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CBD, Medical Marijuana Are Enticing, But Have Limited Data

A ndrew Winkler, MD, associate professor of otolaryngology and director of facial plastic and reconstructive surgery at the University of Colorado, Denver, works in one of the first two states to legalize recreational marijuana and has done research to investigate links between marijuana legalization and facial trauma. But, when patients ask him questions about medical marijuana use, including the ubiquitous cannabidiol (CBD) oil, he often feels ill-equipped to respond.

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“It’s a tricky thing,” he said. “It’s a difficult position. We get asked by our patients—not a lot, but on occasion—about using these medications to treat pain and just recreationally around times of surgery. And I don’t feel like I have a great answer for them a lot of times.”

He said that he recommends patients not smoke marijuana near the time of surgery. “My usual response is, ‘We don’t like smoke in or around surgery, so if you can switch over to oral forms, then I’m OK with it,’” he said. “What is the effect of that on wound healing or pain? I really don’t know.”

States are legalizing marijuana products for medical purposes and recreation at a fast rate—it’s legal at least for medical reasons in 33 states—and CBD shops are popping up everywhere, with CBD gummies, CBD chocolates, CBD caramels, and CBD cupcakes, as well as CBD lotions, balms, and salves. These, along with CBD and cannabis vaping pens and thumb drives, let people customize their CBD experiences.

All of this is tantalizing to customers and patients. But as patients become more interested in cannabis for their conditions, physicians, including otolaryngologists, are still awash in uncertainty and trepidation when it comes to whether and how to use marijuana products in their care plans. The interest level among otolaryngologists in medical marijuana products seems to be growing, and the push continues for more research, as well as the release of federal dollars and approval of policies to make this research more feasible.

Limited Data

Although he is in the state that could be considered the cannabis capital of the U.S., Dr. Winkler said he has never recommended any form of marijuana to patients, including CBD oil, as a medical therapy. His knowledge is unavoidably limited to the scant research and to the word of mouth of colleagues, he said. An anesthesiologist colleague who ran a pain clinic has told him that “he wasn’t super convinced that it had a huge effect in his practice.” It’s these types of observations and feedback on which Dr. Winkler largely relies.

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“He said, in his opinion, the data on chronic pain was limited, and certainly in acute pain,” Dr. Winkler said. “But, of course, there are different formulations, and that was a while ago. So I’d be interested in using it—I’m not against using it—it’s just I would like to see more data.”

Dr. Winkler has done his own research, looking at incidence of facial trauma in Colorado in the two years before legalization of recreational marijuana compared with the two years after. He hypothesized that facial trauma incidence could go up if people behaved irresponsibly as a result of marijuana use, or perhaps go down if it had a calming effect and led to fewer assaults. Ultimately, there was no difference, although he acknowledged that two years is a relatively short time and behavioral patterns following legalization are undoubtedly continuing to be re-shaped.

Responding to the explosion of interest in cannabidiol—one of the more than 100 compounds, or cannabinoids, that are unique to the cannabis plant—and other marijuana products, the Food and Drug Administration (FDA) recently released a consumer update. It contained little medical guidance. “Other than one prescription drug product to treat rare, severe forms of epilepsy, the FDA has not approved any other CBD products, and there is very limited available information about CBD, including about its effects on the body,” the update said. It also said the FDA is looking into safety questions, including potential liver toxicity and cumulative exposure if CBD is used in a variety of forms at the same time, such as in the case of someone who eats CBD gummies, rubs CBD lotion on their skin, and vapes every night.

In what might be the most authoritative review undertaken on the limited research that has been conducted on medical marijuana products, including CBD oil and other forms, an expert committee of the National Academies of Science, Engineering, and Medicine determined that oral cannabinoids are “effective antiemetics” for adults with chemotherapy-induced nausea and vomiting. The group also determined that adults with chronic pain who were treated with cannabis or cannabinoids were more likely to experience clinically significant reduction in pain symptoms, and that using oral cannabinoids improves patient-reported spasticity symptoms in adults with multiple sclerosis.

“For these conditions, the effects of cannabinoids are modest,” the committee wrote. “For all other conditions evaluated, there is inadequate information to assess their effects.”

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Among the report’s most prominent findings on the potentially negative effects of cannabis and cannabinoids, the committee found there is strong evidence of a statistical link between long-term cannabis smoking and worse respiratory symptoms and more frequent bronchitis episodes. But the group also found some evidence of no statistical link between cannabis smoking and the incidence of lung cancer.

Some Cannabinoids May Result in Tinnitus

Public opinion surrounding marijuana and cannabinoids have transformed remarkably over the last few decades. THC, cannabinoids, and even marijuana are legal for medical use in most states. A decade ago it would have been unthinkable for marijuana to be legal for recreational usage but some states have even passed this law.

Cannabinoids are categorized as a group of compounds produced from the cannabis or marijuana plant. Regardless of their recent legalization in certain states, we’re still learning new things about cannabinoids. We usually consider these particular compounds as possessing universal healing qualities, but established research implies there could also be negative impact such as a strong link between cannabinoid use and the occurrence of tinnitus symptoms.

Cannabinoids Have Numerous Types

There are many forms of cannabinoids that can be used now. It’s not just pot (or refer, or grass… look, let’s just all agree right now that marijuana has a significant number of nicknames and move on). These days, THC and cannabinoids can be obtained in pill form, as lotions, as inhaled vapor, and more.

The types of cannabinoids available will vary state by state, and under federal law, many types are still illegal if the THC content is over 0.3%. That’s why some people tend to be rather careful about cannabinoids.

We still require more research and experience before we will truly comprehend the long term and side effects of cannabinoids. Some current research into how cannabinoids influence your hearing is a prime example.

Cannabinoids And Your Hearing, Some New Studies

Whatever you want to call it, cannabinoids have long been connected to improving a wide variety of medical ailments. According to information that is anecdotally available, conditions including vertigo, nausea, seizures, and many more appear to be helped by cannabinoids. So could cannabinoids help with tinnitus? That’s what scientists decided to figure out.

Tinnitus could actually be triggered by cannabinoid use, as it turns out. Ringing in the ears was reported by over 29% of participants after implementing cannabinoids. And that’s in people who had never dealt with tinnitus before. Furthermore, marijuana users were 20-times more likely to report having tinnitus symptoms after 24 hours.

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And for those who already suffered from tinnitus, marijuana use caused it to get worse. This basically means, there’s some very strong evidence that cannabinoids and tinnitus don’t really mix all that well.

How Cannabinoids Make Tinnitus Worse

There are a couple of tangible ways that cannabinoids can make your tinnitus experience worse. First, the incidents of tinnitus symptoms can become more consistent, you might notice the ringing or buzzing in your ears more frequently. Cannabinoids can also make those tinnitus episodes more overwhelming. The discomfort from the ringing may become more noticeable or harder to just ignore.

The research also seems to reveal that cannabinoids are capable of causing the development of the initial symptoms of tinnitus. To put it a different way: after you begin using cannabinoids you could start to experience tinnitus symptoms even if you didn’t have them before.

The Causes of Tinnitus Are Unknown

We know that there’s a link between tinnitus and certain triggers but we’re still uncertain what the actual root causes are. It’s clear that cannabinoids can have an effect on the middle ear and tinnitus symptoms. But it’s much less clear what’s causing this impact.

But we recognize that using marijuana, in contrast to other mood altering substances such as alcohol, will cause tinnitus.

Of course, we will continue to do the research. Cannabinoids today come in so many varieties and forms that understanding the root connection between these substances and tinnitus would help people make smarter choices.

Beware The Miracle Cure

In recent times there has been a lot of hype created around cannabinoids by marketers. That’s partly because perceptions are changing about cannabinoids (and, to some extent, is also a reflection of a desire to move away from opioids). But this new research makes clear that cannabinoids can and do produce some negative effects, particularly if you’re concerned about your hearing.

The marketing about cannabinoids has been very assertive and you can’t completely escape all of the enthusiasts.

But this new research certainly reveals a solid link between cannabinoids and tinnitus. So if you have tinnitus, or if you’re worried about tinnitus it might be worth keeping away from cannabinoids if possible, regardless of how many ads for CBD oil you might run into. The link between cannabinoids and tinnitus symptoms has been quite securely demonstrated by the research, so it’s worth exercising a little caution.