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What Cannabis Can (and Can’t) do for Chronic Pain. Pot for Pain Relief?

What Cannabis Can (and Can’t) do for Chronic Pain. Pot for Pain Relief?

(Story by Karen Weintraub, USA TODAY) reprinted 1/26/2023. 
A growing, but still incomplete body of research suggests the cannabis plant, the source of marijuana, can help fight some kinds of pain.

Rob Sims grew up hearing stories about what opioid addiction could do. The former Detroit Lions guard, whose father, Mickey, also played in the NFL, watched a number of his dad’s friends get hooked. Some died. He vowed his own story would be different.

Then, playing for the Seattle Seahawks in 2008, early in his pro football career, Sims tore a pectoralis muscle in his chest. Primed for his best year ever, Sims was sidelined.

After surgery, he received an open-ended prescription for opioids. “Take when you have pain,” the bottle read. “That’s seared in my memory,” he said. As a football player, “I have pain all the time.”

Scared by the lesson he had learned as a child and with little to do besides focus on his recovery, he remembers thinking: “This could go in a bad way.”

That’s when he turned to marijuana.

It remains unclear whether cannabis can be an effective treatment for pain. Plenty of circumstantial evidence supports the idea, but exactly how, what kinds of products and what can be expected from them has yet to be determined.

“There’s some caveats before it’s ready for broad, prime-time usage for chronic pain,” said Dr. Devan Kansagara, a professor of medicine at Oregon Health & Science University and a staff physician at the VA Portland.

It’s possible that cannabis helps with the psychological aspects of pain, said Dr. Nora Volkow, head of the National Institute on Drug Abuse. “Cannabis may improve pain indirectly, for instance, through decreasing anxiety so that someone may be able to deal with pain better,” she said.

Rob Sims was a guard with the Detroit Lions and now runs a cannabis business with fellow former Lion Calvin Johnson Jr., right. © Carlos Osorio, AP

Detroit Lions guard Rob Sims during the game against the Green Bay Packers at Lambeau Field, Dec 9, 2012.© Benny Sieu, USA TODAY Sports

One recent examination of previous studies found the benefits of cannabis were equal to the benefits of a placebo, which means that if people thought it would help, it did.

“There’s very limited evidence out there to support that cannabis is effective against pain,” said Karin Jensen, the Swedish neuroscientist who led the study. So far, most of the information showing its usefulness is anecdotal.

“People who use cannabis to relieve pain may have the experience that it helps – there is no doubt about that,” she said. “What’s needed is solid scientific evidence to determine how much of the relief is due to the cannabis and how much is due to other things, such as the placebo effect.”

The general public is already largely convinced.

Marijuana remains illegal in 12 states, but as of 2019, 18% of U.S. adults reported using cannabis at least once in the previous year, and 4% to 5% use it daily or nearly daily, Kansagara said.

In a 2017 study, the majority of people who used medical marijuana or self-medicated with the drug said they did so to relieve pain, and 65% of those who requested medical marijuana licenses said they wanted it to treat pain.

The marijuana plant provides a wide range of chemicals, including THC, which has psychotropic effects/

But cannabis comes with cautions.

At least 5% of Americans ages 12 and up abuse or are dependent on marijuana, and the risk for dependence increases the younger someone starts. Marijuana use directly affects parts of the brain responsible for memory, learning, attention, decision-making, coordination, emotion and reaction time. And long-term or frequent marijuana use, particularly at higher doses, has been linked to increased risk of psychosis or schizophrenia.

It’s not possible to predict ahead of time who will react badly to marijuana, said Dr. Charles Berde, co-founder of a pediatric pain clinic at Boston Children’s Hospital.

THC, the part of the plant that has psychotropic effects, “has narrow uses for nausea and appetite stimulation in patients with severe weight loss due to AIDS or cancer,” but the data for CBD for treatment of chronic pain is “murky,” Berde said. “All the more reason to be hesitant to prescribe it.”

Cannabis and pain relief

When a body is in pain, the brain releases its own pain relievers. There are special receptors in the brain designed to take in these natural cannabinoids and offer relief.

Ingesting or inhaling weed fills up those receptors, too.

Providing more cannabinoids than these receptors can accept overloads them making the person’s own internal cannabinoids ineffective, said Dr. Jordan Tishler, a cannabis specialist physician in Cambridge, Massachusetts, and founder and president of the Association of Cannabinoid Specialists.

That’s why higher doses don’t provide any additional pain relief compared with lower ones and can have “all sorts of risks,” he said. Side effects from cannabis can include increased heart rate, dizziness, impaired concentration and memory, slower reaction times and, more rarely, increased risk of heart attack and stroke and dependence.

Tishler said many patients come to him taking far too much cannabis, which increases the risk for side effects. He works to convince them that 5 mg to 20 mg a day will treat their pain better than the 200 mg they’re using.

Cannabis is now sold in many different forms.

“Just because (cannabis) doesn’t lead to breaking the law and incarceration and those sorts of troubles doesn’t mean people can’t have their lives significantly altered by getting overly involved with this particular substance,” he said.

There are also open questions about cannabis, including whether the pain-killing benefits seen in short-term studies will last. Some painkillers, like opioids, can actually make people more sensitive to pain. It’s not yet clear whether cannabis can have this effect.

“You’d like to see what happens with these products over a longer period of time, ideally,” Kansagara said. “I would like to see that before recommending wholesale to patients.”

Although legalization and decriminalization are making a difference, cannabis remains hard to study. Until recent years, it was extremely difficult to gain access to cannabis for research, and there was little federal funding for such work. In early December, President Joe Biden signed a law that will make it easier to research cannabis.

Dr. Donald Abrams, speaking in support of the Adult Use of Marijuana Act ballot measure in San Francisco on May 4, 2016. © Jeff Chiu, AP

Gold-standard studies compare a treatment versus a placebo, but it’s impossible to keep people in the dark about whether they’re getting high, said Dr. Donald Abrams, an oncologist and professor emeritus at University of California, San Francisco, who studies cannabis.

When Abrams studied cannabis use in his HIV patients, some critics thought patients must be too stoned to notice their pain. But Abrams said the patients reported that it did alleviate their pain.

Dosages of cannabis aren’t standardized, which adds to the difficulty of comparing one study against another, he said.

That’s why trials of cannabis for pain relief have shown mixed results, said Wil Ngwa, an associate professor of radiation oncology at Johns Hopkins Medicine, who’s working to create such standards for drug trials.

This lack of standardization also means people have to use trial and error to find an effective dose for them, according to Staci Gruber, who directs the Marijuana Investigations for Neuroscientific Discovery (MIND) program at McLean Hospital, a Harvard-affiliated psychiatric hospital outside Boston.

In one study, Gruber followed 37 volunteers using cannabis for chronic pain. After six months of treatment, participants reported lower levels of pain, better sleep, more coherence and less use of conventional painkillers.

‘Positives, not negatives’

Sims experienced the same benefits.

Daily marijuana use after his pec injury helped cut the pain, allowing him to lift more weight and recover faster. “I was able to come back stronger than I was before.”

Playing NFL ball, Sims said, is like living through a train wreck every Sunday. The best players – the ones whose careers last the longest, he said – “have learned how to recover quicker and get ready for that next train wreck.”

During his career, marijuana helped Sims rebound and improved his sleep, which allowed him to push his workouts.

Asked about side effects from his marijuana use, Sims pointed to his athletic and financial successes. “I wouldn’t call those side effects,” he said, laughing. “I see positives, not negatives.”

In 2021, Sims co-founded the cannabis company Primitiv Group with fellow former Lion Calvin Johnson Jr. Sims and Johnson acknowledge they used cannabis during their professional careers, though there was a zero tolerance policy then, which has loosened only slightly since. Both men believe the restrictions should be lifted.

About a decade ago, Sims persuaded his wife, Natalie, to try cannabis, when a bout with the bowel syndrome Crohn’s disease left her on a morphine drip in an emergency room.

“This can’t be how we live for the rest of our lives,” he told her. She uses cannabis now and finds relief, Sims said.

“It made me very passionate about pain and help for pain.”

Challenges of cannabis care

Cannabis doesn’t make pain go away, like Advil might get rid of a headache, Tishler said.

Instead, “it makes it so it doesn’t bother you so much,” he said. “It divorces the pain from the suffering.”

Whether it’s the THC or the CBD in cannabis or both that might be helpful against pain remains an open question, Kansagara said. THC is what makes people feel “high.” CBD appears to have anti-inflammatory properties, which may be useful to some.

Smoking joints isn’t a good approach for relieving chronic pain, said Tishler, who recommends his patients use edibles instead. The effect of inhaled cannabis wears off in three to four hours, while a gummy might last eight to 12 hours.

The yo-yo effect, when pain comes and goes over a few hours, can exacerbate suffering, Tishler said. “Short-acting actually turns out to be a bad approach in general in pain management.”

In Massachusetts, where medical cannabis has been legal since 2013 and recreational since 2016, doctors are more comfortable giving their patients permission to use cannabis, Tishler said. But they rarely bring it up themselves.

So, Tishler is trying to educate his peers. “If you were thinking the patient needs opioids, think cannabis first. Don’t wait for the patient to bring it up – it’s your job to bring it up,” he tells them.

Similarly, he’d like to get cancer patients on cannabis early in their care, rather than waiting until agony sets in. “Once people are at the end of their rope, things are worse and harder to treat than if we had started when things were still kind of OK.”

Most of the advice on what product to use now comes from the patient care advocates or “budtenders” who work behind the counter at dispensaries, Gruber noted with some concern. They typically don’t know the person’s medical history or history of cannabis use or whether they use other substances such as alcohol, other drugs or prescription medication. Product labels can often be misleading about their THC and CBD content.

The trial-and-error approach can be difficult and challenging for patients with major medical problems.

“Knowing what’s in your weed is critical, but also how you’re going to respond to it is an important consideration. And that’s something we don’t spend a lot of time on,” Gruber said. “You have to educate patients. They’re desperate for it, but it’s not easy, because we’re all different and cannabis is not a ‘one size fits all’ solution.”

Research may change future use.

For cannabis to reach its full potential as a painkiller, more research is needed, experts say.

“It’s really untapped right now, because of that lack of research,” Johnson said.

That’s why NFL players and owners have been supporting cannabis research. Owners have donated more than $1 million this year to two cannabis research programs.

“We need to become better educated about all these issues,” said Dr. Allen Sills, the NFL’s chief medical officer.

Dr. Allen Sills, the NFL’s chief medical officer© Rebecca Blackwell, AP

Ngwa, at Hopkins, collaborates with Sims and Johnson to lead some of that research.

He’s also looking at better ways to treat cancer pain with cannabis.

His studies suggest that not enough of the painkiller gets to a tumor when the cannabis is inhaled or ingested, so he has been exploring smart-drug delivery systems than can target the drug directly to the tumor. So far, he has tested only pancreatic tumors but hopes to rapidly expand to other cancer types.

Ngwa is concerned that preliminary research like his will encourage people to self-medicate, taking doses that may not be helpful. “You really have to wait for the clinical trials, but when people are desperate, they just do (anything). I definitely worry about that,” he said.

Until more is known, Sims will keep up his cannabis routine.

Now 39, he has dropped 50 pounds from his 320-pound playing weight, which has helped reduce the lingering bone-on-bone pain in his right knee. He rubs a Primitiv topical on it knee every day.

“My passion behind the plant and what it’s done for my family reigns supreme.”

Contact Karen Weintraub at kweintraub@usatoday.com.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

Consuming medicinal cannabis oil improves sleep in adults with insomnia

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2 New States Voted to Legalize Marijuana in the 2022 Elections.

Maryland and Missouri.

Alaska, Now Lighting Up

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The Amount of Misinformation about CBD is ASTOUNDING! Gives Pause to the Real “Stuff”.

********************************

Over the past few years, CBD has taken the world by storm. Daily, I see claims that CBD “cures” a myriad of ills.

As a holistic nurse practitioner and certified herbalist for more than 30 years, those exaggerated claims “push my buttons”, for a variety of reasons.

.

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MCOA’s New hempSMART” Brazil Operations Has Received Product Recognition From ANVISA – (USA version of FDA)

LOS ANGELES, CA October 11, 2021, Marijuana Company of America, Inc. Reprinted from a previous release 9/21/22 

a diversified holding company with operations and investments throughout the cannabis industry, today

 

announced that the Company’s new hempSMART” Brazil operations has received product recognition from ANVISA,

the Brazilian regulatory agency equivalent to the FDA to sell its premium hempSMART” products via physician prescriptions in Brazil, the biggest CBD market in South America.

The Company has begun to fulfill prescriptions and expects continued requests. ANVISA, the Brazilian regulatory agency,

in 2019 established a legalized environment for the sale and consumption of CBD and cannabis for medical use in Brazil.

ANVISA Agência Nacional de Vigilância Sanitária

ANVISA is an autonomous agency that regulates most, if not all products and services in Brazil.

The institution assures that products follow the necessary standards and health regulations

before they can be sold to patients. hempSMART” products are available to physicians and patients in Brazil.

                                       Cannabidiols are Legal in Brazil with a Prescription

The ANVISA regulatory framework sets a comprehensive procedure for the manufacture and import of CBD products as well as the requirements

for commercialization, prescription, dispensing, monitoring and supervision of cannabis products for medical purposes.

Cannabidiol (CBD) oil can be sold only in Brazil to cannabis medical patients who receive a special control prescription from their physician,

and must be renewed every 60 days. hempSMART” is now being shipped directly to the patient.

US

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Cannabis Global – CBGL. We are an emerging force in the cannabis marketplace with a growing product and proprietary intellectual property portfolio.

Cannabis Global (CBGL) Closed Q2 2022 and Sees Healthy Continued Revenue Increases, Provides Investor Updates


LOS ANGELES, CA July 21, 2022 Cannabis Global, Inc. CBGL Cannabis Global, Inc., a licensed Los Angeles-based manufacturer and distributor in the cannabis sector, today provides an update for its investors and the marketplace after reporting its third fiscal quarter ending in May 31, 2022.

2022 Will Be CBGL Year To Watch

During the third fiscal quarter the Company continued to expand its customer base and the number of products manufactured and distributed. Four new products were launched in the edibles space and five in the solventless. New orders grew significantly during the quarter for solventless cannabis concentrates, zero cannabis taste edibles, and concentrate based flower products. Over the coming weeks the Company expects these products to be delivered to both storefront retailers and delivery companies. During the current quarter, which ends on August 31, 2022, the Company also expects to launch its Northern Lights brand consisting of premium flower-based products, edibles and solventless concentrates.

“During this recently reported quarter, we experienced numerous successes relative to product rollouts, customer orders and deliveries. We believe the strong growth in our order pipeline from significantly sized retailers will allow us to continue to experience growth in product revenues,” commented Arman Tabatabaei, Chief Executive Officer of Cannabis Global, Inc. 

Cannabis Global 2022

For the third fiscal quarter, the Company produced revenues of approximately $792,000, a sequential increase of approximately 25% over the previous quarter. Revenue growth during the quarter was a result of increased orders from recently introduced cannabis brands and an expansion of distribution related activities. Total assets rose to $14.9 million as of May 31, 2022 from approximately $11.4 million as of May 31, 2021. 

About Cannabis Global, Inc. 

Cannabis Global, Inc. is a Los Angeles-based, fully audited and reporting Company with the U.S. Securities & Exchange Commission, trading under the stock symbol CBGL. We are an emerging force in the cannabis marketplace with a growing product and proprietary intellectual property portfolio. We are marketing and producing Comply Bag(TM), an innovative solution for cannabis storage, transport and tracking. Our subsidiary, Natural Plant Extract (NPE), is a Southern California licensed cannabis manufacturer and distributor which licenses our technologies to produce edibles for the cannabis marketplace. Cannabis Global has filed three non-provisional and multiple provisional patents for cannabis infusion and nanoparticle technologies and continues an active research & development program.

Thank you for consideration.

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MCOA Subsidiary cDistro Signs Master Distribution with Mellow to Distribute Dosist brand in Europe

LOS ANGELES, CA July 6, 2022 Marijuana Company of America MCOA; today announced that the Company’s cDistro distribution operating entity has signed a Master Distribution agreement with multi-brand cannabis eCommerce and marketing company Mellow, a subsidiary of CBD of Denver, Inc. (OTC: CBDD), a cannabis roll-up company. The agreement covers the launch and distribution of dosist health’s award-winning line of high-concentration CBD+ formulas & products and innovative delivery vape devices to the UK & Europe. Mellow will be doing this via its newly established Mellow Distribution division.

cDistro distributes CBD brands, along with smoke and vape shop-related products to wholesalers, c-stores, specialty retailers, and consumers in North America. Mellow group operates as a multi-brand eCommerce Marketplace, a full-service digital & performance marketing agency, as well as a market expansion service into the Asian markets and was recently acquired by CBD of Denver.

The Master Distribution Agreement is for both companies to launch and distribute dosist health’s award-winning line of high-concentration CBD+ formulas & vape products throughout the UK & Europe. dosist is a globally recognized, modern wellness company empowering people to naturally manage their health & happiness through dose-controlled cannabinoid therapy. dosist is best known for its targeted formulas, proprietary award-winning dose-controlled vape devices, rigorous testing, use of medical grade and recyclable materials, and their obsession with providing consumers with a safe, natural experience, all now available in its CBD products under the brand dosist health.

dosist was named by Time Magazine as “cannabis that could replace pills“, was recognized by Fast Company as a top 10 Most Innovative Companies in the health sector and was named by LinkedIn as the #2 Top Startup on the top 50 list of hottest U.S. companies to work for. dosist health also recently won the ECRM Buyers’ Choice Award for its CBD+ Vegan, Fast-Acting Gummies during ECRM’s Hemp/CBD Health & Beauty Care forum held this past November.

cDistro and Mellow will be distributing dosist health’s complete collection of high-concentration CBD+ formulas & vape products, specifically engineered to target the need-states of sleep, calm, and relief. The dosist health collection features three performance categories including dose drop CBD+ tinctures, a full suite of CBD+ fast-acting topical solutions, and their new rapid onset gummies that are vegan, non-GMO, and made with natural flavors.

MCOA’s Chief Executive Officer, Jesus Quintero, said, “Not only do we have several new exciting distribution brands and products coming down the pipeline in the CBD/Cannabis sector, but we now have the right partner on-point in the UK and European markets with deep distribution and marketing experience to help us ensure success as we actively build up our international distribution product portfolio on behalf of dosist health and their award-winning product portfolio.

“The UK & EU vape/e-cigarette markets and growing extremely quickly and according to Statista are forecast to be valued at $4.2bn and $11bn respectively by 2025, notwithstanding the UK & EU CBD markets are also growing extremely quickly.”, said Paul Gurney, CEO of CBD of Denver.

Gurney added, “As the vape product markets increasingly blend with the CBD market, we are seeing an increase in customer interest and a blending of purchase trends. We are excited to partner with MCOA’s cDistro, to exclusively bring the award-winning dosist brand to the U.K. and European markets. This is a top 3 US brand in the CBD / vape crossover category and allows us to expand our reach to our customers. And the opportunity to distribute the dosist health portfolio offers additional upside to us.”

About Marijuana Company of America, Inc.

Marijuana Company of America (MCOA) operates, invests, and acquires exclusively companies in the cannabis sector. The Company is a multi-state (licensed) operator and the parent company within the cultivation, distribution, and international consumer product sectors.

About Mellow

Mellow group operates as a multi-brand eCommerce Marketplace, a full-service digital & performance marketing agency, as well as a market expansion service into the Asian markets, added to which is its newly formed distribution division, mellow distribution. Recently acquired by CBD of Denver, mellow is playing a key role in expanding the CBDD business revenue streams, as well as diversifying the brand portfolio, as part of a commercial roll-up strategy. With offices in the UK and Switzerland, CBDD is able to offer an end-to-end service proposition for brands wanting to enter and/or operate across the UK / EU markets, including manufacturing, production, supply-chain, distribution, eCommerce, and Marketing.

About CBD of Denver, Inc.

CBD of Denver, Inc. owns 100% of Rockflowr a full-line Distributor of CBD and Cannabis flowers and a producer of a full line of CBD oil and unique products sold in Switzerland and throughout Europe. It also owns 100% of mellow, a distributor and eCommerce technology business in the global CBD and Health & Wellness space.

As a Cannabis Roll-Up company, CBD of Denver, Inc. is focused on using equity to acquire profitable assets at attractive valuations to create value for all our shareholders and is driven by a passion to improve lives and strengthen communities by unleashing the full potential of cannabis.

Through the Rockflowr brand, CBDD has been able to build a very strong European customer base by focusing on top-quality products and meaningful customer relationships.

Thank you for consideration.

Inspirational Technologies

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