By Francis D’Ambrosio, M.D
In a recent survey of 4,276 medical marijuana patients, we found that 51% use cannabis to reduce or replace their intake of painkillers. Patients also use cannabis to reduce or replace antidepressants (27%), anxiolytics (10%), barbiturates (3%) and anticonvulsants (2%). 36% of patients surveyed use cannabis primarily for pain. So, the question is, “Why is cannabis such an effective painkiller?”
Due to the fact that cannabis is a schedule I substance, answering this question for definite is difficult. The official federal government stance is that schedule I substances have “no medical value”, which goes against most of all the scientific evidence produced so far. Sadly, the way cannabis is scheduled so far means that researching it properly and getting the clinical trials, large-scale longitudinal studies and double-blind, placebo-controlled experiments done is an uphill struggle for many. In the meantime, we can postulate and go on the evidence out there so far …
THC May Affect Opioid Receptors
There are 4 types of opioid receptor, including:
- Delta (?), Subtypes ?-1 and ?-2 – responsible for analgesic, antidepressant and convulsant effects. May have an effect on respiratory depression. Plays a role in physical dependence.
- Kappa (?), Subtypes ?-1, ?-2 and ?-3 – play a role in analgesic, anticonvulsant, dissociative/hallucinatory, diuretic and sedative effects. Kappa opioid receptors are also involved in the development of depression, miosis (constriction of the pupil), neuroprotection and stress.
- Mu (?), Subtypes ?-1, ?-2 and ?-3 – responsible for: analgesia and physical dependence, (?-1 opioid receptors); respiratory depression, miosis, euphoria, reduced GI motility and physical dependence (?-2 opioid receptors); and possibly vasodilation (?-3 opioid receptors). The delta-opioid receptors may also interact with mu-opioid receptors to induce respiratory depression.
- Nociceptin, Subtype ORL1 – nociceptin opioid receptors are responsible for anxiety, depression, appetite and development of tolerance to mu-opioid receptor agonists.
Mu-opioid receptors may modulate THC’s rewarding effects, which is one possible reason why cannabis could work for pain. This may also explain why THC may be useful in keeping withdrawal symptoms and opioid cravings at bay.
The Huge Number of Cannabinoids and Terpenoids
THC, CBD, CBG, pinene, linalool … Cannabis contains many cannabinoids and terpenes that act as anti-inflammatories, sedatives, anti-pathogens and analgesics. Unlike many of the more “traditional” (a misnomer, as cannabis is very traditional) painkillers, this gives cannabis its multi-pronged therapeutic potential, making it arguably superior to opioids for the treatment of chronic pain.
Here’s a list of some of the most common cannabinoids and terpenoids found in cannabis:
|Delta-9 Tetrahydrocannabinol (THC)||The main “psychoactive” cannabinoid found in cannabis. THC enabled scientists to discover the Endocannabinoid system in vertebrate mammals. Especially effective for pain, nausea, tumors and ADHD.|
|Delta-1 Tetrahydrocannabinolic Acid (THCa/THCA)||Not psychoactive. THCa is an anti-inflammatory, encourages appetite, combats insomnia, is anti-tumor and is an antispasmodic. THCa may also work as an insecticidal. THCa converts into delta-9 THC when it is burned.|
|Delta-9 Tetrahydrocannabivarin (THCv/THCV)||Has no known effect, but may have some uses for diabetes. May be somewhat psychoactive, and is generally found in higher concentrations in African landrace strains. Thought to be one of the main reasons why such strains have “buzzy”, “racy” effects.|
|Cannabidiol (CBD)||The other main cannabinoid found in marijuana, alongside THC. CBD is thought to be non-psychoactive, although there are some reports of slight psychoactivity by some users. CBD works in many of the same areas as THC. It is for this reason that CBD has become the new “sought-after” cannabinoid. CBD works in combination with THC and other cannabinoids, psychoactive or otherwise, making this view short-sighted. As CBD has physiological effects, it could be said to be psychoactive to some degree, even if it’s not to the same degree as THC.
CBD, like many cannabinoids, has broad spectrum use, and can be used for pain, stress, asthma, seizure disorders such as MS and epilepsy, and lowering blood sugar levels for diabetes. CBD is also an anti-inflammatory and cancer-killing cannabinoid.
|Cannabidiolic Acid (CBDa/CBDA)||CBDa has anti-inflammatory and anti-tumor properties. Until recently, found mostly in Cannabis ruderalis, which is the type of cannabis used to create auto-flowering strains. Strains such as Cannatonic and ACDC have been developed to produce more CBD/CBDa than THC/THCa.|
|Cannabidivarin (CBDv/CBDV)||Non-psychoactive. A homolog of CBD, meaning they share many of the same properties as each other. The difference between CBDv and CBD is that CBDv is that the side chain is shortened by two methylene bridges. CBDv may also have anti-epileptic effects, and is being looked at by GW Pharmaceuticals as well.|
|Cannabichromene (CBC)||CBC is also non-psychoactive, and it is suggested that CBC is up to 10 times more effective than CBD for treating stress and anxiety (anxiolytic). Also used to treat inflammation and pain relief. CBC has antiviral and anti-tumor properties, and has been shown to stimulate the growth of bone tissue.|
|Cannabigerol (CBG)||Non-psychoactive. Stimulates bone growth and brain cell growth. Combats insomnia and depression. Antibacterial and anti-tumor. CBG is a neurogenic compound, and as such is useful in the treatment of nerve pain. Of particular interest to MS, ME, ALS, head/brain trauma, cancer and HIV/AIDS sufferers. Psoriasis and IBS sufferers may benefit, too.
CBG is one of the few genuinely neurogenic compounds around in the world, and is rarely found in nature.
|Cannabinol (CBN)||Cannabinol is a byproduct of oxidized THC, and normally forms after THC is exposed to oxygen or heat. Older cannabis that’s been exposed to air also shows a slightly higher level of CBN, as THC breaks down to CBN. CBN is slightly psychoactive and a medium to strong sedative. Useful as an antiemetic, anticonvulsant and in the treatment of insomnia.|
|Alpha- and Beta – Pinene||This is what gives some marijuana its “pine” like smell. Pinene is also found in pine needles, dill, parsley, rosemary and basil. Effects include alertness, memory retention and counteracting some of the effects of THC. Useful for asthmatics and as an antiseptic and antimicrobial.
Jack Herer, Super Silver Haze (SSH), Neville’s Haze, Chemdawg and Trainwreck have high amounts of pinene.
|Myrcene||Ever wondered why beer and marijuana have similar sedating effects? That’s because hops contain myrcene, and so do some types of marijuana. Mango, lemongrass and thyme also contain myrcene.
Myrcene is a mild-to-moderate antioxidant, anticarcinogenic, anti-inflammatory and antidepressant. Great for sleeplessness and muscle tension, too. Works in combination with CBD for a “couchlock” effect. High myrcene strains include pure Pure Kush, Skunk #1, Himalayan Gold and White Widow. Can sometimes be found in Blueberry- and White Widow- based strains, too.
|Limonene||As the name of the terpene suggests, limonene is responsible for that “citrus” or “lemony” aroma and taste found in some strains. Limonene is found in fruit rinds, juniper berries, peppermint and rosemary. Provides for an elevated mood and stress relief. Limonene may also help battle cancer.
OG Kush, Lemon Thai, Super Lemon Haze, Jack the Ripper and Lemon Skunk are all high in limonene.
|Beta-Caryophyllene||Beta-Caryophyllene is found in black pepper, cloves, black caraway and cinnamon. Has no psychoactive effect, but does seem to affect the CB2 receptors. Could be useful as an anti-inflammatory. Caryophyllene has use as an antinociceptive (pain blocker), neuroprotective, anxiolytic and antidepressant.
Though not psychoactive, beta-caryophyllene interacts with other phytocannabinoids and can be used for the treatment of pain, inflammation, addiction (particularly alcohol and opiate addiction), anxiety, depression, epilepsy, and fungal and bacterial infections. Hash Plant is a strain that tends to have lots of caryophyllene in it, and Thai- and Vietnamese-.based strains like Chocolope Haze and Willie Nelson could be high in caryophyllene.
|Linalool||Ever smelt some strains of marijuana and found that they smell like flowers or certain types of air freshener? That’s probably because said strain contains linalool, a terpene also found in lavender and jasmine.
Linalool is useful for anxiety relief and sedation, and also has anticonvulsant, antimicrobial, antidepressant and anti-acne properties. Amnesia Haze, Lavender, Master Kush, LA Confidential and G-13 all have lots of linalool in them. Many blueberry- or purple- based strains (e.g. Grand Daddy Purple, Purple Kush) also have moderate to high amounts of linalool in them.
|Humulene||Humulene occurs naturally in clove, basil and hops. Earthy, woody, spicy aromas and flavors are usually associated with humulene, and as such you are likely to find it in abundance in sativa-leaning strains like Congo Haze, Mango Haze, Girl Scout Cookies, and Headband. Indica-leaning strains like Pink Kush and Skywalker OG also contain humulene.
Humulene is an antibacterial, antitumoral and anti-inflammatory.
|Bisabolol||Bisabolol is another flowery-smelling terpene found in cannabis, and has been used in cosmetics for a number of years now. Chamomile and candeia trees contain high quantities of bisabolol, and as such this terpene has low-psychoactivity.
Bisabolol has anti-inflammatory, anti-irritant, antioxidant, antimicrobial and analgesic properties. Harle-Tsu, ACDC, OG Shark, Rockstar and God Bud have high concentrations of bisabolol.
|Trans-Nerolidol||This terpene is most often found in tea tree, jasmine tea and lemongrass, and is thought to contribute to sedative effects. There are also suggestions that trans-nerolidol has antiparasitic, antifungal and antimicrobial properties, and could well inhibit the growth of leishmaniasis (a disease caused by protozoan parasites spread by sandfly bites).
Both indicas and sativas with high levels of THC tend to have high amounts of this trans-nerolidol, so think Aurora Indica, Strawberry Cough, Moby Dick, Maui Waui, Sweet Island Skunk and Sensi Star.
A Cornucopia of Pills – Cannabis as a Replacement
When people are in pain, it’s often not just opioids they’re prescribed, but a cocktail of benzodiazepines, antidepressants, anxiolytics, analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs). Now, some of these are effective and well-tolerated for chronic pain, but others are less so, leading to addiction, nausea & vomiting, organ failure, increased tolerance (meaning higher doses) and an inability to sleep and eat properly, which can in turn make pain worse overall. Moreover, taking a huge number of pills for a long period can be psychologically damaging, and also leads to a greater chance of contraindication between drugs and overdose. Cannabis can potentially replace all of these other pills, making only some of them necessary.
The therapeutic potential of cannabis is amazing. There are few if any plants with its number of cannabinoids and terpenoids, and in some instances produces unique phytochemicals that are rarely found elsewhere in nature. The fact that patients are restricted from accessing what could be an extremely beneficial, safe medication is highly unethical and, some would say, criminal. It’s time the cannabis plant is given its due, and scientists and doctors are allowed to research it properly.
Francis D’Ambrosio, M.D., aka Dr. Frank, is an orthopedic surgeon with over 30 years of experience. After seeing patients come in and out of surgery in pain, and the only prescription available being strong, addictive opioids that bought a pain all of their own, Dr. Frank knew it was time for a change. After reading up on the science behind cannabis and its potential as an alternative to opioids and many other medications, Dr. Frank became an advocate for medical marijuana and patients who need cannabis. To learn more about Dr. Frank, read more on the science behind cannabis or even to book an appointment, go to: https://doctorfrank.com/