Medical marijuana is now legal in 36 states and the District of Columbia. 18 States and the District of Columbia now have legal recreational mariuana. Hemp-derived CBD oil is now legal at the federal level and legal in all but two states—Idaho and Nebraska. Both marijuana and CBD (cannabidiol) oil have been reported to be effective for pain relief. If you’re one of the lucky two thirds of Americans who can get access to both, which should you choose?
Time and Expense
Getting access to medical marijuana involves time and expense. Patients must first go to a health care practitioner qualified by state law to evaluate whether the patient has a qualifying condition that makes them eligible under the state’s medical marijuana laws. Then the patient must pay a registration fee to get a medical marijuana card. Marijuana products can then only be purchased at a state-licensed facility. Access to legal recreational marijuana is much simpler--be over the age of 21 and go to a marijuana dispensary. Hemp-derived CBD oil products are widely available over-the-counter, both locally and over the internet.
Sometimes hemp-derived CBD oil is less expensive than medical marijuana, but not always. Prices vary significantly.
Comparative Effectiveness
Cannabis experts seem to agree that medical marijuana is superior to hemp in its therapeutic effects because marijuana contains a wider array of beneficial compounds. While hemp contains significant amounts of CBD, which has been shown to be effective for reducing pain and inflammation, products derived from the marijuana plant contain a significant amount of other beneficial compounds, including THC, other cannabinoids, terpenes and flavonoids. About a hundred other cannabinoids reside in the average cannabis strain and though these are less well studied, many show promise for treating a variety of symptoms including pain. These compounds work together to produce an even greater therapeutic effect, known as the entourage effect.
As Paul Bregman MD of CannabisResource.info states, “For the relief of chronic pain/inflammation, the evidence-based research shows whole plant cannabis is superior to hemp-based full spectrum CBD or CBD isolate. The entourage effect in whole plant cannabis makes the difference as does the correct THC/CBD ratio and proper dosing.” Bregman also reports that. “The mode of use of the plant cannabis is important as well- combining a strong external topical salve/cream and a measured internal dosing regimen should be considered for maximum relief”.
Both medical marijuana and hemp-derived CBD come in a variety of formulations, including tinctures, edibles and topicals. Marijuana also comes in smokable and vaping forms.
Side Effects
One concern for many patients is that products containing THC tend to have more side effects than those with CBD alone. Some don’t like the “high” that THC produces. Other possible side effects are increased heart rate, coordination problems, dry mouth, anxiety, slower reaction times and problems with memory.
The side effect profile is very dependent on the THC/CBD ratio of a product. CBD tends to balance out the negative effects of THC and the more CBD and the less THC, the less of a “high” and the fewer side effects the marijuana will produce. Because marijuana comes in many strains with varying ratios of compounds and the medical marijuana market is highly regulated, patients are able to select the product with a balance that works best for them.
Drug Testing
Some pain patients have concerns about drug testing, either because they are drug tested on their jobs or because their physicians test for marijuana and discontinue opioid prescribing if they test positive. In these cases, a CBD product derived from hemp that has 0% or undetectable amounts of THC is the better choice. Look for products labeled organic, grown in the USA, and lab-tested for purity and content.
The Bottom Line
Both medical marijuana and hemp-derived CBD products can help with chronic pain. Selecting the most effective products for a specific patient with a specific medical condition can be a confusing, time consuming and expensive undertaking. That’s why Dr. Bregman recommends consulting a medical professional with extensive experience in this area.
Sources for more information:
THC vs. CBD for Pain: The Differences and Interactions http://nationalpainreport.com/thc-vs-cbd-for-pain-the-differences-and-interactions-by-winston-peki-8837164.html
Role of the Cannabinoid System in Pain Control and Therapeutic Implications for the Management of Acute and Chronic Pain Episodes https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2430692/
Cannabis and Pain: A Clinical Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5549367/#B68
The Most Common Terpenes Found In Cannabis and Their Medical Benefits https://www.heylocannabis.com/post/the-most-common-terpenes-found-in-cannabis-and-their-medical-benefits
The Science of Cannabis—a Breakdown of Cannabinoids, Terpenes, and Strains https://goop.com/wellness/health/the-science-of-cannabis-a-breakdown-of-cannabinoids-terpenes-and-strains/
Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems: A Clinical Review. https://www.ncbi.nlm.nih.gov/pubmed/26103031
10 Tips For Buying Hemp-Derived CBD Products https://www.projectcbd.org/guidance/10-tips-buying-hemp-derived-cbd-products
National Center for Biotechnology Information: Cannabis and Pain: A Clinical Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5549367/
THC vs. CBD for Pain: The Differences and Interactions http://nationalpainreport.com/thc-vs-cbd-for-pain-the-differences-and-interactions-by-winston-peki-8837164.html
Role of the Cannabinoid System i Pain Control and Therapeutic Implications for the Management of Acute and Chronic Pain Episodes https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2430692/
Cannabis and Pain: A Clinical Review https://ncbi.nlm.nih.gov/pmc/articles/PMC5549367/#B68
The Most Common Terpenes Found in Cannabis and Their Medical Benefits https://www.heylocannabis.com/post/the-most-comon-terpenes-found-in-cannabis-and-their-medical-benefits
The Sciences of Cannabis-A Breakdown of Cannabinoids, Terpenes and Strains https://goop.com/wellness/the-science-of-cannabis-a-breakdown-of-cannabinoids-terpenes-and-strains/
Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems: A Clinical Review https://ncbi.nlm.nih.gov/pubmed/26103031
10 Tips for Buying Hemp-Derived CBD Products https://www.projectcbd.org/guidance/10-tips-buying-hemp-derived-cbd-products
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