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Medical cannabis: an effective treatment for neuropathic pain

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Limited evidence suggests that medical marijuana/cannabis (a plant that contains biologically active substances in its leaves, flowers, and buds and their extracts – for example, oil and concentrates) can reduce nausea and vomiting during chemotherapy, and reduce chronic pain and muscle spasms associated with neuropathy.

The two most biologically active chemicals in cannabis are THC and CBD. THC affects how you think, act, and feel. It can make you feel intoxicated or “high.” CBD may lessen pain and other symptoms.

There are many types, or strains, of cannabis. Each plant has specific THC-to-CBD ratios. Because of this, some strains have different effects than others. For example, if a strain of cannabis has a higher ratio of THC to CBD, it is more likely to affect your judgment, coordination, and decision making. Your health care provider may be able to tell you about the different strains appropriate for your health problem and their possible effects.

Talk to your doctor before trying cannabis

Before you try cannabis, talk to your health care service provider about

• Any personal or family history of substance use disorder or mental health disorders. Using cannabis may make these problems worse.

• Other medicines you use. Cannabis can interact with many other medicines. It can be dangerous if you use it with medicines including sedatives, anxiety drugs, antidepressants, and opioids, and with alcohol, tobacco, and illegal drugs.  Cannabis can affect your blood pressure, so use caution if you take medicine for this condition. It also increases the chance of bleeding if you are on blood thinners.

Do your homework before you see your doctor.  They will ask you many questions about related things including, but not limited to:

• why you are asking for it (all things)
• your pain intensity
• pain frequency & time of day
• anxiety levels
• depression
• sleep patterns/problems
• Appetite
• previous experience with cannabis 

Each doctor is different and may ask different questions so go prepared knowing what you are asking for and what you expect.  Also, not all doctors or clinics are set up to prescribe medical cannabis so you may be referred to a specialty clinic. Research before choosing to find a clinic that is right for you.

Sourcing your cannabis product

Medical cannabis is obtained with a prescription/medical document from a health care practitioner, often affiliated with a medical cannabis clinic. There are three ways that you can obtain medical cannabis in Canada:

• buy safe, quality-controlled cannabis as a dried plant or oil extracts (in a bottle or capsules) from a licensed producer (LP).  [LP1] Most medical cannabis clinics will recommend licensed producers based on your specific criteria (cost, delivery time, quality). They will set you up with aLP of your choosing by emailing your prescription directly to the LP.  Once the LP has received your prescription from the clinic, the LP will email you authorizing you to set up an account and place orders online or by phone.

• register with Health Canada to produce a limited amount of cannabis for your own medical purposes; or

• register with Health Canada to designate another person to produce it for you

Medicines that contain THC are also available. These include THC and CBD (Sativex). This is a combination medicine that can relieve pain in people with advanced cancer and relieve muscle stiffness in people with multiple sclerosis. This drug has naturally occurring THC and CBD.

Selecting your Cannabis product

There are many ways you can use medical cannabis. For example, you can:

• Ingest cannabis oil.  In comparison to other intake methods, such as smoking or vaporizing, cannabis oil provides more precise dosing and longer lasting effects. These products can be administered under the tongue straight from the dosing syringe or incorporated into various recipes.
• Eat it in prepared or homemade foods (edibles)
• Brew it into tea
• Spray it under the tongue
• Apply it to the skin
• Inhale it as a vapour
• Smoke it as a dried plant

Selecting the method of delivery is a personal choice, however, it is always preferable to use a method other than smoking marijuana. For most of us, choosing which product to use requires some guidance.  Different cannabis strains are used for different purposes and so simply picking the strain to try requires some analysis. A good clinic will have staff trained in the different strains, which work best for which issue and the LPs who have a strain that may meet your need.

Even with the support of the trained staff, there are hundreds of cannabis strains available and finding the ones that are right for you is a testing process. Often people will track the LP/strain and their body’s reaction to each to determine if one strain is working better than another. Be prepared to do some work to find what works best.

Knowing the effects of Cannabis

How soon and for how long you feel the effects of cannabis depend on two factors:

• How you have ingested it.

When you smoke cannabis, you can usually feel the effects within seconds after inhaling. However, you may not feel its effects for up to 90 minutes after eating cannabis or ingesting cannabis oil. Since you do not feel the effects immediately, you may think you need more and use too much. To avoid this, start with small amounts until you know how edibles or oils affect you. Or follow your health care provider’s instructions on how much to use.

• How much cannabis you have used and how long you have been taking it. 

You may feel the effects of cannabis for hours after you have ingested it. In the event you feel you have taken too much THC, it is possible counteract some of its effects by taking CBD.

Cannabis may affect your judgment, memory, concentration, coordination, and decision making.  Cannabis affects different people in different ways. Side effects may include:

• Dry mouth
• Red eyes
• Anxiety or paranoid thoughts
• Faster heart rate
• Dizziness
• Drowsiness
• Nausea and vomiting

Do not drive or operate machinery after using cannabis. Talk with your health care provider about when it’s safe to drive.

Have medical cannabis, will travel… but not outside Canada!

Whether you are leaving or entering Canada, it is illegal to take medical cannabis across the Canadian border.  You could face serious criminal penalties both in Canada and abroad if you try to travel to other countries with any amount of medical cannabis in your possession – regardless of whether or not medical cannabis is legal in the state or country of your destination.

You may be able to purchase cannabis once you arrive at your international destination, depending on local cannabis laws.

United States:  a patchwork of federal and state medical cannabis laws

It is illegal to cross the Canada-U.S. border with any amount of medical cannabis in any form, even if you are travelling to a U.S. state that has legalized possession of medical cannabis. 

If you plan interstate travel, note that medical cannabis with a THC content greater than 0.3% is illegal under US federal interstate commerce laws; and in some states, all medical cannabis is illegal. This means that

• Under the federal interstate commerce law, you risk being charged with possession of an illegal substance if you attempt to cross state lines with any medical cannabis product containing more than 0.3% of THC.  The only type of medical cannabis with which you can cross state lines and not be charged under this federal law for possession of an illegal substance, is CBD oil containing 0.3% or less of THC.
• Depending on the law of your destination and/or transit state(s), you may be able to purchase medical cannabis/marijuana in that state from a licensed dispensary once you arrive at your destination. For additional links to state webpages, click here.

In those locations having state-licensed medical cannabis dispensaries, any dispensary will be able to confirm the following information:

• The feasibility of purchasing the medical cannabis product you need (legality and required documentation) in that state. Some states require no documentation at all for the purchase of medical marijuana (defined by its THC content) while others require a state-issued medical marijuana ID card.   Some states accept medical marijuana documentation from other states.
• The legality under federal law of transporting the cannabis product you purchase across state lines – regardless of the legality of state laws.  For example, if you purchase a cannabis product containing over 0.3% of THC in Washington, taking it with you south to neighbouring Oregon is illegal under federal law, despite that the same product you purchased in Colorado is also legal in Oregon.
• The legality under state law of bringing in the cannabis product you plan to purchase or already have purchased in another state.  For example, if you purchase a CBD product containing 0.3% of THC in Colorado, taking it with you east to neighbouring Kansas is legal under federal law, but illegal under Kansas state law, which, as of May 2020, bans cannabis products with over 0% THC.
• The range of relevant cannabis products available for purchase from the dispensary.

United States:  decisions, decisions – which strain of CBD cannabis should I purchase?

For those locations (sometimes entire states) that do not have state-licensed dispensaries, you might be able to purchase CBD oil extracted from hemp from unlicensed CBD stores. 

Hemp vs. Marijuana

Cannabis plants include both marijuana and hemp. The key difference between these two cannabis plants is the amount of THC contained in each.  CBD is derived from either hemp or marijuana.

Although it contains a naturally low amount of THC (up to 0.3 percent), hemp – like marijuana – contains additional phytochemicals such as terpenes and flavonoids that may have neuroprotective and anti-inflammatory effects. These components may interact together and with the brain’s receptors to create a beneficial “entourage” effect – making it more effective to take THC and CBD together than alone.

Note that CBD products purchased without a prescription are not FDA-approved, so may be inaccurately labelled.

To summarize:

 CBD isolate, broad-spectrum and full-spectrum CBD oil

There are three main types of CBD extract:

• CBD isolate – isolated from the cannabis plant’s other compounds; no THC.
• broad-spectrum CBD oil – contains all the hemp or marijuana plant’s natural compounds, excluding THC.
• full-spectrum CBD oil – contains all the hemp or marijuana plant’s natural compounds, including THC.

To summarize:

For more information, visit:

• https://aphria.ca/cannabis-oil/
• https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/resources.html
• https://www.canada.ca/en/health-canada/topics/accessing-cannabis-for-medical-purposes.html
• https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/licensed-producers/consumer-information-cannabis.html
• https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/information-municipalities.html
• https://www.cbdcentral.com/
• https://cbdoilreview.org/cbd-cannabidiol/is-cbd-oil-legal-in-my-state/
• https://cbdmap.com/
• https://www.foundationforpn.org/what-is-peripheral-neuropathy/treatments/
• https://www.foundationforpn.org/?s=medical+cannabis
• https://www.healthline.com/health/the-entourage-effect
• https://www.healthline.com/health/reading-a-cbd-label#the-basics
• https://www.healthlinkbc.ca/medications/medical-cannabis
• https://www.hg.org/legal-articles/can-you-travel-across-state-lines-with-legally-obtained-marijuana-31789
• https://licensedproducerscanada.ca/
• https://medicalmarijuana.ca/resource-center/links-2/
• https://thecannabisindustry.org/ncia-news-resources/state-by-state-policies/
• https://travel.gc.ca/travelling/cannabis-and-international-travel?utm_source=vanity#leaving
• https://weedhub.ca/access/clinics/
• https://weedmaps.com/dispensaries/in/united-states

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