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posted by mrpg on Sunday April 08 2018, @11:46AM   Printer-friendly
from the king-of-pain dept.

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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  • (Score: 3, Informative) by AthanasiusKircher on Sunday April 08 2018, @01:59PM (6 children)

    by AthanasiusKircher (5291) on Sunday April 08 2018, @01:59PM (#663935) Journal

    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.

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  • (Score: 3, Interesting) by rondon on Sunday April 08 2018, @02:27PM (2 children)

    by rondon (5167) on Sunday April 08 2018, @02:27PM (#663938)

    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)

      by Magic Oddball (3847) on Monday April 09 2018, @02:29AM (#664148) Journal

      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

        by rondon (5167) on Monday April 09 2018, @01:01PM (#664386)

        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)

    by Immerman (3985) on Sunday April 08 2018, @03:22PM (#663960)

    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

      by AthanasiusKircher (5291) on Sunday April 08 2018, @07:14PM (#664033) Journal

      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

    by sjames (2882) on Sunday April 08 2018, @07:41PM (#664044) Journal

    But note that smoking is just one way to ingest cannabis. Edibles, extracts, and vaporizing are becoming more popular even among recreational users.