Cannabis: Questions and Answers
The role of cannabis in the treatment of medical conditions
What are cannabinoids?
Cannabinoids are a class of compounds originally derived from cannabis (marijuana) that interact with the body’s own cannabinoid system. Research has shown that cannabinoids have potential therapeutic value for pain relief, control of nausea, vomiting, appetite stimulation and spasticity.
There are three general types of cannabinoids: herbal cannabinoids are found in the cannabis plant; endogenous cannabinoids (‘endocannabinoids’) are produced naturally in humans and other animals; and synthetic cannabinoids which are compounds produced in the laboratory. Nabilone (Cesamet®), dronabinol (Marinol®) and THC/CBD (Sativex®) of these only are dronabinol (Marinol®) is available in the US.
Measurement of Progress
How will I know these prescription cannabinoids are working?
Cannabinoids may decrease pain by modifying the pathways in the body that handle pain signals. Your doctor should discuss treatment goals with you; these include monitoring effects on pain reduction, sleep quality and overall improvements in activities of daily living (walking, gardening, working etc). For example, your doctor may ask you to keep a record of your progress on pain reduction in a diary. If you are using cannabinoids for other symptoms, you may find that you are sleeping better, have less nausea (if on chemotherapy) or better muscle tone. These are all signs the medication maybe beneficial.
Why have I been prescribed cannabinoids?
Your doctor may have prescribed cannabinoids for pain or other symptom relief. There is good evidence that cannabinoids relieve neuropathic pain (i.e. pain caused by damage to the nerves), pain in patients with multiple sclerosis, and in patients with cancer who are not getting adequate pain relief with maximum tolerated doses of strong opioid therapy (i.e. morphine). Cannabinoids have also been shown to improve sleep quality. Some cannabinoids are approved for appetite stimulation or for the treatment of nausea and vomiting caused by chemotherapy, and spasticity in MS.
Cannabinoids may enhance the action of opioids such that the dose of opioids may be reduced when a cannabinoid and opioid are prescribed together. Combining cannabinoids and opioids may allow a reduction in dose, resulting in fewer side effects.
What Cannabis Product is Right for Me?
Do I Have to Smoke My Medicine? (Smoking products are not available in many states, click here to see about your state).
A lot of people don’t like the idea of having to smoke a “joint” to control pain. This is a valid point: smoking should be avoided if possible, since it may cause or exacerbate bronchial irritation. The good news is that you don’t have to smoke cannabis to use it as a medicine.
Medicinal cannabis can be inhaled using a vaporizer instead. Vaporizers heat the cannabis just below the point of combustion, causing the active compounds to evaporate, eliminating the harmful by-products of combustion. Not all vaporizers are alike – devices known as “vape pens” have not been tested and do not have quality control. They may do more harm than good and should be avoided until more information is available.
Eating or drinking products infused with cannabis, like brownies or teas, also works. However, you should be careful when eating or drinking cannabis to avoid taking too much. Because it takes longer to feel the effects when cannabis is consumed this way, be sure to start with a small amount and wait 30 minutes to 2 hours before taking more.
There are other options too:
Extractions and tinctures are concentrates that may be eaten, smoked, or applied topically, depending on the extraction method used. They can be administered under the tongue by using an eye dropper to control the number of drops used, or applied to the skin in a lotion or cream.
Talk to your doctor to discuss the pros and cons of these different methods of taking medicinal cannabis.
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How do I take prescription cannabinoids?
Currently, there are three types of prescription cannabinoids available in Canada – all have been approved by Health Canada. Nabilone (Cesamet®) and dronabinol (Marinol®) are available as capsules taken orally and THC/CBD (Sativex®) is available as a spray formulation. They should be taken exactly as directed by your doctor. Your doctor or pharmacist may give you additional information regarding the specific cannabinoid you have been prescribed.
Relevant Information
What are the side effects of prescription cannabinoids?
Like any medication, prescription cannabinoids may cause side effects. These side effects may include dry mouth, drowsiness, dizziness, and confusion, side effects tend to be mild and manageable in most patients, however if side effects become bothersome please discuss any concerns with your doctor.
Are prescription cannabinoids covered by my drug plan?
Most private insurance companies cover prescription cannabinoids and you may be able to obtain coverage through government-funded plans. Detailed information on health insurance coverage for cannabinoids is available on the following website: www.drugcoverage.org (type in the DIN number for the cannabinoid you have been prescribed); or please refer to your health insurance provider.
Are prescription cannabinoids the same as cannabis (marijuana)?
Prescription cannabinoids contain chemical compounds that act in the same way as those found in cannabis (marijuana) but because they are approved medications they have been thoroughly tested for quality. Prescription cannabinoids act more slowly and have a longer action than inhaled cannabinoids, and the effects are not the same as smoked or inhaled cannabis.
Will I get “high” while on prescription cannabinoids?
Since the onset of action is much slower than smoked or inhaled cannabis, getting a ‘high’ is uncommon with prescription cannabinoids. If you have never used cannabinoids before, you may feel anxious with the first dose, but most side effects diminish with time.
Will I get addicted to prescription cannabinoids?
Studies to date have shown that appropriate use of prescription cannabinoids does not result in physical dependence or addiction.
Can I take prescription cannabinoids with smoked cannabis (marijuana)?
Please discuss with your doctor if you use smoked cannabis (marijuana). The combination of prescription cannabinoids and smoked cannabis (marijuana) may increase side effects, such as drowsiness. It is recommended that you do not smoke cannabis if you are on a prescription cannabinoid.
What do I tell my family/friends about my taking prescription cannabinoids?
In our society, there may be negative perceptions towards cannabis (marijuana) use. Prescription cannabinoids may be associated with this perception. However clinical trials of cannabinoids have suggested that prescription cannabinoids may be an effective treatment option. Talk to your doctor if you feel concerned about taking a cannabinoid medication and they may help you with strategies to manage these concerns.
Track Progress
How will I know these prescription cannabinoids are working?
Your doctor may schedule regular office visits to monitor your progress against the treatment goals established with you. Your doctor will try to manage any side effects and any other barriers that may prevent you from achieving your goals.
If I smoke pot and then breastfeed, will my baby get high?
Just like with tobacco and alcohol, a pregnant woman or a new mother's use of cannabis can affect her fetus or newborn child. The substances in cannabis are carried through the mother's blood to her fetus during pregnancy. Also, they are passed into the breast milk following birth. This can lead to health problems for the child. Since there is no known safe amount of cannabis to use during pregnancy or breastfeeding, the safest approach is to not use cannabis. If you need more information or support, it is recommended that you talk to your healthcare provider.
Can smoking cannabis trigger schizophrenia in some people?
Although the exact underlying mechanism is still largely unknown, in some people, cannabis use increases the risk of developing mental illnesses such as schizophrenia. This is particularly true for those who:
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start using cannabis at a young age
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use cannabis frequently (daily or almost every day)
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have a personal or family history of schizophrenia
Youth are especially vulnerable to the effects of cannabis, as research shows the brain is not fully developed until around age 25. This is because THC, the substance which gives the “high” in cannabis, affects the same machinery in the brain that directs brain development
You should also be aware that the use of higher potency cannabis products has also been associated with a greater risk of developing schizophrenia. Stopping or reducing cannabis use has been shown to improve outcomes; however, some health effects may not be fully reversible even when cannabis use stops.
What are the known benefits of using cannabis?
There is some evidence of potential therapeutic uses for cannabis or its component chemicals (cannabinoids) and many Canadians report using cannabis for medical purposes for health problems such as chronic pain, nausea/vomiting associated with cancer chemotherapy, and spasticity with multiple sclerosis. While cannabis can be used by some people for their health problems, determining whether cannabis is appropriate to treat an individual’s symptoms is best made through a discussion with a health care practitioner.
Health Canada has information for health care professionals and for authorized patients on the use of cannabis and cannabinoids for medical purposes. This includes information on potential therapeutic uses, dosing, warnings, and adverse effects. For more information, please visit our Accessing cannabis for medical purposes page.
What are the effects of cannabis second hand smoke?
Any kind of smoke is harmful. In fact, studies have shown that cannabis smoke contains many of the same harmful substances as tobacco smoke. Like smoking cigarettes, smoking cannabis can damage your lungs and can cause bronchitis-like symptoms, coughing and wheezing which can, for example, affect athletic performance. While the effects of second hand smoke from tobacco are well known, more research is needed to better understand the health effects of second hand smoke from cannabis.
How is the government going to prevent driving high like they do driving drunk?
Impaired driving by a drug and/or alcohol is illegal in Canada and will remain so after cannabis is legalized. Police are already able to test for drug-impaired driving using Standard Field Sobriety Tests (SFST) and through the use of Drug Recognition Experts (DRE).
On June 21, 2018, new legislation designed to strengthen impaired driving laws came into force. These new laws make it easier for police officers to detect drug-impaired driving. For example, law enforcement will be able to use an oral fluid drug screening device (once approved by the Attorney General of Canada) to test drivers for drug impairment.
The Royal Canadian Mounted Police (RCMP) has developed the “Introduction to Drug Impaired Driving” course enhancing the current SFST curriculum to train officers on the signs and symptoms of drug impairment. Canada currently has over 13,000 officers trained in SFST and over 800 DREs. It is expected that Canada will train more than 7,000 new SFST officers over the next three years. The RCMP and its provincial partners also have a goal of training approximately 500 additional DRE-certified police officers over the next five years.
Additionally, the federal government launched the nationwide Don’t Drive High campaign, which aims to educate Canadians about the safety and legal risks of drug-impaired driving.
How can I help a friend who is addicted to cannabis?
There is no script for talking with your friend about cannabis addiction and it may be difficult to try to convince him or her to stop using cannabis. You can start by encouraging your friend to compare his or her current life situation to how they were when they limited their cannabis use. They might admit that they felt healthier, happier, and more productive.
When someone experiences problematic substance use (including cannabis), it is very important that they seek help. Many resources are available to answer questions, offer advice or give hands-on help. Our Get help with problematic substance use page contains a list of organizations that can offer your friend some assistance. Help is available across Canada. You can help your friend by preparing a list of organizations that are located in your area, with their websites and phone numbers.
CBD (Cannabis) Usage Guidance
What Type Of Cannabis Therapy Is Best For You?
Cannabis remedies are available in many forms and can be utilized in various ways. The most appropriate delivery system for therapeutic cannabis is one that provides an optimal dose for a desired duration with few unwanted aside effects. Read about the different modes of administration here.
Many health professionals have little to no experience with cannabis therapeutics and are not able to guide people on this subject. So Project CBD has created a beginner’s guide to cannabidiol & cannabis therapeutics to address key questions of CBD users.
Numerous commercial start-ups have jumped on the CBD bandwagon. But along with a growing awareness of CBD as a potential health aid there has been a proliferation of misconceptions.
What To Look For In Your Cannabis Medicine
Project CBD’s guide to locating safe and effective medical cannabis products.
Cannabis Is Personalized Medicine. The Right CBD Cannabis Treatment Depends On The Person And Condition Being Treated. For Maximum Benefit, Choose Cannabis Products That Include Both Cannabidiol (CBD), A Non-Intoxicating Compound, And Tetrahydrocannabinol (THC), The Psychoactive Component Of Cannabis. CBD And THC Interact To Enhance Each Other’s Therapeutic Effects. They Work Best Together.
Medical cannabis research shows that CBD may be therapeutic for many conditions, including those listed here.
There are many ways to extract oil from the cannabis plant—each with its pros and cons. Some methods are safer and more effective than others. Cannabis oil made with neurotoxic solvents like butane and hexane may leave unsafe residues that compromise immune function and impede healing.
There’s a big difference between CBD derived from cannabis versus hemp. We recommend CBD-rich products made using only organic, whole plant cannabis (not hemp or trim) because this offers the best safety profile and superior medicinal benefits.