LA Marijuana Products:

Topical Marijuana Products

Topical use of marijuana products are as of yet not well explored but  cannabis-based formulations offered currently appear to provide therapeutic benefits. As research and experience grow, it is expected that even greater benefits particularly for joint and muscle pain will be available. Currently available products are explored here along with a brief review of the mechanisms by which they offer their benefits.

 

Understanding Topical Formulations:

Marijuana (Cannabis): Topical Use of Marijuana

 

LA Marijuana Products:

 

Links to other Pertinent Educational Pages:

Links to ALL Marijuana Educational Pages

 

Marijuana Pharmacies/Dispensaries in Louisiana:

Marijuana Pharmacies

 

Key to Links:

  • Grey text – handout
  • Red text – another page on this website
  • Blue text – Journal publication

 

The medical information on this site is provided as a resource for information only, and is not to be used or relied upon for any diagnostic or treatment purposes and is not intended to create any patient-physician relationship.  Readers are advised to seek professional medical guidance regarding the diagnosis and treatment of their medical concerns.

 

Topical Products

Marijuana-related medications act on the body primarily through the Endocannabinoid System (ECS), a nerve/hormone system present all throughout the body (See: Endocannabinoid System) . These actions are primarily carried out via the medications interacting with cannabinoid receptors associated with the ECS. There are several different cannabinoid receptors in the ECS, but the CB1 and CB2 receptors are the best known.

 

CB1 receptors are mostly found in the nervous system but are also found to a lesser extent in the skin. Tetrahydrocannabinol (THC) interacts primarily with the CB1 receptors. CB2 receptors are mainly found in the skin, organs and immune cells. and respond indirectly to cannabidiol (CBD), as well as other cannabinoids and terpenes (especially β-Caryophyllene). Topical marijuana products act mostly through the CB1 and CB2 receptors in the skin because they do not penetrate systemically to reach the brain. Therefore they can be therapeutically effective without the intoxication, euphoria or sedation associated with the systemic exposure that is associated with ingesting or inhaling marijuana products.

 

For more information regarding the use of topical marijuana:

Topical Use of Marijuana

 

Transdermal vs Topical

Transdermal medications are designed to penetrate the skin barrier in order to provide systemic (whole body) benefits. By penetrating through the epidermis, the topmost layers of the skin, and into the underlying dermis layer where the blood vessels are, transdermal products are transported through the blood to the organs and especially the central nervous system including the spinal cord and brain where cannabinoids provide therapeutic benefits.

 

Topical formulations, on the other hand, refers to creams, lotions, ointments, and other products designed to be massaged into the epidermis only. These products target the skin itself to provide benefits only locally to the area of application. They don’t carry cannabinoids into the blood vessels of the derma below and therefore are not meant to enter systemic circulation.

 

Topical marijuana based products can be helpful for arthritic joint pain, tendonitis, muscle soreness, tightness and spasm, headaches and skin conditions such as such as eczema and psoriasis. Products with β-Caryophyllene may also help with sensitivity to cold as well as the nerve pain associated with peripheral neuropathy or with injured nerves including chronic regional pain syndrome (CRPS).

 

LA Topical Marijuana-Based Products

In LA, currently available topical preparations are formulated with absorption enhancers to facilitate transdermal penetration. The extent to which these LA topically applied THC products actually enter the blood and become available to enter the brain and central nervous system is unknown but they are not promoted as transdermal preparations and they do not seem to provide much, if any, psychoactive effects or other systemic benefits. However, this means that the THC is likely to trigger a positive urine drug screen.

 

Currently available topical preparations are provided in 2 oz jars or 50 ml pumps and are typically applied to affected areas 1-4 x/day. These products have generally been reported by patients to be helpful for pain, especially joint pain but also neck and back pain.

 

It should be noted however that these products all contain THC in significant amounts which contributes to their relatively high cost. Studies are lacking as to whether the THC components of these creams are truly important in their contribution to the therapeutic effects of these products. Alternative over-the-counter products with CBD and terpenes (but no THC) are also available at significantly less expense yet they may offer equivalent or superior benefits. No head-to-head studies have been performed comparing benefits of THC-based formulations vs. CBD/terpenes only-based formulations.

 

See:

Terpenes: Caryophyllene (topical products)

Marijuana (Cannabis): Topicals (coming soon)

 

Topical marijuana products currently available are provided in four THC/CBD formulations:

 

Illera Topical Products:

    1. THC:CBD Topical 5:1  (125 mg THC and 25 mg CBD, Whole plant extraction with Caryophyllene & Humulene per 2 oz/60 cc jar) – Soothe
    2. THC:CBD Topical 2:1  (100 mg THC and 50 mg CBD, Whole plant extraction with Linalool & Terpinolene per 2 oz/60 cc jar) – Breathe

 

Wellcana Topical Products:

Wellcana topicals reportedly have a variety of sources for their constituents but do include a signifcant contribution from the Jenny Kush strain of cannabis which contains pinene, caryophyllene and limonene. No additional information as to other constituents in their products is available.

    1. CBD:THC Topical 1:1 – (300mg CBD and 300mg THC per 50 cc pump dispenser)
    2. CBD:THC Topical 2:1 – (600mg CBD and 300mg THC per 50 cc pump dispenser)

 

 

Resources:

National Academy of Sciences

The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research

 

These lay-person websites appear to be good resources for exploring medical marijuana:

  1. www.GreenCamp.com
  2. www.Healer.com
  3. www.MedicalJane.com
  4. www.ProjectCBD.org
  5. analytical360.com
  6. www.leafly.com

 

 

References:

Epidiolex (cannabidiol)

  1. FDA approves CBD drug – Epidiolex – The Washington Post

 

Marinol (dronabinol)

  1. Marinol – dronabinol

 

 Marijuana – Sativs vs Indica

  1. The Cannabinoid Content of Legal Cannabis in Washington State Varies Systematically Across Testing Facilities and Popular Consumer Products – 2018

 

Medical Marijuana – Federal Law

  1. The legal status of cannabis (marijuana) and cannabidiol (CBD) under U.S. law – 2017

 

 

Marijuana – Topical Medications

  1. Topical Analgesics – Critical Issues Related to Formulation and Concentration – 2016

 

 

Medical Marijuana – Dosing

  1. Practical considerations in medical cannabis administration and dosing – 2018
  2. Measuring cannabis consumption – Psychometric properties of the Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory (DFAQ-CU) – 2017
  3. Quantifying Cannabis – A Field Study of Marijuana Quantity Estimation – 2018
  4. Bayesian inference for the distribution of grams of marijuana in a joint. – PubMed – NCBI – 2016
  5. Delphi Consensus – recommendations on dosing and administration of medical cannabis to treat chronic pain – results of a modified Delphi process – 2021
  6. Delphi Consensus – A cannabis oracle? Delphi method not a substitute for randomized controlled trials of cannabinoids as therapeutics – 2021
  7. Delphi Consensus – Clinical experience and COI disclosures
  8. Delphi Consensus – Dosing and Administration of Medical Cannabis- Physician Survey
  9. Delphi Consensus – Virtual Voting Round 2 Results Delphi Consensus – Voting Round 1 Results
  10. Consensus‐based recommendations for titrating cannabinoids and tapering opioids for chronic pain control – 2021

 

Medical Marijuana – Louisiana Law

  1. Louisiana-2016-SB180-Chaptered
  2. HOUSE BILL NO. 225 – 2017 Regular Session
  3. Louisiana medical marijuana expansion bill signed into law – May 20, 2016
  4. Now in Effect, Louisiana Medical Marijuana Law Shields Patients and Caregivers from Prosecution – Aug 5, 2016
  5. Louisiana-2016-SB180-Chaptered

 

Cannabidiol (CBD)- Overviews

  1. CANNABIDIOL (CBD) Pre-Review Report WHO 2017
  2. Cannabidiol – State of the art and new challenges for therapeutic applications. – 2017 PubMed – NCBI

 

CBD – Anxiety

  1. Overlapping Mechanisms of Stress-Induced Relapse to Opioid Use Disorder and Chronic Pain – Clinical Implications – 2016
  2. Cannabidiol Modulates Fear Memory Formation Through Interactions with Serotonergic Transmission in the Mesolimbic System – 2016
  3. Cannabidiol regulation of emotion and emotional memory processing: relevance for treating anxiety-related and substance abuse disorders. – PubMed – NCBI
  4. Review of the neurological benefits of phytocannabinoids – 2018
  5. Plastic and Neuroprotective Mechanisms Involved in the Therapeutic Effects of Cannabidiol in Psychiatric Disorders – 2017
  6. Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report. – PubMed – NCBI
  7. Evidences for the Anti-panic Actions of Cannabidiol – 2017
  8. Cannabidiol, a Cannabis sativa constituent, as an anxiolytic drug – 2012
  9. Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in Treatment-Naïve Social Phobia Patients – 2011

 

CBD – Interaction with THC

  1. Cannabidiol: a promising drug for neurodegenerative disorders? – PubMed – NCBI
  2. Oral Cannabidiol does not Alter the Subjective, Reinforcing or Cardiovascular Effects of Smoked Cannabis – 2015
  3. Taming THC – potential cannabis synergy and phytocannabinoid-terpenoid entourage effects – 2011
  4. A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. – PubMed – NCBI

 

 

CBD – Metabolites

  1. Human Metabolites of Cannabidiol – A Review on Their Formation, Biological Activity, and Relevance in Therapy – 2016

 

CBD – Drug-Metabolic Interactions

  1. Cannabidiol, a Major Phytocannabinoid, As a Potent Atypical Inhibitor for CYP2D6 – 2011
  2. The Effect of CYP2D6 Drug-Drug Interactions on Hydrocodone Effectiveness – 2014 
  3. Characterization of P-glycoprotein Inhibition by Major Cannabinoids from Marijuana – 2006

 

Medical Marijuana – Prescribing Guidelines

  1. Simplified guideline for prescribing medical cannabinoids in primary care – Canadian Family Physician – 2018
  2. Physician Recommendation of Medical Cannabis Guidelines Calif Medical Assoc – 2011
  3. Prescribing smoked cannabis for chronic noncancer pain. Preliminary recommendations – Canadian Family Physician – 2014

 

 

Medical Marijuana – Opioids

  1. Use-of-Prescription-Pain-Medications-Among-Medical-Cannabis-Patients
  2. It is premature to expand access to medicinal cannabis in hopes of solving the US opioid crisis – 2018
  3. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort – 2018
  4. Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. – PubMed – NCBI
  5. Associations between medical cannabis and prescription opioid use in chronic pain patients – A preliminary cohort study – 2017
  6. The prevalence and significance of cannabis use in patients prescribed chronic opioid therapy: a review of the extant literature. – PubMed – NCBI
  7. The use of cannabis in response to the opioid crisis: A review of the literature. – PubMed – NCBI
  8. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999–2010 – 2014
  9. Rationale for cannabis-based interventions in the opioid overdose crisis – 2017
  10. Cannabis and the Opioid Crisis – 2018
  11. Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability. – PubMed – NCBI
  12. Cannabinoid–Opioid Interaction in Chronic Pain
  13. Synergistic interactions between cannabinoid and opioid analgesics. – PubMed – NCBI
  14. FDA approves CBD drug – Epidiolex – The Washington Post

 

Medical Marijuana, Chronic Pain – Cannabinoids & Palmitoylethanolamide

  1. Therapeutic utility of palmitoylethanolamide in the treatment of neuropathic pain associated with various pathological conditions – a case series – 2012
  2. Palmitoylethanolamide, a naturally occurring lipid, is an orally effective intestinal anti-inflammatory agent – 2013
  3. Cannabinoid-based drugs targeting CB1 and TRPV1, the sympathetic nervous system, and arthritis – 2015
  4. Fatty acid amide hydrolase: biochemistry, pharmacology, and therapeutic possibilities for an enzyme hydrolyzing anandamide, 2-arachidonoylglycerol,… – PubMed – NCBI 2001
  5. Endocannabinoid-related compounds in gastrointestinal diseases – 2018
  6. ‘Entourage’ effects of N-palmitoylethanolamide and N-oleoylethanolamide on vasorelaxation to anandamide occur through TRPV1 receptors – 2008
  7. Medical Cannabis and Cannabinoids- An Option for the Treatment of Inflammatory Bowel Disease and Ca
    ncer of the Colon? – 2018
  8. Effects of homologues and analogues of palmitoylethanolamide upon the inactivation of the endocannabinoid anandamide – 2001
  9. Phytocannabinoids beyond the Cannabis plant – do they exist? – 2010
  10. Palmitoylethanolamide, endocannabinoids and related cannabimimetic compounds in protection against tissue inflammation and pain: potential use in c… – PubMed – NCBI
  11. Cannabinoids as pharmacotherapies for neuropathic pain – from the bench to the bedside. – 2009
  12. Correction – Effect of a new formulation of micronized and ultramicronized N-palmitoylethanolamine in a tibia fracture mouse model of complex regional pain syndrome – 2018
  13. Palmitoylethanolamide induces microglia changes associated with increased migration and phagocytic activity – involvement of the CB2 receptor – 2017
  14. Mast cells, glia and neuroinflammation – partners in crime? – 2013
  15. A Pharmacological Rationale to Reduce the Incidence of Opioid Induced Tolerance and Hyperalgesia – A Review – 2018

 

Medical Marijuana –Misc

  1. A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. – PubMed – NCBI
  2. Cannabis and cannabis extracts – greater than the sum of their parts? – 2001
  3. Medical cannabis and mental health: A guided systematic review. 2016 – PubMed – NCBI
  4. Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly. – PubMed – NCBI
  5. Cannabis-conclusions – 2017 National Academy of Sciences
  6. Cannabis-chapter-highlights – 2017 National Academy of Sciences
  7. Cannabis-report-highlights – 2017 National Academy of Sciences
  8. Clinical Endocannabinoid Deficiency (CECD): Can this Concept Explain Therapeutic Bene ts of Cannabis in Migraine, Fibromyalgia, Irritable Bowel Syndrome and other Treatment-Resistant Conditions?-2004
  9. Marijuana use and the risk of lung and upper aerodigestive tract cancers: results of a population-based case-control study. – PubMed – NCBI
  10. Cannabis use and cognitive function: 8-year trajectory in a young adult cohort. – PubMed – NCBI
  11. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. – PubMed – NCBI
  12. Cannabinoids and Cytochrome P450 Interactions. – PubMed – NCBI Pharmacogenetics of Cannabinoids – 2018
  13. Systematic review of systematic reviews for medical cannabinoids – 2018
  14. Adverse effects of medical cannabinoids – a systematic review – 2008
  15. Cannabimimetic effects modulated by cholinergic compounds. – PubMed – NCBI
  16. Antagonism of marihuana effects by indomethacin in humans. – PubMed – NCBI
  17. Pharmacokinetics and pharmacodynamics of cannabinoids. – PubMed – NCBI
  18. Clinical Pharmacodynamics of Cannabinoids – 2004
  19. Affinity and Efficacy Studies of Te
    trahydrocannabinolic Acid A at Cannabinoid Receptor Types One and Two. – 2017
  20. Quality Control of Traditional Cannabis Tinctures – Pattern, Markers, and Stability – 2016
  21. Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes: a systematic review. – PubMed – NCBI
  22. Pharmacology of Cannabinoids
  23. Current-status-and-future-of-cannabis-research-Clin-Researcher-2015
  24. Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems – A Clinical Review – 2015

 

Medical Marijuana – Products

Medical Marijuana – Product Evaluation

  1. The Cannabinoid Content of Legal Cannabis in Washington State Varies Systematically Across Testing Facilities and Popular Consumer Products – 2018
  2. Quality Control of Traditional Cannabis Tinctures – Pattern, Markers, and Stability – 2016

 

Medical Marijuana – Flower/Bud Products

Wellcana (Good Day Farm):

  1. Grease Monkey Flyer
  2. Lilac Diesel Flyer

 

Medical Marijuana – Topical Products

  1. Soothe Flyer
  2. Breathe Flyer

 

 

Emphasis on Education

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

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For more information, please contact Accurate Clinic.

 

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