Recommending Medical Marijuana for Pain Conditions
Q: Do you recommend medical marijuana to patients with pain conditions?
Dr. Carter: Yes.
Q: What pain conditions do you believe medical marijuana is useful for?
Dr. Carter: Cannabis has been used for thousands of years as a safe and useful means of providing pain relief. A strong evidence base supporting the use of cannabis to treat chronic pain, particularly neuropathic pain, already exists in the peer-reviewed literature. Medical marijuana works very well for patients with fibromyalgia, degenerative arthritis, spinal cord injury, neuromuscular disorders such as amyotrophic lateral sclerosis, and multiple sclerosis, among other conditions.
Q: Could you give an example of a patient with chronic pain who has benefited from medical marijuana?
Dr. Carter: I could give you hundreds of examples. I am particularly interested in how cannabis can help patients with chronic neuromuscular diseases. Cannabinoids can cause neuromodulation via direct, receptor-based mechanisms at numerous areas within the nervous system.1 This neuromodulation results in therapeutic properties including analgesia as well as anti-oxidation, neuroprotection, anti-inflammation, immunomodulation, glial cells modulation, and tumor growth regulation.1,2
Q: Which patients should not use medical marijuana?
Dr. Carter: Cannabis is not for everyone. I would not recommend it for patients with a history of psychiatric disorders, such as schizophrenia.
Q: How do you counsel patients with chronic pain conditions about the benefits and risks of medical marijuana?
Dr. Carter: I use an approach very similar to what I use with opioids, although I think cannabis is considerably safer than opioids. Nonetheless, marijuana is associated with abuse potential and risk of dependency in susceptible patients, so I go over the risk/benefit ratio and do risk stratification with patients.
Cannabis has the potential for adverse effects, including motor and cognitive impairment (see Marijuana: Does It Cause Cognitive Impairment During Driving?). However, from a harm-reduction standpoint, these problems are less serious and less common than the potential risks associated with opioid use.
The safety profile of cannabis is quite good, and there is no hard evidence of significant toxicity at higher doses. For the most part, the risk of developing tolerance to the therapeutic properties of cannabis is minimal, particularly when compared to the risk with drugs such as opioids and benzodiazepines.
Q: What other aspects of this topic should pain specialists know about?
Dr. Carter: Pain medicine specialists should examine their attitudes and beliefs about cannabis to check for any bias, inform themselves about the most current literature and clinical guidelines, and embrace the scientific process, which continues to document the therapeutic effects of cannabis.
Practitioners must be willing to advocate for chronic pain patients who want to legitimately access a medicine that could potentially help them and safeguard them from the harmful effects of other options, such as opioids.
Using science and logic rather than societal and political posturing, we can bring our antiquated cultural conditioning about marijuana into the 21st century and help create safe, rational, and useful regulations for medicinal cannabis. The scientific process should be allowed to evaluate the potential therapeutic effects of cannabis, dissociated from the societal debate over the potential harmful effects of nonmedical marijuana use.
This class of compounds holds tremendous therapeutic potential for neurological disease and also continues to be confirmed as having remarkably low toxicity.
—Reported by Kristin Della Volpe