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• The substance has no currently accepted medical use in treatment in the United States. • There is a lack of accepted safety for use of the drug or other substance under medical supervision. The intention at the time was that marijuana might be coded differently after some research, but that never happened. In short, marijuana is kept as a Schedule 1 substance not because the research suggests that it is dangerous, but because there is a lack of research suggesting potential benefit. And it's difficult to do research on a prohibited product, so trying to change its classification is problematic. WHAT THE CLAIMS SAY Proponents of cannabis-infused topical applications claim the lotions help reduce pain and inflammation, without any psychogenic effect. Several of the people with whom I communicated for this article made the case that their clients love the products, that they themselves have reduced symptoms of pain in their hands and arms, and that they see substantially better impact than with other topical pain relievers or anti-inflammatories. That is important information, and might be of interest to massage therapists who live with work-related hand and arm pain. In addition, some therapists report that the level of overall relaxation they and their clients achieve can be much more profound than they see with standard massage therapy lubricants. All this said, I have not found any record of a successfully conducted, blinded comparison test of a cannabis- infused lotion to a noninfused lotion for client feedback or experience. This begs the question: what is really the active ingredient—the ingredients of cannabis, other ingredients in the lotion, or the massage itself? HOW DO THESE PRODUCTS WORK? Cannabinoid (CBD) receptors were discovered in cells of the brain and spinal cord a long time ago. These receptors are attuned to several chemical triggers, including anandamide—a type of endogenous CBD, and one of the brain chemicals associated with "runner's high." More recently we have found CBD receptors in many other places, included on keratinocytes of the epidermis, and in cells that line hair shafts and sebaceous glands. These sites may be receptive to several other chemicals that can be derived from cannabis, but for this discussion we'll stick to tetrahydrocannabinol (THC)—a chemical compound that is the main psychoactive constituent of cannabis—and cannabinoids. When skin cell CBD receptors are activated in mice, several changes happen. The stimulated cells secrete chemicals that have both direct and indirect influence on inflammation, even deep to the epidermis. This in turn has impact on sensory neurons, including nociceptors. Interestingly, scientists have also found that topical cannabis inhibits some skin activity—a finding that may be very important for people with psoriasis, dermatitis, or eczema. With more research, we will know more about whether cannabis-infused lotions might help this population. These discoveries may explain why cannabis-infused lotions seem to be effective mediators of inflammation and related pain. However, mice are not always an accurate analogue to humans, and it may be found that different mechanisms are at work when people report benefit. WHAT ARE SOME IMPLICATIONS FOR MASSAGE THERAPISTS? If you use any pain-relieving topical applications in your practice (such as Biofreeze, CryoDerm, Prossage, or China-Gel) or anything with arnica or eucalyptus in it (Topricin, Tiger Balm, etc.), you are already working toward the same goals that cannabis- infused lotions intend to address. The question is, which are the best interventions for you and your clients? The massage therapists who spoke to me had no hesitation about this: they absolutely prefer cannabis-infused lotions. LOTS OF QUESTIONS Almost no research on cannabis-infused lotions has been published in the last 80 years, and essentially none has been done on humans. Consequently, we don't know very much about how it works as a topical application, the best dosage or concentration, what the safest transfer medium might be, or how it affects the users and people who apply the lotion over the long term. All of these are still unanswered questions. The fact that anyone can download a recipe to make their own infused lotion gives some insight into the variability of products that might be on the market. If we produce something unreliable for our clients, homemade products can pose a potential risk. Of course, there's also a risk to us if our clients bring us a homemade lotion they want us to apply. Other unanswered questions include: How much of the cannabis gets into the bloodstream if a person uses infused lotions for several hours each day? Some people, including manufacturers, say little to none; some consumers who feel a systemic relaxation even with a local application say it definitely enters the bloodstream. At what point might that material cross the blood-brain barrier for psychogenic effect? Are there any potential risks to working with this product over the F r e e S O A P n o t e s w i t h M a s s a g e B o o k f o r A B M P m e m b e r s : a b m p . u s / M a s s a g e b o o k 39

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