Medical Marijuana's 'Catch-22': Limits On Research Hinders Patient Relief
By the time Ann Marie Owen, 61, turned to marijuana to treat her pain, she was struggling to walk and talk. She was also hallucinating. For four years, her doctor prescribed a wide range of opioids for transverse myelitis, a debilitating disease that caused pain, muscle weakness and paralysis. The drugs not only failed to ease her symptoms, they hooked her.
When her home state of New York legalized marijuana for the treatment of select medical ailments, Owens decided it was time to swap pills for pot. But her doctors refused to help. "Even though medical marijuana is legal, none of my doctors were willing to talk to me about it," she says. "They just kept telling me to take opioids."
Although 29 states have legalized marijuana to treat pain and other ailments, the growing number of Americans like Owen who use marijuana and the doctors who treat them are caught in the middle of a conflict in federal and state laws — a predicament that is only worsened by thin scientific data.
Because the federal government considers marijuana a Schedule 1 drug, research on marijuana or its active ingredients is highly restricted and even discouraged in some cases. Underscoring the federal government's position, Health and Human Services Secretary Alex Azar recently pronounced that there was "no such thing as medical marijuana."
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U.S. Senate Minority Leader Chuck Schumer (D-NY) has come out in support of federal cannabis decriminalization, just in time for 4/20:
The Minority Leader of the Senate is making it official the day before 4/20: He's down with legal weed. In an exclusive interview with VICE News, Sen. Chuck Schumer (D-NY) confirmed he is putting his name on legislation that he said is aimed at "decriminalizing" marijuana at the federal level. For Schumer, this is a shift. While he has backed medical marijuana and the rights of states to experiment with legal sales of pot, what he is proposing is a seismic shift in federal drug policy.
"Ultimately, it's the right thing to do. Freedom. If smoking marijuana doesn't hurt anybody else, why shouldn't we allow people to do it and not make it criminal?" Schumer said.
The legislation should be available within a week or so, and would remove cannabis (still listed as "Marihuana") from the Drug Enforcement Administration's list of Schedule I substances. States would then be free to regulate or continue to prohibit the plant. Cannabis advertising would be regulated as are alcohol and tobacco advertising. (Also at NPR, CNN, The Washington Post, and CNBC, as well as Reason taking a shot at Schumer for not doing it sooner.)
A majority of Americans support the legalization of cannabis, including, for the first time, a majority (51%) of Republicans, according to Gallup. Nine states and the District of Columbia have legalized cannabis for recreational use. 29 states, D.C., Guam, and Puerto Rico have legalized medical use of cannabis, and another 17 states have legalized the use of cannabidiol (CBD). Cannabis became available for recreational purposes in California on January 1.
(Score: 4, Informative) by Runaway1956 on Sunday April 08 2018, @11:52AM (19 children)
The reason doctors don't want to prescribe marijuana has little to do with that lack. We had a recent discussion about doctors being "rewarded" for prescribing high dollar opiods. "Rewarded" properly belongs in quotes, because the pharmaceuticals were actually BRIBING doctors to write prescriptions.
(Score: 2) by Entropy on Sunday April 08 2018, @12:14PM (17 children)
I don't believe for a moment that's responsible for a reasonable number of similar cases. Marijuana is still stigmatized, and until recently was illegal pretty much everywhere. It's still federally illegal(which is retarded), and talking about utilizing it as a treatment is a very, very new concept. I think the new concept alone, if not the stigmatization easily explains away incidents such as this.
The doctors I know at least have a deep sense of professional ethics, which would really prevent things like this. Unless you're going to a "pill mill" doctor, of course. That kind of news story is just part of the new, cool "war on drugs" rebranded into "war on opiates". Of course opiates are the only reasonably strong painkiller we have at the low end in the United States, so there are almost no other options that actually work. I know there are those out there who will just tell everyone that they "man up", take the pain, and refuse to introduce such poisons into their body, and if that's how you want to handle pain then I applaud your dedication, but don't try to force your beliefs on people that want to actually have something relieve their temporary pain.
Other countries have over the counter opiates of varying strengths. Obviously Marijuana will naturally fill the low end painkiller niche, once the federal government steps into the current century that is.
(Score: 2) by rondon on Sunday April 08 2018, @01:13PM (9 children)
Research already shows that cannabis can work better than opiates for long term (chronic) pain. Not that I didn't say always, or for short term pain such as surgeries. But for long term pain, any doctor that steers you towards opiates over cannabis or other long term pain solutions is probably doing you a disservice.
There are reasons to take opiates, and there are reasons to take cannabis. Anyone who tells you differently probably has an agenda - however - this is not a true equivalence. Long term cannabis use can have some small to moderate complications. Long term opiate use is a death sentence. Keep that in mind as you defend doctors who push opiates on their patients who have chronic pain.
(Score: -1, Troll) by Anonymous Coward on Sunday April 08 2018, @01:39PM
A lone man sat on a bench in a certain park. That alone would not be surprising, but what was surprising was that this man was completely nude. Due to this, some might mistake this man for a sexual deviant, but the truth was something much more grand; he was a freedom fighter. That's right: this man was a staunch proponent of public nudity, and fought valiantly for the right to be nude in public. Even though it was not currently tolerated, he still bravely ventured out in public while nude in order to fight for his beliefs. This man, Brendonson, stood up. If one were to glance at the bench on which he previously sat, they would notice that the man left something behind.
Brown. Rancid. Yes, it was feces. What's more, the feces stuck to the bench was almost exactly the shape of the man's buttocks. One might ask, "Why?" Because the man's buttocks was always covered in a thick layer of feces, for precisely such occasions. It was all done in the name of freedom. This man would sit in various places and mark them as his territory using his fetid feces. But that wasn't all, oh no. A keen observer would notice something moving.
They wriggled and they squirmed every which way. These beings inhabitated the feces the man left behind, and were so numerous that they were impossible to count. The most suitable name for them would be "pinworms". However, that was but a deception; these squirming beings were on an entirely different level from ordinary pinworms. Battle-hardened and fierce, they were ready to attack any who might threaten the sanctity of the areas the man had conquered. These worms were Brendonson's true power, and the guardians of his dominions. The man departed in a manner befit for a king, leaving his new territory and army behind.
Where would Brendonson go next? What new lands would he conquer? And how would the bigots who tried to control his freedom of expression react to it all? The only certainty was that the man would bravely charge forth and defeat all who stood in his path to freedom.
(Score: 3, Informative) by AthanasiusKircher on Sunday April 08 2018, @01:59PM (6 children)
I'm not going to disagree about the evil of modern medicine overprescribing opiates.
However, I'd say the "jury is still out" on whether long-term cannabis use has more than "small to moderate complications," particularly when it is smoked. Inhaling smoke from burning matter is never good for your lungs, and studies have shown cannabis smokers have a higher incidence of respiratory ailments than the general population. Much of the research on long-term chronic use is still somewhat inconclusive, but the dangers of smoking (and second-hand smoke, for that matter) are there, even if you're not smoking tobacco.
Part of the issue in comparing to tobacco is that it's easy to find people who smoke tobacco almost constantly, so we could relatively easily measure its long-term effects, cancer risk, etc. (Also, it wasn't illegal, making it easier to get good data from people willing to be honest about their use.) Marijuana smokers generally don't consume anywhere near as much smoke, but I don't think most researchers would be surprised to find the cumulative negative impact of smoking cannabis is as bad as a similar amount of tobacco smoking (possibly worse, due to the length of time cannabis smokers tend to hold smoke in their lungs, often longer than tobacco smokers, thereby increasing absorption of carcinogens, etc.).
For other delivery methods than smoking, cannabis may indeed be a better alternative than opiates, though we desperately need better research. But it's important to note that marijuana is not magically exempt from the general concept that "breathing in smoke" is usually not good for you.
(Score: 3, Interesting) by rondon on Sunday April 08 2018, @02:27PM (2 children)
That is a good point. I don't think of medical cannabis as a "smoked" medication, but your comment made me realize that it is often consumed that way. Pills and other delivery methods are available though.
I understand that my knowledge about this is anecdotal, but that is due to the "war on drugs" and no fault of my own. Anyways, I have seen the results of long term cannabis use and long term opiate use. One of those completely and irrevocably destroys lives, the other may cause lung cancer after a really, really long time. I work in a healthcare related field, so my sample size is a couple of orders of magnitude better than n=2, but I understand that it is still not science.
(Score: 2) by Magic Oddball on Monday April 09 2018, @02:29AM (1 child)
Was the long-term opiate use you witnessed with prescription under medical supervision, or illegal? There's going to be a vast difference between a patient who takes a pill or two 2-3 times/day & sees their doctor every 6 months, and a junkie who is abusing opiates.
There's also the problem of destroying lives by leaving the individual in too much physical pain to function. I can say that my mother's life was still pretty good when she was prescribed enough pills to control the pain from her severely-damaged spine, while scaling her back to a minimal dose has left her in too much agony to do much more than shuffle to the toilet.
(Score: 2) by rondon on Monday April 09 2018, @01:01PM
Mostly doctor supervised, to be honest. Long-term opiate use wears away at an individual's ability to be a functional human being without opiates. Like you've mentioned, in some cases that is still the best case scenario (i.e., your mother). In many other cases, I would like to see other options tried first, second, and third if possible. Seeing a 50 year old, otherwise healthy male die of pneumonia because opiate use has severely depressed his breathing for years feels like a terrible waste. I wish we had better options for chronic pain, and I wish we'd explore the options we do have before we prescribe opiates.
(Score: 3, Interesting) by Immerman on Sunday April 08 2018, @03:22PM (1 child)
Actually there has been research done on long-term cannabis smoking - lots of heavy users out there that were pretty open about it long before legalization. And one of the most surprising findings was that long-term heavy cannabis smoking actually appears to slightly *reduce* your chance of developing lung cancer. Surprising because cannabis smoke actually contains a lot more carcinogens than tobacco smoke. But hemp (cannabis included) is also rich in anti-carcinogens, so that's probably responsible, even if the details aren't yet well understood.
I would still expect other respiratory problems though - it burns hotter than tobacco, so is more likely to cause immediate cell and cilia damage, and is still depositing tar on your lungs, interfering with their normal operation.
(Score: 2) by AthanasiusKircher on Sunday April 08 2018, @07:14PM
I've looked at several recent studies that have said the data is inconclusive for cancer and other serious damage to lungs. (But lesser respiratory problems are common, including chronic ones.) Cancer studies are notoriously difficult because cancer often takes so long to develop and there are so many possible confounding factors.
Anyhow, you may well be right in the long run, but I've seen conflicting data (and just searched again and saw the same). Major lung and respiratory health organizations express a level of concern and that more studies need to be done.
My point is just that many people seem to be focusing on the potential positives of marijuana (and there seem to be some) along with the absurd history of how it was made illegal... But lots of folks ignore the fact that smoking (anything) can have serious negative impacts.
(Score: 2) by sjames on Sunday April 08 2018, @07:41PM
But note that smoking is just one way to ingest cannabis. Edibles, extracts, and vaporizing are becoming more popular even among recreational users.
(Score: 2, Informative) by Anonymous Coward on Sunday April 08 2018, @11:59PM
Lack of access to opioids, for some, is also a death sentence.
February, 2018 update of PAIN RELATED SUICIDES associated with opioid pain medication reductions and discontinuations as recommended by the CDC : https://medium.com/@ThomasKlineMD/suicides-associated-with-non-consented-opioid-pain-medication-reductions-356b4ef7e02a [medium.com]
(Score: 2) by hendrikboom on Sunday April 08 2018, @01:30PM (2 children)
Non-steroidal anti-inflammatories such as ibuprofin are more effective than opiates for a lot of pain. They should be the drug of first resort against pain.
(Score: 2) by Entropy on Sunday April 08 2018, @01:52PM (1 child)
My sample size is of course small on this, but I don't know anyone who would say Ibuprofin would work better for relief of pain for any reasonably distracting form of pain. It may be preferred for other reasons(ability to drive, less distracted, ..) but I think it's well established which one is stronger. If the pain isn't a big deal, then Ibuprofin all the way, of course.
This isn't even considering that Hydrocodone often comes mixed with Ibuprofin.
(Score: 2) by Immerman on Sunday April 08 2018, @03:29PM
Agreed - I was laid up for a week or so after surgery, and opiates are what made motion and sleep possible. I'm the sort that usually only needs a half-dose of Ibuprofen for normal pain, but after surgery even the huge (800mg? bigger?) prescription Ibuprofen did nothing.
For normal pain though - Ibuprofen all the way. Fewer side effects, and the anti-inflamatory effects can often help relieve the source of a lot of pain, rather than just interfering with your ability to feel it.
(Score: 2) by Runaway1956 on Sunday April 08 2018, @03:15PM (1 child)
It seems necessary to point out that there are millenia old recipes for various treatments, using cannabis. Many of them, especially in the US, were nothing but snake oil. But, there were preparations made and used even here, that were credibly decent pain relief medications.
While Jack Herer exaggerated the benefits of cannabis sometimes, he mostly got it more accurate than government, or even most hemp activists. Among the displays on his site, were empty bottles of various preparations for toothache, headache, indigestion, lack of appetite - I can't even begin to remember everything he had. All of them produced prior to the 1930's when the US decided that "hemp is evil".
https://en.wikipedia.org/wiki/The_Emperor_of_Hemp [wikipedia.org]
https://www.erowid.org/culture/characters/herer_jack/herer_jack.shtml [erowid.org]
Meanwhile - the rest of the world has "research" on hemp. It would make a lot of sense to collect the wisdom of the dozens of other countries, then do specific research to verify or to repudiate the various claims.
Cannabis in medicine is a very, very old concept. We are like the backward children who need to re-discover what our elders have known all along.
(Score: 0) by Anonymous Coward on Monday April 09 2018, @03:32AM
The elders also know that a population with access to cannabis is difficult to interest in wars.
(Score: 0, Disagree) by Anonymous Coward on Sunday April 08 2018, @06:59PM
"The doctors I know at least have a deep sense of professional ethics"
while they (perhaps blindly) poison their patients with all manner of fraudulent and misleading medicines.
(Score: 2, Informative) by fustakrakich on Sunday April 08 2018, @07:13PM
It's still federally illegal(which is retarded)
It is not retarded. It is business, operating under very exclusive conditions. And now more people want to *wet their beaks*.
The thing with weed is that it requires very little infrastructure for individual cultivation, which limits its profit potential, so prohibition, which also still has strong racial aspects, still lingers.
La politica e i criminali sono la stessa cosa..
(Score: 0) by Anonymous Coward on Sunday April 08 2018, @04:59PM
I think the more likely reason is that it's still illegal to prescribe marijuana under federal law. Then once the patient does get a prescription, there can be issues with getting it filled.
Also keep in mind that prescribing pain medication has become a massive pain and is getting more and more complicated over time as the feds try to crack down on over-prescription and abuse. Here in WA state, there were 112m doses prescribed a day. That's enough for every man, woman and child in the state to take 16 days worth every day. And it's especially scary since that's even with medicinal marijuana being legal under state law.
AFAIK, the research on medical marijuana is pretty solid, especially for pain management.
(Score: 5, Interesting) by Anonymous Coward on Sunday April 08 2018, @01:50PM (4 children)
Gotta keep the prison industrial complex fed. Gotta keep big pharma funded. Gotta keep giving the police state a reason to exist. If we don't do that, things might actually start to get better for the 99.99%*, and we can't have that now can we?
*The .01% has absolutely no problem whatsoever getting access to any drugs they want. Drug laws don't apply to them.
(Score: 3, Informative) by Whoever on Sunday April 08 2018, @04:00PM (3 children)
The is a huge dose of racism in the motivation to make cannabis illegal.
Cannabis is traditionally the drug of choice for many non-white communities, while alcohol is traditionally the drug of choice for white communities. Cannabis legislation causes blacks to be jailed in disproportional numbers.
(Score: 2) by takyon on Sunday April 08 2018, @04:03PM (1 child)
Close, but it's a bit different:
https://www.aclu.org/gallery/marijuana-arrests-numbers [aclu.org]
[SIG] 10/28/2017: Soylent Upgrade v14 [soylentnews.org]
(Score: 2) by Whoever on Sunday April 08 2018, @06:59PM
Apparently, you missed the use of "traditionally" in my post. Perhaps "historically" would have been better?
(Score: 0) by Anonymous Coward on Sunday April 08 2018, @07:01PM
race has little to do with it these days. it's more about hooverin' up the poor to make room for condos and to further shrink the middle class by making them pay for it all. most of the masters care not for the color of the slave.
(Score: 0) by Anonymous Coward on Sunday April 08 2018, @05:42PM (1 child)
Hearst is responsible for this mess. Hearst had vested interests in things which hemp competed with, such as synthetic fiber and wood pulp. So hearst ran an insane disinformation campaign to try to demonize Hemp, in his papers. These manias can take on a life of their own. It is very similar to the anti-masturbation hysteria of the Victorian era which led to circumcision being pushed by Kellogg to punish males for masturbation, leading to the circumcision scam prevelent in america, but thats another story.
As far as the effects of cannibus, its not all that of an enlightening item in my opinion, but they have the enlightening ones like LSD and mushrooms covered too (which also should be decriminalized). Gotta keep the public in the dark spiritually, and make sure they cannot transcend the 3 dimensional prison of physical reality. Cannibus can really help people live normal lives and alleviate suffering shows the contempt the government has for people that they would want to keep people from this medicinal plant.
(Score: 0) by Anonymous Coward on Sunday April 08 2018, @07:04PM
yes, this is the crux of the issue. that people allow the government to dictate what they can ingest or treat ailments with. it's beyond ridiculous.
(Score: 0) by Anonymous Coward on Sunday April 08 2018, @07:43PM (2 children)
You don't have to fuck up your lungs, get burn spots on your stuff, and support violent dealers. You can get a prescription for normal pills:
https://en.wikipedia.org/wiki/Dronabinol [wikipedia.org]
https://en.wikipedia.org/wiki/Nabilone [wikipedia.org]
If that won't do, then "medical" is a lie.
(Score: 1, Interesting) by Anonymous Coward on Sunday April 08 2018, @08:58PM
There are hundreds of different chemicals in pot, and oral administration metabolizes differently than smoking, which goes quickly into the bloodstream. This is an apples and oranges comparison. The purified, standardized drugs may have their place; but we have a lot to learn about the synergies that take place with the whole plant. If it hadn't been illegal all this time, we'd probably know a lot more.
(Score: 0) by Anonymous Coward on Monday April 09 2018, @03:39AM
Why would there be burn spots on my stuff and violent dealers? The budtender at the dispensary I go to is really friendly and helpful. There's not much in my garage besides the structure itself, so furniture has never been a problem. I don't allow smoke of any kind (tobacco/cannabis/herbal) inside my house.
(Score: -1, Troll) by Anonymous Coward on Sunday April 08 2018, @08:08PM (1 child)
Marijuana is a gateway drug to harder drugs. It has 0 medicinal use. The US does not need more stupid pot heads and other substance abusers. Fix the societal problems, and the root for substance abuse disappears.
(Score: 0) by Anonymous Coward on Sunday April 08 2018, @10:09PM
*slow clap*
(Score: 2, Insightful) by Anonymous Coward on Monday April 09 2018, @12:05PM
There's a whole other healing component to Marijuana that nobody seems to talk about. It's in the Zen of growing your own. Not in an indoor "Grow Op" type way, but outside in the back yard, along with your tomatoes and lettuce. It takes care and patience. Every morning, you get a walk in the garden to deliver water and nutrients. And then you know exactly what has gone into it's production. I use only organic fertilizers with mine - that is seaweed during the grow phase and molasses during flower. It's not the "Best Weed" I've ever smoked but it's totally the "Best Weed" I've ever smoked. You end up a little bit more synced with nature as you have to watch the moon / frost cycles in the fall that indicate when to harvest.
Fresh air, vitamin D, walk in the garden, meditation.... Those are side effects I've experienced from weed.
Eh wot? You can smoke it too? Crazy stuff.