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Except as provided in this policy, Americans for Safe Access will not share any of your personal information at any time with any organization. However, as ASA is the largest patient focused nonprofit in the the United States, we may contact you on behalf of another organization doing work related to ours. Examples of these other organizations include organizations such as the U.S. Pain Foundation, the Epilepsy Foundation, various cannabis based veteran service organizations and others. This list is not meant to be exhaustive but when ASA contacts you on behalf of these organizations, the communications will be prepared by ASA staff.
ASA occasionally allows other organizations to send mail to individuals on its lists. In these cases, lists containing only names and addresses (no contribution data or other personal information) are delivered to a third-party mailing house for one-time use for that organization’s mailing. To request that we never allow your contact information to be used even in this secure manner, please contact firstname.lastname@example.org. If possible, please include your full name, postal address, phone number, and the email address at which you receive messages from ASA.
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If you are a resident of the European Union, the General Data Protection Regulation (“GDPR”) will come into force on May 25, 2018. While we take significant measures to protect privacy of your information, we are working toward ensuring that we are compliant with the GDPR rules by the time they become effective.
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You have the following rights regarding your information:
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Excerpted from the AMA’s current opinions on the physician’s code of ethics - http://www.ama-assn.org
The Principles of Medical ethics of the AMA article III states “A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.”
The following are other portions of the Physician’s code of ethics which relate to medical marijuana:
Section 1.02 – ‘The Relation of Law and Ethics’: “Ethical values and legal principles are usually closely related, but ethical obligations typically exceed legal duties. In some cases, the law mandates unethical conduct. In general, when physicians believe a law is unjust, they should work to change the law. In exceptional circumstances of unjust laws, ethical responsibilities should supersede legal obligations.”
Section 2.17 – ‘Quality of Life’: “In the making of decisions for the treatment of… persons who are severely disabled by injury or illness, the primary consideration should be what is best for the individual patient and not the avoidance of a burden to the family or to society. Quality of life, as defined by the patient’s interests and values, is a factor to be considered in determining what is best for the individual. It is permissible to consider quality of life when deciding about life-sustaining treatment.”
Section 2.24 – ‘Impaired Drivers and Their Physicians’: “A tactful but candid discussion with the patient and family about the risks of driving is of primary importance.”
Section 5.05 – ‘Confidentiality’: “The information disclosed to a physician during the course of the relationship between physician and patient is confidential to the greatest possible degree.”
Section 5.06 – ‘Confidentiality: Attorney-Physician Relation’: “The patient’s history, diagnosis, treatment, and prognosis may be discussed with the patient’s lawyer with the consent of the patient or the patient’s lawful representative.”
Section 8.06 – ‘Prescribing and Dispensing Drugs and Devices’: “(1) Physicians should prescribe drugs, devices, and other treatments based solely upon medical considerations and patient need and reasonable expectations of the effectiveness of the drug, device or other treatment for the particular patient… (6) Patients have an ethically and legally recognized right to prompt access to the information contained in their individual medical records. Since a prescription is part of the patient’s medical record, the patient is entitled to a copy of the physician’s prescription for drugs or devices, including eyeglasses and contact lenses. Therefore, physicians should not discourage patients from requesting a written copy of a prescription.”
Section 8.20 – ‘Invalid medical treatment’: “(3) Among the treatments that are scientifically valid, medically indicated, and offer a reasonable chance of benefit for patients, some are regulated or prohibited by law; physicians should comply with these laws. If physicians disagree with such laws, they should seek to change them.”
Section 9.012 – ‘Physicians’ Political Communications with Patients and Their Families’: “In addition, physicians have a responsibility to work for the reform of, and to press for the proper administration of, laws that are related to health care. Physicians should keep themselves well-informed as to current political questions regarding needed and proposed changes to laws concerning such issues as access to health care, quality of health care services, scope of medical research, and promotion of public health.”
In Conant v. Walters (2004), the Supreme Court ruled that doctors may legally recommend cannabis to their patients. Doctors do not need to be in a state with medical cannabis laws to do so. However, each state with medical cannabis laws requires different mechanisms to put recommendations in writing so that the patient may legally access cannabis. Doctors cannot prescribe cannabis or help patients obtain the cannabis itself.
Click your state in the map below for legal information and forms for recommending cannabis.
The following recipes come from the Vancouver Island Compassion Society (thevics.com). Please note that not all state medical cannabis laws allow for cannabis concentrates. Where they do not, manufacture or possession of these substances usually carries serious penalties. Be sure to check the legal guidelines for your state.
Recipe and Instructions on How to Convert THCA Into THC
A tincture is an alcohol-based solution of a non-volatile medicine (in this case cannabis). In a cannabis tincture, alcohol is not only the solvent used to separate cannabinoids from the plant matter, it is what makes this type of application (particularly in fine-mist form) more bio-available and therefore effective.
In whole-plant cannabis, THC content is expressed as THCA (tetrahydrocannabolic acid) prior to decarboxilation into THC, which takes place when cannabis is heated during cooking, smoking or vaporized ingestion. THCA is a mild analgesic and anti-inflammatory but in order to make a THC-rich tincture that has many of the same therapeutic effects as smoked ingestion (including rapid absorption, quick relief and ease of self-titration), we must convert the THCA in the plant matter into THC prior to extracting it through an alcohol soak.
- Converted cannabis
- Alcohol (50% is preferred, but 40% vodka works just fine)
- Organic mint
- Organic honey
- Large mason jar, x 2
- Cheesecloth or fine mesh sieve
Dry heat conversion of THCA into THC
- Preheat oven to exactly 325°F (160°C). Use an oven thermometer to be sure.
- Spread leaf or bud in a 1 inch (2.5 cm) layer on a clean cookie sheet.
- Put in the oven until the first hint of smoke or 5 minutes, whichever is first; remove and transfer to a glass or ceramic container to cool.
- Pack a mason jar loosely but completely with converted cannabis product.
- Add alcohol until the jar is full.
- Seal, shake and put in a dark, cool place.
- After week one, strain mixture through cheesecloth or fine mesh sieve and add to another mason jar packed with converted cannabis and a few sprigs of fresh organic mint.
- After week two, strain through cheesecloth or fine mesh into mason jar.
- Add organic honey to taste.
- Shake/mix and then decant into bottles fitted with fine mist spray tops.
Initial Dosage: Spray two times on the inside of the cheek, and wait 30 seconds before swallowing. Wait ten minutes. If desired effect has not been reached, repeat on the opposite cheek. Wait ten minutes.Repeat until desired effect is achieved. Dosage will vary between users, but should remain fairly constant once established.
Effect will last for between 1-2 hours. Repeat use as needed. If you feel dizzy or disoriented, immediately discontinue use. Do not operate heavy machinery or drive during use of this product.
The VICS Cannabis Oil Recipe
Makes about 2 Liters of oil.
- 200 to 250 grams good quality organic cannabis shake (trim)
- Slow cooker
- Cheese cloth
- Silkscreen, min. 200+ thread count per inch
- 3 Liters Extra Virgin Olive Oil
- Colander or strainer
- Put cannabis into slow cooker
- Add olive oil until it just covers the cannabis.
- Turn slow cooker to High for 2 hours, and then turn down to Low for an additional 4 to 6 hours, stirring occasionally.
- To make a stronger product, add fresh cannabis to the previously heated oil left in the slow cooker and top up oil to cover the cannabis; keep cooking on low heat overnight or up to two days.
- Strain oil, as warm as possible, through cheese cloth, then strain through silkscreen. The oil is ready to use as is. It will keep for up to 3 months.
- Cannabis oil can be quite potent and have a very narcotic effect. It is recommended that you do not drive or perform difficult tasks after consumption.
The VICS Salve Recipe
This recipe yields roughly 525 ml of topical salve; vary ingredients proportionately for a smaller or larger batch.
- 400 ml Cannaoil (converted cannabis and olive oil - see our Cannaoil recipe)
- 40 grams shaved beeswax
- 45 drops lavender oil
- 30 drops mint oil
- 1/2 tsp. of honey
- Combine Cannaoil and beeswax in a small crockpot, or a small double boiler; put on low heat, no higher than 150oF (65oC).
- Stir constantly until all the beeswax is melted.
- Add lavender and mint oil to the Cannaoil/beeswax. Stir to blend oils. Allow to sit for a few minutes.
- Keeping the crockpot, or double boiler, on very low heat, pour the salve into container(s); stir the mix prior to pouring in order to maintain consistency.
- Let salve cool completely before putting lid(s) on.
- Benefits: Fast skin absorption with minimal residual effect. Eases dry skin conditions. Provides mild pain relief for muscular and/or joint pain.
The VICS Cannabutter Recipe
- Good quality organic cannabis (14 grams of bud or 76 grams of shake (trim) per 454 grams (1 lb.) of butter)
- 6 to 8 Litre (1.5 gallon) capacity boiling pot
- Fine mesh strainer, or colander, or large coffee filter, or nylon stockings
- Large refrigerator-safe pot
- Fill a 6 to 8 litre pot with cold water and bring to boil.
- Add butter and cannabis.
- Lower heat and simmer for 2 to 3 hours, stirring occasionally (add water if necessary).
- Strain out liquid into refrigerator-safe bowl using fine strainer, large coffee filter or nylon stocking. Squeeze butter out of remaining leaf (wear gloves, the leaf is hot!).
- Discard strained leaf.
- Let liquid cool, and then put into refrigerator overnight. Butter will separate from water and form a hard crust on surface of liquid.
- Lift out butter crust and put into large mixing bowl. Cream and fold butter using a large metal or wooden spoon. Discard remaining liquid.
Butter is ready to use as is. It will keep in freezer up to 3 months. When baking with cannabutter, select recipes such as cookies with short, low-heat cooking instructions (below 163 degrees C or 325 degrees F) At higher temperatures, the cannabinoids in the butter will break down and be lost while cooking.
Products baked with cannabutter take effect within 30 to 90 minutes from initial ingestion and can last for several hours. For maximum effect, ingest on an empty stomach. Cannabutter can be quite potent and have a strong narcotic effect. It is recommended that you not drive or perform difficult tasks after ingesting.
First-time cannabis growers should start with a soil-based system rather than other more complicated methods such as hydroponics. Your first harvest will help you get the feel for the growth and life cycle of cannabis. This will help you build confidence that things are going well for your next harvest.
Soil is the easiest medium to grow from for a number of reasons. First, micronutrients, which are critical to proper growth and vigor of the plan, exist in gardening or potting soil naturally. Good quality soil is inexpensively available at any gardening store and not suspicious to neighbors who may wonder what all the equipment is for otherwise.
Make sure that the soil is not too dense. Use perlite, a natural volcanic glass, to lighten and loosen the soil. This provides necessary space in the medium for air. Air is an important factor in cultivating any type of plant. Do not use soil from your yard as it may have pH imbalances, lack nutrients, or contain insects or mold spores that could harm your plants.
If growing indoors, use a high-intensity discharge (HID) light, either a high-pressure sodium (HPS) or a Metal Halide (MH) bulb. Both work well, but HPS systems are the best for flowering.
While fluorescent grow bulbs work for the vegetative growth of the plant, they lack the proper light spectrum and intensity to produce dense buds. Never use regular incandescent bulbs —they will not provide the correct spectrum of light for the plants and are expensive to run. Specialty incandescent “grow bulbs” don't have the intensity needed to grow dense buds, but they will definitely keep the plants alive. New LED bulb technology draws far less power and generates much less heat than HIDs, with better light spectrum output than fluorescents, though yield may not be quite as good as with an HID.
Cannabis flowers form naturally outdoors in the fall, as the nights grow longer. Indoors, we can force cannabis to flower when we want by creating a growing space where the light cycle can be controlled. At least 12 hours of uninterrupted darkness is necessary to force cannabis to flower. This period, known as the flowering period, lasts approximately 6-10 weeks, depending on the strain of cannabis.
The vegetative period, which precedes the flowering period, is usually done under 24 hours of continuous light. If starting with clones, that is rooted cuttings from a mature plant, this period usually lasts from five days to a month depending on strain, vigor, and the desired plant size. If starting from seed (not recommended), the vegetative period will be longer to allow the plant to mature.
Seeds will produce both male and female plants. Males should be culled before they can pollinate the female plants. You can determine the sex of the plant as it begins the flowering cycle.
Cannabis plants will usually increase in size 50% during the flowering period, so plan for that in relation to the height and width of your garden.
There are three main nutrients that plants need to flourish: Nitrogen (N), Phosphorus (P) and Potassium (K). Plant food labels show their N-P-K content as relative percentages. That means a high-nitrogen food good for vegetative growth would be listed as 20-10-10 or 20% nitrogen, 10% phosphorus, and 10% potassium.
When forcing the plants from vegetative to flowering growth (i.e. changing the light cycle from 24 hours of continuous light to 12 hours of light and 12 hours of uninterrupted darkness), the nutrient ratio must change as well. Plants use P and K to make flowers or “buds.” During the flowering stage, feed your plants a plant food high in P and K. Something like 1-10-12 would be appropriate, but some nitrogen is necessary. Don't get hung up on the actual numbers. It is the ratio that is actually important. Follow the instructions on the label and be careful not to overfeed!
Water your plants once the top two inches of soil are dry. Overwatering is a common cause of death for cannabis. Overwatered plants droop and may look like they need water. What the plants are actually lacking is air, because the roots are drowning. One simple way to check for the proper time to water is with a wand-type water meter, another is to lift the pot after watering. Feel its weight, or put it on a scale and make a note. Next time you think the plant needs water, lift the pot and see how heavy it is. If it is light, then water it. If it feels heavy, then don't. Young plants will use less water. As the plant grows and the root ball fills the container, it will use more water.
pH is a measure of the acidity or alkalinity of the planting mix and water. The right pH is critical to the plant's ability to absorb nutrients. In general cannabis likes the root zone to be acidic; around 5.8-6.5 is the ideal range for soil, and no lower than 5.5. The only way to know and adjust the pH of your plants' environment is with pH test strips or a pH test kit that you can use to check the plants' runoff. The pH of your tap water may change from season to season, so it's best to check it frequently.
If you are maintaining proper pH and providing appropriate nutrients and your plants are still not thriving, or are turning yellow or appear to be burning at the edges of the leaf, you should consult a more exhaustive source of information about how to go about solving these problems.
Air and temperature
Cannabis needs circulating air rich in carbon dioxide or CO2. Fresh air from the outside can be used if you are ventilating an indoor garden with fans. Cannabis plants can consume far more CO2 than is in the atmosphere naturally, so for maximum yield some method of CO2 enrichment is frequently used. The easiest is using a regulator attached to a CO2 tank, which can be found at beverage supply stores. Without enrichment or fresh air, plants will consume all the CO2 in the environment and replace it with oxygen, leaving them without the carbon dioxide needed to grow well.
Whether enriched or not, air circulation also helps manage temperature and create stronger plants. HID lights in particular generate a lot of heat, and temperatures above 95 degrees will inhibit growth. Keep the cultivation area temperature between 80 and 85 degrees, using an air conditioner or fans with outside air to cool the space. Too cold is bad as well, especially in the root zone. Below 60 degrees, the plant will be unable to photosynthesize and stops growing.
If you're using fans to bring in outside air and exhausting air from the garden, you may want to use carbon filters or other odor-scrubbing devices on the exhaust. Cannabis emits powerful, distinctive aromas, particularly during flowering, that can attract unwanted attention.
If you keep the basic needs of the plant in mind, cannabis will reward you enormously. For information on managing pests or creating sophisticated hydroponic systems, consult one of the books by experts such as Ed Rosenthal or Jorge Cervantes. Suggested reading for detailed information on cannabis cultivation:
- Marijuana Growers Handbook: Official Course Book of Oaksterdam University by Ed Rosenthal
- Marijuana Garden Saver by Ed Rosenthal and JC Stitch
- Indoor Horticulture by Jorge Cervantes
Cannabis and the psychoactive cannabinoid, THC, both have an excellent safety profile. The Drug Awareness Warning Network Annual Report, published by the Substance Abuse and Mental Health Services Administration (SAMHSA), contains a statistical compilation of all drug deaths which occur in the United States. According to this report, there has never been a death recorded from the use of cannabis. Pharmacology expert and author Dr. Iverson explains the enormous doses that have been tested:
Laboratory animals (rats, mice, dogs and monkeys) can tolerate doses of up to 1000mg/kg. This would be equivalent to a 70-kg person swallowing 70g of the drug-about 5,000 times more than is required to produce a high. Despite widespread illicit use of cannabis, there are very few if any instances of people dying from an overdose.
DEA Chief Administrative Law Judge, Francis Young, in response to a petition to reschedule cannabis under federal law concluded in 1988 that, “In strict medical terms marijuana is far safer than many foods we commonly consume.... Marijuana in its natural form is one of the safest therapeutically active substances known to man. By any measure of rational analysis marijuana can be safely used within the supervised routine of medical care.”
More than a decade later, Institute of Medicine investigators considered the physiological risks of using cannabis and concluded that “Marijuana is not a completely benign substance. It is a powerful drug with a variety of effects. However, except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other medications.”
Since the IOM report, research on the long-term effects of smoking cannabis that studied thousands of users over decades has shown that smoking moderate amounts of cannabis (equivalent to a joint a day) has no negative effects on lung function, even in those who have consumed more than 10,000 joints.
Toxicity, Risk of Overdose
Cannabis has an extraordinarily high estimated lethal dose, equivalent to smoking approximately 1,500 pounds in 15 minutes, a physical impossibility. Scientists have had to estimate the LD50, or Lethal Dose for 50% of the human population, because it has never been demonstrated. This puts cannabis in a class of its own, since even relatively safe medications such as aspirin have a lethal dose. Dr. Grinspoon had this to say in a 1995 article in the Journal of the American Medical Association:
One of marihuana's greatest advantages as a medicine is its remarkable safety. It has little effect on major physiological functions. There is no known case of a lethal overdose; on the basis of animal models, the ratio of lethal to effective dose is estimated as 40,000 to 1. By comparison, the ratio is between 3 and 50 to 1 for secobarbital and between 4 and 10 to 1 for ethanol. Marihuana is also far less addictive and far less subject to abuse than many drugs now used as muscle relaxants, hypnotics, and analgesics. The chief legitimate concern is the effect of smoking on the lungs. Cannabis smoke carries even more tars and other particulate matter than tobacco smoke. But the amount smoked is much less, especially in medical use, and once marihuana is an openly recognized medicine, solutions may be found; ultimately a technology for the inhalation of cannabinoid vapors could be developed.
That technology Dr. Grinspoon envisioned is now readily available in the form of vaporizing devices, manufactured by many companies. And, as mentioned previously, recent research on the rate of lung cancer and pulmonary diseases among even heavy cannabis smokers has revealed that they have no greater risk of lung cancer, obstructive pulmonary disease, or other adverse effects on pulmonary function than those who smoke nothing at all.
However, cannabis should not be considered a harmless substance. Cannabis has a number of physiological effects, such as rapid heart rate and dilation of the blood vessels, that in limited cases could be hazardous, particularly for those with pre-existing cardiac conditions. These adverse effects are within the range tolerated for most FDA-approved medications, and tend to dissipate with continued use.
As Dr. Grinspoon observes, “The greatest danger in medical use of marihuana is its illegality, which imposes much anxiety and expense on suffering people, forces them to bargain with illicit drug dealers, and exposes them to the threat of criminal prosecution.”
The Acute Effects of Cannabis
The acute, or short-term, effects of cannabis may begin when the drug is first taken, if it is inhaled, or within an hour or more if ingested as an edible. Effects can last between one and three hours, longer if taken as edibles. Individual response varies, depending upon both the individual, the situation in which it is taken, and whether cannabis is ingested or inhaled. Short-term effects from using herbal cannabis may include: coughing or wheezing if cannabis is inhaled, euphoria, dry mouth, reddening of the eyes, increased appetite, blurred vision, dizziness, headache, delayed motor reactions, sedation, and anxiety. Many of the psychoactive effects will decrease with prolonged use. In most cases, side effects are mild, well tolerated, and can be controlled with careful titration or dose management.
In rare cases, usually as a result of consuming large doses of cannabis in food or drink, individuals may experience acute complications such as anxiety attacks, temporary psychosis, or convulsions. Referred to in medical literature as marijuana psychosis, it can be severe enough to compel admission to an emergency hospital.
Effects of Prolonged Use of Cannabis
Cannabis is a psychoactive drug, and legitimate concerns have been raised about the effects of prolonged use. Although cannabis remains a prohibited substance, tightly controlled even for medical research purposes, the FDA has approved synthetic derivatives of cannabis' psychoactive cannabinoid, THC, and classified them as Schedule III drugs with less likelihood of creating dependency than many other medications.
In considering the consequences of cannabis use, the Institute of Medicine concluded in 1999 that these concerns fall into two categories: the effects of chronic smoking of cannabis and the effects of THC.
Side Effects of Cannabis
Based on thousands of years of use, anecdotal reports, and extensive research, we know that cannabis is one of the safest medicines: it is impossible to consume enough to produce a fatal toxic effect in the body. However, if you are unfamiliar with its use, you should familiarize yourself with the side effects prior to use so that you can use it effectively.
Cannabis usually has a soothing and comforting effect on the mind, and many use it to manage anxiety. Sometimes, however, people can experience feelings of anxiety while using cannabis. If this happens to you, there are several things you can do. Try to stay in environments where you feel naturally comfortable. If you feel anxious, sit or lie down, breathe deeply, and relax. If you have loved ones with you, hold each other for a while. If you have a pet, hold or stroke it. Eating food will often quickly reduce the feeling of anxiety. Next time you use it, try reducing your dosage. Because of the social stigma related to getting high, you may have feelings of guilt. Understand that “high” or intoxicated feelings related to cannabis consumption are a side effect of using cannabis, much like the side effects of many other pharmaceutical drugs. Know that you have a right to your medicine.
Hunger and Thirst
Many patients use cannabis to stimulate appetite. If you are not using cannabis for this purpose, try to drink water or all-natural juices to avoid unnecessary weight gain. If you wish to eat, choose healthy and nourishing food rather than sweets.
Redness in the Eyes
Red eyes are a normal side effect related to cannabis use. It will not hurt you. If you feel insecure, or if you must go out in public and are concerned about others' reaction to the redness, try using eye drops like Visine or wearing sunglasses.
If cannabis makes you sleepy, try scheduling your medicating around situations that require you to be alert. Taking a nap or relaxing may help you regain energy. As with all medicines that can produce drowsiness, don't drive or operate heavy machinery until you know how cannabis affects you.
If you find that you can't sleep for a while after using cannabis, try reducing your dosage or avoid medicating right before bed. If you need to medicate before going to bed, give yourself two hours or so before you normally sleep.
Short-term Memory Loss
Sometimes people have a hard time with recalling short term memories when using cannabis. Some people may find it difficult to carry on a complicated conversation, keep track of details, or perform complex tasks. If this happens to you, schedule complicated tasks and give yourself some leeway when medicating before-hand. These effects are limited to actively using cannabis.
Feelings of Euphoria
When you start medicating with cannabis, you may find that events or situations that wouldn't normally seem funny become quite amusing. This is a side effect most people enjoy, however if you must deal with situations where humor would be inappropriate, avoid medicating immediately before.
Hazards of Smoking Cannabis
Because cannabis smoke shares many of the same dangerous compounds found in tobacco smoke, concerns have been raised that smoking cannabis can lead to the same increased risk of lung cancer and other chronic respiratory diseases found in tobacco smokers. However, the research done to date indicates that the long term health consequences of cannabis smoking are considerably less serious, if not negligible.
Population studies have found mild lung function changes in heavy cannabis smokers and long-term heavy use may generate symptoms of bronchitis, including wheezing, production of phlegm and chronic cough. More study is required to determine any causal relationship between smoked cannabis and the development of respiratory infections, but anyone needing large or frequent doses may benefit from choosing alternative delivery methods, especially if they smoke tobacco.
While many have historically maintained that heavy cannabis smokers are at higher risk of contracting cancer, new research casts doubt on these claims. Studies at the cellular and molecular level have suggested that chemicals in smoked cannabis may cause cancer; however, new evidence indicates that cannabinoids themselves may decrease the cancer-causing effect of the carcinogens typically inhaled from smoking cannabis, preventing cancers from developing. That prophylactic effect makes cannabis smoke inherently less dangerous than tobacco smoke, even though they contain some similar chemicals.
In 2006, the results of a five year, case-controlled investigation—the largest study of its kind—unexpectedly found that smoking cannabis, even regularly and heavily, does not lead to lung cancer or other types of head, neck or throat cancers. Lead investigator Dr. Donald Tashkin, chief of pulmonary medicine at UCLA medical school, speculated on the basis of other research that cannabis may contain key components that regulate aging cells and keep them from becoming cancerous. Dr. Tashkin's findings reaffirm the results of prior case-control studies dismissing a causal link between cannabis use and certain types of lung and upper aerodigestive tract (UAT) cancers. Other studies have found significant differences between the health effects of cannabis and tobacco smoking. Even heavy smokers of cannabis do not have an increased rate of Obstructive Pulmonary Disease, a common affliction for tobacco smokers, and the rate of head, neck and throat cancers, common problems for tobacco smokers, is considerably lower among moderate cannabis smokers than among those who smoke nothing at all.
To avoid smoke inhalation, cannabis can be used with a vaporizer, orally in baked goods and other food products, in oral sprays, or in a suppository. No data exists suggesting that orally ingested cannabis may cause cancer.
Effects on Cognition
Cannabis use can temporarily impair cognition involving short-term memory, performance, attention and concentration among long-term heavy smokers. While some studies have suggested that deficits in attention and memory occur more often with heavy cannabis use, and that these deficits can extend beyond the period of intoxication, a 2003 meta-analysis of the 15 relevant studies on non-acute effects found that “there might be decrements in the ability to learn and remember new information in chronic users,” but “other cognitive abilities are unaffected.” The researchers note that, despite their expectations to the contrary, all studies done to date have “failed to demonstrate a substantial, systematic, and detrimental effect of cannabis use on neuropsychological performance.”
Effects on psychomotor performance
The most common types of psychomotor functions impaired by cannabis use include body sway, hand steadiness, a test of motor skill performance involving tracking a rotating target, driving and flying simulation, divided attention, sustained attention, and the digit-symbol substitution test, which involves remembering symbols arbitrarily matched to numbers. The effects are generally short-lived and do not appear to persist over the long-term, that is when not using cannabis. Research clearly indicates that cannabis use impairs psychomotor performance, and studies have shown that those unaccustomed to cannabis use are less able to compensate for its effects. With prolonged use, many people develop ways of compensating that mitigate the effects. No one using cannabis should drive or operate dangerous machinery if they feel intoxicated.
Effects on the immune system
The effects of cannabis use on the immune system are not yet fully understood. The discovery of CB-2 receptors in the various cell types of the immune system has excited interest in the interaction of cannabinoids and immune function. Several pharmaceutical companies have expressed interest in developing CB-2-selective drugs which might have utility as immunosuppressants, or in the treatment of arthritis, multiple sclerosis and other autoimmune disorders.
People living with AIDS may experience opportunistic bacterial and fungal infections associated with exposure to pathogens from contaminated cannabis material, according to one study. Yet there is no evidence that the long-term use of cannabis renders users more susceptible to bacterial or additional viral infections. Recent studies have shown cannabis use has no adverse effect on immune function for people living with HIV/AIDS. A 2003 randomized, placebo-controlled clinical trial demonstrated that cannabis did not affect HIV RNA levels, CD4+ and CD8+ cell counts, or protease inhibitor levels. In another randomized, placebo-controlled study, the administration of oral THC or smoked cannabis did not significantly alter pharmacokinetic properties of the protease inhibitors tested and had no effect on antiretroviral efficacy.
In fact, as mentioned in the earlier section on HIV, a 2012 study found that cannabinoids can strengthen immune function. Researchers demonstrated CB2 activation has an anti-viral effect on CD4+ T cells, reducing cell-to-cell HIV infection up to 50%. The authors of that study suggest that the therapeutic use of cannabinoids may help fight the spread of the virus to uninfected T cells in late stages of HIV-1 infection. Other research has shown that cannabinoid drugs reduce viral load in an animal model of HIV.
Be forthright. There is nothing wrong or illegal about discussing medical cannabis with your doctor. Federal courts have ruled that the First Amendment protects doctors in discussing medical cannabis and recommending it to their patients. Doctors are accustomed to patients bringing ideas to them about treatment options and preferences, and cannabis therapeutics should be no different.
Your doctor may be unfamiliar with medical cannabis and hesitant to recommend it, so bring documentation to explain the science and support your experience. ASA has created a series of educational booklets for this very reason. Our Condition-based Booklets and other research can be found in the publications section of the website. Your doctor may not have an understanding of the local laws either. You may also consider bringing them relevant forms and website links for your state. These forms and resources are located in our "State by State: Recommending Cannabis" section for medical professionals.
A primary care physician with an understanding of your medical history is the best person to consult first about medical cannabis. However, we understand that not everyone has a regular doctor, and many physicians remain unfamiliar with the medical uses of cannabis or are afraid of getting in trouble. In addition, some patients are concerned with their current health insurance company finding out about their use of medical cannabis. For these and other reasons, many patients consult one of the many doctors with a specialty practice in medical cannabis. No matter what doctor you see, here are some pointers:
Understand your state requirements and ask for a written recommendation. Bring copies of required paperwork for your state or a sample doctors recommendation from the Medical Professionals section of this website.
Be prepared to tell your doctor specifically what condition or symptoms you treat with cannabis therapeutics. If you have medical records related to the condition or symptoms, bring them. Honestly describe how long you've had the problem, when you began treating with cannabis, the amount of cannabis you use, how often, and by what delivery method.
If your regular doctor will not issue a recommendation, you may choose to visit a physician who is a medical cannabis specialist.
Finding a Doctor if You Don't Already Have One, or if Your Regular Doctor Will Not Issue a Recommendation
There are a number of specialty physicians and clinics available for consultations in states with medical cannabis laws. Before seeing a medical cannabis specialist, patients should already have medical records of diagnosis and treatment or a physician referral. Be aware that:
You should take your medical records with you to the appointment.
It generally costs $100 or more to see a medical cannabis specialist. (Paying for a consultation does not guarantee you a recommendation.)
Time with the doctor and quality of care can vary among medical cannabis specialists.
The medicinal properties of cannabis are varied given the multiplicity of physiological roles of the endocannabinoid system, a ubiquitous molecular signaling system at which compounds in cannabis have robust receptor-based actions. Here is information on medical marijuana practice policies and procedures in your locality, as well as scientific and practice ethics information.