Start low, Go slow, Lay low, Be patient, Be together, Be Responsible
See your physician for an assessment and a risk vs benefit analysis. Some patients are not appropriate for cannabis medications and can be at further risk for complications, harms and side effects with use. Drug interactions are possible. Altered kidney, liver or other organ function can impair or interact with the metabolism of other drugs and cannabis formulations.
Always seek physician guidance for appropriate starting dose. Cannabis medical clinics with nurse navigators (educators) should give holistic, culturally sensitive, trauma-informed care including education, monitoring and follow-up inclusive of family/friends if needed.
A physician can help guide the patient as to the percentage and balance of the right cannabinoids and terpenes for your condition.
The process of finding the right cannabinoid formulation, dose, frequency, timing and route takes time. This is similar to taking other pharmaceutical medications requiring trials of various formulations until finding adequate relief of symptoms. Physicians along with trained and knowledgable nurses can assist with this process.
The social use classifications used in marketing such as “indica” or “sativa” does not apply for cannabis taken for medical intent. Notice in this article cannabis is not defined as “medical marijuana” or “medical cannabis”. The plants are all cannabis from one genus, it’s the intent and purpose that differs.
It is more about the cannabinoid profile (various compounds in that batch) of the particular product and its ratios and amounts of each cannabinoid or terpene etc. Think of each batch as a new recipe with different amounts of each ingredient in each batch. Check labels for product information including the percentages and amounts in each product.
It’s not just about the medication: assessment should consider other factors in a patients life, such as financial, psychosocial, medical and mental health issues. Assessment should also include trauma history with possible subsequent referral to other health care professionals for support.
Like some pharmaceutical drugs, cannabis constituents, like THC-9 (Δ9-tetrahydrocannabinol) can change cognition to varying degrees: possible euphoria, short term memory impairment, anxiety, paranoia or sedation etc. This is largely dependent on the ratios of THC to CBD (cannabidiol), dose of THC, route of administration, other interactions with medications, the status of the person’s own endocannabinoid system, as well as vulnerability to developing psychotic illnesses such as having a personal or family history of bipolar disorder or schizophrenia to name a few risk factors.
Cannabis formulations require a slow increase in dosage to the lowest effective dose. More is not better, and may in fact exacerbate your medical issue. Feeling “high” does not indicate better efficacy. Not all those who take THC formulations feel impaired or euphoric, they may simply feel relaxed for example. Some choose to micro-dose, taking very small doses at a time throughout the day or evening depending on their symptom profile.
Everyone reacts to cannabinoids (cannabis constituents) differently. A calm non-stimulating environment is important when first taking a THC cannabis based medicine. Do not try it on a day where you have to go out or have plans. This would be the same as taking other types of pharmaceutical medications where a person needs to see how they feel. It is thought that perhaps having a higher ratio of CBD to THC, greater than a 10:1 ratio of CBD to THC, may calm THC’s negative effects. Dizziness can result when getting up from lying or sitting, so caution is warranted. This can be similar to the effects of taking other pharmaceutical drugs causing dizziness such as blood pressure medications as one example.
People get into trouble when they can’t feel the effects of cannabis soon enough and take more before the original dose has had time to “kick in”.
Naive consumers will often find themselves having unnecessary unpleasant side effects because they feel it’s not working and take more. They are unpleasantly surprised when they are hit with negative side effects such as rapid heart rate, dizziness, confusion, sleepiness, feeling faint, or paranoid etc. In most cases this abates after time and is a waiting game. There is little literature documenting deaths directly attributed to cannabis ingestion. However, some people could have potential allergies to some formulations. Some folks may have increased risk of heart attack after ingesting very high THC products.
Just because a person has a tolerance to inhalation of cannabis herbs or products does not mean they will have the same tolerance to ingested products (inclusive of under-the-tongue route) and will need to start at very low sub-therapeutic doses initially. THC when taken orally, is metabolized in the liver to a more potent 11 hydroxy THC in larger quantities so the effects can be more potent and last longer. Think of oral formations as being medium and long acting medications and inhaled, as being a short acting medication. Do not hesitate to go to the ER if feeling unwell. Always go if unsure as the symptoms may be due to other issues such as heart attacks and more.
At first, until you know how cannabis formulations will affect you, never try any oral/smoked/vaped/patches with cannabis products containing THC while alone.
This does not generally apply to topicals applied to closed skin as it is thought fat soluble cannabinoids are not well absorbed systemically thus are non-impairing. Some patches have compounds enhancing absorption. Whether they are absorbed systemically is yet to be known. So always be cautious.
Always have a friend or family member stay with you so that you can see how cannabis affects you. This could also apply with any other sedating or psychoactive pharmaceutical drug such as a new prescription for a sedating pain killer, a new antidepressant, anti-psychotic, anti-seizure, anti-anxiety drug etc. where side effects can cause dizziness or other effects.
Do not take THC products before driving or operating heavy equipment, just as you would not do so after taking any other sedating drug.
Ask your doctor for the specific amount of time you need to wait before driving or working with equipment. Do not mix with alcohol or any drugs/medications that may impair or cause sedation. Little is known about how medications affect a person when taking them together, (also referred to as “polypharmacy”).
Lock up any products and keep them out of reach of children and pets, just as you would do with any other medication.
Do not share your medication with others. Your authorization/prescription is specifically tailored to you and your condition.
Be aware current dispensary products may may not be tested so dosages may be completely inaccurate. As regulation evolves, issues such as inaccurate dosing, poor labeling practices, and pesticide/herbicide contamination of products etc. will hopefully address these and other shortfalls.
Photo Credit: Roberto Valdivia
This is not medical advice and cannot be construed as such. ALWAYS seek medical guidance and support from a physician and ideally education from qualified trained nurses for comprehensive, holistic care.
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