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Medical Marijuana in New York

February 5, 2016

There are no bullet points for this essay. I will try to keep it simple but the stuff in here is good for everyone to know.

First of all, I currently find myself practicing in a progressive state, and the medical marijuana law is now in effect in New York. So I certified as a medical practitioner who can provide medical marijuana for patients. Now, let me explain a little bit of the science. I don’t care how old you are. I knew some of this stuff way back when in the 60s and 70s, but I did not inhale. Okay. I will quit lying so you believe the rest of this. I was a chemistry major in college so I understand the medical aspects well on that level. And I do have my medical marijuana practitioner license.

What we all have used is cannabis sativa or cannabis indica. Remember everyone wanted to smoke the “bud.” There is a reason for this. Oil is produced to protect the flower. The hotter and drier the environment, the more resin production and the more potent the marijuana. The fact that it thrives in adverse conditions makes it an excellent weed (I just had to put that in there). The dried oil or resin is known as hashish. The oil produced in the cannabis plant contains primarily a combination of tetrahydrocannabinol (THC) and cannabidiol (CBD). This oil has been provided naturally in our environment in an unprocessed form.

So a lot of investigation has been carried out over the years regarding the cannabis plant. It has been established there is actually an endocannabinoid system that is endogenous to our body. So we have cannabinoid receptors and regulatory enzymes found throughout the body. Hmmmm………… We have receptors for all these compounds in some sort of balance. So the effect of the weed we smoked was different between baggies. It was also more potent if it had been grown in an adverse climate. And it had a different effect on individuals. A lot of things going on here.

There are two primary components of marijuana.

THC is the psychoactive component but also responsible for many of the effects seen regarding pain relief. It also helps in decreasing nausea and can stimulate appetite (munchies). Cannabidiol is the component most prevalent in preparations for medical use. Its effects include anti-anxiety, antipsychotic, antiseizure, and antibacterial qualities. Among the other chemicals found in smaller amounts in the marijuana oil are cannabinol, cannabichromene, cannabigerol, and tetrahydrocannabivaron. Some of these isolated in small amounts have been used to try to stem the side effects of chemotherapy and also potentiate pain relief. Dronabinol was a single component developed into the pharmaceutical product Marinol. This was not found to be very effective. Hold onto that thought.

What is interesting is that THC and CBD are exactly identical in chemical composition and the molecular structure is C 21 H 20   02. This means both are composed of 21 carbon molecules, 20 hydrogen molecules, and two oxygen molecules. However a portion of the ring structure between the two is a little different. Kind of like mirror images– isomers. In fact, in a solution the two may interconvert between themselves. In other words one converts to the other and back and forth until there is a balance. The CBD helps balance the psychic effects of the THC.

That thought—-are you still holding it? Let it go!

There is a process known as synergy. I like to think in terms of vitamin C. Take an orange. Then take a vitamin C supplement 10. The orange not only has ascorbic acid (vitamin C) but also compounds that are very similar in nature but just a little different in chemical structure. All of these working together in synergy make the vitamin C contained in the whole fruit are more beneficial and effective that a supplement which is a processed and isolated compound.

I will briefly mention terpenes as they play a big part as far as the synergy affect. Terpenes are other chemicals found in marijuana. There is a difference in the level of terpenes in different crops which can affect how the other various chemical components of marijuana react. Research has demonstrated in the endocannabinoid system a cannabinoid receptor-1 (cb1) which is 10 times more prevalent than natural opioid receptors (for pain). Better pain relief. These same receptors are found in high concentrations in nerves and brain tissue (explains the psychoactive effects). Another is cannabinoid receptor-2 (cb2), and this one is primarily found throughout the immune system and serves in an anti-inflammatory capacity. As such, we see the myriad of the effects when these receptors are stimulated. All of the chemical components of marijuana react with these primary receptors.

So now we get down to medical marijuana. Marijuana by itself has been classified as schedule I drug following federal legislation in 1937 and the 1970s. Schedule I is similar to heroin. Cocaine and methamphetamine may be used under doctor’s supervision and are classified as schedule II. Many oral pain medications are schedule II or III. Valium is schedule IV. I mentioned Marinol which was approved or released in 1985 for treatment of nausea and vomiting associated with chemotherapy and also AIDS wasting. This is comprised of the single component dronabinol and was not well accepted. Remember the concept of synergy.

So do I write your script and you go to the marijuana drug store to pick out a plant?

First, there is a list of acceptable diagnoses for prescribing. Then there is the pharmaceutical product.

The only thing that has been legally available in the past has been hemp oil with a CBD: THC concentration of 40 to 1 or higher. Medical preparations alter the concentration and we usually start patients with a 20 to 1 mixture and titrate to effect.

Here in New York the products available include oils that can be vaporized or rubbed into the skin, a sublingual form (under the tongue), and there is also an inhaler. The pharmacist works with the patient to decide what is the best delivery system. No smokable medical marijuana product. Oral marijuana is not available (no brownies). By oral ingestion there can be uneven absorption and delayed response over a longer period of time (2 to 3 hours or more). That makes it hard to judge the effect and difficult to dose since side effects may be inconsistent. And it takes a while to wear out of your system versus smoking.

I mention this only to say that I think we will see a liposomal delivery system for medical marijuana which will make it more consistent to control oral dosage in many patients. This is currently available but only in the strength of hemp oil which is a CBD:THC ratio of 40 to 1. To use this therapeutically it is necessary to alter the concentration for each patient. Remember we generally start with 20 to 1 ratio.

So those are the nuts and bolts and a nice summary can be found in this article


It really does well as far as covering some of the basics for you.

Now go back and reminisce about some of those pot stories and think about the uncontrolled CBD: THC concentrations. Think about some of the reactions that you saw in the people who smoked. There are munchy receptors. Some receptors in the brain may make listening to music more dynamic. Others may need dopamine receptors stimulated by smoking a cigarette.

There is a real balance here and it is different for every individual. That is the key that I try to impress on patients. This is a concept outside of conventional medicine and the importance of developing a good personal roadmap for prevention is many times ignored because it may not be covered by insurance. I find I am starting to get off track here so I will quit. I hope you learn something from this pot of information.


Posted in Blog by jbosiljevac

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