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."
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."
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
But note that smoking is just one way to ingest cannabis. Edibles, extracts, and vaporizing are becoming more popular even among recreational users.
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]
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.
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.
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.
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.
The elders also know that a population with access to cannabis is difficult to interest in wars.
"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.
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.
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.