Marijuana to Treat Pain and Osteoarthritis: Pros & Cons

Marijuana isn't just reserved for "pot smoking" teenagers, stoners, and artists! If you suffer from chronic pain--whether it be back, joint, osteoarthritis, or from an injury--you're probably more intrigued than ever with the idea of "marijuana as medicine". After all, marijuana has never been more mainstream and accepted by patients and providers alike. If you're thinking about trying marijuana for pain relief, you've come to the right place! In this article, we're going to break down how marijuana for chronic pain works, the pros and cons of taking cannabis to treat pain, and whether or not it's a viable, legal option for you in your home state.

What, Why & How of Marijuana for Treating Pain

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The What

Marijuana is commonly referred to "cannabis", "weed", "pot" or if you're a product of the 70's, "grass". For the last decade, marijuana has become a much more accepted treatment for pain (somatic, visceral, neuropathic), arthritis, muscle spasms, stress, and other conditions, like cancer and even PTSD. No longer is marijuana just associated with smoking a joint, ordering an XL pizza, and watching "stoner" flicks. For many patients and clinicians, marijuana is an accepted part of a multimodal pain management strategy. In other words, marijuana is medicine.

What is marijuana? Marijuana describes the dried cannabis flowers and leaves which are smoked, while hashish refers to blocks of cannabis resin which can be eaten. Cannabinoids (THC, CBD etc.) are the chemical compounds in cannabis flowers that relieve symptoms.

The Why

Cannabinoids are the active, chemical compounds in cannabis flowers that have medicinal properties. These compounds are used to treat symptoms like pain, inflammation, and nausea. When ingested, these chemical compounds interact with different receptors in the body (including your body's natural cannabinoid receptors).

Cannabis has an estimated 85-113 different types of cannabinoids (THC is just the most well-known cannabinoid compound). Some of these cannabinoids (compounds) have proven medical value with cannabinoids for pain relief. The chemical compounds CBC, CBD, CBN, and THC are all found in marijuana and linked to pain relief, arthritis relief, and help with inflammation, fibromyalgia, spinal injury, and more.

Feeling "high" can be a reaction to ingesting cannabis. However, depending on the administration method and strain, getting "high" is not always an effect. Many states legalize cannabis for medical use only when the psychoactive components of the cannabis are removed.

The How

Like anything else, everyone will respond to marijuana differently. In addition, a lot of different factors will influence how one responds to marijuana. These variables include: tolerance level, the strain of marijuana, how you are administering (e.g. edibles vs. smoking etc.), the condition you are trying to alleviate etc. Here are the different administration methods for medical marijuana, targeting pain relief:

  • Smoking: Dried cannabis flower is put into a pipe or rolled into a joint. As you inhale, you will almost instantly begin to feel the relief. Although smoking may be harmful for your lungs, it is a good option as it's easy to control how much you are ingesting.

Smoking marijuana causes a more immediate, faster reaction to cannabinoids. The peak "high" or symptom relief after smoking cannabis is within 9 minutes.

  • Vaporizing "Vaping": Also using dried cannabis flower that is smoked for instant relief, a vaporizer is less harsh than smoking. Vaporizers can be pricey to purchase, but may be a good option for more regular users.

  • Edibles: Medicated gummies, cookies, lollipops, and baked goods can be the preferred administration method for those who don't like smoke. Edibles generally offer longer-lasting relief, take longer to kick-in, and can offer more of a "body high". On the flip-side, it can be difficult to get the dose right. With edibles, it's hard to know exactly how much "medicine" you are consuming. Always consume small portions at a time and ensure that the manufacturer knows the dosage in each edible.

  • Tinctures/ Sprays: Cannabinoids are mixed into an alcohol, oil or other solution. They can also be sprayed right under the tongue. This is a good option for those who want to try a very low dose. Tinctures and sprays are a good "middle ground", taking longer to set-in than smoking or vaping, but less time than edibles.

  • Topicals: Topicals can be applied right onto the area for localized pain relief. They are said to help treat muscle soreness, spasms, and arthritis. Topicals like creams or lotions will not get you "high" or offer the feelings of relaxation, euphoria, and stress relief typically associated with using marijuana.

So, Why (or Why Not) Marijuana to Treat Pain?

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Marijuana is an all-natural way to treat pain and manage chronic pain symptoms like muscle spasms, inflammation, and side-effects of other medications like nausea or lack of appetite. For many, marijuana is used as part or a multimodal pain management plan. If you talk to your care provider or pain management specialist, they may recommend marijuana to wean yourself off prescription pain medication, reduce narcotic dosage, or to fully substitute for narcotics.

A study in the Journal of Pain, found that "several randomized controlled trials have shown a significant and dose-dependent relationship between neuropathic pain relief and tetrahydrocannabinol -- the principal psychoactive component of cannabis."

The Pros

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  • All natural. Cannabis flower, especially when smoked or vaped, is not processed. This means, that it can be 100% natural. Prescription pain medication, NSAIDS, or over-the-counter medications like Advil, have many chemical properties that are not healthy for long-term use.

  • Safer. Simply put, you cannot really overdose from marijuana. There have been zero recorded deaths from just marijuana. This isn't to say that marijuana can't be dangerous if too much is administered, but unlike opioid pain medication, one cannot die of an accidental overdose. It can also be more safely combined with other pain medications and treatments.

78 Americans die every day from an opioid overdose. At least of half of these overdoses are from prescription pain medication.

  • Less Addictive. Across North America, there is an "opioid epidemic". Compared to opioid and narcotic pain medication, marijuana is categorically less addictive. Although heavy users can develop a dependency with marijuana and experience cravings and withdrawal symptoms (like nausea, sweating etc.), it is far milder than opioid withdrawal. In comparison to narcotic pain medication, marijuana addiction and withdrawal symptoms are much less of a concern.

  • Fewer Side Effects. Along the same vein as being all-natural, marijuana use comes with a much shorter list of side-effects than prescription or chemical pain medication. ¬†NSAIDs, acetaminophen and opioids are associated with heart attacks, seizures, strokes and more mild side effects like constipation, erectile dysfunction, drowsiness, nausea and vomiting. Side effects after ingesting marijuana are milder and limited to: anxiety, hallucination, confusion, increased heart rate, increased risk of stroke, dizziness, dry mouth etc.

  • Take Less Narcotic Pain Meds. Studies have shown that those who take a multimodal approach to pain and use marijuana, require less opioid pain medication. A recent study, "Cannabis as a Substitute for Opioid-Based Pain Medication" found that "97% of the sample 'strongly agreed/agreed' that they are able to decrease the amount of opioids they consume when they also use cannabis."

The Cons

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  • Less Effective: For those with moderate to severe pain, marijuana may not offer the relief you need. Some healthcare providers argue that there isn't a direct link between marijuana and measurable pain relief. However, this is disputed by other studies who have found that marijuana does offer temporary pain relief.

  • Stigma: Historically, marijuana has been thought of as a harmful, illegal drug. Although things are rapidly changing (socially, culturally, and politically), some people are not comfortable with it the idea of using a formerly illegal "street drug" to treat symptoms.

  • Not Covered: For many care providers and insurance providers, medical marijuana cannot be directly prescribed. It can be an out-of-pocket expense, not covered by insurance. To get medical marijuana, many bypass medical institutions and go to a dispensary. This limits access and some patients are uncomfortable stepping outside of formal a medical setting.

Where is Marijuana Legal?

Marijuana for medical purposes is legal (in some capacity) in 30 states, plus District of Columbia, Guam and Puerto Rico. Other states have laws that limit THC content but allow patients to use products with cannabidiol (CBD) that contain none of the psychoactive components of cannabis. Cannabis laws differ from state to state, and dictate how cannabis can be produced, the amount one can consume, how it can be distributed, and what medical conditions marijuana treatment covers.

Here are the states where medical marijuana is broadly legalized:

  1. Alaska

  2. Arizona

  3. Arkansas

  4. California

  5. Colorado

  6. Connecticut

  7. Delaware

  8. District of Columbia

  9. Florida

  10. Guan

  11. Hawaii

  12. Illinois

  13. Louisiana

  14. Maine

  15. Maryland

  16. Massachusetts

  17. Michigan

  18. Minnesota

  19. Montana

  20. Nevada

  21. New Hampshire

  22. New Jersey

  23. New Mexico

  24. New York

  25. North Dakota

  26. Ohio

  27. Oregon

  28. Pennsylvania

  29. Puerto Rico

  30. Rhode Island

  31. Vermont

  32. Washington

  33. West Virginia

Are you in back pain, arthritis pain, joint pain or are facing ACL surgery? Sign-up for PeerWell. We have a free daily smartphone programs that can improve your symptoms.

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Hi, I'm Grace. I write and research about hip and knee replacements, PreHab before orthopedic surgery & ReHab. Content advised or co-authored with physicians (MD) and orthopedic surgeons (OS).

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