The Empowered Pain Patient’s Guide to Medical Marijuana

Tell me all I need to know about using medical marijuana for chronic pain.

If you’re one of the millions of people who live with chronic pain and its common bed partners (hello, fatigue, insomnia, anxiety, and depression),1 you’ve probably thought of trying medical marijuana. Cannabis (marijuana) for chronic pain management straddles the line between pharmaceutical and alternative, while also existing in a grey zone of legality that is largely based on where you live. But the natural plant’s proven benefits are growing, particularly for more than 15 complex conditions, from fibromyalgia to rheumatoid arthritis.

So if you’re already using—or considering using marijuana for the first time—the most important thing is to have a safe strategy in place for where you purchase the product, how and when you use it, and what potential side effects to expect. Here’s all you need to know to get started.

SO, EXACTLY HOW DOES MARIJUANA FALL INTO THE MEDICINE CATEGORY?

Let’s answer that question with another question: Would you put marijuana in the same bucket as LSD? How about heroin? The federal government says yes to both. In fact, in 1970, the US Controlled Substances Act classified marijuana as a Schedule I drug, due to its addictiveness and propensity for abuse. Fifty years later, it’s still illegal on the federal level. But it’s legal for medicinal use in 33 US States and the District of Columbia. California was the first state to permit legal access to and use of botanical cannabis for medicinal purposes under physician supervision with the enactment of the Compassionate Use Act.2

That schism makes navigating marijuana potentially confusing for consumers, and the federal classification creates many obstacles in the scientific study of marijuana for medicinal use.

Luckily, researchers have found some ways to get the science done. Data demonstrates, and many states support, that medical marijuana may be beneficial for managing symptoms of:3-8

But understanding how marijuana works and how to use it for maximum benefit requires more information, and sometimes a bit of trial and error. There’s still a lot we don’t know, but we do know that medical marijuana is a beneficial option for many.

HERE’S WHERE MEDICAL MARIJUANA GETS COMPLICATED

Much of the research into medical marijuana has been preliminary to date (looking at you again, DEA classification) but the predominant pathway for the medicinal effects of marijuana seem to be its interaction with the body’s endocannabinoid system. The system is also named for the plant’s naturally occurring cannabinoids, the two core ones being: cannabidiol (CBD) and tetrahydrocannabinol (THC).

To further explain, this system modulates your body’s desire to stay balanced and stable, known as homeostasis, and plays an important role in neuronal and immune cell function, both of which are important parts of pain perception. There are three parts of the endocannabinoid system:

  1. cannabinoid receptors, namely CB1 and CB2
  2. endogenous cannabinoids (the cannabinoids that your body produces)
  3. enzymes that facilitate the breakdown and use of cannabinoids 

Cannabinoid receptors are located throughout your body and help determine how cannabinoids affect you.

CB1 receptors are found predominantly in your central nervous system (the CNS includes the nerves of your spinal cord and brain) and affect a person’s pain experience. CB1 receptors also play a role in the signaling of pain to the brain via the spinal cord. On a physiological level, CB1 receptors can affect your emotions, memory, executive functioning, and reward. CB1 is the receptor predominantly responsible for the psychotropic effects of cannabis.9

CB2 receptors play an important role in pain via their role in the body’s immune response, mainly due to their anti-inflammatory effect, although they also have analgesic or pain-relieving properties. These receptors are expressed in both immune cells, peripheral (outer) tissues, and in the CNS – but in much lower levels than CB1 receptors.

Marijuana contains exogenous or external cannabinoids such as THC and CBD. THC acts directly on both the CB1 and CB2 receptors, although not with the same precision as our internal endocannabinoids (anandamide and 2-arachidonoylglycerol). While most of the medicinal qualities of marijuana are attributed to these cannabinoids, other plant properties are involved as well.

 

HOW TO GET – AND USE –  MEDICAL MARIJUANA FOR PAIN AND RELATED SYMPTOMS

Step 1: Get a Doctor’s Order

The first step in consuming medical marijuana (legally speaking) will be getting a recommendation from your doctor. Because marijuana is still illegal at the federal level, doctors give recommendations or orders but are not legally permitted to give prescriptions. You can find state-by-state information regarding what conditions qualify for medical marijuana.

Step 2: Pick Your Passion

Next, you’ll need to decide what form you want to use – each type will dictate your experience with it.10 Consumption methods can change the percentage of active compounds your body absorbs, the time it takes to feel the effects of marijuana, and the duration of those effects. There are three main ways to consume cannabis:

  • inhalation – vaping with a vaporizer or smoking (think a “joint”)
  • edibles – gummies, brownies, and other “snacks”; tinctures and oils that dissolve under the tongue fall into this category too
  • topicals – creams, ointments, salves applied directly to your skin

Below is a quick overview of each.

Inhaling

Inhalation marijuana allows the active components to readily cross the blood-brain barrier and may be an effective way to decrease the CNS response to pain sensations. This can be especially useful for difficult to treat neuropathic pain or centralized pain conditions, such as fibromyalgia. When people smoke marijuana, they typically begin feeling effects after 2 minutes, with that feeling peaking after 30 minutes. When smoking, people tend to feel the influence of marijuana for 2 to 4 hours and the body typically absorbs about 25% of the active compounds.

When people inhale cannabis via vaporization, they absorb more of the active compounds than when smoking. This is an important consideration, especially for first-time users. Vaporization typically results in a 33% absorption of cannabinoids so you may want to consume less if vaping than when smoking.

Consuming Edibles

Taking medical marijuana by mouth has similar effects to inhalation, but with a slower and less predictable uptake. There are different forms of edibles on the market. When you eat a marijuana-containing product, it must travel through the digestive tract just like any other food or beverage, so you will not feel the effects right away – a couple of hours is typical. This is one reason why people are more likely to over-consume edibles, so be careful. If you do not feel the effects immediately, do not take more. Some studies suggest that the digestion of marijuana may have increased beneficial effects on the digestive system, due to the direct interaction with the gut microbiota.11

Dispensaries often consider between 1 and 5 milligrams of THC to be a micro-dose, and often a recommended place to begin. The effects of ingesting edibles containing marijuana can be stronger and longer lasting than inhaling cannabis.

Walk into a medical marijuana dispensary and you are likely to see an array of edibles, including:

  • gummies
  • cookies
  • lollies
  • beverages
  • butters
  • brownies
  • granolas

Tinctures and Oils

Tinctures and oils are sometimes thought of as edibles because you take them by mouth, but they are more readily absorbed by the body. Tinctures and oils can be taken under the tongue, where they are rapidly absorbed into the bloodstream and cross the blood-brain barrier. Tinctures may be a good option for people who want greater control over their dose, because they are easier to measure precisely.

Applying Topicals

Topical application is best used to decrease localized pain and inflammation, should not result in systemic absorption, and should not give you a high (like consuming and inhaling marijuana will). If you have joint pain and apply a topical lotion to the source, it can have a pain-relieving effect. Marijuana-infused topicals include:

  • lotions
  • creams
  • oils
  • salves

Just like any medicine, the dose of marijuana you use will be a decisive factor in its effect on your body. Dosage can be more difficult to predict and control because the effects will vary based on the strain, method of consumption, your unique body chemistry, and even your history with marijuana (you may find that you need more as time goes on).

Some things to keep in mind:

  • Your body absorbs more cannabinoids when vaping than when smoking.
  • You will not feel the effects of edibles right away. Start small and go slow.
  • Dosage listings for retail products (especially edibles) may be inexact and it often only takes a small percentage of the product to feel the effects.
  • Tinctures (liquid edibles taken under the tongue) usually allow for the most accurate and measurable dosage.
  • The experience you have with one strain may not be the experience you have with another; doses and brands will vary.

Step 3: Get Into the Science to Stay Safe

Just as the cannabinoids produced by your body interact with a variety of other natural components, the cannabinoids produced by the marijuana plant interact with their own variety of elements. Both are affected by their surroundings.

For us, our specific type of pain, our weight, and our daily habits (what we eat, how much we sleep, and how much stress we’re under) can impact how marijuana affects our bodies. For marijuana plants, the sun, soil, and humidity can impact how they grow. And just like a wine grape, the same marijuana strand may differ from harvest to harvest.

So in addition to selecting the basic form you want to try, you need to look at the product from the inside out. Here’s how.

Examine the THC: CBD Ratio Closely

The most measurable way to anticipate how a certain medical marijuana product will affect you is by its ratio of THC to CBD. Many brands advertise or label their product with this ratio, but without testing of the finished product, we can’t be 100% sure what’s inside.

Many physicians and medical marijuana sellers will recommend a 1:1 ratio to begin. This means that the marijuana is equal parts THC to CBD. (See also, our guide to using CBD for pain).

Remember, marijuana is a plant and its compounds work cooperatively (known as the entourage effect). To quickly explain, CBD can help to balance out the psychotropic effects of marijuana and THC aids in the anti-inflammatory and analgesic effects of CBD. If you are concerned about the high of marijuana, you’ll want to try a product that has a greater percentage of CBD, while maintaining a THC profile. Just like any medicine (or supplement), your body weight, metabolism, and composition will help determine your personalized dosage.

Some product sites feature a weight chart to find the right dosage; you should clarify this with your dispensary and/or doctor before ingesting anything.

For a less balanced approach, you can experiment with THC or CBD dominant strains. Here’s a quick guide although each dispensary or manufacturer may offer distinct products – just as you would a prescription, always double check the labels.

THC-dominant strains are typically selected for a more euphoric experience and to treat pain, depression, anxiety, insomnia, and more. Some people feel anxious with THC-dominant strains and dislike the side effects associated with THC. Examples of common THC-dominant strains on the market are:

  • Do-Si-Dos
  • Death Star
  • Mimosa
  • Wedding Cake
  • Original Glue

CBD-dominant strains typically contain only a small amount of THC and are recommended for people who are highly sensitive to THC and want clear-headed relief. Examples of common CBD-dominant strains on the market are:

  • Charlotte’s Web
  • Harle-Tsu
  • Remedy
  • Sour Tsunami
  • ACDC

Balanced THC/CBD strains contain similar levels of THC and CBD and typically offer mild euphoria alongside symptom relief. Examples of common THC/CBD balanced strains on the market include:

  • Cannatonic
  • Pennywise
  • Sweet and Sour Widow
  • Harlequin
  • Canna-Tsu

Learn the Significance of Different Marijuana Species

So, let’s say you’ve decided to try medical marijuana. Now what? You may notice that marijuana dispensaries often break products into three different categories or species:

  • sativa – said to be more energizing, sativa was traditionally found in Western Europe and Eurasia, where it was cultivated for its fiber and seeds; these plants are tall and have thin leaves
  • indica – said to be more relaxing, indica was traditionally found in India, where it was harvested for its fiber, seeds, and hashish production; these plants are stout and have broad leaves
  • hybrid – said to be more balanced, hybrid types are bred from a combination of sativa and indica

(Note that not all sativas will energize you and not all indicas will relax you.)

This categorization is related to the relative CBD:THC ratio in each species (among other compounds). However, the scientific community’s growing ability to test the chemical make-up of marijuana plants has shown that many of these species are in fact mixed and no longer true to their origins. Because marijuana has been cultivated over the years, pure strains are rare, and lucky for us, most marijuana strains sold today are a hybrid – which makes this information helpful to know, but not necessary to memorize.

Consider the Compounds

Although not crucial, you may wish to pay attention to the compounds in your selected marijuana product – that is, the amount of terpenes and other cannabinoids beyond THC and CBD. Terpenes, by the way, are the aromatic compounds produced by plants and fruits like orange peel, lavender flowers, and hop. If you’ve ever used aromatherapy, you understand terpenes. The most common terpenes found in marijuana are: myrcene, caryophyllene, limonene, and terpinolene.

These compounds will work with your unique biology and tolerance based on how you consume them and the dose you take.

Now, let’s unpack all this. Remember, marijuana’s exogenous (external) cannabinoids bind to endogenous (natural) receptors in your body. The main cannabinoids studied in marijuana are:

  • THC – which is broadly credited for pain relief, nausea relief, and that high feeling.
  • CBD – which is broadly credited for alleviating pain, inflammation, anxiety, and many other medical ailments. CBD is not intoxicating.

When choosing a marijuana strain, it is recommended to focus most on the ratio of THC to CBD.

Read about one woman’s experience trying medical marijuana for the first time, including entering a dispensary and journaling the strains that both worked – and wigged her out. 

 

WHAT ELSE TO EXPECT WHEN USING MEDICAL MARIJUANA

The cloud of taboo and stigma surrounding marijuana can make it difficult for people to get the best results from even its medical version. Often, people are embarrassed to ask questions, or to speak openly about using medical marijuana. The change in public opinion toward a more “pro-marijuana” stance can sometimes make us forget that just because it is a plant, doesn’t mean there aren’t side effects and precautions to take.

Like any medication, before trying medical marijuana, you want to know why you are taking it. Living with joint or migraine pain? Struggling with anxiety? Having trouble falling or staying asleep? This will help you determine how and when to take marijuana. You may also consider lifestyle factors. Are you getting sufficient exercise? Have you been consuming caffeine excessively? As medical marijuana becomes more standardized, it is important that we not consider it a catch-all, but rather, a complementary treatment to other care regimens, such as interventional procedures, physical therapy, and psychotherapy.

Medical marijuana is generally safe and there is no record of any person overdosing from marijuana – ever. Indeed, in New York State, you can get a prescription for medical marijuana for conditions where opioids (which can be highly addictive and potentially fatal in overdose cases) have typically been prescribed. However, this doesn’t mean marijuana has no negative effects.

Some potential side effects of marijuana include:

  • anxiety
  • drowsiness
  • dry mouth (especially with edibles)
  • feelings of paranoia
  • increased heart rate
  • low motivation
  • poor concentration
  • poor motor skills
  • poor sexual performance
  • poor short-term memory

These side effects depend on the strain, dosage, method of consumption, and the individual; long-term side effects are typically related to consistently heavy use at a younger age. Because of these effects, it is recommended that you not drive after using medical marijuana. Some states have under-the-influence laws and studies have demonstrated marijuana-related impairment although the data are inconclusive.

Marijuana may also interact negatively with other medications, such as blood-thinners, so it is important to review your medication regimen with your doctor before consuming marijuana. Marijuana can increase the depressant effect of alcohol as well.

And remember, due to its quasi-legal status, marijuana is not regulated. Although it’s cliché, what you see is not always what you get. Dispensaries may look like your standardized pharmacy but they are not standardized. You can improve you experience by requesting that the products you buy are tested for their chemical breakdown, such as the ratio of THC to CBD.

Overall, medical marijuana use may feel a bit more like an art than an exact science. The response is highly individualized and, often, there is a lot of trial and error involved.

 

WHY YOUR MENTAL HEALTH MATTERS WHEN USING MEDICAL MARIJUANA

Many people use medical marijuana for psychological ailments, such as PTSD and anxiety. While cannabis can ease symptoms of these conditions, some people may experience additional feelings of anxiety and paranoia so you’ll need to track your response. If you end up spiraling out, call your doctor right away and be sure to note which strain/brand caused the effect so that you don’t take it again.

People with psychoses may wish to avoid medical marijuana as it can increase the risk of or symptoms of these disorders.12

One collection of studies associated heavy use of marijuana during adolescence with increased rates of mental illness and cognitive impairment. This may be due to the endocannabinoid system’s important role in brain development. This does not necessarily preclude young adults from medical marijuana use but it should be taken into consideration.

And remember, medicinal or not, marijuana can still get you high. If you don’t do well feeling out of control, cannabis may not be the best choice for you.

WHAT CAN I DO RIGHT NOW?

The best thing you can do right now is to educate yourself about your own state laws around marijuana. NORML is a nongovernmental organization that focuses on the legalization of responsible marijuana use for adults and serves as an advocate for access to high quality and safe marijuana. You can access state-by-state laws. In addition, marijuanadoctors.com can help you find a doctor who is familiar with medical marijuana.

You might also learn about other complementary treatments, such as CBD, alternative treatments, and osteopathic manipulation.

HAVING THOSE HARD CONVERSATIONS

Rolling a joint at work isn’t exactly socially acceptable – yet. It can be difficult to explain your medical marijuana use with family members, especially children (get some tips on talking to young ones about why you use cannabis). The historical propaganda and stigma surrounding marijuana can complicate life for the medical marijuana user. While there is still a dearth of research on medical marijuana, there is no record of anyone overdosing from marijuana.  However, the jury is still out on whether one can develop a physical dependence or addiction to the substance.

At the end of the day, your pain is your own experience and how you choose to manage your condition is a personal choice. While the science of marijuana for pain relief is new and evolving, its historical use is more traditional than most people realize. Whatever your choice, it should be about what helps you live your happiest, healthiest, and most pain-free life.

FAQs 

How does marijuana help chronic pain?

The THC in marijuana may help to temporarily relieve pain by interacting with the body’s natural cannabinoid receptors and reducing pain signaling and pain perception. Chronic pain stemming from systemic inflammation, such as with rheumatoid arthritis, may benefit from marijuana’s anti-inflammatory effects as well. CBD may help to stimulate an immune response and attenuate pro-inflammatory cytokines – those are small proteins involved in signaling pain.13,14

How do you use marijuana for pain relief?

There are many ways to use marijuana for pain relief. You can smoke, vape, apply topicals to your skin, or consume edibles. The way you take marijuana is about personal choice and the type of pain you are experiencing.

Does smoking cannabis help with pain?

Yes, smoking cannabis has been shown to help with pain. How much cannabis helps will depend on your type of pain, the strain of marijuana that you choose, and your individual body chemistry and tolerance.

Which cannabis is best for back pain and muscle spasms?

There is no one best cannabis for back pain. The strain of marijuana that works best for you will depend on the cause of your back pain, the type of marijuana product you use, and other preferences (such as the desired degree of a psychoactive effect). Many people do best with a balanced strain, that is, equal parts THC and CBD as both have pain-relieving effects.13,14

Updated on: 09/18/20
Continue Reading:
The Empowered Pain Patient’s Guide to CBD
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