Pain Patients Prefer Marijuana over Opioids

By Pat Anson, Editor

A small study by Canadian researchers has found that nearly two-thirds of patients who use marijuana medically prefer cannabis over prescription drugs to treat their chronic pain, anxiety and depression.

An online survey by researchers at the University of British Columbia and University of Victoria asked 271 patients about their marijuana use. About half reported having chronic pain, while the remainder suffered from mental health issues, gastrointestinal problems, insomnia or multiple sclerosis.  

Overall, 95 percent of patients said cannabis was very effective at treating their symptoms and 63 percent reported using cannabis as a substitute for opioids, benzodiazepines, anti-depressants and other prescription drugs.

The study, published in International Journal of Drug Policy, was funded by Tilray, a medical marijuana production and research company.

“The finding that patients using cannabis to treat pain-related conditions have a higher rate of substitution for opioids, and that patients self-reporting mental health issues have a higher rate of substitution for benzodiazepines and antidepressants has significant public health implications,” wrote co-author Zach Walsh, PhD, an assistant professor of psychology at the University of British Columbia.

“In light of the growing rate of morbidity and mortality associated with these prescription medications, cannabis could play a significant role in reducing the health burden of problematic prescription drug use.”

Vaporizers were the most common method for using cannabis, followed by smoking, edibles, water pipes, and topical lotions. Most patients reported using 2 grams or less of marijuana. Many said cannabis was safer and had fewer adverse side effects than their medications.

A recent study in Canada found that a significant increase in the use of marijuana coincided with a decline in the use of opioid pain medication and benzodiazepines such as Xanax and Valium.

“The finding that medical cannabis is used primarily to treat chronic pain is consistent with past research. However, the extensive self-reported use to treat mental health conditions and associated symptoms represents a novel and interesting trend, and suggests that the conceptualization of cannabis as deleterious to mental health may not generalize across conditions or populations,” Walsh said.

Medical marijuana has been legal in Canada since 2001, but only to treat certain conditions. Cannabis is currently prescribed to over 65,000 patients.

A small study conducted at the University of Michigan last year also found a significant decline in the use of opioids by pain patients using medical marijuana.  Nearly two-thirds (64%) reported a reduction in their use of pain medications and almost half (45%) said cannabis improved their quality of life.

Previous research also found that opioid overdoses declined by nearly 25 percent in states where medical marijuana was legalized.

Last week, a spokesman for the Trump administration suggested there could be a crackdown in the U.S. on the use of marijuana recreationally.

"There's two distinct issues here, medical marijuana and recreational marijuana," said press secretary Sean Spicer. "I think that when you see something like the opioid addiction crisis blossoming in so many states around this country, the last thing that we should be doing is encouraging people."

Although 28 states have legalized medical marijuana and a handful of states also allow its recreational use, marijuana is still illegal under federal law.  Spicer suggested there could be “greater enforcement” of federal law under Attorney General Jeff Sessions, a longtime opponent of marijuana use.

A Safe Way to Healthy, Restorative Sleep

By Ellen Lenox Smith, Columnist

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

‘Substantial Evidence’ Marijuana Relieves Chronic Pain

By Pat Anson, Editor

A major new study released today on the health effects of medical marijuana has found “substantial evidence” that cannabis is an effective treatment for chronic pain in adults.

The lengthy study by a committee of the National Academies of Sciences, Engineering, and Medicine looked at over 10,000 scientific reports on marijuana and its active chemical compounds. The committee studied a range of possible impacts marijuana can have on pain, cancer, mental health, injuries and other health conditions.

Marijuana is now the most popular illicit drug in the United States, although it is legal under state law in 28 states and the District of Columbia.

A recent survey found over 22 million Americans have used marijuana in the past month, with nine out of ten users saying their primary use was recreational. Only about 10 percent reported they used cannabis solely for medical purposes. 

“For years the landscape of marijuana use has been rapidly shifting as more and more states are legalizing cannabis for the treatment of medical conditions and recreational use,” said Marie McCormick, the committee chair and a professor of pediatrics at Harvard Medical School.

“This growing acceptance, accessibility, and use of cannabis and its derivatives have raised important public health concerns.  Moreover, the lack of any aggregated knowledge of cannabis-related health effects has led to uncertainty about what, if any, are the harms or benefits from its use.  We conducted an in-depth and broad review of the most recent research to establish firmly what the science says and to highlight areas that still need further examination.”

The committee could find only five good-to-fair quality studies on whether cannabis was an effective treatment for chronic pain.  In all five studies, the cannabis was either smoked or vaporized, and did not include other delivery methods such as food, creams or oils infused with cannabinoids.  

“Thus, while the use of cannabis for the treatment of pain is supported by well-controlled clinical trials... very little is known about the efficacy, dose, routes of administration, or side effects of commonly used and commercially available cannabis products in the United States. Given the ubiquitous availability of cannabis products in much of the nation, more research is needed on the various forms, routes of administration, and combination of cannabinoids,” the committee found.

"It is wonderful to see that what I experience is now being recognized and respected in the medical community," said Ellen Lenox Smith, a PNN columnist who uses marijuana to relieve pain from Ehlers Danlos syndrome.

"I have been allowed nightly rest due to a simple teaspoon of oil at night. Somehow, the next day I rarely need to turn to more, for it continues to calm the body into the next day for me."

Others have also found that cannabis reduces their need for pain relievers. In states where medical marijuana is legal, the committee found growing evidence that users were replacing opioids with cannabis.

“Recent analyses of prescription data from Medicare Part D enrollees in states with medical access to cannabis suggest a significant reduction in the prescription of conventional pain medications,” the committee found. “Combined with the survey data suggesting that pain is one of the primary reasons for the use of medical cannabis, these recent reports suggest that a number of pain patients are replacing the use of opioids with cannabis, despite the fact that cannabis has not been approved by the U.S. Food and Drug Administration (FDA) for chronic pain.”

For adults muscle spasms caused by multiple sclerosis, the committee said there was substantial evidence that short-term use of oral cannabinoids – marijuana-based products that are orally ingested – improved their symptoms.  In adults with chemotherapy-induced nausea and vomiting, there was also conclusive evidence that oral cannabinoids were effective in treating those symptoms.

There was a lack of data on the effects of cannabis on the immune system, and insufficient evidence to support or refute a link between cannabis and adverse effects on the immune status of individuals with HIV.  Limited evidence does suggest that regular exposure to cannabis smoke may have anti-inflammatory effect.

Regarding the link between marijuana and cancer, the committee found evidence that suggests smoking cannabis does not increase the risk for cancers often associated with tobacco use. However, the committee did find that smoking cannabis on a regular basis was associated with more frequent chronic bronchitis, coughing and other respiratory issues.

To download a free copy of the study, click here.

How to Ask Your Doctor About Medical Marijuana

By Ellen Lenox Smith, Columnist

If you are considering medical marijuana as an alternative treatment for your chronic pain or other medical issues, you might be uncomfortable about approaching your doctor.

There are so many stories circulating about patients being judged by their doctor or being labeled a “drug seeker” if they ask about marijuana, that many have chosen not to engage in a conversation they really wish to have.  

So, what can you do to make this as comfortable as possible?

First, take the time to understand your state’s medical marijuana law. Over half the states have now legalized medical marijuana, but the rules are different for doctors and patients in each state. Click here to see a summary of medical marijuana laws in all 28 states and Washington DC.

Here in Rhode Island, residents can approach any doctor -- not only in Rhode Island -- but in the adjacent states of Connecticut and Massachusetts. If you have no success with the doctors that treat you, then we have a few locations in Rhode Island that you can turn to. These specialty doctors evaluate your medical issues and can sign you on.  

The one negative for using these facilities is that there is a fee that must be paid upfront and you must return yearly to confirm your continued need for medical marijuana. A regular doctor’s appointment only means a co-pay, depending on your insurance.

Second, you want to approach a doctor you believe might be the most open to considering marijuana. How do you figure that out?

Some states require doctors to take a marijuana course before being allowed to sign for someone. Check and see if your doctor is on that list. If they are not, ask your state health department for a list of qualified doctors you can turn to. You can also ask other patients already in the program what success they had with your doctor or see if they know another doctor in the area who would be better. 

If you think your doctor might be open to this discussion, consider calling their office in advance and sound out where the doctor stands on marijuana before going in. If it sounds hopeless, then turn to a different doctor that treats you.

If your state has set up distribution centers or marijuana dispensaries, they may also be able to guide you to a doctor willing to sign you on, if you have no luck with your own personal doctors.

Third, when you finally approach the doctor, come to the appointment with some knowledge to share. Be ready to educate them. Google your health condition and medical marijuana to see if cannabis has been used to treat it. Feel free to use our website to download articles about the successful use of marijuana with your condition.

Dr. Stephen Corn has a wonderful website for doctors called “The Answer Page” where they can turn to for education on this topic and also submit questions they might have. I would encourage you to share the link with your doctor.

Be sure to share with your doctor what medications you have already tried to help cope with your condition. Explain why they have not worked for you. Remind them that they are not writing a script or prescription for marijuana, but simply confirming you have one of your state’s qualifying conditions for it.

Share with the doctor that you don’t expect them to guide you in how to administer marijuana, and that you will be educated at the dispensary or by a caregiver.

I know it feels intimidating to consider asking your doctor to support you, but if this is a possible solution for your life, take the time to prepare for the meeting and go for it.

There are risks involved with using marijuana without telling your doctor. They could be caught by surprise and discharge you if marijuana unexpectedly shows up in a drug test. That’s happened to some patients, even though the CDC specifically warns that “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.”

I have turned my life around with a simple teaspoon of a marijuana-based oil at night -- and had to be convinced by my own doctor to give it a try! Once I realized what this was doing for my quality of life, I had to share my success with others.  I hope that others may find this natural and safe option to be successful for them too.   

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.

NBA Coach Tried Marijuana for Back Pain

By Pat Anson, Editor

Steve Kerr may have inadvertently started a national conversation about sports and medical marijuana. They’re certainly talking about it in the NBA.

The 51-year old coach of the Golden State Warriors revealed in an interview Friday that he smoked marijuana to see if it might relieve his chronic back pain. Medical marijuana has been legal in California since 1996.

“I guess maybe I can even get in some trouble for this, but I’ve actually tried it twice during the last year and a half, when I’ve been going through this chronic pain that I’ve been dealing with,” Kerr said on The Warriors Insider Podcast.

STEVE KERR

Kerr missed most of the 2015 regular season after two back surgeries that not only failed to relieve his pain, but resulted in a spinal fluid leak that gave him chronic headaches, nausea and neck pain. Kerr took a leave of absence for four months and started trying various pain relievers, including narcotic painkillers and pot.

“A lot of research, a lot of advice from people, and I have no idea if maybe I would have failed a drug test. I don't even know if I'm subject to a drug test or any laws from the NBA, but I tried it and it didn't help it all. But it was worth it because I'm searching for answers on pain. I've tried painkillers and drugs of other kinds as well, and those have been worse. It's tricky," Kerr said.

It’s even trickier if you’re a professional athlete.

If an NBA player is caught using marijuana – either recreationally or medically – the league requires the player to enroll in and complete a substance abuse treatment program.

A second infraction results in a $25,000 fine. The penalties escalate after that, with a third offense resulting in a 5-game suspension, followed by a 10-game suspension for a 4th infraction.  

The NFL and Major League Baseball have similar marijuana policies, with baseball players facing the ultimate penalty after a 4th infraction: Banning from the league.

Even though Kerr is a coach now – he had a lengthy career as a player – it took some courage for him to speak so openly about marijuana.

“I’m not a pot person. It doesn’t agree with me. I’ve tried it a few times, and it did not agree with me at all. So I’m not the expert on this stuff,” Kerr said. “But I do know this: If you’re an NFL player, in particular, and you’ve got a lot of pain, I don’t think there is any question that pot is better for your body than Vicodin. And yet athletes everywhere are prescribed Vicodin like its Vitamin C, like it’s no big deal.

“I would hope, especially for these NFL guys, who are basically involved in a car wreck every Sunday – and maybe four days later, the following Thursday, which is another insane thing the NFL does – I would hope that league will come to its senses and institute a different sort of program where they can help these guys get healthier rather than getting hooked on these painkillers.”

Some of Kerr’s player welcomed his comments about a controversial issue.

''Steve's open-minded, and obviously with the way the world's going, if there's anything you can do that's medicinal, people are all for it, especially when there's stuff like Crohn's disease out there, glaucoma, a bunch of stuff, cancer,” said Klay Thompson. “But not recreationally, that should not be of its use ever. There's obviously a medicinal side to it that people are finding out, especially people with really high pain.''

“I think it makes a lot of sense what he said,” said Draymond Green, adding that he has never tried marijuana and “doesn’t really know how it feels.”

“From what I hear from football guys, I think a lot of them do it because of all the pain they go through,” Green said. “It makes a lot sense. It comes from the earth. Any vegetable that comes from the earth, they encourage you to eat it. So I guess it does make a little sense, as opposed to giving someone a manufactured pill. The way some of these pills take the pain away, it can’t be all good for you.”

Although the NFL has a reputation for regular drug testing and watching for signs of drug abuse, some former players say about half the league is currently using marijuana for pain relief.  Many grew tired of using painkillers, which one player calls “a scourge in the locker room.”

Steve Kerr says professional sports needs to re-evaluate its relationship with painkillers and marijuana.

“Having gone through my own bout with chronic pain, I know enough about this stuff – Vicodin is not good for you. It’s not,” said Kerr. “It’s way worse for you than pot, especially if you’re looking for a painkiller and you’re talking about medicinal marijuana, the different strains what they’re able to do with it as a pain reliever. And I think it’s only a matter of time before the NBA and NFL and Major League Baseball realize that.”

Medical Marijuana Could Help Treat Addiction

By Pat Anson, Editor

Can marijuana be used to treat addiction?

Not according to the U.S. Drug Enforcement Administration, which classifies marijuana as a Schedule I controlled substance with “a high potential for abuse.” Adults who start using marijuana at a young age, according to the DEA,  are five times more likely to become dependent on narcotic painkillers, heroin and other drugs.

But a new study by Canadian researchers found that marijuana is helping some alcoholics and opioid addicts kick their habits.

"Research suggests that people may be using cannabis as an exit drug to reduce the use of substances that are potentially more harmful, such as opioid pain medication," says the study's lead investigator Zach Walsh, an associate professor of psychology at the University of British Columbia’s Okanagan campus.

“In contrast to the proposition that cannabis may serve as a gateway (drug) is an emerging stream of research which suggests that cannabis may serve as an exit drug, with the potential to facilitate reductions in the use of other substances. According to this perspective, cannabis serves a harm-reducing role by substituting for potentially more dangerous substances such as alcohol and opiates.”

In their review of 31 studies involving nearly 24,000 cannabis users, Walsh and his colleagues also found evidence that marijuana was being used to help with mental health problems, such as depression, post-traumatic stress disorder (PTSD) and social anxiety.

The review did not find that cannabis was a good treatment for bipolar disorder and psychosis.

"It appears that patients and others who have advocated for cannabis as a tool for harm reduction and mental health have some valid points," Walsh said.

With medical marijuana legal in over half of the United States and legalization possible as early as next year in Canada, Walsh says it is important for mental health professionals to better understand the risk and benefits of cannabis use.

"There is not currently a lot of clear guidance on how mental health professionals can best work with people who are using cannabis for medical purposes," says Walsh. "With the end of prohibition, telling people to simply stop using may no longer be as feasible an option. Knowing how to consider cannabis in the treatment equation will become a necessity."

The study was recently published in the journal Clinical Psychology Review. Walsh and some of his colleagues disclosed that they work as consultants and investigators for companies that produce medical marijuana.

Previous studies have found that use of opioid medication declines dramatically when pain patients use medical marijuana. Opioid overdoses also declined in states where medical marijuana was legalized..

Is Cannabis Science's Pain Patch for Real?

By Pat Anson, Editor

A California company that claims to be developing a cannabis-based skin patch to treat chronic pain is “a fundamentally unsound company” with a long history of misleading the public and its own shareholders, according to analysts. The founder and former CEO of Cannabis Science has even accused the company’s current management team of fraud and deception.

At various times in its history, Cannabis Science has gone under the name Patriot Holdings, National Healthcare Technology, Brighton Oil & Gas, and Gulf Onshore. Now it has a slick new website, and is passing itself off as a pharmaceutical development company with a pipeline of cannabis-based drugs to treat asthma, HIV and chronic pain.

“I'm not sure if Cannabis Science is a biotech firm, an oil and gas exploration company, an educational university or a pot distributor, the only thing I am certain of is that Cannabis Science is in the business of moving money from public investors to executives' pockets,” wrote John Brody Gay in a lengthy analysis published by Seeking Alpha, an investing website.

Gay and other analysts say Cannabis Science is a classic “pump and dump” penny stock that produces little revenue, but a steady stream of press releases to promote its business activities, which never seem to come to fruition.

Often other websites are hired by pump and dumpers to publish their press releases or write glowing reviews about a company known as “advertorials.” Others are simply ignorant and don't do their homework. The publicity and fake news generates a brief flurry of interest in the company’s stock, which is when executives and other insiders often sell their shares. By raising the stock price by a few pennies, company insiders can double or triple the value of their holdings.

On November 2, Cannabis Science issued a press release saying it was developing skin patches to treat pain caused by fibromyalgia and diabetic neuropathy.

"The development of these two new pharmaceutical medicinal applications are just the tip of the iceberg for what we see as the future for Cannabis Science. While we strive to increase our land capacity for growth and facilities to produce our own product to supply our scientists with proprietary materials to make these formulations, we are also busy researching more potential needs for Cannabis related medical applications,” Cannabis Science CEO Raymond Dabney was quoted as saying in the news release.

Dabney is no stranger to accusations of deception and stock manipulation. In 2005, he admitted issuing 22 bogus news releases to promote another penny stock. For that he received a five year trading ban from British Columbia’s Securities Commission, according to Forbes and the Vancouver Sun.

A former CEO and president of Cannabis Science has also accused Dabney of fraud. Steve Kubby and other directors resigned after learning that Dabney, who was then working for Cannabis Science as a consultant, diverted company funds into a private account.

“When it became clear that our company had become entangled in fraud and deception, we demanded answers. Instead, those behind the fraud illegally removed me. Yes, we could have fought it and won, but attorneys repeatedly warned us that it is only a matter of time before the SEC will be investigating the company’s many questionable activities,” said Kubby in the Independent Political Report. “Actually, these guys have done me a great favor, because they have removed me from a stinking mess and assumed the liability for themselves.”

Kubby himself was accused by the company of "using unauthorized company shares as collateral or consideration for his personal gain."

Calls to Cannabis Science and Dabney for comment on the allegations were not returned.

‘Substantial Doubt’ About Company

The bottom line in all of this is that Cannabis Science is nearly broke and considers its own future questionable, which it discloses in its most recent financial statement to the Securities and Exchange Commission.

“The Company is not currently in good short-term financial standing. We anticipate that we may only generate limited revenues in the near future and we will not have enough positive internal operating cash flow until we can generate substantial revenues,” the company said. “There is substantial doubt as to the Company's ability to continue as a going concern without a significant infusion of capital.”

In the first six months of 2016, Cannabis Science reported revenue of only $5,787, and debt and liabilities of over $5 million.

What the company has plenty of is stock. Nearly two billion shares of Cannabis Science are currently trading on the over-the-counter “pink sheet” market, and the company is authorized to release another billion shares whenever it wants. It pays its executives, debtors and vendors in newly issued shares, which are typically sold at opportune times.  

Chief Financial Officer Robert Kane, for example, was paid with 20,000,000 shares on March 8. In October, Kane sold over 9 million shares for $384,000.

Nice work if you can get it.

With more and more states legalizing both medical and recreational marijuana, the cannabis industry is estimated to be worth $7 billion and growing quickly. So is the opportunity for fraud.

The Financial Industry Regulatory Authority (FINRA) warned about a profusion of marijuana stock scams three years ago, advice that still holds true today for investors, as well as pain patients.

“Like many investment scams, pitches for marijuana stocks may arrive in a variety of ways – from faxes to email or text message invitations, to webinars, infomercials, tweets or blog posts,” FINRA said. “The con artists behind marijuana stock scams may try to entice investors with optimistic and potentially false and misleading information that in turn creates unwarranted demand for shares of small, thinly traded companies that often have little or no history of financial success.”

Cannabis Science was out with yet another press release today, this one talking about its plan to build a 33,000 square foot marijuana greenhouse in Nevada. No details were offered on when the greenhouse would be built, how much it would cost, or who would pay for it.

"It is such an incredible feeling to see our great plans finally coming to fruition," Dabney was quoted as saying.

Marijuana Legalized in Several More States

By Ellen Lenox Smith, Columnist

As we ponder the results of the presidential election, let’s not forget to celebrate the success throughout the country in increasing the number of states allowing access to medical and recreational marijuana.

Congratulations to voters in Florida, North Dakota and Arkansas for approving medical marijuana and providing a choice for patients to turn to. Also, Montana succeeded in expanding its medical marijuana program to include post-traumatic stress as a qualifying medical condition, along with raising the limit on the number of patients a doctor can certify from 3 to 25.

We are so happy for patients in these states! It will take time for them to get their programs up and running. Patience will be needed, but at least they are now on the right road. It will involve years of tweaking the program as patients learn to navigate the system.

Voters in California, Nevada, Massachusetts and Maine also approved the legalization of marijuana for recreational use. A recreational ballot proposal in Arizona was defeated.

It is very important that we keep and improve the integrity of medical marijuana programs as states expand into recreational use. This will become a big money maker for states and I assume the movement will grow fairly quickly as more states realize they can make billions of dollars in tax revenue.

I have always felt that recreational use was not our battle, preferring instead to focus on patients having access to medical marijuana. I appreciate that some want marijuana for use socially, but there are many of us struggling to live life with more dignity, which the use of medical marijuana provides for us. All citizens in the United States deserve the same rights and we are now over halfway there.

Our dream is for all people in this country to have medical marijuana as a choice. All deserve proper education on its use, a variety of strains to accommodate their various needs, patients and caregivers should be allowed to grow their own plants, and marijuana should be available at compassion centers or dispensaries at affordable prices. Also, we look forward to more consistency in qualifying medical conditions, which vary widely from state to state.

If you are in need of advocating in your state to improve your program or to try to get legislation to move forward, feel free to be in touch.

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.

Researchers Unveil 3-D Image of ‘Marijuana Receptor’

By Pat Anson, Editor

An international team of researchers has released the first three-dimensional image of a human cannabinoid receptor – a discovery expected to advance research into the medical and recreational use of marijuana.

The research findings, published in the journal Cell, focused on how tetrahydrocannabinol (THC) -- the chemical in marijuana that makes people “high” -- binds to a cannabinoid receptor known as CB1, which is embedded in the surface of many nerve cells.

Cannabinoid receptors are part of a large class of receptors known as G protein-coupled receptors (GPCR), which account for about 40 percent of all prescription pharmaceuticals on the market.

"As marijuana continues to become more common in society, it is critical that we understand how it works in the human body," said Zhi-Jie Liu, a professor and deputy director of the iHuman Institute at Shanghai Tech University, who is also affiliated with the Chinese Academy of Sciences.

"We need to understand how marijuana works in our bodies; it can have both therapeutic potential and recreational use, but cannabinoids can also be very dangerous."

At the beginning of the study, researchers struggled to collect enough data to produce a crystal form of the CB1 receptor, which was needed to create the high-resolution image.

When they finally succeeded in crystalizing the receptor, they found a complex structure of pockets and channels to various regions of the receptor.

The discovery could help explain why synthetic marijuana and medicines designed to mimic cannabis have had unexpected and sometimes harmful side effects.

For example, a cannabis-based drug developed to treat obesity was found to cause depression, anxiety, and suicidal tendencies, so the medication was pulled off the market.

And synthetic marijuana, such as Spice and K2, can have severe side effects such as seizures, hallucinations, anxiety attacks and even death.  

Yekaterina Kadyshevskaya, Stevens Laboratory, USC

"With marijuana becoming more popular with legislation in the United States, we need to understand how molecules like THC and the synthetic cannabinoids interact with the receptor, especially since we're starting to see people show up in emergency rooms when they use synthetic cannabinoids," said study co-author Raymond Stevens, a professor at the iHuman Institute and a professor of Biological Science and Chemistry at the University of Southern California.

The findings could also guide the development of cannabis-based drugs to treat pain, inflammation, obesity, fibrosis and other medical conditions.

"Researchers are fascinated by how you can make changes in THC or synthetic cannabinoids and have such different effects," says Stevens. "Now that we finally have the structure of CB1, we can start to understand how these changes to the drug structure can affect the receptor."

Keeping Kids Safe from Medical Marijuana

By Ellen Lenox Smith, Columnist

Frequently, someone will mention to me that they want to medicate with cannabis but won’t even consider trying it due to their children living in the house.

I can certainly understand their concern, but feel there are still ways to administer the medication, get control of your pain and also keep your children safe.

What are the biggest concerns a parent has about using marijuana around children?

1. The danger of cannabis getting into the children’s hands.
2. The smell from smoking marijuana alerting children to what you have in the house.
3. The still lingering issues of society’s judgment of it

How can you comfortably still make use of cannabis with children in the house?

As with all medications kept at home, you always have to be alert for the safety of children. Cannabis is no different. For any medication, parents (and grandparents) should consider locking it up to keep it out of the wrong hands. 

To still be able to enjoy the benefits of marijuana, but without the smell, there are ways to administer it that are just as successful as smoking. Many wrongly assume that is the only way you can use it. 

I only take cannabis as an oil. It is kept in a medicine bottle, measured out nightly and mixed with some applesauce. This is not something that children are attracted to. I always make sure it is a secure spot. I sleep through most nights and generally during the day never need to take any other forms of the cannabis, since it continues to offer me benefits from the nightly teaspoon.

Another effective option is to use it topically. The results are soothing and have shown tremendous relief, even for those suffering with Complex Regional Pain Syndrome (CRPS). We make ours with a peppermint oil extract added to mask the smell. The peppermint also helps  open the pores in the skin to allow for absorption.

Tinctures containing cannabis can be made in either a glycerin or alcohol base. They can be stored in a medicine bottle and used as frequently as needed. One simple teaspoon in the cheek or under the tongue allows for absorption and pain relief. You can also take cannabis as a pill or suppository, and many have learned to make it as a drink or steeped as a tea. 

For more on the different ways to use cannabis, see my column: “How to Use Medical Marijuana Without Smoking.”

Finally, as far as societal judgement goes, as your children grow older, it doesn’t hurt to be honest with them about the benefits you have found from using cannabis to improve the quality of your life.  It is no different than any illness you are coping with where there is a need to medicate. As time progresses, this conversation will get easier as society embraces this safe alternative.

If you are one of those people who is putting the benefits of medical cannabis on hold because of your children, you might want to reconsider your options and allow yourself the relief you need. Remember, unless you take too much, you do not experience the high that people associate with marijuana. A body in pain does not react to marijuana like a body using it socially. You get pain relief and the others get the high.

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.

Do Men Get More Pain Relief From Marijuana?

By Pat Anson, Editor

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

DEA: No Schedule Change for Marijuana

By Pat Anson, Editor

After weeks of rumors about a major change in policy, the U.S. Drug Enforcement Administration has announced that it will not reclassify marijuana as a Schedule II controlled substance, a move that would have essentially made medical marijuana legal in all 50 states.

Marijuana will remain classified as Schedule I drug – along with other illegal drugs such as heroin and LSD – meaning it has “no currently accepted medical use.”

"This decision isn't based on danger. This decision is based on whether marijuana, as determined by the FDA, is a safe and effective medicine. And it's not," Chuck Rosenberg, acting administrator of the Drug Enforcement Administration told NPR.

The DEA did say it would loosen the rules to make marijuana more available for research, allowing researchers to register with the agency to “grow and distribute marijuana for FDA-authorized research.” Until now, only the University of Mississippi has held a license to grow marijuana for research purposes.

"As long as folks abide by the rules, and we're going to regulate that, we want to expand the availability, the variety, the type of marijuana available to legitimate researchers," Rosenberg told NPR. "If our understanding of the science changes, that could very well drive a new decision."

Although still technically illegal under federal law, 25 states and the District of Columbia have approved the use of medical marijuana.  Colorado and Washington have also legalized it for recreational use.

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

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

Canadians Can Grow Their Own

The DEA’s announcement came the same day Health Canada said it would allow Canadians to start growing their own marijuana when it updates regulations governing Canada’s medical cannabis program on August 24.

On that date, Canadians who have been authorized by their doctor to use cannabis for medical purposes will be able to produce a limited amount of cannabis or designate someone to produce it for them, provided they register with Health Canada.  Cannabis users will also continue to have the option of purchasing cannabis from one of the 34 producers licensed by Health Canada.

Additional information on how to register and legally purchase starting materials for marijuana cultivation will be available on Health Canada's website on August 24.

Medical Marijuana Lowers Prescription Drug Costs

By Pat Anson, Editor

Prescriptions for pain relievers and other medications have fallen significantly in states where medical marijuana is legal, according to a new study published in the journal Health Affairs.

Researchers at the University of Georgia analyzed data from Medicare’s Part D prescription drug program in 2013 – a year when 17 states and the District of Columbia had legalized medical marijuana -- and estimated there was a cost savings of $165 million in prescription drug claims.

The results suggest that if all 50 states had medical marijuana laws that year, the overall savings to Medicare would have been around $468 million.

“Generally, we found that when a medical marijuana law went into effect, prescribing for FDA approved prescription drugs under Medicare Part D fell substantially,” said lead author Ashley Bradford, a recent graduate from the University of Georgia who will pursue her master's degree in public administration this fall.

"The results suggest people are really using marijuana as medicine and not just using it for recreational purposes.”

Compared to Medicare Part D's 2013 total budget of $103 billion, the $165 million in estimated savings only amounts to half of one percent. But it shows the potential for medical marijuana as an alternative to prescription drugs for a wide range of ailments, including pain. Until now, little was known about the impact medical marijuana was having on healthcare spending.

"We realized this question was an important one that nobody had yet attacked," said co-author W. David Bradford, who is the Busbee Chair in Public Policy in the UGA School of Public and International Affairs.

Researchers studied data on all prescriptions filled by Medicare Part D patients from 2010 to 2013, and then narrowed down the results to focus only on nine conditions for which marijuana might serve as an alternative treatment:  anxiety, depression, glaucoma, nausea, pain, psychosis, seizures, sleep disorders and muscle spasticity (stiffness).

The biggest reduction in prescriptions was for analgesics used to treat pain. Doctors in states where medical marijuana was legal wrote an average of 1,826 fewer daily doses for analgesics in 2013.

Currently 24 states and the District of Columbia have laws allowing for medical marijuana. The federal government still considers marijuana illegal, however the Drug Enforcement Administration is reviewing marijuana’s status as Schedule I controlled substance. Reclassifying marijuana could make it legal for medical use in all 50 states.

“Our findings and existing clinical literature imply that patients respond to medical marijuana legislation as if there are clinical benefits to the drug, which adds to the growing body of evidence suggesting that the Schedule I status is outdated,” said Bradford. “Lowering the costs of Medicare and other programs is not a sufficient justification for approving marijuana for medical use, a decision that is complex and multidimensional. Nonetheless, these savings should be considered when changes in marijuana policy are discussed.”

Previous studies have found a significant decline in use of opioid pain medication in patients who use marijuana and that marijuana users are not at greater risk of alcohol and drug abuse.        

Marijuana Based Drug Effective in Treating Epilepsy

By Pat Anson, Editor

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

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

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

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

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

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

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

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

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

DEA: Decision Not Made on Marijuana Legalization

By Pat Anson, Editor

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

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

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

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

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

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

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

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

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

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

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

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

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

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