Commentary by Greener Pastures
We have all experienced pain in one form or another. Everyone experiences pain differently.
Pain may be acute, short lived and intense — or chronic, persisting for days to years. For acute pain, such as the discomfort that follows surgery, doctors typically prescribe opiates. For chronic pain, however, opiates rarely bring relief. Even when they are effective, opiates often cause nausea, sedation, and a tolerance that may become a burden to the long-term user.
Chronic pain can be an incredibly debilitating condition. For many who live with it on a daily or near daily basis, the condition can be so oppressive that it affects other parts of their lives, impacting their mood, health, and overall well-being.
Fortunately, when it comes to cannabis and cannabinoid-based formulations, chronic pain is one of the most studied conditions.
“Medical cannabis is a very effective therapy for chronic pain patients because it affects people’s perception of pain, has the ability to mitigate the inflammatory process, and has been shown to affect voltage-gated sodium channels in nerves in a way similar to lidocaine,” reports Dr. Mark Rabe, Medical Director of Centric Wellness, in San Diego, and Chairman of the Scientific Advisory Board at Medical Marijuana Sciences, Inc.
One hefty word that belongs in every medical marijuana patient’s vocabulary is cannabinoid. Cannabinoids (e.g., THC and CBD) which can be found in a medical marijuana dispensary, are the chemical compounds secreted by cannabis flowers that provide relief to an array of symptoms including pain, nausea, anxiety, and inflammation. These work their medicinal magic by imitating compounds our bodies naturally produce, called endocannabinoids, which activate to maintain internal stability and health. To put a complex system simply, they mediate communication between cells, and when there is a deficiency or problem with our endocannabinoid system, unpleasant symptoms and physical complications occur. The “key and lock” metaphor is often used to describe this process.
The ability of cannabis therapy to help relieve chronic pain on multiple fronts rests squarely in the cannabinoid receptors — cannabinoid receptor type-1 (CB1) and type-2 (CB2).
Studies have shown that CB1 receptors are located all over the body, however they have particularly high concentration in the brain, central nervous system (in areas that control pain perception), liver, lungs and kidneys. CB2 receptors, on the other hand, are primarily located in areas of the body that control immune function, such as the spleen, white blood cells, and tonsils. CB2 receptors are also common in the brain, although they do not appear as densely as CB1 sites and are found on different types of cells.
CB2 sites are also found in greater concentrations (density) throughout the gastrointestinal system, where they modulate intestinal inflammatory response. This is why sufferers of Crohn’s disease and IBS gain such great relief from cannabis medicine.
When cannabis is consumed, cannabinoids bind to these receptor sites, working like a lock and key, throughout our brain (CB-1) and body (CB-2). Different cannabinoids have different effects depending on which receptors they bind to. For example, THC binds to receptors in the brain whereas CBN (cannabinol) has a strong affinity for CB-2 receptors located throughout the body. Depending on a cannabis product’s cannabinoid profile, different types of relief are achievable.
Numerous studies support these findings, including a report released earlier in January by the National Academies of Sciences, Engineering, and Medicine (NASEM).
One of the strongest conclusions of the report — which provides basically the most comprehensive, up-to-date look at what all available research on cannabis tell us — is that there is conclusive or substantial evidence cannabis or cannabinoids found in the marijuana plant can be an effective treatment for chronic pain. This matters because it has implications for how we treat pain and how we assess the value of medical marijuana. It also helps illustrate how — despite its DEA Schedule I status that declares it has “no currently accepted medical use” — most research indicates there are indeed potentially important medical uses for cannabis.
Due to the depth of research that has been conducted regarding the human endocannabinoid system and its interaction with phytocannabinoids from herbs like cannabis, experts and scientists can currently only speculate regarding the complexity and breadth of this system that is so critical for human health — and is present in all mammals.
Over 70 cannabinoids have been identified in the cannabis plant, many of which have documented medicinal value. Most are closely related or differ by only a single chemical part. The most talked about and researched cannabinoids found in the cannabis plant are tetrahydrocannabinol (THC) and cannabidiol (CBD).
THC, or tetrahydrocannabinol, is the most recognized ingredient in cannabis. Its benefits are numerous, pain relief just being one. THC is also helpful for PTSD. THC is often associated with temporary impairments of memory, which may be seen as a drawback for some marijuana users. Impaired memory can be therapeutic for those who struggle to forget painful memories, such as patients who suffer from PTSD. Recent studies confirm that oral doses of THC can help relieve a variety of PTSD-related symptoms including flashbacks, agitation and nightmares. THC is also great for anti-nausea and vomiting. Along with its ability to reduce nausea, THC is known to work as a powerful appetite stimulant in both healthy and sick individuals.
Treating asthma may not seem like an obvious use for medical marijuana, but as it turns out, THC’s ability to improve breathing in asthmatics is supported by research dating back to the 1970s. Following trials that showed smoking marijuana could help calm asthma attacks, scientists tried (and failed) to develop an inhaler that could deliver THC. While the THC inhaler idea was ultimately abandoned, some say modern-day vaporizers might be the solution.
Another benefit of THC recognized early on was its potential to relieve eye pressure in patients with glaucoma. Many are aware of the sleep-inducing effect of marijuana, and research shows that THC is largely responsible. In fact, trials conducted in the 1970s found that oral doses of THC helped both healthy individuals and insomniacs fall asleep faster.
Unlike THC, CBD, or cannabidiol, is non-psychoactive because it does not act on the same pathways as THC. CBD suppresses seizure activity, combats psychosis disorders, inflammatory disorders, neurodegenerative disorders. It has been shown to fight tumor and cancer cells and helps settle anxiety and depression-based disorders. It also reduces nausea and vomiting.
CBD seems to offer natural protection against the marijuana high. Numerous studies suggest that CBD acts to reduce the intoxicating effects of THC, such as memory impairment and paranoia. CBD also appears to counteract the sleep-inducing effects of THC, which may explain why some strains of cannabis are known to increase alertness.
Overall, we are just at the beginning of our understanding of the possible therapeutic benefits associated with cannabis in the treatment of chronic pain. In addition to the wide range of possibilities in targeting CB1 and CB2 receptors, scientists are beginning to look at targets within the body’s endocannabinoid life cycle for potential opportunities for therapeutic intervention. Given the growing need for clinicians to transition away from an opiate-dependent treatment protocol for chronic pain, hopefully these breakthroughs happen sooner rather than later.
This brief look at cannabis is meant to arm you with a basic knowledge of how cannabis affects the brain and body. Not only will you better understand your medicine, you’ll be able to educate others about why cannabis can truly be an effective remedy for patients suffering a myriad of ailments.
Learn more about the Montana Marijuana Program at http://dphhs.mt.gov/marijuana. A PDF of SB0333, the latest bill revising Montana’s medical marijuana laws, is also available through the above address. The Montana Marijuana Bill (SB0333) was signed by Governor Steve Bullock on May 19th, 2017. Greener Pastures dispensary is located at 7580 Pioneer Way, just outside Bozeman. •