DISCLAIMER: this page is not intended to advise individual patients to use specific methods or strains. It is merely intended to educate patients on what we consider are the unhealthy ways to use medical cannabis, and what are the healthy ways. When Dr. Cook tells the registry that benefits of medical cannabis outweigh the risks for a patient, he is definitely not saying that this patient can safely begin “dabbing” or using “electronic vapor pens” all day long.
Many people wonder:
What is the healthiest way to use medical marijuana?
We recommend vaping (vaporizing) raw flower, or ingesting oil or butter, for several reasons.
Cannabinoids are fatty acids, and are fat-soluble molecules which become active when gently heated, but inactive if overheated. Think of butter. When heated, it makes anything wonderful, but when overheated, it becomes brown, bitter, and unusable.
Igniting (smoking) the cannabis flower with a gas lighter activates much of the THC, but burns other phyto-cannabinoid components in the plant. Vaporizing, on the other hand, is more gentle and produces a more balanced therapeutic effect.
The terpenes, or secondary plan compounds, are what provide that balanced effect. Terpenes are the fragrances that help us tell one cannabis variety from another. They not only determine the smell but the medical application and usefulness of each cannabis cultivar (or strain, or variety). Cannabis is an herbal symphony, not just a “drug.” If one strain has a lot of the terpene called myrcene, (a scent also found in mangos) it will be heavily sedating. Or, if it has limonene, it will be uplifting. Terpenes are part of the entourage effect, a term coined by Israeli marijuana researcher, Raphael Mechoulam. By that term, Mechoulam was referring to the tendency of politicians to appear more important by carrying around extra people with them at all times, aka their “entourage”. The terpenes that are in cannabis act on your brain along with the cannabinoids, and their profile is very important to the effect of the cannabis.
This is part of the reason why vaporizing is superior: when cannabis is burned too quickly, as opposed to gently vaporized, the terpenes can be destroyed. When vaporizing, terpenes take front and center stage.
Vaporizing raw ground flower buds is not at all the same thing as e-cig vaporizing, even though both are called “vaporizing.” The former is healthy, the latter is probably not.
The electronic e-cig style vaporizers are popular, but can be harmful to health. These contain a juice in a glass cartridge, usually made with vegetable glycerin and propylene glycol. The propylene glycol can turn into formaldehyde when heated. Formaldehyde is used for embalming bodies. It is not good for you to inhale that frequently, even in small amounts.
Some people think these e-cig style pens would be good for seizure disorders, since you can whip one out of a purse or bag and hit it right away. Dr. Cook (who does not certify for seizures anyway) does not share this opinion. Reason: formaldehyde has a similar effect to insecticides, the sorts of toxins that can actually bring on a seizure. These sorts of pre-filled e-pens are more convenient than a portable vaporizer, which required freshly ground flower for each use, however, Dr. Cook does not feel that such extreme portability is necessary.
Finally, many people are into “dabbing” which is burning and inhaling a concentrated cannabis resin. If you hear the terms “shatter”, “rosin”, or “wax”, you’re likely dealing with something of this nature. Resins are made with butane usually. Please avoid. You really shouldn’t be inhaling solvents. In Dr. Cook’s experience, dabbing has very little medical application. It is simply a convenient way to take in a tremendous amount of THC very quickly.
Hash oils can be made without solvents, (using fine sieves, CO2, or ice water bag sieves) and these are really the only medically acceptable form of cannabis concentrate. They are available in some existing dispensaries outside Hawaii. It is unclear if our dispensaries here will carry them. Such hashish products are considered by some to be the pinnacle of cannabis since they preserve very well the organoleptic (smell) qualities of cannabis.
However, high quality hashish is not necessary for the vast majority of patients.
We cannot “prescribe” specific doses, strains, methods, or means of use, to you or any other patient. However, we can (and do) say what we feel is an unhealthy way to use it, and what is a healthy way.
Beyond that, because the way the law is written: you are basically on your own.
We can recommend to all patients, that they follow the law at all times. And that they only grow, or use, their own designated medicine.
If you are new to cannabis, we say, loud and clear, start low and go slow. Regarding edibles, be cautious. Remember that edibles can be very weak, or very strong, and are difficult to dose. Furthermore, Hawaii state law has not allowed dispensaries to sell edibles. Some people who grow cannabis do make them on their own. Most ER doctors have seen patients who present to an emergency room with a panic attack caused by eating an entire brownie or other edible, without personally making it, or knowing how it was made.
Be smart, and be lawful, responsible, and safe at all times.
Above all, respect the power of your medicine, and don’t overuse.