Melissa Pressler was diagnosed at age 18 with irritable bowel syndrome and gastroparesis, conditions that caused years of debilitating pain and discomfort.

But in 2019, nearly five years after the diagnosis, the Riverhead resident said she found relief when she started using cannabis for pain management. Now 28, the artist and teacher said tinctures and edibles have changed her life, relieving her most severe gastric symptoms.

“It’s really given me a lot of power in my life,” she said. “I’m not in pain and discomfort all the time.”

Pressler is one of thousands of Long Islanders who use cannabis for pain relief.

Pain is the top qualifying condition for medical marijuana, according to a 2023 report by the Office of Cannabis Management. A 2022 study that surveyed 11,590 medical cannabis users in New York found that chronic pain was the most common reason for use, at 36.5%. Nearly 5,000 of those users were Long Island residents.

But for those new to cannabis, walking into a dispensary can be overwhelming. Newsday spoke with several experts about using cannabis for pain relief — how to find the right products, ask the right questions and make informed decisions.

What are cannabinoids — and how do they help with pain?

A cannabinoid is a natural compound in cannabis that affects how the brain and body respond to things like pain, stress, appetite and sleep.

Sunnyside pharmacist Jason Zvokel broke down how four common cannabinoids can help manage pain and related symptoms: 

• Tetrahydrocannabinol (THC) is psychoactive and can help relieve nerve-related (neuropathic) pain, but may cause impairment or drowsiness at higher doses.
• Cannabidiol (CBD) is non-psychoactive and commonly used to reduce inflammation and anxiety, making it useful for joint pain and autoimmune conditions like arthritis.
• Cannabinol (CBN) is mildly psychoactive and known for its sedative effects, which may help people with pain-related insomnia or nighttime discomfort.
• Cannabigerol (CBG) is non-psychoactive and has shown promise in reducing inflammation and pain in early studies, potentially supporting those with chronic inflammatory conditions.

Why does this matter? Different cannabinoids interact with the body in different ways, which is why patients often adjust the levels of each compound depending on the type of pain they’re treating. For example, someone with inflammatory joint pain might benefit from more CBD or CBG, while someone with nerve pain might need some THC to get relief.

What strains and products work best for pain?

Strains derived from indica species of the cannabis plant are typically effective for pain, said Dr. Lynda Varlotta, who runs In Touch With Your Health, a Stony Brook private practice that integrates traditional care, holistic treatments and cannabis.

Irvin Rodriguez, a wellness adviser at Sunnyside, a medical dispensary in Huntington, recommends indica strains such as Wedding Cake and Ice Cream Cake.

Dan Ryszka, a Buffalo-based pain management-certified pharmacist and board member for the Office of Cannabis Management’s Medical Cannabis Advisory Council, said he recommends products to prospective users that achieve results but don’t impair the consumer, so he will often suggest products other than THC, such as CBD, to start.

What are the best ways to consume cannabis for pain relief?

Ryszka said he doesn’t recommend smoking for pain management because it kicks in in a few minutes but doesn’t last more than an hour or two.

“You’re playing this game of ‘I feel good, I feel bad, I feel good, I feel bad,’ ” he said.

He recommends oral options like capsules, tinctures or gummies. While these take longer to work, they offer longer-lasting relief.

“If you have a gummy, for example, it will take about an hour to start working but then give you three or four hours of coverage,” Ryszka said.

Varlotta said most of her patients use gummies, but recommended non-sugary, non-artificially colored or flavored options for patients looking to maintain a healthy, clean diet while on cancer treatment.

“I always start people with a tincture,” she said.

Are there risks or side effects?

Side effects may include vertigo at high doses, nausea, dry mouth and, in rare cases, sleep apnea, neutropenia (a drop in white blood cells) and irregular heartbeat, according to Varlotta.

How should cannabis for pain be dosed?

Starting slow is key, with doses around 5mg recommended at first, Zvokel said.

“We usually do a ‘go slow, go low’ policy for the cannabis-naive,” said Varlotta, referring to patients who are not regular cannabis users. “If you take too much and get vertigo from taking much, as well as nausea, you’ll never go back to using it.”

Ryszka emphasized that first-time users should stay home until they know how the product affects them before going out in public or traveling.

What should new users ask when buying cannabis for pain?

Patients should always request a pharmacy consultation at medical dispensaries, as New York State law requires medical dispensaries to have a pharmacist on site, according to the Office of Cannabis Management.

Ryszka suggests patients ask pharmacists about which cannabinoids will work for the type of pain they’re experiencing, as well as what types of products are available.

After speaking with a pharmacist, a patient should tell a wellness or medical associate, the medical dispensary equivalent of a budtender, what they’re comfortable consuming (pre-rolls, vapes, tinctures or edibles), Ryszka said.

If a consumer is going to a recreational dispensary instead of a medical dispensary, they should ask a budtender what products are good for their specific type of pain, said Chris Shilling, the manager at Beleaf Calverton.

“A lot of times, if they’re coming in for pain, they skew toward the older population,” Shilling said.

How can a patient get started?

Patients can consult any of the 4,568 providers who are registered to prescribe medical cannabis in New York State, according to the Office of Cannabis Management. Click here to find a provider near you.