Stages of the marijuana plant growth cycle

Cannabis plants, like all living things, go through a series of stages as they grow and mature. If you’re interested in cultivating cannabis, it’s especially important to understand the changes a plant undergoes during its life cycle, as each stage of growth requires different care.

Different stages call for different amounts of light, nutrients, and water. They also help us decide when to prune and train the plants. Determining a plant’s sex and overall health rely on stages of growth as well.

Generally speaking, it takes anywhere from 14-32 weeks, or about 4-8 months, to grow a weed plant.

The biggest variability in how long a marijuana plant takes to grow will happen in the vegetative cycle—if you’re growing indoors, you can force it to flower after only a few weeks when it is small, or after several weeks when it is big. If you’re growing outdoors, you’re at the whim of the seasons and will have to wait until fall to harvest. The plant will develop buds in the last 8-11 weeks.

The life cycle of cannabis can be broken down into four primary stages from seed to harvest:

  • Germination (5-10 days)
  • Seedling (2-3 weeks)
  • Vegetative (3-16 weeks)
  • Flowering (8-11 weeks)

Light cycle: 18 hours of light

(Elysse Feigenblatt/Leafly)

The first stage of life for a cannabis plant begins with the seed. At this point, your cannabis plant is dormant, patiently waiting for water to bring it to life.

You can observe the quality of the seed by its color and texture. The seed should feel hard and dry, and be light- to dark-brown in color. An undeveloped seed is generally squishy and green or white in color and likely won’t germinate.

To begin growing from a seed, learn more about germination here. This stage can take anywhere between 5-10 days.

Once your seed has popped, it’s ready to be placed in its growing medium. The tap root will drive down while the stem of the seedling will grow upward. Two rounded cotyledon leaves will grow out from the stem as the plant unfolds from the protective casing of the seed. These initial leaves are responsible for taking in sunlight needed for the plant to become healthy and stable.

As the roots develop, you will begin to see the first iconic fan leaves grow, at which point your cannabis plant can be considered a seedling.           

Light cycle: 18 hours of light

(Elysse Feigenblatt/Leafly)

When your plant becomes a seedling, you’ll notice it developing more of the traditional cannabis leaves. As a sprout, the seed will initially produce leaves with only one ridged blade. Once new growth develops, the leaves will develop more blades (1, 3, 5, 7, etc.). A mature cannabis plant will have between 5-7 blades per leaf, but some plants may have more.

Cannabis plants are considered seedlings until they begin to develop leaves with the full number of blades on new fan leaves. A healthy seedling should be a vibrant green color. Be very careful to not overwater the plant in its seedling stage—its roots are so small, it doesn’t need much water to thrive.

At this stage, the plant is vulnerable to disease and mold. Keep its environment clean and monitor excess moisture.

Light cycle: 18 hours of light

(Elysse Feigenblatt/Leafly)

The vegetative stage of cannabis is where the plant’s growth truly takes off. At this point, you’ve transplanted your plant into a larger pot, and the roots and foliage are developing rapidly. This is also the time to begin topping or training your plants.

Spacing between the nodes should represent the type of cannabis you are growing. Indica plants tend to be short and dense, while sativas grow lanky and more open in foliage.

Be mindful to increase your watering as the plant develops. When it’s young, your plant will need water close to the stalk, but as it grows the roots will also grow outward, so start watering further away from the stalk so the roots can stretch out and absorb water more efficiently.

Vegetative plants appreciate healthy soil with nutrients. Feed them with a higher level of nitrogen at this stage.

Light cycle: 12 hours of light

(Elysse Feigenblatt/Leafly)

The flowering stage is the final stage of growth for a cannabis plant. Flowering occurs naturally when the plant receives less than 12 hours of light a day as the summer days shorten, or as the indoor light cycle is shortened. It is in this stage that resinous buds develop and your hard work will be realized.

If you need to determine the sex of your plants (to discard the males), they will start showing their sex organs a couple weeks into the flowering stage. It’s imperative to separate the males so they don’t pollenate the flowering females.

There are a number of changes to consider once your plant goes from its vegetative stage to flowering:

  • Your plants shouldn’t be pruned after three weeks into the flowering stage, as it can upset the hormones of the plant.
  • Plants should be trellised so that buds will be supported as they develop.
  • Consider feeding plants with blooming nutrients.

What week of flowering do buds grow the most?

Buds typically grow the most toward the end of the flowering cycle, around week 6-7. You probably won’t notice much budding out at the beginning of flower, and it will slow down toward the end of the cycle, when buds become fully formed.

This post was originally published on July 18, 2017. It was most recently updated on January 17, 2020.

Once the buds have reached full maturation, it’s time to harvest.

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Bigger isn’t better: The case for growing small marijuana plants

We’re not going to delve into other matters where this might be up for debate, but when it comes to cannabis, bigger doesn’t mean better. Sure, giant weed plants look really cool. If nothing else, it’s ridiculously impressive that a warm season annual can go from seed to tree-sized in a matter of months. We get it.

But when it comes to the actual growing, drying, flavor, and quality of your crop, don’t be suckered into thinking that size is everything. In fact, we have solid reasons to encourage you to embrace smaller plants in your garden.

No matter the size, your neighbors might be able to smell the goods from over the fence. But you’ll keep your garden much less conspicuous by growing plants on the smaller side. While weed cultivation might be legal in your state, we’re still operating in a grey area due to federal illegality.

If someone’s got a vendetta against you, you’re just better off not having weed plants towering above fences and in plain sight. And besides revenge seekers, there are people who might be tempted to steal your crop if you’re making it too easy for them.

The best method of pest control always starts with you giving your plants a once over. That’s quite easy to do when plants are on the smaller side. You can reach up or kneel down, walk around your plant, and give every leaf and bud an inspection, usually without breaking a sweat or taking all day.

Things get a little more complicated when you need a ladder to do the same thing. Not only do you open the door to injury from falling, but it’ll take much more time when you’ve grown giant plants. You’ll likely skip the task entirely, opening the door for pest problems to get out of control.

Massive buds definitely look cool, but it can be a headache to try and dry them properly. A tasty, usable crop depends on buds drying evenly from the outside in and inside out. This is a much more reasonable task if buds are a manageable size. Once they feel dry from the outside, a few days of burping them in a storage vessel will suck out the remaining moisture.

Bigger buds are more difficult. Even when you think buds are dry on the outside, they might be packing quite a punch of moisture on the inside. Not only will curing be much more of an artform and take much longer, you’re much likelier to end up with mold problems.

If you’re not sold yet, this one will get you: The Emerald Cup judges often hand out awards to buds coming from plants that yield less than two pounds. Simply put, smaller plants can produce better tasting weed.

Think about it: A plant’s goal in life is to reproduce. If it’s stressed in any way, it abandons unnecessary tasks (like packing on extra foliage) and focuses everything on reproduction. That’s why you hear so much about mouthwatering dry-farmed tomatoes or grapes. The harvest might be smaller, both in fruit size and yield, but the taste is unbeatable, as stressed out plants pour everything they’ve got into their fruit, flowers, or seeds.

In the case of weed, that means stickier buds loaded with terpenes and packed with cannabinoids. Don’t take our word for it—Happy Dreams Farm, Eel River Farms, and High Water Farm are just a few of the Humboldt-area spots having great success with dry-farmed weed. Their plants are itty bitty and tasty as hell.

Not shooting for massive weed also bodes well for the environment as well as your pocketbook. You can skip the heavy doses of fertilizers in the false thinking that bigger weed yields tastier plants. What you want to do is a lot simpler and a lot less expensive.

When you first plant your weed outdoors, make sure the soil is amended with plenty of quality, finished compost. Truth be told, that’s likely all your weed needs for the growing season. It’ll be just enough to get the plant growing nicely, and not too much nourishment for the plant to get lazy about flavor.

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What it’s like to be a kid who medicates with cannabis

It’s awful that there are sick children in this world, that someone so young could already be tied to grown-up matters like mandatory daily medicine. Unfortunately, it’s a very real situation for many families, and its complications are made considerably more so when that medicine is federally illegal. But, due to the extensive nature of the endocannabinoid system (ECS), cannabis can be used to fight many diseases—and many of these ailments can affect people of all ages, not just adults.

We talked with a couple of families with children who regularly medicate with cannabis, aiming to get a picture at what this lifestyle is like, what kinds of challenges they face, and how cannabis has transformed their lives. We discovered stunning stories of improvement, innovation, and a couple of families who’ll make you wish there was a bigger word for “inspiring.”

medical marijuana patient, children who medicate with cannabis, children and marijuana

(Courtesy of the Ryan family)

Sophie Ryan was born October 3, 2012 a perfectly healthy baby girl. But it wasn’t even a year before an MRI diagnosed an optic pathway glioma brain tumor, which doesn’t normally shrink with chemo. Things didn’t look good. Then her parents created a Facebook page called “Prayers for Sophie,” and a friend put them in touch with Ricki Lake and Abby Epstein, who were filming Weed the People, a documentary about the possibility of cannabis oils treating cancer in pediatric patients.

In a phone interview with Leafly, Sophie’s mother, Tracy, told us that Sophie took her first cannabis medicine at 9 months old in the film—a drop of high-concentrated CBD and THC oil on top of her food before beginning chemo treatment. Because Sophie was just a baby, they had to watch her mannerisms to try and gauge dosing, but the only side effects they’ve noted was sleepiness at the beginning, and a higher appetite, which is perfect for a chemo patient.

After 13 months of chemo and high doses of cannabis oil, Sophie’s “unshrinkable” brain tumor was about 85 to 90% gone. Tracy shared with Leafly that even Sophie’s doctor, who was originally skeptical about cannabis, had to concede that cannabis must have helped.

Its’ not just in results that Sophie’s cannabis treatment differs from chemo, her parents note. In addition to being more expensive, Tracy said, “Chemotherapy makes you very sick, it destroys your immune system, it causes organ failure. They lose their hair, they get sores all over their bodies and inside their mouths… Sophie was getting chemo burns when she was in diapers and we’d have to use gloves so we wouldn’t get the chemo acids on our skin—it’s that horrible. And then you have cannabis, and it’s doing the opposite of all that.”

Fortunately, Tracy hasn’t gotten much judgement. She works to ensure that she’s a trusted voice, making sure she’s on top of research and bringing Sophie to lots of speaking engagements to show proof of how healthy she feels, despite chemo. (Tracy said Sophie is a natural and loves doing these events, with rare exceptions.)

medical marijuana patient, children who medicate with cannabis, children and marijuana

(Courtesy of the Ryan family)

After discovering the incredible ways cannabis could heal, Tracy decided to create her own business, CannaKids. They’re now selling high quality tinctures and syringes throughout California and are working on expanding to Canada and Australia, as well as starting a nationwide hemp line with 6-9 cannabinoids. Like many, legalization presented some significant issues, with Tracy sharing that her business “almost didn’t survive the costs and demands of legalization.” For instance, they have had to change the name because of laws about marketing cannabis to children; CKSoul is the new product line, and CannaKids will continue to operate as a non-commercial resource.

They’ve also started a foundation called Saving Sophie, which has raised $60k but Tracy said, “That’s like a week’s work in a laboratory. They’ll need about a half million to get rolling.” And the Ryans have also started a podcast to promote awareness and raise funds—check it out here.

medical marijuana patient, children who medicate with cannabis, children and marijuana

(Courtesy of the Turner family)

Coltyn Turner developed Crohn’s disease when he was 11 years old, after a near-drowning incident led to a bacterial infection. For the next three years, he’d try various traditional treatments, which he and his mother, Wendy, say nearly killed him. In a phone interview with Leafly, Coltyn shared, “The pharmaceutical medications that I’ve tried [range from] pills that do absolutely nothing, to shots that gave me nosebleeds, profusely, for 15 minutes straight, [to] another chemo-like infusion treatment gave me medically-induced rheumatoid arthritis (RA) and lupus.”

You read that right. Coltyn and his family report that traditional medications left him with two more chronic illnesses, each capable of rendering a person debilitatingly ill on their own. Yet, there’s more.

They eventually tried cannabis. “When I got introduced to cannabis, within the first two weeks I was already out of my wheelchair. I felt like a normal kid again,” Coltyn said.

And he’s got proof of the positive changes. “I [went from] 22 centimeters of inflamed bowel with skin lesions, with everything you can imagine—inflammation, ulcers, scar tissue, granulation lymphoma—to a normal colon; no active Crohn’s disease, just using cannabis. So not only did cannabis treat the pain, which is important, but it also took care of what was causing the pain. It also helps with the RA and lupus I got from the [pharmaceuticals].”

medical marijuana patient, children who medicate with cannabis, children and marijuana

(Courtesy of the Turner family)

Coltyn is now 19 years old, having been on cannabis for five years. And his Crohn’s is in remission; they report hardly ever having to go to the doctor these days. He still occasionally gets symptom flares, but is able to control them by upping his cannabis dose during those times. They’ve a great handle on it these days, but they say there were some challenges early on.

Wendy said the main challenge is dosing and ensuring that Coltyn gets the right amount of cannabinoids without getting high. “We are constantly like, ‘How are you doing, how are you feeling?’” she said. “He must be really, really sick of it.”

But Coltyn isn’t phased. “Yeah, I am, but at the same time it’s very important because a lot of patients don’t really know their dose, especially earlier in their cannabis treatment, and you’re changing it pretty frequently,” he said. “When I first moved out of Colorado to start cannabis treatment, we kept a journal and wrote down every little thing that happened: what I ate that day, how many times I went to the bathroom–if I had a stick of gum, we wrote it down. Unfortunately that’s the only way to develop a regimen for people, through trial and error, trying everything under the sun until you find something that works best for you.”

Wendy shares that there were some learning curves on their path. “Sometimes we mess up. For instance, now we know to never give a Crohn’s patient THCV.”

Coltyn adds, “What we know about THCV is that it’s an appetite suppressant. For someone with a wasting syndrome, that’s not a good cannabinoid to have. But we didn’t figure it out until I lost 10 pounds. That’s the struggle with there being no research or anything.”

As far as medicating during school, Coltyn said, “Fortunately, I’ve been homeschooled my whole life, but there are kids who are having trouble having medicine in school. A lot of the time they aren’t even allowed to have it 200 or 1,000 feet from a school. There are kids with seizures who go to public school, and if they need a rescue med, they have to have their parent come to school, pick them up, drive off campus, administer it, then bring them back.”

medical marijuana patient, children who medicate with cannabis, children and marijuana

(Courtesy of the Turner family)

Wendy said that legalization has affected this issue negatively. “These newly legalized states emerging and creating regulation issues in schools with zero tolerance laws. Coltyn attended school for 38 days and we took him out because we couldn’t deal with it. There’s not a feasible option for it, not even in college.”

She added that there is a student suing their school over this issue, and said it’s crazy that pharmaceuticals, which can kill you if abused, are allowed in school, but cannabis isn’t.

Wendy said that without interstate commerce, medicating can also be a challenging task when getting medical care. “Every person who has a medical card is a prisoner of that state,” she said. “Most of Coltyn’s doctors are across state lines in Missouri and the second we cross that state line, Coltyn is illegal. And if he were to break his arm or something, I would have to tell them that he’s medicated with THC. And I cannot give him those meds for Crohn’s disease if he were to have to stay in the hospital for this broken arm for more than a day. So, there we go, into a flare with his Crohn’s disease.”

When asked if they’ve faced much judgement for medicating Coltyn with cannabis, they happily report that they don’t. Tracy shared that it probably has a lot to do with her being an intimidating mom, ready to get into the facts and statistics with doctors and other medical professionals as needed.

medical marijuana patient, children who medicate with cannabis, children and marijuana

(Courtesy of the Turner family)

And their advocacy for cannabis doesn’t end there. The Coltyn Turner Foundation is focused on research and raising the funds to get it done–their first project is a survey of Crohn’s patients using cannabis, which is aimed at getting solid data on how it’s working in their systems that can be used as a resource for other patients. “I felt like it was important, Coltyn said. “All the time I approach doctors and patients who don’t know that cannabis works, and the one thing they say is ‘there’s no research.’”

His mother added that that isn’t the whole truth, “One of the problems we have in the states is our ego, especially with these doctors who say ‘there’s no research,’ just because the research isn’t coming from the US, which has to go through the DEA and other enforcement agencies,” which, of course, aren’t big fans of approving studies with Schedule I drugs—an infuriatingly circular dilemma. But Coltyn’s up for the challenge.

“When the government doesn’t do something right, the people have to do it themselves,” he said. “I’d rather be illegally alive than legally dead.”

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Why isn’t the endocannabinoid system taught in medical schools?

I am currently dependent on medical cannabis, and despite loving the plant, I’m kinda bitter about this fact. And it’s not the usual lamenting of “Why me?” that so often goes with illness; it’s because the medical professionals I encounter have little to offer about the origin and treatment of my disease, fibromyalgia. A major reason that they’re at a loss with it—and so many chronic illnesses like it—is because it may be sourced in the endocannabinoid system (ECS).

As a Leafly reader, you might already know that the ECS is a bodily system made of receptors located throughout the body and that it works with all other systems to maintain homeostasis, or optimal functionality.

But did you know that this vital system isn’t covered in medical school despite the fact that studies worldwide have been articulating its prowess since 1992?

And do you know what their primary reason is? Because they say they “don’t have time to teach it.” That’s right—med schools are apparently no longer open to integrating new science into their curriculums. We reached out to many medical schools for comment, but repeated emails went without response.

According to Dr. Ethan Russo, board-certified neurologist and psychopharmacology researcher, the common response is that they’d have to remove something else from the curriculum to make room for it.

According to Dr. Russo, “The medical curriculum is just jam-packed. I went to med school back in the ‘70s, and even at that point there was just no slack in the schedule. What one has to cram into particularly the first couple years of basic science, is rather astounding. And now there’s been an additional 40 years of scientific discovery that also has to be incorporated. Administrators are always going to be defensive about that. The typical response is, ‘What will we eliminate?’ However, that ignores the scientific importance of this system and its fundamental role in regulating physiology in every aspect.”

One would hope that the response to realizing there is a vital bodily system missing from medical school curriculum would be something thoughtful, like, “This system works with all of the other bodily systems and is essential to maintaining health in the body—maybe it’s time to reassess and reorganize.”

But, alas, the party-line solution is actually to just not teach another piece of medicine, which would remove it from practice. It’s as if medicine goes into a tool belt, and rather than reconfiguring a more suitable tool belt when full—they’d instead just toss aside an irreplaceable tool.

Dr. Russo says that the idea of not educating doctors on the ECS is incomprehensible because it is fundamental to how our bodies work.“A prime example is that there are more cannabinoid receptors in the brain than there are for all of the neurotransmitters put together,” he said.

As you’ve probably ascertained, this is a fact with significant implications. He continues, “One could easily argue that you can’t understand how neurotransmitters in the brain work without knowledge of the ECS.” Additionally, he confirmed this could also imply that there are more opportunities for cannabis to work with the body than pharmaceuticals.

The ECS is also responsible for maintaining the homeostasis of all of the other bodily systems—which is a fancy way of saying that it keeps balance in the other systems, ensuring that they are functioning optimally. It’s also often described simply as the way the brain communicates with the body. Or, as Russo put it in our interview, “Everything in the body is connected, and this is the glue.”

Because the ECS appears to regulate actually recognized bodily systems, many things go awry when it doesn’t function correctly. Endocannabinoids have been observed to directly and indirectly influence a variety of physiological systems that control appetite, pain, inflammation, thermoregulation, intraocular pressure, sensation, muscle control, energy balance, metabolism, sleep health, stress responses, motivation/reward, mood, and memory.

These functions are not minor details—if you were to lose even a single one of these abilities, it could significantly alter your daily life. Chronic illnesses, which last three months or longer and are generally considered “incurable,” affect 40% of Americans. Why is it that so many of our bodies are afflicted with conditions that modern medicine cannot do anything to absolve?

Could it be that we’re missing a crucial piece of the puzzle? Surely, there must be something else going on.

When asked why the ECS isn’t being taught in medical schools, another common response was that there are presently very few medications that interact with it—but how will there ever be if the medical community doesn’t even regard it in the first place? And why does it matter, anyways—do doctors only need to know about bodily systems that can be treated via the pharmaceutical industry? (And even the answer there is a plutocratic ‘yes,’ then do the available synthetic cannabinoids not count?)

These are apparently not questions that are often discussed in the medical community. The basic consensus seems to be that though medical students ought to be taught about all illnesses—not just those that there are presently pharmaceuticals for—that’s simply not how it works.

Another factor is, of course, the federally-illegal status of the plant that works so adeptly with the ECS; still holding its ancient and never-been-true title of ”Schedule I–Drug with no currently accepted medical use.” But since the ECS generally functions without the help of cannabis (thanks to our naturally occurring endogenous cannabinoids), one wonders why this is show-stoppingly relevant—again, shouldn’t doctors need to know about bodily systems that don’t already have viable medications? Isn’t that all the more reason they should be trained in what we do know about the ECS, so they may help patients keep the vulnerable system unharmed?

This next revelation will not surprise you: According to Russo, stigma around cannabis and a lack of funding as a result also appear to play a role in this reckless and willful knowledge gap, “One has to imagine that a prejudice against cannabis, fear of cannabis, and lack of funding is spilling over into a pejorative effect on education about the endocannabinoid system.”

Even though Russo says that grad students rarely want him as a mentor, some colleges are hedging their bets that tomorrow’s generation will have a different take. The University of Maryland School of Pharmacy is one such school, now offering a Master of Science (MS) in Medical Cannabis Science and Therapeutics. Leafly talked with Andrew Coop, PhD, their Professor and Associate Dean for Academic Affairs, who seems hopeful that logical changes in this area are on the way.

“The reason we started the program was because so few programs focus on the health benefits of marijuana,” Coop said, “the pluses, the minuses, the strengths, where further research needs to go, where the indications have good strong evidence, where there is no strong evidence. We are teaching 150 students at the master’s level to understand all aspects—but also to be able to critically assess what the current state of the art says and doesn’t say, and what further studies need to be formed so that we can move forward in a systematic manner.”

Their twelve courses cover a comprehensive range of topics, from an introduction to the history and culture of cannabis, to the highly technical “Genomics and Pharmacognosy,” to “Expert Seminars and Case Studies” where students identify knowledge gaps in the science and design an educational intervention.

Coop is looking forward to more sweeping changes in policy and legislation. “To me, the bottom line is that we need change at the federal level, such as the MORE Act, before we’ll see more med schools include it in their curriculum,” he said. “Once we get things such as the decriminalization of marjiuana, I predict more schools will include it. There is a want and a need for education in all aspects of marijuana.”

Until that day, those of us with diseases suspected to be sourced in ECS malfunction must wait. One day, researchers like Dr. Russo will have the resources to provide necessities like a diagnostic test for fibromyalgia, something he’s waiting on funding to get rolling on—a development that could change the lives of millions.

As Dr. Russo told us, “This failure to address ECS education appropriately is in unforgivable breach of scientific trust and a major disservice to the public health.”


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Endocannabinology with Dr. Rachel Knox

Project CBD: Welcome to another edition of Cannabis Conversations. I’m Martin Lee with Project CBD and today we are privileged to have with us in the studio Dr. Rachel Knox, who is the co-founder of the American Cannabinoid Clinics, with other members of your family who are also physicians. Also, you are the chairwoman of the Oregon Cannabis Commission. We’re glad you can join us. I wanted to ask you about something you’ve been lecturing about to various audiences — you refer to endocannabinology. Maybe you can tell us what is endocannabinology?

Knox: In medicine we silo our fields into “-ologies” really. So people are familiar with cardiology and endocrinology, neurology – and really what we mean is the study of the function and dysfunction of those systems. So, in cannabis medicine the focus for a long time has been on the cannabis, but people come to us with physical conditions and we doctors are trained to treat the patient. What we’re really treating is the endocannabinoid system when we’re assessing different disease processes or symptoms. And, so it made sense to me and my family at the American Cannabinoid Clinics to call ourselves endocannabinologists who practice endocannabinology. And we use cannabis, which is probably as far as we know, the most versatile tool that works on that system, but along with lots of other things that help us treat that system. So endocannabinology means the study of the function and dysfunction of the endocannabinoid system and all the ways we can modulate it.

Project CBD: Let’s talk about the endocannabinoid system. What is its purpose? How do you break it down in terms of its components?

Knox: As far as we know, right, because there’s still so much more to know, but our understanding is that the endocannabinoid system is the maestro to the symphony that is every physiological system in the human body. And its role is to keep us in balance, to keep us healthy. So, a perfectly functioning and in tune endocannabinoid system keeps us in perfect health.

But the reality is that we’re inundated with toxic environments, and emotional and physical stress, and poor foods – you name it. This endocannabinoid system of ours is having to battle a lot of insults today. It’s really hard for it to keep us in balance, which is why so many people are struggling with so many diseases. But again, its role is to keep us in balance. And it does that through a very intricate feedback loop. It’s constantly in flux. It’s constantly adapting and reacting to everything that we’re throwing at it. And so it has to work in sort of a feedback system in response to what we’re throwing at it.

For a long time, we’ve talked about the endocannabinoid system in four components. We talk about the four components of it: The first components were discovered between 1988 and ’92, and those were the CB1 and CB2 receptors, mixed in there was the first endocannabinoid (or endogenous cannabinoid, cannabinoid made in our body) anandamide; shortly followed by 2-AG. So we have the cannabinoids that were on those cannabinoid receptors, like a lock in a key. And then we have the enzymes that create those endocannabinoids on demand when they’re needed; again constantly responding to stimuli. And we have the enzymes that break those cannabinoids down when they’re no longer needed. It is a system that runs all by itself. We call it auto-regulatory. And it works when it’s needed, on demand, in response to, again, what we’re doing to it.

Project CBD: So why, if we have this system and it’s working all the time, why do we need cannabis then?

Knox: Because – I mentioned the things that we’re doing to ourselves in today’s age – we talk about inflammation as the root cause of disease, and that’s true. We’re causing inflammation. But the endocannabinoid system is immunomodulating, it’s supposed to keep inflammation in check. It can’t do that when we’re constantly eating inflammatory foods or we’re constantly under stress, right.

The endocannabinoid system works like this. So if a cell is sending signals of pain or stress or inflammation to each other, well the receiving cell is supposed to create an endocannabinoid that it shoots back to the cells sending that signal to turn it off, to restore balance and harmony. Unfortunately, we’re getting in our own way in some respects. The system is being overwhelmed and overloaded with constant signal of stress, pain, inflammation. It’s very difficult under those conditions for it to properly make these endocannabinoids.

We need to eat Omega-3 and Omega-6 fatty acids to even make these cannabinoids. A lot of us are deficient in the foods that are essential to even create these endocannabinoids. And we’re working at a deficiency, right. So there comes in a very good place for phytocannabinoids. So THC – it’s been around for a long time in our colloquial world around cannabis. THC is an anandamide mimicker. Anandamide was that first endocannabinoid that was discovered. Well THC mimics it. So if we’re having trouble developing anandamide it makes sense to supplement with THC for it to take the place of anandamide and help restore some of that function by working on those cells that are constantly sending those signals of pain and stress and inflammation.

It’s kind of like in conventional medicine where we might recommend a supplement to a patient. If you’re deficient in Vitamin D, well we give you exogenous Vitamin D, you take it in a pill form. Using THC in that way to supplement anandamide is no different than what we already do in the conventional world.

Project CBD: So, it would be similar for CBD, cannabidiol, the non-intoxicating cannabinoid. How does CBD play into this?

Knox: Similarly, in general THC and CBD have a lot of overlapping downstream effects. But CBD does not mimic our anandamide or 2-AG. CBD does something very special with respect to THC and anandamide. And what that does, it blocks the breakdown of anandamide. So wherein we might use THC to supplement somebody who’s deficient in anandamide, we might use CBD to prevent the breakdown of anandamide and keep the anandamide levels higher indirectly.

CBD also binds what we call allosterically to the CB1receptor. And when it binds allosterically, meaning not at the same site THC binds to but maybe over here, it changes the conformation of that receptor site. So THC binds to it, but a little bit differently. And that’s one of the reasons we think CBD has such a significant impact on diminishing or dampening the intoxicating and euphorigenic properties of THC. That’s one of the reasons I think people like to say “use THC and CBD together, they work better together.” In truth, yeah, they work synergistically. Again, for patients who don’t want the intoxicating or euphorigenic effects, we can use them in concert to diminish those sometimes unwanted effects of THC – certainly sometimes they are wanted!

And then CBD works on 65 and counting other receptor targets, enzyme targets. It works on the serotonin system, on the opioid system, and I can list many other systems. But CBD works well throughout the body in so many ways. Phytochemicals in general do. We talk a lot these days about the entourage effect of cannabis, but in our clinics we talk about botanical synergy because we recognize also the benefit of including other botanicals in a formulation with cannabinoids or outside of it. We might be recommending your cannabis product plus your echinacea plus your mushrooms, along with a whole other host of things.

Project CBD: I was going to ask you about that. In terms of the patient populations that you are ministering to, how much of it is strictly cannabis-focused or is it generally that cannabis is a piece of the puzzle and other herbs or holistic healing modalities – or maybe non-holistic, maybe pharmaceutical modalities – would play into it. How does that work in your practice?

Knox: Well 100 percent of patients are coming to us looking for a cannabis solution. Our clinics are called the American Cannabinoid Clinics – it’s in the name. People know what they’re going to get when they come to us. But we do a lot of re-directing as soon as those patients hit the chair. We teach about the endocannabinoid system and all the things that stimulate it. And so, folks will leave with the understanding that nutrition comes first followed by, if not equal to, phytocannabinoids (cannabis). Because again, cannabis is the most versatile botanical that we know that works on that system.

So along with nutrition, which is foundational, we need that to survive- none of us are going to survive on cannabis alone, we need to be eating natural whole foods that our body requires to even create new cells. We have to address that. But then, cannabis is a close second. We get into detoxification for the endocannabinoid system, supplementing with other botanicals to tone and help soothe the endocannabinoid system. We talk about stress reduction. We talk about spirituality. We’re talking about everything that modulates that system.

I haven’t said the fancy new word yet that I mentioned yesterday: cannabimimetics. We speak in terms of cannabinoids in cannabimimetics. Cannabimimetics really do encompass just about everything else that we talk about. Cannabimimetics are substances, non-cannabis substances, or practices that stimulate the endocannabinoid system, too. So again, we have our cannabinoids, then we have everything that falls under the cannabimimetic category, which is nutrition, detoxification, supplementation, physical activity, deep breathing, yoga, meditation, acupuncture – the list goes on there. We talk to patients about all of those things.

Project CBD: One last question, sort of food for thought. You have emphasized the significance of diet. And you mention specifically the Omega-3, Omega-6, the essential oils as being very, very important, if nothing else as building blocks for components of the endocannabinoid system. I’m not one who believes there is one perfect diet. Diets do vary in culture to culture, place to place, but if you were to outline some of the do’s and don’t’s in terms of a diet that facilitates healthy endocannabinoid functioning, what would that be? What would that look like?

Knox: Natural, whole foods. I agree, when we eat natural whole foods it doesn’t matter if you’re a vegetarian, a vegan, a paleo, or Keto subscriber, you are really – how can I say this – that’s like 50 percent of the battle right there. Just eating real food. Overly processed foods are hard to digest. You could make the case of using digestive enzymes to help us digest these overly processed foods, but the fact of the matter is these chemicals and preservatives are really hard to break down. And for the most part, we’re not getting the nutritional benefit from a lot of these processed foods because we just can’t break them down. We don’t have the capacity, the capability to break those things down. Prebiotics, probiotics, those are also great to supplement our diet with. But natural, whole foods, and I feel like when people convert to a truly natural and whole food diet, within 30 to 60 days they’re feeling 40, 50, maybe even 60 percent better than they did already. When we then shift some emphasis onto foods that are higher in fat, we see an even better outcome.

Project CBD: So healthy fats are really key.

Knox: Healthy fats, are so, so, so important. In our clinic we talk about the ketogenic diet a lot. But you can have a whole plant-based ketogenic diet that works really well for you. And then you can have what we call a traditional ketogenic diet, where you are eating protein from meat sources and do really well. For us, emphasis is on getting that fat, high-quality fats. Some really great high-quality fats are hemp seed oil, olive oil, coconut oil, avocado oils, are all really great to use daily. I typically recommend getting 5-7, if you’re a woman, and 6-9 tablespoons of high-quality fat every single day. You know, the preferred fuel of all of our cells is fat. Out of fat comes our Omegas that we need for the basic building blocks for anandamide and 2AG and our secondary endocannabinoids. By consuming a low-fat diet, even if it’s natural and whole in nature, we’re still behind the 8-ball. So, natural whole foods, step one. Step two begin to increase your healthy fat consumption. And that to me is a diet for, or a recipe for, modulating the endocannabinoid system.

Project CBD: I think a take-home message of what I’m hearing from you, is that cannabis is very important as a healing modality, but it really works best in conjunction with healthy diet, healthy lifestyle. I think that’s a good note to end on. I appreciate very much your insights and sharing that with us, Dr. Rachel Knox. That’s been another edition of Cannabis Conversations. Thank you.

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How cannabis can help with migraines

For those who regularly experience migraines, life carries unique challenges. Seemingly harmless sensory stimuli, like bright lights, strong aromas, or loud noises, can trigger unbearable pain. Stress, neck tension, and even jet lag can set a crippling migraine in motion too. This intense pain can be accompanied by a loss of sensation, nausea, or alarming visual changes. The disruption associated with chronic migraines can be so constant it can even erode one’s sense of self.

Although drugs commonly prescribed for the prevention and treatment of migraines help some individuals, they don’t offer relief for all migraineurs. Similar to many heavy-hitting medications, a host of unwanted side effects may ensue with use. However, evidence is accumulating that cannabis may be an effective treatment for migraines and chronic headaches.

A November 2019 study published in the Journal of Pain reported that cannabis could reduce migraine and headache severity by 50%, and although tolerance can increase, cannabis use does not exacerbate headaches or migraines over time. Concentrates appeared to offer more significant relief than flower.

Additionally, a 2019 retrospective study published in Neurology found that 88.3% of a sample of 279 patients reported an improvement in their headaches after using cannabis. More than half of the patients noted a reduction in headache frequency, and 38.3% found that their sleep improved. Fifty percent of those using opioid medications were able to reduce their use.

So now we know cannabis can ease migraine symptoms, what are the most effective ways to harness its benefits?

According to Dr. Jim Polston, who holds a PhD in neuroscience and is the Chief Science Officer at Helius Therapeutics, cannabis works on migraines via the endocannabinoid system.

“There is mounting evidence that the endocannabinoid system can directly reduce migraine pain when activated by naturally produced cannabinoids or medical cannabis taken by patients,” said Polston. Cannabis can help to reduce inflammation in the protective dura mater tissue covering the brain and minimize the release of pro-inflammatory substances, both of which contribute to the onset of a migraine.

Polston also points out that one cause of chronic migraines is anandamide deficiency. “Anandamide is one of two cannabinoids naturally produced in the brain and is associated with reduced inflammation and activation of pain centers in the brain,” he explained.

While the science supporting the use of cannabis for the treatment of migraines is piling up, practical knowledge regarding how, how much, and when to dose is still lagging. That being said, those who are already acquainted with cannabis for migraines have valuable tips to impart.

“I use cannabis both as a prophylactic, to prevent migraines by reducing stress and relaxing muscles, and as a rescue remedy once migraine hits, to reduce intense pain and nausea,” explained Boston Marathon survivor Lynn Crisci.

Dr. Debra Kimless, MD, Chief Medical Officer at Pure Green, observes that cannabis may be most effective when the signs of an impending migraine first become apparent. “The patients I have treated using cannabis enjoy tremendous success in reducing and eliminating the acute onset of their migraine symptoms, especially if they can dose when they first experience symptoms,” she said.

Cannabis can work as both a preventative and a treatment for migraines, because the triggers and symptoms of migraines are so varied.

“Migraines have a complex set of underlying causes, triggers, and various symptoms, noted Polston. “Cannabis may be an ideal migraine medication with its diverse compounds and widespread roles in many of the issues associated with migraines. It’s a potent anti-inflammatory agent, analgesic, and anti-emetic. Furthermore, CBD is a known anxiolytic [anxiety-reducer], thus its presence could be useful in the treatment of stress-induced migraines.”

Most studies investigating cannabis as a treatment for migraine are based on oral administration and inhalation delivery methods.

“Though more research comparing methods is needed, we can theorize from the current research that oral cannabis use may be sufficient and should be attempted first to avoid smoking in certain patients,” advised Polston. “However, some patients may find inhalation useful for more rapid pain reduction as the onset of effects is faster.”

That’s not to say that inhalation and oral delivery are the only effective methods though. “The complexity of migraines means that patient variability may lead to various methods being successful, but in a patient or symptom-dependent manner,” added Polston.

For Kimless, tinctures administered under the tongue also work successfully. “Most of my patients prefer to use a sublingual delivery method; it is fast, effective, and discreet,” she explained.

Crisci has experimented with many ingestion methods to determine what offers the greatest relief for her personally and has settled on vaping. “I prefer vaporizing cannabis oil, preferably in a vape pen, she said. “Vape pens allow me to microdose and control exactly how much medicine I am ingesting, while avoiding inhaling smoke into my lungs.”

The 2019 Journal of Pain study argues that different concentrations of THC and CBD do not impact efficacy. However, other recent research has found that migraineurs prefer hybrid strains with high-THC and low-CBD concentrations. This preference may be due to the potent analgesic, anti-inflammatory, and antiemetic properties of THC.

For Crisci, though, experience has led her to favor low-THC strains. “I prefer a sativa hybrid with a high CBD level as a prophylactic or preventative medicine, as a pure sativa can make some, myself included, feel anxious. I’ll microdose immediately, once I feel a migraine coming on.”

For full-blown migraines, Crisci prefers indica dominant high-CBD strains. “Indica strains lower pain levels more effectively for me, and CBD lowers the THC high. Personally, I do not want to feel high while suffering the effects of an intense migraine, she reflected.

Kimless notes that individual responses to cannabinoids vary—what works well for one may offer less relief for others. That said, some level of THC appears to offer greater alleviation. “Most of my patients require a small amount of THC and not just CBD alone to experience relief,” said Kimless.

Polston added that the therapeutic terpenes, flavonoids, and phytocannabinoids also present in cannabis may play a role in easing migraine. “More in-depth research is needed to determine what, if any, role these compounds may play,” he said.

The frequent use of prescription medication for migraines is often aligned with medication dependency and medication overuse headaches. Several studies, including a 2018 review, suggest that cannabis can reduce or even replace addictive opiate medications, something Crisci has experienced firsthand. “When I started to use cannabis to treat my migraines, I found I was able to stop using many of my prescription medications: no more opioid painkillers, muscle relaxants, or anti-anxiety meds,” she said.

If you’re already taking prescription medicines for migraines but contemplating cannabis as an alternative, it’s best to talk to a physician experienced in cannabis medicine. Kimless endorses the “start low, go slow” adage.

“A little bit goes a long way with cannabis medicine. The sublingual or inhalational method allows for incremental dosing, which will help patients learn how much is needed to be effective,” she advised.

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Is a cannabis cultivar the same as a strain?

As a longtime gardener, I was so delighted by cannabis the first time I included it in my garden. It’s unlike anything I’ve ever grown—it’s the only dioecious plant that needs me to sort males from females, its smells are fantastic and pungent, and its stickiness is so unique (and sort of annoying).

But there are a few other, less fortunate things, that make it unlike other crops, including some inaccurate terminology used by growers and consumers alike. While we’re finally starting to accept that indica and sativa are unreliable labels for categorizing plants, my biggest beef is with the use of the term “strain,” when what is really meant is “cultivar.”

Many cannabis enthusiasts are eager for normalization of the plant they love so much, and I believe that using accurate lingo to talk about the plant would go a long way in that effort.

“Cultivar” is short for “cultivated variety.” This is a horticultural category (as opposed to a taxonomic one) to describe a plant that’s been selected and improved upon by humans. It can be a hybrid (either intentional or not), or selected from the wild, brought under cultivation, and distinct enough to warrant a naming. No matter the origin, it’s something that’s been touched by the human hand through selection.

In writing, cultivars always appear in single quotes, non-italicized, following the genus and species, like this:

  • Cercis canadensis ‘Forest Pansy’
  • Rosmarinus officinalis ‘Tuscan Blue’
  • Festuca glauca ‘Elijah Blue’

The International Cultivation Registry Authority is responsible for the registration of all cultivars. The system is voluntary, focused on making sure cultivar names are distinct. It should be noted that cultivar registration is unrelated to Intellectual Property rights. Those sorts of legal rights must be sought through plant protection programs, patents, and trademarks, which are an entirely different ballgame.

It should be noted: offspring of cultivars are all genetically identical replicas, reproduced by cloning or vegetative cuts. For a cultivar to come from seed, a breeder needs to go through several generations of backcrossing for a reliably stable offspring.

Strain is the term most often used in microbiology and virology. It refers to a genetic variant or subtype within a microorganism. Think: flu strain.

The term is not often used to describe plants. It does sometimes show up in breeding, but mostly as it relates to genetic modification. If genes of a wheat plant are altered, the offspring of that modified plant might be deemed a strain.


Like genus and species, subspecies is a taxonomic rank, just below species. Subspecies are geographically isolated from other members of the species in a habitat. Although it’s genetically possible for the subspecies to interbreed with other members of the species, it doesn’t happen in nature due to the isolation. Because of that sequestration, subspecies can take on different characteristics from other members of the same species.

Some examples include:

  • Euphorbia characias ssp. characias (Mediterranean spurge frond from Portugal to Crete)
  • Euphorbia characias ssp. wulfenii (Mediterranean spurge found from Southern France to Anatolia)


Just like genus or species, variety is a taxonomic rank, more specific yet than subspecies. A variety is a form of a plant that’s different from the rest of the species in habitat. Think: a usually purple-flowered vine that also produces some rogue flowers in white.

Here’s the real rub with varieties: Gardeners have a tendency to use the terms “cultivar” and “variety” interchangeably. I’m super-duper guilty of this one. But they’re not the same. Unlike cultivars, varieties aren’t the results of human-initiated breeding. They’re 100% found in nature.

Some examples include:

  • Acer palmatum var. atropupureum (Purple Japanese maple)
  • Cercis canadensis var. alba (While flowering redbud)


Not a taxonomic rank, this refers to domesticated, locally adapted populations. They’re impacted by both human selection as well as the natural environment. While a landrace population might look relatively uniform, we can generally think of them as rich genetic reservoirs, full of the building blocks for modern breeding programs.

They’re also, more and more, a thing of the past. We think of landrace populations as being largely pastoral in nature, maintained in rural regions by more traditional farming practices.

What we call “strains” should absolutely be called “cultivars.” These are cultivated varieties, hybridized and bred by humans. The clones you buy are genetic replicas of their parent, and any seeds you buy should hopefully have been properly stabilized and come true to their namesake.

Where it gets a little tricky is that there is no accountability or oversite of cannabis cultivar names. So, one clone or seed of “OG Kush” might come true to the parent, but it also might be totally different from someone else’s “OG Kush.”

What we call “landrace” is permissible when we talk about populations that were grown in isolation. A few examples that come to mind are Lamb’s Bread from Jamaica and Hindu Kush from the Middle East.

As for “indica” and “sativa”—it’s really time to let these go. Some people believe them to be historical subspecies of the plant, having evolved in different parts of the world, but given that these populations were always under human cultivation, I find “landrace” a much better term for regional populations.

Perhaps we can think of wild, uncultivated populations, like ruderalis, as a subspecies. But indica and sativa? They are all but outdated terms, used in recent times to describe feelings of the high rather than descriptors of the plant and its origins, but even then, they are inaccurate.


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Illinois pardons 11,000 cannabis convictions on eve of legalization


January 1, 2020

Illinois adult-use cannabis legalization, expungement for Illinois cannabis crimesCook County State’s Attorney Kim Foxx looks on as Illinois Gov. J.B. Pritzker speaks during a press conference in Chicago after Foxx filed motions to vacate more than 1,000 low-level cannabis convictions, Wednesday, Dec. 11, 2019. (Ashlee Rezin Garcia/Chicago Sun-Times via AP)

Just one day before Illinois legalized cannabis for adult recreational use, Governor JB Pritzker granted pardons to more than 11,000 individuals with convictions for misdemeanor cannabis offenses.

“We are ending the 50-year-long war on cannabis,” Pritzker said in a statement. “We are restoring rights to many tens of thousands of Illinoisans. We are bringing regulation and safety to a previously unsafe and illegal market. And we are creating a new industry that puts equity at its very core.”

Announced on New Year’s Eve at a church on Chicago’s South Side, it’s expected that these pardons will be just the first round of their kind. Ultimately, officials estimate that more than 116,000 individuals will be eligible to have convictions for low-level cannabis offenses expunged from their records.

Expungements for previous cannabis convictions were a key part of the bill that legalized cannabis for adult use in Illinois as of January 1, 2020, representing part of the state’s efforts to recognize and mitigate the harm done during prohibition, especially in minority communities.

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Cannabis in Palliative Care

End-of-life care is one of the less frequently discussed uses of medical cannabis. After all, most of us who turn to cannabis, want to continue living, right? And yet, thanks to the ability of cannabis to ameliorate the heavy symptom burden experienced by patients with minimal side effects, palliative care is perhaps the area of medicine that would most benefit from its clinical use.

Dying is a journey all of us will inevitably take, however how to ‘die well’ is something we tend not to consider. Dignity with dying is only possible, I believe, when there is a certain amount of consciousness and acceptance of the process. Something that a skinful of morphine doesn’t allow. But cannabis does, and I experienced this for the first time with a friend’s mother.

As Jose neared the end of her life after battling pancreatic cancer, morphine failed to control her pain, leaving her confused and unable to connect with loved ones. Thanks to an open-minded doctor who recommended cannabis oil, the last few weeks of her life became the gift her family longed for. The pain no longer troubled her, the anxiety lessened, sleep returned, as did her appetite. Not only that, Jose remained fully lucid until moments before she died.

This changed me forever and it’s why I’m sitting here today writing about cannabis.

Holistic medicine

Sadly, when my mother became terminally ill with advanced cancer, this option was not available in the UK. Sure, I had a few offers from my cannabis contacts. But for an 82-year-old Irish ex-nurse, trusting a funky tasting oil (that I couldn’t say for sure how much to take) over the pharmaceutical meds prescribed in precise dosages was never going to happen.

Instead, I found myself administering a list of medications that just kept growing and growing as the disease progressed. This included morphine for the pain (which incidentally my mum couldn’t tolerate), antiemetics for nausea, laxatives for the constipation caused by both the cancer and the pain medication, as well as Lorazepam for the middle-of-the-night agitation.

The frustration was overwhelming. I knew that instead of the sledgehammer approach to her symptom control, a far more holistic, person-centred alternative existed that could not only ease her pain, take the edge off her anxiety and agitation, stimulate her appetite and help with the nausea, but also allow her to be present for the time that remained.

What is Palliative Care?

According to the World Health Organization, palliative care is “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”

In other words, palliative care encompasses end-of-life care, but a patient receiving palliative care is not necessarily approaching death.

However, when a patient enters the end-of-life stage in a hospice setting, the emphasis on quality of life means rules often get bent in a bid to fulfil a dying patient’s wishes and beliefs. Dogs and family pets are welcome guests in a patient’s room, and a glass of wine is not unheard of, if that’s what the patient wants. So why not allow access to medical cannabis if that will help ease the suffering of a dying patient?

In some countries and states in the US, palliative and end-of-life care is considered a qualifying condition for the prescription of medical cannabis.

Using Cannabis in Palliative Care

Since 2007, the Israeli Ministry of Health has approved medical cannabis for palliative care in patients with cancer. This led to a prospective study analysing the safety and efficacy of cannabis in 2970 patients and the responses were overwhelmingly positive.1

Ninety-six percent of patients who responded in the 6 month follow-up reported an improvement in their condition, 3.7% reported no change and 0.3% reported deterioration in their medical condition. Furthermore, while only 18.7% of patients described themselves as having good quality of life prior to cannabis treatment, 69.5% did six months later. Tellingly, just over a third of patients stopped using opioid pain medication.

While observational studies such as these suggest cannabis can improve symptoms commonly found in advanced cancer, as well as improving quality of life, in practice physicians often feel insufficiently informed to prescribe cannabis to their patients.

A 2018 survey found that of the 237 US oncologists interviewed, 80% conducted discussions with their patients about cannabis, while only 30% actually felt they had enough information.2 However, an encouraging 67% viewed cannabis as a helpful additional way to manage pain, and 65% said that it was equally or more effective than the standard treatments for the rapid weight loss often found in advanced cancer. And yet, only 45% of them actually prescribed cannabis to their patients.

These discrepancies mean that even in countries where cannabis can legally be prescribed for palliative care, many physicians prefer to stick to the usual methods of symptom control.

A Physician’s View

Claude Cyr, MD, a Canadian family physician and author of “Cannabis in palliative care: current challenges and practical recommendations,” believes palliative care is uniquely suited to cannabis.3

“If we’re going to integrate cannabis products in medicine,” he told Project CBD, “palliative care is the best port of entry because of the fact that doctors have more time, and patients also have the time to deal with possible issues of the medication.”

However, in order for cannabis to fulfil its potential in palliative care, Dr. Cyr believes a shift in how physicians view symptom control is needed.

“What seems to be coming through with the research for symptom control,” says Cyr, “is that cannabis is mildly effective for pain, mildly effective for nausea, mildly effective for insomnia and anxiety. It doesn’t treat any one of these conditions dramatically better than the other medications that we have. So, many physicians are like ‘why would we take a medication that is mildly effective when I can take a much more incisive approach with specific symptoms.’ Instead of saying ‘Do you have a bit of pain, a bit of anxiety, a bit of insomnia, a lack of appetite and a bit of nausea? So why don’t we start with something that’s mildly effective for all that and then we’ll be able to work on more specific symptoms in the long run’.”

Cyr is also critical of fellow physicians’ tendencies to rely on clinical evidence while dismissing the validity of their patients’ positive experiences.

“Palliative care is a specific situation where we can actually put into question the core philosophy of medicine which is the evidence based paradigm. I think physicians need to stop obsessing over the evidence when their patients are dying and clearly telling them, ‘I’m really enjoying this, I’m getting huge benefits from this, I’m sleeping better, I’m eating better.’ But the physicians are nodding their heads and saying, ‘I hear you, but I can’t accept this because I’m still lacking evidence.’

“But I think there is enough data out there to convince physicians that it’s safe for palliative care patients, and it’s predictable.”

Psychoactivity in palliative care

Cyr urges doctors to find peace with the idea that cannabis is psychoactive, which he believes could actually help patients process the existential anxiety often experienced at the end of their lives.

“When you look at the studies of psychedelics in depression and existential anxiety in cancer patients, some of these results have been dramatic,” says Cyr. “Although cannabis isn’t a true psychedelic, there are some similar experiences that patients tell us about.4 At smaller doses patients experience a psycholytic effect, a lowering of the defenses allowing people to explore other aspects of their psyche, and that’s when they start making connections between different aspects of their reality.”

THC’s ability to reduce activation of the default mode network, the area of the brain involved in cognitive processing and where our ego or sense of self is thought to reside, could also potentially bring a sense of peace to dying patients.56

Cyr explains: “Existential anxiety is rooted in the loss of the self, but when you can dissolve the ego temporarily and you realize it’s not all about me, that can be liberating.”

For the last fifty years, activists have been campaigning for the right to use cannabis to treat their health conditions in order to be well. This must also be extended to using cannabis to maintain quality of life in life-threatening illnesses, and when this no longer becomes possible, to die well and with dignity.

In memory of Jose and Agnes.

Mary Biles, a Project CBD contributing writer, is a journalist, blogger and educator with a background in holistic health. Based between the UK and Spain, she is committed to accurately reporting advances in medical cannabis research.

Copyright, Project CBD. May not be reprinted without permission.


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