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CBD: Chronic Pain Management Without the Addiction

Addiction shifted from opium to opioid … by then ‘recreational use’ could not capture the demand for a better pain reliever without the addiction and side-effects

As early as 2700 B.C., the Chinese documented marijuana’s usefulness for gout, rheumatism and malaria. In old India it was used for anxiety release, dysentery, easier digestion and even sunstroke. In 1500 B.C. Egyptians used cannabis (the tall plant used to produce hemp fiber and marijuana drug) against inflammation.

But when the Spaniards brought cannabis to the new world in 1500, they grew it for hemp – fiber for clothes and ropes for rigging in sailing ships. When steam ships replaced sailing ships in the late 1800s, cotton replaced hemp as a cash crop.

In 1910, people fleeing from the Mexican revolution began bringing cannabis into the U.S. Shortly, the use of marihuana was banned in the 1912 Opium Convention and the 1914 Harrison Act. By 1938 cannabis was restricted in 13 countries, including the U.S.

It’s interesting to note that marijuana was listed in the US Pharmacopeia from 1850 to 1941 and prescribed for nausea, rheumatism and labor pains.

In the 1930s, the Feds campaigned to highlight marijuana addiction that caused some users to be violent. This, despite its use by jazz musicians in the 1920s, then the beatniks in the 1950s and the hippies in the 1960s.

The Controlled Substance Act of 1970 set marijuana alongside LSD and heroin as Schedule 1 drugs. The category meant a high potential for abuse with no accepted medical use.

From 1982 to 1992 saw the passage of stricter drug laws all over the world. But surprisingly, marijuana use among teens declined in the mid-1980s to the early 1990s.

It didn’t take long for addiction to shift from opium to opioid. About four million people were dependent on opioids primarily for pain relief in 2011. By 2013 more than 30 million were using opioid illicitly between ages 15 to 65. In 2015, increased use and addiction were brought about by over-prescription of opioids.

By then, “recreational use” could not fully capture the urgent demand for a better pain reliever without the addiction and the side-effects. Even the toxins extracted from snakes were useful against specific diseases.

Cannabis extraction has been around for a while. In the 1970s, there were several publicized methods for extracting “hash oil”. But it was not until the early 2000s when different methods and different products began to appear on-line.

In 2014, the Rohrabacher-Farr amendment became law and stopped the Justice Department from meddling with state medical cannabis law. Then the 2018 farm bill effectively removed hemp-derived cannabinoids (CBD) from the Controlled Substances Act nationwide.

Former 6Beds provider and Senior Community Learning CEO Mickey Gray explained, “CBD is extracted from either the marijuana plant or hemp through a process called Super Critical carbon dioxide (CO2) extraction. Pressurized CO2 acts as a solvent at certain temperatures and pressure levels to isolate the active compounds from the unwanted phytochemicals (THC) and plant matter. The supercritical CO2 passes through high quality, CBD-rich marijuana or hemp in an extractor. The CO2 will draw the cannabinoids, terpenes and essential oils out of the plant material.”

California is the first state to adopt medical marijuana.

Gray clarified, “Hemp derived CBD is federally legal but marijuana-derived CBD is more complicated because it is derived from a plant that is federally illegal. In states where marijuana is legal for recreational use, marijuana-derived CBD is also legal.”

According to Gray, “CBD oil is not addictive because it does not impact the brain’s dopamine-reward system. Made from the stalks and seeds of hemp or marijuana, CBD oil is dominated by cannabidiol, a naturally occurring and non-psychoactive cannabinoid.”

Based on studies, the FDA has approved CBD products for pain, anxiety and depression, epilepsy, symptoms related to cancer treatment, acne and other skin issues, high blood pressure, addiction, diabetes, nausea and vomiting, seizures, psychosis disorders, inflammation and neuro-degenerative disorders.

CBD can be taken by the patient as oil drops under the tongue for quick absorption (but Gray said, “the flavor can be unpleasant.”) If ingested as capsule or soft gel, it takes longer to absorb. Lotions, balms and creams would be ideal for eczema and acne. CBD-laced food and beverages have the lowest potency.

Although there are no set rules, Clinical Anesthesiology Professor and Chair of the Pain Medicine Department at the University of California San Diego Dr. Mark Wallace recommends if ingested, patients should wait eight hours before driving; if inhaled, wait two hours and if taken transmucosal, wait four hours.

Unfortunately, most everybody is still unprepared to dispense medical cannabis. Dr. Wallace said most states allow only four ounces of marijuana dispensed at a time.

The good news is, a survey in 2016, found a 64 percent reduction in opioid use, decreased side effects and an improved quality of life. A year later, another study revealed a 23 percent reduction in opioid dependence.

Dr. Wallace’s approach in treating patients suffering from chronic pain is to wean them off opioids then introduce medical cannabis. He believes medical cannabis can provide pain relief with little side effects and even manage withdrawal from side-effects caused by opioid.

Gray said “patrons above 21 can enter and purchase from any establishment that carries CBD oil. Since CBD is federally legal, no prescription is required. For use as a medication in a long-term care setting, a simple doctor’s order is needed.”

Stella has been an RN for 25 years and had a brush with the law shortly before CBD was legal. “Doctors did not encourage (it’s use) because of legality in California before 2019. For us in the care home facility, I was about to be cited in 2018. I said it was not even medicine, it was a supplement. You can get it over-the-counter without prescription.”

Stella related her experience with a patient who had 10 to 20 seizures every day since his infancy. She said they tried almost all kinds of anti-seizure medication but the patient still had seizures.

A Stanford pediatric neurologist evaluated the patient every three to six months after two other doctors. Reaching out to other parents in the same situation, they decided to try CBD. The mother started with CBD in 2010. The patient has been at Stella’s facility since 2017. Nowadays, the patient will have at most two to four seizures a day.

Stella said the CBD is delivered in liquid form through a gastrostomy tube, two times daily with a 2ml dose each time. Seizure control stays 24 hours in divided doses. She observed that the only side-effect on the patient was sleepiness.

Senior Community Learning medication training instructor Joan Riordan said, “Side effects are rare but the most commonly reported are tiredness/fatigue diarrhea, nausea, changes in appetite, dry mouth and low blood pressure.”

According to Riordan, CBD studies have not observed a tolerance for CBD. “In human studies, CBD administration did not induce side effects across a wide range of dosages, including acute and chronic does regimens and tolerance to CBD did not develop.”

“For CBD to become toxic to the system through overdosing, someone would need to ingest over 20,000 mg of CBD all at once, which would be an extremely difficult feat to pull off. Since marijuana and its derivative CBD is legal in California, there is no penalty to usage.”

She added, “In most cases, it is highly unlikely that hemp-derived CBD oil will lead to a positive drug test, so discrimination should not be an issue.”
Still, CBD oil treatment is still not common to most care homes.

But Riordan stands by CBD. “I have personally had residents who had successful outcomes with the use of CBD oil for pain management, sleep difficulties and anxiety. CBD was used as replacement for opioids, addictive prescription sleep drugs and addictive anti-anxiety medications like Ativan. Alleviation of symptoms appeared to be more comprehensive than in manufactured medications and with fewer side-effects and contra-indications. The impact of CBD on the body will be apparent at different speeds based on the method of delivery, with drops/tinctures having the fastest reaction times and creams being slowest, based on absorption rates. There is no limit as to how long a person can utilize CBD products.”