Pot for Pain? 80% of Docs Surveyed by PPM Say Yes
Medical marijuana continues to be a hot topic in pain management and of great interest to readers of Practical Pain Management. In September, PPM featured medical marijuana (MM) on our cover and the main article is currently ranked as the #1 most read article on the PPM website.1
In an online poll that accompanied the issue, readers were asked “Do you recommend medical marijuana for your chronic pain patients?” Out of the 414 clinicians who completed the poll, 80% said "Yes" and 20% said "No". Although the results of the survey surprised us, they reflect a national trend of acceptance of medical marijuana.
“The results of the poll do not surprise me,” said Gregory T. Carter, MD, MS, a physiatrist who specializes in neuromuscular medicine and practices in Spokane, WA. I think that most physicians are becoming increasingly aware of the evidence base that supports the use of marijuana for the treatment of chronic pain. There are thousands of years of anecdotal evidence of cannabis used to treat pain, and now we are starting to see that information translated to the peer review literature,” Dr. Carter said.
“I also think that most patients who use marijuana for pain find it easier to use than opioids and in many regards,” Dr. Carter said, adding that, in some cases, marijuana may provide greater efficacy with less side effects, including no constipation or respiratory depression. He added that patients may “feel better overall” when they use marijuana as opposed to opioids for chronic pain.
The poll results should be interpreted with caution, noted Ryan Vandrey, PhD, Associate Professor of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine, in Baltimore.
“Certainly, an overwhelming number of individuals responding to the poll recommended cannabis for pain, but that only reflects 10% of the PPM readership and is not a representative sample,” Dr. Vandrey noted.
9.5% of Americans Use Marijuana
In related news, the percentage of Americans who reported using marijuana in the past year more than doubled between 2001-2002 and 2012-2013 (from 4.1% to 9.5%; P<0.05), according to a report published online ahead of print in JAMA Psychiatry.2 Increases in prevalence of marijuana use were particularly notable among women and individuals who were black, Hispanic, living in the South, and middle-aged or older, the authors report.
The increase in marijuana use disorder during the same time frame was nearly as large (from 1.5% to 2.9%), according to national surveys conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health.3 Groups with notable increases in marijuana use disorders include adults ages 45 to 64, blacks and Hispanics, and adults with the lowest incomes or who live in the South.
Based on this data, approximately 30% of people who reported marijuana use in the past year met criteria for marijuana use disorder during 2012-2013, as defined by the Diagnostic and Statistical Manual of Mental Disorders. This includes symptoms such as taking the drug in larger amounts or over a longer period than was intended by the user; the persistent desire to cut down or control use/unsuccessful efforts to do so; failure to fulfill major role obligations at work, school or home as a result of marijuana use; and tolerance and/or withdrawal.
The near doubling of the prevalence of marijuana use disorder among the U.S. population in the last decade can be attributed to the substantial increase in marijuana use overall, rather than an increase in rates of addiction among users, according to a statement from the NIAAA. The proportion of users with marijuana use disorder actually decreased (35.6% to 30.6%) between 2001-2002 and 2012-2013. Symptoms of marijuana use disorder were assessed during face-to-face interviews.
Significance for Pain Clinicians
Both these surveys reflect a change in attitute toward the use of marijuana. As a growing number of states decriminilize marijuana, clinicians will be confronted with patients who would like to try medical marijuana as an alternative to their current pain regimen. For more information on the legal considerations of recommending medical marijuana, as well as other considerations, please see the September issue of Practical Pain Management.