Educational Materials

The federal government classifies cannabis as a schedule 1 drug; a classification that implies that cannabis has no legitimate medical use. Many believe this classification should be changed because cannabis is recommended by a multitude of physicians for the treatment of many medical conditions. Furthermore, THC (the primary active compound in cannabis) is FDA approved and is called dronabinol [6]. Dronabinol is marketed using the trade name Marinol [6].
There are many methods of using cannabis for the treatment of medical conditions. The following information is intended to inform medical cannabis patients about the various options available to them.
Please note: The only product form option that Breakwater ATC currently offers is flower/bud form. The following is provided for educational purposes only.

Methods of Consumption

Smoking

Smoking is popular among patients for several reasons:
1. Rapid onset: Smoking delivers active compounds quickly into the bloodstream and to receptor sites via the lungs [4].
2. Simplicity: Compared to other dosage methods, smoking cannabis is simple, requiring very little preparation time. Before smoking cannabis, the patient must simply separate the buds into individual flowers and remove any stems [2]. Doing so ensures an even burn and less need for flame application (less unwanted fumes=better-tasting, more healthful smoke). To make this easy, use a handheld herb grinder or a pair of scissors and a shot glass [2].
3. Easy dosage determination: smoked cannabis is effective almost immediately, allowing the user to titrate the dose one puff at a time. This allows the user to get just the right dose, by gradually increasing the dose until effective [7].


If this is your first time smoking medical marijuana, use discretion. Breakwater ATC's cannabis can be highly potent, depending on the strain. Don’t be alarmed though; this is good news for the patient because it allows him or her to burn less plant material to get an effective dose than with lower-potency cannabis [3,2]. This also means that (especially if the patient is new to smoking) it may only take one substantial inhalation to get an effective dose. Start with a small inhalation. Inhale deeply, exhale immediately (it is a myth that holding in the smoke will be more effective), and WAIT for several minutes to feel the effects of the inhale before taking the next so as to minimize the dose [4].
In summary, if a patient wants the quickest relief possible (easy preparation, plus onset in seconds [4]), and understands and accepts the possible risks inherent to smoking his or her medicine, a pipe is the smoking utensil of choice.

Vaporization

Breakwater ATC highly recommends this method to all patients. Good vaporizers allow patients quick-onset relief and oral satisfaction similar to smoking but without the health risks associated with smoke [1]. They do this by delicately heating the cannabis to the point that THC and other therapeutic substances change physical form, becoming gaseous [1]. The gas, or vapor, is then inhaled like smoke. The process leaves behind dry, slightly browned buds that, rather than having gone up in smoke, simply lack richness in medicinal compounds [2]. Studies show vaporizers significantly reduce carcinogens (cancer-causing agents), carbon monoxide (linked to cardiovascular disease), and tar [1,2,3].

Tinctures

Cannabis can be administered orally using cannabis tinctures [2]. Cannabis tinctures have a long history of medical use in the United States [5]. As early as the 1850's American physicians prescribed tincture of cannabis with successful results [5]. There are three types of cannabis tinctures made using alcohol and/or glycerine as solvents [4]. All three of these solutions may be taken under the tongue with an eyedropper [2]. They are absorbed through the mucus membranes of the mouth and take effect in five to ten minutes [2,4]. Tincture dosage varies greatly depending on the concentration of cannabis in the tincture [4]. Glycerine tinctures have the advantages of tasting sweeter than alcohol tinctures, and being well suited for those who do not consume alcohol [4]. Alcohol tinctures have the advantage of usually being more potent than glycerine tinctures. Thus, less needs to be used for the desired effect [4]. Glycerine/alcohol tinctures combine the advantages and disadvantages of glycerine tinctures and alcohol tinctures [4]. Shake glycerine/alcohol tinctures to counteract separation [4].

Methods of Smoking

Joint

a. Joint: (a.k.a. “marijuana cigarette” or “reefer”) Convenience of joints is key, as joints burn for multiple puffs worth of cannabis after only being lit once and are easily transportable [2]. Joints also taste pleasant to most patients, and they don’t require breakable, expensive, or conspicuous equipment [2]. A huge plus is efficient delivery of cannabinoids [3]. This is perhaps due to a joint’s lack of a filter or long piping before the mouth, to which sticky cannabinoids adhere easily, reducing the amount of medicine that actually reaches the patient’s body [3]. It is a skill to roll a good joint, however, novices uninterested in learning how to do so should buy a joint-rolling machine or pre-rolled joints (which BATC will produce)[2]. Before rolling a joint, the patient should break the bud(s) into small, uniform pieces about the size of the individual bud flowers or slightly smaller [2]. Stems should be removed from the flowers to avoid foul, acrid smoke and possible holes poked in the rolling paper [2]. To roll a joint, practice, practice, practice...or ask an expert at your licensed dispensary or patient organization for help. Some joint smokers prefer unbleached rolling papers, hemp rolling papers, or clear, cellulose-based papers, which may taste better and contain fewer impurities than traditional, bleached-white rolling papers.
**Patients should note that, while still remarkably safe, joints are not the healthiest methods of dosage because they burn paper along with cannabis, exposing users to impurities not presented in other dosage methods [2]. Another downside is waste: Some smoke is inevitably lost between inhalations, and there is usually leftover cannabis in the “roach”, or the small, undesirable leftover part of a burned joint [2]. However, joints’ efficient delivery of cannabinoids—relative to other smoking methods—should compensate for such waste [3].

Hand Pipes

These come in a (possibly overwhelming) variety of shapes, sizes, and materials, but the basic mechanics are universal. To smoke a cannabis pipe:
1. Pack prepared buds into the bowl
2. Hold a flame directly over the medicine while simultaneously inhaling through the mouthpiece [2].

Waterpipes

Mechanically, these are nearly identical to hand pipes, but they use a chamber of water to filter and cool the smoke before it is inhaled [2]. There are two main types: bongs and bubblers, classified by either a large or a small filling chamber, respectively, in which the smoke collects. The main proven advantage over dry pipes or joints is comfort; smoke is cooled and free of hot ashes and particles [3]. *BEWARE: large “hits” of smoke will cause light-headedness and an inclination to blacking out, and waterpipes make accidentally taking a bigger-than-expected dose a possibility. Waterpipes are supposed by many smokers to be a safer alternative to dry pipes or joints because the water filters tar out of the smoke [2]. Unfortunately, as one test points out, water filtration removes THC and other desirable active compounds more so than tar [3]. This means “in order to obtain the same effective dose of THC, a smoker would end up taking in at least 30% more tar from a waterpipe than from an unfiltered joint” [2]. However, water filtration may remove water-soluble toxic gases such as carbon monoxide, which is linked to heart disease, and aldehydes, which promote cancer [3], so more research is required to determine whether waterpipes are beneficial or counterproductive [2].
**A problem with all pipe smoking is that you must suck on one side of the pipe, pulling air and, along with the flame—lighter fluid fumes—over the cannabis, through the pipe, and into your lungs to light the cannabis on fire. Grind your bud to minimize the need for a starting flame. To avoid lighter fluid fumes, some patients light their pipe with an organic, beeswax-covered hemp wick, or a magnifying glass under bright sunlight.

Dosage, Potency, Tolerance

Dosage

Cannabis can be administered using tinctures, ingestion, smoking, vaporizing, and by other methods. The effect of each method and the rate of onset when using each method vary. Smoking and vaporization provide the fastest onset of effects of any method of administering cannabis [4]. Effects can be felt almost instantly [4]. Tinctures are slightly slower to take effect than inhalation methods; they start to take effect in five minutes or less [2]. Eating cannabis infused foods or capsules is the slowest method of medicating with cannabis but it provides longer lasting effects than other methods [2]. The effects of ingested cannabis may take from 30 minutes to longer than an hour to be noticeable and may maintain peak intensity for one to two hours before gradually diminishing over several hours [2]. The effects imparted by eating cannabis are also pharmacologically different from those produced by other intake methods, because THC is converted from Delta-9 THC to Delta-11 THC in the liver when cannabis is eaten [2].
When using any cannabis preparation start with a small quantity, wait the proper amount of time for the effects to take place and then take more if necessary [5]. Dosage determination is most easily accomplished using inhalation and tincture methods [2]. It is more difficult to determine ingestion dosage than inhalation or tincture dosage, because the onset of effects is much less rapid with ingestion [2]. The amount of food and type of food in the digestive tract also play roles in determining effective ingestion dosage, further complicating the task [4]. Whatever the method of intake, a lethal overdose of cannabis cannot be achieved [5]. Overdosing on cannabis may produce unpleasant feelings such as drowsiness or anxiety, but users experiencing such feelings should stay calm and wait for the effects of cannabis to diminish [4]. Users who fear the possibility of unpleasant feelings from an overdose may wish to avoid cannabis edibles, as eating cannabis is the most likely intake method to cause an overdose [2].

Potency

The varieties that Breakwater ATC will offer will be of high potency. This is a Breakwater ATC policy for several reasons. One reason is high potency will save caretakers money by allowing them to use less medicine. Another reason is highly potent varieties are healthier for those who choose to smoke their medicine, because less plant material must be smoked to get the same dose of active compounds [2]. Another reason we will produce only highly potent varieties is that this will aid in simplifying the caretaker's task of choosing the right varieties for their individual needs. Another reason for this policy is that it will help caretakers determine the appropriate dosage of each variety.

Tolerance

Heavy cannabis use will, over time, result in lowered sensitivity to the drug [2]. However, most patients lose side effects over time, not medicinal efficacy [2]. To avoid gaining tolerance to cannabis, patients should try different varieties of cannabis and different intake methods [2].

Additional Information

Addiction, Dependence, and Withdrawal

Cannabis isn't physically addictive, however psychological dependence may occur [2]. This means cannabis use may become habitual in some users [2]. When discontinuing cannabis use, long-term heavy users may experience mild withdrawal symptoms including anxiety, difficulty sleeping, and irritability [2].

Side Effects

Possible side effects of marijuana are dry mouth, nausea, vomiting, dry or red eyes, heart and blood pressure problems, lung problems, impaired mental functioning, headache, dizziness, numbness, panic reactions, hallucinations, flashbacks, depression, and sexual problems [9].

Substance Abuse

Signs and symptoms of substance abuse include a persistent desire to use marijuana or having trouble decreasing or controlling its use, significant social, educational, occupational or leisure activities being either abandoned or significantly decreased as a result of marijuana use, and marijuana use continuing despite being aware of or experiencing persistent or repeated physical or psychological problems as a result of its use [10]. If you or someone you know if suffering from substance abuse please visit www.recovery.org for more information about a 12-step program in your area.

References

1. Armentano, P. (2009). Emerging clinical applications for cannabis and cannabinoids: a review of the recent scientific literature 2000- 2009. Washington, DC: NORML Foundation.
2. Gieringer, D., Rosenthal E., & Carter G. T. (2008) Marijuana medical handbook. Oakland, CA: Quick America.
3. Gieringer, Dale (2000). Marijuana water pipe and vaporizer study. Newsletter of the Multidisciplinary Association for Psychedelic Studies, 6(3) Retrieved 6/19/2010, from http://www.maps.org/news-letters/v06n3/06359mj1.html
4. Lauve J., & Luttrell, H. (2010, Feb./Mar.) What is the right amount for me? Cannabis Health News Magazine, 1, 2.
5. Mikuriya, T. H. (Ed.). (2007) Marijuana: medical papers 1839-1972 (Vol. 1). Nevada City, CA: Symposium Publishing.
6. Joy, J. E. (1999) Marijuana and Medicine: Assessing the Science Base. Washington, D.C.: National Academy Press.
7. Earleywine, M. (2002) Understanding Marijuana: A New Look at the Scientific Evidence. NY: Oxford University Press.
8. Hoffman, David. (2002) The Complete Illustrated Guide to Holistic Herbal: A Safe and Practical Guide to Making and Using Herbal Remedies. Element Books.
9. "Marijuana: Uses, Side Effects, Interactions and Warnings - WebMD." WebMD. WebMD, n.d. Web. 31 July 2015.
10. "Marijuana Abuse Signs, Symptoms and Addiction Treatment." Marijuana Abuse Signs, Symptoms and Addiction Treatment. N.p., n.d. Web. 31 July 2015