Cannabis Nurse Truths

In 2020, an estimated 209 million people around the world, or just less than four per cent of the global population, reported using cannabis in the past 12 months. Around the world, cannabis is being legalized or decriminalized and hundreds of thousands of patients are currently being treated with medicinal cannabis. Cannabis products are becoming increasingly diverse, and vary considerably in their concentrations of the one psychoactive cannabinoid found in cannabis, delta 9 tetrahydrocannabinol, also known as THC. It is in use of THC that we develop risks and harms from cannabis.
Currently, there is no standardized THC dose or measure that has been recommended by experts, and there are no approved treatments for THC intoxication. On this episode of Cannabis Nurse Truths, we review the concerns with standard THC dosing - just how high is too high?
 
Episode Resources
Bhaskar, A., Bell, A., Boivin, M., Briques, W., Brown, M., Clarke, H., Cyr, C., Eisenberg, E., de Oliveira Silva, RF., Frohlich, E., Georgius, P., Hogg, M., Horsted, T.I., MacCallum, C.A., Müller-Vahl, K.R., O’Connell, C., Sealey, R., Seibolt, M., Sihota, A., … Moulin, D.E. (2021). Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: Results of a modified Delphi process. Journal of Cannabis Research, 3(1), 22. https://doi.org/10.1186/s42238-021-00073-1
 
Freeman, T. P., & Lorenzetti, V. (2020). ‘Standard THC units’: A proposal to standardize dose across all cannabis products and methods of administration. Addiction, 115(7), 1207–1216. https://doi.org/10.1111/add.14842
 
Glare, P., Chye, R., Bloch, M., Arya, M., Moore, A., & Montgomery, J. (2023). Tolerability and Efficacy of a 10:25 Preparation of Δ9-Tetrahydrocannabinol and Cannabidiol for Treatment of Chronic Back or Neck Pain: A Multiple-Dose Escalation Study. Medical Cannabis and Cannabinoids, 6(1), 66–76. https://doi.org/10.1159/000531232
 
Leung, J., Stjepanović, D., Dawson, D., & Hall, W. D. (2021). Do Cannabis Users Reduce Their THC Dosages When Using More Potent Cannabis Products? A Review. Frontiers in Psychiatry, 12, 630602. https://doi.org/10.3389/fpsyt.2021.630602
 
Rozanc, J., Klumpers, L.E., Huestis, M.A., & Tagen, M. (2024). Tolerability of High-Dose Oral Δ 9 -THC: Implications for Human Laboratory Study Design. Cannabis and Cannabinoid Research, can.2023.0209. https://doi.org/10.1089/can.2023.0209
 
 

It is well known that individuals who use high doses of cannabis for a long period of time will develop tolerance to THC. To overcome tolerance to THC, there are two choices - use more THC or take a THC break, also known as a T- Break. Numerous online forums suggest varying ways to manage a T-Break; a recent Internet search resulted in over 36 million hits on how to reduce THC tolerance.
The problem with these online T-Break guides, however, is that none of them are empirically based, meaning that there is currently no evidence to support the methods suggested online. In this episode of Cannabis Nurse Truths, we consider the data related to cannabis tolerance and how numerous factors may interfere with your T-Break.
 
Episode Resources
Allsop, D. J., Copeland, J., Norberg, M. M., Fu, S., & Molnar, A. (2012). Quantifying the Clinical Significance of Cannabis Withdrawal. PLoS ONE, 7(9), e44864.
Ansell, E. B., Bedillion, M. F., Farris, S. R., Gilbert, J. M., Koch, M. M., & Thureen, S. E. (2023). Cannabis use breaks in young adults: The highs and lows of tolerance breaks. Drug and Alcohol Dependence, 249, 109951.
D'Souza, D., Cortes-Briones, J., Ranganathan, M., Thurnauer, H., Creatura, G., Surti, T., ... & Skosnik, P. (2015, December). Rapid changes in CB1 receptor availability in cannabis dependent males after abstinence from cannabis. In Neuropsychopharmacology (Vol. 40, pp. S589-S590).
 
Fontana, T. (2024). T-Break Guide: Take a Cannabis Tolerance Break. University of Vermont.
 
Fontana, T. J., Schulz, J. A., Budney, A. J., & Villanti, A. C. (2022). Feasibility and utility of a structured guide for cannabis tolerance breaks in young adults. Journal of American College Health, 1-5.
 
Ramaekers, J. G., Mason, N. L., & Theunissen, E. L. (2020). Blunted highs: Pharmacodynamic and behavioral models of cannabis tolerance. European Neuropsychopharmacology, 36, 191-205.
 
Spindle, T. R., Cone, E. J., Schlienz, N. J., Mitchell, J. M., Bigelow, G. E., Flegel, R., ... & Vandrey, R. (2019). Acute pharmacokinetic profile of smoked and vaporized cannabis in human blood and oral fluid. Journal of Analytical Toxicology, 43(4), 233-258.
 
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In 2018, the National Council of State Boards of Nursing published the National Nursing Guidelines for Medical Marijuana. This document provided a road map for nurses to learn and understand how cannabis works in the human body so that they could educate and assist our population as they began to use legal medical marijuana.
Fast forward to 2024, where cannabis nursing is now a recognized subspecialty of nursing, and cannabis nurses are poised to provide our population with safe and knowledgeable practice to promote patient safety as our population is increasingly finding that cannabis heals. On this episode of Cannabis Nurse Truths, we highlight how the American Nursing Association has led the way in providing professional guidelines for all nurses to practice cannabis nursing across the United States. Get ready... the cannabis nurses are going to heal the world.

Cannabis sativa L. is the botanical name for a family of plants that include three distinct types of cannabis.  Cannabis has been used for centuries, long before the Christian era, in Asia, where it was used for construction, food, fabric, paper, and medicine. In modern society, we have confused the two cousins in this family, hemp and marijuana, and there is global confusion about differences within the plants.  It doesn't help that marijuana has been demonized for decades and now, everyone is suffering from Reefer Madness as they think hemp is the devil's lettuce.
In this episode of Cannabis Nurse Truths, we break down the differences between hemp and marijuana and share why hemp will soon be part of every lifestyle in every culture around the world. 

With over eight decades of research, we understand that there are over 500 compounds to be analyzed in cannabis.  One of those compounds is a category known as terpenoids, familiarly known as terpenes or terps.  Imagine walking through a pine forest and smelling pine, or how about through a field of lavender, and smelling that delicious, relaxing smell.  If you are like me, I like my beer with hops, so imagine a hoppy beer smell or what citrus smells like.  These are the compounds that are known as terpenes, and terpenes, while they are very great for what they do and smell like, they also have a physiological effect. In today's Cannabis Nurse Truths episode, we're going to discuss terpenes, because they are actually the 'bus drivers' of every cannabis effect known to man. 
 

Our endocannabinoid system is primarily responsible for maintaining homeostasis, which is our body's balance of the internal environment against the external environment, and all living systems have an endocannabinoid system.  Since the 1930s, our body's endocannabinoid system has lain dormant, as many of the processes in regulation of all of our body's systems require regular care and feeding.  The issue at hand is - what do we feed this system with?
Well, as you can guess, we feed this system with endocannabinoids, either from our body or from a plant. A plant that is especially designed to interact with the systems for balancing and regulating our bodies to either maintain health or prevent disease. In this episode of Cannabis Nurse Truths, we explore Clinical Endocannabinoid Deficiency and why science is now making the case that we all carry this problem. 

We used to think that baseball was America's favorite pastime, but that was decades ago. and something besides baseball fans started showing up at every stadium across the country.  America's favorite pastime can be in every stadium, at every event, at every neighborhood soccer game, and in every refrigerator or pantry across the country.
Our NEW favorite pastime is alcohol, and use of cannabis with alcohol has created some new challenges and surprising evidence related to co-use of both substances.  On today's episode of Cannabis Nurse Truths, we share the good, the bad, and the ugly effects of co-mingling alcohol with cannabis. 

A diagnosis of cancer is a very scary thing. The standard treatment for cancer is chemotherapy, however, this is especially problematic because usually there is a narrow therapeutic window and potential for serious toxic effects of chemotherapy drugs.  Additionally, several cancer types have been found to be drug resistant.  The cannabis plant produces hundreds of compounds with potential therapeutic properties, and many of them have been found to kill cancer and prevent cancer from spreading.
In this episode of CNT, we highlight ongoing important questions - how does cannabis affect chemotherapy treatment and more importantly, why aren't we already integrating these cannabinoids into cancer treatment protocols? 

Over the past several episodes, we have presented how cannabis affects cancer cells: they are hunted by the body's immune system, they commit suicide, they lose their blood vessels, and they are prevented from being born.  Cancer cells contain cannabinoid receptors, and it is for this reason that the endocannabinoid system is an attractive target for pharmacological intervention in the treatment of cancer.
In this episode of CNT, we highlight the effects of cannabinoids on cancer migration and invasion, stopping the spread throughout the body.  The only question remaining is, why aren't we using these compounds in every cancer treatment?

Cannabis and cancer have a love-hate relationship.  Cancer loves cannabis because it gives people the munchies and it's the munchies that feed the cancer cells that cause them to thrive and metastasize.  However, cannabis hates cancer, and in our previous episodes, we have reviewed how cannabis causes cancer cells to commit suicide, helps your body decide which cancer cells to eliminate, and tells your body to stop allowing the growth of cancer cells altogether. 
In this episode of CNT, we review the process of angiogenesis, which is the body's natural way to grow new blood vessels to sustain new cells.  But when cannabis enters the picture, that process of growing new blood vessels is exactly how cannabis strangles cancer cells by blocking new blood vessel growth.  This is just another incredible natural way in which cannabis kills cancer cells.