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Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links health sciences with pharmaceutical sciences and natural sciences. The professional practice is becoming more clinically oriented as most of the drugs are now manufactured by pharmaceutical industries. Based on the setting, pharmacy practice is either classified as community or institutional pharmacy. Providing direct patient care in the community of institutional pharmacies is considered clinical pharmacy.
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Cannabis, also known as marijuana or weed among other names, is a psychoactive drug from the cannabis plant. Native to Central or South Asia, the cannabis plant has been used as a drug for both recreational and entheogenic purposes and in various traditional medicines for centuries. Tetrahydrocannabinol (THC) is the main psychoactive component of cannabis, which is one of the 483 known compounds in the plant, including at least 65 other cannabinoids, such as cannabidiol (CBD). Cannabis can be used by smoking, vaporizing, within food, or as an extract.
Cannabis has various mental and physical effects, which include euphoria, altered states of mind and sense of time, difficulty concentrating, impaired short-term memory, impaired body movement (balance and fine psychomotor control), relaxation, and an increase in appetite. Onset of effects is felt within minutes when smoked, but may take up to 90 minutes when eaten (as orally consumed drugs must be metabolized). The effects last for two to six hours, depending on the amount used. At high doses, mental effects can include anxiety, delusions (including ideas of reference), hallucinations, panic, paranoia, and psychosis. There is a strong relation between cannabis use and the risk of psychosis, though the direction of causality is debated.
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Choosing pain relief depends on factors like pain type, severity (see below), and health conditions. Options include:
- Acetaminophen: For mild-to-moderate pain, safe if taken correctly
- NSAIDs (ibuprofen, naproxen, diclofenac, etc.): Reduce mild-to-moderate pain and inflammation, not suitable for certain conditions
- Combination medications: such as acetaminophen/aspirin
- Topical NSAIDs: such as diclofenac gel or patches
- Topical rubs, creams, or salves, such as those that contain methyl salicylate (Arthricare, Exocaine Plus), capsaicin, lidocaine, and menthol (LidoStream, Veltrix), or combinations of these. These deliver pain relief through the skin
- Mild opioids (codeine, tramadol, etc.): For moderate-to-severe short-term pain, may cause side effects and dependency
- Combination mild pain relievers and opioids, such as acetaminophen/hydrocodone
- Cortisone injections: May be considered if oral medications don’t improve pain and can provide short-term relief. This involves injecting corticosteroids such as methylprednisolone (Depo-Medrol) around nerves
- Antidepressants (amitriptyline, nortriptyline, etc.): Low doses can relieve certain chronic nerve pains, and must be taken consistently
- Gabapentinoids (gabapentin, pregabalin): Provide nerve pain relief, require consistent daily use
- Muscle Relaxants: Prescription medications like cyclobenzaprine (Flexeril) or diazepam may be recommended for short-term pain related to muscle spasms but sedation and dizziness are common side effects
- More powerful narcotics (opioids) (last resort only): Short-term use of opioids like oxycodone or hydrocodone should be considered under close supervision as a last resort only if other options are ineffective, but potential side effects and a high risk of addiction exist.
Pain Severity
The choice of pain relief depends on pain severity, for example:
- Mild: acetaminophen, NSAIDs, such as ibuprofen, naproxen, or diclofenac.
- Moderate: depending on the type of pain, muscle relaxants, gabapentinoids, antidepressants, cortisone injections, or mild opioids, such as codeine or tramadol combined with acetaminophen or NSAIDs.
- Severe: Strong opioids (last resort only), such as oxycodone or hydrocodone combined with acetaminophen or NSAIDs.
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