Medical Cannabis (Vs Opioids)
FEATURE
Part Four in a Series
Jeffrey Tucker
DC, DACRB
I don’t think there is any doubt that the marijuana industry is flourishing. Most predictions about the industry are optimistic. Arcview Market Research indicates that North American sales will have an annual growth rate of 25%. I hope to keep you informed of all of the components of the cannabis industry—from growth to testing, research, and medicinal applications. I feel chiropractic has a role in the growing medicinal expansion of the industry.
Endocannabinoid system
The endocannabinoids called CBD and THC that I have previously discussed act as ligands—or chemicals that bind to receptors—at cannabinoid receptors within the central nervous system. The body naturally produces substances called endocannabinoids. This is very similar to the opioid system in the body. In 2015, a study from Germany concluded that ’‘runner’s high” does not come from endorphins but from the endocannabinoid system. The only thing comparable is the endocrine system.
The endocannabinoid system was not taught in chiropractic college when I went to school. As doctors, we will need more education and it will help as you gain more personal contact with patients using medical cannabis. Almost everybody has a friend, relative, or acquaintance who has used cannabis therapeutically and had very good results. When you see for yourself, I suspect you’ll shed some of the old stereotypes about cannabis. As a profession, we should be familial' with the endocannabinoid system, especially THC and CBD because they have the ability to help decrease pain. This system consists of at least two receptors—CB 1 and CB2. CB 1 receptors are in the brain; THC connects with those receptors. The CB1 receptors in the brain help relieve stress and anxiety. CB2 receptors are in the rest of the body, produce a feeling of well-being, and help maintain homeostasis. These receptors are in every organ, including the skin, and typically are found on nerve cells and immune cells.
If you eliminate the endocannabinoid system, suicide rates and depression go up. CBD has medicinal properties that are very broad. It’s suggested as a muscle relaxant and can help IBS. Also, a publicly traded pharmaceutical company called GW Pharmaceutical is working on anticonvulsant meds for kids with a seizure disorder. So why wouldn’t I want to understand the endocannabinoid system that influences mood alterations, suicide effects, and the sense of feeling less irritable? (The Endocannabinoid System, Cannabinoids, and Pain, www.ncbi. nlm.nih.gov/pmc/). This information is posted on the National Institutes of Health’s website.
We understand the link between inflammation and pain, but patients caught on before we did that these cannabinoids have numerous anti-inflammatory effects that can decrease pain. Patients are already coming in using CBD and THC products for pain relief in the many forms available. The mechanism of the endocannabinoid system influencing pain has to do with THC directly binding to both CB1 and CB2 receptors, “mostly by preventing the release of inflammatory signals from B and T immune cells, and in animal studies [have] been shown to prevent the development of hyperalgesia, or abnormally increased pain signaling at the site of an injury.” (The Endocannabinoid System, Cannabinoids, and Pain www. ncbi .nlm. nih. go v/pmc/).
CBD binds to transient receptor potential (TRPV1) receptors that have a positive influence on the CB 1 and CB2 receptors, which is how CBD indirectly mitigates pain. TRPV1 is directly related to heat and inflammation sensations. It mediates the pain sensations associated with capsaicin and pipeline, and, therefore, pain transmission. Thus, CBD may influence pain in this direct fashion as well, and that is why CBD is considered the more anti-pain compound of the two cannabinoids. CBD has also been shown in animal studies to speed the healing of injured connective tissue.
In previous articles, I mentioned antianxiety and improved sleep effects from using CBD. We know better sleep can influence pain and pain behavior. Some people have said they use CBD for cancer and the effectiveness of the intervention increases with the addition of 2 to 3% of THC in conjunction with CBD (ProjectCBD.org/16/cancer). Tetrahydrocan-
nabinol (THC) is effective for treating glaucoma and PTSD (Leafscience.com).
CBD is fast becoming a major component of self-treatment programs. Be aware that CBD is legal as long as it has less than 1% THC. Chiropractically, CBD has a lot of applications. It is a good analgesic, is anti-inflammatory, reduces anxiety, induces sleep, is antiemetic (anti-nausea), and it helps with Crohn’s disease, ulcerative colitis, IBS, arthritis, menstrual cramps, migraines, and FMS. In my experience, CBD by itself is effective for mild to moderate pain. For more severe intense pain, you need both THC and CBD. The THC activates the CBD and makes it more potent.
Migraine Headaches
Let’s use a case example. Carla is a 59-year-old female who gets frequent migraine headaches that can occur on a weekly basis. Prior to getting a medical cannabis card, she took Imitrex medication at the first sign of a headache. We learned that patients with migraine headaches can use a specific strain of cannabis called Durban Poison. Most people with migraine headaches will get an aura. Usually between the aura phase and the onset of a full-blown migraine, most patients will have about 30 to 40 minutes. She started to keep a vape loaded and ready (instead of the Imitrex). She did not ingest an edible because it takes too long to become active, and a tincture takes about 30 to 45 minutes before it begins to work and it peaks in about an hour to 90 minutes. This strain
in a vape has worked consistently without getting a high. The THC does not have that same psychoactive effect with a migraine as if you used it without a migraine. It has to do with the pathophysiology of a migraine and the constriction of the blood arteries. THC is a central vasodilator. With a migraine, you get constriction of the temporal artery and the THC opens it up, but you don’t get the full psychoactive effect in the brain. The Durban Poison strain is a 70/30 ratio of sativa to indigo. If you inhale that without a migraine, you’d get high. Those with a migraine don’t get high. Overall, she feels less pain, less fatigue, and improved focus.
I hope chiropractors improve their knowledge with respect to cannabis for medical purposes and ultimately advance the sector. I hope to see chiropractors do scientific and medical research through networks of practitioners in our offices. Let’s figure out the best medical cannabis and dosage while tracking the effectiveness and safety of cannabis used in the management of symptoms associated with particular health conditions. Let’s assist patients in identifying which cannabis products are right for them.
Dr. Jeffrey Tucker practices in West Los Angeles, California. He is the current secretary treasurer of the AC A Rehab Council. Dr Jeffrey Tucker is teaching a hands on workshop on April 6, 2018 at the AC A Rehab Council annual symposium in Las Vegas on “Utilizing the CLX Rehab Bands ”. Go to www.CCPTR.orgfor registration. His website is www.DrJeffreyTucker.com.
