Kokua Line revisits the topic of medical marijuana, this time addressing questions from prospective patients, some elderly. The answers are from Amy C. Brown, an associate professor in the Department of Complementary and Integrative Medicine at the University of Hawaii’s John A. Burns School of Medicine.
Question: Does a doctor prescribe a certain amount of marijuana for a particular ailment, or is (their) involvement … limited to clearing the person to get a medical-marijuana card?
Answer: It is against the law for health professionals to prescribe medical cannabis. As a result, there is no amount of cannabis, a Schedule I drug, that the doctor or advanced-practice registered nurse (APRN) will prescribe. They only provide a letter indicating a use (qualifying ailment) approved by the state of Hawaii. … The letter is then submitted to the state Department of Health, which releases a 329 Registration Card (valid for one year) to the patient for using medical cannabis (www.HawaiiDispensaryAlliance.org). There are dosages provided for prescription drugs based on the cannabis plant. These are the synthetic cannabinoids found in brand-name Marinol (dronabinol; approved in U.S.) for cancer-related nausea and vomiting, and AIDS-related weight loss; Cesamet (nabilone; approved in U.S.) for cancer chemotherapy-related nausea and vomiting; and the whole plant extract found in Sativex(R) (nabiximols; not approved in U.S.), which is delivered as an oral spray for cancer-associated pain, lack of appetite in AIDS, and multiple sclerosis spasticity (muscle spasms and stiffness).
Q: So with medical marijuana, how does a patient know what dose to take?
A: It is by trial and error. However, the unofficial mantra is start low, go slow, stop if there’s a reaction, and only do so in a stable place (no driving anywhere) under the watch of a trusted, sober adult. That’s especially true for novices who have not built up a tolerance. The 400-plus cannabinoids in cannabis differ in concentration and effect. Some growers breed for certain cannabinoid concentrations, and certain products list the concentrations on the label: THC (tetrahydrocannabinol) is primarily for psychoactive effects, while CBD (cannabidiol) is for pain. Smoking delivers THC, while other products taken sublingually (under the tongue) might affect pain. Smoking is not usually recommended for seniors due to possible confusion and dizziness increasing the risk of falls, and irritation of the bronchial passages and lungs. There is no official dosing that health professionals can totally rely on. The drug was illegal, so research was very limited, and recent laws allowing the drug now precede extensive research.
Q: Is it true that mind-altering effects last longer when marijuana is eaten rather than smoked?
A: Yes. A marijuana joint is usually felt within five minutes and lasts one to three hours, while an edible takes about one-half to two hours to be noticed and lasts six to nine hours. The potential for overdose is higher using edibles because people don’t feel the effects right away as the food is absorbed into the bloodstream and travels through the liver. As a result, some people might take another bite thinking they need more.
On Monday, Brown answers a question about recreational alcohol and marijuana use which we couldn’t fit in today’s column.
Mahalo
On Jan. 11 I collapsed outside a restaurant at the Niu Valley Shopping Center, where I had just completed lunch with two of my senior friends. Quickly to my aid were some gentlemen who saw to my comfort before the Emergency Medical Service arrived. I wasn’t able to get the names of these gentlemen and am unable to thank them personally. — Mahalo, a grateful senior
Write to Kokua Line at Honolulu Star-Advertiser, 7 Waterfront Plaza, Suite 210, 500 Ala Moana Blvd., Honolulu 96813; call 529-4773; fax 529-4750; or email kokualine@staradvertiser.com.
