What is medical cannabis (medical marijuana)?
According to the National Institutes of Health’s National Center for Complementary and Integrative Health, cannabis has been used in medical treatment for more than 3,000 years for a plethora of conditions, including pain relief, digestive issues, and psychological disorders. While medical cannabis is thought to be useful for treating several medical conditions and symptoms, there is still great debate about the safety and efficacy of using cannabis for medicinal purposes.
Although people with facial pain may have a variety of symptoms, the one constant is pain. Currently, the predominant pain management treatment is opioid medications. Cannabis may be considered an option for management of facial pain along with other surgical, pharmaceutical, and complementary therapies. Most marijuana-based products do not have the approval of the US Food and Drug Administration (FDA) and more research is needed to confirm their safety and effectiveness.
Medical cannabis is the whole, unprocessed marijuana plant or the chemicals contained within it to alleviate the symptoms of certain conditions or diseases. The plant is composed of over 100 chemicals, or cannabinoids. Each has different effects on the body. The first main chemical is tetrahydrocannabinol, or THC. This is the psychoactive compound in marijuana, i.e., the element that produces the high. The second is cannabidiol, or CBD. This substance does not produce any psychoactive effects. Medical cannabis has a higher CBD content, so users do not feel the euphoria associated with recreational cannabis which has more THC content than the medicinal variety.
How does medical cannabis work?
There are two cannabinoid receptors in the human body. CB1 receptors are concentrated in the brain and are believed to be responsible for the psychoactive effects of cannabis. CB2 receptors are found throughout the body, and are believed to play a role in the modulation of both pain and inflammation.
There are two main species of cannabis plants, cannabis indica and cannabis sativa, from which all medical cannabis products are derived. In about 80% of the population, indica strains produce a tired and relaxing effect, while sativa strains can create a more heightened sense of alertness.
There are numerous genetic variations (hybrid strains) resulting from the cross-pollination of these strains that produce different effects from the two dominant strains. Indica strains are favored for pain management, sedation, and sleep while sativa strains may improve energy and mood. You may need to try different strains to find the one that works best for you.
How medical cannabis can help facial pain
Although there is limited research on the effects of cannabis, preliminary evidence suggests cannabis reduces nausea and vomiting, improves appetite, and reduces chronic pain and muscle spasms. Results from a recent study revealed that more than 62% of individuals who use medical cannabis do so to treat chronic pain.
Medical cannabis shows promise for relief of chronic, neuropathic pain though the amount of relief varies from study-to-study. Overall, studies show that it offers low to moderate pain relief. Some studies show considerable pain relief, while others show none at all. Medical cannabis relieved pain no matter where in the body the pain occurred. However, there has not been a study that focused specifically on orofacial pain. Cannabis, the plant, and cannabinoids, natural occurring compounds in the plant, do not always significantly improve pain, but consistently improve sleep and quality of life.
How is it administered and dosed?
Whole-plant cannabis is smoked or vaped, extracts can be delivered via oro-mucosal sprays, and synthetics are taken orally in pill form. Cannabis may be consumed via inhalation, oral, sublingual (under the tongue) and topical routes of administration. Products for inhalation usually consist of dry flower (bud), vaping oils, and physical oil concentrates. Oral dose forms consist mainly of capsules, tinctures and oral solutions. For topical administration, there are lotions and creams that do not provide systemic absorption and can be used topically throughout the day without psychoactive effects, as well as transdermal patches which will cross into the bloodstream and behave as if the medication was inhaled or swallowed.
The effect peaks (ie, THC and other cannabinoid blood levels reach their maximum) of vaporization are at approximately five minutes and may last about two hours. Effects via oral ingestion, on the other hand, may last six to eight hours, but there is less control over the peak (some patients prefer to take this form of cannabis at night). Sublingual spray effects have a shorter duration, at approximately four hours, with a peak effect at one hour.
The most common adverse effects are the psychoactivity that we attribute to being “high”, including dizziness, tiredness, and at high doses vomiting and hallucinations.
Speak to your healthcare provider and educate yourself about medical marijuana dosing and preparation. Cannabis may offer pain reduction without significant side effects in either the short or long term. Cannabis should be considered at least an effective adjunct if not an alternative medication for chronic neuropathic pain.
For more information, FPA published two articles in our Quarterly journal: