongrass, hops, and mangos. One cannabis strain that is high in myrcene is White Widow.
Despite the new focus on cannabinoids and terpenes, many people still have strong preferences for certain sativas or indicas. You might think of it like a preference for red wine over white wine. It can be as simple as that!
THE STATE OF MEDICAL MARIJUANA TODAY
“[Marijuana] doesn’t have a high potential for abuse, and there are very legitimate medical applications. In fact, sometimes Marijuana is the only thing that works … It is irresponsible not to provide the best care we can as a medical community, care that could involve Marijuana. We have been terribly and systematically misled for nearly 70 years in the United States, and I apologize for my own role in that.” —Dr. Sanjay Gupta, neurosurgeon and CNN chief medical correspondent17
Humans have been cultivating and medicating with cannabis for thousands of years. As mentioned earlier, records from 2700 BCE show the documentation of more than 100 medical uses for cannabis.18 Today, we continue to use cannabis for some of these same conditions, despite a federal ban. Cannabis prohibition in the United States began with the Marihuana Tax Act of 1937 and was later reaffirmed with the Schedule I classification in 1970. The most restrictive of the five categories, Schedule I puts cannabis on the same level as heroin, ecstasy, and LSD and classifies it as being more dangerous than cocaine, opium, and meth, all Schedule II substances. This doesn’t make any sense.
A Word of Caution
Current federal law prohibits you from buying or using Marijuana, even if your state has legalized it. Be sure to follow all of the guidelines set forth by your state and use medical Marijuana responsibly. For more information, check with NORML at norml.org/legal.
By definition, Schedule I drugs are substances with a high potential for abuse and no recognized medical or health benefit. Ever since cannabis received this designation, advocates have been working hard to “reschedule” it to a lower tier. Recent efforts to reclassify cannabis have fallen short, despite its legalization by four states and the nation’s capital. Although federal law prohibits the use and sale of Marijuana, the Obama administration has not made criminal prosecution in legal or partially legal states a “top priority.”19
Today, the majority of Americans are in favor of legalizing Marijuana. Where there is a majority, federal reform can’t be far behind. The legalization, or at the very least, the reclassification of cannabis, comes with a number of benefits. The ability to regulate cannabis allows for quality control, potency regulation, proper labeling, and pesticide-testing requirements. In states that have legalized the recreational use of Marijuana, we’ve seen a drastic improvement in the quality of cannabis. Patients and the public know the type and strength of what they are getting because the information is right there on the label. On the other hand, in states with no medical Marijuana program, there is absolutely no control. Patients who choose to pursue cannabis on their own must depend on their supplier for quality assurance and honesty. By legalizing cannabis, an illicit enterprise becomes the territory of doctors, chemists, patients, and business owners—from the black market to the stock market, if you will.
Because the legal landscape for Marijuana in the United States is changing rapidly, it is best to visit norml.org/laws for the most up-to-date information on Marijuana laws in your state. The information that follows is current as of January 2016.
Safe and Responsible Use
Before you purchase medical Marijuana, be aware of all applicable state laws on what is and is not permitted. States have differing possession limits, home cultivation restrictions, and Marijuana concentrate allowances. Responsible cannabis use is important to avoid legal troubles, as well as for the legalization effort. When others witness responsible use, their views might shift. Follow these six principles of responsible cannabis use.
1. ADULTS ONLY
Marijuana is for adults, ages 21 and up. It’s irresponsible to give it to children unless otherwise recommended by a qualified doctor for state-approved conditions and after obtaining a medical Marijuana card.
2. NO DRIVING
Don’t drive while impaired by cannabis, just as you wouldn’t drive under the influence of alcohol or prescription medications that cause psychomotor impairment (which is when thinking is slowed and physical movements are reduced). Be smart.
3. PERSONAL LIMITS
Be aware of your personal limits and environment. Don’t put yourself or others in any danger or unpleasant conditions.
4. RESIST ABUSE
The use of cannabis to the extent that it impairs health or personal development is considered abuse. Know your limits and stop before exceeding them.
5. RESPECT RIGHTS OF OTHERS
When medicating with Marijuana, be aware and respectful of your environment and those around you. Don’t violate the rights of others. Those around you may wish to avoid cannabis, including its smoke, entirely.
6. AVOID ADDICTION
Some research suggests that cannabis users may have the potential to develop dependence on Marijuana over time. THC releases dopamine in the brain, which can trigger an addiction circuit. Regular cannabis use has also been shown to cause withdrawal symptoms in 40 percent of users when they quit.20 Working with professionals to get advice on dosage and frequency of usage can be valuable in reducing your risk for addiction and withdrawal.
If you don’t live in a state with a medical Marijuana program and choose to pursue cannabis as a medical treatment, you must be very cautious. Restriction to patients in need is the worst outcome of Marijuana prohibition; while we don’t endorse illegal activity, we know that there are those of you who want to use this plant for medicinal purposes. Above all, stay safe. If you’re buying from a source without a license to sell, be sure to choose one that is smart, cautious, and has your best interests in mind. Understand that there is no quality control in states where Marijuana has not been legalized.
In the event of any legal problems, it’s important to know your rights. First, to avoid problems in the first place, never leave your cannabis or paraphernalia in plain view. Second, do not consent to a search. If you consent, you waive your constitutional protection and the officer may search and seize your possessions without further authorization. If they find anything, you can be arrested. If you do not consent, the officer must release or detain you, but the fact that you do not consent does not give the officer grounds to detain you or to obtain a warrant. Third, do not answer any questions without an attorney, even if you are not being arrested. You have the right to remain silent, and you should use that right. Finally, ask the officer if you are being detained or arrested. If you are not, you have the legal right to leave.
If you are arrested, again, do not say anything without your attorney present. Do not resist or become physical; always remain calm and polite. If you need a lawyer, you can visit lawyers.norml.org for a list of attorneys in your area.
In the following states, adults can consume cannabis without facing legal action if they adhere to certain requirements. These requirements are outlined in the tables found in Appendix A: Medical Marijuana Laws by State (here).
District of Columbia
These states also have medical Marijuana programs, details of which you can find in the next section.
There are medical Marijuana programs in 23 states, along with the District of Columbia.
Each state has its own set of limits regarding possession and cultivation, along with approved conditions for obtaining a medical Marijuana card. Each state has unique laws to govern their medical programs, so be sure you know what’s allowed in your state. In the tables that appear in Appendix A (here), you can find websites that provide more information on each state’s program and how to apply for their medical Marijuana card.
While many states have legislation underway, there are 27 states that have no true medical Marijuana programs as of January 2016. Some of them have permitted CBD oil for medical purposes, which is a great first step, but it still falls short. CBD is just one compound, and it isn’t as effective on its own as it is with the rest of the plant.21 If you live in one of the following states and choose to pursue the medicinal use of cannabis, it is important to be aware of the laws and risks involved.
For more details about the legal risks, such as the types of offenses charged by each state for Marijuana possession, check out the tables in Appendix A (here).
Originally posted 2021-08-03 21:54:31.