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MEDICAL MARIJUANA PROGRAM
1
ADVANCED CERTIFICATE OF MEDICAL
CANNIBIS
STUDENT HANDBOOK
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Course objectives
At the conclusion of this course, the student will have a basic to solid
understanding of the key aspects of the a-z of medical cannibis.
TOPICS
WHAT IS MEDICAL CANNIBIS?
WHO NEEDS IT?
AIMS & GOALS
STATISTICS
TYPES OF CANNIBIS PLANT
HOW CANNIBIS WORKS
THC LEVELS
END PRODUCTS MADE
CONSUMING PRODUCT
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RECREATIONAL USE
MEDICAL CONDITIONS HELPED
METHODS OF TAKING
DANGER & RISKS
CONTROVERSY
THE FUTURE
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MEDICAL CANNIBIS STUDIES
INTRODUCTION
What is cannibis?
Cannibis is a preparation of the Cannabis or Marijuana plant intended for use as a
psychoactive drug
spiritual drug
medicine
herbal remedy
This usage generally requires a prescription, and distribution is usually done within a
framework defined by local laws.
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Medical cannabis can be used
to reduce nausea and vomiting during chemotherapy
to improve appetite in people with HIV/AIDS
to treat chronic pain and muscle spasms
THC in cannibis
The main psycho-active part of cannabis is tetra-hydro-cannabinol (THC)
There are at least 65 other cannabinoids in cannibis.
THC and its major (inactive) metabolite, THC-COOH, can be measured in
blood
urine
hair
oral fluid
sweat
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Police use it for forensic investigation of a
traffic offense
other criminal offense
The concentrations obtained from such analyses can often be helpful in
distinguishing active use from
passive exposure
elapsed time since use
extent or duration of use
These tests cannot, distinguish authorized cannabis smoking for medical purposes
from unauthorized recreational smoking.
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THC-COOH vs THC
Urine contains predominantly THC-COOH.
Whereas THC is contained in
Hair
oral fluid
sweat
Blood may contain both substances, with the relative amounts dependent on
recency
extent of usage
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Using cannibis
Cannabis can be used by smoking, vaporization, within food, or as an extract.
Cannabis is often used for its mental and physical effects, such as
a high feeling
a change in perception
euphoria (heightened mood)
an increase in appetite
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Aims
The main goals/aim is to deliver medical benefits to a patient in a way which is:
safe
legal
timely
economical
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Statistics
Intro
Cannabis is by far the most widely used illicit substance.
The typical age of first-use is 16, similar to the typical age of first-use for alcohol but
lower than the first-use age for other illicit drugs.
50% of the people in western countries had tried cannibis,
232 million people use cannabis
4.9% of the global population use cannabis between age 15 and 65
12% had used it in the past year
7.3% had used it in the past month
Men are over twice as likely to use cannibis as women
18-29 year-olds are six times more likely to use as over 65-year-olds
44% of the westerrn population has tried cannibis in their lifetime
44% of 12th graders in the west have tried the drug at least once
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Medical conditions helped
Intro
There is evidence supporting the use of cannabis or its derivatives in the treatment
of
multiple sclerosis, above
chemotherapy-induced nausea and vomiting
neuropathic pain
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Other conditions
Some also say it helps with
AIDS wasting syndrome, above
epilepsy
rheumatoid arthritis
glaucoma
schizophrenia
psychosis
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Types of cannibis
Intro
There are 4 main types of cannibis plant.
2 of the main ones are:
Sativa
Indica
Hybrid
Ruderalis
Skunk
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2 of the main ones are:
Sativa
Indica
Sativa
The effects of sativa are well known for their cerebral high, hence its daytime use as
medical cannabis.
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Indica
The indica is well known for its sedative effects and preferred night time use as
medical cannabis
Skunk
What is known as skunk accounts for between 70 and 80% of samples seized by
police
Similar to other varieties of marijuana, skunk weed is commonly produced inside,
under specific grow lamps
in a greenhouse environment
Skunk weed differs from traditional marijuana as it is often created by combining two
different forms of the cannabis : Sativa and Indica.
The combination of these two strains are considered to produce unique and
conflicting effects that separate skunk from other types of marijuana.
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Additionally, this particular strain of cannabis is considered to be a more potent form
of the drug as it contains 2-3 times more THC than standard marijuana.
THC is thought to be the main active ingredient in cannabis, and its higher
concentration in skunk weed has raised concerns regarding its potential negative
psychological effects
Skunk can sometimes be incorrectly mistaken for all types of herbal cannabis.
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Cannibis plant end products
Intro
The 3 main forms or end products of cannabis products are
the flower, above
the resin (hashish)
hash oil, below
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Parts of the cannabis plant
Intro
The 4 main parts of the plant are:
pistil/buds
stem/stalks
seeds
Fan Leaves
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Buds & leaves
The buds (flowers) of the female cannabis plant contain the highest concentration of
THC, followed by the leaves.
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Stalks & seeds
The stalks and seeds have much lower THC levels.
The leaves can contain ten times less THC than the buds, and the stalks one
hundred times less THC
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Risks & dangers
Intro
In this section we will have a look at the risks and dangers.
Contaminants
Cannibis or hashish may contain:
Contaminants
adulterants
Other substances may be added to cannabis to add weight to the product (lead has
been used in some cases) to
increase its psycho-active effects
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as part of the cultivation and processing of the cannabis (fertilizer)
Hashish obtained from soap bar-type sources.
The dried flowers of the plant may be contaminated by
the plant taking up heavy metals and other toxins - from its growing
environment
the addition of glass
In the Netherlands, chalk has been used to make cannabis appear to be of a higher
quality.
Increasing the weight of hashish products in Germany with lead caused lead
intoxication in at least 29 users.
Despite cannabis being generally perceived as a natural product.
Some consider cannabis grown indoors under hydroponic conditions to be a greater
health risk due to increased contamination, added to the plant during cultivation to
enhance the plant growth and quality.
Drug dealers may spike or lace cannibis with other chemicals such as PCP, creating
a product known as wet cannibis; this enhances the effects of smoking it and it can
be used to make low-grade, low-potency cannibis seem more effective.
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Recreational use
Cannabis has psychoactive and physiological effects when consumed.
The immediate desired effects from consuming cannabis include
relaxation
euphoria (the high or stoned feeling)
a general alteration of conscious perception
increased awareness of sensation
increased libido
distortions in the perception of time and space
At higher doses, effects can include altered body image, auditory and/or visual
illusions, pseudohallucinations and ataxia from selective impairment of polysynaptic
reflexes.
Some say cannabis can lead to dissociative states such as
depersonalization
derealization
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Some immediate side effects include
a decrease in short-term memory
dry mouth
impaired motor skills
reddening of the eyes
Aside from a subjective change in perception and mood, the most common short-
term effects include
increased heart rate
increased appetite and consumption of food
lowered blood pressure
impairment of short-term and working memory
psychomotor coordination
concentration
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Some users may experience an episode of acute psychosis, which usually abates
after 6 hours, but in rare instances, heavy users may find the symptoms continuing
for many days.
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MORE ON MEDICAL USES
Intro
In this section we will have a further look at the medical uses of medical cannabis.
Medical use
As stated, medical cannabis can be used
to reduce nausea and vomiting during chemotherapy
to improve appetite in people with HIV/AIDS
to treat chronic pain and muscle spasms
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Its use for other medical applications is insufficient for conclusions about safety or
efficacy.
Short-term use increases the risk of both minor and major adverse effects.
Common side effects
Dizziness
feeling tired
vomiting
hallucinations
Long-term effects of cannabis are not clear.
Concerns include
memory and cognition problems
risk of addiction
schizophrenia in young people
risk of children taking it by accident
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MEDICAL CONDITIONS HELPED
Intro
In medicine, cannabinoids have been shown to exhibit some good effects.
Medical cannibis is the use of cannabis and its cannabinoids to
treat medical disease
improve medical disease symptoms
Let’s look at some of the main ones.
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Cancer
Cannabinoids have been shown to exhibit some anti-cancer effects in laboratory
experiments, although there has been little research into their use as a cancer
treatment in people.
Laboratory experiments have suggested that cannabis and cannabinoids have anti-
carcinogenic and anti-tumor effects, including a potential effect on
breast
lung-cancer cells
there have been no clinical trials on the use of cannabis to treat cancer in people,
and only one small study using delta-9-THC that reported potential antitumoral
activity.
Claims that cannabis has been proved to cure cancer are misleading.
There is no good evidence that cannabis use helps reduce the risk of getting cancer.
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Whether smoking cannabis increases cancer risk in general is difficult to establish
since it is usually smoked mixed with tobacco – a known carcinogen – and this
complicates research.
Cannabis use may be linked to an increased risk of a type of testicular cancer.
The association of cannabis use with head and neck carcinoma may differ by tumor
site, with both possible pro- and anticarcinogenic effects of cannabinoids.
Additional work in this area is needed.
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Dementia
Cannabinoids have been proposed to have the potential for lessening the effects of
Alzheimer's disease.
Some say evidence is either inconclusive or still missing.
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Diabetes
There is emerging evidence that cannabidiol may help slow cell damage in diabetes
mellitus type 1.
There is a lack of meaningful evidence of the effects of medical cannabis use on
people with diabetes
The potential risks and benefits for diabetic patients remain unquantified at the
present time.
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Epilepsy
Although there is a lot of hype and anecdotes surrounding medical cannabis and
epilepsy, studies are limited, and no conclusions can be drawn.
The mechanisms by which cannabis may be effective in the treatment of epilepsy
remain unclear.
Lack of clinical research
Some reasons for the lack of clinical research have been
the introduction of new synthetic and more stable pharmaceutical
anticonvulsants
the recognition of important adverse side effects
legal restrictions to the use of cannabis-derived medicines.
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Glaucoma
While cannabis can help lower intraocular pressure, it recommended against its use
because of its side effects and short duration of action, coupled with a lack of
evidence that its use alters the course of glaucoma.
Relatively little research had been done concerning therapeutic effects of
cannabinoids on the eyes.
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Tourette syndrome
Cannabinoids show potential therapeutic value in treating Tourette syndrome (TS).
A study said that controlled research on treating TS with dronabinol showed the
patients taking the pill had a beneficial response without serious adverse effects.
Other studies had shown that cannabis has no effects on tics and increases the
individuals inner tension.
Cannabinoid medication might be useful in the treatment of the symptoms in patients
with TS
there is not enough evidence to support the use of cannabinoids in treating tics and
obsessive compulsive behaviour in people with Tourette's syndrome.
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Studies on other conditions
Anecdotal evidence and pre-clinical research has suggested that cannabis or
cannabinoids may be beneficial for treating Huntington's disease or Parkinson's
disease, but follow-up studies of people with these conditions have not produced
good evidence of therapeutic potential.
A study argued that cannabis had properties that made it potentially applicable to
the treatment of amyotrophic lateral sclerosis, and on that basis research on this
topic should be permitted, despite the legal difficulties of the time.
A study said that bipolar disorder was not well-controlled by existing medications and
that there were good pharmacological reasons for thinking cannabis had therapeutic
potential, making it a good candidate for further study.
Cannabinoids have been proposed for the treatment of primary anorexia nervosa,
but have no measurable beneficial effect.
Some argue that cannabinoids might have useful future clinical applications in
treating digestive diseases.
Laboratory experiments have shown that cannabinoids found in cannibis may have
analgesic and anti-inflammatory effects.
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A study reviewed all available findings levering the use of cannibis to treat brain
diseases.
The result was that the scientific evidence is weak that cannabis in any form serves
as medicinal for curing or alleviating neurological disorders.
To ease multiple sclerosis patients' stiffness, which may be accomplished by their
taking cannabis extract by mouth or as a spray, there is support.
Cannabis is being investigated for its possible use in inflammatory bowel disease but
there is only weak evidence for its benefits as a treatment.
cannabidiol has shown potential to relieve convulsion, inflammation, cough,
congestion and nausea, and to inhibit cancer cell growth.
Preliminary studies have also shown potential over psychiatric conditions such as
Anxiety
Depression
psychosis
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Because cannabidiol relieves the aforementioned symptoms, cannabis strains with a
high amount of CBD may benefit people with multiple sclerosis or frequent anxiety
attack
Short term effects of cannabis use
Short-term use increases the risk of both minor and major adverse effects.
Common side effects include
dizziness
feeling tired
vomiting
hallucinations
Long-term effects of cannabis are not clear.
Concerns include
memory and cognition problems
risk of addiction
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schizophrenia in young people
risk of children taking it by accident.
The Cannabis plant has a history of medicinal use dating back thousands of years
across many cultures.
Its use is controversial.
Using cannabis
Medical cannabis can be administered using a variety of methods, including
liquid tinctures
vaporizing
oils
capsules
lozenges
dermal patches
oral/dermal spray
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Synthetic cannabis
Synthetic cannabinoids are available as prescription drugs in some countries;
examples include:
dronabinol
nabilone.
Cannabis vaporizers have gained popularity because of the perception among users
that less harmful chemicals are ingested when components are inhaled via aerosol
rather than smoke.
Cannabinoid medicines are available in
pill form
o dronabinol
o nabilone
liquid extracts formulated into an oromucosal spray
o nabiximol
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HIV/AIDS
Evidence is lacking for both efficacy and safety of cannabis and cannabinoids in
treating patients with HIV/AIDS or for anorexia associated with AIDS.
Pain
Cannabis appears to be somewhat effective for the treatment of chronic pain,
including pain caused by neuropathy and possibly that due to fibromyalgia and
rheumatoid arthritis.
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A study found it was unclear if the benefits were greater than the risks, while a study
considered it generally safe for this use.
In palliative care the use appears safer than that of opioids.
A study found limited and weak evidence that smoked cannabis was effective for
chronic non-cancer pain.
The review recommended that it be used for people for whom cannabinoids and
other analgesics were not effective.
A study found moderate quality evidence that cannabinoids were effective for chronic
pain.
A study found that inhaled medical cannabis was effective in reducing neuropathic
pain in the short term for one in five to six patients.
A study found limited evidence that medical cannabis was effective for neuropathic
pain when combined with traditional analgesics.
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Neurological problems
The efficacy of cannabis in treating neurological problems is not clear when it comes
to
multiple sclerosis
epilepsy
movement problems
Studies of the efficacy of cannabis for treating multiple sclerosis have produced
varying results.
The combination of Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) extracts
give subjective relief of spasticity, though objective post-treatment assessments do
not reveal significant changes.
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Evidence also suggests that oral cannabis extract is effective for reducing patient-
centered measures of spasticity.
A trial of cannabis is deemed to be a reasonable option if other treatments have not
been effective.
Its use for MS is approved in ten countries.
A study found no problems with
tolerance
abuse
addiction
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Posttraumatic stress disorder
There is tentative evidence that medical cannabis is effective at reducing
posttraumatic stress disorder symptoms, but, there is insufficient evidence to confirm
its effectiveness for this condition.
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METHODS OF TAKING MEDICAL CANNIBIS
Intro
In this section we will have a look at methods of taking cannabis.
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Vaporizers
Studies have shown that vaporizing cannabis exposes the user to lower levels of
harmful substances than smoking cannabis
A vaporizer is a device used to vaporize the active ingredients of cannabis, for the
purpose of inhalation.
Vaporizers contain various forms of extraction chambers including straight bore,
venturi, or sequential venturi, and are made of materials such as
metal
glass
The extracted vapor may be collected in an inflatable bag, or inhaled directly through
a hose or pipe.
When used properly, cooler temperatures due to lack of combustion result in more
efficient extraction of the ingredients.
Hence, the irritating and harmful effects of smoking are heavily reduced, as is
secondhand smoke.
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Vaporizers are considered medically sound devices for delivering THC.
The factors affecting output are:
Temperature
Specimen density
Weight, content of water and essential oils
Consistency of material in the filling chamber
Storage time of the vapor
Inhalation method (breathing technique)
Not all those have been scientifically tested.
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Suppository form
A suppository is a solid dosage form that is inserted into
the rectum (rectal suppository)
vagina (vaginal suppository)
urethra (urethral suppository)
There it dissolves or melts and exerts
local effects
systemic effects
They are used to deliver both systemically and locally acting medications.
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Capsules (Pills)
Capsules be taken orally or be used as suppositories.
The two main types of capsules are:
Hard shelled capsules
Soft shelled capsules
Lets have a closer look:
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Hard-shelled capsules
Hard-shelled capsules are made using gelatin and contain
dry, powdered ingredients
miniature pellets
These are made in two halves: a lower-diameter body that is filled and then sealed
using a higher-diameter cap.
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Soft-shelled capsules
Soft-shelled capsules, primarily used for oils and for active ingredients that are
dissolved
suspended in oil
Both of these classes of capsules are made from aqueous solutions of gelling
agents, such as animal protein (gelatin) or plant polysaccharides or their derivatives
(starch and cellulose).
Other ingredients can be added to the gelling agent solution including
plasticizers
o glycerin
coloring agents
preservatives
disintegrants
lubricants
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surface treatment
Since their inception, capsules have been viewed by consumers as the most efficient
method of taking medication
Hash oil
Intro
Hash oil is an oleoresin obtained by the extraction of cannibis and/or hashish.
One pound of cannibis yields from 1/5 to 1/10 of a pound of hash oil.
The oil may retain considerable residual solvent: oil extracted with longer-chain
volatile hydrocarbons (naphtha) is less viscous (thinner) than oil extracted with short-
chain hydrocarbons (butane).
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Colored impurities
Colored impurities from the oil can be removed by
adding activated charcoal to one third volume
mixing well
filtering
evaporating the solvent
The THC content of hash oil varies tremendously, since the manufacturers use a
varying assortment of cannibis plants and preparation techniques
The form of the extract varies depending on the process used; it may be
liquid
clear amber solid (shatter)
sticky semisolid substance (wax)
brittle honeycombed solid ( honeycomb wax)
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Hash oil is consumed usually by
smoking
ingestion
vaporization
Smoking or vaporizing hash oil is known as dabbing.
Dabbing devices include special kinds of
water pipes
vaporizers
Some users call their apparatus an oil rig that includes a glass water pipe and a
hollow metal tube (nail), with an indentation on the side which is sometimes covered
with a dome.
The pipe is often heated with a blowtorch rather than a cigarette lighter
Hash oil is produced by solvent extraction (maceration, infusion or percolation) of
cannibis and/or hashish.
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After filtering and evaporating the solvent, a sticky resinous dank liquid with a strong
herbal odor (remarkably different from the peculiar odor of hemp) remains.
Fresh, undried plant material is less suited for hash oil production, because much
THC and CBD will be present in their carboxylic acid forms (THCA and CBDA),
which may not be highly soluble in some solvents.
The acids are decarboxylated during drying and heating (smoking).
Fresh, undried plant material is best suited for concrete production.
A wide variety of solvents can be used for extraction, such as
Chloroform
Dichloromethane
petroleum ether
naphtha
benzene
butane
methanol
ethanol
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isopropanol
olive oil
Currently, resinoids are often obtained by extraction with supercritical carbon
dioxide.
The alcohols extract undesirable water-soluble substances such as
chlorophylls
sugars ( can be removed later by washing with water)
Non-polar solvents such as benzene, chloroform and petroleum ether will not extract
the water-soluble constituents of cannibis or hashish, and will yield a somewhat
more potent oil as a result.
Non-polar cannabis extracts taste much better than polar extracts.
Alkali washing further improves the
odor
taste
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The oil may be further refined by
alkali washing
conversion of CBD to THC
Alkali washing
Alkali washing or removing the heavy aromatic carboxylic acids with antibiotic
properties may cause
heartburn
gallbladder
pancreas irritation
resistance to hemp antibiotics
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Risks & dangers
Intro
In this section we will have a look at the dangers and risks including production.
Production
Most of the solvents employed are flammable, making the extraction process
dangerous.
Several explosion and fire incidents related to hash oil manufacturing attempts in
homes have been reported.
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Solvents used to extract THC are flammable and/or combustible and have resulted
in
Explosions
Fires
severe injuries
deaths
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Handling
The LD50 for THC (Delta 9 Tetrahydrocannabinol) is not exactly known.
Hash oil can contain up to 80% THC (wash with alkali) though up to 99% with other
methods of extraction.
While health issues of the lungs may be exacerbated by use of Hash oil, it is not
known to cause side effects not already found in other preparations of Cannabis
Hash oil is not very lipophilic and it may however ooze through and swell common
glove materials such as natural rubber, except maybe polar materials such as
cellulose film
neoprene
nitrile rubber
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Storage
Hash oil should be
stored in airtight containers
protected from light
When exposed to air, warmth and light (especially without antioxidants), the oil loses
its taste and psychoactivity due to aging.
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CONTROVERSY
Intro
In this section we will have a look at some of the controversies in the use of medical
cannabis.
There is insufficient data to draw strong conclusions about the safety of medical
cannabis.
Typically, adverse effects of medical cannabis use are not serious.
These include:
Tiredness
Dizziness
cardiovascular and psychoactive effects
Tolerance to these effects develops over a period of days or weeks.
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The amount of cannabis normally used for medicinal purposes is not believed to
cause any permanent cognitive impairment in adults, though long-term treatment in
adolescents should be weighed carefully as they are more susceptible to these
impairments.
Withdrawal symptoms are rarely a problem with controlled medical administration of
cannabinoids.
The ability to drive vehicle or operating machinery may be impaired until a tolerance
is developed.
Although supporters of medical cannabis say that it is safe,46 further research is
required to assess the long-term safety of its use.
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A study found that exposure to cannibis had biologically-based physical, mental,
behavioral and social health consequences and was associated with diseases of the
liver
lungs
heart
vasculature
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Cognitive effects
THC intoxication is well established to impair cognitive functioning on an acute basis,
including effects on the ability to
plan
organize
solve problems
make decisions
control impulses
The extent of this impact may be greater in novice users, and paradoxically, those
habituated to high-level ingestion may have reduced cognition during withdrawal.
Studies of long-term effects on cognition have provided conflicting results, with some
studies finding no difference between long-term abstainers and never-users and
others finding long-term deficits.
The discrepancies between studies may reflect greater long-term effects among
heavier users relative to occasional users, and greater duration of effect among
those with heavy use as adolescents compared to later in life.
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A second systematic review focused on neuroimaging studies found little evidence
supporting an effect of cannabis use on brain
A study found that any long-term cognitive effects were relatively modest in
magnitude and limited to certain aspects of learning and memory.
Psychosis
Exposure to THC can cause acute transient psychotic symptoms in healthy
individuals and people with schizophrenia.
A study found that cannabis use reduced the average age of onset of
psychosis by 2.7 years relative to non-cannabis use
A study found that adolescent use of cannabis increases the risk of psychosis,
and that the risk is dose-related
A study found that cannabis use is associated with a two-fold increase in the
risk of psychosis, but that cannabis use is neither necessary nor sufficient to
cause psychosis
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A study found that cannabis use, particularly that before age 15, was a factor
in the development of schizophrenic disorders
Some studies have suggested that cannabis users have a greater risk of developing
psychosis than non-users.
This risk is most pronounced in cases with an existing risk of psychotic disorder.
A study suggested an increased risk in the development of psychosis linked to
polymorphisms in the COMT gene.
However, a more recent study cast doubt on the proposed connection between this
gene and the effects of cannabis on the development of psychosis.
A study reported that cannabis was a causal factor in some cases of schizophrenia
and stressed the need for better education among the public due to increasingly
relaxed access to cannabis.
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The future
Cannabis research is challenging since the plant is illegal in most countries.
There are also other difficulties in researching the effects of cannabis.
Many people who smoke cannabis also smoke tobacco.
This causes confounding factors, where questions arise as to whether the tobacco,
the cannabis, or both that have caused a cancer.
Another difficulty researchers have is in recruiting people who smoke cannabis into
studies.
Because cannabis is an illegal drug in many countries, people may be reluctant to
take part in research, and if they do agree to take part, they may not say how much
cannabis they actually smoke
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As drugs has increasingly come to be seen as a health issue instead of criminal
behavior, cannibis has also been legalized or decriminalized in:
Canada
Czech Republic
Colombia
Ecuador
Mexico
Recreational use of cannabis is illegal in most parts of the world, but the medical use
of cannabis is legal in certain countries, including
Austria
Canada
Czech Republic
Finland
Germany
Israel
Italy
Portugal
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Spain
Netherlands (where it is also legal recreationally)
Some Australian States are doing medical cannibis trials
FINAL SUMMARY
Medical cannibis is not just one thing - it entails an understanding & knowledge of
many varied & different areas such as:
AIMS & GOALS
MEDICAL CONDITIONS HELPED
END PRODUCTS
TYPES OF CANNIBIS
THC LEVELS
PRODUCTS MADE
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METHODS OF CONSUMING
OILS
SAFETY GEAR
EFFECTS
DANGER & RISKS
CONTROVERSY