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Medical Marijuana for Chronic Pain

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Updated April 16, 2014

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Evidence for Medical Marijuana

 

In 1999, the Institute of Medicine (IOM) issued an evidence-based report on medical marijuana. It listed conditions that may be helped by cannabinoids, including neuropathic pain, acute pain, spinal cord injury, post operative pain, cancer pain, multiple sclerosis, nausea and appetite control among others.

The report says that discovery of a cannabinoid receptor in the parts of the nervous system that detect and control pain perception means that marijuana is a very promising source of pain relieving medications in the future.

The IOM found that cannabinoids are capable of giving mild to moderate pain relief comparable to codeine. In one study cited in the report, 10 milligrams of THC (marijuana's active ingredient) yielded the same amount of pain relief as 60 milligrams of codeine. Side effects were similar with both drugs, but the THC seemed to be more sedating than the codeine. The patients taking the THC reported a greater sense of well-being and less anxiety.

The IOM also found that by combining cannabinoids with an opioid, the opioid may work better. This may decrease the dose of addictive narcotics needed to control pain.

The IOM says that opioids are not effective enough for pain, and new medications are "welcome."

What's your opinion? Is medical marijuana use be approved for pain conditions?

 

Medical Marijuana Side Effects

 

As mentioned earlier, side effects from using marijuana are few. In many cases, they are significantly less than the narcotic pain relievers back pain sufferers take to keep their pain under control.

Dizziness is the most common side effect of all types of marijuana and its extracts and synthetic derivatives. Also, it's possible to develop tolerance to or a dependence on the drug.

In Marinol, the synthetic version of THC used for nausea and appetite stimulation mentioned earlier, cardiovascular symptoms such as syncope and tachycardia have been noted. The FDA recommends exercising caution in taking Marinol by people at risk for heart disease or stroke. But research has shown little effect on the risk for heart disease or stroke by marijuana users, even for those who are already at risk. More studies are needed on this important topic. In the meantime, people with increased risk for cardiovascular problems should speak with their doctor before taking marijuana.

The FDA also recommends caution for those with a history of substance abuse, drug or alcohol dependency, depression, mania or schizophrenia, and it recommends against drinking or taking other sedatives, psychoactive drugs or hypnotic drugs along with Marinol. The effects of Marinol have not been studied in pregnant women, nursing mothers or kids, so these people should not take the drug. People under the influence of Marinol shouldn't drive or operate heavy machinery, as dizziness is one of the main side effects. All cautions listed here also apply to smoking marijuana.

Marijuana is usually smoked, which does present a risk to health. Smoking increases the risk for lung cancer and heart disease, for example. Also, the unprocessed marijuana plant contains more toxins than a filtered cigarette. Granted, people usually inhale less marijuana than tobacco (for various reasons) but the Institute of Medicine still does not recommend this drug delivery method. The IOM says that smoked marijuana is not a modern medicine. While their recommendations do call for studies on smoked marijuana, they are quick to clarify their intention by saying, "studies on smoked marijuana will be used as a first step in developing non-smoked ways of taking it." Some of those new drug-delivery methods include inhaling a fine mist and taking it under your tongue.

 

Where It Stands

 

The IOM says its priorities are to develop safe, rapid onset delivery of marijuana-related drugs. It also plans to learn more about how the active ingredients affect the body, including psychologically. And it plans to evaluate the risks of smoking medical marijuana.

Scientists are now are in the lab developing new medicines based on marijuana. According to Dr. Mohamed Naguib, cannabinoid researcher at University of Texas Anderson Cancer Center, "When there's a nerve injury, the body typically overcompensates, creating even more nerve damage. Our research shows that the addition of a certain type of cannabinoid turns off the overcompensation, reducing the likelihood of this type of pain."

 

Concerns about drug abuse and dosing amounts are obstacles to the drug-development effort.

Although most medications currently used for pain work better than marijuana, the IOM acknowledges that everyone is different, and for some, the best choice for relief may be cannabinoids. What's your opinion?

Sources:

Americans for Safe Access Foundation. Chronic Pain and Medical Marijuana. Accessed July 2010.

Hoffmann,D., et. al. Medical Marijuana and the Law. NEJM. April 22 2010 Vol. 362. No 16. http://content.nejm.org/cgi/content/full/362/16/1453

House of Lords. Science and Technology - Ninth Report. Science and Technology Committee Publications. Session 1997-98 http://www.publications.parliament.uk/pa/ld199798/ldselect/ldsctech/151/15107.htm

Joy, J., et al. Institute of Medicine Marijuana and Medicine: Assessing the Science Base. National Academies Press. 1999. Accessed July 2010. http://www.nap.edu/openbook.php?record_id=6376&page=240

Marcus Conant, et. al. Brief of Amici American Public Health Association, American Medical Student Association, California Nurses Association, Lymphoma foundation of America, Barbara M. Douglass, George Lee McMahon, Elvy Musikka, and Irvin Henry Rosenfeld on behalf of the appellees Supporting Affirmance. http://www.drugpolicy.org/docUploads/conantv_jurith.pdf

Marijuana Policy Project. Marijuana Prohibition Facts. Jan 2010. Accessed July 2010.

Marinol Dronibinol Capsules Rx. NDA 18-651/S-021 Sept 04 Accessed July 2010.http://www.fda.gov/ohrms/dockets/dockets/05n0479/05N-0479-emc0004-04.pdf

NIDA Info Facts: Marijuana. National Institute of Drug Abuse. July 09. Accessed July 2010.

 

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