Menopause is something that nearly all women experience. A woman’s reproductive years typically begin when she is between 10 and 18 when she starts having a menstrual period. In most cases, these reproductive years last for several decades, characterized by mostly regular periods, unless the woman is pregnant. If you are experiencing “the change,” it means your body is beginning to transition away from these reproductive years to the next stage of your life.
Though this transition is entirely natural, as you go through it, you may experience some symptoms that could range from uncomfortable to unbearable. As we will see, medical marijuana can be an excellent way to experience natural relief from the symptoms associated with menopause.
What Is Menopause?
Though most women are generally aware of what menopause is, it’s easy to become confused about different terms associated with menopause, including premenopause, perimenopause and postmenopause in addition to the term menopause itself. Additionally, there are two classifications for menopause — natural and induced. Let’s look at each of these terms to clarify what menopause is along with its related terms.
1. PremenopausePremenopause is a generic term that can refer to any time in a woman’s reproductive life before menopause. Some people may use it to refer to a short amount of time before menopause, but it can also be used to refer to the entirety of a woman’s reproductive period.
2. PerimenopauseWhen women’s bodies begin to change, primarily marked by decreased estrogen production, this time is called perimenopause. Many people refer to this transition period leading up to menopause as menopause itself, but this is technically incorrect. It is actually perimenopause that causes the symptoms that are often referred to as menopausal symptoms.
3. Natural MenopauseMenopause technically refers to a woman’s final menstrual period, though many people use the term to refer to the whole transition to this point. A woman can know with certainty that she has reached menopause when it has been one full calendar year since her last period or the last time she experienced any degree of spotting. Not having a period is known as amenorrhea. This year-long duration of amenorrhea signifies that a woman’s periods have permanently ceased and that she can no longer get pregnant.
4. Induced MenopauseIn most cases, menopause occurs naturally. However, it can be brought on by medical interventions that affect a woman’s ovaries, including surgical removal of the ovaries, damage from chemotherapy or radiation or from pharmaceuticals intended to force the onset of menopause. Women whose menopause is induced will experience the same symptoms but will not have the benefit of a more gradual transition period.
5. PostmenopauseThe term postmenopause is used to label the time after a woman has gone through menopause, meaning it has been one year since her last period. At this time, menopausal symptoms may go away, but a woman’s body has entered a new normal. The lower estrogen level puts postmenopausal women at a higher risk of specific health issues, including heart disease and osteoporosis.
Menopause does not affect all women the same way. However, the hormonal changes menopause brings often cause some or all of these symptoms:
Let’s look at several statistics that can help build our understanding of menopause in the world today.
Common Treatment Options and Their Side Effects
Some women may not experience symptoms that are severe enough to motivate them to find treatment. In many cases, however, women may seek relief to keep their symptoms from interfering with their daily lives. They may try one or several different treatment options to help alleviate their symptoms. Since menopause is a natural process and not a disorder, treatment options are not meant to “cure” or resolve menopause but simply to lessen the impact of menopausal symptoms. Let’s look at several common methods of treating these symptoms:
1. Hormone Replacement TherapyOne of the most common means of treating menopause is through hormone replacement therapy (HRT). Since the symptoms associated with perimenopause stem from the drop in hormone levels your body experiences, replacing some of these hormones can lessen the severity of symptoms. Combination HRT involves taking both estrogen and progesterone. Women who have undergone a hysterectomy will only be prescribed estrogen. Hormones can be administered via a pill, patch, cream or vaginal ring among other means.
The possible side effects of HRT include:
2. Prescription Drugs for Hot FlashesIf hormone replacement therapy isn’t an option, some women are prescribed other types of pills, typically to help them with hot flashes. Most of these drugs have other uses beyond treating menopausal symptoms. For example, the drug Gabapentin, which is primarily used for nerve pain and to treat seizures, can also help with hot flashes. This medication often causes dizziness, drowsiness and lack of coordination. The blood pressure medication Clonidine is also useful for providing relief from hot flashes. It can cause side effects similar to Gabapentin along with possible dry mouth and constipation.
Non-hormonal prescription medications designed explicitly for menopause are rare, but one example is Conjugated Estrogens-Bazedoxifene, which treats hot flashes and is meant to help preserve bone mass. Its side effects include:
With the many negative side effects you can expect from prescription drugs, it’s no wonder some women are desperate for an alternative. The natural remedies and lifestyle changes discussed above can help, but unfortunately, there are relatively few studies to support their efficacy. There is another natural remedy that is worth considering, however — one that shows great promise for relieving symptoms related to menopause.
Because marijuana is not legal nationwide, clinical research on marijuana is limited. Therefore, there are no studies that directly look at marijuana as a method of treatment for menopause. However, there is a solid base of research to support the idea that marijuana can help with many symptoms of menopause, including hot flashes, insomnia, changes in mood, depression, anxiety, and low libido.
Why does marijuana help ease symptoms that are the result of a drop in hormones, especially estrogen? The answer is found in the relationship between estrogen and the body’s endocannabinoid system. Estrogen regulates the fatty acid amide hydrolase (FAAH) which breaks down some endocannabinoids. When estrogen levels are up, so are endocannabinoid levels. When estrogen levels drop, so do endocannabinoid levels since FAAH is allowed to break down more endocannabinoids. The idea is that it is not just estrogen helping to regulate the body but the endocannabinoid system, too.
Where does marijuana fit into this?
Marijuana has cannabinoids that directly interact with your endocannabinoid system, supplementing the lower endocannabinoid levels. These endocannabinoid levels are thought to have a strong influence on a person’s mood as well as other physiological factors, so supplementing low cannabinoid levels caused by a drop in estrogen can make a significant difference.
There is still room for scientists to learn more about the endocannabinoid system and the effects of cannabis, but it is already clear that it plays an important role. Since hot flashes are a major symptom of menopause, it’s especially interesting to note that tetrahydrocannabinol (THC), a compound in cannabis, mimics many aspects of anandamide, an endocannabinoid in the body, including the fact that they have both been found to help to regulate body temperature.
Another study of interest demonstrated that cannabidiol (CBD), another compound in cannabis, had antidepressant-like effects in mice, suggesting that it could effectively combat depression in humans, as well. Yet another study demonstrated that regulating a woman’s cannabinoid levels could help boost bone density, which is extremely important for menopausal and postmenopausal women.
Best Methods of Marijuana Treatment
Medical cannabis can be administered in a variety of ways, including:
Side Effects of Medical Marijuana
Being a natural substance, marijuana doesn’t involve a mile-long list of side effects like many pharmaceuticals do. However, it does cause some side effects. The good news is that, with so many strains to choose from, if you don’t like the reaction you experience from one strain, you can always try another.
Here are a few side effects to be aware of that cannabis could cause:
Updated on April 1, 2020. Medical content reviewed by Dr. Joseph Rosado, MD, M.B.A, Chief Medical Officer
Unfortunately, you may have discovered that the medical system is often woefully unprepared to deal with the symptoms of menopause. Previous generations of women were so quiet about “the change” that the medical system is only just now waking up to the needs of peri- and post-menopausal women. So, like many others, you may be turning to traditional herbal medicines – like CBD oil – for support, because our great- great-grandmothers were probably on to something.
Most of us never seriously consider menopause until we find ourselves on its doorstep — woefully unprepared to deal with its many symptoms. Some of us might not even recognize these symptoms during the early stages of perimenopause. But the sooner we notice and proactively respond to the changes happening within our bodies, the better our future health.
Cannabis & Hemp for Menopause
Menopause is one of the top three reasons women use therapeutic cannabis products — menstruation and sex are the other two. The good reputation that hemp and cannabis-derived CBD oils are gaining for treating peri- and post-menopausal symptoms isn’t based just on testimonials — scientific research also indicates how cannabidiol (CBD) could be useful for:
More than Estrogen: A Sea of Changes
You’re probably familiar with the estrogen story by now: women are born with millions of immature eggs in their ovaries. Starting at puberty, our bodies are pumped full of estrogen every time an egg matures — approximately once a month. However, over the years, our supply of eggs dwindles. And once all our eggs are gone, our periods stop and the estrogen bursts go away, triggering menopause.
But in reality, menopause is not so clear-cut. For years before the menopause (a period called the perimenopause), our estrogen levels swing unpredictably high or low before the final plunge. And it’s not just estrogen that goes on a roller-coaster ride — a full supporting cast of hormones that (more-or-less) kept our bodies operating smoothly over the years also begin rebelling.
Controlled by these hormones, countless molecules in our bodies also increase or decrease. Our brain neurochemistry changes. Our bodies ramp up production of inflammatory molecules. From brain function to fat accumulation to bone reabsorption — menopause changes the inner workings of our bodies. And each woman’s experience of menopause will be unique.
Menopausal Symptoms: Causes & Support
If menopause has left you feeling like the medical system doesn’t understand your needs, you’re probably right. Scientists are still uncovering why and how our bodies change during menopause.
Much of the information in this article is at the cutting edge of menopause research, and may have never been explained to you by your doctor — but we believe that the more you understand about your symptoms, the easier it will be for you to find support.
Here are some of the most widespread issues women face during menopause:
Aches & Joint Pain
What’s going on: Does your body hurt more than it used to? Don’t be so quick to blame it on age – without estrogen, our bodies produce higher levels of inflammatory molecules (specifically, tumor necrosis factor, or TNFα). This means arthritis symptoms could skyrocket during menopause. More than 60% of women aged 40 to 64 suffer from pain in their muscles and joints.
How CBD could help: It is more important than ever to reduce inflammation in your body during menopause. Cannabidiol has proven anti-inflammatory properties. In mice, CBD is anti-arthritic, protects joints against inflammatory damage, and lowers levels of inflammatory TNFα. Low-impact exercise and dietary changes are also excellent resources in a fight against inflammation.
Mood Swings & Depression
What’s going on: It’s not unusual for women to experience anxiety or depression during menopause. Estrogen and progesterone influence the activity of serotonin and other neurotransmitters in the brain — which directly affect mood. As levels of these hormones become erratic and eventually plummet, your neurochemistry will change.
How CBD could help: If you’re emotionally distressed, you should seek the support of a medical professional. They might suggest therapeutic or pharmaceutical solutions. If you supplement your treatment with CBD oil, it turns out that CBD activates serotonin receptors, similar to the anti-anxiety drug buspirone. (For more on this topic, read our articles about the different ways that CBD could help anxiety or depression.)
Hot Flashes & Night Sweats
What’s going on: Hot flashes and night sweats are frequently joked about, but in reality they’re no laughing matter. They disrupt our sleep and daily routines, which can reduce the quality of our lives. These “vasomotor” symptoms are caused by altered neurochemistry in the hypothalamus — your body’s thermostat control. In other words, your body’s cooling system — blood vessel dilation & sweat response — gets switched on way too easily. When tested in the lab, women who suffer from hot flashes are triggered when their body temperatures increase by only 1.5 degrees, whereas other women’s bodies don’t switch on the cooling system unless their temperatures increase almost 3 degrees.
How CBD could help: Because hot flashes have a neurochemical basis, some SSRIs and antidepressants can help relieve hot flashes. Although there aren’t studies that have specifically tested CBD for hot flashes, its influence on the body’s serotonin system could be one reason why some women swear by CBD for this symptom. Other treatments like therapy, hypnosis and relaxation techniques that calm the nervous system can also influence your neurochemistry and help reduce hot flashes.
Weight Gain & Diabetes
What’s going on: Hormones shape our bodies on so many levels, including controlling our metabolism. Without estrogen, our bodies burn fewer calories — even while sleeping — and we also burn less fat during exercise. Even if you cut calories and maintain a stable weight throughout menopause, the ongoing hormonal shift tells your body to trade in lean muscle mass for abdominal fat. And this pattern of fat storage unfortunately raises your predisposition to insulin resistance, diabetes and cardiovascular disease.
How CBD could help: Population studies have found that adults who use cannabis products have lower insulin levels and smaller waist circumferences. Cannabidiol could contribute by switching on genes for healthy metabolism (through the PPAR-γ receptor). CBD also helps buffer the activity of natural endocannabinoids, including 2-AG, which is linked to insulin resistance and ramped up during menopause.
Genitourinal Syndrome (Vaginal Dryness, Atrophy & Bladder Control)
What’s going on: Sexual health and bladder control after menopause might seem like two separate subjects, but they are so intimately related that they are now lumped into a single medical condition. Estrogen helps keep blood flowing to the pelvic region, delivering fresh oxygen to the tissues of the urinary tract and sexual organs — keeping things elastic and healthy. Once menopause arrives, women should give their pelvis some extra love and attention to keep up the blood flow. (For more on this topic, read our article on sexual health after menopause.)
How CBD could help: Along with regular sexual activity, a topical lubricant that contains cannabinoids like CBD or THC — which are both potent vasodilators — can increase blood flow to the pelvic region. This keeps tissues healthy while also moisturizing the vaginal canal. Topical CBD can also fight inflammation, relax muscles and calm pain-perceiving nerves in the vulva and vagina, making CBD-infused lube and suppositories one of women’s best companions through menopause.
What’s going on: Our bodies constantly move calcium and other minerals into — and out of — bones. As we enter perimenopause, the net result is often bone resorption (where more bone is taken away than is added), lowering bone density and increasing our risk for fractures. We’ve all heard about the importance of dietary calcium and exercise for preventing osteoporosis, but new research suggests that inflammation from arthritis or other conditions might be one of the biggest causes of bone resorption. Inflammatory TNFα is particularly adept at telling your body to increase bone resorption.
How CBD could help: The same anti-inflammatory features that make CBD oil a popular remedy for arthritic symptoms might also prove useful for bone health. In rats with periodontitis, CBD lowers TNFα levels and prevents oral bone loss. However, human evidence for this application is lacking, and we encourage you to use every medical resource available if you’ve been diagnosed with low bone density. Resistance exercise also decreases TNFα levels, which may explain why exercise can help prevent bone loss.
What’s going on: Many peri- and post-menopausal women have trouble getting a good night’s sleep. And sleep deprivation can really wear a person down — triggering fatigue and a full spectrum of other health issues. Menopause might disrupt your sleep a number of different ways, including through night sweats and increased anxiety or depression. You’ll need to identify the biggest hurdles between you and a good night’s sleep before you can troubleshoot the best solutions. Track your sleep or ask your doctor about a sleep study if you need help.
How CBD could help: People of all genders and ages report that CBD formulations help them get restorative sleep. Whether or not CBD could help you get a better night’s sleep depends on the source of your disruptions. CBD’s influence on neurochemistry and anxiety could help improve sleep for women experiencing insomnia or disruptive night sweats.
What’s going on: It’s tempting to blame memory loss on age, but even younger women who go through surgical menopause can experience rapid memory loss. The brain region responsible for memory, learning and emotion, the hippocampus, is a hotbed of synaptic plasticity. Hormones like estrogen and progesterone encourage neurons in the hippocampus to form new connections, and our memories might suffer without these hormones.
How CBD could help: Scientists are actively investigating CBD for encouraging synaptic plasticity and neuroprotection, particularly in the hippocampus. However, there is not yet solid evidence for its recommendation, and there are many other ways you can protect this important brain region. If you want to improve your memory, check out 9 ways to naturally rewire your hippocampus.
Self-Directed Care for Menopause
Now, more than ever, is an important time to observe the changes happening within your body and life. Be honest with yourself and others about how much support you need.
Estrogen and progesterone shouldered a lot of responsibilities within your body, and CBD should only be one of many resources that help you through (and beyond) menopause.
CBD: Are You Doing It Right?
For those who are new to the world of CBD, in addition to purchasing a high-quality product, it’s important to optimize your dosage and delivery for the desired effect.
For instance, vape pens deliver immediate benefits that dwindle within an hour or two, whereas oral CBD oil takes longer to kick in — but its effects can last 8-12 hours.
For help choosing the best products and optimizing your CBD dosage, check out this article.
Genevieve R. Moore PhD
A person with bipolar disorder probably doesn’t fit the stereotype you have in mind. You might be surprised to learn that bipolar disorder isn’t just classified by out-of-control highs or suicidal lows. While these ups and downs certainly happen, there are also periods of normalcy mixed in on a regular basis.
Another common misconception about people diagnosed with bipolar disorder is that they spend more time experiencing depression as opposed to mania. This is because people suffering from bipolar disorder are more likely to seek help when they are having a depressive episode than when having a manic episode.
In fact, many people suffering from bipolar disorder keep their illness private for fear of judgment or punishment, especially in the workplace.
What is bipolar disorder?Bipolar disorder, or “manic-depressive illness,” is a chronic mental illness. People with bipolar disorder often experience uncontrollable high and low moods known as mania and depression, respectively.
A person’s medical history is important to accurately diagnose bipolar disorder because it is not a one-size-fits-all disease.
People with depression only, also called “unipolar depression,” do not experience the highs and lows of mania. However, some people with depression may also experience some manic symptoms, this is known as “major depressive disorder.”
The symptoms of bipolar disorder can also mimic those of other ailments, and people with bipolar disorder typically have another disorder or disease such as anxiety disorder, thyroid disease, migraines and headaches, so it can be hard for a doctor to make an accurate diagnosis.
The condition can be controlled with self-management, a good treatment plan, and a high level of support.
Four basic types of bipolar disorder
What are the symptoms of bipolar disorder?Bipolar symptoms include extremely intense emotions/feelings, changes in activity level, disturbed sleep patterns, and other unusual behaviors. These tell-tale periods of symptoms are called “mood episodes.”
To gauge the severity of a mood episode, one should compare the intensity of the attitudes and behaviors experienced during these unusual periods of time to what is typical and normal for that person. While jumping out of a moving car is not typical for most people, something like blabbering and talking fast may be normal for one person but not for another.
Some people with bipolar disorder experience hypomania, a less severe form of mania. During a hypomania episode, a person may feel energized, productive, and euphoric — yet they may still feel in control. However, to others that know them well, the mood swings and fluctuations in attitudes and energy levels are very apparent and are a cause for concern. Without proper treatment, people with hypomania may develop severe mania and depression.
A person with severe episodes may also experience psychotic symptoms which tend to match the extreme mood, e.g., hallucinations or delusions. A person having a manic episode may believe he is something he is not, e.g., rich or famous; while a person having a depressive episode may believe he is worthless or a failure. Sometimes a person with bipolar disorder who occasionally has psychotic symptoms may be misdiagnosed with schizophrenia.
How is bipolar disorder diagnosed?No single cause has been identified for bipolar disorder. Scientists believe several factors may contribute to the illness, including genetics, stress, and the structure of the brain itself.
It is important to talk to your healthcare professional(s). It is a good idea to get a complete physical and routine lab tests to rule out other conditions. If no obvious cause for the symptoms is found, a mental health professional, such as a psychiatrist who is experienced in diagnosing and treating bipolar disorder can perform a mental health evaluation. To be diagnosed with bipolar disorder, a person has to have had at least one episode of mania or hypomania.
Bipolar disorder does not discriminate – it can affect anyoneThe average age of onset of bipolar disorder is 25. Every year, 2.9% of the U.S. population is diagnosed with bipolar disorder, with nearly 83% of cases being classified as severe. Bipolar disorder affects men and women equally.
“I am mentally ill. I can say that. I am not ashamed of that. I survived that, I’m still surviving it, but bring it on. Better me than you.” —Fisher told Diane Sawyer on ABC PrimeTime in a 2000 interview
Carrie Fisher recently passed away at the age of 60 after suffering a cardiac arrest. Fisher may be known for her role in Star Wars as Princess Leia, but she is also well-known for battling relentlessly against the stigma of mental illnesses.
Fisher was diagnosed at age 29 with bipolar disorder. Throughout her life, she used her trademark humor and candor to shed light on the condition, and convey the powerful, life-changing message that there is no shame in a mental health diagnosis.
What is the treatment for bipolar disorder?Ironically, conventional drugs used to treat bipolar disorder are mostly psychotropic drugs that can induce more of the symptoms a sufferer is trying to beat, like anxiety, nervousness, impaired judgment, mania, hypomania, hallucinations, feelings of worthlessness, psychosis, and suicidal thoughts.
Lithium is the best known medication for treating the disorder because it is a mood stabilizer and is effective in treating both mania and depression, as well as for preventing relapse. The bad news is that one-third of the patients who have taken lithium for over ten years have developed chronic renal failure from the drug, according to a study in the Journal of Psychopharmacology.
Sometimes antidepressants are used to treat bipolar depression, but this can be controversial because of the possibility that an antidepressant can trigger a switch into mania.
Behavioral or family focused therapies, as well as complementary health approaches such as meditation, faith and prayer, play a big part in developing self-management strategies for coping with bipolar disorder.
Treating bipolar disorder with medical marijuanaAs you might expect from cannabis being labeled as a controlled substance, scientific research and reputable studies are limited. Having said that, there is a plethora of anecdotal evidence that shows promise that the right cannabis regimen can help patients manage some or all of their symptoms of a manic or depressive episode. Unfortunately, without more research it is also possible that cannabis could agitate other symptoms. Knowing your body and its signals will play a huge role in deciding how and if you incorporate cannabis into your treatment plan.
“So I said to her… ‘I don’t know if marijuana will help you enough but I would try it. If it doesn’t help you it surely is not going to hurt you.'” – Dr. Lester Grinspoon
In 1998, the Journal of Psychoactive Drugs published an article by Dr. Lester Grinspoon, an associate professor emeritus of psychiatry at the Harvard Medical School and well-recognized cannabis activist, highlighting case histories of sufferers who found cannabis to be an effective treatment option. Dr. Grinspoon wrote that until more research is conducted on medical marijuana and present social circumstances are changed, we will never know the full extent that cannabis can be used in the treatment of mental disorders.
Ashton ReviewSeveral years later, the Journal of Psychopharmacology published a review and discussion by C.H. Ashton, et al., exploring the therapeutic potential of cannabinoids in bipolar affective disorder. The review recognized that bipolar disorder is often poorly controlled by prescription drugs, and thus, the team was interested in determining if medical marijuana could provide mental health benefits.
Researchers undertook a literature review of cannabis use by patients with bipolar disorder and of the neuropharmacological properties of cannabinoids, and found that anecdotal reports suggest that some patients take it to alleviate symptoms of both mania and depression, thereby suggesting cannabis has possible therapeutic effects in this condition.
The study found that “cannabinoids Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) may exert sedative, hypnotic, anxiolytic, antidepressant, antipsychotic and anticonvulsant effects. Pure synthetic cannabinoids, such as dronabinol and nabilone and specific plant extracts containing THC, CBD, or a mixture of the two in known concentrations, are available and can be delivered sublingually. Controlled trials of these cannabinoids as adjunctive medication in bipolar disorder are now indicated.”
Braga StudyThen in 2012, a study by Raphael J. Braga, et al., focused on the cognitive and clinical outcomes associated with cannabis use in patients with bipolar I disorder.
The objective of the Braga study was to compare clinical and neurocognitive measures in individuals with bipolar disorder with a history of cannabis use disorder (CUD) versus those without a history of CUD. The study compared the two groups on clinical and demographic variables, as well as on performance on neurocognitive tests. The study found that the CUD+ subjects demonstrated significantly better performance on measures of attention, processing speed, and working memory.
Although CUD is historically associated with psychosis and suggestive of poorer clinical prognosis, the Braga study interestingly revealed bipolar patients with a history of CUD had better neurocognitive performance as compared to patients with no history of CUD.
Tyler StudyA 2015 study, published in the journal PLOS ONE in March, was led by Dr. Elizabeth Tyler of the Spectrum Centre for Mental Health Research at Lancaster University, United Kingdom, together with Professor Steven Jones and colleagues from the University of Manchester, Professor Christine Barrowclough, Nancy Black and Lesley-Anne Carter.
“The findings suggest that cannabis is not being used to self-medicate small changes in symptoms within the context of daily life. However, cannabis use itself may be associated with both positive and negative emotional states. We need to find out whether these relationships play out in the longer term as this may have an impact on a person’s course of bipolar disorder.” – Dr. Tyler
The Tyler study had twenty-four participants with bipolar disorder type I or type II complete diaries for 6 days using Experience Sampling Methodology to investigate the temporal associations between cannabis, affect, and bipolar disorder symptoms.
The findings of the Tyler study indicate that cannabis use is associated with a number of subsequent psychological effects; however, there was no evidence that individuals with bipolar disorder were using cannabis to self-medicate minor fluctuations in negative affect or bipolar disorder symptoms over the course of daily life.
Sagar StudyIn the most recent study, published in June 2016 in the journal PLOS ONE, Kelly A. Sagar, et al., set out to clarify the impact of bipolar disorder and cannabis use on cognitive function and mood.
As part of a larger study conducted between 2008 and 2014, 12 bipolar patients who smoke cannabis, 18 bipolar patients who do not smoke cannabis, 23 cannabis smokers without bipolar disorder, and 21 healthy controls who neither smoke cannabis nor have bipolar disorder, were enrolled and completed neuropsychological assessments. A subset of these participants also completed daily EMA assessments over the course of four weeks to assess mood.
The Sagar study found no significant differences between cognitive function in bipolar patients that smoked cannabis and those who didn’t. Furthermore, bipolar participants who regularly smoked cannabis reported notable reductions in mood symptoms each time they medicated with cannabis, indicating potential mood-stabilizing properties of cannabis in at least some participants. The current study also showed that cannabis use in bipolar patients may not result in additional impairment.
Further research is needed to clarify the relationship between cannabis use and the treatment or manifestation of bipolar disorder symptoms. You are the best judge as to whether or not cannabis can work for you. Experiment slowly and cautiously until you know if cannabis can work for you.
The information contained herein is provided for educational purposes only and is not intended to replace discussions with a healthcare provider.
Marijuana is the name given to the dried buds and leaves of varieties of the Cannabis sativa plant, which can grow wild in warm and tropical climates throughout the world and be cultivated commercially. It goes by many names, including pot, grass, cannabis, weed, hemp, hash, marihuana, ganja, and dozens of others.
Marijuana has been used in herbal remedies for centuries. Scientists have identified many biologically active components in marijuana. These are called cannabinoids. The two best studied components are the chemicals delta-9-tetrahydrocannabinol (often referred to as THC), and cannabidiol (CBD). Other cannabinoids are being studied.
At this time, the US Drug Enforcement Administration (DEA) lists marijuana and its cannabinoids as Schedule I controlled substances. This means that they cannot legally be prescribed, possessed, or sold under federal law. Whole or crude marijuana (including marijuana oil or hemp oil) is not approved by the US Food and Drug Administration (FDA) for any medical use. But the use of marijuana to treat some medical conditions is legal under state laws in many states.
Dronabinol, a pharmaceutical form of THC, and a man-made cannabinoid drug called nabilone are approved by the FDA to treat some conditions.
MarijuanaDifferent compounds in marijuana have different actions in the human body. For example, delta-9-tetrahydrocannabinol (THC) seems to cause the "high" reported by marijuana users, and also can help relieve pain and nausea, reduce inflammation, and can act as an antioxidant. Cannabidiol (CBD) can help treat seizures, can reduce anxiety and paranoia, and can counteract the "high" caused by THC.
Different cultivars (strains or types) and even different crops of marijuana plants can have varying amounts of these and other active compounds. This means that marijuana can have different effects based on the strain used.
The effects of marijuana also vary depending on how marijuana compounds enter the body:
A few studies have found that inhaled (smoked or vaporized) marijuana can be helpful treatment of neuropathic pain (pain caused by damaged nerves).
Smoked marijuana has also helped improve food intake in HIV patients in studies.
There are no studies in people of the effects of marijuana oil or hemp oil.
Studies have long shown that people who took marijuana extracts in clinical trials tended to need less pain medicine.
More recently, scientists reported that THC and other cannabinoids such as CBD slow growth and/or cause death in certain types of cancer cells growing in lab dishes. Some animal studies also suggest certain cannabinoids may slow growth and reduce spread of some forms of cancer.
There have been some early clinical trials of cannabinoids in treating cancer in humans and more studies are planned. While the studies so far have shown that cannabinoids can be safe in treating cancer, they do not show that they help control or cure the disease.
Relying on marijuana alone as treatment while avoiding or delaying conventional medical care for cancer may have serious health consequences.
Possible harms of marijuanaMarijuana can also pose some harms to users. While the most common effect of marijuana is a feeling of euphoria ("high"), it also can lower the user’s control over movement, cause disorientation, and sometimes cause unpleasant thoughts or feelings of anxiety and paranoia.
Smoked marijuana delivers THC and other cannabinoids to the body, but it also delivers harmful substances to users and those close by, including many of the same substances found in tobacco smoke.
Because marijuana plants come in different strains with different levels of active compounds, it can make each user’s experience very hard to predict. The effects can also differ based on how deeply and for how long the user inhales. Likewise, the effects of ingesting marijuana orally can vary between people. Also, some chronic users can develop an unhealthy dependence on marijuana.
Cannabinoid drugsThere are 2 chemically pure drugs based on marijuana compounds that have been approved in the US for medical use.
How can cannabinoid drugs affect symptoms of cancer?Based on a number of studies, dronabinol can be helpful for reducing nausea and vomiting linked to chemotherapy.
Dronabinol has also been found to help improve food intake and prevent weight loss in patients with HIV. In studies of cancer patients, though, it wasn’t better than placebo or another drug (megestrol acetate).
Nabiximols has shown promise for helping people with cancer pain that’s unrelieved by strong pain medicines, but it hasn’t been found to be helpful in every study done. Research is still being done on this drug.
Side effects of cannabinoid drugsLike many other drugs, the prescription cannabinoids, dronabinol and nabilone, can cause side effects and complications.
Some people have trouble with increased heart rate, decreased blood pressure (especially when standing up), dizziness or lightheadedness, and fainting. These drugs can cause drowsiness as well as mood changes or a feeling of being “high” that some people find uncomfortable. They can also worsen depression, mania, or other mental illness. Some patients taking nabilone in studies reported hallucinations. The drugs may increase some effects of sedatives, sleeping pills, or alcohol, such as sleepiness and poor coordination. Patients have also reported problems with dry mouth and trouble with recent memory.
Older patients may have more problems with side effects and are usually started on lower doses.
People who have had emotional illnesses, paranoia, or hallucinations may find their symptoms are worse when taking cannabinoid drugs.
Talk to your doctor about what you should expect when taking one of these drugs. It’s a good idea to have someone with you when you first start taking one of these drugs and after any dose changes.
What does the American Cancer Society say about the use of marijuana in people with cancer?The American Cancer Society supports the need for more scientific research on cannabinoids for cancer patients, and recognizes the need for better and more effective therapies that can overcome the often debilitating side effects of cancer and its treatment. The Society also believes that the classification of marijuana as a Schedule I controlled substance by the US Drug Enforcement Administration imposes numerous conditions on researchers and deters scientific study of cannabinoids. Federal officials should examine options consistent with federal law for enabling more scientific study on marijuana.
Medical decisions about pain and symptom management should be made between the patient and his or her doctor, balancing evidence of benefit and harm to the patient, the patient’s preferences and values, and any laws and regulations that may apply.
The American Cancer Society Cancer Action Network (ACS CAN), the Society’s advocacy affiliate, has not taken a position on legalization of marijuana for medical purposes because of the need for more scientific research on marijuana’s potential benefits and harms. However, ACS CAN opposes the smoking or vaping of marijuana and other cannabinoids in public places because the carcinogens in marijuana smoke pose numerous health hazards to the patient and others in the patient’s presence.
Amyotrophic lateral sclerosis (ALS) is a disease characterized by extensive damage over time to motor neurons in the brain and spinal cord. Motor neurons are nerve cells that are responsible for the communication, the signals, taking place between the brain and the muscles.
Due to this damage, the brain is increasingly unable to control muscle movement, and patients progressively loses the ability to easily do activities that most people take for granted, like walk, swallow, or speak. There is currently no cure for ALS, but treatments can help manage its symptoms.
One potential treatment is cannabis sativa, otherwise known as marijuana. Cannabis, as medical marijuana, is being assessed in its various forms for its potential in easing ALS symptoms.
How cannabis worksThe active ingredients in cannabis — tetrahydrocannabinol (THC) and cannabidiol (CBD) — are called cannabinoids. They are believed to work as antioxidants and as anti-inflammatory and neuroprotective agents, and for these reason might slow or prevent further damage to nerve cells in ALS.
Both CBD and THC mainly function by binding to the cannabinoid receptor proteins CB1 and CB2 of the endocannabinoid system. The endocannabinoid system is responsible for regulating brain function, hormone secretion, and the immune system. CB1 receptors are present on the surface of nerve cells in the brain and spinal cord, and regulate neurodevelopmental activities; CB2 receptors are predominantly present in immune cells, and modulate inflammation and immune cell function.
Binding of THC to the CB1 receptor activates the receptor’s anti-glutamatergic action, meaning it inhibits the release of excess glutamate by nerve cells. Glutamate is a neurotransmitter, and in excess can cause nerve cell damage or excitotoxicity. In ALS, excitotoxicity is thought to compound nerve cell damage and increase neurodegeneration.
Since THC prevents excitotoxicity via the CB1 receptors, treatment with THC may be neuroprotective for ALS patients. A study showed that neuronal cells obtained from the spinal cord of ALS mouse models and treated with THC were protected from induced excitotoxicity.
The cannabinoids exert an anti-inflammatory effect through the CB2 receptors, which regulate immune cells and the production of inflammatory proteins. In this way, they might slow further tissue damage.
Cannabinoids also function as an antioxidant, but in a CB receptor-independent manner. Other receptors, such as the transient receptor potential vanilloid receptor 1, have been found to be involved, but how they work in ALS is still unclear.
Medical marijuana in clinical trialsCannabis-derived products are being, or were, evaluated for their potential in treating ALS in various clinical trials.
Sativex (nabiximols), being developed by GW Pharmaceuticals, is an oral spray containing the two active components of cannabis. A Phase 2 trial (NCT01776970) in Italy, called CANALS, evaluated the safety, efficacy, and tolerability of Sativex in ALS patients affected by spasticity, or muscle stiffness. A total of 59 patients, ages 18 to 80, were included in the study. Patients were randomly assigned to receive either Sativex (29 patients) or placebo (30 patients). The study’s findings showed that Sativex was well-tolerated with no serious side effects. Spasticity was significantly reduced in treated patients compared to those given the placebo, whose symptoms continued to worsen.
An earlier single-site study (NCT00812851) tested the efficacy of oral THC in alleviating cramps in ALS patients. This was a crossover study, meaning that all 27 patients enrolled, (mean age 57; with moderate to severe cramps) were given THC at some point during the trial. They were randomly divided into two groups, one receiving 5 mg THC twice daily for two weeks, followed by a placebo; and the other receiving placebo first followed by THC for two weeks. A two-week treatment-free, or washout, period preceded changes in treatment status, and patients were evaluated two weeks after their treatment period.
This trial’s primary goal was changes in cramp intensity. The number of cramps per day, the intensity of muscle twitches, change in appetite, depression, and patient’s quality of life and sleep were measured as secondary goals. Study findings failed to show effectiveness in these measures; THC at 5 mg did did not alleviate cramps in ALS patients, and no significant changes were observed in the secondary outcomes, its researchers reported.
An ongoing Phase 3 study (NCT03690791) is testing the effects of CBD oil capsules by CannTrust on slowing disease progression in ALS patients. The study aims to enroll 30 patients, ages 25 to 75, who will be randomly grouped to receive either the CBD oil capsules or a placebo. In this six-month study, changes in a patient’s motor abilities, lung function, pain and spasticity levels, and quality of life will be assessed to evaluate the efficacy of CBD capsules. Enrollment at this trial’s single site, the Gold Coast Hospital and Health Service in Australia, may still be underway; contact information is available here.
In an observational study (NCT03886753), researchers at Children’s Hospital of Philadelphia are evaluating the effects of four formulations of cannabis-based products — the medical marijuana products Dream, Soothe, Shine, and Ease — by Ilera Healthcare used as standard therapy by people with multiple diseases, including ALS. How this therapeutic moves within the body (its pharmacokinetics) and its chemical interaction in the body (pharmacodynamics) will be monitored, and reports of relief of symptoms collected. The study is enrolling patients, ages 2 and older.
Another large and observational study (NCT03944447) in people with multiple diseases, including ALS, aim to assess the safety and efficacy of cannabis use by up to 10,000 people in the more than 38 states that have legalized medical marijuana. As an observational study, medical cannabis as part of person’s standard therapy — regular use — is being evaluated through patient reporting of perceived relief and findings of side effects.
Called OMNI-Can, the study and its investigators will use an anonymous online questionnaire to assess the potential benefits and side effects of medical cannabis on participants, most of whom are expected to be current users. A separate cannabis-naive group, defined as no use in the past year, will also be enrolled. Participants will first be given the survey at a visit with a physician to establish their baseline (start of the study) characteristics. Subsequent surveys will be given follow-up visits every three months for up to five years.
The study’s primary goal is the perceived benefits of cannabis in treating chronic pain, and the safety of its use via reporting of adverse events. Its impact on patients’ quality of life will be also be recorded, as will preferences such as favored type for use (route of administration, like vaping or eating as a candy) and its formulation (THC/CBD ratio). Contact information is available here.
Other informationCannabis use should be in consultation with a treating physician, who can monitor patients for behaviors that may indicate dependence.
CBD, one of the more than 100 pharmacologically active compounds (cannabinoids) that can be retrieved from the cannabis plant, is thought to hold the greatest therapeutic potential. This is largely because it does not have the psychoactive properties common to other cannabis-related compounds. psychoactive properties
In addition to dependence, side effects attributed to medical marijuana use include lung irritation (smoking or vaping), low or elevated blood pressure, anxiety, dry mouth, changes in appetite, and nausea.
Researchers are calling for formal clinical trials into the efficacy of marijuana for treating opioid use disorder after a newly published study found that cannabis may ease many common symptoms of opioid withdrawal.
The study, conducted by researchers at the Johns Hopkins University School of Medicine and published in the forthcoming issue of the Journal of Substance Abuse Treatment, asked 200 people with past-month opioid and marijuana use whether their symptoms of opioid withdrawal improved or worsened when they consumed cannabis.
Of the 125 respondents who used marijuana to treat their withdrawal, nearly three-quarters (72 percent) said it eased their symptoms, while only 6.4 percent said it made them worse. Another 20 percent reported mixed results, and three people (2.4 percent) said cannabis didn’t seem to have an obvious effect either way.
“These results show that cannabis may improve opioid withdrawal symptoms and that the size of the effect is clinically meaningful.”
At least four states already include opioid use disorder (OUD) as a qualifying condition for medical marijuana, but critics have complained that there’s little evidence to support that policy. In the introduction to their new paper, the researchers acknowledge that “these approvals are concerning because of the limited and conflicting evidence suggesting cannabis can both improve and worsen opioid withdrawal and treatment retention.”
The results of their new study, however, suggest that cannabis is doing far more to ease opioid withdrawal symptoms than to make them worse. Of 18 common symptoms the researchers examined, participants on average said that cannabis helped ease every single one.
“Across all symptoms, more participants indicated that symptoms improved with cannabis compared to those that indicated symptoms worsened with cannabis,” the study found. “Ratios reflecting the participants who experienced improved versus worsened symptoms indicated that more individuals found cannabis to improve rather than worsen all evaluated symptoms.”
“Anxiety is the most common opioid withdrawal symptom improved with cannabis.”
The most frequently reported improved symptoms were anxiety (76.2 percent of respondents), tremors (54.1 percent), trouble sleeping (48.4 percent), bone and muscle aches (45.9 percent), restlessness (45.1 percent), nausea (38.5 percent) and opioid cravings (37.7 percent).
The most common symptoms reportedly made worse were yawning (7.4 percent), runny nose (6.6 percent), teary eyes (6.6 percent), restlessness (5.7 percent), vomiting (5.7 percent) and hot flashes (5.7 percent).
Women reported a significantly greater degree of symptom relief from marijuana than did men.
“On average, withdrawal severity scores nearly doubled on days cannabis was not used,” the study found. The results also inducted that people with “greater cannabis and opioid use experience greater reductions in opioid withdrawal when using cannabis.”
Participants were recruited using the Amazon Mechanical Turk (AMT) platform, a task-based crowdsourcing market.
“One limitation of this study,” the researchers acknowledged, “is that it was conducted using a crowdsourcing platform and, therefore, in-person validation of substance use was not possible.” Nevertheless, they noted that “studies have validated the use of AMT for substance use–related research by comparing MTurk data with data collected in in-person laboratory settings.”
Another limitation of the study is the subjectivity of the self-reported “Subjective Opiate Withdrawal Scale” (SOWS), which asks participants to evaluate the severity of their symptoms on a rubric, from 0 (not at all) to 4 (extremely severe).
“The SOWS has not been specifically evaluated for use as a retrospective measure,” the Johns Hopkins researchers wrote. “However, given the paucity of the data on this topic, the approach provided a feasible way to identify whether specific withdrawal symptoms may be differentially affected by cannabis use and the perceived magnitude of the effect of cannabis use on symptom severity.” Together, those variables “can be used to support prospective evaluation of this topic.”
The researchers don’t quite conclude that cannabis is beneficial for people going through opioid withdrawal, but they acknowledge that their data points to the need for further, more rigorous studies.
“These data suggest that the co-users of opioids and cannabis endorse cannabis as a method for reducing opioid withdrawal therapy,” the study says. “Given the shifting legal landscape, prospectively designed clinical trials that assess whether cannabis or its components can effectively treat opioid withdrawal are warranted.”
Though the matter is far from settled science, a number of other studies in recent years have suggested that cannabis may help reduce opioid use or dependency. Among them, a study published in December found that states with legal marijuana saw decreases in opioid prescriptions. A separate study from November of last year concluded that everyday cannabis use reduced opioid consumption among chronic pain patients.
The federal government is urging researchers to further investigate the role of cannabinoids in providing safer painkilling alternatives to opioids by making funding available for such studies.