Even though legalization of marijuana is on the rise in the United States, the number of physicians who prescribe it is still quite low. Many are unsure of what dosages are needed and exactly what it can or should be prescribed for and in what forms, not to mention the murky legal issues that still need ironing out.
One thing is for sure, though, there is definitely a paradigm shift whereby physicians and patients alike are talking about it, especially when it can come in formats that do not cause a “high” like opioid drugs, which have been used to treat pain so much that now there is an epidemic of prescription opioid drug abuse. Considering this epidemic and the enormous number of people who suffer from chronic pain, it behooves us all to talk more and understand the medicinal benefits of cannabis better and decipher what information is good and what is not so good.
Having said that, it might be good to first understand that the close to 900 different products in the market can be made from one or both of the two variations of the cannabis plant: marijuana and hemp. In addition, not all of the chemical compounds (called cannabinoids) found in the cannabis plants, are created alike. Some make you “high,” and some don’t.
Hemp oil and the endocannabinoid system.
Cannabis has been used in some sort of therapeutic form by many cultures and for many centuries. With the improvement of scientific abilities and technology, scientists have been able to ascertain that cannabis is made up of over 113 different chemical compounds, also called cannabinoids. The two most prominent cannabinoids being (-)-trans-delta-9-tetrahydrocannabinol (or THC) and cannabidiol (or CBD).
Scientists have also discovered that the bodies of all mammals have their own cannabinoid system, called the endocannabinoid system (ECS). This means the body produces a variety of chemicals that bind to millions of receptors (receptors are tiny proteins attached to your cells that receive chemical signals from different stimuli and help your cells respond) located throughout the brain, central nervous system, and rest of the body. These chemicals and their receptors act to regulate the body’s state of balance, influencing your mood, emotional state, learning, memory, sleep, appetite, digestion, pain, immune response, and hormones. In other words: They’re really, really important. When it comes to the endocannabinoid system, there are two major receptors: CB1 receptors are found in the central nervous system and brain and CB2 receptors are found in the immune system.
Cannabinoids ingested from plants influence our body’s ECS, which means they have the potential to affect your mood, memory, appetite, immune system, and so forth. The reason marijuana causes a “high,” or mood alteration, is because THC binds to CB1 receptors in the brain. Where and how different cannabinoids interact with receptors in the body is what makes them unique. The cannabinoid THC, for instance, binds to both CB1 and CB2 receptors. For this reason, THC has the ability to affect all the mentioned bodily systems and cause the “high.” CBD, on the other hand, barely binds to these receptors at all. In fact, CBD seems to exert its effects on the ESC through other pathways completely. Indeed, scientists have found that even at high concentrations, CBD exerts its effects through over 60 molecular pathways.
The many different cannabinoids in hemp oil.
Because CBD fails to bind to CB1 receptors in the brain, the “high” you get from THC doesn’t occur. That being said, it does bind to other receptors involved in mood, cognition, and memory, so CBD can influence other aspects of the mind and mood, including emotions, feelings, and perception. For example, studies have found that CBD binds to the 5-HT1A (serotonin) receptor, which can have the effect of reducing anxiety, among other things.
Reducing anxiety is only one of the therapeutic benefits of CBD being noted, and continued studies on CBD oil use therapeutically are showing great promise. Though more research is necessary, it has also been shown that CBD has the potential to relieve pain and inflammation. When you think about it, it makes sense that cannabinoids influence and help regulate inflammation since both CB1 and CB2 receptors are located in the immune cells.
The connection between hemp oil and pain.
Though CBD only binds slightly to these receptors, and THC is the predominant compound that has been shown to decrease inflammation (since it binds to the CB2 receptor), CBD has been found to exert its own powerful anti-inflammatory action and act as an analgesic (pain reliever), through other metabolic modalities. For instance, it appears that CBD can increase adenosine signaling, a molecule that reduces inflammation.
The reason both CBD and THC help treat pain, however, isn’t only due to their positive effect on inflammation. Both compounds influence the brain and nerve pathways, meaning they affect how we experience and perceive pain. You see, the experience of pain has many components, and it’s a complex phenomenon. Pain that results in the same injury in two individuals, for instance, can be experienced entirely differently by each person. This has to do with the sensory system of the body when the tissues incur damage but also the amount of inflammation the ensues, the person’s mental attitude toward pain and injury, the influence of the culture they come from with regard to injury and pain, their perceptions around their ability to function, what damage means with regard to being a whole and complete person, whether or not he or she will heal, and so on and so forth. And of course, when or if the pain becomes chronic, even more variables are involved, whether the pain is due to an ongoing disease or pathological issues with the nervous system (neuropathic).
For example, if you cut your hand, the sensory and pain nerve fibers that are affected will relay a message to the brain that there is an injury. You will also visually witness it. You most likely will be affected emotionally and physically by the injury. The more upset you are, the higher likelihood that you will incur more pain. Even more so, if the pain persists, chances are that your level of discontent and distress will worsen.
Pain—especially chronic pain—is a very real issue. The National Academy of Sciences Institute of Medicine has concluded that the U.S. economy loses close to a trillion U.S. dollars every year, when pain-related medical services and loss of productivity costs associated with patients in long-term care and within the military are included. Considering the current state of the opioid epidemic, finding better ways to address the complex problem that is chronic pain is of utmost importance. Knowing that the body has an innate system to manage pain, much of which is regulated through the endocannabinoid system, using safe, nonpsychoactive formats of CBD from hemp oil and marijuana is really exciting news.
The research on hemp oil and pain.
Though more research and more evidence are necessary, there are a multitude of promising studies pointing to the myriad benefits CBD has for controlling and reducing pain. A 2011 review of randomized trials that studied the effectiveness of cannabinoids in treating chronic non-cancer pain found that of the 18 trials reviewed, 15 of them met the necessary criteria and demonstrated a significant analgesic effect of cannabinoids versus placebo, without any reported serious side effects. In addition, cannabinoid was found to be better than placebo in improving sleep.
With regard to rheumatic pain, one study found that cannabinoid receptors are found in the synovium (the lining of joints that secretes fluid so that the joint has mobility) in joint spaces of individuals suffering from rheumatoid and osteoarthritis. Another study involving rats with arthritis found that the application of CBD gel for four days reduced inflammation and overall pain in the rats without side effects. Of course, more research in human subjects is needed, but the science is promising, especially with regard to CBD’s positive effect on neuropathic pain especially associated with HIV, multiple sclerosis, or other types of chronic nerve pain conditions.
How to buy hemp oil for pain, legally.
Whatever CBD product you decide to try, you should know that it can be inhaled, ingested, or applied. It comes in the form of a tincture that can be sprayed under the tongue or dropped with a vial dropper. Both these formats do not use the digestive system, so the CBD is absorbed in the blood stream quickly. CBD can also be ingested through infusion into baking mixes or by eating edibles or supplement capsules. Lastly, CBD can be applied topically to the body in the form of salves, massage oils, and lotions.
A total of 29 states, the District of Columbia, Guam, and Puerto Rico have enacted laws that allow for the medical use of marijuana. Each state has its own specific requirements and conditions that must be followed for cannabinoids to be used legally. At the federal level, however, marijuana is still classified as a Schedule 1 substance under the Controlled Substance Act, meaning it is considered to be a substance that has the potential for dependency and has no accepted medical use. This also means that distribution of marijuana is a federal offense, a confusing predicament when it is legal in so many states. In fact, the U.S. Department of Justice reserves the right to challenge the states at any time they deem necessary, which makes many doctors very nervous (much of the reason why so many doctors don’t prescribe it or know much about it).
Technically, the U.S. Drug Enforcement Agency (DEA) labels all cannabinoid products illegal, but it seems the agency is much more concerned about marijuana-derived CBD than hemp-derived CBD (which lacks the THC component), which is available in every state and in online stores like Amazon. Marijuana-derived CBD can usually only be acquired in the states where medicinal marijuana is legal. Thus far, the states have been successfully enabling stores and practitioners to provide CBD for those in need without being prosecuted by the DEA. The truth is, the DEA cannot override the state medical marijuana laws, which means CBD is still legal in the states that allow its use medicinally and if the product contains less than 1 percent THC (as is found in hemp-derived CBD), buying and using it is legal throughout the United States.
Where to buy your hemp oil products.
Trying to find the right hemp oil can be an ordeal, which is why I recommend you speak with a health care provider who is educated on the subject. Having said that, you may want to try hemp-derived CBD first, as it is legal and doesn’t have the mind-altering side effects. Start with the smallest of doses and see how your mind and body respond, and make sure you have your doctor in the loop to track your response. If you are suffering from a lot of musculoskeletal pain and spasms, you can try the massage oils or lotions very safely and will note whether it is working fairly quickly. If you suffer from pains in your digestive tract or chronic inflammation, you may want to try edibles.
If you find the hemp-derived CBD simply isn’t helping, you might then want to try the marijuana-derived products, and for this, you will need to work closely with the medical professional who is doing the prescribing to see what is best for you.
If you are one of the millions of people affected by chronic pain, CBD may be an option for you, and if you are interested in knowing more, your first step should be discussing it with your doctor or knowledgeable health care providers and taking everything you read on the internet with a grain of salt—especially when it’s written by a company that sells CBD products. If your own doctor is not knowledgeable or is uncomfortable talking about CBD, you may choose to speak with a doctor who is educated on the subject and belongs to the many marijuana dispensary clinics throughout the country. Here’s how to find one near you.
This article first appeared in mindbodygreen.com
Photo credit @shanerounce