“There is a crack in everything. That’s how the light gets in”, Leonard Cohen-Anthem
Cannabinophobia has resulted in a frenzy of political, medical, social and cultural chaos for generations in spite of the fact that this herb has been around for 38 million years. Prohibition against cannabis usage has resulted in billions of dollars spent trying to stop its usage; hundreds of lives have been destroyed because of arrests, labelling them as criminals while governments have wasted their time trying to contain its widespread recreational use. But, it is medical marihuana specifically that I am the most interested in and as Backes has written: “The way to approach cannabis as a medicine is to do so cautiously, despite the fact that human beings have been using medicinal cannabis for millennia”, (Backes, p.26, 2014). Physicians cannot prescribe but can authorize the use of cannabis. However, some physicians will not even do that in spite of the patient’s pain and even worse in cases like multiple sclerosis where it has been shown to help with spasms, many will not even authorize it! For those of us with fibromyalgia and other chronic pain, as well as other conditions such as multiple sclerosis, waiting for the legalities to be sorted out means that we are expected to wait until the hysteria has subsided.
In Canada where I live the Liberal government has promised to legalize cannabis, but it is a slow process. It is likely to happen in 2017, the first of the G7 nations to do so. The government’s task force will release its report momentarily. Currently in the US eight states have legalized marihuana for medical and recreational purposes. With the recent US election it is possible that all this progress may be rescinded. Only time will tell. Many want to be open-minded about the topic but it is far too often that their personal biases prevent reasonable discussions. While it is often said that religion, sex and politics are taboo subjects to be avoided in polite company, I believe cannabis should be added to that list.
While I have many books and other reading material regarding marihuana (often spelled marijuana) , The Pot Book remains among my favourite. Searching through the hundreds of internet sites, published articles, and books is an ominous task leaving the confused even more in a quandary. There is so little out there about the fibromyalgia pain, fatigue and malaise, (among a host of other symptoms) and using cannabis for treatment, that it is little wonder those of us with this syndrome wonder what should be done. Even this extensive book does not cover the topic and although most researchers write about chronic pain, the term fibromyalgia is not specifically used.
My view has been and remains- if alcohol, cigarettes and prescription medications are available as a panacea for stress, anxiety, depression and pain why not cannabis? If one can easily access cigarettes or imbibing alcohol for the social, recreational and personal pleasure of relaxation why isn’t it the same for having a toke? Why is it legal to take a prescribed chemical such as valium (Diazepam) for example, but not an herb, like marihuana? But, wait a minute-an herb? I have long ago given up on herbs knowing that the myths associated with them are airy fairy, woo, snake oil, in fact, are unproven to be helpful. I can attest to their ineffectiveness. Why is this particular herb one which I consider to be beneficial for medicinal purposes? In fact, years ago I spent much money and time boiling Chinese herbs, not even realizing the heavy metals and other toxic substances in those concoctions and all this without any positive results. Do people like to be deceived? Although I did not derive any benefit from them I still hoped I would. It was self deception on my part as were the so called ‘complimentary/alternative’ concoctions I wasted even more money on before giving up on them. They are not scientifically evidence based. The ways in which we deceive ourselves is due to inherent biases. Most of these herbs are generally in the realm of pseudoscience. So here’s the question: why do I believe cannabis is helpful for the many ailments of fibromyalgia? Is the use of marihuana scientifically evidence based? Are anecdotes enough for us to rely on? It is difficult to be unbiased/neutral and there are indeed unsupported assertions about marihuana, a highly contested issue.
When I first wrote about cannabinoids on this site(2009) all those years ago I explained that I had never tried cannabis for pain of fibromyalgia, nor for any other reason. I have never smoked a cigarette nor do I drink alcohol, the latter because it is too stimulating for me; it is not a moral issue. I avoid caffeinated coffee for that same reason. I simply don’t like the feeling of being out of control, my central nervous system cannot tolerate stimulants. I have never taken a psychotropic drug, and other than Gabapentin and an occasional Tylenol I suffer through this unrelenting pain. I am not a martyr but until it was suggested I try medical marihuana I believed there wasn’t any other hope for relief and the anecdotes I was reading about cannabis seemed encouraging. When I read the hundreds of comments on these many blogs I have written over the years, I am in awe about how many mood altering drugs people are taking for their emotional wellbeing. The pain of fibromyalgia is non ending. Why not try the unknown I thought. I was eager to try! I am considered a naïve user.
I confess to worry I feel when people smoke cigarettes knowing that the evidence is clear, even written on cigarette packages, that smoking causes lung cancer. The tobacco that tobacco pickers made themselves from leaves burned the back of their throats. Over the years many have told me and written about the same sensations they incur after smoking cannabis, particularly from unknown sources, that is, there is more phlegm and inflammation in the respiratory system like burning, coughing and wheezing from the heat of the smoke. Tobacco wasn’t always regulated nor were the ingredients clearly stated on packages. If cannabis was regulated and ingredients stated before use would buyers become more cautious about from whom they were buying? Would they switch to vaporized, oils, sprays, suppositories, even the new market of pills, or edible means of taking marihuana for recreational reasons? Or, is it the ritual, of preparing, and/or sharing a smoke that is enjoyable? Even more significant, the cost may be prohibitive for many forms of cannabis, so it is likely that those who are taking cannabis for pain are smoking. Costs must always be considered as many people with fibromyalgia have had to stop working due to their pain and cannot afford an oil or vapour and certainly not the spray. For those of us with fibromyalgia and sensitive to smoke we do have alternatives, hopefully the costs will not be prohibitive.
In an article for CBC News, November 24, 2016, Opinion, Peter Thurley writes:”Stigma of the lazy pot-smoker hurts medical marijuana users” and the ways in which “they often give a nudge nudge wink wink and say, “Lucky you, getting high on weed, eh?” He writes of the extractions (such as an oil) that “take much more plant matter to produce than other methods such as smoking or vaporizing”. The process results in higher costs.
In another CBC production, November 25, 2016 Marketplace, alarms went off at the findings when the science based study of four participants who were given weed to smoke to determine brain wave data after they had become high. But, it is this kind of scientific based research that is sorely needed. Technology has allowed us to view responses of our brains using fMRIs and EEGs. We have to be able to make informed decisions. However, where is the brain research after a person has consumed a prescribed psychotropic ‘medication’?
In the last four years at one hospital in Denver it was said that there was a big increase in the number of young clients with nausea, abdominal cramps, vomiting due to cannabis (The Chronical Herald, November 16, 2016, A16). The data has shown that the current level of THC in weed is now 6 times more powerful than it was in the 1970s…and adolescent psychosis is an even more serious problem. It is speculated that using marihuana before the age of 25 is harmful to the brain. Yet, there is anecdotal evidence that cannabis is helpful in some cases of children with such conditions as epilepsy and certainly in cancer related situations.
I am unhappy when I see someone inebriated or completely stoned. It is obvious that regularly drinking alcohol or toking to excess is harmful for personal and societal reasons, as are other addictions. So now where am I on this controversial issue that has the general population in such a frenzy? Well, I have just become registered as a person who is legally allowed to use cannabis oil , taken orally for medical reasons. My fibromyalgia pain has increased tremendously since my hip replacement five months ago. I have residual pain. Central sensitization has accelerated and flare ups are more frequent with intense back pain from many degenerations of the lumbar spine. I have a choice: increase Gabapentin (and weight gain) or take an herb in the form of an oil. I chose the latter, despite still believing that most other herbs do not serve much purpose (although at least half of prescription drugs are plant based, with added chemicals) . I conclude after many years of reflecting and reading the science and hearing anecdotal testimonies that cannabinoid usage is helpful for chronic pain, and what is more chronic than fibromyalgia? It is not a cure but a potential panacea.
History of Marihuana Usage
There are many internet sites, articles and books that delve into the history of the herb, this Indian hemp plant cannabis, from which marihuana and hashish are made. For the most part the history is written about how it was used for euphoria, or hemp itself was used in clothing and other products, rather than for medicinal/medical purposes. As a hallucinogen it is said to have been used by the Chinese Emperor Shen Nung in 2727 B.C. (2737 B.C?, dates vary. See narconon.ca and/or deamuseum.org and/or livescience.com) who reported on its therapeutic use. Books and articles are plentiful about its history. “Cannabis is one of the oldest psychotropic drugs in continuous use. Archaeologists have discovered it in digs in Asia that date to the Neolithic period around 4000BCE”, (Groopman, 2014). More ‘recently’, in 1839, a British doctor, William O’Shaughnessy wrote about its benefits and it became widespread for medical use, even prescribed to Queen Victoria for menstrual discomfort (Groopman, 2014). Could this physician have imagined such a device as a gel pen filled with cannabis oil to apply locally? Or that there would be vaporizers, suppositories, oils, pills and other edibles, and even patches? That there were hundreds of slang words/terms one used that have evolved over the decades of marijuana usage? The spelling of marijuana, or the terms used by users seems to men to be irrelevant so I will use them in various kinds of ways that are easiest for me to make a point.
The literature often appears to be completely two sided without a middle ground of pros and cons about using the plant for mood altering purposes in any form. Furthermore, whether or not it is effective for medicinal purposes has not been as carefully researched as prescription drugs. Much of the data are anecdotal. It is understandable since it is illegal in most countries. Now that several American states have legalized its use it is hoped that more participants will be willing to volunteer for larger studies without fear of repercussion, that is, if the ‘new’ President does not undercut those states who have legalized it. I am certain that Canada will lead the way in research as soon as the new year legalizes this ‘weed’. There is hardly a day that passes when the national paper ‘The Globe and Mail’ does not feature an article on marihuana. Who then will fund these studies? Will fibromyalgia sufferers be participants in these studies?
To be realistic Big Pharma might be unlikely to fund the research so the problem of funding remains an issue, unless it can be shown to be profitable for the pharmaceutical companies. As a point of interest the study conducted by Dr. Mark Ware and colleagues of McGill University in Montreal in 2016, write of the pharmaceutical development of cannabis patches for diabetic nerve pain and fibromyalgia! It is a small beginning for those of us with fibromyalgia and chronic pain. ‘Illegal’ home growers and ‘legal’ growers are of course somewhat leery about this new legalization, particularly if it is taken over by Big Pharma. Marihuana is a social, political and medical issue that is very complex. Growing a crop in one’s yard may be subject to criminality. The pharmaceutical companies may end up having complete control over the countries where it is legal.
The difficulties persist as most people are passionate about the topic and especially about government and/or Big Pharma control of the industry. Daniel LeBlanc wrote “Canada’s new legal marijuana regime is expected to feature a mishmash of provincial rules and a heavily regulated production system that will initially favour existing producers of medical cannabis, sources say” (The Globe and Mail, December 1, 2016A3) .
THC and CBD
It is obvious that with the issue of medical marihuana the ‘prescription’ is not precise. How is a person to know which product will be effective for individual clients? How much THC (tetrahydrocannabinol) and the ratio to CBD (the second most common cannabinoid produced by the cannabis plant) is appropriate for each person? Briefly stated THC will give a person a ‘buzz’ while CBD does not. CBD has medical benefits and can counteract THC lethargy and getting ‘high’. It is used for anxiety, pain, as an anti-inflammatory and antispasmodic. Finding the right combination is a slow process for each individual.
The debate continues
Neither side is willing to be open minded to the other, no doubt myself included. An example might be a discussion about why a drug such as valium for anxiety is socially acceptable and legally prescribed while smoking weed is considered illegal in most countries. The opposite position could be that valium has been scientifically shown to alter a mood and the dosage is tightly controlled, whereas medical marihuana without much THC may not change such conditions as anxiety, in fact, may even increase anxieties. Those who are definitely in one camp or the other are in the majority while those who see both sides of the argument seem to be in the minority. The entire concept is mired in controversy with passion raging on both sides of the argument. Nonetheless, health care providers are left in a quandary as to whether or not medical marihuana is effective for pain or is thought to be because of the placebo effect. That is, those compounds without much THC may help with pain, for example, but may do little for underlying anxiety. Evidence based research is not yet as abundant as it could be, and it is not black and white. When authorizing medical marihuana physicians must use caution and it is by trial and error that one finds the right script.
It is here that I confess my own bias against any kind of invasion of the mouth, throat, larynx, and lungs by smoke, having seen many cancer patients suffering as a result of inhaling cigarette smoke. (There are others who are not in favour of edibles as they have been concerned about gastric issues and the difficulties of dosage control.) In my view the evidence supporting either position is not definitive so our own biases are not ‘provable’ (I use this word loosely). Some suggest that cannabis can actually prevent lung cancer while others suggest it is instrumental in causing it! Those who are pro smoking disagree with others who say that it is equally as dangerous as smoking cigarettes. In fact, it may be more deleterious as the smoke is held longer in the lungs by the inhaler.
While science based evidence is badly needed it may or may not help the situation if one is not open to discussion about their own point of view. It is the old idea that if marihuana is legalized it will lead to addiction and the use of dangerous drugs. A casual alcohol drinker does not necessarily become an alcoholic so that issue is a moot point.
Struggles for legalization: Political Issues Continue
One would have thought that California, of all the perceived laid-back states, would have legalized pot but it wasn’t until November 8,2016 with the ‘Adult Use of Marijuana Act’ that this state ended their prohibition for those over 21. They now have what they consider to be a sensible system that treats marijuana similarly to alcohol with regulations and taxing procedures. Patients with a state ID card for medical usage will not have to pay taxes. It should be fully implemented by 2018. However, “the state would impose a 15-per-cent tax on retail sales of pot and additional taxes on growers” (Gary Mason, The Globe and Mail, Monday, November 7,2016 A7). “(L)egalization could generate more than $1-billion in tax revenue” (Mason). As marihuana becomes legalized in more and more countries, small growers will be penalized, and the greater the opportunities for Big Pharma. It follows that the underground ‘bootleggers’ will be forced to proceed illegally. The complexity is overwhelming. I am at this point myself overwhelmed by the amount of information I have been exposed to over these many years. I could write reams of pages on the political issues involved with legalization, for example, the legalities of driving while taking medical marihuana, using it at work, or travel to other countries as a medical user.
While there is promise regarding the patches I cannot imagine using them for the ‘pain all over’ which affect us on a daily basis! A peculiar sight indeed! I cannot yet attest to the efficacy of medical marihuana oil for fibromyalgia and specifically for myself– stay tuned.
Backes, M. (2014). Cannabis Pharmacy. NY: Black Dog & Leventhal.
Groopman, J. (2014) Marijuana: The High and the Low in A New Leaf: The End of Cannabis Prohibition (A.Martin and N. Rashidian eds) NY: New Press, pp. 264.
LeBlanc,D. (2016) Government receives cannabis task force’s report, The Globe and Mail. Tuesday December 1, pp A3.
Mason,G. (2016). Pot, death penalty on the California ballot, The Globe and Mail, Monday, November 7, pp. A7
Ware, M. et.al (2015). Cannabis for the Management of Pain: Assessment of Safety Study (Compass). Journal of Pain, vol 16, no 12, pp1233-1242.