“Right there. You feel that?” my partner whimpers in the dark. The pain and exhaustion in her voice are audible.
I press my fingers hard into her outer thigh and massage in an expanding circle, over ripples of sculpted rock. Her rectus femoris barely loosens as I knead harder, using my knuckles.
“Sssssssss,” she hisses. “Right there…You can press harder.”
Reaching toward the nightstand, I scan a line-up of spray bottles, lotions and balm jars sitting in the dim light. I grab the smallest jar, said to be the most potent, and scoop a large dollop with my index finger and rub it into her hip and get to work. It smells of herb and mint.
Tonight my partner and I unexpectedly join the thousands — potentially tens of thousands — of Americans this winter turning to marijuana-infused massage therapy.
The practice involves using massage oil or lotion that has been infused with the active ingredients of the federally prohibited plant. Applied to the skin, a marijuana massage won’t get you stoned, but there’s a preponderance of pre-clinical as well as user data to indicate a cannabis-laced rubdown works on chronic, intractable pain and inflammation — even burns, wounds and lesions.
The American Massage Therapy Association takes “no position” on marijuana massage, and massage therapy schools don’t teach the exploding trend, but out in Colorado — which was the first state to implement its adult-use legal cannabis program — canna-massage studios are a booming business. Makers of marijuana-infused skin products, called “topicals,” had a banner year both in the Rockies and in the massive medical marijuana state of California. The nascent industry in Washington also promises to explode.
As more and more Americans grow weary and leery of conventional medicine, with its tendency to over-treat, over-bill and under-deliver, the marijuana massage craze combines American entrepreneurship, self-reliance and skepticism with two hot alternatives: bodywork and pot.
I use my forearm like a rolling pin on my partner’s brick-like thigh. Back and forth. Up and down. The blade of my ulna bounces over her knots like speed bumps. Like legions out there, I have just one question: will it work?
After decades of dating in the underground, massage and cannabis seem like a long overdue match for mainstream America.
Today, the modern spa industry is an $18 billion economic sector. The U.S. Department of Labor expects the number of massage therapists in the country to grow by 23 percent in next 10 years. And massage is now considered more medically legitimate than ever. Americans are embracing massage as an alternative to pharmaceutical treatments for pain, and at the same time, are increasingly embracing cannabis. Today 23 U.S. states have voter-approved medical cannabis programs, and four states as well as Washington, D.C. have outright legalized recreational cannabis use for adults 21 and over.
Special hands-on techniques to rub sore muscles, tendons and joints have been used since ancient Greece to treat various conditions, especially pain and tension, as the Multiple Sclerosis Society notes. However in the Western world “massage” was once seen a foreign, ethnic practice anathema to old-school, protestant values like the stoic, long-suffering of pain. That has changed dramatically, and today massage is seen not only as a relaxing spa option but as a viable way to mitigate pain.
In 1998, 7.7 percent of U.S. hospitals offered massage as a “Complimentary and Alternative Medicine” (CAM). In 2007, 37 percent of hospitals did and today massage is the number one outpatient CAM service. Patients mostly use it to relieve pain, followed by cancer and pregnancy symptoms.
The fragrant, central Asian native cane plant “cannabis” appears in some of the oldest medicinal texts of mankind — Chinese and Ayurvedic manuals. Thousands of years later, cannabis became demonized as the dried, smoked flower buds called “marijuana.” Most of its demonizers were unaware cannabis existed in edible and topical extract form in U.S. pharmacies until the 1930s.
U.S. marijuana prohibition drove the medical processing and application of cannabis underground. In its place rose the “recreational” model of smoking raw flower buds of the plant.
For most of the 20th century, the medical modality of cannabis simply ceased to exist in the U.S. Then, suddenly, it resurfaced in 1996 when California passed the Compassionate Use Act — the world’s first medical marijuana law.
Today, an estimated one in 20 California adults have used medical cannabis to treat a serious illness, and 92 percent of them found it effective. With the spread of cannabis legalization has come the first real, public canna-massage boom — in Colorado, the first state to implement legal adult cannabis use.
If the marijuana massage movement has a heartland, it’s the Rocky Mountain State, where massage therapists who’ve specialized in pot are adding staff and outlets, and topical makers are rapidly expanding.
Asked to describe how 2014 went, massage therapist Jordan Person, founder of Primal Therapeutics in Denver, gets choked up: “This has been one of the best years of my life.”
Photo: Jordan Person gives a canna-massage.
Colorado’s Amendment 20 medical marijuana law, which was passed by voters in November 2000, and the state’s subsequent Amendment 64 recreational use legislation, passed by voters in November 2012, have combined to blow the lid off the once-underground practice of topical cannabis.
Jordan said she is adding staff and working with two cannabis tourism companies as well as two bed & breakfasts. In addition, she’s working on adding outlets outside of Denver to meet demand for in-home appointments.
Colorado’s canna-massage customers are folks Jordan has never seen before.
She’s a certified a nurse from Florida, and she said guys are usually loathe to admit to pain, or surrender to a random rubdown. With canna-massage, her clients are 60 percent male, and aged 30 to 50.
“They’ve never had a hot stone massage in their life, but they are ready to try one now that cannabis is involved,” she said.
Guys have lots of sports-related injuries, tight hips, back pain, and shoulder pain from hunching over a keyboard all day, she said. So, massage makes sense for them.
She’s also seeing another group she’s never seen before: “Honeymooners! Denver never got honeymooners, but now with legalization, couples are booking Denver.”
Jordan came to cannabis massage after her own medical issues led her to the botanical for relief. When she first started giving cannabis-infused massage — with a topical that combines multiple active ingredients from cannabis — she noticed that she could work longer hours, and be in less pain at the end of the day.
“It’s working on me while I’m working on patients,” she said.
Person said she’s never gotten a negative review for a medicated massage — it’s quite the opposite. “They usually say, ‘I wish I could book you one more time before I fly home’,” Person said. “I’ve worked on a pharmacist who wouldn’t fill out the intake form [for fear of consequences at work]. Afterward, he said, ‘Why isn’t this being taught in school?’”
She continued, “I worked on a 90 year-old woman with diabetic neuropathy in her feet. She used topicals and massage and zero narcos [prescription narcotics] — for post-surgery.”
Other industry members tell similar stories.
25-year-old Denver resident Taylor Diller is a self-described “wayward soul” who found her calling as massage therapist five years ago. She first encountered cannabis-infused massage oil at an open-minded massage studio in Denver. “From day one I fell in love with the products,” she said.
Taylor eventually followed her love to a full-time job with the topicals maker, Apothecanna. The Denver-based company, which specializes in making products inspired by traditional plant medicines, has seven employees and five different products in dozens of stores. Taylor said topical cannabis “absorbs into the skin like Icy Hot,” promotes healing and reduces the swelling that causes nerve and muscle pain. She sees customers with medially rotated shoulders from computer work, as well as lots of folks with multiple sclerosis and neuropathy.
“It’s getting huge,” she said. “We’re seeing a huge trend in massage therapists asking for topicals and it’s only going to get bigger in Colorado.”
“Got pain?” the booth attendants at the 2010 High Times Medical Cannabis Cup in Los Angeles asked passersby.
“Yes,” said 70 year-old Los Angeles resident Cynthia Johnston. “Yes I do.”
Cynthia has rheumatoid arthritis so bad that, “I would sit there in the morning and my hands would just ache, but worse than that, I would get explosions in my fingers. I’d be sitting there minding my own business and I’d just yell because my pinky would just explode.”
She continued, “I felt like my hands were inside of a microwave and they were burning from the inside out, and the knuckles were very sore to the touch. My fingers were bent. It hurt to hold a pen. It hurt to type on the keyboard.”
If Colorado is the star of the canna-massage industry, the sector dims as the laws get less liberal. The next bastion is California — which has a larger topicals industry, but lacks studios advertising anything like a “420 massage” — for now.
Instead, the state’s blooming topicals industry converts one patient at a time and Cynthia is an evangelist. She says it changed her life “completely.”
“[The Cannabis Cup attendants] said, ‘try this’, and they gave me a bottle of spray,” she said. “I took it home that night and used it on my hands and it helped me immediately. I went back to the Cannabis Cup that next day and said, ‘I’m a believer.’…The spray works immediately. Smoking pot also helps, but it doesn’t get in as deep or act as immediate in terms of the pain disappearing.”
She continued, “It doesn’t mean that I’m completely pain-free and I still get an occasional explosion in my fingers but on a general basis I’m down from an 8 — in terms of constant and sudden pain — to a 2. I often forget that I have arthritis. It’s a miracle. I don’t hesitate to say that at all.”
With topicals and self-massage, Cynthia has weaned herself off daily Vicodin and Xanax use and says she’s been off conventional meds for over a year. Cynthia’s now a community leader for NORML’s Women’s Alliance and works on de-programming seniors schooled during the Reefer Madness era.
“All my friends use Xternal topicals, because I’ve been giving it to them for a long time,” she said. “Now they’re at the point when they call me saying, ‘I’m almost out of balm. I need some more spray’.”
Xternal has six product lines and retails in hundreds of dispensaries in California. At least a dozen competitor brands are out there.
State laws are a big barrier to swifter adoption of cannabis topicals and treatments. Since all forms of cannabis are still federally illegal, both California massage therapists and customers need a doctor’s recommendation in order to obtain topicals under the state law — or to have a defense in court, in the extremely unlikely event they are arrested and charged with possession of marijuana.
Ramona Rubin, a public health researcher and co-founder of topicals maker Doc Greens said California therapists are loathe to jeopardize their state license if they use cannabis-infused products. Thus, no one’s advertising marijuana treatments.
“The licensing process is intimidating and you don’t want to get on the wrong side of the state,” Rubin said.
Aspiring canna-massage customers must first obtain a recommendation, and a topical, then find a groovy masseuse to apply it. It’s happening in California, but not in a commercial fashion.
“It’s a growing trend,” Ramona said. Doc Greens opens a studio specializing in canna-massage — among the first in the state — this winter in Oakland.
When Doc Green started, patients had few products and almost none of them were made professionally. Today, there are dozens of California topicals makers, some of whom use labs to certify their products.
“It has really taken off from our point of view,” said Ramona, “But it’s still way underutilized.”
The intersection of cannabis and massage truly disappears into the underground in the legalization state of Washington. Unlicensed medical marijuana stores and manufacturers are plentiful, but locals can’t find a single cannabis topical for sale in the state’s newly licensed recreational cannabis stores.
Moreover, under Washington legalization Initiative 502, recreational cannabis stores and topical producers are not legally allowed to advertise that their product has any medical value whatsoever.
60-year old George Penzenik of Mossyrock, Washington finds that especially frustrating, given his story. Penzenik and his wife are a couple of transplants from the Midwest that moved to Washington for work. His wife has severe, chronic, degenerative neck issues that led to a string of surgeries. She had metal rods inserted into her neck and takes a pharmacy’s-worth of pills.
“It was like I was dating Keith Richards,” Penzenik said. “I saw the light go out of my wife’s eyes.”
In college, George and his wife had smoked, but later gave up weed to fit in in Minnesota. Under medical marijuana law in Washington, Penzenik’s wife tried a cannabis-infused topical and found relief. The product’s potency and professionalism proved lacking, George said, and the accomplished home chemist got to work making a super-potent lotion of his own.
Today, Penzenik’s topical brand, Verdantwaye, is part of a nascent cottage industry of medical marijuana topicals makers. Verdantwaye consists of two dozen products in about 20 medical marijuana stores. Penzenik has four full-time employees, two part-timers, and is in the process of raising a million dollars to start a legal, recreational cannabis farm. The plants will go into Verdanwaye topicals, which can then get sold in I-502 compliant stores.
Photo: Verdantwaye products.
His wife is doing “fairly well” now, he said. She’s “actually able to participate in the active farming, the formulation of the topicals and the actual bottling and processing.”
Penzenik knows of two massage therapists performing canna-massage. “There could be many more” but “use of topicals in massage therapy is low [in Washington],” he said.
The path to market and barriers to reaching consumers are “complicated,” he said. Gagged by state law, topicals proponents are counting on the wave of media reports to raise awareness. Penzenik thinks “it’s going to be a very slow groundswell.”
Part of the reason is the paucity of double-blind placebo controlled trials of topicals for the treatment of pain and inflammation — the gold standard in modern medicine.
“We are sort of in the same realm as a lot of herbal supplements where there has to be a disclaimer: ‘None of these products have been approved by the FDA for the treatment or prevention of any disease.’ …I’m not a physician, not a physician’s assistant, and not a registered nurse,” said Penzenik. “The best we can say is there are other individuals who report relief from this.”
It’s a horrifying tragedy that the practice of canna-massage — which patients report can be a matter of life and death — suffers at all due to federal prohibition of marijuana. Applying the active ingredients in pot to the skin does not get you high, or cause you to fail drug tests, advocates report.
A review of the published science shows the research area is both extremely fertile and simultaneously radioactive with federal cannabis prohibition. An effective blockade prevents scientists not affiliated with the government from studying cannabis. Therefore, scientists have yet to do some of the most basic work with “phytocannabinoids” — the active ingredients from the whole plant.
Still, pre-clinical studies do back up what patients report.
First off, skin and muscle tissue both contain nerve fibers with “cannabinoid receptors” — special sites on nerve cells which dock with the active ingredients in marijuana. Moreover, the dozens of active ingredients — called “cannabinoids” and “terpenes” — can penetrate deep into the skin to reach nerves as well as immune cells.
“Topical cannabinoid receptor agonists” — which is a medical phrase for a synthetic marijuana lotion — is an “effective, well-tolerated adjuvant therapy option” for patients with burning skin pain, notes one study.
Researchers use lab-made analogs of natural phytocannabinoids because the ones in the plant are all-but banned from medical research. Patients with post-herpatic neuralgia reported a mean pain reduction of 87.8 percent with “no unpleasant or adverse reactions,” one study states.
In a mouse study of a topical made of the main active molecule in pot, THC, researchers found the molecule effectively reduces “contact allergen inflammation…by decreasing pro-inflammatory mediators.”
And in another study of 22 patients with untreatable skin itching related to nerve dysfunction, patients reported a 86.4 percent decrease in itching with a topical cannabinoid agonist. Cannabis-derived creams would “represent a new, effective, well-tolerated therapy for refractory itching” the study found, and the stronger the potency, the better.
Other studies call topical cannabinoids “a viable target for drug development” and note that they enhance the pain-relieving effect of topical morphine. Whole plant cannabis topicals also seem to affect more than just cannabinoid receptors in the skin, acting on “other inflammatory endpoints targeted by phytocannabinoids” too.
Meanwhile, you can’t throw a frisbee in the medical marijuana community without hitting somebody using canna-massage for pain, inflammation and arthritis. The anecdotal reports are beyond compelling.
“One day I woke up in the morning and my eyeball was hanging out of my head,” said Sandra Hinchcliffe, a self-taught home herbalist from the Bay Area of California.
Hinchcliffe has battled her own immune system her entire life — with weird food allergies, rashes and, eventually, a bought of autoimmune disease so severe it caused swelling that pushed our her eyeball.
“I’m sorry to freak you out, but it was coming out of the orbit and running down my face.”
Hinchcliffe’s immediate treatment at Stanford University mimicked that of treating blood cancer: chemotherapy and radiation. With her immune system beaten back, she was left with body-wide rheumatoid arthritis and crippling joint pain. She worried about becoming addicted to the opioids doctors gave her to manage each day’s agony.
Hinchcliffe found smoked and eaten medical marijuana helped, but didn’t “seem to completely tamper down the pain.”
“I can’t drive and work high,” she said. “I needed something that was going to relieve my pain better than Advil and not be addictive like Vicodin, and be able to drive [sic].”
Hinchcliffe educated herself, discovering that “cannabis is a mild TNF (tumor necrosis factor) inhibitor.’’ TNF is a key part of the body’s inflammatory response.
When off-the-shelf topicals proved too weak, Hinchcliffe started experimenting with her own and the results are written up in her book The Cannabis Spa — which she self-published before it got picked up by Skyhorse for a 2015 commercial release.
Now she’s off all pharmaceuticals for her pain, she said.
“If I did not have cannabis I would be on those drugs. There’s no way I can function, the pain is so severe.”
Back in our room at night, my partner is silent.
Almost an hour into the massage, my hands are not cramping. I can feel her breathing deeply. Her once slab-like rectus has a softer, pliant feel. She sleeps through the night for the first time in a week without waking up and taking Flexeril. She starts applying a topical spray during the day.
Over the next week, a friend emails me asking: “…to source some medicinal help for ‘Curt’, my brilliant but straight-laced stepdad, by this weekend.
She writes: “He’s been suffering from a frozen shoulder that’s not really getting better with physical therapy, etc. Apparently it’s more of an inflammation / autoimmune issue than anything else, and he’s interested in trying some medicinal options, but isn’t ready to go forth with getting a card, etc.
“Wondering if maybe a therapeutic salve and tinctures could help?”
Later in the week, she writes: “My stepdad tried the cream on Sunday and was blown away by how much it helped. Way more than any of the pharmies he’s been prescribed. He’s going to get his card this week. Thanks so much!”
Meanwhile, my partner and I get serious about the problem. Her doctor floats epidurals and steroids. We go with rest, relaxation, yoga, hydration, heat, Pilates, and canna-massage. She makes a full recovery. The problem, and its solution, are multi-factor, it would seem. She has a favorite cannabis cream, she says. The stronger the better.
“Topicals are the thing that’s going to be in everyone’s medicine cabinet,” said Rubin. “I call it the gateway to cannabis and the future of cannabis.
“It cannot hurt. It can only help. It’s what will be the final straw to change people’s minds.”