Sometimes information about medical marijuana card certifications can be confusing and we at AR MMJ Cards like things simple, so we wanted to walk through some of the basics of medical marijuana* including general cannabis-related definitions, medical marijuana doctors, qualifying conditions, MMJ Cards, and dispensaries. Within the article, there are several resources linked to help ensure your medical cannabis journey is more simplified.
What is medical marijuana? What conditions are medical cannabis recommended for in Arkansas?
According to WebMD, “Medical marijuana uses the marijuana plant or chemicals in it to treat diseases or conditions. The marijuana plant contains more than 100 different chemicals called cannabinoids. Each one has a different effect on the body.” Medical Marijuana can be used in Arkansas for 18 Qualifying Conditions including:
Cancer
Glaucoma
Positive status for human immunodeficiency virus/ acquired immune deficiency syndrome
Hepatitis C
Amyotrophic lateral sclerosis
Tourette’s syndrome
Crohn’s disease
Ulcerative colitis
Post-traumatic stress disorder (PTSD)
Severe arthritis
Fibromyalgia
Alzheimer’s disease
Cachexia or wasting syndrome
Peripheral neuropathy
Intractable pain which is pain that has not responded to ordinary medications, treatment or surgical measures for more than six (6) months
Severe nausea
Seizures including without limitation those characteristic of epilepsy
Severe and persistent muscle spasms including without limitation those characteristic of multiple sclerosis
And any other medical condition or its treatment approved by the Department of Health (https://www.healthy.arkansas.gov/programs-services/topics/medical-marijuana-faqs)
Medical cannabis is most often used for the treatment of pain, nausea, insomnia, mood disorders, and inflammation. According to Harvard Health, “the most common use for medical marijuana in the United States in for pain control. While marijuana isn’t strong enough for severe pain (for example, post-surgical pain or a broken bone), it is quite effective for the chronic pain that plagues millions of Americans, especially as they age. Part of its allure is that it is clearly safer than opiates (it is impossible to overdose on and far less addictive) and it can take the place of NSAIDs such as Advil or Aleve, if people can’t take them due to problems with their kidneys or ulcers or GERD.”
What is a MMJ or Medical Marijuana Card?
According to Leafly, “a medical marijuana card (also known as “MMID” or “cannabis card”) is an identification card used by patients to enter medical dispensaries (or “cannabis clubs”) and purchase the plant to treat their corresponding health ailment or symptoms.” A qualifying patient in Arkansas uses a Medical Marijuana Card at a dispensary to purchase medical marijuana products. To receive a medical marijuana card in the state of Arkansas, a patient must receive a medical marijuana card certification from a licensed Medical Marijuana Doctor. The patient will be age 18 or over (or have parental consent), be diagnosed with a qualifying condition (link to other question below), have written certification from a Medical Cannabis Doctor, be an Arkansas Resident, and not be a member of the Arkansas National Guard or United States Military (due to state law regulations). Once the patient receives medical marijuana card certification from an Arkansas Medical Marijuana Doctor, the patient can apply to the state to receive their dispensary card. For a detailed walk through of how to apply to the State of Arkansas for your medical marijuana card, check out our video on YouTube. Arkansas does offer medical marijuana for visiting patients, there is an application that must be competed and approved. Visit the State of Arkansas’ FAQs page for the application for medical marijuana patients in other states who are visiting Arkansas.
What is a medical marijuana doctor? How do I qualify for a dispensary card?
A medical marijuana doctor in the state of Arkansas is a licensed Medical Doctor (MD) or Doctor of Osteopathy (DO) with a current DEA number. At AR MMJ Cards, our founder is a MD, Dr. Daniel Whitelocke is an experienced medical doctor, who has worked as a surgeon or in family medical clinics prior to founding AR MMJ Cards. He passionately studies and researches information and data on cannabis to ensure he is educated about all aspects of medical marijuana and is able to provide accurate information to his patients. Some topics of his studies include qualifying conditions, medical marijuana benefits by condition, medical marijuana potency, possible side effects from cannabis, marijuana terpenes, cannabinoids, THC, and CBD. To read more of Dr. Daniel and team’s blogs, check out AR MMJ Card’s Blog. At AR MMJ Cards, we charge $100 for cannabis card certifications and $99 for renewals (https://www.armmjcards.com/services/). Our medical marijuana card certifications are conducted using telemedicine. Telemedicine visits are completed virtually with a Medical Marijuana Doctor and patient. To see if a patient qualifies for a cannabis card certification, the patient will complete paperwork through a secure portal. The customer care team will reach out to patients that qualify to schedule an appointment with a doctor at AR MMJ Cards. Patients only pay for telemedicine visits where a medical marijuana certification is recommended! To start your cannabis certification with one of our card certification doctors, visit our site – https://www.armmjcards.com/begin-your-certification-now/. Once certification has been received, a patient can apply to the state of Arkansas for their MMJ card.
What are medical marijuana dispensaries and how do I find one?
According to High Times, “Marijuana Dispensaries exist because federal law prohibits cannabis from being prescribed and filled at pharmacies. What is a dispensary without the marijuana? A place that specializes in carrying and selling a specific type of product. So, a marijuana dispensary is where you want to go when you need any type of cannabis product.” Dispensaries vary in their medical marijuana offerings, but usually carry high quality and lab tested medical marijuana products including flower, vape cartridges, edibles, and wax concentrate. The products have a label that lists THC and CBD strength, medical marijuana type (indica, sativa, or hybrid), strain name, price, and weight. Depending on a medical marijuana patient’s condition, specific terpenes, type, and strength of the cannabis product can impact a condition positively. When Dr. Whitelocke or another Medical Marijuana Doctor at AR MMJ Cards meets with a patient, the specifics will be discussed as to which cannabis strains or terpenes may be a good fit for the patient’s condition. At AR MMJ Cards, we are dedicated to helping patients and ensuring that marijuana medicine is a good fit – we aren’t your average Medical Cannabis Doctor (Read more about us)! AR MMJ Cards has reviewed several Cannabis Dispensaries in the Arkansas area including The Releaf Center, Acanza, Purspirit and others. To read our Medical Marijuana Dispensary Reviews, click here. For a full list of dispensaries, review the list on Arkansas.gov.
*Cannabis as medicine is not right for all patients, please consult your medical marijuana doctor for more information to determine if medical marijuana is right for you.
I love you guys. You’re just frigging great. I owe a debt of gratitude to the medical cannabis community for giving me a voice and platform that, ultimately, has led to my success. So in the spirit of paying it forward, I’d like to share some of the knowledge I’ve gained as my clinical career in medicine has now morphed into a much more natural functional approach to whole-body optimization. Cannabis medicine is in its nascent stages in Western Medicine so establishing guidelines regarding whole-plant cannabis dosing and administration is also in its infancy.
Let’s start at 2700 B.C.E. with the first Chinese Pharmacopeia Pen Ts’ao (The Herbal). This early text warned that high doses of marijuana (Ma) seeds could cause a person to see demons, while moderate doses would enable users to communicate with the spirits. The modern translation in today’s peer-reviewed literature is that the threshold for the medical benefits of THC is far lower than many people think. Having a highly sensitive endocannabinoid system is extremely valuable for responding to illness, injury, and stress, and people can achieve that with low doses of cannabis.
Therefore, I’d like to address critical gaps in knowledge regarding dosing of various cannabis medicines. Bringing some cohesion to the topic can guide both patients and clinicians to better shared clinical decisions regarding counseling on cannabis medicine dosing. When you finish reading this you will have a better understanding of how to dose your cannabis products to reach your maximal medicinal benefit while mitigating the less desirable effects of an incorrect balance of the endocannabinoid system (abbreviated ECS moving forward).
The Endocannabinoid System: Enter the Matrix
Recall that the ECS is an expansive neuromodulatory network that encompasses every organ system in the body. In its native physiologic state, the ECS exists to maintain homeostasis, or balance when the body encounters various shifts in equilibrium or insult. In times of stress or when the body’s reserve is not robust, we are said to be in endocannabinoid hypotonia. Understanding this aspect of natural balance will come into play as we formulate a practical guideline for tailored endocannabinoid system balance through administration of external cannabis preparations. My approach employs an individually tailored program to guide cannabis administration as a safe supplement to address natural deficits in endocannabinoid tone as they arise de novo. The ECS is a system that has been around long before cannabis (despite the name) and a healthy ECS can function well with only a minimal necessary dose of cannabis supplementation to achieve significant clinical benefit.
Cannabinoid (CB) receptors and their action
The cell membrane receives a stimulus signal which results in enzymatic production of AEA and 2-AG from the phospholipid cell membrane. They simply diffuse laterally like a float along the phospholipid membrane via carrier proteins to combine with the active site of the cannabinoid receptors CB1 and CB2. The CB1 receptor expression is widespread throughout the central nervous system (CNS) as well as peripherally in virtually every organ system. Although less research has been devoted to CB2 receptors, this class recognizes the same structural groups of cannabinoid agonists as CB1, with differing affinities in some cases. It is highly expressed throughout the immune system, modulating leukocyte migration, activation, and antigen processing. Unlike the CB1 receptor, which is highly conserved across human, rat and mouse, the CB2 receptor is much more divergent.
How does the Natural System react to external cannabinoids?
The primary constituents of cannabis are THC and CBD. The main constituents of the cannabis sativa plant are Delta-9-THC (tetrahydrocannabinol) and CBD (cannabidiol). These are known as phytocannabinoids because these are the plant derived molecules that combine with the same CB receptors as the endogenous anandamide and 2-AG. THC and CBD are not endocannabinoids and they do not have the same mechanism of action, nor are they governed by the same enzymatic controls as our native analogs.The body has adapted a workaround to short-circuit the receptor overactivation in the event of THC overtoxicity. Receptor down regulation because the natural enzymes that break down AEA and 2-AG can’t metabolize a supranormal dose of external cannabinoids as fast as they can a normal dose. The degradative enzymes FAAH and MAGL can be usurped very quickly to metabolize a supranormal cannabinoid dose that the body simply is not accustomed to. Tolerance equals toxicity. Overmedication constitutes manual override of the internal control motherboard. FAAH and AMGL quickly reach their saturation point so receptors have to down regulate to deal with the excess that the enzymes can’t handle.
Therapeutic window
Determining the therapeutic window (where beneficial effects outweigh toxicity) is key to guiding the correct dose schedule. Overmedicating the endocannabinoid receptors causes the receptors to react in a physiologic manner by retreating like a turtle head back into the cell so the THC molecule has no target to combine with. Another important facet to remember is the biphasic property of cannabis, vis-à-vis low and high doses having opposite effects. Small doses stimulate whilst larger doses sedate. After a certain point, dosage increases result in weaker therapeutic effects. This bell-shaped dose-response curve is characteristic of cannabinoid pharmacology and distinct from the linear dose response curve of most Western pharmacopeia (in which adding more drug will continue to effect change without maximum). This is likely an evolutionary protective effect to mitigate possible cannabis psychotoxicity that occurs with overdose. Fatal overdose is, however, impossible due to the scarcity of CB1 receptors in the respiratory center of the brainstem. Overdose of cannabis paradoxically leads to symptoms that cannabis would normally treat at lower physiologic doses. If patients run into this problem, a tolerance break of 48 hours is just the neural cleansing needed to upregulate CB receptors to their physiologic state.
Factors affecting THC bioavailability and Efficiency of administration
Not every patient uses THC as efficiently. Take relative amount (ratio) of smoke inhaled to fresh air for example. Users who take in less smoke per inhalation and more oxygen are going to require a smaller THC dose because their utilization is going to be more efficient. Cloud tokers are far less efficient and much more prone to tolerance. The body is being inundated with a very high concentration of THC relative to oxygen. Furthermore, a great proportion of the smoke is not getting to the bases of the lungs where there is the highest perfusion of blood. This means that these monster hits are missing out on better access to the bloodstream. Oftentimes, precious cannabinoid is wasted in dead space (nonvascularized areas) like the trachea when that smoke is coughed up immediately before ever making it to the bloodstream.
How does variablility in ECS makeup from one person to another determine ideal dose?
Diet, exercise, day-to-day stress, and genetics all play a role. Long story short, healthier people with better lifestyle habits will have a stronger basal endocannabinoid tone. We can deplete the endocannabinoid system through lifestyle choices by pathologically altering the microbiome of our gut (via a process called dysbiosis). Recall that the greatest concentration of cannabinoid receptors outside the central nervous system is in the immune system (which primarily resides in the gut). Micronutrient support of our gut cells can prevent the depletion of homeostatic reserve that we might need to employ during acute stress. Keeping the balance of the microbiome keeps the lines of communication between the pituitary gland, hypothalamus, and adrenal glands clear and functioning in a physiologic fashion.
Dosing: The long and short of how to dose your THC flower
Individualization of treatment is the answer. This means finding the optimal product and route of administration. All these issues will determine the answers to the three questions that patients should ask themselves when selecting a product and route of administration: how much cannabinoid is going to be incorporated into my body, how long before I feel the effects and how long are they going to last. Pharmacokinetics (PK) refers to the movement of drugs through the body, whereas pharmacodynamics (PD) refers to the body’s biological response to drugs. Understanding the exposure-response relationship (PK/PD) will help the patient understand the bioavailability (percent of active compound that reaches the bloodstream) of different cannabinoid preparations. Most literature and drug trials have landed on 5 milligrams of THC per dose, and up to a daily maximum of 30 total mg of THC daily. These doses (and oftentimes much smaller) can potentiate a fast and durable response for a myriad of conditions without an uncomfortable level of psychoactivity.
Prescription cannabis products
These prescription drugs are pure isolates of cannabis compounds and do not contain the full suite of chemicals as in whole-plant preparations. Dronabinol is an isolated THC molecule marketed in oral pill form as Marinol. Clinical trials of Marinol showed effective doses at 2.5 milligrams for children and elderly, up to 10 mg per dose. Nabilone (Cesamet), a synthetic THC derivative which is 10 times more powerful than THC, is a powerful antiemetic used to combat chemotherapy-associated nausea and vomiting. Sativex® (nabiximols) is a combination sublingual spray. Each spray delivers a dose of 2.7 mg of THC with 2.5 mg of CBD into the oral mucous membrane. Their clinical trial on multiple sclerosis patients concluded eight sprays (puffs) per day (21.6 mg of THC and 20 mg of CBD per day) to be the optimal dosing regimen. Epidiolex® is a pure CBD hemp plant extract administered in the form of a syrup. The pure isolate compounds are plagued by slow pharmacokinetics and a very narrow therapeutic index. Big pharma failed at what nature perfected, and patients are far more inclined to use preparations of dried cannabis flowers, extracts, oils and tinctures.
Inhaled Preparations:
Smoking, the principal route of cannabis administration, provides a rapid and efficient method of drug delivery from the lungs to the brain. The smoking route is preferred by many cannabis users because of its rapid drug delivery and resultant fast onset of effects (peak concentration occurs at 9 min) but also for the ability to titrate dose to the desired degree of effect. The most useful method I have found for dosing inhaled cannabis is to take a single inhalation, breathe in deeply, and immediately exhale. Don’t resist the urge to cough and always keep hydration handy. New cannabis users should start with an even smaller dose at 2.5 mg THC before bedtime and carefully titrate up. The obvious disadvantage with combustive inhalation is the more than 2,000 compounds may be produced by pyrolysis.
Vaporisation:
These vaporizers employ dry heat to cannabis products up to temperatures at which the cannabinoids decarboxylate, but without reaching the point of combustion in which the toxic by-products are generated resulting from pyrolysis. Terpenes also have their individual volatile boiling point. Bioavailability of the major cannabinoids consumed by this method is very high (around 25%).The effects of cannabinoids are not prolonged in time, as changes in their plasma levels are very fast, both rising (which can be an advantage during acute pain crises, for example) and lowering. Thus, inhalation may be an interesting route of administration to deal with acute episodes that need immediate relief, but it would be the best option for chronic treatments, in which high levels of cannabinoids are looked for during prolonged periods of time and consistency in the dosage.
Concentrated resins are known for their much higher THC concentrations and are much harder to dose in small amounts. The other disadvantage with these extractions are the solvents used to prepare them (known as menstruum-Yum!)-hexane, butane, acetone, benzene, isopropanol, ethanol, etc. Food grade ethanol is the best option in this group, as some organic solvents can be toxic even in small amounts. Better choice is when supercritical fluid extraction using CO2 is employed, which leaves no toxic residues (but is more expensive to produce). Overall, these are not my favorite choice for medicinal applications of cannabis medicines.
Oral Administration
Slow rates of absorption and low THC concentrations occur in comparison with inhalation, orally administered THC or cannabis edibles can take 60-90 min to feel effects. THC Plasma concentrations peak at peaked ca. 4−6 h after ingestion. The psychoactivity also lasts longer and is less intense at equal doses versus the inhaled method. This lower bioavailability (approximately 15%) is due to slow rates of absorption and the First Pass effect resulting from stomach acid and liver degradation of THC to 11-Hydroxy-THC metabolite prior to active THC absorption to the bloodstream. These aspects are the reason why edible products are more difficult to control in terms of their intensity and the time they take to appear. This is the reason oftentimes for overdosing on edibles (oftentimes referred to as a “cookie casualty.”
On the other hand there are certainly situations that, from a clinical perspective, edibles can be used to clinical advantage. I’m quite preferential to them for elderly patients for a number of reasons. Fire is just bad for grandpa, okay? Especially if he is demented or is on supplementary oxygen. Secondly, if grandma is taking bladder incontinence medication then coughing is also not advisable. Incontinence can ruin any high, let me tell you. Lastly, I’m not counting calories in old folks man I won’t bullshit you. Brownies can be gummed out if dentures are an issue and liquid oil preparations are easily used on breads and muffins. Plus the longer duration of action makes it ideal for a bedtime snack to get them some good rest. Being old is tiring so getting a good night’s sleep comes at a premium.
The Entourage effect:
This further confounds the dosing regimen, as higher doses of pure THC preparations are required to achieve the same clinical benefit as lower doses of THC from full spectrum or “whole plant” preparations. Synergy between naturally occurring phytochemicals outlines the framework for the entourage effect-differing combinations of cannabinoids, terpenoids, and flavonoids producing unique and condition-specific effects. It is important to note that the dose of THC needed for effect will differ based on whether this is THC isolated alone or in combination with whole plant extract with the entire suite of native cannabinoids. This is because a smaller dose of THC will be required to achieve the same effect due to the entourage effect of the other cannabinoids. 5 mg THC of two cultivars will have staggeringly different effects due to the both the synergistic and antagonistic effects of different chemical fingerprints. Individual variability in our endocannabinoid systems also contribute to the range of effects seen at equal doses of different cannabis cultivars.
THC/CBD ratio and dosing:
Here’s a big hurdle to get over when trying to employ medical marijuana in dispensaries that are co-adapted to serve recreational marijuana purposes. Since marijuana prohibition, growers have been crossbreeding high-octane thoroughbred cannabis strains (type 1 THC heavy strains) to steadily drive up THC content while breeding out an essential cannabinoid in CBD. Type 2 strains with a more balanced THC:CBD profile are prized in the medical cannabis world but are much harder to find than their diesel fuel cousins. This aspect of the unavoidable commercial nature of marijuana is unfortunate because adding CBD to THC widens the therapeutic window. The therapeutic effects of THC-dominant cannabis can be achieved at dosages lower than those required to produce euphoria or impairment. A 2011 reviewTrusted Source on the safety and side effects of CBD found that continuous use of CBD, even in high doses like 1,500 mg a day, is tolerated well by humans. CBD may modify the effects of THC and reportedly may inhibit cytochrome P450 (CYP 450)-mediated conversion of THC to 11-OH-THC [20][21]
Final thoughts Cannabis Administration
There are many things to consider in terms of product selection that are far beyond the scope of this blog. Let me just tie it up like this. Check the label for the basic stuff. It is essential to know at least the amount of THC and CBD present in the products you consume to be able to systematically administer and be able to anticipate the effects after taking each dose. The correct dose is the lowest dose that produces a therapeutic benefit without the associated adverse events. The sweet spot is a dose large enough to feel effects but small enough to not cause unwanted psychoactivity. Marijuana is a safe enough drug to keep experimenting with until you find the sweet spot. Individualization of treatment is the answer. This means finding the optimal product and route of administration. Sometimes you might have to get your products from more than one place to get the true entourage effect on all the cannabinoids and terpenoids. A healthy approach to cannabis medication is to replace the endocannabinoid deficit without overshoot. Titrate to effect by starting low and going slow.
As my husband (Dr. Daniel) and I built AR MMJ Cards, it was always our intention to provide medical marijuana patients in Arkansas two things; a simple, cost-effective certification service and plenty of accessible information to aid in making informed decisions about their individual cannabis journey.
Dr. Daniel spends countless hours immersing himself in the science behind the utility of medical cannabis and then translates that information into a medium that anyone can understand. However, from a patient standpoint, knowledge of the science behind the high is only one side of the coin; it’s also crucially important to know where to get your medicine.
We won’t tell you where to go buy your MMJ but we’ll let you know what you can expect from all of the dispensaries we’ve visited. Furthermore, as you read our criteria for reviews, you’re likely find that you could just as easily review these dispensaries yourself. The aim of this post not only informs the patient as to what we are looking for in a dispensary and why, but also gives patients some things to think about the next time they’re in their local dispensary.
Choosing Criteria for Dispensary Reviews
Product Storage
The first and most important thing I look for in a dispensary is how they store their product. The reason product storage is the most important is quite basic: the storage determines the quality of the product and the life of quality viability, i.e. how long it will remain at that quality.
We operate under the assumption that the most important thing to a patient is receiving the highest quality product for their dollar, which is why product storage is the most heavily weighted criteria. Product storage is worth exactly twice as much as the other two criteria when determining our overall rating for a dispensary.
As I’ve mentioned in previous reviews, ideally cannabis flower (including CBD flower) should be stored in a cool, dark location, lacking exposure to air.
From a practical standpoint, I am primarily checking for an overall lack of light, heat, and air. Some dispensaries use vacuum-sealed, heavy-weight bags with a zip closure, and those are really excellent for storage. Personally, I seek out strains that come in those bags.
When you read a label on the product you buy from a dispensary, there is usually a percentage for THC and sometimes CBD. A few places include percentages of other compounds like terpenes, but THC and CBD are most commonly found on the package. These products are tested and labelled before the dispensary receives them. That means, that was the percentage of THC and CBD before it arrived at the dispensary.
Even when stored correctly, terpenes deteriorate over time, and the quality of the product will decline. If you notice a dispensary runs out of strains periodically, and won’t have it for a few days, this is actually a good sign. It may indicate that they have good product turnover and are able to sellout before things sit on the shelf for too long.
Dispensaries that bulk order products and hold on to them for too long, may end up selling a much lower quality product with a label that no longer represents the product’s accurate percentages. Be sure to check the packaged and tested dates to ensure the product isn’t old before you buy it.
Problems with Deli-Style
Deli-Style dispensaries keep the bulk flower products in a large containers separated by cultivar. If a patient wants to inspect the product closer, the budtender will open the container and the patient can look at and smell the product. The patient can select the amount they desire and the tender will measure out that amount on the scale and seal package it there on the spot.
Deli-style dispensaries are going to have an uphill battle against prepackaged products for a number of reasons. The perpetual burping (opening and releasing terpenes) that naturally comes with deli-style dispensaries will inevitably lead to oxidation of the flower. Furthermore, the repeated physical manipulation of flower disturbs the delicate and prized trichomes on their marijuana flower bract. To put it simply, oxidized marijuana flower is less effective at all of its function. Oxidation only requires the presence of oxygen to occur and doesn’t require any additional heat (which would be combustion). This is why deli-style dispensaries automatically receive a reduced product storage score.
In deli-style dispensaries, I’d next look to see where they’re storing their product. If it’s a deli-dispensary that stores its flower in an amber glass jars, they’re protecting the terpenes from the light which would help slow the deterioration. If their jars are clear glass (which is less ideal), I’d check to see if they’re stored in a dark area behind the counter or if they’re exposed to plenty of light, which would burn up scenery experience.
Lastly, I check for the temperature of the room. It’s better if the room where the bud-tenders and product are stored is kept cool.
Personally, I’d never recommend visiting a deli-style dispensary because there really isn’t any way to calculate what you are getting. The bud in those jars deteriorates at all kinds of different rates, and there isn’t an effective way to track that. When you have a big jar of weed, there are too many unknowns for the customer. For example; When was that jar filled? Do they empty the jar before refilling it, or add new flower to what’s already in the jar? How many times a day do they open it? How much time does it spend open?
There are so many more unknowable questions that come with this type of dispensary. I think one of the greatest things about buying bud from a dispensary is the regulation. Regulated growing, regulated drying, regulated burping, and measured THC content. If you buy that carefully cultivated bud from someone who cannot guarantee good care for their product to ensure quality longevity, then what was the point of even printing that cultivar’s testing label and sticking it on the product?
If you’re a dispensary that wants to let customers open and smell all of the products before they choose, then you should really have a small amount of each strain set aside for smelling purposes only, and not for sale. I personally do not want to pay for something that 30 strangers have stuck their nose in and inhaled the terpenes and trichomes that I wanted to smoke.
Pricing
NOTE: Medical Marijuana in Arkansas has a 12% sales tax. That 12% goes directly to the state of Arkansas. The dispensaries get to keep the amount that is listed before tax. If you order online, add an additional 12% to your total to get a very close approximation to your actual price.
The pricing score is really straight forward. I look at the strains they have, and compare what they are selling a particular strain from a particular cultivar for, with what other dispensaries are selling that same strain from that same cultivar.
For example, I love mimosa, so I might try Osage Creek’s Mimosa from 5 different dispensaries and see what each dispensary is selling it for. This is how I create my baseline for product price.
I’d then check for product variety. Some places have strains from extremely high prices to extremely low, while other places don’t. I like to see a variety. I know some patients that want to immerse themselves in cannabis culture and try every bit of “designer” bud ever cultivated, while others may just want a reliable source for their medicine at a price they can afford. Ideally, a dispensary would have an option for each type of patient.
Next, I check to see what increments are sold. A lot of places start at an eighth and go up from there, but I prefer a dispensary to have grams available. If someone were in a pinch and just wanted a little bit, or if someone wanted to test out a small amount of many strains, it would be nice to have a gram option.
The one major advantage that a deli-style dispensary has in the pricing section is that they can measure out any amount, so you could potentially spend less at one time.
Pricing wasn’t difficult to decide how to score, but it has caused a small amount of confusion with some of our patients. I score these prices on how they compare with the Arkansas market for medical marijuana. We had one patient write us because we gave the ReLeaf Center four stars for pricing, but he felt that $30 – $40 (after taxes) for an eighth was a lot and wanted to know why we scored them that way.
I love math, so naturally I worked out my calculation to show him how you get more for what you pay when you purchase more at once. We compared the price for an eighth ounce of Gorilla Glue from a deli-dispensary that he’d been to with the price The ReLeaf Center was selling at, and we saved a little more than $5/gram.
I always caution people to look at what you bought and then what you paid, not just what you paid. If you spend $15 three times on a gram, then you’ve spent $45 on 3 grams. If you buy an eighth for $35, then you’ve spent $35 on 3.5 grams. You get a half gram more, for $10 less.
Sometimes I’ll hear things like, “I always spend more when I go to…” wherever vs. wherever. I always have to ask what they mean when they say that because a lot of the time the case is actually that they bought a $15 gram from one place and a $40 eighth from somewhere else, which made the person feel like they spent more. In fact, $40 for 3.5 grams comes out to a little less than $11.50/gram.
Dispensaries that sell eighths or more at once will very likely give you a better value for what you buy, but you’ll be unlikely to be able to get something for less than $30 – $40 out the door.
Wait & Staff
Our final criteria is meant to rate the feel of a dispensary. The first part of this is wait time. If you’re ready to get your medicine and you drive to a dispensary geared up and excited, then have to wait hours, it’s highly unpleasant.
You can end up waiting a very long time if dispensaries are understaffed or their staff isn’t efficient at getting people in and out. As far as the wait, I generally try to arrive at a dispensary at their peak volume hours and see how long it takes me to get in and out.
The second part of this criteria is the staff. The staff at a dispensary can really make or break the experience. The member of the staff I am most heavily judging is the security guard.
This is because the security guard is the first person you see when you arrive at a dispensary. They’ll be responsible for informing you about their dispensary practices, and they generally carry a gun. If this person is aggressive or rude, they can really dampen the experience.
Security staff should always be positive and friendly. They should greet you before you greet them, and they should offer helpful information or instruction right away. If it’s your first time to a dispensary, you should be able to step out of your vehicle and be pleasantly walked through what to do next by a kind personality. Security guards set the feel for the entire dispensary because they are the gate keepers.
Next, I’m looking at the staff inside. I like to ask questions and get a feel for their general knowledge. I generally visit each dispensary a few times, and try to talk to all of the staff members I can. It’s a nice touch when they know what they are talking about, but far more than that, I am checking to see what kind of attitude they have.
Are they friendly? Are they happy to help? Are they annoyed? Are they in a rush? Can they recommend strains? Can they recommend new products for you?
Some dispensaries take time and effort to ensure their staff is helpful to the customers, while other dispensaries are just trying to fill their dispensary with bodies so they can get them in and out.
The wait & staff score is by far the most subjective, but important nonetheless. A bad bud tender is a little unpleasant, but a bad security guard could make you never want to come again. The wait seems universal to me however; no one wants to wait a long time once they’re ready to make a purchase.
Final Thoughts
I intend to help patients know what they can expect wherever they go. I believe that the process of obtaining medical marijuana should be a pleasant, streamlined process. We continuously strive to make our end (medical certifications) easier and more streamlined, and I hope that by reviewing these dispensaries, we can help make the other end a little easier and pleasant too.
Be sure to stay tune this summer for our coming dispensary review tour! Dr. Daniel and I will be traveling around to visit all of the dispensaries in Arkansas, one area at a time, and reviewing them for our patients’ convenience!
Some of our patients at AR MMJ Cards have asked about the difference between terpenes and cannabinoids. We wanted to walk through the definition of terpenes, why they are important, how they interact with the brain and olfactory system, and a review of selected terpenes/strains. A close appreciation of the powerful value of terpenes is essential to even the casual cannabis connoisseur to unlock the most from your medication. We will delve into how cannabinoids act as a sensory catalyst in the central nervous system by starting a cascade of actions that amplify terpenes action even further. One can quickly glean how terpene genetics can have an enormous impact on the potential that medical cannabis has to offer.
What Are Terpenes?
Since plants are limited in their physical range, they give off chemical clues to the aromatic rewards that they offer. These chemical clues are called terpenes. They are the essential oils behind the intoxicating olfactory allure that draws in a diverse array of species to cannabis. Terpenes ignite the fire of our most primal instincts long before our consciousness is aware of it. Found in cannabis trichomes, terpenes comprise the largest group of components in fragrant essential oils secreted by plants. These pheromones are the economic driver behind the billion-dollar industry of essential oils.
Over 100 different terpenes have been identified in the cannabis plant, and every strain tends toward a unique terpene type and composition. Terpenes may play a key role in differentiating the effects of various cannabis strains. Some terpenes might promote relaxation and stress-relief, while others potentially promote focus and acuity.
Terpenes are further classified based on the number of isoprene units (C5H8) in the molecule. Monoterpenes like linalool and limonene are both monoterpenes (one terpene unit or two isoprene units). β-caryophyllene and humulene are both known as sesquiterpenes with three isoprene units. Carotenoids, which are also components of the visual system, are tetraterpenes composed of eight isoprene units.
The development of terpenes in cannabis began for adaptive purposes: to repel predators and lure pollinators. They shape the attributes that contribute to the overall composition of a strain, adding a dimension to each one’s “personality.”
Why Are Terpenes So Important?
Think of this: cannabinoids are colorless, odorless and tasteless. As far as the external senses go, cannabinoids are, in fact, quite bland and boring. Cannabinoids act as a blank canvas that give terpenes the freedom to bring cannabis its unique variety of color, depth, and texture. Not only do terpenes equip each cultivar of cannabis with its own unique color and flavor, terpenes influence the character of a multitude of effects elicited by cannabis, especially the nature of the euphoric effects.
Consider the scenario of two cannabis strains otherwise equal in their cannabinoid profiles with say, 15% THC and 7% CBD, but one strain being primarily of a beta-caryophyllene heavy profile and the other with a linalool heavy profile. Although these strains might look alike from their cannabinoid profiles, their effects would be vastly different due to their terpene profiles. We can quickly glean that terpenes are the actual stars of the show doing the heavy lifting. Cannabinoids simply provide the scaffolding framework for terpenes to follow the path of least resistance to their receptors. Natures synergistic chemokinetics are busy at work forming each unique chemical identity that gives rise to the architecture of the entourage effect.
The diverse chemical milieu reflected by the wide variety of cannabis cultivars and chemotypes is the chemical fingerprint of cannabis.
How Do Terpenes Interact with the Olfactory System? How Does It Relate to Our Attraction to Natural Scents?
People are naturally drawn to scents. Our olfactory system is vastly unique amongst the cranial nerves. It has direct connections to the emotional center in the brain known as the limbic system residing in the hippocampus and amygdala. The amygdala forms the main hub for a broad spectrum of emotional processes and the hippocampus is largely responsible for consolidating new memories. Its monosynaptic structure means that the sensory nerves in your nostrils synapse directly onto the brain via the first cranial nerve.
The sense of smell is the most preserved of our primitive instincts and holds untold clues into our most profound realms of existence. Deep in the most primordial of our instincts, we are drawn to certain terpenes for reasons we may not consciously understand. The concept is quite similar to the mechanism of déjà vu, where one feels a sense of familiarity that can be quite profound or even unsettling. In other words, there is consciousness of an event or emotional memory without there being an actual memory to tie it to. The reason for this deep emotional reaction to scents lies in the functional anatomic design of the olfactory nervous system.
Terpenes are the sweetly intoxicating perfume of nature that soothes the mind and body. In fact, they act directly on brain cells to modulate their activity. The therapeutic effect of scent is increased thru combustion because terpenes are aerosolized at higher temperatures as these oils vaporize. However, the soothing effect of terpenes occur even in the absence of combustion. Take a walk in a coniferous forest and your psyche will quickly begin to drink in the invigorating effect of focused optimism elicited by bathing the senses in pinene. Combusting terpenes elicits a more robust and rapid effect by releasing a densely concentrated dose of concentrated terpene-rich vapor immediately into the olfactory bulb where it sends synapses to the vital components of the limbic system, the amygdala and hippocampus. We can even see how these terpenes in cannabis can play a vital role in addressing diseases in which parts of the amygdala and hippocampus can be affected by pathology. Cannabis has been highly touted for its efficacy in alleviating symptoms associated with conditions symptomatic for emotion-associated memory impairment such as anxiety, depression and Alzheimer’s disease (AD), etc.
How Do Terpenes Contribute to the Entourage Effect with Cannabinoids?
The entourage effect simply means that cannabinoids such as THC and CBD, along with the hundreds of other compounds, along with the terpenes, are meant to work together in concert to have an effect that is greater than the sum of their parts. The diverse combinations of terpenoids are what afford cannabis with the chameleon-like quality of mimicking a wide array of flavors and olfactory textures. Terpenes add layers of olfactory texture to marijuana’s natural sensual allure. Consider the mechanism of Delta THC acting on the CB1 receptor. This binding opens up the door for terpenes to exert their effects; compound this with the notion that the entire underlying effect is to amplify our sense of perception.
The entourage effect decoded…This idea is that many different terpenes are interacting with many different cannabinoids and the that the sum of the combined effects is greater than the total of the individual parts acting separately. In other words, these interactions modulate and potentiate each other based on the specific relative combinations of concentrations.
As said, cannabis contains some 100 known terpenes, all of which produce their own effects. Combined with the cannabinoids and other terpenes, the future of cannabis may just be in the cultivation of strains rich in certain terpenes and cannabinoids to create strains tailored to produce certain effects. Because terpenes shape the character of the type of euphoria we feel when we use cannabis, the wide array of terpenoid combinations allow the casual connoisseur to indulge in the seductive medley of hints and notes.
What Are the Major Terpenes in Cannabis? How Do they Differ? Which Strains Are High in a Specific Terpene?
Myrcene: This is the Indica/Sativa Checkpoint
Myrcene is responsible for giving marijuana its distinctive aroma. Myrcene can also be found in wild thyme, mangoes, lemongrass, cardamom, and hops and thus has a musky, earthy scent. The majority of commercial cannabis strains are myrcene dominant, meaning the most abundant terpene in their chemical profile is myrcene. β-myrcene comprises 29.4% to 65.8% of the essential oil composition of the fragrance of Cannabis sativa.
Also found in mangoes, myrcene has relaxing properties as well as anti-inflammatory properties. Strains that are high in myrcene are Skunk XL, White Widow, and Special Kush.
Myrcene has a boiling point between 331 to 334 °F, so even people who vaporize their bud at lower temperatures should be able to consistently feel the relaxing, sedating effects. Anything over .5 % myrcene is considered an Indica. Myrcene, for example, is found in many relaxing cannabis strains like Blue Dream and Granddaddy Purple.
Beta-Caryophyllene: The one terpene that acts like a cannabinoid
This terpene, which has a spicy, woody, peppery scent, is also found in black pepper and cinnamon. Studies indicate that this one small terpene is capable of performing the big job of treating anxiety, depression, and inflammation. Caryophyllene is found in such strains as Super Silver Haze, Skywalker, and Rock Star.
β Caryophyllene is the only terpene known to interact with the body’s endocannabinoid system as if it was a cannabinoid using the CB2 receptor, which has anti-anxiety effects and anti-inflammatory properties.
Alpha-Pinene: Great for Alzheimer’s pt, Memory impairment, Anti-inflammatory
Pinene is the most common terpene in the natural world (but not in marijuana; myrcene is the most common terpene in marijuana). It is responsible for the bronchodilation effects of cannabis. It can also act as a stimulant and an AChE inhibitor. It’s also found in rosemary and basil and has a wide variety of positive effects, including pain relief, inflammation and anxiety.
Found in two varieties, alpha, which is responsible for that wonderful pine aroma, and beta, which has a scent like rosemary, dill, or parsley. Pinene is a strong bronchodilator, but also has strong anti-inflammatory and antiseptic effects that have been used for centuries in herbal medicines.
Pinene, found in sage and conifers, has been shown to aid in alertness and memory retention. α-Pinene in particular is thought to reduce the memory deficits commonly reported as a side-effect of THC consumption. It likely demonstrates this activity due to its action as an acetylcholinesterase inhibitor, a class of compounds which are known to aid memory and increase alertness.
α-Pinene contributes significantly to many of the varied, distinct, and unique odor profiles of the multitude of marijuana strains, varieties and cultivars. α-Pinene is rapidly absorbed across lung blood vessels and exerts great anti-inflammatory and antimicrobial effects, as well as having some activity as an ACE inhibitor (controls blood pressure).
Keep in mind that pinene-dominant strains are uncommon (meaning it’s rarely the most abundant terpene in a strain), but it’s commonly seen as the second most abundant terpene in a strain’s terpene composition. Pinene can be found in strains like Strawberry Cough and Blue Dream, Big Smooth, Snoop’s Dream, and Critical mass.
Limonene: Second most abundant terpene in cannabis
Limonene may not be present in all cannabis strains but has powerful anti-fungal and antibacterial properties. Its great smell means that it is a common additive in household cleaning and cosmetic products. Limonene can also help to relieve stress and enhance mood.
Limonene smells citrusy and is found in — you guessed it — citrus! It also vaporizes low, at 350 °F, and is associated with anti-anxiety effects, along with some anti-depressant effects. It’s also used for its anti-inflammation properties. It’s the second most abundant terpene found in cannabis; limonene can also be found in various citrus fruits and is responsible for the citrusy smell. Limonene can also help to bust stress and enhance mood.
Strains high in Limonene include Sour Diesel and OG Kush as well as Super Lemon Haze.
Linalool: Calming; can balance out the anxious side effect of THC
Linalool has a wonderful, floral scent and is found in lavender. It’s also been known to have anti-depressant properties, and if you’ve ever turned to a lavender-scented candle or bath to relax — a strain high in linalool would also do the trick! Linalool can help to balance out the anxious side effect sometimes produced by THC and this makes it an ideal terpene for the treatment of anxiety.
Linalool is present in strains like Special Kush, Amnesia Haze, and OG Shark, Kosher Kush.
Humulene: May actually help to DECREASE appetite
Known for its herbal aroma, Humulene has aromas of hops with woody and earthy scents. Strains that contain humulene may actually help to decrease appetite, counter to the popular notion that weed always gives you the munchies. Found in hops, cloves, coriander, and basil, humulene vaporizes at 222ºF (106ºC) and has shown anti-inflammatory and antibacterial properties in research.
Strains which contain humulene include Liberty Haze, Gelato, Girl Scout Cookies, and Sour Diesel.
Terpinolene: Uplifting ACTIVE strains
About 1 in ten strains is terpinolene dominant. Terpinolene is also found in lilacs, nutmeg, and cumin. The scents are piney, floral, and herbal. It vaporizes at 122ºF (50ºC) and its ocimene is beautiful, sweet, earthy, citrusy aroma, which is why it is frequently used in perfumes.
Terpinolene is commonly found in uplifting, active strains like Jack Herer and Ghost Train Haze, and Chernobyl.
Terpenes and Timmy: Case Report
Take Timmy for example. At his junior prom 20 years ago Timmy, the gentleman, was returning from the restroom with a fresh cocktail made with illicitly obtained bottom shelf grain alcohol. Timmy was already intoxicated by the prospect of social lubricant compensating for the gulf in beauty between his pimple faced self and Fiona, a 5’1” blonde with short hair wearing a white dress with stunningly high heels. Distracted in thought, Timmy tripped over his last step and spilled the entire drink on the front of her dress, drowning her buxom in purple stuff screwdriver that had a mild whiff of sour urine. Stunned by the embarrassment, she instinctively delivered a violently accurate left foot to the right testicle of Timmy, dropping him to his knees. The pubescent mob howled in brace-faced laughter as Timmy lay in the fetal position clutching his groin, soaked in a puddle of dollar store purple drink.
He struggled for years to get his confidence back in the dating life but eventually he was able to attract/convince a wife and successfully procreate with her. So, all good in that department. Although several years have passed, the intrusive thoughts about the experience still haunt him and he still has very hurt feelings about the whole incident.
Timmy now sweats profusely before social work functions and hyperventilates terribly around short haired blonde women in heels. To find solace in situations like this, Timmy drops a couple of Mimosa terpene oil under his tongue before he smokes a small joint of a piney, citrusy variety of cannabis to calm his nerves. This way, those memories don’t control his thoughts on the outcomes of things. The binding of these specific terpenes doesn’t negate the memory, they just reduce the impact of negative emotional intrusion in dictating the emotional outcome of current events.
Final Thoughts….
All fun aside folks, terpenes are really magic stuff that oftentimes can get lost in the mix. It’s really a big subject that I think I can only tackle the tip of the iceberg for now. Certainly look for more to come…terpenes are certainly going to make a loud noise in the cannabis world.
“The Source is the premier medical cannabis destination in Arkansas. We offer deli style flower service with over 50 strains available, as well as a selection of edibles, concentrates, topicals and cannabis accessories.”
Address: 406 Razorback Dr, Bentonville, AR 72712
Phone# (479) 330-9333
Hours:
Monday
9AM–6PM
Tuesday
9AM–6PM
Wednesday
9AM–6PM
Thursday
9AM–6PM
Friday
9AM–6PM
Saturday
9AM–6PM
Sunday
10AM–6PM
AR MMJ CARD RATING & REVIEW ⭐⭐
The regrettable thing about the Source is that they are in the best possible location, but the quality of product, purchasing experience and timeliness are just not there.
Product Storage Score:⭐
Ideally, a dispensary will store their marijuana flower in a dimly lit, cool (not cold) environment, with minimal exposure to air.
Deli-style dispensaries in general will be unlikely to receive a high product storage score from AR MMJ Cards, because it’s the worst possible way to store your product, from a scientific standpoint.
As many MMJ users know, the terpenes in Medical marijuana are largely responsible for your high. However, terpenes are very delicate, and easily degraded by heat and light. Once MMJ flower has been prepared for use, the best thing for the longevity of the product at that point, is to seal it in an air-tight container and store it away from heat and light.
At The Source in Bentonville, their product is stored in large, clear glass jars on high shelves near the light.
Every time the jar is opened for someone to smell, or for the attendant to measure out your bud, that cannabis flower is being oxidized. i.e. deteriorating, and becoming less effective at all of it’s functions. Every time that jar gets opened, and every minute it sits there next to the light, the CBN is increasing.
“CBN, No Beuno” says Dr. Daniel. “That’s the measure of the oxidative age of the flower. You could get mimosa from a place with good product storage, and mimosa from a place with deli-style storage, you could be getting two completely different experience because the CBN is so much higher in the deli-style product storage method.”
Deli-style storage is the fastest way to destroy the terpenes in your product.
Pricing Score :⭐⭐⭐⭐⭐
The Source has excellent product prices in a range that serve everyone. Also, due to their ability to measure on demand, they can sell in small increments like portions of a gram. This can be important if you’ve only got a couple extra bucks and you don’t want to have to pull out another $20.
Wait & Staff Score :⭐⭐
The wait is a huge problem. This dispensary is in an excellent location, so they are often packed, and due to nothing being pre-measured, the line takes a very long time to progress.
The first time I visited was in February 2020 and I arrived about 10 minutes after they opened. There was one other person there, who went in before me, and I waited in the waiting area for 17 minutes before being allowed back. The young man I spoke to was polite, and as helpful as he could be, but didn’t know a lot about the bud.
My second visit was a few weeks later, and I made the mistake of going in the middle of the afternoon. The place was packed and I waited over an hour and a half to get in. I generally time how long the wait is the first few times, but I was there so long, I ended up talking on the phone after the first hour or so, and lost track of the time after that.
By the time I got in there, the staff had clearly had a long day, and seemed annoyed at seeing another person there to purchase product. I actually wanted to ask some questions about what they had and perhaps try something new, but not wanting to be a bother, I just picked something I knew and purchased a little less.
All in all, the buying experience is just sub par in comparison with the environments some of the other dispensaries have created.
REQUIRED: AR MMJ CERTIFICATION
Before purchasing cannabis from a medical marijuana dispensary, like This One, Arkansas patients must first qualify for a medical marijuana certification; AR MMJ Cards can provide qualified patients with the state-required recommendation to complete this process.
According to the Mayo Clinic, “Alzheimer’s disease is a progressive disorder that causes brain cells to waste away (degenerate) and die. Alzheimer’s disease is the most common cause of dementia — a continuous decline in thinking, behavioral and social skills that disrupts a person’s ability to function independently.” Alzheimer’s Disease not only impacts the patient, but also those around.
At AR MMJ Cards, some of our patients are in the early stages of this disorder. We wanted to lay the groundwork for how the intrinsic pharmacology of cannabis medicines counteract the neuroinflammatory process characterizing Alzheimer’s Disease (AD). Starting with a brief history, we delve into the science behind the disease process and how cannabis may hold immense promise AD patients. This installment closes up with guidelines on dosing, methods of ingestion, and which cannabis strains may be most helpful in dealing with symptoms associated with AD.
History of Cannabis Use for Alzheimer’s:
As far back as 1890, Sir John Russell Reynolds, MD, Physician to Queen Victoria, published his findings on cannabinoid treatment on dementia patients. He describes patients wandering and fidgety at night or what Sir Reynolds referred to as sundowning – that is, until they were given a small dose of Cannabis Indica at bedtime. Through Sir Reynold’s research and testing, he determined that cannabis decreased the effect of sun-downing.
“I have found nothing comparable in utility to a moderate dose of Indian hemp given at bedtime. It has been absolutely effective for months and indeed years, without any increase in the dose.” – Sir Reynolds
Pathophysiology of Alzheimer’s Disease:
AD usually begins by attacking the brain’s hippocampus, which is a critical brain region for memory processing. The 3 hallmark characteristics of the Alzheimer’s brain include:
The buildup of amyloid-ß (Aß) plaques
Tangles of fibers inside brain cells called neurofibrillary tangles
The activation of support cells in the brain called microglia
Over time, neurofibrillary tangles from degenerated axons (the long projections from nerves that transmit electrical impulses) form webs. These dense misfolded webs form at the junction of nerves called synapses, thus preventing communication from one nerve to another. In this manner, there is a functional decrease in the amount of available Acetylcholine, the neurotransmitter that is chronically deficient in Alzheimer’s dementia. This forms the basis of nerve degeneration driving the clinically observable manifestations seen in Alzheimer’s dementia including recent memory dysfunction, executive dysfunction, disruption in sleep/wake patterns, personality changes, depression, and irritability.
The Science Behind Cannabinoid Action on the Alzheimer’s Patient:
The increase in endocannabinoid tone in Alzheimer’s patients reflects the adaptive homeostatic response to nerve inflammation. This leads to improvements in neuroinflammation, oxidative stress, neurogenesis, and cerebral blood flow. Cannabinoids exert a multiplicity of actions to modulate neuronal dysfunction. Central to this adaptive process is the critical presence of CB2 receptors on microglia. These vital support cells act as scavengers for the nervous system and clear out inflammatory debris. CB2 receptor activation on microglial cells initiates a cascade of events that potentiates beta amyloid removal as well as reducing nerve inflammation. Please note carefully the concept of cannabis medicines restoring cellular balance by mitigating oxidative stress will be revisited again ad nauseum as this mechanism is central to to the concept of cannabinoid rescue.
Activated CB1 receptors on the surface of microglial cells decrease harmful inflammatory glutamate release from nerve cells. This is the mechanism underlying MMJ’s beneficial effect on Alzheimer’s dementia
CB1 receptor activation also inhibits acetylcholine esterase, the enzyme responsible for breakdown of acetylcholine. Inactivation of this degrading enzyme increases the amount of Acetylcholine available at the nerve endings (synapses). Ironically, the same mechanism is employed by pharmaceutical drugs used to increase acetylcholine concentration in the nerve terminals of the central nervous system of Alzheimer’s patients.
Anandamide and 2-Acyl glycerol (2-AG) are increased in affected areas of the brain, as well as their metabolizing enzymes – Fatty acid amino hydrolase (FAAH) and monoacyl glycerol lipase (MAGL).
How Cannabis Can Help Alzheimer’s Patients
The pathophysiology and science of Alzheimer’s leads to devastating effects on patient’s orientation including person, place, and time. As a result, they are easily confused by familiar places and even distrust family members close to them. Caregivers also suffer miserably with combative patients who oftentimes have other comorbid conditions (one or more diseases or conditions that occur with another condition in the same person at the same time) that complicate management. Visual and hearing loss also contribute to disorientation and resultant mood disorders. In addition, sundowning can be particularly frightening for patients. Because there are deficits in recent memory once the sun goes down, patients can’t discern whether the day has just finished or is just beginning:
Imagine your anger when being denied morning coffee by stranger claiming to be their grown child
You go to grab your car keys, but are told you don’t drive
You want to take your dog for a walk, but are told you don’t have a dog
Everyone telling you what to do is just annoying and undignifying
The disconnect lies in that AD patients have conscious awareness that memories exist, they just can’t access them. This maddening scenario for the patient and caregivers spins into a vicious cycle of constant apprehension and confusion. To alleviate some of these feelings, there are Alzheimer symptoms that may respond to low dose cannabis including: sleep problems, paranoia, anxiety, pain, poor appetite, and weight loss.
Cannabis Studies, Dosing, and Strains for Alzheimer’s Patients:
A 2016 study published in Journal of Alzheimer’s Disease looked at nursing home patients with Alzheimer’s dementia who had THC oil added to their current meds[1,2]. All patients reported improvements in sleep, agitation, irritability, and caregiver distress.
Check out this YouTube video on cannabis and an Alzheimer’s patient – the video is taken by a son of his mom before and after cannabis dosing.
Preliminary studies in rodents show the ideal response at a one to one (1:1) THC to CBD ratio in terms of reducing harmful Alzheimer’s amyloid plaque.
Maximal dampening of neuroinflammation is achieved with the following dosing schedule for Alzheimer’s patients:
2.5 milligrams THC at bedtime and 1.5 milligrams at breakfast and lunch
The target dose is 5 milligrams THC two to three times daily
Balloon vaporizers are the favored delivery method for elderly Alzheimer’s patients. Smoking is not recommended for these patients due to fire hazard – Vaporizing balloons are a better option
Great care must be exercised with the administration to the demented elderly. They are at greater risk for injury with falls. Oral forms are excellent for these patients, but attention must be paid to not make cannabis inaccessible, so they don’t mistake it as a snack.
This clinic suggests that patients or caregivers look for cannabis strains with high myrcene and linalool content for their sedative properties and THC synergy. Myrcene enables the cannabinoids to transfer from the blood to the brain more quickly and linalool promotes relaxation. These strains include high CBD varieties like ACDC and are great options for neuroprotective properties. Other viable cannabis options are Purple Urkle, Granddaddy Purple, and Bubba Kush.
Cannabis can help Alzheimer’s patients with symptoms, but results are dependent on the patient and their bodies. If you need help determining if cannabis may be right for you or a family member, please visit www.armmjcards.com.
Additional References:
1.) Shelef, A., Barak, Y., Berger, U., Paleacu, D., Tadger, S., Plopsky, I., & Baruch, Y. (2016). Safety and Efficacy of Medical Cannabis Oil for Behavioral and Psychological Symptoms of Dementia: An-Open Label, Add-On, Pilot Study. Journal of Alzheimers Disease, 51(1), 15–19. doi: 10.3233/jad-150915
2.) Woodward, M. R., Harper, D. G., Stolyar, A., Forester, B. P., & Ellison, J. M. (2014). Dronabinol for the Treatment of Agitation and Aggressive Behavior in Acutely Hospitalized Severely Demented Patients with Noncognitive Behavioral Symptoms. The American Journal of Geriatric Psychiatry, 22(4), 415–419. doi: 10.1016/j.jagp.2012.11.022
“As the premier destination for medical cannabis dispensary products and services, it is the mission of ReLeaf Center to provide patients access to high quality, affordable alternative solutions to meet the needs of all of their qualifying conditions”
There are a few great dispensaries in Northwest Arkansas, but The ReLeaf Center takes the cake. Although it’s a bit of a drive to get there, the friendly staff, reasonable prices, and incredible selection makes it worth the trip. The ReLeaf Center is true to it’s name. From the moment you arrive to the moment you leave, you feel relieved. Everyone smiles, the atmosphere is pleasant, and the staff learns your name and asks you how you are doing. Above all their superior product storage practices, and routine discounted-sales of aged products, makes us rest assured in our decision to crown ReLeaf as AR MMJ Cards’ favorite dispensary in Northwest Arkansas. You will never get an inferior product or experience at The ReLeaf Center.
Product Storage Score:⭐⭐⭐⭐⭐
Ideally, a dispensary will store their marijuana flower in a dimly lit, cool (not cold) environment, with minimal exposure to air. ReLeaf storage checks all of those boxes. The lighting inside the entire dispensary is dim, and the temperature is moderately cool.
The buds that live in glass containers, are stored in dark bins, which protect them from light. Their product is stored in individual containers, which means it is not exposed to air from the time it is packaged to the time you purchase it.
All of these measures serve to protect the terpenes and tricomes on the plant. That’s just the scientific way of saying it protects your high. When you hear about “old bud,” that’s referring to bud with deteriorated terpenes.
Naturally weed will age, even when kept in ideal conditions, and ReLeaf runs specials to clear out all of their products that are beginning to get old. This is key, because you know you can ALWAYS get good quality from a dispensary with that sort of practice.
Pricing Score :⭐⭐⭐⭐
ReLeaf prices are good considering the amount, but they rarely sell in increments less than an eighth. If you only have a couple bucks to pick up a gram or so, you probably won’t be able to find anything at ReLeaf.
However, if you are fine with buying an eighth or more at once, The ReLeaf Center has strains in different “tier levels,” tier prices ranging from $25 to $55 an eighth for cannabis flower.
There seems to be a choice for everyone, though. If you like edibles, wax, vapes, of even shake (which a lot of places don’t have), there is a variety of options in a wide range of prices.
Wait & Staff Score :⭐⭐⭐⭐⭐
Even when there is a line a ReLeaf there is never a wait. They are adequately staffed, and thus can get people in and out really quickly.
True to its name, The ReLeaf Center has created a buying experience that is pleasant and relaxing. I’ve met three of their security guards, each of whom was kind and helpful. The staff generally remembers your name after your second or third visit, and they are extremely helpful if you want to change it up or ask any kind of questions
The buying experience is positive whether it’s your first or hundredth time. Once you arrive, a smiling face greets you. Once you enter a smiling face asks how you are doing and welcomes you back. You never feel rushed to make a decision, or like they’re trying to get you out quickly.
Once you’ve concluded your time, they wish you a nice day, and you pass a line of smiling employees on your way out. Not only are they never understaffed, but every one of their staff members is kind, helpful, and leaves you feeling positive. The environment of this dispensary is second to none.
REQUIRED: AR MMJ CERTIFICATION
Before purchasing cannabis from a medical marijuana dispensary, like This One, Arkansas patients must first qualify for a medical marijuana certification; AR MMJ Cards can provide qualified patients with the state-required recommendation to complete this process.
Arthritis is the leading cause of disability in the United States, affecting over 27 million adults nationwide. The economic, personal, and societal impact is staggering, with the CDC reporting yearly arthritis-attributable medical care costs and earning losses at $303.5 billion.
How does arthritis occur and what are the symptoms?
Arthritis involves a diverse group of processes and commonly results in inflammation within one or more joints. The two most common forms of arthritis are osteoarthritis and rheumatoid arthritis, with other forms being autoimmune, infectious, cancerous, or traumatic.
The most encountered form of arthritis is osteoarthritis, which is essentially a degenerative disease of the joint space that occurs with normal wear and tear over time. Weight-bearing joints in the knees and hips are most affected, but osteoarthritis can affect many joints including those in the hands, feet, and spine. The inflammatory pathology of osteoarthritis is driven by a powerful cytokine called interleukin 1a. This interleukin driven (ignore the Klingon warship names here) degenerative erosion of ligaments ultimately leads to the destruction of the bone cells underlying the articular cartilage of the joint where bones meet. Patients suffering from osteoarthritis typically present with symptomatic complaints of pain, inflammation, stiffness, and crepitus (otherwise known as crackling, creaky joints).
Rheumatoid arthritis, on the other hand, is an auto-immune process in which the body’s own antibodies mistakenly attack the synovial cells that form the inner tissue lining of the joint. This systemic inflammatory disorder is largely driven by interleukin 6 and affects many organs, leading to painful, deformed joints. Patients often report symptoms of early morning stiffness of hands, feet, and the spinal column in the neck.
How does the pathology of arthritis occur?
As cells that form cartilage (chondrocytes) and line the joint (synoviocytes) become damaged, a distress signal is sent to the innate immune system via chemical messengers called cytokines and chemokines. In response, a variety of pro-inflammatory cell types are recruited to the damaged site as part of the normal response to insult in an attempt to limit joint damage and initiate repair, but this adaptive response becomes harmful when inflammation can’t be shut off. As arthritis progresses, the body’s regenerative capacity can’t keep pace with the rate of cellular destruction. A vicious cascade of events ensues, resulting in swelling of the joint and collagen degradation, and the damage to the bony matrix surrounding the joint forms a fibrotic scar.
How does endocannabinoid rescue work for arthritis?
Recall that the entire endocannabinoid system functions to maintain equilibrium, or the body’s natural balance.In other words, the ECS is a ubiquitous biochemical surge protector that evolved to restore natural equilibrium at the cellular level when systems are perturbed. The cannabinoid entourage of anti-inflammatory and pain reducing compounds interacts with the ECS at this crucial checkpoint to short-circuit this vicious cascade of events. Specifically, CBD induces the change in chemical signal from a cell-toxic pro-inflammatory signal, to cell growth and survival signal.
Chondrocytes, the cells that build cartilage, are richly endowed with CB2 cannabinoid receptors. As inflammation progresses, more CB2 receptors are recruited to the surface of the damaged cell, thereby increasing the rate of cannabidiol (CBD) binding and exerting its effects. When CBD binds with these receptors, a reversal of the pro-inflammatory sequence occurs. Cells stop recruiting to the area, swelling goes down, and redness subsides. The body then begins the process of clearing out the inflammatory debris and restoring elasticity to the joint.
The cannabinoid anti-inflammatory “switch” blocks the effects of prostaglandins driving the pro-inflammatory pathway. This is a very important point to remember because commonly available NSAIDs (advil, ibuprofen, naproxen, aspirin, etc.) and steroids target this exact same pathway. However, all NSAIDs, acetaminophen, and steroids come at the expense of their own toxicity and side effect profile. They can have deleterious effects on the stomach and kidneys in the case of NSAIDs, and toxic liver effects for acetaminophen, which is the leading cause of ED overdose. Steroids also come with their own long list of side effects that can limit their effectiveness.
Emerging scientific cannabis literature.
Cannabis medicines have been shown to reduce joint damage by 70% in chronic arthritis. In addition, cannabinoid medicines address the pain sensation processing known as nociception. Mouse and rat models have shown CBD to be effective at blocking the progression of osteo and rheumatoid arthritis at an optimal dose of 25 mg/kg. That works out to a dose of about 2 grams per day for a 70 kg (154 pound) person. CBD directly modulates the immune system by reducing harmful chemicals tnf-a and ifn-gamma that recruit cells like neutrophils and macrophages that damage the joint. In addition to turning off the destructive pro-inflammatory signals, CBD actually recruits regenerative stem cells (mesenchymal cells) to migrate to the site of injury and differentiate into chondrocytes to rebuild joint tissues. John McPartland summed it up succinctly, “The forces of embryogenesis become the forces of healing after birth.”
Why is it important to talk to your doctor about medical marijuana?
The mainstay of any medical intervention is to treat the underlying cause of symptoms and not just the symptoms of a pathologic process, all while minimizing side effects of treatment. Cannabis can effectively treat the inflammatory and pain symptoms of arthritis, although it is important to note that it does not always address the root cause. Differentiating the exact forms of arthritis is essential, and requires medical training and institute appropriate and timely intervention. For example, some forms of arthritis, like gouty arthritis (gout), are caused by microscopic crystals precipitating in the joint space. This means that gout is effectively treated with targeted medications that lower uric acid levels rather than with cannabidiols. In addition, some joint pains are caused by an infectious agent. These are medical emergencies and require immediate joint drainage and antibiotic therapy to avert permanent damage.
The take home point is that a trained physician can recognize these different entities and take appropriate action to limit joint damage and maximize symptom relief. Cannabis medicines can be a powerful tool in a patient’s armamentarium if used correctly.
How can ARMMJCards help?
At ARMMJCards, we do far more than certify patients for MMJ cards. We educate patients on how to effectively incorporate cannabis medicines into their comprehensive treatment plan. To learn more or see how you can qualify, visit us here or call 479-308-500.
Before purchasing cannabis from a medical marijuana dispensary, like This One, Arkansas patients must first qualify for a medical marijuana certification; AR MMJ Cards can provide qualified patients with the state-required recommendation to complete this process.
With the explosion of cannabis products into the mainstream, this topic couldn’t be hotter. Although cannabis has hundreds of identified cannabinoids compounds, Tetrahydrocannabinol (THC) and Cannabidiol (CBD) are present in the highest concentrations and account for the bulk of beneficial physiologic properties that can be attributed to cannabis plants.
These two compounds have important differences for users, so having the right information about them and what they do is crucial to becoming a more informed patient and making healthier decisions.
THC vs CBD: Psychoactive effects
The most striking difference between these two are the psychoactive effects. THC administration results in an unmistakable euphoric “high” whereas CBD does not have overt psychoactive properties. For this reason, some users might seek out one or the other at a particular time or setting.
CBD has a much more marked effect on peripheral nerves and produces a more marked effect of a body relaxation due to it’s soothing anti-inflammatory properties.
For example, long haul truck drivers might not want to risk using THC for legal and safety reasons, but still might desire the beneficial effects of cannabinoids. In this case, CBD would be a more logical choice.
CBD can help safely promote relaxation and sooth hyperactive nerves, without impairing one’s judgement.
On the other hand, a home-bound patient who might have anxiety and pain issues may benefit more greatly from the euphoric distraction provided by THC compounds.
Research has shown the the highest yield medicinal cannabis strains contain a balanced of both THC and CBD.
The decision on which to use primarily depends on the patient’s comfort level with feeling the euphoric “high” associated with THC administration.
What are Cannabinoids?
Simply put, cannabinoids are compounds that interact with the endocannabinoid system. Cannabinoids can either by synthesized by the body (yes, really) and are thus called ENDOcannabinoids. The two best characterized of endocannabinoids are Anandamide and 2-Acylglycerol, or 2-AG for short. These compounds are made in the body and have similar structures to cannabinoids made in plants. The phytocannabinoids synthesized in plants bind to the same receptors in the body as the endocannabinoids and are degraded by the same enzymes.
This opens up another huge topic of the endocannabinoid system which we will delve into as a recurring theme on future blogs. In short, this system is present in humans and other mammals and has evolved over thousands of years to restore homeostasis, or natural balance, to our physiologic systems when we are encountered with stimuli that perturb our natural balance. As a matter of fact, the endocannabinoid system is a collective of hormones, receptors, and enzymes with active sites in the brain, digestive system, immune cells, reproductive systems, pain sensory nerves, emotional centers, sleep and wakefulness sites, and memory to name a few. With such far reaching functions, it is clear to see why people are so interested in cannabis products making a resurgence as medicine.
Cannabinoids are the lipophilic, fat soluble substances that interact with the receptors of the cannabinoid system. It is only after binding to their specific receptor that cannabinoid compounds exert their effects. Once bound to their cannabinoid receptors, known as the CB1 and CB2 receptors, a cascade of reactions follow within the target cell that result in the release of neurotransmitters or hormone that further medicate and/or amplify the effects of cannabinoids.
THC vs CBD: A closer look at the chemistry
On first look, Tetrahydrocannabinol and Cannabidiol seem almost identical. They share a common chemical formula and have an equivalent molecular weight. Looking at their chemical structure looks almost identical even to the untrained non-chemist. But upon closer look at the THC compound, you can notice a cyclic structure with an Oxygen atom sandwiched in between two carbon atoms in what is called an Ether bond. This enables THC to sit comfortable in its receptor like a lock and key and exert its effects.
On the other hand, Cannabidiol has opened up that ring structure and you notice a hydroxyl group (-OH) at the end where the oxygen was formerly bound on each side by carbon atoms. Now the structure has two -OH groups and is therefore called a -Diol. This means that this structure cannot sit comfortably in the same receptor as THC because of its nonpermissive shape. In fact, when CBD comes into contact with the CB1 receptor, it actually restricts binding of THC to the active site of tis receptor. This modulation of THC’s activity by CBD receptor binding is called Allosteric inhibition.
THC vs. CBD: Legal status
At the time of this writing, products containing higher than 0.3% THC are still considered illegal on a federal level in the United States as a schedule I drug. CBD based products with less than 0.3% THC are not psychoactive and are completely legal for consumption in all US States and do not require a Medical Marijuana Card in order to get CBD from a retailer. On the other hand, in states that have a medical marijuana program, patients can still obtain medical marijuana with appropriate physician certification and licensure by that state despite marijuana’s status as a federally illegal drug. This means that if patients abide by the rules of their respective state’s medical marijuana program, they will not be subject to criminal prosecution by local and state authorities. The Rohrabacher-Farr Amendment of 2014 prohibits the Justice Department from spending funds to interfere with the implementation of state medical cannabis laws.
THC vs. CBD: Will I pass a drug test?
Patients taking THC containing products should be advised that use will likely result in a positive test on a most employment-based drug screens. Most drug tests will not show positive for most CBD based products that are below the 0.3% threshold but certain high sensitivity tests might show positive. Pure CBD isolates contain no THC, but CBD products labeled as “Full Spectrum” contain the full entourage of cannabinoids and it is possible to show positive for THC despite not having psychoactive effects. For the most part, however, users can rest assured that most products marketed as CBD that are below 0.3% THC will not test positive for THC.
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To receive a medical marijuana card in the state of Arkansas, a patient must receive a medical marijuana card certification from a licensed Medical Marijuana Doctor. The patient will be age 18 or over (or have parental consent), be diagnosed with a qualifying condition (link to other question below), have written certification from a Medical Cannabis Doctor, be an Arkansas Resident, and not be a member of the Arkansas National Guard or United States Military (due to state law regulations). Once the patient receives medical marijuana card certification from an Arkansas Medical Marijuana Doctor, the patient can apply to the state to receive their dispensary card. For a detailed walk through of how to apply to the State of Arkansas for your medical marijuana card, check out our video on YouTube. Arkansas does offer medical marijuana for visiting patients, there is an application that must be competed and approved. Visit the State of Arkansas’ FAQs page for the application for medical marijuana patients in other states who are visiting Arkansas.
At AR MMJ Cards, we charge $100 for cannabis card certifications and $99 for renewals (https://www.armmjcards.com/services/). Our medical marijuana card certifications are conducted using telemedicine. Telemedicine visits are completed virtually with a Medical Marijuana Doctor and patient. To see if a patient qualifies for a cannabis card certification, the patient will complete paperwork through a secure portal. The customer care team will reach out to patients that qualify to schedule an appointment with a doctor at AR MMJ Cards. Patients only pay for telemedicine visits where a medical marijuana certification is recommended! To start your cannabis certification with one of our card certification doctors, visit our site – https://www.armmjcards.com/begin-your-certification-now/. Once certification has been received, a patient can apply to the state of Arkansas for their MMJ card.
The products have a label that lists THC and CBD strength, medical marijuana type (indica, sativa, or hybrid), strain name, price, and weight. Depending on a medical marijuana patient’s condition, specific terpenes, type, and strength of the cannabis product can impact a condition positively. When Dr. Whitelocke or another Medical Marijuana Doctor at AR MMJ Cards meets with a patient, the specifics will be discussed as to which cannabis strains or terpenes may be a good fit for the patient’s condition. At AR MMJ Cards, we are dedicated to helping patients and ensuring that marijuana medicine is a good fit – we aren’t your average Medical Cannabis Doctor (Read more about us)! AR MMJ Cards has reviewed several Cannabis Dispensaries in the Arkansas area including The Releaf Center, Acanza, Purspirit and others. To read our Medical Marijuana Dispensary Reviews, click here. For a full list of dispensaries, review the list on Arkansas.gov.
