Author Biography

Kendall Anderson is a progressive and open-minded freshman at Utah State University. He is 27 years old and the second oldest in his family. Kendall has multiple disabilities, but that doesn’t stop him from achieving his goals. He is currently working part-time and going to school part-time and is looking to get a degree in Human Experience and Design Interaction.

This essay was composed in April 2024 and uses MLA documentation.

Waking up in the morning, most people are greeted with some grogginess or sleepiness. For others that are like me, they’re greeted with searing pain going down their leg or a deep dull ache in their back, every morning. Chronic pain and the symptoms that come with other chronic pain disabilities affect around 20% of adult Americans. Patients who struggle with chronic pain usually take some sort of medication to help with pain: it could be normal NSAIDs or opioids, which come with the risk of addiction and a myriad of side effects such as respiratory depression, stomach ulcers, constipation, liver failure, heart failure, and vomiting. Many patients are looking for alternatives to replace these medications, and cannabis-based medicine (CBM) has slowly started to be an option for patients with chronic pain.

The rise in the use of CBM over the last decade has come with a lot of ups and downs regarding public opinions and the actual effectiveness of CBM. At this moment, marijuana in any form is federally illegal. But there is momentum in the government to legalize and decriminalize the use of marijuana as public opinion has changed. With that, there have been research and trials done over the last decade on the efficacy of cannabidiol (CBD) and tetrahydrocannabinol (THC), the main compounds of CBM, for the use of pain. There have been trials on how CBD:THC works specifically in our brains, the types of pain that it can help alleviate, and how a person with chronic pain should go about using CBM, if interested.

The General Consensus on the use of CBD and THC

At a young age, we’re taught that using cannabis is bad and that we should stay away from it because nothing good will come from it. Many Gen X, Millennial, and Gen Z individuals had the D.A.R.E (Drug Abuse Resistance Education) program that taught us how harmful drugs were in a bunch of different ways. As stated on their official “Position and Curricula Regarding Marijuana and Legalization” page, D.A.R.E. asserts that “Just because something is legal doesn’t mean it’s good for you.” (D.A.R.E). So, what exactly is the general consensus on using CBM then? According to a study conducted at Pew Research Center, “An overwhelming share of U.S. adults (88%) say marijuana should be legal for medical or recreational use. Nearly six-in-ten Americans (57%) say that marijuana should be legal for medical and recreational purposes, while roughly a third (32%) say that marijuana should be legal for medical use only” (“Most Americans”). As shown by the survey, a vast majority of U.S. adults are for the use cannabis and CBM in some way or another, with there being only a small amount completely against it all together. More than half of the adult population agrees that cannabis should be legal. As more research into cannabis and its benefits has progressively been conducted, it seems that a lot of people have shifted their views in just a few decades.

With the general public being for the use of cannabis, what about the doctors and experts that work with individuals with chronic pain? Well, it all depends on the doctor, how they practice pain management, how the patient reacts to CBM. In Allison Forsyth’s article “What’s Better for Chronic Pain: CBD or THC?” she speaks with a board-certified Neurologist, Dr. Stein, who has been in practice for 30 years about CBD and THC. Stein claims, “The majority of patients benefit from some combination of the two ingredients.” (Forsyth). But not everyone agrees with that claim. Professor Winston Morgan from University of East London, pharmacology and toxicology expert, claims in a medical news article on a CBM study that “for decades cannabinoids have promised but never quite deliver.” (Medical News Today). In analyzing two differing opinions from two medical experts, I conclude that it all boils down to what I said earlier: it all really depends on the doctor and the patient.

How CBD and THC Work to Alleviate Pain

We have so many different components that make our brain work. One of those components is the endocannabinoid system, and CBD and THC both interact within that system to help with pain. Within that system are two specific receptors, CB1 and CB2, that send out signals to help with pain. So how do CBD and THC work in the endocannabinoid system?  In a scholarly report of CBM, Maha Hameed explains, “Cannabinoid receptors CB1 and CB2 are present in neurons throughout the central and peripheral nervous system; they act on immune and non-neuronal cells in both the central and peripheral nervous system and work through modulation of G-protein-coupled receptors (GPCR).” Hameed explains that when taking CBM, the CB1 and CB2 receptors are going to send signals through your nervous system to help alleviate or stop certain pain. It is also mentioned by Dr. Stein that for an individual to get the full benefits of CBM, the CBM should have a decent amount of CBD in it to get the “entourage effect,” which is basically all the ingredients working together (Forsyth).  For an individual to get the full benefits of CBM, they should ensure that they’re using something that has a ratio of CBD:THC that works for their type of pain.

Types of Pain CBD and THC Work On

Not all pain is similar. There are so many different types of diseases or ailments that leave an individual with chronic pain. Knowing that, you wouldn’t give someone Tylenol for neuropathic pain because it really doesn’t help with nerve pain. So, what kind of pain does CBD and THC work on? There have been a few study and trial groups done to see the efficacy of CBD:THC on pain. In a multicenter, double-blind, randomized, placebo-controlled study group done by Jeremy R. Johson, they were able find that Sativex, a 1:1 CBD:THC ratio endocannabinoid system modulator, was able to decrease overall cancer pain by 22.6%. This study shows that even with the intense pain of cancer, patients were clearly getting a large amount of relief (with minimal side effects) when they were taking the CBM. Those side effects ranged from “dizziness, nausea, [and] somnolence” (Johson).  Dr. Michael A. Überall, Pain Specialist and President of the German Pain League, also has some promising reviews when it comes to CBM. In his review of Nabiximols “Sativex” in the management of Chronic Pain, he speaks about a multitude of different types of pain it treats (Überall). In particular, he speaks on the efficacy of the product for patients with multiple sclerosis (MS) and in all three randomized controlled trials (RCTs), patients “significantly improved their spasticity rating” and had a decrease in their pain (Überall). These trials and study groups show that CBD and THC work to help a wide array of different types of pain, ranging from deep bone pain with cancer to neuropathic pain with MS, and have very minimal side effects.

Ways to use CBD and THC

What would you answer if I asked how you might consume CBD and THC? There are a vast number of ways to go about consuming CBD and THC. Through this paper, I’ve mostly spoken about Sativex which is an “oromucosal spray” that you spray into your mouth is used throughout Europe (Überall). But there are more ways than just that, and smoking is one of them, but there is a need for more research on the efficacy of smoking CBM. In an open label study by Dror Robinson, they studied the efficacy of THC-rich smoke therapy. In that study, it was found “THC-rich smoke therapy was better for back pain than sublingual CBD therapy.” (Robinson). It is promising research, but there needs to be more done around smoke therapy and the benefits that might come from it. I personally think that by having more thorough research done on smoke therapy, it will open up a lot of different methods for people who don’t react well to a standard oral spray.

Conclusion

Chronic pain and all of its issues are always going to be here: it is in its name. Finding medication or some type of therapy to help relieve some of that pain is extremely hard. Going through the traditional methods can be extremely beneficial, but sometimes they do not work. For individuals with chronic pain that are looking for alternative medications for pain management, I fully recommend giving CBM a try. It is shown to help a wide array of different pains, with very few side effects compared to the alternatives such as opioids for pain management. And if CBM doesn’t work for you, that’s okay. As more research details the use of CBM, a path might open for you down the line to treat your chronic pain someday.

Works Cited

“D.A.R.E.’s Position and Curricula Regarding Marijuana & Legalization.” D.A.R.E. America, 2 Feb. 2018, dare.org/d-a-r-e-s-position-and-curricula-regarding-marijuana-legalization/.

Forsyth, Allison. “Is CBD or THC Better for Chronic Pain?” Sarasota Magazine, 26 July 2022, www.sarasotamagazine.com/health-and-fitness/2022/07/cbd-or-thc-better-for-chronic-pain.

Freeborn, Jessica. “Cannabis for Chronic Pain Relief: How Effective Is It?” Medical News Today, MediLexicon International, 2022, www.medicalnewstoday.com/articles/cannabis-for-chronic-pain-new-research-questions-its-effectiveness.

“Most Americans Favor Legalizing Marijuana for Medical, Recreational Use.” Pew Research Center, 26 Mar. 2024, www.pewresearch.org/politics/2024/03/26/most-americans-favor-legalizing-marijuana-for-medical-recreational-use/. Hameed, Maha et al. “Medical Cannabis for Chronic Nonmalignant Pain Management.” Current pain and headache reports vol. 27,4 (2023): 57-63. doi:10.1007/s11916-023-01101-w

Johnson, Jeremy R., et al. “Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain.” Journal of Pain & Symptom Management, vol. 39, no. 2, Feb. 2010, pp. 167–79. EBSCOhost, https://doi-org.dist.lib.usu.edu/10.1016/j.jpainsymman.2009.06.008.

Robinson, Dror, et al. “Comparing Sublingual and Inhaled Cannabis Therapies for Low Back Pain: An Observational Open-Label Study.” Rambam Maimonides Medical Journal, vol. 13, no. 4, Oct. 2022, pp. 1–12. EBSCOhost, https://doi-org.dist.lib.usu.edu/10.5041/RMMJ.10485.

Überall, Michael A. “A Review of Scientific Evidence for THC: CBD Oromucosal Spray (Nabiximols) in the Management of Chronic Pain.” Journal of Pain Research, vol. 13, 14 Feb. 2020, pp. 399-410, doi:10.2147/JPR.S240011. 2