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The Facts About Medical Cannabis
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The Facts About Medical Cannabis
A guide for exploring whether medicinal marijuana is right for you.
Introduction: Who this guide is for… This guide is by no means a comprehensive report on medical cannabis. It is intended to give an accessible introductory overview which will let the reader judge whether they wish to learn more about what is a relatively new (and yet remarkably ancient) subject. We will outline in Part 1 what medical cannabis is, how it actually works, at a very high level, and explain some of the key terms required to understand the discussion around the medical use of this remarkable plant. In Part 2 we will discuss some of the major effects of cannabis on symptoms such as pain, nausea and anxiety. We will then look at some specific conditions, such as arthritis, cancer, PTSD, and see how medical cannabis is being used in the treatment and management of these individual disorders. Part 3 gives an overview of the options for accessing medical marijuana in Canada – whether it be directly purchased from a licensed producer or accessed via a medical marijuana dispensary.
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The Facts About Medical Cannabis
PART ONE
Get to Know Medical Cannabis
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An ancient healing plant with a 21st century future 2
The Facts About Medical Cannabis
What is medical marijuana? And what is cannabis? How does it work? While the interest in cannabis as medicine stems from its wide range of physiological effects, the fact of the matter is that first and foremost cannabis is, simply, a plant. The place we need to begin then is with the plant itself. However, there are a few terms we need to get straight before we can usefully describe the plant which people refer to as both ‘cannabis’ and ‘marijuana’ (and then there’s ‘hemp,’ too).
The Terminology ‘Cannabis’ is the proper botanical term for an entire plant genus, within which there are several species with various physical forms and a wide range of chemical properties. Three of these species – Cannabis sativa and Cannabis indica and Cannabis ruderalis – have been the most actively used by human beings for the qualities of their fibers and their resins. ‘Marijuana’ refers to any species of cannabis in its role as a source of pharmacological effects. So in discussing medical cannabis we’re talking about marijuana – all marijuana is cannabis, but not all cannabis is marijuana. The terms ‘medical marijuana’ and ‘medical cannabis’ can, and are, used interchangeably, but the industry generally prefers the more botanically-based label of ‘medical cannabis’.
‘Hemp’ is a term used to refer to the cannabis plant in its various roles as a source of unique and useful fibrous and seed materials. ‘Hemp’ and ‘marijuana’ are therefore useful terms for distinguishing between the two primary human applications for the cannabis plant.
The Plant
SATIVA
Cannabis varieties are flowering annuals, meaning they germinate, flower and die in a single season. INDICA Cannabis is unusual in being dioecious – it does not self-pollinate, but instead individual plants are male or female. The female plant produces the flowers from which marijuana products are derived. The male plants are used in producing hemp products. The first pair of leaves on a plant will usually have a single leaflet, with the number gradually increasing up to a maximum of about thirteen leaflets per leaf. Approaching the top of a flowering plant, the count decreases again until reaching a single leaflet per leaf at the top. The bulk of the plant has seven or nine, which is the ‘iconic’ form of leaf most commonly used to represent marijuana. The leaves are long and pointed, and have a distinctive serration that results from a consistent diagonal vein pattern. Each serration vein typically connects to the central vein roughly in line with the notch of the next serration down, producing a very even pattern. A typical marijuana leaf, this one showing nine leaflets with the characteristic serrated edges and diagonal vein pattern.
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The Facts About Medical Cannabis
RUDERALIS
Branches grow from the central stem, and seedlings can grow rapidly with the right conditions. The plant grows into a bush-like structure, as small as a few feet high, and as tall as 20 feet high, and produces a pungent flower whose appearance and odor will also vary greatly from strain to strain.
Marijuana as Medicine Historically, medical interest in cannabis has been traced back as far as the time of Chinese Emperor Shen Nung, circa 2697 BC, in texts which advise cultivating the female plant for its greater medicinal properties. Across the centuries and across the world, marijuana has a long and rich history of therapeutic use. The question is, what is it in marijuana that actually makes people feel better? We’ll document some of the effects of marijuana shortly, but first it’s important to understand the basic science and chemistry at work in this unique plant. Marijuana contains literally hundreds of natural chemical compounds, an unusual number of which possess psychoactive and therapeutic properties. When these compounds make their way into the blood stream, whether by inhalation or ingestion, they interact with the body to produce effects that can support healing, wellness and symptom relief. Being unique to marijuana plants, the chemical compounds that make it an effective source of medication are called cannabinoids. Cannabinoids At its simplest, cannabinoids are pharmacologically active compounds. In other words, they are the substances in cannabis that produce a physiological effect of some kind. In the case of cannabinoids, however, this simple definition quickly gets complicated by the number of members of the cannabinoid family, and the various effects they are observed to have. The key compounds of interest in cannabis are summarized to the right, but this is far from a comprehensive list. 4
The Facts About Medical Cannabis
THE MAJOR CANNABINOIDS THC (Delta-9-Tetrahydrocannabinol) THC is the most psychoactive cannabinoid found in marijuana. THCA (tetrahydrocannabinolic acid) is highly concentrated in the flowering clusters or buds. It converts to the more active form of THC as it dries.
CBD (Cannabidiol) CBD is the second most predominant cannabinoid in marijuana. This compound continues to provoke interest for its therapeutic value. It has little or no psychoactive properties. Researchers and patients have begun to focus on the beneficial effects of using THC and CBD together, as well as on individual effect on diseases and afflictions. CBD reduces anxiety and panic in some patients. It is an anti-inflammatory sedative and a neuroprotective agent. Medical demand is high for CBD-rich strains, so marijuana breeders have begun producing high CBD levels plants.
CBM (Cannabinol) The third most prevalent chemical compound in marijuana, cannabinol is the incidental product of the chemical breakdown of THC. You may find higher levels of CBM in improperly stored marijuana resulting in diminished medical effects.
Terpenoids These plant-produced odor molecules result in marijuana`s distinct aroma. They affect the quality of the experience by altering THC’s effects. The terpenoids alter the effects of the cannabinoids pharmacologically, determining the character of the effect, i.e. relaxing, energizing, etc.
Flavonoids Marijuana has over 20 known flavonoids, a large class of water-soluble plant pigments that contribute to plant color. Marijuana has unique flavonoids – dubbed cannaflavins – that have both anti-inflammatory and antioxidant properties. Flavonoids may immobilize viruses and allergens. Studies have demonstrated their carcinogenic properties as well.
Endocannabinoids
The chemical structure of a THC molecule.
Every cannabinoid molecule can be thought of as being like a key, with an associated lock within the human nervous system. These ‘locks’ are the cannabinoid receptors. It’s when a cannabinoid molecule connects with a receptor in the body that a physiological effect is produced. Again, the concept is fairly simple. But cannabinoids and the various cannabinoid receptors create a relatively complex system. The receptors are found in many places in the body, and are classed into two key types – CB1 and CB2. The distinction is quite technical, but can be thought of as mainly about whether the receptors reside in the brain, CB1, or in the peripheral nervous system, CB2. (To be accurate, CB2 receptors are also found in the brain, but in relatively small densities. Likewise, CB1 receptors are found outside the brain, but mainly in the central nervous system). Within the brain, CB1 receptors are found primarily in the hippocampus and cerebral cortex. Outside of the brain, the CB2 receptors are found in several places, including the immune system, organs, spinal cord and gastrointestinal tract. The locations of these receptors do seem relevant to the effects associated with cannabinoid interactions with them. So, for example, CB1 receptors mostly reside in those parts of the brain that deal with things like memory formation, cognition and affect, with the hippocampus playing a key role in many kinds of seizures. And we then find cannabinoids having positive effects on conditions like Alzheimer’s disease, depression and epilepsy. CB2 receptors are found in the tissues around the joints – and cannabinoids are known to have an analgesic effect on arthritic conditions. 5
The Facts About Medical Cannabis
Why is the body full of receptors for the various substances in marijuana? The answer goes a long way towards understanding the breadth and depth of the effects of this unique plant. Our bodies actually have their own cannabinoid production systems in place, and the substances they produce are called the endocannabinoids (or ‘the cannabinoids within’). The endocannabinoids and their many receptors form a natural system that regulates many complex bodily processes, including the management of pain, stress and inflammation. It’s because the body’s own endocannabinoid system is involved in so many processes that medical cannabis has such a broad range of positive effects. The extraordinary collection of reports that a substance will relieve pressure in the eye for glaucoma sufferers, reduce nausea for cancer patients and ease serious depression (among many other things) can make that substance sound far too good to be true. But when we realize that the cannabinoids in marijuana are natural substitutes for those produced by our bodies, which are themselves integral to all of these physiological processes, it suddenly begins to make sense.
With the body’s own endocannabinoid system involved in so many systems and processes, it should not be surprising that medical cannabis has such a broad range of positive effects.
The vastness of the system does provide unique challenges for cannabis researchers, however. Both endocannabinoids and cannabinoids come in several varieties (see the sample in the sidebar above for just a sampling), and the receptors can each receive several of these varieties (this is where they behave a little bit less like ordinary locks and keys). This makes the biochemical mapping of strict cause and effect with cannabinoids and medical conditions much harder to achieve than with many synthetic pharmaceuticals. So while the effects of cannabis treatments on many medical conditions may be relatively easy to see and study, often we’re still speculating at precisely what mechanisms are in play to achieve those effects. Since medical research into cannabis has only recently begun to lose much of its social and political stigma, not too mention its legal complications, we are just at the beginning of a growing wave of research and understanding into exactly how specific cannabinoids achieve the many and varied effects that we can observe in patients. Strains Not surprisingly, the plant that fits so well into such a biochemically complex system is itself quite complex. This complexity has been exploited prodigiously by horticulturists both ancient and modern. These days an ever-expanding range of variations of the cannabis species is being developed, tested and adjusted. These varieties are typically referred to as ‘strains’. The medical purpose of this activity is to develop a range of combinations of the primary active ingredients in medical marijuana, allowing doctors and scientists to have a broader toolkit at their disposal in pairing conditions with treatment. Most commonly, cannabis growers will pay close attention to the levels and ratios of THC and CBD. These are the two most active cannabinoids and have very different properties, as well as complex effects on each other. 6
The Facts About Medical Cannabis
THC and CBD In very broad terms, a higher ratio of THC produces a ‘stronger’ form of marijuana, while a higher ratio of CBD yields a ‘milder’ product. Since THC is the most psychoactive element in cannabis, it is the most associated with psychological effects. These range from euphoric sensations (which no doubt play a role in managing things like pain and depression) to anxiety and panic, which some users of cannabis do experience (though this does appear to be relatively uncommon and greatly affected by the circumstances when the drug is taken). CBD, on the other hand, is not believed to have much psychoactive effect at all, and seems to mitigate those effects from the THC in a given strain. Both can range from less than 2% to as much as 15% (or more) in a given strain. It’s important to keep in mind, however, that there are literally hundreds of distinct chemical compounds in marijuana. We can probably assume that most of these compounds aren’t involved at all in the effects of medical marijuana. Nevertheless, it’s also safe to assume that a good number of these compounds are in fact at play in any effect, and that the levels and ratios of these active ingredients are relevant to exactly how a given strain effects a given condition (and this is broadly believed to be the case by cannabis users and researchers alike). For that matter, from individual patient to individual patient there will a be a great deal of variation in the effects of different strains.
…a higher ratio of THC produces a ‘stronger’ form of marijuana, while a higher ratio of CBD yields a ‘milder’ product.
THC and CBD ratios, then, simply give a reference point for what to expect in terms of the effects of a strain of cannabis. They should not be taken as the whole story or an absolute predictor of how a strain will react with a given user or condition.
Side Effects As with any medical substance, there are side effects to marijuana use. Compared with the adverse effects of other medical substances, those of cannabis are generally mild and “within the range of effects tolerated for other medications.” (Institute of Medicine Report, 1999)
The most common short-term side effect of marijuana use is diminished psychomotor performance. As with alcohol consumption, no one should operate any vehicle or dangerous equipment while under the influence of marijuana, THC, or any cannabinoid drug. Also in the short term, a minority of marijuana users experience dysphoria, or unpleasant feelings. This is often described as sensations of paranoia, panic, or sudden anxiety. There is evidence that these experiences are often related to the conditions and contexts of marijuana use. There are two chronic effects of marijuana use that are of greater medical concern: the effects of long-term smoking and the effects of THC. Like any form of smoking, marijuana smoking is associated with increased risk of cancer and lung disease. For this reason, physicians may be reluctant to prescribe long-term use of smoked cannabis for any but the most serious of conditions. Cannabis does have a growing variety of delivery modes available, each with it’s pros and cons.
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The Facts About Medical Cannabis
…to date there are no known cases of anyone dying from cannabis overdose. A second concern associated with chronic marijuana use is dependence on the psychoactive effects of THC. Although few marijuana users develop dependence, some certainly do. The effects of marijuana dependence are similar to those for other forms of substance abuse. In particular, anti-social personality and conduct disorders are closely associated with substance abuse. In terms of the addictive potential of a drug, marijuana rates quite low. A study of dependence statistics by the Institute of Health ranks five abuse-able substances in the following order: nicotine (32%), opiates (23%), cocaine (17%), alcohol (9%) and marijuana (9%). Significantly, to date there is no established lethal overdose threshold for marijuana, and no known cases of anyone dying from cannabis overdose.
PART TWO A New Day for Patients
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An alternative for symptom relief, healing and wellness
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The Facts About Medical Cannabis The Facts About Medical Marijuana in Florida
What conditions can be improved or treated by medical cannabis? Medical cannabis promises a new era of alternatives for symptom relief, healing and wellness for patients who can’t find relief with conventional pharmaceuticals.
term, the study found that over the following 12 month period, THC use was associated with an ongoing improvement in appetite.
Cannabis should not be considered a cure-all wonder drug, but its effects can be very positive, even lifechanging, in many cases and across a wide range of conditions.
Nausea and lack of appetite, and the lack of food energy and weight loss that follow, leave the body even more weakened and less able to heal and recover from whatever condition the patient is fighting. By alleviating these compounding symptoms in a way that no other available substance seems to do, medical cannabis offers a unique and powerful aid to healing and recovery.
We’ll look at several specific conditions that benefit from medical cannabis treatments, but we’ll first review some of the more general effects of marijuana that are at the heart of its specific benefits.
SYMPTOMS THAT BENEFIT FROM MEDICAL CANNABIS Nausea, Appetite-loss While these are two separate effects, and typically would involve separate prescriptions when treated medically, they do go hand in hand. Medical cannabis offers a powerful combined treatment for this important duo. Marijuana’s positive effects on appetite stimulation and nausea suppression are among it’s best known qualities. The very first approved prescription cannabinoids (nabilone and dronabinol) were in fact specifically for use in treating the vomiting associated with chemotherapy. (Tramer, 2001) Similarly, the effects of THC on appetite have been welldocumented. In a trial of patients with AIDS-related weight- and appetite loss, THC was associated with a stable weight in patients, compared to a measurable weight loss in the non-THC subjects. (Beal, 1995) As well, the THC patients experienced increased appetite, decreased nausea and improved mood. In the long 9
The Facts About Medical Cannabis
Digestive Disorders The presence of cannabinoid receptors (primarily CB2) in the gastrointestinal (GI) system itself goes a long way towards explaining why cannabis use soothes many GI tract symptoms. These receptors allow cannabis to have an “inhibitory effect on gastric emptying and intestinal transit” (Pertwee 2001), meaning that the entire system relaxes and the GI tract tries less actively to empty itself. Along with this, inflammation and pain signals are reduced. The overall effect is a smoother, more regular digestive function.
…the THC patients experienced increased appetite, decreased nausea and improved mood.
Pain
Inflammation
One of the most significant and well-studied effects of marijuana on the body is in pain reduction. The same processes in the brain and nervous system that produce euphoric, mood-elevating sensations are at work in blocking the body’s pain receptors.
CB2 receptors throughout our immune system (with the highest concentration being in the spleen) play a key role in mediating inflammation as part of the natural physiological response to injuries and infection. But when the body’s inflammatory response is overactive or falsely triggered, excessive inflammation can quickly become a source of pain and tissue damage. The cannabinoids in marijuana are known to provide a uniquely localized treatment for many forms of inflammation. Significantly, CB2 receptors have been found in the tissues around our joints and extremities, which is now thought to provide the key mechanism for the analgesic effects of cannabis use in arthritic patients.
Cannabinoids seem to have the most impact on chronic pain and inflammation, rather than the acute pain of something like a fresh injury or a dental problem. However, when combined with opiates, cannabinoids can reduce the overall dosage of opiates required for many types of pain. For patients with chronic pain, be it from arthritis, neuropathy, or the painful complex of factors that occur with conditions like HIV/AIDS and cancer, marijuana can be a unique tool that is highly effective while presenting a much lower level of side effects and addiction concerns that the alternatives. (Karst 2003, Greenwald and Stitzer 2000, Noyes et al., 1975)
…the patient left the clinic and returned within the hour, virtually symptom-free, having smoked a small amount of marijuana in that time.
Convulsions and Spasms Spastic and convulsive episodes are among the most debilitating and unpredictable symptoms of several serious disorders. Medical marijuana has a powerful history in this area. One well-known case involved a young man seeking treatment for severe spasticity, whose symptoms were not responding to conventional medications (drugs which also had unpleasant side effects). The patient had found that marijuana smoking was providing significant symptom relief, and was asked by his doctors to refrain from it. After a six week period of such restraint, he returned to the doctor with more severe symptoms than previously seen. In order to demonstrate for the doctors the remarkable effect of the cannabis on his spasticity and related symptoms, the patient left the clinic and returned within the hour virtually symptom-free, having smoked a small amount of marijuana in that time. This striking case motivated the first proper clinical trial of a cannabinoid drug. (Petro and Ellenberger, 1981)
Research is finding that the cannabinoid CBD is likely responsible for marijuana’s anti-convulsive properties. A range of conditions like MS and epilepsy that produce spasms or convulsions seem to respond very well to cannabis treatments, and this can have the added benefit of allowing the patient to reduce or eliminate far more toxic drug therapies. 10
The Facts About Medical Cannabis
Depression The psychoactive effects of cannabis primarily occur by way of the CB1 receptors, which are the ones found in the brain. It’s been shown that when these CB1 receptors are artificially blocked, stress-coping abilities decline quickly and depression may actually be induced. (Huestis et al., 2001) This is strong evidence for the role of endocannabinoids, and therefore of cannabinoids, in managing the physiology of mental states like depression. Changes in the levels of cannabinoid CB1 receptor are observed in both human and animal subjects experiencing clinical depression. (Mangieri and Piomelli, 2007). Marijuana’s well-known reputation as both an elevator of mood and an aid to mental relaxation, seems to be borne out by studies finding that regular users of marijuana experience lower levels of depression and higher levels of positive affect (Denson and Earleywine, 2006) than non-users.
Anxiety Another very commonly described effect of marijuana use is a calming, relaxing, even tranquilizing property. Studies and found reduced anxiety with cannabinoid use in both animals and humans. (Rubino et. al, 2008) Researchers are finding that the brain’s endocannabinoid system is integral in stress reactions and fear management. (Akirav and Maroun, 2007) CBD
…CBD seems to be especially important in reducing anxiety, performing as well as existing anxiety medications. 11
The Facts About Medical Cannabis
seems to be especially important in reducing anxiety, performing as well as existing anxiety medications. (Zuardi and Guimaraes, 1997) There is a strong body of medical research and evidence supporting the anecdotal reports of marijuana’s anxiolytic effects.
Insomnia Good, regular sleep is a fundamental physical requirement. Lack of sleep does more than make a person tired. It leads to chronic fatigue and physical exhaustion, and has pronounced effects on mental processes like memory formation, reasoning and emotional control. It aggravates existing physical ailments and leaves one more susceptible to other illness. Medical marijuana helps many patients find consistent, restful sleep. This is an area where the variations between strains show clear differences. Some strains of cannabis seem to provide a stimulant effect, at least initially, which users find helps them feel sharp, awake and focused – not at all what one wants for combating insomnia. However, many cannabis indica strains have been found to have relaxing, sedative effects and users report good sleep as a result.
CONDITIONS BENEFITING FROM MEDICAL CANNABIS TREATMENT For patients suffering from a wide range of unrelated conditions, simply discovering the potential effects of medical cannabis on these individual symptoms can be enough to make them very interested in learning more about it. In the following section we discuss several of the major physical disorders where medical cannabis is increasingly being used to very positive effects. While there is a commonality to the symptoms we’ve just described as they occur in many disorders, there are also many detailed and condition-specific effects of medical cannabis that are emerging as it becomes more openly and rigorously studied around the world.
Parkinson’s Seizures Depression & Anxiety Glaucoma
Gastrointestinal Disorders Crohn’s Disease
TARGETED EFFE C TS
Appetite
Cancer Treatment Side Effects Multiple Sclerosis HIV AIDS Symptoms Lupus
Arthritis
Chronic Pain
FULL- BO DY CO NDITIO N S
Nausea
Cancer Symptoms
Fibromyalgia Neuralgia
A BROAD RANGE OF PHYSICAL CONDITIONS Medical cannabis offers a valuable treatment for a broad range of conditions, having both targeted and full-body effects. The above image shows some of the more prevalent conditions with demonstrated benefits from cannabinoid interventions. 12
The Facts About Medical Cannabis
Arthritis At its worst, arthritis is a crippling and chronic disease. Pain and discomfort are the condition’s signature symptoms. The strong anti-inflammatory effect attributed to THC’s interaction with the CB2 cannabinoid receptors around the joints makes it well-suited for use in treating rheumatoid and osteoarthritis. Patients with chronic pain from rheumatoid arthritis have been shown to experience decreased pain both with movement and at rest, as well as improved sleep. (Blake 2006) And in the long term, the reduced inflammation provided by cannabis treatment may serve to slow the progress of certain cases of arthritis by reducing the tissue damage that accompanies prolonged periods of inflammation. Both internal and external use (as a salve or poultice) are appropriate to achieve the desired effects.
• anti-inflammatory • pain relief • improved movement • mitigation of tissue damage
Migraine and Headache Pain Migraine headaches inflict intense, long-lasting pain that interferes will all normal functioning, and which often goes on to induce nausea and cramping. Marijuana has long been used by many to medicate their own headaches, and science now supports those practices. Cannabis’s inhibitory effect on serotonin type 3 receptors in the brain is believed to play a strong role in diminishing the onset of migraine and headache pain. (Fan, 1985) Migraine sufferers who use medical cannabis commonly report a strategy of smoking a small amount at the first indication of an incident coming on. This would get the marijuana into the system almost instantly, which would in fact allow for very fast results. As well, the anti-nausea property of marijuana can help to minimize the overall discomfort and length of the migraine experience.
• can stave off migraines if taken at onset • eases nausea and vomiting • shorter headache duration • diminished intensity
Cancer Treatment Radiation and chemotherapy continue to be the strongest tools in actively treating cancers. These forms of treatment are, by their nature, ordeals for the patients. Marijuana has a solid history of mitigating some of the worst side effects of these harsh regimens. By easing nausea and vomiting while stimulating some appetite in patients who often have virtually none, cannabis therapy not only eases discomfort but helps to maintain the strength of the patient. The physical pain that accompanies both cancer and its treatments has also been shown to be relieved significantly by various THC treatments, comparable in effectiveness to drugs like codeine. (Noyes, 1975, Staquet 1978) The side effects of these cannabis treatments have generally been considered to be mild. Furthermore, the depression and anxiety that very often accompany cancer diagnoses and treatments also respond well to medical cannabis in many patients. 13
The Facts About Medical Cannabis
• mitigates side-effects of chemotherapy and radiation therapy • eases nausea and vomiting • stimulates appetite • pain relief with milder side effects than opiates • can help with depression and anxiety
TESTIMONIAL “With regard to the treatment for his cancer, Danny was given numerous rounds of radiation and chemotherapy, which caused him to lose 60 pounds due to extreme nausea and total loss of appetite. Dan was hospitalized 15 times, for a total of 57 days, and underwent 14 surgeries. The list of pharmaceuticals he was given was lengthy, to say the least. They included Coumadin, Lovenox, Ambien, Lasix, along with a Fentanyl patch, oxycodone, and morphine for pain; for depression and anxiety, lorazepam, trazodone, and Celexa. Some of these medications caused Danny to hallucinate and behave erratically, which frustrated and angered him because he knew his behavior wasn’t right. There were many antibiotics for the multiple infections he developed due to a weakened immune system. Compounding matters, Dan discovered he was allergic to many medications, severely restricting the meds he could take. The anti-nausea medications in particular didn’t work, leading him to the point of trying medical marijuana, provided by a family member as a gift. It led to an immediate change in the quality of life he had left. It reduced his pain and took away his nausea and loss of appetite, which enabled him to live far beyond all projections given by his oncologist at the Mayo Clinic. We were told by the oncologist that this was beyond anything he’d ever seen. During his two-year battle with cancer, Danny insisted on maintaining and growing his lawn care, snow removal, and landscaping business, Dan Peterson Services, which he started on his own in 2001, not to mention trying to uphold his duties as a husband and father of four. He couldn’t have done these important things without the use of medical marijuana to alleviate his nausea, pain, and lack of appetite. […] The use of medical marijuana by our son allowed him a much greater quality of life, with reduced pain and suffering. After witnessing the near-miraculous benefits it provided to our son, my wife and I agreed that we would go to jail or prison, if need be, to support him in this particular use of what is presently an illegal drug.”
Jerry and Carmen Peterson Parents of Danny Peterson In testimony before the Minnesota Health Housing and Family Security Committee, given in support of efforts to pass medical marijuana legislation in Minnesota.
“He couldn’t have done these important things without the use of medical marijuana to alleviate his nausea, pain, and lack of appetite.”
Note: The testimonials in this e-book are quotes taken from publicly available sources. They are individual experiences, reflecting real life experiences of those who have used marijuana products in some way or another. However, they are individual results and results do vary. Vida does not claim that they are typical results that consumers will generally achieve with the use of any medicinal marijuana products. The testimonials are not necessarily representative of everyone who will use medicinal marijuana products.
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The Facts About Medical Cannabis
Crohn’s Disease and GI Tract Disorders Inflammatory bowel diseases (IBDs) such as ulcerative colitis and Crohn’s afflict over a million people in the United States alone with pain, diarrhea and digestive difficulties. Many cases ultimately require surgical intervention to remove affected bowel segments. Recent studies have found that cannabis treatments can produce overall effects of pain relief, decreased inflammation, reduced diarrhea and diminished gastrointestinal hypermotility (which manifests as frequent and sudden urges to void the bowels). (Schicho and Storr, 2013) Acting as a muscle relaxant, cannabis can ease gastrointestinal cramping and spasms. Cannabinoids also appear to speed the healing of injured epithelial tissues. Studies have also found broader potential effects of cannabis treatment, including a lower incidence of surgical intervention, and reduced need for other drugs. (Naftali et al., 2013) Since the drugs typically used in treating these conditions can bring a host of unpleasant side effects, anything that can reduce the need for such interventions is of great benefit to patients.
• reduced pain and discomfort • diminished incidence of diarrhea and GI hypermotility • eased cramping and spasms • less need for other drug therapies and surgery
“This March marked eight years since my surgery and this August will mark nine since my diagnosis. I show no signs of needing surgery again in the foreseeable future. My health is one hundred percent attributable to my decision to ignore everyone’s discouragement years ago and replace all those drugs (including Asacol and Prednisone) with marijuana.” Angela Bacca, Crohn’s Disease Patient From ‘Marijuana Put My Crohn’s Disease Into Remission and It’s Not A Joke’, posted on ladybud.com Note: The testimonials in this e-book are quotes taken from publicly available sources. They are individual experiences, reflecting real life experiences of those who have used marijuana products in some way or another. However, they are individual results and results do vary. Vida does not claim that they are typical results that consumers will generally achieve with the use of any medicinal marijuana products. The testimonials are not necessarily representative of everyone who will use medicinal marijuana products.
Glaucoma Glaucoma, a disease in which progressive damage to the optic nerve leads to gradual, irreversible vision loss, is the second leading cause of blindness. As early as 1971, cannabinoids had been shown to effectively lower pressure in the eye, slowing progressive vision loss. (Hepler and Frank, 1971) Furthermore, in glaucoma, the final stages of vision loss occur via the selective death of retinal ganglion cells. Substances with specific neuroprotective effects are the key to combating this vision loss, and cannabinoids appear to have just such effects. (Yoles et al., 1996, Mechoulam et al., 2002) Cannabis, then has proven to be very useful in the treatment of glaucoma, in both its short and long term effects. 15
The Facts About Medical Cannabis
• reduced intraocular pressure • neuroprotective effects • slowing of progressive vision loss
HIV/AIDS HIV/AIDS afflicts tens of millions of patients with a varying complex of pain, nausea, wasting syndrome and depressive disorders. The HIV-positive population represents one of the largest groups using medical cannabis, with studies finding ranges between 23% and 37% of patients using it to some extent. (Ware et al., 2003)
• chronic pain management
Pain comes in many forms across those infected with HIV. It includes headaches, neuropathy, chronic back pain, throat pain, arthralgia, lymphoma and carcinomas, as well as the pain that accompanies many treatments. Cannabis has proven to be effective at managing many of these pain conditions. Neuropathy in particular is very prevalent and well-studied in this population. Nerves become damaged, both by the HIV virus and by medications used in treatment. Damaged nerves can become hypersensitive, translating ordinary stimuli into pain signals, or even sending pain signalswhen there is in fact nothing stimulating the nerves at all. Cannabis use has beenwidely reported as effective in managing neuropathic pain, and studies have backedup these reports. (Abrams et al., 2007)
• slowed/reversed weight loss
• nausea control • appetite stimulation • depression management • improved sleep • lack of interactions with key medications
Nausea occurs commonly with HIV, and can be a product of the opportunistic illnesses that result from the infection, or as a major side effect of treatments such as antiretrovirals. Marijuana is very effective at nausea control and this provides both an improved quality of life and facilitates proper treatment regimens with essential medications. Loss of appetite and body weight pose serious problems for HIV patients. The overall weakening that results from low food intake exacerbates every other complication of the condition. It also makes day-to-day life consistently unpleasant, which in turn contributes to emotional strain and depression. With appetite stimulation being a strong feature of cannabis use, medical cannabis has shown significant benefits in this key area for HIV patients, with studies finding reduced weight loss, and even weight gain in some cases. (Dejesus et al., 2007) The mood-lifting quality of marijuana manifests itself as a anti-depressive effect in many who use it, and depression is a common challenge for those struggling with complex chronic illnesses such as HIV. THC has also been shown to help with the duration and quality of sleep, which aids with both the physical and mental demands of managing illness. A final important aspect of medical marijuana in the treatment of HIV/AIDS is the apparent absence of significant interactions with the other medications involved, particularly the antiretroviral drugs.
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The Facts About Medical Cannabis
… with studies finding reduced weight loss, and even weight gain in some cases.
Multiple Sclerosis MS is a chronic, progressive neurological disorder where the immune system attacks the central nervous system. More specifically, the target is the myelin sheath around neurons which facilitate transmission between neurons. The result is a gradual breakdown of the central nervous system, and with that comes a host of symptoms, including pain, muscle spasms, tremors, loss of balance, bladder dysfunction, and more.
• reduction of spasticity
Marijuana use has let to reported improvements in virtually every symptom of the disease, including spasticity, pain, mood, weight loss, fatigue, vision, sexual function, bladder control, balance, and walking. (Consroe et al., 1997) The symptoms that have the most evidence of benefit from medical cannabis are spasticity control, neuropathy, bladder control and vision (nystagmus, an eye-muscle disorder that commonly occurs in MS patients). Anything that can impact these core effects of the disease is truly life-changing, as outlined in testimonials like the one below.
• improved walking
• appetite stimulation and reduced weight loss • neuropathic pain management • improved sleep • management of nystagmatic vision loss • improved balance
TESTIMONIAL “Some days I would be semi-ambulatory. Most days I was completely bedridden. My eyesight became very blurred and I lost all ability to focus. Unable to walk, read, or be with my family, I became very depressed. . . One evening some old friends came to visit and we smoked several joints. When my friends got up to leave, I stood up to say goodbye. Everybody in the room suddenly stopped talking and stared at me. At first I could not understand what was wrong. Then I realized I was standing, I had spontaneously stood up, unassisted, as if standing up was a perfectly natural. . . . I quickly discovered that when I did not smoke marijuana my condition worsened, I suffered more frequent spasms, and the spasms were more intense. When I smoked marijuana my condition stabilized, then dramatically improved. After smoking marijuana my spasms were much more controlled and less severe. Marijuana caused me to feel better. I regained control over my limbs and could walk totally unaided. My vision, often blurred and unfocused, improved. I do not like breaking the law. […] However, I do like to walk, talk, read, and see. Marijuana allows me to do these simple, human things by controlling the symptoms of my MS. If I am forced to choose between maintaining my health with an illegal drug or obeying the law, I would choose to maintain my health.” Greg Paufler In testimony submitted to the DEA In the Matter of Marijuana Rescheduling and in Idaho v. Hastings. Note: The testimonials in this e-book are quotes taken from publicly available sources. They are individual experiences, reflecting real life experiences of those who have used marijuana products in some way or another. However, they are individual results and results do vary. Vida does not claim that they are typical results that consumers will generally achieve with the use of any medicinal marijuana products. The testimonials are not necessarily representative of everyone who will use medicinal marijuana products.
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The Facts About Medical Cannabis
PTSD and Anxiety Disorders Post-traumatic stress disorder (PTSD) develops as a consequence of experiencing some kind of terrifying or profoundly disturbing event in one’s life, whether it be a direct experience or the witnessing of a terrible event. The consequence is that the normal physiological responses to danger (sometimes summed up as our ‘fight or flight response’) get triggered long after the original events that caused the disorder, and they can be triggered in unpredictable and inappropriate ways. Essentially the person experiences intense fear even if there’s apparently no immediate cause for it. Characterized by depression, anxiety, insomnia, irritability and a general lack of emotional control, it can be an extremely isolating condition. There is mounting evidence that the endocannabinoid system is at work in stress reactions, emotional regulation and the control of fear. (Jankord and Herman, 2008) This systems seems to interact with a key hormonal system, such that it may in fact be a role of endocannabinoids to reset things after extreme emotional stress. (Viveros et al., 2007) This research, though early, is extremely promising for the treatment of PTSD. Aside from these long term prospects for medical marijuana and PTSD, it is clearly the case that managing some of the core symptoms of this anxiety can be a great aid in managing the condition. Medical marijuana has been shown to reduce anxiety, in both human and animal studies. CBD seems to be of particular use on this front, and has outperformed standard anxiety medications in experimental comparisons. (Zuardi and Guimaraes, 1997)
Additionally, marijuana’s positive effect on sleep can have a great impact on the quality of life and capacity to manage emotions. Anti-depressant, mood elevating effects also play a role in bringing about real change in overall condition for PTSD patients, and those suffering from a range of anxiety disorders where these core symptoms present with similar consequences.
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The Facts About Medical Cannabis
• anti-anxiety effects • improved sleep • improved mood • depression management • long-term promise for targeted PTSD therapy
PART THREE Accessing Medical Cannabis in Canada
3
Is it right for me? Where do I get medical marijuana?
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19 The Facts About Medical Cannabis The Facts About Medical Marijuana in Florida
Accessing medical cannabis in Canada is a controlled but easily navigated process. You can either register directly with a Licensed Producer like Vida, or you can visit a dispensary such as National Access Cannabis.
Option 1: Registering with Vida Cannabis 1. Consult a healtcare practitioner. Cannabis is not appropriate for every patient and every condition. Your regular doctor is the best place to start, but you can consult with any doctor who is familiar with rapidly evolving use of medical cannabis. In some provinces and territories, nurse practitioners may also be qualified to consult with patients and assess the appropriateness of medical marijuana for their situation. 2. Obtain your Medical Document from the healthcare practitioner. Health Canada regulations require that you have a Medical Document, which is much like a prescription. It indicates that the patient is legally permitted to have their medical marijuana, and specifies the type and amount of cannabis the patient may take and possess. Health Canada provides a sample document that practitioners can fill out, but the information required to make a valid medical document is fairly simple and listed here: •
Patient’s full name
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Patient’s date of birth
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Address where patient consulted with the healthcare practitioner
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Daily grams of dried marijuana patient is authorized to use
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Period of use (i.e. number of days, weeks or months). This cannot exceed one year from the date the medical document is signed by the healthcare practitioner
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Healthcare practitioner’s name and, administrative information: profession, licence number, province of licence, business address, phone number, fax number and email address, if applicable
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Attestation by the healthcare practitioner that the information contained in the document is correct and complete
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Document must be signed and dated by the healthcare practitioner.
3. Register with Vida and order your product. Registering is simple, and you can start in the patient section of our site. It requires that a Registration Form be filled out and supplied along with the patient’s Medical Document, and produces a unique Vida ID number used to order product by internet or phone. Vida quickly and discreetly delivers the order directly to the patient’s door.
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The Facts About Medical Cannabis
Option 2: Register with a Licensed Dispensary Dispenaries are an alternative route to accessing medical marijuana. Dispensaries are not growers – they have access to several strains from various growers, and they can consult with each client to determine which strain best suits that patient’s symptoms and conditions. 1. Consult with a dispensary such as National Access Cannabis. Dispensaries like NAC will have a network of doctor’s they can refer each client to for their medical consultation. The dispensary personnel will have the knowledge to help clients find doctors who focus on their particular condition, and they will have a strong familiarity with which strains are generally best-suited to which symptoms. They are also a good overall source of information, both general and specific, and can provide support and guidance at every stage (including helping to determine whether medical marijuana is even an appopriate option to pursue at all). 2. Register with the dispensary. Once the patients has consulted with a physician and obtained the required medical document, the patient registers with the dispensary. Registration information for NAC is available here, for example. Product is then ordered through the dispensary, and picked up at the dispensary location.
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The Facts About Medical Cannabis
About Vida Vida Cannabis Corp. (“Vida Cannabis”) is focused on building a dominant production footprint in the rapidly developing global marketplace for the legal use of medicinal and recreational marijuana. Initial operations are focused on the Canadian market where Health Canada has established national guidelines enabling best-in-class producers to acquire commercial production licenses under the Marihuana for Medical Purposes Regulations. Via its wholly owned subsidiary, Vida Cannabis (Canada) Ltd., Vida Cannabis purchased a 316,700-square-foot production facility in the town of Stellarton, Nova Scotia and secured a 50-year irrevocable approval unanimously from the local municipality to operate a medical marijuana production plant at the facility. The highly secure facility is an ideal location for a customized, state-of-the-art hydroponic medical marijuana production plant. Vida Cannabis is working with Quantum 9, the pre-eminent cannabis consulting firm in the world, which has extensive resources in the United States, Canada and Europe, to establish an optimized end-to-end production plan in order to position Vida Cannabis as the most advanced pharmaceutical-grade medical marijuana facility in Canada. Vida Cannabis continues to evaluate additional potential markets as regulatory bodies around the world pass legislation enabling the production and distribution of medicinal and/or recreational marijuana.
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The Facts About Medical Cannabis