topical cannabis medicine

Topical Cannabis Preparations: Snake Oil or Healing Options?

By Cheryl K. Smith

As medical marijuana has become more widely accepted,  methods  for  its  use have gone beyond simply smoking it.

Vaporizers are replacing pipes and joints, as physicians and other proponents strive to make it as safe as possible for patients.

Medibles — foods that are medicated with cannabis butter  or  oil—have  gone  main-stream, with new gourmet products being added every day.

Entrepreneurs are also creating tinc-tures, ointments, and lotions, with names like Apothecanna, Doc Green’s Therapeutic Healing Cream, and Pain Eraser. Testimonials abound about the effectiveness of these topical medicines, with claims that they are effective not only on skin conditions, but for muscle, joint, and other types of pain. But do they really work?

Brief History.

The use of cannabis as a medicine dates back thousands of years. It was mainly used orally (as a tincture or component in medicine) and by smoking, although there is some doc-umentation of external use. Cannabis is believed to have been used exter-nally by the Egyptians for its antisep-tic properties. Reports from different parts of Africa indicate that it was used for a similar purpose.

In “Cannabis as a Medicament” (http://tinyurl.com/249rcct), the authors report that cannabis was used in European folk medicine as an antiseptic as well.

The narcotic effect apparently was not mentioned or noticed; instead, it was believed to be effective for antibiotic and limited analgesic purposes. They mention the use of the dried leaves with butter for burn treatment, and other external applications for inflamed feet, furuncles (skin infection involving a hair follicle), and erysipelas (bacterial skin infection) in various cultures. In the Victorian era, cannabis plasters and ointments were used to relieve local pain.

In more recent (1968) Arabic medicine, cannabis (or hemp) was used to treat pityriasis (a disorder causing flakiness or scaling of the skin) and lichen (an inflammatory skin condition) by washing with the juice from the leaves.(1)

Effect of Cannabis on Skin Conditions.

Confirming that the historical uses of cannabis are in fact effective, recent studies have shown that cannabis has antibacterial, anti-inflammatory, anti-cancer, and immune-modulating properties.(2) This means it may be effective on skin infections, burns, rashes, and other skin problems. Most of the evidence that cannabis ointments and lotions work when applied topically is anecdotal, although studies have begun to be published.

Different parts of the cannabis plant have been suggested for topical use. The seeds of the plant are made up of essential fatty acids and proteins, and are considered to have therapeutic effects.

The fatty acid, g-linoleic acid, in particular, is recommended for relief from the skin diseases eczema and psoriasis. It is also believed to provide some relief for osteoporosis, rheumatoid arthritis, and other inflammatory diseases. The buds, leaves, and trichomes (resin glands) are the parts of the plant most com-monly used for creating topical preparations. Hashish made from these parts of the plant can also be used.

While early studies looked mainly at the effects of smoked marijuana, recent studies most often use oral cannabinoids (usually THC) or are performed on laboratory animals. These include studies looking at the effects of using fatty acids as a nutri-tional supplement rather than topi-cally. Only rarely has a study looked at topical applications of cannabis, but at least one study found that nerve and mast cells in human skin contain cannabinoid receptors. This would indicate that topical applica-tion of cannabis could have an effect on skin conditions.

In fact, at least one study showed that topical cannabinoids have a positive effect on severe itching. In that 2006 German study, researchers found that 14 of 22 patients had a reduction in severe pruritis (itching) with applica-tion of the endocannabinoid N-palmitoyl ethanolamine (PEA).(3) The PEA was applied in an emollient cream to the skin. No patient experi-enced side effects.

A more recent study, in 2007, looked at how the cannabinoid receptors in mice become activated by adminis-tration of cannabinoids, significantly decreasing inflammation caused by contact skin allergy.(4)

The study’s authors suggest that cannabinoid compounds such as those produced by the cannabis plant may provide an enhancement to therapeutic treatment for humans.

On the flip side of these beneficial effects is the possibility that cannabis may cause some of the very skin problems it is used to treat. A 1983 article in the Western Journal of Medicine noted that many people who have a sensitivity or an allergic reaction to airborne plant pollens, including some in other botanical families, may develop contact der-matitis or urticaria (hives) as a result of prolonged exposure to cannabis (such as trimming or other work in the industry that requires han-dling).(5) Another potential, but less likely, risk may be anaphylactic reac-tion. A 1971 medical article noted such an effect from smoking cannabis.(6)

While the studies cited addressed the effect of cannabinoids on external skin conditions—something that can be readily observed and proven true or not true—the question remains as to whether cannabinoids can effec-tively permeate the skin barrier to affect internal conditions or even joint pain.

Absorption of Cannabis Through the Skin.

According to The Healing Magic of Cannabis, cannabis in a compress, salve, or tincture is absorbed locally when applied directly to the skin, but there is debate about whether it can reach the central nervous system

(CNS).(7) This is why topical applications have no psychoactive effect, despite the claims by some that they do.

A 1987 study from Israel investigated the skin permeation behavior of a tetrahydrocannabinol (THC) in both rat and human skin in vitro.(8) The researchers found rat skin much more permeable than human skin. They also found that “24 hours after application the drug was concentrat-ed in the stratum corneum, in the upper epidermis, and around the hair follicles….” In other words, it doesn’t

penetrate very deeply. However, using a permeation enhancer (oleic acid) on the rat skin only, the researchers found a sustained concen-tration in the blood for about 24 hours. This study still leaves open the question of whether topically apply-ing THC to human skin can deliver it to the bloodstream.

Cannabinoids are similar to opioids in that they inhibit pain by interact-ing with specific receptors within the pain pathways.(9) At least two patent applications have been filed for trans-dermal delivery systems (10), and various other methods have been sug-gested. Some people claim that using ethyl alcohol (such as vodka) as a medium for cannabis more effective-ly delivers cannabinoids to the body through the skin. While it is true that ethyl alcohol can be absorbed through the skin, no comparative studies have been done comparing the effectiveness of cannabis-infused alcohol with cannabis-infused oils in delivering cannabinoids through the skin. A skin patch, similar to those used for delivering certain opiates and hor-

mones, would have to be large enough and contain a large enough dose to overcome the low absorption rate of human skin. The scalp (which has the fatty sebaceous glands and hair follicles) may provide the best possibility for absorption of cannabi-noids into the human body. In addi-tion, DMSO (11) or oleic acid (12) could be used to enhance the penetra-tion into the skin. However, many of the properties of DMSO are the same as those of cannabis (13), which could potentially confound a study on the effectiveness of cannabis.

At the Third National Clinical Conference on Cannabis Therapeutics, held in 2004, University of Kentucky professor Audra Stinchcomb, PhD, spoke on transdermal and intranasal delivery of cannabinoids (14). The study was funded in part by the American Cancer Society.

Dr. Stinchcomb noted that transder-mal patches are a superior method for treating various conditions because they decrease side effects, maintain steady drug levels, and pro-vide controlled release of cannabi-noids. The study also found that the addition of certain proteins can add to permeability and that cannabinol and cannabadiol are more permeable to the skin than THC. Finally, in this study, which used hairless guinea pigs for research subjects, there was diffi-culty in obtaining a high enough plas-ma level to be effective—an indicator that simply applying lotion or oil top-ically won’t relieve joint pain or other internal pains.

Factors in Perceived Effectiveness.

Studies to date have pretty clearly established that cannabis is effective for topical and possibly muscle prob-lems. However, the fact that cannabis doesn’t get you high when topically applied is good evidence that it does not reach the CNS or bloodstream. However, there’s no

lack of testimonials (on Internet boards and heard personally by the author) to the effect that commercial or homemade cannabis-infused oint-ments and lotions are an effective alternative for treating a variety of medical conditions beyond superfi-cial skin disorders.

Without good studies proving that topical cannabis preparations are effective for more than skin condi-tions, e.g., for joint pain or headache, it’s hard to know whether those that are homemade or on the market are really doing what people claim they are doing. Several factors may be at play. These include:

  • Placebo effect
  • Using another method at the same time
  • Other ingredients are causing pain relief
  • They do work, but the right studies haven’t been done

Placebo effect. According to The Skeptic’s Dictionary, “The placebo effect is the measurable, observable, or felt improvement in health or behavior not attributable to a med-ication or invasive treatment that has been administered.”(15) There is dis-agreement as to whether this effect is psychological, physical, or has some other cause. An example of what may be the placebo effect is the claim of some individuals that they have gotten high simply from trimming bud or otherwise handling cannabis plant material. The placebo effect may be at play when topical cannabis preparations are used to treat some medical conditions.

Using another method at the same time. If a person is smoking cannabis, for example, while also applying a cannabis-infused oil to an affected area, determining which method causes the therapeutic effect is impossible. (This obviously isn’t always the case, as many medical cannabis users have no desire to get high.) The only true test is to stop all other methods and try only the topi-cal application for a period of time.

Other ingredients are causing pain relief. Some topical preparations rely not only on carrier oils to get cannabis into the skin, but also con-tain other essential oils such as euca-lyptus, peppermint, menthol, or camphor. These are some of the ingredients in Tiger Balm, a non-cannabis product that is sold for muscle pain relief and works. The principle behind these ingredients is the same as applying heat to joint pain. So is it the cannabis or the other oils? (Or both?)

This is an area that is ripe for study. It may be that cannabis combined with other ingredients adds to the beneficial effect. An example would be camphor, glucosamine, and chon-droitin sulfate in a topical prepara-tion, which were found in a study to relieve osteoarthritis pain.(16)

They do work, but the right studies haven’t been done. Clearly, more studies need to be done. When I started researching this article, I did-n’t believe that cannabis ointments and lotions had a therapeutic effect on anything other than skin condi-tions. I had tried such a salve years ago and found that it did nothing for my muscle pain.

Because I work in the medical mari-juana industry, I continued to hear claims that topical applications are effective in treating all sorts of pain, including muscle and joint pain. Then one day, a man came into our clinic with some olive oil that con-tained 1% hash (or honey) oil. When I scoffed at him, he handed me an eight-ounce bottle with the demand that I try it. I was shocked several days later when I applied it to my shoulders and neck for severe muscle pain and found relief within 15 minutes.

Conclusion. Cannabis salves, lotions, and ointments can be effec-tive treatments for certain skin con-ditions, such as burns, infections, and rashes. Some preparations are also effective in treating muscle pains.

Use of these products is fairly harmless and doesn’t cause psy-choactive side effects, which makes it a good method for such problems.

Other better methods, such as vapor-ization or oral ingestion, exist for treating medical conditions not affecting the skin or muscles. There is no evidence that topical prepara-tions have an effect on headaches or internal problems. If topical cannabis preparations are even effec-tive on joint pain, they would likely be more useful on joints that are close to the skin, such as the fingers or knees.

Despite their shortcomings, topical preparations are a good addition to the medical arsenal that this amazing herb can provide. In the future, we can expect to see more studies of their effectiveness, as well as more sophisticated delivery methods and combinations of herbs or other sub-stances.

Cheryl K. Smith is an attorney and Executive Director of Compassion Center, a medical mari-juana clinic and educational nonprofit in Eugene, Oregon, and serves as secretary of the board of the Institute for Cannabis Therapeutics in Oregon. She raises miniature dairy goats and is a freelance writer and editor.

References

1.The Therapeutic Use of Cannabis sativa (L.) in Arabic Medicine. Lozano, I. J Cannabis Therapeutics 1(1): 63–70.

2.Distribution of cannabinoid receptor 1 (CB1) and 2 (CB2) on sensory nerve fibers and adnexal structures in human skin. Stander, S., et al. J Dermatol Sci 38(3): 177–188.

3.IACM Bulletin, 6 August 2006, citing Topical cannabinoid agonists : An effective new possibility for treating chronic pruri-tus. Stander, S., et al. [Article in German] Hautarzt. 28 Jul 2006; [Electronic publication ahead of print]

4.Transdermal delivery of tetrahydrocannabinol. Touitou, E., et al. International J Pharmaceutics 43 (1–2): 9–15.

5.Allergic Skin Test Reactivity to Marijuana in the Southwest.

Freeman, G. Western J Med138(6): 829–831.

6.Allergy to Marihuana. Liskow, B., et al. Annals of Internal Med 75(4): 571–73.

7.Beverly Potter and Dan Joy. Healing Magic of Cannabis. (Berkeley: Ronin Publishing, 1998.)

8.The Hebrew University of Jerusalem. “Cannabis May Help Alleviate Allergic Skin Disease.” ScienceDaily 17 August 2007. Retrieved 22 May 2011 from www.sciencedaily.com¬ /releas-es/2007/08/070816094649.htm.

9.Franjo Grotenhermen and Ethan Russo, ed. Cannabis and Cannabinoids: Pharmacology, Toxicology and Therapeutic Potential. (Binghamton, N.Y.: Haworth Press, 2002.)

10.Brooke, Lawrence, et al. 2000. Cannabinoid patch and method for cannabis transdermal delivery. U.S. Patent 6328992, filed September 5, 2000, and issued December 11, 2001; Stinchcomb, Audra L., 2009. Transdermal delivery of cannabi-noids. Application 12/511,226, Publication US 2009/0291128 A1, filed July 29, 2009.

11.Dimethyl sulfoxide (DMSO), which has been used as a com-mercial solvent since 1953, is a byproduct of the wood industry. Its potential medical uses were first noticed by Dr. Stanley Jacob, MD, a physician at Oregon Health Sciences University, in 1961. In the midst of studies to determine its effectiveness, FDA closed down clinical trials and, other than approving its use for intersti-tial cystitis, has generally continued to refuse to approve any new trials. DMSO easily crosses membranes and has the added attribute of carrying other drugs across these membranes.

12.Oleic acid is a monounsaturated omega-9 fatty acid found in various animal and vegetable fats. It makes up a large part of olive oil, which is often used as a carrier oil in topical cannabis products.

13.DMSO is very effective as a topical analgesic, causing imme-diate relief from the pain of burns, sprains, and strains. Like cannabis, it also has been found to have potential in fighting cancer, bacteria, and other disease processes.

14.http://video.google.com/videoplay?docid=3104946289553 28203#

15.www.skepdic.com/placebo.html.

16.www.prohealth.com/library/showarticle.cfm?libid=1980.

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