Читать книгу The Medical Cannabis Guidebook - Mel Thomas - Страница 10
ОглавлениеThis portable vaporizer is a great way to administer your medical cannabis.
Cannabis is one of the safest and most effective medications known today, with the potential to treat a wide variety of medical conditions. By the early 19th century, the benefits of medicinal cannabis use had become widely acknowledged in the West, having been brought to France by Napoleon’s army as they returned from Egypt, where cannabis was commonly used for its analgesic and sedative qualities.1 Medical cannabis became universally accepted after extensive research by the Irish physician William O’Shaughnessy, who published a paper in 1843 entitled On the Preparations of the Indian Hemp, or Gunjah, which is noted for having introduced cannabis sativa to European and American medicine.2 O’Shaughnessy experimented with alcoholic tinctures and found this to be an effective way of isolating the major psychoactive component found in cannabis, delta-9-tetrahydrocannabinol (THC).
From 1890 to 1937, Parke, Davis & Company (now part of the Pfizer Group of Companies) marketed many formulations of medicinal cannabis, including tinctures that were available by the pint or fluid ounce and cannabis tablets that could be bought by the gram.3 It was also possible to purchase powdered extracts, and even pressed flowering tops (dried cannabis buds) for users to make their own preparations. All products and formulations were proudly advertised by the company as “originating from American home-grown cannabis.” Pfizer is now one of the world’s top pharmaceutical companies; in 2009 it made $50 billion profit in annual sales of prescription drugs, many of which replaced cannabis medications.4
Mel Thomas inhaling pure CBD vapor from a vaporizer bag.
Another major manufacturer of cannabis preparations and still a familiar name today is Eli Lilly & Co, who, from 1877 to 1935, manufactured and sold fluid, solid, and powdered extracts, all of which were stated to be manufactured from the flowering tops of the pistillate plants of cannabis sativa.5 Merck and Squibb are also both well-known pharmaceutical manufacturing companies that in the past have sold and marketed cannabis preparations.6 The two companies extensively advertised that they supplied dried flowering tops of the female cannabis plant. In addition, Merck was also a manufacturer and supplier of cannabis fluid extracts, tinctures, pills and cannabis oil made from infused tops.7
Alcohol-based tinctures are still used by pharmaceutical companies today; indeed, Sativex, a cannabinoid-based medicine, is basically a cannabis tincture spray. It has a cannabinoid profile of 51% THC and 49% CBD suspended in alcohol and is produced using organic cannabis, just like the tinctures made by Eli Lilly & Co over 150 years ago.8
A 2008 report by the Florida Medical Examiners Commission concluded that prescription medications easily exceed illegal drugs as a major cause of death.9 An analysis of 168,900 autopsies conducted in Florida found that three times as many people were killed by pharmaceutical drugs than by cocaine, heroin and methamphetamines put together.10 Cocaine was responsible for 843 deaths, heroin for 121, and methamphetamines for 25. Cannabis accounted for no deaths whatsoever. In contrast, 2,328 people were killed by opioid painkillers, including Vicodin and OxyContin, and 743 were killed by drugs containing benzodiazepine, including Valium and Xanax.11
In the U.S., over 40,000 people are killed annually by aspirin and painkillers.12 According to The American Journal of Medicine, over 100,000 patients are hospitalized annually for non-steroidal anti-inflammatory drug (NSAID)–related gastrointestinal complications and at least 16,500 deaths occur each year among arthritis patients alone.13 A report in The New England Journal of Medicine stated:
“It has been estimated conservatively that 16,500 NSAID-related deaths occur among patients with rheumatoid arthritis or osteoarthritis every year in the United States.14 This figure is similar to the number of deaths from AIDS and considerably greater than the number of deaths from multiple myeloma, asthma, cervical cancer or Hodgkin’s disease. If deaths from gastrointestinal toxic effects from NSAID were tabulated separately in the National Vital Statistics reports, these effects would constitute the 15th most common cause of death in the United States. Yet these toxic effects remain mainly a ‘silent epidemic,’ with many physicians and most patients unaware of the magnitude of the problem. Furthermore the mortality statistics do not include deaths ascribed to the use of over-the-counter NSAIDS.”
Surgeon W.B. O’Shaughnessy introduced cannabis into Western medicine in the 1840s.
The two main cannabis strains used for medical cannabis are the cannabis indica and cannabis sativa subspecies, which owing to their cannabinoid profiles both differ in their medicinal properties. Cannabis strains are available across the entire spectrum, from pure cannabis sativas to pure cannabis indicas and combinations which are known as hybrids. The resulting hybrid strains will grow and develop medicinal properties relative to the dominant genetics they inherit; for example, cannabis indica strains have more chlorophyll than cannabis sativa, and so grow and mature faster. Furthermore, cannabis indica-dominant plants can have a CBD/THC ratio four to five times that of cannabis sativa-dominant hybrids. Auto-flowering plants containing cannabis rudralis genetics are fine for medical use; just choose either an indica- or sativa-dominant hybrid depending on your particular needs. The effects of cannabis sativa are well known for inducing a THC cerebral high, hence they tend to be used medicinally during the daytime. As the effects of cannabis indicas are predominantly physical and sedative, they are best used for non-active times of the day, being particularly beneficial when used before sleeping. To determine the best strain for your condition it is important to understand the different effects of these two subspecies:
Cannabis indica-dominant strains tend to have a more sedative effect on the user and help to relieve stress and aid relaxation. These plants are recommended for pain relief when vaporized, and for cancer treatment in the form of an oil extraction. They can also help moderate nausea, stimulate the appetite, and reduce intraocular pressure. Most medical cannabis emanates from cannabis indica hybrids. A few examples of these hybrid strains include: OG Kush, Master Kush, Purple Kush, White Rhino, Blueberry, Grapefruit, Lemon Skunk and Northern Lights. Predominantly cannabis indica strains are recommended for treating anxiety, cancer, chronic pain, insomnia, muscle spasms and tremors, and for their effectiveness for appetite stimulation, increase in dopamine production, nausea reduction and sedative action.
As the female flower approaches harvest, the white pistils turn brown.
Cannabis sativa-dominant strains are more energizing, enhance a feeling of well-being and stimulate the neurotransmitter serotonin, a type of chemical that helps relay signals from one area of the brain to another. Of the approximately 40 million brain cells we have, most are influenced either directly or indirectly by serotonin, which also acts on the central nervous system and, amongst other things, is responsible for mood and appetite regulation. Consumption of pure cannabis sativa strains can often induce paranoia attacks and irregular heartbeat, so hybrids also containing cannabis indica are preferred for medicinal use. These hybrids are useful for the antidepressant properties they possess, without inducing the paranoia associated with purebred cannabis sativa, but they rarely have any pain-blocking attributes, so cannabis indicas are preferred for use as analgesics.
The high THC content of many cannabis sativa hybrids is useful in treating any conditions where CBD content is not so useful, such as glaucoma and multiple sclerosis. Common cannabis sativa-dominant hybrids include Haze, Kali Mist, Jack Herer, Willy Nelson and Cheese. Cannabis sativa-dominant strains are recommended for use in treating depression, chronic fatigue syndrome, loss of appetite, cancer, migraines, nausea and as a daytime medication.
Treating Internal Cancers with Cannabis Oil
Providing the treatment is started early enough, the oral administration of cannabis oil benefits most patients diagnosed with cancer.
If you’re a cancer patient beginning treatment with cannabis oil, it is recommended that you make some dietary changes and it is advisable to cut out red meat altogether. Use more hemp seed, oily fish and vegetables such as broccoli, spinach, corn or potatoes for your protein (see appendix I). Do not drink alcohol as this would be adding additional complications. It has been shown that regularly drinking around 3 units of alcohol a day (a large glass of wine) can increase the risk of mouth, throat, esophageal, breast and bowel cancers.
Rick Simpson, in his work, advises that patients should also take high doses of vitamin C daily. The authors have themselves been successfully treating cancer patients for over a decade using cannabis oil and whilst they advise making a dietary change they don’t agree with Simpson on this issue. The claim that vitamin C is useful in the treatment of cancer is largely attributable to Linus Pauling, PhD.15 In 1976 and 1978, he and a Scottish surgeon, Ewan Cameron, reported that patients treated with high doses of vitamin C (10,000 milligrams per day) had survived three to four times longer than similar patients who did not receive vitamin C supplements.
Bud Buddies 1:1 ratio CBD:THC cannabis oil as produced by the authors.
Extensive studies have been carried out on Linus Pauling’s claims that high-dose vitamin C prolonged the life of cancer patients, and these found that the claims were based on improper statistical analysis of data. Subsequent clinical trials found no benefit from his recommendations. Case reports also indicate that very high doses of vitamin C can cause kidney damage and interfere with the body’s ability to absorb copper; therefore even if supplementary vitamin C is eventually found to have some use in fighting cancer, that role is not likely to be extensive. Vitamin C is a potent antioxidant that does help the body protect its cells, and there is no harm in taking up to 1000 milligrams daily as a supplement.16 However, it won’t cure cancer and may give you diarrhea, which will cause dehydration. If you do wish to increase your intake, it is far better to do this by consuming foods that are high in vitamin C content.
Adopting a healthy Mediterranean-style diet is proven to reduce cancer.
Other than these changes, all you require is the cannabis oil itself. Do not buy this from dealers on the black market as the purity will not be sufficiently high. Make a pure, high-quality oil yourself using a cannabis indica variety high in CBD content such as Skunk Haze (from the CBD Crew) and follow the techniques described in this book. One pound of dried cannabis flowers will produce around two ounces of high-grade cannabis oil, which is sufficient to treat even the most serious of cancers, if taken early enough.
Chemotherapy is the general term for pharmaceutical cancer-inhibiting drugs. There is conflicting advice given on whether cancer patients should use cannabis oil before or during chemotherapy. Recently, a team of researchers looking into why cancer cells are so resilient discovered that chemotherapy seriously damages healthy cells and subsequently triggers them to release a protein that sustains and fuels tumor growth, making the tumor highly resistant to future treatment.17 Reporting their findings in the journal Nature Medicine, the scientists state that their findings were “completely unexpected.” After extensive research, Dr. Peter Nelson and his team at the Fred Hutchinson Cancer Research Center in Seattle found that chemotherapy helps cancer to survive, grow faster, and resist treatment.18
The team was trying to explain why cancer is so resilient in the body, yet so easy to kill in the lab, and realized that the culprit is the interaction of chemotherapy and healthy cells surrounding the targeted tumors. When used on cancer, chemotherapy slows or stops the reproduction of rapidly dividing cells found in tumors, but it also damages the DNA of neighboring fibroblast cells, which normally help heal wounds. These cells then produce 30 times more than normal of a protein called WNT16B. This protein encouraged prostate tumors to grow and spread into surrounding tissue, as well as to resist chemotherapy. The team examined cancer cells from prostate, breast and ovarian cancer patients who had been treated with chemotherapy and found similar results. It is up to the patient to make an informed decision as to whether he or she wishes to undergo chemotherapy or not but certainly the earlier you start cannabis oil treatment the better.
The general consensus is that cancer sufferers require a treatment course total of 2 ounces (56 grams) of cannabis oil, to be ingested over a three-month period for maximum effectiveness. The dose is gradually built up to 1 gram a day. After this, many survivors continue a maintenance dose to keep the cancer at bay; this varies between individuals and the severity of their illness, but averages at 100-200 milligrams daily. The oil produced using the techniques we describe will be extremely potent, so patients are advised to begin their treatment with very small doses starting off with dabs the size of a match head to be taken four times a day. For initial doses patients generally find that having the oil in a syringe enables them to easily squeeze the required amount onto their finger and then place this into the mouth.
Bud Buddies 1:1 CBD:THC oil.
The dose should be increased slowly every three to five days depending on the patient’s tolerance, until they are able to take one gram daily. A set of digital scales accurate to a tenth of a gram are required to enable patients to accurately measure their consumption, however, it is not possible to overdose on cannabis oil and your body will not become dependent. Medically a patient has to be in remission for five years before being declared cancer-free, so once the course has been completed, it is recommended that you continue a maintenance dose of cannabis oil, the general consensus being between one tenth to one fifth of a gram per day.
General Administration of Cannabis
There are basically five methods of administering cannabis: inhalation (smoking), ingestion (eating), suppositories (anally), topically (creams) and also by intravenous injection (IV).
When choosing a route of administration it is important to exercise caution and build up your dose slowly. The side effects of over-consuming cannabinoids wear off quickly and will not have any detrimental long-term effects, but the immediate experience can be unpleasant for some individuals. The two most widely used routes of administration are inhalation and ingestion.
Vaporizing or smoking cannabis is the preferred method for pain relief, as the effects are felt very quickly. When cannabinoids are drawn into the lungs, they rapidly enter the bloodstream, with the initial effects being felt within 20 seconds. First-time consumers who choose to try inhalation are advised to leave at least ten minutes between medications so they can gauge the effects. It is much easier to get the correct dosage when you inhale cannabis; as soon as you feel the effect you wish for, you should stop inhaling.
For most smokers, the preferred method is the traditional joint, which is simply made using cigarette papers rolled into a cigarette containing cannabis; it is not recommended that you include tobacco. When you smoke a joint, the combustion occurring at the tip generates temperatures of around 1,112°F (600°C); when you draw (inhale) the temperature rises to around 1,652°F (900°C). These temperatures deliver the cannabinoids. However, the act of combustion also creates harmful gases such as benzene and toluene. There are conflicting arguments concerning the harmful effects of smoking cannabis. Some studies have indicated that smoking cannabis without tobacco is much less harmful than when they are consumed together, but other studies have concluded that even the smoking of cannabis without tobacco is damaging.
Consuming cannabis with tobacco is not recommended.
The results from one of the most comprehensive studies ever carried out on cannabis use and lung disorders was published in The Journal of the American Medical Association.19 Researchers working on a long-term study of risk factors for cardiovascular disease (the Coronary Artery Risk Development in Young Adults or CARDIA study) tested the lung function of 5,115 young adults over the course of 20 years, starting in 1985 when they were aged between 18 and 30. Whilst tobacco smokers showed the expected decrease in lung function, the research found that cannabis smoke had unexpected and seemingly positive effects. Low to moderate users actually showed increased lung capacity compared to non-smokers on two tests. The first test, known as FEV1, is the amount of air someone breathes out in the first second after taking the deepest possible breath; FVC is the second test and records the total volume of air exhaled after the deepest inhalation. Dr. Mark Pletcher, Associate Professor of Epidemiology and Biostatistics at the University of California, San Francisco and the lead author of the study, stated:
A pure cannabis joint containing no tobacco.
“FEV1 and FVC both actually increased with moderate and occasional use of marijuana. That was a bit of a surprise, there are clearly adverse effects from tobacco use and marijuana smoke has a lot of the same constituents as tobacco smoke does so we thought it might have some of the same harmful effects. It’s a weird effect to see and we couldn’t make it go away.”20
Results indicate that smoking cannabis, even regularly and heavily, does not lead to lung cancer. Donald Tashkin of the University of California at Los Angeles, a pulmonologist who has studied cannabis for 30 years, states:
“We hypothesized that there would be a positive association between marijuana use and lung cancer, and that the association would be more positive with heavier use. What we found instead was no association at all, and even a suggestion of some protective effect.”21
Water-cooled pipes or bongs can also be used for inhalation, and many medical users choose this method. Smaller hand held pipes can also be used, and as long as you choose a small bowl model designed specifically for cannabis, the fumes inhaled when smoking will not be unnecessarily hot. Pipes and bongs are readily available for purchase online if you do not have a suitable store nearby. It should be remembered that smoking is not a very efficient method of delivering your medication, as the act of combustion destroys over 50% of the cannabinoids.
A much more efficient and precise method of inhalation is a specially designed vaporizer. These units don’t actually burn the cannabis material, but instead gently heat to set temperatures that release the cannabinoids as a mild vapor that can be inhaled.
A vaporizer does not use combustion, so none of the cannabinoids are consumed by flame, making a vaporizer very economical. With a quality vaporizer you are receiving 100% of the cannabinoids from your herbal cannabis, as opposed to losing over half of the cannabinoids through combustion when smoking. Vaporizers are usually portable and can be carried with you, with some being small enough to place in your pocket. The non-portable types are larger, and ideally you should purchase one that includes a variable temperature function that gives more precise delivery of the cannabinoids. The ability to choose the temperature at which you vaporize will allow you to administer the cannabinoids you wish, and, whether your desire is to medicate or get high, this essential facility gives you total control. It is the higher temperatures involved in smoking that are responsible for the production of carcinogenic hydrocarbons, and these are almost completely eliminated by the use of a quality vaporizer, as the lack of combustion suppresses the formulation of the health-damaging compounds. In 2007, a study of vaporization conducted at the San Francisco General Hospital concluded:
Volcano vaporizer. The vapor is collected in the bag for inhaling.
“Vaporization is a safe and effective cannabinoid delivery mode for patients who desire the rapid onset of action associated with inhalation while avoiding the respiratory risks of smoking, as they significantly reduced the intake of gaseous combustion toxins, including carbon monoxide.”22
The vaporizer used by the 18 participants in the study was a Volcano Vaporizer, manufactured by Storz & Bickel, which was chosen for its reliability, efficiency and its accurate temperature control. Many Volcano owners find that its advantages more than compensate for its lack of portability. The Volcano is known as a “bag type” vaporizer, and works by generating heat via a thermostatically controlled heating element. When the desired temperature is reached, the operator activates a fan that blows the hot air through the chamber containing the cannabis. The air passing through the ground cannabis in the chamber is collected in a plastic bag, and then inhaled via a mouthpiece attachment. As well as efficiently vaporizing ground and dried cannabis buds, a good quality vaporizer should also be capable of vaporizing cannabis oil and hashish.
Researchers reported that vaporization resulted in higher plasma concentrations of THC compared to smoked cannabis for up to 60 minutes following inhalation. Investigators also reported that subjects self-titrated their intake of cannabis vapor, taking smaller and less frequent puffs when exposed to stronger cannabis. On average, the Volcano vaporizer exposed subjects to 54% of the applied dose of THC. Previous studies have shown that as much as 80% of the THC burned in cigarettes or water pipes is lost in slipstream smoke.
Variable heat settings allow you to select which cannabinoid you prefer to vaporize.
To get the best from your vaporizer, you have to be aware of the cannabinoid profile of the cannabis you are vaporizing, as you will only obtain high levels of CBD if it is actually present. If you wish mainly to experience the effects of THC, do not set your temperature control above 320°F (160°C). After a couple of bags, you can increase the temperature to allow the release of CBD or you may wish to save the already vaporized cannabis for later use. To get the best out of your vaporizer, you should experiment; you may find that vaporizing THC during the day and re-vaporizing the same cannabis at a higher temperature in the evening is a good regimen. As an alternative to re-vaporizing you may prefer to use the remaining cannabinoids in an edible form or cannabis preparation.
CANNABINOID RECOMMENDED TEMPERATURES
THC 284-320°F (140-160°C)
CBD 320-356°F (160-180°C)
CBN 365°F (185°C)
CBC 428°F (220°C)
Temperatures in excess of 446°F (230°C) will produce benzene and other harmful chemicals.
The cannabis plant also produces terpenoid essential oils, which are responsible for its distinctive aromas and tastes and also have beneficial medicinal properties. Like the cannabinoids, they evaporate at set temperatures.
TERPENOID PROPERTIES TEMP
ß-caryophyllene Anti-inflammatory 248°F (120°C)
a-pinene Bronchodilator stimulant 312°F (156°C)
ß-myrcene Analgesic & Anti-inflammatory 330°F (166°C)
d-limonene Antidepressant 350°F (177°C)
linalool Sedative 388°F (198°C)
pulegone Sedative 435°F (224°C)
The inhalation of cannabinoid oils in this fashion is referred to as “dabbing,” and the amount of oil (dab) used per dose will usually vary between 0.1 and 0.8 of a gram.
There are many edible preparations of cannabis. Patients who are ingesting or eating cannabis for the first time should be cautious as the effects can take between 30 minutes to three hours to be felt, depending on the preparation and the metabolism of the individual. With such a wide variance it’s possible to inadvertently take an additional dose before the full effects of the initial dose have been felt.
It is important when ingesting cannabis to know the cannabinoid content of the preparation being consumed. This is much easier if you are making the edibles yourself, as you have complete control over the potency and strength. If you live in an area where medical cannabis is legal and you obtain your cannabis edibles and preparations from a dispensary, the cannabinoid content should be clearly displayed on the product. When ingesting cannabis, it is far more effective to consume your necessary dose on an empty stomach.
These are useful for ease of administration and monitoring dose, so many patients choose to encapsulate their cannabinoid oil concentrate. Empty 500-milligram capsules made from plant starch are available online. The capsules come in two halves and you fill one half with oil at your required dosage, then close the cap with the other half.
1:1 CBD:THC cannabis oil preparations.
These are an excellent way to utilize the plant’s medicinal ingredients, and a good alternative to smoking. Tinctures are easy to make and involve soaking your dried cannabis buds in ethanol or ethyl alcohol. The proof listed on commercial alcohol refers to the percentage of ethanol that the drink contains. The proof is twice the percentage (purity), so 70 proof means that the mixture contains 35% ethanol. The higher the alcohol content, the better the extraction. High-proof spirits such as Everclear 95% pure grain alcohol can be difficult to obtain, but if you have access to these products, they are ideal to use.
When you are making a tincture, the cannabis used must be absolutely dry and decarboxylated by gently heating in an oven at 110°C (230°F) to activate the cannabinoids. The process of heating converts the cannabinoid acids such as THCA into THC. It is advisable to chop but not finely grind the material before use. The cannabis should be soaked from between one and 10 days, with around seven days being adequate. The recommended minimum effective ratio to use is one gram of bud per 35 milliliters (one fluid ounce) of alcohol, with up to eight grams per 35 milliliters used for those preferring a stronger tincture. Place the solution into a sealed jar that you can periodically shake to assist in the process. Throughout the soaking period use only enough ethanol to cover the plant material. To make what is known as a “cold extraction”, place the jar in the freezer compartment of your refrigerator and remove periodically to shake the container. This cold extraction can be completed in around four days, but is not necessary for good results.
Cannabis oil can be easily made at home using kitchen equipment.
Once the soaking process has finished, strain the solution, and then further purify it by filtering through a coffee filter. Store the tincture in a cool dark place, preferably in a bottle with a dropper. Because of the varying strengths of tinctures, patients should experiment with small doses until the desired effect is achieved. Administer under the tongue using the dropper.
You can further concentrate the tincture by reducing the volume of the alcohol by evaporation; the more alcohol you evaporate the more potent the tincture will be. Evaporate too much though, and you will have an oil and not a tincture!
For those who prefer not to use alcohol, food-grade glycerin is an alternative solvent. Using ½ gallon (64 fluid ounces) of food-grade glycerin will be sufficient to process three ounces (84 grams) of quality cannabis buds. Again, the more cannabis you add, the more potent and stronger it will be. Unlike the “cold tincture” method with the alcohol tincture, a glycerin tincture requires some heat to assist the absorption of the cannabinoids. The plant material should be finely ground and placed into a crock pot (slow cooker) on the lowest setting, and left to heat for at least 12 hours with the lid on. Ensure the setting is low enough not to burn the mixture. After the heating process allow the mixture to cool and strain as before.
The most common form of suppository is the rectal suppository, a very effective method of administration for the delivery of cannabinoids. Suppositories are designed to dissolve or melt and this allows the active ingredients (in this case cannabinoids) to enter the bloodstream via the blood vessels lining the rectum. There are many advantages to this method of administration:
Works faster than when taken orally.
Avoids the production of the very psychoactive 11-Hydroxy-THC.
Requires a lower dose due to increased bioavailability.
Very effective for delivering cannabinoids to people who cannot take them orally due to nausea and vomiting.
The effects are longer lasting.
Suppositories are very easy to make. Add half a gram of oil to three grams of natural cocoa butter, slowly melt, and mix thoroughly. Professional suppository molds are available online, or alternatively you can create a simple mold by wrapping tin foil round your little finger. If you have made capsules for oral application, these can also be used as a suppository. However, some people may find that they need to apply a small amount of lubricant to aid insertion.
Studies indicate that using THC-HS suppositories for rectal administration offers around twice the bioavailability of oral administration.23 Converting THC into the ester THC-HS makes it water soluble, improving uptake and bioavailability. However, the esterfication of cannabinoids is beyond the scope of this book.
