Many individuals suffer from nerve pain: diabetic neuropathy, migraines (yes, they are considered a nerve pain), trigeminal neuralgia, chemotherapy-induced, and idiopathic (unknown cause).  

THC and CBD work on the endocannabinoid system in our bodies.   There are 2 types of cannabinoid receptors - CB1 and CB2.   

CB1 receptors are mainly found in the nervous system and brain.  The easy way to remember is you have "1" brain (CB "one").    CB2 receptors are mainly found throughout the body - on our organs and tissues ( We have 2 lungs, 2 kidneys, etc...CB "two").

When we experience pain in the nervous system, both THC and CBD can helped to reduce pain by binding to these CB1/2 receptors.   CBD is non-psychoactive and the more CBD in a medical cannabis product, the less psychoactive effects one will experience.   

Of course it will be helpful once we have more research to further investigate what particular doses will work for various types of nerve pain and interactions with current pharmaceuticals already being used for treatment of said pain.

Not too many patients that I have treated in the past 14 years have never experienced nausea.   Nausea can arise from migraines, from indigestion, medication side effects, viruses, gastrointestinal disorders and chemotherapy.

Many have heard of a prescription medication, Dronabinol.   It is a synthetic form of THC.  A study was conducted in cancer patients receiving chemotherapy and assessing their nausea.   The study compared patients receiving Zofran + steroids versus Dronabinol + steroids.   They did discover that both regimens seems to control nausea.  (see article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165951/)

So how does this work:

THC, the psychoactive component in cannabis/marijuana, works on the brain and body.   CB1 (cannabis or cannabinoid type 1 ) receptor is where THC binds.   Here when THC binds to CB1 receptors it can stop vomiting and decreasing intestinal motility. 

(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165951/#b142).   

In individuals undergoing chemotherapy, for example, a combination of THC and CBD has also shown to be effective.  

This may be helpful for not just patients on chemo, but for those with other causes of nausea.

Hope this little explanation helps!

- Dr Sam Urick

Diabetic Neuropathy.  Migraines.  Sciatica.  These are all nerve related types of pain.   Those suffering from these conditions may have tried medications such as Lyrica or Gabapentin without much relief or with unwanted side effects.    In this case medical cannabis may help.

A study demonstrated that the efficacy of medical cannabis was comparable in some cases to current prescription medications for treatment of nerve pain (see PubMed https://pubmed.ncbi.nlm.nih.gov/29388063/).   More studies will need to be conducted to give us a better picture.

CBD, a cannabinoid, can block or suppress inflammatory and nerve related pain without giving a patient psychoactive effects.     The combination of THC and CBD works synergistically to provide even better nerve pain treatment.   

For those who are unaware, the CBD and THC bind to the same chemical receptor in the brain (CB1 receptors).  The more CBD present on that chemical receptor, the less psycho-activity one will experience from THC.   For those who do not tolerate the psychoactive effects, it is best to look for high CBD/lower THC content.  A study showed that by co-administering CBD and THC, it reversed the anxiety-like behavior caused by THC  (https://www.sciencedaily.com/releases/2019/09/190930131115.htm).

Through medicating with products higher in CBD/lower in THC, migraine sufferers have been able to cut back on over the counter medications like Tylenol/Advil/Alleve and prescription medication like Imitrex, Maxalt, etc.       

Not only do inhaled and ingestible forms of medical cannabis help with nerve pain, but topical ointments/salves can also be of great benefit for nerve pain.

Maybe medicating with MMJ will be of benefit to you!

The issue of medical cards that stop working before the expiration date is something that patients always bring up.   Here is how this works with the PA Dept of Health Medical Marijuana Program:

Let's say you were certified by a physician on October 1, 2020.    Your pay the state fee ($25 or $50) for the card.    Your card arrives and the expiration date says "October 7, 2021".

It is now one year later, October 1st, 2021.   You go to your dispensary and you are told your card is "inactive".  You don't understand how because it's not expired. Why?

The state actually goes by the date you were certified (October 1, 2020).  If you do not pay the ANNUAL CARD FEE ($25/$50) before October 1, 2021 (the ONE YEAR Anniversary of when you were certified, your card goes inactive.  So how do we remedy this?

So let's go back to October 1, 2021.   You simply have pay the state the ANNUAL CARD FEE.  The unexpired card is now REACTIVATED!   The expiration date is October 7, 2021.  The card will LAST BE ACTIVE the date before - October 6, 2021.

Maybe this is all starting to make sense.   

The PA Dept of Health Medical Marijuana Program notifies patients 60 days before their card expires that its time to get in touch with your certifying physician.  You can renew your card from that point forward.   This will not move your expiration date up at all!  

Example:  You are certified March 14, 2021.  You receive an email from the state on January 14, 2022 telling you to get re-certified.  You decide to re-certify with your physician on January 20th 2022. Your NEW card will expire around March 14, 2023 (NOT January 2023).    Its similar to how you can renew your Pennsylvania Driver's license 90 days before your birthday but it will still expire the day after your birthday.   

I wish the program explained this better to patients but I'm hoping this helped.

To your health!

​Dr Sam

Either from personal experience or from pop culture, patients usually assume that marijuana always gives one the "munchies".   While it is true that medical cannabis products can lead to increased appetite, there are also strains that can lead to weight loss.

Prior to medical legalization, there have been individuals that have used cannabis to gain weight.   In cancer patients, for example, we prescribe a medication called Dronabinol - a man-made form of THC.   This medication can help with increasing appetite and calming down nausea.

We need to think beyond the THC content.  Remember, when we think about medical cannabis, we need to take into consideration the cannabinoids (and terpene profiles).

If you look at the label of a cannabis product (or the online dispensary menu), you will see a breakdown of certain cannabinoids - THCa and THCv.

THCv is a cannabinoid that can cause psychoactive effects.  THCv can actually DECREASE appetite.  (When you hear THCv, think of "v" for "void" - it will void your appetite).  Anecdotally, it has been shown to benefit diabetic patients.   Type II Diabetes is the form that is weight related.  Weight loss can reverse Type II diabetes in many individuals.     

THCv can be found in certain strains of medical cannabis, particularly in Sativa strains.  

On the other hand, THCa can increase appetite (When you hear THCa ,think of "a" for "appetite").  THCa  is also not psychoactive.  When THCa is heated up, it can be converted into THC through a process called decarboxylation. 

Pay attention to the labels and menus at the dispensaries.    I have seen patients with significant weight loss from medical cannabis. 

​- Dr Sam Urick
 

In May-June 2018 I had already been registered as a medical marijuana physician in Pennsylvania.  I did not feel that the state approved courses had taught me much.  I then turned to a colleague from medical school, Dr Sasha Noe, PhD, D.O.   She started the Medicanna Academy as she is the only physician in the US with a PhD in the field of molecular cannabinoid research.   In this video, we discuss Medical cannabis and her course.