Pain Patients More Likely Than Doctors to Favor Greater Access to Cannabis

By Pat Anson

Americans living with chronic pain are significantly more likely to support greater access to cannabis than the physicians who treat them, according to a new survey that found broad support for cannabis education in medical schools.

Rutgers Health surveyed over 1,600 adults with chronic pain and 1,000 physicians in states with medical cannabis programs. The survey results, recently published in JAMA Network Open, show that 71% of  pain patients support federal legalization of medical cannabis, compared to 59% of physicians.

Patients are also more likely to support nationwide legalization of recreational cannabis (55%), compared to about a third of physicians (38%).

"Cannabis is unique in terms of the complicated policy landscape," said lead author Elizabeth Stone, PhD, an Instructor at Rutgers Robert Wood Johnson Medical School. "Depending on what state you're in, it could be that medical cannabis is legal, it could be that medical and recreational use are legal, it could be that neither is legal, but some things are decriminalized.”

Currently, 38 states and Washington, DC have legalized medical cannabis and 23 of those states (plus DC) have legalized its recreational use. Cannabis remains illegal under federal law as a Schedule I controlled substance, but the DEA is considering a proposal from the Biden Administration to reclassify cannabis as Schedule III substance, which would allow for limited use of cannabis-based medication.

Personal experience plays a significant role in shaping attitudes about cannabis. The Rutgers survey found that people who used cannabis for chronic pain had the highest levels of support for expanding access, while physicians who don’t recommended cannabis for pain management had the lowest levels of support.

Although they have different attitudes about legalization, about 70% of patients and physicians favor requiring medical schools to train future doctors on cannabis treatment of chronic pain. There is also broad support for training that would allow physicians and nurse practitioners to recommend cannabis to their patients.  

"I think it points to the need for future guidance around cannabis use and efficacy," Stone said. "Is it something they should be recommending? If so, are there different considerations for types of products or modes of use or concentration?"

Nearly two thirds of patients (64%) and about half of physicians (51%), favor requiring insurance companies to cover cannabis treatment of chronic pain.

Support for Cannabis Policies

JAMA NETWORK OPEN

Previous surveys have also found distinct differences in patient and physician attitudes about cannabis. A recent survey of primary care doctors found that nearly one in five (18%) would not accept a new patient using medical cannabis. And 40% said they would not accept a patient using non-medical or recreational cannabis.

Many doctors are worried what their colleagues will think or what law enforcement will do if they prescribed or recommended cannabis. A 2019 survey of oncologists and pain management specialists found that nearly two-thirds (65%) were concerned about the legal repercussions of recommending medical cannabis to their patients. And 60% were worried about professional stigma.

Many patients who live with chronic pain are turning to cannabis as an alternative to opioids. A recent PNN survey found that over 30% of pain patients said they had used cannabis for pain relief. Many did so because they couldn’t get an opioid prescription or had problems getting one filled.

Feds Warn About Copycat Packaging of Delta-8 THC Edibles

By Crystal Lindell

The U.S. government is once again going after companies that sell Delta-8 THC edibles in packaging that looks like popular brand name candy and snacks. 

The Food and Drug Administration and the Federal Trade Commission sent warning letters to five companies for selling copycat food products containing delta-8 THC derived from hemp.

For example, one company was selling a package of “Slizzles” edibles that looks strikingly similar to “Skittles” candy. Another company sold a “Double Stuff Stoneo” product in packaging that looks like “Oreo” cookies. 

The cease and desist warning letters were issued to Hippy Mood, Earthly Hemps, Shamrockshrooms, Mary Janes Bakery and Life Leaf Medical CBD Center

“Inadequate or confusing labeling can result in children or unsuspecting adults consuming products with strong resemblance to popular snacks and candies that contain delta-8 THC without realizing it,” FDA Principal Deputy Commissioner Namandjé Bumpus, PhD, said in a statement. 

“As accidental ingestion and/or overconsumption of Delta-8 THC containing products could pose considerable health risks, the companies who sell these illegal products are demonstrating complete neglect for consumer safety.”

Delta-8 THC is derived from hemp, which Congress legalized in the 2018 Farm Bill. Hemp contains only trace amounts of THC, the psychoactive ingredient in cannabis, so the thinking was that hemp would only be used to make cash products such as rope, clothing and horse feed. It didn’t take long, however, for cannabis companies to develop a synthetic form of hemp-derived THC that is just as potent as regular THC. 

Efforts are underway to close that loophole in the next Farm Bill, but in the meantime delta-8 THC products remain legal under federal law, although some individual states have banned them. 

In 2022 and 2023, the feds issued similar warnings against other companies marketing Delta-8 THC edibles. Although those products were withdrawn from the market, other companies have stepped into the void and began selling similar ones. 

The FDA and FTC say the copycat branding of delta-8 edibles violates federal laws against unfair or deceptive marketing, including practices that present health or safety risks. The agencies say children are particularly vulnerable, because they might not realize the edibles contain THC. 

“Companies that market and sell edible THC products that are easily mistaken for snacks and candy are not only acting illegally, but they are also putting the health of young children at risk,” said Samuel Levine, director of the FTC’s Bureau of Consumer Protection. “Those that prioritize profits in front of children's safety are at serious risk of legal action.”

Industry groups that represent companies that have seen their branded products mimicked have come out against this type of copycat packaging.  The Consumer Brands Association (CBA) has a position paper on its website specifically addressing THC edibles that mimic popular brands. 

“Companies are unequivocally opposed to their brands being illegally used in products containing THC,” the CBA writes. “But rooting out these bad actors is like a game of whack-a-mole. By the time a company or government entity goes after them, their local storefront or online presence disappears and they pop up with a new name and new site.”

The issue goes beyond simple copyright infringement. The CBA cites recent data showing that national poison control centers handled nearly 10,500 incidents involving products laced with THC. Of those cases, 77% involved consumers 19 years old or younger.

“The urgency of this issue is not about intellectual property infringement, but about how that infringing use of trusted food brands creates a direct threat to consumer safety — particularly that of children,” the CBA says. “As incidents of children being hurt by lookalike products that endanger them increase, greater enforcement is necessary.”

The National Confectioners Association (NCA) has also warned about cannabis companies using packages that looks like popular candy and snacks.

Edibles may deliberately mimic the trade dress of beloved consumer brands,” the NCA said. “It is often very difficult to distinguish these edibles from conventional foods and beverages, resulting in confusion and injury to consumers, including children, and reputational damage to food companies.”

The NCA says it is difficult and costly for companies to try to protect their brands in this situation, because it requires “state-by-state surveillance” and “burdensome legal action.”

The FDA is also concerned about the processes used to synthesize delta-8 THC, as impurities or variations in the processing can result in products that may be harmful or have unpredictable effects. The agency has requested written responses from the companies within 15 working days stating how they will address these violations and prevent their recurrence. 

Can Cannabis Help Prevent Dementia?

By Pat Anson, PNN Editor

People use cannabis for a variety of reasons. Some use it to relieve pain. Others use it to help them sleep, improve their appetite, or reduce anxiety and stress. Still others use cannabis because it makes them feel good.

A new study suggests there’s another unexpected benefit from consuming cannabis, especially when it’s used recreationally: It may help middle-aged adults ward of dementia.

Researchers at SUNY Upstate Medical University looked at health survey data that assessed the subjective cognitive decline (SCD) of over 4,700 U.S. adults between the ages of 45 and 64. Memory loss and confusion are symptoms of SCD, which is considered an early sign of dementia.

To their surprise, researchers found that participants who only used cannabis recreationally had significantly lower risk of SCD – as much as 96% less risk compared to non-users. Those who used cannabis for medical reasons or combined it with recreational use also had lower odds of SCD, but the difference was not statistically significant.

“We found that non-medical cannabis use was significantly associated with reduced odds of SCD in comparison to non-users. Several factors might explain this observation. Non-medical use of cannabis often contains THC, which has a psychoactive component that creates the ‘high’ sensation. Whereas CBD is non-psychoactive and often used for anxiety and chronic pain management,” the SUNY research team recently reported in the journal Current Alzheimer Research.

One likely reason for the disparity in SCD between recreational and medical users is that those who consume cannabis for health reasons may have comorbid medical conditions – such as diabetes, hypertension, cardiovascular disease and musculoskeletal disorders -- that raise their risk of dementia.

Another consideration is sleep. One of the primary reasons people use cannabis is to help them fall asleep faster and stay asleep longer. Recreational use of cannabis has the added benefit of improving sleep quality. A recent study found that insomnia is associated with a 51% higher risk of dementia risk.

The frequency of cannabis use and whether it was smoked, vaped or ingested had no significant connection to SCD risk.

Although the study found no direct cause-and-effect relationship between cannabis, SCD and dementia, researchers think it’s worth exploring further. More than six million Americans have Alzheimer’s disease or some form of dementia, a number that’s expected to double by 2050. 

“Despite the advancement of medicine and technology, dementia remains incurable and non-preventable. While some medications can slow symptom progression, they are only effective if started during early stages and cannot reverse its course,” SUNY researchers concluded. “Given the widespread use of cannabis in the U.S., it is imperative to pursue further research to understand the mechanism underlying the reduced odds of SCD among non-medical cannabis users.”

Is It Safe for Doctors to Recommend Medical Cannabis?

By Dr. Joseph Parker

Nearly two-thirds of oncologists and pain management specialists say they are worried about the legal repercussions of recommending medical cannabis to their patients. This is not an unreasonable fear.

According to one survey, 60% of doctors fear professional stigma, and for good reason. I have seen colleagues call the DEA to report that a physician who certified patients for cannabis was selling marijuana from their office.  As absurd as this might seem, once the DEA gets rolling, they can always find an excuse to prosecute a physician treating pain or addiction. 

Cannabis may soon be moved from a Schedule I controlled substance, with no approved medical use, to a less restrictive Schedule III, where it would be regulated like codeine. This might relax some of those physicians, but I’m not sure it will.

There are many politicians and law enforcement officers who simply believe that marijuana is evil. The extreme was former Attorney General Jeff Sessions, who said at one time that marijuana was “only slightly less awful” than heroin. 

Sessions may truly believe this, but the comparison has no basis.  Heroin can cause respiratory depression and death.  Cannabis cannot.  Heroin works on the endorphin receptors in the brain to trigger a dopamine-mediated reward response, which can lead to what I call “true” addiction. 

Cannabis works predominately through the endocannabinoid system, though it can indirectly influence the release of dopamine and other brain areas associated with the reward system. That’s because the endocannabinoid system and CB1 receptors play a regulatory role in the release of various neurotransmitters, including dopamine.

When tetrahydrocannabinol (THC) binds to CB1 receptors, it can affect the release of dopamine and other neurotransmitters, which contributes to the pleasurable and rewarding effects associated with cannabis use.

I am not saying that someone cannot develop a cannabis substance use disorder or dependence. They certainly can, just like you can with caffeine, sugar or gambling, for that matter.  What I’m saying is that cannabis can make people feel good and want more, but it is nowhere near as dangerous as heroin.  It is also not neurotoxic, like methamphetamine, which can cause the death of brain cells with a single use. 

Some studies actually show a neuroprotective effect from cannabis. And, when taken by itself, cannabis cannot cause an overdose death. This is important. 

Every time the U.S. government targets something, they pay an army of statisticians to generate scary-sounding numbers. For example, you will hear claims that a rise in fatal car accidents was “associated” with cannabis. What exactly does that mean?  It means that a large percentage of accidents involve people who use cannabis, which is unsurprising since about 40% of the adult U.S. population has or is using cannabis.

Those same accidents show a much higher correlation with caffeine.  Caffeine use could be “associated” with probably 90% of all car accidents.  But correlation, of course, does not prove causation. 

These arguments present no evidence that cannabis caused the accidents.  However, the news media can get sloppy about scientific accuracy.  A study will say that a certain number of accidents “involved” cannabis, and the media will report that the cannabis “caused” the accident.

CBD vs. THC

For some reason, Sessions was also obsessed with CBD (cannabidiol). CBD is not THC, which is psychoactive and has a significant effect on a user’s mental processes.  CBD is considered non-psychoactive by a majority of experts, including the World Health Organization.

THC has a higher affinity for CB1 receptors, which are primarily found in the brain and central nervous system, and is a partial agonist for both CB1 and CB2 receptors. Activation of CB1 can cause euphoria and relaxation. It also alters sensory perception, impairs short-term memory, induces anxiety and paranoia, and impairs motor coordination.

CBD does not directly activate those receptors or have those effects. It is instead considered a negative allosteric modulator of CB1 receptors. CBD modifies the CB1 receptor response to THC and actually moderates some of the psychoactive effects of THC.  

There is also evidence that CBD can be anxiolytic and antipsychotic, while THC has been linked (not proven) to be associated with schizophrenia and psychosis.  THC can lead to the release of dopamine, which accounts for the euphoria, but at too low a level to be compared with more addictive substances.

CBD has been found in at least one study to be effective in the treatment of heroin addiction, and in another study to increased motivation, possibly giving us something to treat symptoms of schizophrenia.

Does this all mean it is safe to recommend cannabis to your patients?  Not really. While cannabis has been shown in several replicated studies to be helpful in the treatment of chronic pain, right now it is not safe for doctors to prescribe or recommend. 

Even in states where cannabis is legal for medical use and federal courts have upheld the right of physicians to recommend it, I would argue that the DEA takes a different view.

In the recent prosecution of a physician for “overprescribing” opiates, prosecutors claimed at a press conference that they started investigating the doctor after a call from local police regarding an overdose death.  Evidence later showed this was not the case.  The doctor was actually first targeted for agreeing to certify patients for their state’s medical cannabis program. 

You can help educate your patients about cannabis, but send them on to someone who does not prescribe controlled substances. Until physician rights are restored and protected in this country, it’s just not safe to recommend cannabis.

Joseph Parker, MD, is Chief Science Officer and Operations Officer at Advanced Research Concepts, a company developing solutions to the challenges of space travel and space-related medical issues.  In clinical practice, Dr. Parker specialized in emergency medicine and served as Director of Emergency Medicine at two hospitals. Prior to that, he had a distinguished career in the U.S. Marines and Air Force. 

In 2022, a federal jury convicted Dr. Parker on two counts of unlawful opioid prescribing. He has filed an appeal as he awaits sentencing.

Most Employees Want Insurers to Cover Medical Cannabis

By Pat Anson, PNN Editor

A new survey highlights the divide that often exists between patients, doctors and employers when it comes to using medical cannabis.

EO Care Inc. surveyed 1,027 Americans on their views and use of cannabis. All respondents were employed, either full or part-time, and lived in states where cannabis is legal for medical and/or recreational use.

Nearly one in five (18%) said they had used cannabis for health reasons in the past year, primarily for pain, anxiety, and to help them sleep. A large majority --- 88% --- said it helped them reduce their use of prescription drugs, alcohol or both.

Medical cannabis is so popular that 56% of workers said they would be more likely to take a job at a company that has a health plan that covers cannabis. And nearly half (44%) said they would reconsider applying for a job at a company that tested employees for cannabis or prohibited its use outside the workplace.

Nearly two thirds (65%) said they would feel more comfortable using medical cannabis if they were screened and dosed by a physician. And over half (51%) said they would be likely or very likely to use cannabis if it was covered by their insurer.

Previous surveys have found that doctors and patients are often reluctant to discuss cannabis. Many patients fear they’ll be labeled as drug abusers and lose their jobs if they admit using cannabis; while many doctors don’t consider themselves educated enough to recommend cannabis or have doubts about its safety and effectiveness.

“Finding clinical guidance for medicinal cannabis is difficult because most doctors lack the knowledge and retail dispensaries are not equipped to provide medical advice,” Sean Collins, co-founder and CEO of EO Care, said in a news release. “As a result we have tens of millions of Americans using cannabis for health reasons without guidance on specific product recommendations, dosage amounts, possible drug interactions, or consideration of their health history and other potential health risks.”

EO Care provides its members with access to clinicians who, based on a patient’s needs and medical history, develops a personal cannabis plan for them that includes recommendations for specific CBD and THC products and dosages. Members gain access to EO Care through employers who offer the program as a health benefit.

The company is trying to convince employers that offering cannabis care will help attract and retain good workers. Unguided cannabis use can lead to health issues, bad reactions or even abuse, leading to more sick days and loss of productivity.

“We know a large percentage of Americans have used cannabis in the past year, so this is definitely impacting employees and health outcomes,” said Collins. “With the right medicinal cannabis guidance, employers have an opportunity to help their employees, improve health outcomes and be progressive leaders in offering this important benefit that employees will come to expect.”

Currently, most employers and insurers don’t offer cannabis care, but attitudes are changing. A state court in Pennsylvania recently ruled that workers’ compensation plans must cover medical cannabis when an employee uses it to recover from a workplace-related injury. The court ruled that employees in Pennsylvania had “a statutory right” under state law to be reimbursed for medical cannabis.

Chronic Pain Patients Report Improvement from Cannabis Oil

By Pat Anson, PNN Editor

Patients with chronic pain and other illnesses who did not respond to conventional treatment reported improvements in pain, anxiety, depression, fatigue and quality of life after being prescribed cannabis oil for three months, according to a large new Australian study. There were no improvements in patients with insomnia.

Researchers at the University of Sydney surveyed 2,327 patients with chronic health issues who were prescribed cannabis oil products containing cannabinoids, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). The oils are made by Little Green Pharma , a company that specializes in cannabis-based medicine and provided funding for the Quality of Life Evaluation Study (QUEST Initiative).

Over two-thirds of the participants (69%) suffered from chronic pain. Half were being treated for more than one health condition; and one in four were unemployed, on leave, or had limited work duties due to illness.   

Medical cannabis was legalized in Australia in 2016. Cannabis is only available by prescription in Australia to patients with health conditions that are unresponsive to conventional treatment.

“Short-term findings over 3-months indicate that patients prescribed MC (medical cannabis) in practice have improved HRQL (health-related quality of life) and reduced fatigue. Patients experiencing anxiety, depression, or chronic pain also improved in those outcomes over 3-months, but no changes in sleep disturbance were observed in patients with sleep disorders,” researchers reported in PLOS ONE.  

“The study continues to follow patients over 12-months to determine whether improvements in PROs (patient reported outcomes) are maintained long-term. In addition, further subgroup analyses will be undertaken to determine whether patients with specific health conditions have better outcomes compared with others when using validated condition-specific questionnaires.”

The researchers did not measure adverse effects in the QUEST Initiative, but 30 participants withdrew from the study due to “unwanted side effects.” The authors noted that more research on cannabis oil products used in the study is needed in order to successfully treat patients with insomnia and sleep disorders.

Another recent survey in Australia of patients with chronic illness found significant improvements in their physical and mental health after they started using medical cannabis. Most of the cannabis products in that study were oils containing CBD and/or THC.   

Veterans Say Cannabis Reduces Drug Use and Improves Quality of Life

By Pat Anson, PNN Editor

The U.S. Department of Veterans Affairs (VA) and the Department of Defense (DoD) have long taken a dim view of medical cannabis. VA providers are not allowed to recommend or prescribe cannabis, and veterans who admit using cannabis will have it recorded in their VA medical records, which could potentially lead to drug testing or “adjustments” in their treatment plans.

Despite those barriers, cannabis use among U.S. military veterans is growing. In a 2019-2020 survey, nearly 12% of veterans reported using cannabis, with younger veterans (20.2%) and those with psychiatric conditions (24%) even more likely to be cannabis users.

A new study helps explain the popularity of cannabis among veterans. In an anonymous survey of 510 veterans who use medical cannabis, 91 percent said it improved their quality of life and nearly half said it helped them reduce their use of over-the-counter and prescription drugs, including opioids, anti-depressants, muscle relaxers and anti-inflammatory medication.

Veterans who were Black, female, served in combat, and those with chronic pain were most likely to report a desire to reduce their use of “unwanted” medications.

“Many of the respondents reported that medicinal cannabis treatment helped them to experience a greater quality of life, fewer psychological symptoms, fewer physical symptoms, and to use less alcohol, fewer medications, less tobacco, and fewer opioids,” researchers reported in the journal Clinical Therapeutics.

“These findings should inform clinicians who work with the veteran population, as cannabis may be an effective means of helping veterans, especially women and racially minoritized members of this population, to reduce unwanted medication use.”

Previous research has suggested that medical cannabis may play a “harm reduction role” by helping people reduce or even stop their use of opioid pain medication. But a recent study found otherwise. In an analysis of prescription data for over 150,000 chronic pain patients, researchers found that opioid prescribing declined only slightly in states after medical marijuana was legalized.

The VA is also holding the line against using cannabis as a treatment for post-traumatic stress disorder (PTSD).  While many veterans use cannabis to relieve symptoms of PTSD and several states consider PTSD an approved use of medical cannabis, the VA maintains that “cannabis can be harmful,” especially when used long-term, and is “not recommended for the treatment of PTSD.”

Medical Cannabis Effective but Expensive for New Zealanders

By Pat Anson, PNN Editor

Medical cannabis is very effective at relieving pain, improving sleep and reducing anxiety, according to researchers in New Zealand, who say government policies need to change to make cannabis cheaper and more accessible to Kiwis.

Researchers at the University of Otago, Victoria University and the University of Auckland surveyed and conducted interviews with 213 people who had prescriptions for cannabis under New Zealand’s medical cannabis program. Participants were asked about the quality of cannabis products they used and their effectiveness.

The study findings, published in the journal Drugs, Habits and Social Policy, show that nearly 96% reported that cannabis helped them with their medical conditions. Almost half (49%) said they were able to reduce or stop taking prescription drugs.

The most common therapeutic use of medical cannabis was pain relief and 96% of participants said it helped reduce their pain. Cannabis also helped users who had difficulty sleeping (97%) and those with mental health issues (98%).

Of the participants who took cannabis for other reasons, such as autism, attention deficit hyperactivity disorder, post-traumatic stress disorder, and difficulty eating, 98% found cannabis helpful.

"An important finding of the study was that participants either decreased or stopped their use of prescribed medicines, many of which were opioid based," said co-author Geoff Noller, PhD, a Research Fellow at Otago University's Dunedin School of Medicine. "This both reinforces that they experienced some actual effect from using cannabis in that they ceased or decreased other medications with recognized efficacy, and in the case of many of these other medications, they reduced their use of potentially more problematic medications.

"There is a place for both approaches, with the results of this study suggesting that cannabis products could have a role in treating patients with chronic pain and other conditions refractory to treatment by conventional means."

But many New Zealanders find medical cannabis difficult to obtain and rely on the black market. A recent study by the NZ Drug Foundation estimated that while over a quarter of a million Kiwis use cannabis for medical reasons, only 6% -- about 17,000 people -- obtained cannabis with a prescription.

Many doctors won’t prescribe medical cannabis and there are a limited number of products on the market, keeping prices high. The Foundation said CBD oil can cost a patient $150-350 per month, with other cannabis products costing even more.

"At present, current regulations appear to be creating problems for many New Zealanders who otherwise report positive benefits from their use of medicinal cannabis,” says Noller. "Specific barriers include cost, with currently available medicinal cannabis products being too expensive for many New Zealanders due to the compliance costs of production imposed by regulations, and also the lack of knowledge about it for physicians, leading to a reluctance to prescribe, in many cases."

To obtain medical cannabis, New Zealanders need a prescription from a doctor that spells out what cannabis products can be used and the amount. Medical cannabis can only be obtained legally from a doctor or pharmacy, although many Kiwis use a “Green Fairy” – a person who provides cannabis for a nominal fee.

Medical Cannabis Reduced Opioid Use in High Dose Patients

By Pat Anson, PNN Editor

In recent years, there have been several studies and surveys – most of them anecdotal -- suggesting that cannabis reduces the need for opioid pain medication. A large new study takes that research a step further, finding direct evidence that chronic pain patients, including those on high doses, significantly reduced their opioid use once they started using medical cannabis.

Researchers with the New York State Department of Health and University of Albany School of Public Health followed over 8,100 patients on long-term opioid therapy (LOT) after they began using medical cannabis. All of the patients had been on opioids for at least 120 days, including some on relatively high daily doses of 90 or more morphine milligram equivalents (MME).

Researchers found that average daily doses declined significantly over time, especially for patients on high opioid doses. After eight months of using medical cannabis (MC), patients taking over 90 MME saw their daily doses fall by nearly 70 percent, compared to a 29% reduction in those getting 50 to 90 MME and a 15% reduction in those on 50 MME or less.

“This cohort study found that receiving MC for longer was associated with opioid dosage reductions. The reductions were larger among individuals who were prescribed higher dosages of opioids at baseline. These findings contribute robust evidence for clinicians regarding the potential benefits of MC in reducing the opioid burden for patients receiving LOT and possibly reduce their risk for overdose,” researchers reported in JAMA Network Open.

The study has some weaknesses. Researchers did not track the pain levels of patients or the types of pain conditions they suffered from. Also unknown is the dose or types of cannabis products they consumed.   

Although the study was conducted at a time when patients nationwide were losing access to opioids or having their doses reduced, researchers say it is “highly unlikely” that impacted their findings because the dosage decline for their patients didn’t begin until they started consuming cannabis.  

Marijuana advocates cheered the study findings.  

“The relationship between cannabis and opioid use is among of the best-documented aspects of marijuana policy,” Paul Armentano, Deputy Director of NORML, said in a statement. “In short, the science demonstrates that marijuana is a relatively safe and effective pain reliever — and that patients with legal access to it consistently reduce their use of prescription opioid medications.” 

A similar study of over 500 chronic pain patients being treated at medical cannabis clinics found a significant decline in their pain levels. And 85% of patients reported they either reduced or stopped using opioids.

Low-Dose Cannabis Inhaler Effective in Treating Chronic Pain

By Pat Anson, PNN Editor

Low-doses of medical cannabis delivered through an inhaler significantly reduced pain in patients with neuropathy, back pain and other chronic pain conditions, according to a new study.

Researchers assessed the efficacy of vaporized cannabis in 138 pain patients using the Syqe Inhaler, a pocket-sized device that delivers microdoses of aerosolized cannabis. The study was funded and conducted by Syqe Medical, a medical technology company in Israel that makes the inhaler.

Unlike smoking or traditional vaping, the Syqe inhaler heats the cannabis to a temperature below combustion and uses airflow controls to deliver precise doses of cannabis to the patient's lungs in less than 2 seconds. The mean dose in the study was 1.5 mg of aerosolized delta-9-THC, a fraction of what a typical cannabis user would get from a joint or vaporizer.

Participants in the study used the inhaler up to several times a day, depending on need, and were followed for up to a year.

The study findings, published in the journal Pain Reports, show that pain levels fell from an average of 7.3 (on a zero to 10 pain scale) to 5.5 after 120 days – a reduction of nearly 23 percent. For patients in severe pain, pain levels dropped over 28 percent.

Most participants also reported significant improvement in their quality of life, with 92% saying their lives were “better” or “much better.”  

Of the 43 patients who were using opioid pain medication at the start of the study, 58% reported using lower doses after initiating treatment with the inhaler.

Adverse events, such as dizziness and headache, were minor and usually lasted only a few minutes. About 17% of patients reported no decrease in pain intensity and 7% reported more pain.

SYQE MEDICAL IMAGE

“Medical cannabis treatment with the Syqe Inhaler demonstrated overall long-term pain reduction, quality of life improvement, and opioid-sparing effect in a cohort of patients with chronic pain, using just a fraction of the amount of MC (medical cannabis) compared with other modes of delivery by inhalation,” researchers reported.

“These outcomes were accompanied by a lower rate of AEs (adverse events) and almost no AE reports during a long-term steady-state follow-up. Additional follow-up in a larger population is warranted to corroborate our findings.”

The Syqe Inhaler is currently only available in Israel and Australia. The company said in an email that it plans to launch the device in Canada and New Zealand in the coming months. No timetable was offered on its availability in the United States.

“We believe it is our responsibility to reduce the pain and suffering of as many patients as possible in the fastest possible way, and we are determined to make medical cannabis treatment a standard of care utilizing advanced technologies,” said Sharon Cohen of Syqe’s Customer Experience Team.

Medical Cannabis Significantly Reduced Opioid Use by Pain Patients

By Pat Anson, PNN Editor

Pain patients on long-term opioid therapy were able to significantly reduce their use of opioid medication after they started using medical cannabis, according to a small new study.

Researchers at the Institute for Pain Medicine in Pittsburgh followed 115 patients with severe chronic or intractable pain who had consumed opioids for at least six months before trying medical cannabis. Many lived with pain from failed back syndrome or rheumatoid arthritis. Their average daily opioid dose was nearly 50 MME (morphine milligram equivalent).

Patients were allowed to continue taking opioids during an initial trial with cannabis, but agreed to be weaned off opioids if cannabis was used long-term. Researchers encouraged patients to try different formulations and types of cannabis, but to start with low doses of THC and to avoid smoking.

Thirty patients dropped out of the study because cannabis was ineffective or had unwelcome side effects.

Of the 75 patients who continued using cannabis, many were able to taper themselves to a lower dose of opioids. There was an average 67% decrease in MME after one month and a 73% decrease after two months (from 49.9 MME to 13.3 MME).

“The current study’s approach has led to a significant decrement in chronic opioid use for the majority of patients with chronic pain deciding to trial medical cannabis in our clinical setting,” researchers reported in the journal Pain Physician.

“We feel strongly, based on our study, that medical cannabis should only be available for treatment under a physician’s oversight and as part of a treatment strategy which includes compliance monitoring to minimize harms and improve efficacy rates. After discussing the risks, benefits, and potential side effects of chronic opioid therapy with the patient, the authors of this study present medical cannabis, used with the current study’s paradigm, as a potentially effective class of treatment for chronic pain.”

Previous studies have also found an association between cannabis and reduced opioid use, although this is one of the first to measure it through MME.

A 2020 study found that nearly half of chronic pain patients using medical cannabis reported significant improvement in their pain levels. Most were able to reduce or stop their use of opioids.

A recent Harris Poll found that twice as many Americans are using cannabis products to manage their pain than prescription opioids.

Patients and Doctors Finally Talking About Medical Cannabis

By Pat Anson, PNN Editor

Communication is important in every relationship, especially between doctors and patients. And a new survey suggests that the stigma that has long kept cannabis a dirty secret in the exam room may finally be disappearing.   

The survey of 445 healthcare providers who treat chronic pain found that 72% of them have patients who requested or asked about medical cannabis in the last 30 days. Patients asked about cannabis far more often than other alternative pain treatments, such as acupuncture (37%), physical therapy (13%) and massage (10%).

The online survey was recently conducted by Cannaceutica, a healthcare company developing a line of cannabis products to treat pain. A variety of providers participated in the survey, including general practitioners, pain management specialists, neurologists, rheumatologists, and nurse practitioners.

People weren’t always so willing to talk to healthcare providers about cannabis, fearing they’d be seen as pot heads or even be dropped as patients. National surveys conducted in 2018 and 2019 found that less than 40% of patients told their doctors about their cannabis use.  

More patients are talking about cannabis today, and more doctors are willing to listen. The vast majority of providers (81%) in the Cannaceutica survey believe cannabis will play a role in the future management of chronic pain, but only one in four are likely to recommend it now. The primary factors holding them back are legal and regulatory issues, and the lack of good quality cannabis research.

Medical cannabis is legal in 36 states, but remains illegal at the federal level. If cannabis were legalized federally, 74% of providers said they would be likely to recommend it to a patient.

To increase their comfort level about recommending cannabis, providers want to see more research and documentation about cannabis as a pain treatment. Nearly two-thirds (64%) said patients were their main source of information about cannabis, followed by the internet (44%) and medical journals (40%).

Over half the providers surveyed said current treatment options are insufficient to treat chronic pain (56%) and that they were actively seeking alternatives (58%) for their patients. It’s worth noting that pain management specialists were most likely to say current treatments are inadequate (59%) and that they were seeking alternative treatments (66%).  

Clinical Trial Seeks Volunteers

Cannaceutica is currently enrolling chronic pain patients in a clinical trial to test the safety and efficacy of its cannabis capsules, which contain a blend of tetrahydrocannabinol (THC) and cannabidiol (CBD), as well as the cannabinoids cannabichromene (CBC) and cannabigerol (CBG). A recent study found that CBG boosts the potency of cannabis products used to treat chronic pain, depression, insomnia and anxiety.

The observational study is being led by University of California, Irvine researcher Dr. Marcela Dominguez. She and her team hope to enroll 107 patients in the trial, which is expected to last 14 to 16 weeks. They’re looking for people who have experienced pain for at least three months, have tried at least two different medications, and are not currently using cannabis. Patients with fibromyalgia or cancer pain are not eligible to participate.

If you would like to volunteer or get more information in the study, click here.

Medical Cannabis No Help to Lobsters

By Pat Anson, PNN Editor

Do lobsters feel pain when they’re boiled alive?

Seafood lovers, cooks, academics, animal rights activists and even governments have debated that question for years, with the general consensus being that they do. Lobsters, crabs and other crustaceans will often writhe in pain and try to escape when dropped into a pot of scalding hot water. The practice is considered so cruel that Switzerland and New Zealand made it illegal to boil a live lobster.

Some cooks try to ease the lobsters’ pain by stunning them with a jolt of electricity or putting them on ice to dull their senses before cooking them.  In 2018, a restaurant owner in Maine even blew marijuana smoke on a lobster named Roscoe, who reportedly grew so mellow he never wielded his claws as weapons again while in captivity.

We’ll never know the long-term effect of getting a lobster stoned because Roscoe was returned to the ocean as a thank you for his service. Good for him.

Which brings us to a bizarre study recently completed by scientists at the University of California San Diego and the Scripps Research Institute, who decided to replicate the Roscoe experiment in a lab.

"The 2018 minor media storm about a restaurant owner proposing to expose lobsters to cannabis smoke really was the starting point. There were several testable claims made and I realized we could test those claims. So we did," lead author Michael Taffe, PhD, an adjunct professor at Scripps Research told IFLScience.

Taffe and his colleagues purchased ten Maine lobsters at a local supermarket, fed them a last meal of frozen krill and fish flakes, and placed them in an aerated vapor chamber.

For the next 30 to 60 minutes, the lobsters were exposed to vapor rich in tetrahydrocannabinol (THC), the psychoactive ingredient in cannabis.

Afterwards, some of the lobsters were “rapidly euthanized” with a kitchen shear and dissected, while others were immersed in hot water to see how they’d react.

Detectable levels of THC were found in the muscles and organs of the euthanized lobsters, so from that standpoint the experiment was a success. But the THC apparently had little effect on the remaining live lobsters, who displayed “distinct motor responses” and other signs of pain when put in hot water.   

"The effect of vapor THC on this nociceptive (pain) behavior was very minimal. Statistically supported in one case, but of very small magnitude," said Taffe.

We’ll leave it to readers to decide whether a study like this is humane, worthwhile or even makes sense. But it is worth noting that taxpayers helped pay for it.

The lobster cannabis study was supported by grants from the U.S. Public Health Service. Researchers were careful to note that federal funding was not directly used to purchase the lobsters. That money came from La Jolla Alcohol Research, a private company that is developing vapor inhalation technologies.  According to GovTribe, La Jolla Alcohol Research has received about $3 million in federal funding in recent years, most of it coming from the National Institute on Drug Abuse.

Most Older Adults Don’t Tell Doctors About Their Cannabis Use  

By Pat Anson, PNN Editor

A growing number of older adults have discovered the medical benefits of cannabis – everything from pain relief to lower blood pressure. But a new study found that most older Americans aren’t telling their doctors about their cannabis use.

In an analysis of over 17,000 Americans aged 50 and older who participated in the 2018 and 2019 National Surveys on Drug Use and Health, researchers at the University of Texas at Austin found that nearly nine percent had used cannabis in the past year. Of those, less than 40% had discussed their cannabis use with a healthcare provider.

Researchers say that’s an alarming figure because the cannabis users were significantly more likely to have substance abuse and mental health problems than nonusers.  

“Only a minority of older cannabis users discussed their drug use with a healthcare professional, although medical users were more likely than nonmedical users to have done so,” said lead author Namkee Choi, PhD, Professor of Gerontology at the University of Texas at Austin.

“Given little difference in cannabis and other substance use/use disorders between nonmedical and medical users, older cannabis users, regardless of use reasons, should consult healthcare professionals about their use, and healthcare professionals should screen for cannabis and other substance use as part of routine care.”

Compared to recreational users, medical users consumed cannabis more frequently, with nearly 40% using it everyday or a few times each week. Surprisingly, less than 20% of medical users bought their cannabis from a dispensary; most obtained it from friends, family or strangers. About 95% of medical users said obtaining cannabis was fairly easy or very easy.

“The finding that a significant proportion of medical and nonmedical users obtained cannabis via private/informal sources indicates that they are likely to use cannabis and cannabis products with unknown tetrahydrocannabinol (THC) potency,” said Choi. “Given the increase in THC potency, healthcare professionals should educate older cannabis users, especially high-frequency users, on potential safety issues and adverse health effects of cannabis and cannabis products obtained from unregulated sources.”

The study findings were published in The American Journal of Drug and Alcohol Abuse.

A 2018 survey by the American Association of Retired Persons (AARP) found that most older Americans think marijuana is effective for pain relief, anxiety and nausea. Seventy percent of those surveyed say they would consider asking their healthcare provider about medical marijuana if they had a serious condition that they thought might respond to it.

A recent study published in the journal Cannabis and Cannabinoid Research found that older adults are more likely to purchase sublingual formulations of cannabis, such as edibles and tinctures, as well as products low in THC and high in CBD.

Harvard Study Finds Cannabis Effective for Chronic Pain

By Pat Anson, PNN Editor

Long-term use of medical cannabis may be an effective treatment for chronic pain, according to a small study by researchers at Harvard Medical School and McLean Hospital in Boston.

Thirty-seven patients suffering from arthritis, joint pain, neuropathy and other chronic pain conditions were evaluated over a six-month period while ingesting cannabis products through smoking, vaporizing, edibles, oils and other methods. All of the patients were cannabis “naive” — meaning they had never used cannabis before or had abstained from use for at least a year prior to the study.

After six months of daily treatment with cannabis, patients reported significant improvements in their pain, sleep, mood, anxiety and quality of life. Their use of opioid pain medication declined by an average of 13% and 23% after 3 and 6 months of treatment, respectively, although not to a degree that was considered significant.

A control group of 9 pain patients that did not use cannabis did not have a similar pattern of improvement in pain or other symptoms. 

“This naturalistic study of medical cannabis (MC) patients with chronic pain provides preliminary evidence that ‘real world’ MC treatment may be a viable alternative or adjunctive treatment for a least some individuals with chronic pain,” wrote lead author Staci Gruber, PhD, Associate Professor of Psychiatry at Harvard Medical School. 

“As results also revealed that individual cannabinoids appear to exert unique effects on pain and comorbid symptoms, more research is needed to potentially optimize cannabinoid-based treatments for pain.”

Gruber and her colleagues say increased exposure to tetrahydrocannabinol (THC), the psychoactive ingredient in cannabis, appeared to be closely related to improvements in pain, while increased CBD exposure was related to improvements in mood, but not pain. Many patients reduced their use of THC as the study progressed.

“Interestingly, we have found that many patients aim to achieve symptom alleviation without experiencing the intoxicating effects of THC. Therefore, it is likely that patients are able to achieve adequate pain relief using lower doses of THC over time than initially utilized,” said Gruber, who heads the Marijuana Investigations for Neuroscientific Discovery (MIND) program at McLean Hospital.

Researchers say additional studies are needed to explore how THC and CBD modulate pain and other symptoms. Their findings are published in the journal Experimental and Clinical Psychopharmacology.  

While the findings are intriguing, the small number of patients involved in this and most other cannabis studies makes it hard to draw firm conclusions.  

Last month two professional pain societies – the International Association for the Study of Pain (IASP) and the Australian and New Zealand College of Anaesthetists -- released statements saying they could not endorse the use of cannabis to treat pain because there are no large, high-quality and unbiased clinical trials of cannabis as an analgesic.