Accessing medical cannabis

Education

To access medical cannabis, you will need to speak to your doctor or qualified healthcare practitioner (HCP) to see if medical cannabis is right for you. As your HCP has an understanding of your medical history, he/she is the best person to consult about medical cannabis and also to guide you if you are eligible to take medical cannabis. Physicians are usually open to patient’s queries and to talk about various treatment options. However, there may be instances where your physician may be unfamiliar with medical cannabis or is hesitant to recommend it. In such cases, educating yourself on how medical cannabis may help you is a great way to prepare for speaking with your HCP. It is advised to:
• go prepared with the information and explain how medical cannabis could benefit you. 
• make a list of medications that you have tried to manage your condition/symptoms and identify the ones that worked for you and the ones that didn’t. 
• clearly identify the symptoms you feel can be managed effectively with medical cannabis. 
• be honest and forthcoming with sharing information, including any research that you may have come across.
If your HCP determines that medical cannabis is right for you, they will complete a Medical Document and send it to CannTrust. A Medical Document acts as a prescription and is required to order medical cannabis from us.

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How to talk your healthcare practitioner about medical cannabis?

In order to transfer your medical document to us and get access to estora branded products, you are required to follow the steps below.
• Contact your current licensed holder and request a “Transfer” of your medical document and details to estora, a medical brand of CannTrust. Once your request is submitted to them, they will fax your documents to us.
• Register your details with us. We recommend completing this as soon as possible to avoid delays with your registration. This can be completed online by visiting [<a href="https://estoramedical.com/en/sign-up#signupform">https://estoramedical.com/en/sign-up#signupform</a>) 
Alternatively, you can fill and complete the registration form [<a href="https://estoramedical.com/en/sign-up#signupform">https://estoramedical.com/en/sign-up#signupform</a>) and return them to us by e-mail, fax or mail.
Once we receive your registration form and medical document, we will process your request (our processing time is approximately 24–48 business hours). Once your account is approved, we will notify you via email; you can then place an order with us.
For assistance or more information, please contact our customer care team at 1-855-794-2266 between 8 am - 6 pm EST, Monday to Friday and 9 am - 5 pm, Saturday and Sunday.

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How to switch back to CannTrust?

Our Patient Assistance Program offers compassionate pricing to qualifying patients in order to make medical cannabis more affordable. If your annual income is less than $30,000, you may be eligible for a 30% discount* on your purchases through the Patient Assistance Program..
How to Apply
• We accept any documentation from a Federal or Provincial program that shows your annual or monthly income. 
• Any patient under the age of 18 will automatically qualify for the Patient Assistance Program. 
• Email your documentation to customerservice@canntrust.ca or fax to 1-844-295-6641, and we will process your application within 1-2 business days. 
• You will receive a confirmation email or phone call from our customer care team once you have been approved.
Individuals approved with a Notice of Assessment from Revenue Canada must confirm their eligibility on an annual basis. Individuals approved with supporting documentation from a Federal or Provincial program must confirm their eligibility with each medical document submitted to CannTrust.
CannTrust reserve the right to request documentation of eligibility based on the criteria identified above and reserves the right to cease an individual’s participation in the CannTrust Patient Assistance Program. We also reserve the right to limit the size of this program and/or change or cancel this program at any time.
For assistance or more information, please contact our customer care team at 1-855-794-2266 between 8 am - 6 pm EST, Monday to Friday and 9 am - 5 pm EST, Saturday and Sunday.
<italic>*Limited to 60 g per month. Not applicable to accessories. No other discounts can be applied to this special offer.*

holding hands

Patient Assistance Program

Medical cannabis and me

Every responsible medical cannabis user should know how to safely store cannabis for two principal reasons.

<ul>
<li>to make sure it is out of reach from curious children or overzealous pets. </li>
<li>so that the medical cannabis maintains its potency and doesn’t turn stale or mouldy.</li>
</ul>

The best way to store cannabis is by following these simple guidelines:

<ul>
<li>Cannabis should be kept in a cool, dry place out of direct sunlight as it may degrade the cannabinoids thereby affecting the potency of the product. </li>
<li>Cannabis should be stored in a tight, air controlled container as exposure to too much oxygen can degrade the cannabinoids. However, it is also important to ensure that the cannabis is dry when stored as moisture can lead to humidity which can ultimately cause mould.</li>
<li>Storing medical cannabis in its original container is the best idea as it is marked and child proof.</li>
<li>It is recommended that medical cannabis containers be kept out of sight and preferably in a locked place out of reach of non-medical cannabis users.</li>
<li>If medical cannabis is used to make edibles, clearly mark the edibles so they cannot be confused as regular food(s).</li>
</ul>

For more information on how to successfully store medical cannabis, please contact our customer care team at 1-855-794-2266 or email
<a href="mailto:customerservice@canntrust.ca" target="" rel="noopener noreferrer">customerservice@canntrust.ca</a>

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Storage and handling of medical cannabis

Support Search

CannTrust is committed to supporting Canadian veterans on their journey of accessing medical cannabis. We are proud to offer veterans a seamless process in navigating the steps necessary to get VAC coverage for the full cost of their medications.
CannTrust offers hassle-free access to medical cannabis for Canada‘s veterans by working hand-in-hand with Veterans Affairs to ensure seamless claim processing and prompt reimbursement. We will submit medical cannabis claims if a veteran has:
• A Veterans Affairs client number beginning with the letter ‘K‘ 
• A completed Medical Document filled out by your healthcare practitioner 
• Confirmation of registration with CannTrust 
• A letter or documentation of your specific medical condition(s)
Veterans Affairs will also reimburse up to $300 every three calendar years for vaporizers. Please call one of our customer care team members at 1-855-794-2666 for more details.
Pre-Approval
Here at CannTrust, we believe in making the process as easy as possible, which is why we have a pre-approval program for veterans. This means you can start treatment as soon as you are a registered patient of CannTrust, and you do not have to wait the 6–8 weeks for VAC to authorize coverage. Contact us today to see if you are eligible for our pre-approval program.
Personalized Care
We value those who have served our country. Approved veterans benefit from personalized customer care, ordering services via phone as well as 24/7 access to our online ordering system. Let us guide you in getting the best care possible.
We encourage all veterans considering medical cannabis as a treatment option, to contact our customer care team at 1-855-794-2266, or email us at veterans@canntrust.ca.

canadian flag

Veterans Assistance Program

My journey in cannabis

For centuries, the cannabis plant has been used for food, fiber, and medicinal purposes.1 Marijuana and hemp are broad classifications of cannabis and do not qualify as 'species' or 'strains' of the same. The term hemp is used for cannabis plants that contain no more than 0.3% THC by dry weight of the leaves and buds.2
Traditionally, hemp has been grown for either seed or fiber and is viewed as an eco-friendly and highly sustainable crop. Hemp has high fiber content, and the seeds contain approximately 30% protein, 25% starch, and 30% oil. Hemp is harvested to produce a variety of products including, but not limited to:
<ul>
<li>Food products: hemp seed oil, hemp seed-based products, and hemp flour</li>
<li>Industrial products: clothing, carbon nanosheets, paper, plastic, and building materials</li>
<li>Medicinal products: CBD-infused topicals and oil tinctures 2,3</li>
</ul>
The cannabis variety containing &gt;0.3% THC is termed marijuana; its use can induce psychotropic or euphoric effects on the user. Differences in cultural practices of marijuana and hemp result in morphological variations, allowing the distinction between these two crops. In summary, the quantity of THC in the plant or whether this will get the user 'high' defines a significant characteristic difference between hemp and marijuana.
Disclaimer: This information is not intended to be a substitute for the advice of a healthcare professional nor a recommendation of any particular treatment regimen. Please consult with your healthcare practitioner for professional advice pertaining to your particular condition.
References
<ol>
<li>Pain S. A potted history. Nature. 2015;525:S10–11.</li>
<li>Schluttenhofer C and Yuan L. Challenges towards revitalizing Hemp: A multifaceted crop. Trends Plant Sci. 2017;22(11):917–29.</li>
<li>National Academies of Sciences, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research, National Academies Press (2017). </li>
</ol>

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Cannabis versus Hemp

Know your product

Due to lack of any established dosing guidelines for cannabis, individualization of dosing is the preferred option and depends mostly on titration (i.e. finding the right dose where potential therapeutic effects are maximized while adverse effects are minimized).1 Before you start using cannabis, it is critical to understand and identify the correct dosage of the cannabinoid(s) in consultation with your healthcare practitioner. Your healthcare practitioner will help you determine the most appropriate cannabinoid, type of cannabis product (capsule, oil, dried) and dosage most suitable for your condition.1</sup1>
Patients with no prior experience with cannabis and initiating therapy with cannabis-based therapeutics for the first time are advised to commence at a very low dose and gradually increase the dose to achieve the optimal therapeutic outcome and reduce possible adverse effects. Patients should immediately discontinue the treatment upon undesirable side effects. Patients are advised – start low and go slow – and wait for a minimum of 30 minutes between puffs or inhalation and 30–90 minutes between the ingestion of cannabis-based oral products to gauge for strength of effects or for possible overdosing.1,2 Results from various studies suggests that most individuals use less than 3 grams daily of dried cannabis, whether that amount is taken orally, inhaled, or a combination of both.1,2
We strongly suggest that you consult your healthcare practitioner for any queries related to dosing or identifying the most appropriate cannabinoid for your condition
Disclaimer: This information is not intended to be a substitute for the advice of a healthcare professional nor a recommendation of any particular treatment regimen. Please consult with your healthcare practitioner for professional advice pertaining to your particular condition.
References
<ol>
<li>Health Canada, “Consumer Information - Cannabis (Marihuana, marijuana)”, 2018. Available at <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/laws-regulations/regulations-support-cannabis-act/consumer-information.html" target="_blank" rel="noopener noreferrer"><a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/laws-regulations/regulations-support-cannabis-act/consumer-information.html">https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/laws-regulations/regulations-support-cannabis-act/consumer-information.html</a></a></li>
<li>Health Canada, &quot;Information for Health Care Professionals: Cannabis (marihuana, marijuana) and the cannabinoids, 2018&quot; Available at: <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids.html" target="_blank" rel="noopener noreferrer"><a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids.html">https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids.html</a></a></li>
</ol>

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Dosing and Titration

Terpenes are organic compounds that are responsible to provide flavour and aroma to the plant. The yield of terpenes may represent 10% of the trichome content in the cannabis plant. Various factors may influence the concentration of terpenes in the plant including weather, climate, age and maturation, soil type, fertilizers, etc. Terpenes can also develop due to plant stress (such as excess heat).
Terpenes influence the differentiating effects of various cannabis strains e.g. citrus, berry, pine, etc. Research suggests that they may have a broad spectrum of action (e.g. anti-oxidant, anti-anxiety, anti-inflammatory, anti-bacterial, anti-neoplastic, anti-malarial). However, this information comes from few pre-clinical studies and there are no clinical trials to support these claims. 
The list of common terpenes found in cannabis plant are summarized below.
<table>
<thead>
<tr>
<th style="text-align: left;">Terpenes</th>
<th style="text-align: left;">Potential pharmacological activity</th>
<th style="text-align: left;">Also found in</th>
</tr>
</thead>
<tbody>
<tr>
<td style="text-align: left;">Myrcene</td>
<td style="text-align: left;">anti-oxidant, sedating, analgesic, muscle relaxant, anti-inflammatory</td>
<td style="text-align: left;">Lemon grass, bay leaves, cardamom, basil</td>
</tr>
<tr>
<td style="text-align: left;">Limonene</td>
<td style="text-align: left;">wound healing, anti-inflammatory, anti-oxidant, anti-cancer, viral infection, anti-anxiety</td>
<td style="text-align: left;">Lemon ring, ajwain, bolivian coriander</td>
</tr>
<tr>
<td style="text-align: left;">β-Caryophyllene</td>
<td style="text-align: left;">anti-inflammatory, anti-cancer, neurodegenerative and metabolic diseases, immunomodulatory, anti-anxiety, anti-depression, anti-oxidan</td>
<td style="text-align: left;">Clove, rosemary, black pepper, lavender</td>
</tr>
<tr>
<td style="text-align: left;">Terpinolene</td>
<td style="text-align: left;">anti-oxidant, anti-cancer, anti-inflammatory, sedative, pain</td>
<td style="text-align: left;">Sage, apple, cumin, tea tree, pine and fir trees</td>
</tr>
<tr>
<td style="text-align: left;">α-Pinene</td>
<td style="text-align: left;">anti-inflammatory, anti-oxidant, anti-cancer, bronchodilator, anti-anxiety</td>
<td style="text-align: left;">Conifers, Spanish sage,</td>
</tr>
<tr>
<td style="text-align: left;">Humulene</td>
<td style="text-align: left;">anti-inflammatory, anti-cancer, depression, anti-anxiety, digestive disorders</td>
<td style="text-align: left;">Sage, ginseng</td>
</tr>
<tr>
<td style="text-align: left;">Linalool</td>
<td style="text-align: left;">anti-anxiety, analgesic, anti-convulsan</td>
<td style="text-align: left;">Lavender</td>
</tr>
</tbody>
</table>
Disclaimer: This information is not intended to be a substitute for the advice of a healthcare professional nor a recommendation of any particular treatment regimen. Please consult with your healthcare practitioner for professional advice pertaining to your particular condition.
References
<ul>
<li>Nuutinen T. Medicinal properties of terpenes found in Cannabis sativa and Humulus lupulus. Eur J Med Chem. 2018;157:198–228.</li>
<li>Russo EB. Taming THC: Potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J Pharmacol. 2011;163:1344–64.</li>
</ul>

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Terpenes

There are specific traveling guidelines and regulations to keep in mind while traveling in and out of Canada with medical cannabis. Documentation is critical to avoid hassles while traveling with medical cannabis. 
When travelling within Canada
Patients authorized to use medical cannabis may travel with their medicine provided they always keep documentation with them. Every province or territory have their own laws related to the use of cannabis; it is advised that you familiarize yourself with the laws of the province or territory you are going to visit and follow the laws in that jurisdiction. 
When traveling outside of Canada
Although, cannabis is legal for adults in Canada, the import/export of cannabis and cannabis-related products (including those containing CBD) across the Canadian border is still prohibited. This prohibition is:
<ul>
<li>irrespective of the amount of cannabis being carried</li>
<li>applicable even if someone has the authority to use cannabis for medical purposes (any form), including CBD</li>
<li>even if one is traveling to or from an area where cannabis has been legalized or decriminalized</li>
</ul>
Patients must contact the visiting country's embassy or the consulate regarding permission to carry cannabis-based medicines. Aviation security may verify documentation. Thus, allow plenty of time before traveling outside of Canada to determine authorization and means of obtaining permission, if applicable. Criminal offense charges could be faced by anyone traveling to other countries and possessing any amount of cannabis, including edible cannabis and cannabis topicals and extracts. This rule applies to all countries, whether cannabis is legal there or not. If one tries to travel internationally with cannabis, including CBD products, one may face severe criminal consequences. One could also be denied access to other countries in the future.
When entering Canada
If you are entering Canada and possesses cannabis in any form, you must declare it to the Canada Border Services Agency. Not claiming cannabis in possession at the Canadian border is a serious criminal offense. Additionally, receiving or delivering cannabis in any form into or out of Canada by mail or courier is unlawful. Unauthorized purchases (online or other) from outside Canada will be confiscated at the border, and one could be arrested and prosecuted
Kindly refer to travel guidelines and laws of the country one wishes to visit before carrying any amount or form of cannabis.
References
<ul>
<li>Cannabis and the border. Cannabis in Canada – Get the facts. Government of Canada. Available at: <a href="https://www.canada.ca/en/services/health/campaigns/cannabis/border.html">https://www.canada.ca/en/services/health/campaigns/cannabis/border.html</a></li>
<li>Patient Access – Medical Cannabis. Available at: <a href="https://www.patientaccess.ca/travel-tips/">https://www.patientaccess.ca/travel-tips/</a></li>
</ul>

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Traveling with medical cannabis

The use of cannabis may lead to interaction with several drugs. Even though cannabis is generally well-tolerated at a lower dose, bidirectional events could be possible due to concomitant administration of drugs.1,2 Generally, co-administration of two or more drugs with similar or dissimilar actions may lead to drug interactions, e.g., warfarin with aspirin.2 Drug interactions involving cannabis and cannabinoids may vary considerably in their clinical significance considering the variability in product potencies, ratios of cannabinoids, route of administration etc.1
Before using cannabis for medicinal purposes, patients must notify their healthcare practitioners about their usage of the prescription, non-prescription drugs or herbal products. Especially when using:
<ul>
<li>drugs causing drowsiness such as medications for pain, allergy or cold, sleeping pills, tranquilizers, or anti-seizure medications.</li>
<li>antiretroviral drugs used for HIV/AIDS, stomach acid inhibitors, certain antidepressants, antibiotics, antifungal, heart medications, and Saint John's Wort.3</li>
</ul>
The information on drug interaction(s) with cannabis is limited, hence caution should be exercised, and response to the treatment (when using cannabis with certain drugs) should be monitored closely, especially in the elderly population and those with kidney and liver conditions or other chronic diseases. We advise you to talk to your healthcare practitioner to know more about drug interactions with cannabis and how to manage it (if any).
Disclaimer: This information is not intended to be a substitute for the advice of a healthcare professional nor a recommendation of any particular treatment regimen. Please consult with your healthcare practitioner for professional advice pertaining to your particular condition.
References
<ol>
<li>Health Canada, &quot;Information for Health Care Professionals: Cannabis (marihuana, marijuana) and the cannabinoids, 2018&quot;. Available at: <a href="https://www.canada.ca/en/health-canada/services/drugsmedication/cannabis/information-medical-practitioners/information-health-care-professionalscannabis-cannabinoids.html">https://www.canada.ca/en/health-canada/services/drugsmedication/cannabis/information-medical-practitioners/information-health-care-professionalscannabis-cannabinoids.html</a> </li>
<li>Alsherbiny MA and Li CG. Medicinal cannabis—Potential drug interactions. Medicines. 2019:6;3.</li>
<li>Health Canada, “Consumer Information - Cannabis (Marihuana, marijuana),”. Available at <a href="https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/dhp-mps/alt_formats/pdf/marihuana/info/cons-eng.pdf">https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/dhp-mps/alt_formats/pdf/marihuana/info/cons-eng.pdf</a> </li>
</ol>

Can I take medical cannabis along with my other medications?

The potential therapeutic and risk/benefit ratio associated with cannabis use depends essentially on the amount of cannabis used and the concentration of cannabinoids in the product, age of the patient and their medical condition, prior experience with cannabis or cannabinoids, and the use of other prescription or non-prescription drugs.
As per the guideline(s) provided by Health Canada, you should not use cannabis if you are:
<ul>
<li>an individual &lt;25-year-old</li>
<li>an individual allergic to any cannabinoid</li>
<li>an individual with severe kidney, liver, heart, or lung disease</li>
<li>an individual with a family/personal history of severe mental disorders such as schizophrenia, psychosis, depression, or bipolar disorder</li>
<li>a pregnant woman, a woman planning to get pregnant, or is breast-feeding</li>
<li>a man wishing to start a family</li>
<li>an individual with a history of alcohol, drug abuse, or substance dependence</li>
</ul>
We strongly recommend that you talk to your healthcare practitioner if you fall into any of the above categories. There may be other conditions where cannabis should not be used, but which are unknown due to limited scientific information. Kindly contact your healthcare practitioner for further details.
Disclaimer: This information is not intended to be a substitute for the advice of a healthcare professional nor a recommendation of any particular treatment regimen. Please consult with your healthcare practitioner for professional advice pertaining to your particular condition.
References
<ul>
<li>Health Canada, "Information for Health Care Professionals: Cannabis (marihuana, marijuana) and the cannabinoids, 2018". Available at: <a href="https://www.canada.ca/en/health-canada/services/drugsmedication/cannabis/information-medical-practitioners/information-health-care-professionalscannabis-cannabinoids.html">https://www.canada.ca/en/health-canada/services/drugsmedication/cannabis/information-medical-practitioners/information-health-care-professionalscannabis-cannabinoids.html</a></li>
<li>Health Canada, “Consumer Information - Cannabis (Marihuana, marijuana),”. Available at <a href="https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/dhp-mps/alt_formats/pdf/marihuana/info/cons-eng.pdf">https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/dhp-mps/alt_formats/pdf/marihuana/info/cons-eng.pdf</a></li>
</ul>

Who should not use cannabis?

Information on adverse effects associated with the therapeutic use of cannabis and cannabinoids is limited due to paucity of established scientific evidence. Adverse effects are usually observed with high dose of cannabis or cannabinoids.1 Though there is no scientifically defined dose of cannabis, generally, a low dose is well-tolerated with infrequent adverse effects. A higher-dose or an overdose is often associated with short- or long-term side effects.1 Some well-known adverse effects associated with the use of cannabis and cannabinoids may include euphoria, spontaneous laughter and excitement, increased appetite, and dry mouth.1,2 Other recognized adverse effects associated with short-term and long-term use of cannabis are described as below: 1-3
Short-term use
<ul>
<li>fatigue, dizziness, headache, drowsiness, feeling faint or lightheaded</li>
<li>disturbances in attention and impaired memory, concentration, and ability to think and decide</li>
<li>disorientation, confusion, feeling &quot;too high,&quot; feeling an extreme slowing of time</li>
<li>nervousness, suspiciousness, anxiety episodes resembling a panic attack, paranoia (loss of contact with reality), hallucinations</li>
<li>impairment in motor skills and perception, altered bodily perceptions, loss of control of bodily movements, falls</li>
<li>hypersensitivity reactions (contact dermatitis/hives)</li>
<li>fast heartbeat</li>
</ul>
Long-term use
<ul>
<li>increased risk of triggering/aggravating psychiatric and/or mood disorders (anxiety, schizophrenia, depression, psychosis, bipolar disorder)</li>
<li>increased risk of developing respiratory infections or chronic cough (when smoking)</li>
<li>negative impact on cognitive functions (ability to think and decide)</li>
<li>lead to a decrease in one or more of the effects of cannabis (tolerance)</li>
<li>withdrawal-type symptoms upon abrupt discontinuation of its use</li>
<li>psychological dependence (addiction) characterized by impaired control over drug use, compulsive use, continued use despite harm, and craving</li>
</ul>
The above list of short-term and long-term adverse effects is not complete. Should you experience any unexpected adverse effects while taking cannabis for medical purposes, it is advised that you contact your healthcare practitioner or visit the emergency department of your nearest hospital..
Disclaimer: This information is not intended to be a substitute for the advice of a healthcare professional nor a recommendation of any particular treatment regimen. Please consult with your healthcare practitioner for professional advice pertaining to your particular condition.
References
<ol>
<li>Health Canada, &quot;Information for Health Care Professionals: Cannabis (marihuana, marijuana) and the cannabinoids, 2018&quot;. Available at: <a href="https://www.canada.ca/en/health-canada/services/drugsmedication/cannabis/information-medical-practitioners/information-health-care-professionalscannabis-cannabinoids.html">https://www.canada.ca/en/health-canada/services/drugsmedication/cannabis/information-medical-practitioners/information-health-care-professionalscannabis-cannabinoids.html</a> </li>
<li>Health Canada, “Consumer Information - Cannabis (Marihuana, marijuana),”. Available at <a href="https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/dhp-mps/alt_formats/pdf/marihuana/info/cons-eng.pdf">https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/dhp-mps/alt_formats/pdf/marihuana/info/cons-eng.pdf</a> </li>
<li>Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: A systematic review and meta-analysis. JAMA. 2015;313(24):2456–73.</li>
</ol>

The Truth About Terpenes In Medical Cannabis

Adverse effects of cannabis and cannabinoids

Cannabinoids are a diverse class of organic compounds that interacts with specific targets found in the body known as cannabinoid receptors.1 These cannabinoid receptors are involved in the regulation of many functions in the body including brain and nervous system activity, heart rate and blood pressure, digestion, inflammation, immune system activity, perception of pain, reproduction, wake/sleep cycle, regulation of stress etc.1 Cannabinoids when classified according to their origin can be either endocannabinoids (made naturally by our body) or phytocannabinoids (produced by the cannabis plant) or synthetic cannabinoids (produced in the lab).2
More than 100 cannabinoids are found in the cannabis plant.2 The two commonly known phytocannabinoids are ∆9-tetrahydrocannabinol (THC) and cannabidiol (CBD).2 THC is the primary constituent of cannabis responsible for the euphoric effect i.e. &quot;high&quot; feeling, while CBD is a non-euphoric component of the cannabis plant and does not cause a high. Apart from THC and CBD, other phytocannabinoids include cannabigerol (CBG), cannabinol (CBN), cannabichromene (CBC), tetrahydrocannabivarin (THCV), etc.2 These phytocannabinoids are present in inactive state in the plant and requires heating to be activated. Phytocannabinoids are normally extracted and reformulated for medical use e.g. oils, capsules, sublingual spray, topical creams.
Cannabis and cannabinoids have been implicated for potential use in various medical conditions including but not limited to:
<ul>
<li>severe refractory nausea and vomiting associated with cancer chemotherapy</li>
<li>loss of appetite and body weight in cancer patients and patients with HIV/AIDS</li>
<li>pain and muscle spasms associated with multiple sclerosis</li>
<li>chronic non-cancer pain (mainly neuropathic)</li>
<li>severe refractory cancer associated pain</li>
<li>insomnia and depressed mood associated with chronic diseases (HIV/AIDS, chronic non-cancer pain)</li>
<li>symptoms encountered in the palliative/end-of-life care setting.1</li>
</ul>
The potential therapeutic and adverse effects associated with cannabinoids depends on multitude of factors e.g. concentration of cannabinoids, patient’s age and medical condition, previous experience with cannabis etc.1 We strongly advise you to consult your healthcare practitioner to identify the most appropriate cannabinoid to manage your medical condition.
Disclaimer: This information is not intended to be a substitute for the advice of a healthcare professional nor a recommendation of any particular treatment regimen. Please consult with your healthcare practitioner for professional advice pertaining to your particular condition. 
References
<ol>
<li>Health Canada, “Consumer Information - Cannabis (Marihuana, marijuana),”. Available at <a href="https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/dhp-mps/alt_formats/pdf/marihuana/info/cons-eng.pdf">https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/dhp-mps/alt_formats/pdf/marihuana/info/cons-eng.pdf</a> </li>
<li>Health Canada, &quot;Information for Health Care Professionals: Cannabis (marihuana, marijuana) and the cannabinoids, 2018&quot;. Available at: <a href="https://www.canada.ca/en/health-canada/services/drugsmedication/cannabis/information-medical-practitioners/information-health-care-professionalscannabis-cannabinoids.html">https://www.canada.ca/en/health-canada/services/drugsmedication/cannabis/information-medical-practitioners/information-health-care-professionalscannabis-cannabinoids.html</a> </li>
</ol>

What are cannabinoids?

Cannabis (marihuana, marijuana) is an annual plant that is frequently found in temperate and tropical climates.1,2 It is one of the oldest plants used for medicinal purposes. It is a dioecious plant, i.e., having separate male and female plants.2 The male plants produce flowers full of pollen, whereas female plants produce large resin-filled flowers. The female plants, when not pollinated, are used for medicinal purposes. 
The common species of the cannabis plant are ─ Cannabis sativa, Cannabis indica, and Cannabis ruderalis; however, there is still much debate surrounding the classification of cannabis due to the wide variation in its gene pool.2 Most of the medically used cannabis is a hybrid of sativa and indica cultivars due to extensive breeding programs. Cannabis sativa is a thin-leaved plant that flowers under certain light conditions and is tall with growth up to 5–18 feet with widely spaced branches.2 It tends to produce high amount of THC and is described as having an uplifting and energetic effect. Cannabis indica is shorter (2–4 feet tall), with a denser branch structure and broad leaves.2 Cannabis indica may have sleepy and relaxing effects. Cannabis ruderalis is principally used in hybrids; is smaller than Cannabis sativa, usually (≤2 feet), with auto-flowering characteristics i.e. flowers appear as a result of plant age rather than the light conditions.2
The commonly associated names with cannabis include Ganja, Grass, Ma, Hashish, Hemp, Indian Hemp, Pot, Bhang, and Weed.
Disclaimer: This information is not intended to be a substitute for the advice of a healthcare professional nor a recommendation of any particular treatment regimen. Please consult with your healthcare practitioner for professional advice pertaining to your particular condition. 
References
<ol>
<li>Health Canada, &quot;Information for Health Care Professionals: Cannabis (marihuana, marijuana)and the cannabinoids, 2018&quot;. Available at: <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids.html" target="_blank" rel="noopener noreferrer"><a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids.html">https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids.html</a> </a></li>
<li>Gloss D. An overview of products and bias in research. Neurotherapeutics. 2015;12:731–34.</li>
</ol>

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