Earlier this year, singer and actress Olivia Newton-John, revealed that her breast cancer had returned over 20 years after her original diagnosis. And in a recent interview with Australia’s 60 Minutes, she opened up about the details of her pain—and that she’s been using medical cannabis to deal with it.
Originally diagnosed with breast cancer in 1992, Newton-John said in May that her cancer had come back. Initially, the 68-year-old thought she was dealing with back pain. But it turned out that her pain was caused by breast cancer that had returned and metastasized into the bones of her lower back.
“The pain level was really the hardest thing,” she said in the interview. “I was trying to do shows and it was pretty agonizing,” she continued. She says she can walk now, but only short distances.
But, in an interview with Today this week, she says she’s not as scared this time around, partly because her daughter is an adult now. “I’ve had a wonderful life,” she said, “so I’m not as freaked out as I was when I had a young child.”
Still, treating metastatic cancer and its symptoms is serious business. In addition to undergoing photon radiation therapy, Newton-John says she has been using cannabis grown by her husband to help with the pain caused by her illness. Although it’s still a somewhat controversial topic in the U.S. (and illegal at the federal level), some experts believe medical cannabis really can help with chronic pain—especially pain that’s related to cancer.
Pain management is one of the few uses for medical cannabis that we actually have solid research on.
“It’s extraordinarily useful for pain control,” Jordan Tishler, M.D., a medical cannabis expert based in Massachusetts, tells SELF. “A number of studies show that when you compare opiates and cannabis for pain, they’re sort of equivalent in how they work,” he says, “but cannabis is much safer.” Some research has even shown that cannabis can help patients decrease their use of opiates, a welcome benefit in the context of our current opiate crisis.
“Treatment for cancer pain is one of the indications [for cannabis] that has quite a bit of research on it—including pain that hasn’t responded fully to opioid medication,” Dustin Sulak, D.O., founder of medical cannabis education company Healer, tells SELF. But he explains that a fair amount of the research on cannabis and chronic pain comes from the clinical trials for Sativex, a drug approved in several countries outside of the U.S. containing the two major compounds in cannabis—not the plant itself.
That’s because it’s “very difficult to study cannabis [the plant] as a therapeutic intervention in the U.S.” due to its status as a Schedule I drug, Donald Abrams, M.D., an integrative oncologist at UCSF, tells SELF. That designation means the drug has a high potential for addiction and no accepted medical value (according to the DEA). This creates a sort of catch-22 scenario: Researchers have a hard time getting access and funding from the government to study cannabis’ potential medical uses because it’s a Schedule I substance, which makes it nearly impossible to study whether or not it should actually be a Schedule I substance.
The research we do have, however, is encouraging. In one double-blind placebo-controlled trial published in 2013, those who were on low doses of Sativex reported less pain daily than those in the control group. All of these participants were also taking opioids, but still experiencing refractory pain. An earlier review of Sativex-related research concluded that it improved patient’s sleep quality, especially among those with chronic pain conditions.
And, a meta-analysis published in JAMA in 2015 looking at 28 previous studies found overall “moderate-quality” evidence to suggest medical cannabis could ease chronic pain. Earlier this year, Dr. Abrams co-authored another comprehensive review of that same data for the National Academies of Sciences, Engineering, and Medicine and found similar results. That committee concluded that there is “conclusive or substantial evidence that cannabis is effective for the treatment for chronic pain in adults.”
However, he says, yet another review of that data published just this month in the Annals of Internal Medicine found that cannabis had no effect on pain. So, although we are beginning to form a more solid understanding of cannabis’ effects here, the science isn’t totally settled.
Researchers don’t totally understand the way cannabis helps with pain, but they have a pretty good theory.
We tend to think of pain as simple process (“I stubbed my toe and now it hurts and that sucks”). But, Dr. Tishler explains that the way your brain interprets and manages pain signals is actually far more complicated than that—and there’s a possibility for cannabis to act at nearly every step of the way.
First, there’s inflammation at the site of the pain (e.g. in your toe). “That inflammatory process is mediated by a bunch of cells that secrete chemicals that help repair the damage but also stimulate the nerve and their own cells,” Dr. Tishler says. Those cells have cannabinoid receptors on them, which are activated by the cannabinoid compounds your body creates on its own and those in cannabis (primarily THC).
Cannabinoid receptors are also present in cells along your spinal cord and in the areas of your brain involved in processing pain. So, at multiple points along that pathway, there’s a potential for cannabis to interact with your body’s natural processes to calm inflammation and pain signaling.
But treating pain with cannabis isn’t as simple as getting high whenever you’re hurting.
Although that might work for some people, that isn’t what these experts are suggesting. “Most of the patients who are coming to me to treat pain—particularly from cancer—are not experienced users,” Dr. Tishler says. “We get a lot of people that it took a terminal diagnosis to get them to be open minded to cannabis,” Dr. Sulak agrees.
Regardless of your experience (or lack thereof) with cannabis, it’s wise to speak with a professional (i.e. your doctor or oncologist) to come up with a treatment plan, the logistics of which may differ depending on your location and situation. For instance, because medical cannabis has been available for this use since 1996 in California, Dr. Abrams says he can prescribe it by simply writing a letter for a patient, which they can then take to a dispensary. But Dr. Tishler says many of his patients are referred to him by their oncologists.
But, in all circumstances, how much you’ll consume—and how you’ll consume it—will depend on a variety of factors. For instance, Dr. Tishler says that the effects of cannabis take longer to come on when taken orally (with edibles) than when inhaled, but those effects also last longer.
And, as is the case with basically any burned material, smoking cannabis comes with inhaling carcinogens. (Albeit, far fewer than those you would inhale from cigarettes.) And smoke in itself can irritate the lungs. So Dr. Tishler and Dr. Sulak recommend using a vaporizer to inhale cannabis instead, which heats the plant material without burning it.
Although Dr. Abrams says he doesn’t have any problems with his patients smoking cannabis, he recommends they smoke or vaporize the actual plant material rather than a concentrated oil or wax because there isn’t much research about the health effects of those formulations. He also cautions that cannabis can increase your heart rate, so patients who have cardiac issues may want to steer clear.
Unlike in the U.S., medical cannabis has been legal in Australia since 2016. For those who are interested in trying medical cannabis for their pain but don’t happen to live in a state where that’s legally available, Dr. Sulak suggests talking to your doctor or oncologist. They may know about pharmaceutical-grade THC that they can legally prescribe (a.k.a. dronabinol).
At this point, medical cannabis is available in 29 states and the District of Columbia. So, although Newton-John’s herbal remedy may seem as far off as it is far out, it may be a little closer than you think.
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