In this series, we do a deep dive with cannabis industry folks to get an insider’s perspective of all things cannabis. This week, we pose our questions to a patient – EO CEO Scott Foster – and a doctor – Medical Cannabis Physician Dr. Jennifer Minkovich.
Dr. Minkovich, what factors should a person consider when choosing a strain (indica v sativa, THC content v plant profile, etc.)?
That is a great question. There’s really only one reliable way to evaluate and pick a cannabis product, and that is, to look at the cannabinoid and terpene profiles on the label. The cannabinoids and terpenes in the cannabis plant are the naturally-occurring plant molecules that bind to the receptors in our body and produce an effect. Different cannabinoids create different effects, and different terpenes create different effects. For example, from the available scientific literature, we know that the minor cannabinoid called CBN, or cannabinol, has a sedating effect when used in conjunction with even a small amount of THC. Thus, many products out there that are marketed for insomnia are actually just isolates of THC and CBN. It’s also important to look at the amount of THC contained in the product. THC has what’s called a “bimodal effect,” meaning that, at low doses, it often causes an uplifting, energetic feeling, while at higher doses it induces sedation. By the way, this is not unique at all to THC; many chemical compounds affect the human body in this bimodal way.
When it comes to terpenes, the research is less robust. There are some well-accepted concepts however. For example, myrcene, which is the most abundant terpene found in the cannabis plant naturally, causes sedation at high levels. What is a “high level” you ask? The answer is that we don’t know exactly. There’s not enough research to give a clear answer. The widely accepted answer amongst dispensary pharmacists is that any terpene present in an amount that is 2% or more of the total weight of the product is considered to be significant. To this day, it is still unclear to me where this rule of thumb comes from, and I suspect that, just like every other chemical, medicine, or molecule, each terpene probably has a specific range of dosing that is optimal. For now though, we are just making due with the information that we have and making the best decisions that we can based on imperfect data, which happens a lot in the world of medicine. The take-home message is really that if you know what cannabinoids and what terpenes are in your cannabis flower or in your cannabis product, and you have a basic understanding of what effect each cannabinoid and terpene has in the human body, you can then predict the overall effect that that cannabis product is going to have in your body.
What about picking products based on the sativa versus indica labels?
Great question. One totally unreliable way to pick a cannabis flower or product is to go by the misleading terms “sativa” and “indica,” which continue to plague us to this day. We are so entrenched with these terms that patients, budtenders, and grower/processors alike still use them and label products as such, which is very detrimental to the consumer. We’ve been brainwashed to believe that something labeled as “indica” is going to cause sedation, relaxation, and couch-lock, while something labeled as “sativa” is going to cause an uplifted, euphoric feeling. Unfortunately this doesn’t line up, and many cannabis consumers and MMJ patients are relying on those terms to make purchasing decisions, which can lead to poor outcomes.
To be clear, “sativa” and “indica” are horticultural terms that refer to the morphology of the cannabis plant, meaning what the plant looks like. If the plant is short and bushy we call it “indica”; If the plant is tall and thin with long leaves, we call it “sativa.” But the way a cannabis plant looks does correlate with the exact genetics of the plant and does not tell us the cannabinoid and terpene makeup of the plant, and therefore does not accurately predict how that plant is going to affect us. I try and try and try to discourage people, including GP reps, dispensary staff, and patients, from using those terms, but I’m basically screaming into the void. The terminology is still too widespread. I’m confident though that moving forward, with so much interest being focused on the science of cannabis, and with so many people actively trying to learn about it, that we will one day shake those terms off.
Scott how do you, as an MMJ patient, navigate cannabis products?
With indica vs sativa not being a reliable term as Dr. Minkovich mentioned, I tend to look more at the genetics and cannabinoid profile, when it’s available. Using sites like Leafly or Wikileaf, if I see a strain that was created from other strains that I like, then there’s a good chance I’m going to like that new one as well. In PA, a few dispensaries have started putting some of the product labels online on their websites to view, but it’s rare, and their accuracy should be taken with a grain of salt. My strategy has been that when I find a new strain that I like, I try to take note of the cannabinoid profile on the label and compare it to other strains that may have had similar effects. After a few months of logging this data, I started to identify the specific terpenes and THC/CBD ratios that suited me best. I treat my anxiety with cannabis, but I found that some strains could actually worsen my anxiety due to a high THC/CBD ratio, so I pay close attention to THC and CBD content. In addition, I have found that certain terpene profiles make my head race, so I avoid them. I also try to follow genetic lineage, but even that is getting harder to trust with continued hybridization over the years.
Scott, as you are aware, a lot of folks out there focus solely on THC content when making a purchase. What do you think about this purchasing strategy?
I’m definitely pro-THC; It is of course a really important cannabinoid, but it’s definitely not the only thing to consider. I’ve had high-THC products that were nearly completely devoid of any other cannabinoids, and the experience was severely lacking in medicinal benefit. Focusing mainly on the THC content when purchasing also perpetuates some of the mislabeling in the industry as well. That’s why it’s so important that patients understand the entourage effect and how these compounds work together to provide their effects. That’s the only true way to get the most out of this awesome plant– Understand it and understand yourself, then apply the two.
Dr Minkovich, What about picking products using their so-called strain name?
This approach is better than nothing but it’s not as reliable as going by the cannabinoid and terpene profile. A recent study done looked at same-name cannabis varieties (“strains”) from several dispensaries in three states. The study specifically looked at the genetics of the strains and found that strain names often didn’t match up with the expected genetics. Meaning that cannabis flower that’s called Purple Kush that you purchase at one dispensary may be vastly different in it’s chemical composition from a Purple Kush product purchased at another dispensary. The study even found that there were inconsistencies within the same dispensary. This might seem crazy when we consider that the plants are often clones of each other, which should be genetically identical. However, we know that growing conditions affect the chemical composition, the cannabinoid and terpene contents, of a plant. The study also suggests that there may be some mislabeling going on out there, with a grower processor labeling a specific chemovar (aka “strain”) as whatever the popular strain is at the time. This is a deceptive practice and is done obviously to increase sales.
Scott what do you say on this topic of strain name?
I agree with Dr. Minkovich that even this isn’t the most reliable way to go. It is known that batches can even vary at the same dispensary. One approach I’ve taken is to follow influencers and other community members on social media like Instagram and Reddit for recent product reviews of what’s on the shelf currently. The cannabis community loves to take pics and share their product reviews.