Subscription is FREE for qualified healthcare professionals in the US.
15 Articles in Volume 16, Issue #6
Osteoarthritis and Central Pain
Uncovering the Sources of Osteoarthritis Pain
The Synergistic Effects of Mood and Sleep on Arthritis Pain
Nonsurgical Rx of OA: Analyzing the Guidelines
Osteoarthritis Disability Is Often Underestimated By Rheumatologists
10 Pain Medication Myths
The Use of Medical Marijuana for Pain in Canada
6 Common Concerns Regarding Medical Marijuana
What Pain Specialists Need to Know About Medicinal Cannabis
Applying Kinesiology as a Multipronged Approach to Pain Management: Part 2
Practical Guide to Adding Recreation Therapy Into Pain Management
A Novel Treatment for Acute Complex Regional Pain Syndrome
Genetic Testing in High-Dose Opioid Patients
No More “Fifth Vital Sign”
Letters to the Editor: Disc Herniation, SCS, Arachnoiditis, Tapering Opioids

What Pain Specialists Need to Know About Medicinal Cannabis

Page 2 of 2

Q  Can you talk about some of the other compounds that exist in the oral form of medicinal cannabis and if they may be useful for people with neuropathic pain and other conditions?

Dr. Wilsey: There are several compounds in oral form currently approved by the FDA. For instance, dronabinol (Marinol), an oral form of delta-9-THC, is used to stimulate appetite, reduce nausea, and reduce pain. There’s also nabilone (Cesamet). Such pharmacologic oral preparations avoid harmful effects on the respiratory system. However, some experts believe that whole plant cannabis is superior to the FDA-approved oral compounds. As verification, these experts point out that oral delta-9 THC compounds have been on the market in the United States for many years and yet are not widely used.11 Presumably, patients favor whole plant cannabis because of its rapid onset and easy titratability.

Q Is using cannabis in a vaporized form a viable alternative for pain patients?

Dr. Wilsey: Cannabis vaporization is a method aimed at controlling irritating respiratory toxins by heating cannabis to a temperature where active cannabinoid vapors form, but below the point of combustion where smoke and associated toxins are produced. Vaporization has been shown to have similar pharmacokinetics to the inhalation of cannabis cigarettes.12

Q Preventing young people from having access is a big concern with medicinal cannabis. What should pain specialists know about this issue?

Dr. Wilsey: Cannabis is one of the most widely used illicit drugs among adolescents. All too often, they report obtaining cannabis from someone who uses medicinal cannabis. Patients must be warned to safeguard their supply of cannabis and prevent it from being diverted to children and adolescents (similar to recommendations for opioid medications). It is clear that youth who are under the influence of cannabis may suffer academically and, with continued use, drop out of high school or college. In some cases, this may be due to a loss of motivation.  

Q Can adults using medicinal cannabis also be at risk for losing motivation?

Dr. Wilsey: Whether a motivational syndrome in adults exists or not is still controversial; there are still too few studies to draw a conclusive answer. But medicinal cannabis patients who stop going to work or doing their chores need to talk to their doctor. This can indeed be a sign that the patient is losing motivation and perhaps becoming addicted to cannabis. If people begin to take cannabis with the intent of getting stoned rather than to relieve pain, this is also a sign that they need to speak with their physician.

Q Is withdrawal from medicinal cannabis a concern?

Dr. Wilsey:  People who use cannabis heavily can experience withdrawal when they stop abruptly. The syndrome can last for up to 2 weeks. Among other things, the signs of withdrawal include anger, sweating, restlessness, interrupted sleep, reduced appetite, stomach pain, nightmares, and weight loss. Re-administering and tapering the cannabis slowly over time can help suppress these symptoms.13

Q What are some other safety and work-related issues that pain specialists should consider with medicinal cannabis?

Dr. Wilsey:  The National Highway Traffic Safety Administration points out that cannabis has been shown to impair performance on driving simulator tasks and on open and closed driving courses for up to approximately 3 hours.14 Furthermore, mixing alcohol and marijuana may dramatically produce effects greater than either drug on its own.  It’s also worth noting that when people test positive for marijuana in their urine, they can lose their jobs. There are currently no laws protecting medicinal cannabis patients at this time, and courts usually decide in favor of employers.

Q What about using opioids and marijuana [cannabis] together?

Dr. Wilsey: Patients should be counseled to stop or lessen use of other drugs that can impact the central nervous system, including opioids, sedative-hypnotics, and alcohol, while using medical cannabis. That being said, there is a study that demonstrates that when opioids and cannabis are taken together, the effect of the opioid is augmented.15 Another epidemiologic study has shown that in states where medicinal cannabis is legal, there is a lower rate of inadvertent overdoses from opioids.16

Q How can pain specialists learn more about this topic and how can they access a copy of the medical cannabis agreement you developed?

Dr. Wilsey:  Pain specialists can refer to an article published by several faculty from the UC Center for Medicinal Cannabis Research in The Clinical Journal of Pain in December 2015.6 There is an appendix that provides the tenets of the written agreement (medical marijuana contract) I mentioned earlier. Physicians can copy this and keep it in their files. When a patient wants to use medicinal cannabis, pain management physicians can retrieve the agreement and go over it with the patient.


Last updated on: August 4, 2016
Continue Reading:
Applying Kinesiology as a Multipronged Approach to Pain Management: Part 2

Join The Conversation

Register or Log-in to Join the Conversation