Common questions about medical cannabis

Medical cannabis is currently legal in 37 states, and with 94% of Americans advocating legal access to medical marijuana, it seems like this treatment option is returning to the mainstream. Unknown to many people, cannabis was a popular treatment in this country in the late 1800s and early 1900s – often given by doctors – and that the American Medical Association was one of the strongest voices against a ban in 1937.

I have been aware of medicinal cannabis’ ability to alleviate suffering since I saw my brother Danny use it during his unsuccessful battle with leukemia. Cannabis was the only thing that allowed him to keep food low during chemotherapy. Now, decades later, I am a doctor certifying patients who qualify for medical cannabis in Massachusetts. People often have questions about their safety and proper use, and these are often the same considerations I have before certifying patients.

Is it safe?

As with almost everything else about cannabis, how safe or dangerous it is remains hotly debated. As a family doctor, I have to ask myself: is cannabis safer than the alternatives I would prescribe? For example, if I am treating a patient for chronic pain, is cannabis safer than opiates? The risk of medication must be weighed against the safety concerns of cannabis. The main ones are as follows:

• The safety during pregnancy and lactation has not been established.
• It can aggravate and even cause psychotic disorders.
• It can temporarily worsen short-term memory and cognitive functions.
• It can have Heart and lung effects, like rapid heart rate and bronchitis.
• You can get addicted.
• There can be Drug interactionsespecially with CBD.
• At high doses, it can cause or worsen anxiety and even lead to panic attacks.
• Driving and operating heavy machinery is impaired.
• Use can be especially dangerous for teenagers as there is evidence that they are particularly prone to cognitive effects and addiction.

Cannabis should be used with extreme caution, if not avoided entirely, in patients with a history (or possibly a family history) of the problems listed above, such as psychosis, substance abuse, or cardiac arrhythmias.

As I often tell patients when they read the warning labels on any Drugs that are commonly prescribed, each one has potential side effects, some serious. There really is no such thing as a free lunch with medication, including medicinal cannabis. However, with good training and regulation (which results in a safer product), much of the harm noted above can be avoided or minimized. For example, many of the harms are dose related, so I always remind patients to “start low and go slowly,” which means keeping doses as low as possible for the desired effect.

How can I consume cannabis?

Cannabis can be consumed in a number of ways: by inhalation, with a tincture under the tongue, as an edible, or as a topical lotion. The benefits of consuming cannabis by inhalation, either by smoking it or vaporizing dried flowers with a machine that heats it, is a quick start and easier titration of the dosage. The downsides are that it can irritate the lungs and cause chronic bronchitis, and the therapeutic effects only last a few hours, so it has to be repeated frequently.

In many places, the burning of cannabis is simply not allowed, for example in public housing. The advantages of using an edible are that you do not need to breathe anything and the therapeutic benefits can last for up to eight hours. Finding the right dose is much more difficult, however: it usually takes an hour or two for an edible to start working after it is consumed, meaning you really have to start low and go slowly so as not to take too much!

A tincture is a liquid formulation that can be placed under the tongue for faster absorption. its mode of action and duration are somewhere between inhalation and edible: maybe 30 minutes to take effect, with a duration of about four hours.

Topics are exactly what they sound like: creams and lotions for rubbing on painful, inflamed or itchy areas. There are very few safety concerns with topical preparations.

I’ll get up

In many cases the answer to this is only if you want to, unless the dosage needed is quite high. The doses required for medical purposes are often significantly lower than those used for recreational purposes. In a regulated cannabis market today there are many more choices for different cannabis strains or “chemovars” – in the past, medical patients only had access to what the dealer had at the time.

Nowadays, people can avoid highly sedating strains as well as strains with extremely high levels of the main poisoning agent, THC. In addition, patients develop a tolerance to the psychoactive effects of cannabis, so that a medical patient who consumes a small dose of cannabis twice a day is significantly less affected than a recreational cannabis user who, for example, consumes a high dose once a month. They still shouldn’t be driving while using this drug, but they report that they are quite functional.

Is it legal

Cannabis isn’t legal if you don’t live in a state that has legalized it for medicinal purposes, but it is now state-legal in most states. Some states have partially gone and have only legalized CBD or low-THC cannabis formulations. It’s important to remember that cannabis is still illegal at the federal level, which means it’s illegal to fly and cross state lines with it – even if you’re crossing between two states that have legalized it.

Having drug tests at your workplace can also affect your employment – a medical cannabis card won’t always protect you. Many hospitals, even in legal states, won’t allow you to take it into the building as they receive federal funding that could be at risk if viewed as sanctioning medical cannabis use.

I am optimistic that we as a society will continue to make progress on medical cannabis so that the millions of patients who are being exempted from medical cannabis can do so without stigma, judgment and legal harm, and so medical research can be free and can be carried out without restriction. In this way, our knowledge of the advantages and disadvantages of cannabis can be further enhanced.