With 19 states allowing marijuana to be used for medical purposes, and four states—Alaska, Colorado, Oregon and Washington—plus Washington, D.C., allowing the possession of marijuana by adults for both medical and recreational purposes, the cultivation of this plant and the manufacture of various health-related products derived from it is at an all-time high.
A medical marijuana patient may purchase marijuana in bud form, in strains with names such as Headband, Jack Flash and Buddha’s Sister. Tetrahydrocannabinol (THC)—or cannabidiol (CBD)—infused chocolate bars, elixirs, tinctures and hard candies might also be in a medical marijuana dispensary’s cases, along with a variety of marijuana-derived topical products
That category of topicals—the growing number of CBD-containing salves, creams, oils and patches touted as relaxing and pain-relieving—is the point at which marijuana and massage intersect.
MASSAGE Magazine spoke with experts around the U.S. to get the answers to questions massage therapists have about marijuana and massage, regarding the differences between products that contain hemp-derived versus marijuana-derived CBD; the pain-relieving mechanism of cannabis products; possible effects on massage therapists who apply such products; legality; and research.
1. Does every type of massage-related CBD product contain the same marijuana-derived ingredients?
No. Some of the salves, creams, lotions, oils, sprays and patches on the market contain hemp-derived CBD, which contains a miniscule amount of THC—no more than .3 percent—as their pain-relieving property; others contain marijuana-derived CBD, which contains much more—up to 25 percent in dried marijuana buds—THC.
Both CBD and THC are compounds within plants of the genus Cannabis—which includes both hemp and marijuana. CBD oil derived from hemp does not effect the high commonly associated with marijuana, according to several sources. CBD oil derived from marijuana contains an appreciable amount of THC, the same compound that gets people high, or stoned, when they smoke a joint.
2. What is the mechanism by which CBD and THC might effect pain relief?
Both CBD and THC are called endocannabinoids, and both act as ligands—or chemicals that bind to receptors—at cannabinoid receptors within the central nervous system, according to the article, “The Endocannabinoid System, Cannabinoids, and Pain,” posted on the National Institutes of Health’s website. The human body contains an endocannabinoid system, which is involved in “a host of homeostatic and physiologic functions, including modulation of pain and inflammation,” the article noted.
Jean Talleyrand, M.D., is the founder of MediCann, which operates complementary health care clinics that offer massage, medical cannabis consultations and more, throughout California. In an interview with MASSAGE Magazine, Talleyrand explained that both THC and CBD stop pain through the endocannabinoid system.
“This system consists of at least two receptors, termed CB1 and CB2 … the receptors are in every organ, including the skin, and typically found on nerve cells and immune cells in these organs,” he said.
The [endocannabinoid] system modulates inflammation and pain, said Talleyrand—and because inflammation may also cause pain, the system affects pain in two ways.
First, THC directly binds to both CB1 and CB2 receptors, and so directly influences pain, while CBD binds to a TRPV1 receptor. That TRPV1 receptor has, in turn, a positive influence on the CB1 and CB2 receptors, which is how CBD indirectly mitigates pain, Talleyrand said.
Additionally, he said, “TRPV1 is directly related to pain transmission, and thus CBD may influence pain in this direct fashion as well—and that is why CBD is considered the more anti-pain compound of the two cannabinoids.”
Osteopath Dustin Sulak, D.O., who treats patients with cannabis at his Maine Integrative Healthcare clinic in Manchester, Maine, told MASSAGE Magazine that both THC-containing and almost-THC-free CBD have numerous anti-inflammatory effects that can decrease pain, “mostly by preventing the release of inflammatory signals from B and T immune cells, and in animal studies [have] been shown to prevent the development of hyperalgesia, or abnormally increased pain signaling at the site of an injury.”
CBD has also recently been shown in animal studies to speed the healing of injured connective tissue, and also has numerous anti-anxiety mechanisms, which can indirectly influence pain and pain behavior, Sulak added.
3. Would a massage therapist who applies a CBD- or THC-infused product with his or her bare hands get high from doing so?
This is possible but not likely, according to Talleyrand, who said the THC and CBD oil applied in massages is unlikely to raise blood levels enough to cause a high.
“Patients who receive THC or CBD massages only report the high from relaxation, [which is] different from the high of [ingesting] THC,” he said.
However, both THC and CBD are absorbed systemically via the skin, meaning a massage therapist using a topical product containing THC could potentially experience a psychoactive effect from what he or she absorbs through his or her hands, Sulak said.
“It all depends on the dose,” he said. “If a very potent oil is used over a large surface area, some psychoactive effects will likely occur, but typically the dose and potency needed to produce local benefits like pain relief and muscle relaxation can be achieved at potencies that will not cause either the therapist or client to get high.”
The key to staying sober when using cannabis oil, said Sulak, is to stay in the 1-to-2 milligrams-per-milliliter potency. “This will typically be a light green or amber coconut oil that has cannabis extract or whole herb infused into it,” he explained. “Cannabis oil can also refer to a full-strength extract, which is very sticky and usually has a potency of 500 milligrams per milliliter, or more—not a good idea to try this for massage.”
4. Is it legal for massage therapists to use marijuana- and hemp-derived topical products?
It depends on where the massage therapist practices, and on the type of topical product he or she intends to use.
Whether marijuana is legal for medical, recreational or both types of use, there are myriad laws regarding the use of THC-containing products—and in some states, no regulations specifically addressing topicals—so massage therapists must obtain information directly from their state.
In Colorado, for example, where marijuana is legal for medical and recreational use, massage therapists and day spas are cashing in on the popularity of cannabis with treatments such as the Mile High Massage, offered at Denver’s LoDo Massage Studio—while in Alaska, where a recreational marijuana law goes into effect in 2016, regulations regarding topical use have not been finalized.
Michael Hayes, the president of the Care By Design Guild, which manufacturers CBD sprays, oil and other products, said a person working in a state where marijuana is illegal “almost certainly cannot buy or use THC-infused products.”
However, CBD derived from hemp is legal to purchase, ship and use in all 50 states, because it does not contain THC, according to medical massage educator Shamaya Chah, who developed and sells a concentrated pain-relieving, hemp-derived CBD Salve through her business, Advanced Therapies of Mount Dora, in Mount Dora, Florida.
More information about the legality of forms of marijuana-derived products may be found at the websites of the National Organization for the Reform of Marijuana Laws and Governing—and, again, the best source of information on a state’s laws is each state’s government.
5. Has research been conducted that supports claims made by companies that sell marijuana- and hemp-derived massage products?
No. Some researchers have begun looking at the effects of endocannabinoids, but there is no solid body of evidence yet.
A search of the U.S. National Library of Medicine’s database turned up little in the way of cannabis research, and most of it is on the ingestion of CBD products for medical conditions including chemotherapy and AIDS-related nausea; epilepsy; and multiple sclerosis.
The database search did bring back the article, “Cannabidiol: Promise and Pitfalls,” which noted, “Over the centuries, a number of medicinal preparations derived from C. sativa have been employed for a variety of disorders, including gout, rheumatism, malaria, pain, and fever. These preparations were widely employed as analgesics by Western medical practitioners in the 19th century.”
According to one source, the nonprofit Canadian Consortium for the Investigation of Cannabinoids will soon conduct a study on applied cannabis oil.
Until evidence builds, the exact pain-relieving effects, and the mechanism by which marijuana- and hemp-derived topical products may relieve pain, is unknown.
“Very few studies have been conducted regarding the efficacy of topical cannabis creams, and the vast majority of claims praising their medical performance are purely anecdotal,” Jordan Tishler, M.D., a medical marijuana doctor in Cambridge, Massachusetts, told MASSAGE Magazine. “These claims, while outwardly logical, are simply not supported by any sort of robust or conclusive body of medical literature.”
Relief for clients
Patients, physicians and other health care practitioners aren’t waiting for double-blind studies to take place. They are using THC and CBD products now, in forms including oils, salves, creams and patches.
Shah, who sells the CBD Salve, said she was teaching a massage class recently, and one student was experiencing the pain of fibromyalgia at a level 7. “She used the salve and almost immediately went down to a 0,” Shah said. “[The salve] helps reduce pain immediately, if the pain is muscular in nature.”
And Sulak said that in New England clinics, where he and colleagues treat more than 18,000 patients with cannabis, there have been “numerous reports of topical cannabinoids working wonders for arthritic joints, tender points, muscle spasms, phantom limb pain, peripheral neuropathy and inflammatory skin conditions—and we almost never hear any reports of adverse effects associated with its use.”
The acceptance and use of marijuana is growing. A bill providing for the legalization of medical massage in Pennsylvania has been sent to the state’s Health Committee, for example, while voters in Ohio will decide whether or not to legalize marijuana for both medical and recreational use when they go to the polls on Nov. 3.
Massage therapists interested in using CBD- or THC-infused topical products to effect pain relief for clients must understand their particular state law, and then decide if this type of product will best support their clients and practice—while being cognizant that a growing number of the U.S. general population is increasingly aware of the potential health benefits of both marijuana- and hemp-derived topical products.
About the Author
Karen Menehan is MASSAGE Magazine’s editor in chief. She has also served as MASSAGE Magazine’s editorial assistant, managing editor and editor. Menehan has reported and edited for additional publications and organizations, including Imagine Magazine, the Sacramento Bee newspaper and the LIVESTRONG Foundation.