13 Sizzling Questions about Marijuana and Chronic Pain

Celeste Cooper, RN | Jul 11th 2016 Apr 10th 2017

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The cannabis plant: is it hemp, CBD, or marijuana? Does it matter? Are there benefits and risks? Is it recommended for treating pain?Approximately half of all states have medical cannabis laws in some form or another, but are the laws the same in all states? Who can recommend it, and how do you talk to your doctor about it? Let’s answer these and other important questions.

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How long have we been studying medicinal marijuana (MMJ)?

W. B. O’Shaughnessy, M.D. published case studies on what we know today as MMJ in one of the oldest peer reviewed journals in 1843. Benefits of cannabis were reported for various convulsive disorders, cholera, rheumatism and more. He prepared tinctures, and resin for use in pills, and he assessed therapeutic doses directly related to these medical problems.

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Do you have to smoke MMJ to get the benefits?

No. Smoking MMJ works faster, but vaporizing provides cannabinoids at low temperatures without the by-products of smoke. Edibles are available, but it is harder to determine the effect. Topical preparations may be helpful for muscle and joint pain, and skin conditions. Tinctures/elixirs are highly concentrated, readily absorbed under the tongue with precautions.

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What is the difference between hemp, marijuana and cannabis?

Hemp, cannabis, and marijuana are all part of the cannabis sativa species. There are more than 80 known cannabinoids in cannabis plants. Concentrations of CBD (cannabidiol) and THC (tetrahydrocannabinol) are the highest.

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How is hemp used?

The cannabis we know today as hemp was bred with other plants to provide fiber. It’s used to make products including rope, fabrics, paper, and other consumer products. Hempseed is compressed and used for biodiesel fuel. Hemp produces more CBD than THC and countries that grow hemp restrict THC equivalencies. Canada, as an example, restricts THC content maximum to 0.3%.

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What makes marijuana different from hemp?

Cannabis with higher THC levels than CBD is considered marijuana and has psychoactive qualities. On average, marijuana cannabis has 5 to 20 percent THC, but some strains can be higher. (Leaf Science).

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Does all cannabis make you high?

No. Neither hemp oil nor CBD oil causes euphoria, but there is a difference. Industrial grade “hemp oil” is extracted from agricultural hemp plants grown from seeds and has little CBD resin. Horticultural medical grade “CBD oil,” though sometimes also referred to as “Hemp Oil,” is extracted from plants grown from asexually reproduced clones producing high concentration of CBD resin.

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What are the medical qualities of CBD?

Current Drug Safety says CBD has multiple pharmacological actions, including anti-anxiety, antipsychotic, antiemetic and anti-inflammatory properties and does not induce changes on food intake or trance, does not affect vital signs or digestion or alter psychomotor or psychological functions.

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Is there a difference between the herbal plant and synthetic cannabinoids?

Yes. NIH Drug Facts says synthetic cannabinoids are similar to chemicals found in the marijuana plant, but marketing these chemicals as “synthetic marijuana” is misleading. “They are not safe legal alternatives. In fact, they may affect the brain much more powerfully than marijuana; their effects can be unpredictable and, in some cases, severe or even life-threatening.”

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How many states have some type of medical cannabis law?

Governing the States and Localities” report 25 states and the District of Columbia have varying MMJ laws. A map is provided to locate the states, updated May, 2016. Some states allow CBD oil for treatment of a limited numbers of conditions, particularly seizure disorders. “Americans for Safe Access” provides a map that includes states with “CBD Oil” legislation for qualifying patients.

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Do all MMJ states approve it for chronic pain?

No. Qualifying medical conditions vary from state to state. Find Law gives a concise listing of MMJ state-by-state.

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Do all MMJ states approve it for chronic pain?

No. Qualifying medical conditions vary from state to state. Find Law gives a concise listing of MMJ state-by-state.

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Are there risks?

Everything has risk, even over-the-counter drugs. We suspect marijuana causes problems with sperm production, can harm a fetus, and can retard cognitive development during ages of brain development. If Epidiolex is approved by the FDA, cannabis could be is rescheduled from schedule 1, likely encouraging research including benefits and risks.

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Who can recommend medical marijuana?

Who can recommend MMJ also varies from state to state, but in general, the provider must be state licensed, usually as a medical doctor (MD) or osteopathic physician (DO). Some states also allow naturopathic or homeopathic physicians and other licensed providers, such as a physician assistant or advanced registered nurse practitioner. Leafly offers a doctor locator.

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How do I bring it up with my provider?

Good doctor-patient communication is critical to your care, regardless of the conversation. State legislation and credible research makes it easier to discuss. Share what you have learned and make sure your condition qualifies according to your state laws. Openly discuss the benefits and risks particular to you, and let your provider know the reasons you want to try MMJ.