imageCannabis is one of the oldest psychoactive plants known to humans.
Its therapeutic potential has been recognized since ancient times—for at least 4,000 years. In the second millennia B.C.E., cannabis was cited in the Atharva Veda, a sacred Hindu text, as a remedy for anxiety. In Egypt, there is evidence that cannabis has been used in medicine since the time of the pharaohs. In China, cannabis was used as a surgical anesthetic in 200 B.C.E. All around the ancient world, from Babylonia to Israel to Rome, cannabis has been used as a medicine.

The medicinal properties of cannabis became part of Western medicine in the mid-19th century when cannabis strains from Egypt and India were imported by the French and British, respectively. Between 1840 and 1940, numerous English, Irish, French and North American physicians and pharmacists testified to the usefulness of various cannabis preparations for pain relief and other conditions including malaria, rheumatism, migraines, gout, and glaucoma. Cannabis was in the Canadian pharmacopeia until 1923, when it became a restricted drug and all possession, cultivation, and distribution became illegal.

Although the medicinal benefits of cannabis have been understood for thousands of years, its use in medicine today is still controversial. Studies indicate that between 1.9% and 4% of the Canadian population currently use cannabis for therapeutic purposes. A third of cannabis users in BC report using cannabis for medicinal reasons. Over 50% of Americans now support, claim to use, or have used cannabis at one point of their lives. This majority opinion has led the Obama administration to finally announcing a hands-off approach to whatever the state voters decide. This is an amazing step after years of fighting to achieve legalization, and it’s a move by the federal government that many will consider to be timely and just.

How does cannabis work as medicine?
Cannabis leaves and flowers contain unique molecules called cannabinoids. There are more than 60 different cannabinoids, but the one with the most significant psychoactive effect is also the most well-known: THC (delta-9-tetrahydrocannabinol). Medicinal effects have also been attributed to other cannabinoids, including CBD (cannabidiol), as well as other plant molecules (terpenoids and flavonoids). Together, these molecules contribute to the overall effect of cannabis. The human body produces endocannabinoids, its own natural version of cannabinoids. They help to regulate the body's systems. Cannabinoid receptors are found throughout the body, especially in the nervous and immune systems. Endocannabinoids and cannabinoid receptors naturally respond to biological events—for example, endocannabinoid levels will increase in response to brain injury and strokes, and receptors will increase in response to nerve injuries and associated pain. Both plant cannabinoids and endocannabinoids bind to the body's cannabinoid receptors. When this binding occurs, effects such as pain relief and the suppression of stress result.

Indica, Sativa and Hybrids
"Indica," "Sativa" and "Hybrid" are commonly used terms to categorize strains of cannabis that have different effects on the user. For example, people often say that Indica strains are sedating and good at reducing anxiety, pain, muscle spasms, and tremors, along with other symptoms. In contrast, people often say that Sativa strains are energizing and good for appetite stimulation, depression, and migraines, amongst other symptoms. Hybrid strains, which are a cross of the two previous strains, tend to be mood stabilizing while also being particularly good for the relief of nausea and appetite stimulation. While such categorizations are very helpful for matching strains with particular symptoms, these common names do not correlate with the botanical species Indica, Sativa, and Hybrid.

Studies indicate that there are two main species of the cannabis plant, Cannabis indica and Cannabis sativa. Generally, the indica species (which has higher levels of THC) is used as a medicine, while the sativa species is used for hemp fiber and seeds (which contain nutritional essential fatty acids).

Plant breeders have developed hundreds of different strains of cannabis from these two species. The effects of cannabis vary depending on which strain is being used. Many people report experiencing different medicinal effects from different strains. Potency also varies with strain. Higher-potency cannabis means that less is needed to achieve the desired effect.

Although there has not been much formal research done into the medicinal effects of different strains, it appears that the different effects of cannabis strains are related to the concentration and balance of various active ingredients in the plant. It is important that medicinal users have access to a variety of cannabis strains to meet their individual needs. Most people rely on word of mouth or trial and error to choose a strain that they feel works for them.

What conditions or symptoms is cannabis used to treat?
Cannabis can be used to treat a wide variety of medical conditions and symptoms, as well as the side-effects of pharmaceutical medications. In some cases, cannabis may be more effective than pharmaceutical options and have fewer negative side-effects. It is often recommended to improve quality of life for people who have critical and chronic illnesses.

Some of the symptoms cannabis is used to treat include:

  • Nausea, loss of appetite
  • Chronic pain
  • Anxiety
  • Insomnia
  • Inflammation
  • Muscle spasms

  • There are many medical conditions that cannabis is used to treat. Some of the most common ones are:

  • Arthritis
  • Cancer
  • HIV/AIDS
  • Hepatitis C
  • Glaucoma
  • Multiple sclerosis
  • Cerebral palsy
  • Spinal cord injuries
  • Epilepsy
  • Attention deficit hyperactivity disorder (ADHD)
  • Crohn's disease
  • Fibromyalgia
  • Migraines
  • Parkinson's disease
  • Depression
  • Post traumatic stress disorder (PTSD)

  • Cannabis has also been used for substance addiction and withdrawal as it can be effective for decreasing cravings and withdrawal symptoms. Some people have used it as a substitute for more harmful substances, including alcohol and opiate-based drugs such as morphine and Oxycontin®.

    Although cannabis can aggravate mental health conditions in certain circumstances, some patients suffering from mental illness use it to relieve the symptoms of their disorder or the unpleasant side-effects of their medication. Cannabis can also be used to treat depression—whether it’s the primary diagnosis or related to another diagnosis. Some people with schizophrenia and bipolar disorder have been able to successfully use cannabis to relieve their symptoms with no significant side-effects. The use of cannabis by people with these disorders should be monitored carefully, however, because negative side effects are possible.

    How do people use cannabis for medical purposes?
    There are several ways to use cannabis, each with a different time of onset, duration, and degree of quality. Some methods may be more effective than others for certain symptoms and conditions, and they may be preferable in certain circumstances.

    Smoking is one of the fastest and most efficient ways for patients to experience the therapeutic effects of cannabis. When inhaled, the medicine moves quickly into the blood stream through capillaries in the lungs. Since effects are usually felt within a few minutes, correct dosing is a simple effort. Because of its immediacy, this method may be ideal for symptoms such as nausea and muscle spasms. The effects from cannabis inhalation can last several hours.

    Vaporizing is another form of inhalation. When heated to a certain temperature, cannabis is vaporized; the result tends to be less irritating on the throat and lungs than smoking. Some people find the 'high' produced from vaporizing to be different than the 'high' from smoking. Since it does not produce smoke, vaporizing may be more suitable for indoor use such as hospitals or palliative care settings.

    Cannabis can also be digested. Because it is fat soluble, the active ingredients can be extracted into butters, oils, or milk. For example, cannabis-infused butter can be used in baking or blended into a milkshake. When cannabis is ingested, the effects are much stronger and last longer than when it is inhaled. This may be suitable for chronic pain or other persisting symptoms. However, ingestion may not be suitable for everyone because it can take up to a few hours to feel the full effects and the effects depend on many factors. This makes the desired dosage more difficult to determine. Too high a dosage can lead to vomiting and anxiety, while too low a dosage will be ineffective.

    Although cannabinoids are minimally soluble in water, cannabis tea provides a less potent alternative with unique properties that may be suitable for some people. Oral-mucosal sprays are absorbed through the mouth's membranes. The effects are usually felt within 10–20 minutes; however, since some of the spray will also be swallowed, dosage can be difficult to assess and the effects may come at different stages. Another method of use is topical ointments and lotions.

    What are the side-effects and risks of using cannabis to treat medical conditions or symptoms?

    Contraindications
    There are certain conditions that increase the risk of using cannabis. Patients with a history of psychotic disorders, particularly schizophrenia and bi-polar disorder, should be under careful psychiatric monitoring when using cannabis. Cannabinoids are contraindicated for patients with a history of active cardiac ischemia. Those receiving digitalis or other cardiac medications should use cannabis under careful supervision by a medical doctor. Cannabis use should be avoided where the immune system is needed to fight off infections, particularly intracellular pathogens such as those that cause Legionnaire's disease, Leishmaniasis, and tuberculosis.

    All drugs have side-effects and potential harms. The important question to consider when using any medicine is whether the benefits outweigh the potential harms. Many studies document the therapeutic effectiveness of cannabis. Many people, through personal use, assert that cannabis has a direct impact in terms of improving their well-being with minimal adverse effects.

    The side effects associated with cannabis are typically mild and are classified as "low risk", particularly when compared to many of the pharmaceutical drugs used for the same conditions and symptoms. Serious complications are very rare and there is no known case of a lethal overdose. The ratio of lethal to effective dose is estimated at more than 1,000 to one.

    While over-consumption does not kill or seriously harm the user, it can be unpleasant. Someone who has consumed too much may become dizzy, agitated, nauseous, nervous, or paranoid. The most intense feelings will last about an hour and the effects should wear off in four to five hours. Some acute effects of too high a dose, particularly in new users, include tachycardia (accelerated heart rate) and hypotension (lowered blood pressure). Several studies have documented mild short-term impairments in motor-coordination, attention span, and memory.

    These short-term effects are dependent on factors such as the patient's familiarity with cannabis, the strain and dosage used, and the method of use.

    Euphoric mood changes are among the most frequent side effects of cannabis. While some people find the 'high' that can accompany cannabis use to be a therapeutic benefit, others do not like the feeling. Heavy cannabis use may make symptoms worse for mood and personality disorders and can exacerbate existing schizophrenic psychosis or increase the risk for developing psychosis in predisposed persons.

    There isn’t a lot of data about the long-term effects of using cannabis, and the data that does exist is inconsistent. Generally, the effects are believed to be limited. Inhaling cannabis smoke can lead to some respiratory problems such as bronchitis and phlegm production; however, a link between smoking cannabis and chronic lung diseases such as Chronic Obstructive Pulmonary Disease (COPD) has not been proven. Studies do show that smoking cannabis and tobacco together increases the risks of COPD and lung cancer. However, solely smoking cannabis (occasionally or heavily) does not appear to be associated with lung cancer. There is increasing evidence that endocannabinoids are able to inhibit the growth and spreading of cancer tumors.

    Cannabis is generally perceived to have low risk for producing physical dependence; however, long-term, frequent use of large amounts can lead to mild psychological dependence. Chronic, heavy use of cannabis may lead to the development of tolerance so that more cannabis must be used to achieve the desired effect. Using a different strain of cannabis or stopping use for a short time can reduce tolerance levels. Some users (about 10%) may find it difficult to stop. Some users experience minor withdrawal symptoms when they stop using cannabis, such as irritability, anxiety, upset stomach, loss of appetite, and disturbed sleep. These symptoms generally last for a few days at most.

    Drug interactions
    Because of the way cannabis is metabolized, it has been suggested that there is a potential for it to interact with other drugs. Clinically significant interactions have not been detected; however, some study results and case reports indicate that there is a possibility that cannabis may increase or decrease the effectiveness of other medication. While inconclusive, these results suggest that patients should be monitored for a change in dosing requirements if they are taking other drugs.

    Reports from patients indicate that negative drug interactions are not common. Patients report that they are able to reduce the doses of some of their pharmaceutical drugs (particularly opiate-based painkillers) when using cannabis. Cannabis has also been shown to mitigate the negative side effects of pharmaceutical drugs and other therapies. This helps patients stick to their treatment schedules.

    Quality
    Depending on how cannabis is cultivated and stored, some mold, bacteria, and other contaminants may grow on it. Most of these are harmless, but others can be toxic. These contaminants can usually be detected through a visual, olfactory, and tactile inspection.

    Synthetic pesticides, fungicides, and other harmful chemicals often used in horticulture can also be toxic. It is believed that all cannabis meant to be used by humans (especially medicinal-grade cannabis) should be grown without these products. Many medical cannabis users report that they prefer organically grown cannabis. Laboratories are able to test for biological and chemical contamination; however, due to the legal status of cannabis, it can be difficult to obtain such tests.

    Sativa
    While tending to have a higher concentration of tetrahydrocannabinol (THC), Sativa is typically less potent than Indica. Effects of Sativa include increased focus, creativity, energy, and serotonin levels, offering not just relief but also an elevated mood. Sativa is often characterized as "cerebral," due to it giving the patient more of a "head/mind high." For some illnesses, however, Sativa alone is not strong enough to provide sufficient therapeutic relief for pain.

    The effects of medicating with Sativa are mostly due to of their high THC levels. Sativa strains act like a stimulant. The high THC content tends to stimulate thoughts, activate the mind, and mildly alter perception. Patients with pure lethargic depression choose to medicate with Sativa because it acts as a mental stimulant to help uplift their thoughts. A caution for patients with depression is to be on guard for suicidal thoughts. It is always beneficial for patients with depression, whether they medicate with cannabis or another antidepressant, to have a good support system, family member, friend, therapist, or psychiatrist that they can call day or night for suicidal thoughts. Cannabis use does not increase suicide risk.

    Another group of patients that tend to choose medicating with Sativa are those who suffer from ADD or ADHD. Most report that Sativa tends to give them a reverse effect; instead of being stimulated, they feel calm (and without the loss of appetite commonly associated with Ritalin and Adderall). A caution for patients who medicate with cannabis for ADD or ADHD: never drive or do dangerous tasks while medicating.

    Still, there are patients who shouldn’t medicate with Sativa strains, particularly those who suffer from anxiety disorders or bipolar disorder. Sativa makes anxiety worse and can destabilize bipolar disorder. In addition, Sativa might also make insomnia worse. Anyone who cannot tolerate stimulants should not medicate with Sativa strains.

    Indica
    This strain is reported to be more relaxing and sleep-inducing, relieving nausea and stress while giving a sense of calm. Indica is used to treat a larger number of conditions and is often favored by those diagnosed with cancer, HIV/AIDS, and glaucoma, as it is shown to be very effective at reducing nausea, stimulating the appetite, and reducing intraocular pain. Indica is often characterized as giving a "body high" in contrast to the "head high" of Sativa.

    Most patients choose to medicate with Indica strains. The higher cannabidiol (CBD) levels are a strong sedative. Indica can be used at night for pain instead of morphine or oxycodone, or for anxiety instead of Xanax or Valium. Overall, Indica helps one sleep.

    Anyone with pain or anxiety who wants to relax and sleep should choose an Indica. Indica has two separate effects: the sleep effect and the body numbness effect. These two effects can vary greatly depending upon the strain of Indica. The sleep effect can knock you out, make you drowsy, or simply provide relaxation. The body numbness effect is for pain control. It can scale from completely numb for maximum pain relief, to just a little pain relief and no numbness.

    Hybrid
    In addition to the two main strains, thousands of hybrid marijuana strains are also available. A hybrid is made by cross-breeding an Indica and a Sativa. Hybrids will often fall into two broad groups: Indica-Sativa or Sativa-Indica. Each hybrid strain is developed to treat different ailments and have different effects. The goal of hybrids is to combine characteristics of each strain to minimize some of the unwanted effects of one while adding the desired effects of the other. For instance, Indica-dominant hybrids are effective for pain relief, with the Sativa component allowing the patient to maintain energy levels. Sativa-dominant strains are good for stimulating appetite, with the Indica component helping to reduce body pain and increase relaxation.

    If Sativa can make anxiety worse without the pain reduction, but Indica lulls one to sleep, how can a person medicate for pain and anxiety during the day? In this case, a hybrid is recommended. A patient can get pain control and anxiety control from the Indica with less sedation while using the Sativa stimulation to counter the residual Indica sedation. If a 50/50 Indica/Sativa hybrid does not give enough pain or anxiety control, the patient can move to an Indica dominant hybrid. The higher Indica content leads to more symptom control, but also more sedation. If a 50/50 hybrid is too sedating, you can move to a Sativa dominant hybrid. The more Sativa, the less sedation and symptom control with more stimulation (except for people with ADD who get reverse effects). Hybrids can be used as replacements for Tylenol with Codeine, Vicodin, or low doses of Xanax or Valium.

    Summary
    The patient has a lot of choices when it comes to cannabis, both with strains and with methods of application. Whether using Indica, Sativa, or Hybrid, cannabis is still a medication and should be used appropriately. Whether smoking, vaping, eating, drinking, or topically applying, it is the same with cannabis as with all medicine: there are benefits and there are drawbacks. Cannabis is not for everyone and must be determined to be the proper medication for the happiness and well-being of the patient.





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