Can medical marijuana help treat Lyme disease? A doctor’s perspective.
by Daniel A. Kinderlehrer, M.D.
I have a confession to make. I proposed a talk on medical marijuana at ILADS because it would force me to learn everything I could on the topic. I live in Colorado where it seems there is a dispensary on every corner, and many of my patients have been using medical cannabis. But the huge assortment of products is confusing, and I wanted to give specific recommendations to help patients get the most benefit. Here is what I learned.
Marijuana has 483 phytocannabanoids, which are naturally occurring compounds that can affect many body processes such as appetite, mood and sleep. Most people have heard of one of them—THC, or tetrahydrocannabinol—the psychoactive component of marijuana. THC can make you high, giddy, or euphoric, and provide seemingly awesome universal insights that may appear quite trivial the next day.
Some strains of marijuana now available are not your father’s weed—they have a much higher THC content. It’s important to choose the appropriate strain for your needs, and some people may want to avoid THC entirely. However, it has been clearly established that THC is quite beneficial for pain, sleep, nausea, appetite, and PTSD, so there are medically valid reasons for choosing it.
Most of the non-THC phytocannabanoids fall into the category of cannabidiols, or CBDs. CBDs were once considered to be physiologically inactive unless paired with THC, but it turns out that is not the case. There is compelling scientific research documenting its independent activity, and now there is extensive clinical experience as well.
Did you know that we make our own CBDs? All vertebrates going back 600 million years on the evolutionary tree have an endocannabanoid system, which modulates immune and nervous system function. CBDs are potent anti-inflammatory agents, they regulate neurotransmitters, and they may enhance immune competence. CBDs decrease neuroinflammation and are neuroprotective. They can significantly reduce pain and anxiety.
Marijuana is not the only product that supplies CBDs. Hemp, a variety of cannabis that is used to make rope, fabric and paper, contains CBDs. Hemp has less than 0.3% THC, and is not psychoactive.
There are two strains of cannabis: indica and sativa. Indica is great for pain but is sedating, so it is best used in nighttime. Sativa is activating, can increase energy, and is better suited for daytime use. The difference between indica and sativa is another ingredient, terpenes. Terpenes modify the activity of CBD and THC. There are also a number of hybrid strains now available that essentially cross categories.
If your problem is pain, consider taking CBDs in the form of hemp oil in the daytime. My patients have had excellent responses to a liposomal sublingual extract (taken under the tongue), and it is activating, not sedating. In the evening, you can take a marijuana extract with equal parts THC and CBD, since these together will have additive pain-relieving effects. There are a number of delivery systems available, including smoking, vaping, edibles and sublingual extracts. I recommend the extracts since the onset is reasonably quick, usually in about 30 minutes, and the dose can be easily titrated by adjusting the number of drops under the tongue.
Both hemp-derived CBD and marijuana are available as balms that can be applied topically to relieve pain. Whether taken systemically or applied locally, these products can help many patients significantly decrease their need for pain medication. In fact, states that have legalized medical marijuana have experienced a 25% decrease in opiate overdose deaths. That’s right. This scourge, which took 42,000 lives in 2016 (66,000 including all drug overdose deaths), was significantly reduced by the availability of marijuana.
For sleep, take a THC-dominant indica strain. THC is not only sedating, it increases the time spent in the deeper stages of sleep, so sleep is more restorative. If your problem is difficulty falling asleep, use a short-acting vehicle like vaping, which kicks in within 15 minutes. Vaping is high-tech smoking without the ill effects of the smoke. Alternatively, use a sublingual extract, which has an onset within 30 minutes. Both of these will hang around for up to an hour.
If your problem is staying asleep, then take an edible. It takes 60-90 minutes to get into the circulation, and hangs around for an average of 3-4 hours. I don’t recommend cookies or candy, as they usually have a lot of junk in them—you can take pure THC tablets. The average dose is 10mg, but start with 2.5mg to see how well you tolerate it.
If you have problems with both sleep initiation and maintenance, you can take sublingual extract or vape to fall asleep, and a THC tablet to stay asleep. The table below includes some considerations for choosing among the available options.
While THC is only available in states that have legalized medical marijuana, CBD from hemp oil is available everywhere—although the attorney general in Nebraska seems to be confused about that. You can buy it on the Internet, travel across state lines, and I have even taken it out of the country when I traveled to Israel to visit my daughter.
CBD can lessen anxiety, without any of the psychoactive giddiness of THC. CBD is anti-inflammatory—it not only decreases pain, it can improve energy, cognitive function and general well being. When I started selling it in my office, it went flying off the shelf. The full effects of CBD from hemp oil do not kick in for two to three weeks.
While properly administered marijuana has been extremely effective in helping people with PTSD, in some people it will make anxiety worse. Similarly, THC can help depression in some people, but in others can make depression worse, particularly if it is abused by chronic users. If you develop tolerance to the benefits of cannabis because of chronic use, it is important to take a drug holiday. Pregnant women should not take marijuana.
The legal status of marijuana is dicey. It is unjustifiably classified as a Class I controlled substance by the Food and Drug Administration, in the same category as heroin, and the Obama administration declined to enforce federal laws regarding marijuana in states where it was legalized and properly regulated. The current administration is trying to change that, but I predict it will be like trying to put toothpaste back in the tube.
The analgesic, anti-inflammatory and neuroprotective properties of cannabis make it extremely valuable as an adjunct to the treatment of tick-borne diseases. There is a lot of research available on the medical uses of cannabis. A couple of good resources are listed below.
Kowal MA et al. Review on clinical studies with cannabis and cannabinoids 2010-2014. Cannabinoids 2016;11(special issue):1-18
Dr. Daniel Kinderlehrer specializes in the treatment of tick-borne disease in Denver, Colorado. He has found that properly administered medical marijuana and CBD from hemp oil have been extremely beneficial for many of his patients.
A Colorado Lyme doctor reports that properly administered medical marijuana and CBD from hemp oil have been extremely beneficial for many of his patients.
Touched by Lyme
Dorothy Kupcha Leland
Book review: “Cannabis for Lyme disease and related conditions”
In my role as a Lyme disease advocate and support group leader, I regularly hear from people who are sick and suffering and kicked to the curb by the medical establishment. Many are afflicted with serious pain, seizures, nausea, insomnia, or other intractable manifestations of Lyme. Those who have the resources to see a Lyme-literate practitioner may find relief after treatment—though not always. And many others have no access to Lyme-literate care whatsoever. (For more information about why, see our coverage of the IDSA’s stranglehold on Lyme diagnosis and treatment.)
I have no personal experience with medical marijuana. But more and more, I’m hearing from Lyme patients who have tried it for sleeplessness, pain, and other symptoms. Many people say it helps them significantly. Others report no change at all. However, as medical marijuana becomes more available, I also hear from many patients seeking specific information about using pot for Lyme disease.
Because medical marijuana is legal in some places and not in others, the whole area is murky. There are bits and pieces of information floating around on the Internet, but no place that pulls it all together specifically for tick-borne disease. Thus, Lyme patients who do choose to try pot are pretty much flying blind.
A new book, Cannabis for Lyme disease and related conditions, hopes to fill the information gap. Author Shelley White, now publisher and editor of the magazine Public Health Alert, suffered serious Lyme symptoms for many years. Then, she tried cannabis oil, an extract of the marijuana plant.
White does not call the substance a “cure” for Lyme disease, but states, “Cannabis oil greatly reduced the severity of my symptom picture and improved my quality of life while going through Lyme treatment.”
This experience prompted her to learn more about the medical use of marijuana and produce this book to help inform other people with Lyme.
She explains the chemical make-up of cannabis, its different strains, and various ways it can be taken. She discusses the use of cannabis with assorted Lyme symptoms, along with safety issues and legal concerns. She cites scientific research. An appendix includes first-hand accounts by people who have successfully used pot for Lyme disease.
I do not give medical advice and I am not suggesting that the reader try marijuana. However, if you do plan to try treating Lyme with pot, I suggest you do your homework first. And part of that would include reading this book.