Dr. Bearman said he also prescribes dronabinol, the man-made or synthetic THC, for some patients. “It doesn’t work as well as cannabis, it’s more expensive than cannabis, and it has more side effects than cannabis. Nevertheless, there are some good reasons for prescribing it,” he noted. Specifically, because dronabinol is regulated by the FDA and must meet purity and manufacturing standards, he knows exactly how much THC a patient is getting.
Where does this leave chronic pain patients interested in trying medical cannabis? Regardless of the strain or form of cannabis, the key is the amount of THC and CBD in the final product, according to Dr. Bearman.
See also, a 2019 blog on PainDr (managed by Jeff Fudin, PharmD, PPM editor-at-large) on hemp use and drug screenings).
In PPM online poll, about half of respondents said they had tried medical marijuana to help alleviate their pain and related symptoms.
Strains of cannabis may come with names like Purple Diesel and Blue Sky. While the term “strain” is commonly used by dispensaries, medical cannabis users and even physicians, it’s not a term used for plant nomenclature. 9 A strain name may come from a grower, producer, processor, or dispensary. A 2018 study out of Washington state found that commercial Cannabis strains fell into three broad chemotypes (chemically distinct plants that otherwise appear indistinguishable) that were defined by the THC:CBD ratio. 10
For pain relief, he recommends a dose of 15mg THC (0.0005 oz) to 15 mg CBD. In his experience, doses of THC less than 15 mg generally don’t provide pain relief. Doses may be increased if necessary, best guided under a doctor’s orders, to achieve pain relief without unacceptable side effects.
Two of the cannabinoids found in cannabis, Δ 9 -tetrahydrocannabinol (THC) and cannabidiol (CBD), along with other cannabinoids, terpenes, and flavonoid compounds, are thought to exhibit synergistic effects that promote pain relief. 5 THC is the most psychoactive cannabinoid found in cannabis and is primarily responsible for the “high” associated with marijuana. It can also reduce nausea and increase appetite. CBD does not provide the euphoria associated with THC and is associated with reduced pain and inflammation. 6
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