The Novice Guide to Medical Cannabis

We live in ironic times: a plant that’s been labelled criminal and dangerous is providing unrivalled relief for a variety of symptoms and conditions.

Leafly: Cannabinoids 101: What Makes Cannabis Medicine?

Cannabis activists and users have long been aware that the reality of cannabis use is very different to the way it is usually portrayed by media and government agencies. Those who dug deeper discovered that as early as 2900BC and right up to the 1930s this plant had had a long history as an herbal medicine for a wide variety of ailments as well as being used for religious/mystical experiences [A Timeline of Cannabis Use throughout History]. From the 1940s however things changed. Marijuana use was termed “reefer madness” and a War on Drugs was declared. Documents reveal much of the reasoning behind this was social/political and economic rather than factual but it had the consequence that science-based twentieth century medicine dismissed such therapeutic use as belonging to an age of superstitious quacks. Medical cannabis use is now becoming widespread, and this is written as a guide for those completely new to the subject.

1995: Cannabis once again becomes a viable method of treating illnesses (in some parts of the world)

During the turn of the century the status of cannabis worldwide shifted dramatically. California took the first major step of legalizing marijuana use for medical purposes in 1996 , permitting patients and caregivers to administer cannabis for the treatment of AIDS, cancer, muscular spasticity, migraines, and several other disorders, without fear of punishment. In 1998 Alaska, Oregon, and Washington become 2nd, 3rd, and 4th US States to legalize Medical Marijuana and in the same year a UK House of Lords Committee recommends legalization, with Lord Perry of Walton, chairman of the inquiry stating:

‘We have seen enough evidence to convince us that a doctor might legitimately want to prescribe cannabis to relieve pain, or the symptoms of multiple sclerosis (MS), and that the criminal law ought not to stand in the way. Far from being a step towards general legalisation, our recommendation would make the ban on recreational use easier to enforce. Above all, it would show compassion to patients who currently risk prosecution to get help.'”

By 2016 patients can use cannabis to alleviate or treat illnesses legally, and without fear of prosecution in a number of countries:

So why the swing-turn? Just how did cannabis make the move from “devil’s harvest” to the “miracle medicine”?

As areas made use of medical marijuana non-prosecutable, I have to admit my first response was sceptical. I made the assumption that lawmakers gave into pressure from the silver pound – that the hippies of the 1960s discovered that their political weight as tax paying retirees gave them a leverage that their protests lacked. That smoking a joint helped ease arthritic aches but these pensioners no longer wished to go to jail for their means of relaxation.

And I was wrong.

(although the progression of twenty-something rebels to open-minded power brokers may have had an influence).

The legislative/medical shift in attitudes towards medicinal cannabis came as a result of science. 

If you have come to the subject of cannabis as medicine through anecdotal testimonies on the internet, you probably believe in your heart of hearts that it is a folklore cure-all. After all,

how can one plant treat so many different illnesses throughout the whole body?

The answer is straightforward (and simultaneously horribly complex):

• Cannabis does not target individual illnesses. It is not a treatment for epilepsy and additionally a cure for cancer and an analgesic and etc etc
• Rather the different chemical components in Cannabis (but most notably THC and CBD) enable the brain and body to perform corrective actions to restore a natural health.

In the 1990s an Israeli researcher mapped out what he described as the endocannabinoid system: the largest neurotransmitter system within mammals. At cellular level, there are cell receptors – locks, which when triggered by the correct fitting key (chemical molecules called agonists) will respond with a pre-determined action. Normally the body produces these agonists itself, but if there is an imbalance or deficit, illness results. Externally there are various plants which trigger an agonist production, but cannabis is the one plant which appears to be able to fit all “locks”.

The National Geographic has an excellent and readable article, Science Seeks to Unlock Marijuana Secrets, about this research and the people behind it.

Cannabinoids?

Lets just take a step back to describe the plant cannabis itself. Cannabis has grown wild worldwide for millennium; it is an annual, meaning that seeds germinate in early spring, the plant achieves large vegetative growth until midsummer when the lengthening of night hours stimulates the plant to flower. Naturally seeds develop into either male or female plants, and the female flowers are fertilised by pollen from male plants. Fertilised flowers develop seeds which ripen and fall into the earth where they remain until the following spring. Having fulfilled their reproductive function, both male and female plants wither and die as winter starts.

It is the female cannabis plant that interests us, whether as a recreational or a therapeutic user. Her flowers are very different to the male’s both in form and construction. Cannabis flowers are not an arrangement of petals (like you would find on a rose), but are formed from a clustering of calyx (tear-shaped nodules) sprouting hair-like pistils. Each calyx has a high concentration of trichomes (crystals), miniscule glands oozing resinous terpines and cannabinoids. Resin production is highly valued by cannabis cultivators, and most modern strains now produce trichomes not only on the bud sites, but across small leaves (sugar leaf) and even onto the upper stem.

Chemically, cannabis is a complex plant with 483 chemicals, 85 of which are unique to the cannabis strain.  These 85 chemicals are called cannabinoids: 

Recreational cannabis users get their kick thanks to THC, which is psychoactive – but as you can see, THC forms only part of the plant’s unique chemical structure. The science is still new, but it seems that CBD has a huge part to play in treating many illnesses. But what is also emerging is an understanding that focusing on one compound alone, lessens the efficacy of treatment. Possibly this is because cannabis as a medicine works by interaction with the entire endocannabinoid system rather than targeting the non-functioning point. Terpenes also have an unexplored role.

The difference between Indica and Sativa

There are 3 sub-species of the plant Cannabis: Indica, Sativa & Ruderalis. Most modern day strains are the result of crossing (several times over) plants of these different sub-species, but it is worth understanding a little about what the terms mean.

Cannabis Sativa originated and first spread throughout equitorial countries such as Columbia, Mexico, Thailand. Sativa strains can grow exceedingly tall – surpassing 3 meters –  and flowering time is also extended, with some “landrace” strains taking up to 17 weeks in flower to fully ripen. Most sativa strains take 12-14 weeks to take full advantage of the long summers. Another distinctive environmental development of the sativa is that in order to optimise transpiration in hot temperatures leaves are thin and narrow (and pale in colour) to slow down evaporation of water from the leaf’s surface.

Cannabis Indica on the other hand originated in the cooler mountainous areas of North India and Afghanistan. Leaves are darker, plumper and wider to optimise photosynthesis, and flowering times are much shorter in accordance with the earlier onset of winter (8 weeks). Plants tend to grow little more than 1.2m in height.

Cannabis Ruderalis. There is some argument as to whether this is a subspecies or a different species altogether. Native to Asia and Central Europe (mainly Russia), some believe it to be a form of Indica that adapted to the harsher, colder climate. It is a distinctively small plant, usually only 30cm – 1m in height, and was for many years dismissed by cannabis enthusiasts due to its very low THC content (it does however produce more significant concentrations of CBD). But its height and non-psychoactive effect are not Ruderelis’  only distinctive characteristics. Unlike .Sativa and .Indica, where flowering is triggered by the increase in darkness hours after mid-summer, Ruderlis flowers automatically as the plant matures. In other words, you can make a .Sativa or .Indica grow larger indefinitely by giving it more than 18 hours a day of light: a .Ruderlis will start flowering after around 21 days no matter how many leaves she has. Realization of this trait has led to the development in the past 10 years of a new type of cannabis – the autoflower or automatic, crossbreeding ruderalis with more potent THC strains to produce a quick flowering but productive plant.

Almost all cannabis seeds on sale today are cross-breeds: with other similar strains or mixing high yielding indica types with more cerebral sativas. But just as these different substrains evolved different physical appearences, so too have they created differing effects and chemical variations. Because the sativa takes longer to ripen, the development of the psychoactive elements is richer and more profound (more “trippy”) than the corporeal indica stone.

Medically, sativa-dominant strains are more useful for treating mental and behavorial issues like ADHD, depression, appetite problems and some forms of cancer, whereas indica-dominant strains are more effective for pain relief and insomnia. These are only guidelines though and if you cannot source cannabis of a specific strain type,don’t worry too much. The essential genetic make up is similar no matter the strain.

What illnesses can be treated with cannabis?

Because medical research focuses on man-made medication, much of the evidence of what cannabis treats is anecdotal. As sufferers of a particular illness connect through the internet to share their experiences the list of ailments increases year by year. Doctors in medical marijuana clinics report that the main issue people come with for treatment is pain management. It also works extremely well as an anti-inflammatory and anti-spasmodic.

Doctors also may prescribe medical marijuana to treat:

• Muscle spasms caused by multiple sclerosis
• Nausea from cancer chemotherapy
• Poor appetite and weight loss caused by chronic illness, such as HIV, or nerve pain
• Seizure disorders
• Crohn’s disease
• Nausea
• Epilepsy
• AIDS/HIV
• Alzheimer’s disease
• Arthritis
• Cancer
• Chronic pain
• Epilepsy
• COPD
• Fibromyalgia
• Glaucoma
• Multiple sclerosis
• Sleep disorders
• Post-traumatic stress disorder
• Drug Addiction

• And many more: this article lists 700 illnesses treatable with cannabis, with links to clinical papers and anecdotal evidence.

We’ll come to treating specific illnesses in individual posts later in the series. If you have personal experience, we would love to hear from you! Email cc@growersguidetocannabis.com.

Esteemed scientists explain how cannabis cures cancer

How do you take medicinal cannabis?

Unlike most prescribed drugs, cannabis doesn’t come in tablet or liquid form. Worldwide, the most commonly available form of cannabis is as dried buds, flowers that have been trimmed of excess leaves, dried and cured until ready to smoke. Recreational smokers often crumble these buds, mix with tobacco, and smoke in joints or blunts. As a health conscious medical user, smoking tobacco is probably not attractive. Vaporizing cannabis is a healthier alternative as it heats the buds to the point where THC and CBD are evaporated without the harmful effects of combustion (read our guide to vaporizing here). Edibles are made using cannabis infused butter. Dosage can be difficult to judge, so take small amounts at a time, leaving an hour to realise the full effect, however, this effect is deeper and long lasting, usually at least 4 hours. Tinctures dilute highly concentrated cannabis oil and should be taken drop by drop.

Smoking / vaping / eating buds works extremely well for some medical problems, for example pain, insomnia and tremors. But it was Rick Simpson’s use of cannabis oil to push his cancer into remission – and the power of the internet to spread this information, that galvanised worldwide investigations into the power of cannabis as a means of treatment for a huge number of differing diseases.

Mankind’s newfound understanding of how the cannabinoids in this “miracle plant” interacted with our bodies at cellular level hinted at that potential cannabis might have as a medicine, but if that was true, “stoners” wouldn’t fall ill. Cannabis oil however concentrates the amount of cannabinoids consumed at a level impossible even for the hardened toker – and for some ailments, it is this high concentration that is necessary to trigger the necessary changes within.

Our article on cannabis oil will follow shortly …