LA Marijuana Products:

Introductory Principles

In an effort to present information vital to understanding the therapeutic use of THC-based marijuana products available in Louisiana, this section is directed at reviewing basic principles necessary for understanding how to get the most benefit out of using marijuana-based products for medicinal purposes.

 

Before pursuing a trial of therapy with cannabis-based products,  first read:

Then:

Understanding Marijuana Products:

 

Links to other Pertinent Educational Pages:

Links to ALL Marijuana Educational Pages

 

Marijuana Pharmacies/Dispensaries in Louisiana:

Marijuana Pharmacies

 

The medical information on this site is provided as a resource for information only, and is not to be used or relied upon for any diagnostic or treatment purposes and is not intended to create any patient-physician relationship.  Readers are advised to seek professional medical guidance regarding the diagnosis and treatment of their medical concerns.

 

Key to Links:

  • Grey text – handout
  • Red text – another page on this website
  • Blue text – Journal publication

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A Brief Overview

When the decision is made to try using medical marijuana, one needs to identify the specific benefits one hopes to obtain in order to make the appropriate choice of product. When considering dosing, it is important to start with low doses until one becomes familiar with how one responds to a particular product. This is especially true for those with little or no experience with marijuana. In addition, one needs to understand that marijuana is not a drug but a plant with more than 100 pharmaceutically active drug constituents. The benefits to be obtained from a marijuana product will depend on the different constituents found in that product including not just the am0unts or concentrations but also the ratios of the different constituents.

 

The most common conditions for turning to marijuana products for therapeutic benefits include pain, anxiety and insomnia, but other benefits may be achieved. When selecting a product one must understand which constituents found in marijuana  contribute to one’s desired benefits. While the cannabinoids delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are the most dominant constituents found in marijuana, other constituents including other cannabinoids, terpenes and flavonoids are critical in determining which benefits a product offers. The interactions, or “entourage effects,” between the various constituents (especially between THC and CBD) contribute greatly to the benefits and side effects a product offers. This is the reason there are so many hundreds of strains of marijuana each with their unique attributes.

 

Besides the therapeutic contribution from the constituents found in marijuana, the form of the marijuana product as well as the method of ingestion or intake of the product is equally important in determining the ultimate therapeutic impact of the marijuana product. Currently available forms of marijuana products include tinctures that can be ingested under the tongue (sublingual) or swallowed, vape products that are inhaled, edible forms to be eaten and topical creams that are applied to the skin. Each of these forms have their advantages and disadvantages discussed below.

 

Finally, when assessing a marijuana product to predict its potential benefits by evaluating its profile of THC, CBD and the secondary cannabinoids and terpenes it is important to understand that the profile provided may vary quite a bit from one plant from another even within the same specific strain such as Jenny Kush. This is because the conditions in which the plant is grown have a great impact on the plant’s constituents. When reviewing reported profiles one can see significant variation in reported contents and amounts. This can be seen below where profiles published by different sources can be very different.

 

In the LA medical marijuana industry, however, the plants are cloned and grown in essentially the same conditions for the products available. According to the manufacturer, there is no greater than 15% variability from one batch to another. This constituent consistency is an important advantage to buying illicit-source marijuana products or even commercially available products in marijuana-legal states.

 

Pain

It should be noted that despite overwhelming interest in the public and medical community as to marijuana and marijuana constituents regarding benefits for pain, there remains only weak evidence based on relatively poor quality research studies to guide one in the use of marijuana products for pain. As of 2024, there is greater evidence for the benefits for pain, especially nerve (neuropathic) pain. However the devil is in the details – it is still not clear how to best achieve pain benefits from the various marijuana strains and products. What does appear clear is that the use of THC products does enable pain patients to better cope with their pain.

 The constituents found in marijuana that are most helpful in treating pain include:

 

Cannabinoids

THC & CBD

The two primary cannabinoids found in cannabis, THC and CBD, are are responsible for the majority of cannabis’s pharmacologic effects, especially the analgesic effects. THC is in most cases the strongest analgesic constituent in marijuana. THC is neuroprotectant and has the ability to reduce certain forms of neuropathic and chronic pain. In addition, it has  anti-spasmodic, anti-tremor, anti-inflammatory, appetite stimulant and anti-emetic properties.

 

The addition of CBD to THC is generally believed to enhance the benefits of THC as well as suppress some of THC’s side effects, especially the anxiety, paranoia, cognitive and memory impairment that is associated with THC.  A 2016 study, however, suggests that oral CBD does not reduce the reinforcing, physiological, or positive subjective effects of smoked cannabis and recommended that CBD be inhaled with the THC. Yet most studies show that neither smoked, vaporized nor oral CBD alters THC’s positive subjective effects. The explanations for this lack of consistency is likely that most studies were not well designed.

 

There are differences in opinions as to whether the ratios of THC to CBD should be high, low or balanced to provide the most analgesic benefit so it is generally left to the individual and their trials and errors to identify what works best for them. Be aware that the recommended dosing limit for THC is 30 mg/day unless otherwise advised by the recommending physician.

See: Dosing

 

CBD by itself has benefit for pain for some people but it is less potent alone than when combined with THC. CBD does not produce the mind-altering “high” effects like euphoria but it does reduce anxiety and enhance sleep. It has anti-inflammatory, anti-convulsant, anti-psychotic, antioxidant, neuroprotective and immunomodulatory effects.For in-depth information regarding CBD and its clinical characteristics, See: Cannabidiol (CBD).

 

Minor Cannabinoids

Other minor cannabinoids found in cannabis may also exert additional effects of therapeutic interest, including cannabinol (CBN), tetrahydrocannabivarin (THCV), cannabigerol (CBG) and cannabichromene (CBC).  Cannabinol (CBN) is the third most common constituent of marijuana after THC and CBD. CBN is not psychoactive but it does provide some analgesic benefit. However, the specifics of which secondary cannabinoids are present, or their amounts, are not reported in most of the products currently available in LA (See: Cannabinoids).

 

Terpenes

Terpenes have a great deal of popular support for their pain benefits although most of the research that explores this is preclinical: animal or lab-based (in-vitro). For more in-depth information regarding terpenes, please see “Terpenes – An Overview.”  The following terpenes are most commonly recognized for their benefits for pain:

 

    1. Beta-Caryophyllene
    2. Pinene
    3. Limonene
    4. Linalool
    5. Myrcene
    6. Eucalyptol

 

Anxiety

The constituents found in marijuana that are most helpful in treating anxiety include:

 

Cannabinoids

While THC may reduce anxiety at low doses, higher doses of THC often cause or worsen anxiety and trigger paranoia. CBD on the other hand has anxiolytic effects which are reasonably supported in the literature, especially regarding the belief that CBD reduces the side effect of anxiety induced by THC (See: Cannabidiol (CBD). The dose of CBD required for anxiety relief varies considerably between individuals but may require as little as 5 mg to as much as 200 mg or more. Also, the minor cannabinoid, Cannabigerol (CBG), has benefit for anxiety although it is present in only very small amounts in most cannabis strains.

 

Terpenes

Terpenes are frequently promoted as having sedative and anxiety benefits. The following is a list of terpenes commonly believed to have sedative or anxiolytic effects:

    1. β-Caryophyllene
    2. Limonene
    3. Linalool
    4. Myrcene
    5. α-Pinene
    6. Phytol
    7. α-Terpineol
    8. Terpinolene

 

insomnia

The constituents found in marijuana that are most helpful in treating insomnia include:

 Cannabinoids

Preliminary research into marijuana and insomnia suggests that CBD may be helpful for treating insomnia. Like using CBD for anxiety, the CBD dose to facilitate sleep may range from low (5-10 mg)  to as high as 200 mg or higher.  THC at doses of as little as 5 mg or as high as 30 mg or higher may improve sleep latency (falling asleep) but could impair sleep quality in the long-term.

Terpenes

The following is a list of terpenes commonly believed to have benefit for insomnia:

 

    1. Beta-Caryophyllene (BCP)
    2. Myrcene
    3. Linalool
    4. β-Pinene
    5. Terpinolene

 

 

Marijuana (Cannabis)-based Medications Available in Louisiana (LA)

The marijuana-based products for medical use currently available fall into these categories:

  1. Oral liquid tinctures
  2. Edible Products
  3. Vape products for inhalation
  4. Topical products to apply to the skin
  5. Marijuana Plant Flower/Buds

 

 

The differences, advantages, disadvantages and pharmacology of these different categories are addressed on the other  educational pages on this site, see links above. This section will review the specific products currently available in LA.

One important point needs to be made regarding these products. The benefits of any medical marijuana product will be dependent on the pharmacologic activity of the constituents found in the product. These constituents include cannabinoids (THC, CBD and others) and terpenes the aromatic constituents that contribute to the scent as well as therapeutic benefits of a marijuana product. If a marijuana product does not provide the desired therapeutic benefit, it may be due to inadequate dosing or due to an inadequate profile of the constituents found in the product. Therefore one may need to supplement any given marijuana product with additional constituents rather than simply increase the dose of the product to achieve a desired benefit.

 

Brand Name Products: Wellcana (Good Day Farm) and Ilera

Currently in Louisiana only two brands of marijuana-based products are available: Wellcana (formerly GB Sciences, 2019, and recently partnered with “Good Day Farm,” 10, 2021) which contracts with LSU and Ilera Holistic Healthcare which contracts with Southern University. Because the two Louisiana-approved marijuana growers, LSU and Southern, grow different strains of marijuana, their products are not the same despite sharing similar doses of the major marijuana constituents, THC and CBD. The secondary constituents including the minor cannabinoids, terpenes and flavonoids have important clinical impact but they vary between strains. Therefore when exploring the products it may be necessary to try the other brand when one is not fully satisfied with their response to a particular brand’s product.

 

Unfortunately, because the marijuana strains from which these secondary constituents are derived are proprietary, as are the actual amounts and ratios of the constituents found in these products, this information is not disclosed. Because these variables determine the potential therapeutic benefits of the formulations it is not possible to predict their specific efficacy for medical conditions.

 

 

 

Resources:

National Academy of Sciences

The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research

 

These lay-person websites appear to be good resources for exploring medical marijuana:

  1. www.GreenCamp.com
  2. www.Healer.com
  3. www.MedicalJane.com
  4. www.ProjectCBD.org
  5. analytical360.com
  6. www.leafly.com

 

 

References:

Epidiolex (cannabidiol)

  1. FDA approves CBD drug – Epidiolex – The Washington Post

 

Marinol (dronabinol)

  1. Marinol – dronabinol

 

 Marijuana – Sativs vs Indica

  1. The Cannabinoid Content of Legal Cannabis in Washington State Varies Systematically Across Testing Facilities and Popular Consumer Products – 2018

 

Medical Marijuana – Federal Law

  1. The legal status of cannabis (marijuana) and cannabidiol (CBD) under U.S. law – 2017

 

 

Medical Marijuana – Dosing

  1. Practical considerations in medical cannabis administration and dosing – 2018
  2. Measuring cannabis consumption – Psychometric properties of the Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory (DFAQ-CU) – 2017
  3. Quantifying Cannabis – A Field Study of Marijuana Quantity Estimation – 2018
  4. Bayesian inference for the distribution of grams of marijuana in a joint. – PubMed – NCBI – 2016
  5. Delphi Consensus – recommendations on dosing and administration of medical cannabis to treat chronic pain – results of a modified Delphi process – 2021
  6. Delphi Consensus – A cannabis oracle? Delphi method not a substitute for randomized controlled trials of cannabinoids as therapeutics – 2021
  7. Delphi Consensus – Clinical experience and COI disclosures
  8. Delphi Consensus – Dosing and Administration of Medical Cannabis- Physician Survey
  9. Delphi Consensus – Virtual Voting Round 2 Results Delphi Consensus – Voting Round 1 Results
  10. Consensus‐based recommendations for titrating cannabinoids and tapering opioids for chronic pain control – 2021

 

Medical Marijuana – Louisiana Law

  1. Louisiana-2016-SB180-Chaptered
  2. HOUSE BILL NO. 225 – 2017 Regular Session
  3. Louisiana medical marijuana expansion bill signed into law – May 20, 2016
  4. Now in Effect, Louisiana Medical Marijuana Law Shields Patients and Caregivers from Prosecution – Aug 5, 2016
  5. Louisiana-2016-SB180-Chaptered

 

Cannabidiol (CBD)- Overviews

  1. CANNABIDIOL (CBD) Pre-Review Report WHO 2017
  2. Cannabidiol – State of the art and new challenges for therapeutic applications. – 2017 PubMed – NCBI

 

CBD – Anxiety

  1. Overlapping Mechanisms of Stress-Induced Relapse to Opioid Use Disorder and Chronic Pain – Clinical Implications – 2016
  2. Cannabidiol Modulates Fear Memory Formation Through Interactions with Serotonergic Transmission in the Mesolimbic System – 2016
  3. Cannabidiol regulation of emotion and emotional memory processing: relevance for treating anxiety-related and substance abuse disorders. – PubMed – NCBI
  4. Review of the neurological benefits of phytocannabinoids – 2018
  5. Plastic and Neuroprotective Mechanisms Involved in the Therapeutic Effects of Cannabidiol in Psychiatric Disorders – 2017
  6. Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report. – PubMed – NCBI
  7. Evidences for the Anti-panic Actions of Cannabidiol – 2017
  8. Cannabidiol, a Cannabis sativa constituent, as an anxiolytic drug – 2012
  9. Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in Treatment-Naïve Social Phobia Patients – 2011

 

CBD – Interaction with THC

  1. Cannabidiol: a promising drug for neurodegenerative disorders? – PubMed – NCBI
  2. Oral Cannabidiol does not Alter the Subjective, Reinforcing or Cardiovascular Effects of Smoked Cannabis – 2015
  3. Taming THC – potential cannabis synergy and phytocannabinoid-terpenoid entourage effects – 2011
  4. A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. – PubMed – NCBI
  5. Oral Cannabidiol does not Alter the Subjective, Reinforcing or Cardiovascular Effects of Smoked Cannabis – 2016
  6. Impact of cannabidiol on the acute memory and psychotomimetic effects of smoked cannabis – naturalistic study – 2010

 

 

CBD – Metabolites

  1. Human Metabolites of Cannabidiol – A Review on Their Formation, Biological Activity, and Relevance in Therapy – 2016

 

CBD – Drug-Metabolic Interactions

  1. Cannabidiol, a Major Phytocannabinoid, As a Potent Atypical Inhibitor for CYP2D6 – 2011
  2. The Effect of CYP2D6 Drug-Drug Interactions on Hydrocodone Effectiveness – 2014 
  3. Characterization of P-glycoprotein Inhibition by Major Cannabinoids from Marijuana – 2006

 

Medical Marijuana – Prescribing Guidelines

  1. Simplified guideline for prescribing medical cannabinoids in primary care – Canadian Family Physician – 2018
  2. Physician Recommendation of Medical Cannabis Guidelines Calif Medical Assoc – 2011
  3. Prescribing smoked cannabis for chronic noncancer pain. Preliminary recommendations – Canadian Family Physician – 2014

 

 

Medical Marijuana – Opioids

  1. Use-of-Prescription-Pain-Medications-Among-Medical-Cannabis-Patients
  2. It is premature to expand access to medicinal cannabis in hopes of solving the US opioid crisis – 2018
  3. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort – 2018
  4. Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. – PubMed – NCBI
  5. Associations between medical cannabis and prescription opioid use in chronic pain patients – A preliminary cohort study – 2017
  6. The prevalence and significance of cannabis use in patients prescribed chronic opioid therapy: a review of the extant literature. – PubMed – NCBI
  7. The use of cannabis in response to the opioid crisis: A review of the literature. – PubMed – NCBI
  8. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999–2010 – 2014
  9. Rationale for cannabis-based interventions in the opioid overdose crisis – 2017
  10. Cannabis and the Opioid Crisis – 2018
  11. Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability. – PubMed – NCBI
  12. Cannabinoid–Opioid Interaction in Chronic Pain
  13. Synergistic interactions between cannabinoid and opioid analgesics. – PubMed – NCBI
  14. FDA approves CBD drug – Epidiolex – The Washington Post

 

Medical Marijuana, Chronic Pain – Cannabinoids & Palmitoylethanolamide

  1. Therapeutic utility of palmitoylethanolamide in the treatment of neuropathic pain associated with various pathological conditions – a case series – 2012
  2. Palmitoylethanolamide, a naturally occurring lipid, is an orally effective intestinal anti-inflammatory agent – 2013
  3. Cannabinoid-based drugs targeting CB1 and TRPV1, the sympathetic nervous system, and arthritis – 2015
  4. Fatty acid amide hydrolase: biochemistry, pharmacology, and therapeutic possibilities for an enzyme hydrolyzing anandamide, 2-arachidonoylglycerol,… – PubMed – NCBI 2001
  5. Endocannabinoid-related compounds in gastrointestinal diseases – 2018
  6. ‘Entourage’ effects of N-palmitoylethanolamide and N-oleoylethanolamide on vasorelaxation to anandamide occur through TRPV1 receptors – 2008
  7. Medical Cannabis and Cannabinoids- An Option for the Treatment of Inflammatory Bowel Disease and Ca
    ncer of the Colon? – 2018
  8. Effects of homologues and analogues of palmitoylethanolamide upon the inactivation of the endocannabinoid anandamide – 2001
  9. Phytocannabinoids beyond the Cannabis plant – do they exist? – 2010
  10. Palmitoylethanolamide, endocannabinoids and related cannabimimetic compounds in protection against tissue inflammation and pain: potential use in c… – PubMed – NCBI
  11. Cannabinoids as pharmacotherapies for neuropathic pain – from the bench to the bedside. – 2009
  12. Correction – Effect of a new formulation of micronized and ultramicronized N-palmitoylethanolamine in a tibia fracture mouse model of complex regional pain syndrome – 2018
  13. Palmitoylethanolamide induces microglia changes associated with increased migration and phagocytic activity – involvement of the CB2 receptor – 2017
  14. Mast cells, glia and neuroinflammation – partners in crime? – 2013
  15. A Pharmacological Rationale to Reduce the Incidence of Opioid Induced Tolerance and Hyperalgesia – A Review – 2018

 

Medical Marijuana –Misc

  1. A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. – PubMed – NCBI
  2. Cannabis and cannabis extracts – greater than the sum of their parts? – 2001
  3. Medical cannabis and mental health: A guided systematic review. 2016 – PubMed – NCBI
  4. Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly. – PubMed – NCBI
  5. Cannabis-conclusions – 2017 National Academy of Sciences
  6. Cannabis-chapter-highlights – 2017 National Academy of Sciences
  7. Cannabis-report-highlights – 2017 National Academy of Sciences
  8. Clinical Endocannabinoid Deficiency (CECD): Can this Concept Explain Therapeutic Bene ts of Cannabis in Migraine, Fibromyalgia, Irritable Bowel Syndrome and other Treatment-Resistant Conditions?-2004
  9. Marijuana use and the risk of lung and upper aerodigestive tract cancers: results of a population-based case-control study. – PubMed – NCBI
  10. Cannabis use and cognitive function: 8-year trajectory in a young adult cohort. – PubMed – NCBI
  11. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. – PubMed – NCBI
  12. Cannabinoids and Cytochrome P450 Interactions. – PubMed – NCBI Pharmacogenetics of Cannabinoids – 2018
  13. Systematic review of systematic reviews for medical cannabinoids – 2018
  14. Adverse effects of medical cannabinoids – a systematic review – 2008
  15. Cannabimimetic effects modulated by cholinergic compounds. – PubMed – NCBI
  16. Antagonism of marihuana effects by indomethacin in humans. – PubMed – NCBI
  17. Pharmacokinetics and pharmacodynamics of cannabinoids. – PubMed – NCBI
  18. Clinical Pharmacodynamics of Cannabinoids – 2004
  19. Affinity and Efficacy Studies of Te
    trahydrocannabinolic Acid A at Cannabinoid Receptor Types One and Two. – 2017
  20. Quality Control of Traditional Cannabis Tinctures – Pattern, Markers, and Stability – 2016
  21. Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes: a systematic review. – PubMed – NCBI
  22. Pharmacology of Cannabinoids
  23. Current-status-and-future-of-cannabis-research-Clin-Researcher-2015
  24. Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems – A Clinical Review – 2015

 

Medical Marijuana – Products

Medical Marijuana – Product Evaluation

  1. The Cannabinoid Content of Legal Cannabis in Washington State Varies Systematically Across Testing Facilities and Popular Consumer Products – 2018
  2. Quality Control of Traditional Cannabis Tinctures – Pattern, Markers, and Stability – 2016

 

Medical Marijuana – Flower/Bud Products

Wellcana (Good Day Farm):

  1. Grease Monkey Flyer
  2. Lilac Diesel Flyer

 

Medical Marijuana – Topical Products

  1. Soothe Flyer
  2. Breathe Flyer

 

 

Emphasis on Education

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.

 

Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

 

For more information, please contact Accurate Clinic.

 

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