My local library often puts their newly-acquired books on display, in a special near the main entrance, just as bookstores do! The first thing I do whenever I visit our library is always to skim through these new books. I have to admit that I’m often surprised that they have such a good selection of current health-related books. They even buy new books dealing with bioethics, or biomedical ethics, my field.
Last week I picked up a brand-new book that seemed intriguing. It was a smallish book, with an interesting introduction:
In this fun, illuminating book, cannabis journalist Amanda Siebert delves deep into the latest research to separate marijuana fact from fiction, revealing ten evidence-based ways this potent little plant can improve your life. She speaks with some of the world’s top researchers, medical professionals, and consultants to answer questions…”(1)
First off, I wondered, what exactly is a “cannabis journalist”? Second, just how unbiased could the book be, if the journalist describes herself as a pro-cannabis writer? Third, could this written work teach me anything about the potential use of cannabis for chronic pain?
Those questions were enough to convince me to take out the book. After all, it’s free at the library ‘-) I’ve finished the book, and can give you a few quick responses to those questions that I’d asked myself.
The answers to my first and second questions were more or less what I’d expected; to be fair, I kept an open mind and was almost hoping to be surprised. Unfortunately this book leads me to view a “cannabis journalist” as someone who not only uses the product herself, but also seeks out others who view it primarily as a beneficial treatment for a number of medical issues.
When there known risks of cannabis use are raised, these are touched on fairly lightly and using language that could be misleading. For example, rather than spending time on the well-documented risks of cannabis use for individuals dealing with substance abuse, or those with a personal or family history of psychosis, the author chooses a different approach.
She instead describes an interview with a physician who prescribes cannabis, in terms of the questions he asks his patients:
Other questions more specific to cannabis treatment are whether a patient has a history of psychosis in the family, or if there is a historical or active substance use issue.”(1)
My view is that this would have been an appropriate moment, in the text, to delve into the reasons for which a physician would ask these questions. Instead, she ends this paragraph with the comment that this doctor:
says an unstable heart or arrhythmias would also make a clinical “very cautious” about prescribing a cannabinoid drug.”(1)
A simple Google search for cannabis risks can lead to an excellent summary article by the science editor of The Guardian newspaper, from last year. This article describes several known risks of cannabis use, for which “side effects range from anxiety and paranoia to problems with attention, memory and coordination”.(2) And:
Daily users have a 2% chance of developing schizophrenia in their lives, about double that of the general population, though the risk of other less serious mental health issues is greater.”
These aren’t unimportant risks, particularly given that these health issues don’t necessarily resolve once the patient has discontinued their use of these products. In my evaluation, the author was both pro-cannabis and biased in her so-called journalistic approach to this topic.
As for the third question I’d asked myself, prior to reading this book; yes, I did learn something about the potential use of cannabis for chronic pain. One of physician-researchers interviewed by the author specifies that:
a cannabinoid-based drug will affect multiple centers of the brain, including memory and cognition, as well as sensation and so on.
When he speaks to patients who use cannabis to treat their pain, they’ll often say that while they can sometimes still feel that it’s there, it doesn’t come attached with the unpleasant feelings or negative emotions that it was previously associated with.
“I’ve heard this too many times for it just to be random: people say that it takes them away from the pain – it doesn’t take the pain away from them.”(1)
So rather than removing the pain, cannabis products may disassociate pain from the patient’s experience of suffering; an emotional aspect of chronic pain. In my case, Complex Regional Pain Syndrome or CRPS causes several different types of pain. Some of these are; allodynia (skin pain), joint pain, neuropathic (nerve) pain, and temperature-related pain in which my hand and arm feel as though they’re burning from either extreme cold or heat.
As I often say, it can feel as though someone is holding a blowtorch to these parts of my body. That is, in fact, a common description of CRPS. For a fantastic visual explanation of allodynia, which is one of the most common symptoms of CRPS, watch Dr. Eliot Krane’s TEDtalk: “The mystery of chronic pain”. In it, he describes a young patient with this condition.
I’ve included a link to this video clip, as the third reference at the end of this post. In it, he explains:
allodynia, the medical term for the phenomenon that I just illustrated… The lightest touch of her arm – the touch of a hand, the touch even of a sleeve, of a garment, as she put it on – caused excruciating, burning pain.”
The neuropathic pain of CRPS can occur so quickly, for me at least, that I’ll immediately faint or vomit – from pain – if someone unexpectedly bumps my hand or arm. There isn’t time for me to have an emotional reaction to the pain, to ‘suffer’ so to speak, prior to this reaction.
So if I’ve understood this physician’s statements correctly, if cannabis products doesn’t remove this pain but only the emotional response to it, then it wouldn’t be much help to me.
It might help with the constant joint pain of CRPS, which has been compared to rheumatoid arthritis. With the pain from ankylosis, similar to scar tissue, which forms in the joints of my fingers and wrist. While ankylosing spondylitis affects the spine, CRPS can cause ankylosing of the joints in the affected areas of the body.
The book did include a note that any ‘cannabinoid-based drug will affect multiple centers of the brain, including memory and cognition”.(1) This is why it’s important not to drive, or to try to complete any other tasks which require concentration and focus, while under the influence of cannabinoids.
The author’s intent truly seemed to be to promote the use of cannabinoids, to improve anxiety, exercise or physical performance, pain relief, sleep, stress management, weight loss, etc. In terms of pain management for CRPS – or other conditions which cause neuropathic pain – there just didn’t seem to be any solid evidence.
Hope and hype, yes. Evidence from solid clinical or medical research? Not so much.
To wrap up, I want to tell you why I was so interested in this book. Last year my multidisciplinary pain management unit, within a university hospital centre, suggested that I try a prescription cannabinoid. What they recommended was a completely legal (in Canada) pharmaceutical-grade medication.
My blog is completely non-commercial, so I won’t mention any brand name; only that the medication contains both THC (delta-9-tetrahydrocannabinol) and CBC (cannabidiol). And, again, that it’s legal in Canada!
I was very hesitant about this, given that I’ve never even tried any illicit drugs. Seriously, folks – never! When I was a child, someone who lived nearby had a substance abuse problem; I grew up well aware of what drugs can do to a person. So I never wanted any part of that… long before the current epidemic of fentanyl overdoses.
What did this fast-acting combination CBD and THC medication do? Not much. I’d been advised to take this buccal (mouth) spray only when I experienced a severe neuropathic pain flare, but it didn’t even take the edge off this type of pain. The aftertaste of this mouth spray was disgusting and long-lasting. It gave me a headache, and made me both dizzy and very hungry. The “marijuana munchies”(4), I suppose.
The strict instructions I’d received from my physician and my pharmacist were to try this medication at home, while my husband was with me, at least a few times before taking it anywhere else. They each explained that CBD and THC, particularly when combined, are likely to interfere with a person’s ability to complete complicated or complex tasks – like driving.
It was quickly apparent that I wouldn’t be able to work – for at least several hours – after taking this medication, because I’d feel confused and ‘out of it’. My doctor had told me to stop taking the medication if there were any side effects that I didn’t like, or if it didn’t help with pain management for the neuropathic pain flares.
Two strikes, and you’re out. The side effects of the medication would have prevented me from working, and it didn’t reduce my neuropathic CRPS pain. I tried it for these pain flares over the course of three weekends, at home with my husband, but it wasn’t a success.
All I can say is that I’m very happy that both my physician and my pharmacist had warned me to try this medication at home. I would definitely not have wanted to be stumbling around, bumping into things, and feeling dazed and confused while at work!
In all fairness, there may be some conditions for which cannabinoids truly are helpful. Mine isn’t one of them!
As always, thanks for reading! Have a great day, and try to do something today that’s just for you ‘-) Because you deserve some time just for you…
References:
(1) Amanda Siebert. The Little Book of Cannabis. Greystone Books Ltd. Oct 2018. Book information available from the publisher, at:
(2) Ian Sample; Science Editor. What are the true risks of taking cannabis? The Guardian. 28 Nov 2017. Online:
https://www.theguardian.com/science/2016/apr/15/what-are-the-risks-of-taking-cannabis
(3) Elliot Krane. The mystery of chronic pain. TED2011: TEDtalk. Mar 2011. Online:
(4) Matthew Zuras. This Is Why Weed Gives You the Munchies. Vice. Vice Media LLC. 19 Apr 2017. Online:
https://www.vice.com/en_us/article/9ag3x5/this-is-why-weed-gives-you-the-munchies