I present quite often on medical cannabis and get quite a few questions on the topic. Here are a few things that every healthcare professional should know about cannabis. If people are interested, I am happy to share more cannabis facts and tips.
1. Medical Cannabis is Different from Every Other Medication in Canada
Repeatedly I have people that try to compare cannabis to other medications. If cannabis is used for pain, comparison to opioids come up. If it is being used for spasms or sleep, it is compared to antispasmodics and benzodiazepines.
Here are some of the basic things you should know about cannabis:
- Cannabis is a plant with varying levels of phytocannabinoids and other potentially active ingredients (e.g. terpenes).
- Cannabis is not one drug but many. With the different levels of active ingredients, responses to a specific variety (strain) can vary significantly between patients
- Herbal cannabis was not officially approved for any indication in Canada. Currently there are two approved cannabinoid prescription medications (nabilone and nabiximols)
- The level of research with cannabis is growing, but it is less than that seen for most pharmacotherapies. Also, it is hard to mimic the exact parameters of a study as there are varying levels of cannabinoids and administration methods
2. Medical Cannabis is Generally Not a First-Line Treatment
Cannabis has no formal indications and it does not have the level of evidence of many other therapies. I think that it is important for clinicians to look at all the different options for a patient and weigh the risk and benefits of each treatment option.
Many clinicians are unsure of who should use medical cannabis. The typical patient is one that has chronic pain and other treatment options have been exhausted or are not the most appropriate.
A typical cannabis patient is one where the clinician is unsure of what to try next and has tried approved therapies. When there are not many other options, cannabis can be considered.
3. THC is only Part of the Cannabis Story
THC is probably the most studied cannabinoid. It leads to the psychoactive effects of cannabis such as euphoria. Many medical patients will want to try a high THC product as they assume that it is the most effective.
Most medical patients use higher levels of CBD than a recreational user. CBD is pharmaceutically active but lacks the psychoactive effects of cannabis. It also reduces many of the adverse effects of THC. Many cannabis physicians are starting patients on CBD only products, due to its efficacy in some conditions and the lower risk of adverse effects.
4. Never Smoke, Consider Vaporization or Oral
Smoked cannabis is preferred by many recreational users. When ever a plant is combusted, they release potential carcinogens and toxic material. Smoked cannabis (e.g. rolled cannabis or ‘joint’, waterpipe or ‘bong’) releases the same toxic chemicals as when someone burns tobacco.
Vaporization heats the cannabis to the level to release the cannabinoids but doesn’t burn the cannabis. This offers all the same benefits of smoked tobacco (rapid onset and short duration of action) but without the exposure to the same level of toxic chemicals.
Cannabis oral oils and capsules are increasing in popularity for many chronic conditions due to their longer duration of action (up to 8 hours) and ease of administration. Oils and capsules are the treatment administration of choice for many of the elderly patients.
5. The Most Patients Use Cannabis for Pain, Sleep and Anxiety
If you search online, you will see claims that cannabis has been used for so many different conditions. The research is growing on many different diseases and symptoms. Currently most people are using it to help with chronic pain, sleep and anxiety. They find it reduces pain and relaxes them to be able to better cope with many of the stressors in their lives.
This is likely to change dramatically in the near future as the level of cannabis research throughout the world is exploding as more regions are allowing medical