Medical Marijuana and Pain

The arguments for legalizing marijuana are overwhelming, only being delayed by governments that get elected on a ‘tough on crime’ stance. This despite the fact that legalizing or decriminalizing pot would allow police to focus on crimes that cause more damage to individuals and society. The first step along the the way to complete decriminalization has been the approval of the use of the drug for medical purposes. Unfortunately, the evidence for the medical benefits in many areas is not particularly strong.

David Gorski at Science Based Medicine refers to medical marijuana as The New Herbalism in two posts from July and August of this year. In those posts he discusses the mechanisms of cannabinoid receptors and some of the medical conditions that marijuana is currently used for. He discusses the current evidence, or lack thereof, for its use along with of the downfalls. Primarily his criticisms include the lack of well designed studies to back the claims and the issues with smoking, the most common delivery method.

He further describes some of the issues around the lack of studies; one of which has been the difficulties in using an illegal product in research. In addition, with any plant based medical treatment the issue of quality control is virtually impossible. Varieties vary in active ingredients making dosing difficult. Researchers and prescribers need to know the dosage of medication they are using to determine when and how much to use for each patient.

Another problem is the politicization of medical marijuana. Chronic pain and Chemotherapy-induced nausea and vomiting (CINV) are two conditions that can be treated with chemically derived products, legislators have been reluctant to allow prescriptions for such a broad swath of society.

Gorski’s second post focuses on the false hype of marijuana as a cure for cancer.

However, a new study published in the Journal of the American Medical Association suggests that the use of marijuana for chronic pain may decrease deaths from long term opiod use.

Legalization of Medical Marijuana and Incidence of Opioid Mortality Marie J. Hayes, PhD; Mark S. Brown, MD

The rapid acceleration of prescription opioid–related overdose deaths in the United States is correlated with the availability of stronger opioid medications, as well as a change in medical practice from withholding opioid medication because of dependence risk to treating patients with chronic pain with opioids. Subsequently, the pendulum of concern has swung again, driven by the public health crisis of rising opioid analgesic addiction, overdose, and death. Opioid medications are problematic as a treatment for chronic pain. Opioid pharmaceuticals cause other adverse effects when used for long periods, such as tolerance, hyperalgesia, and gastrointestinal complications, making this class of drugs a poor choice for long-term use. As is well known, prescription opioids also have great abuse potential due to their influence on stress and reward circuits in the brain, promoting nonmedical use and abuse and diversion of prescription medications.

According to the US CDC, “each day 46 American adults die from an overdose of prescription painkillers, and Health care providers wrote 259 million prescriptions for painkillers in 2012.” This does not include the non-lethal effects of addiction on individuals and society.

This paper should not be the last word on the topic, but it gives us another reason to fund quality research on the appropriate use of marijuana. Something that is definitely not going to happen in Canada under our current anti-science government.

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