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Considering cannabis for pain relief? Include your MD in decision-making.Shutterstock; David Mack\Getty Images

Medical marijuana is legal in more than half the states in the US, and it is commonly used to treat chronic pain. Here’s how to discuss this treatment option with your doctor.

Have you ever discussed cannabis with your doctor? Despite the fact that 29 states plus the District of Columbia have decriminalized the use of marijuana for the treatment of certain medical problems, research published in the September 2017 journal Drug and Alcohol Dependence found that nine out of ten doctors were unprepared to prescribe it to their patients. “Most doctors don’t know much about it, even in the states where it is legal,” says Rav Ivker, DO, a holistic family physician in Boulder, Colorado and author of Cannabis for Chronic Pain: A Proven Prescription for Using Marijuana to Relieve Your Pain and Heal Your Life.

No Substitute For Rheumatoid Arthritis Medication

It is important to note that among RA experts, there's a consensus for early, aggressive, and conventional treatment for rheumatoid arthritis (RA). People diagnosed with RA should never use complementary and alternative medicine (CAM) therapies in place of disease-modifying anti-rheumatic drugs (DMARDs), which have been proven effective in altering the course of the disease. No other treatment can stop the inflammation, prevent the joint damage, and reduce the risk of long-term complications that are associated with RA the way DMARDs can.

Can Marijuana Help Treat RA Symptoms?

But what about using complementary and alternative medicine therapies, such as marijuana, in addition to traditional treatment? To date, the medical establishment has largely shied away from treating RA pain with cannabis, citing a lack of evidence. But doctors who prescribe medicinal marijuana to their own patients disagree, saying there is tremendous potential in this form of treatment. There are at least 80 different cannabinoids — chemical compounds that alter neurotransmitter release in the brain — that have been identified. “The most effective ones for medicinal treatment are THC [tetrahydrocannabinol], which is the most psychoactive, and CBD [cannabidiol], which is possibly the most highly medicinal,” says Ivker.

Possible Mechanisms of Marijuana

Advocates say the drug is an effective remedy for chronic joint pain, citing theories on how the herb might be helpful.  “Medical marijuana has two ways it helps with rheumatoid arthritis,” says Matthew Roman, MD, president of Nature’s Way Medicine, an alternative medicine practice in Wilmington, Delaware. People who use cannabis may perceive an anti-inflammatory-like effect, “similar to ibuprofen or an ice pack,” he says. In addition, marijuana may influence immune cells. Research is ongoing.

Cannabis and Chronic Pain

“I have seen more than 7,000 medical marijuana patients, and well over 90 percent of them suffer from chronic pain,” says Dr. Ivker. “THCA [Δ9-tetrahydrocannabinolic acid] is another cannabinoid that is not psychoactive, and that’s the one we use most for rheumatoid arthritis.” It can be extracted into a tincture, and it is also available in transdermal patches that are absorbed directly into the bloodstream. There are also topical creams and balms that contain CBD that you can rub right into the joints.

Marijuana Dispensary Access, Your State, and Your Doctor

If you live in a state that has legalized medical marijuana, and you are interested in trying it, Dr. Ivker says to ask your doctor to write you a recommendation, which will be authorized by the state. Once that’s registered, you will receive a document that you can take to a medical dispensary to purchase treatments. “But you first have to go through a physician, and there are many who are still reluctant to provide the recommendations,” he says. Dr. Roman agrees, and advises patients to be bold with their physicians when they discuss this treatment option. “Ask them what their position is on the topic, and tell them that you are interested in trying it.” After all, it is important to discuss any supplement or remedy that you are considering with your doctor before you use it, so she can consider, among other things, potential interactions with the medications you are already taking.  In other words, you can’t avoid this conversation if you want to experiment with pain treatments in a responsible way. If your own doctors won’t write a recommendation, consider using a site like marijuanadoctors.com, which provides a list of cannabis-friendly MDs in your area.

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