DISPELLING THE MYTHS ABOUT MEDICAL CANNABIS
Dr. Lionel Marks de Chabris, a pain and addiction specialist in Sudbury, demystifies medical cannabis and answers the top questions about the practicalities.
WHAT IS IN CANNABIS?
There are 144 compounds called cannabinoids in cannabis. The main ones are THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol), but there are many others. Of all the ones we know about, only THC has psychoactive properties. But you don’t have to get high to reap the plant’s benefits. If you’re thinking about using cannabis for medical purposes, Dr. Marks de Chabris advises limiting the amount of THC and concentrating on the CBD.
HOW DOES IT WORK?
Inside our bodies we make our own cannabis-like chemicals called endocannabinoids. When something happens such as injury or inflammation, the body gets thrown out of balance. “If that goes on for a long time, you get stuck in this inflammatory phase that doesn’t seem to want to resolve. The purpose of the endocannabinoids seems to be to bring the body back into balance,” he explains. We currently know about just two kinds of endocannabinoids our bodies make: 2-AG and anandamide. Scientists have also discovered two cannabinoid receptors. The cannabinoid 1 receptor (where THC works) is primarily in the brain and spinal cord. The cannabinoid 2 receptor (where CBD works) is primarily in the immune system and gut. WHY IS THERE STILL A STIGMA?
According to Dr. Marks de Chabris, stigma is a big problem—despite cannabis being used as a medicine for over 5,000 years. It was commonly used in the 1800s and early 1900s. But over the last 80 years, there’s been a deliberate campaign of disinformation about cannabis, started initially for political and racist reasons. People are beginning to realize that cannabis was unfairly judged and sentenced to exile from the medical community. “I hear this argument all the time: Oh, you can’t use it because there’s no evidence. Well, no evidence of benefit is very different than evidence of no benefit. Evidence of no benefit means we know it doesn’t work or it’s harmful. No evidence of benefit means we haven’t done the studies yet.”
WHAT DOES CANNABIS DO?
There are a few good studies that show cannabis works well for many people for pain and spasticity. There’s also early evidence for weight gain, nausea and sleep disorders. Does it cure cancer? “Who the heck knows? But we have no evidence yet.” Research has been lagging, he believes, because since 1970, federal funding on the medical benefits of cannabis has been banned in the United States—typically a global leader in health research and innovation.
WHAT ARE THE SIDE EFFECTS?
Common side effects of cannabis include dizziness, nausea, sleepiness,
dry mouth, anxiousness and red eyes. He says the important thing to know about all the side effects is that they’re both initial and dose-dependent. This means you’re going to get more side effects the first time you try using and the higher the dose that you start with, so he strongly recommends starting at a low dose and only increasing very slowly over time. The side effects tend to get better as you continue to use it, and experienced users rarely report any side effects.
ISN’T IT ILLEGAL?
If you have an authorization from a physician and you purchase the cannabis from a licensed producer, it’s legal. If you have an authorization but you purchase it from a dispensary, compassion club, local grow-op or store front, that’s illegal. It’s always illegal if you don’t have an authorization.
HOW DO I USE CANNABIS?
You can smoke it, vaporize it or take it by mouth. Dr. Marks de Chabris doesn’t recommend smoking because it has a strong smell and creates products of combustion—the same tars and carbon monoxide produced by cigarette smoking. “Why would you want that stuff in your lungs?” he asks. “It’s hard to imagine a physician giving you a medicine and saying, ‘Here. Take this pill, set it on fire and breathe in the fumes.’” Vaporizing has minimal odour, no products of combustion and you can even use it around home oxygen. But he believes ingesting cannabis oil is better because it provides a slow, steady release to control symptoms over many hours. The effects can last 8-12 hours (compared to 2-3 hours with vaporizing). He also advises his patients to try different strains, beginning with an oil high in CBD, until they find one that works for them.
WHAT SHOULD I DO THE FIRST TIME?
Trying cannabis doesn’t have to be scary. For first-time users, set and setting are key. “Your mindset when you first use medical cannabis is very important and directly affects how it will make you feel,” he says. Don’t try it if you’re anxious or frightened. Make sure you’re in a quiet, calm environment where you feel safe and comfortable. He suggests starting with a low dose of oil in the early evening. “One of its biggest side effects is it may make you sleepy. Perfect—go to bed. If you get side effects, they’ll be gone in 3-4 hours or when you wake up in the morning.” Start with 0.1 ml in your mouth. The next night, try 0.2 ml. The following night, try 0.3 ml. Gradually increase the dose until you have beneficial effects or problematic side effects. If you get problematic side effects, go back to the previously tolerated dose for about a week and then try going up again if needed. “If all you’re getting is side effects and no benefit, stop the medicine.”
HOW SHOULD I TALK TO MY DOCTOR?
Dr. Marks de Chabris suggests being prepared with studies and research. He emphasizes that cannabis is one of the safest and least addictive medicines. Tell your doctor the risk is low and the potential benefits are there. Ask for a 3- or 6-month trial and see whether things improve. If your doctor says no, request a referral to a cannabis clinic or cannabinoid medical centre.
HOW MUCH WILL IT COST?
Doctors are not allowed to charge you a fee for an assessment or authorization for medical cannabis. The cannabis itself, however, is not typically covered by insurance plans, although it can be claimed as a medical expense on your personal tax return.