Friday, May 6, 2016

Some Truth on Medical Marijuana

     Recently, I have been coming across more and more patients who inquire about the use of medical marijuana. Since spring of 2015, dispensaries have been popping up around the Las Vegas valley and I would not be surprised if I encounter even more questions regarding this newly available type of intervention. There are a lot of pharmaceuticals and homeopathic remedies available nowadays, but arguably none are as controversial in this age as those derived from the hemp plant. It is this that I wanted to explore. What are the documented benefits of the "wondrous weed" that it can now be classified as medicinal? What types of patients get prescribed medical marijuana? What kind of physicians would prescribe them, and do they need special credentials to do so? How are prescriptions dosed? My questions led me to go visit one of Las Vegas' medical marijuana dispensaries to learn more about this new frontier in healing.
    Walking towards the dispensary, located on the corner of Sahara and Rainbow Blvd., I must admit to being a little intimidated, even afraid as to what kind of joint (pun intended) I was walking into. All the concerns, legalities and stigmas attached to being around marijuana played in my head. So I kept telling myself that this was after all not regular marijuana, but "medical" marijuana. That should make a difference. I scanned the area first, careful to spot any possible threats in the vicinity, as I thought I would come to expect from a place that sells 'buds'. But it was clean and well-kept. The storefront had one way glass which was pristine, sparkling and could have been a clinic as far as I was concerned. As I walked into the entrance, I was met by a mature professional greeter that welcomed me in a friendly and professional tone. This caught me a little off guard, as my personal biases commanded me to see a scruffy, hippy-type dude with a beard, bandanna and 'John Lennon' type glasses rolling a thick reefer in a corner next to a scale, saying "what up, dude!".  But no. The surroundings were very white, clinical and even spa-like. I found myself in a lobby that overlooked a glass-enclosed showroom of medical marijuana products and paraphernalia perfectly showcased like high-end jewelry store. The lobby was separated by a thick, transparent glass wall and door. After I introduced myself as a registered nurse and that I was there for educational purposes, the greeter directed me to an equally sharp looking receptionist, who sat behind a glass encased counter. She then very gracious paged the manager so as to address my inquiries. The manager met me at the lobby coming from the secure showroom. At first impression he kinda looked the part of my preconceptions. A bald young man in a t-shirt with some arm 'tats' (tattoos) approached and shook my hand. He introduced himself as Dominic. However, as our introductions progressed, it became apparent that Dominic not only behaved in a very professional manner about his product, but was also very knowledgeable at that. He was very thorough in explaining that to get medical marijuana, one must first obtain a state-issued medical marijuana card (I'll call it an MMC). To do that, one must first get a medical doctor's prescription, then applying for state clearance. Once you have your card, then their entire product line becomes available to you. From the lobby he pointed out the different grades of dried marijuana clusters as well as the other cannabis derived products such as oils, creams, tinctures, edibles, sublinguals with their corresponding paraphernalia. I then went to ask him a few specific questions, which were as follows:
    1) Does it require a special type of doctor to get a medical marijuana prescription?
        ans: No. a regular MD will do, but good luck in finding one that is willing to work with cannabis. You can schedule an appointment with our medical doctor after attending a quick orientation.
    2) How are prescriptions dosed?
       ans: Like pharmaceuticals, dosing happens individually as recommended by a physician. However, there are no preset, measured doses. This detail can be overlooked since there is no such thing as cannabis overdose. It is not possible to overdose on cannabis' active ingredients THC or CBD (the main cannabinoids that give it its effects on our bodies).
    3) What are the legalities of using medical marijuana?
        ans: Whatever form medical cannabis comes in, it should be consumed in a private place. For nurses, it is still not currently legal for you guys to administer medical marijuana. It has to be prepared and consumed by the patient.
    4) What forms do medical marijuana come in, and how are they taken?
        ans: The most common way is smoking it. But that may produce carcinogens. A cleaner way of deriving THC through inhalation is by vaping oils and other concentrates. People who choose to inhale medical marijuana use it for pain management. Other forms come as sub-lingual (under the tongue drops), and topical creams, patches, gums and edibles available. Inhalation yields faster effects but its effects generally only lasts for 2-3 hours. Patches and edibles take longer to effect and are more timed and lasts longer. Aside from THC, CBD is another active ingredient found in medical marijuana. CBD products do not produce the "high" sensation and is used most often for its anti-inflammatory effects. For more information on this dispensary I went to, go to: http://thesourcenv.com/.
    Now, after all I've learned at such a short span of time about medical marijuana, I began to wonder how such a miraculous plant is not immediately exalted  into the list of mainstream medicines, especially since it is now called "medical marijuana". So I decided to continue my independent research on the matter. Apparently, the title "medical marijuana" is the term specifically used for when the unprocessed hemp plant or its raw derivatives are used to treat ailments. In contrast, pharmaceutical medicines contain only the isolated active ingredients from a plant, such as those derived from the poppy plant (aka opioids) such as morphine, codeine and methadone. Since medical marijuana and its derivatives fall under the previous category, it has not been blessed by the US Food and Drug Administration as a medicine. Though many government studies done by the US and abroad show that the hemp plant has a lot of medicinal properties, the fact that a patient takes in all the active ingredients of medical marijuana upon consumption, regardless of symptom/ailment puts the general public at risk in their eyes. And of course we all know that the FDA is only here for the public's safety, right? But at risk of what? I'm still looking into that since I have not found any documented cases of THC induced overdoses anywhere. Even the National Center for Biotechnology Information (NCBI), is hard pressed to find lasting harmful effects of excessive cannabinoid use, and has to specify the incidents have to do with synthetic marijuana (see: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3470439/). For most people though the side effects of marijuana overdose revolves around feelings of nauseousness, vomiting, and weakness. It seems like a far cry from putting the public at risk (unless you're smoking a reefer while operating heavy machinery in downtown Manhattan during rush hour. -But, what do I know). With that said however, there have been studies where the use of cannabis has exacerbated psychosis of people with potential or existing mental imbalances. I'm also still looking further into this but it kinda makes sense since marijuana does have mood altering qualities. Ever wonder how it does that? Alter your mood, I mean? It plays with your internal endocannabinoid receptors (yes, our bodies naturally work with THC by producing its own cannabinoids when needed). Simply put, by interacting with your natural THC receptors, marijuana can affect and mess up the pattern of your brain enzyme use. Like any toy, mess it up too much or too frequently and it will eventually stop working right.


    So there you go. The new world frontier of medical marijuana use has been opened and has reached the Las Vegas valley in full force. But the battle for the acceptance of medical marijuana is far from over. Much studies need to be done to isolate and overcome areas of public risk and social taboos. But then again, Las Vegas has always been a place where people come to test the limits of social boundaries, healthcare included. So we will see how this pans out. As far as whether to go down the road to use medical marijuana or not, that is something you have to discuss with a medical doctor (MD). If you feel you need to get a second opinion with an MD that works with medical marijuana, I've seen some dispensaries able to set you up with an appointment with their staff doctor. Remember that yes, you do know your body best, but get your information from valid experts to make good decisions.

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