Do Strains Really Matter in Medical Cannabis?
Given that there are about 7,000 cannabis strains out there, one has to ask themselves: How different can they all be?
The cannabis industry would have you believe that each of these thousands of strains is unique, and that as a patient you really need to try them all in order to find the one perfect for you.
However, as a clinician, I’ve found that as far as medicinal cannabis goes, the unique strain doesn’t really matter in terms of medical benefit.
How can this be?
To start off, we should talk about the difference between a patient’s preferences and feelings about a strain versus their individual outcome in terms of treatment.
For a rough analogy, let’s take pizza.
If I were to place an order at the local pizzeria and ask for your choice of toppings, you might tell me that you want pepperoni instead of mushroom. You ask for this based on your experience of how the taste of that pizza makes you feel.
That’s your preference.
However, if you were simply trying to solve your hunger, the toppings wouldn’t matter as much. As long as the slice in your hand fills your belly, the major issue troubling you is solved.
That’s your outcome.
Following that same train of thought, let’s take a medical issue such as back pain.
Both recreational and medical cannabis consumers may find one strain they prefer in terms of the effect it has on their perception. Say that you really enjoy the uplifting experience of consuming Strawberry Cough over the more drowsy Afghan Kush.
That’s your preference.
However, when it comes to the question of whether your back pain is relieved by vaporizing Strawberry Cough, Afghan Kush, or Pineapple Express, it turns out they all work just fine.
That’s your outcome.
To summarize: what we’ve found on a clinical level is that while cannabis patients may prefer treating their issue with one strain of cannabis over the other, there is not a significant difference between strains in terms of outcome on their condition. Thus, there’s no medical reason to focus on prescribing one strain over the other.
This isn’t really surprising once you take a step back from the established wisdom on strains.
Take, for example, the basic classifications of “Indica” and “Sativa.”
While anecdotal cannabis culture would tell you that one is relaxing and the other is energizing, that just doesn’t hold a lot of water when studied in a clinical setting.
Historically the terms “Indica” and “Sativa” referred mainly to the morphology of the plant and where it came from. They did not pertain to which medical outcome consuming them would produce.
If you look further into the research, you’ll find that strains which are supposed to fall directly into one category or another have so much chemical similarity that there’s no real basis for the expected difference in their behavior.
Even the idea that strains with high terpene levels supposedly lead to medical outcomes doesn’t necessarily ring true when it comes to the research.
While you could say that a strain containing higher levels of linalool is better for someone with ADHD, that strain may also have other terpenes, like Limonene, that could make the ADHD worse.
At a clinical level, there’s just not enough data that leads to a clear answer regarding individual strains and medical outcomes at the moment. The jury is still out.
So, how should we classify strains?
Are we still a ways off from the ideal medical cannabis strain classification system?
There is a growing movement among scientists to categorize strains based on their genetics or their chemical composition rather than strictly on their lineage.
A number of interesting studies such as the one reported on in the journal Nature have shown that by conducting chemical analysis on a range of strains, 5 different groups emerged that were chemically distinct enough to merit being separate.
What do these classifications mean for cannabis patients? Do certain illnesses or conditions respond to one category rather than another?
Unfortunately, the answer to this question hasn’t even begun to be researched.
We’ll get there someday, but at the moment we just don’t have the clinical experience to make any definitive claims that any of these categories will consistently lead to a desired medical outcome.
In the meantime, my opinion is that we need to get away from strain names altogether. They’re ridiculous, unreliable, and uninformative.
Instead, we should get specific about the chemical profiles of each strain. We should have unique cultivars that we know contain specific percentages of THC, CBD, terpenes, and other cannabinoids.
Then we need to figure out ways to clinically match these chemical components to different illnesses and perform studies to determine if those elements cause a positive outcome.
Ideally, someday clinicians will be able to plug the desired cannabis components - such as terpenes profiles or THC content - into a program containing all the individual strains available in their area. The program could then recommend to the patients a strain that will result in their desired medical outcome the most closely.
But all that is dependent on a whole lot of science we’re not doing yet and is a long way off.
So, what do I recommend to my patients if strains don’t matter in a medical outcome?
I give them broad outlines of what to look for in the shops around them.
Instead of telling them to search out, say OG Kush - which their dispensary might be out of or may be chemically different from the last batch - I recommend finding a strain that has between 15-20% THC.
The reason for such a modest THC content is that a supercharged THC percentage crowds out other helpful cannabinoids. This decreases the strain’s entourage effect and thus its overall effectiveness.
As a doctor, I’m looking for strains that are well-balanced and provide the best medical benefit for my patients rather than some unique “perfect” strain. A moderate level of THC and a balanced profile of cannabinoids will usually do the trick.
If that strain also turns out to be their pepperoni pizza, all the better.
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