People are discovering medical cannabis to be beneficial for a long list of health issues, but the tricky part is that it doesn’t come with clear instructions. The best dosing advice is to “start low and go slow”, but what does that mean and with different cannabinoids to choose from, where do you start?
Here is one nurse’s journey to help her mother with symptoms of Osteoarthritis, anxiety, and high blood pressure. Spoiler alert: she was able to get her off all but one pharmaceutical, AND her mother feels so much better!
Two years ago, I started on the road to transition my 88-year-old mother off of her daily pain pills (opioids and NSAIDS) to something less harmful and with better relief. My mother suffers from Osteoarthritis (OA) in her hips, knees, shoulders, feet and hands and was taking 3-4 Norco (hydrocodone/acetaminophen) daily with intermittent ibuprofen as needed, and she was miserable. She was also on an anti-anxiety medication, a high blood pressure medication, a diuretic, and eye drops for glaucoma. She was living in an assisted living facility run by the Carmelite nuns and I spoke with them to get their approval before starting cannabis medicine and they were very supportive.
Everybody’s response to cannabis is different and unique to each person, so the regimen that I outline below is not going to be effective for everyone, and it was an exercise in trial and error. I started her out on 5 mg CBD (cannabidiol) gummies. I gave her 5 mgs of CBD three times a day and held off on her pain pills until she asked for one. After three nights, of not sleeping well in spite of a pain pill, we determined that CBD at night was keeping her awake, so I increased to 10 mgs of CBD from hemp, in the form of a capsule from CV Sciences, in the morning and afternoon only, and eventually added 5 mgs of THC at night. That worked better!
She hadn’t been sleeping well for months no matter what combination of meds we gave her so I continued to increase her nightly THC from 5 mg to 7.5 mg then 10 mg then 12.5mg then 15mg using either Trokies, which are a dissolvable lozenge that goes under the top lip or THC oil from Cannakids.
My mother was also dealing with anxiety and dementia for the past few years and so I continued to increase her CBD to try to achieve better pain relief as well as decrease her level of anxiety. The caregivers at the facility saw the positive mood changes in her as we decreased the opioids to just one at bedtime. She continued with the CBD, now at 15 mgs twice a day and 15 mgs THC at night along with the pain pill and they reported she was calmer and complained a bit less of pain.
She remained at these doses for months and I added a vaporizer for breakthrough pain, made by Dosist, that formulates vaporizers specifically to target certain symptoms (e.g. pain, anxiety, insomnia, and depression). The vaporizer heats the oil inside until it vaporizes and one inhales the vapor. This is more like the idea of an asthma inhaler and different from smoking, which burns the material and can produce harmful by products of combustion. The beauty of this specific product is that each inhalation delivers a measured dose of 2.25 mgs of total cannabinoids, which is a specific combination of THC, CBD, other cannabinoids and terpenes. It worked great and provided quick relief in about 5 minutes, enough to help her stand up and get moving. Vaporized medicine has a quicker onset than orally ingested products, but it doesn’t last as long (usually 2-4 hours) and she only needed to use the vape pen a few times a week.
We also found an effective topical balm to rub on her knees when the pain was flaring up, made by Papa & Barkley in a 3:1 THC:CBD ratio. After a few months we increased her daily CBD dose to 30mg (two 15 mg capsules) in the morning and again at lunch and kept up the Norco and 15 mg THC at bedtime.
Fast forward one year – she was requiring more assistance than the facility could provide so we made the decision to move her home with our family (I have a husband and 2 sons in their late teens) along with hiring 24-hour caregivers to attend her. Now I really started experimenting with her meds because I could see the results more accurately. A combination of things happened, I put her on an Anti-Inflammatory diet as outlined in the book The Plant Paradox by Dr. Steven Gundry and switched her from hemp CBD to CBD from the “marijuana” plant. She was getting 50, then 100 mgs of CBD twice a day, as her pain needs required. I also added 10 mgs THCa by Treat Well (it is the raw form of THC and not psychoactive) every 8 hours and continued her nightly Norco, plus 15 mgs THC oil from Cannakids.
For breakthrough pain, she could no longer use the wonderful vape pen because with the dementia, she couldn’t follow the direction to suck in and inhale and would just blow on it. I then switched to a 1:1 ratio of THC:CBD spray by Care By Design, which she got once or twice a day as needed (5 mgs THC:5 mgs CBD in 2 sprays).
The best and cheapest experiment was to grow my own cannabis plants in my garden (legal per California law) and add some fresh leaves to my mom’s daily smoothie which provided THCa and CBDa in their raw form, and non-psychoactive.
This crazy journey recently took an unexpected twist. After nine months at my house, my mom has lost 36 pounds (from 166 lbs to 130 lbs for a 5-foot little lady), she sleeps through the night like a champ, is no longer incontinent daily (I forgot to mention that issue earlier) and is calm enough that we discontinued her prescription anti-anxiety medication. After a fainting episode we discovered that her blood pressure had lowered considerably and she no longer needed her blood pressure medication since THC has been known to decrease blood pressure. We monitor her blood pressure daily to ensure it remains in the normal range without the medication and have kept her doctor informed of all of these changes. Her eye pressures are now in the low normal range rather than high normal with the same eye medication. I believe that she, like MANY people, had a high level of systemic inflammation when she arrived at my house and over 9 months the inflammation has decreased significantly with the use of cannabis, which is known to have anti-inflammatory properties. So much so, that I was able to decrease her CBD intake to 50 mgs twice a day and mom tolerated it fine. When she ran out, I wanted to see what would happen if she was off completely, and again she was no worse. Then her THCa ran out and she did fine without it, but we increased the number of fresh cannabis leaves in her smoothie to 10-15 leaves which would theoretically provide THCa and maybe CBDa (I haven’t had the leaves tested).
Currently her regimen includes:
remaining on the anti-inflammatory diet
10-15 raw cannabis leaves from our plants in a smoothie
one Norco and 15 mgs THC oil at night
For breakthrough pain she gets either:
1 or 2 Petra mints (2.5 – 5 mgs THC) OR
2 sprays 1:1 THC:CBD by Care By Design (5 mgs:5 mgs) OR
1 chocolate covered blueberry Terra Bites by Kiva (5 mgs THC) AND/OR
Papa & Barkley Releaf Balm 3:1 THC:CBD applied to her knees
I expect at some point she will need more cannabis medicine again when her pain worsens. This experience just goes to show that our body’s needs change and our medications should adapt to its changing conditions.
The products I mentioned are not available everywhere and may be only found in California, but there are many other high quality products on the market that I haven’t discovered yet. The most important things to look for in a cannabis product are:
Current lab testing for harmful contaminants, potency and cannabinoid content
The type of the cannabinoids it contains (THC, CBD, THCa, CBG, etc)
How much of each cannabinoid in milligrams (mg) per dose and/or per bottle
A way to accurately measure a dose that is repeatable and consistent (not really achievable with a cookie or brownie)
From my own experience, and from others I have spoken with, those that have the most success with cannabis medicine are the ones who don’t give up easily and are willing to go through this experimentation phase. It will take longer for some and shorter for others. One of the most exciting things for me is that nature has given us not just one medicine in cannabis, but dozens and maybe hundreds of medicines and combinations that can yield different results so there is bound to be one that is just right for each of us. Keep trying and remember to start low, go slow and let your doctor know!
Sue Feldmeth, RN
Sue Feldmeth provides educational presentations to groups who want to learn more about the use of medical cannabis as well as one on one consultations and guidance for those who want to use cannabis to treat their particular condition. She is located in Pasadena, California and can be reached at [email protected].