Frequently Asked Questions about Cannabis Therapy

What is medical cannabis?

Medical cannabis is the use of the plants, cannabis sativa and cannabis indica to treat medical and neurological conditions.

Is there a difference between medical and recreational cannabis?

The differences lie mostly in motive, application, consistency of product and regularity of use rather than in the actual substance. Medical cannabis is used to treat a specific or set of medical conditions in a controlled environment: using a tested, regulated (and consistent) product.

How does it work?

Cannabis contains many bioactive chemicals that interact with the human endocannabinoid system (CB1 and CB2 receptors) to regulate and normalize cell, organ, nervous and immune system function. These chemicals include cannabinoids, terpenes and flavonoids. The ratio of these chemicals to each other determine a particular strain’s profile.

What are cannabinoids?

Cannabinoids comprise a group of related component chemicals found uniquely in cannabis. Although well over 100 distinct cannabinoids have been identified, the most prevalent, most studied and most bioactive are: THC (Δ-9-tetrahydrocannabinol), CBD (cannabidiol), CBG (cannabigerol), CBC (cannabichromene) and CBN (cannabinol). See below:

THC (Δ-9-tetrahydrocannabinol): is the principal psychoactive constituent  of cannabis and is useful in the treatment of chronic pain, multiple sclerosis, PTSD, Parkinson’s disease and Alzheimer’s.

CBD (cannabidiol): CBD is the second most common phytogenic cannibinoid, making up to 40% of the plant’s profile and is only very mildly psychoactive (reduces anxiety). It has been proven effective as a treatment for a wide variety of conditions, including chronic pain and depression.

CBG (cannabigerol): CBG is not psychoactive and has been shown to relieve intraocular pressure, which may be of benefit in the treatment of glaucoma. It can also be used to treat inflammatory bowel disease. CBG can also inhibit the uptake of GABA in the brain, which can decrease anxiety and muscle tension. It is the precursor of many other cannabinoids.

CBC (cannabichromene):  CBC is not psychoactive. Evidence has suggested that it may play a role in the anti-inflammatory and anti-viral effects of cannabis, and may contribute to the overall analgesic effects of medical cannabis. It has also shown anti-depressant, anti-motility (anti-diarrhea) effects and to promote neurogenesis.

CBN (cannabinol): mildly psychoactive, CBN is a metabolite of THC, forming after THC is broken down through exposure to air or sunlight. It has been shown to be effective in sleep disorders and for pain relief.

What are the health benefits of cannabis?

In general, cannabis acts to regulate a variety of systems and states to achieve homeostasis in the body. The endocannabinoid system is actually more diffused and extensive than the opioid system (which regulates pain), as it contains many more receptors in more parts of the body and brain. For this reason, cannabis can act as an analgesic, anti-convulsant, anti-psychotic, anti-oxidant, antiviral, anxiolytic, anti-emetic, antibacterial, antibiotic, neuroprotective, antifungal, anti-cancer, anti-inflammatory and antiseptic agent. It can also reduce intraocular pressure (glaucoma) and increase appetite for patients suffering from cachexia or wasting away from illness.

What conditions can be treated with cannabis therapy?

In the Czech Republic, cannabis therapy has been approved for the following conditions:

Chronic unstoppable pain (especially pain associated with cancer, pain associated with degenerative diseases of the musculoskeletal system, systemic rheumatic disease and immunopathological conditions, neuropathic pain and glaucoma);

Spasticity and its associated pain in multiple sclerosis or spinal cord injury, painless intractable spasticity significantly restricting movement and mobility, or the patient’s breathing, involuntary kinesis caused by neurological diseases and other health complications originating from neurological diseases or spine injury with spinal cord injury or brain injury, neurological tremors caused by Parkinson’s disease and other neurological problems at the discretion of the attending physician;

Nausea, vomiting, appetite stimulation in connection with the treatment of cancer or the treatment of HIV infection;

Gilles de la Tourette syndrome;

Surface treatment of dermatoses and mucosal lesions.

It has also been used in the treatment of: alcohol and opiate abuse, Alzheimer’s disease, amyotrophic lateral sclerosis (ALS), anorexia nervosa, loss of appetite, asthma, arthritis (rheumatoid or osteo), ADHD, atherosclerosis (also known as ASVD), autism, bipolar disorder, cancer, colitis and Crohn’s disease, cystic fibrosis, depression, diabetes mellitus, emphysema, epilepsy, fibromyalgia (FM or FMS), glioma, hepatitis C, herpes, high blood pressure, HIV, Huntington’s disease, incontinence, insomnia, irritable bowel syndrome (IBD), leukemia, MRSA, migraines, multiple sclerosis, OCD, osteoporosis, post-traumatic stress disorder (PTSD), pruritus, psoriasis, schizophrenia and sleep apnia, among others.

How is medical cannabis administered?

There are several ways to deliver cannabis to the body depending on the condition being treated – as well as personal preference. Methods differ in bioavailability of the respective cannabinoids. Your doctor will lay out a plan and method(s) based on your medical needs. These methods include:

smoking / vaping (inhalation): Smoking provides the quickest relief and almost immediate cannabinioid bioavailability (peak at ten minutes). While roughly 30% of the cannabinoids are absorbed by the body, this can be increased to up to 45% bioavailability when using a vaporizer.

As only the raw, unprocessed flower is available by prescription in the Czech Republic, the following preparations require further processing by or on behalf of the patient:

in an oil or fat (ingestion): Cannabinoids are highly lipophilic (fat-soluble) and many preparations can be made when they are dissolved in fats. Bioabsorption, however, is low (only about 5%) and the process is longer (40-90 minutes) as the cannabinoids have to pass through the GI tract and be processed in the liver.

as a tincture (mucosal absorption): Cannabinoids that are absorbed through the mucous membranes in the mouth (buccal mucosal application) have bioavailabilities of around 13% and a faster absorption than ingestion as they bypass the liver.

as a cream, lotion or ointment (topically applied): Bioavailability varies greatly depending on the concentration and makeup of the cream. Topical remedies are preferred when the condition presents on or close to the skin, as the application works directly (and almost exclusively) on the target area.

in a suppository (rectal insertion): this method can reach absorption rates of up to 50% and is most suitable for conditions affecting the lower GI. When used as a suppository, the psychoactive effects are greatly reduced, allowing for higher doses to be absorbed with little risk of adverse reaction.

What is the usual dosage?

Dosage is determined by your doctor according to the condition being treated and its severity, your own biological makeup and your tolerance for cannabis. Normally, you will begin at a lower dose and gradually increase it to a higher tolerable threshold. This process is known as titration. The legal prescribed maximum in the Czech Republic is 180g/month or roughly 6g/day of dry, unprocessed cannabis flower.

Is cannabis addictive?

Although not physically addictive (like nicotine, alcohol and opioids), heavy cannabis users may develop a psychological dependence much as with any enjoyable habit. Withdrawl symptoms for heavy, chronic users may include irritability, restlessness and trouble sleeping.

Is cannabis a “gateway drug” to harder drugs?

No. In fact, cannabis users are less likely to need higher amounts of opioids for the treatment of pain and are less reliant on alcohol for mood enhancement.