Let’s face it – there are still a ton of questions surrounding the best practices and approaches to medical cannabis. Here I’ve compiled a few reader-submitted medical cannabis questions that I’ve gotten and am providing in-depth answers to each.
From using cannabis during recovery from surgery, to the disagreement over the safety of vaping versus smoking, to medical cannabis for symptoms of PMS, I’m giving you the ins-and-outs of cannabis as a treatment option. If you have a medical cannabis question, please send me an email: firstname.lastname@example.org.
1. I am having ACL surgery next month. As a recreational cannabis user, I wonder if I can manage my post-op pain with weed. Can you make a suggestion?
First, I am sorry to hear that you need surgery for your ACL. My guess is that you are a sports enthusiast. And, if you are using recreational cannabis, I am also guessing that you might live in Colorado and hurt your knee skiing.
Anyway, here is the story about medical cannabis and pain management. Generally speaking, cannabis is not a good way to manage acute, surgical pain. Cannabis is best for chronic pain, such as arthritis or nerve (neuropathic) pain.
Having said that, many patients achieve a balance by using a combination of non-narcotic pain medications in conjunction with cannabis to manage postoperative pain. For example, it is popular to use non steroidal anti-inflammatory medications such as Anaprox, Celebrex or Mobic to minimize inflammation at the surgical site. Tylenol can also be added to help with pain. The two together have been shown to be quite effective.
Many orthopedic surgeons will offer a short term (three to five days) prescription for a narcotic such as Hydrocodone/Tylenol (Vicodin, Norco) or Oxycodone/Tylenol (Percocet). The risk of using these as directed for a very short period of time is quite low. If you want to try to use cannabis instead of the narcotic, that would be ok, or to use the narcotic for a few days if the pain is severe, and then replace it with cannabis after that.
Considering Your Personal Cannabis Use
You did not mention how you usually use cannabis. For those who smoke or vape, taking a hit for breakthrough pain will let you find out pretty quickly if it works for you and your Endocannabinoid System. If there is not enough relief, then you would need to contact your doctor about other options.
If it does work, then you can continue to use it as needed. There is less chance of drug-drug interaction with inhaled cannabis. If your go-to is a gummy or any other form of swallowed cannabis, you need to be mindful that the cannabis is processed through the liver prior to going to work on pain. It can take up to two hours after ingestion for that to happen.
Once your bandages are off and the doctor gives you permission, you might want to use a topical cream or balm directly to the area.
2. Please help solve an argument between me and my partner. He says that vaping pot is safer than smoking it. I disagree. I think they are both equally dangerous for your lungs. Who’s right?
Let me assure you that many people have this same discussion, and it can get a little heated. In fact, I am asked this on a daily basis from patients coming in for a medical cannabis consultation.
Let’s start with vaping. About five years ago, lung disease took the U.S. by storm. It was caused by vaping. But this was nicotine vaping, not cannabis. It had to do with contaminated products, [such as] Vitamin E acetate used as a thinning agent and heavy metals in the cartridges purchased on the street.
A lot of the cases ended up being teenagers who were trying to make their e-cigarettes into cannabis vapes. The fear of lung damage related to vaping spilled over into the cannabis world. Provided you purchase your products at a dispensary with quality control and testing, this is not likely to happen.
Vaping uses cannabis oil with varying concentrations of cannabinoids and terpenes in a cartridge that is heated to a relatively low temperature compared with smoking. Most vaping is done at 250-375°F. The higher the temperature, the more likely that the terpenes and some of the cannabinoids will be burnt away. This will cause the THC effect to become more pronounced.
At these temperatures, the products are not combusted and do not release the carcinogenic by-products that are formed when cannabis is heated to higher temperatures. Vaping is efficient. There is over 50 percent bioavailability of the cannabinoids. And, best of all, vaping does not appear to be as damaging to the respiratory tract as smoking.
Long Term Effects of Vaping?
Having said all that, we still do not know the long term effects of vaping. It simply hasn’t been around for enough time for that to be evaluated.
Smoking involves combusting cannabis flower, using a flame that is well over 600°F. At that temperature, the flame burns off a lot of the elements that make cannabis a good medicine, and leaves little flavor, but a lot of high. It also produces tars and carbon monoxide, both of which are particularly unhealthy and are reasons that make cigarettes so dangerous. Smoking cannabis can definitely lead to chronic bronchitis and lung damage. However, studies have been unable to prove definitively that smoking cannabis causes lung cancer.
I like to suggest a compromise, which is vaping flower as opposed to oil. It takes getting used to, but there are nice handheld flower vaporizers which allow for custom settings. This way, the user can dial in to exactly the right temperature to maximize all elements of the plant, while avoiding all the risks of inhaling oils and/or carcinogens made by combusting their medical cannabis.
3. Hi Dr. Bone. I read that you are a gynecologist as well as a medical cannabis specialist. My question is about PMS. I have tried birth control pills and antidepressants, but I still get moody and bloated, and I just don’t want to be around anybody. A friend gave me some gummies and they helped a lot. Can you give me guidance about what products to try because I live in a state with legal recreational weed and can get them.
PMS, Premenstrual Syndrome, is a combination of physical, psychological and emotional symptoms that start about one week before the period begins and end within a day or two after the onset of bleeding. Common complaints include mood swings, bloating, sugar cravings, depression and anxiety. A severe form of PMS called PMDD for Premenstrual Dysphoric Disorder, can manifest itself as suicidal depression or anger that includes violent outbursts.
The current standard of care to manage PMS/PMDD is to use a multi-faceted approach including diet, exercise and antidepressants. Selective Serotonin Reuptake Inhibitors such as Zoloft or Prozac are FDA-approved to help with the mood and rage associated with PMS/PMDD. Many gynecologists will also add birth control pills to eliminate hormonal fluctuations that can contribute to some of the PMS/PMDD symptoms.
Rigorous aerobic exercise can be extremely helpful, but it is hard for many women to force themselves to do it when they are suffering. Avoiding excessive salt and sugar is also important, but can be challenging in the face of chocolate binging.
Where Medical Cannabis Comes In
Even with all these interventions, I have many patients who feel they are inadequately treated. This is the place for cannabis… not as a primary intervention, but as an adjuvant recommendation. Given the high degree of anxiety that most women will suffer from, I suggest using a cannabis product that is fairly high in CBD, CBC and CBG. These cannabinoids have a calming effect on the body and are helpful with cramps as well.
THC will be uplifting and help with pain/bloating. A gummy that is a ratio of 1:1 CBD:THC may be a good bet. Higher THC may have a tendency to worsen anxiety, especially in those with less experience with cannabis.
Gummies are a good approach because most women know when their period is coming and have plenty of time to wait for the cannabis to start working. Remember, a gummy may take up to two hours to be effective and can last at least eight hours in some women. Tinctures can also be used and layered with inhalation for times when immediate relief is needed. There may be a need for trial and experience to figure out exactly which ratio of product and which delivery system is best for you, but this is a good starting place.
Eventually medical cannabis may be first line treatment for PMS/PMDD, but studies need to be done to prove this, and they have been limited by the Schedule l status of cannabis.