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The Science of Pain and Cannabis: A Chat With Dr. Staci Gruber

Staci Gruber, PhD, is the director of the Cognitive and Clinical Neuroimaging Core and director of the Marijuana Investigations for Neuroscientific Discovery (MIND) program at McLean Hospital. The MIND program was designed to support a wide range of studies that generate ecologically valid, empirically sound data regarding medical cannabis use. Through these investigations, MIND examines the unique and synergistic effects of cannabis and its constituents to determine the efficacy of cannabinoids for specific conditions and diseases and to clarify the overall impact of cannabinoid-based treatments on physical and mental health.

MIND is poised to improve patients’ overall well-being by striving to harness the therapeutic potential while minimizing harms of cannabinoid-based treatment.

Foria has partnered with Dr. Gruber to conduct a research study on the efficacy of CBD suppositories, in an effort to find natural and safe alternatives for relief from debilitating menstrual pain. We were thrilled to chat with her about cannabis research, women’s health, and the exciting future of an ancient natural medicine – explored through modern science.

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Foria: What drew you to this plant? What was it about cannabis that piqued your interest?

Dr. Gruber: Many, many years ago, when I first started at McLean Hospital – which at this point is now several decades, I'm embarrassed to tell you – among other work that I was involved with, which had to do with the neurobiology of different psychiatric disorders and substance use, we were doing studies of recreational cannabis consumers, primarily studies of college students. 

And my job was to administer comprehensive neuro-psych batteries to these college students who were using recreationally several times a day. So it's been a part of my professional life since the very early days. When we think about what we know with regard to the impact of medical cannabis use, it's a very different story from what we know about the impact of recreational cannabis use.

So I guess that's a long-winded way to say I've always been interested, because we know so little about the long-term effects of cannabis use for medical purposes, especially in comparison to what we know or what we think we know about the impact of recreational use, and they are really very different. 

The reason I started the MIND Program in the end of 2014 [was that] despite really scouring the literature, and despite the fact that cannabis has been legal in the United States for medical purposes since 1996, we don't really have data on the long term impact of cannabis use as medicine in terms of things like cognitive performance, quality of life, sleep changes, and conventional medication use. And I really couldn't believe that.

That's when I started the program. I couldn't find anything that looked at the long-term impact of cannabis used for medical purposes, when the goal is not to get high, to change your current state of being, but to simply feel better.

What are the major differences between recreational and medical cannabis consumers?

Some of the things that really differentiate the two populations have to do with product choice, first and foremost, even before you get to frequency and magnitude. What's the goal of use? If it's to relieve pain, or to relieve anxiety, or for almost any indication, it may well be that you choose a product that's very different from someone who's exclusively looking to get high.

Things like concentrate products are designed to have significantly higher levels of THC, the primary intoxicating constituent of the plant. They're designed for one purpose, to give the consumer a bigger bang for the buck. Those products have almost no cannabidiol [CBD] or other non-intoxicating constituents, which may actually have their own bio-behavioral health effects. 

So I think product choice is the very first distinguishing fact. Recreational consumers tend to choose things that are high in THC. Medical consumers may choose products that have considerable THC, or they may choose products with very little to no THC, that have a range of other cannabinoids, other constituents, a full range of terpenoids – the essential oils that give cannabis its characteristic flavor profile, but also exert their own effects.

I think, historically, we tend to lump everybody together. That's a mistake. Most of our patients say, “I don't want to get high. I just want to be able to take a walk with my husband.” “I don't want to feel completely blotto. I just want to sleep through the night and not be awakened by pain.” So these are very different goals.

This brings us to the study that we are collaborating on with you, about the effect of our CBD suppositories on menstrual pain, which we're very excited about. Cannabis has been used for pain, both officially and unofficially, for a very long time. What studies have you seen on the effects of CBD or cannabinoids in general on menstrual pain?

On menstrual pain specifically, as opposed to generalized pain, there's really not much. This is part of the problem.

In terms of pain, we don't really have empirically sound data so far, that looks specifically at menstrual pain, or pain that is related to endometriosis, or other conditions that disproportionately impact women. 

Anecdotally, we know that anti-inflammatory and analgesic agents tend to help with pain, especially pain related to menstruation, so it's not surprising that women say “I took two hits and suddenly my cramps are gone.” It is not clear how these mechanisms work at this point, and especially not clear with regard to the individual constituents and the route of administration.  

This is why these types of studies are so critical. And it's you know, it's not just about premenstrual or menstrual pain. You have endometriosis, you have pelvic inflammatory disease, you have all sorts of things that women are confronted with, with very few treatment options available that don't necessarily convey unfortunate side effects.

So cannabis, for many women, presents a real opportunity to try a non-conventional or non-Western approach to solving the problem. We don't [yet] have much in the way of understanding the impact of cannabis or cannabinoids on menstrual pain, that really is rather debilitating for a very large percentage of women.

It’s really unfair, if you think about it. Think of the sheer number of women you know, in your life, who have complained of pain or nausea of bloating to the point where some women are so overwhelmed by pain that they will literally pull the car overand and throw up. If there's something that we can do to exploit the potential benefit of certain cannabinoids, we should be doing it. 

And you know, if these things affected men, we have no shortage of potential treatments. But I think we are now entering an era where we really can focus much, much more closely on the relationship between cannabis and cannabinoids and pain, specifically related to things like menstruation, or PID, or endometriosis. And from my perspective, for other things as well. You know, there's lots of reasons to be looking at cannabis and cannabinoid-based therapies for other conditions that seem to disproportionately impact women.

What interested you about our suppositories particularly?

A lot of people are very interested in alternate routes of administration that are not quite as – I wouldn't say they're not systemic, because when you insert a suppository, it's certainly not just local, but it's a far more localized administration method than taking something that's an oral sublingual tincture, for example.

I'm very interested to see what the experiences from these women look like in terms of what they notice right away. Because I think that will really help guide how these products can be made extremely effective. Lots of women are affected just before the onset of menses, a lot of women are affected the moment their flow starts. So that’s an interesting thing to look at.

I think that suppositories offer some unique opportunities to understand the ways in which these products work, especially given the fact that when you take something – whether it's a sublingual solution, or smoking, or inhaling, or consumable, or a topical, people work differently. And that's going to be very important for us to know, right? 

What other cannabinoid research are you most excited about?

I think some of the most exciting stuff is exploring the potential utility of some of the lesser-known cannabinoids. Everybody always wants to talk just about THC and CBD, and I think that's great as a start. I can tell you that there are other cannabinoids that are far more effective at things like helping with inflammation or pain, and we don't have real data yet, but it would appear they work synergistically with our Big Two. 

So I think the most exciting things to figure out [are] the role of what I would call whole-plant full-spectrum versus broad-spectrum versus single extracted constituents. I think that if you can understand some of the ways in which these things interact and or work on their own, we actually have quite a platform that we can then [utilize] for lots of different conditions and indications. 

When you combine that with some of the other work that we're doing with regard to clinical or cognitive outcomes, that actually allows us to predict what you're going to look like afterwards – you're starting to get to the point where you go, wow, this is really the ultimate personalized medicine. And to me, that's the most exciting.

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