Editor’s note: This article is in response to the many patient inquiries we have received concerning medical marijuana. The FPA does not endorse the use of medical marijuana, or any specific treatment modality, our mission is to educate patients and aid them in advocating for their healthcare.
Patients with trigeminal neuralgia and other facial pains often need to develop an armamentarium, a collection of resources and methods to carry out one’s purpose in order to reduce their pain. When the trigeminal nerve is involved, the pain can be unbearable, debilitating and result in hopelessness, loss of work, isolation and depression.
The pain usually cannot be controlled with analgesics or opioids and it can be difficult to find the right anticonvulsant, antidepressant or muscle relaxer. Over time, drug tolerance with these medications can occur, requiring dosage increases that may result in undesirable side effects or the drug may no longer be effective in treating the pain.
Patients are inquiring about other options to control their pain and the use of marijuana is becoming a legitimate alternative.
Cannabis, or marijuana, was widely prescribed as early as the 1800s by physicians as a therapeutic agent until it became illegal in 1970 with the passage of the Controlled Substance Act. Public demand led to the legalization of marijuana for medical use in California 1996.
There are now 29 states, plus Washington DC, where the use of medical marijuana is legal. Marijuana possession is still considered a federal crime and possibly a felony. Transportation into a state where it is illegal is a crime. Doctors may not “prescribe” cannabis for medical use under federal law, though they can “recommend” its use under the First Amendment.
Medical marijuana was brought to the forefront with the successful treatment of a young patient with seizures. Her name is Charlotte Figi and she started having seizures soon after birth. By age 3, she was having 300 a week, despite being on seven different medications. A special strain of medical marijuana, which was administered as a tincture and does not produce a “high” but acts to calm the brain, limited her seizures to 2 or 3 per month.
This special strain was named Charlotte’s Web and contained CBD, cannabidiol, which is a cannabis compound that has significant medical benefits but does not produce the high feeling that is associated with the psychoactive THC, tetrahydrocannabidiol.
In fact, CBD actually counteracts the psychoactivity of THC , making it an appealing option for patients for relief from inflammation, pain, seizures and spasms and other conditions without the disconcerting feelings of lethargy or dysphoria.
The amount of CBD in relation to THC is referred to as “CBD-rich” or “CBD-dominant”. “CBD-rich” is a cannabis strain that has equal amounts of CBD and THC or more CBD than THC. “CBD-dominant” is a strain that is CBDrich but has very little THC content. CBD and THC work best for pain control when used together.
Although CBD does not cause a “high”, has no lethal dose, is non-toxic, and exhibits no abuse potential, it is on Schedule 1 (with heroin and LSD) of the Controlled Substances Act because it is a part of the cannabis plant. A hemp derived CBD is marketed in most states and seen as legal but is not considered as effective as CBD derived from the cannabis plant.
So, you as a patient with pain, decide you would like to add this treatment into your armamentarium. Now what? The first thing you need to do is to find a doctor in a legalized state that will assess your condition, see if it qualifies for cannabis treatment and apply for a medical marijuana card. Once you get your card, you will need to go to a reputable dispensary. You would want to look for a dispensary that is meticulous in product quality and safety.
Entering the dispensary, you will be required to show your card and ID to the front desk and be taken to the back to view and choose from the plethora of medicinal products. The most important person at this point will be the budtender. He or she talks with you about what you are looking for in your product such as relaxation and being able to sleep at night or more of an active product so you can function during the day. The budtender can also inform you about the effect of each strain and dosage for the desired effect. This emphasizes the need to have a well-informed budtender and staff. Basically it is felt that “less is more” and it is always best to start with the smallest amount first and then titrate up to the desired effect with the fewest side effects. Overdosage can result in unplanned side effects so be careful and start with a small amount and increase slowly.
There are also many various modes of administration to choose from. Smoking a joint or pipe was the first method of choice in the beginning. Now the options have increased to inhaling by vaping (an e-cigarette), edibles that are in all flavors and forms, oils, topicals and teas.
Using a vape pen creates a vapor that is easy to smoke without irritation or negative side effects and also allows for a more rapid effect. The down side, for chronic pain, would be that it only lasts 2-3 hours. Edibles such as candy last for a much longer duration that can be up to 8 hours. The downside is that it takes 1-2 hours to take effect. Many patients have had undesirable results from assessing too early that they need to take more and end up with too much. Topicals such as sprays, bath salts, creams and dermal patches do not give any psycho-active effects and can have a long lasting effect but possibly not as effective for a more severe pain.
In conclusion, medical marijuana offers an alternative treatment for intractable and chronic pain. Much more evidence-based, peer-reviewed, legitimate research is needed to encourage more physicians and pain management practitioners to feel empowered to prescribe medical marijuana and to prove that it can be superior to or take the place of other pharmaceuticals for pain control.
The testimonies from patients who have used medical marijuana to control pain should be a beacon for patients, researchers and physicians that concurring pain drugs can be reduced or even eliminated to create a better quality of life.
This article originally appeared in the Fall 2016 edition of the FPA Quarterly Journal, written by Pam Neff, retired RN who is the patient support and services consultant for the Facial Pain Association. She can be contacted at (800) 923-3608 for more information. For information on marijuana laws, check out the Americans For Safe Access site.