Medical Marijuana: A Beginner's Guide

From talking to your family about medical weed to knowing which products will – and won't – get you high

Even the people who are cool with pot often don't know very much about how they might go about integrating cannabis into their own wellness routines. Credit: Matthew Staver/Bloomberg/Getty

This week, I finally convinced my father to try a cannabis salve for his arthritis. You would think after four years of reporting on the marijuana world, I would have made headway on this long ago. After all, like over 85 percent of Americans, my dad supports the medical use of marijuana in a general way, and has been complaining about his achy joints for several years. Weed topicals don't even get you high. But somehow it just never happened.

Then, on Sunday morning, he texted me: "I put the rub on my knees. It works!"

"Duh!" I responded. Cannabis is a powerful medicine, even if we still know very little about what conditions it works for and why. As baby boomers like my father struggle to figure out how to age gracefully, it's very possible that legal pot could play a major role in alleviating a wide range of pains and discomforts, from chemotherapy to throwing out your back.

And yet people over 65 are the least likely to support cannabis legalization. Not every grandma gets gently handed a bong and turned into a YouTube star. Even the people who are cool with weed often don't know very much about how they might go about integrating cannabis into their own wellness routines.

So I wanted to offer up some of the collected wisdom I've managed to gain during years of conversations with scientists, doctors, patients and caregivers. Just as I hoped a few weeks back that my fellow stoners might help spread the gospel about how to be a good weed citizen with their canna-curious friends, this guide aims to provide you with the tools to help introduce someone to the world of medical marijuana.

Considering the information available online about medical pot is all over the place, here's a sort of cheat sheet for anyone trying to navigate conversations with reluctant parents, relatives and friends – regardless of access to a legal dispensary. Perhaps after listening to your grandmother ramble on in too much detail about her psoriasis, you'll feel emboldened to take her aside and suggest a calming cannabis cream. Maybe you'll talk to your insomniac uncle about acquiring a vape pen. It may sound difficult at first, but remember: taking a few minutes to have this conversation could vastly improve someone's quality of life.

Start simple: acknowledge that cannabis has medical properties.
A lot of people are under the impression that the "medical" part of medical marijuana is a euphemism – an excuse to legalize the drug so that hippies and stoners can get high. To a certain extent, this is politically true. Activists in the 1990s knew that AIDS and cancer patients were more sympathetic than all of the young black men being disproportionately fucked over by the war on drugs, and hoped that a California ballot initiative for medical use would ultimately open the door to full legalization. They were right, but by allowing wink-wink doctor's recommendations for everything from anxiety to a stubbed toe, they managed to convince a whole lot of people that medical cannabis was a joke. As a result, as recently as last year we still had reporters for major newspapers out here asking stupid questions like "Is there a legitimate reason for people to get medical marijuana?"

I've found that it helps to recognize the political realities before pivoting to explain that the therapeutic use of pot and its constituent compounds are a very real thing. Just because California has had a de facto recreational use market going for two decades under the auspices of medical use, doesn't mean that medical cannabis as a whole is fake. Remind people that lots of powerful medications – especially opioids – can both help with pain relief and be used recreationally. Heroin ruins lives by making people feel good, but morphine is still a useful and valuable drug.

If the people you're talking with still aren't convinced that medical marijuana is real, get them to watch Sanjay Gupta's Weed, a very persuasive 2013 documentary about how CNN's chief medical correspondent came to change his mind about the therapeutic use of cannabis.

Recognize that there are very few downsides.
Even if you are giving your dad shitty brick weed from a dealer that gets shipments from a Mexican cartel, there are hardly any potential negative health consequences to trying marijuana. Here's what we know, for sure: pot is considerably less addictive than pretty much every other drug out there, legal or illegal. It's not going to kill you, under any circumstances. It's not a gateway drug; one spray of a tincture is not going to lead your cancer-stricken aunt to suddenly want methamphetamine. And perhaps most relevant to the views of your skeptical relative: cannabis is 114 times less harmful than alcohol.

But be familiar with the downsides
So, before I review some potential safety issues with cannabis, I want to make it clear that many conversations with experts over the years have led me to believe that none of these are significant enough to deter a truly sick person from seeking relief with pot. Think about the long list of side effects at the end of most commercials for prescription drugs. Even the very worst cannabis is not that bad.

That being said, here are the concerns you might want to take into account: A) Consuming too much at once can lead to a very, very uncomfortable situation. If someone is inexperienced, they shouldn't take more than a few milligrams of THC at first. B) Edibles or capsules or tinctures on an empty stomach can lead to some discomfort. Anyone new to these forms of the plant might need a meal first. C) That gold, viscous stuff that you see in vape pens likely contains concentrated pesticides and other chemicals. If your relative is considering vaping hash oil over smoking because they believe that will be healthier, they should be aware of the trade-off.

Remember that doctors receive no education about medical marijuana.
Unfortunately, most primary care physicians know almost nothing about the receptors in the body that respond to the active compounds in marijuana, or about what kinds of pot to buy for which diseases. So if your mom is waiting for the go-ahead from her doctor before she starts lighting up to deal with her glaucoma, let her know she could be waiting a while. She should feel free to ask her doctor's opinion, but keep in mind that they are likely not up to date on the research. Even in states with legal markets, many doctors are afraid to recommend pot because it remains federally illegal.

We are living through crazy times, and it's completely bananas that the federal government still considers marijuana to have no medical value while a majority of states have legalized pot for medical use and the FDA is fast-tracking trials of a cannabis drug. This situation sucks, but ideally in a decade or so we'll have a lot more research, regulation and legal access to this very important plant. Then, and only then, will more doctors suggest using it.

Stop talking about "medical grade" marijuana. That's not a thing.
A friend called me last year after his mother was diagnosed with cancer, asking if he should bother getting her pot from a dealer in their (black-market) state, or if it was worth it to make a trip to Cali to get some "medical grade" cannabis.

Sadly, there is no such thing as medical grade pot. The dispensaries in medical states are carrying the exact same bud as the dealers in Brooklyn or Atlanta or Dallas. If you're referring to the super strong pot that's become available in recent decades, like the frosty stuff with 25 to 30 percent THC content, be aware that that came along because the black market pushed weed farmers underground and indoors, leading to innovations in lighting and grow techniques that created increasingly powerful marijuana. It had nothing to do with medical markets or doctors.

Now, it's entirely possible you'll find stronger pot in dispensaries than from your dealer, especially if the weed had to get smushed and smuggled to get to you, but for the most part the whole thing is a crapshoot. Cultivators and dispensaries mislabel things to push shitty cannabis on patients and customers all the time. So please, retire this phrase from your vocabulary, and know that if you're just looking to help someone going through chemotherapy feel less nauseated, there's no reason to make a pilgrimage to Colorado.

Consumption doesn't have to mean coughing.
A lot of people just hate the feeling of smoke in their lungs. Fortunately, there are now myriad non-joint options available for anyone interested in trying medical marijuana. People with access to dispensaries can pick up pot-infused mints, balms, truffles, or tinctures. And even if your Iraq veteran cousin lives in a black-market state, and all she has access to is the green stuff, she doesn't necessarily need a bong to relieve her PTSD. She could try a flower vaporizer, like the PAX, or buy a Nova or a Magical Butter machine and make her own edibles.

Not every medical cannabis option involves getting high.
In the future, you'll probably think of shopping for medical marijuana as akin to shopping for frozen yogurt. You go to the store with your friends; everyone chooses and mixes different flavors and toppings; and when you walk out, it's hard to even recognize that you're all eating a single product. Peanut butter froyo mixed with cheesecake froyo topped with chocolate chips is most definitely not the same thing as plain yogurt topped with kiwis and blackberries. In the same way, cannabis can be broken down into separate compounds that create different smells and perform different functions. THC, the compound that gets you high, is the most famous of the plant's components, but several other compounds have huge medical potential and are not psychoactive. CBN, for example, seems to help people sleep. THC-V seems to suppress your appetite. CBD seems to be a powerful analgesic and anti-convulsant.

So if your uncle is suffering from some intractable medical issue like Parkinson's or MS, but he's totally freaked out at the prospect of using medical cannabis, make sure he knows that not all of the options will get him stoned.

Also, just going to say this again, because it's important: you cannot get high through your skin, so even if a cream or a salve has THC in it, it's totally safe for sober relatives to use.

When you look up info about pot online, consider the source.
As with all Internet research, do a little digging into who is giving you information. Are they selling something themselves? Many of the people spouting pro-pot propaganda online are doing so because they themselves own cannabis businesses.

Nothing is legal in all 50 states.
A number of products these days, especially those containing CBD derived from industrial hemp, advertise themselves as legal in all 50 states. Please be advised: even if they come from hemp, these compounds are illegal. The DEA has made this abundantly clear.

This doesn't mean your grandfather is going to get arrested for ordering CBD products online. He almost certainly isn't – not least because most of the conservative states that don't yet have legal marijuana do have narrow laws allowing for the use of CBD. But still, don't lie to your grandfather about what is and isn't legal. That's a jerk move.

Temper your expectations, and the expectations of those around you. 
Don't make huge promises. A lot of people talk about marijuana like it's some kind of magical cure-all that is going to clear up your acne and eliminate your migraines and save your life. I mean, it might do some of those things. But it's certainly not guaranteed. So when you're introducing your friend or your dad or your friend's dad to the medical uses of cannabis, don't oversell the thing. Emphasize the fact that it works for some conditions, in some people, some of the time – just like most pharmaceuticals.

Acknowledge that mice are not people.
One of the hardest things about medical marijuana is that we have oodles of anecdotal evidence and a lot of promising research in mice but not many clinical trials in humans. And a lot of the clinical trials that have been done involved extremely small populations. Therefore, it can be difficult for reasonable people to agree on the veritable and unexaggerated benefits of the plant.

My favorite extreme example is that some people think that marijuana cures cancer, and other people think that marijuana causes cancer. To be honest, after years of hearing stories and seeing evidence in mice, I'm tentatively convinced that some combination of cannabinoids might be able to shrink tumors, but I would never try to push anyone to believe that or open a conversation about medical cannabis with that point, because it just straight up sounds crazy. People who go around evangelizing pot's ability to "cure" anything, let alone one of the biggest public health challenges of our time, are likely turning off more people than they're bringing in. Besides, at this point, it's sort of impossible to know anything for sure, so don't overstate your case when talking to someone about trying pot for medical reasons. Outsized claims are not a good look.

And if it helps your skeptical relatives, explain that we know so little precisely because cannabis is federally illegal, and the government has made doing research nearly impossible.