Medical Marijuana: Finding the trees in the forest!

Even before my MND/PMA diagnosis, I started to talk to medical professionals who were treating me for a then-unspecified neuro-muscular disorder about the possibility that Cannabis could be beneficial for my condition. The first thing that I discovered was that although Medical Marijuana was about to be legalised here in Canada, most of those that I spoke to were unwilling to engage in a meaningful conversation of the pros and cons and how it might help or hinder my condition (since diagnosed as PMA – Primary Muscular Atrophy, a form of ALS). I soon realised that ‘if it’s to be, it’s up to me!’ Accordingly, I started doing research into the world of medical cannabis.

There is a vast array of information available on the benefits, pitfalls and even dangers of medical marijuana but most of it refers to the category as a whole and does not do a good job of highlighting the fact that sourcing cannabis is a bit like buying a motor vehicle. First, you have to decide on car, van, SUV, truck, motorcycle or electric scooter. They will all get you from point a to point b, but speed, ease of use, cost and durability are all factors affecting your choice. Similar differences exist in styles, types, potencies and cost of various strains and formats of consumer cannabis.

Possible benefits FOR PMA/MND Sufferers:

What follows here is a purely personal summary of what I have found during my research on Cannabis & PMA. I would encourage you to do your own inquiries as to whether there might be some benefit for your own particular case. Bear in mind that these benefits may be specific to a particular blend or ratio of active ingredients.

1.  Relief of muscular pain, stiffness and/or cramps.
2.  Lessening of anxiety and depression.
3.  Aid in relaxation and sleeping.
4.  Possible neuroprotective properties.
5.  Anti-oxidant

Types or Forms of Cannabis:

1. Flower or leaf
   This is probably the most popular and possibly the least expensive way to purchase marijuana. The drawback here is that the active ingredients need to be activated with heat. This means that you either have to smoke it, bake it or use some other high-temperature method to release or activate those ingredients. One significant advantage to this method is that the desired effects will manifest much more quickly as the active ingredients are introduced directly into the bloodstream via the lungs. Dosing will be somewhat harder to judge with this method and it is hardly unobtrusive since all strains of cannabis give off a distinct aroma. Although the manufacturer will list the amount of each active ingredient, there is no way of knowing how much is activated and actually absorbed into your system. Also, there is some concern that long-term smoking of weed can be harmful to one’s lungs, similar to the effect of sustained tobacco smoke.
2. Oils or sprays
   Made to be orally ingested, cannabis oils make precise dosing easy and provided you have no problems swallowing the liquid and can stomach the taste, this will be the preferred choice of many users. It is easy to transport, leaves no noticeable aroma and can be taken at any time, anywhere. It can take up to 90 minutes to fully enter the bloodstream but this can be quickened by holding the oil under your tongue for as long as possible before swallowing. As a general rule, you can be sure that 100% of the active ingredients will eventually be made available to your system.
3. Capsules
   In my personal experience, this is an expensive way of using marijuana. Dosing, although precise, is more difficult to modify. Due to cost, they tend to be fairly potent but since they are in a gelcap form, you cannot divide one and take only a portion. Additionally, this is the slowest acting of the 3 normal formats, since the gelcap has to be dissolved in your stomach before its ingredients are released. Generally, only those who cannot smoke or swallow the oils for any reason will opt for the gels.
4. Edible products
   We have all heard of ‘special’ brownies baked with marijuana. There is now a dizzying array of products available laced with marijuana. They are not usually geared to the medical marijuana market though and, as one might expect, both higher price and lower potency are likely with this option.

Active Ingredients in Marijuana:

There are too many potential active ingredients in the various strains of cannabis plants for us to give an extensive overview here, so I will limit myself to the three main ones.
THC – This is the psychoactive component of marijuana that gives the user the perhaps familiar and often sought after high. It is the main ingredient for pain relief and for improving sleeplessness but has the disadvantage of being mind-altering and therefore would have many of the same drawbacks as alcohol consumption and can indeed be addictive. In general, the Indica strains tend to be high in THC.
CBD – Unlike THC, CBD has no mind-altering properties and is also non-addictive. It is an anti-inflammatory and it that capacity can have analgesic effects similar to Ibuprofen. CBD is also the principal ingredient in marijuana that offers potential neuroprotective properties with long-term use. In addition to its stand-alone properties, when combined with THC, it can lessen some of the potential side-effects of the latter, in particular, the possible psychosis that THC can cause. In general, the Sativa strains tend to be high in CBD.
Terpenes – These are a large class of organic compounds found in various combinations in all cannabis plants. They are what give each strain its individual aroma or taste. They are generally considered to be safe and are seen to provide ancillary or complementary benefits to the two main active ingredients above. In many manufactured cannabis products the terpenes are removed to remove tastes and odours that some find unpleasant. Most medical marijuana manufacturers will list the terpenes (if) present in their various offerings.

Although there is currently a lot more research being done on determining the benefits and side-effects of the various ingredients that make up the different strains of the cannabis plant, much of the literature to be found abounds with anecdotal evidence rather than empirical research.

Determining the active strength of different offerings:

Most manufacturers of medical marijuana will list statistics of THC/CBD concentrations without giving any indication of what this means. Since I personally use Oils, I will discuss those here, though similar calculations can be done with the alternate formats. I personally use 2 differing formulations of cannabis oil. One for daytime and one for nighttime.
Daytime Formula: 20MG CBD/ML, <1MG THC/ML
Nighttime Formula: 15MG CBD/ML, 10MG THC/ML
Clear as mud, right? Well, it is actually quite easy to figure out what this means. In the daytime formula, the active ingredients are 95+% CBD and <5% THC. This low level of THC will make this formulation legal in many jurisdictions where THC is a banned substance. It will have little or no psychoactive effect. In the nighttime formula, the ingredients are 60% CBD and 40% THC. Although there is some potential for psychoactive effects, these will be tempered by the higher level of CBD.
You will find that you can obtain products that range from virtually 100% down to 0% of both CBD and THC. You may need to experiment to get the correct blend(s) suitable for your individual needs. However, there is one final factor that we need to look at.

Dosing:

Now we get into one of the more difficult and nebulous areas of medical marijuana consumption. How to determine the correct dosage for your personal situation. My first piece of advice is to start out slowly and gradually increase dosages until you reach the desired level of results. Be aware that not all formulations are equally strong and you may well wish to opt for the most potent combination and choose a lower dosage since this tends to be the most cost-effective route.
As an example, my preferred supplier offers 40 ml with 5mg CBD/ML, 5mg THC/ML. That means at a dose of 1ML, I will be taking 5mg THC and 5mg CBD. My usual blend offers 15mg CBD/ML and 10mg THC/ML. Therefore, the same 1ml dose will give me 15mg CBD and 10mg THC. I would have to take 2 -3 times the dose of the former blend to equal the potency of the latter.

Cost:

Prices are really all over the map and it can be quite hard to determine which is the best value for money. Again, I will restrict my comments here to oils but the same type of calculation can be done for any format to determine how much bang you are actually getting for your buck. To make life simple, we will assume that both THC and CBD have equivalent cost/value per MG. Most oils come in either 20/30/40ml bottles. To determine the equivalent cost per active ingredient we have to multiply concentration by volume. In the two examples above, the bottles are each 40ml and cost $50 and $90 respectively. On the surface, the lower cost would appear to be the better value for the same quantity of oil. However, when we do the math, we find that all is not as it appears. In the first case, we have 5mg+5mg of active ingredient per ml. Therefore in the whole bottle, we have 400mg of active ingredients. If the bottle costs $50, then we are paying 12.5 cents per mg. In the second bottle, we have 10mg + 15mg, so 40ml gives us 1,000mg of active ingredient. The bottle costs $90, so we are now paying only 9 cents per mg. The more expensive bottle reduces our overall cost by 25% or more.