The wave of cannabis legalization sweeping the United States has proven the power of capitalism and market competition for creating and making available to patients a wide variety of valuable products containing cannabinoids. From traditional raw flowers, hash, and tinctures to modern interpretations on the theme — like BHO (Butane Hash Oil), shatter, and wax — there is an ever-increasing number of ways to consume marijuana.
Because cannabis is lipophilic, meaning it can be dissolved into a fat-soluble substance, it easily permeates cell membranes — making it perfect for use as a topical medicine applied directly to the skin. Because topical medicines do not pass through the digestive system and become diluted by the stomach and liver, they feature much faster onset than edibles and greater localized potency.
Topicals are cannabis-infused lotions, oils, salves, balms, and sprays that provide no psychoactivity or euphoria (making them suitable for children). They offer robust medical efficacy for a variety of ailments (see below). From generalized conditions such as inflammation, tension, and soreness to specific ailments like eczema, dermatitis, pruritis (itching), and psoriasis, cannabis topicals are a convenient and stealthy way for patients to treat particular conditions. Some users have even reported relief from headaches and menstrual cramping.
Novel “transdermal” cannabis treatments, common for other drugs or medical therapies, are quickly becoming available from innovative medical dispensaries and cannabis manufacturers in legal states such as Oregon, Washington, and Colorado. Cannabis patches (similar to the nicotine patches used by people trying to quit smoking) and strips are becoming available that are discrete and deliver almost instantaneous relief. Imagine if common bandages were available with cannabinoid-based topical solutions that, in a very localized manner, provided direct treatment to a burn, bug bite, or infection.
Topicals can be especially helpful for the number one cause of disability in the United States: Arthritis. Because a major symptom of this condition is inflammation, cannabis-infused topicals are an excellent method of treatment. If, that is, the topical contains the correct cannabinoids. Because THC (tetrahydrocannabinol) does not decrease inflammation, it is of little value to arthritis sufferers.
Rather, THC-A, the acidic precursor to THC that is most abundant in the plant prior to the application of heat during smoking or vaporizing — in combination with CBD (cannabidiol) — has been found to be most effective for the crippling disease. Because of something called the entourage effect, THC-A and CBD work synergistically to produce not only a reduction in inflammation due to increased circulation, but also a decrease in pain. Cannabis-based alcohol rubs have been found to be especially therapeutic for arthritic joint pain and sore muscles.
In 2004, University of Kentucky professor Audra Stinchcomb delivered a presentation at the Third National Clinical Conference on Cannabis Therapeutics regarding a study of the transdermal and intranasal delivery of cannabinoids. Stinchcomb reported that transdermal patches can be an effective method for treating many conditions because of the lack of negative side effects and the steady, controlled release of cannabinoids. The study concluded that the addition of some proteins can increase skin permeability. It also reported that CBN (cannabinol) and CBD more easily permeate skin than THC.
Why don’t topical cannabis treatments deliver a euphoric high — even when they contain THC? The answer lies in the fact that there are two types of cannabinoid receptors in the human body: CB1 and CB2. Topical products utilize the CB2 receptors found throughout the body and in abundance in the skin. These receptors typically don’t allow THC to permeate the bloodstream and reach the brain (necessary for a psychoactive effect).
Topicals are also a good way for patients to gain relief without the potential negative side effects of very potent cannabis, especially varieties and products high in THC. Disorientation, confusion, paranoia, and racing heart are never side effects of topical or transdermal treatments, making them well suited for use while driving, working, caring for children, or during any activity that might be negatively impacted by the traditional side effects of cannabis that plague some users who consume enough of particular strains.
One physician, Dr. Mark Sircus, who has written extensively about the medical efficacy of cannabis, described a situation in which a fellow doctor had an infection severe enough to warrant amputation:
“One hospital pathologist cut his finger during an autopsy; bacteria resistant to antibiotics infected the wound and it seemed that an amputation was going to be inevitable. Then someone had the idea to ask Prof. Kabelik, who was known for his research on the medicinal use of cannabis, for help. He applied his hemp salve and two days later the wound was already healing and the amputation was avoided.”
While the specific cannabinoid profile of a transdermal product is what is most important when considering its potential medical efficacy for a targeted condition, indica strains typically are more effective than sativas. The need for attention to the cannabinoid volumes of a topical product is especially evident when one considers the long list of conditions for which transdermal products are effective — many of which will surprise even seasoned patients and cannabis consumers.
A future filled with cannabis-based lotions, salves, and patches for ailments as common as mosquito bites, muscle soreness, and even migraine headaches is certainly enticing and a subject on which the medical establishment should be more focused — especially when such treatments can be administered to children and the elderly without fear of negative side effects.
Unfortunately, the Schedule I status of cannabis by the federal government prevents clinical research and human trials into the efficacy of any cannabis-based product, including topicals.