Ask a Marijuana Doctor: How to Use Medical Marijuana for Pain
Posted by Marijuana Doctors on 08/05/2019 in Medical Marijuana
Updated on January 4, 2020. Medical content reviewed by Dr. Joseph Rosado, MD, M.B.A, Chief Medical Officer
Dr. Joseph Rosado is an experienced physician who specializes in Physical Therapy & Alternative Addiction Therapy/Management. MarijuanaDoctors.com caught up with him at his Florida practice to discuss how and why medical cannabis is an ideal choice for treating all kinds of pain.
What types of pain is marijuana best at treating?
Dr. Rosado: Cannabis is incredibly powerful for pain management. As a medical director I oversee the care of patients who have been put on cannabis for all kinds of pain, and we’re not talking mild pain you treat with aspirin, not just back pain from muscle spasm—but truly debilitating pain. Pain associated with failed back and neck surgeries, pain from scoliosis, degenerative joint disease, osteoarthritis, pain from sciatica, neuropathy symptoms, and nerve pathology.
In particular, neuropathic pain can be devastating. Not only are patients in excruciating pain, this type of pain doesn’t respond well to pain medications. And patients can get this sort of nerve damage from all sorts of circumstances: chemotherapy, from an old type of HIV medication, from infections like Lyme disease, and from certain vitamin deficiencies like from B-Vitamins.
I also see a lot of diabetic neuropathy, associated with Type 1 or Type 2 diabetes. That’s when prolonged high blood sugar causes permanent damage to a diabetic’s nerves, most often in the legs and feet, and it’s a very painful condition. And, we’re finding that cannabis can treat this sort of pain very, very well.
We’re even seeing results with this really rare, but freaky, condition called RSD, or Reflex Sympathetic Dystrophy — also now called CRPS (or Complex Regional Pain Syndrome) — and this is where the main symptom is nerve endings firing with extreme pain, out of proportion to the injury, and the condition gets worse over time. We were able to treat a 17-year-old girl suffering from RSD—because doctors applied a cast too tightly after a minor foot fracture—and for months she’d been in so much pain she was unable to tolerate the sensation of a bedsheet, or even the wind from a fan, on her foot. She hadn’t left her bed in months, and was on megadoses of opiates. Cannabis was able to alleviate her symptoms almost immediately. Granted, it will be a condition she’ll be treated for for the rest of her life, but she’s able to leave her house now and live her life. It’s amazing.
How does cannabis medicine treat pain, and chronic pain?
Dr. Rosado: As part of our nervous system, our brain sends and receives messages sort of like on an information railroad, via receptors that go from different parts of your body and run up your spinal cord to the brain, and back down again. And chronic pain is when the signals keep firing—and get completely overworked.
Over 140 phytocannabinoids in cannabis, particularly one called CBD, work to really calm these pain signals in the body, in particular via the receptors CB1 and CB2. And this is what can make a huge dent in chronic pain. Another, CBG, is an anti-inflammatory—twice as strong as hydro-cortisone, and up to 20 times stronger than aspirin. This is powerful stuff.
What makes cannabis particularly well-suited for treating pain?
Dr. Rosado: Pain is often treated with strong pain medications like opiates. But opiates work on a single brain receptor. For example, opiates work on our endorphin receptor, and some antidepressants like SSRIs work specifically on the serotonin receptor.
Well, cannabis doesn’t work on just ONE receptor, it targets multiple receptors, located all over our body: in our gut, our brain, in the spinal cord. In a single dose of medicine you can treat not only the sensation of pain, but also treat the source of that pain, at the same time you’re engaging all the healing mechanisms of the body. This is through our endocannabinoid system.
On top of that, though it takes some experimentation because everyone is different, with cannabis you’re able to fine tune to treat different conditions, because each individual marijuana strain will have a different ratio of phytocannabinoids and a different ratio of CBD to THC. You’re also able to select between an indica for nighttime use or sativa for daytime use, and that kind of versatility doesn’t exist in any other kind of pain medication in pharmacology right now.
Why is cannabis better than other sorts of pain medication?
Dr. Rosado: First, depending on the method of cannabis ingestion, the medication can be either fast-acting or slow-acting. This is huge for the treatment of pain, because often a patient needs both. First there’s the baseline pain—often a dull ache or pain that’s constant, and then also what we call “breakthrough” or acute pain. So, we treat the breakthrough pain with a fast-acting form of marijuana such as a tincture, smokeable flower or vaporized oil. And then we can also treat the baseline pain with longer-acting medication in the form of edibles or pills. Edibles can even replace the long-acting opiates in the 6-8 hour range, while vaporized or smokable marijuana comes on in about 3-5 minutes, and lasts up to 2-4 hours. .
Speaking of pain medications, some are calling cannabis some kind of cure, or hope, for the opioid epidemic. What do you think?
Dr. Rosado: Truthfully the opioid epidemic is where I see cannabis making the most difference in health care right now. More and more, I’m weaning patients—who, by the way, have spent decades addicted to pain medications—off their pills in a matter of months, if not days. One patient, a 45-year-old man, was taking up to 42-58 pills per day. We’ve also had success weaning patients off not only opiates, but other kinds of medications like benzodiazepines, antidepressants, anti-epileptics, antipsychotics.
But with millions of Americans addicted to painkillers, cannabis is poised to do really positive things in communities, getting patients to reduce the amount of pain meds they take if not stop them altogether. We’re seeing tolerance reductions for pain meds go up by up to 1.6 times on average. Cannabis can reduce the therapeutic dose for morphine by up to 3.6 times—and 9.5 times for codeine. That’s huge. I just weaned an 80-year-old woman off of opiates, for example, who’d been suffering terrible, chronic pain from a botched surgery. She’d been on opiates probably over a decade—and in a matter of months she was off her pills, having replaced them all with cannabis. This is really breakthrough therapy.
How does one go about getting a prescription for marijuana for pain?
Dr. Rosado: Until the federal laws around cannabis change, “prescriptions” for cannabis are called recommendations, and qualifying patients with a variety of pain conditions can seek out a certified local cannabis doctor to guide them through the process of registering with the state, applying for a medical card, and purchasing cannabis medicine through a licensed dispensary. Though with services like Marijuana Doctors.com and others, this process has become very fast and easy these days.
Dr. Joseph Rosado is a cannabis physician, lecturer, podcast host, and author of the book, Hope and Healing: the Case for Cannabis. Considered a pioneer in the medical cannabis community for being one of the first internal medicine doctors to recommend cannabis to patients his home state of Florida, he’s treated hundreds since with cannabis medicine and proudly shares his expertise as a renowned speaker at police agencies, physician training programs, community groups, and medical associations all over the country as well as the world.
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