Dr. Florian Birkmayer's Guide to Treatment with Medical Cannabis

Highlights from 'How to Optimize Using Medical Cannabis: What Everyone Should Know' from Hemp Fiesta August 4, 2018

Dr. Florian Birkmayer, MD in his Homegrown t-shirt on top of Wheeler Peak in Taos for a weekend stroll in the forest.
Dr. Birkmayer sent us a shout out from one of his weekend hikes with the caption: "Representing on Wheeler Peak. We don't stop till we get to the top (of customer service)."

Late is always better than never! My goal was to publish at least one blog post every couple of weeks but I'm now clocking in at once a month. Faaaaar from my goal but hey, it's a work in progress, okay? This blog is a highlight of Dr. Florian Birkmayer's presentation 'How to Optimize Using Medical Cannabis: What Everyone Should Know' at Hemp Fiesta here in Albuquerque on August 4th. This was a great give and take between Dr. B and the audience because, together, they answered so many questions that even I didn't realize I had. Dr. Birkmayer's extensive background is in trauma and addiction and really hones in on an in depth approach to holistic healing through aromatherapy and medical cannabis as an alternative to often overprescribed psych meds and opiates.  

For starters: What makes cannabis 'medical cannabis'? Ask yourself before reading on because it is important to develop your own understanding of what makes cannabis medical as you are on your journey of healing. The answer to this question is quite simple. It is the intention in which we use it. Makes sense right? If you're using cannabis with the intention of recreational use or to get stoned (if you want to be blunt...haha) then your intention is not medical. If you're using cannabis to help get off of prescriptions and/or manage symptoms of any ailment or condition either physical or psychological then you're using it with the intention of healing. 

With that in mind, there are a host of different forms of delivery available. There is smoking or vaping, ingestibles (or edibles), topicals, and suppositories. When you smoke flower or use any other form of medical cannabis, they are heated up to activate the THC through a process called decarboxylation. This is what produces the effects of THC, the "high". However, smoking the flower through conventional ways like in a pipe or joint loses a lot of the profile of the flower like the terpenes, THC or CBD, and other cannabinoids through combustion. Vaping is a much better way to opt for smoking your flower or concentrated oils. Ingestibles, topicals, and oils are already activated, if you will because they've already gone through the heating process in some way in order to activate the THC or CBD.

How would you use the different forms to treat different symptoms or illnesses? 

Smoking or vaping produces almost instantaneous effects but they are shorter lived than through other forms (2-3 hours). Edibles of any form take 30 mins to an hour to kick in but the effects last several hours afterwards (4-6 hours). Suppositories are the quickest way to the bloodstream because they bypass the liver. Patients with COPD or other lung related conditions can opt for any mode aside from smoking and still get the full benefits of the flower. You can treat localized pain with topicals or patches. People with cancer and aggressive diseases need every milligram of THC or CBD so suppositories are ideal for them because the body doesn't have a chance to break it down which means you're getting less. Through experience and patient testimony the best treatment for PTSD is by using two forms. Vaping or smoking to treat immediate symptoms like triggers causing panic attacks (think fireworks or other uncontrollable triggers) and edibles to help patients sleep and stay asleep. This method is also great for people with pain who need treat pain and sleep through the night. Edibles are great for people who work and need all day long coverage because they can't take smoke breaks. The key is that you can incorporate as many different forms depending on your needs.  

Treatment with medical cannabis also involves the oversimplified sativa/indica divide. They are the two parent strains: indica is from India and sativa from the Middle East. It is fairly common knowledge that in general indicas are calming and sedating. The effects range from some strains that just calm you down a bit all the way to strains that will put you to sleep for a good long while. In general, sativas are uplifting and stimulating. What differentiates the different strains between  the two categories is terpenes. Most strains, however, are hybrids. There are hardly any pure strains anymore. The generalization is helpful starting point and then you can start defining terpene profiles to make usage more individualized. One thing to keep in mind is that some patients have paradoxical effects from indicas and sativas. Some patients might feel stimulated from indicas or very tired from sativas. It's like a switch run backwards. Dr. B says he finds this in about 1 in 100 patients. There are individual reactions to different strains from person to person.

Terpenes are an important topic of interest that you may have heard of. They're responsible for for the smells, or essential oils, found in cannabis. You can find terpenes in other food or plants. Limonene, for instance, is responsible for the citrus smell in lemons which is also found in citrus strains like Lemon Haze. If you have two different strains of cannabis with the same amount of THC, they're going to give you widely different effects and this is because of the terpenes. They're like the alphabet. Each strain has different letters. You can also get different profiles of terpenes based on the environment, the grower's skill, and growing conditions (like indoor/outdoor, soil, nutrients, etc) but the general idea of each terpene can help predict the effects the strain will produce. Strains are tested and each label identifies the cannabinoid percentages in the strain and sometimes the terpene profile. It's also very helpful to ask or look it up online at a reputable site so you can find out what terpene profiles work for you and choose strains based on them. 

A third class of cannabis to consider is high CBD strains. The definition of a high CBD strain is not entirely specific. The thing is that since the 60s, breeders have been concentrating their focus on high THC strains and then CBD came into light and now there's a fascination with high CBD for its' numerous healing properties. In nature there are both high THC and high CBD strains. It's like we're finally listening to what nature has been saying this whole time: you need the whole balance. When you add CBD to your THC usage this is called the entourage effect. You have to have the full range of cannabinoids to receive the full benefit, or full intelligence, of the plant. CBD is non-psychoactive so you don't get the "stoniness" and it has a wide range of benefits like anti-cancer and anti-inflammatory. It even helps with PTSD symptoms. In the same sense, there are many people who only take CBD who really should be adding at least 3% THC to their healing to get the entourage effect. If you do take THC and are able, it's better to smoke THC and eat CBD because the THC will go to your head and the CBD will go to your body. This is also because of the different types of receptors that are in your body. Dr. B recommends that we should all be adding a little CBD to our lives.

The ratio of CBD to THC or vice versa is really dependent for each person. We each have our own perfect CBD:THC ratio and the best way to identify what it is is by playing around with it. Oils are the easiest. A couple of important notes about CBD are that it is very poorly available so adding the 3% or more of THC helps your body use more and the other important thing is that if you take a lot of CBD it does have major drug interactions. Having said this, it is important to know that CBD slows does the liver enzyme Cytochrome 3A4 (or just 3A4 for the purposes of this article). The importance of this is that 3A4 breaks down many psych meds like Prozac, opiates, and steroids. So if you're taking Prozac and CBD, your level of Prozac goes up and the side effects get worse. Dr. B had a friend who was prescribed Prednisone and experienced toxicity symptoms because she was also taking CBD. If you are taking prescription medications, it is always important to talk to your doctor if you are taking CBD. If you don't think that they're for it, then mention that you're taking an herb that interferes with Cytochrome 3A4 and they should be able to help with the rest.

That wraps it up for Dr. Birkmayer's presentation at Hemp Fiesta! Thanks for tuning in. If you have any follow up questions about this blog, feel free to write us an email at homegrown@kushkardsnm.com. Until next time!

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