Cannabis Types and Tips

Cannabis Types and Tips

A friend recently shared that she suffers from chronic pain in her back and hips. She has heard so much hype about CBD, but is “on the fence” about trying the product to help her pain. She wondered how people could go to work if they were “high on CBD”?

Press the pause button here. I don’t think she’s unique in her lack of understanding about cannabis products.

In a general sense, we can divide cannabis products into the following broad categories:

  • High Time – High THC (“The High Causer”) and Low CBD ratio. This would be the familiar marijuana smoked by millions to get high.
  • Possibly High Time – Mixed ratio of THC to CBD. Could possibly cause a psychoactive effect, but not as intense as varietals that are THC dominant.
  • No High Time – High CBD to Low THC ratio. This is the non – euphoric marijuana or hemp products.

Cannabidiol does not cause a psychoactive effect on the body like THC. The use of cannabis as a botanical healing agent does not have to come with a “high” effect. Dr. Dustin Sulak, director of Integr8 Health, notes “Most people are surprised to learn that the therapeutic effects of cannabis can be achieved at dosages lower than those required to produce euphoria or impairment.” It is possible to achieve healing without the high.

CBD and THC work better as a couple than as single isolates. For example, CBD can enhance THC’s anti-inflammatory and pain relieving benefits and reduce the unwanted side effects. For some people, however, THC is either not tolerated or is undesirable. Still, studies show that single molecule cannabinoids are not as therapeutic as whole plant formulations. So the key is finding the right balance, and within legal restrictions, for your needs.

CBD for the masses is moving towards a high CBD to THC ratio with less than .3% of the latter (meeting federal standards). There are many products to choose from, so be selective. The tips I shared with my friend (and my clients) include:

  • Start low and go slow with dosing of cannabis products.
  • Work with a medical professional, a Nurse Cannabis Coach, to help guide your dosing and monitor results.
  • If THC restrictions are dictated by law or employment in your part of the world, CBD isolate products are a reasonable start.
  • You can heal without the high.



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So a nurse walks into a weed shop….

I’m a life long learner. A forever student. A seeker of information. As they say, if you are the smartest person in the room, then you are probably in the wrong room. So I find new rooms.

I am a CBD and cannabis educator and I thought it might be helpful to find out what people are being told about these products out in the world. Out on the front lines. Out in the dispensaries. In early 2018, Colorado had approximately 520 active recreational dispensaries – plenty to choose from for my “research”. Here’s a sampling of what I learned.

Dispensary 1: It’s a Saturday morning around 10 am and I coax my husband to go with me to a dispensary in Aurora, Colorado.  Just off a well traveled road and located in a strip mall, Dispensary 1 is flanked by a donut shop and nail salon. Upon entering, we notice the waiting room is VERY full. The space resembles an old medical office or a laundromat. A number of people are sitting quietly, although there is a group of 4 or 5 adults that are not sitting quietly. Rather, they are loud, laughing, looking in brown paper bags and eating gummy stars. There is a window  – kind of like at the DMV – where a young lady speaks through a metal hole. She takes our ID’s and gives us a number – kind of like at the DMV. When our number is called, we are buzzed through a large metal fire door.  Our escort takes us down a long corridor and several turns later, we enter a large open room with 3 glass counters. Our “budtender” is Ace and he will be helping us today. I ask for a product to help with flying anxiety. Ace shows us several strains high in THC, to be inhaled that are “guaranteed to knock you right out”. “Hmmm”, I say, “but what about just taking the edge off?”. Ace tells us his mom uses 1:1 ratio capsule, 10 mg of THC and 10 mg of CBD. Anything else we need to know? I ask. Ace says nope. We make our purchase and leave the way we came, escorted. The rowdy folks are still partying loudly in the waiting room. I have to say, it was weird.

Dispensary 2: I am between appointments during a workday on a Tuesday. Since I have some time, I stop at a recommended dispensary in Denver, Colorado. As I am walking towards the front door, I get a nosebleed. Great. I push on the door and nothing happens. I push again, holding pressure against my nose with my left hand and try pushing harder with my right hand. Nothing happens. Then, there’s a buzzing sound and I almost fall into the lobby as the door opens. You can just picture it, right? Lady in nice business clothes stumbling into a marijuana lobby with blood dripping from her face. I’m not kidding. “Hello”, I say to the young lady sitting at a large metal desk – kind of like at a car dealership. “May I have a kleenex?” She gives me a kleenex, and she’s laughing and for some reason I try to regain a sense of dignity, so I say “I’m a nurse”. Great. Moving on, she takes my ID and I am escorted through another metal fire door. Another corridor, another big room with several glass counters. This time, my budtender is Bill. Bill has been enjoying the product line. Bill is high but helpful as he recommends Chewba Chews. These CBD chewables do contain more than 0.3% THC. I would not be able to legally bring them on my airplane trip. Bill says since they look like tootsie rolls, I can just wrap them with my other snacks and I should be “fine”. Thanks Bill!

Dispensary 3: A friend tells me about a pen that is discrete and sleek. One can inhale hybrid product (sativa and indica) that REALLY helps with anxiety. So, I find dispensary number 3. In a suburb of Denver, in a strip mall with a coffee shop and a pet store and a bakery, I feel happy when I walk in the lobby. No locked door, no glass window, no metal desk noted. Instead, I walk into a living room. I am greeted by a smiling young lady who says, “Welcome! How can we help you today?” Nice. I tell her about my friend’s pen and she offers me a first time customer coupon. Nice. She takes my ID and walks me back to the product room. There a green ferns, soft music and it smells like coffee. Nice, again. I am a customer for life. David asks about my experience with CBD and THC. Do I like tinctures? Have I tried oils? He tells me all about the pen, in great detail, with room for my questions. David is like my brother. This is a good place. I am happy. I make my purchase and I know I will tell others about Dispensary 3.

All in all, my “research” did not surprise me. I see a need for more consumer education, both for recreational and medicinal users. Nurses can fill that knowledge gap.

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The ABC’s of CBD

Alot of Big Controversy about CBD.

Project CBD shares with us that  CBD is a cannabis compound that has significant medical benefits, and should not be mistaken for “pot”. The fact that CBD-rich cannabis is non-psychoactive or less psychoactive than THC-dominant strains makes it an appealing option for patients looking for relief from inflammationpainanxietypsychosisseizures, spasms, and other conditions without disconcerting feelings of lethargy or dysphoria.

The World Health Organization’s Expert Committee on Drug Dependence concluded  that “In humans, CBD exhibits no effects indicative of any abuse or dependence potential.”

Conversely, the U.S. Drug Enforcement Administration (DEA) says that CBD must be treated the same as THC and other cannabinoids from a cannabis plant, and it should remain a Schedule I drug.

As a child of the 70’s, I know marijuana. As a mom  in Colorado, I experienced the 180 degree turnabout of talking to the kids about a substance that was once illegal but now is not in 29 states. As an RN and a member of the American Cannabis Nurses Association, I embrace the value of sharing knowledge about the endocannabinoid system and the safe use of herbal products in standard nursing practice.

For me, CBD is a food. And food can be powerful medicine. And I can’t help but dream of a world where opioids have some major competition.



3 Top Tips for Using a Nurse Case Manager

“I feel like a nurse case manager would be helpful on this file.” “I’d like to see what a nurse could do to get this moving.” “I think I might want a nurse on this one.”

Ask any adjuster,  experienced or novice, why they would bring a nurse case manager on to a file, and you are likely to get a variety of responses.

Based upon managed care industry reports, the typical impact a nurse case manager can have upon claims is approximately an 18% reduction in future medical costs, a 26% lower overall claims cost and a 15% faster claims resolution.

The challenge for program managers and claims adjusters is knowing when, how and why to utilize nurse case management services. While it often makes good sense to use nurse case managers, a strategy should be in place.  Excessive use may only increase claims costs while random usage can lead to lost opportunity.

You can’t manage what you don’t measure. Shouldn’t there be standard practices for referral to case management? Shouldn’t there be structure in the referral process?  Mid claim utilization monitoring? Outcome measurements? Yes, yes, yes and yes.

3 top tips to consider for improved utilization of NCM services:

  1. Know your triggers. Bringing a nurse case manager on a file should be triggered by internal team criteria. Train the claims team on the triggers for having support on a file. These triggers can vary according to the organization. They can be injury specific, industry specific or result from social behavioral impacts identified on the initial interview.
  2. Know your timing. Early in and early out is the goal of a good case manager. Early intervention has been shown to be more cost effective in the long run. Claims that are likely to turn off the predictable course should have NCM support out of the gate. Train the claims team on the recognizable claim “red flags”. Early case management support can help save medical and indemnity costs.
  3. Know your end game. Train the claims team on the measurable markers of successful nurse case management support. National guidelines can help to predict the expected outcome. Goal markers can include: reduction in medical costs, early return to work if medically appropriate, and timely arrival at file closure (maximum medical improvement).

The opportunity for medical cost savings does exist with the appropriate use of nurse case managers!  Monitor  the “product” and achieve better results.