CBD bioavailability and you

Some of our patients have a great response to CBD alone or in combination with THC for their pain or other symptoms.  Some other patients either have no response or have side effects from CBD taken by mouth. So what gives?

We’ve been thinking a lot about CBD bioavailability.  Basically this concept asks how much CBD your body actually absorbs from whatever CBD you take by mouth or inhalation.  There is a great review paper on this topic and a lot of really useful info can be gleaned from it.

First, if you take CBD by mouth your body might only get 1% of the total amount you ate. So a 20 mg CBD capsule might deliver only 0.2 mg of CBD to your bloodstream.

Second, CBD bioavailability is very variable between people. Your friend may absorb 10% of the CBD they eat, but you might only absorb 0.1% of the same CBD that you eat. So maybe “I’m not responsive to CBD ” might really mean “My body just doesn’t absorb CBD from my gut.”

We know that the bioavailability of inhaled (eg vaped) CBD is around 30%. So if you vape 1 mg of CBD in a hit, your body sees 0.3 mg of that vaped CBD. This is way more than your body might see from  20 mg of CBD that you take by mouth.

So maybe if CBD taken by mouth either does not work for you or causes you side effects like indigestion, you might want to try vaping your CBD.

One source for such a vape that some people find helpful is the cbd store . Although we can not recommend it, we can inform you that there is a CBD vape cartridge/pen combination on this site. The 400 mg Pure Ratios CBD vape cartridge costs around $80 and the pen itself is $20. At around 250 hits per ml, this would deliver around 1.6 mg CBD per vape hit  At 30% bioavailability your body would see  around 0.48 mg of CBD per vape hit. So 3 vape hits per day might give you, on average, way more CBD than three  20 mg CBD capsules would. And the vape cartridge would last over 2 months.  Just information.

 

vaporizer that has good reviews

xeo_void

A lot of our patients would like to find a vaporizer that is inexpensive and easy to use. The XEO VOID seems to fit this bill. It’s about $60 online, has great reviews from the vaping community, and seems to be really easy to use. You just stand it up, unscrew the top, and add your vaping oil. Easy.

Some facts shaking down after 700 patients

We have now certified about 700 patients in the NYS Medical Marijuana program. We have over 250 data points in our results database.  Some things that are shaking down, in no particular order seem to be:

  • sleep often gets better first, then pain gets better after you adjust the dosing
  • there is a lot of CB1 receptor heterogeneity in response to inhaled delta-9-THC versus ingested (eaten) 11-OH-delta-9-THC. This heterogeneity is not only in the response to the medicine, but also to the side effects from the medicine.
  • CBDs will give a very small percentage of people side effects like a buzz, GI issues like dyspepsia or diarrhea
  • you can get around 50% excellent symptom relief if you adjust medical marijuana in the first couple months
  • you can’t predict what or how much of what medical marijuana will work for any one person

More updates as we get more data.

 

syracuse.com on drugged driving: misleading at best

Here’s an article that sounds really scary:  “Drugged driving now bigger threat than drunk driving.”   A report by the Governor’s Highway Safety Association and the Foundation for Advancing Alcohol Responsibility  is the basis for the headline. To quote from the article:

Marijuana was the most common drug found in fatally-injured drivers. More than one third — 36.5 percent — tested positive for marijuana…The reported cited a study which found heavy marijuana use can double the risk of motor vehicle crashes resulting in serious injury or death.

OK so let us look at the evidence about marijuana use and car crashes, shall we?

The National Institute on Drug Abuse page about marijuana and driving tells quite a different story. Although some studies show that there is an impairment of driving with higher levels of marijuana in the blood, this page finishes by quoting a 2014 study by the National Highway Traffic Safety Administration (NHTSA) that found “no significant crash risk correlated with cannabis” when all other confounding factors were accounted for.

This  NHTSA study, worth the read because it is a really well designed study, found:

…analyses incorporating adjustments for age, gender, ethnicity, and alcohol concentration level did not show a significant increase in levels of crash risk associated with the presence of drugs.

Let’s say that again, there was NO significant increase in crash risk associated with marijuana or other drugs when you account for age, sex, and alcohol use.

It is a fact that marijuana remains in the body for weeks after use, so “testing positive” for marijuana means simply that one has used marijuana some time in the past few weeks. Note how “testing positive” gets morphed into “drugged driving” in the article.

It is also worth mentioning that the  Foundation for Advancing Alcohol Responsibility is funded almost exclusively by companies that produce and market alcohol. It is a fact that alcohol producers view recreational marijuana as a threat to their profits and have responded by funding anti-marijuana “public service” announcements in many states.

Can marijuana impair driving? Of course. Is the danger of marijuana impaired drivers bigger than alcohol impaired drivers? Despite the propaganda, the answer is a clear no.

 

 

 

What gets better first?

We now have over 600 patients in our medical marijuana program with well over 200 data points. So some patterns are beginning to emerge.  One of the really common patterns is this:

  • sleep starts improving first with our first few adjustments
  • then daytime pain improves with more adjustments

This highlights the benefit of adusting the medical marijuana dose during the first few weeks: you can dial in better sleep, then keep the sleep good while you dial in daytime pain relief.  This is one very common pattern of getting better on medical marijuana.

 

Vaped THC now way less expensive !

Vireo has just come out with a 1 ml oil product with about 400 mg of THC . This is a “refill” for vape pens, and delivers vaped THC for around 30-35 cents per milligram, way inexpensive  vaped THC in NYS. Last we heard the price was around $130-135.

Here’s a link to the XEO VOID , easy to use vape pen for around $60.

So for under $200, you can get your vape pen and 1 ml of THC vape oil.  So you buy the vape oil, load up the vape pen, and you are good to go. For under 200 bucks. Just sayin’.

 

Medical Marijuana and the VA healthcare system

The official policy of the VA system is that medical marijuana is still a Schedule I drug under federal law, so they will not recommend or provide it.

However, the VA has a policy about veterans who are in state regulated medical marijuana programs. This Veterans Administration policy clearly states that the VA cannot deny care to a veteran because they are in a state regulated medical marijuana program.

Here’s the official VA policy on pain clinics prescribing medicines like opioids to patients who are in a state regulated medical marijuana program, from the 2011   VHA  directive 2011-004 :

 While patients participating in State marijuana programs must not be denied VHA services, the decisions to modify treatment plans in those situations need to be made by individual providers in partnership with their patients.

That’s it. That means that the VA is leaving it up to you and your practitioner on how to integrate medical marijuana into your VA based treatment plan.

One reasonable practice pattern for VA practitioners  might simply be to note the patient’s medical marijuana use and continue their care for the patient  which meets the standard of care guidelines for the individual state the practitioner is licensed in.

Regarding medical records, remember that a patient’s medical record belongs to the patient.   New York State law requires doctors and hospitals to provide patients access to their medical records.

Veterans can also sign up for a  MyHealtheVet Premium account and go through the authentication process.  They can then  can download their own medical records using the VA Blue Button method.

Just as an editorial note, we think that our veterans deserve everything we can do to help them live their lives better.  Some of these guys never came back. Let’s do something  sensible and tangible to help the guys who did make it back.

 

PTSD and medical marijuana

New York State is considering adding PTSD as an approved condition  in the NYS Medical Marijuana Program. This is a Very Good Idea.

There is a ton of experience out there indicating that marijuana works for anxiety in lots of different people, especially  veterans who suffer with PTSD . Don’t expect the VA system to wake up any time soon.

Like any other class of medicine, medical marijuana’s effect on the endocannabinoid system may work or not work for any one individual.  There is overwhelming evidence from veteran’s lived experience that it should be available to folks as just another class of medicine to try.  With all these guys have sacrificed for us, it just seems right that we should give them the opportunity to live each day a little better. Contact your state legislator and tell them what you think.

 

How to take liquid THC (which tastes horrible)

Here’s a tip from one of our patients who happens to be  a nurse. Nurses are really smart.

Since liquid THC works great but tastes terrible, this is how you take it:

  • take the dropper and put the medicine UNDER your tongue
  • then grab a glass of water and take a drink

That’s it. The water that you sip from the glass washes the liquid THC past your taste buds and it is not nearly as vile tasting.

Nurses Rule ! ! !