So Much For Medical Cannabis… I’m Done With THC

I gave it a go for a little over 2 years.  I had to try it to know I’d done what I could to avoid staying on opiates, but I can’t take the increasing pain of the progressive sensory neuropathy, degenerative disc disease, degenerative joint disease, fibromyalgia, and now gout, with THC.  I’ll still take the CBD as a supplement, as it helped me to get off of one anticonvulsant completely (I’ve got a seizure disorder), and %40 of another- along with the meds to deal with the side effects.  This week, I went back to the pain management doc that I’ve seen on and off for over a decade, and got pain meds (patch), as well as an injection in my neck. I kind of feel like I failed right now, even though intellectually I know that’s not accurate.  I have to be practical, and safe.  My quality of life and ability to get anything done around the house isn’t possible with the pain. My legs shake, and I become unsteady.  There are no brownie points for needless suffering. I don’t use the word ‘suffer’ lightly, as it feels like another way to play the victim. But it’s been bad.

Something else that made trying THC something to consider is the emphasis on those who use opiates as inevitable future junkies. It’s actually far from inevitable. Studies have shown for decades that those who use prescription pain meds as ordered are very unlikely to become addicted to them. The terms tolerance and dependence aren’t explained, and everybody gets lumped together.  People who use medications AS PRESCRIBED will likely develop dependence and tolerance if they take them for a while (ever had a caffeine-withdrawl headache? Same concept.)  Those terms are not the same as addiction. Addiction is driven by emotional issues, and the individual trying to relieve emotional pain with medication for physical pain. No amount of the wrong medication for any problem will ever relieve the real issue. This explains that addiction is a combination of behaviors and substances (that can be drugs, alcohol, food, the ‘high’ from gambling, and other things that trigger positive responses in the pleasure center in the brain).

https://www.mentalhelp.net/addiction/

There are now so many restrictions on who can prescribe what meds in medical groups, that the writing was on the wall- pain medication was the new ‘evil’.  Never ask a doctor for something for pain, no matter how many documented diagnoses there are.  I felt I needed an option if the restrictions got worse. I’d like to see the statistics for the increase in heroin users after hydrocodone was made a Schedule II drug (in the class with morphine, hydromorphone, and other very strong opiates). The ‘rules’ are always made because of the behavior of rule breakers. That ‘logic’ escapes me… it’s not like the rule breakers will suddenly jump on the straight and narrow. They’ll find a new way to break rules.   The rules don’t take into account those who do what they’ve been instructed to do. Should there be good follow-up with those on prescription pain medications ?  Absolutely.  But there is no reason to make anybody “live” with pain that limits their life to the point of decreased mobility to avoid more pain even within their own home.   This article has some good explanations about the differences between tolerance, dependence, and addiction.

Distinguishing Between Pain-Related Dependence and Addiction

Some of the issues I’ve had with the THC include the following  (I realize some folks have had good results with THC- this is MY experience):

–  I can’t know if the same strain is in each bottle of the stuff I got, as  no strain of cannabis is listed on the tablets/capsules/edibles containers that I’ve used (I don’t smoke the stuff- the stench is not welcome in my house. Dry herb vaping- no solvents at all- just the dry cannabis that vaporizes, not combusts- was also not going to work because of the coughing). There are literally hundreds of strains of cannabis.  Third-party testing is on the container (required by law), but not the strain, aside from a general sativa, indica, or hybrid.   I don’t know if it’s strain-consistent from batch to batch– just the number of milligrams of ‘whatever’.  Different strains are good for different things. And some have more likelihood to cause specific side effects- can’t know what might be causing what if no strain is listed.

I live alone. Some of the effects of THC are not safe on a mobility level.  My balance goes wonky if a strain is stronger than what I’m used to, and I’m already one fall away from needing help with more than just the lawn, snow removal, and grocery delivery.  I can’t risk that. My joints are already trash. It wouldn’t take much to finish off  my shoulders, hips, or knees. Or end up with compression fractures in my spine. That means my independence is at risk, and that is something I won’t even consider. If I can’t be at home with my dog, it’s over.

–  the dryness of my eyes was horrible. I was either dripping with tears (that burned) as my body tried to protect my eyes, or using artificial tears to not feel like I’d had cotton shoved into my eyeballs. That also caused blurred vision to the point of not being able to read anything without a 10x – 30x lighted magnifying glass (some print is tiny on a good day anyway… I couldn’t see individual words. Watching TV was lousy, and the computer (my lifeline) was nearly useless. A blue light filter helped a little- but not enough.

the ‘thought stealing’ sensation was too weird.  I could be thinking about something, then it would just be gone, and it was going too fast to get back.  That is unsettling, especially because the awareness of it was acute. Even harder to carry on a conversation with another actual human being.

there isn’t a consistent time when it takes effect.  I used it mostly to help ease the pain so I could sleep. If I waited too long to turn the lights out and drift off, I got a literal body ‘buzzing’ sensation (hence the term buzzed), or floating, or like I couldn’t move.  There was a sensation in my head that something wasn’t right – not necessarily bad- but not OK.  There’s a term called ‘couch lock’- and that’s what it feels like- being locked to the furniture, almost being part of it.  There was nothing about those sensations that will ever be desirable to me.

it’s useless for acute pain.  I broke my ankle a few months after getting my medical cannabis card.  I iced it, and had it wrapped (before getting an x-ray a week later- thought it might be a sprain similar to what I’d seen with adolescent patients who landed wrong while playing basketball).  I felt guilty using some Norco from 2014.  I used 3 full doses and 3 1/2 doses in 6 weeks.  And I hurt a lot more than was necessary.  I was diagnosed with gout a couple of weeks ago after a nasty flare that was a kind of pain I hadn’t felt before- tiny crystals in the joint felt like someone was sitting on a chair into the bone on top of my foot.  One urgent care a couple of months earlier, with milder but definitely ‘not right’ pain, thought it could be a blood clot (minus warmth, redness, swelling, or any other symptoms of a clot). The second urgent care a few weeks ago had a very astute nurse practitioner who knew to check my uric acid level, which came back very high.  I was on prednisone for 5 days, which jacked my blood sugars badly, but the prednisone did the trick to help that first flare. I’d already decided not to use the THC over a month ago, so was using my trusty ice packs, and the vintage Norco in 1/2 doses x 4 over a week.

Part of another disorder I have (dysautonomia) causes some similar symptoms to the side effects of THC, and I pay good money for the meds needed to help NOT to feel those symptoms. Why would I make it worse on purpose?   That is so bizarre and counter-intuitive. I don’t want to feel even a tiny bit stoned. I took microdoses after getting the CBD dose figured out (more on that in a minute), and still had side effects that are not acceptable to me.

I can see where it could be useful for severe PTSD, where escape is the only way to get any sort of relief from memories and flashbacks. I guess it could help with anxiety IF someone finds a strain that is consistent (those who smoke cannabis can get strains consistently, or those who want to make their own edibles and don’t care about consistent dosing). But for folks who are using that type of quantity, I’d hope they were housebound, and had access to someone to drive them anywhere they needed to go.  I never took a dose if I had to drive to an appointment.  I’d just have to hurt, and take a dose after getting home.  Once I did take a dose, there was never any desire to leave home.

There are people who have had positive experiences– and initially, my psoriasis was completely cleared up. Then came the hyperemesis cannabinoid syndrome, with months of nausea and eventual vomiting. I’m not a puker- that’s what put it together for me.  During 20 months of daily chemo for leukemia, I barfed once on day 8.   Because I didn’t have accurate info from a very well known CBD producer about the specific amount of CBD (not the total cannabinoid dose), I didn’t have the THC dose right- CBD helps counteract side-effects of THC. I also had a gallstone that was acting up, and that blended into the symptoms of the build up of THC because of using it daily, and I was SICK.  (The half-life of THC is very long, with some still showing up in drug tests more than 4 weeks after the last use, and with dietary changes that alter body fat percentages, more can be released months after the last dose- used to freak out the detox patients I took care of years ago).  I went through ultrasounds, CT scans, lab work, surgical consults, a bitch of a GI nurse practitioner, etc because it was thought that there was something going on besides the gallstone. I had THC continuing to build up, and  I didn’t know the accurate dose on that one brand’s product (if you use CBD, you want to see the exact amount of CBD per specific quantity of product- and third party testing). Everybody and their wombat is on the hemp bandwagon, and  saying how wonderful hemp oil  is, but non-CBD hemp oil (like on Amazon)  has no CBD, and is good for salad dressing- and you can get plain hemp oil for about $20 for a quart; the “therapeutic” hemp oil can be $50 an OUNCE- for essentially nothing). Hemp oil does have Omega 3 fatty acids, and hemp hearts (I like the ones without the little shells) taste a lot like pine nuts, but much smaller. Those are just flat out food- nothing specifically “magical” about it. Just another healthy fat source.

I’m a disabled RN; I’ve been an RN for 35 years, disabled for 15 years, where I’ve been my own full-time job.  Anything used to relieve symptoms MUST be consistent.  And I can’t get that with commercial medical cannabis products.  Some of the CBD companies out there are isolating other cannabinoids (CBG and CBN are two I’ve tried, and CBN has been good for sleep, though I only take it if I’ve been having trouble sleeping for a few days. Some brands of full-spectrum are out there- just don’t generally get the amount of each cannabinoid, so I’m not a fan of those). I don’t need a state-issued card for CBD. I get it online. Just like any herbal supplement.

And that’s what they are.  THC and CBD are not medication- which left me confused when talking to my pain doc during my visit. When I got home, I realized he hadn’t seen the way I’d printed out my list of medications and supplements, putting the CBD in the same area with vitamins and Co-Q 10, under a line of *****, separating the medications from the supplements.  The person who filled out their form with the list I’d typed up didn’t need to keep the typed one- so I agree with my doc, but I was scratching my head for a few minutes, as it seemed like he felt I considered THC and CBD to be actual medications. I agree with him on the characterizing THC and CBD as supplements. They are not medications. People use them like medications, but there are no studies proving efficacy, side effects, contraindcations, doses, longterm impact,  etc- and that’s what those of us who have used medical cannabis signed up for.  We knew it was an experiment, but desperation will lead people to anything that could be a source of hope.

I needed to try it. I wanted the hope of something different. And now I know.  For me, THC is unpleasant, and ineffective for what I needed it for.

Four Months Using MEDICAL Cannabis… It’s About the CBD, Folks !!

OK, so it’s been 4 months since I’ve had my medical cannabis card.  I’m still learning, but have been amazed at the unexpected effects of using CBD and THC.   I’m now getting into terpenes, which is a totally different post for the future.  Chemistry was never my ‘thing’, but I’m having to adjust a bit with that !!

I actually have this poster in front of my gas fireplace in my living room !! No hiding it !

 

CBD oils are not all the same.  You need one with a good track record.  I USED to  like Charlotte’s Web.  Then I discovered the unclear labeling that looks like the capsules are 15 or 35mg of CBD, when that is the  total cannabinoid dose.  This matters a LOT when titrating THC doses.  I got VERY sick from this unclear labeling and only noticed the change when they added the actual dose of CBD to the info on their website, but NOT on the bottles of their products. I will no longer use Charlotte’s Web, and am moving to Plus CBD, Sunsoil, and ThoughtCloud- they have third party testing of their products, which I now view as mandatory for me.   I asked Charlotte’s Web about the lack of clear labelling on the bottles, and got no reply.  THC side effects can be muted by CBD – which is a good thing.  I thought I was taking 50mg of CBD/day.  I was getting half of that, with a THC dose of 30-50 mg/day.  The THC built up in my system, and ended up with symptoms (along with a dicey gallstone at the time) that required multiple medical tests, surgery consults, scans, ER visits, and ultimately caused the beginnings of hyperemesis cannabinoid syndrome.  I only puked once- and that was the clue that led to figuring out what was going on.  (THC has a VERY long half-life, so doesn’t clear for about a month- but if folks keep using it daily, like medicine, it just accumulates; it’s not dangerous per se, but causes a lot of GI distress). I had been scheduled for surgery… what I needed was accurate info on the CBD.

Most of the time, I use the CBD softgels.  I do have the oil for edibles, or sublingual use for faster onset of action.  CBD is the base of my medical cannabis ‘program’.  That might disappoint those who hope for using more  mind-bending THC as their primary medication.  But THC is more of an enhancer.  I don’t like the feeling of having too much THC (and that amount is different for everyone).  This is a core difference between medical and recreational cannabis.  I don’t find anything “recreational” about it.    This is about a better quality of life….not escaping it.

Since starting the CBD and THC,  my psoriasis cleared up by about %95; with less THC, it has come back somewhat.  The clearing was unexpected, and amazing after years of prescription and over the counter shampoos, creams, solutions, etc.   I’ve also been able to completely get off of carbamazepine (Tegretol), cut the gabapentin (Neurontin) by %60, and subsequently stop or reduce the medications and supplements to deal with the side effects of those meds (especially the carbamazepine).

Cannabis is great for chronic conditions, and some acute symptoms (nausea).  It’s not optimal for acute pain, as I found out when I broke my ankle a month ago.  I’ve needed opiates a few times this month (6 doses) to allow me to sleep with the acute pain.  But that’s still very little compared to most opiate consumption after something like a broken weight-bearing bone.  I was disappointed about taking the opiates, but I also needed to be practical.  Since I’ve never been addicted to drugs or alcohol, I have some leeway to use opiates, but the goal is not to use them.  It had been quite a while since I’d used the Norco 10/325, and the first dose was a doozy.  I could definitely feel it (not good).   After that, I split the pill in half.


As I mentioned, my next ‘thing’ to figure out is how to use the terpenes, which are compounds in virtually every plant.  They have medicinal benefits, and I want to learn how to use them.  I’ll post more as I learn more, and have a chance to use them. I hope to use them in an aromatherapy diffuser.

So, there’s always more to learn, but it’s been an overall VERY good experience.   My primary form of cannabis is capsules, but I also use tablets, mints, candy/chocolate, other edibles, concentrates, occasional vaping, and occasional dry herb vaping.   I don’t smoke. No combustion = no products of combustion.  Vaping creates steam, so MUCH less likely to have toxins.  To me, smoked cannabis absolutely reeks, and I don’t want to expose my dog to that (or get her stoned), bug the neighbors, or stink up my house.   I also have distillates of CBD to use with cooking, should I ever get some culinary bug after my ankle heals.  Watch “Bong Apetit” on Viceland if you want some great ganja cooking tips.

By getting the small dose products, it’s easier to titrate the THC dose. That’s one reason I love the Ascend THC tablets- they’re only 2.5mg each, and can be split if need be (I use a whole one).

These come in different ratios of CBD:THC… I like the 2:1. Ends up being about 12-14mg of CBD and 6-7mg THC in each capsule.

2.5mg THC tablets.


SO, if you aren’t getting the benefits from medical cannabis that you hoped for, I’d encourage you to take a look at how much CBD you’re using.   
An example of the doses I use per day (and it is different for everyone, and you ALWAYS start low and go slow when increasing doses !!).  My current dose is 44 mg CBD (take 18 mg in the a.m., and 26mg in the evening) and 2.5-7.5mg of THC in divided doses per day.

CBN and CBG are also available now in ingestible oils. CBN is great for sleep, and CBG has anti-inflammatory properties.  I can’t take Aleve/Motrin because of kidney disease, so these have been great. I like the products from ThoughtCloud.  Not cheap- but worth the relief.

EDIT:  Because of dosing confusion on the Charlotte’s Web capsules, I’ll be changing to Elixinol and/or Plus CBD.  I went through a lot of craziness with the THC dose because of the CBD dose not being clear- it was off by half.  TOTAL cannabinoids are NOT the same as the CBD dose.  Charlotte’s Web wouldn’t accept my product review.

The Ongoing Journey With Medical Cannabis

I’ve had my medical cannabis card for 6.5 weeks now.   It’s been a very educational and hopeful thing to find a natural product that makes such positive changes.  For so long, I have been tolerating life.   Now I have glimpses of actually having a better life (at least with the stuff I am taking the cannabis for).   It hasn’t been all perfect (takes some time to get the dosing right), but that’s operator error and inexperience).    For years, I didn’t believe that marijuana could have anything positive to give to the world, and wow… was I ever wrong.  

I had been cutting down one of my seizure meds because of kidney and liver issues, but had only gotten down to %50 of my usual dose, because of wide mood swings with getting off of the stuff (I’d dealt with it in the past, so knew to go slow).  With the medical cannabis, I’m off of it completely, and have cut down another anticonvulsant by %60- with no known change in the frequency of seizures (they are nocturnal, so I only know I’ve had seizures if I wake  up in the morning with the inside of my mouth chewed up).   I have only taken opiates two times in 6 1/2 weeks.  That’s it.  Before the medical cannabis, it was 3-5 days a week; the rest of the time, I just put up with the pain to avoid any sort of physical dependence or tolerance.   I’ve had chronic pain since 1995- so 23 years- and while I don’t expect to be pain free (gotta keep expectations reasonable), there has been improvement.   Also,  I am definitely  sleeping better and my mood isn’t as wonky. 

The sensation of using cannabis isn’t what I expected.  For medical cannabis patients, the goal is to find the dose that takes care of the symptoms without altering psychoactivity.  Getting ‘stoned’ is NOT the goal of medical cannabis.  It’s more like a ‘thing’ that I didn’t know I was missing, and suddenly feeling like life is more good than miserable.   With CBD oil (I use capsules and vaping more than the sublingual oil, but I have used it that way), I do feel a mild sleepiness, and I take the larger of two daily doses around supper time, so that I’m ready for bed at a decent hour.   With THC, the doses are very small.   CBD is the cornerstone of cannabis pain management.   THC is the enhancer.

Depending on the strain of cannabis, the effects are either more sedating (indica strains) or uplifting (sativa strains).  It’s %100 possible to customize pain relief with the level of relaxation desired, to make daily life less interrupted by the symptoms being medicated- or the side effects of the ‘treatment’.  With traditional pharmaceuticals, fatigue and sedation were the only options.

I have had a couple of times when I overshot the dose (homemade edibles usually), and the feeling of being ‘buzzed’ is not pleasant to me.   There is a literal, physical ‘buzzing’ sensation that isn’t painful, but noticeable.   The ability to form memories is altered- though there isn’t a sensation of being messed up.   It’s a very “aware” feeling, and initially it scared me- but it  is fairly easy to take care of with some CBD (I usually vape when I’m trying to counteract any ‘bad’ THC effects, as it acts faster than edibles).   But there is also a very relaxed feeling that is welcome after days when pain is really lousy (i.e. taking trash cans to curb, laundry, etc).   I’ve decided to buy most of my edibles because the consistency in dosing is better.

I don’t smoke.  Anything.   I used to smoke regular cigarettes, and did try a couple of puffs from a joint, but didn’t like the coughing fit that seems to be fairly standard for smoking the stuff.  I like vaping (steam, not  smoke), capsules (yep, just regular capsules), edibles ( gummies and chocolate, and an infused granola bar), sublingual sprays, concentrates and RSOs,  making my own topicals, and some homemade edibles (baked goods- easier to get the dose more consistent, at least when I’m making stuff).    I use cannabis 3-4 times a day; morning,  early afternoon, suppertime, and just before going to bed.  I don’t feel ‘altered’ with the dose that is working now.   There is no urge to jump in the car and drive all goofy.  There haven’t been a bunch of ‘munchies attacks’ (thank GOD).

Initially, it’s not cheap to use medical cannabis, since there is so much trial and error that goes on with finding the strains and doses that work the best.   I recommend saving up money (gotta take cash to the dispensary) while waiting for the medical card to show up (took me 113 days to get mine).

Bottom line:  this prior anti-weed snob is SO thankful for something that works so well, has few side effects (and those are dose dependent), and WORKS for so many things.  It’s not the evil herb that I was preached to about as a kid.   It’s not about being stoned, like I saw when I worked as a detox RN.  It’s about getting better, and having a better quality of life.   It offers hope.   It very well could be a lifesaver, as there is only so much constant pain a person can take.  I had a doctor tell me that pain doesn’t kill anybody.  Well, maybe not physiologically, but emotionally and mentally, it’s an absolute life-sucker.   I’m getting a bit of life back.