How Should the U.S. Regulate Medical Marijuana?

By Chris Meyers

Medical marijuana could soon be reclassified into a medical category that includes prescription drugs like Tylenol with codeine, ketamine and anabolic steroids.

That’s because in December 2025, President Donald Trump signed an executive order to reschedule marijuana to a less restricted category, continuing a process initiated by President Joe Biden in 2022.

Currently, marijuana is in the most restrictive class, Schedule I, the same category as street drugs like LSD, ecstasy and heroin.

For years, many researchers and medical experts have argued that its current classification is a hindrance to much-needed medical research that would answer many of the pressing questions about its potential for medicinal use.

In January 2026, Republican Senators Ted Budd, of North Carolina, and James Lankford, of Oklahoma, introduced an amendment to funding bills trying to block the rescheduling, claiming that it “sends the wrong message” and will lead to “increased risk of heart attack, stroke, psychotic disorders, addiction and hospitalization.”

As a philosopher and drug policy expert, I am more interested in what is the most reasonable marijuana policy. In other words, is rescheduling the right move?

Broadly speaking, there are three choices available for marijuana regulation. The U.S. could keep the drug in the highly restricted Schedule I category, move it to a less restrictive category or remove it from scheduling altogether, which would end the conflict between state and federal marijuana laws.

As of January 2026, cannabis is legal in 40 of 50 states for medical use and 24 states for recreational use. Rescheduling would only apply to medical use.

Let’s examine the arguments for each option under the Controlled Substances Act, which places each prohibited drug into one of five “schedules” based on proven medical use, addictive potential and safety.

Drugs classified as Schedule I – as marijuana has been since 1971, when the Controlled Substances Act was passed – cannot be legally used for medical use or research, though an exception for research can be made with special permission from the Drug Enforcement Administration. Schedule I drugs are believed to have a high potential for abuse, to be extremely addictive and to have “no currently accepted medical use.”

As a Schedule I drug, marijuana has been more tightly controlled than cocaine, methamphetamine, PCP and fentanyl, all of which belong to Schedule II.

Option One: Keep the Status Quo 

Some policy analysts and anti-marijuana activists argue that marijuana should remain a Schedule 1 drug.

A common objection to rescheduling it is the assertion that 1 in 3 marijuana users develop an addiction to the drug, which stems from a large study called a meta-analysis.

A careful reading of that study reveals the flaws in its conclusions. The researchers found that about one-third of heavy users – meaning those who use marijuana weekly or daily – suffered from dependence. But when they looked at marijuana users more generally – meaning people who tried it at least once, the way addiction rates are normally measured – they found that only 13% of users develop a dependency on marijuana, which makes it less habit-forming than most recreational drugs, including alcohol, nicotine and caffeine, none of which are scheduled under the Controlled Substances Act.

Further, if the 1-in-3 figure were accurate, then marijuana would be more addictive than alcohol, crack cocaine and even heroin. This defies both common sense and well-established studies on the comparative risk of addiction.

Critics of rescheduling also deny that there is convincing evidence that marijuana or its compounds have any legitimate medical use. They cite research like a 2025 review paper that assessed 15 years of medical marijuana research and concluded that “evidence is insufficient for the use of cannabis or cannabinoids for most medical indications.”

This claim is problematic, however, given that the Food and Drug Administration has already approved several medicines that are based on the same active compounds found in marijuana. These include the drugs Marinol and Syndros, which are used to treat AIDS-related anorexia and chemotherapy-induced nausea and vomiting. Both of these contain delta-9-tetrahydrocannabinol, or THC, the substance that is responsible for the marijuana high.

If the active ingredients of marijuana have legitimate medical use as established by the FDA, then it stands to reason that so must marijuana.

Option Two: Move Marijuana to Schedule III

Moving marijuana to schedule III would make it legal at the federal level, but only for medical use. Recreational use would remain federally prohibited, even though it is legal in 24 states as of early 2026.

The most obvious benefit to rescheduling, noted above, is that it would make research on marijuana easier. The system of cannabinoid receptors through which marijuana confers its therapeutic and psychoactive effects is crucial for almost every aspect of human functioning. Thus, marijuana compounds could provide effective medicines for a wide variety of ailments.

Contrary to the 2015 review mentioned earlier, studies have shown that cannabis is effective for treating nausea and AIDS symptoms, chronic pain and some symptoms of multiple sclerosis, as well as many other conditions.

Rescheduling could also improve medical marijuana guidance. Under the current system, medical marijuana users are not provided with accurate, evidence-based guidance on how to use marijuana effectively. They must rely on “bud tenders,” dispensary employees with no medical training whose job is to sell product. 

If cannabis were moved to Schedule III, doctors would be trained to advise patients on its proper use. On the other hand, medical schools need not wait for rescheduling. Given that many people are already using medical marijuana, some medical experts have argued that medical schools should provide this training already.

Rescheduling, however, is not without complications. To comply with the law, medical marijuana programs would have to start requiring a doctor’s prescription, just like with all other scheduled substances. And it could be distributed only by licensed pharmacies. That might be a good thing, if marijuana is as dangerous and addictive as critics claim. 

But advocates of medical marijuana might be concerned that this would increase costs to the consumer and restrict access. That concern might be mitigated, however, if health insurance companies are required to cover the costs of medical marijuana once it is rescheduled.

In addition, it is unclear how rescheduling would affect state-level bans on medical marijuana. Generally speaking, states cannot legally restrict access to pharmaceuticals that have been approved by the FDA. However, this principle of federal preemption is currently being challenged by six states claiming they have the authority to restrict access to the abortion medication mifepristone.

Option Three: Unschedule Marijuana

The debate over rescheduling ignores a third option: that marijuana could be removed entirely from the Controlled Substances Act, giving states the authority to allow medical marijuana to be distributed without a prescription.

Some of the objections to rescheduling come from marijuana advocates. Given that marijuana is safer and less addictive than alcohol – which is not scheduled under the Controlled Substances Act – a case could be made for removing it entirely from the list of scheduled substances and allowing states to legalize it for recreational use, as many states have already.

In fact, many drugs as, or more powerful than, marijuana are also not scheduled. For example, most over-the-counter cough medicines contain dextromethorphan, a hallucinogenic dissociative, which in large doses causes effects similar to PCP.

Removing marijuana from the list of controlled substances would also decriminalize the drug. Over 200,000 Americans were arrested for marijuana in 2024, over 90% of them for mere possession.

At the moment, the third option seems very unlikely. Although over 60% of Americans are in favor of full marijuana legalization, it lacks support in Congress.

Medical marijuana rescheduling looks likely to occur in 2026. After all, it has been proposed by both Biden and Trump. Whether it is the right move, only time will tell.

Chris Meyers, PhD, is an Adjunct Professor of Philosophy at George Washington University. 

This article originally appeared in The Conversation and is republished with permission.

From Reefer Madness to Schedule III: What I Learned About Marijuana

By Carol Levy

I was a child of the late 60's and early 70's. I gave daisies to policemen as I walked by them. My friends called me a “hippie dippy.”

In a way, I was. I protested against the Vietnam war. I sat in the park with friends and sang folk songs. One of the boys wore love beads. I wore a headband.

I never did try any of the psychotropic drugs that were easily obtained at that time. Illegal, yes, but very available. Marijuana seemed to be the one most easily gotten.

Since my trigeminal neuralgia pain started in 1976, doctors prescribed me with most of the opioids that were available, including tincture of opium, morphine, oxycodone, fentanyl, codeine, Demerol, Darvon, and even methadone.

I had the same reaction to all of them. I felt groggy, cotton-headed, and dry-mouthed – and they didn't help my pain at all. 

Google “How do opioids make you feel?” and you’ll get answers like, “Opioids make you feel calm, relaxed, and euphoric by blocking pain signals and activating pleasure centers in the brain."

None of which I found to be true.

The stories about marijuana made me nervous. My friends said it makes you high and gives you the munchies. 

Google “How does marijuana make you feel?” and you’ll be told it causes “feelings of euphoria, deep relaxation, intensified sensory experiences, and altered time perception.”

All of which I was afraid was true!

I like to be tied to reality. My fear was that marijuana would make me feel as though reality had left me, as the “Reefer Madness” movie said it would. This was a drug I would never try.

But then medical marijuana became legal in my state of Pennsylvania. Despite the pain and no benefit from any opioid, I wasn't sure I wanted to try it. 

To be honest, as much as none of the opioids scared me, marijuana did. I wasn't sure how it would make me feel.

Most of us know the quiet desperation of poorly treated pain: “I'll try anything to stop the pain.” That is how I felt about marijuana. Fearful or not, maybe, just maybe, it will help. And, I had reason to believe it might.

Despite marijuana being an illegal Schedule I controlled substance with “high abuse potential and no accepted medical use,” limited research was permitted under strict FDA and DEA regulations. Marijuana may soon be rescheduled as a legal Schedule III substance, although its future use in medicine is still an open question.

Over the years, I have seen research that showed marijuana helped those with anaesthesia dolorosa (phantom pain), which is the pain and numbness many amputees feel after a limb is removed. I have anaesthesia dolorosa on one side of my face, a side effect of surgery. 

If marijuana helped them, would it help me?

I signed up for Pennsylvania’s medical marijuana program. The next step was to find a doctor, authorized by the state, to certify that I met the requirements for certification, which meant having one or more of the disorders on a list of allowable health conditions. Once I was certified, I was free to go to a dispensary and buy medical marijuana.

It may sound incredible today, but when I got my first prescription for opium – way back when – the pharmacist immediately filled it for me. The same was true for all the other opioid prescriptions I was given. If I had questions, the pharmacist could answer them.

I expected the same would be true for marijuana.

The dispensary had security, that was not a surprise. I had to show my state certification card to get inside the building. Then I sat in a waiting room, filled with others waiting their turn. 

After a few minutes, someone came out of the office, and called my name. We went to a room with a counter and 5 or 6 stations where you would select the marijuana you would buy. 

I knew nothing about how marijuana worked, what kind I should try, or how much I needed. There was no prescription setting the dose or how often I should take it. No doctor told me what to get or the CBD and THC combination I should try. The salespeople could not answer my questions about dosage, effects, or how long it would stay in my system. 

I am glad so many of us are now able to try marijuana, a drug that carries fewer consequences than some of the higher-level opioids I used to get. 

But I hate that no one can tell me the important points: how much, how often, etc. When I first tried marijuana, it didn't help. The two pain doctors I saw told me I wasn’t taking enough. But they couldn't tell me how much is “enough.”

Marijuana is a wonderful addition, finally, to the list of drugs we are allowed to have. I am happy I have the option. But I am very unhappy that it is still not seen as a medical medication. It’s more of a “what the heck, give it a try” substance.

Maybe marijuana can be another tool that doctors have in their arsenal for chronic pain. Maybe getting it off Schedule I and putting it into Schedule III will let the research start in earnest, and it will then become a real medication your doctor can prescribe with specific instructions on the type, combination, and dosage. 

I look forward to the day you can get marijuana from a pharmacist, instead of an untrained salesperson in a dispensary

Middle-Aged Adults Increasingly Identify as Cannabis Consumers

By Pat Anson

Cannabis use continues to grow among older Americans, according to a new study that found nearly one in five middle-aged adults consumed cannabis within the past year.  

The study by researchers at Columbia University is based on data from the 2022 Health and Retirement Study — a nationwide survey of older adults.

Researchers reported that 18.5% of adults aged 50 to 64, and 5.9% of adults over the age of 65 acknowledged using cannabis products. The findings are consistent with previous studies that found rising percentages of middle-aged and older adults consuming marijuana products. Smoking was the primary way used to consume cannabis in both groups.

About 25% of middle-aged adults and 20% of older adults said they used cannabis for medical purposes. Over 75% of respondents in both age groups supported the medical use of cannabis, but researchers sounded a note of caution about its growing acceptance.

“Cannabis use among both middle-aged and older U.S. adults is higher than previously reported in state and national-level studies, with many engaging in cannabis behaviors associated with increased harm. Greater public health and clinical efforts are needed for tailored prevention and intervention strategies,” Columbia researchers reported in the American Journal of Preventive Medicine.

While cannabis use is growing for therapeutic purposes, most medical organizations still frown on it. The American College of Physicians (ACP) recently released a new guideline that recommends against the use of medical cannabis for most patients with chronic noncancer pain.

The ACP said physicians should warn patients that the harms of cannabis use outweigh their potential benefits. Medical cannabis may produce small improvements in pain, function and disability, but the ACP warns it could lead to addiction and cognitive issues, as well as cardiovascular, gastrointestinal and pulmonary problems.

A large study in the UK recently found that cannabis use may actually benefit older adults by slowing the aging of brains and improving cognitive function. Normal aging typically involves a gradual decline in cognitive abilities, but when researchers compared the cognitive performance of cannabis users and non-users, they found that cannabis users had better cognitive function and had brain characteristics “typically associated with younger brains.“  

“It is not surprising that a growing percentage of adults consider cannabis to be a viable option in their later years,” said Paul Armentano , Deputy Director of NORML, a marijuana advocacy group.

“Many middle-aged and older adults struggle with pain, anxiety, restless sleep, and other conditions that cannabis products can mitigate. Many older adults are also well aware of the litany of adverse side effects associated with available prescription drugs, like opioids or sleep aids, and they see medical cannabis as a practical and potentially safer alternative.”

A recent analysis found that medical cannabis is most effective for managing neuropathic pain, but doesn’t work as well for migraine, headache and acute pain. The report by Green Health Docs, a company that connects patients with licensed medical marijuana doctors, is based in part on a survey of 1,450 patients who use medical cannabis.

The vast majority (86%) of those surveyed reported moderate-to-significant pain improvement. Many patients were able to reduce or stop using opioids and other prescribed analgesics once they started using medical cannabis.

Medical Cannabis Works Best for Neuropathic Pain

By Pat Anson

Medical cannabis is most effective for managing neuropathic pain, but doesn’t work as well for migraine, headache and acute pain, according to a new report that is one of the first to look at the efficacy of cannabis in treating different types of pain conditions.

The comprehensive report by Green Health Docs, a company that connects patients with licensed medical marijuana doctors, is based in part on a recent survey of 1,450 patients who use medical cannabis.

The vast majority (86%) of those surveyed reported moderate-to-significant pain improvement. Nearly 73% said they use cannabis daily and nearly 88% said it was a long-term option for their pain management.  

The survey also found that many patients were able to reduce their use of opioids and other prescribed analgesics once they started using medical cannabis. Over a third (35%) stopped using all prescription pain medications, nearly 15% stopped some medications, and nearly 12% reduced the dosage or frequency. Only 18% reported no change in their use of pharmaceuticals.

Many respondents, especially seniors, also reported better sleep, appetite, mood, mobility and quality of life.

Researchers say medical cannabis works best for neuropathic pain, but further studies are needed to demonstrate its effectiveness in treating other types of pain.

“One of the most important findings across cannabis research is that not all types of chronic pain respond equally to cannabinoid-based therapies,” the Green Health Docs report found.

“Neuropathic pain -- caused by damage or dysfunction in the nervous system -- is one of the most studied and responsive categories for cannabis treatment. Conditions such as diabetic neuropathy, postherpetic neuralgia, and multiple sclerosis-related pain fall into this category.”

The evidence is either mixed or lacking for cannabis relieving cancer-related pain and musculoskeletal pain, which includes back pain, arthritis, fibromyalgia, and pain involving bones, joints, and connective tissue.  

Cannabis also appears to be less effective for headache or migraine pain, visceral pain in the internal organs, and surgical or acute pain.

“Taken together, these findings suggest that while medical cannabis is not a universal solution, it holds promise as a viable component of multimodal pain management—especially when other treatments prove inadequate or intolerable,” the report concluded.

38 states and Washington, D.C. have legalized medical marijuana, and “chronic pain” or “intractable pain” are two of the top qualifying conditions.

Many patients use different methods to consume medical cannabis. Tinctures, edibles and capsules are often used for steady symptom control; vapes and smoking provide faster relief from breakthrough pain; and patches and topical creams are popular for localized musculoskeletal pain.

The "entourage effect" is also an important consideration. Medical cannabis products seem to work best when they combine THC and other cannabinoids with terpenes and other compounds found in cannabis. This supports the use of full-spectrum cannabis for managing chronic pain.

Large Study Finds Medical Cannabis ‘Effective Treatment’ for Chronic Pain

By Pat Anson

Medical cannabis is an “effective treatment option” for chronic pain and significantly improves quality of life in long-term users, according to a large new study.

Researchers at George Mason University and the medical cannabis telehealth company Leafwell analyzed healthcare trends for over 5,200 chronic pain patients. Those who had used medical marijuana for at least one year reported fewer unhealthy days and significantly better quality of life. They also had slightly fewer emergency department and urgent care visits than non-users.

“The findings of this study suggest, in line with existing research, that medical cannabis is likely an effective treatment option for patients with chronic pain. Moreover, we found that, in addition to an increase in QoL (quality of life), medical cannabis exposure is associated with lower risk of urgent care and ED visits, when comparing patients who used medical cannabis for at least one year to cannabis-naïve patients,” researchers reported in the journal Pharmacy.

“This underscores the potential for not only QoL gains associated with medical cannabis use, but also positive downstream effects on the healthcare system resulting from treatment.”

The study did not distinguish between the types of medical cannabis consumed or what kind of chronic pain conditions that participants had. Most of the researchers work for Leafwell, which helps patients get medical marijuana cards in states where it is legal. The company does not manufacture or sell cannabis products.

Pain Relief #1 Reason for Use 

Pain relief is the most likely reason for people to use cannabis for medical reasons, followed by those seeking help with sleep, anxiety and stress, according to a new survey of over 4,000 cannabis users in California.

There were distinct differences between participants who used cannabis solely for medical reasons and those who used it for both medical and recreational purposes.

Medical users were more likely to be female, and to live in households with children. Their average age at first use was 34, compared to 23 among combined users, who were more likely to be male.

Medical users spent less money on cannabis, about $127 per month, compared to combined users ($186), and used it far less frequently (1-3 times a week vs. multiple times a day).

Medical users also had less desire to “feel the high” from cannabis (42% vs. 75%).

Medical/recreational users were more likely to smoke dried flower (65%), while medical users preferred edibles (48%), topical ointments (28%) and oils (18%).

“Cannabis use is growing with expanding legalization, necessitating more research to understand the ramifications of increased access, and better understand the factors influencing the choices and options available to users. Special attention should be given to medicinal users, who may represent a vulnerable group seeking symptom relief,” researchers at UC San Diego reported in the Journal of Cannabis Research.

While medical cannabis is gaining in acceptance, many healthcare providers still take a dim view of it. The American College of Physicians (ACP) recently released a cautious new guideline that recommends against the use of medical cannabis for most patients with chronic noncancer pain. Medical cannabis may produce small improvements in pain, function and disability, according to the ACP, but potential harms include addiction and cognitive issues, as well as cardiovascular, gastrointestinal and pulmonary problems.

Medical Marijuana Saved Me After Forced Opioid Tapering

By Christine Kucera

I can tell you outright that medical marijuana saved my life!  

I am an intractable pain patient who was harmed in 2019 when the chief medical officer at my well-known health institution decided to implement mandatory system-wide opioid policies for all doctors and patients, based on the CDC’s opioid guideline.

I am not opioid naive, don't have adverse reactions to opioids (other than some don't work on me), and I wasn't misusing or even at risk of overdose. But that didn't matter to the CMO. He forced my pain management provider to taper all his patients on opioids or risking losing his position.

I was subsequently tapered to 90 MME (morphine milligram equivalent), which was a third of the well-managed opioid regimen I was on for over 30 years.  Messed up, right?  

Medical marijuana/cannabis was the alternative of last resort for me. Unlike opioids, I'm extremely sensitive to marijuana, and need to be able to think and talk. As the taper continued, my ability to cope with unmanageable, agonizing pain went bye-bye. I couldn't sit, stand, lay down or sleep without the pain being unbearable. I was literally being tortured to death.  

I became severely ill, my health destabilized, and I was hospitalized numerous times. I became depressed and suicidal, reaching out to everyone for help as hopelessness set in. Thoughts about transitioning to death were my constant companion. 

I had a choice: fight with what's available or give in to despair. I refused to give up hope and decided to try medical marijuana. After discussing it with my provider, I applied for a Massachusetts medical marijuana license. Once approved, I immediately went to a dispensary and the experimentation began. 

Everyone will have different experiences with cannabis. Just like opioids, it depends how your body metabolizes it. I had more than a few negative experiences, but refused to give up. It took me 2 years of experimentation to figure out the right dose, strain (sativa, indica, hybrid) and preparation (flower, edibles, tinctures, topical).  

After a lot of trial-and-error, I found my goldilocks zone. It was micro dosing a 1:1 tincture (equal parts THC and CBD) and applying a 1:1 cream. That regime saved my life!  

Key to Success: Start Slowly 

Some important things I learned along the way:  

For naive patients using cannabis for the first time, I recommend starting with a couple drops of tincture (0.25ml to 0.5 ml under the tongue) every 6-8 hours. It can take upwards of 2 hours to feel the full effects. Do not consume additional tincture too soon or you will potentially experience a compounding effect, producing unwanted side effects.

Increasing the dose, amount and frequency should only be attempted once your body adjusts. Everyone has different titration periods, which can take days or weeks. Experimenting is the only way to figure out what will work for you personally.

I suggest going slowly, incrementally increasing the dose by 0.25ml (0.5ml, 0.75ml, 1ml and so forth) over days to weeks until you reach optimal effect. I personally use <0.25ml during the day and <0.5ml at night. During my experimentation period with the 1:1 tincture, I would try increasing every 3 days.

There are many types of tinctures. I do not recommend jumping straight to a full strain tincture, using indica or sativa, without building a tolerance first

The same goes for edibles. Cut them in half or even a third to start with. Remember it can take up to 2 hours for edibles to work, so don't take more or you may experience unwanted side effects. I could successfully microdose edibles 2-4 times daily, depending on need.  

Topicals are amazing and work! I prefer the ointment over creams and gels, but the costs can add up. You can make your own inexpensive topical by mixing a tincture with a favorite ointment or cream.  

For first time users, I don’t recommend smoking marijuana flower or buds until you've first built-up tolerance with a 1:1 tincture or edibles. Smoking has a much faster mode of action and it can be difficult to manage the unwanted side effects.  

If you're willing to experiment, I recommend smoking at night at home when you have no responsibilities. I found that was best. Start slowly with one very small hit, it doesn't take much. Wait approximately 15-20 minutes before deciding to inhale a second or third hit. The side effects can be bad if you smoke too much, especially if you haven't built up tolerance.  

Always research the side effects and talk with staff at the dispensary. They can help with selecting flower or edibles that have pain, sleep, and mood helping properties. 

If you live in a state where medical marijuana is legal, get a license or card to protect yourself from discrimination, pain management contracts, and urine drug tests. I informed my providers and gave them a copy of my license to put in my medical health records.  

Before you use marijuana, be sure to talk with your prescribing provider, as you don't want to unintentionally breach your pain contract. If you smoke at home, landlords may also be an obstacle. 

The war on drugs propaganda is only meant to illicit fear. Educate yourself about the benefits of marijuana. It's not a gateway drug. Utilized responsibly, with the right strain, dose and preparation, marijuana can help reduce pain, inflammation and anxiety. It is absolutely worth trying.   

Lastly, don't give up! 

Christine Kucera lives with psoriatic arthritis, spondyloarthropy, spondylitis, polyarthritis, sacroiliitis, degenerative joint disease, dermatomyositis, mixed connective tissue disease, spinal radiculopathy, hypoparathyroidism, rare endocrine tumors, psoriasis, endometriosis stage IV, pelvic adhesive disease, and other painful conditions.

Prior to becoming disabled, Christine was a healthcare research systems developer and analyst for federally funded CMS, AHRQ, and NIH grants and programs.

Medical Marijuana Laws Had Little Impact on Opioid Prescribing

By Pat Anson, PNN Editor

The cannabis industry and advocates in the U.S. have long claimed that state laws legalizing medical marijuana could help solve the opioid crisis by reducing demand for prescription opioids.

Various studies have suggested that may be true, like a recent one in New York state that found patients on high-dose opioids significantly reduced their opioid use once they started using medical cannabis. A similar study in 2021 found that cannabis was so effective in reducing chronic pain that most patients were able to reduce or completely stop their use of opioids.

But a large new study of commercially insured adults with chronic non-cancer pain found that the legalization of medical cannabis in 12 states (Arkansas, Connecticut, Florida, Louisiana, Maryland, Minnesota, North Dakota, New Hampshire, New York, Oklahoma, Ohio, Pennsylvania) had little to no effect on opioid prescribing.  

“Some research suggests that perhaps medical cannabis laws reduce opioid prescribing for chronic non-cancer pain because some people may substitute cannabis,” said lead author Beth McGinty, PhD, chief of the Division of Health Policy and Economics at Weill Cornell Medicine. “We found no effects of these laws on opioid prescribing or any types of treatment for chronic non-cancer pain that we looked at.”

McGinty and her colleagues looked at prescription data for over 150,000 chronic pain patients in the four years prior to state legalization and compared it to their medication use in the three years after medical marijuana laws were adopted. That data was then compared to prescription data for over 430,000 pain patients in 17 other states without medical marijuana laws, who served as a control group   

The study findings, published in Annals of Internal Medicine, show that opioid prescribing for chronic pain fell only slightly in states with medical marijuana laws, leading to tiny decreases in the average supply of opioids (0.35 fewer days) and for daily doses in morphine milligram equivalents (0.42 less MME). Small reductions were also noted in the prescribing of non-opioid pain relievers and in treatments such as physical therapy.

Importantly, the decreases were not substantially different than the data from states where medical marijuana remained illegal.

“Medical cannabis laws do not appear to be associated with changes in the prescription opioid or other non-cannabis, non-opioid treatments for chronic non-cancer pain,” McGinty said. “Policy makers trying to curb excess opioid prescribing and overdoses should focus on other strategies.”

Researchers say the minimal impact of medical cannabis on opioid prescribing may be due to the slow implementation of medical marijuana laws. Surveys show that most doctors are reluctant to discuss cannabis with their patients, and have doubts about its safety and effectiveness.

Doctors may not approve, but nearly a third of U.S. adults with chronic pain have used cannabis as a pain reliever and over half of them have reduced their use of pain medication. Many had no choice but to look for alternatives. Nationwide, opioid prescribing for commercially insured adults has fallen by 51% since 2011.

More States Should Require Insurers to Pay for Medical Cannabis

By Paul Armentano, Guest Columnist

Should health insurance programs reimburse patients for their use of medical cannabis products? In a growing number of states, the courts are saying “yes.”

In the most recent example, a Pennsylvania Appellate Court ruled that workers’ compensation plans must cover cannabis-related expenditures when an employee uses it to recover from a workplace-related injury. The court ruled that employees in Pennsylvania possess “a statutory right” to be reimbursed for medical marijuana expenses that are reasonable and necessary to treat a work injury.  

“The MMA (Pennsylvania Medical Marijuana Act) specifically mandates that no medical marijuana patients be denied any rights for (the) lawful use of medical marijuana,” the Court said.

The Pennsylvania Court is not the first to issue an affirmative verdict in this matter. Courts in several states, including Connecticut, New Hampshire, New Jersey, New Mexico and New York, have provided similar opinions – determining that the denial of compensation claims would be antithetical to the legislatures’ express findings that cannabis is a state-legal therapy.

By contrast, courts in some other states, including Minnesota, have issued contradictory opinions – finding that it would be inappropriate for insurers to reimburse claimants for their use of a federally illegal substance. Federal law still classifies marijuana as a Schedule I controlled substance, placing it in the same legal category as heroin.

In most states, however, the law is largely silent on the issue. But don’t expect that to be the case for much longer. As scientific consensus and public attitudes surrounding the safety and efficacy of medical cannabis continue to evolve, the way insurers approach patients’ use of marijuana is likely to change too.

For example, lawmakers in Massachusetts recently introduced legislation explicitly providing that injured employees be reimbursed for their medical marijuana-related costs. In New York, lawmakers just advanced legislation, A. 4713, requiring public insurance plans to treat medical cannabis like any other medication. 

Thirty-eight states and the District of Columbia currently regulate the production and dispensing of cannabis for medical purposes. No state government has ever repealed or even rolled back these laws. That’s because these policies are widely accepted among both the public and among health professionals.

In fact, according to nationwide survey data recently compiled by the Centers for Disease Control and Prevention, over two-thirds of practicing physicians acknowledge the efficacy of medical cannabis and over one-quarter say that they have recommended it to their patients. 

Tens of millions of Americans are now using cannabis therapeutically. The number has doubled over the past decade, as peer-reviewed data that support the use of medical cannabis for the treatment of pain, multiple sclerosis, and other ailments has continued to grow. In many instances, patients are replacing their use of opioids, benzodiazepines and other prescription medications with cannabis because they find it more effective and with fewer adverse side effects. 

In short, most patients, most physicians, and most state laws view cannabis as a legitimate therapeutic option. Therefore, the millions of Americans who rely upon medical cannabis products ought to be afforded the same entitlements as those who use other conventional medications and therapies. Those privileges should include insurance-provided reimbursement for medical cannabis treatment.  

State legislators ought to see to it that this is a right provided for and protected in jurisdictions where medical marijuana is legally available under the law. 

Paul Armentano is the Deputy Director for NORML, the National Organization for the Reform of Marijuana Laws.

Medical Cannabis Helps Pain Patients Stop or Reduce Use of Opioids

By Pat Anson, PNN Editor

A large new survey of medical marijuana users found that many who have chronic pain were able to reduce or even stop their use of opioid pain medication. The survey also found that pain patients reported less pain and better physical and social functioning once they started using medical cannabis.

Researchers at Emerald Coast Research and Florida State University College of Medicine surveyed 2,183 people recruited from marijuana dispensaries in Florida. Participants had a range of health problems, including chronic pain, anxiety, depression, insomnia and post-traumatic stress disorder (PTSD).  Most were using medical cannabis daily.

Answers to the 66-question online survey revealed that nine out of ten participants found medical cannabis to be very or extremely helpful in treating their medical conditions.

Most (61%) reported using opioid pain medication prior to medical cannabis. Of those, 79 percent reported either stopping (42%) or reducing (37%) their use of prescription opioids. A small number were also able to stop using psychiatric medications for anxiety, depression and PTSD.

“The majority of Florida medical cannabis users surveyed described medical cannabis as helpful and important to their overall quality of life. Notably, a large percentage of patients reported improvements in the areas of physical functioning, social functioning, and bodily pain after beginning medical cannabis,” wrote lead author Carolyn Pritchett, PhD, founder of Emerald Coast Research.

“We also found a substantial number of patients reduced the amount of OBPM (opioid-based pain medications) used after gaining access to legalized medical cannabis, with some patients specifically describing improved functioning in daily life as a result.”

The survey findings, published in the journal Substance Use and Misuse, lend credence to previous studies suggesting that legalization of cannabis leads to fewer prescriptions for opioids and other medications.

A recent study by researchers at Cornell University found that legalization of recreational marijuana in 11 states significantly reduced prescribing for Medicaid patients for a broad range of medications used to treat pain depression, anxiety, seizures and other health conditions.

A 2021 study of chronic pain patients being treated at medical cannabis clinics also found that most were able to stop or reduce their use of opioids. Almost half (48%) reported a significant decrease in pain, and most said they had better quality of life (87%) and better physical function (80%) while using medical cannabis.

A 2021 Harris Poll found that twice as many Americans are using cannabis or CBD to manage their pain than opioid medication.

Medical Cannabis Is Losing Credibility

By Roger Chriss, PNN Columnist

As more and more states legalize medical cannabis for chronic pain, anxiety, seizure disorders and other common medical conditions, the question of efficacy becomes increasingly important. Recent studies show a lack of efficacy, but so far states are not modifying their list of approved conditions for medical cannabis.

Many states approved cannabis for medical conditions without good evidence. California legalized medical marijuana in 1996, yet nearly three decades later the Medical Board of California is still advising physicians that “there is a lack of evidence for the efficacy of cannabis in treating certain medical conditions.”

We not only still lack evidence, but new research suggests that cannabis doesn’t help and may actually be harmful:

• A small randomized trial in Boston found no significant improvement in pain, anxiety or depression in people given medical marijuana cards, but a higher risk of developing cannabis use disorder.

• A matched cohort study in Hawaii on people 50 or older saw a “significantly greater risk of coronary heart disease, chronic non-cancer pain, stroke, myocardial infarction, cyclic vomiting, and injuries” in people using cannabis compared to non-users.

• An observational study in New York of 29 people with epilepsy given two formulations of cannabidiol (CBD) and tetrahydrocannabinol (THC) concluded that “we found no evidence of efficacy… in treating epilepsy, sleep, or behavior in our population.”

Recent reviews of past studies are similarly disappointing.

• A review of 16 studies of CBD for mental health disorders found that “there is currently not enough high-quality evidence to suggest the clinical use of CBD for any psychiatric disorder.”

• A systematic review of 28 studies on medical marijuana for multiple sclerosis concluded that “the magnitudes of effects on short-term neurological outcomes in MS patients are either small, limited, or moderate.”

Lack of Efficacy

The 2017 National Academies report on cannabis noted the need for more research. Since then, over 6,400 studies have appeared on PubMed on medical cannabis specifically, and a total of 12,100 studies on cannabis in general. More studies are forthcoming, including 460 clinical trials of cannabis that are active or recruiting.

The result so far is a growing body of high-quality studies and clinical trials published in major journals showing a lack of efficacy and a risk of poor outcomes for conditions that cannabis is state-approved for.

Ordinarily, states follow the laws and regulations of the Food and Drug Administration, recommendations from medical societies, and research findings and other sources of major reviews. With almost any other substance with such a weak track record, there would have been a reassessment by now. But not with cannabis.

California still approves medical cannabis for glaucoma, even though the American Academy of Ophthalmology is against it due to lack of efficacy. California is not alone. So far, no state has removed any condition from its approved list for medical cannabis use.

However, the conditions of using cannabis are changing. Some states now require patients in pain management programs to have their urine tested for cannabinoids. Many medication management agreements – known as “pain contracts” – also expressly forbid cannabis use even if it has been legalized in that state. Some medical specialties tell patients to simply avoid cannabis because of risks from drug interactions and contraindications.

Although cannabis may be safer than some prescription drugs, that won’t matter if it has no demonstrable benefit. Cannabis is losing credibility as a therapeutic as studies show poor outcomes for diagnoses that states approve cannabis for.

Holding cannabis to the same standards as other therapeutics would increase confidence in cannabis where it is shown to be beneficial. It will also help improve patient outcomes. As it stands now, however, medical cannabis is starting to look more like medicinal alcohol during Prohibition than a credible therapeutic for 21st-century medicine.

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research. 

Study Warns of High Risk of Addiction in Medical Marijuana Users

By Pat Anson, PNN Editor

Medical marijuana is often touted as a treatment for chronic pain, but a new clinical trial found cannabis provided no significant improvement to people who took it for pain, anxiety or depression. Marijuana did help people sleep better, but it also raised their risk of cannabis use disorder (CUD).

“There have been many claims about the benefits of medical marijuana for treating pain, insomnia, anxiety and depression, without sound scientific evidence to support them,” says lead author Jodi Gilman, PhD, with the Center for Addiction Medicine at Massachusetts General Hospital (MGH). “We learned there can be negative consequences to using cannabis for medical purposes. People with pain, anxiety or depression symptoms failed to report any improvements, though those with insomnia experienced improved sleep.”

Gilman and her colleagues enrolled 186 people in the study and randomly assigned them to one of two groups. The first group was allowed to immediately obtain a medical marijuana card, while the second group had to wait 12 weeks before getting one. Both groups were allowed to choose their cannabis products at a dispensary, with no limits on the dose or frequency of use.

Participants in the immediate card acquisition group reported significantly more cannabis use in the study period, with nearly one in five (17%) developing CUD symptoms such as craving, tolerance and withdrawal within 12 weeks. The odds of having CUD were nearly 3 times higher in the immediate acquisition group than in the delayed acquisition group.

“This trial showed that CUD can develop at a fast rate within the first 12 weeks of medical marijuana card ownership, suggesting that those with a card may develop CUD at a similar rate as those who use cannabis recreationally and that the (medical) motive for use may not be protective,” researchers reported in in JAMA Network Open.

“Although most cases of CUD onset in the trial were mild, with 2 to 4 symptoms, these symptoms developed over a short, 12-week initial exposure. The most commonly reported CUD symptoms were higher tolerance and continued use despite the recurrent physical or psychological problems caused or exacerbated by cannabis.”

People with anxiety or depression -- the most common conditions for which medical cannabis is sought -- were at significantly higher risk of developing CUD than those with pain and insomnia.

Incidence of Cannabis Use Disorder

SOURCE JAMA NETWORK OPEN

“Our study underscores the need for better decision-making about whether to begin to use cannabis for specific medical complaints, particularly mood and anxiety disorders,” said Gilman, who called for more regulation of medical marijuana.  “There needs to be better guidance to patients around a system that currently allows them to choose their own products, decide their own dosing, and often receive no professional follow-up care.”

Cannabis advocates say Gilman’s findings are at odds with larger observational studies (here, here and here) that found cannabis use disorder declined in states that legalized medical marijuana. They feel the study also lacked detail of CUD symptoms or what impact they had.

“Although the authors stress the notion that those in the card-holders groups were more likely to be diagnosed with symptoms of CUD, they never identify what these symptoms were, their severity, or how disruptive they were to these individuals daily lives and functioning — or even if in fact they were at all,” said Paul Armentano, Deputy Director of NORML, a marijuana advocacy group. 

“Finally, it should be recognized that virtually all therapeutic agents possess varying safety profiles. Medical cannabis is not innocuous. But its safety profile is far superior to that of many conventional pharmaceuticals for which it can provide an alternative, including opioids and benzodiazepines — even if one is to take these findings at face value.” 

A recent survey found that twice as many Americans are now using cannabis or cannabidiol (CBD) to manage chronic pain than opioid medication.

The Pros and Cons of Medical Marijuana

By Joanna Mechlinski, Guest Columnist

If you live with chronic pain, chances are someone has mentioned medical marijuana to you. And why shouldn’t they? It’s constantly being discussed in the media.

So far, 36 states have legalized medical marijuana, and many have extended the qualifying illnesses to include some chronic pain conditions. A 2021 Pew Research Center survey found that 91% of American adults approve of the use of cannabis for medicinal purposes. And a recent Gallup poll found that over two-thirds of adults believe marijuana should be legal for both medical and recreational use.

So to the average person, trying to be helpful, it might seem that cannabis is a simple and obvious answer to a pain patient’s prayers. Unfortunately, it doesn’t work that way for everyone.

In 2019, my rheumatologist suggested I try medical marijuana. Considering that I’d been living with chronic pain for over fifteen years, thanks to lupus and polymyositis, and tried all sorts of medications and treatments to no avail, I was understandably excited.

Although I’d had my hopes dashed numerous times already, I still continued to feel a tiny bit of hope whenever a doctor suggested something new. Maybe, just maybe, this would be the thing that would help alleviate my life of never-ending pain and fatigue. If so many other people were turning to medical marijuana, surely it had to be a good thing?

Like many other pain patients, I was tired of the constant battle to prove I “deserved” opioid painkillers. I was also tired of never daring to mention the fact that opioids were the main reason I was still a productive member of society. Many people choose to ignore that fact and focus instead on the potential for addiction.

Unfortunately, it’s not as if you can just walk into a marijuana dispensary and be handed a life-altering concoction. There’s a lot more to it, much of which no one ever seems to mention.

For starters, not every medical professional is legally permitted to certify a patient for cannabis, which is required in many states. You need to find a doctor or APRN (advanced practical registered nurse) who is --- and it’s usually not cheap.

Here in Connecticut, the practitioner I saw charged $175 for new patients and $125 for a renewal. Then, along with your application, you need to send the state $100. This gets you a medical marijuana certificate, good for only one year, if you have a “debilitating medical condition” recognized by the state.

Different states charge different prices and your certificate or license can last longer, depending on where you live. There are also some discounts - again, not everywhere - for veterans and low-income individuals. Still, the various costs can add up quickly, and they are not covered by insurance.

Your first visit is a consultation, at which you and a staff member discuss your condition and symptoms. Unfortunately, it’s not a one-size-fits-all kind of thing. Your body may react differently to a particular marijuana strain or product than another person suffering from similar symptoms.

So, if you’re like me, you may have to try a wide variety of tinctures, oils, vapes and other products. Each will cost, on average, between $50-$100 for a few weeks’ dosage. You can only pay with cash or a debit card.

Over two years, I returned to the dispensary numerous times, hoping the next product might be the one. But at best, there was just a slight improvement. I was wanting so badly for cannabis to work that it might have solely been in my imagination.  

At any rate, I wasn’t willing to keep paying large amounts of money for something that was causing me about 5% improvement at best.  More realistically, it was probably closer to zero.

Does all this mean you shouldn’t give medical marijuana a try? Of course not. If you and your doctor feel it may alleviate your pain and is a good option, you should definitely give it a try. Just keep in mind there are a lot of factors to consider, and patience is definitely key to the process.

Joanna Mechlinski is a former journalist who currently works in school transportation. She lives with lupus, polymyositis and fibromyalgia, and is passionate about advocacy. 

Pain News Network invites other readers to share their stories with us. 

Send them to: editor@PainNewsNetwork.org. 

The Marijuana Ad You Won’t See During the Super Bowl

By Pat Anson, PNN Editor

The hype over Super Bowl LIII between the Los Angeles Rams and New England Patriots took a back seat this week to a debate over the benefits of medical marijuana.

The February 3 game is being broadcast by CBS, which rejected a 30-second Super Bowl ad by Acreage Holdings -- the cannabis company that recently hired former House speaker John Boehner as a spokesman. Along with the other broadcast networks, CBS currently does not accept any cannabis related advertising.

The Acreage ad features 3 cannabis users -- a boy who suffers from epilepsy, a man who took opioid medication for 15 years for back pain, and a military veteran who suffers from phantom limb pain after losing a leg in the service. The ad doesn’t promote Acreage products, but urges viewers to call their congressional representatives and advocate for medical marijuana.

“We’re disappointed by the news but somewhat unsurprised,” Acreage President George Allen told CNN Business. “Still, we developed the ad in the spirit of a public service announcement. We feel it’s our responsibility to advocate on behalf of our patients.”

The chief marketing officer for Acreage was less diplomatic.

“You will see countless ads (during the Super Bowl) for beer and erectile dysfunction medications but our ad with an educational goal to help people who are suffering is rejected. That is the irony we are looking to highlight,” Harris Damashek told the Green Entrepreneur.

A 30-second ad during the Super Bowl would have cost Acreage over $5 million, but the company is getting a lot of free publicity over the controversy.  A 60-second version of the ad was posted on YouTube.

Medical marijuana is legal in 33 states and Washington DC, but remains illegal under federal law. Although cannabis is a banned substance in the NFL, many current and former players use it for pain relief.

“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,” former NFL player Nate Jackson told PNN. “I was never big on those pills. I medicated with marijuana and it helped me and I think it helped save my brain.”

Although the NFL has a reputation as a league that closely monitors and disciplines players for illegal drug use,  Jackson estimates over half its players currently use marijuana to relieve pain and stress after games.

Seniors in Pain Hop Aboard the Canna-Bus

By Stephanie O’Neill, Kaiser Health News

Shirley Avedon, 90,­­ had never been a cannabis user. But carpal tunnel syndrome that sends shooting pains into both of her hands and an aversion to conventional steroid and surgical treatments is prompting her to consider some new options.

“It’s very painful, sometimes I can’t even open my hand,” Avedon said.

So for the second time in two months, she’s climbed on board a bus that provides seniors at the Laguna Woods Village retirement community in Orange County, Calif., with a free shuttle to a nearby marijuana dispensary.

The retired manager of an oncology office says she’s seeking the same relief she saw cancer patients get from smoking marijuana 25 years ago.

“At that time [marijuana] wasn’t legal, so they used to get it off their children,” she said with a laugh. “It was fantastic what it did for them.”

Avedon, who doesn’t want to get high from anything she uses, picked up a topical cream on her first trip that was sold as a pain reliever. It contained cannabidiol, or CBD, but was formulated without THC, or tetrahydrocannabinol, marijuana’s psychoactive ingredient.

“It helped a little,” she said. “Now I’m going back for the second time hoping they have something better.”

As more states legalize marijuana for medical or recreational use — 30 states plus the District of Columbia to date — the cannabis industry is booming. Among the fastest growing group of users: people over 50, with especially steep increases among those 65 and older. And some dispensaries are tailoring their pitches to seniors like Avedon who are seeking alternative treatments for their aches, pains and other medical conditions.

On this particular morning, about 35 seniors climb on board the free shuttle — paid for by Bud and Bloom, a licensed cannabis dispensary in Santa Ana.

After about a half-hour drive, the large white bus pulls up to the parking lot of the dispensary.

About half of the seniors on board today are repeat customers; the other half are cannabis newbies who’ve never tried it before, said Kandice Hawes, director of community outreach for Bud and Bloom.

“Not everybody is coming to be a customer,” Hawes said. “A lot are just coming to be educated.”

STEPHANIE O’NEILL FOR KHN

Among them, Layla Sabet, 72, a first-timer seeking relief from back pain that keeps her awake at night, she said.

“I’m taking so much medication to sleep and still I can’t sleep,” she said. “So I’m trying it for the back pain and the sleep.”

Hawes invited the seniors into a large room with chairs and a table set up with free sandwiches and drinks. As they ate, she gave a presentation focused on the potential benefits of cannabis as a reliever of anxiety, insomnia and chronic pain and the various ways people can consume it.

Several vendors on site took turns speaking to the group about the goods they sell. Then, the seniors entered the dispensary for the chance to buy everything from old-school rolled joints and high-tech vaporizer pens to liquid sublingual tinctures, topical creams and an assortment of sweet, cannabis-infused edibles.

Jim Lebowitz, 75, is a return customer who suffers pain from back surgery two years ago.

He prefers to eat his cannabis, he said.

“I got chocolate and I got gummies,” he told a visitor. “Never had the chocolate before, but I’ve had the gummies and they worked pretty good.”

“Gummies” are cannabis-infused chewy candies. His contain both the CBD and THC, two active ingredients in marijuana.

Derek Tauchman rings up sales at one of several Bud and Bloom registers in the dispensary. Fear of getting high is the biggest concern expressed by senior consumers, who make up the bulk of the dispensary’s new business, he said.

“What they don’t realize is there’s so many different ways to medicate now that you don’t have to actually get high to relieve all your aches and pains,” he said.

Limited Research

But despite such enthusiasm, marijuana isn’t well researched, said Dr. David Reuben, the Archstone Foundation professor of medicine and geriatrics at UCLA’s David Geffen School of Medicine.

While cannabis is legal both medically and recreationally in California, it remains a Schedule 1 substance — meaning it’s illegal under federal law. And that makes it harder to study.

The limited research that exists suggests that marijuana may be helpful in treating pain and nausea, according to a research overview published last year by the National Academies of Sciences, Engineering and Medicine. Less conclusive research points to it helping with sleep problems and anxiety.

STEPHANIE O’NEILL FOR KHN

Reuben said he sees a growing number of patients interested in using it for things like anxiety, chronic pain and depression.

“I am, in general, fairly supportive of this because these are conditions [for which] there aren’t good alternatives,” he said.

But Reuben cautions his patients that products bought at marijuana dispensaries aren’t FDA-regulated, as are prescription drugs. That means dose and consistency can vary.

“There’s still so much left to learn about how to package, how to ensure quality and standards,” he said. “So the question is how to make sure the people are getting high-quality product and then testing its effectiveness.”

And there are risks associated with cannabis use too, said Dr. Elinore McCance-Katz, who directs the Substance Abuse and Mental Health Services Administration.

“When you have an industry that does nothing but blanket our society with messages about the medicinal value of marijuana, people get the idea this is a safe substance to use. And that’s not true,” she said.

Side effects can include increased heart rate, nausea and vomiting, and with long-term use, there’s a potential for addiction, some studies say. Research suggests that between 9 and 30 percent of those who use marijuana may develop some degree of marijuana use disorder.

Still, Reuben said, if it gets patients off more addictive and potentially dangerous prescription drugs — like opioids — all the better.

Jim Levy, 71, suffers a pinched nerve that shoots pain down both his legs. He uses a topical cream and ingests cannabis gelatin capsules and lozenges.

“I have no way to measure, but I’d say it gets rid of 90 percent of the pain,” said Levy, who — like other seniors here — pays for these products out-of-pocket, as Medicare doesn’t cover cannabis.

“I got something they say is wonderful and I hope it works,” said Shirley Avedon. “It’s a cream.”

The price tag: $90. Avedon said if it helps ease the carpal tunnel pain she suffers, it’ll be worth it.

“It’s better than having surgery,” she said.

Precautions to Keep in Mind

Though marijuana use remains illegal under federal law, it’s legal in some form in 30 states and the District of Columbia. And a growing number of Americans are considering trying it for health reasons. For people who are, doctors advise the following cautions.

Talk to your doctor. Tell your doctor you’re thinking about trying medical marijuana. Although he or she may have some concerns, most doctors won’t judge you for seeking out alternative treatments.

Make sure your prescriber is aware of all the medications you take. Marijuana might have dangerous interactions with prescription medications, particularly medicines that can be sedating, said Dr. Benjamin Han, a geriatrician at New York University School of Medicine who studies marijuana use in the elderly.

Watch out for dosing. Older adults metabolize drugs differently than young people. If your doctor gives you the go-ahead, try the lowest possible dose first to avoid feeling intoxicated. And be especially careful with edibles. They can have very concentrated doses that don’t take effect right away.

Elderly people are also more sensitive to side effects. If you start to feel unwell, talk to your doctor right away. “When you’re older, you’re more vulnerable to the side effects of everything,” Han said. “I’m cautious about everything.”

Look for licensed providers. In some states like California, licensed dispensaries must test for contaminants. Be especially careful with marijuana bought illegally. “If you’re just buying marijuana down the street … you don’t really know what’s in that,” said Dr. Joshua Briscoe, a palliative care doctor at Duke University School of Medicine who has studied the use of marijuana for pain and nausea in older patients. “Buyer, beware.”

Bottom line: The research on medical marijuana is limited. There’s even less we know about marijuana use in older people. Proceed with caution.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

App Helps Document Effectiveness of Medical Cannabis

By Pat Anson, PNN Editor

Two innovative studies have found evidence that medical marijuana can provide significant relief from a wide range of symptoms associated with chronic pain, including insomnia, seizures, depression, anxiety and fatigue.

Unlike many clinical trials that evaluate a small number of patients with surveys, researchers at the University of New Mexico relied on data from the Releaf App, a free mobile software program that collected user-entered, real-time information from over 2,800 people on their use of cannabis and its effects.

"If the results found in our studies can be extrapolated to the general population, cannabis could systematically replace multi-billion dollar medication industries around the world. It is likely already beginning to do so," said co-author Jacob Vigil, PhD, a UNM psychology professor.

In the first study, published in the journal Frontiers in Pharmacology, users reported an average symptom reduction of nearly 4 points on a 1-10 scale after the consumption of cannabis in various forms, including vaporizers, joints, oils and topicals.

Twenty-seven different health conditions were evaluated, from inflammation and tremors to muscle and nerve pain. Over 94 percent of cannabis users reported some type of symptom relief, with patients suffering from anxiety and depression having the greatest improvement.

“Clinically and statistically significant reductions in patient-reported symptom severity levels existed in every single symptom category, suggesting that cannabis may be an effective substitute for several classes of medications with potentially dangerous and uncomfortable side effects and risky polypharmaceutical interactions, including opioids, benzodiazepines, and antidepressants,” said Vigil.

“Our results indicate that patients report greater symptom relief for treating agitation/irritability, anxiety, depression, excessive appetite, insomnia, loss of appetite, nausea, gastrointestinal pain, stress, and tremors than they do for treating back pain. Patients reported less symptom relief for treating impulsivity, headache, and nerve pain as compared to relief for treating back pain.

source: frontiers in pharmacology

The second study, recently published in the journal Medicines, focused on the use of cannabis flower (also known as “buds”) in treating insomnia. Over 400 patients self-reported their symptoms using the Releaf app. Researchers found the use of pipes and vaporizers to ingest cannabis was associated with greater symptom relief and fewer negative side effects than the use of joints. Cannabidiol (CBD) was also associated with greater symptom relief than tetrahydrocannabinol (THC), the active ingredient in marijuana that causes euphoria.

A major weakness of both studies is that there was no control group or use of a placebo. Participants were also more likely to have previously used cannabis and may have been biased when reporting on their own symptoms. But UNM researchers say their findings are more representative of what cannabis users will actually experience.

“Observational studies are more appropriate than experimental research designs for measuring how patients choose to consume cannabis and the effects of those choices,” said Vigil. “By collecting massive amounts of patient-entered information on actual cannabis used under real-life circumstances we are able to measure why patients consume cannabis, the types of products that patients use, and the immediate and longer-term effects of such use.”

In addition to its therapeutic benefits, cannabis use was associated with frequent, although not serious side effects. Patients reported more positive feelings (relaxed, peaceful, comfy) than they did negative ones (paranoid, confused, headache).  

"If the short-term risk-benefit profile of cannabis found in our studies reflects its longer-term therapeutic potential, substitution of cannabis for traditional pharmaceuticals could reduce the risk of dangerous drug interactions and the costs associated with taking multiple medications by allowing patients to treat a constellation of comorbidities with a single treatment modality,” said co-author Sarah See Stith, PhD, a UNM economics professor.