Dear Legalization Nation,
I have some serious back pain and I heard medical marijuana can help. I got a doctor's recommendation for the herbal remedy, but there's, like, sixty kinds of pot at my dispensary, plus concentrates, edibles, tinctures, and topicals. I'm feeling a bit overwhelmed. What should I chose?
To get a better handle on what pot works for you, it helps to know what pot is, what it does, and what people say is working for them. But first, a special point about the various ways to ingest marijuana.
Rick Pfrommer, a Harborside Health Center manager, repeats popular wisdom in noting that smoking or vaporizing pot is the fastest-acting method of use — with effects beginning in seconds or minutes. This method also has the shortest duration of effect, anywhere from 45 minutes to a couple hours. (According to the federal government, smoking pot is not associated with increased risk of lung cancer.)
Meanwhile, a tincture delivered under the tongue will begin working in as little as five minutes, as will topical preparations of cannabinoids that you rub into your skin. "Topical cannabis has very little to no psychoactive effect. Older patients often enjoy this form of cannabis," Pfrommer wrote in an email.
The problem with tinctures today is, just like one hundred years ago, there's no regulation to confirm a tincture will perform as advertised. Meanwhile, edibles like marijuana cookies have the longest onset, an hour or two. Eating cannabis also generates a much longer and sometimes stronger effect. "This is why people that don't have much experience and re-dose after the initial high can experience too strong an effect," Pfrommer wrote of the concerns of edibles.
But regardless of how you decide to ingest pot, you need to know some basics. Cannabis strains can be divided into two general categories — indica and sativa. "In general parlance, indicas are considered to have more of a sedative effect, whereas sativas are thought to be more uplifting," Pfrommer explained.
Doctors commonly recommend indicas for pain relief, insomnia, post-traumatic stress disorder, nerve damage, appetite stimulation, and anxiety disorders. However, if you suffer from depression, you might want to stay away from indicas.
Sativas, by contrast, can be used to treat depression and to stimulate your appetite. Patients with depression tend to use sativas like Jack Herer and Durban Poison for energy and a mood lift. "Sativa is also very good for creative work and generally doesn't have the couch-lock effect that many indicas have," Pfrommer noted.
Patients commonly report that pot doesn't actually eliminate pain, rather, weed dethrones it. As San Francisco patient advocate David Goldman pointed out, the pain is still there, but it's not as insistent or overwhelming. "The person is no longer obsessed with it," Goldman explained. "Part of the misery of pain and suffering is the obsessing about it. You can't think about anything else besides how much misery and pain you're in. Cannabis can distract you."
Patients generally report that the purer the indica, the better it is for pain. Try Pure Afghan, Afghani #1, Grape Ape, Jilly Bean, King Louis, or L.A. Confidential. For those who don't want to sleep, sativas in the Jack Herer line have been reported to relieve pain.
THC is the main psychoactive cannabinoid in pot and is responsible for the euphoria or "high" associated with the drug. The second most abundant cannabinoid in pot is cannabidiol, better known as CBD, and it's a known anti-inflammatory. That means strains with high levels of CBD — typically sativas — can also be effective in relieving pain. And patients who seek pain relief but don't want to be too stoned are now often turning to sativas with low levels of THC and high levels of CBD, such as Trident or Harlequin.
After pain, insomnia and tension were the top three reasons why East Bay patients sought a physician's recommendation for cannabis, according to 2006 RAND survey. For insomnia, indicas provide a knockout punch, and you probably want to stay away from sativas, which can make you feel speedy and energetic. Blackberry Kush and Platinum Bubba Kush are two go-to insomnia strains.
Tension, Stress, and Anxiety
For tension, sites like Leafly.com and other experts recommend hybrid strains that include both indica and sativa, like the famed OG Kush lineage, which includes Sour Diesel and Chemdawg. Hybrids that include the sativa Haze can also melt anxiety. We love Blue Dream, a fifty-fifty mix of sativa Haze and indica Blueberry.
Some people recommend the hybrids Girl Scout Cookies, Green Ribbon, Green Crack, and Trainwreck for stress, but if you suffer from anxiety, high-THC strains such as these have been known to worsen anxiety in some patients. If you're anxious, and pot makes you paranoid, a strong indica like Romulan can relieve anxiety.
However, if you have problems with both anxiety and depression, you might try Trident or Harlequin — strains, as we noted above, that are low in THC and high in CBD. High-CBD, low-THC tinctures can also work for cancer patients who need an appetite but don't want to feel euphoric.
UC Davis' Kymron deCesare, lab manager at Halent Labs wrote in an email that sativas high in THC like Super Silver Haze also are being used to treat attention deficit disorder in some patients.