I educate my patients on the differences in the strains of cannabis they are using because there are two major different strains of Cannabis: Sativa strains and Indica Strains. What most people have been exposed to in the United States, other than during the Vietnam war, is the Indica strains.

These Indica strains produce the typical sedating/munchies inducing/stony type “high” people now associate with, Marijuana = POT = stoner. Because of the media and Cheech and Chong, we have all come to expect that all Cannabis products produce this “stoned” and “unfocused” state. With the Indica strain this is true, but let’s not forget, that these strains do help people with insomnia, severe pain and of course comfort in so many ways for the seriously ill cancer and HIV patients.

Then there are the Sativa strains. These were around for a while during the Vietnam war, but until marketed as a part of the California Medical Marijuana system, it was nearly impossible for anyone to find Sativa strains because they were commercially unviable due to their being difficult to grow, low production rate and long flowering cycle. Now that they are available medically, patients are discovering that the Sativa strain can help to address their symptoms, yet keep them alert, focused and content.

When you look at the list below comparing the effects of the Indica and Sativa strains, it will probably surprise you.

SATIVA STRAINS

Activating
Anti-Anxiety
INCREASED FOCUS!
Anti-Depressant
Increased Creativity
Treats Chronic Pain
Increased Levels of Serotonin

INDICA STRAINS

Sedating
Relaxing
DECREASED FOCUS!
Muscle Relaxant
Treats Acute Pain
Increased Appetite
Decreased Nausea
Increased Levels of Dopamine

http://www.cbsnews.com/stories/2008/04/26/health/main4048107.shtml

So, we have here a terminally ill patient. He is dying of liver failure caused by Hepatitis C. Apparently he was initially infected with Hepatitis C injecting himself with infected needles. He will die without a liver transplant. He is a candidate for a transplant despite his prior serious IV drug habit having caused his liver failure. So, his behavior and habits caused his liver to fail, yet the hospitals and insurance companies are OK with this fact.

This is a reasonable and caring position on the part of the hospital and insurance company. What is not remotely reasonable is the insurance company and hospital now saying he is not “covered” due to his use of Medical Cannabis! Prior IV drug injections causing Hepatitis C and now liver failure are “OK”, but the Cannabis use leads them to be concerned about drug addiction.

Most likely, if the Cannabis had caused some long term medical problem, they would have covered it, but there are NO long term problems caused by Cannabis.

Insurance companies always cover injuries from activities requiring the “patient” to wear a helmet for protection. I contend that any activity requiring a helmet is much more dangerous than using Cannabis. From Timothy Garin’s story, it is clear that the prejudice regarding medical cannabis causes much more harm than does cannabis.

Allan I Frankel, MD

In the practice of Cannabis Medicine, I am often asked by patients if they will be placed on a “list”.

The only “list” that I am aware of, is the list compiled by the State of California. This list is generated when patients purchase a “State ID Card”. This card is NOT MANDATORY and in Southern California, is seldom recognized at the “Dispensaries”. The Physician letter, which all patients receive at the end of an approved and legitimate visit, is the only required ID.

Allan Frankel, MD

As a Physician licensed to practice in the State of California, I believe Medical Marijuana is a powerful and yet extremely safe medication. Anything that interferes with my patients getting the best possible medication compromises the Doctor Patient Privilege. After thirty years of practice and serving two decades as a Clinical Instructor of Medicine at a prestigious University Hospital I believe I am qualified to decide whether a given patient might benefit from Medical Marijuana.
Whether someone suffers from depression, anxiety, nausea, pain, … all patients should have the option of discussing their symptoms and Treatment Plan with a Physician. If this plan includes Medical Marijuana as determined by the Patient/Physician partnership AND is legal, as it is has been since 1996 in California any “Care Giver” should be permitted to dispense the medication.
Marijuana is far safer than Aspirin and Tylenol. It has highly predictable effects and has no known lethal dose. The “Therapeutic Ratio” i.e. the “Benefits to side effect” ratio, is the highest of any known medication. There are also predictable side effects as no medication is entirely without side effects. Various strains of Marijuana have very different psychoactive effects. If a patient medicates with an activating form, they might become over stimulated. If a patient medicates with a sedating strain, they might become overly sleepy. Knowing how to take a medication is always critical and the same applies to Medical Marijuana. It is in fact a Medicine and should not be used without adequate professional advise. Remember, Marijuana is a “restricted” drug for political reasons – not medical safety or efficacy.
The current California Medical Marijuana System is a major advance over where we were just a few years ago. This system is emerging as a significant force in alternative care for patients who have not been well served by traditional methods. Many have dedicated their lives to this end and we should all be very grateful. Without these pioneers risking incarceration, we would still be groping in the dark.
Although Marijuana has been used medicinally for thousands of years, it was not until recently that physicians and patients have learned that myriad strains of the plant have entirely different actions and therefore, diverse applications. Various Marijuana strains are mind activating and are used for conditions such as depression and ADD/ADHD. Other strains can be as sedating as sleep medications. These strains, as all strains of Marijuana are effective, safe and non-addicting.

With the assistance of a medical doctor the various strains can be used for specific patient needs. For example:
➢ On the “street”, most Marijuana strains are NEVER IDENTIFIED. I know of chemotherapy patients who were forced to the streets to purchase their Marijuana! They have little or no idea whether they are purchasing a stimulant or relaxant. I recently saw a woman with Breast Cancer on chemotherapy who was told by her Chemotherapy nurse to go “find some Marijuana on the streets….”!! This is a pretty big issue when it comes to patients properly treating their symptoms. Is all Marijuana just “pot”? Do all strains make the patient sleepy or “stoned”? Is it possible to recommend different “medications” to a patient?
➢ SATIVA STRAINS: These are strains of Marijuana whose THC molecule has been genetically altered over many years that have stimulant, activating, focusing and anti-depressant activity. An individual can be medicated with a Sativa strain achieving an increased level of focus, alertness, mood elevation and increased creativity. I have many patients who have unsuccessfully tried various medications for mood disorders who are currently using Sativa Marijuana strains to alleviate their depression. These patients do not look or act stoned. They are functioning at or above where they usually function.
➢ INDICA STRAINS: These strains have very different biological effects than the Sativas. Indicas are sedating, calming and muscle relaxing. These are the strains used best for pain, anxiety and insomnia. The patient, however, does look and feel “stoned”. These can be used at bedtime or during an acute Migraine Headache or acute back spasm.

Who would deprive a dying patient Medical Marijuana? Who would prosecute a CANCER CENTER for giving their patients a Medical Marijuana Recommendation? Yet, most people with cancer have NO IDEA how to get Medical Marijuana. This needs to be remedied. Suggestions anyone?