During your time as a Medical Cannabis patient, you may have noticed that your medicine gradually loses its effectiveness. As a result, your Pharmacy Medical Provider (PMP) has suggested that you take brief and regular breaks. You do and discover that things go back to normal. Your medicine starts working again. Do you understand why this is?
Those of us in the Medical Cannabis field recommend that patients take regular breaks. The breaks are sometimes referred to as tolerance breaks – or T-breaks if you prefer. The reason for our recommendation is found in the name itself: tolerance.
Tolerance is a physical reaction to a drug, a reaction that occurs when a person’s body gets used to that drug. Tolerance can be experienced with any kind of drug whatsoever; it is not limited to Medical Cannabis. But in the cannabis realm, tolerance is the result of how cannabinoid receptors in the brain interact with the drug.
A good way to illustrate tolerance is to discuss THC. As you know, THC is the cannabinoid that produces the high feeling in cannabis users. That feeling is the result of how THC interacts with CB1 receptors in the brain. If you only used Medical Cannabis once every few weeks, it is likely that the CB1 receptors would continue functioning normally. If you used every day though, it would be a different matter.
Cannabinoid receptors can gradually get used to the amount of THC they are exposed to. When that happens, you have the condition known as tolerance. Your brain gets used to a certain amount of THC in your system and adapts accordingly. Now, you do not experience the same effects from the same dosage. You need to increase your dosage to achieve the effects that you are looking for.
At this point, it must be made clear that tolerance is not dependence. Tolerance is simply a physical reaction to using Medical Cannabis – or any other drug, for that matter. This is not to say that marijuana dependence is impossible. It’s not. But the likelihood of it being a problem for Medical Canada’s patients under the supervision of a Qualified Medical Provider (QMP) are pretty low.
The reason for taking breaks is not to prevent dependence. Rather, it is to allow the cannabinoid receptors to reset themselves. The interesting thing is that there is no black-and-white formula we can apply to every Medical Cannabis patient.
A long-term patient using mostly Type I (THC dominant) products on a daily basis may need a break of several weeks if they have gone 10-12 months without a break. Such a long break might be too difficult for some patients, especially those who rely on Medical Cannabis to treat chronic pain. Perhaps a better plan would be to set aside three days per month as break days. The days need to be consecutive if they are at be of any value.
The bottom line is that Medical Cannabis patients should consider taking regular breaks so that tolerance doesn’t become an issue. Otherwise, obtaining medicines can get awfully expensive. Managing tolerance makes it possible to consistently use the least amount of medicine to feel better.
If you are a Medical Cannabis patient and have any questions about tolerance or taking breaks, consult with your medical provider. That could be your QMP, LMP, or PMP. Regardless, your medical provider should be able to explain tolerance to you and recommend an adequate schedule for taking breaks. Please heed their advice. It is offered for your benefit.
Cannabis plants contain more than a hundred cannabinoids along with a handful of terpenes. Among the cannabinoids are the well-known THC and CBD. That much you probably knew already. But what about CBG? Have you heard anything about it? And if so, what have you heard?
Interest in CBG is quickly growing. Researchers trying to understand how phyto-cannabinoids (plant-based cannabinoids) come to be, have discovered some interesting things about CBG. We still don’t know a lot about its potential medical benefits, but researchers are looking into that too.
CBG has been referred to as the ‘mother of all cannabinoids’ due to its relationship with the other cannabinoids in a cannabis plant. To understand this, we need to go back and first discuss the difference between cannabinoids and cannabinoid acids.
Cannabinoids do not actually occur naturally in plants. Plants give us cannabinoid acids. Before you can have THC, you need to have THCA. Likewise, you start with CBDA to produce CBD. How do you get from cannabinoid acid to active cannabinoid? Through decarboxylation.
Decarboxylation is the process of separating the carboxyl group from a cannabinoid acid. The easiest way to do that is to apply heat. That’s why burning cannabis plant material produces THC. Heat from the combustion process decarboxylates the plant’s cannabinoid acids in real time.
That brings us back to CBG. It also doesn’t occur naturally in cannabis plants. Rather, plants produce CBGA. That’s good to know. But it still doesn’t explain why CBGA is the mother of all cannabinoids.
Now we get to the fun part. Cannabis plants normally produce tons of CBGA in their trichomes. It turns out that CBGA is the precursor to all other cannabinoid acids. In other words, a cannabis plant naturally produces CBGA. When enzymes are applied to that CBGA, it is transformed into other cannabinoid acids.
That means some of a plant’s CBGA gets converted into CBDA. Some of it could get transformed into THCA as well. All the cannabinoid acids you can extract from plant material were derived from CBGA.
Growing interest in the medical potential of CBG is causing quite a stir in the Medical Cannabis community. Here is the most important thing you need to know right now: the science is incomplete. In fact, you could say it is virtually nonexistent. It wasn’t until recently that we understood CBGA as the mother of all cannabinoid acids. No significant research has been done on the substance to date.
There have been a few small-scale studies conducted to try to understand a bit more about CBGA. For example, researchers in Oregon took a look at this substance and its potential ability to either block COVID infection or reduce the symptoms of the disease. The results were promising, but only mildly so.
The researchers did not conduct their study using either human or animal patients. Rather, they simply treated human cells with CBG in petri dishes. It was a tightly controlled study in a tightly controlled environment. While CBG did not show the ability to deal with coronavirus in that experiment, the data offers little more than a reason to conduct future studies. Results achieved with cells and a petri dish do not constitute scientifically valid data that can be used to draw conclusions.
At any rate, we now know that CBGA is the precursor for all other cannabinoid acids. That is exciting stuff. Now researchers are starting to look into whether CBGA or CBG has any medical benefits. We are betting they will discover something.
Years of experience in the Medical Cannabis arena have taught us that it is easy to chase THC levels in the pursuit of pain relief. It’s easy to believe that more is better. In reality, a patient’s choice of strain for pain treatment could have more influence on pain relief than the actual volume of THC consumed.
It is generally accepted among Medical Cannabis professionals that Type I and Type II are the best strains for pain relief. In addition, some patients seem to do better with certain terpene profiles. Linalool, pinene, beta-caryophyllene, limonene, and myrcene immediately come to mind.
What does this mean for medical marijuana pain patients in Utah? It means that treating with Medical Cannabis should involve ongoing consultations with a Pharmacy Medical Provider (PMP) for the purposes of determining the best strain and dosage. It doesn’t hurt to understand the differences between Type I and Type II strains either.
Type I cannabis is easily the most popular type among Medical Cannabis users. A Type I strain is purposely bred to ensure that THC is the dominant cannabinoid. Type I plants generally have a THC level of 0.3% or more and a CBD volume of 0.5% or less.
How high can THC levels go in a Type I plant? That is a good question. We have heard of plants with THC content as high as 30%. However, such potent plants are the exception to the rule.
A Type II strain is bred by the grower to contain balanced amounts of both THC and CBD. If both levels are above 0.3%, you have a Medical Cannabis plant. If both are below that threshold, you are looking at industrial hemp. Either way, the point is that the two cannabinoids are balanced. One does not dominate to an extreme degree.
Though Type III cannabis is rarely recommended for pain relief, it is worth discussing briefly. As you might have figured out by now, a Type III plant is CBD dominant. In nearly every case, it is going to be classified as industrial hemp with a THC volume of less than 0.3%.
What you have read thus far constitutes generally accepted guidelines within the Medical Cannabis community. But don’t forget that you are a unique individual. How you respond to any given strain will largely determine what products offer you maximum pain relief. Maintain an open mind. Be willing to try different strains, delivery methods, and dosages in your search for the best treatment.
Also keep an open mind about microdosing. We know of at least one study that suggests microdosing could be a viable pain relief strategy for patients dealing with chronic neuropathic pain. The microdosing mindset calls for starting out with smaller doses to see how they work. You ideally want to use the smallest dose possible to achieve the desired effect.
As you work with your PMP to figure out strain for pain treatment and dosage, tracking your results will help considerably. Write things down. Create a paper journal or write a digital note on your phone. The point is to track every time you use Medical Cannabis, how you consume it, and how it makes you feel. Such information is invaluable to your PMP.
Remember, chasing THC volume is not necessarily the best way to treat pain with Medical Cannabis. It is more important to find a strain that works for you. You are most likely going to want a Type I or Type II strain with a particular terpene profile. Your PMP can probably make a few recommendations.
Have you ever noticed that every visit with your doctor comes with a question about other medications you might currently be taking? There is a reason for that. Doctors always need to be concerned about drug interaction. In some cases, drug interaction can dilute or enhance the effects of a particular medication. Moreover, some drugs just shouldn’t be mixed for safety reasons.
Does all of this apply to Medical Cannabis? Yes. If your primary care physician is not also your Qualified Medical Provider or Limited Medical Provider, they need to know that you use Medical Cannabis. Likewise, it is a good idea to inform your Pharmacy Medical Provider of any other medications you are currently using.
A big concern people seem to have is that Medical Cannabis could interfere with prescription antibiotics. Some people are concerned that mixing the two is not safe. Let us nix the safety issue right from the get-go. To our knowledge, there have been no reports of dangerous drug interactions between cannabis and antibiotics. No worries there.
Still, there are legitimate concerns the cannabis might dilute the effects of certain antibiotics. This is entirely possible; we just don’t know at this point. Some of the antibiotics that raise concern are clindamycin, erythromycin, and clarithromycin. Penicillin and amoxicillin both appear to be unaffected by cannabis.
Antibiotics are largely benign in terms of their side effects. That is not the case with other drugs. Your doctor might prescribe a medication with a known side effect of making you drowsy. In such a case, using Medical Cannabis along with that other medication could enhance that particular side effect. Remember that THC has a sedating effect in most people.
You should also be careful about using Medical Cannabis alongside prescription opioids. We personally know of people who used cannabis to get themselves off opioids, and that’s good. But doing something like that is always best when there is medical supervision involved. You can get yourself into real trouble by consuming too much cannabis while also taking prescription opioids.
All of this boils down to the realization that it’s entirely possible for cannabis to interact with other medications. We do not have any hard science on the topic because Medical Cannabis is still so new. That’s the bad news. The good news is that we have never heard widespread reports of extremely negative drug interactions.
As a patient, be prepared to have frank discussions with your Qualified Medical Provider and Pharmacy Medical Provider. Both need to know about all the medications you use. This includes over-the-counter drugs. They need to know for the simple fact that drug interactions do occur.
As of now, there do not seem to be any particular safety issues related to using Medical Cannabis alongside other prescriptions. But don’t just assume. Talk things over with your medical providers and give them the opportunity to offer their recommendations.
In closing, do not hesitate to report any potential interaction issues to your medical provider. For instance, you may suspect that your Medical Cannabis enhanced the sedating effects of another medication. Your doctor needs to know this. They may decide that it is best to write you a new prescription for a different drug.
Drug interaction is always a concern when doctors write prescriptions. Thankfully, Medical Cannabis doesn’t appear to cause any major interaction issues with the most commonly utilized prescription drugs. If anything on this front changes, we will be sure to let our readers know.
Pay a visit to your Utah Medical Cannabis Pharmacy and you will find strain and product names like Bubba Kush, Fatso, and Purple Afghan Kush. Whatever you do, don’t choose a Medical Cannabis product based solely on its name. Do not get drawn into names to the extent that you believe they tell you something about the effectiveness of the product. They don’t.
Both product and strain names are largely meaningless from a medical standpoint. They mean everything from a marketing perspective, and that’s exactly the point. Manufacturers choose names that will get consumers’ attention. So do growers and processors. They want memorable names that will stick out in the marketplace. But that is as far as they go.
If it helps, think of naming as branding. Imagine you are a Medical Cannabis cultivator here in Utah. You have gone to great lengths to produce a strain completely unlike anything else other cultivators are producing. You want that strain to stand out. So what do you do? You give it a name that people will remember – maybe Mind-Blowing Bonanza of Love.
People would definitely remember that name. But from a medical standpoint, the name tells you very little about what the product can actually do for people. None of this is bad, by the way. Growers and processors need to make money. They need to adopt a business-first mindset if they hope to keep their operations viable. And part of that is branding.
The number one reason for being ambivalent about strain and product names is this: what is inside the package is more important than the name written on the package. As a Medical Cannabis user, your main concern should be cannabinoid and terpene profiles. It is the cannabinoids and terpenes that provide the relief you are seeking. Product or strain name doesn’t matter much here.
With that in mind, it is very helpful to learn the differences between the three different types of cannabis strains. Type I is THC dominant; Type II is balanced between THC and CBD; Type III is CBD dominant. Each type has its appropriate applications for medical treatment.
Next up, do not forget the terpenes. Terpenes are those volatile compounds that give plants and trees their unique odors. Though the science isn’t quite settled on the mechanisms involved, it does seem that certain terpene profiles can be more effective at treating certain conditions.
If we can say one good thing about strain and product names, it is that they help patients remember their favorites. That’s a good thing. If you find a product that works for you, and it has a memorable name, you aren’t likely to forget it. You will be able to walk right up to the Medical Cannabis Pharmacy, tell them what you want, and walk away with your medicine. Easy peasy.
Understand that this is exactly what growers and manufacturers want. That’s why they and their marketing teams pick such interesting names. They want customers to be able to easily remember their favorite products; it is no different than any other industry. Names mean things because they stick in our brains.
Speaking of brains, just use yours in your search for the optimal Medical Cannabis treatment. Do not let yourself be drawn to a particular product because it has a name that appeals to you. The name probably means nothing from a medical standpoint; it is only there for branding purposes. Your concern is strain type, dominant cannabinoid, and terpene profile. Get that right and it won’t matter what a product’s name is.