Proper Medical Use of Combustible Cannabis Concentrates in Pain Management

62 year old Mary Hart* was lying in agony as her body battled against colon cancer. Her husband, Allen, hadn’t been away from her side in days, and had run out of ideas. The cannabis oil she is taking to kill the cancer, is just not sufficient, and when she does increase her dose to ease the pain, the THC knocks her out for the day. She isn’t ready for that. There is still a spark of fight in her – if she can just get out of pain.

At this point no one cares whether it is the cancer, or the chemotherapy, or the radiation
treatments that are the culprit. The only thing that matters is reducing her level 10 pain

They have been receiving cannabis oils and proper dosing guidance from Aunt Zelda’s for several months, but this was a new development. The husband reported her as suicidal, hopeless. It was pointless to discuss long term solutions. Palliative care was needed.

According to the Mayo Clinic, the following are the options available to a cancer patient in
pain:

• Over the counter and prescription strength pain relievers, such as aspirin, acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin, others).
• Weak opioid (derived from opium) medications, such as codeine.
• Strong opioid medications, such as morphine (Avinza, Ms Contin, others), oxycodone
  (Oxycontin, Roxicodone, others), hydromorphone (Dilaudid, Exalgo), fentanyl (Actiq,
  Fentora, others), methadone (Dolophine, Methadose) or oxymorphone (Opana).
• Other therapies such as acupuncture, acupressure, massage, physical therapy,
  relaxation, meditation and humor may help.

Opioids have been used against pain since before recorded history, and still have their proper place in treatment planning. Unfortunately, the side effects associated with opioids are often unacceptable including decreased respiration, itchiness, constipation, drowsiness, nausea and vomiting, and in some cases, opioid induced hyperalgesia, or increased pain, and death.

According to the Center for Disease Control:

“Natural and semi-synthetic opioid analgesics were involved in about 11,700 drug poisoning deaths in 2011, up from about 2,700 deaths in 1999. About 70% of the opioid analgesic poisoning deaths in 2011 involved natural and semi-synthetic opioid analgesics such as hydrocodone, morphine, and oxycodone.

The number of drug poisoning deaths involving natural and semi-synthetic opioid analgesics increased each year from 2,749 deaths in 1999 to 11,693 deaths in 2011. The number of drug poisoning deaths involving synthetic opioid analgesics other than methadone, such as fentanyl, meperidine, and propoxyphene, increased from 730 deaths in 1999 to 2,666 deaths in 2011.”

Furthermore:

“From 1999 through 2011, adults aged 55-64 experienced the greatest increase in
the opioid analgesic poisoning death rate.
While the age groups 25–34, 35–44, and 45–54 have higher opioid analgesic poisoning death rates than other age groups, the greatest increase in rates over the past decade was seen for persons aged 55–64. The opioid analgesic poisoning death rate for adults aged 55–64 increased more than six fold, from 1.0 per 100,000 in 1999 to 6.3 per 100,000 in 2011.”

What options are there for Mary?
Enter the vaporizer pen. By inhaling a small amount of the same oil she takes therapeutically to kill the cancer, she was able to reduce her pain within minutes to a manageable level 4/5. An hour later, a couple more puffs reduced her pain even further.

12 year old Sammy Stone*

He suffered from peripheral neuropathy after undergoing extensive chemotherapy and radiation. As he improved from wheelchair to walking, he was forced to walk on his tiptoes. Occupational therapy was the only available option, but the sessions were of only limited success because of the severe pain involved.

The cannabis oils Sammy was taking against the cancer were a big help most of the time, but he needed something more. Smoking a bit of the oil was just what he needed to push through the painful therapy sessions. By instructing him to “do a dab” of the THC concentrated oil prior to his sessions, he was able to make far more progress. The pain was under control. Granted, he was more ‘medicated’ than would have been comfortable for the classroom, but the intense effects of the vaporized oil were quicker acting, and shorter lasting.

Sleep, like water, is a necessary requirement for life. Even one hour less sleep per night results in increased…risk of dying from any cause. Pain is one of the biggest causes of sleep deprivation. Many chronic pain sufferers experience anxiety at the mere anticipation of ‘bedtime’. By vaporizing a small amount of cannabis before bed, the patient relaxes, pain is minimized, and sleep achieved and maintained. The shorter lasting effects of the dab wear off by morning.

What is a Dab?
According to Leafly.com “A dab usually refers to a dose of concentrate that is heated on a
hot surface, usually a nail, and then inhaled.” The concentrate is often extracted with noxious chemicals, such as butane and hexane, and these leave dangerous residue in the oil, and are extremely dangerous to produce. CANORML issued its report, Why BHO? Seven possible reasons for the butane craze early in 2014, enumerating its explanation for the boom in dab’s popularity. One of those reasons discussed is the excess cannabis bi-product available.

Most processors use shake or trim to make extract, selling the flowers to the dispensaries at a much higher price. There is a lot of profit to be made when extracts are made from the leftovers that are otherwise unmarketable. Butane (and hexane) is cheap, and processing shake into extract is relatively simple. It’s also poisonous, explosive, and causes major organ damage. “The acute effects of inhalants include dizziness, hypertension (increased blood pressure), tachycardia (increased heart rate), impaired coordination, disorientation, temporal distortion, confusion, thick slurred speech, delirium, hallucinations, assaults and suicide attempts.” There are some extractors that use CO2, and these are safer. The terpenes, however, in CO2 oils are frequently missing from the final product because of the extraction process.

The concentrated oils that we most commonly recommend for patients are already
decarboxylated. In other words, converted from the raw acid form of THCA to activated THC. These tend to be more relaxing, less dysphoric especially for those who are unfamiliar with the psychoactivity associated with THC.

What to look for when selecting oils for dabbing

• How was the oil extracted? Organic ethanol, water extraction, and CO2 are the only methods we recommend.
• What cannabis is used? We recommend kiefing the loose leaves and buds in order to maximize the collection of trichomes, and minimizing the plant material.
• Is it lab tested? Cannabis lab testing is becoming more prevalent, and is especially
  important for the chronically ill.

A little bit goes a long way when vaporizing oils, so start small. Take a small puff, and wait for at least 5 minutes before determining if another is needed. This is a good rule for experienced users, too.

*real names are not used

About Mara Gordon and Aunt Zelda’s Inc.

Mara Gordon is a cannabis alchemist and process engineer with Aunt Zelda’s, Inc., in the San Francisco Bay Area. She brings her two passions together – integrated medicine and data – helping patients individualize and customize their cannabinoid and terpene intake.

Her involvement with cannabis began as a patient. After twenty-six prescription medications failed to treat her chronic pain and nerve disorders. She formed Aunt Zelda’s and began creating cannabis oils to treat chronic pain, but she soon expanded the scope of treatment to include cancer.

Mara knows better than almost anyone how hard it is to have a loved one diagnosed with cancer—her mother, father, sister, first husband, and brother-in-law all died of cancer. After seeing the brutal—and often futile—effects of chemotherapy and pharmaceuticals, she was determined to find a better way to treat the disease.