Chronic pain patients need help managing their pain. The latest data from Medscape Medical News reports around a third of chronic pain patients are using cannabis to do so, resulting in more than half of pain patients decreasing their opioid medications.  This data is based on a survey of 1724 American adults with chronic noncancer pain who live in an area with a medical cannabis program.

What we gather from this study and others is that people need effective ways to manage chronic pain and are trying cannabis. However, we have little data to show the risks and benefits of using cannabis for chronic pain. Keep in mind that “medical” cannabis is regulated at a state level. The Federal government still considers it a Schedule 1 substance, meaning it does not have a therapeutic use. It has not been proven for use in chronic pain. In terms of medical use, the FDA has approved the cannabidiol (Epidiolex) and dronabinol (Marinol, Syndros) for use in two rare and severe forms of epilepsy.

And when we say “medical” cannabis, here is what that means. To get a medical cannabis card, you need a written recommendation from a physician in a state where it is legal. It’s not a prescription, only a recommendation. For the recommendation, you must have a condition that qualifies. Now, here is the rub, conditions that are listed for recommendations have not been proven to be effectively treated with marijuana. However, once you have the card, you can go to a dispensary to purchase marijuana. Note, this is not a prescription filled by a pharmacy. It is a recommendation you take to a dispensary-there is no dose or specific product tied to the recommendation. You and those dispensing (usually with no medical training or background) give you the product. So physicians do not prescribe unless they are writing for those seizures prescriptions or chemotherapy side effects.

Currently, the evidence to support the medical value of cannabis for chronic pain is inconclusive. Additionally, research indicates many negative side effects of marijuana use- increased risk of cancer, lung damage, bacterial pneumonia, poor pregnancy, etc. A pregnant or breast-feeding woman should not use marijuana. Side effects of cannabis use can include blood shot eyes, depression, dizziness, fast heartbeat, hallucinations and low blood pressure. It can also affect judgment and coordination, a potential risk for accidents and falls. Also, we have evidence that daily marijuana use can drive tumor growth. Furthermore, patients with other prescription drugs may have interactive effects with cannabis which could impact the effectiveness of those drugs.

In fact, a randomized clinical trial on the effectiveness of using a marijuana card to manage pain, showed no improvement of pain. It did show an increased incidence (2.9X) of Cannabis Use Disorder, again begging the question of risk/benefit. Furthermore, a systematic review and meta-analysis of studies found no benefit to noncancer pain conditions. Results were basically the same as using a placebo.

Additionally, we know that frequent use of marijuana among young adults significantly increases their of use of other illegal drugs. And a study at Yale Medical School noted teen users were at greater risk for misuse of prescription opioids.

Also, cannabis products are variable in terms of how they are used (smoked, eaten, etc.) and in their composition. The amount of cannabidiol (CBD) and THC can vary considerable from product to product. There is little quality control over products because the roll out of products came from business people, not the medical community.

Because “medical” cannabis did not go through the normal FDA regulatory process, we really don’t know the risks and benefits. Bottom line, we don’t know the long-term impact or the health and age-related vulnerabilities of marijuana use yet. It is not medical doctors driving the use of medical marijuana, rather it is business.  If medicine was in charge, rigorous testing would be done on safety, efficacy, dosing, purity of products and more. This is beginning to happen and is a good thing. We can’t go by subjective experiences of people without better understanding the risks and benefits. So…

  • Be skeptical of Internet reports that say cannabis is safe and effective. Profit is driving this message.
  • Ask: Will long term use create its own set of problems?
  • Are alternate treatments for pain available?

We need to do better helping people with chronic pain and do the research needed to properly evaluate effectiveness. In the meantime, know there is a lot of messaging that may not be based on science.

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