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Got the Green Light

We were lucky enough to grow up in an environment where there was always much encouragement to children to pursue intellectual interests; to investigate whatever aroused curiosity. In a different kind of environment, our curiosity might have been nipped long before it could have borne fruit.

Orville Wright, father of flight

The First Step

So after some preliminary checking you've decided to give medical marijuana a try. Now what?

The first question concerns legality and can only be answered by you. If you live in a state where medical marijuana is legal and available, you can see a doctor and go through the appropriate channels to receive a medical marijuana registry card. Many dispensaries offer guidance in this process and finding a good one that does is a place to start. You can also check-out the website of Americans For Safe Access (ASA). With over 30,000 active members and offering all sorts of assistance and information, legal, medical and otherwise, ASA is the largest national member-based organization of citizens and professionals dedicated to promoting safe and legal use of medical marijuana.Theirs is a site worth exploring and bookmarking and a community worth joining.

If you don't live in a state where medical marijuana is legal, or if you decide to just bypass the legal channels, that decision is totally yours. My own opinion is that, by all definition and reason, medical marijuana should be available over-the-counter (a topic I address elsewhere). However, going through appropriate legal channels wherever possible is the easiest and safest route to obtaining your medicine.

Assuming you go legit and get a registry card, your next step may involve finding a good dispensary. As with shopping for anything else, you'll probably need to look around a bit, get recommendations from friends, and finally listen to your instincts. Find a dispensary that's clean, friendly and professional. A good dispensary offers a number of varieties and can tell you what you might expect from each of them. Does the staff know their stuff? Do they listen to your needs and problems? Do they offer a variety of products, hardware and dosage forms, and if not, can they tell you how to get them? Finally and most importantly, does their product deliver?

What To Expect

When you smoke marijuana or inhale its vaporized product, you can expect a change in consciousness within seconds, including changes in mood and thinking and bodily sensation. This immediate effect of inhaled marijuana provides not only quick relief of symptoms but also makes for easy dose adjustment or titration. This is a rare and advantageous find in pharmaceutics where pill forms take many minutes to work and immediate dose titration is rarely possible.

A cannabis high may be pleasant, relaxing and/or stimulating to varying degrees. Fits of laughter, increased humor and talkativeness are more the norm than anything else. The typical high includes heightened awareness and sensory stimulation and appreciation, giddiness and sudden appetite increase ("the munchies"). Ideas may come easily and flow freely, while disjointed and seemingly random impressions may readily derail one's train of thought. Time perception is altered, a couple minutes may seem like a dozen, a few hours an entire day. Consciousness may assume an almost dreamlike quality. The body too may feel different, either heavy or light, slightly numb or a bit tingly. With such changes in mind and body, communication and focused concentration may be difficult, along with decision-making and performance of complex tasks. Such challenges of cannabis often decrease with experience.

All this may sound a bit intimidating and overwhelming to the uninitiated. And it's true, the experience may be unpleasant, especially to the novice, or even the veteran who neglects his/her P's and Q's (or set and setting as I'll discuss later).

Some folks may get quite anxious, disturbed by their racing mind, chaotic thought process or intrusions of paranoia (relax, it will pass). Increased heart rate, slight tremor or general body excitation may arise and worsen the situation (relax, this too will pass). Some folks say marijuana merely makes them tired or sleepy. Keep in mind however, these are often only first impressions and isolated incidents, more the exception than the rule.

For most people, one or two "hits" or puffs of cannabis are enough for the desired effect. For others it takes more. Inexperienced users often feel little to nothing the first time or two around. Experience here helps. Eating marijuana instead of inhaling will delay the onset of effect by 20 to 30 minutes or more, but will prolong the high or desired therapeutic effect from a few hours to 6 or 8. Small amounts in a brownie, cookie or muffin may cause minimal or barely noticeable changes, while large doses can produce intense effects closer to strong hallucinogens.

When it comes down to it, the cannabis experience is highly subjective. Its effect on your experience depends heavily on set and setting, as well as the cannabis variety you are using. Finally, remember there is no lethal dose of cannabis by itself, and any undesirably effects will soon wear off. Make the most of the experience and enjoy.

Mixin' It Up

It's good to be cautious when mixing any drugs together and cannabis is no exception. Ideally, you should avoid mixing marijuana with anything else. But of course that's not always practical.

For the average person, mixing marijuana with alcohol is probably the biggest concern. It's best to go one at a time, as least until you have good experience with each one separately. Taking them together can be a real crap shoot, especially the more alcohol you have. Generally the two together will put you in more of a stupor. So unless you want to risk a really crappy mental-physical state, proceed only with due vigilance and experience, going especially light on the drink.

Less common, but not at all unknown, some people mix marijuana and nicotine. As stimulants, both nicotine and caffeine no doubt affect the cannabis experience to some extent. Again, experience will tell what works for you. Overwise, both my professional and personal opinions say ditch the cigs.

Mixing marijuana with psyche meds raises a big yellow flag. Not that it can't be done, but it's going to depend on what other drug(s) you're taking and why you're taking them. Too many individual variables here to give an easy answer. If you're a light case so to speak, be careful. If you're a serious case, don't go there without professional help. Definitely DO NOT drop your psyche meds in favor of medical marijuana without qualified supervision. Not that marijuana cannot help you, and perhaps even lighten your regimen, but this is very delicate and often uncertain territory that should be monitored closely.

Given decades of relatively widespread use, it's unlikely, but not impossible, that marijuana will have negative interactions with many other drugs. But caution is always recommended when mixing chemicals, especially drugs that act on the central nervous system and/or cause major physiological/psychological changes. When in doubt consult an expert and, as we say in pharmacy, start low and go slow.

A Strain for Your Brain

So now you've got a medical marijuana registry card and you've located one or more dispensaries you'd like to check out. Here are a few tips to keep in mind:

What condition or symptoms are you wanting to treat? Be prepared to share this information with the dispensary. It will help them recommend a plant variety, as well as method of delivery that best suits your needs. Different varieties of cannabis offer different effects depending on their relative cannabinoid content. In general , the higher the THC concentration, the greater the psychoactive effects, including euphoria, appetite stimulation, anti-nausea, muscle relaxation, etc. Varieties with higher cannabidiol and cannabichromene concentrations will have greater sedative and analgesic activity, while those with higher cannabinol and cannabigerol content are better at lowering intraocular pressure (good for glaucoma patients).

Now don't expect the dispensary to list relative cannabinoid concentrations on their product. But they should be able to tell you what general effects you might expect from each of their varieties. Finding a variety that works best for you is a bit like finding your favorite wines. Advice from an experienced "pro" will make your efforts easier and more fruitful. Beyond that, education and experience, a bit of variety and trial and error will get you there.

In addition to finding the right variety, you'll also want to choose a delivery system that best suits your needs. A number of choices besides smoking are available. Vaping may be a better option because it can be easier on the lungs than smoke while still allowing the benefit of immediate effect and easy dose titration.

Oral ingestion in the form of various foodstuffs, butter and capsules is another good option depending on what you're after. Oral delivery changes the kinetic profile of the drug, prolonging marijuana's onset and duration of action as mentioned before. While oral ingestion does not allow immediate effect and dose titration, it does "spread-out" the effect so to speak, potentially reducing intense peaks while offering longer more subdued effect. Correct dosing is crucial here. So again, advice from a qualified dispensary goes a long way. And again, start low and go slow.

Perhaps the most under-utilized method of delivery is the topical route. Yet there's great potential benefit here. Being highly fat-soluble compounds, cannabinoids are easily absorbed through the skin. In a suitable base like sesame oil or cocoa butter, cannabis can be applied directly to affected areas. Because topical delivery maximizes local action while minimizing systemic effects, it could be an ideal route for special populations like the elderly and arthritis patients where local pain and inflammation is a problem. Working similar to today's medical patches, topically applied cannabinoids would tend to reservoir in the affected tissues thus giving sustained localized action.

Dosing Regimens

What does it mean to be a user of marijuana? Some people may use it only occasionally, say a few times a year, or once or twice a month. Some people may use it more regularly, say a few times a week, or once or twice a day. Some people have used it only once or twice in their life, or maybe much more, but are now done with the drug. Yet for all these people, who knows when the trials of life may demand their reconsideration.

So what is the typical usage pattern or dosing regimen of medical marijuana users. The apparent answer is, there is none. And that's a good thing.

When someone has occasional pain---say headache or joint-ache or heartache or pain-in-the-rear--- the last thing they need is to start taking painkillers on a regular basis, whether those painkillers are aspirins or opioids, antidepressants or valiums. Aspirins are too tough on the stomach long-term. Opioids and valiums are too addicting and do nothing for the underlying problem. Most antidepressants take a week or two for effect, and once on them, their mandatory consumption is a sort of de facto addiction (abruptly stopping some antidepressants can be near fatal or profoundly disturbing). Cannabis has no such problems.

There's an undeniable empowerment when the patient can decide the how and when of their medicine consumption. And beyond that, there's rarely a reason to take medicine regularly for a problem that only happens occasionally.

Unlike most drugs that have a set dosing regimen, say one capsule every morning or two tablets every 12 hours, marijuana is much more flexible and accommodating to meet individual needs and tastes. So dosing regimens of medical marijuana may vary greatly from patient to patient depending on one's condition and unique circumstances.

In many, if not most instances, marijuana is more like a "prn" or "as needed" medication. In this way you can use it similarly to hydrocortisone cream, whose directions might read, apply to affected area 3 or 4 times daily as needed for rash and itch. And when the rash disappears, you stop using the cream altogether.

The same applies when using marijuana for something like periodic muscle cramps, in which case the directions might read, inhale 2 to 4 puffs as needed for monthly cramping.

For occasional bouts of anxiety, directions could read, inhale cannabis once or twice weekly as needed for stress reduction.

For migraines or doldrums, 1 or 2 inhalations via vaporizer as needed.

In the hospice setting where I once worked, most patients typically experience some sort of pain. Consequently they are taking one or more opioid painkillers. Now because their pain is chronic, in other words regular and predictable, they receive a scheduled or routine dose of long-acting painkiller as well as an immediate-acting painkiller given "as needed" for breakthrough pain.

Cannabis may be used similarly. For instance, folks with chronic pain might have dosing regimens that say, one marijuana muffin every morning for chronic pain control and vaporized cannabis as needed for breakthrough pain.

Funny and even ridiculous as that may sound, when you really think about, taking medicine couldn't be more natural. As a proven painkiller, cannabis may decrease a patient's need for sedating narcotics, thus improving alertness, communication, interaction and quality of life.

Dosing flexibility is one of medical marijuana's greatest advantages, allowing occasional problems to be handled "as needed" without the side-effects of more addictive and demanding drugs. Yet beyond that, there's an even bigger benefit to cannabis. Rather than just mask the underlying problem by treating only the symptom, cannabis may actually help you get at the root of your problem. So whether yours is depression or anxiety or whatever, medical marijuana may bring you closer to a cure. Now that's healing!