Help, I overdosed!

Relax. Please just relax.

Repeat to yourself, “I will be fine. This will wear off.”

It is literally all in your head and there is a fantastic chance that you’ll be just fine very soon. I’d list the symptoms of over-medication, but chances are that you’ll know them when you see them, and they vary from person to person. Bottom line, if cannabis has caused you impairment and it makes you uncomfortable, you are over-medicated. Now that you’re calm, you can try:

CBD – Take 1mg of CBD per 10 pounds of body weight. Example: a 200lb person should take 20mg CBD. CBD generally counteracts the psychoactive effects of THC to some extent.

Change your environment – Adjust the lighting, turn on some soothing music, or lay down. Any of these things can help you change the experience. Just be careful walking if you’re feeling dizzy or have too much physical impairment.

Take your mind off of it – Grab a puzzle book or maybe fire up the Xbox. Call a friend and have a chat; there is some truth in the notion of “talking someone down.” Anything you can occupy your mind with will help distract you from the strange sensations and anxious thoughts you may be feeling. Sometimes a little distraction is all it takes.

Sleep it off – If you feel like falling asleep, you go right ahead! Drowsiness is a common effect of THC and this is the time to embrace it. You will be fine. It is extremely unlikely that anything will happen when you’re asleep other than fast-forwarding through an unpleasant experience.

Once you’re feeling better, talk to your physician or local Patient Care Advisor and ask them for tips to avoid over-medicating with cannabis. It would be a great idea to document the dose and situation that lead to your discomfort.

Further Reading:
Green-flower.com
TheRecoveryVillage.com

Bi-phasic effect: THC is a two way street

THC is the component of cannabis that produces psychoactive effects in the patient. It is also with this compound that most of the negative side-effects of cannabis are associated. Isn’t it interesting that, scientifically, THC has proven to be a highly effective anti-emetic (anti-nausea) agent; yet nausea can be a symptom of over-medication as well? This has to do with the compounds therapeutic window and its bi-phasic effects.

“Bi-phasic effects” is just a fancy way of saying that it can effect the same person in two very different ways. Remember, the endocannabinoid system (ECS) is a bodily system that has to do with balance, or homeostasis. Not enough of an endocannabinoid and the scale tips to one side, too much and it can tip to the other side. A proper dose of phytocannabinoids aims for balance in the system.

The therapeutic window refers to the difference between the minimum and maximum effective doses. You know it is an effective dose because it alleviates the desired symptoms. Cannabis is well known for having a wide therapeutic window as well. Meaning you can find symptom relief with a range of doses.

For example: let’s consider a chemotherapy patient who is taking high-THC cannabis to control nausea symptoms. That patient may consume 1mg or 2mg of THC without relief. However, when the patient takes 3mg, the nausea goes away. This is the minimum dose in that patient’s therapeutic window. This is also the precise dose we would recommend. Less is more.

However, let’s say the patient can take as much as 10mg of THC and still get relief, but at an 11mg dose, the nausea returns. In this case, 10mg is the maximum in this patients therapeutic window. If the patient were to take 20mg of THC, there is a very real chance that not only will they be nauseous, but they may be even worse off than before they consumed their medicine.

So remember, less is more. Finding and staying at the lower end of effective doses is for the best. Never forget that, especially with THC, too much of a good thing can be very, very uncomfortable.

Further reading:
Psychopharmacologia
Healer.com

Edibles: use with caution

‘Edibles’ are within a class of products that are often referred to as marijuana-infused products. They are similarly named in the medical program here in Missouri. Edibles are generally made by infusing oil or butter with cannabinoids from cannabis, then substituting the resulting infused oil or butter in a recipe for cookies, brownies, salad dressing, or just about anything else you can think of. The reason for this article isn’t to offer cooking advice, but rather a cautionary tale.

Edibles are a leading cause for emergency room visits due to over-medication and the resulting negative side effects. We believe that there are good reasons for this.

  1. Edibles infused with THC can have a stronger psychoactive effect. Edibles are processed via the gut, and then the liver, before continuing their journey into the bloodstream. The liver metabolizes the delta9-THC into a compound known as 11hydroxy-THC. This variation of THC is known to have stronger psychoactive effects than it’s less vigorous cousin, delta9-THC. 11hydroxy-THC is also very specific to edibles for this reason.
  2. Edibles have a slow absorption time. This means that it can take 45 minutes to 2 hours to feel the effect of the dose. This can seem like an eternity and can lead a patient to believe it’s not working, so perhaps they’ll take a second or third dose. When it finally does start ‘kicking-in,’ hold on to your hat!
  3. Edibles have an effect that can last from four to six hours. This means that if you do over-medicate with edibles you will be uncomfortable for an extended period of time. I can’t blame someone for seeking assistance for relief from these uncomfortable symptoms.

All this being said, edibles can be a fine way to consume your medicine. The long-lasting effects can be desirable for some conditions. The moral of the story here is to eat the recommended amount of your edible and then have a seat, relax, and be patient!

Since you have the time before the edible begins to effect you, you might consider using that time to sit quietly and take an inventory of your symptoms so you can properly assess how the edible helps you (or not). Answer the question “How much did it help?” about two hours after you take your edible.

To avoid the compounding effect of dosing, wait a minimum of 8 hours before trying an alternate dose.

Enjoy the following video where some poor chap gets made fun of due to his relevant trip to the ER. Bear in mind, that if you do have an episode of over-medication with edibles, take comfort knowing that this reaction is the worst that it gets. Some will laugh about it later, others won’t. That’s ok too.

Further Reading:
Safety tips from HighTimes.com

<explicit language warning>

Proper dosing with cannabis

It is possible to medicate with cannabis without becoming intoxicated. Beyond intoxication, when patients feel they have over-medicated with cannabis it is almost always because of the negative side effects of THC. It is often extremely uncomfortable. That said, even the most mild side-effects can be undesirable. As such, it is important to find the correct dose.

Here at Lit Naturals, we feel like the perfect dose is the minimal dose that has the desired effect. This keeps patient tolerance low and requires the patient to consume less to get the desired effect, thus saving money. Yes, you heard us right, we want you to spend less. This is best for the patient, and here at Lit Naturals our patients’ welfare is our top priority.

First and foremost, it is best to choose an option that includes both THC and CBD. The two have synergistic effects (work better together), which is great for symptom relief. Moreover, CBD has the added benefit of moderating the negative side-effects of THC.

For chronic pain alleviation, we’ll usually start by recommending a 1:1 ratio of CBD:THC. However, for other conditions we may recommend a 2:1 ratio of CBD:THC. As such, it is very possible to treat your symptoms without becoming intoxicated. Consequently, there really are a limited number of conditions where THC (without CBD) is the best course of treatment. That said, all patients are different and may respond differently to treatments. Whatever the case may be, your local Patient Care Specialist can help you with this recommendation.

Depending on your chosen method of consumption, there are different procedures that will help you find your perfect dose. For the sake of brevity, the pros and cons of the various consumption methods will be covered in other articles. Please keep notes to track your dosages! Following these procedures should help to prevent over-medicating.

Whatever your chosen form of consumption, we recommend taking the ‘initial dose’ for three days before increasing dosages. Its possible that this initial dose may become effective without increasing the dose size.

Oral Absorption

  1. Wait at least 10 minutes since the last time you drank fluids or ate food.
  2. Using the direction on the label, administer enough drops/sprays/lozenges for a 2.5-5 mg dose (lower is better) of total cannabinoids. We’ll call this your ‘initial dose.’
  3. Follow printed directions for how long to allow the product to sit in the mouth.
  4. Swallow and wait 10 minutes before eating or drinking (if possible).
  5. You may feel effects in 10-60 minutes, with maximum effectiveness reached at 60 minutes.
  6. If the desired effects are not achieved after 60 minutes, you may repeat this procedure using an additional initial dose. NOTE: If possible, it is best to wait six total hours before attempting treatment with double your initial dose.

Effective Dose: Once you have found your effective orally absorbed dose, you may repeat that dose every 2-4 hours as needed. Take notes while it’s fresh in your mind regarding your preferred dosage.

Edibles

  1. For finding dosage, we recommend ingesting an edible on an empty stomach (one hour before, or 90 minutes after eating). NOTE: Dosage and absorption can be affected by the content (fattiness) of your meal or snack. This can be great for prolonging the effects, but may cause difficulty finding appropriate dosage.
  2. Using the directions on the product, eat enough of the edible for a 2.5-5 mg dose (lower is better) of total cannabinoids. We’ll call this your ‘initial dose.’
  3. Avoid eating food. You may begin to feel effects in as little as 30 minutes, but it will likely be two hours before you feel maximum effect. Be patient! Taking too many edibles can be quite uncomfortable.
  4. If, after two hours, the desired effects are not achieved, you may repeat this procedure with an additional ‘initial dose.’ NOTE: If possible, it is best to wait eight total hours before attempting treatment with double your initial dose.

Effective Dose: Once you have found your effective dose of edibles, you may repeat that dose every 3-6 hours as needed.

Dermal (topical)

  1. Determine where to apply topical. These seems obvious, but you could have a headache because your neck is sore.
  2. Clean the area that will receive treatment along with your hands, preferably with soap and water, then dry thoroughly.
  3. With a dime sized dollop (or enough to cover the affected area), rub into the skin in the affected area. This amount will be considered your ‘initial dose.’
  4. Wait 10 minutes and apply a second ‘initial dose’ as needed.

Effective Dose: Once you have found your effective dosage of topicals, you may repeat that dose every 1-2 hours as needed. A patient doesn’t need to be quite as stringent about this method of consumption as there is little chance that it will affect a person in negative ways.

Note: Always wash hands before and after application. Thoroughly washing the application area may also help with absorption.

Transdermal

  1. Decide on a location to place the patch. This should be a location with a concentration of veins and thin skin. The underside of one of your wrist is a common place along with the tops of feet.
  2. Clean the area of application thoroughly with soap and water.
  3. Use the manufacturers instructions to place the patch.
  4. Wait 30-60 minutes for the effects to begin.
  5. At this point, a patient could add a second patch if the desired affect is not reached.
  6. If at any point you feel uncomfortable with the side effects you can simply remove the patch and symptoms will abate within 15-30 minutes.

Effective Dose: Once you have found your effective dose of transdermals, you may repeat that dose (with a new patch) per the directions on the package. Different patches can have different effective times and are a great way to deliver a direct, controlled dose of cannabinoids.

Note: It can be important to rotate the location of a transdermal patch. Using the same location day after day can cause irritation to the skin.

Inhalation

  1. Prepare your personal pipe by making sure it is reasonably clean and free of obstruction.
  2. Grind a small portion of dried cannabis flower.
  3. If possible, weigh .125 g of ground flower. Otherwise, the smallest measuring spoon you can find will due. This will be your ‘initial dose,’ and it can be quite small. NOTE: Your Patient Care Specialist can assist in calculating the approximate amount of cannabinoids you are administering.
  4. Insert measured amount of ground cannabis flower to your pipe’s bowl and pat down softly.
  5. Place the pipe to your mouth and light your flame. Slowly inhale as you get the flame close to the cannabis. When the cannabis lights (you’ll know), remove the flame.
  6. Within two inhalations you should have consumed the entire amount. If not, stop after two inhalations.
  7. You should acquire maximum effect within 5-10 minutes, though you will feel the onset of effects almost immediately. Repeat this procedure to take additional inhalations.

Effective Dose: Once you have found your effective dose of inhaled product, you may repeat that dose every 2-3 hours as needed.


Notes on inhalation:
-Consult with your Patient Care Specialist regarding calculating the cannabinoid content by weight of dried flower. This varies depending on the variety selected for use.
-We recommend controlling dosage by weight of the dried cannabis flower consumed.
-Some people prefer to monitor dosing by a count of inhalations. This is fine, but be sure that each inhalation is the same. Large variations can occur depending on whether your inhalation was long and deep, or short and shallow.
-Despite what you may hear, we do not recommend deep inhalation of dried cannabis flower.
-We do not support the use of ‘dabs’ (sap, wax, shatter, budder, rosin, etc.) or vapor pens for medical use. While there are some cases where these highly concentrated substances should legitimately be used, but it is very difficult to control dosing. A single inhalation of these products could allow a person to ingest 10 mg or more of cannabinoids. This is felt immediately, and intensely. If you feel the need to use dabs to get the desired effect, consult with one of our Patient Care Specialists for ideas on how to reduce your tolerance.

Patients substitute medical cannabis for addictive drugs

For over 100 years cannabis has been scorned for being a gateway drug. Recent studies are suggesting cannabis may actually be the opposite: an exit drug. This means patients are able to use cannabis to reduce their need for drugs such as opioids, benzodiazipines, SSRIs, and, to a lesser extent, even alcohol and tobacco.

The largest benefit of cannabis comes with opioids. Clinical research indicates that cannabinoids actually increase the sensitivity of the body’s opioid receptors. This makes a smaller dose of opioids more effective at relieving pain. At the very least, patients won’t build tolerance to opioids as quickly and can keep doses low. In a number of cases, patients have actually ceased opioid use altogether because cannabinoids can be effective pain killers as well.

Many patients indicate they feel that cannabis is safer than opiods or benzodiazepines. In fact, a majority of patients feel that the side-effects of cannabis are more acceptable than those of other prescription medications. We’re fortunate here in Missouri; chronic pain is in the list of qualifying conditions for treatment by medicinal cannabis. Article 14 of our constitution specifically allows for cannabis to be used as an alternative to potentially addictive medications where appropriate.

I can only hope that physicians are paying attention. The potential for reducing addiction and possible substitution for other prescriptions has the ability to positively affect the general health of the public.


Further Reading:
MarijuanaMoment.net
National Library of Medicine
Healer.com
Americans for Safe Access

Lowering health risks associated with cannabis use

To date, we have discussed the various side effects and risks of cannabis use for qualifying medical conditions. But how can those risks be avoided? Here we catalog 10 ways to reduce health risks according to Canada’s Lower-risk Cannabis Use Guidelines.

  1. Don’t use Cannabis.
  2. Choose to start using cannabis later in life (particularly after age 16)
  3. Choose low-strength products, such as those with a lower THC content or a higher ratio of CBD to THC.
  4. Don’t use synthetic cannabis products.
  5. Smoking cannabis (for example, smoking a joint) is the most harmful way of using cannabis because it directly affects your lungs.
  6. If you choose to smoke cannabis, avoid inhaling deeply or holding your breath.
  7. Try to limit your use as much as possible.
  8. Cannabis use impairs your ability to drive a car or operate other machinery. Don’t engage in these activities after using cannabis, or while you still feel affected by cannabis in any way.
  9. People with a personal or family history of psychosis or substance use problems, and pregnant women should not use cannabis at all.
  10. Avoid combining any of the risky behaviors described above.

NOTE: The above guidelines are primarily for adult-use (recreational) scenarios. However, there is sound advice here even for medical patients.

Further reading:
Canada’s Lower-risk Cannabis Use Guidelines
ScienceDaily.com

Side effects and risks associated with cannabis use

One of the first things that prospective medical patients should understand are the risks and side effects associated with cannabis use. This article will attempt to outline these negative outcomes and supply some additional reading on the topic. Please check out the article we’re linking, as it is a very well researched piece on the topic and goes into more depth than what is stated here.

A majority of side effects are produced via the cannabinoid known as delta9-tetrahydrocannabinol (THC). These side effects include:
-Euphoria/dysphoria
-Altered senses (e.g. seeing brighter colors)
-Altered sense of time
-Changes in mood
-Impaired movement and coordination
-Impaired memory
-Difficulty with focus and/or problem solving
-Tachycardia (elevated heart rate)
-Nausea
-Anxiety
-Paranoia

When taking high doses of THC, patients may also suffer from:
-Hallucinations
-Delusions
-Psychosis

The patient should take special note of tachycardia. Elevated heart rates are associated with an increased chance of heart attack. Although this was derived from a limited study, caution is advised. If you have or suspect any heart issues, seek specific counseling from your doctor.

THC also acts as a vasodilator, which can cause changes in blood pressure and temporarily affect blood flow to the brain. This effect is stronger in some more than others and has been known to cause users to pass-out. While there are no real long term effects from passing out, danger does arise if the patient takes a nasty fall after losing consciousness. With this in mind, there has been one documented death from a patient user fainting and striking their head. This lead to eventual death due to head trauma.

Risks associated with inhalation

The remaining (known) risks primarily have to do with inhaling cannabis. Inhalation is the fastest way of getting cannabinoids into your system. These compounds are absorbed through the lung tissue and go straight to the heart and brain. This is a great way to realize the therapeutic value of cannabis. However, it can also be overwhelming and may lead to over-medication. You’ll know when this happens.

Furthermore, the burned cannabis used in inhalation produces smoke and fumes that are known to aggravate sensitive lung tissues. This will produce a cough and tightness in the chest which may persist for a short time. However, THC is a bronchial dilator, so very soon your airways will relax. As such, inhaled cannabis has been used to thwart acute asthma attacks. That said, there are safer ways to accomplish this effect other than through inhalation.

Chronic long term smoking is associated with the development of chronic bronchitis. Despite many studies there has yet to be a proven link between the inhalation of cannabis with emphysema, COPD, lung cancer, or any other conditions commonly associated with tobacco smoking. That said, caution is advised before selecting inhalation as your consumption method of choice.

Further reading:
National Institute for Drug Abuse
Healer.com

Myths and facts about cannabis

In the age of information, the amount of data a person can access on any given subject is staggering. However, there is a volume of misinformation available as well. Of course, we all know about fake news and the dire effects it can have. It can be difficult to tell fact from fiction, even when the information seems to be coming from reliable sources.

For example, did you know that less than 25% of medical schools teach any content surrounding the endocannabinoid system (ECS)? Despite that this system is present in all human anatomy and its effect on nearly every other system in the body, little to nothing is taught about ECS and its benefits. It was discovered in 1993, which is quite recent by some standards. It also has obvious ties to a plant that has 100 years of stigma associated with it and is federally illegal, so it’s no wonder that ECS wouldn’t be taught by schools competing for federal money for other less controversial research.

I do want to be clear: doctors are our friends! I’ve also known many a doctor who have endeavored on their own to look at the titanic amount of studies being conducted on the ECS, phytocannabinoids (e.g. THC and CBD), and the relationship of the two. The medical professionals studying these systems as a way to continue their education are to be applauded. It is also these medical professionals that I lean on for my information. It’s ok to not just take a doctor’s word for it. It’s ok to challenge with deeper questions.

Healthy doubt will go a long way, so do some research and question what you think you know. We try to sell truth here, good or bad. If you see anything you think is untrue please let us know! In the mean time, here are some more resources to help in deciding fact from fiction.

Further reading:
Americans for Safe Access
Drug Policy Alliance
Healer.com
CannabisDigest.ca

“Marijuana” is racist

Anyone who takes a close look at the introduction of this word to the English language, and its use thereafter, will agree. “Marijuana” and especially “marihuana” are indeed racist. The word came from native Mexicans who were immigrating to America and bringing with them the habit of smoking marijuana, which was legal at the time. It makes some sense as to why the ‘h’ was substituted for the ‘j’ so broadly. It was a matter of poor translation at the time. Now “marihuana,” the perverted version of the word, is included in a great many legal documents and ordinances.

This foreign sounding word was used as propaganda to stir up the xenophobic american population of the day. Harry Anslinger, arguably the father of cannabis prohibition, was credited with saying; “There are 100,000 total marijuana smokers in the US, and most are Negroes, Hispanics, Filipinos and entertainers. Their Satanic music, jazz and swing, result from marijuana usage. This marijuana causes white women to seek sexual relations with Negroes, entertainers and any others.​​” Search his other public statements and you will be stunned. Some of what he said publicly at that time I won’t even repeat on my website.

However, while I prefer not to use these terms at all, times are changing. I’ve slowly come around to the idea that the term has it’s usefulness. I prefer using cannabis and will do so interchangeably. However, cannabis can refer to any variety of the plant. Marijuana, on the other hand, almost always refers to cultivars of the cannabis plant that contain active levels of THC. Hemp tends to be used in reference to cannabis plants with very low THC, and an abundance of CBD.

Further, for good or bad, “marijuana” has been enshrined in Article 14 of the Missouri State Constitution as well as federal legislation regarding hemp. There seems to be no avoiding it in the long term and the vast majority of folks who use that term these days are ignorant to its racist roots. So, while hesitate each time I say that word, I will use it for descriptive purposes. I might bring this up when we speak, but I won’t harp on it. Even I have a hard time not using the term.

Older patients are increasingly turning to cannabis for their ailments

Recent studies seem to indicate that our older citizens will be electing to try medical marijuana more and more. Between the years of 2013-2016 the usage rates of folks ages 50-64 were up by several percentage points. It’s not clear precisely why, but this could have to do with; increased social acceptance, less cost for marijuana as compared with prescription drugs, good effectiveness with less side effects, high safety profile of cannabinoids, and promising treatments for Alzheimer’s and other maladies specific to our senior citizens. Besides, why not try it?

Whatever the reason, it seems clear that not only are more seniors using cannabis for treatments, but that they are also staying active in the workforce longer. The increase of time spent in the work force, and the time spent working each month, continues to climb for seniors in medical marijuana states. While we’re not seeing huge upswings, the finding are still statistically significant. I’ll be clear too that the link between medical cannabis and these figures aren’t iron clad, but they do seem to be consistently applicable to states with approved medical cannabis programs.

This news makes sense given that the endocannabinoid system (ECS) in the human body is central to maintaining homeostasis in a wide range of bodily functions. As we age many systems, including the ECS, can lose their ability to function properly. Maintaining your ECS by adding phytocannibinoids (plant cannabinoids like THC and CBD) can act to up regulate, or down regulate the ECS as needed. Even microdoses of cannabinoids can be an effective therapy to generally maintain ECS tone. However, this is all probably best left for an article of it’s own.

Further reading:
EurekaAlert.org
Aging.com
National Institutes of Health
NPR.org