Cannabis Pharmacy. The Practical Guide to Medical marijuana
Authoritative, evidence-based information, plus advice on treating dozens of ailments and conditions
Michael Backes, foreword by Andrew Weil, MD
Black Dog & Leventhal Publishers, New York, 2014
Foreword by Andrew Weil, M.D.
From the perspective of someone who has studied traditional therapies as a career, it is surprising that cannabis ever left our medicine cabinets, since the plant has been used for millennia in cultures throughout the world as a curative for ailments of both mind and body. In 1942, the American Medical Association (AMA) fought to keep it as part of the U.S. Pharmacopeia. In spite of the long history of cannabis as a safe and effective treatment for many conditions, the AMA lost that battle, and cannabis was banned. Now, more than seventy years later, the American Herbal Pharmacopeia has begun publishing a two-part monograph on cannabis, returning the plant and its derivatives to their proper places as useful medicines.
During its long exile, cannabis was falsely characterized as a dangerous narcotic, though the reality of its medicinal value was known by many. Patients undergoing treatment for HIV shared that cannabis increased appetite. Multiple sclerosis patients reported that cannabis relieved stiffness and pain. And a few cancer patients for whom allopathic treatments failed, found that cannabis could occasionally help the body overcome drug-resistant tumors. The medical and research communities are only just beginning to discover and investigate what their patients have known for decades.
Michael Backes’ excellent overview combines current research with real world observations from the patients utilizing cannabis dispensaries in California to present compelling evidence about the medical conditions for which the plant can often provide effective treatment. Intended as a guide for patients and their physicians, the book explains what has been recently learned and what has been rediscovered about the uses of the cannabis plant as a medicine. I have often said that Western medicine could benefit from using traditional plant remedies instead of, or in combination with, the synthetic drugs that dominate the modern pharmacopeia. I would also say that cannabis is one of the best examples of a safe and effective botanical remedy that is underutilized and still largely misunderstood by many conventional practitioners.
Owing to variations in their chemistry, different cultivated varieties of cannabis produce different physiologic effects, and sometimes widely different experiences, yet there is little evidence-based guidance about using particular cannabis varieties to address specific conditions or symptoms. This book helps fill that gap.
Clinical investigation is confirming that many common Western diseases such as diabetes and cancer may be closely linked to metabolic dysfunction caused by poor diet and inactivity. We are also beginning to see evidence that cannabis contains potent homeostatic regulators that can help balance and maintain metabolism. Its chemical constituents interact with the body’s own endocannabinoid system, affecting every physiological process, including appetite, regulation of mood, and perception of pain.
My journey in developing integrative approaches to health and wellness began with a strong emphasis on mind-body interactions, and when I began studying cannabis in 1968, in my senior year at Harvard Medical School, I learned that it is capable of producing an extraordinary range of effects. This work was conducted two decades before the endocannabinoid system was discovered. Since that time, science has continued to confirm what experience has told us for centuries. With the evidence presented in this informative guide, the value and utility of cannabis as medicine becomes even clearer.
It is my strong hope that the work of Michael Backes and other like-minded professionals will inspire further rational and scientific approaches to cannabis, steer us away from the political agenda that has made it difficult for patients to access the benefits of this useful plant, and guide the medical community to use it intelligently.
When we consider the arguments against the use of cannabis as a medicine, we must first look at the evidence. What we know is that cannabis is certainly not a panacea, but for specific individuals and circumstances, it is very useful and quite safe. Both advocates and detractors of medical cannabis continue to promote a somewhat shocking range of misconceptions about medical cannabis. Cannabis won’t cure every cancer; it does produce side effects; and it is not right for everyone. Before the publication of this book, finding evidence-based information about herbal cannabis medicines often proved challenging. I wrote this book primarily because I needed information on the history of medical cannabis, how to use it appropriately, and the varieties and conditions it has successfully treated for my work in California with patients using cannabis under a physician’s supervision. But with only 21 U.S. states permitting the medical use of cannabis in late 2013, I recognize that there are many seriously ill individuals who must rely on illicit sources for cannabis, and these patients have an acute need for accessible and informed guidance. This book is not intended to replace professional medical advice and supervision. Anyone comtemplating using cannabis as a medicine should seek advice from a doctor.
The prohibition of cannabis has unfortunately ensured that a spectacular amount of nonsense about cannabis and its medical uses is taken as fact. In my experience, opponents of medical cannabis remain opponents only until an illness strikes. Numerous times, politicians, judges, and law enforcement
officials who suddenly find themselves in need of some cannabis advice have approached me for discreet consultations on behalf of themselves or their loved ones.
Since the 1980s, a small coterie of determined scientists and physicians have studied cannabis and its effects. Conducting that work has been arduous in a hostile regulatory environment in which the study of cannabis is severely restricted and often prohibited altogether. But these determined individuals have
not only persevered, they have succeeded in greatly broadening our understanding of the plant.
Cannabis and cannabis medicine remains a moving target. Every month, new studies further our understanding as to how cannabis works and might be used as a medicine. And our understanding of both the benefits and risks of using cannabis also continues to deepen. Because cannabis does not exhibit the toxicity of drugs such as opioids, dosing cannabis as a medicine tends to be imprecise.
A brave group of activists choose to challenge the status quo and demand access to cannabis as a medicine. This book would not exist without the courageous precedent that these activists set. Organizations such as the Wo/Men’s Alliance for Medical Marijuana, Americans for Safe Access,
Marijuana Policy Project, Drug Policy Alliance, and NORML have fought hard to ensure that medical cannabis is available to those in need.
Far too many people have gone to prison for using or providing cannabis as a medicine. Laws that prohibit physician-supervised access to medical cannabis are fundamentally wrong and must be reformed. California was the first U.S. state to provide legal access to medical cannabis. Initially, California failed to create a regulatory system to provide storefront access to cannabis, and this created an uncertain climate in which some Californian cities tolerate dispensaries, very few permit them, and most ban them. Even laws that intend to enable storefront access to medical cannabis often create an oppressive bureaucracy that can be dauntingly difficult to navigate.
In this work, I attempt to provide a comprehensive overview of the uses of cannabis as medicine, even though the scientific and medical understanding of how cannabis works as a medicine continues to evolve. Cannabis is an extremely complex medicine, made more so because different varieties and forms of cannabis produce a range of medicinal effects. Part 1 provides a historical and scientific overview of cannabis as a medicine. Part 2 offers a guide to using medical cannabis. Part 3 focuses on 27 cultivated varieties of cannabis and how they produce different effects. And Part 4 provides information about using cannabis effectively with different ailments under a doctor’s supervision. The research collected herein is drawn from hundreds of recent studies, but this book hopes to present this evidence in an accessible manner for the layperson. Cannabis Pharmacy is designed to encourage further inquiry, so I have attempted to avail myself of as many open and accessible sources as possible in its creation, so that patients and physicians wishing to dig deeper may do so easily and inexpensively. I hope that this book will encourage patients and physicians to discuss the advantages and limitations of cannabis as a medicine. It would be great if patients and physicians felt as comfortable discussing the potential use of cannabis as they do discussing an herbal medicine such as echinacea.
On the rear flap of the 1967 book, Pot: A Handbook of Marijuana, the author John Rosevear writes:
“The author does not pretend to impartiality in this controversial question but
he does claim that this handbook is an objective statement of the truths about
marihuana. Once the prejudice and hysteria surrounding this subject are put
aside, these truths are quite simple.”
Nearly a half-century later, the prejudice and hysteria may finally be fading, but the truth about cannabis as a medicine is more interesting and complex than anyone could have imagined.
Foreword by Andrew Weil, M. D.
Part 1: Cannabis as a Medicine
The Cannabis Plant
How Medical Cannabis Does and Doesn’t Work
How Cannabis Works Within the Body
Adverse Effects of Medical Cannabis
The Endocannabinoid System: a Brief Primer
Phytocannabinoids and terpenoids—The Principal Active Ingredients of
Genotypes, Phenotypes, and Chemotypes of Medical Cannabis
Part 2: Using Medical Cannabis
Metabolizing Medical Cannabis
Dosage: A Short Introduction
Cannabis Contaminants, Pathogens, Pesticides, and Adulterants
Forms of Cannabis
Delivery and Dosing
Using Medicinal Cannabis in the Workplace
Part 3: Varieties of Medical Cannabis
What Makes a Cannabis Variety and Why it’s Important
Grand Daddy Purple
Northern Lights #5 X Haze
Part 4: Medical Uses of Cannabis
Attention Deficit Hyperactivity Disorder
Autism Spectrum Disorders
Cachexia and Appetite Disorders
Chronic Fatigue Syndrome
Insomnia and Sleep Disorders
Migraine and Headache
Multiple Sclerosis and Movement Disorders
Nausea and Vomiting
Post-traumatic Stress Disorder
Cannabis and Adolescence
Cannabis and Children
Cannabis and Pregnancy
Cannabis and Preventive Medicine
Cannabis and Women’s Health
Cannabis Dependence and Withdrawal