Marijuana and LBD, Part 2: Preparation.

Here it is! The missing Part 2 of this 3-part series. Sorry I got it mixed up. (And no, it wasn't because I was sampling the MJ!)

OK, you've decided that medical marijuana (MMJ) may be just the right medication for your loved one, or at least worth a try, it is legal in your state, and you want to give it a try. But how do you do that? You can't just walk into a pharmacy and buy some. You can't get a prescription for it from your regular doctor and you know you don't want to buy the street stuff. (PLEASE, don't buy the street stuff for anyone with dementia or any other disorder where hallucinations, delusions and paranoia are common!)

As with any doctor's visit, it will some preparation. Each state is different, with different regulations, costs and requirements. Marijuana Doctors.com. is a good place to start. It provides needed information for each state for:

• The laws specific to your state, and other state specific information such as a website, phone numbers and registration requirements.

• The specific illnesses your state has stipulated to qualify for MMJ treatment. Check to see if your state covers any of your loved one's illnesses. If it doesn't, you may not qualify for use.

• Obtaining a Medical Marijuana Registry Card. Some states allow you to get this online. Most require a personal visit to a marijuana doctor. Registration can cost from $25 to $150, depending on the state. It may cost less for persons on SSDI, or other specific groups. This just gives the patient, their caregiver or other legal representative the privilege of buying the MMJ. States that allow recreational marijuana may not require registration.

• Choosing a marijuana doctor. Your state may not allow your regular doctor to recommend MMJ. Or, it it does, your regular doctor may not feel comfortable doing so. "Marijuana doctors and clinics" are listed for each state by community. Most states require at least one visit to this doctor to acquire the registration card and get a recommendation for the type and amount of MMJ to use for the specified illness. The initial visit can cost from $85 to $200. Renewal or followup prices are usually lower. This doctor "recommends" the MJ (vs. prescribe which is still illegal under federal law).

Find a dispensary where the medical marijuana is sold. Once you have your registration and recommendation, you must go to a dispensary to buy the drug. You can probably get a list of local dispensaries from your MJ doctor. The websites listed below this paragraph provide lists of dispensaries by location, as well as other information such as information about the various strains and their THC/CBD content. These sites and clinics are usually directed towards the recreational as well as the medical user. When you buy your MJ, remember that you want as high a CBD content as possible in most cases. Discuss this with the doctor, of course. Different strains also may work better for different problems and so be ready to explain just what you want the MMJ for. Is it to decrease anxiety? Or pain? Or....?

Websites that list local locations and other information:

• weedmaps.com: You don't need to sign in to get the information you need.
• leafly.com: Provides maps.

Before the visit to the doctor:

• Forward the medical records. Well before the visit, sign a release and ask the staff at your regular doctor's office to forward the medical records. Do this with each doctor your loved one sees, and for any doctors seen in the past for the illness you want to use the MMJ for. Wait a week and then call the MJ clinic to see if the information has arrived. Follow-up if it hasn't.

• Forward records of x-rays, and other tests. Perform the same follow-up procedure as above.

• Complete a medical history form. When you make the appointment, ask if you can obtain a copy of the medical history and fill it out at home. If a copy of their form isn't available, you can find a good, inclusive form at BestMedicalForms.com  (Keep this website handy, it has a good list of forms to use for other needs too!) You may need to fill out another form at the clinic, but you will at least have the info handy and it won't take as long.
  

• Make a list of the therapies used and doctors visited for the illness you want to treat with MMJ.

• Update your ER Kit. If you don't already have one, see our 7/15/16 and 5/29/15 blogs for what should be in your kit. Is the list of current drugs, doses and times accurate? Do you need to add anything new to the "avoid this drug list"? Have you found a helpful, short article to share with clinic personnel?

What should I bring with us to the marijuana doctor's visit?

• Your ER Kit. Besides the fact that it has needed lists of presently used drugs,etc, you are probably going to be talking to someone who knows little about LBD.

• The medical history form you completed

• Your list of therapies and doctors pertaining to the present illness

• Your loved one. Although a caregiver, spouse or other legal representative may obtain the marijuana once it is recommended, the doctor will want to see the patient. (Yes, common sense, but worth mentioning, just in case!)

Go back a couple of weeks for Part 3. Next week, will be a new subject.

* Acronyms:
MJ: Marijuana
MMJ: Medicinal marijuana
LBD: Lewy body dementia
THC: cannabinoid in marijuana that causes the high
CBD: cannabinoid in marijuana that has antipsychotic properites
PlwD: person living with dementia
PlwLBD: person living with LBD
DLB: dementia with Lewy bodies
PDD: Parkinson's disease with dementia
MCI: mild cognitive impairment
MCI-LB: the form of MCI that precedes LBD
BPSD: behavioral and psychological symptoms of dementia

For information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

Marijuana and LBD, Part 3: Ways to Use it

The last two blogs have been about marijuana (MJ). Wow! I didn't know I'd need three blogs to cover this subject! This one is about the different methods of ingesting the drug. Again, there are a lot more than I'd have thought. Let's start with the most common:

Smoking: Recreational users like smoking because, besides being about the easiest and cheapest way to go, it is the most likely to facilitate its psychoactive properties. Smoking also exposes lungs to many risks. For these two reasons, we can't recommend smoking for the person with LBD.

Vaping: This is a process similar to that used by electronic cigarette smokers. It is much less risky to the lungs than smoking, but just as likely to foster psychoactive properties. (Of course,  a lower THC content predicts less psychoactivity. Thus, vaping MJ with a high CBD/low THC content might be considered. However, other forms of use are still likely better.

Edibles: You can add MJ to your own baking or teas, or you can buy products from cookies to popcorn to sodas with the MJ already added. Edibles do not irritate the lungs and have low psychoactive properties, making them good candidates for use. They can be very attractive to the sweets lover, and easy to use. With edibles, the effects are slow to arrive, although once present, they are long lasting.

Tinctures and sprays: These are alcohol extractions of the cannabis (marijuana) plant. Place a few drops under the tongue, or in a liquid like coffee, or even directly to the skin. (I interviewed a local doctor who advocates marijuana use for a variety of symptoms. He suggests this method as the best for a person with dementia.) These provide the instant relief similar to smoking when used sublingually, with a very low risk of psychoactive effects. Try out a small area first if you apply it directly to the skin, to test for allergies or irritations.

Topical applications: Marijuana dispensaries offer a variety of lotions, salves and creams, used to relieve localized pain and reduce inflammation. As with edibles, there is no risk to the lungs and limited if any psychoactivity. There's also some evidence that these topicals can provide better local relief than smoking. As with tinctures and sprays, test a small area for allergies and irritations first.

Capsules: Usually, the capsule contains CBD oil, which is neither water soluble nor easily metabolized. Therefore, the capsules should also contain turmeric oil, which facilitates metabolization. Hemp CBD oil is legal everywhere, but is a much lower quality than that from the MJ plant. Capsules are convenient if your love one can take pills easily. However, dose sizes are limited. Unlike the tinctures or the edibles, you can't cut the dose from a capsule in half.

Aromatherapy: Cannabis flower oil is high in CBD and can be used in a regular distiller. This method is probably not the best for pain relief, since the effect is mild and of course, it will affect everyone in the room. But it can create a calm, relaxing atmosphere.

This is a very broad overview of the ways to use MJ. Like most drugs and their use, it is really much more complicated and varies greatly with the individual and what you want it to do. Thankfully, the people in marijuana clinics are very helpful. They are especially used to questions from "new users," that is from people who likely never considered using what was, until lately, considered an illegal substance. Do ask lots of questions. You want to feel comfortable with whatever you choose to do and use.

* Acronyms:
MJ: Marijuana
MMJ: Medicinal marijuana
LBD: Lewy body dementia
THC: cannabinoid in marijuana that causes the high
CBD: cannabinoid in marijuana that has antipsychotic properites
PlwD: person living with dementia
PlwLBD: person living with LBD
DLB: dementia with Lewy bodies
PDD: Parkinson's disease with dementia
MCI: mild cognitive impairment
MCI-LB: the form of MCI that precedes LBD
BPSD: behavioral and psychological symptoms of dementia

For information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

LBD and Marijuana, Part 1

Now that marijuana (MJ) is legal in many states, we are beginning to get questions and comments about its use.

Bottom line, medical MJ is probably safer for the person with LBD than most pain, anxiety, or behavior management drugs and is therefore worth considering. It is not a cure and probably won't work to improve cognition, even short term.

MJ is NOT an anticholinergic. This is perhaps its biggest attraction for LBD families. It doesn't block acetylcholine,  the main brain chemical that LBD attacks. Thus, MJ starts out being more compatible with LBD than many drugs, including most of those for pain, anxiety and psychosis.

But what about MJ's high? Couldn't that cause more problems instead of fewer? Well, it turns out that there are two types of MJ: Recreational and medicinal. MJ is a naturally grown plant, that produces several "cannabinoids" or chemical compounds, the two main ones being THC* and CBD*. In nature, these two compounds balance each other.

• THC is psychoactive, and can trigger a high, with hallucinations, paranoia and other psychotic behaviors. If a person is already displaying psychotic behaviors, such as hallucinations or anxiety, it may increase them. Although it is only mildly addictive chemically, it can be psychologically addictive. That is, it doesn't change body chemistry to where it requires more and more of the drug to get the same result the way alcohol does. However a person can become psychologically attached to the process of its use and the enjoyment of the high.
• CBD is an antipsychotic that acts to counteract the high caused by THC. In some cases, it may decrease already present BPSD* such as hallucinations, delusions, depression and anxiety. However, we believe that CBD's value in this area is more about what it isn't than what it is: it isn't psychoactive and it isn't addictive.

Plants can be bred selectively to produce varying amounts of each compound.

• Recreational marijuana is produced by cannabis plants bred to have such a high ratio of THC to CBD that the latter cannot stop the psychoactive qualities of the drug.
• Medicinal marijuana is produced by cannabis plants bread to have such a high ratio of CBD to THC that it prevents any psychoactive effects.
• Marinol, a synthetic marijuana, is mostly THC with no CBD at all.
• CBD oil is oil made from low-THC, high-CBD plants. So far as we know, there is no straight CBD product. That is not a bad thing. While both THC and CBD act to treat a variety of issues, THC, with its psychoactive qualities buffered, is often the most effective of the two.

Marijuana has long been used as an effective treatment for:

• Pain, including chronic nerve pain which is common with Lewy body disorders.
• Poor appetite
• Intestinal upsets, such as nausea.

Research is showing that it may also be useful:

• As an anti-inflammatory agent. It appears to block the release of cytokines, substances that signal the production of inflammation. Thus, it may help with autoimmune diseases such as arthritis.
• To decrease motor symptoms, such as tremor, rigidity and bradykinesia. The research for this is still very limited, but side effects appear minimal and so it might be worth a try. It only treats symptoms--its effect stops when the drug is no long used.
• For maintaining circadian (sleep) rhythms. CBD works to improve alertness, especially in lighted areas. Medical MJ may help with excessive daytime sleeping, but it should not be taken before bedtime. THC tends to promote nighttime sleep, but medicinal MJ probably won't be effective and the recreational MJ's psychoactive qualities make it a poor choice for someone with LBD.

Next week, more about marijuana, how to find it and how to use it.

Reference:
Medical cannabis. Wikipedia. https://en.wikipedia.org/wiki/Medical_cannabis

* Acronyms:
MJ: Marijuana, or cannabis. A plant grown for its psychoactive and medicinal qualities.
RMJ: Recreational marijuana
MMJ: Medical marijuana
THC: tetrahydrocannabinol, the cannabinoid or chemical compound in marijuana that provides a high.
CBD: cannabidiol, the cannabinoid in marijuana that does not provide a high.
BPSD: behavioral and psychological symptoms of dementia

LBD: Lewy body dementia
PlwD: person living with dementia
PlwLBD: person living with LBD
DLB: dementia with Lewy bodies
PDD: Parkinson's disease with dementia
MCI: mild cognitive impairment
MCI-LB: the form of MCI that precedes LBD

For information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.