Marijuana is big news—and big money.
Many states have passed laws that allow people to use CBD extract, primarily in oil form. Nine states have legalized recreational marijuana while 29 states have legalized medical marijuana.
In just six states—Idaho, South Dakota, West Virginia, Nebraska, Kansas and Indiana—all forms of cannabis are illegal.
The cultivation of marijuana and its cousin, hemp (and the manufacture of various health-related products derived from them) is at an all-time high.
What does this mean for massage therapists curious about products that contain CBD or THC? Here, MASSAGE Magazine tackles the eight most important questions regarding the use of this growing trend.
Glossary of Terms
- Cannabis: the genus of plant to which both marijuana and hemp belong.
- Cannibinoid: chemical compounds found in cannabis plants; there are more than 100 active cannabinoids in cannabis.
- THC: a cannabinoid that has psychotropic effects.
- Cannibidiol: a cannabinoid that has pain-relieving and other effects, minus the psychotropic effects of THC.
- Marijuana: a cannabis plant bred for a high THC content.
- Hemp: a cannabis plant containing less than 0.3 percent THC.
A medical marijuana patient may purchase marijuana in bud form, in strains with names such as Headband, Jack Flash and Buddha’s Sister. Tetrahydrocannabinol (THC)—or cannabidiol (CBD)—infused chocolate bars, elixirs, tinctures and hard candies might also be in a medical marijuana dispensary’s cases, along with a variety of marijuana-derived topical products.
That category of topicals—the growing number of CBD-containing salves, creams, oils and patches touted as relaxing and pain-relieving—is the point at which marijuana and massage intersect.
MASSAGE Magazine spoke with experts around the U.S. to get the answers to questions massage therapists have about marijuana and massage, regarding the differences between products that contain hemp-derived versus marijuana-derived CBD; the pain-relieving mechanism of cannabis products; possible effects on massage therapists who apply such products; legality; and research.
1. Does every type of massage-related CBD product contain the same marijuana-derived ingredients?
No. Some of the salves, creams, lotions, oils, sprays and patches on the market contain hemp-derived CBD, which contains a miniscule amount of THC—no more than .3 percent—as their pain-relieving property; others contain marijuana-derived CBD, which contains much more—up to 25 percent in dried marijuana buds—THC.
Both CBD and THC are compounds within plants of the genus Cannabis—which includes both hemp and marijuana. CBD oil derived from hemp does not effect the high commonly associated with marijuana, according to several sources. CBD oil derived from marijuana contains an appreciable amount of THC, the same compound that gets people high, or stoned, when they smoke a joint.
2. What is the mechanism by which CBD and THC might effect pain relief?
Both CBD and THC are called endocannabinoids, and both act as ligands—or chemicals that bind to receptors—at cannabinoid receptors within the central nervous system, according to the article, “The Endocannabinoid System, Cannabinoids, and Pain,” posted on the National Institutes of Health’s website. The human body contains an endocannabinoid system, which is involved in “a host of homeostatic and physiologic functions, including modulation of pain and inflammation,” the article noted.
Jean Talleyrand, M.D., is the founder of MediCann, which operates complementary health care clinics that offer massage, medical cannabis consultations and more, throughout California. In an interview with MASSAGE Magazine, Talleyrand explained that both THC and CBD stop pain through the endocannabinoid system.
“This system consists of at least two receptors, termed CB1 and CB2 … the receptors are in every organ, including the skin, and typically found on nerve cells and immune cells in these organs,” he said.
The [endocannabinoid] system modulates inflammation and pain, said Talleyrand—and because inflammation may also cause pain, the system affects pain in two ways.
First, THC directly binds to both CB1 and CB2 receptors, and so directly influences pain, while CBD binds to a TRPV1 receptor. That TRPV1 receptor has, in turn, a positive influence on the CB1 and CB2 receptors, which is how CBD indirectly mitigates pain, Talleyrand said.
Additionally, he said, “TRPV1 is directly related to pain transmission, and thus CBD may influence pain in this direct fashion as well—and that is why CBD is considered the more anti-pain compound of the two cannabinoids.”
Osteopath Dustin Sulak, D.O., who treats patients with cannabis at his Maine Integrative Healthcare clinic in Manchester, Maine, told MASSAGE Magazine that both THC-containing and almost-THC-free CBD have numerous anti-inflammatory effects that can decrease pain, “mostly by preventing the release of inflammatory signals from B and T immune cells, and in animal studies [have] been shown to prevent the development of hyperalgesia, or abnormally increased pain signaling at the site of an injury.”
CBD has also recently been shown in animal studies to speed the healing of injured connective tissue, and also has numerous anti-anxiety mechanisms, which can indirectly influence pain and pain behavior, Sulak added.
3. Would a massage therapist who applies a CBD- or THC-infused product with his or her bare hands get high from doing so?
This is possible but not likely, according to Talleyrand, who said the THC and CBD oil applied in massages is unlikely to raise blood levels enough to cause a high.
“Patients who receive THC or CBD massages only report the high from relaxation, [which is] different from the high of [ingesting] THC,” he said.
However, both THC and CBD are absorbed systemically via the skin, meaning a massage therapist using a topical product containing THC could potentially experience a psychoactive effect from what he or she absorbs through his or her hands, Sulak said.
“It all depends on the dose,” he said. “If a very potent oil is used over a large surface area, some psychoactive effects will likely occur, but typically the dose and potency needed to produce local benefits like pain relief and muscle relaxation can be achieved at potencies that will not cause either the therapist or client to get high.”
The key to staying sober when using cannabis oil, said Sulak, is to stay in the 1-to-2 milligrams-per-milliliter potency. “This will typically be a light green or amber coconut oil that has cannabis extract or whole herb infused into it,” he explained. “Cannabis oil can also refer to a full-strength extract, which is very sticky and usually has a potency of 500 milligrams per milliliter, or more—not a good idea to try this for massage.”
4. Is it legal for massage therapists to use marijuana- and hemp-derived topical products?
It depends on where the massage therapist practices, and on the type of topical product he or she intends to use.
Whether marijuana is legal for medical, recreational or both types of use, there are myriad laws regarding the use of THC-containing products—and in some states, no regulations specifically addressing topicals—so massage therapists must obtain information directly from their state.
In Colorado, for example, where marijuana is legal for medical and recreational use, massage therapists and day spas are cashing in on the popularity of cannabis with treatments such as the Mile High Massage, offered at Denver’s LoDo Massage Studio—while in Alaska, where a recreational marijuana law went into effect in 2016, regulations regarding topical use have not been finalized.
Michael Hayes, the president of the Care By Design Guild, which manufacturers CBD sprays, oil and other products, said a person working in a state where marijuana is illegal “almost certainly cannot buy or use THC-infused products.”
More information about the legality of forms of marijuana-derived products may be found at the websites of the National Organization for the Reform of Marijuana Laws and Governing—and, again, the best source of information on a state’s laws is each state’s government.
5. Has research been conducted that supports claims made by companies that sell marijuana- and hemp-derived massage products?
No. Some researchers have begun looking at the effects of endocannabinoids, but there is no solid body of evidence yet.
A search of the U.S. National Library of Medicine’s database turned up little in the way of cannabis research, and most of it is on the ingestion of CBD products for medical conditions including chemotherapy and AIDS-related nausea; epilepsy; and multiple sclerosis.
The database search did bring back the article, “Cannabidiol: Promise and Pitfalls,” which noted, “Over the centuries, a number of medicinal preparations derived from C. sativa have been employed for a variety of disorders, including gout, rheumatism, malaria, pain, and fever. These preparations were widely employed as analgesics by Western medical practitioners in the 19th century.”
According to one source, the nonprofit Canadian Consortium for the Investigation of Cannabinoids will soon conduct a study on applied cannabis oil.
Until evidence builds, the exact pain-relieving effects, and the mechanism by which marijuana- and hemp-derived topical products may relieve pain, is unknown.
“Very few studies have been conducted regarding the efficacy of topical cannabis creams, and the vast majority of claims praising their medical performance are purely anecdotal,” Jordan Tishler, M.D., a medical marijuana doctor in Cambridge, Massachusetts, told MASSAGE Magazine. “These claims, while outwardly logical, are simply not supported by any sort of robust or conclusive body of medical literature.”
Patients, physicians and other health care practitioners aren’t waiting for double-blind studies to take place. They are using THC and CBD products now, in forms including oils, salves, creams and patches.
Shah, who sells the CBD Salve, said she was teaching a massage class recently, and one student was experiencing the pain of fibromyalgia at a level 7. “She used the salve and almost immediately went down to a 0,” Shah said. “[The salve] helps reduce pain immediately, if the pain is muscular in nature.”
And Sulak said that in New England clinics, where he and colleagues treat more than 18,000 patients with cannabis, there have been “numerous reports of topical cannabinoids working wonders for arthritic joints, tender points, muscle spasms, phantom limb pain, peripheral neuropathy and inflammatory skin conditions—and we almost never hear any reports of adverse effects associated with its use.
6. What is the New DEA Code for Extract?
Cannabidiol (CBD) personal-care products include topical products such as patches, salves and oils intended for pain relief, and are created from both hemp, a cousin to marijuana. Massage therapists, chiropractors and the general public have embraced these products.
Now, many in the cannabis industry are scrambling to interpret a new rule issued by the Drug Enforcement Agency (DEA) on Dec. 14 titled “Establishment of New Drug Code for Marihuana Extract”—and to determine if it could affect manufacturers and distributors of hemp-derived products. The rule took effect Jan 13, 2017.
What has resulted is a flurry of misleading media reports and near-panic on the part of some hemp advocates and even legal professionals regarding whether or not the new code will have an effect on the CBD industry.
What is seems to come down to is whether a CBD product is ingested or applied topically.
DEA Spokesperson Russ Baer told MASSAGE Magazine that CBD lotions, topical ointments and patches are exempt from controls under the Controlled Substances Act, while edible hemp-derived products are not.
Plants of the genus Cannabis include both hemp and marijuana. Industrial hemp contains less than 0.3 percent THC; therefore, CBD oil derived from hemp seeds does not effect the high commonly associated with marijuana, while CBD oil derived from marijuana seeds contains an appreciable amount of THC.
CBD Law At a Glance
- Topical products derived from cannabis are used by many people to effect pain relief.
- The DEA has issued a new rule that established a drug code for extracts of all forms of cannabis, which includes hemp-derived extracts.
- Hemp has less than 0.3 percent THC and doesn’t get people high like marijuana does.
- In some states, the cultivation and distribution of hemp-derived products is legal. In other states, it is not.
7. Will There be New DEA Action?
According to the Office of the Federal Register, a new Administration Controlled Substances Code Number was created for marijuana extract in order to better allow quantities of extract material be tracked apart from quantities of marijuana, and therefore help in complying with international drug control treaties.
The action taken by the DEA was to amend the Code of Federal Regulations related to food and drugs, to include a new subparagraph that creates a new code, 7350, pertinent to CBD extracts. Until now the DEA had used code 7360 for marijuana, or cannabis, and everything derived from it.Some cannabis advocates say that with this change, the DEA is signaling increased vigilance over interstate hemp-product distribution, while the DEA’s Baer indicated the code change was more along the lines of administrative housekeeping meant to better reflect the activities of scientific research.
“Some attorneys are interpreting it as, ‘This is DEA sending up a red flag’ regarding whether it’s legal to move hemp across state lines or not,” Deputy Director of the National Cannabis Industry Association Taylor West told MASSAGE Magazine.
It’s possible that due to this rule, hemp-derived product distributors could be in violation of federal law when shipping such products across state lines, West said—but whether or not all those distributors were actually in compliance with federal law before now is not clear either.
“Certainly lots of people have made that case [for compliance], but I would not consider that to be a 100-percent accepted theory,” West said.
What is known is that in the 24 states that are compliance with Section 7606 of the federal Farm Bill, it is legal to grow and distribute hemp, because that section “defines hemp as distinct from marijuana and does not treat it as a controlled substance when grown under a compliant state program,” according to a Dec. 14 press release published the Hemp Industries Association.
8. Why is There Lack of Clarity?
Despite laws on the books pertaining specifically to hemp products, there has been a lack of clarity among the public, the media and even hemp advocates about whether hemp-derived CBD products fall under the Controlled Substances Act that lists marijuana as a Schedule I drug—a class that also includes LSD and heroin; therefore, many companies have operated under the belief that hemp-derived CBD products were not under the controlled substances act, West added, “and they have been moving products across state lines and selling them in nonregulated areas.”
However, the Industrial Hemp Facts published by the Kentucky Department of Agriculture—Kentucky being one of the states that is compliance with Section 7606 of the federal Farm Bill—reads, “Under the current U.S. drug policy, all cannabis varieties, including hemp, are considered Schedule I controlled substances under the Controlled Substances Act.”
Yet, in recent years, various governmental entities have acknowledged the differences between hemp and marijuana, and have legislated accordingly.
In California, for example, the California Industrial Hemp Farming Act, passed in 2013, revised the definition of marijuana to exclude industrial hemp, and defined industrial hemp as a “fiber or oilseed crop, or both,” that contains less than 0.3 percent of THC and that is intended to be used for fiber or oil derived from the stalks or seeds.
Then in 2014, President Obama signed into law the Farm Bill of 2013, which included an amendment to legalize hemp cultivation for research-related purposes.
Yet, just as medical- and recreational-marijuana laws vary from state to state, so too do laws applying to the cultivation of hemp. While some states have approved hemp-cultivation laws, in 20 states and the District of Columbia, cultivation of hemp is illegal.
One thing is clear: As a growing number of U.S. states legalize marijuana for medical or recreational use, the number of people in the general population who are turning to marijuana and its more sedate cousin, hemp, is growing as well.
Even with the lack of consistent regulation, CBD products are big business. According to the Hemp Business Journal CBD Report, by the year 2020 the CBD market will increase by 30 percent to $2.1 billion, with $450 million of that derived from hemp-based sources.
Understand the Law
Massage therapists interested in using CBD- or THC-infused topical products to effect pain relief for clients must understand their particular state law, and then decide if this type of product will best support their clients and practice—while being cognizant that a growing number of the U.S. general population is increasingly aware of the potential health benefits of both marijuana- and hemp-derived topical products.
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About the Author
Karen Menehan is MASSAGE Magazine’s editor in chief. She has also served as MASSAGE Magazine’s editorial assistant, managing editor and editor. Menehan has reported and edited for additional publications and organizations, including Imagine Magazine, the Sacramento Bee newspaper and the LIVESTRONG Foundation.