Updated: Jun 21, 2018
Almost everyone can agree on two benefits of a massage. When done well, a massage produces at least relaxation and pleasure. Similarly, most cannabis-using patients agree that, when used at the proper and subjective therapeutic dose, cannabis produces at least, deep relaxation, and an easy smile, while enhancing and deepening the simple pleasures of being alive.
In addition, targeted delivery of a therapeutic touch as well as that of medicine to where it hurts are key elements of practicing effective healing medicine. So why is it that the apparent winning combination of touch and topical cannabis oil is not practiced everywhere?
One obvious answer are the legal issues (which is another story all by itself).
However, there are a few other legitimate and common concerns that are slowing adoption. Many massage therapists hold paradoxical fears about using cannabis-infused oil. On one hand, they are worried that the expensive oil doesn’t absorb enough to make a difference and therefore is a waste of money. On the other hand, the fear that it does get absorbed too much causing the therapist and/or the client alike to experience extra-ordinary states of consciousness or in other words be “stoned out of their minds” and potentially increase the very symptoms they are trying to alleviate such as anxiety or nausea for example.
Both are valid concerns, but what is the truth and the actual evidence around these issues behind them?
Cannabis is one of the most studied herb of the past two decades. Research has shown that the cells that make up most of the outermost layer of the skin (keratinocytes) contain a significant amount of cannabinoid receptors sites (CB1 and CB2) that function much like a lock. The keys, made from either the body’s own endocannabinoids (such as anadamide), from plant-based cannabinoids (such as cannabis or certain spice plants) fit the locks perfectly.
Once unlocked, the cell can realize a host of critical functions such as homeostasis (balance and stability), protection from invading microbes and the healing of inflammations (due to allergies, injury, sunburn, dehydration, toxins, bacteria, fungi, or viruses) for example.
But beyond these basics, relatively little hard data is know about the topical applications of cannabinoids.
Let’s have a closer look. Researchers from the University of Bonn, Germany (2013)1 discovered that topical THC applied to mice significantly reduced inflammation of the skin. Scientists from the Brody School of Medicine, NC, (2015)2 demonstrated that anandamide may be an ideal, topical agent to eliminate non-melanoma skin cancers.
However, it was researchers from the University of Kentucky, Lexington (2004)3 that provided us with the only known specific absorption rates to date. A transdermal patch containing delta-8-THC delivered a sustained and steady amount of THC to the bloodstream. To be specific the patch delivered 4.4 nanogram (ng/mL) of THC per milliliter of blood within 1.4 hours.
To put these numbers into perspective, let’s look at an estimates from the Addiction Research Center at National Institute on Drug Abuse in Baltimore (1992) which suggested that to “feel high” one would need to have between 7-29 ng/ml of THC in the blood. According to these numbers, even a topical application such as a sustained patch produces absorption below the level of “feeling high”.4
The same study from Lexington also reported that the non-psychoactive cannabinoids CBN and CBD (primarily CB2) were able to penetrate the skin at rates ten times that of THC thus delivering potent anti-inflammatory and immune modulating action to the skin without affecting the mind. Based on this evidence topical oil application can provide a potent therapeutic synergy relevant to localized inflammation and pain management.
Thus, research to date would seem to alleviate both concerns around lack of effectiveness and fears of psychoactive overstimulation from topical use of cannabinoids while encouraging the adoption of topical cannabinoid oils.
Additionally, some massage therapist have addressed concerns about mind-altering effects of THC by using oils infused with non-psychoactive CBD only. And, this strategy can certainly be used to substantially reduce the fear of “being stoned” and still to support homeostasis, reduce inflammation and support healthy immune functions. However, research has shown that the therapeutic powers are strongest when some THC (of better yet a full spectrum of plant constituents are present).5 Because of this, other therapists may choose to use oils containing at least some THC for the increased therapeutic benefit while risking higher psychoactive effects.
It is important to note that there is a key element not addressed by these transdermal study results that may also impact the massage therapists’ decisions. When infused cannabis oil is heated and applied to the skin, absorption rates increase significantly including that of THC making the massage therapists fear of “becoming stoned” a potential reality.
And, while no studies have been conducted to provide specific data, if massage therapists are using oils with large amount of THC or heating the oils before applying, they may want to follow three simple precautions.
During the initial visit, you might want to consider creating a plan B where the client arranges for a designated driver and care-taker ahead of the cannabis oil massage appointment. Additionally, in case the client exhibits mild unplanned extra-ordinary states of consciousness, you can do the same things that most emergency rooms do. Provide a quite environment, reassure the client, give her company and initiate plan B.
As the massage therapist, you might want to consider wearing gloves when applying warm or hot oils to a client’s skin especially if your sensitivity is high.
Apply hot cannabis-infused oil only to specific problem areas.