The field of healthcare is undergoing a transformation as more practitioners adopt integrative approaches that blend traditional treatments with alternative therapies.
For DCs, whose focus is primarily on musculoskeletal health, spinal care and overall wellness, this shift offers opportunities to enhance their patients’ outcomes through noninvasive and holistic treatment options. One of the most promising areas of growth is the integration of cannabinoid therapies—particularly cannabidiol (CBD)—into chiropractic practices.
As interest in cannabinoids grows, so too does the potential for DCs to incorporate these treatments into their clinical care. Cannabinoids, compounds found in the cannabis plant, have shown promise in addressing issues such as pain, inflammation, anxiety and sleep disorders—conditions that align closely with the focus of chiropractic care.
Understanding chiropractic scope and the rise of cannabinoids
Chiropractic care has always emphasized natural, noninvasive treatments that focus on the spine, muscles, joints and nervous system. DCs are trained to diagnose and treat a variety of conditions related to musculoskeletal health, including back pain, sciatica, headaches and neck pain. Traditional chiropractic care centers on spinal manipulation and adjustments, but over the years, practitioners have expanded their scope to include other forms of care such as nutritional counseling, exercise rehabilitation and stress management.
Integrating cannabinoid therapies into your practice can fit seamlessly into this evolving scope of care. As more patients seek holistic alternatives to pharmaceutical medications, especially for chronic pain or stress-related issues, DCs are increasingly exploring how cannabinoids can complement traditional chiropractic treatments. Whether administered topically, ingested or used in combination with other therapies, cannabinoids may offer a safe, effective option for patients looking for natural relief.
What are cannabinoids and how do they work?
Cannabinoids are chemical compounds derived from the cannabis plant, and the most well-known are THC (tetrahydrocannabinol) and CBD (cannabidiol). These compounds interact with the body’s endocannabinoid system (ECS), which plays a critical role in regulating various physiological processes, including pain, inflammation, sleep, mood and appetite.
Key cannabinoids: THC vs. CBD
Both THC and CBD interact with the ECS, but in different ways. THC is the psychoactive component in cannabis, meaning it can induce a “high” when consumed. It binds to CB1 receptors in the brain and nervous system, producing effects that can range from euphoria to sedation, depending on the dose. In contrast, CBD is non-psychoactive and doesn’t produce a high. Instead, CBD works more subtly by enhancing the body’s natural endocannabinoids, which help regulate pain, inflammation and other functions. While CBD has become increasingly popular in healthcare for its therapeutic properties, THC is still used for more intense pain relief, particularly in conditions like cancer or severe muscle spasms.
Therapeutic benefits of CBD and THC
Pain management. Both CBD and THC have demonstrated analgesic properties. THC is often preferred for acute pain, such as that associated with injuries or surgeries, due to its quick action and psychoactive effects. On the other hand, CBD is more commonly used for chronic pain conditions like arthritis or neuropathy, where long-term relief is needed without the psychoactive effects.1
Inflammation. Chronic inflammation is a significant concern for many patients, particularly those suffering from conditions like rheumatoid arthritis or chronic back pain. CBD is widely recognized for its anti-inflammatory effects and may help reduce swelling, stiffness and discomfort by targeting the body’s immune response.2
Anxiety and sleep. CBD has been shown to have anxiolytic (anti-anxiety) properties. For patients who experience chronic stress or anxiety, CBD can provide relief without impairing cognitive function, making it an attractive alternative to traditional anxiety medications. Additionally, both CBD and THC can help improve sleep quality, with THC offering more sedative effects and CBD providing relaxation without drowsiness.3
Full-spectrum, broad-spectrum and isolate CBD
DCs considering cannabinoid therapies must also decide which type of CBD product to recommend. There are three primary forms:
Isolate. Contains only pure CBD with no other cannabinoids or terpenes. This form is suitable for patients who want to avoid THC or other compounds entirely.
Broad-spectrum. Contains multiple cannabinoids but no THC. This may provide some of the synergistic effects of other cannabinoids without the risk of THC-related side effects.
Full-spectrum. Contains all the naturally occurring cannabinoids and terpenes in the cannabis plant, including trace amounts of THC (less than 0.3%). Many believe full-spectrum CBD products are more effective due to the “entourage effect,” where cannabinoids and terpenes work together to enhance their therapeutic effects.
Legal and ethical considerations
As the use of cannabinoid therapies increases, so too does the importance of understanding the legal and ethical landscape surrounding their integration into chiropractic practice.
Federal and state regulations
The 2018 Farm Bill legalized hemp-derived CBD products containing less than 0.3% THC at the federal level. However, the legal status of cannabis and cannabinoids varies significantly
between states. Some states have fully legalized both medical and recreational marijuana, while others permit only CBD products. Still, some states have more restrictive laws that may limit a DC’s ability to recommend or dispense cannabinoid products.
For DCs, this legal ambiguity presents challenges. It’s essential to be aware of both federal and state regulations regarding the use of cannabinoids in healthcare. In states with more permissive laws, DCs may incorporate THC and CBD into their practices more freely, while in other states, the use of THC may be prohibited entirely.
Legal risks and documentation
DCs must also be aware of potential legal risks. Recommending or dispensing cannabinoid products, particularly in states with unclear regulations, could expose practitioners to malpractice claims or other legal challenges. Clear documentation and patient consent are essential to reduce these risks. DCs should ensure patients fully understand the cannabinoid products being recommended, including their potential benefits, risks and legal status.
Ethical responsibility
DCs have an ethical obligation to prioritize patient safety and autonomy when recommending cannabinoid therapies. DCs should ensure they provide objective, evidence-based information to patients, specifying the risks and benefits of cannabinoid products. When considering partnering with specific CBD companies, access to available evidence-based research is critical. It is also critical to choose products that are backed by third-party testing, including a certificate of analysis for each product. Staying current with evidence-based research and cannabinoid best practices as well as proper vetting of products recommended should be the foundation of any DC offering cannabinoid services and products.
Best practices for incorporating cannabinoids into chiropractic care
To integrate cannabinoid therapies effectively into chiropractic practice, DCs should develop clear guidelines for selecting and recommending cannabinoid products. Here are some best practices:
When to consider cannabinoids in treatment plans
Cannabinoids may be particularly useful for patients with chronic pain, inflammation, sleep disorders or anxiety. These conditions are common in chiropractic practice and can significantly benefit from the addition of cannabinoid therapies. Cannabinoids can complement traditional chiropractic treatments by addressing underlying issues, such as muscle tension, inflammation or nerve irritation, thereby enhancing the overall therapeutic effect.
Develop a therapeutic protocol
DCs should create individualized treatment plans for patients, considering the specific condition being treated and the patient’s response to cannabinoid therapy. A therapeutic protocol might involve selecting the appropriate form of CBD or THC, determining the correct dosage and monitoring progress over time. Collaboration with other healthcare providers, such as primary
care physicians or pain specialists, may also be necessary to ensure a comprehensive approach to care.
Educate your patients
Patient education is a cornerstone of successful cannabinoid integration. DCs should educate patients about the benefits, risks and legality of cannabinoid products. Setting realistic expectations is critical, as patients should understand that cannabinoids may take time to produce noticeable effects. DCs can also provide information on product quality, helping patients choose reputable brands that meet safety standards.
Final thoughts: A new frontier in chiropractic care
The integration of cannabinoid therapies into chiropractic care offers a unique opportunity to enhance patient outcomes, especially in the management of pain, inflammation and stress. As the legal landscape evolves and patient demand for holistic, non-pharmaceutical treatments increases, DCs who stay informed about the science of cannabinoids and navigate legal and ethical considerations carefully will find themselves at the forefront of an exciting new chapter in healthcare.
By embracing cannabinoids as a complementary tool in the treatment toolbox, DCs can offer their patients a broader, more integrative approach to health and wellness, providing effective alternatives to traditional pharmaceuticals while maintaining a commitment to patient safety and well-being. With careful consideration of patient needs, legal requirements and ethical standards, cannabinoid therapies can be a valuable addition to chiropractic care.
MISTY GREEN, DC, MS, became a cannabis educator for physicians after completing the first graduate-level cannabis program in the US, obtaining a master’s degree in medical cannabis science and therapeutics through the University of Maryland, School of Pharmacy. She has combined her decades of clinical practice with her fascination with all things cannabis to pivot into the cannabis space, helping bridge the gap between healthcare workers and much-needed cannabis education through lectures and cannabis curriculum production. Contact her at drmistydc@hotmail.com.
References
1. Khurshid H, et al. A systematic review of fibromyalgia and recent advancements in treatment: Is medicinal cannabis a new hope? Cureus. 2021;13(8):e17332. https://doi.org/10.7759/cureus.17332. Accessed January 10, 20mist25.
2. Holloman BL, et al. Epigenetic regulation of cannabinoid-mediated attenuation of inflammation and its impact on the use of cannabinoids to treat autoimmune diseases. Int J Mol Sci. 2021;22(14):7302. https://doi.org/10.3390/ijms22147302. Accessed January 10, 2025.
3. Shannon S, et al. Cannabidiol in anxiety and sleep: A large case series. Perm J. 2019;23(1):18–041. https://www.thepermanentejournal.org/doi/10.7812/TPP/18-041. Accessed January 8, 2025.
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