Marijuana and Pain

Marijuana May Help Solve the Opioid Crisis

The opioid crisis is a complex problem with many components, one of which is untreated pain. To the extent that it could be used to help patients manage pain, marijuana might have the potential to become part of the solution.

However, the U.S. Drug Enforcement Administration (DEA) has made it difficult — although not impossible — for researchers to responsibly explore marijuana’s use in treating pain. Since 1970, the DEA has categorized marijuana as a Schedule I drug “with no currently accepted medical use and a high potential for abuse.”

In addition, the Federal government imposed criminal prohibitions against the commercial uses of marijuana nearly 81 years ago. The Marijuana Tax Act of 1937, which is still in effect, economically discourages research that might uncover whether or not there might be a medical use for marijuana.

Research on Marijuana and Pain

That is why it is interesting to look into the research Canada has done. Canada has had years of experience and has conducted numerous clinical trials to study the efficacy of marijuana in treating several disorders. Recently, Canada published medical marijuana prescribing guidelines that state cannabis is not appropriate for patients under age 25 years, for people with a current or past substance use disorder, for those who have a personal or family history of mental illness, for patients with a significant cardio-pulmonary disease, or for a woman during pregnancy. The guidelines also note that THC is transferred through breast milk and could have long-term detrimental effects on an infant’s brain development.

A paper recently published by a Canadian team of researchers called “Therapeutic potential of medicinal marijuana: an educational primer for health care professionals” suggests that, while more research is needed, cannabis might be an “appropriate alternative therapy option for patients who have epilepsy, movement disorders, and pain.”

In the United States, researchers are making headway in learning more about how marijuana might be used to treat pain. According to a statement made by the National Academies of Science, “Adults with chronic pain are more likely to experience clinically significant levels of pain reduction when treated with cannabis and cannabinoids.” Additionally, when states are given legal access to medical marijuana, prescription rates of opioids go down by about 25%, leading to fewer drug-related deaths.

That said, we have weak evidence that cannabis-derived compounds help the nerve pain associated with chemotherapy or conditions like fibromyalgia. According to a meta-analysis published March 7, 2018 by Cochrane, cannabis might reduce this kind of neuropathic pain — but not by a lot, and not by much more than a placebo. In cases where the efficacy of marijuana is unproven, the potential side effects may mean the treatments can do more harm than good.

Marijuana Facts

When we talk about marijuana, we are actually talking about three different species of the plant (C. sativa, C. indica and C. ruderalis) that contain different amounts and strengths of THC and CBD. C. staiva contains more THC than CBD.  According to Professor Jordan Zjawiony at the University of Mississippi, and other members of their research team, marijuana can be more hallucinogenic than lysergic acid diethylamide (LSD), depending on the strain. The higher the THC:CBD ratio, the more psychoactive effects there will be. The lower the ratio, the more sedative and relaxing effects it will produce. Therefore, it is important to know the strain and concentration ratio of the primary active components to gauge marijuana’s potential good and bad effects.

Every drug that has benefits also carries risks. We don’t fully know the extent of marijuana’s dangers, but it probably depends, in part, on the THC:CBD ratio. It is likely that, the higher the THC:CBD ratio, the greater the potential hazards.

Risks of Marijuana

The efficacy and safety of cannabis also may depend on how the drug is administered. The amount of active drug(s) delivered, and the positive and negatives effects it may carry, are determined, in part, by whether the cannabis is administered by oral tablets, oromucosal spray, vaporizing, or smoking.

For example, smoking marijuana may be safer than ingesting foods, such as brownies, containing marijuana. Edible marijuana products, once ingested, undergo metabolism that can produce a metabolite that is far more toxic than the parent THC molecule. This metabolite is not produced by smoking marijuana. There have been reported cases of psychosis and self-harm after oral consumption of marijuana edibles, presumably due to the THC metabolite.

Another risk is that of substance use disorder. According to National Epidemiological Survey on Alcohol and Related Conditions, marijuana addiction occurs in about 8.9% of  marijuana users. This is comparable to the risk of developing an addiction to opioids. However, the risks of overdose with marijuana and opioid users are not the same. Opioids can easily cause respiratory depression. Marijuana, on the other hand, is not known to significantly depress respirations.

As more states legalize marijuana, the rising demand may create problems. We’re already seeing that in Uruguay, where recent legalization has caused a surge in demand, people who cannot obtain legal marijuana may be driven to the black market where they will be forced to take their chances with adulterated, and potentially lethal, street marijuana.

It appears some components of marijuana may be helpful in treating some types of pain in some people, some of the time. However, not everyone is likely to benefit. There is much more research that needs to be done. In the meantime, marijuana provides an example of an alternative pain treatment that may, in time, be beneficial in reducing the need for prescription opioids.

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