The use of medical marijuana dates >5000 years, with references to the treatments of headaches dating back to the 6th and 7th centuries. Now with 31 of the United States + DC legalizing medical marijuana, cannabis is widely accepted and used. By opening up a dialogue about medical marijuana in my practice, I have come to realize that many patients are using it for pain relief, and that many do have questions.
SAFETY. A multicenter study revealed that marijuana is safe. There have been no known cases of anybody dying from an overdose. There is a side effect, which can result in psychosis at very high doses. Dependency issues are low. Withdrawal can occur if high dose consumption is suddenly stopped. There is very little data on the safety for driving. Don’t smoke and drive.
USE FOR PAIN. In a retrospective cross-sectional survey, cannabis use has been associated with 64% decreased opioid use along with increased quality of life. A systematic review of randomized control trials showed that cannabinoids have a significant effect for pain reduction; this study revealed that it helps conditions such as neuropathic pain, rheumatoid arthritis and fibromyalgia. Not all studies are positive. There was also a recent 4-year prosective cohorot study that concluded that cannabis users have greater pain and lower efficacy in managing pain. This study did not control dosing or type of marijuana (high dose THC is known to cause increased pain) and only a small % of these patients were actually using it for pain.
CBD vs THC. Most of my pain patients are using pure CBD or a high CBD:THC ratio. THC at lower doses can treat pain and anxiety, and at higher doses, can induce paranoia, psychosis, sedation, hyperalgesia (increased pain). There is a therapeutic window of pain relief for THC use, and THC is what gets people stoned. CBD is what most of my patients use for pain and inflammation. CBD has minimal psychoactive effect (ie. stoned effect), but high dose CBD can be sedating. CBD also acts on the receptors that can help with depression and anxiety. CBD at specific doses, can also help with alertness, as well as improved quality of sleep. Antipsychotic and anti-seizure uses have also been identified. Several of my Parkinsons patients are also using CBD. Many of my arthritis patients are using topical solutions for their achy joints. Aside from THC and CBD, cannabis has other compounds with anti-inflammatory as well as analgesic effects.
HOW TO USE. There are many dispensaries and now even personal distributors for these products. Vaporizing medical marijuana is a safe way to release some of the cannabinoids without having to inhale smoke. The long-term safety of vape pens (which is different from vaporizing the plant) is unclear. Vape pens are sold as electronic devices where you plug a cartridge which has processed extract inside it. While this is a convenient way to inhale without smoke, it may be bad for your lungs. Edibles (candies, cookies, mints), tinctures, creams and patches are out there. Just know that if you consume it, absorption is very erratic and differs from person to person. Onset is also slower and more unpredictable. Dosing, unfortunately, is not an exact science. If you are trying CBD medical marijuana for pain, start low and go slow till you feel a pain reduction. Stop if you feel side effects. Don’t feel shy about going into a dispensary and asking medical questions. Don’t feel shy about approaching your doctor. And doctors, open up this dialogue!
Special thanks to the Chair of UCSD Pain Medicine, Dr. Mark Wallace, who provided me with research and information to help convey facts versus myths on medical marijuana.
