Medical Cannabis
FEATURE
Final Article in a Series from Jan, 2018 to June, 2018
Jeffrey Tucker
DC, DACRB
The skin has a lot of endocannabinoid receptors. People are trying hemp oil and/or cannabis-derived topicals to see if it helps their symptoms for arthritis, neuropathic pain, insomnia, Shingles, TMJ, musculoskeletal injuries, post-op pain, low back pain, and more. They are smoking, vaping, and eating cannabis for GI ailments, emotional pain, the above mentioned conditions, and a host of others. My experience with patients who have arthritis is to use cannabis-based topicals. Think of it as a steroid cream alternative. Think rashes, inflammation, acute pain, nerve issues, plantar fasciitis, sciatica, skin issues, scar tissue, joint pain, muscles, and neuropathy. In previous articles I’ve expressed using cannabis as the gateway drug going the other way. But I think for now and until the laws change that in our offices we should stick to hemp-based topicals.
Hemp oil contains less than .3% THC, whereas medical-grade cannabis topicals contain more than 3% THC.
The difference between Hemp-derived CBD and cannabis-derived CBD look like the same molecules. However, hemp is actually a subspecies of cannabis sa-
tiva. Hemp was not breed like the cannabis plant was for its secondary compounds. Secondary compounds are the compounds like cannabinoids and terpenes that actually have or hold the medicinal qualities of cannabis. Hemp was bred for its primary compounds—fibers and proteins. It was bred to clean up soil, to eventually be made into fuels, textiles (fiber) or paper, and food (protein). These are all breeding techniques specifically for primary compounds. Therefore, you don’t really get the high level of secondary compounds in hemp.
Cannabis was and is bred for its secondary compounds, the cannabinoid potency and terpene potency. Cannabis has evolved to having a diverse range of secondary compounds. The real medicinal efficacy lies in this diverse range of secondary compounds and this is a theory called the ‘entourage’ effect, that all of these secondary compounds are working together to create the most medicinal experience possible.
When I talk about hemp-derived CBD oil (tinctures, lotions, creams, and other products), it can still be medically efficacious because, again, that CBD molecule is the same whether it’s in hemp or cannabis. However, hemp-
derived CBD does not have that full range of secondary compounds behind it to support the way in which CBD interacts with our physiology.
We as chiropractors are currently being bombarded by hemp-derived creams and lotion producers. The wonderful thing about hemp CBD is that it is federally legal and we can sell it in our offices. You may find that your hemp-derived CBD tincture doesn’t work as well as something that a patient purchased at a medical pharmacy that sells cannabis-derived CBD tincture. Please watch out for companies who are just looking to capitalize on the CBD movement. There are a lot of elixirs sold online. I’ve seen products that are sold on Amazon that really highlight “CBD tincture,” but then you read the fine print and it’s simply hemp seed oil.
1 have been going through the process of making a hemp-based lotion specifically for my chiropractic patients. 1 hired an award-winning chemists in the cosmetic industry to develop the formula, ft has taken months and months to develop and get ready to the point of properly testing for molds, fungus, bacteria, etc. ft takes months to figure out the shelf life ... a process of freezing and heating over weeks and weeks. There are a lot of companies who are trying to profit on the CBD movement that have not gone through proper testing. So, please, just be careful! If you are looking to source hemp CBD, use a
company that’s testing for both pesticides and potency, and you can find something that is clean, predictable, and effective. Above all, it has to work!
Cannabis Research
The National Academies of Sciences, Engineering, and Medicine developed a report called “Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research” (2017). This was developed to present the evidence and provide clinical recommendations on the health effects of cannabis and cannabinoid use.
An expert committee categorized the evidence regarding cannabis or cannabinoids used for therapeutic purposes. The question they asked , “Is cannabis an effective or ineffective treatment for certain health conditions?” The conclusions were presented and discussed during a meeting held at the Academies on January 12, 2017. Members of the committee who worked on the report are expert in fields that include substance abuse, neurodevelopment, epidemiology, cardiovascular health, and oncology. To accurately determine the current state of evidence in cannabis research, a systematic review was initiated in which online medical research databases (including Medline, Embase, and the Cochrane Database of Systematic Reviews) were consulted. Among the ini-
tial 24,000 articles identified, 10,000 abstracts were considered. The committee favored recent reviews featuring high-quality research focused on at least 1 of the 11 health-end points considered to be a priority by the committee, including therapeutic effects, cardiometabolic risk, mental health, respiratory disease, and substance abuse.
I have included the Conclusions for: Therapeutic Effects
There is conclusive or substantial evidence that cannabis or cannabinoids are effective for:
• The treatment for chronic pain in adults (cannabis)
• Antiemetics in the treatment of chemotherapyinduced nausea and vomiting (oral cannabinoids)
• Improving patient-reported multiple sclerosis spasticity symptoms (oral cannabinoids)
There is moderate evidence that cannabis or cannabinoids are effective for:
• Improving short-term sleep outcomes in individuals with sleep disturbance associated with obstructive sleep apnea syndrome, fibromyalgia, chronic pain, and multiple sclerosis (cannabinoids, primarily nabiximols)
There is limited evidence that cannabis or cannabinoids are effective for:
• Increasing appetite and decreasing weight loss associated with HIV/AIDS (cannabis and oral cannabinoids)
• Improving clinician-measured multiple sclerosis spasticity symptoms (oral cannabinoids)
• Improving symptoms of Tourette syndrome (THC capsules)
• Improving anxiety symptoms, as assessed by a public-speaking test, in individuals with social anxiety disorders (cannabidiol)
• Improving symptoms ofposttraumatic stress disorder (nabilone; one single, small fair-quality trial)
There is limited evidence of a statistical association between cannabinoids and:
• Better outcomes (i.e., mortality, disability) after a traumatic brain injury or intracranial hemorrhage
There is limited evidence that cannabis or canna-
bmoids are ineffective for:
• Improving symptoms associated with dementia (cannabinoids)
• Improving intraocular pressure associated with glaucoma (cannabinoids)
• Reducing depressive symptoms in individuals with chronic pain or multiple sclerosis (nabiximols, dronabinol, and nabilone)
To read the full report, please visit nationalacademies. org/CannabisHealthEffects.
In summary, I feel it’s appealing to us as chiropractors to try this type of medication not “just because” it is natural, but because it has been illegal and the majority of patients have not been exposed to this type of medication to see if it can help them.
As we maintain ourselves as noninvasive, nonpharmacologic practitioners for treatment of musculoskeletal pain, we need to monitor clinical outcomes, evaluate therapies that help reduce or eliminate pain, help offer improvement in musculo-skeletal-specific and overall function. I hope we become known as the profession that helps slow down the aging process and helps people enjoy
improvement in health-related quality of life. As a dayto-day practitioner, I have a bias: I will try anything that helps get rid of pain and pain episodes, and I’m willing to always improve patient satisfaction and avoid adverse effects. Will you be involved in the cannabis/hemp trend?
References:
1. Costigan M, Scholz J, Woolf CJ. Neuropathic pain: a maladaptive response of the nervous system to damage. Annu Rev Neurosci. 2009:32:1-32.
2. IOM Committee on Advancing Pain Research. Care, and Education Board on Health Sciences Policy Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Institute of Medicine of the National Academies, 2011. Available at: http:// tinyurl. com/43 77gws.
3. Dworkin RH, O 'Connor AB, Audette J, et al. Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc. 2010;85:S3—14.
4. Beaver WT, BuringJ, Goldstein A, Johnson K, Jones R. Ad Hoc Group of Experts Report to the Director. Bethesda, MD: National Institutes of Health: 1997. Workshop on the Medical Utility of Marijuana: p. 19.
5. Rahn EJ, Hohmann AG. Cannabinoids as pharmacotherapies for neuropathic pain: from the bench to the bedside. Neurotherapeutics. 2009:6:7137.
6. Nationalacademies. org/CannabisHealthEffects.
Jeffrey Tucker, DC, DACRB, practices in West Los Angeles, (A. He is the President of the ACA Rehab Council (CCPTR.org). Dr Tucker's website is www. Dr Jeffrey Tucker, com
