A beginner's guide to medical cannabis and CBD

In Canada over 350,000 people use cannabis for medical purposes, and that number continues to grow.

Why is it so popular, how safe is it, and how do you get started?

A brief history

Cannabis (often called marijuana) has been used both medicinally and recreationally in different cultures around the world for thousands of years. In the late 1800s to early 1900s, cannabis tinctures were readily available at pharmacies.

 

During the 1920s cannabis was caught up in a wave of prohibition that saw many other substances made illegal, including opium and cocaine.

 

Cannabis was first legalized for medical use in Canada in 2001. Since that time, the regulations have evolved to improve patient access and provide greater choice in products and suppliers (called licensed producers). In 2018, cannabis was legalized for adult recreational use as well.

Health Canada/Santé Canada

"This is not an exhaustive list of symptoms or conditions for which cannabis may be authorized for use by your health care practitioner."

What medical cannabis is being used for

Cannabis is being used to relieve the symptoms of a wide variety of conditions, including:

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    Arthritis

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    Pain (acute and chronic)

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    Nausea from cancer treatment

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    Digestive problems (Crohn's, IBS, etc.)

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    Fibromyalgia

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    Migraines

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    Hepatitis C

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    HIV/AIDS

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    Insomnia and other sleep disorders

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    Anxiety, stress, depression

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    Multiple Sclerosis

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    Epilepsy

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    Parkinson's

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    ALS

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    Low appetite

How it works

The endocannabinoid system (ECS) was discovered in 1992, and is a cell-signalling system that plays a role in regulating functions such as pain, immune responses, sleep, mood, appetite and others. Endocannabinoids naturally occur in our bodies, whereas phytocannabinoids are found in plants (such as cannabis) and mimic the ones found in our bodies. It is believed the primary role of the ECS is to maintain the stability of the body’s internal environment, and that the introduction of external cannabinoids helps when the body’s own cannabinoid production is deficient.

 

Because of its role in regulating so many different functions, the ECS is a significant focus of research today.

Active compounds

There are over 100 cannabinoids present in the cannabis plant, however the two most prevalent and well-known are THC (tetrahydrocannabinol) and CBD (cannabidiol). THC is the compound that causes intoxication, however it does have medicinal benefits such as pain relief, and these benefits can be achieved at doses well below intoxicating levels. CBD is non-intoxicating and has anti-inflammatory and anti-anxiety properties. Most patients benefit from a combination of the two, however the amounts and ratios can differ widely from condition-to-condition and patient-to-patient.

 

Cannabis also contains terpenoids (which give it its aroma) and flavonoids (which give it its colour). These are also thought to provide therapeutic benefit, however there is not much research available at present.

 

Again, clinical experience is that positive outcomes require a combination of THC and CBD, and that the most reliable source is a licensed producer via a medical prescription.

Dr. Raphael Mechoulam, pictured here, is widely considered the godfather of cannabis research. (Image credit: Elior Rave)

CBD vs. THC

CBD is found in many medical cannabis products. CBD is receiving a lot of attention due to its apparent ability to provide benefit without the intoxicating effect of THC.

Most medical cannabis products will be labelled for both their CBD and THC content. Some products will also summarize the content as a ratio of CBD to THC, e.g. 20:1 or 1:1.

Having some THC present is not necessarily a bad thing. There is some evidence to suggest that CBD is less effective (or even non-effective) without at least some THC. And CBD seems to make THC's pain-fighting qualities work better at lower doses. Finally, CBD may also counteract the anxiety-inducing effect of THC.

Side effects

Common side effects from cannabis products with mainly THC in them include red eyes, dry mouth, and drowsiness.

Most users of mainly CBD products don't report side effects, but some include diarrhea, drowsiness, and dry mouth.

Side effects wear off within hours.

Safety

Compared with many pharmaceuticals and illegal narcotics, cannabis has an extremely good safety profile. There has not been a single death attributed to the direct effects of cannabis ingestion. Unlike opioids cannabis does not act on the central nervous system, which regulates breathing.

 

Cannabis is not without risk, however. For example, it does interact with some medications, and can cause an elevated heart rate. It is important to have medical supervision when using cannabis to treat a health condition.

 

Ask your employer about their policies before beginning treatment.

 

DON'T DRIVE HIGH.

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Cannabis products

Cannabis comes in dried leaves or flowers, as an oil (dropper, spray or gel capsule), topical gels and creams, and also edible products such as chocolates and drinks. Most patients are using cannabis in an oil form. Smoking is discouraged, however vaporization is an option if immediate effect is required (oil forms can take 15min to 2 hrs to take effect). Home-made edibles are not recommended due to imprecise dosing.

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Are you buying illegal CBD?

There are hundreds of unregulated CBD products appearing on the market, such as CBD oil, CBD creams, and CBD gummies. Many of these do not actually contain CBD, or only in very small amounts. Some may actually contain high amounts of THC. Most of these products are derived from hemp and may not have the beneficial compounds that the full cannabis plant does.

Learn how to tell

How to buy medical cannabis and CBD

While cannabis is now legal to purchase for recreational purposes in Canada, many people are using it for medical purposes under the supervision of a healthcare provider. Read more about each of these steps.

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Get a prescription

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Choose product(s)

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Register with a licensed producer

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Order and receive products

Buying at a cannabis store

With the recent legalization of cannabis for recreational use, many retail outlets have opened, providing convenient access. If you are contemplating cannabis to treat a medical condition, we recommend doctor’s supervision, medical prescription, and ordering directly from a licensed producer. This will ensure your safety and that you are using the right product, in the right amount.

Other issues when buying from a retail outlet include:

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No insurance coverage or tax deductions

The CRA and insurers will require proof of medical prescription and receipts from a licensed producer of medical cannabis.

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No special discounts or programs

For example, seniors discounts, direct billing for veterans, etc..

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No health advice

Store personnel are not permitted to offer health advice, and could actually lose their license if they do.

Prices, taxes and insurance coverage

Patients are spending $120 month on average. Very few have insurance coverage under their employer's policy, even though major insurers do offer such clauses. It is, however, an eligible expense under most health spending accounts.

No provincial plans cover medical cannabis. Veterans DO have coverage.

Medical cannabis is deductible as a medical expense at tax time, so long as it was purchase from a licensed producer under a prescription.

Significant discounts are usually available to certain groups, e.g. seniors and low income.

The four ways to get a prescription for CBD or medical cannabis

Nursing service (i.e. us 🙂)

Home visits or telemedicine. Prescriptions, detailed treatment plans and product recommendations. Extensive and unlimited nursing support may not be required by some patients. Usually fee-for-service, but often covered by insurance.

Your own doctor

About 5% of doctors feel confident enough to authorize cannabis. If your doctor does prescribe, consider how much in-depth education you will get, and ask if you have a choice in medical cannabis supplier.

Cannabis clinic

Specialty physical clinics with "education centres". Many are owned by cannabis producers themselves. Ask how much time you will get with the doctor, what their formal specialty is, and about the medical training of the "patient educators".

Telemedicine services

Video conference with a doctor or Nurse Practitioner. Usually provided by or affiliated with a cannabis clinic. Ask what kind of post-visit support is provided, as well as the medical training of the "patient educators".

Choosing a product: factors to consider

Cannabinoid amounts and ratios

How much THC, how much CBD, and the ratio between them.

Terpene profile

The presence and amounts of terpenes such as linalool, pinene, and myrcene.

Product format

Inhaled products may take effect faster, but not last as long as orally ingested products. Gel capsules are easier to handle than oil dosed by syringe.

Supplier considerations

Reliability in supply, consistency in product make-up, etc.

Cost

Cost per milligram of the desired cannabinoids, availability of special discounts from the supplier.

Using medical cannabis

Our standard advice is to use medical cannabis under the supervision of a health care professional. This will ensure your safety as well as giving you a better chance of finding the right product and dose, faster.

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Start low

Start with a low dosage, e.g. 0.25mL if taking oil (spray, dropper, or gel capsule).

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Go slow

Slowly increase your dosage over a period of days/weeks

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Stay low

Stay at the lowest dosage that works for you with no or minimal side effects

What to expect from medical cannabis and CBD

When it's working as intended, the only thing you should notice is an absence or reduction in pain, or reduced anxiety, or a better night's sleep (or all of the above).

 

If you are taking a high CBD ratio product (e.g. 20:1 CBD-to-THC), this small amount of THC is unlikely to cause any psychoactive effects.

 

But because you are slowly introducing cannabinoids to your body, you may not feel the effects right away. We've even had patients say "I didn't think it was doing anything--until I stopped taking it".

Travel

You are legally allowed to bring your medical cannabis with you while travelling within Canada. If you plan to carry or pack more than 30g (the recreational limit), keep your product in its original packaging, as it will have your name on it which will be proof of legal possession above the recreational limit.

 

Do not try to bring cannabis across Canada's borders, in either direction.

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Ready to get started?

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