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By Mary Carpenter
AS BILLS to decriminalize marijuana circle through Congress, consumers interested in its potential health benefits—better sleep, relief of chronic pain—are asking: how are specific health effects determined for each product; how can buyers be sure which products will achieve the desired benefits; and how can they be sure what’s in the products they get?
At this point, “more research is needed into cannabinoids, marijuana’s active chemical compounds,” notes UC San Diego Pain Medicine Department Chair Mark Wallace. In addition to a range of effects that depend on the different strains, other variables can play a role in effects of products, including chemical compounds, potency, delivery methods (smoking, edibles, tinctures) and the user’s age.
Cannifornian reported a 250 percent rise in marijuana use by Americans 65 and older between 2006 and 2016—though the total number was still only 1.4 percent of that population. The many variables and the resulting unpredictability of products help explain the dearth of scientifically rigorous studies on marijuana’s health effects —and the inability to do anything like “precision prescribing.”
The Importance of Trustworthy Sources
After reading the research along with informative websites such as Leafly, I found the best advice from two younger-generation marijuana growers whom I know personally: one, a co-founder of a Colorado marijuana business; and the other, a DC backyard gardener. In turn, these two rely on professionals in the business: “samplers,” who work for grow-operations and elsewhere, and reviewers at sites like the Cannifornian.
Early on, I depended on salespeople at dispensaries (in Colorado and California, and in DC during the year I had a marijuana card), also considered trustworthy sources by the two young growers for the same reasons that apply to samplers and reviewers: because each of these people has tried the products, and because their reputations and business success depend on the reliability of their judgments.
Professional evaluations are especially helpful because of the extreme variability in marijuana products even within a single batch of the same strain—due to variations in growing methods, including soil, sunlight and nighttime temperatures. But even after products receive professional ratings, individuals can have varying responses due, for example, to habituation after long-time use.
Genetics determine each strain’s “unique profile of terpenes and cannabinoids… that play off each other” in what’s called an entourage effect, according to Leafly. Terpenes are the flavor chemicals, such as the most common, myrcene, believed to boost pain relief; or limonene (and other citrus flavors), thought to “promote an uplifting and energetic high.”
Cannabinoids are similar to the body’s own endocannabinoids, which have corresponding receptors throughout the body—and affect, for example, various aspects of circadian rhythms, such as appetite, alertness and sleepiness. THC, the primary psychoactive cannabinoid, creates the “high.”
The genetic profile helps explain “why one sativa strain helps you focus while another has you bouncing off the wall instead,” according to Leafly. Sativa and indica refer generally to the two categories of effects—with sativa linked to alertness and higher energy, and indica to calming and relaxation.
What’s the THC Percentage?
For most marijuana consumers, potency—based on THC content — is the key rating of interest. When I sought an edible marijuana product for sleep during stressful times—and secondarily for chronic pain— my number one request was for low THC to minimize the high. Starting out low is especially important for edibles, because these can take as long as two hours before effects set in, making it risky to up the dosage any sooner.
On my visit to San Francisco’s Apothecarium, the salesperson suggested Petra mints from the Kiva Company, at 2.5 milligrams of THC each. Eating one mint before bed has helped me sleep. When I checked for reviews, the Cannifornian rates the “Effects: 10 out of 10 for relief from mild aches and pains, emotional turbulence, and other low- grade ailments.”
[The mints] “benefit from Kiva’s extraordinary attention to detail in terms of taste and efficacy,” writes the cannifornian reviewer, who felt about an hour and fifteen minutes after eating, that two mints “get into the task of smoothing my jagged edges and I felt noticeably more cheerful after two hours passed.”
THC can alter sleep architecture, the nightly structure of sleep—specifically lengthening periods of the “deep sleep” state, which is believed to be the most restorative and restful. In turn, however, comes a reduction in the amount of REM sleep — characterized by rapid eye movements; the phase when dreaming occurs; and important for healthy immune and cognitive functioning, specifically for the consolidation of memories.
Potency levels on labels can be unreliable—and, more importantly, have little or no relationship to the [entourage] effects of the different products, explains chemist Josh Wurzer, co-founder of SC Labs, which tests cannabis products. On the other hand, scientists still disagree about the existence or importance of the entourage effect.
Until the passage of a national bill, the FDA has no role in marijuana regulation, and oversight remains up to individual states. Massachusetts, for example, requires testing by “certified labs” of “all cannabis harvested for commercial and medical use, as well as all marijuana products” —for “cannabinoid profile and potency,” as well as for contaminants such as pesticides.
The Risk of Side Effects
The greatest risk of marijuana for some people is side effects— anxiety, paranoia, delusions, and psychosis —mainly linked to THC. Despite a common belief that the non-psychoactive ingredient CBD can block psychiatric effects —especially as CBD levels approach a 1 to 1 ratio with THC —a systematic review of research found “no consistent evidence” of this.
Another risk, specifically with THC edibles—because the kick-in time is unreliable —is a longer-than-intended effect that causes grogginess the following day. As a result, edibles are best ingested at least an hour before bedtime, according to Harvard Medical School marijuana therapeutics expert Jordan Tishler.
In addition to psychiatric side effects, a worrisome risk for the typical novice comes from imbibing an excessively high dose, which can create feelings of being out of control, a racing heart or a panic attack.
Milder effects include “couch-lock,” which “some want while others don’t,” explained one of the young growers. I’m in the latter category—neither seeking what sounds like inertia, nor hoping for the “noticeably more cheerful” effect described by the Petra mints reviewer.
But I probably will never know any of these effects because I restrict my consumption to near bedtime—being slightly fearful of the high, also worrying about any interference with my nighttime reading—and I go to sleep shortly afterwards. Although the mints seem to provide better “deep sleep,” I restrict them to weekends because I need a lot of that memory-enhancing REM sleep at least as much.
Mary Carpenter regularly reports on topical issues in health and medicine.