Medical Marijuana Update

Medical Marijuana Update

As we enter a new era in Canada, it’s important to look at what’s happening in other places.  Medical marijuana is legal in the majority of states in the USA.  It is also legal in Australia although it is much more difficult to get.  The supply is limited and there are no dispensaries.  Medical marijuana in general doesn’t make it accessible to most people.  Finding a doctor who will prescribe it isn’t always easy.  Only a limited number of conditions are approved.  What medical marijuana does is increase quality because the product is lab tested.

Recreational use is legal in Canada and in nine states of the US.  This designation makes it much easier to obtain and quality can be determined by the consumer.  In these states we find labs creating cleaner products that are free of fungus, pesticides, bacteria and chemicals.  We can also get specific amounts of CBD:THC which allows is important for targeting specific symptoms.  I’m looking forward to these kinds of labs emerging in Canada.  At this time we can’t import across the border safely.  It can be hit or miss what you get from a dispensary.

CBD For Pain

Medical marijuana is antispasmodic.  Women who experience intractable pain during their cycle, CBD can help relax the muscles.  It also dampens the communication from the pain receptors to the brain.  What people report is still feeling the pain but it doesn’t bother them in the same way.  This is important because the body can begin to heal when the pain response is lower.

Medical marijuana is anti-inflammatory.  Therefore we see an improvement other symptoms as well.  The side effects of other anti-inflammatories and pain medications can be severe.  Not to mention that many of the stronger pain killers are habit forming and can result in overdose.  I had a patient yesterday with a severe back spasm.  The hospital denied him pain medication.  NSAIDs don’t work for him because they are hard on the gut.  He suffers from gastritis.  He has no history of addiction to opiods.  So why was he denied?

Another patient of mine had suffered with endometriosis for years.  CBD was the only pain medication that helped her function.  Once her pain was down she was able to make important decisions about her health, her career and her family.

Why does it work? How to take it?

The endocannabinoid system is part of our body. It’s a modulatory system that affects brain, endocrine, and immune tissues. Our body has endocannabinoid receptors.  We produce chemicals naturally that are very similar to the chemical cascade of what occurs when we take CBD.

Smoking causes harm.  Vaporization is a good alternative as are oils or tinctures.  Suppositories can be excellent for severe abdominal and pelvic pain. Women who suffer from pain during intercourse are experiencing relief.  But again we need to have standardized products.  I have had two patients who experienced high anxiety and paranoia using products from a dispensary.

Women’s Health

Endocannabinoids appears to play a very important regulatory role in the secretion of hormones related to reproductive functions and response to stress.

Women are using CBD for symptoms associated with PMS including painful periods, anxiety and insomnia.  During perimenopause and menopause women are experiencing relief by using CBD particularly for insomnia and anxiety.

Pregnancy and Breastfeeding

There are only a few small studies on the subject of use in pregnancy.  The results show a propensity towards pre-term labour and delivery.  They also showed use over 20 days during pregnancy may result in lower birth weight.  It is difficult to do clinical trials during pregnancy but this limited evidence shows that caution is warranted. Use during breastfeeding exposes the infant so the benefits need to be weighed carefully against the benefits.

One circumstance where more research could be valuable is when nausea/vomiting during pregnancy are extreme.  Given that malnutrition of both mother and fetus is a concern, careful administration of CBD likely offers less risk than other medications that are used in this circumstance.

Dr. Rachna Patel is an expert in use of medical marijuana.  Her website is an excellent resource.

 

 

CBD is Changing The Game

CBD is Changing The Game

CBD (cannabinoid) is a natural, safe, and effective. Its affect includes reducing inflammation, pain and seizures.  There is evidence that it may inhibit cancer growth.  It certainly helps with nausea and other side-effects of chemotherapy including loss of appetite.  In my practice I have seen it work on insomnia caused by recalcitrant pain.  I’ve had patients stop opiates and other damaging pain medications after decades of use.

What are the benefits of CBD?

In clinical studies there is evidence that CBD is effective in five areas.

  1. The most established benefit on relieving pain and inflammation. It does this without the serious side effects of opiate drugs and NSAIDS.
  2. Studies have also shown effectiveness with PTSD especially on veterans experiencing social anxiety. Its important to note that in a percent of the population CBD can also increase anxiety.
  3. CBD has successfully treated drug-resistant children who have epilepsy with non of the side-effects of traditional seizure medications. Anti-seizure meds come with the worst side-effects of any drugs.
  4. It works against viruses, fungi, and bacteria as an anti-microbial. Some studies suggest that it may even be effective against superbugs like MRSA and other anti-biotic resistant infections.
  5. CBD is anticarcinogenic. Several studies demonstrate that CBD is antiproliferative and proapoptotic. More research is needed but it may inhibit cancer cell migration and invasion.

 

How does CBD work?

All mammals have receptors for CBD. This is called the the endocannabinoid system. It regulates a variety of functions including mood, appetite, sleep, hormone production, and immune system response.  For patients with autoimmunity causing pain I’ve seen excellent clinical results.  This may be because of the link between the gut and autoimmune conditions.

Interestingly the gut, which is part of the nervous system, has many endocannabinoid receptors.  This is why CBD can be a game changer for people with IBS, IBD, and other GI issues like nausea.  This may be part of why it is such an effective remedies for insomnia.

What forms is it taken?

CBD is available in several different forms and ratios.  THC is needed to activate the CBD but it can be a minute amount.  The psychoactive component does not appeal to most patients I talk to (if not all).  It can be purchased as capsules, liquid extracts, sprays, vapours and topical salves or creams. CBD taken internally is best for reducing pain and insomnia, whereas a topical is best for treating skin conditions and relieving musculoskeletal pain.

Is it legal?  What other challenges are there?

CBD is generally well tolerated.  There are however a few potential contraindications. Like some other botanicals CBD may interact adversely with pharmaceuticals.  This is because it inhibits cytochrome P450. This enzyme in the liver metabolizes many drugs so it may increase the effects.  A medical herbalist is trained in understanding which drugs are potentially affected and its important to discuss this with your prescribing doctor.

The potential that it may increase anxiety must be taken into account as well.  A major issue right now in Canada, is that it is difficult to get a reliable source with the proper ratios.  Legalization will hopefully lead to more standardization in products.  The right ratio is important depending on what is presenting.  I’ve had some patients respond very well 4:1 whereas others report uncomfortable psychoactive properties. This may be due to product inconsistency or individual response. 20:1 is more difficult to find but this is a much lower dose of THC and is indicated for neurological disorders.

We always start with a low dose and build up slowly.  In the US patients can purchase these products from reputable labs and companies so they know what they are getting.  It is legal in the US without a prescription. Within the next fews years I expect to see reliable sources.