Kush Jem

Table of Contents

NexT TexT Frum https://www.etymonline.com/word/gem

[ Ehtimmolluhjee Uhv Wrd ] gem (n.)

"a precious stone" (especially when cut or polished), c. 1300, probably from Old French gemme (12c.), from Latin gemma "precious stone, jewel," originally "bud," from Proto-Italic *gebma- "bud, sprout," from PIE *geb-m- "sprout, bud" (source also of Lithuanian žembėti "to germinate, sprout," Old Church Slavonic prozebnoti "to germinate")…

Of persons, "a rare or excellent example (of something)" from late 13c. Alternative forms iemme, gimme persisted into 14c. and might represent a survival of Old English gimm "precious stone, gem, jewel," also "eye," which was borrowed directly from Latin gemma.

gem (v.)

c. 1600, "to adorn with gems;" earlier (mid-12c.)

"to bud," from gem (n.).

Related: Gemmed; gemming.

3 Typs Uhv Kush Jemz:

1: Sollid Kush Jemz

2: A ThoT Kush Jem

  • ReeGahrdz An ImpohrTanT ( biochemical FacT Ohr SaeefTee Info ) UhbouT Ehnee Psychoactive drug, Lyk Thohz In Thuh Kush Byb EL.

3. An Adorn Kush Jem Iz A Kuhnsuum Task.

NexT TexT Wuhz Frum

[ Ehtimmolluhjee Uhv Wrd ] adorn (v.)

late 14c., aournen, later adornen, "to decorate, embellish," also "be an ornament to," from Old French aorner "to order, arrange, dispose, equip; adorn," from Latin adornare "equip, provide, furnish;" also "decorate, embellish," from ad "to" (see ad-) + ornare "prepare, furnish, adorn, fit out," from stem of ordo "row, rank, series, arrangement" (see order (n.)). The -d- was reinserted by French scribes 14c. and in English from late 15c. Related: adorning, Adorned.

Sykehdehlik Wrd Dehskripshuhnz

Thuh Wrd Speld "Psychedelic" Iz Sownded Owt az p->s->ah->ee->k->ee->d->ee->l->i->k.

Baeest Fruhm Heereeng That Wrd Spohk AT https://www.howtopronounce.com/psychedelic/,

Thohz Sowndz Myt Get Rehpreezehnted In Fohnehtik Eeng-Glish Speech Sownd Synz Az:

  • S->ŏ->ē->k->ĕ->d->ĕ->L->ĭ->k

Then Mayd Shohrt Az Sykehdehlik.

Ĕtĭmŏlŭjē Ŭv Wrd Prōnăwnst Ăz Sykehdehlik

Thŭ Nĕkst Tĕkst Wŭz Frŭm:

psychedelic (adj.)

In popular use from 1965 with reference to anything producing effects similar to that of a psychedelic drug or enhancing the effects of such a drug.

occasionally psychodelic,

As a noun from 1956. [ Mŏdrn Egzampul: Tōkt Sŭm psychedelic ]

1956, of drugs, suggested by British-born Canadian psychiatrist Humphry Osmond in a letter to Aldous Huxley

[ Then ] used by Osmond in a scientific paper published the next year;

from Greek psykhē "mind" (see psyche) + dēloun "make visible, reveal," from dēlos "visible, clear,"

from PIE [ Pan Indo-European ] root *dyeu- "to shine."

Dĕskrĭpshŭnz Ŭv Wrd psychedelic Fruhm merriam-webster.com

Thŭ Nĕkst Tĕkst Wŭz Frŭm:

First Known Use of psychedelic

Noun 1956, in the meaning [ Dĕskrybd Bēlōw ]

Adjective 1957, in the meaning defined at sense 1a
[ Dĕskrĭpshŭnz Ŭv Wrd] psychedelic…

( Entry 1 of 2 )…

psychedelic noun…

Definition of psychedelic (Entry 2 of 2)…

psychedelic adjective…

1a : of, relating to, or being drugs (such as LSD) capable of producing abnormal psychic effects
b : produced by or associated with the use of psychedelic drugs a psychedelic experience
2 : imitating, suggestive of, or reproducing effects (such as distorted or bizarre images or sounds) resembling those produced by psychedelic drugs psychedelic color schemes
3 : of, relating to, characteristic of, or being the period of the mid- to late-1960's that is associated with the psychedelic drug culture

Thŭ Nĕkst Tĕkst Wŭz Frŭm:

Psychedelic drug [ Frŭm sciencedaily.com ]

Psychedelic drugs are psychoactive drugs whose primary action is to alter the thought processes of the brain.

Many psychedelic drugs are thought to disable filters which block or suppress signals related to everyday functions from reaching the conscious mind.

These signals are presumed to originate in several other functions of the brain, including but not limited to the senses, emotions, memories and the unconscious (or subconscious) mind.

This effect is sometimes referred to as mind expanding, or consciousness expanding as your conscious mind becomes aware of (or sometimes assaulted by) things normally inaccessible to it.

At high levels this can overwhelm the sense of self and can result in a dissociative state.

Thiss Iz Thuh Last Lyn Uhv Tekst Uhv Thuh Paeej Naeemd Sykehdehlik Wrd Dehskripshuhnz.

Psychotropic Wrd Deskripshuhnz

Thuh Nekst Tekst Wuhz Fruhm:

Psychotropic (adj.)

1956, from psycho- + Greek -tropos "turning," from trepein "to turn" (from PIE root *trep- "to turn"). Hence, what "turns" the mind.

Thuh Nekst Tekst Wuhz Fruhm:

psy·cho·trop·ic (sī'kō-trop'ik, -trō'pik),
Capable of affecting the mind, emotions, and behavior;
denoting drugs used in the treatment of mental illnesses.
[psycho- + G. tropē, a turning]
Farlex Partner Medical Dictionary © Farlex 2012

psychotropic /psy·cho·tro·pic/ (si″ko-tro´pik)
capable of modifying mental activity; exerting an effect on the mind; said especially of drugs.
Dorland's Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

psy·cho·tro·pic (sī'kō-trō'pik)
Capable of affecting the mind, emotions, and behavior; denoting drugs used in the treatment of mental illnesses.
[psycho- + G. tropē, a turning]
Medical Dictionary for the Health Professions and Nursing © Farlex 2012

drug/agent used to treat mental illness
Illustrated Dictionary of Podiatry and Foot Science by Jean Mooney © 2009 Elsevier Limited. All rights reserved.

psychotropic (sīˈ·kō·trōˑ·pik),
concerns drugs that affect the mind and influence behavior._
Jonas: Mosby's Dictionary of Complementary and Alternative Medicine. (c) 2005, Elsevier.

capable of modifying mental activity.
[ Az In: ] psychotropic drugs
the important groups in veterinary medicine are the phenothiazine, thioxanthene, butyrophenone and benzodiazepine derivatives.
Saunders Comprehensive Veterinary Dictionary, 3 ed. © 2007 Elsevier, Inc. All rights reserved

Thiss Iz Thuh Last lyn Uhv Tekst In Thuh Payj Naymd " Psychotropic Wrd Deskripshuhnz ".

Wrd nohrm Speld "PsychoAcTive" Iz Sownded Owt Az p->s->ah->ee->ch->oh->a->k->T->ah->ee->v->eh

Thoh Iz Nohrm Spohk Az S->ah->ee->k->oh->a->k->T->ĭ->v.

That Myt Get Maeed Shohrt Az Sykoaktiv.


Thuh Nekst Tekst Wuhz Impruuvd Thoh Sohrst Frum:

A psychotropic substance [ That Haz Beekuhm Uh ] psychoactive drug…is a chemical substance that acts primarily upon the central nervous system where it alters brain function, resulting in temporary changes in perception, mood, consciousness and behavior.

These drugs may be used recreationally to purposefully alter one's consciousness ( such as coffee, alcohol or cannabis ), as entheogens for spiritual purposes…and also as medication (such as the use of narcotics in controlling pain, stimulants to treat narcolepsy and attention disorders, as well as anti-depressants and anti-psychotics for treating neurological and psychiatric illnesses).

Many of these substances (especially the stimulants and depressants) can be habit-forming…

Conversely, others (namely the psychedelics) can, in certain circumstances, help to treat and even cure [ So-Kahld ] addictions.

Table of Contents

Drug DeTox NooTrishuhn

EnhansT NexT TexT Fruhm http://www.heretohelp.bc.ca/vision-alcohol-vol2/role-nutrition-recovery-alcohol-and-drug-addiction

A diet for recovery should include:

Complex carbohydrates (50% to 55% of the calories you consume),

  • which means plenty of grains, fruits and vegetable

Dairy products or other foods rich in calcium

Moderate protein (15% to 20% of calories):

  • two to four ounces twice a day of meat or fish (or another high-protein food such as tofu [ Or Milk ])

Fat choices (30% of calories), preferably good oils (EssenTial Fatty Acids)

NachruL DeTox

NexT TexT Frum: https://www.leaf.tv/articles/how-to-naturally-detox-from-drugs-at-home/

Drink lots of fluids

A daily intake of eight to 12 glasses of fluids each day flushes out the toxins and chemicals. All healthy fluids water, fruit juices, vegetable juices and herbal teas are a good way to clean the body internally. The wastes, impurities and drug residues are washed out of the cells, tissues and organs.

Lose fat by exercising.

Even if you aren't overweight, losing fat will help with detoxification from drugs. Most chemicals and toxins that enter the body are stored in the fat cell. By losing excess fat, a person also loses toxins. To lose the fat, do aerobic exercise. Swimming, running, dancing and cycling are good cardiovascular exercises that help to burn calories and fat. During a high-impact workout, a person also builds up a sweat. Toxins are released through the sweat glands. Building muscle with weights or resistance training also burns fat. In time, the muscles replace the fat deposits. Breathing deeply during any type of exercise helps to expel toxic carbon dioxide from the lungs. On inhalation, more oxygen enters the body.

Have a healthy diet.

Eating fruits and vegetables gives the body the nutrients it needs to repair itself

  • and carry out its many functions.

Organic foods are more expensive, but they are better for the body,

  • because they contain fewer chemicals like preservatives and pesticides.

Adding fiber to the diet helps in moving wastes & debris through the intestines & out the body.

DeTox NooTrishuhn


ReComMendEd, Common, NuTrishuhnuL Drinks DeTox, Eezee Tu GeT AT A Corner STore Drinks Include:

ION4 Advanced ELECTROLYTE SysTem POWERADE MounTain Berry BlasT

* SporTs Drink WiTh VITAMINS B3, B6, & B12
* MounTain Berry BlasT With Mixed Berry Flavored + OThr NaTural Flavors

GLACEAU ViTamin WaTer Energy Tropical Citrus Flavored

* WiTh ViTamins: C ViTamin, b5, B6, B12
* With Electrolytes And 50 mg Caffein
* NuTrienT enhanced WaTer beverage

V8 Energy Protein

V8 Original 100% VegeTable Juice WiTh 2g Uhv [ProTein


See ALso:

Addict syt blaeem Drug Tho Naturopath Praise Drug

Table of Contents

Drug AddikT SyTs Tend Tu miss-BLaeem pSykohAkTiv Drugz Fohr Suhm [[Heewman]]]'z bad KehrakTr fahLTs.

Kuhmpehr Thuh Nekst Risks blamed on Marijuana With Thuh Following Naturopathic Praise Uhv Marijuana.

++Thuh NeksT TeksT Wuhz Fruhn: https://www.addictions.com/marijuana/#risks

[ Supposed Risks uhv ] Mental Effects of Marijuana use include:

An anxiety that does not go away or gets worse as a result of smoking pot
Depression or a depressed state
Social intolerance or a lack of desire to be social
Paranoia or feeling like everyone is out to get you
Acute psychotic reactions

[ Supposed Risks uhv ] Effects of Marijuana on the Heart:

Increased heart rate by 20-100%
Increased risk of heart attack
Increased risk of cardiovascular vulnerabilities

[ Supposed Risks uhv ] Effects of Marijuana on the Lungs:

Carcinogenic toxins create lung cancer
Increased exposure to disease
Increased risk of pneumonia
Increased risk of cold

[ Supposed Risks uhv ] Effects of Marijuana on Life:

Lack of motivation
Physical impairment
Mental impairment
Reduced cognitive abilities
Poor social life

[ Supposed Risks uhv ] the Side Effects of Marijuana Addiction?

Extensive research has shown that smoking marijuana can lead to some physical and psychological consequences such as:

Changes in appetite
Mood swings
Red eyes
Sleep disturbances
Increased heart rate
Difficulty concentrating
Memory problems
Dry mouth
A productive cough

[ Supposed Risk uhv ] Paranoia is also a common symptom of marijuana use,

  • although friends and family members of the individual suffering from marijuana addiction are more likely to notice this effect than the user. Only after they are in recovery do most individuals realize the degree to which marijuana-induced paranoia has been negatively impacting their lives.

Most of these symptoms will wear off as the drug itself wears off, but for some, the psychological effects of marijuana can last many months or even years after the individual stops smoking pot.

Insomnia can persist for many months, often pushing individuals to relapse and to return to marijuana.

Anxiety and depression are also common outcomes of marijuana abuse that can persist for months, often leading to relapse…

No longer using marijuana after a prolonged phase of marijuana use can lead to the following

[ possible ] withdrawal symptoms:

Poor appetite
Mood swings

Kuhmpehr Those Addict Site warnings Tu Mehriwahnuh Nachropathik Eeuuss Kyndz.

Mehriwahnuh Nachropathik Eeuuss Kyndz

Table of Contents

Thuh NekST TekST Wuhz Fruhm:

Medical Cannabis and Naturopathy

By Qingping Zheng, M.Sc, ND, Clinic Supervisor & Research Faculty,

  • Canadian College of Naturopathic Medicine on October 16, 2018

The genus Cannabis, commonly known as marihuana or marijuana, refers to a flowering plant of which

there are 3 main species, Cannabis sativa, Cannabis indica and Cannabis ruderalis.

It has received a lot of public and media attention since the announcement of legalization for recreational use in Canada.

Medical cannabis refers to using cannabis or cannabinoids as a medical therapy to treat disease or alleviate symptoms.

In addition to requiring prescription and oversight from a healthcare provider with knowledge, skills, scope and competency, this may also differ from recreational use due to differences in product quality and consistituents.

Despite the fact that the

herb Cannabis has been used for more than 3,000 years for the treatment and management of pain, digestive issues and psychological disorders

  • by various cultures, many healthcare providers are somewhat familiar or experience discomfort with appropriate medicinal usage. A recent survey (1) of Canadian physicians revealed that dosing and the need for safe, effective treatment monitoring places were at the forefront of educational needs. This may be in part due to stigma, as well as significant changes in the volume and quality of both evidence and high quality products as well as the regulatory and legal policies surrounding its use (2). Although the list of conditions for approved medical use has been growing, the research to support many of these treatments is limited. To help further understand this plant, a brief review of the available evidence on its pharmacology and medical uses, along with the safety issue from the perspective of naturopathic medicine, is provided to help address gaps in knowledge or understanding.

Chemical Composition Uhv Hemp

Hemp grows throughout temperate and tropical climates but originated from central Asia or in the foothills of the Himalayas (3).

++The leaves and flowering tops of cannabis plants
+++contain at least 489 distinct compounds known as cannabinoids distributed among 18 different chemical classes,
+++and harbor more than 70 different phytocannabinoids (4).

Many of these compounds interact with our bodies via the endocannabinoid system (5),

where their actions are mainly

mediated by their interaction with two closely related receptors, CB1 and CB2,

  • first chemically identified in the 1940s (6,7). Potential for these receptor-mediated interactions are high, particularly throughout the central nervous system (CNS), with

CB1 receptor being expressed in neurons and

CB2 receptors being localized primarily on cells of the immune system.

Δ9-THC is by far the best studied phytocannabinoid, and is responsible for the psychoactive effects of cannabis through its actions at the CB1 receptor (8). It is the major psychoactive constituent and also has the largest association with tolerance and withdrawal effects. THC is regularly used to measure the herb’s potency. Typical concentrations of THC are less than 0.5% for inactive hemp, 2% to 3% for marijuana leaf, and up to 4-8% for higher-grade seedless, or sinsemilla buds. Higher concentrations can be found in extracts, tonics, and hashish (concentrated cannabisresin).

THC displays complex psychoactive effects, analgesic, cognitive, muscle relaxant, anti-inflammatory, appetite stimulant and antiemetic activity (9).

Cannabidiol (CBD) is the main non-psychoactive phytocannabinoid in the cannabis plant

  • that has drawn more attention in recent years. It does not have the intoxicating effects of THC, and
  • [ Cannabidiol (CBD) ] does not develop tolerance and withdrawal effects (10).

Despite its weak affinity for the CB1 and CB2 receptors, CBD seems to antagonize CB1/CB2 receptor agonists in CB1 and CB2 expressing cells and tissues (11).

Animal studies have demonstrated
[ Cannabidiol (CBD) ] has neuroprotective (12,13), anti-inflammatory, antioxidant properties (14), anticonvulsant, analgesic, anti-anxiety, antiemetic, immune-modulating and anti-tumorigenic properties.

Preliminary clinical trials suggest that

high-dose oral CBD (150–600 mg/d) may exert a therapeutic effect for social anxiety disorder, insomnia and epilepsy,

  • but it may also cause mental sedation (15).

There is considerable variation in the consistency of constituents amongst Cannabis plants and species. In general, cannabis products (recreational and medicinal) derived from

Cannabis sativa exhibit a higher CBD/THC ratio than products derived from Cannabis indica.

Administering different ratios of THC and CBD leads to diverse outcomes. Experimental studies indicate CBD attenuates effects of ∆9-THC requiring at least 8 : 1 (±11.1) ratio of CBD to THC; whereas CBD appears to potentiate some of the effects associated with THC when the CBD to THC ratio is around 2 : 1 (±1.4) (16).

** Use of Medical Cannabis:

Cannabis is a potent antiemetic with…Cancer chemotherapy:

Nausea and vomiting associated with cancer chemotherapy is one of the most familiar and well-established uses of cannabis in modern medicine. Cannabis is a potent antiemetic with therapeutic potential in cancer care(17). A systematic review and meta analysis of medicinal cannabis (18) found all studies suggested a greater benefit of cannabinoids compared to both active comparators and placebo, however no single study reached statistical significance. It is also important to note that paradoxically at excessive doses, Cannabis can precipitate cannabis hyperemesis syndrome (CHS) (19). This is relatively infrequent, but significant adverse reaction is characterized by severe nausea and vomiting followed by a period of deep sleep. For patients undergoing chemotherapy and radiation, THC is known to increase appetite, and subsequently weight, as an additional benefit.

effectiveness of cannabis in treating Chronic pain:

The systematic reviews on the efficacy and safety of cannabis-based medicine for chronic pain conditions have yielded diverse conclusions. A recent systematic review (20) supported the effectiveness of cannabis in treating chronic pain, primarily for neuropathic pain patients. However, Häuser W et al (21), didn’t come to a conclusion of the effectiveness of cannabis based on the quality of the clinical trial, most critical challenge being the small size and short term of research design. A 2014 statement issued by The Canadian Pain Society (22) recommended cannabis-based medicines as a potential third-line treatment for chronic neuropathic pain; while the Canadian Agency for Drugs and Technologies in Health (23) (2016) reviewed clinical safety and effectiveness of cannabinoid buccal spray for chronic non-cancer or neuropathic pain and suggested there was insufficient evidence to make well-founded conclusions about the clinical advantage and use of cannabis-based medicines for the management of cancer and non-cancer pain.

Cannabinoids typically lowers intraocular pressure (IOP) by up to 30% [ with ] Glaucoma:

Ocular (as well as systemic) administration of cannabinoids typically lowers intraocular pressure (IOP) by up to 30% although the mechanism is not well elucidated (24). A small but well-controlled pilot study of 6 patients with ocular hypertension or early primary open-angle glaucoma reported that two hours after sublingual administration of a single 5 mg Δ9-THC reduced the IOP significantly and was well tolerated by most patients. Sublingual 20 mg of CBD did not reduce IOP ( intraocular pressure ), while 40 mg of CBD increased IOP at four hours after administration (25).

clinical use of CBD for spasticity and pain in Multiple sclerosis:

The various needs and symptom profiles of patients with multiple sclerosis (MS) present with make it difficult to assess the observed and potential effectiveness of cannabis. Pharmaceutical CBD have been investigated for its effectiveness and safety in treating MS. A recent systematic review (26)supports the clinical use of CBD for spasticity and pain in multiple sclerosis, while it is not inconclusive on use to treat other common symptoms like bladder control, ataxia and tremor. Adverse effects including dizziness, dry mouth, euphoria, diarrhea, and difficulty concentrating were most frequently described as “mild” to “moderate”. Some researchers argued that a risk/benefit decision may be needed in the management of CBD used by MS patients. According to another study (27), the benefitsof CBD were generally observed within the first 4 weeks; thus a trial of 4-6 weeks is recommended to determined whether patients will receive clinical benefit.

CBD has been drawing more attention in treating most of Anxiety disorder:

Compared with THC, that has been found to induce anxiety in healthy subjects (28), CBD has been drawing more attention in treating most of anxiety due to its anxiolytic property (29) without impairing cognitive performance (30). Increasing doses of CBD leads to a linear reduction in anxiety, compared with the biphasic anxiolytic/anxiogenic effect of THC use (31). A double-blind randomized design study (32) on 24 patients with generalized social anxiety disorder (SAD) demonstrated that 600mg orally pretreatment with CBD significantly reduced anxiety, cognitive impairment and discomfort in their speech performance, compared with the placebo group. A fMRI study on fifteen healthy men found that oral administration of 600mg CBD and 10mg D-9-THC presented opposite neurophysiological effects when performing different cognitive task; while the following behavioral experiment on six healthy volunteers, after pretreatments of 5mg CBD intravenously (IV) followed by 1.25 mg IV D-9-THC prevented the acute induction of psychotic symptoms, thus might lessen the anxiogenic effects of THC (33).

CBD…shows a promising anticonvulsant profile [ for ] Epilepsy:

Cannabis preparations have reported to be beneficial in treatment of epilepsy and other seizure disorders, particularly drug refractory childhood epilepsies. Cannabis products with moderate to high THC content are generally unsuitable for this condition, considering the potential risk of seizure aggravation (34) and undesired side effects such as psychiatric disorders, addiction liability, cognitive and motor impairment in the childhood population. CBD, on the other hand, shows a promising anticonvulsant profile in the recent high quality RCT trials. The efficacy of CBD as add-on therapy for patients with Dravet syndrome (35) and drop seizure in patients with Lennox-Gastaut syndrome (36) were investigated. The results of these studies demonstrate that, at a dosage of 20 mg/kg/day, add-on CBD was efficacious in reducing the frequency of convulsive seizures. The CBD group was had higher adverse events such as diarrhoea, somnolence, pyrexia, decreased appetite, and vomiting, but generally well tolerant. As seen in other disorders, this case illustrates that the risk: benefit profile of cannabinoids needs to be weighed and discussed with patients prior to initiating therapy. Current best practices do not suggest CBD as stand-alone monotherapy in seizure disorders.
Sleep disorder:

According to the studies, different doses of THC yields mixed results.

A low dose of THC (less than 5 mg) seems to increase the quality of sleep

  • and reduce the frequency of nightmares (37) while administration of

larger dose [ of THC ] (15mg) decreased sleep latency on the following morning,

  • and disturbed both mood and memory on the next day. Novel studies investigating cannabinoids and obstructive sleep apnea suggest that synthetic cannabinoids such as nabilone and dronabinol may have short-term benefit for sleep apnea due to their modulatory effects on serotonin-mediated apneas. CBD may hold promise for REM sleep behavior disorder and excessive daytime sleepiness, while nabilone may reduce nightmares associated with Post-traumatic stress disorder (PTSD) and may improve sleep among patients with chronic pain.

Chronic cannabis use is associated with negative subjective effects on sleep that are manifested most prominently during withdrawal. Symptoms reported include sleep difficulties such as strange dreams, insomnia, and poor sleep quality.

These results are consistent with one interpretation that cannabis is typically not beneficial to sleep except among medicinal cannabis users who are identified by the presence of pre-existing sleep interrupting symptoms such as pain. As such, cannabis may be thought to improve sleep via the mediating improvement of these confounding symptoms.

Methods for using Cannabis:

Cannabis can typically be administered by inhalation, oral ingestion, and topical application.

Each delivery method has its advantages and disadvantages. The effects of cannabis are felt fastest when it is inhaled (i.e. liquid aerosol, nebulized or ‘smoked’). Inhalation is the most common way with the advantages of quick action, ease of monitoring the amount ingested, convenience, and short-term duration of effect. Side effects often include increasing risk of bronchitis and potential link to cancers of the respiratory tract, particularly when smoked.

Vaporizing (liquid aerosol) has been considered safer than smoking

  • because there are less by products since a lower temperature is used in the vaporizer and is thus a healthy alternative to smoking, however these statements deserve further investigation and evaluation.

Cannabis oils and tinctures are examples of concentrates of cannabis taken orally.

Compared to smoking, oral administration results in slower onset of action, lower blood levels of cannabinoids, and a longer duration of pharmacodynamic effects (38), though there is some indication that different oral forms (sublingual, food-product, ‘extended-release’) will have differing pharmacokinetic profiles.

Topicals are one of the lesser known forms of medicinal cannabison the market,

  • but they have significant potential to benefit people with inflammation and pain. The low THC content make them particularly attractive to consider for cannabis-naïve or cannabis-hesitant users. The other topical application is suppositories which can sometimes have some psychoactive effect depending on the product constituents.

Prescribed cannabis or cannabidiol approved by Health Canada

  • includes Nabilone (commercial name of Cesamet®) and Dronabinol (commercial name of Marinol®) which are the orally administered synthetic structural analogues of Δ9-THC. The latter was discontinued in the Canadian market in 2012. Cesamet® is sold as capsules (0.25, 0.5, 1 mg) and is indicated for the treatment of the nausea and vomiting associated with cancer chemotherapy (39). Nabiximols (commercial name of Sativex®) is from a whole-plant extract of two different, but standardized, strains of Cannabis sativa containing approximately equivalent amounts of Δ9-THC (27 mg/mL) and CBD (25 mg/mL), and other cannabinoids. It is marketed as an adjunctive treatment for the symptomatic relief of spasticity and neuropathic pain in adults with multiple sclerosis and as an adjunctive analgesic in adult patients with advanced cancer who experience moderate to severe pain (40).

[ Cannabis ] Safety

1: [ Cannabis ] Toxicity:

* To date there has been no documented fatal overdose from isolated Cannabis use.**

These statistics are impressive if compared with other commonly used recreational drugs. Globally, alcohol was linked to over 3 million deaths per year in 2012, and tobacco is reportedly linked to the deaths of more than 6 million people each year (41). Although several toxicology studies (42,43) with THC in animals suggested that THC was considered a safe drug both in acute and long-term exposure, toxicity of the commercial synthetic cannabinoids was found to be increased compared with Cannabis itself (44).

[ Cannabis use ] side effects typically include:

dizziness/light-headedness, sedation, confusion, ataxia, a feeling of intoxication, euphoria (“high”), xerostomia, dysgeusia, and hunger (20).

2: [ Cannabis ] Tolerance:

Ina residential laboratory study (45,46) on twelve daily marijuana smokers, the development of tolerance was evaluated after four-day period administration in two different groups including the oral THC pills group and the smoked marijuana group. Each pills contained 30 mg of THC and smoked marijuana dose consisted of 3.1% THC, and they were administrated four times a day in each group. Both groups became tolerant to subjective effects of THC such as feeling “high” and “good drug effect” but not to its effects on food intake or social behavior. The tolerance was disappears rapidly following cessation of administration (47). In addition, the dynamics of tolerance vary with respect to the different constituents and effects (48). However, some long-term studies reported the absence of pharmacological tolerance (49, 50)– this suggests that dosing straetgies may help alleviate or prevent issues of tolerance.

3: [ Cannabis ] Addiction: Cannabis is considered to be also far less addictive

There is evidence that cannabis dependence (physical and psychological) occurs especially with chronic, heavy use (51). However, Cannabis is considered to be also far less addictive than alcohol, nicotine, cocaine, opiates and other psychoactive drugs. In the 1970’s, recreational cannabis became known as “the gateway drug,” but facts do not support this statement. In fact, studies suggest medical cannabis is a safer alternative rather than prescriptions of some pharmaceuticals with well-known potential for addiction (52).

4: [ Cannabis ] Exacerbations: smoked Cannabis is not recommended in patients with respiratory insufficiency

Cannabis does have the potential to exacerbate symptoms of underlying conditions, such as severe cardiopulmonary disease because of occasional hypotension, possible hypertension, syncope, or tachycardia (53); Studies showed that although Cannabis smokers have minimal changes in pulmonary function studies as compared to tobacco smokers, they may develop bullous disease and spontaneous pneumothorax. The relationship between Cannabis smoking and lung cancer remains unclear due to design limitations of the studies published so far. Therefore, Health Canada stated in 2013, “smoked Cannabis is not recommended in patients with respiratory insufficiency__ such as asthma or chronic obstructive pulmonary disease (COPD)__” (54).

5: [ THC impairs Tho CBD Improves ] Cognitive function:

Evidence has demonstrated that high THC/low CBD Cannabis (55) lead to greater cognitive impairments, in particular memory function, attention and emotional processing in individuals. On the other hand, research showed CBD seems to antagonize THC-induced impairments and improve cognition in multiple preclinical models of cognitive impairment, including models of neuropsychiatric (schizophrenia), neurodegenerative (Alzheimer’s disease), neuro-inflammatory (meningitis, sepsis and cerebral malaria) and neurological disorders (hepatic encephalopathy and brain ischemia) (56). However it is unclear whether at specific concentrations CBD might outweigh any harmful effects of THC on cognition.

6: Uncertainty of risks [in] mental health…during…Brain development:

The regular (mis)use of cannabis during developing childhood and adolescence is of particular concern and the question of whether Cannabis is harmful remains the subject of heated debate. Although multiple studies have reported the adverse effects of Cannabis use on mental health are greater during development, particularly during adolescence, than in adulthood (57), others studies (58) have not made definite conclusions as to whether cannabis use alone has a negative impact on the human adolescent brain (59). Given the uncertainty of potentially risks, “Cannabis should not be used in any person under the age of 18, and physicians in Ontario “are not allowed to prescribe Cannabis to patients under the age of 25 unless all other conventional therapeutic options have been attempted and have failed to alleviate the patient’s symptoms” (60).

7: Mental health: cannabis should not be used in patients with schizophrenia

Whether the use of Cannabis might precipitate mental illness in some patients is a long standing concern. Cannabis has been linked to episodes of acute psychosis (61) and can exacerbate the symptoms of existing psychotic illness like schizophrenia (62, 63). However, some studies report the opposite results—CBD seems to represent a mechanistically different and less side-effect prone antipsychotic compound for the treatment of schizophrenia, even though the underlying pharmacological mechanisms are still debated (64). Given the uncertainty of results, Health Canada suggests “medicinal cannabis should not be used in patients with a personal history of psychiatric disorders (especially schizophrenia)” (65). In other conditions like anxiety disorders, the anxiolytic effects of Cannabis in clinical populations are inconsistent (65).

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By Christopher G. Fichtner, MD, And Howard B. Moss, MD

Perceived benefits of medical cannabis

Regardless of the legal status of cannabis, many patients with psychiatric disorders use cannabis and report improvement in their symptoms. Patients use cannabis for symptoms of PTSD, anxiety disorders, depression, ADHD, bipolar disorder, chronic pain, insomnia, opiate dependence, and even schizophrenia. In addition, patients use cannabis for neurological conditions such as the spasticity of multiple sclerosis, agitation in dementia, and specific seizure disorders that are unresponsive to standard therapies. Patients also use cannabis to reduce the nausea and anorexia of cancer chemotherapies and to improve their mood and outlook—frequently with their oncologist’s approval…

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By Christopher G. Fichtner, MD, And Howard B. Moss, MD

Schizophrenia, CBD, and THC

Molecular CBD has been shown to treat symptoms of schizophrenia

  • under controlled clinical trial conditions, with results comparable to those of treatment with an approved antipsychotic medication, and with a favorable adverse-effect profile.4 Other studies support the view that

CBD may have therapeutic potential as an antipsychotic

  • and may counter or offset psychotomimetic effects of THC. Differences between THC and CBD notwithstanding, in a small case series, 6 patients with schizophrenia and a history of symptom relief with cannabis use were treated with the addition of low-dose prescription THC to regimens that included clozapine in some cases or multiple antipsychotics in 1 patient.5 Four of the 6 patients showed improvement with the addition of THC to their regimen, and in 3 of the 4 patients a specific antipsychotic effect was evident. As with the anxiogenic potential of THC, dosage may be important in the relationship between THC and psychosis.

Cannabis and cognition

The National Academy report also acknowledged that there is moderate evidence of a statistical association between cannabis use and better cognitive performance among individuals with psychotic disorders and a history of cannabis use. It has been speculated that this could represent a less cognitively vulnerable subgroup of patients who would not have developed psychosis in the absence of exposure to cannabis, but this is not known. More generally, there is moderate evidence of a statistical association between acute cannabis use and impairment in the cognitive domains of learning, memory, and attention. However, results have been mixed on the question of longer-term and residual cognitive impairment. A recent report indicates neuropsychological decline in persistent long-term users with cannabis use disorders, although an earlier meta-analysis found no residual impairment.6,7 Evidence of impaired academic achievement and educational outcomes was judged to be limited according to the National Academy report. Again, with cognitive functioning as with the risk of psychosis, dosage may be an important factor, since the findings of impairment relate primarily to heavy long-term use and even more specifically to those patients with cannabis use disorders.

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By Christopher G. Fichtner, MD, And Howard B. Moss, MD

Cannabis and PTSD

Evidence that cannabis or cannabinoids are effective for improving symptoms of PTSD

  • is considered limited by the National Academy report, but clinical reports and case series excluded under its research quality criteria are more positive for the benefits of cannabis for PTSD symptoms.

A growing number of states have included PTSD as one of the acceptable indications for recommending or approving medicinal use of cannabis.

Clinicians who have written large numbers of medical cannabis recommendations have documented that a sizeable minority have been for psychiatric indications, with PTSD being perhaps the most common.10

Greer and colleagues11 reported on 80 patients with PTSD who were approved for medicinal use of cannabis through the New Mexico Medical Cannabis program. As a retrospective assessment, the study’s methodology limits the scientific conclusions that can be drawn. However, the authors reported decreases of 75% overall and separately in each of the 3 respective (DSM-IV) symptom clusters: re-experiencing, hyperarousal, and avoidance, as measured by current versus retrospective baseline Clinician Administered PTSD Scale (CAPS) scores, with and without cannabis use, respectively. The study was not included in the National Academy report, but it was reviewed by Walsh and colleagues,1 who noted that most studies on the therapeutic use of cannabis by persons with mental health conditions are not of methodologically high quality.

The beneficial effects of cannabinoid medicines for PTSD are consistent with what is known about the psychobiology of PTSD and the emerging research on the endocannabinoid system.12 Components of the endocannabinoid system include cannabinoid (CB1 and CB2) receptors; endogenous ligands anandamide, 2-arachidonoylglycerol (2-AG), and others; and enzymes that regulate endocannabinoid ligand production. Endocannabinoid signaling occurs in retrograde fashion, with postsynaptic release of ligands that bind to presynaptic cannabinoid receptors and inhibit presynaptic neurotransmitter release. This contrasts with the classic monoaminergic neurotransmitter systems that have shaped much of our thinking in psychopharmacology, and represents a potential alternative strategy for psychopharmacologic intervention (Figure).

CB1 receptors are widespread throughout the brain. Based on animal and human studies, the endocannabinoid system appears to be involved in the extinction of aversive memories, and both THC and CBD have been shown individually in separate studies to facilitate extinction of the conditioned fear response.13,14 Recent neuroimaging studies have found increased CB1 receptor availability in multiple brain regions in PTSD, including the amygdala-hippocampal-cortico-striatal circuit implicated in its pathophysiology.15

The National Academy report also found limited evidence of an association between cannabis use and increased severity of symptoms among individuals with PTSD, but the cause-and-effect relationships are unclear. Individuals with more severely symptomatic PTSD may be more likely to self-medicate with cannabis. The possibility of symptom exacerbation with cannabis use must be weighed against reported therapeutic benefit in individual cases. Other psychiatric diagnoses for which the National Academy report found limited evidence for effectiveness include Tourette syndrome and social anxiety disorders.

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MORE ABOUT Christopher G. Fichtner, MD

Dr. Fichtner is a Clinical Professor of Psychiatry at the University of California, Riverside School of Medicine, and a staff psychiatrist with the Riverside University Health System—Behavioral Health. He received his medical degree from The University of Chicago Pritzker School of Medicine (1987). Dr. Fichtner is a diplomate of the American Board of Psychiatry and Neurology and a Fellow of the American Psychiatric Association, with specialty certification in administrative psychiatry. In addition, he is a Fellow of the American Association for Physician Leadership and a past President of the American Association of Psychiatric Administrators…

Dr. Fichtner and Dr. Moss are Clinical Professors of Psychiatry at the University of California, Riverside School of Medicine.

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