I have been wanting to write an article about cannabis for a while now but didn’t know exactly how I wanted to present my opinion on the topic.  I am a physiotherapist in Vancouver, Canada, a place that has long embraced the use of cannabis, but up until recently it carried the stigma of technically being illegal.  I say technically because we have had weed shops on every other corner for years in this city that law enforcement had chosen to let function in a grey area due to public opinion.  On October 17, 2018 the federal government of Canada officially made marijuana legal and countless companies have been jockeying for position at all levels of the industry.

As a physiotherapist, that works with many people with resistant and chronic pain problems, I have definitely noticed an increase in people’s openness to talking about their use of cannabis or their new interest in trying it as an option for their pain.  Healthcare professionals have always had to walk a fine line in their discussions about marijuana with patients both due to legal implications and the lack of strong research on the topic.  My goal with this article is to help decrease the residual stigma of cannabis by talking about its effects on pain, stress and anxiety from my perspective and to introduce a leading physician in the cannabis space named Dr Caroline MacCallum .Pain can simply overwhelm people. It can be sharp and acute or dull, aching and chronic.  It is not a tangible, physical thing, but more of a perception, or an experience.  It is hard to explain this concept to someone in pain and not have them think that you are calling them crazy and suggesting that it is ‘all in their head.’  We are programmed to think that pain is related to a physical structure in our body being damaged, and if we can somehow fix that structure all of our problems will just go away, but unfortunately that is not the case.  The days of surgeons just cutting out pieces of you that hurt seem to be numbered as the complex nature of pain is becoming more understood.  The poor long-term outcomes of many back and knee surgeries combined with the raging opioid crisis should give everyone the cause to pause and reflect that we as a society should stop chasing the solutions to pain that don’t involve any personal accountability.  The surgeries, pills and injections that the medical system are currently offering you for pain are typically treating the symptoms more than the root cause of your problems.

It is human nature to pursue a quick fix to problems, whole bureaucratic industries have been created around our tendencies to do so.  Pain is no exception and the opioid crisis is the result of big business taking advantage of people’s ignorance and the medical system’s misguided attempts to try and help people.  The deep-rooted problem begins with the average person’s low level of awareness of how their body actually works combined with an ever-growing need for instant gratification or in the case of pain…relief.

Pain comes in many forms and for many reasons, none of which will be fixed by a pill.  Most pains can be relieved by a pill, but there is a difference between helping someone find relief and helping them find a solution.  Relief is by nature temporary and can easily set the stage for addiction in a person without a strong family or friend network around them.  Opioids are powerful drugs that hold the power to take a person’s perception of pain away for a period of time, but when it comes back, all that they have learned is that those pills make me feel better...a dangerous lesson.  Cannabis on the other hand doesn’t really take pain away, but instead seems to help your brain pay attention to other sensations in your body for a while and provides relief more by a product of distraction.  I believe this can be a more productive and much less addictive experience for people suffering chronic pain.Pain can very much narrow your focus and close your mind to much of the world around you when it rises above a certain level or continues beyond a certain period of time.  It can become exhausting and consuming and take away a person’s capacity to look at their situation objectively and as a result make them more difficult to help.  Stress, anxiety and pain all feed off of each other in this situation and even the smallest things can become very difficult to deal with.  A multifaceted approach including physiotherapy, counselling and possibly cannabis instead of prescription drugs is a much safer and more proactive approach to helping pull people back to normalcy instead of sending them down a path of dependence.

In August of 2014, I badly injured my eye and had to undergo seven surgeries to try and save my vision.  I was bed ridden for three months leaving my wife to care for our three young children and my partner to run our business.  I endured intense levels of pain and varying levels of stress and anxiety about family, work, money and life going forward with compromised vision and persistent headaches.  I was given morphine, T3s, Oxycodone and buckets full of Advil, but I have always tried my best to stay pill free.  The only substance that I can genuinely say has had a positive impact on my life in the past five years has been Cannabis.

I lead an extremely busy, scheduled life with three young children and running two busy physiotherapy clinics in Vancouver.  I work clinically four full days a week, manage my businesses and coach two soccer or baseball teams at any given time all with a persistent low-grade headache, double vision and intermittent migraines.  I am a high functioning person that understands my body and my brain very well and I spend most of my days trying to teach others how to understand theirs.  Cannabis has been a part of my journey and I think that it is important that people understand why and how it could or even should be part of theirs.

Your body is a collection of systems that all have sensory feedback loops that allow you to experience the world around you.  Your skin has receptors to allow you to sense hot, cold, sharp and dull.  Your joints, tendons and ligaments have receptors that send your brain information as you move to help you balance.  Each of your eyes create a picture for your brain to make sense of and each of your ears have three little tubes that give you feedback about where you are in space.  Your brain processes a phenomenal amount of data instantaneously, constantly and largely subconsciously.  You are free to think and move while your autopilot takes care of most of the functions in your body.  You will tune into some of the stimuli your body experiences, but you will habituate to most of it out of necessity.  It is important to try and create some awareness of the things your body is habituating to and acknowledge some of the things it may be overly sensitizing.  Chronic pain is typically the product of either a physical or emotional trauma combined with the impact of life stress and the battle of trying to navigate an imperfect medical system.

‍Stress and anxiety are increasingly problematic emotions for people in today’s world and they directly affect your brain’s ability to effectively process all the data that is constantly being thrown at it.  The overstimulation can impact your brain’s choices of what it does or doesn’t pay attention to at any given moment.  People that feel overloaded and under supported tend to develop very linear thought processes and become hyper-sensitized to things like pain.  Stress, anxiety and pain can become an entity that is experienced as a physical discomfort in a person’s muscles, head or body.  It can be related to a physical structure, but more often it is driven by your body’s reaction to that structure instead of actual physical damage.  Your brain holds the capacity to ignore important signals from your body while overly attending to negative ones as it draws you down a tunnel vision path of chronic pain.

‍Enter cannabis…My experience with cannabis is that it doesn’t take pain away, but it does draw your attention to different sensations in your body and helps you consider your pain more objectively, i.e. it can broaden your tunnel vision and help you take a more constructive path to dealing with your problem.  When I felt like my head was going to explode after my first eye surgery, weed did not help at all, but when I get worn down with tension headaches from my eye by the end of the day, marijuana can help my brain focus on music, taste buds, and funny conversations all of which relax me and distract me.  My headaches almost instantly can go from being front and centre in my conscious awareness, to an objective sensation that is happening in the background.  Cannabis helps me to acknowledge and compartmentalize my pain which helps me not let it define me.  I have accepted that pain is part of my life and I work to improve it every day, but it is important for me to have something that I can take that is both a sociably relaxing thing to do and gives me a break from my discomfort at the same time.

Pain, stress and anxiety can be very socially isolating experiences and when people turn to drugs and alcohol to try and cope with them it can be a slippery slope to dependence and even further isolation.  Alcohol is the most socially acceptable drug that people use to relax and unwind, but as everyone knows it is easy to abuse and the effects of addiction can destroy your life.  In my experience cannabis makes conversations more interesting, makes food taste better, adds another dimension to music and generally relaxes you and helps you live in the moment instead of worrying about all the stressors in your life.  It doesn’t seem to be addictive and you just seem a bit foggy the next day which is a much better option than a hangover.

I have seen people taking all types of prescription drugs with side effects that are worse than the ailment that they were trying to treat.  Pain should not be treated with pills, injections and surgeries.  It should be addressed by engaging people brains, supporting them and empowering them to assertively work at getting better.  I believe cannabis can have a positive role in that process for some people.

All of that being said, it can be hard for a person that has never used cannabis before to figure out how they may want to consume it and what dosing might be appropriate.  There are a growing number of products that have various levels of THC and CBD (the main active components of cannabis) in them and it can be hard to trust the tattooed, high guy in the dispensary of how much you should try.  This is where I would like to introduce Dr Caroline MacCallum to explain the medical role of cannabis and give you some parameters on dosing and different methods of consumption.  Dr MacCallum is an internal medicine specialist that also has a degree in pharmacy and is doing a lot of consulting work to help create some structure in the prescription of cannabis.

I asked Dr MacCallum a series of questions based on my clients’ questions to me about Cannabis:

1. Currently, what is the best way for a person to consult directly with a medical professional that is knowledgeable about the use of cannabis as a therapeutic practice to review dosing and methods of use?
2. Is there a difference between the medical marijuana products that you have been prescribing and the ones that are now available at government sanctioned stores?
3. There are a lot of CBD products on the market today. Can you briefly discuss the benefits of CBD alone and when a person may benefit from products that have both CBD and THC in them?
4. What are your common recommendations for the method of consumption for patients consuming THC/CBD products, i.e. when should a person chose to smoke, vape, take oils or eat cannabis products? Do different methods have different risks/benefits?
5. Should people be worried about cannabis products interacting negatively with any of their prescription medications and are there any strong contraindications to trying cannabis?
6. What role do you believe cannabis has in helping people that are dependent on opioids and/or preventing their prescription in the first place?
7. What are your thoughts on the role of counselling, cannabis and physiotherapy in the treatment of chronic pain compared to prescription medications?

Dr MacCallum’s answers were thoughtful, in depth and informed by research, but we both agreed that they were better processed by people as part of a conversation than written out in blog form because there are a lot of nuances to medical advice and it is easier to engage in a group discussion.  As a result, Dr MacCallum has developed a series of interactive group Zoom classes that answer all of my questions and all of yours.  She has developed four Cannabis Classes and a handful of Wellness Classes:

‍Cannabis Classes:

• 101: The Fundamentals of Cannabis
• 201: Cannabis Counselling & Treatment Plans
• 301: Vaporization, Dried Flower, Extracts & Vape Pens
• 302: Cannabis Extracts, Edibles & Topicals

Wellness Classes:

• Emotional Health Through a Different Lens
• Mind & Body Approaches to Persistent Pain
• Acupressure for Chronic Illnesses
• Chronic Pain & Osteopathy

I believe that these classes are free with a Canadian Provincial Healthcare Number.  Click here to go the Greenleaf Medical Clinic site for more details

‍Please feel free to leave comments and questions in the space below and Dr MacCallum and I will try our best to answer them.  Be respectful and understand that this site is not providing direct medical advice.  The resources on Dr MacCallum’s site and Greenleaf are your best references on this topic.