The treatment with Cannabis and its effects vary from one person to the next. Because of the vast differences between patients, it is necessary to personalize the treatment to the patient’s needs – gradually increasing the dosage while taking into consideration the symptoms they wish to treat, the medication the patient is taking, his age, adapting the times of taking the Cannabis during the course of the day, accompaniment and answering questions, as well as dealing with side effects. The precise and optimal dosage will be determined only several weeks after the beginning treatment.
Light, heat and humidity conditions affect the product and may impact the composition of the active ingredients leading to the growth of molds and fungi. Therefore, the product must be stored in a dark and cool place. In case of inflorescent, it is important to store it in an air tight and dry container. Maintaining the product under the suitable conditions will guarantee its quality and effectiveness over time. it is important to keep the product out of the reach of children and animals.
According to the Israeli law, the Cannabis plant and anything produced from it (except for oil which is produced from its seeds), is defined as a dangerous drug which is prohibited for use or possession. In order to use and/or possess Cannabis, it is necessary to obtain a special license issued by the Unit for Medical Cannabis at the Ministry of Health, or by a physician authorized to do so by the Ministry of Health. A physician with the relevant specialty may submit an application for a license for his patients through the Ministry of Health website.
“A patient with a license for medical Cannabis may consume it by smoking only in the places specified in his license, when in most cases it is his residential address, and the consumption of Cannabis by vapor is allowed also outside the home, provided it is carried out with no other person in the room, in a separate room which is ventilated and that there is no prohibition to use Cannabis in it, provided the approval of the property holder is obtained. Also, patients who are hospitalized in a medical institute may consume medical Cannabis in accordance with the license in their possession.
Places in which it is prohibited to use medical Cannabis are locations designated for minors such as schools and kindergartens. Medical Cannabis may not be used in all work areas in which the use of Cannabis is forbidden on the various professionals such as the operators of a public vehicle, and factories which contain heavy duty equipment. It is prohibited to possess medical Cannabis and/or use it in any form in areas of customs, airports, harbors and border crossings.”
The Ministry of Health has established a number of counter indications for using medical Cannabis among which are: heart failure, psychosis, psychotic condition in the past, anxiety, significant psychiatric heredity among a close family member and a history of drug, or prescription drug addiction. In addition, the use of drugs that have a known unwanted interaction with medical Cannabis may disqualify that patient from receiving a medical Cannabis license. The physician recommending the provision of the license must rule out the existence of these conditions prior to submitting an application for medical Cannabis to the Ministry of Health.
Any doctor with an “expert” degree in the fields for which it is possible to provide a license for medical Cannabis in Israel, may submit an application for a medical Cannabis license for his patients through the Ministry of Health website. The physician should rule out counter indications, provide follow-up reports for the treatment provided so far, and accompanying documentation as required.
In Israel, it is customary to prescribe medical Cannabis after every conventional course of treatment have been exhausted for the patient’s condition. In these cases, the Ministry of Health approves the provision of medical Cannabis for several medical diagnoses: Neuropathic pain, Fibromyalgia, cancer patients who suffer pain, nausea or loss of appetite due to their illness or due to treatment, epilepsy, Parkinson’s disease, MS, adults with Tourette’s Syndrome, PTSD sufferers, Crohn’s, Colitis, HIV and AIDS, and those receiving palliative care (more details can be added for each indication). Even patients with autism are eligible for a medical Cannabis license under certain criteria. Those dealing with other conditions will be able to obtain a medical Cannabis license provided they stand before an Exceptions Committee which will examine the case individually.
There is no age limit on starting treatment with medical Cannabis. The decision to begin Cannabis treatments is based on medical need only. However, the age of the patient is significant when making the medical decision, and must be considered when evaluating the risk when choosing treatment. In children and youths, the central nervous system undergoes constant processes of change and development, and the use of THC may have an adverse effect on its development. It is not currently known what the effects of high doses CBD consumption at these ages are. In light of this, the prevailing approach for treating children and youths with Cannabis, is to administer as lower doses of THC as possible , and to adjust the minimal dosage of CBD which helps their condition.
As of March 2018, driving a private vehicle under the influence of Cannabis is permitted for patients with a medical Cannabis treatment permit, only after at least three hours have elapsed from the moment of taking the Cannabis by inhalation or vapor, or six hours in any other form of use, including oil drops under the tongue. Medical Cannabis users may not engage in commercial or professional driving such as driving a truck or a bus.
At this point, there is insufficient literature on the subject in order evaluate the effects of Cannabis on the fetus or the developing baby. In order to prevent possible harm to their development, the consumption of Cannabis should be avoided during these periods.
Using any of these substances in conjunction with using Cannabis may expose the body to harmful substances and increase the unwanted side effects of Cannabis. Cannabis may have a sleepiness or drowsing effect, and its combination with alcohol may cause an increased blurring effect. As for smoking tobacco, the smoking of Cannabis inflorescent together with tobacco may impact the medicinal effect of the Cannabis since the combustion temperature of tobacco is higher than that of the Cannabis, which in turn impairs the availability of the active ingredient, therefore the combination of the two is not recommended.
It is recommended to avoid the use of Cannabis for those who have a history of psychiatric illness or psychiatric heredity, pregnant and nursing women, or those with a history of addiction or drug abuse. There are other populations where it is important to carefully consider the giving of medical Cannabis and they include youths under the age of 18, people with severe heart and vascular diseases, people with kidney or liver problems, the elderly depending on their functional state, patients with a history of medication or other substance addictions, patients who take sedatives or sleep inducing drugs, and patients who consume alcohol in large quantities.
When using more than one medication, there may be a situation of drug interaction, which is also true in the case of medical Cannabis. It is recommended to consult with your treating physician prior to starting treatment with Cannabis, and to examine whether there are reciprocal reactions that can be expected between the Cannabis and the medication taken by the patient. Also, during the treatment with Cannabis it is important to monitor the patient’s condition regularly and to ensure that the drug treatment remains balanced even with the use of Cannabis.
Addiction is defined by a physical dependence and the existence of withdrawal symptoms in the absence of Cannabis in the body together with a yearning to consume Cannabis. There is a possibility of developing an addiction, with 1 in 10 people developing a dependency on Cannabis. The longer the use of Cannabis, the more likely you will become dependent. It is important to remember that tolerance is not equivalent to dependency, and those using Cannabis for a long period of time, may demonstrate less effect of the Cannabis and the need to take larger dosages in order achieve the desired effect. Discontinuing the use for a certain period of time may diminish the tolerance and enable a therapeutic effect even with smaller doses.
In general, medical Cannabis is considered safe to use, it is difficult to reach a state of overdose when using Cannabis, and no fatalities were reported as a result of Cannabis use. In cases of overdosing on Cannabis, the patient may experience symptoms such as anxiety, panic to the point of paranoia, extreme confusion, accelerated heart rate and high blood pressure, nausea and vomiting, hallucinations and delusions. Some populations are at a higher risk of experiencing unwanted side effects and it is recommended they consult with their treating physician and perform a risk assessment prior to starting treatment with Cannabis. These populations are people with diabetes, hypertension, psychiatric disorders, people who have trouble with coordination and those who are taking neural suppressants. (For further information on health effects – link to the CDC website: http://www.cdc.gov/marijuana/health-effects
One of the first principles of safely treating with Cannabis is – ‘Start low and go slow’. In order to reduce side effects, one need to start the treatment with a low dosage and advance according to the patient’s needs and reactions. (Gradual titration). Those who seek to reduce the unwanted effects of the Cannabis, such as the “high” feeling, anxiety, dryness of the mouth and others, can try using products with a higher content of CBD, since a high THC content is what causes most of the side effects. Another option is to reduce the dosages of the doses taken until readjustment and reduction of side effects, and in this case it is recommended to consult the treating physician before changing the dosage. In addition, the consumption of certain foods is reported to reduce the unwanted effects such as eating chocolate, sucking on a wedge of lemon, drinking citrus juice and eating certain salty foods.
As the use of medical Cannabis continues, so does the endurance against side effects develops and the side effects subside more and more with time. Of course there is no need to suffer during this period, and there are ways to relieve the side effects if they are presented.
Medical Cannabis is generally considered safe to use and its side effects are mild and are mostly tolerated by patients. However, it is important to know that in some cases there are more severe side effects, similar to other medications you choose to use. Side effects may include, dry mouth, Arrhythmia and changes in blood pressure, dizziness, changes in sugar levels in the blood, headaches or abdominal pain, trouble concentrating, thinking and in the perception of space and time.
The effect of Cannabis lasts about 6-8 hours, but it takes longer to be expelled from the body and Cannabis can be traced in lab tests even 3-5 days after using it.
Like other drugs, there are a variety of factors which determine the specific effect of the Cannabis on the users, which include among other things prior use of Cannabis, genetics, biological gender, form of administration and more. The composition of the active ingredients in the product being used, affects the effect felt. THC, for example, has a psychoactive effect, and the use of strains which contain a large amount of it will be accompanied also with the feeling of “high”, contrary to strains that are rich with CBD. Depending on the composition of the stain you choose to use, it is possible to generally assess the effect you can expect, however, as mentioned, there are many factors which affect your personal reaction to Cannabis, and therefore it is important to allow trial and error during the treatment with Cannabis in order to find the right strain and dosage for you, which will obtain the therapeutic effect with minimal side effects.
For many, the use of medical Cannabis requires adaptation on several levels. First, one must adapt to the form of administration of the Cannabis, which is different than taking other medicines. The patient must learn what is the form of administration that is most comfortable for him, while gaining a sufficient therapeutic effect. Second, one must learn the appropriate dosage, and finally, there is a need to familiarize oneself with the different strains and understand which one is more suitable to treat the patient’s condition. The many options of medical Cannabis treatments and the vast differences between the various patients, create a situation where there is no one treatment that suits everyone, and most patients go through the process of trial and error until they find the correct dosage, strain, and manner of consumption which suits them. The medical staff is able to assist with guidance according to the patient’s needs and wishes.
There are thousands of Cannabis strains, each having their own characteristics, different effects and suitability to a different medical condition. The Cannabis strains are categorized according to the quantity of THC and CBD in them. It is important to select a strain that is appropriately suited in its composition to the situation you are trying to treat, when there are strains in which the CBD percentage is higher, they will act against anxiety, seizures, PTSD and more, whereas strains with higher levels of THC are more suitable for complaints of pain, loss of appetite and nausea. Strains with high levels of THC create a sense of “high”, whereas strains with high CBD levels are able to neutralize the sense of “high” caused by taking a high dosage of THC.
Cannabis is consumed primarily by smoking or vapor, as oil and rarely as food. The advantage of having a variety of administration forms, is that patients have the option to choose to consume Cannabis in the manner which most suits them and their therapeutic needs and in the most accurate way The main difference between the forms of administering the drug, is the amount of time each product requires to bring relief from the symptoms. Smoking takes effect in the shortest amount of time, and in a few minutes it is possible to feel the relieving effect of the Cannabis since the active ingredient reaches the blood stream quickly through the lungs. On the other hand, the effect of oils takes place after about 20 minutes or more from the time it is taken, since it takes time to absorb into the body. However, smoking Cannabis is expected to have a shorter effect relative to that of using the oils. In food products which contain Cannabis, the onset of the effect is even longer due to the need to absorb the substances through the digestive system, which makes it hard on patients to estimate in real time the amount of Cannabis they need to consume in order to obtain an effect, thus making this form of administration less common.
The inflorescence of the Cannabis plant is used to make preparations for medical treatment. There are a variety of preparations, and each has different effects on its uses. The manner in which it is administered also has a considerable impact on the effects of the drug. For example, it is possible to smoke the dried inflorescence of the Cannabis using a pipe or a rolled cigarette (‘Joint’). Some prefer to vapor the inflorescent of the Cannabis using vaporizers designed for that purpose. There are Cannabis extracts that are sold as oils that are dripped under the tongue or sprayed into the mouth cavity, and it can also be mixed in food products and be consumed.
In our body we have the Endocannabinoid system that is linked to the control and balance of a variety of processes such as neuro-conduction, the activity of the immune system, the sense of pain, mood swings, memory and more. The active ingredients in the Cannabis plant effect this system and its activity can be harnessed to treat a variety of medical conditions. According to the medical literature existing on the subject today, Cannabis can constitute a supportive treatment, leading to the improvement of many symptoms such as pain, insomnia, loss of appetite, anxiety and many more, however, at this stage, there is insufficient research evidence as to the ability of Cannabis to cure disease, and it is not officially recognized as medicine in Israel.
Cannabis is a plant. It is used for making fabric fibers and oils, and its seeds may be used as a food source. This plant has been known for its medicinal traits for thousands of years, and it is possible to consume its dried inflorescences for various medicinal purposes. The plant contains several chemical substances which have a therapeutic effect, among which are cannabinoids such as THC, which have a psychoactive effect, it aids in sleeping and acts as an analgesic, and CBD which is not psycho-active but has an anti-inflammatory role. In addition, the plant contains flavonoids and terpenes, the effects of which on the therapeutic effects of Cannabis are currently being studied.