Earlier this week, I finally managed to finish editing my book Young, Sick, and Invisible: A Skeptic’s Journey with Chronic Illness. What does this mean? It means I have successfully written a book! It means that now I have a product that is ready to start being sent out to potential publishers in the hopes that I can find someone who wants to turn this into a real book. It means that I managed to prove to myself, and other’s who said that I couldn’t, that this is a thing I can do. That this is a thing I’ve done. I can call myself a writer without question now. This on the heals of submitting my first short story for publishing earlier this year.
It might not seem like something that I would need to prove to myself, but self-doubt is something I’ve lived with for a long time. There is a voice in my head that tells me that I cannot do this, that I never finish anything, and it is a voice I recognize from my life.
I’ve done it!
Scientists confirm that marijuana, whether medical or recreational, is safer than both alcohol and tobacco. One of the considerations that went into this statement has to do with the lethal dose determinations.
When it comes to determining the danger of various drugs, there is a need to compare the lethal dose to the standard dose. How much do you need to get high, versus how much will kill you. One of the dangers of addiction with a chemical tolerance component, has to do with the fact that a higher tolerance means a higher consumption. In the case of drugs with a low ration of needed to get high to lethal dose, increased consumption can mean higher fatalities due to what people call overdose.
Whenever I bring up the topic of medical marijuana, whether openly asking people to bring up myths and questions, or discussing it with someone who knows about my own use, the first topic to come up is invariably the one of addiction. People are concerned about the addictive properties, and like anytime a patient takes treatment for pain, there are the inevitable questions about whether we are worried about becoming addicted.
I’ve addressed some aspects of addiction and addictive properties in the first MMJ 101 post. Most importantly I discussed the fact that no one pauses to consider the importance of ending pain. It is such an important point that it bears stressing again. Chronic pain has severe long term consequences, and causes long term changes to the body. Treating it is a high priority. To question whether we are sure we have to treat pain, is to underestimate its importance, and this is something that most people, unless they’ve experienced it themselves, can have a hard time comprehending. To them, it’s just pain.
To have an honest discussion of addiction, we must first understand what it is. The social perception of addiction is that it is a series of bad decisions that lead to a chemical dependency. Some views stop there and collapse addiction entirely into chemical dependency, often joking of being “addicted” to caffeine or sugar. At some point one becomes physically dependant on the chemical, creating a driving need, and ultimately the addicted person has to make another choice, this time to give up their addiction and begin the long hard road to recovery. This view often fails to distinguish between addiction and any craving or yearning for something that one enjoys, and thus regards addiction as an act of irresponsibility. There are some variations on this perception, ranging between people believing that addiction is wholly the result of some internal flaw within a person, and others believing that it is entirely the result of a chemical dependency. Neither view grasps the true nature of this phenomenon.
Among one of the concerns regarding medical marijuana are the potential barriers to the use of this medication. In places, medical marijuana is still not legal, but even in places where it is, like Canada, there are still challenges that present themselves. While my experience is limited to Canada, I find that a lot of the barriers that exist remain the same. If you have experiences you would like to share, please feel free to include them in the comments.
Knowledge – Patient’s
One of the first and biggest barriers to medical marijuana is a lack of information as to how to go about getting a prescription. It used to be that you had to fill out a large complicated set of forms to be submitted to Health Canada. The application would then be handled by some bureaucratic process at which point you would be approved or denied.
In March 2014 the rules changed. Now, instead of filling out a Health Canada form, you fill out a form directly with your choice of dispensary. The Health Canada website provides you with a list of licensed dispensaries, and most of them have their forms available online.
The forms include two parts: personal information, and doctor prescription.
The prescription form has to be filled out by a medical doctor, and includes dosage information as well as the doctor’s office information.
The forms are mailed to the dispensary, which confirms that the doctor who filled out the prescription is properly licensed, and you become a registered patient.
Knowledge – Doctor’s
While patients are uninformed, so too are doctors. When I was first looking for a prescription, I asked my GI for it. He said no. I was surprised since he actually seemed supportive of my occasional use.
Over the next few months, whenever marijuana came up with other doctors like those at the ER, they recommended that I get a prescription. I was torn, doctors seemed supportive of the idea, but yet I seemed unable to get a prescription. Finally, I decided to bring it up with my GI again and ask why he was unwilling to give me one.
It turned out that my doctor was under the impression that a condition had to be fatal in order to allow for the use of medical marijuana. Even though he thought that pot would be beneficial for me, he believed he wasn’t allowed to prescribe it for me.
Other doctors are unaware of the current available research. I had one ER doctor believe that marijuana was counter-indicated for Crohn’s even though Crohn’s is one of the few conditions that have had studies confirming the benefit of marijuana.
Patients are not the only people being fed misinformation about medical marijuana. Doctors are just as likely to have mistaken ideas about its use, its addictive properties, and so forth. The new rule changes make doctors the gatekeepers to prescriptions, but no efforts have been made to properly educate them. This leaves it up to patients to educate them or find a sympathetic doctor.
Even those patients who are more knowledgeable in the effects and use of marijuana may find it difficult to find a sympathetic doctor. It is counterintuitive to most patients to push their doctors for explanations. Since there is the fear of being labeled a drug seeker, patients might also worry about seeming over-eager about the acquisition of a prescription.
I have a lot of sorting to do.
I have an underwear drawer to sort. I have a closet to sort. I have a bathroom to sort. I have habits and patterns and assumptions and expectations to sort. I have friends and relatives to sort.
I have twenty-seven years of memories to sort.
A few days ago, I took the most public step so far in my social transition and I changed the gender line on my Facebook profile from “male” to “female.” From now on, Facebook will not misgender me: people will be prompted to post on her wall, look at what she has posted, tag her in photos. I made a life event post out of it, and the collected well-wishing of 150 people of varying levels of closeness to me was a welcome reminder that, where I go, I do not need to go alone.
I needed that. The self-actualization on which I embarked a few months ago is the single most terrifying thing I have ever done. A dozen awkward courtships, becoming an atheist, admitting my disinterest in medical school, moving 1600 kilometers away from my family, enduring being grilled by professors until they were impressed enough to turn my nascent MSc into a Ph.D. in waiting, learning the hard way that one of Mom’s six siblings is too toxic a person to have in my life any more than absolutely necessary, recognizing my autism without a formal diagnosis—none of that compares to the thrumming, thrilling existential terror before me now.
I used to be terrified of cannabis. When I was in high school, I was chosen to be our schools representative at the regional anti-drug advocacy seminar. I was terrified of drugs. I was convinced that if I ever tried even a single puff, that I would spiral into the depths of addiction and end up on the streets looking for another fix. This is what we were taught through the anti-drug commercials, the talks at school and so forth.
When I left the sheltered community I lived in for university, the reality seemed quite different than what I was taught. I saw responsible and intelligent individuals indulging from time to time without any negative consequence. The more I heard about marijuana from people how had used in the past, the more I came across studies, and the more I witnessed, I realized that what I had been taught was wrong. Marijuana wasn’t some scary devil’s weed.
Although intellectually I knew that what I had been taught was wrong, I still feared touching the stuff. It just wasn’t my thing. And that’s perfectly ok.
I remember the first time I tried it. I was 25 years old, and I had been flaring for weeks. Every trip to the bathroom ended with me in tears. I felt like I had a rusty knitting needle sticking through my colon. I hadn’t really eaten in several days, terrified of the pain it brought. My roommate at the time was a stoner. Strangely, knowing her made me a bit more afraid of marijuana rather than less. She had told me more than once that her cousin with Crohn’s used it to help her with the pain. By this point I was desperate but still worried. I was allergic to smoke! Would it really work? Was I just setting myself up for some tragic result?
So I did what I usually do when questions such as this come up, I went to the google. I browsed several scholarly sites, and what I found reassured me. A lot of studies out of the Netherlands showed a link between marijuana use and pain reduction in Crohn’s patients. There was another site that showed the arguments for and against. The argument against boiled down to “it probably works but we don’t know because we haven’t studied it enough”.
I decided to brave it.
To understand how I felt, you would have to have been through extreme pain that lasted a long time, only to suddenly have it disappear. You would have to have been hungry and unable to eat, and suddenly being able to enjoy food again. It was like having a sudden vacation in the midst of all this pain.
It was several months before I tried it again.
It is hard to explain what it is like to experience pain every single day. Energy becomes a precious resource, like water in the desert, and like water it is rare and needs to be guarded carefully.
There is a lot of misinformation surrounding medical marijuana. On the one hand you have peddlers of misinformation making it out that marijuana is the very worst of drugs, creating rumours about how stoned people commit acts of violence. On the other hand you have the people elevating it to the status of panacea.
As a user of medical marijuana who has experienced both sides of the coin (the fear and the treatment), I thought it would help demystify it by answering the most common questions I see and explaining about what my use looks like.
Why do you take it?
Cannabis works very well on a variety of symptoms. It is known for its pain control abilities, however, it can also help with nausea and relaxation. Different strains can also help with other symptoms, including anxiety, depression, and even certain types of focus problems. There a variety of different conditions that benefit from different effects.
In my case I use it to control the chronic pain and nausea associated with Crohn’s. It helps stimulate my appetite on the days when I am having a hard time eating. It helps my muscles relax which in turn reduces arthritis pain. I have had prescription painkillers and anti-emetics, but when my Crohn’s is flaring I have a hard time digesting pills. Oral medications don’t work for me. They either don’t work at all, or wear off long before I can take my next dose. A lot of pain killers also cause elevated nausea.
Marijuana on the other hand provides pain relief without involving my digestive system, without provoking nausea, and leaving me a lot more clearheaded than pain killers do.
Are you afraid of getting addicted?
A lot of stoners will immediately start talking at this point about how marijuana is not addictive. There are conflicting studies on the matter, however, what is known is that marijuana is safe. With the conflictive information, it can be difficult to know what’s what.
There are numerous studies that suggest that marijuana is not chemically addictive. So why the confusion?
The confusion comes from the matter of tolerance. Once of the markers of addiction is building a tolerance to the medication and requiring a higher dose to achieve the same effect. Consistent [read daily] use of marijuana can lead to an increased tolerance over time, which can lead to greater use. This would suggest that it is addictive.
However, if you talk to chronic users, whether medical or otherwise, they will tell you that all it takes to reset the tolerance is to skip a day here and there. In fact you can rid your system of marijuana in just four days. Withdrawal symptoms are mostly not present.
So if it is not chemically addictive, then what else is there. There is some suggestion that like many other activities that lead to feeling good, sex, video games, Facebook, it can be psychologically addictive. This means that people can begin to seek the sensation.
When all is said and done marijuana is one of the least addictive painkillers available, and one with the fewest side effects.
But is the pain really that bad? Pain is natural! You don’t look in pain.
Pain may be natural, but that doesn’t make it good. Pain and inflammation have more long term side effects than marijuana. Pain and inflammation can cause memory loss and reduced cognitive function, it can cause permanent nervous system changes. It can cause depression, change brain chemistry, supress appetite and sleep. It is a serious condition that a lot of people underestimate.
Chronic pain is not like the pain you get from a paper cut, or even a broken leg. It drains your energy your motivation.
When you live with chronic pain, you learn how not to show it. Pain becomes our reality so we have to learn to live our lives around it. I’ve laughed and danced around while my insides felt they were tearing. It costs me something to pretend not to be in pain, but the alternative is to never be able to have fun or too often make other people uncomfortable.
Earlier this year I had my wisdom teeth removed. Before the operation I was hooked up to a machine that measured my heart rate, blood pressure, and oxygen saturation. I was talking happily with the nurses, and periodically, my heart rate would jump up for some time. He nurses kept trying to figure out what was going on, until finally one of them thought to ask me if I was having any pain and I admitted I was. They had been unable to tell if not for the heart monitor. If trained professionals cannot tell when I am in pain, what hope do you have?
Ok, so why doesn’t everyone do pot?
Pot is not a panacea. While it is very good for a variety of conditions, pot is also counter-indicated for others, and not everyone reacts the same way. For example some people have had great luck with pot for migraine, while others find that marijuana makes their migraines worse.
While some people find it useful to help control anxiety, others find that the paranoia exacerbates it.
Even in my own use, I have learned that it doesn’t work for all types of pain. It is great when dealing with the pain from my Crohn’s and arthritis, but I have found that it doesn’t work at all for pancreatitis and tooth related pain.
Some people have adverse reactions to marijuana.
How does it work?
There are two active ingredients in cannabis: THC and CBD. Both of these have medical applications and both are useful for pain.
THC is most often used for the treatment of pain, nausea, and aids in relaxation. It is also the ingredient that is associated with the psychoactive side effects some people experience. A high THC strain is recommended for chemotherapy patients and other pain and nausea conditions.
CBD has anti-psychotic properties that act as a sort of antidote to THCs psychoactive effects. High CBD strains are recommended for convulsive disorders including seizures, and can be better for anxiety.
What do you mean by strains?
There are a variety of different genetic lines that lead to slightly different products that in turn yield different effects.
There are three major species: Sativas, Indicas, and Hybrids.
When it comes to the specific science of these three strains, I am not an expert. Some ideas are common knowledge however. Sativas tend to be associated with a more energetic high. Indicas provide a more mellow, sleepy high, and is commonly associated with couch lock. Hybrids combine elements of both. There are also some discussions of a head high versus a body high.
I know that I prefer sativas for days when I need to get work done at home, and indicas when I need to sleep. However, mostly I do a mix of both types, including hybrids to get the desired effects.
Among the species there are different product yields (strains) as well. The best analogy I can think of would be roses. The species might be the difference between creeping vines of roses versus bushes, while the strains would be the different colours that can be produced.
Strains often have interesting names. For example the strains that have been offered by my dispensary include Blue Dream, Afghani Bullrider, White Widow, Pink Kush, Girl Scout Cookies, etc. Each of these produces a slightly different effect and works on different symptoms.
How do I know which strains will work for me?
A little bit of experimentation is needed to know what works best for you, however, there are resources out there that can give you a guide to what the different properties of different strains are. My favourite resource is called Leafly. It lists the strain information, the effects, the medical information, as well the negative side effects like dry mouth, headaches, etc.
The site also includes blog information which includes more 101 information.
Some people, myself among them, find it useful to mix strains to achieve the desired effect.