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How to Use Cannabis to Manage Pain

There’s no one-size-fits-all approach.

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PHOTO ILLUSTRATION BY BRIAN BRENEMAN
  • Photo Illustration by Brian Breneman




Until about eight months ago, Kevin Allen had never considered using cannabis. "One of the number-one things I did as a cop was confiscate drugs from people," explained the 55-year-old Oakland resident, who served on the city's police force in the 1980s. "I was always afraid of narcotics or drugs."

But his perspective changed when his doctor told him he might benefit from it.

In April 2016, Allen was diagnosed with stage four prostate cancer. By then, his kidneys had gotten infected, so he needed catheters. "I had these two tubes in my back to drain my kidneys, and that's very painful," Allen said. "I had to watch how I slept, rode in the car. It was pain, pain, pain."

Allen was prescribed OxyContin, a powerful narcotic. But he didn't like the drug's effects on his body. After a couple of years, he decided to stop taking it and just dealt with the pain on his own. That's when his doctor asked him if he was taking any cannabis.

Although initially hesitant, Allen decided to try it. He got a medical cannabis card and went to Harborside Oakland, where he was recommended a THC-rich, full-extract cannabis oil. He began taking a tiny amount in his tea or coffee because he didn't want to taste it or know it was there. Nonetheless, the effect was immediate — and powerful.

"It worked almost instantaneous on the pain, but because I'm able to sleep, it's kind of two in one," he said.

And the benefits didn't end there.

Before taking cannabis, Allen often woke up nauseous from the chemotherapy drug he takes at night, and it would take him hours to get up in the morning. And because he suffered from hot flashes, he also needed fans to cool him off at night so he could fall asleep. Cannabis, he said, changed all that. "It's been an amazing journey for me," he said. "I cook my own breakfast. I haven't been able to do that for two years. And I get my boys dressed for school and send them off. Before, I would be lying in bed in pain and throwing up. It would take me until 11 a.m. to get up out of bed." Allen had his catheters removed in December, and although he's still being treated for cancer, he's no longer in pain. "I feel like I'm doing what my body is asking for," he said about taking cannabis.

For too many Americans, pain is a daily reality. A 2012 study estimated that some 25.3 million adults in the U.S., or 11.2 percent, suffer from chronic pain. Meanwhile, patients are being prescribed prescription opioids more than ever before, and deaths from opioid overdoses have spiked correspondingly. According to the CDC, overdose deaths involving prescription opioids were five times higher in 2016 than 1999, resulting in the deaths of more than 200,000 people.

Cannabis could be the answer. A study published last year in Cannabis and Cannabinoid Research found that 97 percent of sampled medical cannabis patients who also used opioid-based pain medication in the past six months "strongly agreed/agreed" that they are able to decrease the amount of opiates they consume when they also use cannabis. Eighty-one percent also "strongly agreed/agreed" that taking cannabis by itself was more effective at treating their condition than taking cannabis with opioids. Other studies show that cannabis reduces opioid use.

Why is cannabis so effective for pain? The reason has to do with our endocannabinoid system, which is composed of cell receptors (aka cannabinoid receptors) and corresponding molecules (endocannabinoids) that are responsible for regulating various activities in our bodies, including the mediation of pain and inflammation. The pharmaceutically active components of cannabis mimic endocannabinoids in our body. So, when our bodies are out of whack, cannabis' analgesic components can help us restore balance. (Because cannabis is still illegal at the federal level, we don't know as much as we could about its effects.)

When it comes to taking cannabis for pain, experts say there is no one-size-fits-all approach. Morgan Tano, a budtender at Harborside Oakland who uses cannabis for his own chronic pain, said treatment depends on the type of pain a person is experiencing — for example, muscular, joint, nerve, or neuromuscular.

For nerve-based pain, he recommends THCA, the non-psychoactive form of THC, found in raw cannabis. Because heat converts THCA into THC, THCA can't be consumed by smoking cannabis or ingesting edibles. Tano usually recommends capsules or tinctures. (You could also eat raw cannabis flowers, although it may not be enjoyable.)

When it comes to muscular pain, Tano said it's all about the ratio of THC to CBD. Depending on whether the person is comfortable with THC or not, he might start them at a 20:1 CBD to THC ratio, and then slowly increase their THC intake as the person gets more comfortable or their tolerance level rises. Such a product might come in the form of edibles, tinctures, or capsules.

Jude Thilman, a cannabis medicine educator who owns Dragonfly Wellness Center in Fort Bragg, Calif., reinforced the fact that treatment depends on the type of pain, as well as whether it's acute or chronic, and also on the individual because people respond differently to different forms of cannabis. But, she said, THC and CBD work best together. "They are both anti-inflammatory, and inflammation is the root of most pain," she wrote in an email.

Pain relief has nothing to do with a particular strain of cannabis or even smoking, for that matter, which only provides short-term symptom management, she said. "But even that is dangerous since some people get hyper-sensitive from THC and feel pain more," she wrote.

Instead, Thilman recommends microdosing THC in oil form. "Microdosing is the best way to benefit from the pain relieving and overall healing effects of THC without getting high." With THC, you start slow and low, whereas with CBD you start high and reduce the dose as you feel better, she wrote. "CBD is the best anti-inflammatory in the world. THC, we learned in the AIDS crisis, is the best pain reliever in the world."

In a document she gives to patients, Thilman notes that the only side effect you might feel from THC oil is an analgesic effect. If you feel dizzy or "high," then the dose is too big. "If you feel little to no pain relief after waiting 30-60 minutes after dosing, then take another dose, same size," she advises. "You can increase the number of doses but do not increase the size of the dose. That can lead to psychoactivity." (For more information on microdosing, see "Everything You Need to Know About Microdosing Cannabis," 2/7/18.)

Tinctures, on the other hand, are the best way to take CBD, and alcohol-based tinctures are the most absorbable. The best way to get the whole cannabinoid profile into your system is through the mouth. "So, let the medicine melt on your tongue or swish in your mouth so the liquid penetrates through the oral mucosa," Thilman said.

Thilman said there's a huge lack of information — both in the public sphere and within the cannabis industry itself — on how to best choose cannabis medicine. (She's teaching a class on the science of cannabis medicine in Berkeley in late-March.)

Which is unfortunate, considering the large need. Tano estimates that some 65 to 75 percent of Harborside customers are looking for some sort of pain relief.

Tano used to be one of them. A major accident in 2012 landed him on several pain medications, including OxyContin, Norco, and Dilaudid, as well as drugs to treat anxiety and depression. He got off opiates by going cold turkey — something he doesn't recommend. But now, he only uses cannabis. (Granted, he takes about 300 mg a day.)

While he was smoking cannabis before his accident to help with his migraines, he didn't realize cannabis could be used for pain as well. "I was using it just to feel better to get through," he said. "I didn't realize the medicinal benefits. It changed my life."


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