When we say the words “cannabis user” or “medical marijuana patient”, it conjures up an image of a particular kind of person. That image is likely to be of a person who doesn’t have a huge amount of wealth, likely lives in an urban or poor rural environment, listens to a certain kind of music, and is more than likely male (and probably has darker skin, too). In other words, the sort of person people do not mind seeing get arrested.
And this is why we like patients like Karen talking to us about using cannabis as a medicine. She is what some might call your stereotypical “soccer mom”, and the fact is that there is a lot less money and a lot more social opprobrium in arresting those from such backgrounds. The other fact is, we need people like Karen to open up and talk about their medical cannabis use, otherwise all 50 states in the U.S. would probably still be following the federal line and keeping it illegal. Arresting a young, socially/economically disenfranchised man is an easy sell; arresting a soccer mom is not, regardless of whether a red tie or a blue tie is running the state or country.
So, away from the social commentary and onto Karen Kinne herself. Like most people when they get older, aches and pains become an everyday experience. From rollerblading up to 50 miles per week to zero and having to plan daily activities around her pain, Karen’s life took a massive u-turn. When she turned to doctors, they prescribed to her what are many physician’s port of call for chronic, moderate-to-severe levels of pain: non-steroidal anti-inflammatory drugs (NSAIDs – in Karen’s case, ibuprofen) and opioids.
Now, Karen herself states that she is “a lightweight when it comes to opiates”, and so she never had many troubles with this particular prescription. Rather, it was the more accessible and benign, ibuprofen. Whilst the pain in her joints and muscles would go away, it would just create another pain in her stomach. As ibuprofen has little effect until too much is taken, this is not surprising. Karen would take 400 mg of ibuprofen without any issue, and would think nothing more of using a couple more pills.
The havoc this would have cause Karen’s body, without her even necessarily realizing it until too late, is actually quite huge. Taking too many ibuprofen, or indeed most NSAIDs, can cause intestinal bleeding and puts huge pressure on the digestive system. Nausea, vomiting and diarrhea are also common side-effects of taking too many ibuprofen, and in some cases can lead to kidney failure. Moreover, ibuprofen can increase opioids’ pain killing properties and effects, including negative side-effects. The chances of overdose increase dramatically when people are using multiple medications to control their pain.
Many doctors have seen the problems of using opioids, especially when used in combination with other medications. There is a move away from opioids, and when it comes to short-term, acute pain, a combination of ibuprofen and acetaminophen may be just as effective as low-dose opioids. However, when it comes to long-term, chronic pain, having to take consistently high doses of NSAIDs and weak analgesics is not ideal, as Karen found out. This is where cannabinoid-based medications can come in. Here are some reasons why …
- Cannabis does not carry the same risk of fatal overdose that opioids and NSAIDs do.
- Cannabinoids such as cannabidiolic acid (CBDA) act as COX-2 inhibitors, helping control pain and reducing inflammation. Beta-caryophyllene also displays analgesic effects.
- Terpenes such as linalool also show antinociceptive effects, meaning there are multiple compounds in cannabis that work in conjunction with one another in order to control pain.
- The endocannabinoid system (ECS) is related to the opioid system, and they “cross talk” with one another. Using cannabinoids may be able to affect the opioid system in an “indirect” manner, and hence could be used as a treatment for both pain and addiction.
There are many different kinds of pain, all with different causes. The current prescriptions tend to take a “one size fits all” method to treating pain, with the only differences in dosage being made due to age, weight and sex. Whilst many may benefit from such a system, many will also lose out. Essentially, people have different tolerances and intolerances to different drugs and medications, sometimes leading to deadly consequences. Learning how to use cannabinoids for different kinds of pain and different conditions may be the safer, better way of treating pain for a substantial number of people. Let’s hope that we can do more clinical trials, and move away from the rodents and into humans.