- Part IV of Health Rising’s “Marijuana as Medicine for ME/CFS and Fibromyalgia Series” focuses on a general Cannabis treatment approach.
The Doctor Speaks
Dr. Michael Moskowitz is a pain doctor in Sausalito who sees the worst of the worst. He’s generally the end of the line for people in chronic pain. The author of “Medical Cannabis: A Guide for Patients, Practitioners, and Caregivers”, he’s also on a mission to convince patients and the medical establishment that Cannabis is worth a try.
While recognizing that randomized, placebo-controlled studies are rare, Moskowitz asserts that plenty of information, in the form of animal studies, pharmacological studies and case reports, indicates that when used properly, Cannabis is a safe and sometimes quite effective treatment for a wide variety of issues.
In a recent Leafly interview, Moskowitz explained the frustration he’s felt over 30 years of inadequate pain treatment.
“I was treating patients for probably thirty years when I came upon this [Cannabis] in chronic pain treatment, and what I was impressed with was how muddy all of the medicines we were using were. Even though we got people better, we never got anybody well or rarely got anybody well. The rubric in chronic pain treatment is to tell the patient, ‘we can help you reduce your pain but we can’t make it go away’. I thought, that’s just crap, why are we telling people that? We’re only telling them that because we don’t have the tools that we know how to use to make it go away, but it doesn’t mean they don’t exist.” Moskowitz
Moskowitz’s personal experience with Cannabis began after a devastating injury resulted in four surgeries on his ankle and lower leg. With opioids having little effect on his pain, he tried something new:
“I started using more cannabis with higher THC because I was doing nothing but laying around at that point… I came up with a treatment where I used a combination of THC and CBD in an alcohol tincture in a rollerball, rolled around the area where the surgery was because I couldn’t touch it, it was still an open wound, and it took the pain away 100% within three minutes. It never failed to do that, not once.”
The effect would last from six to eight hours. At that point, he began slowly incorporating Cannabis treatments into his practice and created a database that followed 161 people over 19 months. He had worked with many of the patients for years. The results were remarkable in a practice such as his: eighty-seven percent reported pain reduction, 81% reported improved sleep, 73% improved stress, and 76% improved quality of life.
Norman Doidge reported on Moskowitz’s use of neuroplasticity to reduce his patients’ pain, but in a recent interview, Moskowitz stated that Cannabis was producing a more robust response.
The Case for Synergy
There’s this tremendous synergy that makes up that ensemble or entourage effect. Moskowitz
Knowing only the THC and CBD content of a strain is limiting; it takes away the blending of the entourage effect and doesn’t help in recommending something based on its medical values. Moskowitz
THC and CBD do different, sometimes even opposing, things in the body, but when it comes to healing, they work better together than separately. Studies suggest that when taken alone, CBD is usually less effective than when taken with THC (and other phytocannabinoids).
While CBD is the most anti-inflammatory substance yet found in Cannabis, other phytocannabinoids in the plant have their own and differing anti-inflammatory effects. Combining them into one more potent anti-inflammatory package seems to make sense in ME/CFS/FM.
If fact, one study suggested that taking CBD alone greatly reduces its window of efficacy: i.e. you have to get just the right amount to relieve pain. Animal studies suggest that with pure CBD oil, less is more, and increasing the dose beyond a certain point does not help relieve pain. This plateau effect did not, however, occur with full-spectrum Cannabis extracts.
The same appears to be true for THC. Backes reported that a CBD/THC spray called Sativex significantly reduced cancer pain while pure THC did not.
Note that as much attention as THC and CBD have received, they’re just the beginning of the medicinal story regarding Cannabis. The other phytocannabinoids (CBN, CBG, etc.) and chemicals in the plant (terpenes, linalool, etc.) also have medicinal effects and, if possible, should be included in one’s treatment regimen. (Because less of these factors are found in hemp-derived CBD oil, Cannabis-derived CBD oils may work better.)
A Focus on Variety
Openness to trying new approaches can be quite helpful. The advantage of a constantly shifting internal and external mix of endocannabinoids and phytocannabinoids is that the body does not become tolerant to any one approach, making it harder for disease to express itself in the face of this constantly adjusting treatment. Moskowitz
Moskowitz believes that, for medical purposes, the methods of delivery which provide the broadest sweep of phytocannabinoids possible are tinctures, vaporized plants and capsules. His recommendation that one start out with tinctures and then incorporate other delivery methods into one’s regimen fits well with his general approach to incorporate as much variety into one’s regimen as possible. This ultimately includes using different strains and different modalities (tinctures, oils, vapor, capsules, topicals, raw plant).
Stopping the Treatment “Burnout” Blues
Focusing on only one component or strain of the plant is limiting and gives too much chance for the treated illness or injury to adapt and overcome effectiveness. The body’s ability to do this is an unfortunate fact of most treatments. Mostkowitz
Moskowitz believes that Cannabis may be uniquely positioned to deal with a common problem in ME/CFS, fibromyalgia and other diseases; treatments which are effective at first but which peter out over time. Cannabis’s ability to keep producing effective results when other medications have failed may lie in three factors: the many different strains of the plant, the many routes of application available, and the many systems it affects suggests to Moskowitz that when used skillfully, Cannabis may be able to, in effect, nudge the body out of illness states that it’s become mired in.
In chronic conditions, the body resets to survive within the relentlessness of the disease. With a treatment that constantly shifts its own milieu and the body’s internal milieu, combined with such broad-based anti-inflammatory and neuroprotective traits, we have a real chance of making fundamental changes. For the patient, then, establishing effective care, then trying new and varied products can be extremely helpful. Moskowitz
Moskowitz also draws a distinction between stronger but shorter-lived responses and slower, more profound responses.
The true gift of this treatment is in its ability to transform the body back to normal states in a slow, methodical way. This slow nudging back to normal is the best way to move from a state of disease to that of wellness because it allows the body to slowly adapt…to establish a new and lasting balance point of health and pleasure…Moskowitz
When CBD Oil Stops Working
This article suggests that while it is possible to build up a tolerance to THC, it’s not as likely to happen with CBD. Still, reports indicate that this can happen. Oddly enough, one of the solutions to CBD tolerance is to take less of it.
Other options include giving yourself a short vacation (2-3 days to a week) from the plant. Trying different strains and/or different delivery methods is recommended as well.
How to Get Rid of an Unwanted High
- Take a high CBD / low THC tincture and then hang on for the 60-90 minutes it will take for it to take effect. (CBD inhibits THC activity.)
- Or for quicker relief, vaporizing a high CBD / low THC strain should knock that high (or anxiety, etc.) down in 3-5 minutes.
According to Backes, high THC Cannabis with CBD, limonene and pinene may be less prone to producing anxiety. A plant with 10% CBD and 5% THC will generally produce no intoxicating effects. Mixing a plant with 10% THC and little CBD with one that has 15% CBD and little THC will likely also produce no intoxicating effects.
Check out our CBD oil rating site here and please rate your experiences with Cannabis in our new review program
Health Rising’s Fibromyalgia and Chronic Fatigue Syndrome Cannabis Review Program
when you get it right
you pass it on… Gary Snyder
The first Cannabis review program for people with ME/CFS and/or FM. (Note that all answers are anonymous. There is absolutely no way to tell who provided what answer.)
Health Rising’s Marijuana as Medicine for ME/CFS and Fibromyalgia Series
- Pt I: Marijuana as Medicine for ME/CFS and/or Fibromyalgia: The Science Behind Cannabis – Amber Ella
- Pt. II: Getting Started with Cannabis – Amber Ella
- Pt. III: Cannabis – More Than Just THC and CBD – Cort Johnson – the other health enhancing factors in Cannabis
- Pt. IV: The Doctor Speaks: – Moskowitz on Cannabis / A focus on variety / Stopping the Treatment Burnout Blues / How to quickly stop a high / What to do when CBD stops working
- Pt V: CBD OIl – A Primer for ME/CFS and Fibromyalgia – Finding safe and effective CBD Oil and more
- Pt. V: Strain Specific – Picking Your Plants – coming up
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