marijuana-for pain

Current Research on Marijuana for Pain is Lacking

Is Marijuana Use for Pain Driving Negative Societal Effects?

by Kenneth Finn, MD

Pain is the most common diagnosis associated with marijuana being recommended for medical use 1. With more states moving towards accepting marijuana use for medical purposes, there is a call from the medical and scientific community for more research and
evidence that it actually works for common pain conditions.

Out of the top 20 medical diagnoses presenting to the primary care physician nationally, there are only 3 that are associated with a painful condition 2: spinal disorders (i.e., lower back pain), arthropathies and related disorders (i.e., knee arthritis), and abdominal pain.

There were no other pain diagnoses in the top 20 diagnoses which present to the primary care physician for treatment, including cancer pain or neuropathic pain.

What does the medical literature tell us about the use of marijuana for pain? In 2011, The British Journal of Pharmacology released a paper looking at the use for cannabinoids for the treatment of chronic non-cancer pain 3. They narrowed a broad literature review to only 18 trials with a total of 925 participants. Most of the trials reviewed studied neuropathic pain (72%), including HIV neuropathy, in multiple sclerosis (3 trials), and single studies looked at arthritis or chronic spinal pain. There were only 4 studies which looked at smoked cannabis and in neuropathic pain only. Six studies evaluated synthetic cannabinoids (Dronabinol, Nabilione) for pain (off-label use).

From these trials, the average number of patients was 49 with average duration of 22 days, some of which were one week long. Despite their conclusion that cannabinoids may be helpful for chronic non-cancer pain, they note there were limitations with small sample sizes, modest effects, and stressed the need for larger trials of longer duration to determine safety and efficacy.

In 2015, the Journal of the American Medical Association (JAMA) released an article on cannabinoids for medical use 4. Chronic pain was assessed in 28 studies, involving 63 reports and 2454 participants. 13 studies evaluated nabiximols (not available in the US), 4 for smoked THC, 6 evaluated synthetic THC, 3 for oromucosal spray, 1 for oral THC, 1 vaporized cannabis. The majority of studies looked at some form of neuropathic pain or cancer pain. Two studies were at low risk of bias, 9 at unclear risk, and 17 at high risk of bias. Studies generally suggested improvements in pain measures associated with cannabinoids but these did not reach statistical significance in most individual studies. Despite that, they concluded that there was moderate-quality evidence to suggest that cannabinoids may be beneficial for the treatment of chronic neuropathic or cancer pain (smoked THC and nabiximols). Note these are less common pain conditions that present to the physician for treatment nationally. The authors noted an increased risk of short-term adverse effects with cannabinoid use, including some serious adverse effects. Common adverse effects included asthenia, balance problems, confusion, dizziness, disorientation, diarrhea, euphoria, drowsiness, dry mouth, fatigue, hallucination, nausea, somnolence, and vomiting.

In 2017, The National Academies of Science, Engineering, and Medicine released a paper on the health effects of cannabis and cannabinoids 5. It may be important to note that none of the authors had a background in Anesthesia or Pain Medicine. The authors felt the above JAMA article was the most comprehensive and that the medical condition most often associated with chronic pain in that article was a neuropathy and a majority of studies evaluated treatment with nabiximols, which are not available in the United States.

The committee found that only a handful of studies evaluated the use of cannabis and that many of the cannabis products sold in state regulated markets bear little resemblance to the products available for research at the federal level in the United States. They also note that very little is known regarding efficacy, dose, routes of administration, or side effects of commonly used and commercially available products in the United States. Despite that, they still concluded that “cannabis is an effective treatment for chronic pain in adults”.

The above noted papers are all that is available to the public and medical community and are the only information available regarding treatment of pain with marijuana. Despite that, the public has embraced that marijuana can treat all pain conditions and state governments have followed suit, without scientific evidence, and have allowed an industry to prosper on the thin ice of what is currently and scientifically available.

It is important to understand that pain covers a broad spectrum of disorders and pain of different origins does not necessarily respond the same to different medications. It is also important to understand that dispensary cannabis is considered a generic substance without defined or accepted dosing guidelines and will vary in purity as well as potency. It may also contain hundreds of other compounds, some of which may have physiologic activity. Cannabinoids are purified components of the plant which have been isolated in a
laboratory and have more scientific foundation, but are currently not available for study or use in pain conditions in the United States.

Since de facto legalization in Colorado in 2009, there has been a significant increase in public health and safety concerns, which include utilization of the health care system, an increase in adolescent substance use treatment for cannabis, as well as an increase in marijuana related driving fatalities 6. The addiction rates are reportedly 9% in the adult and roughly 18% in the adolescent, which was based on the potency of marijuana nearly 20 years ago. The potency has significantly increased in the past 5 years alone, so we are now in uncharted waters and unable predict the long term effects or addiction rates of currently available, highly potent products, with variable delivery systems.

As the number of medical marijuana patients increased in Colorado, there appears to be a parallel increase in the number of adolescents needing substance use treatment, most often for cannabis. Colorado is now contending with a huge opioid and heroin epidemic and despite the widespread availability of Narcan, does not appear to have leveled off or curb the number of opioid or heroin deaths in the state which continue to rise 7.

Although the concept of using marijuana to decrease opioid use is attractive and there is little data to suggest that may be the case. According to the CDC, the number of drug overdose deaths in Colorado has continued to increase, ahead of the national average 8. The above problems are now landing in the laps of other groups such as law enforcement and mental health providers who are pushing back and are straining their respective resources.

In summary, the problem of increased marijuana use has origin in its purported use for pain, but the medical literature is completely void of evidence for the treatment of common pain conditions with cannabinoids or cannabis. Current medical literature suggests benefit in less common pain conditions, with products not commercially available in the United States, or with synthetic THC, not with dispensary cannabis. The variability of available products changes regularly and their use in medicine, particularly pain, is unproven. The end game is in the court of law enforcement, mental health providers, the medical community, and our educational systems, at unknown societal costs, which are only now
becoming apparent.

Kenneth-Finn-MD
Dr. Kenneth Finn is a pain medicine specialist

Kenneth Finn, MD
Board Certified, Physical Medicine and Rehabilitation
Board Certified, Pain Management
Board Certified, Pain Medicine
American Board of Pain Medicine
Exam Council
Executive Board
Appeals Committee

 
 
 
 
 

1. https://www.colorado.gov/pacific/sites/default/files/
CHED_MMR_Report_April_2017.pdf
2. https://www.cdc.gov/nchs/data/ahcd/namcs_summary/
2013_namcs_web_tables.pdf, Table 16
3. https://www.ncbi.nlm.nih.gov/pubmed/21426373/
4. http://jamanetwork.com/journals/jama/fullarticle/2338251
5. https://www.nap.edu/catalog/24625/the-health-effects-of-cannabis-andcannabinoids-
the-current-state
6. http://www.rmhidta.org/html/
2016%20FINAL%20Legalization%20of%20Marijuana%20in%20Colorado%20The%20Imp
act.pdf
7. http://www.thedenverchannel.com/news/local-news/heroin-deaths-skyrocket-756-
percent-in-colorado-over-15-years
8. https://www.cdc.gov/nchs/data-visualization/drug-poisoning-mortality/

See Dr. Finn’s article, The Clinical Conundrum of Medical Marijuana

See PopPot’s previous article, Marijuana Can’t Substitute for Pain Pills

Marijuana Can’t Substitute for Pain Pills

The marijuana industry pushes an agenda to encourage marijuana use as a substitute for pain pills.  With a massive Public Relations effort, it uses the media to do its bidding.  However, the opiate and heroin epidemic mirror the legalization of marijuana.

Governor Chris Christie’s Opioid Commission should not pause one second to consider marijuana as a substitute for pain medication.  Save Our Society from Drugs recommends that we petition the group not to consider marijuana for pain.

Why So Much Chronic Pain?

Over prescribing by doctors was an issue in the past, but is not the major issue now.  Not everyone who becomes addicted to opiates started because of pain.  Those who under 35 who are dying from drug abuse at an unprecedented rate, often started abusing drugs just for fun.

People usually don’t get addicted to opiates by taking them as pain medications, according to Jon Daily, of Recovery Happens, outpatient addiction treatment centers.  He explains that the pain pills given after surgery and taken as prescribed, don’t produce a high for most people.  However, there’s a subset of people who respond differently and feel euphoria.  The difference in this minority may be because they’re responding to unresolved issues of painful experience earlier in their lives.

Dr. Libby Stuyt, addictions psychiatrist and advisor to Parents Opposed to Pot said: “Most patients with chronic pain issues find that holding onto emotional pain from past trauma comes out in the form of physical pain.  When they work through this and are able to let go, the physical pain greatly diminishes.”

Too much medical intervention and surgery is also an issue.  Ten years ago Shannon Brownlee wrote Overtreated: How Too Much Medicine is Making us Sicker and Poorer, and now people are noticing that overtreatment create problems.

A wise Chinese doctor said:  “When a body has an imbalance, which is displayed in the form of some or other dis-ease, it will continue to display this imbalance.  If we cut out the place where that imbalance is currently occurring, then chances are, it will simply move to the next area of the body.”

Could it be that unnecessary surgeries and too many surgeries contributed to the addiction problem?

Why People Get Addicted to Opiates

Studies show that only about six percent of the population gets addicted to pain pills after surgery.   A recent study shows that states with the highest drug abuse are also the states that have legalized marijuana.

According to Daily,  most people in his practice begin pain pill abuse because they were using alcohol and marijuana.  They began a relationship with intoxication that first came from these substances. It is why Daily recommends a paradigm shift from heroin to marijuana. 

We believe the future of pain medicine is in utilizing alternatives that treat the root of the pain.  Some of these techniques may need to be combined with Dialectical Behavior Therapy or Cognitive Behavior Therapy and spiritual help.   Cannabis, a psychotropic plant, is anything but “natural.”

Marijuana lobbyists have played a trick on America’s children by using the green pharmaceutical cross and pretending to be doctors.  They insist marijuana is “not a gateway” drug, but studies show otherwise.

We need propaganda to push back on the pot industry’s promotion of marijuana as a cure and the media’s advocacy on their behalf.   Remember, “medical” marijuana was planned as a hoax.

The United States uses 80 percent of the world’s opiate pain pills.  The United States and Canada have 56% of the world’s illegal drug users.   Polydrug use is the rule today and marijuana is usually part of the drug cocktail.

Prevention and Treatment

There are many other ways to treat the opiate epidemic:  better prevention programs; mandating education in the schools; clamping down on internet sellers of these drugs, and reversing America’s constant craving to be high.

As for using drugs to treat an addiction, this practice is questionable.  What works for some will not work for others. Perhaps long-acting naltrexone (Vivitrol)  which blocks the effects of opiates, and apparently the craving, can help.  Let’s hope Governor Christie’s Commission devises some good recommendations.

Marijuana Crack Weed Advertised on Instagram

It’s so difficult to be happy when my 19-year-old daughter is succumbing to using illicit drugs; I pray and wish she’d stop using but with this new drug culture in our country.  This culture is trying to normalize recreational drugs such as marijuana which makes it difficult for her to stop.

This is a picture from a drug dealer on Instagram; they sell to people on social media; does this look natural to you? It’s today’s crack weed marijuana and THC levels are extreme.

I was able to snap this picture from my daughter’s Instagram of someone she follows. This is not natural.  I oppose ever legalizing marijuana because it’s causing mental illness and breaking apart families; that’s the real drug war.

“Dabs” and “wax” are considered the crack weed of today. There are websites which promote these products that can cause immediate psychosis. It’s not “natural.”

I feel like a failure as a parent; I couldn’t protect her from drugs because society is influencing her.   Please, other parents, please be warned about the drugs and drug dealers, and what they are doing to your kids.  Watch out for crack weed.

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By Patricia Silva-Duran

Editor’s Note: Alternative names are “wax,” budder,” “rosin,” “earwax”  “710,” “shatter” and more.  Search for our other articles on dabbing for a better understanding.

Mathematics Proves Correlation to Marijuana as Gateway Drug

Two Studies Show Cannabis-Gateway Effect

The 25-year Christchurch Longitudinal Study demonstrated that in 86% of cases of those who had taken two or more illegal drugs, marijuana had been the drug the study subjects had taken first. The correlation is in the mathematics and can’t be denied.

The researchers concluded that the use of marijuana in late adolescence and early adulthood had emerged as the strongest risk factor for later involvement in other illicit drug use.

New research has been released that adds to these findings. Researchers at the University of Bristol in the UK has found regular and occasional cannabis use as a teen is associated with a greater risk of other illicit drug taking in early adulthood.

The study by Bristol’s Population Health Science Institute, published online in the Journal of Epidemiology and Community Health in 2017, caught the attention of most major newspapers in the UK.  It was reviewed in the British Medical Journal and Science Daily in June of 2017.    But, once again, the news was under-reported in the North American media.

Cannabis Use Predicts Many Forms of Problematic Substance Use in Adulthood

Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), the researchers looked at levels of cannabis use during adolescence to determine whether these  might predict other problematic substance misuse in early childhood – by the age of 21.

In addition to the findings on pot and illicit drug use, the study found that early cannabis use was associated with harmful drinking and smoking.

The lead author of the study, Dr. Michelle Taylor from the School of Social and Community Medicine told the UK media: “I think the most important findings from this study are that one in five adolescents follow a pattern of occasional or regular cannabis use and that those individuals are more likely to be tobacco-dependent, have harmful levels of alcohol consumption or use other, illicit drugs in early adulthood.”

Spearman’s Rank Correlation Coefficient:

Now for all those that are still question the Gateway Theory or are willing to dismiss the evidence from these studies here is the Statistical Mathematical Evidence of Correlation:

A survey that was conducted in Canada and 9 other countries was used to determine the percentage of teenagers who had used marijuana and other drugs.

Using Spearman’s Rank Correlation Coefficient to test the correlation between the two variables as extracted from the population as pairs of sets of data, it was mathematically demonstrated that there is a positive correlation between the two variables.

The claim that there is a positive correlation between smoking marijuana and doing other drugs is made with at least a 95% level of confidence by mathematical calculation.

If after this evidence you still cling to the position that the Gateway Theory is old-school and can be cast aside, you are being asked for your evidence, your proof and your calculations.

by Pamela McColl, SAM Canada

“Legalization would result only in more cannabis users and thus a higher secondary demand for and entanglement within the remaining illegal drug market,” wrote David Sergeant of The Bow Group, London, England.