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Medical Marijuana - general information

Natural cannabis products or THC (Dronabinol), the cannabis extract Sativex and Nabilone can be used for a variety of diseases. There are already effective drugs for treating all of these diseases. However, these drugs do not work well for all patients, or they can sometimes cause severe side effects.

Often times, cannabis products can be sensibly used together with other drugs so that their dose can be reduced. For example, Dronabinol and opiates complement each other in their pain-relieving properties, while Dronabinol can alleviate the nauseating effects of opiates. Sometimes the dose of the opiates can be reduced.

Many medical effects of cannabis and Dronabinol occur with single doses of 2.5 to 15 mg THC, but significantly higher doses are often required. The responsiveness is very variable. The effect lasts when taken orally usually between 4 to 12 hours, so that
Cannabis products are mostly taken 1 to 4 times a day.

Cannabis products, however, are not magic bullets. They do not help many patients, or only little, while others benefit very well.

Diseases

Spasticity: In clinical studies, a good influence on spasticity was observed in multiple sclerosis or paraplegic diseases. Other positively influenced symptoms included bladder dysfunction, coordination disorders (ataxia), painful conditions, abnormal sensations, tremors and coordination disorders of the muscles.

Movement disorders: There are positive studies and experiences with so-called hyperkinetic movement disorders, especially with Tourette’s syndrome. Most patients experience little improvement, but some get remarkably good improvement. The results in dystonia (spastic torticollis, etc.) are contradictory. This also applies to experiences with Parkinson’s disease.

Tourette Syndrome: Studies have shown that cannabis products may be of great help to some patients with Tourette’s syndrome who do not respond well to other drugs. This affects both theTics as well as psychological pressure. Cannabinoids can also help with other tic disorders.

Chronic pain: Cannabis can help with pain that is due to nerve damage (neuropathic pain). Further indications are degenerative diseases of the musculoskeletal system, neuralgia, phantom pain, inflammatory pain (arthritis, ulcerative colitis), all pain diseases in which relaxation of the smooth or striated muscles has a beneficial effect, such as painful spasms, painful menstruation, etc. Often so-called Paresthesia (tingling, pins and needles) and hyperalgesia (hypersensitivity to even minor stimuli) are good. Cannabis can also be very effective for fibromyalgia.

Migraines and cluster headaches: Common pain relievers are often ineffective for migraines and cluster headaches, a particularly severe form of headache. For some patients, cannabis products are a good alternative.

Loss of appetite: An appetite-stimulating effect in AIDS and cancer is already observed at daily doses of 5 - 10 mg THC. Cannabis products are also used for hepatitis C and gastrointestinal diseases with loss of appetite and disgust for food, as well as for refusal to eat in Alzheimer’s disease.

Nausea and vomiting: The use in side effects of cancer chemotherapy has been well studied in clinical studies. Cannabinoids can be combined well with other nausea-inhibiting drugs and increase their effectiveness. They are also popular for other causes of nausea, especially AIDS, hepatitis C, and severe vomiting during pregnancy.

Glaucoma: The inhalation of cannabis and the oral administration of THC in doses of 10 to 20 mg lower the intraocular pressure in healthy individuals and in people with increased intraocular pressure by an average of 25 to 30%, occasionally by up to 50%, but sometimes only very little . Unfortunately, there are no eye drops with cannabinoids yet.

Epilepsy: According to some experience reports, for some patients with focal and generalized epilepsy, cannabis is a means of controlling an otherwise uncontrollable seizure disorder. Clinical studies have shown that CBD can be of benefit in some forms of epilepsy. (CBD see below)

Withdrawal symptoms: According to historical reports and many patient experiences, cannabis is a good remedy for combating withdrawal symptoms in benzodiazepine, opiate and alcohol addiction. Many addicts can more easily reduce the dose of their addictive substance with the help of cannabis. It takes the pressure off others and prevents relapses.

Asthma: The effects of a cannabis cigarette or 15 mg of oral THC correspond roughly to the therapeutic doses of known asthma drugs such as salbutamol in terms of bronchodilating effects. After inhalation, the effects last for about 2 hours.

Alzheimer’s Disease: Some small studies have shown that THC not only increases appetite in Alzheimer’s sufferers, but also decreases confused behavior.

Depression: A mood-enhancing effect of cannabis and THC in reactive depression in the context of severe illnesses and in neurotic depression has been repeatedly observed. Many patients have already tried many antidepressants that could not have a relevant effect on their disease and have found an effective therapy in cannabis for the first time. Occasionally, positive effects in bipolar disorders (manic-depressive disorder) have also been reported.

Sleep disorders: There are testimonials from patients with very severe sleep disorders who only experienced relief from cannabis.

Anxiety Disorder: Anxiety disorders are often associated with other medical conditions, such as depression. A common form of anxiety disorder is social phobia, which is the fear of socializing. For some people, THC is primarily effective, for others, CBD.

Post-Traumatic Stress Disorder: A few small studies have shown that cannabis can be effective for post-traumatic stress disorder. Such PTSD can be caused by childhood abuse, war experiences, and other severe trauma.

Inflammation: Cannabis is anti-inflammatory. This effect may play an additional role when used for inflammation-related pain and symptoms (for example, ulcerative colitis, Crohn’s disease, ankylosing spondylitis, asthma, or arthritis).

Autoimmune diseases: The anti-inflammatory properties of THC and CBD can also be used in autoimmune diseases. Allergies: Some patients with allergic asthma and other allergies report that it relieves their symptoms.

Itching: According to a few small studies, cannabinoids relieve the itching of various causes internally or externally in ointments.

Irritable bowel syndrome: Cannabis products relieve the symptoms of irritable bowel syndrome, especially the tendency to diarrhea.

ADHD / ADD: There is a small clinical study showing that patients with ADHD (attention deficit / hyperactivity disorder) experienced an improvement in concentration and impulse control disorder from cannabis. Many patients with ADHD cannot or only poorly tolerate the usual substances.

Obsessive-Compulsive Disorder: Cannabis products can help with obsessive-compulsive disorder and obsessive-compulsive thoughts that do not respond to other medications.

Cancer: Cannabis and THC relieve symptoms of cancer, such as pain and loss of appetite. Animal experiments show that THC and CBD also have anti-cancer effects. The importance of cannabinoids in cancer treatment cannot yet be assessed.

Other diseases: There are also positive experience reports on other diseases, including severe hiccups, Parkinson’s disease, ringing in the ears (tinnitus), neurodermatitis, inverse acne, psoriasis, borderline disorder, chronic fatigue syndrome (CFS) and hyperhidrosis (profuse sweating) .

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Cannabidiol

CBD

Cannabidiol is a cannabinoid that is mainly found in fiber hemp, in a range of 0.5-2% in the flowers. It exhibits some notable therapeutic properties without causing any psychedelic or other relevant side effects. Anyone who wants to use CBD for therapeutic reasons in German-speaking countries today can purchase appropriate dietary supplements made from fiber hemp, which is rich in CBD. The legal status of these dietary supplements is controversial. (…) Some finished CBD extracts are also available in pharmacies and some drug stores. There are also some CBD-rich cannabis flowers that can be prescribed by a doctor, including the Bedrolite and Aurora 1/12 strains. There are also some varieties with medium levels of CBD and THC. Since 2019, a CBD-rich cannabis extract called Epidiolex has been approved in Germany for the treatment of some forms of childhood epilepsy.
CBD has anti-inflammatory, neuroprotective, anti-epileptic effects, relaxes the muscles in dystonia and dyskinesia (certain disorders of muscle tension), inhibits nausea, kills cancer cells and promotes bone healing. Most important today are the anti-anxiety and antipsychotic properties, as well as the effects in certain forms of epilepsy, such as the difficult-to-treat Dravet syndrome in children. It is seldom a pain reliever. CBD can also relieve withdrawal symptoms after stopping cannabis.
The usual doses for treatment with cannabidiol are generally between 50 and 800 mg for adults and 1 to 25 mg per kg of body weight for children. These doses are normally divided into two to four doses, for example 2 x 250 mg with meals in the morning and evening. Anxiety-relieving and antidepressant effects often occur even with daily doses of 40 mg or more.
A study from 2018 showed that the low bioavailability of CBD after oral consumption can be increased by more than fourfold through the simultaneous consumption of a lot of fat (English breakfast). The type of fat probably doesn’t matter. Consumption with little fat will improve the bioavailability less.
In addition to oral ingestion, inhalation of CBD is becoming increasingly popular. The bioavailability of CBD is more audible when inhaled than after oral ingestion (without a lot of fat). Inhalation is possible through the use of CBD-rich cannabis flowers as well as through the use of CBD crystals with 98% CBD, which can be inhaled with a vaporizer after dissolving in a little alcohol. Pure CBD and crystalline CBD, which is dissolved in hemp oil, for example, is forbidden for the seller in Germany, the buyer has nothing to fear.
In the hemp plant, the cannabinoids are mainly present as carboxylic acids (CBDA, THCA). They are converted into the phenolic forms (CBD, THC) mainly through heating. These phenolic forms exhibit the medicinal effects described herein.

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Dose determination for THC, Sativex and marijuana

Dose determination

When determining the dose, a trial phase is essential to determine the individual dose. The tolerance and thus the appropriate dose varies between different people. Therefore, at the beginning of a treatment with THC / Dronabinol / Sativex, a small amount should be taken, which can then be slowly increased until the desired effect is achieved. This creeping dosage can be started, for example, with 2.5 milligrams of THC (Dronabinol) twice or only once per day and then increased by 2.5 milligrams per day daily or every two to three days. For Sativex it is recommended to start with one spray in the evening, on the 3rd day an increase to one spray in the morning and one in the evening, etc. Average daily doses are 15 to 20 mg THC (Dronabinol) or 6 to 8 sprays (Sativex). If necessary the dose can be increased to up to 50 milligrams per day and more. But there are also people who cannot tolerate or need more than 5 milligrams of THC per day.

The THC of cannabis flowers (marijuana) can range from around 1 to 24 percent. It is recommended to start with around 10 to 20 mg, i.e. this amount should be weighed with a fine scale and then inhaled or e.g. in the form of powder or tea. With a THC content of 20 percent, 20 mg of marijuana contains 4 mg of THC.

Patients who start cannabis flower-based therapy often need daily doses between 0.1 and 0.3 g, corresponding to a monthly dose of 3 to 10 g.

These patients often refrain from applying for reimbursement. At prices of 20 euros (about 24$) per gram, this medication is the cheapest cannabis-based therapy.
For comparison: heavy cannabis users consume several grams of cannabis every day. However, they have become used to higher doses.
When inhaling natural cannabis products, the tolerated and effective dose can be determined well, as the effect occurs after a few minutes.
After eating or drinking, the effect only sets in after about an hour, sometimes after 30 minutes or only after two hours, and is usually weaker, but lasts longer than after smoking. If the oral intake (eating, drinking) does not have any effect, a slightly higher amount is used after a few hours or the next day.
Not only the optimal amount of THC, but also the frequency of intake must be determined individually at the start of treatment with THC. Some patients prefer to take it twice, morning and evening, while others prefer to take small doses several times a day. To relieve nocturnal symptoms, many patients also like to take a larger dose before going to bed. Even with acute treatment, such as In the event of a migraine attack, a larger amount of THC is preferably taken once, at the risk of possible psychological effects.
The optimal dose and the type of dosage depend on the type of disease and the individual responsiveness and tolerance of THC. Different doses can be taken on different days and adjusted according to the symptoms.
You should be aware that even an accidental overdose generally does not cause any harm, for example if fear arises from unfamiliar psychological effects. The psychological effects usually subside on their own. However, it is better to slowly work your way towards the desired and effective dose. In this way, undesirable effects can largely be avoided.

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Inhalation or oral intake

Inhalation or oral intake

Many people have the idea that cannabis can only be smoked or even inhaled. People who use cannabis as medicine often ingest it orally through the stomach.
It is important that cannabis has been heated a long enough time at some point before ingestion. Because this is the only way to produce effective THC. In cannabis, THC is usually more than 95% inactive carboxylic acid, which is converted into the effective THC by heating.
After inhalation, the effect takes a few seconds to minutes and lasts for 2 to 3 hours. The maximum effect is measured after 20 to 30 minutes.
After oral ingestion (eating and drinking), the effect is delayed after 30 to 90 minutes, but it also lasts longer, namely 4 to 8 hours, and longer after very high doses. Some physical effects can last 12 to 24 hours even with an average dose. Due to the quick onset of action, inhalation of cannabis products allows better dosing than absorption through the stomach. Another advantage of inhalation is the comparatively high yield of THC. When smoking a cannabis cigarette, around 15 to 25% of the THC it contains ends up in the bloodstream, another part is lost through side currents, combustion and re-exhalation of unabsorbed THC. The main disadvantage of smoking cannabis products is the damage to the airways from combustion products. The composition of cannabis smoke is at least qualitatively similar to that of tobacco, with the main difference that cannabis smoke
Contains THC and other cannabinoids that are not found in tobacco and that tobacco contains the nicotine that is not found in cannabis. Smoking cannabis, like smoking tobacco, can cause chronic bronchitis, but because of the anti-cancer effects of THC, cannabis use may not increase the risk of cancer. The lowest possible strain on the lungs from smoking results from using cannabis that is as rich in THC as possible and burning the pure herb (without tobacco) in special pipes.
The damage can be further reduced by using electric vaporizers. They make it possible to inhale vaporized cannabinoids without burning the herb. The quality of the vaporizers varies greatly. An important quality criterion is the ability to actually keep the specified temperature constant. Due to the air flow that is created during inhalation, the air in the area of ​​the heated material cools down considerably, so that strong temperature fluctuations can occur. Few vaporizers have satisfactorily solved this problem. There are two vaporizers that are approved as medical devices in Germany (Volcano Medic and Mighty Medic).

When eating and drinking cannabis products, most of the THC is absorbed into the blood through the gastrointestinal tract. However, part of the active ingredient is destroyed beforehand by the stomach acid and most of the THC absorbed into the bloodstream is immediately broken down in the liver. The effect after ingestion through the stomach is just as strong as after inhalation of cannabis products. A major benefit of eating and drinking cannabis preparations compared to smoking is that they stay away from it
of possible damage to the airways.
In principle, THC-containing cannabis products can be taken both on an empty stomach and after a meal. Ingesting fat at the same time can improve the bioavailability of orally ingested cannabinoids. This may be due to direct absorption into the lymphatic vessels, bypassing the liver, so that immediate breakdown in the liver can be avoided.
Since the active ingredient THC is not soluble in water, when baking and cooking with cannabis, make sure that a little fat is added to the respective preparation, for example some cream when preparing tea

Simple reciepies

Cannabis tea: add half a gram of cannabis flowers to half a liter of boiling water. Add some cream or milk. Let cook for ten minutes. Strain the cabbage and sweeten to taste. Drink a cup of it one or more times a day. Since THC is only briefly heated to 100 ° C when making a tea, the THC yield is relatively low. The yield can be significantly improved if the cannabis flowers are heated in the oven for half an hour to about 120 ° C (248 ° F) or for about 15 minutes to about 140 ° C (284 ° F) before making tea. Then the same effect can be achieved with 0.1-0.2 g as with 0.5 g. Never heat above 145 ° C (293 ° F) as THC will vaporize above 157 ° C (314 ° F).

Cannabis Oil: The most popular method of making cannabis oil suggests using naphtha or petroleum ether as a solvent for extraction. In a Dutch study, olive oil was the optimal choice for making cannabis oil for self-therapy. Olive oil is inexpensive, non-flammable, or toxic, and the oil only needs to be heated to 70-90 ° C (158-194 ° F) so that the oil cannot overheat. This is done by placing a glass jar containing the oil and cannabis in boiling water for an hour or two. Long heating at 70-90 ° C (158-194 ° F) will provide adequate decarboxylation of the THC. After cooling down and filtering off the oil, it is immediately available for consumption. In order to achieve adequate decarboxylation, the cannabis should also be decarboxylated before the oil is prepared (e.g. heating in the oven for 30 minutes at 120 ° C (248 ° F)).

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Side effects

Side effects

Cannabis affects many organ systems, so a variety of side effects can occur. However, these are generally not severe, and cannabis is usually very well tolerated. To date, there is no known case in which a patient has ever died while using cannabis for medicinal purposes.
However, there is evidence that heart attacks have occurred from cannabis’ s effects on pulse and blood pressure in recreational users with heart disease. It’s a particular benefitof dronabinol not to damage internal organs such as the stomach, liver and kidneys, even in high doses. The most important are the effects on the psyche and the cardiovascular system.

Psychological effects:

  • Sedation and fatigue.
  • Elevated and cheerful mood, states of anxiety, psychotic state, increased sensory experience.
  • Thought disorders, memory disorders, altered perception of time.

The psychological effects are very attractive to many cannabis users as they are generally experienced as pleasant and mood-lifting. Sick people also occasionally enjoy “this vacation from illness”. You feel relieved and cheerful, the sensory impressions are more intense. For example, every meal tastes delicious and music sounds wonderful. However, one should initially stay below the psychotropic limit as possible in order to gradually become familiar with cannabis and to avoid unpleasant psychological effects such as fear and panic. For adults, the limit for psychological effects is a single oral dose of 10 to 20 milligrams of THC. However, some people react more sensitively (already at 2.5 or 5 mg).
When inhaling, psychological effects from about 1-2 milligrams can be noticed.
Dosages associated with psychological effects should be avoided in children and adolescents, as the growing brain is more sensitive to negative effects than the adult. Young people are at increased risk of developing psychosis when using cannabis products.

Physical effects:
In addition to the effects on the psyche, above the psychological threshold, side effects on the cardiovascular system must be observed. The heart rate increases; blood pressure can drop when standing and rise slightly when lying down. However, when therapeutic doses of THC are used orally, no measurable effect on the cardiovascular system is usually found.
The course of pregnancies is only marginally affected by the use of cannabis. Heavy and regular cannabis use can reduce the length of pregnancy by about a week and result in a slightly lower birth weight. Minor developmental disorders of the brain with impaired thinking, which often only become noticeable after the age of 3, can occur.
Other possible acute side effects are a deterioration in coordination of movements, dry mouth and red eyes. Nausea or headaches are rare.

Dependency:
Cannabis and dronabinol are addictive. Dependence is not a very big problem in a therapeutic setting. Withdrawal symptoms are generally mild. The withdrawal symptoms are about as severe as with tobacco. As with tobacco, they depend on the duration and dosage. There is also great variability from person to person. After discontinuing large doses, anxiety, restlessness, insomnia, nightmares and, to a lesser extent, physical symptoms (salivation, diarrhea) were observed for a few days. If the thought of potential addiction worries you, you can stop taking cannabis products for 2 or 3 days three to four weeks after starting therapy to see how this withdrawal affects you. You can repeat the same after a longer period of use. In this way you will get to know this topic for yourself and gain confidence in handling cannabis products.

Illegality:
Serious side effects can occur when substances are consumed that contain harmful substances in order to increase their weight (glass, hairspray, etc.). This is based on the legal situation, according to which many patients still have to deal with illegality.

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How THC and CBD work in the body

How THC and CBD work in the body

The characteristic ingredients of cannabis have a similar effect in the human body to the body’s own substances, which are called endocannabinoids (from the Greek endo, “inside”). This is especially true for the mode of action of THC) and less for CBD, which has a variety of mechanisms of action. The first endocannabinoid was discovered in 1992 and named anandamide. Its name is composed of the Sanskrit word “ananda” for bliss and “amid”, its structure. Today about 200 endocannbinoid-like substances are known.

How THC (dronabinol) works
The mode of action of THC is similar to that of the endocannabinoids, but is of longer duration. Most of the effects of the body’s own cannabinoids and THC are mediated by binding to specific binding sites that are on the surface of many body cells. These binding sites are called cannabinoid receptors. They come in large numbers on nerve cells
in the brain and spinal cord, but also on cells of the heart, intestines, lungs, skin, urinary tract, uterus, testes, internal glands, spleen, blood vessels and on white blood cells. Depending on where the receptors are and what type they are, their activation leads, for example, to the inhibition of the conduction of pain, to a change in the sense of time, to cheerfulness, relaxation, anxiety, the inhibition of inflammation or other effects. Many of the effects of the body’s own and plant cannabinoids can be explained by influencing the mechanisms of action of natural messenger substances in the human body. Endocannabinoids are also among those messenger substances that transmit messages about the state of the body in the brain and other organs and the cells react to certain reactions
cause. In complex control loops with other messenger substances, they protect e.g. Nerve cells from damage or reduce nausea and vomiting as well as muscle spasms and cramps.
In some physical disorders, the amount of endocannabinoids and cannabinoid receptors change. The concentration of endocannabinoids in some brain regions that are responsible for processing pain increases when there is pain
to alleviate this pain, or it decreases when inadequate
Food intake too.

How CBD (cannabidiol) works
The mechanisms of action of CBD have not yet been fully explored. They are diverse and not as simple and brief to describe as the mechanisms of action of THC.
CBD binds to the cannabinoid-1 receptor, but inhibits several effects of THC that are mediated via this receptor, such as the psychological effects and the increase in appetite. CBD inhibits the admission of the body’s own cannabinoid anandamide into the cell and its degradation. With this, CBD increases the concentration of this endocannabinoid. CBD binds to a number of other receptors, including vanilloid receptors (TRPV1 and TRPV2), the glycine receptor, and the GPR55, another possible cannabinoid receptor.

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(According to the german Association for Cannabinoid Medicines; ACM.
See full text in german: http://www.cannabis-med.org/german/download/magazin.pdf ;

see also IACM-Page for more Information in English.)

IACM
The International Association for Cannabinoid Medicines (IACM) is a non-profit scientific society whose purpose is to promote knowledge about cannabis, cannabinoids, the endocannabinoid system and related topics. This is achieved, for example, by promoting the exchange of information between researchers, doctors, patients and the public, and by developing and disseminating reliable information.

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Disclaimer

We’re here for social and emotional support, but that can’t be separated from members’ medical experiences and knowledge. Ben’s Friends doesn’t take responsibility for any of the information which members share amongst themselves on our sites. We do medical fact checking to the extent that we can (given our limited resources) but nothing that you read here should be assumed to be true. Your medical professionals are always the ones to consult: principally, your doctors and pharmacists.

Before you try anything new, even complementary therapies or seemingly-benign OTC supplements, please tell all your medical professionals. There may be interactions!

Recreational use is a whole other issue: its legality varies from country to country, and even jurisdiction to jurisdiction. If it is illegal where you are, don’t do it. JUST DON’T.

This post is about medically-supervised (prescription) marijuana use, not recreational. Comments about recreational marijuana use will be deleted from this thread.

I assume y’all on here are pretty computer savvy, but for those who (like me) are a little more “old school”, you can call on Google translate (translate.google.com) to translate the text of the paper for you if you want to read it in English.

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Hi Isaiah, that is mostly done by Google translator. Because translating the whole document does not work properly, I translated it with assistance. I will review again, but I ve had not enough concentration left last evening.

Thank you, TheDude. Either I missed the link for the English translation last night, or you added it after I read your post. I appreciate your effort. :blush:

Me again, Seenie from Admin.

This is a most interesting post, thank you Dude, and we need to make a few clarifying statements here so that nobody gets the wrong impression:

We’re here for social and emotional support, but that can’t be separated from members’ medical experiences and knowledge. Ben’s Friends doesn’t take responsibility for any of the information which members share amongst themselves on our sites. We do medical fact checking to the extent that we can (given our limited resources) but nothing that you read here should be assumed to be true. Your medical professionals are always the ones to consult: principally, your doctors and pharmacists.

Before you try anything new, even complementary therapies or seemingly-benign OTC supplements, please tell all your medical professionals. There may be interactions!

Recreational use is a whole other issue: its legality varies from country to country, and even jurisdiction to jurisdiction. If it is illegal where you are, don’t do it. JUST DON’T.

This post is about medically-supervised (prescription) marijuana use, not recreational. Comments about recreational marijuana use will be deleted from this thread.

Just so that we are all on the same page …

Seenie from Admin.

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