Cannabis and CRPS

Hello everyone.

I wanted to take some time to write about my experience with medical cannabis. My friends often ask me if I use cannabis for pain, and if it’s effective. So get ready for loads of thoughts, feelings, science, law, debate, and maybe even magic or something.

I’ve been writing this for a while, because there are many facets of cannabis. I have a lot of ideas, a lot of opinions, and there is a lot of new data available due to its changing status across the globe. Thanks for your patience!

*Disclaimer: Medical cannabis is legal where I live. I understand that in some places cannabis is illegal even if it is for medicinal purposes. I am truly sorry if the laws in your place of residence rule out cannabis as an option for you, and I hope for their amendment. The opinions expressed in this piece are my own and a direct result of my experiences. Cannabis is not an appropriate therapy for everyone. OK, carry on…

I use cannabis for the chronic pain I developed due to Complex Regional Pain Syndrome. Cannabis is my main pain medication now that I’ve discontinued opioids. I inhale and ingest cannabis in the forms of flowers, concentrates, infused oils, and tinctures several times daily. Cannabis helps decrease my pain, increase my energy and mood, and therefore allows me greater function. Like any medication, there are some side effects. The main side effect I experience with my enteric cannabis capsules is drowsiness, which can be desirable at times depending on the situation. Sometimes the drowsiness is an inconvenient barrier or interruption in my day. When I fall asleep because of the capsules, it’s a very deep sleep where it is nearly impossible to wake me up. The cannabis capsules allow me some of the best sleep I have, but since I don’t sleep very well but since I don’t have control over when I need the naps it can be frustrating. Inhaling cannabis allows for a quicker delivery of effects, happening in a matter of minutes rather than hours for ingested products. Cannabis that is smoked or vaporized takes effect quicker, but does not last as long.

Without cannabis, I doubt I could have come off opioids. Without cannabis, I’m not sure I would be here in the way I am right now. It would be nice if cannabis was a cure for CRPS but it’s not. It’s a tool that helps me better tolerate daily life with CRPS. Without cannabis, thinking about being able to sleep through some of my pain seems impossible. I am very grateful to have legal access to it.

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Many people are starting to use cannabis as an alternative to other medications such as opioids. (Some patients are being forced off opioids they have been on for years that allow them quality of life due to politics and hysteria over opioid crises, but that is another story…) Humans have receptors in our bodies for cannabis compounds, this is our endocannabinoid system. The big question- how can cannabis help people? Be prepared for many answers.

– Cannabis helps patients get off opioids (Lynch and Clark, 2003) with chronic pain patients decreasing by an average of 64% (Boehnke, et al., 2016)

– Cannabis helps with Crohn’s disease symptoms by improving appetite, sleep, and can even induce remission in some patients (Naftali, et al., 2013 )

– Cannabis helps with irritable bowel disease (IBD) symptoms (Ahmed and Katz, 2016) and ulcerative colitis symptoms (Lal, et al., 2011)

– Cannabis helps with fibromyalgia symptoms including stiffness, pain, and general feeling of well-being (Fiz et al., 2011)

– Cannabis helps people with PTSD by reducing symptoms in some patients (Greer et al., 2014)

– Cannabis helps with chronic pain (Hill, et al., 2017)

– Cannabis helps with ________. I’m leaving this here because as new information comes out I’m sure I will be able to add to this list.

I’m not sure many other medications have a therapeutic effect on the range of conditions that cannabis does. I will leave a reminder here that I am always up for a discussion. If you are unsure about my claims and conclusions drawn from articles just start a conversation with me! Since those are not my personal experiences you may provide me with your point of view, which will hopefully in turn help me to more fully understand this complex topic.

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There are also many accounts of personal success stories with cannabis. Here are just a few:

Charlotte’s Story: Marijuana stops child’s severe seizures (CNN)

Weed is Helping Me Quit Opioids (NY Post)

Cannabis as an Opioid Exit (Leafly)

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Dangers?

There are some bad experiences patients have had with cannabis. A condition called Cannabis Hyperemesis Syndrome is being discussed more now. According an article in The Canadian Journal of Gastroenterology, cannabis can cause extreme vomiting that is paradoxical to its normal anti-nausea effects. In the article, Dr. Sullivan describes the 26 cases documented at the time. I have to say I have never experienced this from cannabis. I know many people who use cannabis, and I have never heard of this happening except in literature, and usually as a means to reject all potential cannabis therapies. I understand my pro-cannabis bias, so I figured I would mention this because it is a documented effect that could possibly happen to someone using cannabis.

In Canada, there is an ongoing class action lawsuit against the Licensed Producer Organigram due to their unapproved use of pesticides on their cannabis. Patients were essentially poisoned by what would normally be medicine for them. So tainted medication can be a danger for patients considering cannabis therapy. It was a very small percentage of patients who received the illegally sprayed batch, but these patients had serious symptoms like dizziness, nausea, and vomiting. You trust that when you are prescribed a medication by your doctor that you will have reliable access to a tested, standardized, and regulated medication. I can’t imagine what that betrayal of trust feels like. This is a statistically small, but very real risk.

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CBD vs. THC vs. Everything else inside

There are hundreds of compounds in cannabis including cannabinoids that interact with our endocannabinoid system, and terpenes that have aromatic properties. The main components of cannabis that are most talked about are cannabidiol (CBD), and tetrahydrocannabinol (THC). Since there are so many different cannabinoids in the plant often it’s only CBD and THC that are discussed for clarity’s sake. The scientific community is still trying to understand CBD and THC, so we have a ways to go until cannabis and all its compounds are fully understood.

CBD is the non-psychoactive component with many effects, including anti-inflammatory, pain relieving, anti-anxiety, and anti-convulsant properties. CBD can also help to dampen the psychoactive and sometimes anxiety-inducing effects of THC.

THC is the psychoactive component of the plant. Its effects include pain relief,  a psychoactive high, euphoria, drowsiness, and appetite stimulation.

Sometimes it’s easier to see things, so here are some awesome info graphics that break it down! Check them out here and here.

Some examples of the aromatic compounds found in cannabis, the terpenes, include linalool (also in lavender), pinene (yes, that pine smell), and limonene (in lemons). Terpenes have their own effects on the body, and contribute to the compound-rich plant that is cannabis. There’s a simplified info graphic on some terpenes here, although I prefer this source for more full view of the terpenes in cannabis .

There are many different strains of cannabis, so patients usually have to experiment at first to find the right product for them. With the amount of genetic diversity in hybrids beween the indica and sativa species, you can find strains to really target your individual needs. There aren’t very many true indicas, and sativas left. I generally prefer indica-dominant hybrid strains for my pain. Whenever I can get a proper heavy indica, I definitely sleep better.

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Legality?

Cannabis is currently illegal in Canada without a prescription that is filled from a Licensed Producer. Licensed Producers (LPs) are the only way to legally obtain cannabis in Canada. LPs can be publically traded companies with fiduiciary duties to their stockholders. So even though they are companies providing medical cannabis to legal patients only, they must legally act in the interest of their shareholders as far as profits go. For example, you can review MedReleaf’s financial report from 2017. You can see that the average cost to grow a gram of cannabis during their 2017 fiscal year was $1.73, with their average selling price at $11 per gram. I’m not suggesting that cannabis providers should be non-profit entities with volunteers keeping them going! I just believe there are signs that the looming legal change has many of these companies laser focused on their profits, and that they may leave medical patients behind.

Cannabis is going through a legal transition in Canada. It is supposed to be legal by this summer. The federal government’s plan can be viewed here. There are different provincial regulations, so be sure to look those up as well if you’re interested in this. Of course there is ruckus over the cannabis bill (C-45) so it appears the timeline has been thrown off. Colour me shocked *dripping with sarcasm*. Just shocked. I’m not including any recent legal news here because I’m sure it will be outdated by the time I post this. And then a day later when the bill is amended again.

In the United States of America, their Controlled Substances Act lists “marihuana” as a Schedule 1 drug. This means that even though there are numerous individual states that allow medical, and even recreational use, the federal government can choose to persecute business/ individuals/ patients/ clubs at any time. Since cannabis is so restricted, getting approval for cannabis research is difficult. It’s so tricky, there’s even a research article about the barriers to cannabis research articles. Side issue, any income from cannabis is considered proceeds of a federal crime, so if you are making your money from the industry, you do not want to put it in a bank. The fact that you can make a living in cannabis legally according to the state, but will need to have a cash house like an illegal drug dealer because the federal government is still hysterical over cannabis is ridiculous. There are banks now taking funds earned in the cannabis industry, an article from the New York Times talks about this issue.

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Cost?

I think Mara Gordon summarizes it really well in her presentation on cannabis in the context of CRPS.

“So the question is about the cost. It’s actually…it’s a very undemocratic medicine. I’m not going to lie. There’s nothing equal access, not only because of geographical limitations but also financial limitations. It is expensive, and it is not covered by insurance.”

I’ll put some real examples in here. The cannabis from my LP costs anywhere from $6.50 to $17.50 per gram. Since I qualify for the federal Disability Credit, I get 25% off. The cannabis extract I purchase is anywhere from $75 to $130 per 3500 mg of THC. So if I use a gram of cannabis in a day, as well as taking two of the cannabis capsules I prepare it could cost up to $22. Now, my LP selling cannabis for $17.50 a gram is absolutely sinful and frightening. I will never purchase that strain of theirs. So the average cost of my daily cannabis doses in this example is more likely around $9. In comparison, a month of opioids cost me about $36, which included the extended and immediate release formulas I was taking at the time. Now, I do not use the same amount of cannabis every day. I usually average about 2 grams combined a day. Some days require a lot more, some days require less. Some days also require different ratios of inhaled to ingested cannabis, so it really just depends.

There are a lot of numbers here, so I’ll give you the gist. The daily cost for cannabis versus opioids as pain medication can be around 10 times more expensive for me. That’s ignoring the fact that I used cannabis when I was on opioids as well. I am very grateful that my parents have the resources to provide me with the option of cannabis. Cost alone is a reason why cannabis may not be appropriate for everybody. It’s a hell of a reason to not be able to access a medication though.

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Additional Links-

Veterans and cannabis coverage cuts– previous blog post

Tikun Olam– Company from Israel that is involved in cannabis research, production, genetics, advocacy, and more. Many excellent links to be found.

MCR Labs– Massachusetts’ first independent cannabis testing lab. They have many great links to information, experiments, and more. My favourite part of their site is The Cannabis Review where they organize relevant scientific studies in beautifully accessible tables.

Project CBD– a non-profit organization promoting CBD education. A world-class source for information about CBD. You can everything you need here, education for beginners to advanced interests, technical advice, a dispensary locator, videos, and loads more.

Mara Gordon – Cannabis vs. Pain: Strategies to Combat CRPS – an excellent, excellent, highly recommended science-based presentation on how cannabis works in the body, specifically in the body of a person with CRPS. There are also some important personal connections in this presentation. Mara was on 20+ pharmaceuticals, including opioids before she started working with cannabis. When she found cannabis, the first emotion she felt was anger. Mara was furious that no medical practitioner had ever recommended cannabis for her, and that she had been conditioned to think of it as a drug next to heroin. Mara sums up one of the issues with cannabis very well. “So the question is about the cost. It’s actually…it’s a very undemocratic medicine. I’m not going to lie. There’s nothing equal access, not only because of geographical limitations but also financial limitations. It is expensive, and it is not covered by insurance.”

FDA backs synthetic CBD treatment for childhood seizures – some kids spoke at the panel to express how important and life changing the medication was for them in trials. A 12-year-old patient named Alexis Bortell said, “ever since I’ve been on this cannabis, I’ve actually been seizure-free for — today it’s 974 days, so we’re coming up on 1,000. So I think that’s pretty good.”

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Scientific Articles Cited- I know these aren’t in any proper format. Giving a middle finger to APA is maybe the best part of being forced to quit my degree…or is that too dark and relatable? Heh heh.

Lynch and Clark, 2003 – case studies of 3 patients who decreased their opioid use with the aid of cannabis.

Boehnke, et al., 2016 – opioid dosage was decreased by an average of 64%, with quality of life increasing by a reported 45% throughout the patient population.

Naftali, et al. 2013– five patients of eleven total in the THC-dosed group experienced remission from their Crohn’s disease.  “A short course (8 weeks) of THC-rich cannabis produced significant, clinical, steroid-free benefits to 10 of 11 patients with active Crohn’s disease, compared with placebo, without side effects.”

Ahmed and Katz, 2016– study found that even though many IBD patients use cannabis for their symptoms, they could not find significant evidence from the trials available to make that conclusion beyond the anecdotal evidence of the patients. The authors comment that alternative treatments that IBD patients may require could be more dangerous to the patient overall than cannabis, warranting further research into cannabis as a therapy.

Lal, et al., 2011– certain factors make ulcerative colitis and Crohn’s patients more likely to use cannabis for symptom alleviation. These include chronic pain, abdominal surgery, and a reported low quality of life.

Greer et al., 2014– New Mexico’s pilot study for PTSD and cannabis therapy. Symptoms were reduced by 75% or higher in patients using cannabis compared to when they were not using cannabis.

Fiz et al., 2011– this study produced a statistically significant reduction in fibromyalgia symptoms for patients. Quality of sleep was improved, as well as pain and stiffness.

Hill, et al., 2017– modest evidence found supporting cannabis use for chronic pain patients. Of course there is a strong suggestion that more evidence and trials are needed.

Challenges and Barriers in Conducting Cannabis Research, National Academy of Sciences, 2017 – comprehensive article identifying how the inconsistent state and federal legal designations of cannabis are preventing needed research, which makes it a public health issue. The article discusses regulatory, supply chain, funding, drug delivery, and study design barriers that all contribute to the issue.

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Additional Scientific Studies- some studies I thought were interesting and should be included here in case you want to fall down that rabbit hole of science!

Gaoni, and Mechoulam, (1964) – the first isolation of THC from cannabis. A landmark paper. Please note that it was published in 1964.

Devane, et al., (1992) – the identification of anandomide as a novel binder in the endocannabinoid system.

Volicer, et al. (1997) – studied the effects of dronabinol on Alzheimer’s patients with anorexia. The study showed that using this was effective with minimal side effects that did not require any patient to stop the placebo controlled trial. Dronabinol is a synthetic cannabinoid, usually marketed under the brand Marinol.

Weydt, et al. (2004) – mice with amyotrophic lateral sclerosis (ALS) who were given cannabiol (CBN) had the onset of their symptoms delayed by up to two weeks.

Guzman, et al. (2006) – people with brain tumors had THC administered directly into the tumor. Although the conclusion was that there were better cannabinoids for antitumor properties than THC administered into the skull, it was the first study of its kind and is a very interesting read. Some of the drawbacks for the THC included its high hydrophobicity.

Appendino, et al. (2008) – cannabis contains some antibacterial compounds, some of which can be quite effective. This study looked into the effects of isolated components of cannabis on MRSA infections. Methicillin-resistant Staphylococcus aureus (MRSA) infections are a deadly problem worldwide, with less antibiotic alternatives every time a bug develops a resistance. Five major components of cannabis were concluded to be “attractive antibacterial leads,” with some of the results being noted as exceptional.

Russo (2008) – this study tries to discover why cannabis can help different conditions and what mechanism that occurs through. This research suggests that Clinical endocannabinoid deficiency (CECD) could be the culprit. “Migraine, fibromyalgia, IBS and related conditions display common clinical, biochemical and pathophysiological patterns that suggest an underlying clinical endocannabinoid deficiency that may be suitably treated with cannabinoid medicines.” You know how every research article ends with “more research is needed”? Well, I screamed that at this article after I read it.

De Petrosellis, et al. (2013) – using CBD to trigger death in prostate cancer cells. Researchers on this paper say the data suggests that CBD is a candidate for a clinical trial in the context of prostate cancer. This paper is heavy, even for a scientific paper. I definitely don’t understand a lot of this…so many pathways!

Niesink and van Laar (2013) conclude that CBD can help counteract the negative effects of THC.

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Magic! I did promise.

Nonna Marijuana Cooking Video **Highly recommended for good vibes and educational purposes!**

The Wo/Men’s Alliance for Medical Marijuana– long running patient founded and centered advocacy group, grow co-op, and more

Blog cover photo by Arne Hückelheim– this shot is magical. I thought it captured a beautiful serene scene of cannabis growing naturally and freely in the Himalayas. Disagree with me, I dare you.

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Thank you for reading! Hopefully this information will help someone out there who has been considering cannabis therapies.

Stay lifted! ❤

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And now for the most hilariously placed tl;dr ever!!!

tl;dr – cannabis helps a lot of people with many conditions and symptoms, and I am one of them. I am pro-cannabis and it has helped me regain some quality of life as I live with this shitty condition called CRPS!