Using Medical Marijuana/Cannabis for Fibromyalgia

Using Medical Marijuana/Cannabis for Fibromyalgia

By Ginevra Liptan, MD

Editor’s Note: Ginevra Liptan, MD is both a fibromyalgia patient and physician specialist. Her new book The FibroManual: A Complete Fibromyalgia Treatment Guide for You…And Your Doctor releases May 3, 2016.

My last blog post examined the current legal and medical status of using marijuana as medicine. But how about specifically for treating fibromyalgia symptoms?

Many of my fibromyalgia patients report that medical marijuana/cannabis reduces their pain and improves sleep. A study of 28 fibromyalgia patients reported that two hours after use of cannabis they had a significant reduction of pain and stiffness.

The use of cannabis to relieve symptoms of fibromyalgia is not new. Around 2000 BC, the Chinese Emperor Shen-Nun described marijuana’s ability to diminish pain and inflammation and noted that it “undoes rheumatism” (an antiquated term for fibromyalgia). Fast forward to the U.S. in the early 1900s and we find medicinal cannabis extracts marketed by Merck, Bristol-Meyers, and Eli Lilly, among other pharmaceutical companies, along with medical textbooks listing numerous indications for cannabis including joint and muscle pain.

But then cannabis use was outlawed in 1936. All access for medical purposes was lost until 1996, when California became the first state in U.S. to legalize medical marijuana use. So now we find ourselves about 60 years behind in medical understanding of the cannabis plant.

We do know that the two primary active ingredients of cannabis are THC and CBD (cannabidiol). THC is a strong analgesic (pain reliever) and is also strong anti-inflammatory—in fact, it is 20 times stronger than aspirin! THC is responsible for the psychoactive effects or “high” of cannabis. CBD also has some pain-relieving and anti-inflammatory properties, along with strong anti-anxiety and muscle relaxation effects. CBD has the effect of lowering the psychoactive effects of THC, so cannabis with equal amounts of CBD to THC tend to be the most medicinally effective by providing desired pain relief with less of the undesirable “high.”

But we currently don’t have any standardized medication options beyond the two THC- only prescription medications, dronabinol and nabilone, which are expensive and tend to cause lots of side effects. Pharmaceutical companies are now racing to better find ways to produce standardized ingredients and dosing of cannabis.

In Canada and Europe, a cannabis-based medical extract is approved for use as an oral spray (Sativex). It is entirely derived from a specially grown plant with extensive quality control and balanced amounts of THC and CBD, and it has been shown to significantly lessen pain and improve sleep for rheumatoid arthritis, with few side effects. This product is currently undergoing clinical trials in the U.S. and will hopefully be available within the next few years.

But for now, patients who want to try medical cannabis for fibromyalgia—or any health condition—are at the mercy of the knowledge of the dispensary or growers that are providing them the cannabis. Here is a scenario I see quite frequently: a patient gets a medical marijuana card and goes to a dispensary. There, the employees are the only guide to strain and dose. It’s the equivalent of someone walking into a drugstore with a blank prescription and asking the cashier what medicine they should purchase. Some dispensary employees are quite knowledgeable, but often they are more recreational marijuana enthusiasts who have no idea what to recommend for a fibromyalgia patient.

One of my patients, who is 65 and had never used marijuana in her life, went to a dispensary and was directed to buy a cookie that contained a high amount of THC. An hour later she was hallucinating and so terrified that she called 911!

Is there anyone who should not try cannabis? There are some people for whom it is absolutely a bad idea, including those with uncontrolled psychiatric conditions characterized by psychosis or active substance abuse. Marijuana can also increase pulse rate, so should be used with caution in people with heart problems such as atrial fibrillation.

In general, you want to look for strains with roughly equal THC to CBD ratio. Start with very low dosages; one study found that while low-to-moderate doses lowered pain, high doses actually increased pain! Avoid smoking cannabis, as this is damaging and irritating to lung tissue. Instead, consider edibles, tinctures (liquid cannabis extracts), or topical balms or salves. My fibromyalgia patients report that cannabis balms and salves applied topically to sore muscles can be a very effective pain reliever with little to no brain “high.”

If you are serious about trying cannabis as medicine, you need to first educate yourself, because your doctor or your grower/dispensary staff may not be able to give you much guidance. I highly recommend the book Cannabis Pharmacy: The Practical Guide to Medical Marijuana by Michael Backes. Another helpful resource is the website www.leafly.com, which is like the Yelp of marijuana, with user reviews on different strains.

Remember, we are just beginning to uncover exactly how to use the cannabis plant safely and most effectively.

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Authored by: Ginevra Liptan, MD

There are 10 comments for this article
  1. Laurie at 12:24 pm

    I was on dronabinol for a period of months a few years ago, and it was a life saver for me at the time I needed it as I was having a hard time eating. There is a lot of research being done on the benefits of THC and CBD for certain health conditions – if it makes people better I don’t see the harm in it. Thanks for sharing!

  2. Rachel at 9:09 am

    I know several people who have fibromyalgia, and they’ve told me that the pain can be debilitating sometimes. If medical cannabis has been shown to help that much, I think everyone should try it at least once and see what it does for them. Like you said, it’s not for everyone, but it could make a significant difference for some. Thanks for sharing!

  3. Dave O at 4:32 pm

    So pleased to read this as a 45 year old guy 3 years into debilitating Fibro. Lost 2 years to prescriptions (Cymbalta, Atavan, Gaba Pentin etc) and finding medical help with insight and empathy. Now off all meds (so so so hard but so so important) and using cannabis thusly:

    Daytime: Vaporize (much better than smoking) a 100% Sativa strain to releive the depression and get me outta bed and stimulate appetite.

    Afternoon: Vaporize a hybrid strain (part Indica and part sativa) to relieve muscle spasms/pain and maintain mood and limit anxiety

    If going out to a medical appointment by bus (tough for me) i use both sativa and indica rather than a hybrid to get max benefits of each

    Also afternoon 50mg THC 30 mg CBD capsule

    Evening: Vaporize Indica

    1 hour before bedtime, 100 mg THC and 30 mg CBD in capsule ++ when symptoms (including insomnia are high) use a generous does of Phoenix Tears (aka Ric Simpson oil) a super dense concentrate taken orally. Despite the high THC concentration, i dont get high from this but instead is the best for sleep and inflammation and restless legs.

    I live in a place (BC Canada) where i can easily obtain all of the above (moved here for this reason) but long before i was ill, i was an activist for medical cannabis and industrial hemp (made a doc film called HempenRoad) but after i became sick, i stopped using cannabis for a long while as getting a “nice buzz” and not being able to do anything (go outside and play!) made smoking no fun but i’ve recalibrated and experimented and found this keeping me sorta stable.

    This isn’t cheap but no one dealing with these illnesses is get by easily that way i suppose. I also use a load of supplements each morning and evening to chill mood, aid digestion, help cell regeneration, mitochondrial support and so on.

    If you are battling with this weird set of illnesses, i am cheering for you. This sucks in so many ways. And staying positive is tough for me but the meds behind me and the cannabis in front of me (and 26 US states now legal!)

    Move to somewhere where you can get cannabis medicine. Your friends and family can come visit. Washington and Oregon are lovely.

  4. Christine Pohl at 10:24 pm

    I think legalizing it will be beneficial for anyone with a chronic illness. No matter which one or ones I think it will be a breakthrough on what they find out.

  5. Kimberly at 3:19 pm

    There are many articles on using canabis especially for cancer written by Rick Simpson aka Rick Simpson Oils.

    I myself was lucky enought to get an authorization for my arthiritis/fibromyalgia and locate a medical dispensary that was very knowledgable about dosage/types of product like the lotions/balms/tinctures. If you live in the Seattle area try A Green Cure. They have two shops, one in Shoreline and one in Snohomish.

  6. Pat Kays at 8:37 pm

    I year off of pain meds and using medicinal marijuana.
    25 yr chronic pain survivor living with RSD/CRPS
    mpp.org

  7. Bob Schubring at 7:25 pm

    This is precisely the sort of article that needs to be circulated about cannabis. Having earned a degree in chemistry, I appreciate the horrendous complexity of identifying every last trace of the substances in a plant leaf. And then figuring out whether the substance was created in the plant’s own cells, or was an environmental contaminant that got into the plant somehow. Several hundred other substances have been identified in cannabis, that performed some function in keeping the living plant alive. Dosing ourselves with the plant, we experience an entourage effect, of the THC, CBD, and all the other substances present (including manmade pollutants and toxins that got in it somehow). The instinct of pharmaceutical chemists has been to identify each substance in the plant, obtain a pure sample of that substance by crystallization, then perform animal and human tests to see what the pure substance does.

    This blog post did a valuable service, in pointing out that equal-strength CBD and THC seem to give superior pain relief, than THC alone.

    What now needs to be researched, is the effect of each of the hundreds of other compounds in the plant, in combination.

    Hiding in the cannabis leaf is a secret. People with cancer, have had it go into remission from consuming cannabis products. This is no longer a mere hypothesis, but has been repeatedly found.

    Learning the hidden secret…which ingredient, or combination of ingredients, stops cancer growth, will yield important insights into why cancer happens in the first place.

    As of today, we know of a handful of powerful carcinogens, such as the benzopyrenes, that are thousands of times more likely to lead to cancer, than drinking pure water. And there are hundreds of substances on California’s Prop Thirteen list, that may be 1.1 times as likely as plain water, to lead to cancer…which means, in plain English, that there’s a chance of experimental error landing a pure natural substance on the Prop Thirteen list, even though it’s naturally part of a plant leaf that when eaten, reversed the growth of cancer.

    Under California’s Prop Thirteen law, all substances “known to the State of California to cause cancer or reproductive harm”, must be listed on the Prop Thirteen list. But the State of California itself, cannot actually know of any substance causing cancer, unless it first figures out why cancer happens.

    This creates a problem.

    If we apply the standard methods of organic chemistry, we’re going to find things that are made synthetically in factories and used as paint thinner, which also grow naturally in the cells of the cannabis plant. The entire class of terpene hydrocarbons, represent over half the substances found in cannabis leaves…and turpentine, a mixture of terpenes taken from pine trees, is used in paint thinner. But there are studies of paint thinner formulations, that are known to the State of California, to show a weak statistical correlation between painting and getting cancer. Mindlessly applying the Prop Thirteen standard, it would be quite easy to slander the cannabis plant as containing carcinogens, when in fact, people have used it to stop cancer in its tracks.

    In fact, this is precisely what the National Institute on Drug Abuse was attempting to do in the 1970’s, when it inadvertently discovered that cannabis smoke prevented cancer in laboratory animals…tried to cover up the finding…obstructed any research on the subject…and finally got pushed into full retreat, when foreign scientists duplicated the US research and proved it.

    We’re going to have to restore our scientific literacy in this country, and take greater responsibility for the choices we make.

    It’s very easy to buy the “organic” product and to shun substances made of “chemicals”…until one studies organic chemistry and learns there to be no clear distinction between the two.

    Even weirder problems can arise by misuse of the legal system. Bacillus thuringensis toxin has been transplanted into several crop strains by Silicon Valley firm Celgene and sold under the “Monsanto” brand name, that Celgene acquired in Monsanto’s bankruptcy liquidation and uses to sell seeds. Those of us who’d like not to eat Bt toxin, face a weird legal problem. Celgene lobbyists bought a law from Congress, allowing them to mis-label food that contains Bt toxin when selling it for food or feed, but to prosecute lawsuits against farmers who plant the genetically-modified crops as seed, because this allegedly infringes Celgene’s right to call itself Monsanto and be the exclusive supplier of seeds.

    The Monsanto problem is basically a problem of fact. If I want to know what’s in something before I buy it, should someone have a legal obligation to lie to me about what’s in it?

    Sorting out what to do with cannabis research, would benefit from seeing what’s wrong with Celgene’s Monsanto scheme and getting that right. There needs to be real science behind these laws, and when the science is inconclusive, the consumer must be free to make the choice, as to what risks the consumer wants to take.

  8. Mel Freeman at 6:26 pm

    Lots of mistakes in their article but it’s understandable if you don’t consistently work with both the medicine and patients. I have over 6 years in dealing directly with both and it’s absolutely false thay heart patients not use medicinal
    Cannabis in fact it is very useful for treating those patients.

  9. George at 5:46 pm

    Headaches. Body pain lower back. Aaaargh. Fibromyalgia ???
    3 days on short course of prediselone and still suffering.
    Wish I could try something that works. 🙁

  10. Gail at 9:35 am

    I have been using CDB for about 6 months and now rarely need Vicodin. I have so much more energy! It has changed my life!