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Marijuana For Palliative Care: Interview With Hospice Doctor

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Marijuana For Palliative Care: Interview With Hospice Doctor

Bernard Lee, a hospice and palliative care doctor in the greater New York City area, is leading the charge to educate physicians on its safe and effective use in order help alleviate the suffering of patients with chronic and terminal illness. As the Associate Chief Medical Officer at MJHS Hospice, he works with large interdisciplinary teams of hospice and palliative care professionals to provide end-of-life care to terminal patients, including the use of medical marijuana for pain and symptom management. He also sees private patients at his Scarsdale, NY office, and lectures and teaches at MJHS Institute for Innovation in Palliative Care.

He began seeing and certifying patients for medical marijuana (cannabis) in February 2016, just a month after it became legal in New York.

How did you become interested in marijuana as a palliative treatment?

I saw that for some of my patients, traditional medicines were just not effective in relieving their debilitating pain and emotional distress. I’ve always been an advocate for alternative treatments—I’m certified in medical acupuncture and HIV and cancer pain massage—so it seemed like marijuana was a logical next alternative to look into.

Who is the typical medical marijuana patient?

There is no typical patient. I was surprised at the diversity of the patient population that came to see me for medical marijuana certification. I met patients of all ages, socioeconomic groups, races/ethnicities, and levels of marijuana experience and knowledge.

What conditions have you recommended marijuana for and has it helped?

Cancer, Multiple Sclerosis, Parkinson’s Disease, Inflammatory Bowel Disease, spinal cord injury with spasticity, and neuropathy.

Marijuana seems to help with the pain, nausea, seizures, and spasticity associated with these conditions. It also helps with other kinds of pain, like emotional pain, fear, loneliness, depression, and isolation. My patients say they sleep better, have less anxiety and depression, and just feel better overall.

How do you decide how much to recommend?

When I prescribe traditional medications, I usually rely on the current best practices, research, and my experience as a doctor. But since medical marijuana is a very new area in medicine, those resources are scarce. I find that I learn a lot from cannabis pharmacists at dispensaries—sometimes they call me to discuss one of my patients or recommendations, and sometimes my patients tell me what they suggested. Patient feedback and the results I can see in my patients give me anecdotal evidence that helps me make more informed recommendations.

That said, I typically start new patients at a low dose (low THC level) for a short period of time to see how it’s working (or isn’t working) for them. Then I can raise or alter my recommendation based on whether it’s helping and the side effects.

What are some side effects of marijuana? Can you counteract them?

The main chemical components of marijuana, responsible for its medicinal properties, are the cannabinoids THC and CBD. THC is known for its tendency to make you feel high or intoxicated, while CBD is often found to produce feelings of calm and relaxation. Unpleasant side effects of THC include feeling too high or intoxicated, dizziness, disorientation, paranoia, confusion, hallucinations, or disconnectedness. CBD can counteract or modulate these side effects, so I always recommend that my patients keep a supply of CBD oil in case they need to calm or balance the side effects of THC; a few drops held under the tongue can bring relief as quickly as 15 or 20 minutes.

Does it help all patients?

I think it always has the potential to help, but for some patients, the side effects outweigh the benefits. When I recommend marijuana, I consider the patient’s experience level with marijuana and classify them as either cannabis-naive (basically non-users) or experienced (current or recent users). For some, usually cannabis-naive patients, the negative side effects are just too incapacitating and frightening so they choose to stop using it in favor of another treatment.

Is marijuana better than opioid pain medications?

The demonization of opioids seems to be a trend these days, but it’s not really opioids vs marijuana as much as finding what works best for a particular patient. It’s really a question of which one provides the most symptom relief for the person with the most manageable side effects.

Dr. Lee sees private patients with qualifying conditions for medical marijuana certification and follow-up care at Scarsdale Integrative Family Medicine, in Scarsdale, NY.

If you are interested in making an appointment with Dr. Lee, you can contact his office at 914-722-9440.

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Five Ways Cannabis Affects Sleep

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Five Ways Cannabis Affects Sleep

Medical patients often suffer from not sleeping well. We dug into recent studies to see if cannabis improves sleep. Here are five things you should know:

THC boosts melatonin

The psychoactive ingredient in cannabis, THC has been shown to dramatically increase melatonin production, causing a spike up to four thousand times that of baseline levels. Melatonin is a naturally occurring hormone that regulates circadian rhythm and sleep.

Increase slow-wave sleep

According to the Department of Psychiatry at the University of San Diego, THC increases the third and fourth stages of the sleep cycle, also known as ‘slow-wave sleep’ (SWS). Increased SWS has been linked to an increased reduction of beta-amyloid, the harmful neural protein associated with Alzheimer’s Disease, dementia, and other memory loss conditions.

Reduce REM

While cannabis is known for increasing SWS, it also reduces the fifth phase of sleep, commonly known as rapid eye movement (REM). Less REM means having less dreams, but there is yet to be any evidence of negative effects.

Treat sleep apnea

Cannabis’ sleep-inducing properties are an excellent natural remedy for those suffering from sleep apnea. This helps them to fall and stay asleep easier and with less interruption.

Reduce RBD in Parkinson’s Disease

By using a high-CBD cannabis before bed, you can lessen REM Sleep Behavior Disorder (RBD) effects such as tremors, violent movements, and nightmares. High-CBD cannabis has been found to be more effective than Levodopa, a prescription drug commonly prescribed to patients with Parkinson’s and onset-RBD.

More Information

Melatonin and marijuana (Lissoni, P., Resentini, M., and Fraschini, F. “Effects of Tetrahydrocannabinol on Melatonin Secretion in Man.”)
Cannabinoids for medical use (Journal of American Medical Association)
Effect of drugs on sleep (National Center for Biotechnology Information)
THC effects on sleep & sleep during withdrawal (Europe PMC)
How Cannabis can help RBD in Parkinson’s (Vanwinkles.com)

Has cannabis had an affect on your quality of sleep? Let us know in the comments section below.

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Grow Medicinal Marijuana At Home With A Grow Box

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Grow Medicinal Marijuana At Home With A Grow Box

Growing your own medicinal marijuana is a liberating experience. You control all the variables. You know exactly what is in the bud you are smoking. grow box is a discreet and easy way to grow marijuana indoors at home, freeing yourself from dependence on both doctor and dispensary.

Gain independence with a grow box

A grow box is like a tiny, camouflaged green house. It is a self-contained unit with soil or hydroponic growing medium, lights, filters and pumps. Just add seeds, electricity and voila! You are growing your own medicinal marijuana.

Choose the right marijuana strain for you

There are two important considerations when choosing a strain of medicinal marijuana to grow yourself:

Your Medical Requirements – Are you looking for a powerful sedative effect to help with your insomnia or a functional day-time smoke to relieve pain and lighten anxiety?

Your Growing Space – Choose small, bushy strains like Indica or hybrid seeds instead of a tall, leggy Sativa. For your first grow an auto-flowering marijuana variety is the best choice because they require very little care or expertise.

Grow enough marijuana to meet your needs

Grow boxes are available in all sizes. Several surveys in the UK, Canada and the US suggest that most medicinal marijuana patients use 1-3 grams per day, or about 2 ½ pounds per year.

Even the tiny PC Grow Box, which holds just two small plants, can produce two pounds of dried bud per year. The compact SuperBox allows you to grow 8 plants at once with annual yields of 7 pounds or more.

Grow your medicinal marijuana under lights

Marijuana grows best under lights that mimic natural sunlight. There are three common types of grow lights used in the cultivation of marijuana:

  • Compact Fluorescent Lights (CFLs)
  • High Intensity Discharge Lights (HIDs)
  • Light Emitting Diodes (LEDs)

Most grow boxes use either CFL or full spectrum LED grow lights. HIDs don’t work well in the enclosed space of a grow box because they get too hot.

While you can grow small amounts of marijuana successfully using CFLs, high quality LED grow lights save electricity and produce the highest yields.

Obtain higher yields using hydroponics

A hydroponic system doesn’t use soil. Growing hydroponic marijuana is not as complex as it may sound.

Many grow boxes come with a simple hydroponic system already set-up. You simply add nutrients, which often come with the grow box, and water. You can even choose to grow marijuana with organic nutrients.

Grow marijuana naturally in soil

Some people prefer to grow marijuana as naturally as possible. The Earth Cab grow box series is one style of grow box designed for soil.

Grow a continuous supply of medicinal marijuana

Once you get started you don’t need new seeds for each growing cycle. You can propagate new marijuana plants by taking cuttings, called clones, of your favorite existing plant.

A dual chamber grow box has a special space for making clones. These grow boxes allow you to produce a constant supply of fresh buds.

Find the perfect grow box for your situation

For the many medicinal growers discretion is essential. Look for a specially designed stealth grow box.

You can also choose a fully automated grow box that allows you to leave town for two weeks and come home to healthy plants.

Use this detailed review of the best grow boxes of 2015 to find the perfect set-up for you.

Grow medicinal marijuana at home with a grow box

Are you considering growing at home? Let us know why in the comments below!

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How Edibles Are Made

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How Edibles Are Made

Since there are so many manufacturers throughout the US, cannabis-infused foods are produced in a variety of different ways. Read up on how your favorite edibles are made and learn how to make your own medicinal treats:

They’re usually made with trim

Trim contains the leftover leaf matter from the cannabis flower that growers usually throw away. It’s less potent than bud, but it’s full of trichomes and can be used in large quantities to produce a stronger effect.

Cannabis is decarboxylated

Decarboxylation activates THC and other cannabinoids to result in a more potent product. To achieve this, cannabis needs to be heated either through smoking, vaping, or baking. The flower is typically cooked for a long time over low heat before it’s used to make edibles. Eating raw cannabis won’t have a very strong effect, and it won’t taste good.

Cannabinoids are extracted

Edibles are infused with highly concentrated cannabis extracts. Depending on the extraction method, edibles can contain either tinctures, canna oil, or cannabutter. If you’re wondering how a specific edible was made, ask your budtender or contact the manufacturer.

Canna oil and cannabutter are common

THC is fat soluble, so cannabis is often cooked with oil or butter. When heated, the activated cannabinoids absorb into these ingredients. Check out this recipe for cannabis cooking oil and this one for cannabis-infused butter. Or try making cannabis coconut oil.

Tinctures are used in hard candies

Some edibles don’t go through a baking or cooking process, so tinctures are added instead of flower. Tinctures are liquid cannabis extracts made from a solvent like alcohol, vinegar, or glycerol. Rather than passing through the digestive system like cannabinoids in most edibles, these are absorbed by the body and can result in a quicker effect.

Have you ever made your own edibles? Tell us in the comments below.

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