Tag Archives: pain

Marijuana isn’t Helping and not a Solution for Pain Pill Epidemic

By Ken Finn, MD, Springs Rehabilitation, PC, Colorado Springs

Dr. Kenneth Finn is a pain medicine specialist

Dr. Sanjay Gupta has been supporting the use of marijuana to curb the opioid crisis. Dr. Gupta does not have specialty training in Pain Medicine, Physical Medicine and Rehabilitation, Pain Management, or Anesthesia. I have been practicing Pain Medicine in Colorado for 24 years and I have seen patients referred to me on very high dose opioids, reporting very high levels of pain, and using marijuana for pain control, making no clinical sense. In discussions with these patients, and overall, a significant percent report that their use of marijuana does not help with their presenting pain symptoms. I have had a rare patient who opt to taper their opioids and use marijuana, and all of those continue to report high levels of pain. Continue reading

Medical Studies Document Dangers Related to marijuana

Attached is a list of medical articles that document medical warnings against marijuana that are running in newspapers throughout the country, to warn in advance of participation in 420 events.

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Marijuana Potency unlike 1990s

Highly potent marijuana today is different for the 1990s, with much higher THC and much lower cannabidiol concentrations (Elsohly et al 2016).

ElSohly MA, Mehmedic Z, Foster S, Gon C, Chandra S, Church JC. Changes in Cannabis Potency Over the Last 2 Decades (1995-2014): Analysis of Current Data in the United States. Biol Psychiatry. 2016;79(7):613-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987131/pdf/nihms-762043.pdf

Average flower is 17.1% in one state with legal sales of recreational marijuana, Colorado, much higher than the national average (HIDTA, 2017), and as high as 30% THC in some samples (NBC News report).  It should be noted that variation in testing results is quite high between laboratories (Jikomes and Zoroob, 2018).

HIDTA, Rocky Mountain High Intensity Drug Trafficking Area Report, The Legalization of Marijuana in Colorado: The Impact. 2017 Vol. 5, Rocky Mountain High Intensity Drug Trafficking Area Investigative Support Center, Denver, Colorado. https://www.rmhidta.org/html/FINAL%202017%20Legalization%20of%20Marijuana%20in%20Colorado%20The%20Impact.pdf


Jikomes N, Zoorob M. The Cannabinoid Content of Legal Cannabis in Washington State Varies Systematically Across Testing Facilities and Popular Consumer Products. Sci Rep. 2018 Mar 14;8(1):4519. doi: 10.1038/s41598-018-22755-2. https://www.nature.com/articles/s41598-018-22755-2.pdf

Processed cannabis reaches up to 90% THC

Jikomes N, Zoorob M. The Cannabinoid Content of Legal Cannabis in Washington State Varies Systematically Across Testing Facilities and Popular Consumer Products. Sci Rep. 2018 Mar 14;8(1):4519. doi: 10.1038/s41598-018-22755-2. https://www.nature.com/articles/s41598-018-22755-2.pdf

Marijuana is the Number 1 substance now found in Colorado suicides, 10-19 years old, 2014-2016


Marijuana use is linked to increased suicide risk.

Marijuana products contain contaminates, (fungus, heavy metals, pesticides, and chemicals







Causes mental illness, and is associated with onset of schizophrenia and other psychotic disorders such as bipolar disorder with psychosis

Association with schizophrenia and other psychotic disorders such as bipolar and schizophrenia. (Miller, 2017; Cougle et al., 2015), completed suicides and suicide attempts (Arendt et al., 2013; Silins et al., 2014; Clarke et al., 2014) and violence towards others (Arseneault et al., 2000; Dugre et al., 2017; Harford et al., 2018)  particularly in those who develop marijuana-induced psychosis.

Arseneault L, Moffitt TE, Caspi A, Taylor PJ, Silva PA. Mental disorders and violence in a total birth cohort: results from the Dunedin Study. Arch Gen Psychiatry. 2000;57(10):979-86.

Arendt M, Munk-Jørgensen P, Sher L, Jensen SO. Mortality following treatment for cannabis use disorders: predictors and causes. J Subst Abuse Treat. 2013;44(4):400-6.

Clarke MC, Coughlan H, Harley M, Connor D, Power E, Lynch F, Fitzpatrick C, Cannon M. The impact of adolescent cannabis use, mood disorder and lack of education on attempted suicide in young adulthood. World Psychiatry. 2014;13(3):322-3.

Cougle JR et al. (2015). Quality of life and risk of psychiatric disorders among regular users of alcohol, nicotine, and cannabis: An analysis of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). J Psychiatr Res., 66-67, 135-141

Di Forti M, et al. Proportion of patients in South London with first-episode psychosis attributable to use of high potency cannabis: a case-control study. Lancet Psychiatry. 2015;2(3):233-8.

Dugré JR, Dellazizzo L, Giguère CÉ, Potvin S, Dumais A. Persistency of Cannabis Use Predicts Violence following Acute Psychiatric Discharge. Front Psychiatry. 2017 21;8:176. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613094/pdf/fpsyt-08-00176.pdf

Harford TC, Chen CM, Kerridge BT, Grant BF. Self- and other-directed forms of violence and their relationship with lifetime DSM-5 psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol Related Conditions-III (NESARC-III). Psychiatry Res. 2018;262:384-392.

Miller CL. The disconnect between the science on cannabis and public health campaigns. Addiction. 2017;112(10):1882-1883. https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.13918

Silins E, Horwood LJ, Patton GC, Fergusson DM, Olsson CA, Hutchinson DM, Spry E, Toumbourou JW, Degenhardt L, Swift W, Coffey C, Tait RJ, Letcher P, Copeland J, Mattick RP, for the Cannabis Cohorts Research Consortium. Young adult sequelae of adolescent cannabis use: an integrative analysis. Lancet Psychiatry 2014; 1(4): 245-318.

Starzer MSK, Nordentoft M, Hjorthøj C. (2018) Rates and Predictors of Conversion to Schizophrenia or Bipolar Disorder Following Substance-Induced Psychosis. Am J Psychiatry,175(4), 343-350

Harm to unborn, nursing babies

Marijuana harms unborn children (Jenkins et al., 2007; Trezza et al., 2012; Tortoriello et al., 2014; Grewen et al., 2015; Zumbrun et al., 2015; Leemaqz et al., 2016; Benevenuto et al., 2017), and may concentrate in breast milk if used repeatedly (Perez-Reyes and Wall, 1982; Grotenhermen, 2003), with consequences for the developing neonate (Astley and Little, 1990).

Astley SJ, Little RE. Maternal marijuana use during lactation and infant development at one year. Neurotoxicol Teratol. 1990 Mar-Apr;12(2):161-8.

Benevenuto SG et al., Recreational use of marijuana during pregnancy and negative gestational and fetal outcomes: An experimental study in mice. Toxicology. 2017 Feb 1;376:94-101

Grewen K, Salzwedel AP, Gao W. Functional Connectivity Disruption in Neonates with Prenatal Marijuana Exposure. Front Hum Neurosci. 2015;9:601.

Grotenhermen F. Pharmacokinetics and pharmacodynamics of cannabinoids. Clin Pharmacokinet. 2003;42(4):327-60. Review.

Hurd YL, Szutorisz H, High times for cannabis: Epigenetic imprint and its legacy on brain and behavior. Neuroscience and Biobehavioral Reviews 85 (2018) 93–101  https://oir.nih.gov/wals/2015-2016/high-times-drugs-epigenetic-imprint-legacy-brain

Jenkins KJ, Correa A, Feinstein JA, Botto L, Britt AE, Daniels SR, Elixson M, Warnes CA, Webb CL; American Heart Association Council on Cardiovascular Disease in the Young. Non-inherited risk factors and congenital cardiovascular defects: current knowledge: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young: endorsed by the American Academy of Pediatrics. Circulation. 2007 Jun 12;115(23):2995-3014.

Leemaqz SY et al. Maternal marijuana use has independent effects on risk for spontaneous preterm birth but not other common late pregnancy complications. Reprod Toxicol. 2016;62:77-86.

Perez-Reyes M, Wall ME. Presence of delta9-tetrahydrocannabinol in human milk. N Engl J Med. 1982;307(13):819-20.

Tortoriello G, et al. Miswiring the brain: Δ9-tetrahydrocannabinol disrupts cortical development by inducing an SCG10/stathmin-2 degradation pathway. EMBO J. 2014;33(7):668-85.

Trezza,V. et al. Altering endocannabinoid neurotransmission at critical developmental ages: impact on rodent emotionality and cognitive performance. Front Behav Neurosci. 2012; 6: 02. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3265033/

Zumbrun EE et al. Epigenetic Regulation of Immunological Alterations Following Prenatal Exposure to Marijuana Cannabinoids and its Long Term Consequences in Offspring. J Neuroimmune Pharmacol. 2015; 10(2):245-54.

Marijuana causes cyclic vomiting

Sorensen CJ, DeSanto K, Borgelt L, Phillips KT, Monte AA. Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment-a Systematic Review. J Med Toxicol. 2017;13(1):71-87. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330965/

Alaniz VI, Liss J, Metz TD, Stickrath E. Cannabinoid hyperemesis syndrome: a cause of refractory nausea and vomiting in pregnancy. Obstet Gynecol. 2015 Jun;125(6):1484-6.

Marijuana can trigger violence in those with PTSD and make PTSD worse

Wilkinson ST, Stefanovics E, Rosenheck RA. Marijuana use is associated with worse outcomes in symptom severity and violent behavior in patients with posttraumatic stress disorder. J Clin Psychiatry. 2015 Sep;76(9):1174-80.

Friedman A, Glassman K, Terras A Violent Behavior as Related to Marijuana and Other Drugs, by Albert Journal of Addictive Diseases, Vol 20(1), 2001,pp. 49-72. Marijuana users nearly as likely to engage in violent behaviors as crack users.

Marijuana is linked to increased driving fatalities

Hartman RL, Huestes ME, Richman JE Hayes CE, Drug Recognition (DRE) examination characteristics of cannabis impairment.  Accident Analysis and Prevention 92(2016)219-229.  http://www.decp.org/wp-content/uploads/2017/06/302-Marijuana-DRE-Evaluations-Study.pdf .  Factors to measure cannabis impairment

 Staples JA, Redelmeier, DA, The April 20 Cannabis Celebration and Fatal Traffic Crashes in the United States. JAMA Intern Med. 2018;178(4):569-572. doi:10.1001/jamainternmed.2017.8298 Rate of traffic fatalities go up 12% after 4/20 festivities, in comparison to one week before and one week after.

Bosker WM, Kuypers KP, Theunissen EL, et al. Medicinal Δ9-tetrahydrocannabinol (dronabinol) impairs on-the-road driving performance of occasional and heavy cannabis users but is not detected in standard field sobriety tests. Addiction. 2012;107(10):1837-1844.

Compton WN, Volkow Nd, Lopez MF. Medical marijuana laws and cannabis use: intersections of health and policy,  JAMA Psychiatry.  2017: 74 (6): 559-560

Del Balzo G, Gottardo R, Mengozzi S, Dorizzi RM, Bortolotti F, Appolonova S, Tagliaro F, “Positive” urine testing for Cannabis is associated with increased risk of traffic crashes, Journal of Pharmaceutical and Biomedical Analysis.   https://doi.org/10.1016/j.jpba.2017.12.059

Hartman RL, Huestis MA. Cannabis effects on driving skills. Clin Chem. 2013;59(3):478-492.

Gjerde H, Morland J. Risk for involvement in road traffic crash during acute cannabis intoxication.  Addiction 2016;111(8):1492-1495.

Martin J-L, Gadegbeku B, Wu D, Viallon V, Laumon B (2017) Cannabis, alcohol and fatal road accidents. PLoS ONE 12(11): e0187320.    https://doi.org/10.1371/journal.pone.0187320

Ramaekers JG, Kauert G, van Ruitenbeek P, Theunissen EL, Schneider E and Manfred R Moeller, High-Potency Marijuana Impairs Executive Function and Inhibitory Motor Control. Amer Col of Neuropsychopharmacology (2006) 31, 2296–2303.

Raemakers, JG  Driving Under the Influence of Cannabis: An Increasing Public Health Concern. JAMA published online March 26, 2018  Regular cannabis users wrongfully believe that cannabis does not affect their driving performance or that they can compensate for cannabis-associated impairment.  Raemakers_2018 JAMA driving editorial.pdf

World Health Organization. Drug Use and Road Safety: A Policy Brief. Geneva, Switzerland: World Health Organization; 2016.

Marijuana associated with lung disease, cancer

Marijuana smoke is associated with lung disease (Tan et al., 2009; Tashkin, 2015) and the development of some cancers (Efird et al., 2004; Lackson et al., 2012).  High levels of the cannabinoid receptor that is preferentially activated by THC (CB1) correspond to shorter survival in many cancers (Michalski et al., 2008; Carpi et al., 2015; Suk et al., 2016)

Carpi S, Fogli S, Polini B, Montagnani V, Podestà A, Breschi MC, Romanini A, Stecca B, Nieri P. Tumor-promoting effects of cannabinoid receptor type 1 in human melanoma cells. Toxicol In Vitro. 2017 Apr;40:272-279. doi: 10.1016/j.tiv.2017.01.018. Epub 2017 Jan 26

Efird JT, Friedman GD, Sidney S, Klatsky A, Habel LA, Udaltsova NV, Van den Eeden S, Nelson LM. The risk for malignant primary adult-onset glioma in a large, multiethnic, managed-care cohort: cigarette smoking and other lifestyle behaviors. J Neurooncol. 2004 May;68(1):57-69.

Lackson et al., 2012, Population-based case-control study of recreational drug use and testis cancer risk confirms an association between marijuana use and nonseminoma risk. Cancer 188:5374-83

Michalski CW, Oti FE, Erkan M, Sauliunaite D, Bergmann F, Pacher P, Batkai S, Müller MW, Giese NA, Friess H, Kleeff J. Cannabinoids in pancreatic cancer: correlation with survival and pain. Int J Cancer. 2008;122(4):742-50. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225529/pdf/nihms38106.pdf

Suk KT, Mederacke I, Gwak GY, Cho SW, Adeyemi A, Friedman R, Schwabe RF. Opposite roles of cannabinoid receptors 1 and 2 in hepatocarcinogenesis. Gut. 2016;65(10):1721-32.  http://gut.bmj.com/content/gutjnl/65/10/1721.full.pdf

Tan WC, et al. Marijuana and chronic obstructive lung disease: a population-based study. CMAJ. 2009;180(8):814-20

Tashkin DP. The respiratory health benefits of quitting cannabis use. Eur Respir J. 2015;46(1):1-4

Legal marijuana increases youth use (Cerda et al., 2017) and is associated with youth switching to more potent marijuana products (Borodovsky et al., 2017)

Use by youth in 8th and 10th grades has gone up significantly in Washington State (Cerda et al., JAMA Pediatrics ). School districts with the highest density of legal dispensaries in Colorado have a 30% higher rate of use in students by the time they reach their senior year of high school (Healthy Kids Colorado Survey, 2015: Adolescent Health); and to compile data on density of dispensaries for each school district https://weedmaps.com/dispensaries/in/united-states/colorado)

The percentage of youth on probation testing positive for marijuana has increased steadily since 2012 (DPS, 2017)

Borodovsky JT, Lee DC, Crosier BS, Gabrielli JL, Sargent JD, Budney AJ. U.S. cannabis legalization and use of vaping and edible products among youth. Drug Alcohol Depend. 2017; 177:299-306. https://www.ncbi.nlm.nih.gov/pubmed/28662974

Cerdá M, Wall M, Feng T, Keyes KM, Sarvet A, Schulenberg J, O’Malley PM, Pacula RL, Galea S, Hasin DS. Association of State Recreational Marijuana Laws With Adolescent Marijuana Use. JAMA Pediatr. 2017;171(2):142-149. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5365078/

Marijuana decreases IQ in those who begin their use young

Meier MH, Caspi A, Ambler A, Harrington H, Houts R, Keefe RS, McDonald K, Ward A, Poulton R, Moffitt TE. Persistent cannabis users show neuropsychological decline from childhood to midlife. Proc Natl Acad Sci U S A. 2012 Oct 2;109(40):E2657-64. doi: 10.1073/pnas.1206820109


Mj harms developing adolescent and young adult brains.

Camchong J, Lim KO, Kumra S. Adverse Effects of Cannabis on Adolescent Brain Development: A Longitudinal Study. Cereb Cortex. 2017 Mar 1;27(3):1922-1930. doi: 10.1093/cercor/bhw015.  https://academic.oup.com/cercor/article/27/3/1922/3056289

Marijuana does not cure cancer


Marijuana does not help common pain conditions

Allan GM Simplified guideline for prescribing medical cannabinoids in primary care  Canadian Family Physicians Vol 64: February 2018      2018 Cannabis Prescribing Guidelines.pdf.

Richards JR, Treatment of acute cannabinoid overdose with naloxone infusion.  J Toxicology Com-munications Vol 1, 2017 https://www.tandfonline.com/doi/full/10.1080/24734306.2017.1392715

Finn, K, The Clinical Conundrum of Medical Marijuana, Pain Medicine News, 2016 https://www.painmedicinenews.com/Commentary/Article/06-17/The-Clinical-Conundrum-of-Medical-Marijuana/41579

Finn, K, Current research on marijuana for pain is lacking. http://www.poppot.org/2017/06/26/current-research-marijuana-pain-lacking/

Olfson M, Wall M Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States   American J Psychiatry. Cannabis use, even among adults with moderate to severe pain, was associated with a substantially increased risk of nonmedical prescription opioid use at 3-year follow-up.  https://doi-org.proxy.hsi.ucdenver.edu/10.1176/appi.ajp.2017.17040413

Graph provided by The Marijuana Report/National Families in Action. March 2018
 Marijuana is not curbing the opioid crises

Caputi TL, Humphreys K, Medical Marijuana Users are More Likely to Use Prescription Drugs Medically and Nonmedically, JAddiction Medicine: April 17, 2018 https://journals.lww.com/journaladdictionmedicine/Abstract/publishahead/Medical_Marijuana_Users_are_More_Likely_to_Use.99476.aspx?PRID=JOAM_PR_041718

Olfson M, Wall M Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States, American J Psychiatry. Cannabis use, even among adults with moderate to severe pain, was associated with a substantially increased risk of nonmedical prescription opioid use at 3-year follow-up.  https://doi-org.proxy.hsi.ucdenver.edu/10.1176/appi.ajp.2017.17040413

This data is available in SAM’s Lessons Learned report https://learnaboutsam.org/wp-content/uploads/2018/04/SAM-Lessons-Learned-From-Marijuana-Legalization-Digital.pdf