“This is why vapor is preferred for medicinal use,” explained Dr. Wallace. A disadvantage of the vaporization, however, is that the effect peaks (ie, THC and other cannabinoid blood levels reach their maximum) at approximately 5 minutes and may last about 2 hours. Effects via oral ingestion, on the other hand, may last 6 to 8 hours, but there is less control over the peak (some patients prefer to take this form of cannabis at night). Sublingual spray effects have a shorter duration, at approximately 4 hours, with a peak effect at 1 hour.
With regard to long-term safety and the use of medical cannabis to treat chronic pain, Dr. Wallace referenced a Canadian study by Ware et al published in the Journal of Pain in 2015, which found no significant difference in risks between groups using controlled cannabis and not using it. Furthermore, he noted that cannabis’s abuse potential is significantly less robust than that of heroin, cocaine, or nicotine, based on animal study findings (Cooper ZV, Haney M, Int Rev Psychiatry, 2009:104-112)
At this time, healthcare companies are not prepared to handle dosing or delivery method coverage surrounding medical cannabis, according to Dr. Wallace. Many state laws allow only 4 ounces of marijuana to be dispensed at a time, he said, and dispensaries do not necessarily understand how to dose a patient with chronic pain versus an individual seeking other uses. Dr. Wallace said he is, therefore, working to develop a national education program to help practitioners gain a more in-depth understanding of all the factors at stake.
Historical & Regulatory Background
Overall tolerance to cannabis may be developed on the psychological side (eg, increased heart rate, drop in blood pressure) and the subjective side (ie, a feeling of euphoria), but there has not been a demonstrated tolerance with analgesic effects, according to Dr. Wallace. That said, a patient may experience withdrawal symptoms from cannabinoids depending on the dose of tetrahydrocannabinol (THC) and/or abrupt termination by habitual users. These withdrawals may exhibit similar symptoms to opioid withdrawal, but effects are less likely with lower dose cannabinoid consumption.
Safety Concerns: Alcohol & Driving
Previous research shows that some people substitute medical cannabis (often with high concentrations of THC) for opioids and other pain medications, reporting that cannabis provides better pain relief and fewer side effects. However, there is far less data on CBD use.
For this study, the team focused on 878 people with fibromyalgia who said they used CBD to get more insight into how they used CBD products.
Yet the finding that products containing only CBD also provided pain relief and were substituted for pain medications is promising and merits future study, noted Boehnke.
The U-M team found that more than 70% of people with fibromyalgia who used CBD substituted CBD for opioids or other pain medications. Of these participants, many reported that they either decreased use or stopped taking opioids and other pain medications as a result.
CBD, short for cannabidiol, is the second most common cannabinoid in the cannabis plant, and has been marketed for everything from mood stabilization to pain relief, without the intoxicating effects produced by the most common cannabinoid, THC. THC, which stands for delta-9-tetrahydrocannabinol, is the ingredient in marijuana that causes people to feel high.