Body Care: The Rise of Cannabis Massage

The benefits of massage therapy have made it a staple in integrative medicine, as research supports claims that regular massage therapy can help reduce anxiety, pain, and stress in humans. It’s been linked to improved immunity, reduction in inflammation, elevated mood, and overall wellness.

This evidence-backed treatment can be a powerful tool in an individual’s health kit, but what happens when cannabis is introduced into the experience?

Cannabis massage is becoming increasingly popular as more states legalize cannabis for both adult and medicinal use. Though the plant remains illegal at the federal level and is considered a controlled substance, 15 states and the District of Columbia have legalized marijuana for adult use for those older than 21. It’s been legalized for medical use in 36 states, with five states added to the list in the November 2020 election.

Topical Cannabis Massage
Jordan Person, LPN, LMT, describes herself as one of the first massage therapists in Colorado to experiment with cannabis massages. Having spent more than 20 years as a nurse, Person has also been a licensed massage therapist for 15 years and started her cannabis massage company in 2014.

In her private practice, Person and her team use high THC and CBD oils and salves she designed specifically for her company’s patients. Full-spectrum hemp versions of the products can now be purchased by anyone wanting to experiment with activating their endocannabinoid systems topically.

As for the legal facet of cannabis massage, Person says this “varies on a state by state basis, and some state boards are saying they don’t want people working with cannabis. So you need to do the research in your own state, because some states don’t allow the use of topical cannabis.”

What does it take to become a cannabis massage therapist? According to Person, it’s all in the education. “Anyone can rub cannabis on someone and call themselves a massage therapist. The difference between us and them is education”—being licensed as a massage therapist and pursuing further education to learn specifically about cannabis.

To explore whether cannabis could augment a client’s experience during massage, Person spent six months asking dozens of clients for permission to apply a cannabis salve during their massages. The salve was made from full-spectrum hemp, so it contained less than 0.3% THC. She reports that 100% of her clients noted a difference in how they felt during the massage, reporting a greater reduction in muscle pain.

Using her knowledge of the human body as well as her experience working at a medical marijuana dispensary, Person created a curriculum in 2017 that centered on cannabis massage as a therapeutic modality. She now teaches this course to groups of massage therapists in 28 states as well as in Canada and New Zealand to educate them on the endocannabinoid system and how to use cannabis effectively in massage therapy.

About whether cannabis massages are backed by research, Person is transparent. She acknowledges that research is lacking but says, “Anecdotally, the evidence is there. We have worked on thousands of patients, and the results are always the same. They say, ‘That was the best massage I have ever had.’”

Oral Cannabis Massage
Topical application of cannabis isn’t the only way to provide a cannabis massage. Angie Wong, a licensed massage therapist based in Los Angeles, combines oral cannabis with topical cannabis to create a cannabis massage experience for her clients.

Her protocol is straightforward. They initially get a 25 mg dose of oral CBD. That, she says, “will kick in around 30 minutes into the massage, and I’m also using CBD-infused salve for topical application.”

Prior to incorporating cannabis into her practice, Wong took a medical cannabis course and became certified to use cannabis as part of her massage therapy. The certification course was through the Medical Cannabis Caregivers Directory, an educational program approved by the California Department of Social Services to provide courses to medical cannabis practitioners on California cannabis regulations as well as best practices for implementing cannabis into a health care practice.

Wong says only a few of her clients prefer traditional massage therapy compared with cannabis massage therapy. “Most of my clients say they are more relaxed and less stressed out. Even after the massage, if something happens that would usually get them upset, they are better able to cope with it because of the cannabis.”

Wong’s goal in transitioning to cannabis massage therapy was to better help people. “A lot of people have pain, and cannabis really helps,” she says. “So I wanted to learn about it and give them that help that they need.”

Like Person, Wong recognizes the lack of research behind this type of treatment but agrees that anecdotal evidence has been powerful enough to inspire her to continue providing cannabis massages to her clients.

Jordan Tishler, MD, who became an expert in cannabis medicine after graduating from Harvard Medical School, says that while cannabis massage holds promise when THC is ingested orally, the use of CBD for topical application is questionable. “Let’s start with what’s known about absorption of cannabinoids topically,” he says. “There isn’t any. Cannabinoids are hydrophobic and do not readily pass through the skin. There is evidence that cannabinoids topically can affect skin, but not deeper structures like muscles. There are agents that can be added to make cannabinoids penetrate skin, much like other conventional medications that can be used in a patch. However, these agents often cause skin irritation or rash, leaving open the question of why use this route of delivery for something like a massage.”

It’s also important to note that CBD research has involved animals, not humans, and has been performed under conditions that can’t be replicated in a real-world setting. The studies involved injuring mice and then evaluating the impact of CBD on pain control, “which isn’t a good model of human arthritis or other chronic degenerative pain,” Tishler says. “So there really isn’t evidence that even if massages with CBD could get the CBD into the muscles, it would do anything.”

Tishler further explains that the efficacy of CBD in medical treatment has only been established in human children with rare genetic seizure diseases and with exceedingly high CBD doses (10 to 20 mg/kg) that aren’t available to the public. However, he says, “as to cannabis itself, containing THC as the main ingredient … that’s entirely a different story. THC has a long track record of research showing that it is indeed a pain reliever and muscle relaxer. I use this in my practice routinely with exceptional results. There is, however, no legal basis for use of THC in massage at this point, nor would that work given that the same issues apply to topical THC as to CBD that I mentioned.

“Taking THC either orally or by inhalation (preferably vaporized cannabis flower, not oil) would make for a great adjunct to massage, but needs to be done in a manner that doesn’t put the client or massager at risk from travel-related danger or liability,” Tishler continues. “How does the intoxicated person get to and from the massage safely, and how much liability does the massager have for recommending cannabis use without providing safeguards against risk to the client? The same issues apply to cannabis yoga or for any other office-/site-based service. There are ways around this, like Uber, but liability issues abound.”

While Tishler maintains there’s no research to support topical cannabis application or oral CBD ingestion to augment a massage therapy session, he does value the power of the human mind. “The placebo effect is very real,” he says, “and accounts for all of the frequent reports of benefit from CBD.”

Though the effectiveness of cannabis massage isn’t supported by scientific literature at this time, massage clients remain interested. Why is this? “Orally ingesting CBD is a placebo at the doses people can take,” Tishler says. “So whether someone would feel an effect during a massage depends entirely on their willingness to believe.”

— Sandeep Kaur Dhillon, MS, RDN, received her master’s degree in nutrition and exercise physiology from Columbia University. She completed her dietetic training in New York City and practices as a dietitian in Los Angeles.