There’s no question that the traditional drug-focused healthcare system is failing many patients who are in pain.
Despite all of mainstream medicine’s best efforts, including prescription and over-the-counter options, the best ways to treat pain still remain elusive for millions of people.
Chronic pain can interfere with an individual’s ability to work, attend school, or care for their family.
Therefore, it should not be surprising that more patients are exploring alter- native therapies to address their pain.
Pain care in the U.S.
A 2015 analysis of the landmark 2012 National Health Interview Survey (a key source of data on the health of Americans) painted a rather grim picture for the health status of Americans who live with pain.1
By extrapolating the data from nearly 8,800 responses, a group of researchers found that as many as 126 million adults experienced some pain in the previous three months, with more than 25 million of these (about 11 percent) living with daily chronic pain for those three months. Furthermore, more than 23 million people (over 10 percent) reported severe pain.1
Even more recently, the U.S. has been hit by what the media has termed an “opioid crisis.”2
According to the Centers for Disease Control and Prevention (CDC), overdose deaths from prescription drugs have quadrupled since 1999. Between 1999 and 2015, more than 180,000 people died from such overdoses. More than half of these overdose deaths involved prescription opioids.3
The statistics for those who struggle with opioid addiction are equally distressing. As many as 1 in 4 non-cancer patients who receive long- term opioid prescriptions from their primary care physician struggle with addiction. In 2014, this added up to almost 2 million Americans addicted to prescription opioids.3
A safer option
Over the past 25 years, there have been thousands of studies to determine the efficacy and safety of cannabis extracts—principally CBD and THC—to treat pain. But you may have concerns about using and recommending such products, particularly if your patients are subject to random drug screenings.
If you are recommending these products in topical form for your patients to use it is vital to understand their safety profiles, so you are assured the products will provide the relief your patients seek, but without the dangers of adverse side effects or their showing up in drug screenings.
The following discussion of the two main types of cannabis extracts on which researchers are focused will look at the types of products with cannabis extracts that DCs can dispense. It will explore the manufacturing and certification processes that assures the highest quality for topical analgesics that use cannabis extracts.
Differences between CBD and THC
There are an estimated 113 cannabinoids in cannabis plants.4
Cannabinoids are the chemical compounds in cannabis. Cannabidiol (CBD) and tetrahydrocannabinol (THC) are the best-known and most studied of these cannabinoids. Both marijuana and hemp share the same Latin name, Cannabis sativa, but each is cultivated as a separate variety.
Traditionally, hemp plants have been grown for their fibers to make textile products (such as rope and clothing), while marijuana has been traditionally grown for its psychoactive properties.5
Both plants contain a spectrum of cannabinoid compounds that act on the human nervous system, but in different ways.
CBD and THC act on the peripheral nervous system to reduce the sensation of pain. THC, however, also has a psychoactive compound that produces a euphoric effect.
Hemp plants have higher concentrations of CBD than THC, while those cultivated as marijuana plants have higher concentrations of THC compared to CBD. The CBD in most products is derived from hemp plants, not marijuana.
While THC products may have medicinal value in reducing certain types of pain, nausea, and seizures, they cannot be dispensed by DCs because of current federal law.6
Instead, patients can obtain THC products only from a properly licensed, medical marijuana dispensary in states that have passed laws supporting such distribution.
Currently, 29 states and the District of Columbia have some provision for legal or medical marijuana.
With respect to CBD, there are 18 States with laws specifying its legality.
Nevertheless, no medical claims can be made for products containing CBD. Unless a topical analgesic with cannabis extracts is registered with the U.S. Food and Drug Administration (FDA), no claims can be made regarding its safety, uses, or effectiveness.
Ensuring product quality
As a discerning practitioner, you want to know that you have a certain level of assurance regarding the quality of the products you are providing or recommending to your patients. After all, your reputation is on the line when you do, so it is vital to do your homework in advance. This is particularly true in the case of topical analgesic products that contain CBD.
There is a lot of hype and misinformation regarding medical marijuana, and CBD products are in high demand. As a result, there are many companies jumping in to offer products that claim to be made with CBD. So how can you determine a quality product from a questionable one? Recommending or purchasing a product that’s made in an FDA-compliant and FDA-audited facility is an important first step.
And you need to look for some other things, too.
First, you want assurances that the concentrations of key ingredients are guaranteed. In 2016, the FDA had several CBD products tested by independent laboratories. The testing showed that the amount of CBD in many products was significantly less than what the labels claimed. Some products did not even contain any CBD at all.
Second, look for consistency. A product you bought six months ago should work just as well as the one you bought last week. You don’t want to wonder if your patients are not getting the right results because the formulation is not consistent from jar to jar. If a topical analgesic product is made in an FDA-audited facility, there must be a quality system in place that assures consistency from batch to batch.
Finally, you want assurances that such products contain no more than trace amounts of THC and do not penetrate transdermally to enter the blood stream. Some of your patients may be submitted to random drug testing and not want any amount of THC to be present in their urine.
The Drug Enforcement Administration (DEA) requires that CBD products contain no more than 0.3 percent THC, which is a trace amount. Furthermore, if the product is not transdermal, it cannot enter the bloodstream, so it will not be detected on standard urine-based drug tests.
Again, if a topical analgesic, with or without CBD, is registered with the FDA, then it is subject to FDA requirements to assure quality and safety. If you are considering using CBD-based analgesic topical products, your concerns about efficacy and safety are certainly valid.
This is why practitioner education about the difference between CBD and THC is vital, as well as understanding the importance of using products made in an FDA-audited facility, so you can be reassured about the safety and benefits of such products for your patients.
[Note: Laws regarding the status of cannabidiol vary by state. Check with your state board before making decisions regarding CBD products — eds.]
Tina Beychok is an editor and writer with expertise in technical, academic, and scientific materials. She is a regular contributor to Chiropractic Economics and resides in Long Beach, Calif. Her online portfolio can be viewed at thatwordgrrl.com, and she can be contacted at email@example.com.
1 Nahin RL. Estimates of pain prevalence and severity in adults: United States, 2012. Journal of Pain. 2015;16(8):769-780.
2 Woods R. “Opioid-crisis cost revised to $504 billion in six-fold surge.” Bloomberg. https://www.bloomberg.com/news/arti– cles/2017-11-20/trump-economists-say-opioid- crisis-much-bigger-than-envisioned. Published Nov. 2017. Accessed Dec. 2017.
3 “CDC Prescription Opioid Overdose Data.” https://www.cdc.gov/drugoverdose/data/ overdose.html. Centers for Disease Control and Prevention. Updated Nov. 2017. Accessed Nov. 2017.
4 Aizpurua-Olaizola O, Soydaner U, Öztürk E, et al. Evolution of the cannabinoid and terpene content during the growth of Cannabis sativa plants from different chemotypes. Journal of Natural Products. 2016;79(2):324-331.
5 “What Is Hemp? Understanding the Differences Between Hemp and Cannabis.” Medical Jane. https://www.medicaljane. com/2015/01/14/the-differences-between-hemp-and-cannabis. Updated Dec. 2017. Accessed Dec. 2017.
6 Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: A system- atic review and meta-analysis. JAMA. 2015;313(24):2456-2473.