A Further Guide to Medical Marijuana

Or, God May Be Dead, but the Dispensary’s open! Hooray!

Message to Cancer support group:

Another possibly critical update; the dispensary in [redacted] is open at the moment, albeit under some very stringent guidelines…

Two hours later, a reply:

Do you know how much they are charging for the RSO?

So, as we all decide that we’ve had enough of a terrifying infectious disease, and it magically vanishes, my local dispensary opened to foot traffic (more on that in a moment). To be fair, they’ve been doing home-delivery for a while, but doing drug deals via telephone (even if they’re legal) seemed a little too tacky and Miami Vice for me. Also, I’ve read enough Carl Hiaasen novels to be wary. The fact that I’m fine with refilling my numerous prescriptions via telephone tells you everything you need to know about America’s unique double-standard perception about drug use in this country (also, when you sign up for a Phase 1 chemo clinical trial, the bet you’re effectively making is, “Well, his has some promising initial evidence going for it, but it could also maker my heart explode at any minute, so, what the hell”)(one can understand why it’s not much of a leap to go from, “legal drugs that cause hallucinations” (yes, MRZ really did, but not the fun, 1964 kind), to “legal drugs that make you a little hungry, sleep really well, and slightly more energetic.” Under those circumstances, adding another substance to a regimen of seriously-controlled substances (if you thought getting heroin in this country is hard, God help you if you try to leave an infusion center with a single drop of a study drug still in your veins)(I’m exaggerating that, but not as much as you’d begin to think) so you can sleep and function is a rather minor step.

So, like every newly-diagnosed cancer survivor, I did a little research, and wound up with some edible products that made Life on Chemo far more bearable. I’ve written about this before, but, in this country, we talk almost exclusively about THC (the Timothy Leary, fun, anti-nausea, appetite-inducing substance linked to chemo efficacy) and CBD (the pain-killing substance linked to anti-tumor actions), and smoking it. To put that in context, imagine your only familiarity with alcohol was that it was made of water and ethanol, and “butt chugging” (it’s exactly what it sounds like, and it explains why people vote the way they do) was the preferred method of ingestion. Your 21st birthday would be a nightmare of ER visits, stomach-pumping, etc. America takes a similar stance on marijuana — there are only two primary chemicals we’re interested in, one delivery method, and no one apart from long-term, nigh-unkillable cancer survivors are interested in the other stuff. Which is a crying shame, because there are 167 different psychoactive components to marijuana (before anyone freaks out, “psychoactive” is a technical, biochemical term, and aspirin is psychoactive, as is caffeine, tylenol, anti-allergy meds, and a lot of other compounds you probably never give a lot of thought to)(BTW, caffeine has a more noticeable effect than CBD)(also, for anyone really interested, I do normally use hemp-derived oral CBD for most of my daily aches and pains; I took cannabis-derived CBD during chemotherapy, that has a little more “zing” to it), not including some of the more exotic and interesting metabolites (when your body metabolizes a substance but it’s still biochemically interesting)(including CBN, which my father takes as a sleep-aid)(when my family’s equivalent of Ward Cleaver, but with nigh-uncontrollable insomnia says, “Yeah, this stuff helps me sleep,” maybe it’s time to change societal views about a substance). Don’t get me wrong; I love those two components as much as anyone else who’s debated a port-a-cath vs IV (and got some gummies), but you really do miss an awful lot of the benefits of medical marijuana if you’re focusing exclusively on inhalation and just those two chemicals.

I’ve also written before about Rick Simpson Oil (pioneered by well-respected sound-recording engineer Michael Eberstein when he was diagnosed with Stage 4 melanoma)(some of that’s true). As I’ve written previously, RSO has an almost-religious reverence amongst long-term survivors, because it allows us to go from “Hallmark Channel special” to, “somewhat normal existence,” which, unsurprisingly, makes oncologists a little more comfortable dousing Grandma in more Agent Orange. Attitude is the unquantifiable “X-factor” in cancer survival, although it’s less of a “cheerful, happy” attitude and more of a, “Bring it on, I can take it,” attitude.

So, I’m writing this particular article today, both to address some recent issues/questions I’ve been asked, and to describe the current kulturkampf in ‘Merica. Since we’ve, apparently, decided we’ve had enough of the plague and it no longer exists, society has come down into two separate, unequal (in 2–4 weeks, anyway) groups. In the first group — best exemplified by my local organic supermarket; people are all wearing masks, avoiding each other, and not interacting. In the second group, people are loudly and aggressively trying to act normal and trying to ignore the fact that Grandma’s being intubated (I have no idea what that really looks like, because I’m a coward who doesn’t want to die drowning in his own fluids). There is a third group, embodied at the local dispensary: hermetically sealed, and likely to survive a smallpox epidemic. I’ve been in ORs that had more germs than the dispensary. Seriously. Masks were required for entry (as their website points out, you can buy a mask from them for a buck, but supplies are limited)(as I also know, if you go that route, you then get the skin-crawling sensation of watching a stranger — who’s been God-knows-where — touching an item that will be on your face in five minutes), only a certain number of people in the dispensary at any given time, and the “display area” is closed, so you have to know what you want before you even enter the store. That last one isn’t a big ask for cancer survivors familiar with medical marijuana; we even have preferred brands. Also, since most medical marijuana dispensaries cater to immunocompromised patients (blood cancer treatments are harsh), I can’t imagine it’s a major reorganization issue just to go that extra step on cleanliness/germ reduction and just completely eliminate all microbes within a two-block radius (I’m not exaggerating). I’ll admit that my rush for getting there was because we have a really bumpy track record for this whole “reopen EVERYTHING without reservation” followed immediately by “near-military lock-down of everything 96 hours later,” and if I’m going to spend another month trapped in my own house, I’d really prefer not to do it completely sober (I realize that “mentally dealing with the likelihood of one’s own imminent demise if a single rule is broken” might appeal to some folks, but I got more than enough of that during the Year of Chemo). Also, I finally got a full night’s sleep, and that really changes one’s perspective (do you regular, non-insomniacs have any idea how weird it is to wake up fully alert, feeling good, and without the need to take a nap? It’s crazy). Which brings me to today’s topic;

As I’ve suggested, if you know three or more long-term cancer survivors, I guarantee you that you know someone who uses medical marijuana products on a semi-regular basis. Most of us don’t smoke it, because that whole “open flame” thing is a pain in the neck after a day of metabolizing toxins, plus, adding carbon monoxide and known carcinogens on top of chemo is just extra steps after a day spent talking yourself into things you really don’t want to do, anyway (Not that gripping the armrests on the infusion puke-a-loungers and biting through your cheek as you feel the infusion going up your arm isn’t a great fore-runner to talking yourself into not coughing at all even when your poor, battered lungs are full of smoke, but most of us seem to take the route of least resistance, which, for marijuana products, is oils, edibles, and other things that don’t involve sputtering like the President after a member of Congress suggests He’s fat). There is, of course, one primary problem with edibles, and it’s like Jack and Diane who only know about vodka suddenly learning about Jello shots — it’ll take a while to absorb. Which means, there’s a lot of potential to misjudge your tolerance and the effects thereof, and you might be in for a bad night of the planet moving too fast. This is compounded by videos on Instagram of people taking massive, raisin-sized dollops of RSO (you do you, but the mere thought of that makes me want to go and lie down with my head between my legs). BTW, this brings up an excellent point about why marijuana isn’t considered medically addictive, nor is there much of a drive to experiment with other drugs or greater dosages — a little is great (and that same amount will achieve the same results consistently; this isn’t even like caffeine where I started college on a cup a day, and now I need two pots of coffee to stagger through a day), too much is amazingly terrifying. I’ve seen those same videos of people taking an ounce at a time (hang on just a second), literally the most I’ve ever personally heard of survivors consistently using is a rice-grain-sized drop (if you’re really feeling physically awful and like you need to escape your own body, then you can always take more; you can’t really do much if the floor is zipping past at a high speed). My own experience with RSO is, a little (with some added CBD, which hinders the psychedlic effects of the other 160-odd substances there) is fun and leaves one feeling alert, productive, and oddly creative the next day. A lot is terrifying and can leave you babbling in the corner for the evening, so there’s actually a distinct biochemical punishment for experimentation (a GBM survivor who asked for a little guidance on this recently pointed out that she’d done a fair amount of marijuana in college, and this was an entirely different, somewhat scary experience). My rule of thumb for everyone starting out is, “Try just a smudge at first.” That’s it, for starters. Also, based on personal experience, there is a sort of cumulative effect of RSO, not dissimilar to modern SSRI antidepressants (the difference being, you can take SSRIs consistently and daily, and, if they’re working for you, you should), so, the first night is great, the second night is better, and the third night is a little scary (I try to go 2–3 nights on RSO, 2–4 nights off)(when I was in chemo, I couldn’t take it on infusion days, because MRZ gave me hallucinations, but I digress). And, since THC has a stimulant effect, you might want to consider taking it at least 2–4 hours before you go to bed (if you’re on oral chemo, like most GBM patients are; take it with your zofran and other pre-bed-time meds), or else you’ll be staring at the ceiling for a few hours.

Also, bear in mind at all times the warning I got from Head Warlock in Charge — this is a largely unregulated market, there’s very little wide-spread safety/efficacy testing available, and there aren’t a whole lot of peer-reviewed studies available, so, be careful and caveat emptor (for everyone wondering, I always try to get a 1:1 THC: CBD ratio). Also, even though you shouldn’t be driving while stoned (which, bad news, that’s life on chemo), and you might fall off a step-ladder and kill yourself, you can’t OD on edible marijuana products (in a worst-case scenario, you’ll spend the evening afraid to get off the sofa). Also, it’s not going to make you go crazy and murder your family with an axe (unless that sort of behavior was already an issue, in which case, look into those SSRIs I mentioned). And, even though it’s linked to far better long-term outcomes in various health issues (I’ve seen some studies linking it to weight loss), keep in mind that it’s rarely due to a direct linkage between marijuana and the disease/problem in question, but more due to it resolving other, related conditions (again, if you’re eating and sleeping well, you’re probably going to be healthier in general), that have a greater impact on one’s health and well-being.

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Science journalist, cancer survivor, biomedical consultant, the “Wednesday Addams of travel writers.”

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