A Word About Hemp
Strains of cannabis may come with names like Purple Diesel and Blue Sky. While the term “strain” is commonly used by dispensaries, medical cannabis users and even physicians, it’s not a term used for plant nomenclature. 9 A strain name may come from a grower, producer, processor, or dispensary. A 2018 study out of Washington state found that commercial Cannabis strains fell into three broad chemotypes (chemically distinct plants that otherwise appear indistinguishable) that were defined by the THC:CBD ratio. 10
These states, as of spring 2019, include: Alabama, Georgia, Indiana, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Virginia, Wisconsin, and Wyoming. It is important to know that consistency and quality of the product received may vary from dispensary to dispensary and from state to state. Stay up to date with the National Conference of Sttae Legislatures which lists current medical marijuana laws at http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx.
In PPM online poll, about half of respondents said they had tried medical marijuana to help alleviate their pain and related symptoms.
Herbs, Oils, and Edibles, Oh My!
CBD is not marijuana – even though it can be derived from the marijuana plant. Still, some CBD products contain THC, and for some people these products may work better (remember the entourage effect). The stigma surrounding marijuana-derived treatments can be difficult for people who benefit from their medicinal effects. Having honest conversations with family members (including how to talk to your kids about CBD and medical marijuana use) about the science and history of medicinal cannabis use is often a good place to start.
13. Nuutinen T. Medicinal properties of terpenes found in Cannabis sativa and Humulus lupulus. Eur J Med Chem. 2018;157(5):198-228.
Because of the way the endocannabinoid system works, the bioavailability of CBD is an important factor in how you will respond. Bioavailability is the amount of a substance that successfully makes it into the bloodstream and has an effect. Think about how some medications require you to take them with food or water, or on an empty stomach. Well, the amount of CBD that you actually absorb when taking a CBD product works the same way and will depend on:
HAVING THOSE HARD CONVERSATIONS ABOUT CBD USE
Let’s break it down:
6. De Petrocellis L, et al. Effects of cannabinoids and cannabinoid-enriched Cannabis extracts on TRP channels and endocannabinoid metabolic enzymes. Br J Pharmacol. 2011;163(7):1479-1494.
Given these benefits, CBD is thought to be helpful in easing the symptoms of the following conditions:
The (i)llegality surrounding CBD and medicinal marijuana (which are a whole other category, described in our medical marijuana for pain guide) can make choosing and using the right product confusing. Here is what you may find when you start searching the marketplace.
In fact, the FDA has issued several warning letters to companies and individuals that market unapproved new drugs that allegedly contain CBD. The FDA has tested the chemical content of cannabinoid compounds in some of the products, and many were found to not contain the levels of CBD the manufacturers had claimed they contain.
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CBD is emerging as a promising pharmaceutical agent to treat pain, inflammation, seizures, and anxiety without the psychoactive effects of THC. Our understanding of the role of CBD in pain management continues to evolve, and evidence from animal studies has shown that CBD exerts its pain-relieving effects through its various interactions and modulation of the endocannabinoid, inflammatory, and nociceptive (pain sensing) systems. The endocannabinoid system consists of cannabinoid receptors that interact with our own naturally occurring cannabinoids. This system is involved in regulating many functions in the body, including metabolism and appetite, mood and anxiety, and pain perception.
Beware of powerful testimonials
Given the ongoing challenges of chronic pain management coupled with the consequences of the opioid epidemic, pain management practitioners and their patients are searching for effective and safer alternatives to opioids to alleviate pain. With the legalization of marijuana in many states and resulting cultural acceptance of this drug for recreational and medical use, there has been an increased interest in using cannabis for a myriad of medical problems, including pain.
If you or someone close to you is considering trying CBD, I would recommend Dr. Robert Shmerling’s advice about the dos and don’ts in choosing an appropriate product. Until there is high-quality scientific evidence in humans, it is difficult to make a recommendation for the regular use of CBD in chronic pain management.
Given its promising results in animal models, along with its relative safety, non-psychoactive properties, and low potential for abuse, CBD is an attractive candidate to relieve pain. Unfortunately, there is a lack of human studies about the effectiveness of CBD. However, there is an abundance of commercial advertisements about the magical effects of CBD, and it is frequently presented as a cure-it-all potion that will treat everything including diabetes, depression, cancer, chronic pain, and even your dog’s anxiety!
So far, pharmaceutical CBD is only approved by the FDA as adjunct therapy for the treatment of a special and rare form of epilepsy. Currently, CBD alone is not approved for treatment of pain in the United States. But a combination medication (that contains both THC and CBD in a 1:1 ratio) was approved by Health Canada for prescription for certain types of pain, specifically central neuropathic pain in multiple sclerosis, and the treatment of cancer pain unresponsive to optimized opioid therapy. There is currently no high-quality research study that supports the use of CBD alone for the treatment of pain.