Telemedicine, online ordering, and home delivery — all developments sparked by the COVID-19 pandemic — have sped up the process and encouraged more individuals than ever to consider if cannabis is a good health option for them.
When patients new to the program visit state-approved mail order marijuana merchants, known as dispensaries in Pennsylvania, they are confronted with a baffling selection of cannabis items.
“You received whatever your dealer had back in the day, and it was always “this is very excellent s—,” said one West Chester patient who began taking cannabis to cure his melancholy in the 1970s. “There are now dozens, if not hundreds, of items and kinds to choose from.”
So, how can a rookie figure out which product is best for them, let alone how much of it they need?
Pennsylvania residents can get a doctor’s recommendation for marijuana if they have one of 23 “serious qualifying conditions,” according to state law. Chronic pain, anxiety, terminal sickness, and post-traumatic stress disorder are among the illnesses.
The elderly are among the most active participants in the program, taking marijuana to treat chronic pain, anxiety, glaucoma, cancer, and other grave conditions.
They require direction. Many others are utterly unaware of the substance, having missed out on the 1960s and 1970s cannabis counterculture.
“I meet a lot of senior patients who don’t know where to start,” said physician Sue Sisley, an Arizona-based cannabis researcher who consults as a medical director for several Pennsylvania medical marijuana companies, including Whole Plants and Penn Health Group.
“Reliable information is sometimes more difficult to come by than the treatment itself,” Sisley explained. “This is because the federal government has stymied clinical research that would help us figure out which strains, products, and dosages are most effective for which diseases.”
However, she points out that Canada and Israel are collaborating with others in the United States to put the foundations in place.
“Patients must embark on their own personal journey,” she explained. “Because everyone’s body chemistry is different, it’s critical for patients to try several things until they discover the proper fit.” “There is no such thing as a cookie-cutter algorithm.”
Medical marijuana has a lot of value, according to Glenn Rosen of Parkside Family Medicine in Germantown, but he avoids providing it to patients with serious psychological disorders such extreme bipolar disorder or schizophrenia “because you could potentially provoke a psychotic episode.” I also don’t think you’d want someone with severe mania to be a part of the program.”
Rosen will not recommend marijuana to young patients who are depressed for the first time. He also looks for signs of drug abuse.
“If anything, you’re attempting to wean people off of specific prescriptions.” If someone is taking a benzo[diazepine] or an opioid, your goal is to get them into the program and off those drugs so they can start taking something safer.”
He’s also wary of prescribing marijuana to kids because of the risk of negative effects on the growing brain. “No one can speak to the long-term effects on any professional level, but the same can be said for Adderall or Ritalin.”
So, according to Sisley and other cannabis health experts, start slowly and try kinds of cannabis with low levels of the intoxicating component THC.
“You don’t need a high-potency product,” Ryan Goodchild, director of education at TerraVida Holistic Centers, a marijuana dispensary company with locations in Sellersville, Malvern, and Abington, said.
Patients and consumers with years of cannabis experience prefer more sophisticated goods.
Choosing a cannabis strain with the highest THC content is equivalent to downing pure 151 proof rum. You’ll feel it, but it won’t always be pleasant.
“People who think THC is the be-all and end-all of good marijuana irritate my team,” he remarked. “It isn’t. It’s a little more complex than that.”
Another myth that cannabis experts would want to debunk for both newbies and seasoned users is the supposed effects of “indica” and “sativa” kinds.
According to Andrew Atterbury, chief pharmacist at Ethos Medical Marijuana Dispensaries in Philadelphia and Montgomeryville, “the rule of thumb used to be that indica was more soothing and sativa was more stimulating.”
“The rhyme was that indica put you ‘in da couch,'” said Atterbury. “However, there has been so much crossbreeding that those descriptions are largely obsolete. They essentially define the morphology or shape of the plant. It may be more beneficial to move outside of those groups.”
The appropriate ratio of THC to CBD is the first thing patients need to figure out. Another chemical discovered in marijuana is CBD, often known as cannabidiol.
THC is known to suppress pain perception, whereas CBD is thought to lower inflammation and anxiety, according to Goodchild.
Some strains are supercharged with high levels of THC and low levels of CBD. Others provide a more evenly distributed one-to-one ratio.
“Strain names can be worthless,” said Sisley, the Scottsdale Research Institute’s principal scientist.
“For example, because genetics vary, a strain called Blue Dream plucked from ten different retail outlets can be dramatically different,” she explained. “That’s why you should stick to the material’s biochemical profile,” the label says.
The amounts of THC, CBD, and other significant chemical components must be labeled on every marijuana product sold in Pennsylvania and New Jersey.
Patients might seek assistance from a dispensary pharmacist or a salesman known as a “budtender.”
Still, searching for the optimal strain could be fruitless.
“The ‘best strain’ can be the only one available at your local dispensary,” Ethos’ Atterbury explained. “Things are gradually improving, but supply and demand remain a problem. As a result, what we sell the most is what we have on hand.”
Through a phenomenon known as “the entourage effect,” terpenes, the hundreds of chemicals that give cannabis its distinct rainbow of odors, might improve efficacy.
Limonine, a terpene with a lemony aroma, is said to be “energizing.” Myrcene contributes to a more soothing “couch-lock” feeling by producing a skunky or diesel stench.
Patients should keep a journal to determine the best beneficial product for them, according to TerraVida’s Goodchild.
“Because several of the strains have a big effect on [disturbing] short-term memory, it’s vital to record how soon they work and how long they last,” he added. “Keep track of how the strain affects you throughout the day and how it impacts your mood.”
Most importantly, take it slowly at first. Patients can pick from inhalable materials (typically flowers), an under-the-tongue oil, a tablet, or a salve. Purchase — and test — little quantities at first.
“Just because you rolled a joint doesn’t mean you have to finish it in one sitting,” she explained. “Start with one or two inhalations to get the hang of it. If you have to drive, wait three hours or more before getting behind the wheel.”
Concentrates should only be used by patients who have a lot of cannabis expertise, according to Sisley, because they are quite strong.
Sisley recommends calling a poison control center if a patient consumes too much and becomes insane or paranoid.
“They’re used to receiving calls and can help you through a bad situation,” Sisley explained. “The paranoia generally goes away after 30 minutes.
“All they can do is offer supportive care if you go to the ER,” she continued. “You’ll only waste your time and end up with a hefty payment a month later.”