Education

Disclaimer: This Product and information has not been evaluated by the Food and Drug Administration. This Product is not intended to diagnose, treat, cure or prevent any disease. Although A patent was awarded to the U.S. Health and Human Services in 2003 (US6630507) that covers the use of CBD as a treatment for various neurodegenerative and inflammatory disorders; focused on oxidative associated disease states. That being said, the following information is anecdotal.
Visitors to Trokie.com acknowledge that the information on the Website is provided “as is” for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health care professionals who are intimately knowledgeable about your individual medical needs.
http://www.google.com/patents/US6630507

An Introduction to Medical Cannabis:

Many patients have been achieving a higher quality of life as the result of using medical cannabis for a range of symptoms, most notably:

pain relief
sleep aid
relief from nausea and vomiting
relief from seizure disorders
relief from the neurological attacks and muscular spasms caused by a number of neuro-muscular disorders. Positive outcomes have been reported with epilepsy and MS patients.

The Cannabis plant has hundreds of active ingredients with THC and CBD, both cannabinoids receiving most of the attention. Terpenes and flavonoids are components of this important adaptogenic herb and have significant clinical physiologic effects. Cannabis has been used in medicine for over a thousand years.

Cannabis has many medicinal effects that are a perfect match for pain management. Healthcare providers are quick to prescribe opiate based narcotics for pain relief which are heavily abused with many negative side effects. That list includes addiction, constipation, nausea and extreme sedation. Cannabis is an analgesic with pain relieving qualities and few side effects. Studies have shown cannabis can Reduce Opiate Use by 30%-100%.

Dosing Guidance

How Often do I need to take capsules?

Capsules usually have an onset of 45 minutes but can take as long as 2 hours to reach peak effects, from the peak they should last 6 – 8 hours. So, if we are treating a chronic symptom 3x per day should provide all day coverage. Below is a breakdown of the 4 traditional methods of marijuana delivery: inhalation, consumption, sublingual, topical. Effects will vary depending on type of product, these are just averages.

	Consumption	Oral Absorption	Inhalation	Topical
	Edibles, Capsules	Tincture, Sublingual drops	Smoking or Vaping	Salve, Lotion
Onset	30 – 120 minutes	Within 30 minutes	Within 5 minutes	Within 30 minutes
Duration	4-9 hours	Duration: 2-4 hours	2 hours	2-4 hours

When treating patients with medical cannabis, one size does not fit all. 50% of patients receive relief with less than 15mg of THC. We recommend starting the treatment regimen slowly to experience what works best for each individual. We have found that over time as the tolerance to THC improves, a higher ration of THC to CBD has better medicinal effects. A person’s level of comfort with psychoactivity will usually determine the best product and cannabinoid ratios are best.

Patients benefited more from a bedtime dose than any other time of day. Bedtime dosing allows the patient to consume larger doses of cannabis while sleeping through the psychoactive effects of THC. Improving tolerance to THC with nighttime dosing is critical to enjoying the experience of daytime dosing allowing patients to medicate while maintaining very high function.

Most high CBD products will not get you high. As with all medicine, the goal is to find the lowest dose that provides the maximum relief. Patients should be advised that it might take up to two weeks to find the optimal dose and that undesirable effects can occur during this time, most commonly dizziness. These undesirable effects are usually mild and resolve in a few days.

Titration period or THC tolerance ramp up:

A titration period is required to reach optimal dose. The number and timing of doses will vary between individuals. We recommend to start slow and gradually increase the dose or change up the cannabinoid profile until they achieve optimum symptom relief. Below is a reference chart for dosing.

Therapeutic dosing levels of THC:

Experience level	Dose
New to cannabis	10mg THC
Intermediate user (therapeutic dose)	15-30mg THC
Heavy User (during flare)	25-60mg THC

As Stated above, this is just a guide every patient has a different dose that achieves optimum relief. Depending on severity of ailments and symptoms, much higher doses are maintained on a daily basis. For example, some patients going through Chemo Therapy require well over 100 mg THC per day to relieve the symptoms associated with the treatment like nausea, and pain relief.

First Time Users

50% of Patients receive relief with less than 15mg THC

What do I do if I am using Cannabis for the first time?

GO SLOWLY, you can always increase the dose, you cannot go backwards. If you find yourself overmedicated, there is not much that can be done other than waiting for the effects to subside. To date, there has not been any deaths caused by Marijuana. Keep in mind that edibles can be very strong in comparison to inhalation (smoke or vape) therapy. In addition, the effect of ingesting medical cannabis can last up to 6 times longer than the effects of smoking or vaping.

We recommend first time users to start with Relax 10mg capsules, most patients experience a mild “high” similar to two glasses of wine and receive symptom relief.

Start at Bedtime, patients benefited more from a bedtime dose than any other time of day.

Dosing at bedtime has been shown to:

Promote higher quality, deeper sleep –The quality of your sleep directly affects the quality of your waking life, including your mental sharpness, productivity, emotional balance, creativity, physical vitality, and even your weight. No other activity delivers so many benefits with so little effort!
Allows the patient to consume larger doses of cannabis while sleeping through the psychoactive effects of THC.

Dosing factors to consider:

Severity of Symptoms – Some Patients have such severe symptoms that they must medicate more than once a day at high dose.

THC Tolerance – Some patients need strong relief but do not want to feel the psychoactive (stoned) effects of THC while other patients function better with the THC effects. If you have a good tolerance to THC you will want to experiment with day time dosing until you achieve the desired results. WARNING- high THC products can impair motor and cognitive function and must be used with caution when attention to detail is required.

Driving, operating machinery of any kind, being in situations where a person’s full attention is required should be advised to use extreme caution and/ or refrain from using high THC products during the day. If you do not like feeling the brain effects of THC (being high) you would do best with a strong THC dose at bedtime and enhance your symptom relief during the day by using low THC, high CBD products (pure CBD and a 1:1 ratio is best). In fact this is the case in most patients and patients need to start their treatment regimen slowly to experience what works best for them.

Life Style – Some patients need symptom relief but cannot be impaired by THC because of their job, family commitments or daily tasks. This patient would do best dosing with THC at bedtime and enhance your symptom relief during the day by using products that are low in THC and high in CBD.

Gender – Women can store more cannabinoids in their fat cells than men. Often men will have to dose twice a day to get the same result as a woman dosing once a day.

Weight – Cannabis is the ultimate time released medication. It is stored in the fat cells in the body and released into the blood stream over time, which varies from person to person. Extremely thin persons my need to medicate up to 3 times a day with cannabis edibles to achieve desired medical results while heavier patients will receive symptom relief with a strong cannabis edible dose at bedtime.

How Cannabis Works

Our body is pre-programmed to receive the cannabinoids in medical cannabis. Two types of endocannabinoid receptors in our body allow us to absorb the effects of medical cannabis. The first receptor is the cannabinoid receptor type 1, abbreviated as CB1. CB1. is a G protein-coupled cannabinoid receptor primarily located in our central and peripheral nervous system. It is activated by plant cannabinoids, such as the compound THC; and by synthetic analogues of THC, such as dronabinol. CB1 receptors are located in the brain, spinal cord, and periphery. In addition to CB1 we possess CB2 receptors. These are located in the immune tissues. When we consume cannabis high in THC, our body produces molecules (called endocannabinoids) that interact with these CB1 and CB2 receptors to dull our senses and produces euphoria. CBD, another key compound in cannabis, on the other hand, has little affinity for CB1 and CB2 receptors, but of the two, it has a greater affinity for the CB2 receptor than for CB1. In fact, it acts as an indirect antagonist of cannabinoid agonists. Because CBD acts as a receptor agonist, it acts as an antidepressant, anti-anxiety medication, which also has the beneficial side effect of being neuroprotective. Other benefits of high CBD concentrations include its recently discovered anti-psychotic effects, which may in time lead to its use in the treatment of schizophrenia.

Current Legal Environment

Cannabis (marijuana) is a schedule 1 substance and the United States Federal Government has concluded that the drug has no medicinal purposes. Hopefully, re-scheduling from the Feds is coming soon.

There has been legislation fighting this categorization since the 1970’s. As of today there are 23 states that have declared MMJ to be a legal substance for medicinal use, many more are following suit. 2 states, Colorado and Washington, have legalized Marijuana for recreational use. Oregon and Alaska are in process now.

The Market is dictated by each State Medical Marijuana program. In California, patients receive a Letter of Recommendation from their physician that states “this patient has been diagnosed with a medical condition and the use of medical marijuana is appropriate”. After the patient obtains their “Rec”, they are allowed to visit dispensaries to donate in order to receive their medicine.

Conventional Healthcare Situation

Most people are not aware that a synthetic version of THC has been legally prescribed and used in FDA-approved pharmaceuticals for decades in the form of Marinol. In 1985, Marinol (dronabinol) received FDA approval as a treatment for chemotherapy-related nausea and vomiting. Synthetic THC.

GW Pharmaceuticals has created Sativex: a Marijuana derived pharmaceutical oromucosal spray containing equal proportions of THC and CBD. Sativex uses the same cannabinoid ratio CBD:THC as the Trokie 1:1 Lozenge (available in 40mg and 160mg dosing). Sativex has been approved in Europe and Canada for treatment of neuropathic pain and spasm in multiple sclerosis (MS) and for moderate-to-severe pain in advanced cancer. Numerous randomized clinical trials have demonstrated safety and efficacy for Sativex in central and peripheral neuropathic pain, rheumatoid arthritis and cancer pain. Epidiolex is another marijuana derived orally-administered liquid containing CBD created by GW pharmaceutical that has received orphan drug status in the US, for use as a treatment for Dravet syndrome and Lennox-Gastaut Syndrome.

As you can see: Cannabis (marijuana) is Medicine. Prohibition has created an information void and discouraged the best medical professionals and research scientists to get involved in the Taboo industry of medical cannabis. Because of this prohibition, there is a lack of research studies that are peer reviewed and widely accepted by the medical community as a whole. The Team at Trokie is working with healthcare organizations, clinicians and patients to help identify and collect data to support research and attempt to understand the importance of a whole cannabis extract.

Grotenhermen F. Pharmacokinetics and pharmacodynamics of cannabinoids. Clin Pharmacokinet. 2003;42(2):327-360.

Lohr L. Chemotherapy-induced nausea and vomiting. Cancer J. 2008;14(2):85-93.[PubMed 18391612]

Marinol (dronabinol) [prescribing information]. North Chicago, IL: AbbVie Inc; February 2013.