A BEGINNERS GUIDE FOR MEDICAL CANNABIS
20 JANUARY 2011
This is intended for those of you who are interested in using cannabis therapeutically but who are not fully familiar with what’s involved in becoming a patient in California. Whether you have been advised to try cannabis by your physician or, if you are wondering if medical cannabis could work for you — this guide will (hopefully) help you understand: How to become a medical cannabis patient; how to navigate the California dispensary framework; and various ways to use cannabis that you may encounter on your journey to better managing your health.
Let’s begin by talking about what cannabis is and how it works on the body. Cannabis is one of the oldest forms of medicine that exists in the world, with evidence dating back to 4,000 B.C. The word cannabis is used to describe the fresh plant and dried buds used for smoking/vaporizing (we call food made with cannabis extracts, “edibles”). Although the effectiveness of medical cannabis has been disputed by most governments (please visit this link to find out why and how cannabis became illegal in the first place), medical cannabis/compassionate use programs now exist in 15 states nationally.
Modern research suggests that cannabis is a valuable aid in the treatment of a wide range of clinical applications. These include pain relief – particularly of neuropathic pain (pain from nerve damage), migranes – nausea, spasticity, glaucoma, and movement disorders like Arthritis. Marijuana is also a powerful appetite stimulant, specifically for patients suffering from HIV, the AIDS wasting syndrome, or dementia or anorexia. It has been shown to assist with gastro-intestinal disorders and Post-Traumatic Stress Disorder. Emerging research suggests that marijuana’s medicinal properties may actually protect the body against some types of malignant tumors and are neuroprotective.
There are also a wide range of mental health problems that our patients have found relief from. Depression,anxiety, insomnia, ADD, and lack of libido come up frequently at the dispensary as reasons for medical cannabis use.
How can cannabis work so well in treating many illness’ and symptoms? Cannabis’ efficacy has been well-proven by using our own endocannabinoid system, which is involved in a variety of physiological processes including appetite, pain-sensation, mood, and memory; it also mediates the psychoactive effects of cannabis. The cannabinoids from the cannabis plant fit nicely into human cannabinoid receptors. Thus, the cannabinoids from the cannabis plant can be utilized by the human cannabinoid system.
For more detailed info Public Medical.gov ,has many articles illustrating the role of our own endocannabinoid system, find them by searching “endocannabinoid system” in the search box.
One of the most abundant cannabinoids in cannabis – THC – creates a euphoric effect. The other cannabinoids in cannabis do not. CBD is another cannabinoid in cannabis. CBD has medicinal applications both in conjunction with THC, but also independently of it. Other cannabinoids also have likely medicinal applications though there is less data available.
Once you and/or your physician decide to look into cannabis as treatment, you must obtain a “recommendation” for medical cannabis use from a licensed California MD. This is a little different from a traditional prescription written by your doctor and must include the language “I recommend” rather than “I prescribe” or, “I am aware of cannabis use”, as written in the California compassionate use act enacted in 1996, Prop 215. The statement may include, but does not have to, a reason for treatment or any limits, exceptions or guidelines for the patient. The letter MUSTinclude: the Dr.’s signature, the date the statement was written and a phone number or website where cannabis dispensaries can call the doctor’s office to verify the date of expiration or re-evaluation of the cannabis recommendation, usually one year. If your physician is unsure how to format the recommendation, find a PDF file of a BLANK PHYSICIAN’S STATEMENT here.
This letter can be written by ANY LICENSED CALIFORNIA MD and does not have to be made by your primary physician. Many doctors offices now exist that only see patients for medical marijuana evaluations and do not perform other medical doctor duties in that office (let’s call them Medical Cannabis Doctors). Although I would still suggest you attempt to talk to your primary physician/oncologist, etc first — Sometimes those doctors, who do not deal with cannabis evaluations daily, can be unclear on the legality of what you are asking them or, in the case of Kaiser Permanente, have their legal managers forbid them from writing the note properly (Kaiser Dr.’s cannot use the word “recommendation” even though the law explicitly asks for it) – even for the terminally ill.
Mother Jones magazine recently wrote an article, How to get a Pot Card (Without Really Trying). In it, the author and his wife had a competition to see who could obtain a medical marijuana recommendation the fastest – the author, for “writer’s cramp” a vague, undocumented pain in his wrist, went to a Medical Cannabis Doctor; his wife, for the treatment of painful, rheumatoid arthritis with complications found from prescribed pharmacy meds, went to her rheumatologist.Who do you think became a medical patient first? Even a quick search pulls up dozens of articles regarding medical cannabis and treating the pain and inflammation associated with arthritis but still, her rheumatologist and a GP she saw afterwards, were not willing to write her a letter of recommendation for cannabis treatment. The author obtained a recommendation for his writer’s cramp quite easily, costing him $70 and not covered by his insurance.
Going to a doctor who specifically evaluates for cannabis use will certainly mean that cannabis will be considered for your case.
Also, Medical Cannabis Doctors often have systems in place that make it very simple for dispensaries to contact them at any time for verification of the physician’s statement, like a website or 24 hour phone number. California NORML has compiled a list of medical cannabis evaluators by city, find it here. Others can be found by searching with Google.
Verification can sometimes be more difficult for patients who’s physicians keep shorter hours or are harder to reach. For those patients we recommend obtaining a verified Patient I.D. Card from thePatient I.D. Center in Oakland (suggested) or a Patient I.D. from the Public Health Department of your county- in addition to your recommendation. Theses ID cards can help stream-line the registration/verification process when you visit dispensaries for the first time because you have been pre-verified by one of these agencies. Usually, each dispensary you visit will verify your letter of recommendation once when you first register and again each year when you renew your patient status – so it is important your doctor is reachable.
To clarify: the additional I.D. is not mandatory – as long as your doctor can be reached by phone or online, PCC will accept and try to verify any recommendation from any licensed California MD. Aone-time-basis visit will be allowed pre-verification if the patient has provided an original letter with an embossed seal with either a California ID/DL or photo I.D and proof of CA residency. Once verified, please bring your valid patient information and a valid California I.D or driver’s license each time you visit.
Once you receive your recommendation, you are a qualified medical cannabis patient, protected by Prop 215 to possess, consume, transport and grow cannabis.
If you aren’t planning on growing your own medicine you will be visiting a medical cannabis dispensary. Here at Berkeley Patients Care Collective we strive to make the first time visit to our dispensary as comfortable and educational as possible. First time patients come in every day that, because of changes to their health, have decided to try cannabis – sometimes for the first time in decades. For these patients, the cannabis they remember from their teens is often quite different from the quality and potency of cannabis that dispensaries carry these days, and with many more choices available.
The registration process at Berkeley Patient’s Care Collective includes a complete introduction to all types of medicine by one of our extremely informed consultants. When you approach the security at the door, save time by having your physician’s statement and California ID or driver’s license out and ready to be examined. As a first time patient, security will direct you to the front office where you will fill out our membership registration form. You will also be informed of our guidelines and hours of operation, etc. From there, front desk staff walks you to a personal consultant who will acquaint you with how our counter is set up and guide you through your entire experience with information and recommendations, answering any questions you may have along the way.
The first time you visit a dispensary, it’s likely there will be a lot of phrases, strains and products you are not familiar with. Take your time, ask questions and look at different things. A lot of patients enjoy smelling a variety of strains before they make their decision –”The nose, knows!”. For the new user however, this method isn’t always helpful, as new patient’s aren’t used to judging the smell for quality or taste. Share your desired effect – like whether you’re using cannabis for pain or for mood; maybe you’d like to try edibles or using a vaporizer- with your consultant, and a little experimentation of your own, is the best approach to learning about cannabis as medicine.
Coming soon,… Part II of A Beginners Guide to Medical Cannabis… manager David will clearly explains how to go about choosing the right strain and an easy formula for finding what you need when confronted with a sea of foreign strain names.
It’s important, for a certain level of comfort, to feel assisted yet in control of your dispensary experience. Do your own research to find the best dispensaries or doctors in your area. User-based resources like Yelp and Weedmaps can help you find the very best products and service just by reading other patient reviews. Dispensaries should be happy to talk to potential new patients on the phone about what to expect on your first visit, so feel free to call ahead if a phone number is provided. Expect high quality service and if you don’t get it, take your business elsewhere. There are steps you can personally take to make your dispensary experience more comfortable – this interesting article in East Bay Express called Medical Marijuana Dispensary Etiquette – 101 is a useful tool in helping to cultivate the right attitude and in being prepared. Our own David Bowers is quoted several times within!
‘Everybody must get stoned’ ~ Bob Dylan
U.S. and Brazilian scientists have just proven that one of Bob Dylan’s most famous lines—”everybody must get stoned”— is correct. That’s because they’ve discovered that the brain manufactures proteins that act like marijuana at specific receptors in the brain itself. This discovery, published online in The FASEB Journal, may lead to new marijuana-like drugs for managing pain, stimulating appetite, and preventing marijuana abuse.
Studies show that the release of the body’s own marijuana-like compounds is crucial to stress-induced analgesia the body’s way of initially shielding pain after a serious injury.
Cannabinoid compounds have been shown to inhibit the growth of tumour cells in culture and animal models by modulating key cell-signalling pathways.
Scientists from Hungary, Germany and the U.K. have discovered that our own body not only makes chemical compounds similar to the active ingredient in marijuana (THC), but these play an important part in maintaining healthy skin. This finding on “endocannabinoids” just published online in, and scheduled for the October 2008 print issue of, The FASEB Journal could lead to new drugs that treat skin conditions ranging from acne to dry skin, and even skin-related tumors.
“Our preclinical data encourage one to explore whether endocannabinoid system-acting agents can be exploited in the management of common skin disorders,” said Tamás Biró, MD, PhD, a senior scientist involved in the research. “It is also suggested that these agents can be efficiently applied locally to the skin in the form of a cream.”
Biró and colleagues came to this conclusion by treating cell cultures from human sebaceous glands (the glands that make the oil on our skin) with various concentrations of endocannabinoids (substances produced by the body that are similar to the active ingredient in marijuana).
Then they measured the production of lipids (fat cells, such as those in skin oil), cell survival and death, and changes in gene expression and compared these outcomes to those in an untreated control group.
“This research shows that we may have something in common with the marijuana plant,” said Gerald Weissmann, MD. “Just as THC is believed to protect the marijuana plants from pathogens, our own cannabinoids may be necessary for us to maintain healthy skin and to protect us from pathogens .”
The CB1 receptor
The CB2 receptor
The possibility of CBn receptors
Docosatetraenylethanolamide and Homo-g-linoenylethanolamide
Some Proposed roles of the endogenous cannabinoid system
Learning and synaptic plasticity
Allergy and regulation of inflammation
Source: Federation of American Societies for Experimental Biology