Pain is a constant in far too many lives. Opiates, medications, energy work, dietary changes, specialized exercise routines, individualized herbal and supplement regimens, and complementary medicine practitioners are some of the avenues open to those of us in pain. Medical marijuana is another avenue that an increasing number of people are pursuing with the help of their physicians. Yet another option for those that do not qualify for a medical marijuana card is Cannabidiol (CBD) products.
Understanding the difference between the two may help those in pain find the right option for their situation. Tetrahydrocannabinol (THC) is one of over 85 chemical compounds, or cannabinoids, found in the female cannabis flower, and the only one with psychoactive effects. Cannabidiol, or CBD, is another cannabinoid component that is non-psychoactive. The U.S. Department of Agriculture’s 2014 Farm Bill defined cannabis containing less than 0.3 percent THC as “industrial hemp” while cannabis with a THC of more than 0.3 percent was deemed “marijuana”. While a medical marijuana card from Connecticut’s Medical Marijuana Program (MMP) is needed to order products with more than 0.3 percent THC, CBD products are now more readily available.
Conditions Qualifying for Medical Cannabis
Currently, 31 states and the District of Columbia have legalized public medical cannabis programs. There are now 30 conditions approved for adults and eight for patients under the age of18 (Portal.CT.gov/DCP/Medical-Marijuana-Program/Qualification-Requirements).
The original Connecticut list of approved medical conditions for adults included cancer, glaucoma, positive status for HIV or AIDS, Parkinson’s disease, multiple sclerosis, damage to the nervous tissue of the spinal cord with objective neurological indication of intractable spasticity, epilepsy, cachexia, wasting syndrome, Crohn’s disease, post-traumatic stress disorder (PTSD), sickle cell disease, post laminectomy syndrome with chronic radiculopathy, severe psoriasis and psoriatic arthritis, amyotrophic lateral sclerosis, ulcerative colitis, complex regional pain syndrome, cerebral palsy, cystic fibrosis, irreversible spinal cord injury with objective neurological indication of intractable spasticity, terminal illness requiring end-of-life care, and uncontrolled intractable seizure disorder.
For patients less than 18 years of age, the covered debilitating medical conditions include cerebral palsy, cystic fibrosis, irreversible spinal cord injury with objective neurological indication of intractable spasticity, severe epilepsy, terminal illness requiring end-of-life care, and uncontrolled intractable seizure disorder.
The Connecticut legislature’s Regulations Review Committee very recently approved eight new conditions for the medical marijuana program. Muscular dystrophy and osteogenesis imperfecta, also known as brittle bone disease, were the two conditions approved for adults and patients under 18. Six new conditions were added for adults only, including:spasticity or neuropathic pain associated with fibromyalgia;severe rheumatoid arthritis;post-herpetic neuralgia (a complication of shingles that affects nerve fibers and skin);hydrocephalus, or fluid buildup in brain cavities, with intractable headache;intractable headache syndromes; andneuropathic facial pain.
The Department of Consumer Protection does consider petitions to add debilitating conditions, treatments or diseases to the current list of 22 conditions for adults and six conditions for youth patients allowed by law.
Usage and Forms
As of mid-September, Connecticut’s Medical Marijuana Program had 27,811 patients, as compared to nearly 18,000 registered medical marijuana users in May 2017. Current statistics show that there are 5,909 in Fairfield County, 6,777 in Hartford County, 6,412 in New Haven County, 1,655 in Middlesex County, 1,724 in Litchfield County, 3,073 in New London County, 1,322 in Tolland County and 935 in Windham County.
Currently, there are 968 certifying physicians, nine dispensary facilities and four medical marijuana producers in the state. Local dispensaries include Arrow Alternative Care, Inc. in Hartford and Milford; Bluepoint Wellness of Connecticut in Branford; Caring Nature, LLC in Waterbury; Compassionate Care Center in Bethel; Southern CT Wellness & Healing, LLC, in Milford; Thames Valley Alternative Relief, LLC in Uncasville; and The Healing Corner, Inc. in Bristol.
There are several ways medical cannabis can be prescribed for patients. Products come in many forms, such as flowers, vape oils, concentrates, edibles, capsules/tablets, oral syringes and sprays, oral strips, tinctures and topical, according to Southern CT Wellness & Healing.
For someone interested in obtaining medical marijuana, a physician needs to start the MMP application process to show the patient has a qualifying medical condition. The patient needs to submit online proof of identity, proof of Connecticut residency, a passport-size photograph and a $100 registration fee to get the medical marijuana registration certificate. For those who need a primary caregiver to fill the medical marijuana prescription, that person must register as a qualified caregiver before the department will issue the registration certificate.
The patient then turns to an approved medical marijuana dispensary to begin the prescription process. “When a patient is diagnosed with one of the conditions, we need to know which symptoms they need help them with. With PTSD, for instance, we would investigate whether they have anxiety during the day, night terrors or other specific symptoms. Based on the need, we would adjust what THC:CBD ratio was needed and what type of delivery system was best for that patient,” explains Deepa Desai, PharmD, one of four pharmacists who own Southern CT Wellness & Healing.
Dosing depends on the patient’s symptoms, their history, the side effects of their current medications, and the patient’s familiarity with using marijuana and how it affects their body, says Desai. As an example, she explains, they may start with lower dose for patients that have not tried cannabis before in order to gauge how their body reacts.
Marc Huberman, a New Fairfield-based musician and a film media manager, says an individualized medical-grade marijuana protocol enabled him to diminish pain, nausea and headache symptoms associated with Crohn’s disease. Originally taking opiates to combat the chronic pain, he came to rely on them to function. At the urging of his doctor, Huberman applied for and received a medical marijuana card. He began to work with Angela D’Amico, founder of Compassionate Care Center of CT, and her staff to find the most appropriate mix for him. It took over a year to pinpoint the right combination of psychoactive and non-psychoactive products that enabled him to alleviate the pain and the anxiety associated with the pain, and, ultimately, to wean himself slowly off of the opiates completely.
“Working with the pharmacist and tech staff at Compassionate Care, I started a tapering program to be off opiates from April to August of 2017,” Huberman says. “I documented what I went through with video blogs and writing. I hope to produce a documentary about my journey to inspire others. In addition to the marijuana-focused program, I utilized other tools to better my health and undergo a complete mind-body-emotion shift, including incorporating a healthier diet, wheat grass supplements, collagen peptides, breathing work, meditation and exercise.”
Since medical marijuana has the potential to alleviate nausea, vomiting and headache symptoms, it can be useful for those with digestive issues and the side effects of chemotherapy so the patient eats more food. Since there may be issues with ingestion, delivery might be suggested via syringes under the tongue, tinctures or dissolvable strips.
D’Amico hopes opiate addiction and cancer reversal will be added to the approved list. “Right now, we are focused on palliative care. We need more proactive cancer protocols. We need to let the doctors deem what is necessary for each patient based on the protocol, not on a set state maximum for use,” she says.
She is taking proactive steps to bring this to fruition, joining the multi-state Acreage Holding group as vice president in addition to her founding responsibilities at Compassionate Care. Acreage Holding is working to universalize the patient experience across all U.S. medical marijuana dispensaries with universal protocols on dosing, nutritional counseling and more.
For those experiencing conditions that are not approved for medical marijuana prescriptions, companies with CBD products operate outside of the state medical marijuana program. CBD-labeled dietary supplements with the single CBD cannabinoid can currently only be legally sold in states with medical marijuana laws. However, a whole-plant, hemp extract CBD product that contains all cannabinoids—such as the Stanley Brothers’ proprietary Charlotte’s Web grown in Colorado—can be sold in all 50 states. Many local wellness centers now carry high quality CBD products in a variety of forms.
Whether it is utilizing medical marijuana, CBD oils or whole-plant hemp extracts, an important emotional and mental aspect is best summed up by physician David Casarett. “A lot of the patients I talked with who’ve turned to medical marijuana for help, weren’t turning to medical marijuana because of its benefits or the balance of risks and benefits, or because they thought it was a wonder drug, but because it gave them control over their illness. It let them manage their health in a way that was productive and efficient and effective and comfortable for them,” he said in his “A doctor’s case for medical marijuana” TedMed 2016 video.