Cannabis and your sex life!

Dear Nurse Susan,

I was in the dispensary last week and I saw some cannabis vaginal suppositories that claim to intensify your sexual sensations and experience. Seriously?

Aphrodisiac skeptic

Dear Skeptic,

Yes, cannabis has had a reputation as an aphrodisiac in many cultures throughout history.  In ancient India, for instance, tantric sex practitioners believed that the herb increased libido, produced longer-lasting erections, and delayed ejaculation.

Others claim that frequent use of cannabis has a negative effect on their libido. Testosterone is the hormone that stimulates the sex drive in both men and women, and there are conflicting studies that conclude that frequent use of cannabis can depress testosterone.

A recent large-scale study by Stanford University School of Medicine and reported in the Journal of Sexual Medicine concludes that marijuana use is independently associated with increased sexual frequency and does not appear to impair sexual function: http://www.jsm.jsexmed.org/article/S1743-6095(17)31417-0/fulltext

Assistant professor of urology Michael Eisenberg, MD, was the senior author of the study of 50,000 Americans between the ages of 25-45.  “What we found was, compared to never-users, those who reported daily use had about 20 percent more sex.” Here is a video about the study results: https://www.youtube.com/watch?v=RPSKvjhAQgI

In one 2016 study, approximately half of pot users reported feeling aphrodisiac effects after smoking pot, while 70% said they experienced “enhancement in pleasure and satisfaction.” Here is a link to that study: https://www.ncbi.nlm.nih.gov/pubmed/27884725

So, what do The Doctors say about cannabis and sexual health? Here is a link to an episode of this popular show: https://www.youtube.com/watch?v=arpnYyqGFMI

Remember that everyone responds differently to cannabis, so it ultimately depends on you whether it enhances or suppresses your libido and sexual pleasure. Since there seems to be some degree of contradictory evidence here are a couple of more sources for additional perspectives.

http://www.greenstate.com/explained/marijuana-aphrodisiac-can-used-sex-aid/

http://bigthink.com/philip-perry/heres-how-marijuana-use-effects-ones-sex-drive

Here are some strains, including sativa, indica and hybrid, that may help you get into the mood:

Sativa: Lime Haze, Drizella, Rene, Foria suppositories

Indica: Sugar Mama, Eran Almog, El Jefe, Foria Suppositories

Hybrid: Boysenberry, Swiss Bliss, Pink Mango, Foria Suppositories

Generally speaking, if you aren’t afraid of falling asleep, the Kushs are good for increasing sensitivity or an indica dominant hybrid.

So Aphrodisiac Skeptic, it seems like there are more saying “yes” than “no”, for both men and women regarding the positive impact of cannabis on sex. Given the variety of options from smoking to sprays to suppositories, experiment to see what works best for you.

 

Have some fun with this!


Cannabis can help you sleep!

Dear Nurse Susan,

Help, I need some sleep! Can cannabis help me sleep?

Bone Tired

 

Dear Bone Tired,

I am glad you reached out for help with sleep. You aren’t the only one with this problem. This is one of the most common uses for cannabis. In fact, 70% of Americans suffer from sleep problems: 40% of men and 30% of women suffer from insomnia. Sleep deprivation results in:

  • 20% increase in driving accidents; approximately 1 million crashes occur due to drowsy driving each year in the US
  • 30% higher risk of obesity
  • 15% increase in cardiovascular risks
  • 45% increase in depression symptoms

Sleep deprivation is closely related to diabetes and hypertension. Sleep apnea effects 18,000,000 adults and narcolepsy effects 200,000 people.

How can cannabis help? There are a few cannabinoids in cannabis that are helpful for sleeping. The best ones are CBN and CBD. Today I’m going to talk about CBN.

CBN is a cannabinoid that has sedative effects. CBN is produced by the breakdown of THC through aging or exposure to sunlight. This short video provides a good introduction to CBN.

https://www.youtube.com/watch?v=9BRpkO9EPvI

What are the effects of CBN in addition to promoting sleep?

  • Anti-convulsant
  • Anti-bacterial, including MRSA
  • Promotes bone growth (good for osteoporosis)
  • Anti-inflammatory; good for arthritis, fibromyalgia
  • Inhibits skin cell formation (good for psoriasis)
  • Anti-nausea/vomiting
  • Anti-cancer: breast cancer, certain lung cancers
  • Promotes healing of burns
  • Relieves pain
  • Anti-depressant
  • Anti-anxiety
  • Muscle relaxant
  • Anti-spasmodic
  • Anti-asthma

Ambien doesn’t give you all those benefits! Plus you can avoid all the side effects! So, Bone Tired, the next time you are in a dispensary, ask for products with CBN.

Here’s to a good night’s sleep!  ZZZZZZZZZZZZ

Nurse Susan

For more information on CBN check out these additional resources:

https://,ww.massroots.com/learn/cannabinol-cbn-cannabinoid/ - Basic CBN information

https://www.steephill.com/blogs/34/Cannabinol-(CBD):-A-Sleeping-Synergy – A little bit of CBN science

www.youtube.com/watch?v=tREh1eYdwuA – A lot of CBN science with Dr. Bonni Goldstein and a researcher from SC Testing Lab


Cannabis can help your skin!

Dear Nurse Susan,

Lately I have been seeing all these new skin care products and cosmetics made from hemp and cannabis. What are the skin benefits of hemp and cannabis, or is this just a marketing scheme?

Sensitive Skin

 

Dear Sensitive Skin,

First, let me explain the different cannabis-ingredients that you may run across while you are in the beauty isle. Not all cannabis/hemp products are created equal, so here is some information that will help you chose the product you are looking for.

Cannabis is well-known for its anti-inflammatory, antioxidant and anti-aging properties. Whole-plant cannabis oil contains cannabinoids (THCA, CBD, CBC, etc.) and terpenes (lavender, pinene, limonene, etc.) and you will find them at your local dispensary. Terpenes are the essential oils in cannabis that give it its fragrance. They also have therapeutic effects but are easily lost (volatile) unless the cannabis is cold pressed and has not been exposed to heat or sunlight. If heat is used in the processing of the flowers, terpenes will be lost but they can be added later in the processing. Cannabinoids and terpenes are produced in the resin glands, or trichomes, of the female flower. There are specific cannabinoids and terpenes that are beneficial to your skin’s health. So, when selecting products look for these compounds that address a variety of skin issues:

  • Acne: CBD, CBC, THC, a-terpineol, limonene and linalool.
  • Burns: CBD, CBN, THC, linalool, and borneol.
  • Herpes Simplex 2: THC and eucalyptol.
  • Bacterial infection: CBD, CBC, CBG, b-caryophyllene, limonene, a-pinene.
  • Fungal infection: CBC, CBG, CBCA, limonene, eucalyptol, terpinolene.
  • MRSA infection: CBD, CBC, CBG, b-caryophyllene, a-pinene, a-terpineol.
  • Viral infection: CBC, CBD, CBG, a-terpineol, eucalyptol, b-ocimene.
  • Inflammation: THCA, CBD, THC, b-caryophyllene, b-myrcene, a-pinene.
  • Itching: THC, b-caryophyllene.
  • Pain (local anesthetic): linalool, b-caryophyllene.
  • Melanoma: THC, CBD, b-myrcene, camphene.
  • Psoriasis: THC, CBD, THCA, camphene.
  • Reddened skin: CBG, CBD, linalool, borneol.

Products that contain CBD with little to no THC can be purchased online or in retail stores. Products with CBD are usually made from hemp or a CBD isolate. You will get some benefits from these products, due to the CB2 receptors in your skin, but not like the list above. Whole-plant cannabis products are almost always superior in their therapeutic effects.

Finally, products that contain hemp seed oil, may try to ride the coat tails of cannabis/hemp products, but don’t be fooled! There are NO cannabinoids or terpenes in the seeds of the hemp plant, and when it comes to therapeutic benefits, look for an ingredient list that includes “cannabis oil” or “CBD” and is lab tested. But that is not to say that hemp seed oil isn’t worth exploring! Hemp seed oil is a nutrient-rich moisturizer for the skin. Hemp seed oil contains a balanced ratio of omega 3, 6, and 9 that protect and moisturize the skin.

So Sensitive Skin, if you have skin issues, try the whole-plant cannabis products with the cannabinoids and terpenes listed above; if you can’t access cannabis where you live, purchase a CBD product online or at a good health-food store; and finally, hemp seed oil is wonderful, but remember there are NO cannabinoids and terpenes, so its therapeutic effects are limited.

At the end of this article I’ve included a couple of video links so you can see some of the cannabis skin care applications currently being used. And, if you’d like to better understand the basics of hemp and hemp seeds, this link will take you to an article I’ve written to explain more about the uses of hemp for health. http://dearnursesusan.com/the-benefits-and-uses-of-hemp/

All the best in your quest for better health using the wonderful cannabis plant!

Nurse Susan

https://www.abc15.com/nct/health/cannabis-skincare-products-aim-to-help-women-children

https://www.youtube.com/watch?v=_ugxHJxySWQ

https://www.mirror.co.uk/news/us-news/toddler-painful-skin-condition-makes-12307702


Cannabis and Sports Injuries

Dear Nurse Susan,

I am an executive that works long hours during the week, mostly behind my desk. On weekends, I like to get lots of exercise, and I recently injured my back. This injury is interfering with my activities and stamina at work and on weekends. Is cannabis good for sports injuries and is it possible to use it without getting high?

Stiff & Tired

Dear Stiff and Tired,

Whether you are a professional athlete, or a weekend athlete, cannabis is a good treatment for pain, inflammation, and muscle spasms, the usual suspects with sports injuries. Attempting to select the best products or strains that will relieve these issues is like putting together a puzzle. You want to match the best cannabinoids and terpenes with each condition, select the best method(s) of ingestion, and find your best dose.

So, we begin by identifying the best cannabinoids and terpenes for each of these conditions.

  • Inflammation: There are several compounds in the cannabis plant that relieve inflammation including the cannabinoids THCA, THC, and CBD, and the terpenes caryophyllene, myrcene and pinene.
  • Muscle spasms: The compounds in the cannabis plant that relieve muscle spasms include the cannabinoids THC, CBD, and CBG, and the terpenes a-terpinolene, linalool, and myrcene.
    • Pain: Cannabis is an excellent pain reliever. The cannabinoids that best address pain are THC, CBD, and THCV, and the terpenes myrcene, linalool and pinene.

Next, we will consider all these compounds together, and prioritize compounds that address all three of these conditions and they include THC, CBD, and myrcene. The compounds that address 2 out of 3 conditions include pinene and linalool. So, you want to use a product or products that contain THC, CBD, myrcene, linalool and pinene.

Often the most effective cannabis protocol requires the use of more than one product. Your desire to avoid the “high” or psycho-activity produced by THC is the perfect example of why you will want to use more than one product. Clearly THC is effective for managing pain, inflammation and muscle spasms, but it does come with dose-dependent psycho-activity. If you use a product with THC, linalool and myrcene (all are sedating) at night only, you will not feel the high and your sleep will most likely improve. During the day, use a product that has CBD and pinene which are not sedating.

Now that you know which compounds are best for these conditions, you can go to your local dispensary and ask to see products for daytime use that are high in CBD and pinene, and products for nighttime use that have THC, myrcene and linalool.

There are several methods of ingestion to choose from: inhalation, topicals, suppositories, edibles etc. Most of my clients prefer using tinctures and topicals to manage sports related injuries. I usually don’t recommend smoking due to the irritation caused by the products of combustion. If they need immediate relief, vaping is a good alternative.

Dosing is the most important factor in having a successful experience with cannabis: if you take too much you will feel uncomfortable, and if you take too little it will be ineffective at managing your symptoms. The rule of thumb is to start with a low dose (~2.5 mg) and slowly titrate up until you are getting the results you need. If you start feeling worse with the newly increased dose, then you know it is too much for you, and you back down to the prior dose.

So, Stiff and Tired, cannabis is a safe medicine when used strategically and responsibly, that can be used to manage your sports injuries. So much so, that many professional athletes support using cannabis for injuries as well as helping them endure the demands of the game. See the links below to learn more about what some professionals think about cannabis.

To your health and better pain management,

Nurse Susan

Eben Britton video - https://www.youtube.com/watch?v=uHwBIYdXZRA

https://athletesforcare.org/

Bleacher Report article - http://bleacherreport.com/articles/2771410-athletes-smoke-weed-interviews-nba-nfl-420?utm_source=cnn.com&utm_medium=referral&utm_campaign=editorial


Cannabis and Cardiovascular Disease

Dear Nurse Susan,

I was recently diagnosed with high blood pressure. I was researching the common pharmaceutical drugs that doctors prescribe to lower blood pressure. The side effects were pretty scary. Whenever possible, I like to use natural remedies, but I don’t want to mess around when it comes to my heart. What do you think about using cannabis for high blood pressure?

Under Pressure

Dear Under Pressure,

It’s always a good idea to discuss the use of cannabis with your doctor, no matter what your health concern is; though, don’t be surprised if they don’t know much about it. The more information your healthcare provider has about your health history and lifestyle, the more accurate they can be with their diagnosis and treatment plan.

Cannabis is known to affect your cardiovascular system in a couple of ways, but before we get into that, let’s discuss hypertension:

High blood pressure: also known as hypertension, is an increased resistance to blood flow in the arteries. It is a major risk factor for heart failure, stroke, kidney disease, abnormal heart beats, vision loss, dementia, and peripheral vascular disease. The normal blood pressure of adults at rest is between 100/60 and 140/90. Watch this 6-minute video on high blood pressure: https://www.youtube.com/watch?v=1-4hNFxoZog

Cannabinoids and Terpenes for Cardiovascular Disease

The cardiovascular effects of cannabis have not been well studied, so use caution when consuming cannabis for a heart condition. The effects that we know of are dilation of blood vessels making the heart pump harder, increased heart rate, and decreased blood pressure. Patients with heart disease who are under stress develop chest pain more quickly if they recently smoked cannabis. The risk of a heart attack is higher in the hour after smoking cannabis. So again, use caution.

Activation of the CB1 receptors is pro-atherogenic (tending to promote the formation of fatty plaques in the arteries) and activation of the CB2 receptors is anti-atherogenic. (If you are rusty on the endocannabinoid system and the CB1 and CB2 receptors, watch this short video: https://www.youtube.com/watch?v=Z-OEpwgv6aM&t=0s&index=3&list=PLj3YZ12PT1hWGvNfxUSI0qHCFhe2gu8WX).                                   Smoking as a delivery method for cannabis consumption should be avoided. Long-term studies have failed to show a definite increase in cardiovascular mortality with marijuana use, but it is always better to err on the side of caution. There are tinctures, edibles and topicals available with the 3 top cannabinoids and terpenes that I discuss below.

The top 3 cannabinoids as they relate to cardiovascular disease:

  • CBD is non-psychoactive, antioxidant, anti-inflammatory, pain reliever, relieves stress, reduces blood pressure, anti-anxiety, and inhibits the progression of atherosclerosis.
  • CBC is anti-inflammatory, relieves pain, anti-anxiety, relieves stress, and reduces edema.
  • CBN relieves pain and is anti-anxiety.

The top 4 terpenes as they relate to cardiovascular disease:

  • B-Caryophyllene binds to the CB2 receptor so it is anti-atherogenic, antioxidant, anti-inflammatory, relieves pain, and is anti-anxiety.
  • Linalool is anti-anxiety, relieves stress, reduces pain, anti-inflammatory.
  • Terpinolene is antioxidant, anti-anxiety, relieves pain, anti-inflammatory, reduces cholesterol, relieves stress.
  • Camphene: antioxidant, anti-bacterial, relieves pain, bronchodilator

If lab reports on cannabis products are available in your area, choose products that have high levels of these cannabinoids and terpenes. For anyone who is taking prescription medications, find out if there are any interactions with cannabis. For example, coumadin is a commonly used anti-coagulant and your blood level of coumadin could increase if you take it near the same time as cannabis. This will increase your risk for hemorrhage. That risk can be decreased if you wait two hours between your prescription drugs and cannabis. Also, you may want to get your coumadin levels checked more frequently until you know how cannabis is affecting you.

Drug Interactions with Common Cardiac Pharmaceuticals

If there is a concern regarding possible drug interactions between cannabis and common cardiac medications, consult your Medscape app. In the list below, although far from an exhaustive list of cardiac medications, cannabis effects the levels of the following common drugs:

  • Anticoagulants including Warfarin, Heparin and Apixaban
  • Antiplatelet Agents including Plavix
  • Beta Blockers including Lopressor, Inderal
  • Combined Alpha and Beta Blockers including Coreg
  • Calcium Channel Blockers including Norvasc, Cardizem, Plendil, Adalat, Nimotop, Sular, and Calan
  • Cholesterol-lowering meds including Lipitor, Lovastatin, and Vytorin

 

So, Under Pressure, caution is the golden rule when using cannabis in the presence of heart disease, especially if you are new to cannabis….simply because there is little research on the subject. If you are already a cannabis user you likely have an idea of how you respond to cannabis and its effects on your body. If you decide to try cannabis to control your blood pressure, I would recommend that you take your blood pressure a couple of times in the first hour following consumption of cannabis. You need to discover how your body responds.

In this case, proceed with caution is the best route.

All the best as you experiment and take care of your heart!

Nurse Susan


The Benefits and Uses of Hemp

Dear Nurse Susan,
I’m kind of new to this cannabis thing and I’ve heard people use “hemp”, “cannabis” and “marijuana” interchangeably. From what I’ve read it seems that they all are not the same, but I’m not clear about the whole thing. Can you set me straight on this….so to speak?
Thank you,
Just the Facts

Dear Fact seeker,
The cannabis sativa plant has many different uses, but don’t confuse hemp with marijuana. Hemp is the cannabis sativa L plant that contains less than 1% of delta-9 tetrahydrocannabinol (THC), whereas the cannabis that is sold in dispensaries can have up to 30% THC. THC is the only compound in cannabis that causes psycho-activity. Today I want to talk about the many uses of hemp! After a high-level review of some of the many uses of hemp, I will talk about why and how you can take advantage of this wonderful plant. Here is a quick review of the many benefits of hemp:
https://www.youtube.com/watch?v=a4_CQ50OtUA

Although hemp has been used for centuries in the paper, textile, rope, biodegradable plastics, food, auto-parts, fuel, and construction industries it was banned as an agricultural crop in the US in 1937. There was a reprieve of this illegal status in 1942 as hemp had many uses during World War 2 and the government again encouraged it as an agricultural crop. After the “need” for hemps many uses receded it again became illegal in the U.S. in 1957. The U.S. Department of Agriculture, Office of Public Affairs produced the following film in 1942 - “Hemp for Victory”
https://www.youtube.com/watch?v=d3rolyiTPr0

In the 2014 Farm Bill, universities and state departments of agriculture became able to grow hemp for research and limited industrial purposes. Legislation continued to open up for hemp and as of 2017, 38 states have considered some type of legislation related to hemp and it is now legally grown in fifteen states.
http://www.ncsl.org/research/agriculture-and-rural-development/state-industrial-hemp-statutes.aspx

Hemp is also a bio-accumulator, meaning that it is very efficient and effective at removing toxins and heavy metals from the soil (it was used at Chernobyl after their nuclear accident). As a multipurpose highly efficient plant, this ban as an agricultural crop was believed to be due to competitive interests with the petroleum and other multi-national companies like DuPont, as well as its association with marijuana.

Hemp is a Superfood!
Hemp seeds are a densely nutritious food that contains fiber, highly digestible protein, edestin and albumin, that convert to amino acids in the gut, and contain significant amounts of essential amino acids. Hemp can be consumed as hulled hemp seeds (also called hemp hearts), hemp oil, and hemp seed protein. The shelled hemp seeds, contain chlorophyll, fiber, protein and fatty acids, and have a nutty, sweet flavor.

Here is a short video from Dr. Axe on the benefits of hemp seeds. If you are intrigued by the information in this video, then continue reading this article for more in-depth information!
https://www.youtube.com/watch?v=7_55RHECltY
Hemp should not be heated, roasted or baked because it will affect the digestibility. 100 grams or ½ cup of hemp seeds contain between 31-33% protein and meets 73% of the Daily Value for protein, based on a 2,000 calorie diet.
Hemp protein powders are produced from seeds by removing the omega oils via expeller pressing methods. Hemp protein powers can be used as a substitute for whey and soy proteins.

Hemp is an excellent source of all 20 amino acids including the 9 essential amino acids. Essential fatty acids are called “essential” because the body does not produce them so we must ingest them from the foods we eat. They support neurological functioning, cell membrane stability, oxygen transfer, immune response, inflammatory regulation and cardiovascular stability.
Omega 6 and omega 3 fatty acids are in a perfect ratio which is between a 4:1 or 1;1 ratio. Too much omega 6 from refined vegetable oils and grain-fed animals, can cause chronic inflammation. That is why it is important to add omega 3 fatty acids to balance the omega 6 fatty acids. Hemp seeds are also high in Vitamin E, an important antioxidant, moisturizer, and it supports the cardiovascular and neurological systems.

Good for the Heart! – Hemp normalizes high blood pressure, lowers LDL cholesterol, reduces inflammation, and is good for weight loss and diabetes due to its long-lasting fuel source. The fatty acids in hemp seeds regulate blood sugar levels, and is high in magnesium that relaxes muscles and supports proper brain function. The following article from the U.S. National Library of Medicine further explains the heart benefits of hemp.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868018/

Whichever form of hemp you use, make sure your product is certified organic, made from raw hemp seeds, cold-processed (never hexane processed), unrefined and chemical free. Here is a link to an in-depth video from Superfood Evolution on the benefits of hemp:
https://www.youtube.com/watch?v=hb-WE9_yiOQ

Fact Seeker, this should set you straight about hemp and hopefully encourage you to include it in your quest for good health. I enjoy a number of hemp products including hemp seed in my smoothies and hemp protein bars widely available at natural food stores, Amazon, etc.
To your health!
Nurse Susan

Sources for good quality hemp products:
https://store.nutiva.com/hempseed/
http://amzn.to/1WmoJMP
http://amzn.to/1W7UZ5M


How To Use CBD Effectively

Dear Nurse Susan,
I recently bought a CBD sublingual tincture for my arthritis pain and inflammation. I have used most of the bottle but have not noticed any benefits. Is this expected? Does that mean that CBD doesn’t work for me?
Skeptical

Dear Skeptical,
Great question! People often ask me about cannabidiol (CBD) and if it really works. CBD is a cannabinoid found in cannabis and has many therapeutic effects, without the intoxicating effects of delta-9 tetrahydrocannabinol (THC). In addition to pain and inflammation from arthritis, CBD is frequently used for conditions that are difficult to treat, such as Crohn’s disease, PTSD, anxiety and Multiple Sclerosis. CBD interacts with 65 targets and receptors in the body. CBD does not bind to the CB1 receptor, but it reduces the intoxicating effects of THC, while boosting THC’s pain killing and anti-inflammatory properties. Due to its lack of intoxication, it is ideal for use by the elderly, children, and those who need to be clear-headed. If you prefer to consume CBD using infused beverages, remember that plastic absorbs CBD so you may end up with more CBD in the plastic than the beverage!
Let’s start with a short video of what some doctors have to say about CBD:
https://www.youtube.com/watch?v=Fh-s64RNtz0
I want to address your question in a couple of different ways:
First, what did you buy? There are more and more CBD products flooding the market every day. Unfortunately, some manufacturers are less scrupulous than others and are making low-quality products. Some products have been tested independently and have little to no CBD in them! According to a recent report by the Journal of the American Medical Association (JAMA), discrepancies between federal and state cannabis laws have resulted in inadequate regulation and oversight, leading to inaccurate labeling of some products. You can read about it here: https://arstechnica.com/science/2017/11/study-nearly-70-of-online-cbd-marijuana-extracts-tested-were-mislabeled/
The FDA has tested the chemical content of cannabinoid compounds in some of the products, and many were found to not contain the levels of CBD they claimed to contain. It is important to note that these products are not approved by FDA for the diagnosis, cure, mitigation, treatment, or prevention of any disease. Consumers should beware purchasing and using any such products: https://www.fda.gov/NewsEvents/PublicHealthFocus/ucm484109.htm
It is important to only use cannabis products that have been lab tested for purity, potency, safety, and consistency. The most comprehensive testing measures the levels of cannabinoids (THC, CBD, etc.), terpenes (myrcene, pinene, etc.), residual solvents (ETOH, butane, etc.), pesticides and microbial content (mold, bacteria, etc.).
So, how do you get lab results? Go to the manufacturer’s website and see if they post their lab results. For example, go to www.wvapes.com and under Products, click on Strain Results and you can review lab reports on each of their products. If a manufacturer does independent lab testing they are happy to show the lab reports because it is instant credibility. If a manufacturer cannot provide lab reports, don’t use their products. Ask your dispensary which testing laboratory they use and look into that laboratory. If your dispensary cannot provide lab results on the products it sells, maybe it’s time to find a new dispensary.
Second, what dose did you use? If a 30ml bottle lasted 6 months, you probably weren’t getting an optimal dose. Just as with many traditional pharmaceuticals, every individual must find the dose that is best for them, because dosing is the most important factor in a successful cannabis experience. That is one of the services I provide to medical patients who want to use the appropriate cannabinoids and need help finding their optimal dose. The general rule for dosing is to start low and go slow. That means slowly increase the daily dose until you get the results you are looking for. If you aren’t feeling as well as you did with a lower dose, go back to the lower dose and make a note of how many milligrams of CBD, THC etc. work best for you.
Finally, cannabis is not a miracle drug and does not work for everyone. Don’t expect cannabis to cancel out your less-than-optimal lifestyle choices. To obtain the optimal effects of CBD for arthritis, combine cannabis/CBD therapeutics with healthy choices such as
• minimal consumption of sugar
• no tobacco
• minimal caffeine
• limited consumption simple carbohydrates like bread, pasta and rice
• eat lots of vegetables and berries
• use healthy fats like avocado, coconut, olive oil etc.
• avoidance of night-shade vegetables (peppers, eggplant, tomatoes etc.)
• minimal alcohol consumption
• plenty of good-quality sleep and exercise
Skeptical, don’t give up! Make the effort to find the best products and dose for your optimal cannabis experience. The exploration of all the different products and methods of consumption can be educational and fun!


Cannabis for Chronic Pain

Dear Nurse Susan,

I suffer from Fibromyalgia and as you would expect I have good days and bad days…..and the bad days are really hard. I support my family so missing work isn’t an option and I use  prescription meds to get through most days. I’ve read that cannbis is an alternative to opioids, but I don’t want to trade in one problem for another. Can you explain how cannabis can replace the current pain medication I’m using. Thank you,

Looking for Help

 

Dear Looking,

The cannabis plant is more than 70 million years old, and has been used for fiber, food, medicine, paper, clothing, textiles and in spiritual practices. Human’s and cannabis have evolved together which may be why we have a natural attraction to the plant.

Many chronic pain sufferers are turning to cannabis for relief. The standard therapies for pain relief include non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil, Motrin, Celebrex, Naprosyn, aspirin, and Alleve; Tylenol; and opioids such as morphine, Vicodin, OxyContin and fentanyl. All these therapies come with significant risks. For example, NSAIDs can cause stomach ulcers and bleeding, cardiac arrest, and stroke. NSAIDs are intended for short-term use, i.e., less than 10 days. Tylenol or acetaminophen can cause liver failure leading to death and is toxic to the kidneys. Opioids can cause vomiting, constipation, depression, loss of appetite, and respiratory depression leading to death. In 2017, 65,000 people died of opioid overdose. Eighty percent of heroin addicts were addicted to prescription opioids before starting heroin.

Cannabis side effects are transient and considered mild to moderate, and include dry mouth, euphoria, short-term memory impairment, anxiety, paranoia, relaxation, sedation, heightened sensory perception, altered perception of time, increased appetite, tachycardia, pain relief, lowered blood pressure, tolerance, dependence, tooth discoloration with smoked cannabis, diarrhea, constipation, urinary retention, dry eyes, hallucinations, impaired coordination, and increase phlegm production in cannabis smokers. Cannabis overdose has never led to death; a person can be extremely uncomfortable for several hours, but they do not have to worry about dying.

That is not to say that opioids don’t have their place in pain management. Nothing is better than opioids for acute post-operative or traumatic pain, but opioids are highly addictive and need to be used with caution. Addiction can develop after only 7 days of continuous use, and for some people as few as 3 days. Opioid withdrawal can be a life-threatening experience with nausea, vomiting, seizures etc. They are not appropriate for chronic pain management, and have very little effect on nerve pain, such as trigeminal neuralgia (also known as the suicide disease), sciatica, shingles etc. If you have never experienced nerve pain and have difficulty understanding how bad it can be, here is a short video clip of a trigeminal neuralgia attack: https://www.youtube.com/watch?v=YCGCT9XsVf4

Fortunately, cannabis is effective and appropriate for chronic pain. It is only slightly more addictive than coffee, tolerance can be reversed by abstaining from using cannabis for 48 hours, and although it can cause psychological dependence, the physical withdrawal symptoms are like caffeine withdrawal: 2 weeks of insomnia, irritability, and headaches.

Cannabis is effective with nerve pain, it reduces nerve inflammation, and protects the nerves. See my earlier article on cannabis for migraine headaches. Cannabis is a powerful anti-inflammatory, twice as strong as hydrocortisone, and 20 times stronger than aspirin, so it is very effective for arthritis and auto-immune pain, such as fibromyalgia and Crohn’s disease.

If you have been using opioids to manage chronic pain and have developed an addiction there is some good news. When cannabis and opioids are given together there is a synergistic effect which means you can get the same pain control using less opioids. Over time, it is possible to reduce your opioid dose while you increase your cannabis dose, without the withdrawal. If you are thinking of using cannabis to relieve opioid addiction working with a physician is a must to ensure a safe and effective process.

I have a client with chronic pain who had been taking 180mg of oxycontin for more than eight years. By using cannabis as I just described, he was able to get his oxycontin dose down to 20mg/day, almost eliminating his risk of death by overdose of oxycontin. It took almost one year, but he was able to continue working and have adequate pain control.

If you suffer from chronic pain and want to try cannabis, I recommend working with a cannabis nurse to discover your ideal protocol for cannabis therapy. If you are currently using cannabis for pain management but you aren’t getting the results you seek, here are some ideas to consider:

  • For inflammation, raw cannabis, THCA and CBDA are the most effective cannabinoids.
  • For auto-immune issues, THCA is also your go to cannabinoid.
  • Whole-plant cannabis medicine is hugely more effective than isolates.
  • Some people with nerve pain respond best to a combination of THCA, THC and CBD.
  • A 1:1 ratio of THC and CBD is sometimes more effective at relieving pain than a THC dominant medicine.
  • Often, pain is relieved with a low dose of cannabis, and can increase the pain if you take too much, so remember to start with a low dose and slowly increase.
  • If you need a high dose to control your pain, but don’t like the psychoactivity, use a THC-dominant suppository at night, and a CBD-dominant suppository in the morning.

Chronic pain of any sort is a complex and potentially debilitating condition to live with. When you have something that works it’s a great relief and most people are willing to face the double-edged sword of pain reduction and the often significant negative side effects of prescription medication. Cannabis has proven to be a successful alternative for many. If all of what I’ve described here seems complex or confusing, please bear in mind that treating chronic pain and the often complex symptoms that come with it is often a challenge for the best medical professionals. If you are sincerely seeking cannabis as an alternative it is best to work with an experienced cannabis doctor or nurse and unfortunately they are few and far between. You can get more info at the American Cannabis Nurses Association (https://cannabisnurses.org/) or contact me at hello@dearnursesusan.com.

I hope this is helpful to you and other chronic pain sufferers you may share this with.

All the best in your search to alleviate pain,

Nurse Susan


Can cannabis get rid of this cold and flu?!?!

Dear Nurse Susan,

I have had this freaking cold/flu of almost 6 weeks and I still feel worn out. I have tried every product on the market. I even did the flu shot for a few consecutive years but always got the flu anyway. Can cannabis help?

Can’t stop coughing.

Dear Can’t Stop Coughing,

This year’s flu season has been a beast. It has caused a shortage of flu medications and packed emergency rooms. Symptoms of the flu include sudden onset of fever, body aches, sore throat, runny/stuffy nose, headache, fatigue, and non-productive (no phlegm/sputum) cough. According to the CDC, 114 children have died so far from this season’s flu outbreak. The flu can sometimes weaken the lungs and people can die of a secondary infection, usually bacterial, that causes pneumonia which is the worst complication of the flu. If you have any of these symptoms, go immediately to the nearest Emergency Department:

  • Any kind of breathing problem, such as shortness of breath, difficulty breathing, severe coughing, etc.
  • Signs of a lack of oxygen, including blue coloration/shading around mouth and fingernail beds, dizziness, lightheadedness, confusion.
  • Chest pain, abdominal pain, diarrhea, and vomiting.

So, what do we know about cannabis, and how does that relate to the flu? It is well-known that cannabis compounds (aka cannabinoids, terpenoids and flavonoids) have anti-oxidative, anti-inflammatory, neuroprotective, pain relieving, immunomodulation, and anti-viral/bacterial/fungal actions.

  • Anti-oxidative: An antioxidant inhibits the production of free radicals that can lead to cell damage, thereby protecting the brain and body from the harmful effects of free radicals. According to the US Patent US6630507B1, assigned to the US Department of Health and Human Services, “Cannabinoids have been found to have antioxidant properties, unrelated to NMDA receptor antagonism. This newfound property makes cannabinoids useful in the treatment and prophylaxis of wide variety of oxidation associated diseases, such as ischemic, age-related, inflammatory and autoimmune diseases.” Thus, cannabis protects our healthy cells and prevents diseases. I use cannabis (high CBD, low THC) daily to manage my neurological movement disorder, and I believe I am gaining prophylactic benefits which have resulted in fewer, shorter, and less severe episodes of the flu. I especially like spraying a 1:1 CBD:THC tincture on my sore throat for almost immediate relief from pain and swelling. Here is the link to the patent: https://patents.google.com/patent/US6630507
  • Anti-inflammatory: Inflammation is the body’s immune system response to injury, infection, and tissue injury. This is a protective process, but the results are pain, swelling, joint stiffness, redness and heat. When the inflammation is chronic, it can lead to diseases such as cancer, arthritis, bowel disease etc. With the flu, inflammation is associated with general flu-like symptoms including fever, headaches, body aches, chills, and fatigue. Inflammation in the lungs can cause shortness of breath. Thus, cannabis may relieve your flu symptoms. I can obtain long-lasting, daytime relief by using a microdose (2.5mg – 5mg) of a 1:1 CBD:THC edible with virtually no psychoactivity. At night, a little THC helps me get the rest I need without the negative side effects from products like Nyquil that contain alcohol (known to damage the liver), Tylenol (known to damage the liver), and Benadryl (known to cause thick bronchial sputum).
  • Neuroprotective: Protects nerves against damage due to injury or disease, which can inhibit brain function. Nerves die from several processes, some of which are oxidative stress (see above, anti-oxidative), and inflammation (see above). This does not directly relate to the flu, but in my situation with a neurological disorder, neuroprotection and slowing down the progression of my condition, is one of my top priorities. Any physical stress, including illness, exacerbates my tremor and adds another layer of unpleasantness to the underlying illness.
  • Pain-relieving: This is self-explanatory. The flu can be painful due to a sore throat, body aches, headaches etc, which can lead to sleep disturbances which can weaken our body and intensify the flu symptoms.
  • Immunomodulation: Immune system modulation means increasing (up-regulating) or decreasing (down-regulating) immune system activity. Immune cells express cannabinoid receptors and therefore, the cannabinoids in cannabis can modulate the immune system. For example, in auto-immune diseases, the immune system is overactive, attacking our tissues as if they were foreign invaders. Cannabis down-regulates the system, so it decreases the immune system activity and prevents tissue destruction. According to scientists, developments involving the cannabinoid system and immune regulation suggest that this system will be exploited for treatment of chronic diseases and immune deficiencies.
  • Anti-viral: Influenza is a virus and requires treatment with an anti-viral; it cannot be eradicated using antibiotics. Pneumonia, sometimes a complication of the flu, can be bacterial and is therefore treated with antibiotics. According to researchers, CBD, CBG, and CBC are cannabinoids in the cannabis plant that possess anti-viral, antibacterial and anti-fungal properties. Unfortunately, there is a dearth of human research into the anti-microbial effects of cannabis. In the lab however, these cannabinoids showed “exceptional antibacterial activity against drug resistant “super bugs” like MRSA. I routinely ingest a raw cannabis smoothie, using fresh cannabis plant material, to get all those cannabinoids without the psychoactivity.

So, Can’t Stop Coughing, you can use cannabis prophylactically to support your immune system and prevent free radicals, during illness to relieve your symptoms and inflammation, and as an ongoing nutritional super-food. Get well soon!

Nurse Susan


Dear Nurse Susan - Can Cannabis Help My Migraines?

Dear Nurse Susan,

I have been plagued with migraines for the last 20 years. I have tried everything and sometimes it helps, but most of the time it doesn’t. I’ve never tried cannabis and I’m a little bit afraid, but willing to put up with the high if it will ease my pain. I figure I can’t function with the pain, so what does it matter if I get high?

Thanks for your help,

Splitting Headache

Dear Splitting Headache,

You are not alone; migraine is an extremely prevalent headache syndrome affecting 14% of Americans, with a 3:1 female:male ratio with an annual cost of $20 billion. Ethan Russo, MD, a world-renowned cannabis researcher posits that migraines (and many other disorders) are the result of an endocannabinoid deficiency (ECD). The endocannabinoid system interacts with every other system in the body and is responsible for maintaining balance or homeostasis. Here is a link to a short video that explains the endocannabinoid system: https://www.youtube.com/watch?v=Z-OEpwgv6aM&list=PLj3YZ12PT1hWGvNfxUSI0qHCFhe2gu8WX&index=3&t=160s

Migraine is a neurovascular disorder with neurogenic inflammation. Researchers have found that endocannabinoid (cannabinoids that we produce in our body) levels were significantly lower in chronic migraine patients. Serotonin levels were also strongly reduced in chronic migraine patients. This information supports the hypothesis that dysfunction of the endocannabinoid system is involved in migraine headaches and the fact that cannabinoid treatment, in the form of cannabis, frequently provided symptomatic benefit.

Significant differences in levels of anandamide (a cannabinoid that we make in our bodies) in cerebrospinal fluid have been documented in migraine patients, and advanced imaging studies have demonstrated below-normal function of ECS in post-traumatic stress disorder. Clinical data have also produced evidence for decreased pain, improved sleep, and other benefits to cannabinoid treatment and adjunctive lifestyle approaches affecting the ECS.

According to Dr. Russo, until recently, only case reports and surveys of use of THC and cannabis and its effects on migraine have been published but a more formal observational trial has been reported from a cannabis-oriented clinic in the state of Colorado. Among 120 adults with migraine for whom cannabis prophylaxis (prevention) was recommended, and of which 67.8% had previously used cannabis, the frequency of headache diminished from 10.4 to 4.6 attacks per month. Overall, 85.1% had decreased migraine frequency, with 39.7% reporting positive effects: prevention of or reduced headache frequency (19.8%) or aborted headache (11.6%) in this selected and uncontrolled population employing a mixture of administration techniques with unanalyzed but presumably high-THC cannabis. Here is a link to an interview with a neurologist from the world famous Cleveland Clinic discussing cannabis for migraines and other health concerns: https://www.youtube.com/watch?v=0avkOph7QCk. Although the video is a little long, it is filled with great information from a very knowledgeable specialist.

It is worth remembering that cannabis was a mainstay of treatment of migraine in Europe and North America for a century between 1843 and 1943, similarly supporting claims of a high degree of efficacy of cannabis treatment in both acute and prophylactic treatments of migraine. The only thing that changes was the politics around cannabis…..not its’s effectiveness as a treatment.

The best results are usually found with a combination of preventive (ongoing use) and acute (when having an event) use of cannabis. A daily regimen of the lowest possible dose of THC combined with CBD whole-plant medicine (oil, tincture, sublingual spray for THC or CBD) will help prevent the onset of migraines, but when they do appear, treat immediately, as soon as you think a migraine is coming on. When a migraine hits, vaping or smoking is quickest way to ingest the medicine and get results.

So, Splitting Headache, cannabis does have promise for patients suffering from migraines. If you’re not a frequent cannabis user make sure you have something on hand for when the next migraine sneaks up on you. Experiment as needed to find out what works best for you.

Wishing you the best in your efforts to manage the pain of this debilitating and all too common problem,

Nurse Susan

p.s. Here are a few more informative resources

https://www.youtube.com/watch?v=-0ulfsHzkpc – University of Colorado Pharmacy School

https://www.ncbi.nlm.nih.gov/pubmed/26015168 - Article by Dr. Eric Baron of the Cleveland Clinic (speaker in the above video)

https://www.hellomd.com/health-wellness/5833c3741acf3d000ce08758/how-to-stop-migraines - article

https://www.hellomd.com/health-wellness/577d4650d64ada0007000013/treating-migraines-with-marijuana-dr-patricia-frye - article