Cannabis: Getting it and using it medicinally
By: Dr. Michael Cutler
When I first heard about medical uses of marijuana I thought there were physicians with a special medical license who could prescribe it. It’s actually a little more complicated than that.
In fact, I wouldn’t be surprised if you were as confused as I was. There is little information available on obtaining it legally or the best ways to take it. But there are definitely some important things you should know before seeking this hotly-debated remedy. So I’m going to show you how to stay on the right side of the law AND reap the biggest health benefit.
Legally obtaining medicinal marijuana is not easy—but possible
As you may suspect, there are a small handful of “marijuana physicians” who will provide nearly anyone with a certification letter regardless of legitimate medical need. In my opinion, from 50 to 90 percent of people using it for “medicinal” purposes do not qualify, but obtain it this way for recreational use. And this accounts for part of the reason that those patients who legitimately may benefit from medicinal marijuana have to jump through hoops to get it.
But for patients who have a real need for medicinal marijuana, in California and the other 22 states currently allowing its medical use, the following steps should be taken:
Firstly, to learn which states currently allow medical marijuana and their legal possession limits, follow this link: https://medicalmarijuana.procon.org/view.resource.php?resourceID=000881
Then, you’ll need to learn what medical conditions are legally treated with medical marijuana in your state. To do that, follow this link (from my previous article): https://www.leafly.com/news/health/qualifying-conditions-for-medical-marijuana-by-state
In all states, to become a medical marijuana patient you need your driver’s license (or state photo ID) and a valid doctor’s recommendation letter certifying your medical condition that qualifies you. I recommend you also obtain a state-authorized medical marijuana ID card through your county, which provides users and their caregivers near guaranteed protection from being arrested by state or local law enforcement officials (as long as you possess within the legal limit for your state). However, obtaining this ID card is voluntary, not mandatory.  It is easiest to obtain a medical marijuana ID card in California, Colorado, Michigan and Montana.
Finding a physician who understands the laws and medicinal uses of cannabis may not be easy. You’ll want to take your medical records with you and you’ll need to have a legal and legitimate medical necessity. Your doctor will need to write a letter stating he/she recommends marijuana use to treat your specific condition. You can search for such a doctor by state here: https://medicalmarijuana.com/medical-marijuana-directory/dispensaries-doctors-lawyers
Once you have your physician’s letter of recommendation and your photo ID (preferably a medical marijuana ID card) you can purchase marijuana from a dispensary. The salesperson at the dispensary will serve as your “cannabis pharmacist” and show you the various options for taking it, as well as legal precautions you should be aware of (both explained below).
Smoking anything can worsen respiratory illnesses, especially if you already have decreased lung function, heart disease or a history of stroke. Also, as with conventional medical prescriptions, be careful your medicinal marijauna doesn’t fall into hands where it doesn’t belong (children, teenage youth, pregnant or nursing mothers).
A June 2015 article  in Clinical Pediatrics describes a new problem in America: increasing numbers of young children being exposed to marijuana. According to their study, researchers found a 147.5 percent increase in marijuana exposure among children under age 6 between 2006 and 2013, and a 610 percent increase in states where marijuana was legalized for medicinal purposes before 2000. More than 75 of these children were under 3 years of age. They ingested marijuana in the form brownies, cookies and other foods containing the drug.
From a legal perspective, once you are using marijuana for your medical condition, you still must not smoke it in public:
- where smoking is prohibited by law
- within 1,000 feet of school grounds, any recreation center, or youth center
- on a school bus
- while in a car, boat, airplane, bus, or other vehicle that is being operated
Best ways to take medicinal cannabis
At your local dispensary you’ll find there are two main marijuana strains: Indicas and Sativas. There are also now hybrid strains of these two. Indicas tend to be more sedating and relaxing with full body effects and therefore are best to treat anxiety, muscle spasms, chronic pains, and insomnia. Sativas tend to be more mentally uplifting and therefore would be best to treat depression, fatigue or attention-deficit disorder.
Though I have rarely suggested medicinal cannabis, most resistance from patients comes from the negative stigma of it and the fear of smoking it. Let’s look at the best ways to take it. When you get to your local dispensary they will share with you the details of what I describe below.
As you might suspect, the quickest way to get marijuana into your blood stream is to smoke it. But I don’t see the need for quick relief in chronic health conditions. Quick relief often means bigger chance of getting hooked on it. Nevertheless, you can smoke a rolled cigarette (joint), a glass pipe, or a bong (a type of water pipe). You’ll feel the effects almost immediately and you can stop smoking it as soon as you reach symptom relief.
We know smoking anything can worsen an existing lung disease. Studies on cancer risk with smoking marijuana have shown mixed results. A recently reported  pooled analysis of 2,159 lung cancer cases and 2,985 controls from U.S., Canada, UK and New Zealand revealed only a slight increased risk of lung cancer among chronic marijuana smokers.
In my opinion, there are other better methods of medical marijuana consumption. However, if you do choose to smoke it, minimize your risk of exposure to toxins and tars contained in marijuana by doing the following:
- Use a higher THC content cannabis so you use less inhalation for your effective dose
- Use a pipe for more consistent dosing
- Use a filter and/or non-chemical rolling paper (if making your own joint)
- Exhale immediately after deeply inhaling it and you will lower the risk of tars coating your lungs
Using a marijuana vaporizer is a better alternative to smoking it. Vaporizers gently heat up cannabis to a lower temperature than smoking it, and can even achieve digital accuracy. This releases the active medicinal component, such as THC, with fewer harmful byproducts such as tars, hydrocarbons, benzene, carbon monoxide or other gases of combustion.
The easiest and safest way to use medicinal marijuana is by eating or drinking it. Edibles are slow to get to a therapeutic level in your blood stream, yet the medicinal effect will last longer and deeper than smoking or vaporizing it. That’s the exact effect you need to best treat a chronic condition.
Be aware that cannabinoids dissolve in fats and alcohol but not in water. So if it is in butter or a vegetable oil it will give you the desired effect. Edibles are made in the form of power bars, cookies, candies, soups, sauces and even “popcorn.”
Active ingredient cannabinoids can also be effective as a drink, and must be made by using alcohol or a fat-based liquid as previously described. These are milks, teas, sodas and alcoholic drinks.
Medical marijuana milk is called “Bhang,” and you can make at home by slowly boiling milk and adding 1/4 ounce of medical marijuana.
Teas can be made by adding marijuana edibles or tinctures to water with alcohol, oil or butter in order to effectively dissolve the THC.
Sodas are now being sold in different flavors too: cola, lemon-lime, Dr. Pepper flavor, grape and orange.
Tinctures, capsules and sprays
Marijuana can be made into tinctures and tonic and then added to food or liquid. A liquid tincture can be placed by drops under your tongue, and is the best route to go if you experience nausea or vomiting. These are made much like the edibles: cannabis plant tops and leaves get soaked in alcohol and the solids get strained to leave behind a liquid containing THC and other cannabinoids.
To make capsules just purchase empty capsules at a health food store or online and place some of the edible pieces inside for ingestion.
Under the tongue sprays are made mostly outside the U.S. but this delivery system has been found to have an unpredictable effectiveness.
Tinctures and tonics can also be applied to your skin. These marijuana topicals are made from cannabis oils and put into balms, salves, lotions, sprays and ointments. They can be very effective pain relievers and anti-inflammatories.
Delivery by suppository would probably be your last choice. But again, this delivery method may help those who experience nausea or vomiting. To get it into a suppository form, you’ll need marijuana powder and a suppository kit that contains beeswax and mold. Then you can keep it (labeled) in your refrigerator
Now you know about marijuana from a holistic new viewpoint, right?
To your health and happiness,
Michael Cutler, M.D.
Easy Health Options
 Bridget Onders, Marcel J. Casavant, Henry A. Spiller, Thiphalak Chounthirath, and Gary A. Smith. Marijuana Exposure among Children Younger Than Six Years in the United States. Clinical Pediatrics, June 7, 2015.
 Zhang LR, Morgenstern H, Greenland S, et al. Cannabis smoking and lung cancer risk: Pooled analysis in the International Lung Cancer Consortium. Int J Cancer. 2015 Feb 15;136(4):894-903.