My phone blew up this morning with health reporters asking about Whoopi Goldberg’s new health venture – medical marijuana for period pain.

Why did the health reports ask me? Yes I’m a doctor on social media a lot, but I’am also board certified in OB/GYN as well as holding two different board certifications in pain medicine. I have unique expert qualifications to discuss this topic.

Medical cannabis is different from recreational use. For it to be recommended as medical it should be safe and effective. People also should know what they are taking as THC is not believed to be important for pain control.

(Note from Jen. An advocate reached out to me about the wording in the above paragraph, which has now been changed. It was poorly written and reading it now I can see how it could be hurtful to some and I apologize. I never meant to insinuate that cramps are used as an excuse. I have always believed every woman with pain. I have dedicated my professional career to helping women with pain. I was trying to covey — very poorly — the idea that a pure THC product is not recommended medically for pain control as we think the CBD component is very important. I have included the way I reached those conclusions below in the post based on the best available data in 2016, when the post was written. Thank you to the person who reached out and kindly helped me to do better. Once again, I apologize to anyone I offended or hurt. Looking back I a shocked at how it read and I appreciate being notified. I am always trying to do better. I am including this note right after the correction for transparency.).

So what about Whoopi’s menstrual marijuana?   

Marijuana may help pain in a variety of ways, but it is really under studied so all these products hyping themselves as some natural cure from mother earth are, well, just hype for now. Sometimes the hype proves out to be worth it and other times it’s a bust. Remember when we though opioids would be awesome for everyone with pain? Right. We have opioid receptors in lots of places just like we have endocannaboid receptors in lots of places, but stimulating receptors pharmacologically doesn’t always do what we think it should or want it to do. That’s why pharmaceuticals, and yes Whoopi’s period pot is a pharmaceutical, need to be studied.

THC and cannabidiol (CBD) are the compounds that Whoopi & Maya’s products contain. THC is psychoactive (causes the high) with marijuana and can relax muscles. It may help pain. It can also cause anxiety, paranoia, and dysphoria. Cannabidiol can stimulate receptors in the brain, reproductive, endocrine (hormone), gastrointestinal, and vascular systems. Some research suggests CBD may lessen the bad side effects of THC (like the rapid heart rate and anxiety), but we don’t know for sure. CBD may also help pain (probably more so than THC, but the jury is still out).

To help period pain a product probably needs to work on prostaglandins and while THC and CBD might do that in animal models, we don’t know enough to say for sure. One study I read found they were not very potent blockers of prostaglandin production. In some ways period pain is like acute pain and we don’t really know if cannabis can even help acute pain. The studies are not terribly robust or encouraging. I will admit the studies are all in their infancy, but that also means it’s a little to soon to be producing niche products.

There are no studies on THC and/or CBD for menstrual cramps, so everything I am going to say about the product is based on what I have read about the ingredients and what I know about pain medicine, which is a lot. I’m not paid my Big Pharma for anything and very open to any therapy that works. For example, I prescribe TENS units for painful periods all the time.

 

The Soak

Contains epsom salts, apricot kernel oil, avocado seed oil, sun grown cannabis, jojoba oil, tocopherol (vitamin e), aloe barbadensis (aloe vera), and essential oils.

Unlikely to anything medical at all. Heat helps cramps, so the warm water might be soothing and certainly if you take the time out your day for the self-care of a bath you might feel better, but skin is waterproof so there isn’t a lot of medicinal absorption going on. Imagine what would happen to us swimming in the ocean!  Might it smell nice and might that make you feel better? Sure, but you can get a lavender pillow at Walgreens or some inexpensive lavender aromatherapy at Target. Also, I see allergic reactions to plant-based products in bath water all the time. Cannabis can cause an allergic contact dermatitis (likely rare, but it is described) so there’s that too.

Verdict – likely placebo.

soak-lavender

 The Savor (an edible)

There are two – THC only and CBD heavy. The THC one has approximately 50 mg THC in a 2 oz jar and approximately 100 mg  THC in a 4 oz jar. Every time THC and CDB are listed they are prefaced by approximately. I like my medicines to be accurate (especially ones with a psychoactive potential), but that’s me. The CBD heavy one has 40 mg CBD and approximately 2 mg THC in a 2  oz jar and 80 mg CBD and approximately 4 mg THC in an 8 oz. jar.

Other ingredients: organic raw cacao butter, organic raw cacao powder, organic coconut oil, organic raw agave, sun grown cannabis, sea salt.

There is nothing in here that is really medicinal except the THC/CBD. The serving size is 28 g or one ounce.

The 2 ounce jar has only 2 servings!  So 25 mg of THC (assuming the “approximately” is right and that a BIG ASSUMPTION) is a lot of oral THC. The maximum recommended daily dose when THC is used for pain in a studied drug (that also contains CBD) with no “approximate” dosing is 32.5 mg spread throughout the day. As the product can separate (it says so on the site) this could lead to inconsistent dosing.

The CBD heavy one might possibly be of use for pain, but it is untested. And again, the separation means a compounding issue and this affects dosing and drug stability. A drug should not separate, that’s why compounding pharmacists have to levigate and emulsify correctly.

Verdict – the THC product has a lot of THC and we don’t believe THC is important for pain relief. The CBD one, maybe an option, but it is untested. Untested and the separation issue is a big deal for me. It’s not salad dressing it’s medicine so it does actually matter how much of the THC/CBD you get.

The Rub ( a salve or topical)

For the rub to be effective the ingredients need to be absorbed through the skin and enter the blood stream and circulate to the uterus where the cramp causing chemicals are being produced. To do this a topical must be compounded correctly which means the right dose in the right vehicle or base. Some drugs cross the skin better than others. THC is lipophilic so should theoretically cross the skin if compounded correctly (there are people who make transdermal patches).

The ingredients in the rub are “approximately” 50 mg THC and 15 mg CBD in a 4 oz jar and “approximately” 25 mg THC and 10 mg CBD in a 2 oz jar. Also olive oil, avocado seed oil, apricot kernel oil, jojoba oil, beeswax, sun grown cannabis flowers, St John’s Wort, Cramp Bark, White Willow Bark, Chamomile and essential oils. Not sure the dose – a teaspoon, a tablespoon, half a jar?

St. John’s Wort has never been tested for dysmenorrhea. The one study on oral chamomile was considered “unsuitable for analysis” for a Cochrane review. Cramp bark (Viburnum opulus) is promoted on many sites, but there are no studies.  White Willow Bark when taken by mouth can help back pain. The ingredient is similar to aspirin and topical aspirin can help pain, but then again you could just get Aspercreme.

Verdict – who knows, could be placebo but definite erratic dosing concerns. If there is enough white willow bark and it is  compounded correctly it could potentially help, but that seems a cumbersome way to get the effect. Orally would likely be much cheaper.

The Tincture

Serving Size: 1 dropper (and all THC, no CBD). The math is a bit fuzzy. The site says “Approx thirty 3.3 mg droppers per 1 oz bottle.” They must mean each dropper has 3.3 mg of THC and there are 30 servings. But maybe not, who knows.

The bottles have a lot of THC, so if someone drank the whole thing that might be concerning. The 1 oz bottle has 100 mg THC and the 2 oz bottle 200 mg.

If put under the tongue this dosing will be very different from a hot beverage or a “sparkling” beverage. Heat and carbonation affect absorption. Oral is different than under the tongue, so to imply it could be used the same way to get the same benefit is ridiculous. Under the tongue, if one dose is used and it 3.3 mg of THC, is about the same dose as Savitex, but that’s a lot of ifs.

Other ingredients are cane alcohol, vegetable glycerine, sun grown cannabis, organic raw unfiltered honey, organic elderberries, cramp bark, red raspberry leaf, passion flower, motherwort and solvent-free cannabis extract.

There are no studies on motherwort for painful periods. Motherwort might cause miscarriage and possibly increase uterine bleeding and can also interfere with many cardiac medications. I wouldn’t use motherwort without safety studies especially when the dosing is unknown and “approximate” at best.

Whoopi and Maya think this kind of tincture was good enough for Queen Victoria so it’s good enough for you! What’s next, Victoria era surgery? I don’t know about you, but I like my medicine a little more modern. I’ll just leave this Victorian era case report (from 1840) here that describes a case of 48 hours of serious side effects (unconscious, twitching, violent ill health etc.) after the use of a tincture for dysmenorrhea.

Verdict –  motherwort has unresolved safety issues.

 

Summary

The Soak likely can’t help anything at all, but maybe it smells nice. The Rub could be placebo, but there is a potential for erratic (in medicine that’s bad) absorption. The THC Savor is just THC so I am unclear why that is promoted for pain control and the Tincture has some real concerns. The CBD Savor? That seems the best option, but unclear based on lack of data. A compounded product prone to separation could be a concern.

If Whoopi really wants to help women with medical marijuana maybe she could fund some studies. Just saying.

 

 

Dec 2, 2019

This post has been edited for clarity. One note is above.

Also, as this data is 3 years old there may be more information on THC and CBD for pain. This was based on data available in 2016. In general I recommend against using medical information online that is older that 2 years newer medications as things are evolving constantly or hopefully they are.

 

 

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