Because of this past November elections, the total number of states that have voted to legalize recreational or medical marijuana is now up to 29. That means that 65 million people in United States are authorized to use marijuana either recreationally or medically. Put another way, more than 50% of Americans have access to medical marijuana.
As time goes on, more and more people reach for marijuana as a treatment method for pain or other health concerns. As a result, physicians are increasingly being asked by patients about marijuana, its risks, its potential benefits and whether they should consider it as part of their overall treatment program.
Unfortunately, the clinical record is still being developed. Physicians, however, need to be able to accurately address these questions as they arise.
Fortunately, a recent study from Harvard as well as other recent clinical research gives us more insight into the situation and allows the clinician to address the patient’s questions as to whether marijuana should be used for medical treatment and if there are any short or long-term side effects of use.
One of the reasons legislatures in states around the country have put the medical marijuana question on the ballot is because there is some scientific support for the use of marijuana to decrease pain and to offer an alternative to opioid use.
Indeed, several scientific studies have found evidence that patients who use medical marijuana could reduce their use of other prescribed pain medications. Opioid use, for example, has been the subject of significant regulatory and medical concern lately.
Per the American Society of Addiction Medicine, drug overdose is the top cause of accidental deaths in the U.S., and opioid addiction is leading the epidemic—with over 20, 000 overdose deaths related to prescription pain relievers in 2015, and zero deaths related to medical marijuana. One of the downfalls of prescribed pharmacological medication is the negative and potentially dangerous side effects, especially those which are long term and irreversible.
The other issue is the danger of adverse effects if patients take more than one medication and a harmful reaction occurs. Furthermore, patients become tolerant to the medication and need more and more of it to reduce the pain. Therefore, it is a significant finding that patients who use medical marijuana have been able to reduce their intake of opioids use.
But aside from decreasing the use of pharmacological prescription medications, how beneficial is medical marijuana on its own and what risks does it pose?
Researchers from Harvard Medical School, Tufts University, and McLean Hospital conducted a study which assessed the impact of marijuana use on patient’s cognitive performance and function, as well as impact on pain score, along with some other factors. Some of the tests were Stroop Color Word Test and Trail Making Test, social and emotional disability scales, pain severity and pain interference on brief pain inventory (BPI) among others.
The objective of the study was to determine the long-term effects of medical marijuana treatment on pain and functional outcomes of patients who had chronic pain and were resistant to other treatments. The first phase of the pilot study was completed in three months.
This was the first study to examine the cognitive performance in medical marijuana patients prior to initiation of treatment and then compare the scores to performance following regular marijuana use.
The results indicate that patients have shown improvement on assessments of executive functioning by increasing the speed rate at which tasks were performed, without diminishing the accuracy of responses. Patients showed improved pain scores and more functionality. Other outcomes included improved S-TOPS scores (physical, emotional and social disability scale), pain severity, pain interference on the brief pain inventory, better sleep patterns and reduction of opioid use. These results suggest long-term benefits of medical marijuana.
There are other recent and past studies which demonstrated the benefits of medical marijuana use. For example, a study done in California revealed that out of the people surveyed who used medical marijuana, 92% noted that it was helpful in helping them treat a serious medical condition, pain being cited as the number one reason people wanted to use medical marijuana in the first place.
It is also interesting that many of the patients in the Harvard study stopped taking other pharmaceutical drugs for pain once they started using medical marijuana and this was evident as the pain scores improved.
Recent studies conducted in Europe by Dr. Haroutounian have also shown reductions of opioid use with patients using medical marijuana. It had also been found that patients felt greater pain relief when using medical marijuana in conjunction with their medication versus if they only took the pharmacological medication by itself.
Another study which looked at data from 1992-2010 found that states with medical marijuana laws had an increase in labor supply among older adults, as well as improvement in health for older men and some women, showing other beneficial factors of legalizing medical marijuana.
There have also been arguments against the use of prescription medical marijuana. For example, one argument is that marijuana is potentially addictive and amidst the opioid crisis we should be cautious to add another potentially addictive substance.
Since a person builds tolerance for the substance, it is hard to say whether marijuana will achieve long-term success for chronic pain management without disrupting the patient’s life even more and potentially causing addiction. To hedge against this, scientists suggest more low-risk non-pharmacologic approaches, such as exercise and behavioral therapy instead of overloading the brain by introducing additional psychoactive substances, like this opium exactly that relax the mind and make people feel more calm, and that’s why so many people like marijuana, but there is also people who like to feel alert and the opposite effect, so they buy other kind of supplements like the drug from the Lucy film, where she become over smart and alert. Overall, the current scientific evidence is mixed and not enough research conclusions have been made to show a strong argument for either side. It would be difficult to argue that more research is necessary to come to more definite conclusions.
Because of these new laws, clinicians will no doubt be confronted with more questions from their patients. We need more clinical data.
In my opinion, given the current opioid crisis, it is important to research and thoroughly investigate the potential of cannabinoids, because many patients do not get full symptom relief from conventional opiate-based therapies, which are often also associated with various negative side effects.
However, we do not yet understand the interaction between marijuana and opioids, and so I would recommend avoiding medical marijuana certification in a patient prescribed high-dose opioids. Without this research it is impossible to know the full extent of risks and benefits of cannabinoids in the medical arena.
Author’s Information: Didier Demesmin, M.D. is an Interventional Pain Medicine Specialist who is double Board Certified in Anesthesiology and Pain Medicine. He is the president and founder of University Pain Medicine Center. He graduated from Robert Wood Johnson Medical School, where he received the prestigious award for Academic Excellence in Anesthesiology. He completed an Interventional Pain Medicine Fellowship Program at Columbia University, College of Physicians and Surgeons/St. Luke’s-Roosevelt Medical Center in New York. Dr. Demesmin is affiliated with some of the finest hospitals in Central New Jersey, including Saint Peter’s University Hospital, Robert Wood Johnson University Hospital, JFK Medical Center, and Somerset Medical Center.
