Looking HIGH for Some Pain Relief

With the article about 1 in 8 FM patients using marijuana, there has been a lot of talk about it’s use – legally and morally; but what if there were no ‘high’ associated with cannabinoid use for relief of pain? Without the suspicion that pain patients really want cannabis for ‘recreational’ purposes, would there be fewer stigmas? And would pharmacological research, drug development, prescribing practices, and patient relief forge ahead?

The Tikun Olam company in Israel, after years of cross-breeding, with no genetic engineering involved, have developed a strain of marijuana reported to be virtually free of the psychoactive THC (tetrahydrocannabinol) cannabinoid, and also very high in the anti-inflammatory CBD (cannabiodiol) cannabinoid.

So while the receptors in the pain and pleasure centres of the brain are not being stimulated (so you’re NOT getting high), those receptors will be responding to the anti-inflammatory CBD, or so it is proposed.

Reportedly it has already been tried with good results by a select group of patients to ease symptoms of chronic illness such as pain and nausea. These are people who have a physician’s prescription for medicinal cannabinoids and want symptom relief, but also want to stay functional if they can – so consider THC’s effects on the pleasure centres an unwanted side effect.

Dubbed “Avidekel,” the new strain has been tested on mice in the lab, and human clinical trials are expected in a few months, according to Professor Emeritus Ruth Gallily, PhD, a researcher specializing in study of inflammatory processes and anti-inflammatory cannabinoids at Hebrew University.

Is Avidekel the most promising high-CBD medical marijuana strain in the works today? But, FibroMAGICians, don’t hold your breath – there is still a lot of testing to be done before it reaches us!

Ah…But Did You Inhale?

Ssshhhh! Don’t tell anyone but as a partying young adult (as opposed to an old adult now), I tried some drugs. I found that I liked the upper, party-type drugs. Marijuana did nothing for me, except maybe bring me down from some speed. If I smoked, all it did was put me to sleep.

This brings me to the present time – I have fibromyalgia. Fibromyalgia is notoriously difficult to treat and only 35%–40% of people with the condition get relief from the available medications. So, while there are prescription medications around (and I’m working my way through them), I’ve found one unconventional drug – marijuana – that really does the trick, when I’m so tight and in pain that nothing else works.

Although there are strong opinions surrounding its use, some patients are trying marijuana—legally or illegally—and finding it can help fibromyalgia pain.

“My patients are asking me all the time about it,” says Stuart Silverman, MD, a clinical professor of medicine and rheumatology at Cedars-Sinai Medical Centre, in Los Angeles. “Historically and anecdotally, marijuana has been used as a painkiller.”

Why Marijuana Sometimes Helps
Although our bodies naturally make pain relievers called endorphins, they also make other substances that can trigger pain relief in the so-called endo-cannabinoid system. This system seems to play a key role in modulating how we feel pain. Marijuana contains cannabinoids very similar to those that occur in the body naturally.

Typically, we take multiple drugs for a variety of symptoms (not just body-wide pain); however, marijuana may treat multiple symptoms, and some patients are seeing results. As such, it seems logical that we should try marijuana for our symptoms (leaving aside the illegal part, depending on where we live).

But there are two problems with herbal cannabis, D. Silverman and other critics say: It’s a complex natural substance that contains about 60 different compounds with potentially medicinal effects, some of which may interact with one another. The other problem is that the amount of these various compounds may vary by batch, as marijuana is not synthesized but grown.

While Dr Silverman says he has great hopes that synthetic medicines based on individual compounds in cannabis may one day help us (but only after appropriate randomized controlled clinical trials have been done), he argues that the real thing today is just too inconsistent. Personally, I agree that it is unreliable in its effects. Sometimes, I end up in a spineless lump on the couch, where I can’t do a thing; and sometimes, I end up energised and laughing and almost like my old self. the only consistent part of it is the pain is GONE!!! Sometimes, that’s enough!

Drugs Derived from Marijuana

Mark Ware, MD, an assistant professor in family medicine and anesthesia at McGill University, in Montreal, and the executive director of the Canadian Consortium for the Investigation of Cannabinoids, recently published a study showing that one such compound, nabilone (Cesamet), helped FM patients sleep better than amitriptyline, a tricyclic antidepressant often prescribed to fibromyalgia patients to ease pain and improve sleep. And a study published a couple of years ago found nabilone helped lessen pain and anxiety.

The US Food and Drug Administration (FDA) approved Nabilone, a synthetic analog of delta-9 tetrahydrocannabinol—THC for short—often thought of as the active ingredient of cannabis, back in 1985 for treating nausea in cancer patients undergoing chemotherapy. It has also been approved in the UK, Australia and Canada.

The only other cannabis-based drug now on the market in the US, Denmark and Canada is dronabinol, which is sold as Marinol in the U.S. and is FDA-approved for treating chemo-related nausea and vomiting.

Unlike the previous two options, Sativex, which contains chemicals derived directly from marijuana, was approved and launched in the UK on June 21, 2010, making it the first cannabis-based prescription medicine in the world. Spain, Canada, the Czech Republic, Denmark, Germany, Austria and Sweden have all approved it to treat spasticity caused by multiple sclerosis. The drug is sprayed under the tongue or into the cheek, and contains THC and cannabidiol, a non-psychoactive compound found in cannabis that eases inflammation and pain and may also reduce the side effects of THC (like anxiety, hunger production, and some of the intoxicating properties), as well as a number of other compounds (other cannabinoids and terpenoids, which are analgesics in their own rights).

But do they help?

“It is quite possible that cannabis-based medicines could be helpful for sufferers of fibromyalgia based on available science,” says Ethan Russo, MD, who is senior medical advisor to GW Pharmaceuticals, which makes Sativex, and a study physician for the U.S. clinical trials now underway for cancer treatment.

Dr Russo says he’s hopeful Sativex will get FDA approval for treating cancer pain in 2013. “While a theoretical basis for Sativex potentially helping benefit fibromyalgia symptoms is quite strong, and we know it has been very helpful with neuropathic pain and sleep disturbance in many other conditions,” he adds, “it’s ultimate utility in fibromyalgia can only be proven in a meaningful, practical fashion through formal randomized clinical trials.”

For now, Dr Ware says, patients with fibromyalgia who aren’t being helped by their existing treatment might want to discuss nabilone with their physician. “A lot of doctors just don’t know that these prescription cannabinoids exist,” he says.

However, these drugs have side effects too. “The most typical side effects are what I call the three D’s: drowsiness, dizziness, and dry mouth. It’s not euphoria as such,” he adds.

In Australia, marijuana is illegal. In Canada, federal law allows patients to use medical marijuana with a doctor’s support (not on prescription). In the US, the legality of medical marijuana is determined state-by-state, and rules and regulations vary widely.

“I would suggest to any ‘fibromyalgiac’ to try marijuana if they are open to it,” says Diane, another FM patient. “I swore when I became a parent I would not touch weed again (ah, youth), but times have changed, and I was desperate to find something for the burning pain so I could function. I’m glad that I made this decision because it works for me.”

Personally, I take it when I’m desperate.