Physical Medicine

& Rehab Center of Orlando

341 N. Maitland Ave

Ste. 200

Maitland FL 32751

For Life-Threatening Emergencies Call 911

© 2018 Physical Medicine & Rehab Center of Orlando. Proudly created with Wix.com

Click below to read Dr. Oliveros' article published by The Orlando Sentinel:

Medical marijuana can help reduce our opioid dependency: Physician

Is Medical Marijuana right for you?

Medical Marijuana is approved for:

  • Chronic Non-Malignant Pain

  • PTSD

  • Glaucoma

  • HIV/AIDS

  • Crohn's Disease

  • Multiple Sclerosis

  • ALS

  • Parkinson's

FAQ Medical Cannabis

Is it covered by insurance? And can I use my insurance card to pay for my visits?

Since cannabis is still classified as schedule I by the DEA and illegal under federal law, it is not covered by medical insurance.  The cannabis, medical evaluation, follow up and refills will be cash only. There is ongoing political lobbying to change cannabis to schedule II, which will make it legal. Cannabis is only dispensed by 7 approved dispensaries in the state of Florida. It cannot be obtained through regular pharmacies.

 

How do you take it?  Do I have to smoke it?

Smoking is not allowed. It is available for oral consumption, topical application, nasal sprays, suppositories and vaporization.  The dose of medical cannabis that you take will vary based on the type and severity of your condition, the level of experience you have with cannabis, and the delivery method you choose. The one important recommendation to follow: Start low and go slow. Be patient. You may not notice a significant response initially. For the oral capsules and the edible oil, wait at least 4-6 hours, before taking another dose.  Patients who are new to edible cannabis oil should begin their therapy with a dose less than 0.5 ml. 

 

Why and how does Cannabis Works?

Medical cannabis shouldn’t be seen as a cure for any disease. Instead, it is used to relieve the symptoms caused by a variety of different diseases and conditions. During the last 3 decades, it was discovered that every person has an endocannabinoid system, just like a nervous system. The cannabinoids from the medical cannabis supplement the endocannabinoids normally produced in your body, improving homeostasis/balance and providing symptomatic relief.

The endocannabinoid system is involved in many processes including pain-sensation (chronic pain, neuropathic pain), mood (anxiety/depression), memory (extinction), inflammation and appetite. Some conditions affect the proper functioning of the endocannabinoid system, which can lead to many of these symptoms.

 

Why try THC cannabis if opioids work for my symptoms?

  • Opioids come with a significant risk of side effects and dependency.

  • Combining cannabis with opioids in a complementary plan of care may result in a to achieve the desired level of pain management (Manzanares, et al., 2006).  Numerous patients have successfully used medical cannabis to eliminate or reduce the need for opioids.

  • As opposed to opioids, with even high doses of medical cannabis because there are relatively few cannabinoid receptors in the brainstem, which controls involuntary reflexes and cardiorespiratory centers (Herkenham et al., 1990). 

  • Due to cannabis multiple effects, you may also be able to decrease or eliminate other medications such as medications for anxiety, depression, nerve pain and for insomnia.

Can I decrease opioids with medical cannabis? Is it safe taking medical cannabis with an opioid?

A study showed 64% were able to decrease their opioids with medical cannabis. The combination of opioids and cannabis has a more effective synergistic therapeutic effect allowing for lower dose of opioids and therefore lesser side effects from the opioids.  Cannabis can alleviate anxiety and instead taking a benzodiazepine e.g. Xanax, it is safer taking it with an opioid. On the other hand, the combination of anti-anxiety medications such as the benzodiazepines e.g. Diazepam (Valium), Alprazolam (Xanax), Clonazepam (Klonopin), etc. can be fatal. In 2015, 23 % of people who died of opioid overdose also tested positive for benzodiazepine. Both the opioids and benzodiazepine can suppress breathing leading to fatal overdose. States with legal cannabis have 25% less opioid overdoses. A recent medical conference in Australia discussed this in more details.  Please check the link by clicking HERE.   

How do I know what will work for me?

1. Categorize your medical cannabis either by ratio of the  THC:CBD or by species.

              a. By ratio of THC:CBD:  Progress from low THC (primarily CBD) or CBD Dominant to Balanced, then THC dominant   (THC decreases pain)

              b. By species: Sativa vs. Indica vs. Hybrid. Sativa – energizing; daytime; Indica – relaxing; night time

2. The route of administration depends on the goal:

        a. oral (sublingual or ingestion): slower onset but longer relief, q 6-8 h

        b. Vaping: quicker onset but shorter duration of relief  q  3 hours

        c. Topical: for localized conditions, apply 3-4x/day

3. Minimize side effects: Start low and titrate slowly; take whole plant’s extract: Entourage effect; CBD mitigates THC’s adverse effects.

4. Patient’s experience and preference. Naive  vs. experienced

  • ’s:  Set and setting. Safe place, right frame of mind.

  • Wide range of dose:  1-5ug/kg/day up to 1-20 mg/kg/day. Be patient.

5. Cannabis is an adaptogen

6. Gradual tolerance to the side effects of large doses.

Ok, I've started medical marijuana but nothing seems to work!

  • Find your "Sweet spot".  Decrease the dose or potency of the THC. 

  • Take a "drug holiday" for 1-2 days to reset your endocannabinoid system (ECS).

  • Change route of administration: 70 % prefers vaping. Rapid response and easier to titrate.  Vape properly.

  • Small but frequent dosing with vaping to minimize psychoactive effect.

  • Different routes:lozenges, rectal, etc?

  • Different forms:may need the whole plant e.g. flower buds for the entourage effect.

  • Work with your dispensaries and try several blends until you find which ones work well for you.