Most Medical Marijuana Patients Benefit From Treatment

By Pat Anson, Editor

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

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

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

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

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

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

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

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

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

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

Teenage Marijuana Problems Declining

By Pat Anson, Editor

A large survey of nearly a quarter of a million adolescents indicates the number of American teenagers with marijuana related problems is declining – despite the fact that nearly half the states have legalized medical marijuana or decriminalized it.

Researchers at Washington University School of Medicine in St. Louis studied a national database on drug use by over 216,000 young people, ages 12 to 17, and found that the number dependent on marijuana or having trouble in school and in relationships declined by 24 percent from 2002 to 2013.

During the same period, the number of kids who said they used marijuana in the previous 12 months fell by 10 percent. The drops were accompanied by reductions in behavioral problems, such as fighting, shoplifting and selling drugs.

Researchers believe the two trends are connected -- as kids became less likely to engage in problem behavior, they are also less likely to have problems with marijuana.

"We were surprised to see substantial declines in marijuana use and abuse," said lead author Richard Grucza, PhD, an associate professor of psychiatry at Washington University School of Medicine

"We don't know how legalization is affecting young marijuana users, but it could be that many kids with behavioral problems are more likely to get treatment earlier in childhood, making them less likely to turn to pot during adolescence. But whatever is happening with these behavioral issues, it seems to be outweighing any effects of marijuana decriminalization."

The new study is published in the Journal of the American Academy of Child & Adolescent Psychiatry. The data was gathered as part on ongoing study called the National Survey on Drug Use and Health, which surveys young people in all 50 states about their drug use, abuse and dependence.

In 2002, just over 16% reported using marijuana during the previous year. That number fell to below 14% by 2013. Meanwhile, the percentage of young people with marijuana-use disorders declined from around 4% to about 3%.

"Other research shows that psychiatric disorders earlier in childhood are strong predictors of marijuana use later on," Grucza said. "So it's likely that if these disruptive behaviors are recognized earlier in life, we may be able to deliver therapies that will help prevent marijuana problems -- and possibly problems with alcohol and other drugs, too."

A similar survey, the University of Michigan's Monitoring the Future Study, found that marijuana use by teens has leveled off since 2010, but was still at stubbornly high rates. In 2015, about 35% of 12th­ graders reported using marijuana at least once in the past year.

The same survey found that teenage abuse of prescription opioids declined for the fifth year in a row. Only about 5% of 12th graders reported using an opioid pain medication in the last year, and the number reporting that prescription opioids were “fairly easy” or “very easy” to get also continues to drop.

Medical marijuana is legal or decriminalized in 24 states and the District of Columbia, and several states are considering legalization. Opponents have long maintained that legalization would have harmful effects on young people.

“Perhaps the biggest public health concern around medical marijuana liberalization and legalization concerns the potential impact on teenagers, who could have greater access to it as a drug of abuse and who may increasingly see marijuana as a ‘safe, natural’ medicine rather than a harmful intoxicant,” wrote Nora Volkow, MD, director of the National Institute on Drug Abuse, in Alcoholism & Drug Abuse Weekly.

“Although there is still much to learn about marijuana’s impact on the developing brain, the existing science paints a picture of lasting adverse consequences when the drug is used heavily prior to the completion of brain maturation in young adulthood. In teens, marijuana appears to impair cognitive development, may lower IQ and may precipitate psychosis in individuals with a genetic vulnerability.”

According to a recent report from the Colorado Department of Public Safety, where marijuana has been fully legalized since 2013, nearly a third (31%) of young adults, ages 18 to 25, have used in marijuana in the last 30 days, up from 21% in 2006. The number of juveniles on probation testing positive for THC has also increased since legalization.  

Legalizing Marijuana? Don’t Forget its Medical Use

By Ellen Lenox Smith, Columnist

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Big Decline in Opioid Use by Marijuana Users

By Pat Anson, Editor

A new study has found that use of opioid pain medication declines dramatically when chronic pain patients use medical marijuana.

The small study by researchers at the University of Michigan involved 185 pain patients at a medical marijuana dispensary in Ann Arbor, who were surveyed in an online questionnaire about their use of marijuana and pain medications.

Nearly two-thirds (64%) reported a reduction in their use of prescription pain medications and almost half (45%) said cannabis improved their quality of life. Patients also had fewer side effects from marijuana than they did from opioids.

"We're in the midst of an opioid epidemic and we need to figure out what to do about it," said lead author Kevin Boehnke, a doctoral student in the School of Public Health's Department of Environmental Health Sciences. "I'm hoping our research continues a conversation of cannabis as a potential alternative for opioids."

Last week the Centers for Disease Control and Prevention issued new guidelines that recommend non-pharmalogical therapy and non-opioid drugs for chronic pain. The guidelines do not endorse medical marijuana as a pain treatment, but they do discourage doctors from testing patients for marijuana and from dropping them from their practices if marijuana is detected.

Currently, 23 states and the District of Columbia have legalized marijuana for medical purposes and four states allow it for recreational use.

The University of Michigan researchers found that patients with less severe chronic pain were more likely to report less use of opioids and a better quality of life.

"We would caution against rushing to change current clinical practice towards cannabis, but note that this study suggests that cannabis is an effective pain medication and agent to prevent opioid overuse," Boehnke said.

Researchers said their findings, published in the Journal of Pain, also suggest that overdose death rates would decline dramatically if marijuana was used more widely for pain relief.

“We are learning that the higher the dose of opioids people are taking, the higher the risk of death from overdose. This magnitude of reduction in our study is significant enough to affect an individual's risk of accidental death from overdose," said senior study author Daniel Clauw, MD, a professor of pain management anesthesiology at the U-M Medical School.

Previous research has found that opioid overdose rates declined by nearly 25 percent in states where medical marijuana was legalized. Another recent study of cannabis use by pain patients in Israel found a 44% reduction in opioid use.

One limitation of the current study is that it was conducted with people at a marijuana dispensary, who are more likely to already be believers in the medical benefits of marijuana.

CDC Guidelines Urge Doctors Not to Test for Marijuana

By Pat Anson, Editor

One of the less publicized provisions in the Centers for Disease Control and Prevention’s opioid prescribing guidelines is a recommendation that doctors stop urine drug testing of patients for tetrahyrdocannabinol (THC), the psychoactive ingredient that causes the “high” for some marijuana users. The guidelines also discourage doctors from dropping patients if marijuana is detected.

Urine drug screens are conducted almost routinely by pain management physicians and other opioid prescribers for a variety of drugs, both legal and illegal.

Some doctors use a positive result for THC as an excuse to discharge patients from their practices, even in states where medical marijuana is legal.

While the CDC guidelines encourage physicians to conduct urine drug tests before starting opioid therapy and at least annually afterwards, they draw the line at THC.

“Clinicians should not test for substances for which results would not affect patient management or for which implications for patient management are unclear. For example, experts noted that there might be uncertainty about the clinical implications of a positive urine drug test for tetrahyrdocannabinol (THC).” the guidelines state.

"Clinicians should not dismiss patients from care based on a urine drug test result because this could constitute patient abandonment and could have adverse consequences for patient safety, potentially including the patient obtaining opioids from alternative sources and the clinician missing opportunities to facilitate treatment for substance use disorder."

As Pain News Network has reported, “point-of care” (POC) urine drug tests, the kind widely used in doctor’s offices, frequently giving false positive or false negative results for drugs like marijuana, oxycodone and methadone. One study found that 21% of POC tests for marijuana produced a false positive result. The test was also wrong 21% of the time when marijuana is not detected in a urine sample.

Not mentioned in the CDC guidelines is evidence that opioid overdose rates declined by nearly 25 percent in states where medical marijuana was legalized.

"We applaud the CDC's reasoned approach to the use of urine testing and its drawbacks when used on pain patients," said Ellen Komp, Deputy Director of California NORML. "Considering that opioid overdose deaths are significantly lower in states with medical marijuana programs, we are sorry the agency apparently didn't read the letter Elizabeth Warren recently sent to its chief calling for marijuana legalization as a means of dealing with the problem of opiate overdose."

That letter by Sen. Warren encouraged the CDC to adopt the guidelines and its restrictive approach to opioids “as soon as possible,” but also encouraged the agency to further study the impact legalization of medical and recreational marijuana could have on opioid overdose deaths.

The annual cost of drug testing in pain management is estimated at $2 billion per year. While POC tests are relatively cheap, more expensive laboratory testing can cost thousands of dollars and is often not covered by insurance.

Results of Cannabis Drug Study Cause Market Frenzy

By Pat Anson, Editor

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

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

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

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

image courtesy gw pharmaceuticals

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

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

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

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

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

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

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

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

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

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

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

How to Advocate for Medical Marijuana Legalization

By Ellen Lenox Smith, Columnist

I wish everyone in the U.S. had safe and affordable access to medical marijuana. Although legal in 23 states and the District of Columbia, many of you still live in states where cannabis is illegal and may want to know what you can do to help expedite the process of legalization.

I thought it might be helpful to share our experience with you to help you turn your state into a more compassionate state.  My husband and I are the co-directors of medical marijuana advocacy for the U.S. Pain Foundation. We are very proud of the foundation for supporting the use of this medication and for taking a positive stand.

So here are our suggestions:

1) Google your state’s medical marijuana laws and become familiar with where your state stands.

2) If a bill has been submitted, find the names of the legislators that submitted it. Contact them and request a meeting, leave a phone message, write a letter or offer to testify. The goal is to begin establishing a relationship with this person, to let them know of your willingness to help get their legislation passed.  

3) Remember that you are in an illegal state, so you want to share the success you had while living or visiting a legal state. You do not want to take any chance getting arrested!

4) You will find that telling your story is the key. Try to find others who will also be able to share how this medication helped them too.  Share your medical condition, how it affects your daily life, and how using medical marijuana made a difference.

5) If you are able to attend a hearing, be sure to dress like you are going to work. Keep the language clean and show them that you are an everyday person trying to live life with major medical difficulties. You do not want to be perceived as a recreational drug user, so dress and act with a serious demeanor.

6) Along with sharing your story, you also need to discuss the qualifying conditions for treatment in the bill. Some states where marijuana is legal do not allow cannabis to be prescribed for chronic pain. If you don’t get the correct wording in there now for chronic pain, it may never qualify. Therefore, it is very important to include the following language in your bill:

A chronic or debilitating disease or medical condition or its treatment that produces one or more of the following:

• Cachexia or wasting syndrome
• Severe, debilitating, chronic pain
• Severe nausea
• Seizures, including but not limited to those characteristic of epilepsy
• Severe and persistent muscle spasms, including but not limited to those characteristic of multiple sclerosis or Crohn's disease
• Agitation related to Alzheimer's Disease

If they want you to testify, prepare your speech before your arrive. Consider putting your main points on a card to talk from, instead of just reading from a paper out loud. Eye contact can really help.

Stay on point. Time is limited and you must respect this or they will shut you off to allow others time to speak. Share details about your medical condition, what effect it has on your daily living and how medical marijuana has made life more tolerable for you. Ask them to have a heart and help you and all the others in your state.

I always end with: “You never know what life might bring you next. I didn’t ask to have to cope with this condition. Please show your compassion.”

If there is no bill under consideration, then your work will be a bit different. You need find out if a bill had been submitted in the past and locate the sponsor. You should contact that person or persons and tell them you are ready to advocate and ask what they need from you to help get the bill reintroduced.

Whether you have a bill submitted or are working to get one started, you want to keep the topic alive in the media, so write letters to the editor, send a written story to news and radio stations, telling them you would like to share your story and why you want to see this legalized. You will be surprised how they can respond!

Another thing you can do is also contact us via the U.S. Pain Foundation to see if we have any ambassadors in your state that have expressed interest in advocating. We are happy to connect you if we have them listed. Email us at ellen@uspainfoundation.org or stu@uspainfoundation.org

Good luck and may medical marijuana soon be legal for all.

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

For more information about medical marijuana, visit their website.

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

Survey Finds Medical Marijuana Safe and Effective

By Ellen Lenox Smith, Columnist

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For more information about medical marijuana, visit their website.

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

Players Say Half of NFL Using Medical Marijuana

By Pat Anson, Editor

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

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

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

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

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

nate jackson

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

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

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

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

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

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

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

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

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

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

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

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

Medical Marijuana May Reduce Migraine Headaches

By Pat Anson, Editor

New research is adding to the growing body of evidence that medical marijuana can be used to treat migraine headaches.

In a small study of 121 migraine patients by researchers at the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of Colorado, 103 patients reported a significant decrease in the number of migraine headaches they had every month. The frequency of headaches dropped from an average of 10.4 to 4.6 per month. Most patients used more than one form of marijuana and used it daily. The study was published in the journal Pharmacotherapy.

"There was a substantial improvement for patients in their ability to function and feel better," said senior author Professor Laura Borgelt, PharmD. "Like any drug, marijuana has potential benefits and potential risks. It's important for people to be aware that using medical marijuana can also have adverse effects."

Fifteen of the patients reported marijuana use had no impact on their headaches, while three said they had more headaches.

The study looked at patients treated at Gedde Whole Health, a private medical practice in Colorado that utilizes medical marijuana for a variety of conditions. Inhaled marijuana appeared to be the favorite method for treating acute migraines, while edible cannabis, which takes longer to be absorbed into the body, helped prevent headaches.

Exactly how cannabis relieves migraines is not fully understood. Natural cannabinoid receptors in the brain, connective tissues, and the immune system appear to have anti-inflammatory and pain-relieving properties. These cannabinoids also seem to affect neurotransmitters like serotonin and dopamine.

"We believe serotonin plays a role in migraine headaches, but we are still working to discover the exact role of cannabinoids in this condition," Borgelt said.

“We have had numerous patients finding results with migraines and the use of cannabis,” said Ellen Lenox Smith, a Pain News Network columnist who is a caregiver to medical marijuana patients in Rhode Island.

“We just had a woman out at the house a few days ago that was suffering will full body Reflex Sympathetic Dystrophy (RSD) and when she took one hit on a vaporizer of day meds, you could actually see the forehead relax and had headache relief immediately. When it is right for you, the results are amazing.” 

A 2013 study on rodents published in The Journal of Neuroscience found that triptans – a drug widely prescribed to treat migraine – appear to activate cannabinoid receptors just as marijuana does.

A 2007 study published in the European Journal of Critical Pharmacology found that migraine patients possessed significantly lower levels of endogenous cannabinoids than healthy control subjects.

Finding the Right Strain of Medical Marijuana

By Ellen Lenox Smith, Columnist

As a medical marijuana patient and caregiver since 2007, I would like to share some thoughts and observations about a recent survey by Care by Design, a medical cannabis company based in California.

They surveyed 621 patients who had been using medical marijuana for over 30 days, asking them about:

1. The conditions for which they are taking cannabidiol (CBD) rich cannabis

2.  The ratio of CBD-to-THC (tetrahydrocannabinol) they are using

3. The impact of CBD-rich cannabis therapy on their pain, discomfort, energy, mood, and overall well being

I would like to address three areas about the survey findings, based on my personal use of medical cannabis and the patients we assist as caregivers.

“Patients with psychiatric or mood disorders and patients with diseases of or injuries to the CNS (central nervous system) system favor CBD-dominant cannabis therapies,” the survey found. “Patients with pain and inflammation favor CBD-rich cannabis therapies with more equal levels of CBD and THC.”

I have to agree with this personally and also through observation of the people we have helped find their correct medical marijuana strain. I now sleep better at night using a night oil made with a high CBD ratio. I found that when I used another strain that has a higher THC ratio, I experienced some strange head sensations that I did not enjoy. But when I use the higher CBD mix, I do not experience those odd sensations and can safely get out of bed without concerns.  

One patient, who has numerous medical issues including depression and post-traumatic stress disorder (PTSD), has found she does well mixing a day sativa plant with the highest CBD plant we have (24% CBD/1% THC) called ACDC. She uses this mixture both day and night and finds it addresses her levels of pain more effectively. Just using the high CBD strain does not address her pain.

Another patient, a scientist, was just thrilled switching to the new high CBD plants we grow. He has found that his mood is calmer and his PTSD is under control. He is a thriving, productive worker again with no negative side effects

I correspond with many people online and one person who uses legally pure CBD found that it did address her pain. Many will not be that successful with just pure CBD and most need some THC to address pain.

The Care by Design report also states that “THC matters. A higher ratio of CBD to THC does not result in better therapeutic outcomes. Patients using the 4:1 CBD-to-THC were the most likely to report a reduction in pain or discomfort, and improvements in mood and energy.

“Patients using the 2:1 CBD-to-THC ratio reported the greatest improvement in overall wellbeing. This finding is consistent with scientific research indicating that CBD and THC interact synergistically to enhance one another’s therapeutic effect.”

I have to totally agree with the above statement. Most will not be lucky and find success without some THC in their medicine.

People tend to have a negative attitude towards THC because it makes them high and think medical marijuana strains work better without THC or lower ratios of it. But we have not had one patient that just uses the highest CBD plant alone. They appreciate the fewer “head issues” that come from reduced THC, but quickly find that their medical problems are not being addressed successfully until they use a mixture with more THC.

Finally, they survey report states that, “CBD-rich cannabis’ does not appear to have a significant impact on energy levels (as compared to pain, discomfort or mood).”

I am living proof of that, as are all the patients we have worked with using medical marijuana. When I need a boost on a tough pain afternoon, I find vaporizing or using tincture from the high CBD plant does not provide an increase in energy. However, when I use the 2:1 ratio that includes more THC, I not only get pain relief but also increased energy and interest in being involved with life again.

As the study found and we have found, you still have to experiment with dosage and ratios to find the correct type of medication strain to successfully alleviate your issues.

Using medical marijuana will never be like it is going to the pharmacy. One pill does not fit all and one strain does not fit all. No single ratio is right for all people, even when dealing with the same conditions.

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

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

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

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

Decline in Teen Opioid Abuse Continues

By Pat Anson, Editor

An annual survey that tracks teenage drug abuse continues to show a decline in the misuse of prescription opioid pain relievers, as well as heroin, alcohol, cigarettes, amphetamines and other substances.

The University of Michigan's Monitoring the Future Study (MTF) has tracked drug abuse among 8th, 10th, and 12th graders since 1975. This year’s survey included nearly 45,000 students at 382 public and private schools in the United States.

The MTF survey tracked the steady rise in teenage abuse of prescription opioids in the 1990's, before the trend reversed itself in the last decade. For the fifth year in a row, the survey found there was a significant decline in the misuse of opioids by teens (reported in the survey as “Narcotics Other Than Heroin”).

About 5% of 12th graders reported using an opioid pain medication in the last year, including 4.4% who used Vicodin and 3.7% who used OxyContin.

The number of teens reporting that prescription opioids were “fairly easy” or “very easy” to get also continues to drop.

Most teens abusing prescription opioids reported getting them from friends or family members. About one-third reported getting them from their own prescriptions.

"The recent declines in the abuse of prescription pain medicines among teens are encouraging. The Partnership has been working for quite some time through both our Above the Influence program and the Medicine Abuse Project to help educate teens, parents and communities about the risks of medicine abuse and we are glad to see continued progress," said Marcia Lee Taylor, President and CEO of the Partnership for Drug-Free Kids.

“While today's news about substance use among teens is mostly positive, we cannot let that take our focus off of the prescription drug and heroin crisis among other age groups.”

Despite widespread media reports about the so-called heroin “epidemic” in adults – heroin use among teens is at its lowest level since the MTF survey began. Past year use of heroin fell to 0.5% of 12th graders, an all-time low.

Use of several other illicit drugs – including MDMA (known as Ecstasy or Molly), amphetamines and synthetic marijuana – also showed a noted decline in this year's data. Use of alcohol and cigarettes reached their lowest points since the study began.

Marijuana, the most widely used illicit drug, did not show any significant change. After rising for several years, teenage marijuana use has leveled out since 2010, but still remains stubbornly high. In 2015, 12% of 8th ­graders, 25% of 10th­ graders and 35% of 12th­ graders reported using marijuana at least once in the past year. For the first time ever, daily marijuana use exceeds daily tobacco use among 12th graders.

"We are heartened to see that most illicit drug use is not increasing, non-medical use of prescription opioids is decreasing, and there is improvement in alcohol and cigarette use rates," said Nora D. Volkow, M.D., director of the National Institute of Drug Abuse, which funded the MTF survey.

"However, continued areas of concern are the high rate of daily marijuana smoking seen among high school students, because of marijuana’s potential deleterious effects on the developing brains of teenagers, and the high rates of overall tobacco products and nicotine containing e-cigarettes usage."

One growing area of concern is the abuse of Adderall and other prescription amphetamines, which are typically used to treat Attention Deficit Disorder (ADHD) but are widely perceived as a study aid.  About 7.5% of 12th graders used those drugs in the past year.

Can Marijuana Help Treat Heroin Addicts?

By Pat Anson, Editor

There’s a new twist to the rising use of heroin in the United States – and what can be done to help addicts in recovery.

A recent study by researchers at Columbia University found that medical marijuana improves the treatment outcome of heroin addicts. Patients who were given dronabinol -- a prescription drug that contains THC, the active ingredient in marijuana -- had lower withdrawal symptoms compared than those given a placebo. In addition, patients who smoked marijuana regularly during the outpatient phase of treatment had fewer sleeping problems, less anxiety and were more likely to finish treatment.

"One of the interesting study findings was the observed beneficial effect of marijuana smoking on treatment retention," the researchers concluded.

"Participants who smoked marijuana had less difficulty with sleep and anxiety and were more likely to remain in treatment as compared to those who were not using marijuana, regardless of whether they were taking dronabinol or placebo."

The Columbia study appears in the journal Drug and Alcohol Dependence.

According to High Times, several other studies have reached similar conclusions. Studies at the New York Psychiatric Institute found that opiate addicts who consumed marijuana intermittently were less likely to start using opioids again, compared to those who never used marijuana or used it habitually.

Earlier this year, researchers at the RAND Corporation and the University of California, Irvine reported similar results in a study for the National Bureau of Economic Research – going so far as to suggest that marijuana is a good substitute for opioid pain medication.

“Many medical marijuana patients report using marijuana to alleviate chronic pain from musculoskeletal problems and other sources. If marijuana is used as a substitute for powerful and addictive pain relievers in medical marijuana states, a potential overlooked positive impact of medical marijuana laws may be a reduction in harms associated with opioid pain relievers,” they wrote. “We find that states permitting medical marijuana dispensaries experience a relative decrease in both opioid addictions and opioid overdose deaths compared to states that do not.”

And what happens in states where regulations make it harder to obtain prescription opioid medication?

There were unintended consequences in Washington, one of the first states in the country to impose strict new guidelines on opioid prescribing. From 2008 to 2014, the number of deaths from prescription opioids in Washington fell from 512 to 319. But over the same period, the number of heroin deaths almost doubled, to nearly 300.

But the surge in heroin use wasn’t confined to Washington. According to the National Survey on Drug Use and Health, the number of heroin users nationwide rose from 161,000 in 2007 to 289,000 in 2013, an increase of nearly 80%. During the same period, the U.S. Centers for Disease Control and Prevention (CDC) reported the number of poisoning deaths involving heroin rose from 3,041 to 8,257, an increase of 172%.

“There is no robust evidence that recently enacted policies regarding prescription opioids are responsible for large-scale shifts to heroin,” the CDC’s Courtney Lenard recently told Alcoholism & Drug Abuse Weekly. Only about 1 in 25 people who use prescription opioids recreationally start using heroin within five years, she said.

Pot for Pain Approved in Minnesota

By Pat Anson, Editor

After months of debate, Minnesota’s health commissioner has decided to include chronic pain in the list of conditions that allow residents to legally use medical marijuana. They just have to wait another nine months before they can buy it.

Commissioner Ed Ehlinger said it was “the right and compassionate choice” to allow pain patients into the program.  Only nine health conditions currently qualify for marijuana prescriptions in Minnesota – and chronic, intractable pain won’t be added until August 1, 2016. Health care providers can start certifying intractable pain patients on July 1 of next year.

Ehlinger, who is a physician, said “the existing tools are not working well” to manage pain, according to the Minneapolis Star Tribune.

“There are strong and conflicting opinions ... in both the professional community and in the general population. However, as a physician who is concerned about the treatment each individual patient receives and as the Minnesota Health Commissioner who is concerned about the overall health of everyone in this state, I believe that adding intractable pain to the list of qualifying conditions for our medical cannabis program is the correct decision,” said Ehlinger

Last month a state advisory panel recommended against the inclusion of chronic pain in Minnesota’s marijuana program, saying cannabis was not a “magic bullet” and there wasn’t enough evidence to support its use for pain.

“Panel members expressed concern that patients eligible to use medical cannabis for pain have expectations that it would provide total relief and that such a perception may leave patients to abandon other proven pain-management methods, such as physical therapy,” the recommendation said.

“Panel members cited the recent opioid crisis, where good medications were demonized because prescribers used it to treat pain without knowing its proper uses. Even after studying the information available on medical cannabis, panel members said providers do not feel prepared to certify patients for its use.”

Over a dozen public hearings on the issue were held across the state, and the vast majority of speakers favored including intractable pain in the list of health conditions marijuana can be used for.

Intractable pain is defined as “a pain state in which the cause of the pain cannot be removed or otherwise treated with the consent of the patient and which, in the generally accepted course of medical practice, no relief or cure of the cause of the pain is possible, or none has been found after reasonable efforts.”

The nine conditions that currently qualify for medical marijuana in Minnesota are cancer, glaucoma, HIV/AIDS, Tourette Syndrome, Amyotrophic Lateral Sclerosis (ALS), seizures, severe muscle spasms, Crohn’s Disease and terminal illness. In addition to strict limits on conditions it can be prescribed for, medical marijuana is not available in leaf form and cannot legally be smoked in Minnesota.  It is only legal in a pill, vapor or liquid form.

The limits are so restrictive, less than 800 patients have enrolled in the program so far. Enrollment is expected to increase dramatically once chronic pain is included.

"Congratulations to the State  of Minnesota for now becoming a true state of compassion," said Ellen Lenox Smith, a medical marijuana advocate and a columnist for Pain News Network.  "I do hope that in the near future, they will also consider to adjust their stand on cannabis being sold only in pill or liquid form — nothing smoke-able.  For those of us in Rhode Island, we can choose to vaporize, use topicals, smoke if that is your only way to make it work for you, along with tinctures, drinks and edibles. We all have to find the right way to make this medicine work for our conditions, so may they realize their limitations are very controlling and holding back pain relief for many."

Minnesota is one of 23 states and the District of Columbia where medical marijuana is legal.

8 Tips for Patients Newly Diagnosed with Ehlers-Danlos

By Ellen Lenox Smith, Columnist

Ehlers-Danlos Syndrome (EDS) is a condition that causes one to be born with deformed connective tissue, the “glue” that holds the body together. At this time, there is still no cure to correct this problem, so living life with this condition means a accepting a certain level of chronic pain.

There are simple things to learn to live your life with EDS more safely. For instance,  learning how to properly strengthen the muscles that are on overload doing their job, along with that of the useless ligament and tendons. Or understanding how certain twists and turns bring on other slippage of the body.

Living with Ehlers-Danlos Syndrome means, at times, a long, lonely and difficult journey burdened with a constant search for direction on how to try to create something resembling   a normal life. I am 65, but it wasn’t until eleven years ago that I was finally given the correct diagnoses of something I was actually born with!

There have been times that I felt guilty for almost wishing I had been given a diagnosis of cancer -- for then the doors of hope, direction, plans and medical interest would have been with me at all times. Instead, as many other EDS patients have learned, we cope with the unknown, judgment from friends and even family, isolation, confusion, and the lack of consistent knowledgeable  help.

All I ever wanted, when first diagnosed, was for someone to reach a hand out and guide me. That hand has never been there. So, instead, I have spent the past eleven years attempting  to help prevent others from having to replicate my experience. I simply wish to assist other EDS patients avoid some of the uncertainty and stress that I was forced to experience.

The task is often overwhelming and difficult, but you have no choice. This is the life you have been given.

With that in mind, I would like to make suggestions to the newly diagnosed, in hopes that your journey will begin safely by addressing these issues:

1) Confirm with a knowledgeable geneticist that you have EDS. If you get the feeling they do not understand or believe you have EDS, then go to another geneticist. I met with three before I was convinced and accepted the diagnosis.

2) Mourn your losses. It’s okay and necessary to allow yourself to mourn the loss of your past life -- it will never again be exactly as you have known it. As you go through that process, remember you need to reach the goal of moving on.

3) Address pain control. Accept that you cannot take this journey on your own. You need to address your pain to have a chance of living as normal a life as you can. You might be like many of us and have trouble metabolizing certain medications. In that case, DNA drug sensitivity testing would help you to identify a compatible pain medication.

Many respond beautifully to medical marijuana instead of opiates. It can be taken in a simple dose of oil at night, that not only allows you to sleep but also carries pain relief to the body even into the next day.

4) Be evaluated by a neurologist for common EDS conditions such as tethered cord, Chiari I Malformation, and instability of the neck . This is a very important. Every patient should have this evaluation and have a neurologist monitor you. Many of us need to have the tethered cord released to end issues with the bladder, kidneys, pressure in the chest, and issues with legs. If you test positive, get it done and then you will feel so much better and be able to progress onto physical therapy more successfully.

Instability of the neck will cause havoc with your body if strengthening does not succeed. Chiari I Malformation must also be addressed. Any or all of these may be an issue for you in time, but please know that correcting them when the time is right will make the difference in moving forward again.

5) Find a good manual sacral physical therapist. This is your chance to take better control of your life by learning, through the guidance of a manual therapist. “Living Life to the Fullest With Ehlers-Danlos Syndrome” is a new book written by my therapist, Kevin Muldowney. He learned by taking on many EDS patients at his clinic, that there are safe ways to strengthen our muscles. I have been through the protocols and have found they work for me.

You’ll need to stay loyal to the daily workouts. But believe me, I love being proactive and so appreciate the good that is now showing -- like having the sacrum hold!

6) Develop a network of doctors that understand EDS or are willing get educated.  Feel free to visit my website to see if a doctor is listed near you. Also feel free to contact us if you have a good doctor that we can add to the list.

Remember, we are complicated and never get all better. That is a lot for a doctor to want to take on. Be patient and look for compatible personalities and let them learn through you.

7) Be sure to have a cardiologist.  You should have an echocardiogram (echo test) done yearly. The test uses sound waves to produce images of the heart and allows the cardiologist to see if your heart is beating and pumping blood correctly.

8) Determine drug and food allergies. I wish years ago I had a clue that there was testing out there to see why I had bad reactions to some medications and foods since birth. A simple DNA drug sensitivity test can help you find a safe drug to be able to put into your body. The same goes for food sensitivity testing. You will learn what foods are causing issues or what drugs are not metabolizing.

Both these issues are VERY important to address. If you keep taking medication or eating foods that are not compatible to your body, then you are adding to the inflammation in your system. More inflammation means more pain due to the increase of subluxations.

It's also important to remember that you are not alone. Find a local EDS support group and learn as much as you can to live more safely with this condition.

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

For more information about medical marijuana, visit their website.

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