Medicinal Cannabis: “Safe but complex therapy”

Six years have passed since the first training received by doctors on the island to recommend the use of medical cannabis people with certain health conditions. Dr. Jaime Claudio Villamil remembers him very well because he was one of those who participated as a physician on that historic occasion. These days, moreover, the family doctor and professor at the University of Puerto Rico has just published his book on the subject, “Medicinal Cannabis: Recommendation, formulation, dosage, review, integration”where he collects his experience with some 5,000 patients and training 1,000 doctors with “this safe, but complex therapy.”

But, above all, the family doctor says that his interest in the text is to offer a guide on the use of medicinal cannabis and draw attention to the importance of making precise and integrated recommendations for what he calls “the medullary trinity of discomfort”. It refers to sleep problems, anxiety-depression and chronic pain.

“I am emphasizing the steps we have to take to continue improving the clinical quality of this therapy, which includes universal digital recommendation, availability of flower core inventory and products with a consistent and transparent composition, observational studies, communication and collaboration with the rest of the team. of health (of the patient) and the integration of other alternative mind and body therapies to promote well-being and healing”, explains Dr. Claudio, after indicating that, to date, over 220,000 patients have been certified for the use of medicinal cannabis , of which 120,000 are inactive.

Cover of Dr. Jaime Claudio's book where he proposes that precise and integrated recommendations be made for what he calls
Cover of Dr. Jaime Claudio’s book where he proposes that precise and integrated recommendations be made for what he calls “the core trinity of discomforts”, sleep problems, anxiety-depression and chronic pain. (Supplied)

In the same way, the researcher emphasizes the importance of educating people who use medicinal cannabis and “innovative health surveillance.” According to Claudio, building “a regulated and top-quality industry in terms of raw material for flowers, the production of quality products and their availability in dispensaries throughout the island” has been fully accomplished.

But a reference guide is necessary “to have a north, a compass”. According to the doctor, medical cannabis is a safe botanical polypharmaceutical, but complex, with minimal adverse effects in the short and long term. However, he points out that there is the potential for some unpleasant short-term effects and long-term considerations for effective treatment. He mentions, for example, the risk that certain cannabis ingredients, such as THC (tetrahydrocannabinolthe chemical compound in cannabis that has the main psychoactive effect on the human body) or CBD (cannabidiol, a non-psychoactive cannabinoid used to relieve anxiety, inflammation and the perception of pain), may interact with any medication the person takes for other health conditions.

“You have to be aware that there are other medicines that can interact, not so much with THC, but with CBD. That is the paradox, the ingredient that we consider most innocuous, because it is not psychointoxicant, it can have interactions with some medications. That is why we need fairness of reference and encourage dialogue. And that is why, in my book, in addition to a reference video, there is a call to action for all stakeholders to encourage all doctors to use the same criteria and parameters to recommend medical cannabis. But it must be done with a universal recommendation sheet that allows us to carry out observational studies”, reiterates the doctor.

It should be clarified that THC and CBD are two cannabinoids or one of the more than 200 known chemical compounds in cannabis that define and modify its mechanism of action, but there is no lethal amount or one that causes permanent damage, says Dr. Claudio. Furthermore, both act on the cannabinoid receptors in the human body, which are mainly found in the brain and in the nervous and immune systems.

What is there and what is needed

One of the difficulties at the moment, points out Dr. Claudio, is that no observational studies have been carried out in the population on the use of cannabis. To which is added the stigma that the Drug Enforcement Administration (DEA) determined that cannabis remains a Schedule I drug under the federal Controlled Substances Act, along with LSD and heroin.

“This has absurdly limited methodical research, but all this must be changing in the next two years,” says the doctor, who emphasizes that the medicinal use of cannabis has been used by humanity since time immemorial, although more is remembered its recreational use is believed to have begun in the 16th century.

Patients who used the treatment had fewer seizures, according to the FDA's internal review.  (Shutterstock)
According to Dr. Claudio, very good cannabis products have been grown in Puerto Rico “that we know what they contain, but there has not been a panel of experts that says what we should have in these medullary flowers.” (Shutterstock)

According to Dr. Claudio, very good cannabis products have been grown in Puerto Rico “that we know what they contain, but there has not been a panel of experts that says what we should have in these medullary flowers.” For example, he says that some flowers are easier to grow and give a higher yield. In the same way, there are sustained products -such as edibles and gummies-, and acute or fast-acting ones, such as vaporized flower and vaporizing oil.

“We could have access to flowers high in CBD harvested in Puerto Rico, but if there is no promotion and demand, it is not the best-selling one because the flowers that most captivate people are those with a high THC content. It is not merely what the industry comes up with as an opportunity, but little by little, with the experience that we are adding, with observational studies, we begin to reconcile what is available with what is needed”, proposes Dr. Claudio, after mentioning another important component: the integration of mind and body.

“Whoever comes looking for cannabis is looking to take more of their disease process. That is why I always say that I practice cannabis and much more, that it relieves pain, but you must also disarm fatuous thoughts through cognitive behavioral therapy, which is part of my recommendation for patients who want to live a life with less pain and with integration of mind and body”, he recommends.

Communication with the rest of the medical team treating the person using cannabis is also extremely important. However, Dr. Claudio points out that at this time there is no responsibility or system that guarantees that the specialist doctor who treats a disease, such as a cardiologist, gastroenterologist or rheumatologist, has detailed and accurate information on cannabis therapy. “Imagine that we have a universal recommendation, that you go to the dispensary and they dispense something to you, that information goes to your doctor’s office. That would be a quantitative and qualitative leap in improving the quality of medical cannabis therapeutics.”

However, the specialist clarifies that what he is proposing is a reference guide to use when needed, in addition to having “reasonable expectations because this is not a miraculous therapy, it is a therapy that can have a very favorable effect if it is paired (related to ) with other alternatives related to general health”. Among them, he mentions cognitive behavioral therapy, meditation, yoga and exercises.

Cannabidiol oils and their derivative products have become increasingly popular.  (Julia Teichmann/Pixabay)
Cannabidiol oils and their derivative products have become increasingly popular. (Julia Teichmann/Pixabay)

Another difficulty that patients seeking medicinal cannabis encounter is finding the one that only has CBD, because it is not easily available in dispensaries, but it is in gas stations and supermarkets. They are products brought from the United States, Europe and China and you can “run the risk of being given a pig for a hare”. “It’s a product that says CBD cannabis, but they don’t give you specific details of how much CBD it has, so it’s not necessarily going to be therapeutic,” warns Dr. Claudio.

“Normally you are looking for a broad-spectrum CBD. This means that it has all the components of the plant except THC, since it has all the burundanga of the plant. That has been seen to be more effective, usually, than isolated CBD. But, in short, because CBD is available outside the dispensary, you don’t have an incentive to sell it, “says the doctor, who believes that this also has to do with the demand. “In other words, if the patient asks for the tall flowers that CBD, I think they would be more available.”

The book “Medicinal Cannabis: Recommendation, formulation, dosage, review, integration” is available in the main bookstores in the country and in medical cannabis dispensaries.


Depending on the type of therapy you are looking for, you can opt for cannabis strains with higher or lower levels of THC or CBD. For example, if you are looking for an experience where you do not have the psychoactive effects of THC, you can opt for the CBD products on the market. The other decision has to do with choosing cannabis sativa, cannabis indica and hybrid cannabis:

Sativa: The plant takes 10-15 weeks to mature and is known for its cerebral, energetic and invigorating potential which is particularly suitable for daytime use. Medically, it can be used to help people with depression and chronic pain.

Indica: It takes six to eight weeks to mature and is known for its high level of relaxation and medically can help people with nausea, anxiety and acute pain.

Hybrid: It is a mix between two different species of cannabis, usually sativa and indica. This allows for two or more particular traits to be selected and bred, as well as accounting for much of the diversity of choice in a dispensary.

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