Prescription anti-inflammatory and over-the-counter (OTC) medications are readily prescribed, easily available, and used very commonly. NSAIDS, or non-steroidal anti-inflammatory drug, are the most common types of anti-inflammatory medications. According to consumer survey responses, over 17 million Americans take NSAIDs every day, with over 70 million prescriptions and over 30 billion NSAID OTC tablets are sold in the United States every year.
OTC NSAIDs include naproxen, ibuprofen, and aspirin, and prescription NSAIDs include ketoprofen, etodolac, diclofenac, and celecoxib. NSAIDs block enzymes called COX-2 and COX-1. Those enzymes produce compounds that are made by our cells called prostaglandins. COX-1 enzymes make prostaglandins that activate platelets (used for blood clotting) and help to protect the lining of the intestines and stomach. COX-2 enzymes make prostaglandins in response to infection or injury and regulate inflammation. A majority of NSAIDs work non-selectively on both of the enzymes (with the exception of celecoxib, a COX-2 inhibitor). The lack of selectivity becomes a problem since inflammation and pain relief from NSAIDs from blocking COX-2. However, COX-1 unfortunately also is blocked, which causes unwanted negative side effects.
Complications and side effects of NSAIDs are serious and common. One study found that the risk of adverse drug reactions from NSAIDs was 26% (Gor 2011). These complications include stroke, heart failure, heart attack, high blood pressure, leg swelling, kidney or liver problems, dizziness, headaches, ringing in the ears, heartburn, upper gastrointestinal ulcers and bleeding, or even death. The New England Journal of Medicine in June 1999 estimated that there are 16,500 NSAID-related deaths happen among Americans who have osteoarthritis and arthritis each year (Wolfe 1999). More than 100,000 NSAID users become hospitalized each year due to gastrointestinal complications.
In a review looking at 17 studies found 11% of drug-related preventable hospital admissions are caused by NSAIDs (Howard 2007). A public health advisory was issued by the FDA in 2005, which warning individuals of the increased cardiovascular risks caused by NSAIDs and then once again in 2007 a medication guide was published for NSAIDs which recommended the lowest possible dose for patients who use the drugs. The FDA in January 2016 strengthened the current label for all NSAIDS warning that there is an increased risk of stroke and heart attack. There are some NSAIDs, like rofecoxib (Vioxx brand name) and valdecoxib (Bextra brand name) were taken off of the market based on the fact that the risks clearly outweigh their benefits as well as the pharmaceutical company "misrepresentation."
Over the last twenty years, the anti-inflammatory benefits of terpenoids and phytocannabinoid compounds have been proven by many studies. The cannabinoids are extracted using closed loop extractors , and then the concentrates are sold by the miligram. There are a number of different action mechanisms that plant cannabinoids have within their anti-inflammatory properties, which include their pro-inflammatory compounds being blocked that are made within the body that is the result of illness or injury.
Cannabidiolic acid, CBDA, is the non-psychoactive raw cannabinoid precursor of CBD, showed major COX-2 enzyme blocked as compared with a placebo, other cannabinoids, and two NSAIDs (Takeda 2008). Dr. Geoffrey Guy and Dr. Ethan Russo , in their outstanding 2005 study, reported that phytocannabinoids work in a synergistic manner (entourage effect) in order to provide nontoxic and balanced medicinal effects when they are compared to single molecule anti-inflammatory options (Russo and Guy, 2005).
Patients who suffer from inflammation have a number of different cannabis medicine options to choose from. In addition to being able to select "non-smokable" delivery options, like vaporizers, topical balms, edibles, and tinctures, patients now have a number of choices when it comes to the combination of cannabinoids they can use. For example, cannabis medicine can be taken that is CBD-rich, THC-rich, combination CBD+THC, CBD, CBDA and/or THCA. Some suppliers of cannabis medicine are combining heated and raw cannabinoids in tinctures in order to increase their anti-inflammatory benefits. Numerous patients benefit from drinking raw cannabis plant juices. I have witnessed thousands of patients in my medical practice be able to reduce or eliminate their need for NSAIDs, reduce side effects, and possibly even death, by using cannabis.