There are many choices to make when choosing how to consume cannabis for pain. But in all cases, a doctor can help.
Pain is not disease-specific. It is a debilitating symptom for a wide range of chronic conditions affecting nearly eight million Canadians and approximately fifty million Americans. With cannabis-related pain research and awareness growing, more and more patients are taking notice. However, when choosing a consumption method for pain, new patients, and even experienced cannabis consumers, may be unsure.
Pain Relief in Animals and Humans
There is strong evidence supporting the prescription of medical cannabis for pain relief. A study published in Neuropsychopharmacology (2019) found that cannabis and morphine reduced measures of allodynia in chronic, neuropathic sciatic nerve pain in mouse models. However, tolerance for morphine developed after just one week, while cannabis continued to reduce allodynia for three weeks. Furthermore, a review of the Canadian Pain Society’s Consensus Statement concluded that the most robust evidence for cannabinoid-based medicine is required for neuropathic pain from HIV, diabetes, and post-surgical and post-traumatic events.
Cannabis is an effective and sustainable pain reliever, but how should it be utilized? Should you use a vaporizer or an oil? High CBD or low CBD? What dose should you consume, and how often should you consume it? What about side effects? These are all complicated and essential aspects of a medical cannabis treatment plan. In recreational markets like Canada and individual U.S. States, some patients may not want to bother making a doctor’s appointment. However, there are many reasons why they should see a physician.
Why You Should get a Prescription
Medical cannabis is just that – medicine. Like all pharmaceutical drugs, an experienced health professional should be part of the discussion. Medical input is important for determining a starting dose, selecting a cannabinoid profile, and monitoring progress. If a pain patient is finding their cannabis treatment to be effective, their physician may advise them on how to taper down other drugs, such as opioids. Patients should not make this type of medical decision independent of physician direction and guidance.
Physicians also play a vital role in monitoring adverse effects. Medical cannabis may not work for everyone, and some patients might find that they feel worse when taking cannabis. Furthermore, a physician can alert a patient if they should not be consuming cannabis. Although dangerous drug interactions with cannabis are rare, research suggests that some negative drug interactions with cannabis do exist. For example, researchers found that THC inhibits the metabolism of Warfarin, an anticoagulant drug used to prevent blood clots. Warfarin patients who are interested in medical cannabis may need to alter their Warfarin dose or avoid cannabis altogether.
Medical Cannabis is More Affordable Cannabis
Finally, if buying from the legal market, patients should get a medical cannabis prescription because it is a more economical choice. Private insurance companies have started to cover medical cannabis for specific conditions, many of which come with substantial pain. Sun Life Financial Inc. became the first Canadian insurance company to offer coverage for medical cannabis and covers patients who have cancer, multiple sclerosis, rheumatoid arthritis, HIV/AIDS, and patients requiring palliative care.
Additionally, prescription cannabis costs are eligible medical expenses and claimable on Canadian tax returns. These tax exemptions do not apply to cannabis bought from the recreational market. The black market is an even more affordable option for cannabis consumers. However, there is no way to guarantee quality of Black market products. Because of this, medical doctors might be weary of advising patients who rely on the black market for their cannabis.
How to Consume Cannabis for Pain – Guidelines from a Medical Doctor
For chronic pain, Dr. David Bearman suggests that patients start with an equal dose of THC and CBD. “I usually suggest that people start with seven and a half milligrams of THC and seven and a half milligrams of CBD, three or four times a day… I tell them that the most likely effect is that (a) it’s not going to make their pain go away, and (b) they’re not going to get high.” Dr. Bearman notes that it is important to start on a low dose of THC and CBD and work your way up at the discretion of your doctor.
For pain relief, he recommends fifteen milligrams of THC and fifteen milligrams of CBD, as anything less than that is unlikely to relieve pain. Importantly, Dr. Bearman believes that the specific form and the strain of cannabis are not as critical as the amount. Patients may have more autonomy in choosing these aspects of their cannabis-based pain treatment.
Do I Have to get ‘High’ for Pain Relief?
Researchers from McGill University demonstrated that CBD, a non-intoxicating cannabinoid, can provide safe chronic pain relief without the ‘high’ associated with THC. However, one of the authors clarifies that this was an animal study and that more robust human trials are lacking and needed. However, that research is on its way. The National Institutes of Health funding for CBD-focused studies went from zero in 2014 to approximately sixteen million dollars in 2016. But what about THC?
Through ‘microdosing,’ it is possible to achieve the therapeutic benefits of THC without the popularized ‘high.’ Microdosing involves taking small amounts of THC throughout the day, keeping the dose under what would result in intoxicating effects. There doesn’t appear to be any supporting research for microdosing THC. But some believe it allows a consumer to remain in control of their day-to-day activities while managing pain. Researchers have concluded that THC is an effective pain reliever, and microdosing could be the answer to eliminating the ‘sleepy’ side effect.
