What Pain Professionals Are Saying About Marijuana

March 23, 2015 / Thomas Cohn, MD

Marijuana is a controversial topic in society. Some people want it legalized while others demonize the compound. The reality in the medical field is somewhat in the middle. The first thing that needs to be understood is that in most circumstances, medical experts are primarily interested in all the compounds in marijuana except for THC. That means most medical professionals are interested in what cannabinoids or cannabidiols (CBD) compounds are present and what medical purpose they serve. The major compound that is present in almost all available marijuana is THC, which also happens to be the compound responsible for the high one receives from marijuana.

For pain professionals, there is good understanding of the action and effects of THC. Most strains available in states that have legal marijuana, including strains that are “medicinal” in use have high amounts of THC, 10% or greater in amount, and virtually no other cannabidiols, or less than 2%. In the years of the hippie generation, the 1960’s and 1970’s, THC to CBD ratio was 1:1, and averaged 1-2%, while the really good stuff was just around 5%. Now available in legalized states, most available strains are minimum of 10% with up to 30% THC.

Medically, the best comparison of legal marijuana at this time, is to alcohol. The risk of dependence to THC is about 9%, including when using once a week (in reality this is a very strong way to become dependent), compared to alcohol which is 15%. Regular use, once a week, is known to increase depression, suicide, impulsivity, schizophrenia and psychosis, especially if use is started under the age of 20. It also leads to an 8-point loss of IQ in the young. Further, smoking does cause problems with the lungs. Recommending regular marijuana is no different for medical professionals to recommending drinking alcohol. The risks and associated problems are clearly out numbering benefits.

Need To Understand More

What we know about cannabidiols is just the beginning. In marijuana, we know there are over 100 different types. Our experience so far has found that they have some properties that may be helpful in about 30% of patients with neuropathic pain associated with MS and HIV. In low back pain, we’ve learned:

It has helped in anxiety but not with pain.

More people respond to acetaminophen then marijuana.

The future of cannabidiols is interesting for pain. It is unlikely that many professionals would be enthused to prescribe a substance that has the risk profile of THC. Once we can find the particular cannabidiols that have medical uses, it is likely that we will try to study them fully and make them commercially available for specific conditions. Cannabidiols may be helpful in the future, but we still don’t know enough right now to safely prescribe marijuana for a wide range of conditions.

Marijuana and the Reduction in Painkiller Overdoses – Part 2

September 10, 2014 / Thomas Cohn, MD

Last month we discussed the new study published in JAMA (The Journal of the American Medical Association) showing that drug overdose deaths due to opioids declined in 13 states that legalized medical marijuana. The study just looked at death rates overall due to opioids and noted that they happened to decline up to 30% in states that legalized medical marijuana. Today, I expand on the findings.

This study is great, sensational news, but in reality, it is a leap of faith that these two subjects are truly correlated. Opioid overdose and deaths are a very complex issue. The overdose of opioids is linked to many things, especially recreational use. The death rate from overdose is related to many factors, including whether the overdose was accidental or on purpose, such as a suicide. Furthermore, the access to treatment for overdose is important, especially whether first responders can recognize it and provide drug reversal rapidly and then get a person to a hospital for support. So, if you are using opioids to get high, it does not matter if marijuana for medical use is legal since they are not using it.

Medical marijuana is used for a variety of problems, including nausea related to cancer, seizures, and glaucoma. None of those conditions have much to do with opioids and drug overdoses. So if marijuana is legal for glaucoma or treating seizures, why would death rate due to narcotic overdose change? Rationally, it would not.

Unfortunately, this is just another example of a study finding a nice statistic that has no true correlation to the data. This study did not specifically look at factors that are related to opioid overdose death. If the study actually looked at reasons related to opioid overdoses, treatments, and deaths, there may be some validity. Rewarding medical marijuana with this lofty success is poor research and data interpretation. A prestigious journal, JAMA, should do much better at critically analyzing research and publishing articles. This is an amazingly poor job of data analysis and conclusions with an over simplification of causes of opioid related deaths.

Medical Marijuana in Minnesota

May 12, 2014December 11, 2015 / Thomas Cohn, MD

The debate for legalizing marijuana is continuing in Minnesota. Bills are progressing through the legislature, but nothing as of yet has been decided. There are some very vocal groups supporting medical marijuana in Minnesota, with one of the most passionate groups being parents with children who are prone to seizures. The medical and law enforcement communities are less excited about the legalizing of medical marijuana.

It’s interesting to note that the Senate and House bills are not legalizing the smoking of marijuana. Instead, they’ve proposed the legalization of state-dispensed marijuana in pill or liquid form for vaporizing. There will be fees paid by the user and pharmacy, and it appears that it will be restricted to only certain medical conditions.

Qualifying Conditions

The Senate has created a list of conditions that would make a person eligible for medical marijuana. Some of the conditions include:

HIV
Glaucoma
ALS, MS, and Crohn’s Disease
PTSD
Seizures
Some forms of Chronic Pain

The Senate and the House do not agree on some eligible conditions, as the House is not supporting medical marijuana for PTSD or chronic pain.

The legal community is not thrilled with legalizing marijuana due to concerns about control and abuse. There are so many prescription medications that are currently being abused, and the law enforcement community does not want to add to the existing problems. Tight restrictions on use may control the availability and abuse potential, but these problems are unknown. In states where less restrictive medical marijuana laws are present, abuse is a large problem.

The medical community is not thrilled with marijuana at this time more on a scientific basis. There are at least 84 cannaboids associated with different forms of marijuana. All these compounds have different actions in the body and they have not been studied in depth. The compounds that are helpful in various conditions have not been isolated. In general, it is bad medicine to give people drugs without knowing all of the potential side effects. Medically, we have no idea if these compounds may cause cancer or other horrible problems later in life.

Marijuana may have some very good attributes for treatment in some conditions, but at this time we are only guessing what may be helpful or dangerous. The best solution would be to get serious in testing and scientifically studying the various ingredients in marijuana. Legalizing does not really help in our understanding of the plant. Research is needed to determine the real nature of the cannaboids in the plant. A national effort to appropriately study marijuana would be beneficial.