Please give us a call at 623-1000 to schedule an appointment, reach out to our Medical Cannabis expert Dr. Kwinter directly via WhatsApp at (+1 345) 324-2424 or send us a message via our CONTACT FORM.

Cannabis and its derivatives are currently approved for medicinal purposes in roughly 50 nations, the Cayman Islands included. Only 8 countries have legalized it for recreational enjoyment. Over 100 million people across the globe use cannabis, but discerning how many use it medicinally versus recreationally remains challenging.

The main active elements in cannabis, known as cannabinoids, influence the human body in numerous ways. Despite their known effects, much about their therapeutic applications, benefits, and potential side effects, both immediate and long-term, remains undiscovered. Moreover, the cannabis plant has hundreds of other active compounds, like terpenes, which are yet to be fully understood. Dr. Kwinter actively follows research in this area and conveys the latest findings on this platform in a user-friendly manner.

Many individuals find medical cannabis to be a suitable treatment option, and their choice to use it should be respected. As detailed further, numerous conditions and symptoms can benefit from medical cannabis treatment. The scope of ailments it addresses is expected to expand over time. For the best patient outcomes, a personalized treatment plan is recommended, ideally under the guidance of a doctor experienced in prescribing medical cannabis.

In 2017, the Misuse of Drugs Law (2017 Revision) was enacted, legalizing cannabis extracts, such as those with THC and CBD, for possession and medicinal purposes. However, this is only when prescribed by a physician licensed in the Cayman Islands.

In the Cayman Islands, cannabis flower is prohibited. The only permissible forms are concentrates, which are available as oils in capsule and liquid forms, and as cartridges for vaporizers.

In the Cayman Islands' legal framework, cannabis is categorized as a "Part I of Schedule I" controlled substance. In local legislation, such substances are officially termed "hard drugs".

Without a prescription from a Cayman-licensed medical doctor and unless procured from a Cayman Islands pharmacy, possessing cannabis in any form or amount is unlawful.

Traveling across borders with cannabis is prohibited, irrespective of its legal status in the originating country.

Traveling internationally with cannabis is prohibited, regardless of its legal acquisition in one's home nation.

Visitors who require medical cannabis are encouraged to consult with a Cayman-licensed physician before their trip to ensure uninterrupted treatment during their stay.

Dr. Kwinter is dedicated to offering exceptional medical services to both residents and tourists in Cayman. This commitment includes facilitating access to safe and premium-grade medical cannabis.

For assistance with medical cannabis during your Cayman Islands visit, feel free to email, send a private message directly to Dr. Kwinter via WhatsApp at (+1 345) 324-2424, or contact us at 1-345-623-1000.

Research indicates that cannabis can offer pain relief for individuals across a variety of conditions. A selection of recent studies on this topic is provided and cited below:

References:
Medical Cannabis for Chronic Nonmalignant Pain Management

Curr Pain Headache Rep. 2023 Apr;27(4):57-63.

"This paper demonstrates that medical cannabis use provides adequate pain management. Patients suffering from chronic nonmalignant pain may benefit from medical cannabis due to its convenience and efficacy."

Therapeutic Potential of Cannabis, Cannabidiol, and Cannabinoid-Based Pharmaceuticals

Pharmacology. 2022;107(3-4):131-149.

"In general, data support a role for cannabis/cannabinoids in pain, seizure disorders, appetite stimulation, muscle spasticity, and treatment of nausea/vomiting."

Medical Cannabis for Gynecologic Pain Conditions: A Systematic Review

Obstet Gynecol. 2022 Feb 1;139(2):287-296.

A systematic review of 16 studies that evaluated nonpregnant adult women who used cannabinoids for gynecologic pain conditions (e.g. chronic pelvic pain, vulvodynia, endometriosis, interstitial cystitis, and malignancy). Study types included randomized controlled trials, cohort studies, and cross-sectional studies.

Most women ingested or inhaled cannabis and used cannabis multiple times per week, with dosages of THC and CBD up to 70 mg and 2,000 mg respectively. 61-95.5% reported pain relief. The average decrease in pain after 3 months of treatment was 3.35+/-1.39 on the 10-point visual analog scale.

Result: Most women reported that cannabis improved pain from numerous gynecologic conditions.

Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: a systematic review and meta-analysis of randomised clinical trials

BMJ. 2021 Sep 8;374:n1034.

Analysis of 32 trials with 5174 adult patients, of which 29 studies compared medical cannabis or cannabinoids to placebo. Medical cannabis was administered orally in 30 of the studies, topically in 2. Clinical populations included non-cancer pain (28 studies) and cancer related pain (4 studies).

Result: Small to very small improvement in pain relief, physical functioning, and sleep quality with only transient side-effects including cognitive impairment among others.

Cannabis and cannabinoids in cancer pain management

Curr Opin Support Palliat Care. 2020 Jun;14(2):87-93.

"Recent findings: A cohort study using nabiximols on advanced cancer pain in patients already optimized on opioids, over 3 weeks, demonstrated improved average pain score. A large observational study of cancer patients using cannabis over 6 months demonstrated a decreased number of patients with severe pain and decreased opioid use, whereas the number of patients reporting good quality of life increased."

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.

Washington (DC): National Academies Press (US); 2017 Jan 12.

"There is conclusive or substantial evidence that cannabis or cannabinoids are effective: For the treatment of chronic pain in adults (cannabis)"

Insomnia frequently receives treatment through medical cannabis. Considering the usual administration time and the relatively safe profile of cannabis when compared to other sedatives, there's a compelling case for using cannabis to treat this condition.

References:
An investigation of cannabis use for insomnia in depression and anxiety in a naturalistic sample

BMC Psychiatry. 2022 Apr 28;22(1):303.

"In terms of perceptions, individuals with depression, anxiety, and both conditions who use cannabis for insomnia report significant improvements in symptom severity after cannabis use. The current study highlights the need for placebo-controlled trials investigating symptom improvement and the safety of cannabinoids for sleep in individuals with mood and anxiety disorders."

Medical cannabis and cannabinoids for impaired sleep: a systematic review and meta-analysis of randomized clinical trials.

Sleep. 2022 Feb 14;45(2):zsab234.

Conclusion: Medical cannabis and cannabinoids may improve impaired sleep among people living with chronic pain, but the magnitude of benefit is likely small."

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.

Washington (DC): National Academies Press (US); 2017 Jan 12.

"There is moderate evidence that cannabis or cannabinoids are effective for: Improving short-term sleep outcomes in individuals with sleep disturbance associated with obstructive sleep apnea syndrome, fibromyalgia, chronic pain, and multiple sclerosis (cannabinoids, primarily nabiximols)"

Similar to various psychoactive medications, cannabis has the ability to induce feelings of calmness and uplifted mood. This can be beneficial in reducing symptoms of generalized anxiety, social anxiety, and depression. Research also points towards the potential of cannabis in treating other mental health issues, such as post-traumatic stress disorder.

However, patient experiences vary. While some note marked improvements, others find an increase in their symptoms. This inconsistency could stem from several reasons. One possibility is that there's an optimal therapeutic range for cannabis's mental health benefits, where lower doses might be helpful but higher ones detrimental. The specific mix of cannabinoids and terpenes in a particular product might also lead to varied effects among different people. Furthermore, given the complex nature of mental health issues, individual patient factors could also cause varied responses. An interesting hypothesis in this context is the idea that some individuals with mental health challenges might suffer from an "endocannabinoid deficiency", which cannabis can potentially address.

Those who've observed positive changes in their mental health symptoms using recreational cannabis might find more consistency and safety in switching to a medical-grade cannabis product.

For those contemplating the use of medical cannabis for mental health but haven't tried it, it's prudent to commence with minimal doses and gradually increase. Regular monitoring and consistent follow-ups are essential to ensure a successful outcome.

References:

Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review.

BMC Psychiatry. 2020 Jan 16;20(1):24.

"There is currently encouraging, albeit embryonic, evidence for medicinal cannabis in the treatment of a range of psychiatric disorders."

Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naive social phobia patients.

Neuropsychopharmacology. 2011 May;36(6):1219-26.

"Pretreatment with CBD significantly reduced anxiety, cognitive impairment and discomfort in their speech performance, and significantly decreased alert in their anticipatory speech."

Medical cannabis has shown signs of being safe for use among Parkinson's Disease (PD) patients. However, data supporting its benefits remains limited at present. The effects of cannabis can vary widely among PD patients due to the diverse symptoms they experience. Some of these symptoms may respond better to cannabis than others. Further studies are essential to understand its full potential.

References:

Effects of Cannabis in Parkinson's Disease: A Systematic Review and Meta-Analysis

J Parkinsons Dis. 2022;12(2):495-508.

Five randomized controlled studies utilizing oral capsule cannabis administration showed no significant safety issues. The studies showed, to varying degrees, improvement in anxiety, tremor, dyskinesia, functioning and wellbeing of PD patients. Eighteen non-randomized studies showed additional side effects including cough (in groups that smoked cannabis) and very small numbers of cases of psychosis (<1%), restlessness, hallucinations and confusion.

Over a dozen randomized controlled clinical studies have showcased the effectiveness of cannabis in treating spasticity linked to multiple sclerosis. The American Academy of Neurology has issued guidelines grounded in evidence, suggesting doctors consider a cannabis oral extract, inclusive of both THC and CBD, for managing spasticity and pain in multiple sclerosis patients.

References:

Summary of evidence-based guideline: complementary and alternative medicine in multiple sclerosis: report of the guideline development subcommittee of the American Academy of Neurology

Sleep. 2022 Feb 14;45(2):zsab234.

"Clinicians might offer [oral cannabis extract (OCE)] to patients with MS to reduce patient-reported symptoms of spasticity and pain (excluding central neuropathic pain) (Level A) and might counsel patients that this symptomatic benefit is possibly maintained for 1 year (Level C), although OCE is probably ineffective for improving objective spasticity measures (short-term) or tremor (Level B). Clinicians might offer THC to patients with MS to reduce patient-reported symptoms of spasticity and pain (excluding central neuropathic pain) (Level B). Clinicians might counsel patients that this symptomatic benefit is possibly maintained for 1 year (Level C), although THC is probably ineffective for improving objective spasticity measures (short-term) or tremor (Level B)."

Many patients have indicated that cannabis products help them manage and mitigate the side effects of chemotherapy. These include issues such as appetite loss, nausea, vomiting, nerve damage symptoms, fatigue, sleeplessness, stress, anxiety, and depression.

There's also growing evidence hinting that cannabis might possess immune-enhancing and tumor-fighting properties. However, this remains a topic of debate. The underlying mechanisms for these potential effects are the subject of numerous theories and represent a critical focus in current research.

References:

Should oncologists trust cannabinoids?

Front Pharmacol. 2023 Jul 13;14:1211506.

Cannabis use prevalence, patterns, and reasons for use among patients with cancer and survivors in a state without legal cannabis access.

Support Care Cancer. 2023 Jun 29;31(7):429.

Cannabis for cancer - illusion or the tip of an iceberg: a review of the evidence for the use of Cannabis and synthetic cannabinoids in oncology.

Expert Opin Investig Drugs. 2019 Mar;28(3):285-296.

Contraindications serve as strong justifications for refraining from particular treatments. A number of such contraindications exist for prescribing medical cannabis, which include:

• Unstable cardiovascular disease
• Respiratory disease [if inhaling cannabis]
• Personal or strong family history of psychosis/bipolar disorder
• Pregnant, planning on becoming pregnant, or breastfeeding
• Under 25 years of age*
• Current or past cannabis use disorder*
• Current or past substance use disorder*

*While the source cites these as relative or partial contraindications, Dr. Kwinter, leaning on the side of caution, regards them as strong contraindications.

References:

"Is medical cannabis safe for my patients?" A practical review of cannabis safety considerations.

Eur J Intern Med. 2021 Jul;89:10-18.

There's a consensus that the effects of cannabis products on cognitive functions like memory, attention, and processing speed are dose-dependent. Prolonged heavy consumption, especially starting at an early age, has been identified as a risk factor for neurocognitive challenges.

Some of the short-term cognitive side effects of cannabis can be reduced by opting for strains with lower levels of THC, which is the primary psychoactive component in cannabis.

In terms of long-term cannabis consumption, a significant study from New Zealand tracked 1,037 individuals over a span of 27 years, from ages 18 to 45, retaining 94% of the participants. The study's notable finding was that persistent cannabis consumers exhibited cognitive shortcomings and reduced hippocampal volume by midlife. The research underscored the need to explore if such users face heightened dementia risks in their later years.¹

This study, coupled with the understanding that certain brain regions continue to mature until around 25 years of age, influences many physicians to regard being under 25 as a strong reason to advise against medical cannabis use.

References:

Long-term Cannabis Users Show Lower Cognitive Reserves and Smaller Hippocampal Volume in Midlife

Am J Psychiatry. 2022 May;179(5):362-374.

Adverse Effects of Recreational and Medical Cannabis

Psychopharmacol Bull. 2021 Jan 12;51(1):94-109.

Apart from its influence on cognitive functions, cannabis can occasionally induce psychotic symptoms. This phenomenon is thought to be more prevalent in individuals with underlying mental health conditions, notably schizophrenia or bipolar disorder. Even though such side effects are rare, they are often the rationale behind classifying a personal or significant family history of psychosis or bipolar disorder as reasons to advise against the medical use of cannabis.

References:

Rates and correlates of cannabis-associated psychotic symptoms in over 230,000 people who use cannabis

Transl Psychiatry. 2022 Sep 6;12(1):369. doi: 10.1038/s41398-022-02112-8.

"Taken together, acute self-limiting psychotic symptoms in the context of cannabis use may occur in about 1 in 200 PWUC's lifetime. Some individuals could be particularly sensitive to the adverse psychological effects of cannabis, such as young individuals or those with pre-existing mental health vulnerabilities."

In 2019, a surge in cases of a condition termed as E-cigarette or Vaping product Use-Associated Lung Injury (EVALI) was observed. Investigations revealed that the majority of the affected patients had either THC or vitamin E acetate present, as confirmed by toxicology reports or self-disclosure. During 2018 and 2019, Vitamin E acetate was commonly used as a diluent in THC-rich e-cigarettes. It's now recognized that Vitamin E acetate can disrupt lung surfactant functions leading to respiratory complications.¹

The CDC has stated: "Vitamin E acetate is strongly linked to THC-containing products used by EVALI patients."²

Furthermore, the CDC mentioned, "Vitamin E acetate is strongly linked to the EVALI outbreak; it has been detected in product samples tested by FDA and state laboratories and in lung fluid samples from patients tested by CDC from geographically diverse states. Vitamin E acetate should not be added to any e-cigarette, or vaping, products. In addition, any substances not intended by the manufacturer should not be added to e-cigarette, or vaping, products, including to products purchased through retail establishments."²

According to the data, "The weekly number of hospital admissions for EVALI reported to CDC peaked at 215 during the week of September 15, 2019 (Figure 1). Since then, the number of cases reported each week has continued to steadily decline."²

E-cigarette, or vaping, product use-associated lung injury: a review.

Pneumonia. 2020 Oct 25;12:12.

Update: Characteristics of a Nationwide Outbreak of E-cigarette, or Vaping, Product Use-Associated Lung Injury — United States, August 2019-January 2020.

MMWR Morb Mortal Wkly Rep 2020;69:90-94.

Before recommending medical cannabis, it's essential to consider the following factors:

• Concurrent mood or anxiety disorder
• Risk factors for cardiovascular disease
• Tobacco use
• E-cigarette use
• Severe liver dysfunction/disease
• Medications associated with sedation or cognitive impairment
• Driving or safety sensitive occupations^*
• Older adults
• Safe storage of medical cannabis to prevent diversion
• Drug interactions (see section titled "Safety Issues: Drug Interactions")

^*It's important to note that this encompasses roles such as parenting, teaching, or any other position of authority or responsibility. Similarly, the effects of cannabis on attention, memory, and judgment should be regarded with the same seriousness as the impacts of alcohol.

References:

Is medical cannabis safe for my patients?" A practical review of cannabis safety considerations.

Eur J Intern Med. 2021 Jul;89:10-18.

Before considering a therapeutic trial of medical cannabis, patients should be honest with their doctor about any usage of common depressants. These include:

• Alcohol
• Opioids
• Antipsychotics
• Benzodiazepines
• Tricyclic antidepressants
• Antiepileptics

Using these depressants in combination with cannabis may intensify sedation and cognitive impairment.

It's also worth noting that there are many medications that might have interactions with THC and/or CBD. This is due to their effect on enzymes critical for drug metabolism. Proper medical supervision is required when using these drugs. The list of these drugs includes:

Alprazolam	Amiodarone	Amitriptyline
Aripiprazole	Atorvastatin	Azole antifungals
Buprenorphine	Caffeine	Carbamazepine
Cimetidine	Citalopram	Clarithromycin
Clobazam	Clopidogrel	Clozapine
Cyclosporine	Dabigatran	Diazepam
Digoxin	Diltiazem	Duloxetine
Erythromycin	Escitalopram	Esomeprazole
Estrogens	Fluconazole	Fluoxetine
Fluvoxamine	Grapefruit	HIV protease inhibitors
Imipramine	Isoniazid	Loperamide
Macrolides	Melatonin	Metronidazole
Mifepristone	Mirtazapine	Moclobemide
Norclobazam	Olanzapine	Ompeprazole
Pantoprazole	Phenobarbital	Phenytoin
Rifampin	Rosuvastatin	Sertraline
Simvastatin	Sirolimus	St. John's wort
Sulfamethoxazole	Tacrolimus	Theophylline
Ticlopidine	Valproic acid	Verapamil
Warfarin	Zopiclone

References:

"Is medical cannabis safe for my patients?" A practical review of cannabis safety considerations.

Eur J Intern Med. 2021 Jul;89:10-18.

Similar to ethanol and certain over-the-counter medications, abusing cannabis, especially those with psychoactive properties, can lead to a clinical disorder. While this is rare in older adults, it's notably more frequent among cannabis users who are 25 years old or younger.

The high occurrence of cannabis use disorder observed in young individuals across numerous countries is a primary reason why being under 25 years old is often viewed as a contraindication to medical cannabis use.

Key Substance Use and Mental Health Indicators in the United States: Results from the 2021 National Survey on Drug Use and Health

U.S. Department of Health and Human Services

In extensive studies on cannabis consumption, the following adverse effects have been noted:

• Dizziness (8-13%)
• Dry mouth (7-10%)
• Nausea (3-10%)
• Fatigue (6%)
• Diarrhea (2%)
• Disturbance in attention (2%)
• Vomiting (2%)

References:

Medical cannabis and cannabinoids for impaired sleep: a systematic review and meta-analysis of randomized clinical trials.

Sleep. 2022 Feb 14;45(2):zsab234.

In the Cayman Islands, medical cannabis is offered in two primary formats: orally ingested forms like oil drops or capsules, and inhaled vaporizers. When deciding on a dosage form, patients should opt for the one most suitable for their specific ailment.

Typically, for continuous symptoms like chronic pain, oral oils or capsules are recommended. These might take longer to take effect, but they provide relief over an extended period. On the other hand, for conditions that demand immediate relief, such as initiating sleep, alleviating nausea, or addressing migraines, inhaled vaporized cannabis is often the go-to choice due to its rapid onset, even though its effects might not last as long.

A crucial note for patients: those consuming medical cannabis with THC should refrain from driving or participating in activities that demand high levels of attention. The recommended waiting times are 4 hours post-inhalation, 6 hours after oral intake, and 8 hours if feelings of euphoria are present.¹

References:

Is medical cannabis safe for my patients?" A practical review of cannabis safety considerations.

Eur J Intern Med. 2021 Jul;89:10-18. doi: 10.1016/j.ejim.2021.05.002.

If you're seeking information or have inquiries about medical cannabis, consider booking an appointment with Dr. Kwinter at Cayman Medical Center. With a wealth of experience, Dr. Kwinter has successfully prescribed medical cannabis for a variety of ailments. He's an esteemed member of the UK Medical Cannabis Clinicians Society and continuously updates his knowledge on cannabis research. This ensures he's well-versed in the most effective products tailored for specific conditions.

For tourists visiting Cayman: If you're a medical cannabis user in your home nation, reach out to Dr. Kwinter. He can guide you in accessing a comparable medical cannabis product here, ensuring a hassle-free continuation during your stay. You can reach him directly via WhatsApp at (+1 345) 324-2424

For comprehensive details on high-quality cannabis, check out the Cannabis Educational Resources page.

Cannabis in Cayman
Cannabis Research
Cannabis Educational Resources

Please give us a call at 623-1000 to schedule an appointment, reach out to Dr. Kwinter directly via WhatsApp at (+1 345) 324-2424 or send us a message via our CONTACT FORM.