What Kind of Cannabis Product Is Best for Pain?

2018 was a promising year in the opioid epidemic. The National Institute on Drug Abuse noted a decrease in opioid overdose deaths – seemingly a win, with all hoping it to be the start of a downtrend. But then, COVID-19 struck.

From May of 2019 to May 2020, over 81,000 overdose deaths were recorded, according to the Centers for Disease Control and Prevention. While not all of these fatalities were due to opioids, the CDC notes a 38% increase in opioid overdoses year over year. Despite these statistics, opioids like hydrocodone, oxycontin, fentanyl, etc. remain the “go-to” for still remain the “go-to” for many doctors treating patients with chronic pain.

Long-term use of NSAIDs is proven to cause kidney disease, increased risk of gastrointestinal ulcers/bleeding, and even heart attack. Long-term use of acetaminophen also carries its own set of risks: gastrointestinal issues and liver disease. Overdoses, too, are common with these analgesics, and are one of the top reasons for calls to Poison Control, according to nonprofit National Capital Poison Center.

If you experience pain in any form, you know first-hand how debilitating it can be, and how the dulling or alleviation of pain becomes your top goal. It sometimes seems simpler to take an opioid or an OTC medication to relieve the pain, if only to get on with daily life.

Unlike its competition, cannabis has no known detrimental internal effects from its use, nor does it show any signs for legitimate medical concern of chemical-based addiction/dependency (psychological addiction being the outlier). While it might seem like one needs a degree in biology or chemistry to understand the complexities of cannabis, that is not so; all one needs to make an educated, well-rounded decision for their own pain is a few simple “breakdowns” of the substance and its various applications.

Breaking The Stigma Around Marijuana

The stigma around cannabis is slowly breaking, opening cannabis as an option for those living with chronic pain.

One of the first steps to being open to the benefits of cannabis is to destigmatize its use. For years, it has been painted in the media as a kind of craze or dangerous fad that created addicts, degenerates, and criminals of its users. Even popular teen movies of the 2000s had characters who smoked marijuana portrayed as stupid, lazy, dirty, or any number of stereotypical behaviors attributed to those who use marijuana. Some who grew up with this mindset find it difficult to break from it. This stigma or demonization of the cannabis plant is largely why many opt for more “socially acceptable” over the counter or doctor-prescribed opioid pills, patches, and injections.

Thanks to the recent expansion of medical cannabis markets, more and more research is confirming the therapeutic potential of the plant. In Florida, marijuana is only legal for consumption with a medical marijuana (MMJ) card from a certified physician. To be eligible, one must meet one of the below qualifying conditions:

• ALS
• Cancer
• Chronic nonmalignant pain caused by a qualifying medical condition or that originates from a qualifying medical condition and persists beyond the usual course of that qualifying medical condition.
• Crohn’s disease
• Epilepsy
• Glaucoma
• HIV / AIDS
• Medical conditions of the same kind or class as or comparable to the others listed.
• MS (Multiple Sclerosis)
• Parkinson’s disease
• PTSD
• Terminal condition diagnosed by a physician other than the qualified physician issuing the physician certification.

If you believe you meet one of the above conditions and are interested in medical cannabis, you can find a physician near you to schedule an appointment. Recommending physicians are the only physicians approved to recommend cannabis under Florida’s laws.

The Science Behind Cannabis

To understand the science behind cannabis and how it works with the body, it helps to have a brief history of some important scientific discoveries. Did you know your body is made to interact with cannabis? And that THC and CBD were discovered before this internal system and the endogenous compounds that interact with it?

CBD was first isolated in the early 1900s, followed by THC in the ‘60s. Both were structurally defined and eventually led to the identification of receptors with which they interact. As the compounds were dubbed cannabinoids (canna- as they came from the cannabis plant), the receptors they interact with were named cannabinoid receptor 1 and 2, or CB1 and CB2 for short. These receptors are found throughout the human body, with CB1 receptors prevalent in the central nervous system and CB2 the peripheral, comprising what is known as the endocannabinoid system (ECS). Interestingly, the human body, too, produces compounds that interact with the ECS named endocannabinoids (endo- as they are cannabinoids produced within the body).  

Today, there are 568 distinctive molecules inside cannabis of any species, with 60+ being specifically cannabinoids. Significantly more research is needed to explore the potential of these cannabinoids, but there is enough to indicate some positive effects from THC and CBD.

Best Marijuana For Pain Relief: CBD Or THC Strains?

There are a few factors to consider when determining the best strain for pain, like the person using and their experience, terpene profile and the consumption method.

THC is associated heavily with the euphoric or “high” of marijuana and what is usually (and erroneously) depicted in media as the sole function and purpose of marijuana use. THC has specific pain-relieving properties and is also key in helping to alleviate nausea and promote appetite, which is especially helpful for those undergoing chemotherapy for cancer. The compound interacts and locks with the CB1 receptors found throughout the body, providing a range of benefits.

CBD, on the other hand, is enjoying much more social acceptance. It is primarily used in soft-chews, tinctures, among other methods to help with inflammation, anxiety, insomnia, and a host of other ailments. CBD interacts with the CB2 receptors to provide these benefits, and potentially offset the cerebral effects of THC.

But, what are the best marijuana strains for pain?

To really understand the effects of cannabis on pain, you must look at three things:

The Person Using Cannabis

The person using the product is the first step in determining efficacy. When one uses marijuana, they might experience something altogether different than a person next to them using the exact same ratio/product. The person's experience with cannabis is also worth considering - someone experienced may require higher doses, as will someone who has used opioids to manage pain.

In addition, some may be wary of the psychoactive effects of cannabis. For these patients, CBD or 1:1 ratios of THC/CBD are an ideal starting place. CBD does not produce the “high” feeling that goes hand-in-hand with cannabis and can even counteract some of it when taken in conjunction, in a 1:1 tincture or vape, for example.

The Terpenes

When in a medical marijuana dispensary, you will see the creative and clever names associated with the different “strains” of marijuana, but what you should focus on is the terpene content. Research is beginning to confirm that it is these precious essential oils produced in the cannabis plant that drive the strain-specific effects described by the terms “sativa” and “indica.” Terpenes are found in many other plants, too - linalool is abundant in lavender, and some cannabis strains. Some of the most abundant terpenes found in cannabis and their potential therapeutic benefits are:

• Caryophyllene - analgesic, anti-inflammatory, antispasmodic, sedative
• Humulene - analgesic, anti-bacterial, anti-inflammatory
• Limonene - analgesic, anti-epileptic, anxiolytic
• Linalool - analgesic, anti-epileptic, anxiolytic
• Myrcene - analgesic, anti-bacterial, anti-inflammatory, sedative
• Pinene - analgesic, anti-epileptic, anxiolytic

Like with cannabinoids, more research is needed to unlock the full potential of these compounds, but the evidence is telling enough to use terpenes as a guide in your strain selection.

The Consumption Method

Some cannabis consumption methods have longer-lasting effects when compared to others. The duration of effects is key for patients living with pain, as longer-lasting effects require less overall medicating.

Methods Of Cannabis Delivery

MÜV produces an ample variety of cannabis applications in every category.

When entering a medical marijuana dispensary, finding the right ratio of CBD/THC and terpenes seems daunting enough, but the added confusion of products might send a person into information overload. Let us take some of the weight off and break it down even further:

Inhaled Cannabis

Inhaling cannabis can be achieved in multiple ways, including smoking flower, vaping or even inhalers.

• Smoking flower is perceived as the “traditional” way of consuming cannabis, whether it’s by sparking a joint or using a wooden or glass pipe to avoid added materials. Water pipes, or bongs, too, are a popular option for smoking flower due to their perceived cost-effective delivery.

          Typical Onset Time: 5-10 minutes
          Duration of Effects: ~2-4 hours

• Others may prefer vaping flower, or the method of heating whole flower until the desired cannabinoids and terpenes vaporize to a water vapor to be inhaled. Marijuana vape cartridges and concentrates, too, are heated to the point of vaporization of the desired compounds.

          Typical Onset Time: 5-10 minutes
          Duration of Effects: ~2-4 hours

• Smoking and vaping aren’t ideal consumption methods (nor are they recommended) for those with chronic obstructive pulmonary disease (COPD), emphysema, lung cancer or severe asthma or allergies due to the fact that they may exacerbate or trigger symptoms. Instead, cannabis inhalers are recommended, as they are easier on those with these conditions, with the added bonus of THC’s potential as a bronchodilator (though it is never recommended to replace your inhaler with a cannabis inhaler!).

          Typical Onset Time: 3-5 minutes
          Duration of Effects: ~2-4 hours

It's worth noting that each of these delivery methods can be "stacked" with the others mentioned below. Because smoking flower, vaporizing cannabis in various forms or using an inhaler provides immediate onset of effects, these can be used to manage breakthrough pain.

Edibles

Edibles are exactly as they seem – foods you eat, infused with cannabis. Many patients choose edibles or other orally consumed methods to manage pain due to the longer-lasting effects when compared to inhaled forms of cannabis.

There are ways of infusing regular culinary ingredients (such as butter or syrup) with cannabis for use in home cooking, but it’s much less time-consuming and significantly more convenient to buy them at a medical dispensary. Common edible/consumable products are baked items (cookies, cake, brownies), chocolates, lozenges, lollipops or suckers, drinks, soft-chews, and powders to be mixed in with shakes and drinks. Always remember to start low and go slow with this method (and keep CBD tincture on hand), as the first-pass effect makes the 10mg dose you take feel more like 50mg!

          Typical Onset Time: 30-60 minutes
          Duration of Effects: ~4-8 hours

Tinctures and Other Oral Methods

Tinctures have been used in medicine for thousands of years, and are traditionally made by dissolving the medicinal compound in grain alcohol, or ethanol. Typically, the tincture oil is placed sublingually (under your tongue) to access the arterial vein directly for maximum absorption. Tinctures can also be found in oral spray formats.

There are other oral delivery methods, as well:

• Encapsulated Tinctures - Encaps™ patented technology encases the desired cannabinoids in a water-soluble shell. This allows for tinctures with onset times of just 15 minutes, with the added bonus of the capability of adding it to your favorite beverage for onset times comparable to edibles.

          Typical Onset Time: 10-15 minutes
          Duration of Effects: ~4-8 hours

• Encapsulated Cannabis Pills – There is a distinct difference between Encaps Cannabis Capsules vs. edibles. Encaps are isolated cannabinoids in pill form with a 1:1 THC/CBD ratio or other formulas which have varying cannabinoid mg by batch. Encaps use patented technology to render the capsule water soluble for fast-acting effects.

          Typical Onset Time: 15-30 minutes
          Duration of Effects: ~4-6 hours

• RSO Cannabis Syringe – Don’t worry, it’s not a shot! No cannabis method is injectable; the syringe is just used for accurate dosing. It is consumable on its own or with food and can provide much-needed sedative effects for those suffering from insomnia. Topically, it has shown to heal skin abrasions, lesions and may hold anti-cancerous qualities. It’s important to note that RSO contains all components of the cannabis plant and should never be inhaled.

  Typical Onset Time (Oral): 30-60 minutes
          Duration of Effects (Oral): ~4-8 hours

          Typical Onset Time (Topical): 15-20 minutes
          Duration of Effects (Topical): ~6-10 hours

• Distillate Oil – Those who want to make their own edible products at home can use distillate oil, an isolated and concentrated form of THC, for easy incorporation into fat-based ingredients, like butter or oil. It can also be administered orally for edible-like effects, or inhaled with a vapor device for more immediate onset times.

         Typical Onset Time (Inhaled): 5-10 minutes
          Duration of Effects (Inhaled): ~3-4 hours

          Typical Onset Time (Oral): 30-60 minutes
          Duration of Effects (Oral): ~4-8 hours

• RSO Tincture - RSO Syringes are an incredibly potent form of cannabis. RSO Tinctures, on the other hand, are the same potent syringe incorporated into MCT oil. This allows for more precise dosing, at lower milligrams-per-dose than the typical 25mg dose of RSO Syringe. Instead, the tincture allows for doses as low as you’d like, and up to 20mg per full dropper.

         Typical Onset Time: 20-60 minutes
          Duration of Effects: ~4-8 hours

You might be wondering, what tincture is best for pain? Much like any product involving cannabis, this is based on personal preference. Tinctures, overall, are a great option for pain as they provide longer lasting effects than inhalants - typically 6 hours compared to the 4 expected from smoking or vaping. Some patients may prefer Encapsulated Cannabis Tinctures and their isolated THC/CBD due to their ability to combine with water, while others may seek RSO Tinctures as they are strain-specific and are a whole plant extract.

Topicals

Topicals are an extremely discreet form of cannabis, with no cerebral effects. Because THC and CBD are fat-soluble, they interact with the endocannabinoid receptors in the upper layers of the skin, and are unable to penetrate the watery bloodstream. This results in targeted, localized pain relief. Sports Gel is a popular option for patients as it is infused with arnica and peppermint for sensations similar to Icy Hot, in addition to 100mg THC and 100mg CBD. Though sports is in the name, it is by no means limited to sports-related aches and pains! Pain Relief Cream is formulated to give a hydrating, lotion-like feel, with 200mg THC and 200mg CBD.

         Typical Onset Time (Sports Gel): 5-10 minutes
          Duration of Effects (Sports Gel): ~2-4 hours

          Typical Onset Time (Pain Relief Cream): 5-10 minutes
          Duration of Effects (Pain Relief Cream): ~4-6 hours

Transdermals

Transdermal application of medicine isn’t new, but it is for the cannabis space. Transdermals are topicals that are applied for systemic effects. These medicinals are usually in two formats: gels or patches.

Transdermals at MÜV, like Cannabis Tincture, utilize patented Encaps encapsulation technology, which encases THC and CBD in a water-soluble shell. This allows the cannabinoids to penetrate the bloodstream when applied topically for systemic (whole body) effects.

• MÜV Transdermal Patches last a remarkable 72 hours when applied, providing a steady release of just 0.24mg of cannabinoids per hour. Patches are a great starting point for newcomers to cannabis, as they are the only product that provides cannabis with an “off” button - effects dissipate 45 minutes after the removal of the patch. And, for those worried about the psychoactive properties of THC, CBD-only patches are available.

          Typical Onset Time: 10-15 minutes
          Duration of Effects: ~72 hours

• Evolve Transdermal Gels can be thought of as a potent macrodose to the Patch’s microdose. The gel provides 8mg of cannabinoids per pump. The higher dose makes Evolve Gel an ideal item for breakthrough pain symptoms.  

          Typical Onset Time: 10-15 minutes
          Duration of Effects: ~2-4 hours

The Future Of Cannabis For Pain

All of these delivery methods as well as the breakdown of the cannabis components like terpenes can seem like an intimidating prospect. Fortunately, with the advent of innovative (and discreet) methods of using cannabis like vapes and inhalers, cannabis is more approachable than ever.

As science continues to make headway into new territories and advocacy for availability grows more mainstream, dependency on opioids and OTC pills will soon become a thing of the past. For long-term, low-risk alleviation of pain, consult with your doctor about your options, as well as a reputable medical marijuana dispensary to find the cannabis product that is right for you and your pain management.

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