photography by Mariah Hamilton. creative direction by oana cazan
It’s a big week for cannabis in Canada. On October 17, legalization 2.0 of recreational cannabis takes effect, which means that edibles and topicals like cookies, sparkling waters, salves and even lubes will soon hit the shelves of licensed retailers. It’s a whole new world of legal ways to get high, so we’ve prepped your lesson plan for using cannabis now.
“I am basically a walking PSA for CBD,” says Sasha Exeter. The 39-year-old Toronto content creator and model has a rare kidney disease and fibromyalgia, both of which have left her bedridden for months in the past. She has tried a number of medical and alternative treatments to manage her pain—pain-blocking injections as well as pills, physiotherapy, chiropractic adjustments, therapy, restorative yoga, reiki and osteopathy—but her go-to treatment these days is cannabis. “I talk about it whenever I can, and it is very much a regular part of my routine,” she says. “If I am in the midst of a pain flare-up or having issues with my anxiety, I am taking it several times a day to keep my pain and anxiety at bay.”
Exeter was initially introduced to cannabis as pain management by her family physician in 2010, but more recently has been managing her treatment on her own. “I had to try several strains and different products to find something that was effective; however when I eventually did, it was life changing,” she says. “It not only helped with my pain, but it also helped significantly with my anxiety and sleep issues, making my overall health better.”
She’s just one of many women on social media singing the praises of cannabis to help treat period pain, migraines and endometriosis, with or without a prescription. Toronto entrepreneur and influencer Sara Koonar talks about using it for menstrual cramps and muscle pain. Bloggers and “mommy group drop-outs” Nikita Stanley and Aleks Jassem of The Rebel Mama embrace cannabis as it pertains to motherhood: an April Instagram caption gave thanks for “healing tinctures, soothing creams, calming teas and well-dosed edibles.”
Medical cannabis has been legal since 2001 in Canada, available with a doctor’s prescription and used to treat a host of illnesses ranging from irritable bowel syndrome to arthritis. But cannabis use often falls somewhere between medicinal and recreational, especially since recreational cannabis was legalized in 2018. In what’s often called the second phase of recreational cannabis legalization, regulations on edible and topical cannabis products come into effect on October 17. This means that familiar, easy-to-ingest products such as tea blends, cookies and sparkling waters, many of which are marketed in the grey lifestyle-meets-health area of wellness, will hit the shelves of licensed retailers as of December. These new formats broaden the appeal of cannabis well beyond those comfortable with smoking or vaping, and with increased accessibility, increased use seems inevitable. Whether you’re thinking of trying cannabis as a primary method of relief or in conjunction with other therapies, here’s what you need to know about using cannabis to treat pain.
How is chronic pain treated medically?
First, it’s important to understand what chronic pain is. “Chronic pain is a sensory and emotional experience that is subjective, but very much real,” says Women’s College Hospital pharmacist Karen Ng, who works within the Toronto Academic Pain Medicine Institute program. She explains that feelings of pain are processed in the central nervous system, and chronic pain often has to do with an overactive nervous system that’s sending lots of pain signals to the brain. There are many factors that turn up the “danger alarm,” and pain management aims to turn it down. In the past 10 years, treatment has shifted away from a medical model (treating pain with medication) to a more holistic lifestyle approach. “What we’re realizing through more studies is that a lot of the medications we use for chronic pain aren’t very efficient,” says Ng. “They don’t provide long-term, significant pain reduction, so the model now is moving more toward self-management for patients, using lifestyle skills to turn down that pain alarm.” Now, doctors educate patients about the mind-body connection and suggest psychotherapy and physiotherapy to manage pain. When it comes to prescribing drugs, they recommend medications according to a tier system determined by the evidence of the drug’s efficacy and safety issues. Medications including Duloxetine and Lyrica (an anti-depressant and anticonvulsant, respectively) are considered first tier, opioids are second tier, and cannabis ranks third tier, but only for chronic neuropathic pain, which is pain related to the abnormal processing of nerve signals, often the result of nerve injury or impairment. In the midst of an opioid crisis, doctors as well as patients are certainly considering alternatives like cannabis in light of the risks of some traditional treatments.
Why are women turning to cannabis to treat pain?
“I think there is a general trend of people looking for more natural remedies as an alternative or supplement to traditional medication,” says Trang Trinh, founding director and CEO of TREC Brands, the parent company of new-to-market cannabis brand Blissed. Just as women are looking for natural alternatives in their beauty products and food, they’re looking to sub out or augment pain medication. Cannabis is becoming a more appealing and legitimate option thanks to increasing wellness-based marketing from lifestyle cannabis brands entering the scene, as well as word-of-mouth recommendations via social media, as women share their experiences of treating conditions such as endometriosis and multiple sclerosis with cannabis.
Is cannabis effective at treating pain?
Because cannabis has been used medically since 2001, there are a large number of studies on the relationship between cannabis and pain, although according to Ng, most of them are poor quality and of a short duration. The consensus is, there is no robust evidence that cannabis can effectively treat common pain conditions like acute pain, post-surgical pain, trauma pain, headaches and migraines, osteoarthritic pain or fibromyalgia. In some cases of neuropathic pain, it shows some degree of benefit for reducing pain intensity.
In her practice, Ng has found that very few people report improvement with their pain when using cannabis. She hopes to see more longer-term studies to give us a better understanding of the long-term effects of cannabis use in patients who report pain. “And it would be good to see studies that compare cannabis to other medications, because right now a lot of the studies compare it to nothing,” she says. “Comparing it to nothing isn’t really reflective of usual practice because if we’re trying to manage someone with chronic pain who is really suffering, we don’t manage them with no medication.”
Of course, there are plenty of anecdotal reports that it is effective—many women have come forward, sharing their pain journeys as champions of the plant.
Why do people say they find cannabis effective for pain if medical studies show it isn’t?
Possibly because cannabis is a very complex substance. “This plant has almost 400 chemical compounds and more than 60 of them of them are cannabinoids, which are chemicals that could potentially work in pain,” says Ng. “We really only know two of them, THC and CBD, so we’re behind in terms of understanding what the contributions are of other cannabinoids and chemicals.” As well, people are using cannabis in myriad ways (smoking, vaporizing, cooking, ingesting oils) and in countless strains, so every user experience is different. It’s hard to control dosage and it’s hard to measure success. As well, “because many people use cannabis recreationally, the line between recreational use and medical use is very blurred,” says Ng. “It’s hard to delineate between those two uses.”
What do we know for sure about cannabis’s benefits?
We know that cannabis can help with some conditions that are linked to pain, which may explain why people report finding pain relief while using it. For example, cannabis can help with insomnia. “A lot of our fibromyalgia population has sleep challenges, and so when they use cannabis, that might help them to sleep,” says Ng. “We know that sleep and pain are highly linked, so this might help their pain management.” Exeter mentions improved sleep as one of the prime benefits of using cannabis: “It helps reduce the pain I suffer from daily and it definitely helps with my anxiety and sleep disorders,” she says. “It helps induce relaxation in my muscles and my mind, making it easier for me to go to bed at night.”
We also know that cannabis contains terpenes, which give it its aroma and some of its effects. “Terpenes have natural anti-inflammatory, antifungal and antimicrobial properties that are also found in other plants and fruits,” says Trinh. For instance, myrcene is found in hops and has sedative effects; beta-caryophyllene is found in black pepper and is anti-inflammatory.
What are the risks of using cannabis for pain?
“Generally, people can’t overdose on cannabis, compared to opioids, because it doesn’t bind to the breathing centre in the brain the way an opioid does,” says Ng. “If someone were to take too much opioid they would overdose and stop breathing—that doesn’t happen with cannabis.” Many people using cannabis regularly for pain choose a strain with high CBD and low or no THC, but it’s important to note that the psychoactive element THC in cannabis affects cognition and response time, putting you at a higher risk of accidents. There is also evidence that THC is addictive, particularly if you are at a higher risk of a misuse disorder (if you have a strong family history or a personal history of addiction). And when used in the context of mental health, cannabis is a concern to medical professionals as it may worsen or destabilize conditions such as depression and anxiety if these conditions are already poorly managed. The reason is still elusive. “What we do know is that clinical studies have suggested that lower doses of THC appear to have an anti-anxiety and mood-elevating effect whereas high doses of THC can produce anxiety and lower mood,” Ng says.
Weighing the costs and benefits of any medication is key to determine if it’s right for you. And yes, it can interact with other medications you may be taking. So if you’re thinking of using cannabis to treat any pain-related issues, talk to your doctor first.