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chronic pain, complementary and alternative medicine, menstrual cycle, Supplements

Whoopi Goldberg’s menstrual marijuana has lots of issues, a GYNO explains

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 medical it has to be safe and effective otherwise you are A) wasting your money or B) using your cramps as an excuse to get high or C) exposing yourself to a potential risk (or some combination of the three).

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.

Based on the data available I do not recommend marijuana or THC/CBD products for menstrual cramps.

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.

Wow – the 2 ounce jar has only 2 servings!  So 25 mg of THC (assuming the “approximately” is right and that a BIG ASSUMPTION), which is a lot of oral THC. The clear goal of the THC Savor is to get you high. The dose of oral THC most people consider “safe” if you have no experience with oral use is 10 mg. The maximum recommended daily dose when THC is used for pain in a studied drug 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 one, potentially unsafe and seems to exist for the high only. The CBD one, who knows. 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 is 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.

Does the THC and CBD add anything? Who knows. The dose? Well, a 2 oz jar is small so I guess about half a jar or 12.5 mg, but how much is absorbed? Could you get high from it?

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.

There bottles have a lot of THC, so if someone drank the whole thing that would be very concerning in a psychosis kind of way. 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 – serious overdose potential and 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 and the Tincture have some real concerns. The CBD Savor? Who knows, but I wouldn’t use a compounded product that was prone to separation. After all, they’re selling it as medicine not salad dressing.

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

 

 

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