Talking to your doctor about medical marijuana

At this point, you have accepted the potential risks associated with cannabis use. You have either been diagnosed with or believe you should be diagnosed with a qualifying condition. So, it’s time to talk to your doctor. But this can be a little scary. Cannabis, the so called “devil’s cabbage,” has a lot of stigma still associated with it. A lot of folks still look around awkwardly before whispering about medicinal cannabis in a public space. However, you are your best advocate and it’s high time to speak openly about this topic.

I will always recommend talking to your current physician first in regards to the topic of possible medicinal cannabis. They have known you and have worked with you to help treat many of your medical conditions. This bond is important since many doctors will be suspicious of ‘doctor hunters’ who are just looking to get high. Go ahead and make your appointment to discuss your condition(s). Do it soon because it can be a long process that I will explain in depth below.

Conversation starters:
“How do you feel about medical cannabis?”
“Does your practice have a policy about medical cannabis?”
“Are you open to recommending medical cannabis [for a condition like mine]?”
“Can I come back in a couple months so we can talk more seriously about medical cannabis?”

The process:
If you have taken cannabis to treat the symptoms of your condition, go ahead and share those experiences with your doctor. Provided no one (including yourself) is in danger, physicians are professionally and ethically bound to keep your secrets (patient-doctor confidentiality). As I mentioned, however, there is a process involved.

  1. Don’t forget to bring some materials with you to your visit. There is good information for your
    qualifying condition that might help jump start your doctor’s research.
  2. If you’re feeling a hard ‘no’ from your doctor and already have the diagnosis of a qualifying condition, you can stop here. However, if you don’t have a qualifying diagnosis, press forward until you do. It’ll make finding a new doctor for medical cannabis much easier.
  3. Your physician may not be comfortable with making a recommendation for medical cannabis yet, and that’s ok. You can pretty much bet that you have started a conversation in the office and they will need time to do research and confer with colleagues. Be direct and ask, “When should I make an appointment to discuss medical cannabis in more depth?”
  4. Be ready to discuss the current treatments you use for your symptoms. Your doctor will want to review these in depth.
  5. Be willing to adjust your current therapies. It is safe to assume that physicians will, when possible, want to treat your condition with known medicines first. Now is the time to be honest; if a prescribed drug makes you feel crappy as a side effect, or if it makes you unable to function properly, you won’t take it for that reason. What’s the point? Furthermore, you don’t have to get high using cannabis and your doctor needs to know that’s not what you’re after. You just want to be healthy.
  6. Be willing to make follow up visits to adjust your therapies. Remember, finding relief to your symptoms is often a process. It will be no different with medical cannabis. It is not a solution for everyone.
  7. Finally, please have patience. Unless you have the know-how, desire, and resources to grow your own, medical cannabis dispensaries won’t be opening until well into 2020. As such, there is ample time to work through this process.

Further reading:
Americans for Safe Access
Columbia Missourian

Mizzou conducts marijuana market study

The Department of Economics at the University of Missouri – Columbia recently released a study entitled, Missouri’s Medical Marijuana Market: An Economic Analysis of Consumers, Producers, and Sellers. The intent of their study is to provide the Missouri Department of Health and Senior Services (DHSS) with a quantitative analysis of the market for medicinal cannabis here in Missouri.

Although I appreciate the intent of this study, it would seem the authors missed their mark. Specifically in the area of quantifying patient counts over time. The table below summarizes the projected Missouri patient counts from the Mizzou report and compares them to our own internal estimates, and includes the delta (difference).

2020202120222023
Mizzou19,00022,50026,000N/A
Lit
Naturals		49,00879,638116,394183,780
Delta30,00857,13890,394N/A

It must be understood that we did not have our analysis provided by economic experts, for whom I have a deep respect for. However, our methods led to estimates that largely match up with estimates used to build Article 14 of the Missouri Constitution. Furthermore, industry experts and the DHSS itself have used estimates very similar to ours before this report was published.

As you can imagine, a business plan isn’t worth the paper it’s written on if proper marketing research isn’t completed. The delta between our figures and Mizzou’s are very significant. So the work began. We started pouring over the 47 page report to find out why. The answer seems to lie with the qualifying condition of chronic pain.

The authors of Mizzou’s report clearly acknowledges that chronic pain, as a qualifying condition, is a significant driver of patient uptake. However, this information is quickly abandoned as the researchers made their calculations. It is clear that the authors used available data from all states who have a medical marijuana program. No distinction was made between states that do and do not have chronic pain as a qualifying condition. It is well known that many states do not.

At this point I could illustrate other differences in methodologies, but I think this single point accounts for the most significant difference. Only time will tell whose projections are more accurate. I hope that, in the meantime, the DHSS uses a healthy amount of skepticism as they review this report and especially if they elect to make decisions based on the data presented by Mizzou’s study.

Further reading:
MU Market Study
The Kansas City Star
KCUR Radio
Columbia Missourian
Springfield News-Leader

Topical application of cannabinoids

Topicals are another class of marijuana-infused products. They are generally defined as lotions, salves, or massage oils that have been infused with various cannabinoids. Topicals can be especially effective at treating muscle and joint pain. It’s even possible to treat headaches. There are some challenges for certain skin types and a patient may need to experiment with a number of products before finding a product that works well for them.

The Good
-No intoxicating effects (localized treatment)
-Fast onset (2-3 minutes)
-Discreet
-Easy to transport
-No learning curve

The Bad
-Low bioavailabilty (5% – 10%)
-Expensive

Patients may have to wait some time before these products become available since these products don’t have a wide variety of uses. They can also be tricky to produce in a consistent form.

Further reading:
SafeAccessNow.com
MedicalJane.com

It’s 4:20 on 4/20, so what?

We’ll take a break for the serious information for a bit to provide a funny bit of history. There are many stories on how the term, 4:20 and it’s many incarnations, have come to be. It’s often used to insinuate cannabis, or the use of cannabis, and I’m often surprised at how many people who use the term have no idea how it got started.

The story is actually quite mundane. A group of young men in southern California used to meet at 4:20 every afternoon to smoke cannabis together. They started to remind each other using the time, which soon took on a more general meaning related to cannabis. Soon they used it to regularly communicate about the drug so that no one else knew what they were talking about.

Sometime later, the group happened to make some connections with the band, the Grateful Dead. They happened to share the term with the group, who latched on to it and began to use it themselves. Given the amount of influence the band had at the time, it wasn’t long before others started using the term as well. The rest is, as they say, history.

You know, it’s a lot of fun hearing the stories about how 4/20 became the calling card for the cannabis subculture. In fact, take a moment to enjoy two professionals ply their craft.

Smoking cannabis

Smoking is, by far, the most well known method for consuming cannabis. Joints are commonly used as are bongs and other paraphernalia used for smoking. Here we’re talking about medication though, not subculture references. Although smoking isn’t a top recommendation from us, for those who can tolerate the associated risks, smoking cannabis can be an effective way to take your medicine.

The Good
-Immediate effect (0 – 5 minutes)
-Easy dosing (with very little practice)
-Very little learning curve for use
-Uses cannabis efficiently (pipes in particular)
-High bioavailabilty 50% for pipes / 30% for joints
-Whole plant entourage effect

The Bad
-Risks associated with inhaling smoke
-Transporting is not easy
-Not discreet

Smoking your medicinal cannabis can be effective and allow a user a broad range of control for dosing. The assortment of medicinal cannabis varieties can also be fully taken advantage of, which could allow for a broader effectiveness for treatment. We’ll mention it again; always know your risks. Although it may seem complicated, our Patient Care Advisers can also help you easily calculate the amount of cannabinoids in your product. This will give you a jump start on finding the perfect dose for you.

Further reading:
SafeAccessNow.com
MedicalJane.com

Vaporizing cannabis

Vaping is the common term used for vaporizing cannabis. Vaping involves heating a product to the point where cannabinoids, terpinoids, and other aromatics are released. To be a true vapor, this must be achieved without causing the material to ignite, thus avoiding smoke. Although you can save money (after your initial purchase) and make full use of the product you buy, vaping has its downsides too.

Shown: A tank filled with red liquid is screwed into a black, cylindrical battery. The silver button ignites the ‘vape pen.’

Vape pens, like this one, are the most common tool used to vaporize cannabinoids. This has the potential to be an inexpensive and reliable delivery method. However, we would be remiss if we didn’t point out that the highly concentrated cannibinoid liquids can make dosing difficult. The patient must also be aware of what other ingredients are in the liquid (e.g. propylene glycol) and research the potential risks of vaping them. Cheaply made tanks containing the liquids have also been known to leak heavy metals (e.g. lead) into the liquid. For these reasons, we will not readily recommend these products unless they meet our high standards.

Shown: common wood-box style vaporizer.

Vaporizers designed for dried cannabis come in a huge array of sizes, shapes, and prices. This simple wood-box vaporizer, or whip vaporizer, can be purchased relatively inexpensively and give many years of good service. It works by heating air to an adjustable temperature that is then drawn, by the patient, across the herb. This releases the active components into a vaporous form. This vapor travels down a tube so that it cools before reaching the patient. Now that we have the basics out of the way, let’s look at the pros and cons of vaping.

The Good
-No smoke!
-Immediate effect (0 – 5 minutes)
-Easy dosing (but takes practice)
-Vast array of equipment options
-Uses cannabis efficiently (cheap to medicate after initial equipment purchase)
-Highest bioavailabilty 50% – 80% (range is due to variety of equipment used and patient’s ability to use that equipment)
-Whole plant entourage effect

The Bad
-Equipment can be expensive and confusing
-Learning curve for equipment use and care
-Transporting is not easy
-Not discreet

Vaporizing your medicinal cannabis can be effective and allow a user a broad range of control for dosing. The assortment of medical cannabis varieties can also be fully taken advantage of, which could allow for a broader effectiveness for treatment. That said, always know your risks, then take your time with finding a dosage that’s right for you. This is one method of consumption where you might lean on the equipment knowledge of a Patient Care Adviser.

Further reading:
SafeAccessNow.com
MedicalJane.com

Oral absorption of cannabinoids

Consuming your cannabinoids in a form that can be absorbed through the venous membranes of the mouth is highly recommended. This category of products includes tinctures, oral sprays, lozenges, and dissolving strips. Like edibles, these products are within the category of marijuana-infused products (MIPs). All such products are meant to be held in the mouth until they are absorbed.

This form of consumption avoids agitation of sensitive lung tissues while also allowing patients to easily find and maintain proper dosing. The biggest challenge with these products will be to find manufacturers who can create a consistent line of products. We’ll do our best to help patients with this.

The Good
-No Smoke!
-Quick onset: 5-60 minutes
-No equipment is needed
-Discreet usage
-Ease of transport
-High bioavailability (40% – 50%)
-Relatively easy to titrate doses

The Bad
-Generally of higher cost
-Alcohol based
-Variability in dosing due to oral conditions (e.g. dry mouth)
-Product variability due to manufacturing processes

Be wary of any of these products marketed as indica or sativa, or with any other effects such as creativity or sedating. The potential for these nuanced effects are due to the entourage effect and are usually eliminated during the manufacturing process.

Further reading:
SafeAccessNow.com
MedicalJane.com

Eating cannabis-infused products

Edible cannabis products in Missouri will become available once Marijuana-Infused Product facilities come online. These products, commonly known as edibles, come in a vast array of choices. Among the most popular are gummies, sweet tarts, cookies, and brownies.

Edibles are generally produced using a cannabis infused oil as a substitute in a common recipe. While a qualifying patient can make these products at home, for the purposes of this article we’ll concentrate on the pros and cons of this consumption method.

The Good
-No Smoke!
-Long lasting effects (up to 6 hours), great for overnight use
-No equipment is needed
-Vast array of product options, from confections to tea
-Discreet usage
-Ease of transport
-Relatively cheap

The Bad
-Longer time for onset (30-90 minutes)
-Difficulty in finding a consistent, effective dose due to variability in metabolism and gastrointestinal (GI) conditions
–Increased chance for over-medication
-THC is converted to an even more psychoactive compound
-Only 4%-20% of cannabinoids present become bioavailable (absorbed by the body)

Edibles can be made with a variety of cannabinoid content. We will generally recommend an edible for patients who have sleep issues related to their medical condition(s). Those patients suffering from GI issues may also find great benefit in this mode of consumption.

Be wary of any edibles marketed as indica or sativa, or with any other effects, such as creativity or sedating. The potential for these nuanced effects are generally due to the entourage effect and are eliminated during the cooking process.

Further reading:
SafeAccessNow.com
MedicalJane.com
RealFarmacy.com

Bioavailability of cannabinoids

At first glance, its easy for a patient to choose their medical cannabis products based solely on the amount of cannabinoids contained in each one. However, what really matters is how much of said cannabinoids actually make it into the patient’s system. Bioavailability: “the degree and rate at which a substance (such as a drug) is absorbed into a living system or is made available at the site of physiological activity” –Merriam-Webster

100% bioavailablity can only be achieved through intravenous (IV) administration of a compound. Cannabinoids are hardly ever administered through an IV. The most common routes for administration are via the lung tissue, mouth tissue, GI tract, or the skin. Saving you the little details, the sections below will outline these various routes for consumption, in order, and their rates of bioavailability.

Inhalation, vaporization/vaping:
Products – Dried cannabis flower
Absorption site – Lung tissues
50% – 80% Bioavailability
10mg dose: 5mg – 8mg will be absorbed within 0-5 minutes.
NOTE: Although dabs, e-cigarette style pens, and other concentrates may produce vapor, we will advise against the use of those products except in certain circumstances.

Oral Absorption:
Products – drops, sprays, lozenges, dissolving strips
Absorption site – Mouth tissues
40% – 50% Bioavailability
10mg dose: 4mg – 5mg will be absorbed within 10-40 minutes.
NOTE: Bioavailability range has to do with concentrations of veins in the mouth, relative blood flow, as well as conditions inside the mouth.

Inhalation, smoking, pipes:
Products – Dried cannabis flower
Absorption site – Lung tissues
50% Bioavailability
10mg dose: 5mg will be absorbed within 0-10 minutes.

Inhalation, smoking, cannabis cigarettes:
Products – Dried cannabis flower, pre-rolled joints
Absorption site – Lung tissues
30% Bioavailability
10mg dose: 3mg will be absorbed within 0-10 minutes.

Edibles/eating:
Products – Pills, tarts/mints, cookies, gummies, brownies, etc.
Absorption site – GI (gastro-intestinal) tract
4% – 20% Bioavailability
10mg dose: 0.4mg – 2mg will be absorbed within 30-90 minutes.
NOTE: A wide range of bioavailability is due to large variations in gut conditions, even when given to the same person on a different day (e.g. time of last meal, fat content of last meal, illness, time of day, etc.).

Topicals:
Products – Lotions, salves, massage oils, etc.
Absorption site – Skin near affected area
5% – 10% Bioavailability
10mg dose: 0.5 – 1mg will be absorbed (locally) within 2-3 minutes.

Further reading:
SafeAccessNow.com
RoyalQueenSeeds.com
Medium.com

Mode Entry PointBioavailabilityRate
VaporLungs50% – 80%0-10min
PipeLungs50%0-10min
OralMouth40%-50%10-40min
JointLungs30%0-10min
EdibleGI tract4%-20%30-90min
TopicalSkin5%-10%2-3min

Criminal marijuana markets on the rise in Maryland

States have an enormous influence on the trajectory of the emerging cannabis markets. Out west, states like Washington, Oregon, and Colorado have created a free-for-all in the legal market. This has led to a glut of surplus cannabis and extremely low wholesale prices. These conditions make it very difficult for legal cannabis businesses to stay afloat. The additional unsold product makes it tempting to sell it ‘out the back door’ in order to earn some much needed revenue.

Oklahoma may the next on this list. They are the very first state to start licensing cannabis establishments without having regulations in place. Further, there are currently more cultivation licenses than there are dispensaries and manufacturing facilities combined. This is surely a recipe for trouble and I fear that OK may be the next to join the likes of those other western states.

Meanwhile, states like Maryland and Ohio are at the opposite end. Government controls and bureaucracy are artificially making it difficult to produce and sell cannabis in general. Add to that mix the high taxes charged on top of the already high prices, a function of supply and demand, and you have a recipe for consumer dissatisfaction. Dispensaries are few and far between and people are turning back to the criminal market to try and get what they want.

Fortunately, Missouri is poised to shoot the issue down the center. A careful balance between over-regulation and under-regulation will allow medical patients to enjoy an ample legal supply of their recommended medicine. The Missouri Department of Health and Senior Services has repeated, many times, that their intent is to do what’s best for the patients. Let’s hope this isn’t lip service.

Further reading:
Boston Herald
Statistics Canada
MJBizDaily.com