9 out of 10 Patients Prefer Cannabis Over Opioids

By Pat Anson, Editor

A survey of nearly 3,000 medical marijuana users has found that 9 out of 10 patients prefer cannabis over opioid medication when managing their chronic pain. A similar number prefer cannabis over non-opioid pain relievers such as Tylenol or Advil.

The survey was conducted by researchers at the University of California Berkeley and HelloMD, a website that links patients to doctors in California and New York that prescribe medical marijuana. The survey was administered by email to a HelloMD database of cannabis patients who were asked how marijuana affected their consumption of opioids and other pain relievers.

Eighty percent of those surveyed said that cannabis was more effective at relieving pain than opioid medication and 97 percent said they decreased their opioid use when using cannabis. The latter finding supports previous research that found use of prescription pain medication declining in states where medical marijuana is legal.

“The results of our study were striking, showing 97% of people were able to decrease the amount of opioids that they used in conjunction with cannabis use. This was more than double the amount shown in any previous studies conducted,” said Perry Solomon, MD, Chief Medical Officer of HelloMD.

DRUG POLICY ALLIANCE

DRUG POLICY ALLIANCE

“The (study) clearly showed that chronic pain is one of the medical conditions that cannabis can be used for with great efficacy. Our study not only supports this but also goes further in that the clear majority of patient’s state that they prefer it. Hopefully this will awaken the public, medical professionals and legislatures to the fact that there is a safe, non-addictive product available to help fight the opioid epidemic, and that is cannabis.”

Other key findings from the survey of medical marijuana users:

  • 93% said they prefer cannabis to opioids
  • 92% said cannabis' side effects were more tolerable than side effects from opioids
  • 90% said cannabis works well with non-opioid pain relievers
  • 96% said they need fewer non-opioid pain relievers when using cannabis
  • 89% said cannabis was more effective than non-opioid pain relievers

"With cannabis not only becoming more accepted in the mainstream but also coming in a variety of preparations, some of which are nonintoxicating, more people are looking at cannabis as a viable treatment for everyday ailments such as muscle soreness and inflammation,” wrote Amanda Reiman, PhD, of UC Berkeley and the Drug Policy Alliance, lead author of the study published in the journal of Cannabis and Cannabinoid Research.

“Participants in this study overwhelmingly supported the notion that they would be more likely to use cannabis as a substitute for pain medication if it were less stigmatized and more available, suggesting that there are populations of people who could benefit from this practice but are shying away due to the stigma and legal restrictions related to cannabis use.”

The survey should not be considered a scientific study on the effectiveness of cannabis, because participants were self-selected and reported their perceptions about cannabis use, as opposed to an objective measurement by a third party. There was also no control group of pain patients who only had access to opioids and other pain relievers.

A small study last year by the University of Michigan found that nearly two-thirds (64%) of medical marijuana patients reported a reduction in their use of prescription pain medications.

A 2014 study published in JAMA Internal Medicine found that opioid overdoses declined by nearly 25 percent in states where medical marijuana was legalized.

A Safe Way to Healthy, Restorative Sleep

By Ellen Lenox Smith, Columnist

For many of us suffering from chronic pain, coping with our medical issues can be physically and emotionally draining. Often, the lack of healthy sleep is the culprit.

Living with Ehlers Danlos syndrome (EDS) and sarcoidosis, I used to constantly wake up in the middle of the night with so much pain it was impossible to get any form of rest. When I was teaching, I somehow went for years trying to teach on “empty” due to a chronic lack of restorative sleep.

I remember having to cheat and use a seating chart to remember the names of my wonderful students, who were sitting right in front of me. These were students I had known, loved and taught for months. It was embarrassing, heartbreaking, and created a sense of loss and hopelessness.

Thankfully, those days are gone. I have gone from years of almost no quality sleep to being someone who goes to bed at night and wakes up in the morning feeling well rested. I don’t even remember any dreams, so I am getting the real REM sleep!

How did I do it? A teaspoon of oil made from medical marijuana. I take it before bedtime, mixed with a little applesauce or a small amount of food.

Within an hour, my body is ready for bed and sleep. 

For years I made this oil at home on top of the stove, but today enjoy using the Magical Butter machine. We find that oil made from the indica strain of marijuana works best for sleep. Directions for making the oil can be found on our website. 

I am now both a medical marijuana patient and a caregiver in the state of Rhode Island. Patients visit us with a variety of different illnesses, but the one thing they all have in common is lack of sleep. Without sleep, you lose hope and courage to move forward with your life. Each patient that has tried this oil has found that it gives them rest and hope.

Recently, a young woman and her husband came to our home. Living with both EDS and Chronic Regional Pain Syndrome (CRPS), she had a difficult life, but was hoping to find something to make it easier. We have the same pain doctor and he suggested she get in touch with us to learn about cannabis. 

The first night that she tried the oil, she slept for eight hours and was both thrilled and shocked. She said even her face looked calmer and more rested.  She is now happier, hopeful and has more strength to get through the day.

There was another patient sent to us who was a paraplegic in constant pain. He was angry, miserable and wished he hadn’t been given life-saving surgery after his accident. He was at a loss as to what to do to cope with the life he was now given. 

He tried the oil and was shocked what it did for him. From that point on, the desperate man who first called me and couldn’t even be understood due to his level of pain, was happy, laughing and finding some meaning in his difficult life. He later passed, but the oil gave him a better quality of life and a sense of purpose again.

We have seen one success after another of pain patients getting real quality sleep and rest. We have seen it work for cancer patients, and those suffering with post-traumatic stress disorder, multiple sclerosis, back pain, fibromyalgia, arthritis and other conditions.

For those of you who are caught up in opioid hysteria and can no longer get medication, I hope you take a moment and think about trying cannabis oil at night for rest. I have used it safely for a decade, since I am not able to metabolize even an aspirin or Tylenol, let alone any opiate. May you find the courage to try it and get the same results.

Ellen Lenox Smith suffers from Ehlers Danlos syndrome and sarcoidosis.  Ellen and her husband Stuart are co-directors for medical marijuana advocacy for the U.S. Pain Foundation and serve as board members for the Rhode Island Patient Advocacy Coalition.

For more information about medical marijuana or to contact the Smith's, visit their website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Do Men Get More Pain Relief From Marijuana?

By Pat Anson, Editor

Experts tell us that women are more likely to experience chronic pain than men, feel pain more intensely, and are more likely to be undertreated for pain than men are.

The gender gap in pain grew a little wider this week with a new study, published in Drug and Alcohol Dependence, which claims women get far less pain relief from smoking marijuana than men do.

"These findings come at a time when more people, including women, are turning to the use of medical cannabis for pain relief," said lead author Ziva Cooper, PhD, associate professor of clinical neurobiology at Columbia University Medical Center. "Preclinical evidence has suggested that the experience of pain relief from cannabis-related products may vary between sexes, but no studies have been done to see if this is true in humans."

Cooper and her colleagues conducted two double-blinded, placebo-controlled studies that looked at the analgesic effects of cannabis in 42 healthy recreational marijuana smokers – half of them men and half women.

All smoked marijuana at least four times a week prior to enrolling in the study. Participants were excluded if they had pain.

After smoking the same amount of cannabis or a placebo, the participants immersed one hand in a cold-water bath until the pain could no longer be tolerated. Following the immersion, the participants answered a short pain questionnaire.

Among those who smoked cannabis, men reported a significant decrease in pain sensitivity and an increase in pain tolerance. But the women who smoked cannabis did not experience a significant decrease in pain sensitivity, although they did report a small increase in pain tolerance shortly after smoking.

No gender differences were found in how intoxicated the participants felt or how much they liked the effect of cannabis.

“These results indicate that in cannabis smokers, men exhibit greater cannabis-induced analgesia relative to women,” said Cooper.  “Sex-dependent differences in cannabis’s analgesic effects are an important consideration that warrants further investigation when considering the potential therapeutic effects of cannabinoids for pain relief.”

A marijuana advocate and caregiver for patients in Rhode Island said she was shocked by the study findings.

"This study concerns me that some women will read this and not even try the most magical pain relief out there," said Ellen Lenox Smith, a columnist for Pain News Network. "We have never, in the nine years of growing for myself and as caregivers for patients, ever had a time that this was not successful because of one's sex. We have had equal amounts of men and women and the only person that did not have success was an elderly woman that was not able to follow the directions due to her anxiety of using it. That was due to the stigma from society, not the product."

Do women really respond differently to marijuana or is there a flaw in the study itself?

Previous research has found that women respond differently to the cold water test and have far less tolerance for pain induced by cold water immersion than men.

“Most studies have used some form of the cold pressor test in which subjects immerse their arm or hand in circulating cold water for a defined period of time, and their results support the hypothesis that cold pain sensitivity is more pronounced in females,” researchers reported in a 2009 review of nearly two dozen studies that used the cold water test.  “Based on the present set of studies, it appears that sex differences in cold pain are consistent, particularly for suprathreshold measures such as tolerance and pain ratings.”

The Columbia University study was funded by the U.S. National Institute on Drug Abuse. Ziva Cooper also received salary support from Insys Therapeutics, which is developing cannabis-based drugs.

Marijuana Based Drug Effective in Treating Epilepsy

By Pat Anson, Editor

A British pharmaceutical company has released positive results from a Phase 3 clinical study of an experimental drug derived from marijuana.

GW Pharmaceuticals (NASDAQ: GWPH) reported that the drug – called Epidiolex – significantly reduced seizures in patients with Lennox-Gastaut syndrome, a rare form of childhood epilepsy. Epidiolex contains cannabidiol (CBD) a chemical compound found in marijuana that does not produce the “high” associated with cannabis plants.

“From a physician’s perspective, the positive outcome in this trial of Epidiolex in patients with Lennox-Gastaut syndrome is very exciting. Lennox-Gastaut syndrome begins in early childhood, is particularly difficult to treat, and the vast majority of patients do not obtain an adequate response from existing therapies,” said study investigator Linda Laux, MD, Director of the Comprehensive Epilepsy Center at Ann & Robert H. Lurie Children's Hospital of Chicago.

“I am excited about the prospect of Epidiolex being made available on prescription in the future and believe it has the potential to make an important difference to the lives of many patients.”

The placebo controlled study involved 171 patients with Lennox-Gastaut syndrome. Epidiolex reduced the number of seizures in a month by 44 percent, compared with those taking a placebo medication that reduced seizures by 22 percent.

In March, another Phase 3 trial of Epidiolex also showed positive results in children with Dravet syndrome, another form of childhood epilepsy. GW is also conducting a Phase 3 trial of Epidiolex in Tuberous Sclerosis Complex and expects to initiate a Phase 3 trial of Epidiolex in infantile spasms in the fourth quarter of this year.

If approved by the Food and Drug Administration, the drug would be the first cannabis derived drug to win approval for the treatment of childhood epilepsy. Epidiolex has both Orphan Drug Designation and Fast Track Designation from the FDA. GW plans to formally file for FDA approval later this year.

GW is already marketing a marijuana-based oral spray called Sativex that is being sold in Europe, Canada and Mexico to treat muscle tightness and contractions caused by multiple sclerosis. Canada also allows Sativex to be used for the treatment of neuropathic pain and advanced cancer pain.

Sativex is not currently approved for use in the U.S. for any condition. It is estimated that over 400,000 cancer patients in the U.S. suffer from pain that is not well controlled by opioid pain medications. However, two recent Phase 3 studies found that Sativex worked no better than a placebo in treating cancer pain.

DEA: Decision Not Made on Marijuana Legalization

By Pat Anson, Editor

The U.S. Drug Enforcement Administration is considering, but has not yet made a final decision on whether to reclassify marijuana as a Schedule II controlled substance, a move that would essentially make medical marijuana legal in all 50 states.

Last week two media outlets, the Santa Monica Observer and the Denver Post published reports speculating that marijuana could be rescheduled sometime this summer. The Observer even set a date for the announcement – August 1st – and cited an unnamed “Los Angeles based DEA Attorney” as the source of the information.

"Whatever the law may be in California, Arizona or Utah or any other State, because of Federal preemption this will have the effect of making THC products legal with a prescription, in all 50 states," the Observer quoted the DEA lawyer as saying.

The two stories fueled rampant speculation in blogs and on social media that a rescheduling of marijuana was imminent. Snopes.com even published its own take on the rumors, calling them “unproven.”

“There is as yet no indication that the information published on the topic was accurate, and there has been no official confirmation the DEA would moving in that direction on 1 August 2016,” Snopes said.

“We don’t have anything official to report,” DEA spokesman Rusty Payne confirmed to Pain News Network.

Like many rumors, there is some truth in the details. In a letter sent several months ago to Sen. Elizabeth Warren and seven other U.S. senators, a DEA official said the agency was finally getting around to making a decision on a five year old petition to reschedule marijuana.

“And in that letter we said we hoped to have a decision around July first. That’s certainly not a deadline, that’s just neighborhood ballpark, around that time. So people are getting antsy as the time is getting nearer,” said Payne, adding that DEA would not be making the decision alone.

“The agency that determines whether or not something is a medicine is the FDA, not the DEA. That’s why we have to rely on their portion of an in-depth study to determine whether or not something should be rescheduled or essentially determined to be a medicine. And if the FDA rules something is not a medicine, we’re bound by that. We cannot move it ourselves. We can’t overrule or override FDA on that,” said Payne.

The DEA has already received a recommendation from the FDA on whether to reschedule marijuana, but has not disclosed it. In the past, both agencies have resisted any attempt to legalize marijuana at the federal level, even as dozens of states moved to legalize medical marijuana.

In 2011, the DEA rejected a similar petition, saying “the known risks of marijuana use have not been shown to be outweighed by specific benefits in well-controlled clinical trials that scientifically evaluate safety and efficacy.”

Marijuana is currently classified as Schedule I drug – along with heroin and LSD – because it is considered to have no medical benefit and has a high potential for abuse. Moving it into the Schedule II classification, along with opioids such as hydrocodone and oxycodone, could potentially make marijuana available by prescription in all 50 states.    

Such a decision would upend the $40 billion medical marijuana industry, which is mostly composed of small companies and dispensaries that have created a niche for themselves while dealing with a cornucopia of state laws and municipal regulations. Rescheduling would open the door for pharmaceutical companies and pharmacies to get into the marijuana business.

"Schedule II would be a nightmare for the cannabis industry," Andrew Ittleman, a lawyer for a Miami law firm that advises marijuana companies, said in Inc.

Most Medical Marijuana Patients Benefit From Treatment

By Pat Anson, Editor

Over 90 percent of long term medical marijuana patients reported significant improvement in their pain and nausea while using cannabis, according to researchers at Israel’s Ben-Gurion University of the Negev.

Medical marijuana has been legal in Israel for over 10 years, but this was the first in-depth study of patients who have a cannabis prescription from Israel’s Ministry of Health.

"Although medical cannabis has been legal for a decade and is licensed to patients to relieve pain and other symptoms, there has been no information about the users themselves," said Pesach Shvartzman, a professor at Ben-Gurion’s Faculty of Health Sciences.

The study examined more than 2,000 cancer and non-cancer patients using medical marijuana. Almost all said they sought a cannabis prescription after trying conventional treatments that were ineffective. Patients were interviewed by telephone in the first three months of treatment and subsequently every four months for two years. 

Users reported that their pain, nausea, anxiety, appetite, and general feeling had improved. Fewer than one in 10 stopped using marijuana due to side effects or ineffectiveness after the first interview, and only six percent after the second interview.

About three out of four patients experienced minor side effects that included dry mouth, hunger, sleepiness or “high” sensations.

Three-quarters of the patients smoked marijuana, while one in five used a vaporizer or cannabis oil.

Israel still considers cannabis a “dangerous drug” and it is not registered as a medicine. However, the Ministry of Health says “there is evidence that cannabis could help patients suffering from certain medical conditions and alleviate their suffering.”

There are over 20,000 registered marijuana users in Israel. About 50 new users are approved each week by the Health Ministry.

Ministry of Health regulations allow for medical marijuana to be used to treat cancer symptoms and to reduce the side effects of chemotherapy. Eight farms have Ministry of Health permission to grow cannabis for medicinal use, and four companies have permission to deliver cannabis to cancer patients.

Legalizing Marijuana? Don’t Forget its Medical Use

By Ellen Lenox Smith, Columnist

At least half a dozen states may be joining Colorado and Washington in the full legalization of marijuana. As a medical marijuana patient in Rhode Island, that has never been my battle. I have tried to stay focused on improving medical marijuana laws in Rhode Island and 23 other states, such as expanding the conditions for which it can be prescribed to include chronic pain and other medical issues.

It is mind boggling to me that some states have not yet approved marijuana’s medical use, but seem to be jumping right into legalization, most likely because they see it as a way to generate tax revenue.

We must hold onto the medical programs and be sure they are not mixed into the rules for full legalization. That would be like allowing medication from the pharmacy available to anyone to enjoy for pleasure. This is our medicine.

I have no problem with others having the pleasure of using cannabis socially, but let’s make sure we maintain the integrity of the medical programs.

This is our vision for every state in this country in the near future:

1) Medical marijuana is approved in all states and it includes reciprocity from state to state so we are safe to medicate legally when we travel.

2) Patients qualify when their doctors confirm they have a need and cannabis is no longer limited to specific conditions. There are many less common ones that can be treated effectively with this medication. 

3) Patients have a choice of growing, which is both therapeutic and helpful for those who find strains they are compatible with.

4) Each state offers compassion centers or dispensaries that are strategically placed so all have access within a reasonable distance.

5) Prices at these centers are affordable and on a sliding scale. Many who are afflicted with health issues already have massive medical bills. We do not want to have the mindset of making a large profit off the sale of their medication.

6) When all states are legal, we then conquer the battle of being reimbursed for our medicine from our insurance companies.

7) Allow centers to grow the plants they need to accommodate patients with all of the various strains. 

      8) Allow centers to sell various forms of medical marijuana, including dry product, oils, tinctures, topicals, edibles, etc.

      9) Allow a delivery system for those seriously ill and a gifting program to those financially unable to pay.

     10) All centers grow organically, keeping us safe from pesticides and other chemicals.

     11) People using medical marijuana will have the legal right not be drug tested, discriminated or fired from employment.

As the demand for full legalization continues to spread across the country, please help your state maintain the integrity of its medical program. Medical marijuana is intended to help us with quality of life, not to make a huge profit from. Let those that are using it for recreation be the ones to pay taxes and bring in the revenue for your state.

Let’s keep this medicine affordable for those in need.  For those that do not need it for medical reasons, be glad you are able to use cannabis socially and not have to face issues like us!

Ellen Lenox Smith suffers from Ehlers Danlos syndrome and sarcoidosis.  Ellen and her husband Stuart are co-directors for medical marijuana advocacy for the U.S. Pain Foundation and serve as board members for the Rhode Island Patient Advocacy Coalition.

For more information about medical marijuana or to contact the Smith's, visit their website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Results of Cannabis Drug Study Cause Market Frenzy

By Pat Anson, Editor

A British pharmaceutical company has reported positive results from a Phase 3 clinical study of a marijuana-based medication for Dravet syndrome, a severe form of children’s epilepsy.

The study found that Epidiolex, a liquid formula containing a plant-derived cannabinoid (CBD), significantly reduced the number of seizures in children with Dravet syndrome. CBD is a compound in cannabis that does not produce the “high” caused by marijuana.

The study findings caused shares of GW Pharmaceuticals (NASDAQ: GWPH) to more than double in trading Monday, much of it fueled by speculation that the company’s cannabinoid products would eventually be approved by the Food and Drug Administration for pain relief.

“If they get this, doctors will say, here’s a cannabinoid prescription,” said CNBC’s Jim Cramer. “This will be the pure cannabis that a lot of people who have been waiting for, an actual painkiller that is not addictive. This will replace, I believe, the terrible, terrible wave of death that oxycodone has caused.

image courtesy gw pharmaceuticals

image courtesy gw pharmaceuticals

“If you want to prescribe actual medical marijuana, a real doctor is reluctant to do it because there are no uniform standards, and what you really want is the pure cannabinoid. There will be use of this galore.”

In a statement to CNBC, GW said it was not investigating Epidiolex for pain relief.

"Today's Phase 3 results of Epidiolex (cannabidiol) were not studying the medicine as a possible treatment for pain. Epidiolex is being investigated for Dravet syndrome, Lennox-Gastaut syndrome and Tuberous Sclerosis Complex (TSC), three rare, extremely debilitating epilepsy syndromes that begin in infancy or early childhood," the company said.

The Phase 3 placebo controlled study involved 120 children with Dravet syndrome, who were averaging about 13 seizures a month before the trial began. Seizures declined by over a third in patients treated with Epidiolex, with few side effects.

“The results of this Epidiolex pivotal trial are important and exciting as they represent the first placebo-controlled evidence to support the safety and efficacy of pharmaceutical cannabidiol in children with Dravet syndrome, one of the most severe and difficult-to-treat types of epilepsy,” said Orrin Devinsky, MD, of New York University Langone Medical Center’s Comprehensive Epilepsy Center.

“These data demonstrate that Epidiolex delivers clinically important reductions in seizure frequency together with an acceptable safety and tolerability profile, providing the epilepsy community with the prospect of an appropriately standardized and tested pharmaceutical formulation of cannabidiol being made available by prescription in the future.”

Epidiolex has both Orphan Drug Designation and Fast Track Designation from the U.S. Food and Drug Administration. There are currently no approved treatments for Dravet syndrome in the U.S.

“We are excited about the potential for Epidiolex to become the first FDA approved treatment option specifically for Dravet syndrome patients and their families,” said Justin Gover, GW’s CEO. “In light of this positive data, we will now request a pre-NDA (new drug application) meeting with the FDA to discuss our proposed regulatory submission.”

GW is recruiting 150 patients for a second Phase 3 trial of Epidiolex for Dravet syndrome and is currently conducting a Phase 3 study for Lennox-Gastaut syndrome. Another study of Epidiolex is scheduled to begin soon for a third form of epilepsy, Tuberous Sclerosis Complex.

The company is already marketing a marijuana-based oral spray called Sativex that is being sold in Europe, Canada and Mexico to treat muscle tightness and contractions caused by multiple sclerosis. Canada also allows Sativex to be used for the treatment of neuropathic pain and advanced cancer pain.

Sativex is not currently approved for use in the U.S. for any condition. It is estimated that over 400,000 cancer patients in the U.S. suffer from pain that is not well controlled by opioid pain medications. Two recent Phase 3 studies found that Sativex worked no better than a placebo in treating cancer pain.

Survey Finds Medical Marijuana Safe and Effective

By Ellen Lenox Smith, Columnist

Recently HelloMD, an online “telehealth” service that provides consultations with doctors who can write prescriptions for medical marijuana, conducted an extensive survey of 1,400 of patients. Patients were asked to complete a questionnaire consisting of 31 questions dealing with their marijuana use.

The survey results (which you can see by clicking here)  really caught my attention and are very exciting.

The survey found that the most common conditions that medical marijuana was being used to treat were chronic pain, anxiety, stress and insomnia. Eight out of ten patients (84%) strongly agreed that cannabis provides them with relief from their symptoms.

Medical marijuana may be legal in 23 states, but many of those states have yet to certify chronic pain as a condition marijuana can be prescribed for. Yet we have 100 million in our country suffering from pain! Let’s hope surveys like this will help to educate those states.

“There were few to no reports of negative consequences of cannabis use, with over 96% of users either somewhat likely or highly likely to recommend cannabis use to friends, family or others seeking improved wellbeing,” according to the HelloMD report.

This statement does not surprise me at all, for we have not seen negative consequences of marijuana use since 2007, when my husband and I first started helping patients wanting to try cannabis. Those of us that have felt the benefits of cannabis talk and encourage others to consider trying it all the time when we meet someone who is suffering.

I also do not believe this was any select group surveyed by HellloMD, but are typical cannabis users that realized how gentle, safe and effective this medication is.

The survey found that middle aged and elderly patients were more likely to use marijuana for pain management, while younger age groups were using it to treat stress, anxiety, mental-health disorders, nausea and issues with appetite. I love this finding. That is exactly what we are observing in the different ages we deal with.  

HelloMD also found that social perception of cannabis use is moving into the mainstream of society, as more and more states pass legislation allowing medical marijuana.

“Amongst those that use medical marijuana, 82% are open with family members about their use with 44% strongly agreeing. 15% still hide their use from family members (perhaps their children, although this is unclear from our data). 59.5% of patients are open with their close friends and a further 35% with all friends (close and otherwise). Only 5.3% do not admit to friends that they use medical marijuana,” the report found.

How exciting that we are now able to feel comfortable sharing the truth of our lives and the benefits we are gaining by being allowed to use this medication. As the report points out, there has never been a death from overdose attributed to cannabis and the safety record of cannabis is superior to that of pharmaceutical pain medications. This reinforces what we have been observing and I am thrilled what we have been saying is mentioned here!

“Our data indicates that 78% of those using cannabis for health and wellness are above the age of 25. In stark contrast to the stoner stereotype, these people are highly educated working professionals. Many are parents. They could be your friends, your colleagues, or your neighbors. All of them have legitimate health issues. All of them are seeking alternatives to traditional prescribed medication considered toxic and laden with the potential of negative side effects,” the report concludes.

Thanks to surveys like this, we can continue to work to get the education out there for people to understand that those of us using cannabis for pain are not all getting high or stoned. The brain receptors react to marijuana and we simply get pain relief! However, anyone can take too much of any medication and have a negative reaction.

I hope we will see even more surveys about medical marijuana, along with research, so that more will get on board and understand the advantages of this plant.

Ellen and Stuart.JPG

Ellen Lenox Smith suffers from Ehlers Danlos syndrome and sarcoidosis. Ellen and her husband Stuart live in Rhode Island. They are co-directors for medical marijuana advocacy for the U.S. Pain Foundation and serve as board members for the Rhode Island Patient Advocacy Coalition.

For more information about medical marijuana, visit their website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Players Say Half of NFL Using Medical Marijuana

By Pat Anson, Editor

With the countdown underway for Super Bowl 50, there’s a renewed focus on the NFL’s high rate of injuries and concussions, and whether the league should be open to players using medical marijuana to treat their pain.

“The growing legality of the plant, especially for medical use, is putting the NFL into a bit of a moral quandary,” says former Denver Broncos wide receiver Nate Jackson.

“When you compare it to what the alternative is in their training rooms; pills, pills, pills, that are being put into these guys’ hands and turning them into addicts. I was never big on those pills. I medicated with marijuana and it helped me and I think it helped save my brain.”

Jackson suffered numerous injuries during his six years in the NFL, breaking several bones and suffering at least two concussions. After retiring, Jackson wrote a memoir about his football career, Slow Getting Up: A Story of NFL Survival from the Bottom of the Pile and became an advocate for medical marijuana.

Pain News Network recently spoke to Jackson at the Cannabis World Congress & Business Exposition in Los Angeles, where he told us he started smoking marijuana as a high school football player and has been using it ever since.

nate jackson

nate jackson

“It’s been pretty effective. It didn’t prevent me from getting to the NFL. It didn’t prevent me from excelling and being my best. It was an effective way to take the edge off, deal with pain, and deal with injuries without taking away my edge on the field,” said Jackson. “I would say probably half the guys (in the NFL) use marijuana. They’ve been using it since they were teenagers. They’re familiar with what it does with their bodies. Top level athletes, you tinker with the process as you go, with your body, with your performance, with what works for you and what doesn’t.

"So if these guys get into the NFL with a marijuana habit intact, it means that it’s under control, it’s actually something that works for them, works for their body, allows them to perform at the highest level they can, and it doesn’t affect them negatively. Because if it does affect them negatively, they get cut. The demands of the job are so strict and so intense, if you’re not playing well, you get cut. And so if they are in the league, they are playing really well. They’re punctual, they’re memorizing their playbook, and they’re taking care of their business. If they’re using marijuana to do that, I think it’s healthy.”

Although the NFL has a reputation as a league that closely monitors players for signs of illegal drugs or performance enhancing medication, Jackson says it’s relatively easy to avoid getting caught by a drug test.

“Because the street drug test is only once a year. It’s in May, June or July somewhere around there. Once you get it, then you’re good for the next year, as long as you don’t fail it. I never failed it,” he said.

“The problem is for those guys who get put into a substance abuse program. That could be because of a positive marijuana test or DUI or ephedrine or Adderall or domestic dispute program, whatever it may be. You get put in the substance abuse program and I would say there are maybe a couple hundred guys in the league who are in that program and you get tested. You’re urine tested three or four times a week, every week, all year long for several years.”

Several current players support Jackson’s claim that at least half of the NFL is using marijuana. They told the Bleacher Report that many players smoke marijuana three or four times a week during the season. None of the players wanted to be identified.

"It's at least 60 percent now," said Jamal Anderson, a former running back for the Atlanta Falcons. "That's bare minimum. That's because players today don't believe in the stigma that older people associate with smoking it. To the younger guys in the league now, smoking weed is a normal thing, like having a beer. Plus, they know that smoking it helps them with the concussions."

Former Chicago Bears quarterback Jim McMahon says medical marijuana helps him deal with severe headaches, depression, memory loss and early onset dementia – which he blames on the NFL’s negligence in handling concussions during his playing career. McMahon said he was taking 100 Percocet pills a month for pain before he started using marijuana.

"They were doing more harm than good," McMahon told the Chicago Tribune. "This medical marijuana has been a godsend. It relieves me of the pain — or thinking about it, anyway."

With about 300 players being put on injured reserve every season – many with career ending injuries – Nate Jackson says it’s time for the NFL to acknowledge what’s already happening and change its marijuana policy.

“I think they (injured players) should be given a choice at that point and be able to avoid the opioid painkillers, which are pretty much a scourge in the locker room,” Jackson says.

“When you get put on injured reserve, if you have a severe enough injury that your season is over, you’re going to be given drugs by the team doctors and the team trainers because you are legitimately hurt. Are you going to take those pills or are you going to take something else? I chose to take something else.”

CDC Should Consider Marijuana as Alternative to Opioids

By Ellen Lenox Smith, Columnist

Presently in our country, those that are successfully using opioids for pain relief are feeling dirty and lost -- largely due to fears about addiction and  overdoses. Pain patients often have to cope with physicians who are reluctant to prescribe opioids and pharmacies that are sometimes unwilling to fill their prescriptions.

The Centers for Disease Prevention and Control (CDC) is considering new guidelines that would encourage doctors to shift even further away from prescribing opioids, leaving the patient with little effective medication to turn to.

Why is the CDC not even considering the use of medical marijuana to help these people in need?

The Boston Herald recently reported that hundreds of opioid addicts are being treated successfully in Massachusetts with medical marijuana.

“We have a statewide epidemic of opioid deaths,” said Dr. Gary Witman of Canna Care Docs, which issues medical marijuana cards in seven states. “As soon as we can get people off opioids to a non-addicting substance — and medicinal marijuana is non addicting — I think it would dramatically impact the amount of opioid deaths.”

Witman is treating about 80 patients at a Canna Care clinic who are addicted to opioids, muscle relaxants or anti-anxiety medications. After enrolling them in a one-month tapering program and treating them with cannabis, Witman says more than 75 percent of the patients have stopped taking the harder drugs. Medical marijuana gave them relief from pain and anxiety — and far more safely than opioids.

Patients across the country are also learning they can use cannabis for pain relief, decreasing or even eliminating their use of opioids.  Marijuana works far better than other substitutes since it is not synthetic and does not cause organ damage or deaths like opioids can in some circumstances.

Medical marijuana works naturally on what is known as the “endocannabinoid system,” binding to neurological receptors in the brain that control appetite, pain sensation, mood and memory.

Here in Rhode Island, my husband and I have witnessed the amazing transition of pain patients on opioids that chose to transition to medical marijuana.  Most that turn to cannabis do so to eliminate the side effects of opioids and concerns about their long term use. They still achieve pain relief but know they are gaining that relief in a safer manner -- no organ damage, no teeth getting destroyed, no concerns of addiction and no deaths.

Marijuana may still be illegal at the federal level, but it is legal in 23 states and the District of Columbia, and millions of people are discovering its therapeutic benefits. The CDC should consider adding medical marijuana to the list of “non-opioid” therapies in its guidelines.

Ellen Lenox Smith and her husband Stuart live in Rhode Island. They are co-directors for medical marijuana advocacy for the U.S. Pain Foundation and serve as board members for the Rhode Island Patient Advocacy Coalition. 

For more information about medical marijuana, visit their website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Medical marijuana is legal in 23 U.S. states and the District of Columbia, but is still technically illegal under federal law. Even in states where it is legal, doctors may frown upon marijuana and drop patients from their practice for using it.

 

Searching for Medical Marijuana’s ‘Therapeutic Window’

Dr. Mark Ware is one of the world’s leading experts on medical marijuana. Ware is an associate professor in Family Medicine and Anesthesia at McGill University in Montreal and director of clinical research at the Alan Edwards Pain Management Unit at McGill University Health Centre. He practices pain medicine at Montreal General Hospital.

Although medical marijuana is legal throughout Canada, and in 23 U.S. states and the District of Columbia, mainstream medicine still frowns upon its use. Research into the therapeutic benefits of cannabis -- particularly for pain management -- has also been limited.

Pain News Network editor Pat Anson recently spoke with Ware at the annual meeting of the American Pain Society. The interview has been edited for content and clarity.

DR. MARK WARE.

DR. MARK WARE.

Anson: You’ve called medical marijuana an “incredible social experiment.” What do you mean by that? 

Ware: I think what we’re seeing is the lid coming off something that’s been going on for a long time. I think people have been self-experimenting with marijuana for years and years. People have been growing it in their basements and backyards. So there’s been a social experiment with cannabis since the 1960’s in the Western world.

I think the medical aspect of it has kind of followed through with that, because as you get thousands of people using cannabis, eventually somebody with an illness is going to stumble upon it. Lester Grinspoon (a marijuana researcher) reported on this in 1971. So that’s how long we’ve known or suspected the potential medical properties. The fact that the drug has been illegal has suppressed the possibility of there being much in the way of good quality research. So the experiment has been going on underground, out of sight and out of the public eye.

What we’re seeing now is that suddenly we’re able to talk about it. We’re able to look at this seriously. And we’re beginning to realize how much was already going on. So I think it’s an experiment that’s been going on for a long time and we’re beginning to put some parameters around it now, which allow us to track it more carefully. And hopefully it can yield some important results that can help inform the patient and the physician about what to do with this.

Anson: Some doctors have told me they don’t think marijuana will ever go mainstream until big companies like Pfizer and Purdue Pharma start backing marijuana research and doing clinical studies. Would you agree with that?

Ware: I don’t know if I would agree with that. That’s true for new pharmaceutical drugs. If you’re developing a molecule from the lab up, you need Big Pharma to come along and take that and move it to the point where they can do the big clinical trials.

With an herbal medicine, I think you almost don’t want to look at the pharmaceutical model for drug development. It’s more like how we regulate natural health products in Canada. We want good quality cultivation techniques, we want good quality processing, and we want to know what it is that we’re giving to patients.

I think fundamentally what we have to figure out is what we want to know about this drug. What is it that we need to know and how do we go about getting that information?

I think if we wait for Big Pharma to come along it’s going to be a long wait.  They would have been on this long ago if they thought this was important.

It’s a plant based medicine that’s already in our society at some level and we need to recognize the reality that mainstream doesn’t mean mainstream prescription availability. It’s going to mean mainstream figuring out how to put cannabis in a safe place in our society.

Anson: Medical marijuana is so widely available today, it’s like we’re already past the clinical trial phase.

Ware:  Exactly.  And to go back and do the Phase III study now, it’s expensive and would take hundreds of millions of dollars. And that requires knowing whether you’re going to get your money back. Companies invest that money when they know they’ve got a patent and they can make money back on the drug in the ten years after it’s launched. It’s much harder to see that happening with an herbal material like cannabis.

Why invest the money? It’s already available. You can already buy it at the dispensary. So now the question is how do we improve that process? How do we improve the quality of the product? How do we label them so people know what’s in them? How do we provide information to the patients that are buying them? What they should be looking for and what they should be careful about?

And how do we inform the physicians and health professionals who should be managing that whole process or at least informing it? What kinds of patients should be avoiding this? This isn’t for young kids. This isn’t for women who are pregnant. Some of this is obvious, but some of it needs to be specified and mandated.

I don’t think there’s strong enough evidence to start using cannabis in younger people. I think that the risks of cannabis on the developing brain in teenagers is significant enough that, unless there is a very real reason like a younger person with a severe intractable illness, this is a drug that should be held for the 25 and older crowd.

I would caution people who have unstable heart problems against using cannabis. It does increase your heart rate, can open up your blood vessels, and that could precipitate some heart problems.

Anson: What are the pain conditions that you think medical marijuana can be beneficial for?

Ware: I think for sure it’s more likely effective for chronic pain than acute pain. It’s never been reported for acute pain syndromes, but it has been reported for chronic pain.  There are clinical trials now that bear out that chronic neuropathic pain is one of the relieved conditions that it seems to respond to. We’ve seen reports for spinal cord injury, fibromyalgia, and PTSD (post-traumatic stress disorder). Cannabinoids appear to have some signals in some of these conditions.

And then you go beyond that to abdominal pain with Crohn’s disease, diabetic neuropathy, and so on. The list of conditions where it looks like it may work is as long as your arm.  There are individual case reports of cannabis being used on a huge range of conditions.

Anson: What is the most effective delivery system? Everyone thinks of smoking, but there are plenty of other ways to ingest marijuana.

Ware: There are. And I think the key thing is the difference between inhaling and taking it by mouth. The inhaled route is a very quick onset, has a very rapid effect on the patient, and then a fairly quick half-life; whereas the oral route takes much longer to absorb and takes a longer time for the patient to feel the effects. But then it lasts a lot longer. 

courtesy drug policy alliance

courtesy drug policy alliance

So it’s almost like a short acting versus a long acting medication. I don’t think there’s any way of saying one is more effective than the other. I think they’re effective in different ways.

If I was vomiting because of chemotherapy, I’d want something I could inhale to control the vomiting quickly. But if I’m not able to sleep because of my chronic pain, I want something that would be longer lasting so I could sleep through the night.  I don’t want to wake up three hours later and have to do it again. So I think we just have to figure out how to use the different administrative techniques for different clinical conditions.

Anson: Most of our readers are pain patients and when this subject comes up many of them say, “I’ve never tried marijuana. I’m curious about it and I’d like to try it, but I’m worried about getting high.” Can they get pain relief without getting high?

Ware: We’ve done studies where we kept the doses very, very small -- to the point where people have read the protocols and said you’re not giving these patients enough to feel the effect. And in fact, what happens is patients are still able to find analgesic benefit and avoid that euphoric or psychoactive effect.

That’s important for most patients. They want to be able to use a drug or any kind or a therapy that doesn’t impair them from doing the things that they need to do. They need to drive. They need to work. They need to hang out with their families. They need to do their sports and their activities. And this is part of pain management generally. We want people to be living as full and as active a life as possible. We don’t want them collapsing on the couch all day long.

So can we find that window, what we call that therapeutic window, that dose where you get the benefit but you don’t get the sedative or psychoactive effect? And I think we can. I think for patients who are considering this approach, they really have to learn to be very patient and use very, very small doses. Try very small amounts first and allow your body to feel what the drug is doing to you. And if nothing happens, that’s okay. You’ve started with a low enough dose that you felt nothing. You gradually work your way up.

The interesting thing about cannabis is that there are two ways of thinking about dose. One is the amount of the drug itself, the number of grams, joints or pipes, if you will. The other is the THC level of the cannabis itself.

courtesy drug policy alliance

courtesy drug policy alliance

If patients have access to material where the THC level has been standardized or has been measured, they should be trying to use THC cannabis that is as low as possible, because the likelihood of having a psychoactive reaction to a high THC cannabis is much higher.

If it’s high in THC, it doesn’t take much to get that effect, where if they use very low THC levels, less than 10 percent THC, and they use a small quantity of the material, then potentially they can find that therapeutic window that can be effective.

Anson: What about taking marijuana with opioids? Can you do that?

Ware: You can. There’s no medical reason why you shouldn’t. I think the key thing for patients who are doing that, and again I emphasize with the knowledge and support of their physician, is that they can reduce the doses of other medications which may not be helping as much.

Cannabis use can be seen in terms of improving patients in two ways. One is in reducing the medications that they’re already taking, which may have side effects. And the other is in improving their functioning state so that they’re doing more. This is where I think the responsibility lies with the patient to prove to the doctor that this drug is helping. And you do that by reducing your other medications with the doctor’s support, by increasing your functioning and by showing that you’re doing things that you weren’t doing before. That is what doctors want to see.

There appears to be evidence, at least in animal studies, that opioids and cannabinoid drugs work synergistically. So if you take the two separately and you take the two combined, you get a greater effect with the combination than if you took either of the others by themselves.

This synergism, we’ve seen it in patients who started using cannabis successfully and they were able to reduce their other medications. In some cases they find that the dose of opioids they were taking, they can lower it and get a similar effect with much lower doses. With others, they don’t need the opioids any longer and they can taper off it and stop completely. 

Anson: One fear of using medical marijuana is that it could make you more prone to abusing other substances.

Ware: I think patient selection is very important when you’re considering as a physician whether to authorize or prescribe cannabis, because cannabis is a drug with a known risk of abuse and dependence by itself. There are people who struggle with their marijuana use and withdrawal when they try to get off it. Physicians need to be sure they’re not making things worse for a patient that has a dependency disorder by authorizing cannabis.

Screening for dependence means looking for abuse of other substances, such as alcohol. If you’ve done that carefully, prescribing cannabis to a patient who doesn’t have that addiction risk appears to be fairly safe.

Medical cannabis should be used as an option only when all the conventional therapies have failed; when all of the other approaches to pain management, and I’m not just talking about pharmacology, but when all of the non-pharmacological approaches have all been considered and tried. Cannabis is not at the point where it can be thrown in as a first line agent for a patient struggling with pain management.

Anson: Thank you, Dr. Ware.