Neurologist Answers Questions on Medical Cannabis

This weekend, neurologist Ethan Russo with non-profit organization Pain BC, took to Reddit for an online question and answer session on medical cannabis.

The interview offered those the chance to ask Russo, also author of Handbook of Psychotropic Herbs and co-editor of Cannabis and Cannabinoids: Pharmacology, Toxicology and Therapeutic Potential, questions about medical cannabis and its use in pain management.

Over the course of the session, Russo touched on issues like CBD strain strength, cannabis’s interaction with opiates and potential birth defects due to use by pregnant mothers.

Russo advised readers that, in his opinion, the healthiest method to take cannabis was oral or oromucosal (applied directly to the mouth or throat).

“Vaporization reduces, but does not eliminate potentially toxic by-products (polyaromatic hydrocarbons, ammonia, etc.),” Russo wrote.

Russo also said cannabis is best at treating pain that stems from systematic and degenerative nervous system issues, but can also be used well on other types of pain.

“Cannabis shines in treating neuropathic pain,” Russo said. “It is also very good in cancer pain. CBD strains would be especially applicable to arthritic conditions.”

Russo cautioned that, in his medical opinion, cannabis isn’t effective for treating acute, localized pain, like toothaches or broken legs.

In response to a question about using cannabis to treat traumatic brain injuries, Russo said the disorder, which produces migraine-like headaches, dizziness, nausea, memory problems and emotional issues, is a complex problem.

“It is my experience as a neurologist that very low doses of cannabis help with various symptoms,” Russo said. “Additionally, both THC and CBD produce neuroprotective effects that could be helpful. Anecdotally, some football players with chronic traumatic encephalopathy report benefit, as well.”

Russo pointed out that no formal studies have been done on TBI using cannabis.

A reoccurring talking point for opponents of cannabis is the perception that it causes psychosis in users. Russo said that it’s a complicated topic and more research needs to be done to disprove the idea completely.

“THC is associated with triggering psychosis in susceptible people, but there is no proof that it will cause it de novo, or else there would have been an explosion of cases starting in the 1960s,” Russo wrote. “Interestingly, cannabidiol is very helpful in treating such symptoms.”

Russo said marijuana compares favourably to other painkillers, but more work needs to be done to look at the plant’s place in chronic pain treatment.

“Paracetamol (acetaminophen) is a pretty weak painkiller and is dangerous in high chronic dosing,” wrote Russo, looking at other common painkillers. “Ibuprofen and other non-steroidal anti-inflammatory drugs have their place, but lead to ulcers, intestinal bleeding and other serious side effects.”

According to Russo, cannabis’s benefits can also lead to dependency. The neurologist said, while cannabis is less addictive than cigarettes, alcohol, opioids, amphetamines or cocaine, users can still develop chronic use and find they’re unable to stop using despite their own desire to.

“The figure in the literature is that 9 per cent of people who start cannabis will develop dependency, but at least in the USA, these figures are skewed by the fact that over 50 per cent of people in treatment for cannabis dependence are there by court order,” Russo wrote. “Concentrates, and oils are much more likely to produce tolerance and other problems. The faster a drug gets in (e.g, inhalation) the more rapidly it reaches the brain, producing greater intoxication and the possibility of reinforcement.”

On the subject of side effects related to cannabis, Russo said there is no evidence for cannabis producing birth defects.

“There have been a couple of studies showing slight decreases in birth weight, but these are not always well controlled for other substance use, prenatal care, nutrition, etc.” Russo said.

Russo encouraged readers to investigate Pain BC, a non-profit focused on helping those living with with debilitating chronic.

Those interested in donating to Pain BC can visit their website.