Pro. Carraso
Many mistakenly assume that medical cannabis treatment is “One size fits all”, when in reality, experts in the field know that there are countless factors to consider when matching each patient with the right strain based on the specific condition and symptoms in question. It is, in fact, one of the biggest dilemmas in the field.
Unlike regular pharmacological medication, which enables us to know its exact influence, effective dosage, expected side-effects, and more, medical cannabis is far more complex. There are many personal factors that vary from one patient to the next and which are related to their medical, cognitive and functional condition.
Therefore, the chosen treatment for a patient in nursing care, for instance, will be different than that of fully functioning patient; a clear-minded patient will be treated differently than a patient suffering from dementia; a patient enduring pain will receive treatment different than that of an epileptic patient; a person diagnosed with a lung disease or Parkinson’s will not be treated the same as someone suffering from Crohn’s or colitis, or PTSD, and more.
Another important decision to make has to do with the cannabis’ consumption format. There are different ways to consume medical cannabis, which include smoking, vaporizing and taking oil. Each format has its own advantages and disadvantages and sometimes we need to combine different formats, such as smoking and oil consumption, in order to reach optimal use.
In addition, we must take into account the different strains if cannabis in terms of their genetic source, with the most prominent ones being sativa and indica. The sativa is energizing, appetizing, improves our mood, decreases depression, enhances creativity and more suitable for daytime consumption. Indica, on the other hand, is tiring, soothing, relaxes the muscles, decreases pain and is more suitable for nighttime consumption.
As we create the personalized dosage for patients, it is also crucial that we consider the cannabinoids in each strain: THC and CBD. THC affects the patient’s spirit, create a sense of euphoria, relaxes the muscles, reduces shivering, relives pain, enhances the appetite, decreases nausea, expands the bronchial tubes and is considered anti-inflammatory. On the other hand, THC may also harm the cognitive performance and damage the coordination (which might be dangerous while driving, for instance). CBD has almost no psychoactive influence, it soothes patients, relieves pain, is neuroprotective, anti-inflammatory, reduces anxiety, influences the blood sugar levels, and more. There is a symbiotic relationship between THC and CBD as they balance once another.
When matching the right strain, we should also keep in mind the existence of the entourage effect, which is the overall influence of all cannabinoids and ingredients in each strain and genetic source. Only then, will we be able to truly understand the complexity of locating the optimal, personalized match.
Countless factors participate in the process. We must protect the clarity, daily function and coordination of active patients using one substance during daytime and improve their relaxation and sleep abilities using another at night. For a patients in nursing care who is restless, suffers from dementia and spends their days in bed we will match one type of treatment; a religious patient who doesn’t light fire on Shabbat will receive medical cannabis oil during weekends, even if treatment via smoking proves efficient; we must consider the influence of each format of medical cannabis and remember that smoking influences patients within a few minutes and subsides after an hour or two, whereas medical cannabis oil begins to influence much later (thirty minutes to an hour) and lasts longer.
As we can see, finding the ideal medical cannabis match for each patient, including the strain, dosage, format and THC/CBD ratio, is a combination of science and art which is based on the principal of starting and advancing slowly and gradually, while monitoring the patient and side effects and providing a detailed explanation regarding the expectations for change. We must remind patients that in most cases they will not experience overnight transformation and that patience is required to reach maximum impact.
