Medical Marijuana Reduces Opioid Use in Older Adults

By Pat Anson, Editor

Medical marijuana can significantly reduce pain levels in older adults and reduce their need for opioid pain medication, according to a small study of cannabis users. The findings add to growing -- and sometimes conflicting evidence -- that medical marijuana reduces demand for prescription opioids.

To gauge how effective medical marijuana is at managing chronic pain and reducing opioid use, researchers at Northwell Health, a healthcare network based in New York State, surveyed 138 patients who started using medical marijuana in the previous month. The patients have chronic conditions such as osteoarthritis, spinal stenosis, and chronic hip and knee pain.

The 20-question survey focused on how often they used marijuana, in what form they took it, how much it reduced pain and whether they were able to cut back their use of painkillers.

A month after they started using medical marijuana, most patients reported that their average pain score dropped from 9 (on a scale of 0-10) to a more moderate pain level of 5.6.

Nearly two-thirds said they were able to reduce or stop their use of painkillers, with 27% saying they were able to stop completely. Over 90% said they would recommend medical marijuana to others.

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"My quality of life has increased considerably since starting medical marijuana," one patient said. "I was on opiates for 15 years."

"It (medical marijuana) is extremely effective and has allowed me to function in my work and life again. It has not completely taken away the pain, but allows me to manage it," another patient said.

About 45% of patients said they ingested marijuana using vaporized oil, 28% used pills and 17% used marijuana-laced oil. Most said they used marijuana daily, with 39% using it more than twice a day.

"What I'm seeing in my practice, and what I'm hearing from other providers who are participating in medical marijuana programs, is that their patients are using less opioids," said Diana Martins-Welch, MD, co-author of the study and a physician in the Division of Geriatric and Palliative Medicine at Northwell Health. "I've even gotten some patients completely off opioids."

Research in Israel also found that cannabis can significantly reduce chronic pain in elderly patients. But the evidence is less certain that it reduces opioid use.   

A recent study of Medicare and Medicaid patients found that prescriptions for morphine, hydrocodone and fentanyl dropped in states with medical marijuana laws, but daily doses for oxycodone increased. A second study found nearly a 6% decline in opioid prescribing to Medicaid patients in states with medical marijuana laws.  Both studies were conducted during a period when nationwide opioid prescribing was in decline.

A recent study by the RAND corporation found little evidence that states with medical marijuana laws experience reductions in the volume of legally prescribed opioids. RAND researchers believe some pain patients may be experimenting with marijuana, but their numbers are not large enough to have a significant impact on prescribing. 

Despite the uncertainty of the evidence, the Illinois Senate recently passed legislation that would expand the state’s medical marijuana program by allowing doctors to prescribe marijuana to any patient who is prescribed opioid medication.  The idea is to get patients off opioids before they become addicted or dependent on the drugs.

"We know that medical cannabis is a safe alternative treatment for the same conditions for which opioids are prescribed," said Sen. Don Harmon, the bills’ sponsor. "This legislation aims to stop dependence before it begins by providing an immediate alternative."

Although 29 states and the District of Columbia have legalized medical marijuana and a handful of states allow its recreational use, marijuana remains illegal under federal law.

Do Men Get More Pain Relief From Marijuana?

By Pat Anson, Editor

Experts tell us that women are more likely to experience chronic pain than men, feel pain more intensely, and are more likely to be undertreated for pain than men are.

The gender gap in pain grew a little wider this week with a new study, published in Drug and Alcohol Dependence, which claims women get far less pain relief from smoking marijuana than men do.

"These findings come at a time when more people, including women, are turning to the use of medical cannabis for pain relief," said lead author Ziva Cooper, PhD, associate professor of clinical neurobiology at Columbia University Medical Center. "Preclinical evidence has suggested that the experience of pain relief from cannabis-related products may vary between sexes, but no studies have been done to see if this is true in humans."

Cooper and her colleagues conducted two double-blinded, placebo-controlled studies that looked at the analgesic effects of cannabis in 42 healthy recreational marijuana smokers – half of them men and half women.

All smoked marijuana at least four times a week prior to enrolling in the study. Participants were excluded if they had pain.

After smoking the same amount of cannabis or a placebo, the participants immersed one hand in a cold-water bath until the pain could no longer be tolerated. Following the immersion, the participants answered a short pain questionnaire.

Among those who smoked cannabis, men reported a significant decrease in pain sensitivity and an increase in pain tolerance. But the women who smoked cannabis did not experience a significant decrease in pain sensitivity, although they did report a small increase in pain tolerance shortly after smoking.

No gender differences were found in how intoxicated the participants felt or how much they liked the effect of cannabis.

“These results indicate that in cannabis smokers, men exhibit greater cannabis-induced analgesia relative to women,” said Cooper.  “Sex-dependent differences in cannabis’s analgesic effects are an important consideration that warrants further investigation when considering the potential therapeutic effects of cannabinoids for pain relief.”

A marijuana advocate and caregiver for patients in Rhode Island said she was shocked by the study findings.

"This study concerns me that some women will read this and not even try the most magical pain relief out there," said Ellen Lenox Smith, a columnist for Pain News Network. "We have never, in the nine years of growing for myself and as caregivers for patients, ever had a time that this was not successful because of one's sex. We have had equal amounts of men and women and the only person that did not have success was an elderly woman that was not able to follow the directions due to her anxiety of using it. That was due to the stigma from society, not the product."

Do women really respond differently to marijuana or is there a flaw in the study itself?

Previous research has found that women respond differently to the cold water test and have far less tolerance for pain induced by cold water immersion than men.

“Most studies have used some form of the cold pressor test in which subjects immerse their arm or hand in circulating cold water for a defined period of time, and their results support the hypothesis that cold pain sensitivity is more pronounced in females,” researchers reported in a 2009 review of nearly two dozen studies that used the cold water test.  “Based on the present set of studies, it appears that sex differences in cold pain are consistent, particularly for suprathreshold measures such as tolerance and pain ratings.”

The Columbia University study was funded by the U.S. National Institute on Drug Abuse. Ziva Cooper also received salary support from Insys Therapeutics, which is developing cannabis-based drugs.

Most Medical Marijuana Patients Benefit From Treatment

By Pat Anson, Editor

Over 90 percent of long term medical marijuana patients reported significant improvement in their pain and nausea while using cannabis, according to researchers at Israel’s Ben-Gurion University of the Negev.

Medical marijuana has been legal in Israel for over 10 years, but this was the first in-depth study of patients who have a cannabis prescription from Israel’s Ministry of Health.

"Although medical cannabis has been legal for a decade and is licensed to patients to relieve pain and other symptoms, there has been no information about the users themselves," said Pesach Shvartzman, a professor at Ben-Gurion’s Faculty of Health Sciences.

The study examined more than 2,000 cancer and non-cancer patients using medical marijuana. Almost all said they sought a cannabis prescription after trying conventional treatments that were ineffective. Patients were interviewed by telephone in the first three months of treatment and subsequently every four months for two years. 

Users reported that their pain, nausea, anxiety, appetite, and general feeling had improved. Fewer than one in 10 stopped using marijuana due to side effects or ineffectiveness after the first interview, and only six percent after the second interview.

About three out of four patients experienced minor side effects that included dry mouth, hunger, sleepiness or “high” sensations.

Three-quarters of the patients smoked marijuana, while one in five used a vaporizer or cannabis oil.

Israel still considers cannabis a “dangerous drug” and it is not registered as a medicine. However, the Ministry of Health says “there is evidence that cannabis could help patients suffering from certain medical conditions and alleviate their suffering.”

There are over 20,000 registered marijuana users in Israel. About 50 new users are approved each week by the Health Ministry.

Ministry of Health regulations allow for medical marijuana to be used to treat cancer symptoms and to reduce the side effects of chemotherapy. Eight farms have Ministry of Health permission to grow cannabis for medicinal use, and four companies have permission to deliver cannabis to cancer patients.

Teenage Marijuana Problems Declining

By Pat Anson, Editor

A large survey of nearly a quarter of a million adolescents indicates the number of American teenagers with marijuana related problems is declining – despite the fact that nearly half the states have legalized medical marijuana or decriminalized it.

Researchers at Washington University School of Medicine in St. Louis studied a national database on drug use by over 216,000 young people, ages 12 to 17, and found that the number dependent on marijuana or having trouble in school and in relationships declined by 24 percent from 2002 to 2013.

During the same period, the number of kids who said they used marijuana in the previous 12 months fell by 10 percent. The drops were accompanied by reductions in behavioral problems, such as fighting, shoplifting and selling drugs.

Researchers believe the two trends are connected -- as kids became less likely to engage in problem behavior, they are also less likely to have problems with marijuana.

"We were surprised to see substantial declines in marijuana use and abuse," said lead author Richard Grucza, PhD, an associate professor of psychiatry at Washington University School of Medicine

"We don't know how legalization is affecting young marijuana users, but it could be that many kids with behavioral problems are more likely to get treatment earlier in childhood, making them less likely to turn to pot during adolescence. But whatever is happening with these behavioral issues, it seems to be outweighing any effects of marijuana decriminalization."

The new study is published in the Journal of the American Academy of Child & Adolescent Psychiatry. The data was gathered as part on ongoing study called the National Survey on Drug Use and Health, which surveys young people in all 50 states about their drug use, abuse and dependence.

In 2002, just over 16% reported using marijuana during the previous year. That number fell to below 14% by 2013. Meanwhile, the percentage of young people with marijuana-use disorders declined from around 4% to about 3%.

"Other research shows that psychiatric disorders earlier in childhood are strong predictors of marijuana use later on," Grucza said. "So it's likely that if these disruptive behaviors are recognized earlier in life, we may be able to deliver therapies that will help prevent marijuana problems -- and possibly problems with alcohol and other drugs, too."

A similar survey, the University of Michigan's Monitoring the Future Study, found that marijuana use by teens has leveled off since 2010, but was still at stubbornly high rates. In 2015, about 35% of 12th­ graders reported using marijuana at least once in the past year.

The same survey found that teenage abuse of prescription opioids declined for the fifth year in a row. Only about 5% of 12th graders reported using an opioid pain medication in the last year, and the number reporting that prescription opioids were “fairly easy” or “very easy” to get also continues to drop.

Medical marijuana is legal or decriminalized in 24 states and the District of Columbia, and several states are considering legalization. Opponents have long maintained that legalization would have harmful effects on young people.

“Perhaps the biggest public health concern around medical marijuana liberalization and legalization concerns the potential impact on teenagers, who could have greater access to it as a drug of abuse and who may increasingly see marijuana as a ‘safe, natural’ medicine rather than a harmful intoxicant,” wrote Nora Volkow, MD, director of the National Institute on Drug Abuse, in Alcoholism & Drug Abuse Weekly.

“Although there is still much to learn about marijuana’s impact on the developing brain, the existing science paints a picture of lasting adverse consequences when the drug is used heavily prior to the completion of brain maturation in young adulthood. In teens, marijuana appears to impair cognitive development, may lower IQ and may precipitate psychosis in individuals with a genetic vulnerability.”

According to a recent report from the Colorado Department of Public Safety, where marijuana has been fully legalized since 2013, nearly a third (31%) of young adults, ages 18 to 25, have used in marijuana in the last 30 days, up from 21% in 2006. The number of juveniles on probation testing positive for THC has also increased since legalization.  

Big Decline in Opioid Use by Marijuana Users

By Pat Anson, Editor

A new study has found that use of opioid pain medication declines dramatically when chronic pain patients use medical marijuana.

The small study by researchers at the University of Michigan involved 185 pain patients at a medical marijuana dispensary in Ann Arbor, who were surveyed in an online questionnaire about their use of marijuana and pain medications.

Nearly two-thirds (64%) reported a reduction in their use of prescription pain medications and almost half (45%) said cannabis improved their quality of life. Patients also had fewer side effects from marijuana than they did from opioids.

"We're in the midst of an opioid epidemic and we need to figure out what to do about it," said lead author Kevin Boehnke, a doctoral student in the School of Public Health's Department of Environmental Health Sciences. "I'm hoping our research continues a conversation of cannabis as a potential alternative for opioids."

Last week the Centers for Disease Control and Prevention issued new guidelines that recommend non-pharmalogical therapy and non-opioid drugs for chronic pain. The guidelines do not endorse medical marijuana as a pain treatment, but they do discourage doctors from testing patients for marijuana and from dropping them from their practices if marijuana is detected.

Currently, 23 states and the District of Columbia have legalized marijuana for medical purposes and four states allow it for recreational use.

The University of Michigan researchers found that patients with less severe chronic pain were more likely to report less use of opioids and a better quality of life.

"We would caution against rushing to change current clinical practice towards cannabis, but note that this study suggests that cannabis is an effective pain medication and agent to prevent opioid overuse," Boehnke said.

Researchers said their findings, published in the Journal of Pain, also suggest that overdose death rates would decline dramatically if marijuana was used more widely for pain relief.

“We are learning that the higher the dose of opioids people are taking, the higher the risk of death from overdose. This magnitude of reduction in our study is significant enough to affect an individual's risk of accidental death from overdose," said senior study author Daniel Clauw, MD, a professor of pain management anesthesiology at the U-M Medical School.

Previous research has found that opioid overdose rates declined by nearly 25 percent in states where medical marijuana was legalized. Another recent study of cannabis use by pain patients in Israel found a 44% reduction in opioid use.

One limitation of the current study is that it was conducted with people at a marijuana dispensary, who are more likely to already be believers in the medical benefits of marijuana.

CDC Guidelines Urge Doctors Not to Test for Marijuana

By Pat Anson, Editor

One of the less publicized provisions in the Centers for Disease Control and Prevention’s opioid prescribing guidelines is a recommendation that doctors stop urine drug testing of patients for tetrahyrdocannabinol (THC), the psychoactive ingredient that causes the “high” for some marijuana users. The guidelines also discourage doctors from dropping patients if marijuana is detected.

Urine drug screens are conducted almost routinely by pain management physicians and other opioid prescribers for a variety of drugs, both legal and illegal.

Some doctors use a positive result for THC as an excuse to discharge patients from their practices, even in states where medical marijuana is legal.

While the CDC guidelines encourage physicians to conduct urine drug tests before starting opioid therapy and at least annually afterwards, they draw the line at THC.

“Clinicians should not test for substances for which results would not affect patient management or for which implications for patient management are unclear. For example, experts noted that there might be uncertainty about the clinical implications of a positive urine drug test for tetrahyrdocannabinol (THC).” the guidelines state.

"Clinicians should not dismiss patients from care based on a urine drug test result because this could constitute patient abandonment and could have adverse consequences for patient safety, potentially including the patient obtaining opioids from alternative sources and the clinician missing opportunities to facilitate treatment for substance use disorder."

As Pain News Network has reported, “point-of care” (POC) urine drug tests, the kind widely used in doctor’s offices, frequently giving false positive or false negative results for drugs like marijuana, oxycodone and methadone. One study found that 21% of POC tests for marijuana produced a false positive result. The test was also wrong 21% of the time when marijuana is not detected in a urine sample.

Not mentioned in the CDC guidelines is evidence that opioid overdose rates declined by nearly 25 percent in states where medical marijuana was legalized.

"We applaud the CDC's reasoned approach to the use of urine testing and its drawbacks when used on pain patients," said Ellen Komp, Deputy Director of California NORML. "Considering that opioid overdose deaths are significantly lower in states with medical marijuana programs, we are sorry the agency apparently didn't read the letter Elizabeth Warren recently sent to its chief calling for marijuana legalization as a means of dealing with the problem of opiate overdose."

That letter by Sen. Warren encouraged the CDC to adopt the guidelines and its restrictive approach to opioids “as soon as possible,” but also encouraged the agency to further study the impact legalization of medical and recreational marijuana could have on opioid overdose deaths.

The annual cost of drug testing in pain management is estimated at $2 billion per year. While POC tests are relatively cheap, more expensive laboratory testing can cost thousands of dollars and is often not covered by insurance.

Finding the Right Strain of Medical Marijuana

By Ellen Lenox Smith, Columnist

As a medical marijuana patient and caregiver since 2007, I would like to share some thoughts and observations about a recent survey by Care by Design, a medical cannabis company based in California.

They surveyed 621 patients who had been using medical marijuana for over 30 days, asking them about:

1. The conditions for which they are taking cannabidiol (CBD) rich cannabis

2.  The ratio of CBD-to-THC (tetrahydrocannabinol) they are using

3. The impact of CBD-rich cannabis therapy on their pain, discomfort, energy, mood, and overall well being

I would like to address three areas about the survey findings, based on my personal use of medical cannabis and the patients we assist as caregivers.

“Patients with psychiatric or mood disorders and patients with diseases of or injuries to the CNS (central nervous system) system favor CBD-dominant cannabis therapies,” the survey found. “Patients with pain and inflammation favor CBD-rich cannabis therapies with more equal levels of CBD and THC.”

I have to agree with this personally and also through observation of the people we have helped find their correct medical marijuana strain. I now sleep better at night using a night oil made with a high CBD ratio. I found that when I used another strain that has a higher THC ratio, I experienced some strange head sensations that I did not enjoy. But when I use the higher CBD mix, I do not experience those odd sensations and can safely get out of bed without concerns.  

One patient, who has numerous medical issues including depression and post-traumatic stress disorder (PTSD), has found she does well mixing a day sativa plant with the highest CBD plant we have (24% CBD/1% THC) called ACDC. She uses this mixture both day and night and finds it addresses her levels of pain more effectively. Just using the high CBD strain does not address her pain.

Another patient, a scientist, was just thrilled switching to the new high CBD plants we grow. He has found that his mood is calmer and his PTSD is under control. He is a thriving, productive worker again with no negative side effects

I correspond with many people online and one person who uses legally pure CBD found that it did address her pain. Many will not be that successful with just pure CBD and most need some THC to address pain.

The Care by Design report also states that “THC matters. A higher ratio of CBD to THC does not result in better therapeutic outcomes. Patients using the 4:1 CBD-to-THC were the most likely to report a reduction in pain or discomfort, and improvements in mood and energy.

“Patients using the 2:1 CBD-to-THC ratio reported the greatest improvement in overall wellbeing. This finding is consistent with scientific research indicating that CBD and THC interact synergistically to enhance one another’s therapeutic effect.”

I have to totally agree with the above statement. Most will not be lucky and find success without some THC in their medicine.

People tend to have a negative attitude towards THC because it makes them high and think medical marijuana strains work better without THC or lower ratios of it. But we have not had one patient that just uses the highest CBD plant alone. They appreciate the fewer “head issues” that come from reduced THC, but quickly find that their medical problems are not being addressed successfully until they use a mixture with more THC.

Finally, they survey report states that, “CBD-rich cannabis’ does not appear to have a significant impact on energy levels (as compared to pain, discomfort or mood).”

I am living proof of that, as are all the patients we have worked with using medical marijuana. When I need a boost on a tough pain afternoon, I find vaporizing or using tincture from the high CBD plant does not provide an increase in energy. However, when I use the 2:1 ratio that includes more THC, I not only get pain relief but also increased energy and interest in being involved with life again.

As the study found and we have found, you still have to experiment with dosage and ratios to find the correct type of medication strain to successfully alleviate your issues.

Using medical marijuana will never be like it is going to the pharmacy. One pill does not fit all and one strain does not fit all. No single ratio is right for all people, even when dealing with the same conditions.

Ellen Lenox Smith and her husband Stuart live in Rhode Island. They are co-directors for medical marijuana advocacy for the U.S. Pain Foundation and serve as board members for the Rhode Island Patient Advocacy Coalition.

For more information about medical marijuana or to contact the Smith's, visit their website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Medical marijuana is legal in 23 U.S. states and the District of Columbia, but is still technically illegal under federal law. Even in states where it is legal, doctors may frown upon marijuana and drop patients from their practice for using it.

Can Marijuana Help Treat Heroin Addicts?

By Pat Anson, Editor

There’s a new twist to the rising use of heroin in the United States – and what can be done to help addicts in recovery.

A recent study by researchers at Columbia University found that medical marijuana improves the treatment outcome of heroin addicts. Patients who were given dronabinol -- a prescription drug that contains THC, the active ingredient in marijuana -- had lower withdrawal symptoms compared than those given a placebo. In addition, patients who smoked marijuana regularly during the outpatient phase of treatment had fewer sleeping problems, less anxiety and were more likely to finish treatment.

"One of the interesting study findings was the observed beneficial effect of marijuana smoking on treatment retention," the researchers concluded.

"Participants who smoked marijuana had less difficulty with sleep and anxiety and were more likely to remain in treatment as compared to those who were not using marijuana, regardless of whether they were taking dronabinol or placebo."

The Columbia study appears in the journal Drug and Alcohol Dependence.

According to High Times, several other studies have reached similar conclusions. Studies at the New York Psychiatric Institute found that opiate addicts who consumed marijuana intermittently were less likely to start using opioids again, compared to those who never used marijuana or used it habitually.

Earlier this year, researchers at the RAND Corporation and the University of California, Irvine reported similar results in a study for the National Bureau of Economic Research – going so far as to suggest that marijuana is a good substitute for opioid pain medication.

“Many medical marijuana patients report using marijuana to alleviate chronic pain from musculoskeletal problems and other sources. If marijuana is used as a substitute for powerful and addictive pain relievers in medical marijuana states, a potential overlooked positive impact of medical marijuana laws may be a reduction in harms associated with opioid pain relievers,” they wrote. “We find that states permitting medical marijuana dispensaries experience a relative decrease in both opioid addictions and opioid overdose deaths compared to states that do not.”

And what happens in states where regulations make it harder to obtain prescription opioid medication?

There were unintended consequences in Washington, one of the first states in the country to impose strict new guidelines on opioid prescribing. From 2008 to 2014, the number of deaths from prescription opioids in Washington fell from 512 to 319. But over the same period, the number of heroin deaths almost doubled, to nearly 300.

But the surge in heroin use wasn’t confined to Washington. According to the National Survey on Drug Use and Health, the number of heroin users nationwide rose from 161,000 in 2007 to 289,000 in 2013, an increase of nearly 80%. During the same period, the U.S. Centers for Disease Control and Prevention (CDC) reported the number of poisoning deaths involving heroin rose from 3,041 to 8,257, an increase of 172%.

“There is no robust evidence that recently enacted policies regarding prescription opioids are responsible for large-scale shifts to heroin,” the CDC’s Courtney Lenard recently told Alcoholism & Drug Abuse Weekly. Only about 1 in 25 people who use prescription opioids recreationally start using heroin within five years, she said.

Pot for Pain Approved in Minnesota

By Pat Anson, Editor

After months of debate, Minnesota’s health commissioner has decided to include chronic pain in the list of conditions that allow residents to legally use medical marijuana. They just have to wait another nine months before they can buy it.

Commissioner Ed Ehlinger said it was “the right and compassionate choice” to allow pain patients into the program.  Only nine health conditions currently qualify for marijuana prescriptions in Minnesota – and chronic, intractable pain won’t be added until August 1, 2016. Health care providers can start certifying intractable pain patients on July 1 of next year.

Ehlinger, who is a physician, said “the existing tools are not working well” to manage pain, according to the Minneapolis Star Tribune.

“There are strong and conflicting opinions ... in both the professional community and in the general population. However, as a physician who is concerned about the treatment each individual patient receives and as the Minnesota Health Commissioner who is concerned about the overall health of everyone in this state, I believe that adding intractable pain to the list of qualifying conditions for our medical cannabis program is the correct decision,” said Ehlinger

Last month a state advisory panel recommended against the inclusion of chronic pain in Minnesota’s marijuana program, saying cannabis was not a “magic bullet” and there wasn’t enough evidence to support its use for pain.

“Panel members expressed concern that patients eligible to use medical cannabis for pain have expectations that it would provide total relief and that such a perception may leave patients to abandon other proven pain-management methods, such as physical therapy,” the recommendation said.

“Panel members cited the recent opioid crisis, where good medications were demonized because prescribers used it to treat pain without knowing its proper uses. Even after studying the information available on medical cannabis, panel members said providers do not feel prepared to certify patients for its use.”

Over a dozen public hearings on the issue were held across the state, and the vast majority of speakers favored including intractable pain in the list of health conditions marijuana can be used for.

Intractable pain is defined as “a pain state in which the cause of the pain cannot be removed or otherwise treated with the consent of the patient and which, in the generally accepted course of medical practice, no relief or cure of the cause of the pain is possible, or none has been found after reasonable efforts.”

The nine conditions that currently qualify for medical marijuana in Minnesota are cancer, glaucoma, HIV/AIDS, Tourette Syndrome, Amyotrophic Lateral Sclerosis (ALS), seizures, severe muscle spasms, Crohn’s Disease and terminal illness. In addition to strict limits on conditions it can be prescribed for, medical marijuana is not available in leaf form and cannot legally be smoked in Minnesota.  It is only legal in a pill, vapor or liquid form.

The limits are so restrictive, less than 800 patients have enrolled in the program so far. Enrollment is expected to increase dramatically once chronic pain is included.

"Congratulations to the State  of Minnesota for now becoming a true state of compassion," said Ellen Lenox Smith, a medical marijuana advocate and a columnist for Pain News Network.  "I do hope that in the near future, they will also consider to adjust their stand on cannabis being sold only in pill or liquid form — nothing smoke-able.  For those of us in Rhode Island, we can choose to vaporize, use topicals, smoke if that is your only way to make it work for you, along with tinctures, drinks and edibles. We all have to find the right way to make this medicine work for our conditions, so may they realize their limitations are very controlling and holding back pain relief for many."

Minnesota is one of 23 states and the District of Columbia where medical marijuana is legal.

Marijuana No ‘Magic Bullet’ for Pain in Minnesota

By Pat Anson, Editor

Minnesota may be one of 23 U.S. states where medical marijuana is legal, but getting a prescription for cannabis there is difficult – especially for chronic pain patients.

Since Minnesota enacted one of the nation’s strictest medical marijuana laws last year, less than 700 people have enrolled in the state’s cannabis registry. Only nine health conditions qualify for a marijuana prescription in Minnesota – and chronic pain isn’t one of them – a status that appears unlikely to change after an advisory panel voted 5-3 not to allow pain patients into the cannabis registry.

The reason? Medical marijuana is “not a magic bullet” and there’s not enough evidence that it can treat pain.

“Panel members expressed concern that patients eligible to use medical cannabis for pain have expectations that it would provide total relief and that such a perception may leave patients to abandon other proven pain-management methods, such as physical therapy,” the recommendation said.

“Panel members cited the recent opioid crisis, where good medications were demonized because prescribers used it to treat pain without knowing its proper uses. Even after studying the information available on medical cannabis, panel members said providers do not feel prepared to certify patients for its use.”

The panel recommended that marijuana not be prescribed to anyone with a history of substance abuse or patients with mental health problems. If marijuana is allowed for intractable chronic pain, the panel suggested that patients should be disqualified if they are under 21, have a history of psychosis, are pregnant or breast feeding.

The final decision is in the hands of Minnesota’s Health Commissioner, who has until the end of the year to decide if medical marijuana should be allowed for intractable pain.

The nine conditions that qualify for medical marijuana in Minnesota are cancer, glaucoma, HIV/AIDS, Tourette Syndrome, Amyotrophic Lateral Sclerosis (ALS), seizures, severe muscle spasms, Crohn’s Disease and terminal illness.

Terminally ill cancer patients – many of whom are in pain – are allowed to use medical marijuana. And many say they’ve been able to reduce their use of opioids since they started taking marijuana, according to the Minneapolis StarTribune.

“What are we going to do about patients? What do we tell patients who we know we can help, but we currently can’t help them? That’s the remarkably frustrating thing about this process that gets to me,” said Manny Munson-Regala, CEO of LeafLine Labs, one of the state’s two medical marijuana producers.

In addition to limits on the conditions it can be prescribed for, medical marijuana is not available in leaf form and cannot legally be smoked in Minnesota.  It is only legal in a pill, vapor or liquid form.

CDC Should Consider Marijuana as Alternative to Opioids

By Ellen Lenox Smith, Columnist

Presently in our country, those that are successfully using opioids for pain relief are feeling dirty and lost -- largely due to fears about addiction and  overdoses. Pain patients often have to cope with physicians who are reluctant to prescribe opioids and pharmacies that are sometimes unwilling to fill their prescriptions.

The Centers for Disease Prevention and Control (CDC) is considering new guidelines that would encourage doctors to shift even further away from prescribing opioids, leaving the patient with little effective medication to turn to.

Why is the CDC not even considering the use of medical marijuana to help these people in need?

The Boston Herald recently reported that hundreds of opioid addicts are being treated successfully in Massachusetts with medical marijuana.

“We have a statewide epidemic of opioid deaths,” said Dr. Gary Witman of Canna Care Docs, which issues medical marijuana cards in seven states. “As soon as we can get people off opioids to a non-addicting substance — and medicinal marijuana is non addicting — I think it would dramatically impact the amount of opioid deaths.”

Witman is treating about 80 patients at a Canna Care clinic who are addicted to opioids, muscle relaxants or anti-anxiety medications. After enrolling them in a one-month tapering program and treating them with cannabis, Witman says more than 75 percent of the patients have stopped taking the harder drugs. Medical marijuana gave them relief from pain and anxiety — and far more safely than opioids.

Patients across the country are also learning they can use cannabis for pain relief, decreasing or even eliminating their use of opioids.  Marijuana works far better than other substitutes since it is not synthetic and does not cause organ damage or deaths like opioids can in some circumstances.

Medical marijuana works naturally on what is known as the “endocannabinoid system,” binding to neurological receptors in the brain that control appetite, pain sensation, mood and memory.

Here in Rhode Island, my husband and I have witnessed the amazing transition of pain patients on opioids that chose to transition to medical marijuana.  Most that turn to cannabis do so to eliminate the side effects of opioids and concerns about their long term use. They still achieve pain relief but know they are gaining that relief in a safer manner -- no organ damage, no teeth getting destroyed, no concerns of addiction and no deaths.

Marijuana may still be illegal at the federal level, but it is legal in 23 states and the District of Columbia, and millions of people are discovering its therapeutic benefits. The CDC should consider adding medical marijuana to the list of “non-opioid” therapies in its guidelines.

Ellen Lenox Smith and her husband Stuart live in Rhode Island. They are co-directors for medical marijuana advocacy for the U.S. Pain Foundation and serve as board members for the Rhode Island Patient Advocacy Coalition. 

For more information about medical marijuana, visit their website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Medical marijuana is legal in 23 U.S. states and the District of Columbia, but is still technically illegal under federal law. Even in states where it is legal, doctors may frown upon marijuana and drop patients from their practice for using it.

Visiting a Medical Marijuana Dispensary

By Ellen Lenox Smith, Columnist

Many people who are considering medical marijuana for pain relief are reluctant to visit a marijuana dispensary, fearing it might be in a bad part of town or that they may encounter some unsavory characters.

Since I am a home grower of marijuana, I felt it was best to visit a dispensary in my home state of Rhode Island to get a fresh, first hand view of what the experience is like. Through the kindness of Barbara Pescowolido at the Thomas C. Slater Compassion Center in Providence, this visit was made possible.

The first thing that I noticed was the professional layout that included informed, pleasant and knowledgeable employees who were there to greet me. There is 24 hour surveillance of the premises, a well-lit parking area, and a professionally trained security team.

I had to show to identification, which requires a Rhode Island medical marijuana patient or caregiver card,  and another form of ID, like a driver's license. After my information was put into the computer and confirmed, I was buzzed into the center. If a patient is not able to walk without assistance, he or she can be accompanied by a licensed caregiver, who would also be required to present credentials.

Every new patient is given an orientation session that includes a one-to-one educational conversation, and a folder of information to take home and review for future visits.The folder includes the different methods of ingesting marijuana, the concentrated forms available, their laboratory testing procedures, how to use your medicine sensibly, and a form that explains cannabis and the difference between sativa and indica plants.

There’s also a patient journal so you can record the type of marijuana you tried, how you ingested it, the date/time of taking, and the duration/effect. This is to help both the patient and staff make educated decisions on your next purchase.

Also included is a “Good Neighbor Agreement” the patient is to read and sign. You are expected to follow the guidelines to be able to continue using their services. They include:

• Not to smoke or consume marijuana on site or in the parking lot
• Refrain from using cellphones or cameras while in the building
• No minors allowed unless they are a patient and accompanied by a parent or legal guardian
• No minors left in your vehicle unattended while visiting the center
• No animals except guide/service animals are allowed inside
• Keep all medicine and money our of plain sight
• No weapons allowed.
• Do not invite individuals who are not patients or caregivers, unless special arrangements are made with management
• Do not throw litter in the parking lot or surrounding area
• Marijuana purchased in the center is not for resale. Any member found reselling will have their membership revoked
• Keep all conversations respectful and appropriate

New patients also learn about a wide range of free ancillary services, such as massage, reiki, hydrotherapy bed, cultivation, and classes on cooking and methods of consumption. There are also product showcases and live demo’s that include weekly open house tours, 1:1 consultations, loyalty rewards program, a community newsletter and a cannabis library/DVD section.

The next step for me was to take a number while relaxing in a tastefully designed waiting area. When you are called up to the counter, you get to work 1:1 with a knowledgeable patient advisor/employee.

A menu hangs over the counter sharing what medications are available. A variety of edibles, capsules, concentrates in syringes, flowers, exilers, and topicals are for sale.

This center has come up with a novel idea. For just $20, you can purchase a sampler packet that includes small samples of medicine that includes THC capsules, CBD capsules, elixir, a cookie, hard candy and gummy bears. This allows the patient to return home and try these different methods to decide what fits best for their needs.

The center is still not able to grow all that is needed to accommodate patients, so there are times customers return for a specific product to find it is not available. It is difficult for the center to have to rely on others growing for them, so their goal is to one day be totally self sufficient.

Patients are allowed to purchase 2 ½ ounces every fifteen days. Records are kept in a computer so that no one ever goes over that amount unintentionally or intentionally. You are able to check the center’s website for a "menu" of the current product being sold, but you are not allowed to purchase online.  

Prices presently range from $25 to $50 for an eighth of an ounce of product. Prices can fluctuate if the marijuana tests out to be stronger. All marijuana, either grown on site or purchased from growers, is tested and cleaned.

My experience there was pleasant and educational. For a closer look at the Thomas C. Slater Compassion Center, you can watch this short video the center has on YouTube:

Uploaded by Slater Center on 2015-06-09.

If you live in a state that allows medical marijuana, but does not permit you to grow your own or have a caregiver grow for you, then a dispensary like the one I visited can probably meet your needs. But each state has different laws and regulations for both patients and dispensaries, so your experience may differ from mine.

Visiting a dispensary and trying medical marijuana for pain relief could result in a significant improvement in your quality of life.

Ellen Lenox Smith suffers from Ehlers Danlos syndrome and sarcoidosis.

Ellen and her husband Stuart live in Rhode Island. They are co-directors for medical marijuana advocacy for the U.S. Pain Foundation and serve as board members for the Rhode Island Patient Advocacy Coalition.

For more information about medical marijuana, visit their website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Medical marijuana is legal in 23 U.S. states and the District of Columbia, but is still technically illegal under federal law. Even in states where it is legal, doctors may frown upon marijuana and drop patients from their practice for using it.

'Telehealth' Doctor Visits for Medical Marijuana

By Pat Anson, Editor

With medical marijuana legal in 23 U.S. states and the District of Columbia, millions of Americans can now legally obtain cannabis to treat chronic pain and other health conditions.

But many pain patients are leery about asking their doctors for a medical marijuana card or about visiting a marijuana dispensary in some shady part of town.

Into this void has stepped HelloMD, the first “telehealth” provider to offer live online video consultations with a physician about medical marijuana. For $49 – a fraction of the cost of visiting a doctor in their office -- the company says it will provide a private consultation with a licensed physician via a desktop computer, laptop or mobile device. If the doctor agrees on the need, they will write a medical marijuana recommendation for immediate use.

HelloMD also provides links to trusted marijuana dispensaries and delivery services – meaning the patient never has to leave the comfort of their own home.

“Delivery service is really what they’re interested in,” says Mark Hadfield, CEO and Founder of HelloMD. “The patients that we’re talking about, the elderly, infirm, professionals, moms and dads, are people that are concerned about confidentiality; they don’t want to end up in a state database, they don’t want to be filmed going in and out of a dispensary. Those people were never going to get their (marijuana) cards prior to this service.”

HelloMD began providing medical marijuana consultations in March, but the San Francisco based company has actually been around for two years, at first providing online access for patients interested in reaching neurologists, oncologists and other medical specialists.

“It’s a very hot space. Digital health care is a multi-billion dollar segment growing very, very rapidly. It’s also very competitive. There are at least five or six companies with tens of millions of dollars in funding competing for that space. The latest one is Walgreens,” Hadfield told Pain News Network.

Faced with that kind of competition, HelloMD decided to focus exclusively on medical marijuana.

“There’s obviously a big need. A lot of doctors are leery, uninformed or uncomfortable with cannabis. A lot of people go to their traditional doctors and they’re told they’re just not able to advise them on that,” Hadfield said.

“We think there’s a much bigger demographic that until now has not been involved in cannabis products. So millions of Americans are coming into the industry for the first time and are curious to try those products. And so our goal is to be the resource for those patients, starting off with connecting them with the right medical assistance and keeping them compliant with the law.”

For now, HelloMD can only provide medical marijuana consultations to people in California. It has about a dozen doctors “on call” in the state to meet online with patients. Many of the physicians are retired or semi-retired and work from their own homes.

The company plans to expand into other medical marijuana states later this year and to recruit about 300 doctors nationwide. Doctors must be licensed to practice medicine in the state where their patient is located.

About 150 patients a week are currently getting consultations on HelloMD.

"We were quite surprised to find that the majority of folks coming through our service were not recreational users at all.  Instead we met retirees, veterans, and working professionals looking for alternative medicinal treatments to a wide variety of conditions spanning chronic pain through everyday anxiety and stress,” says Perry Solomon, MD, Chief Medical Officer at HelloMD.

“All of them had heard about marijuana as an alternative but found their general practitioner lacking the knowledge to offer good advice. They didn't know where to go for more information on medical marijuana, who to talk with, or how to go about becoming a legal patient. Many had difficulty leaving their homes while others were afraid to venture into the parts of town where medical marijuana practitioners were likely to be found."

According to a new report by the National Business Group on Health, telehealth services are saving companies more than $6 billion in healthcare costs.  American Well, Doctor on Demand, MD Live and Teladoc offer online consultations with a physician for about $40 to $50.

Success Stories of Real Medical Marijuana Patients

By Ellen Lenox Smith, Columnist

My husband and I have been licensed medical marijuana caregivers in the state of Rhode Island for over five years. Our lives have been touched by the many people who have been sent our way by doctors for education about medical marijuana. Some of the people below are either our present or past patients, along with some from other states we met and have kept in touch with.

We hope their stories will help you gain the courage to give this safe, non-invasive pain medication a try.

Bob - Paraplegic

Bob arrived at our house in his handicap equipped van and we met him in the driveway. It was difficult to understand Bob’s speech at first due to his intense level of pain. He seemed overwhelmed and lost.

The doctor who saved Bob’s life when he fell off a roof and was impaled and paralyzed, warned him when he awoke from surgery that he would experience intense pain for the rest of his life.  

However, things changed when Bob tried medical marijuana. He vaporized marijuana right there in the driveway, proceeded to tell us that he felt no change, and before he knew it was having a conversation with us. At times, the effects of marijuana are so gentle you don’t realize what is changing.

Bob became an advocate for medical marijuana and almost daily would call on the phone to make sure we were doing okay. He became a gentleman that was able to share, care and feel again.

Bob has since passed and is missed, but we know that his dignity was restored by cannabis relieving his pain. Vaporizing medical marijuana allowed Bob to have a peaceful ending.

image courtesy drug policy alliance

Scott -- Multiple Sclerosis

42-year old Scott, who has a severe case of multiple sclerosis, told me that turning to medical marijuana saved his life. The former customer service representative was thrilled when he found an alternative to using Avonex for his condition. He did not like using the drug because it caused flu like symptoms and a high fever.

By smoking cannabis, Scott is able to control his pain and is thrilled how he is able to move his stiff legs. He also says it relieves his neuropathic pain too.

School Teacher - Ehlers Danlos Syndrome

An elementary school teacher, who asked that we not use her name, was diagnosed with Ehlers Danlos Syndrome (EDS). She was not sleeping and had a terrible time functioning in her job. Then she decided to try medical marijuana. She began taking an indica oil at night before going to bed and a sativa tincture during the day after work. Just 10 minutes after each dose, her pain levels are diminished or completely relieved.  

She finds the night time dose carries into the following day, but doesn't hinder her either mentally or physically.  It allows her to function and be the teacher she was before --- vibrant and focused.

“Without this gift of oils, I would be in continuous pain 24 hours a day, 365 days out of the year,” she told me.  “This does not change who I am. It just changes how I am, functioning and living each day, which should be to its fullest.”

Lori - Spinal Injury

57-year old Lori had been employed as a medical coding technician at a local hospital. In 2007, she had an injury to her spine. Unfortunately, back surgery led to epidural fibrosis. After months of failed alternative treatments and medications, Lori's doctor suggested she try medical marijuana.

She found immense relief using a portable vaporizer (PAX) two to three times a day. Lori no longer has to rely on narcotics for pain relief and her entire lifestyle has changed.

“I have at least half of my life back,” she says. “I am not severely depressed, I get out alone more often, and the pain is there but not ruling my life!”

Stryder - Ehlers-Danlos Syndrome and Epilepsy

We met 5-year old Stryder at an EDS conference in 2013. A pain clinic doctor got in touch with us after meeting with his mother, Angela.

Our hearts broke to see a gorgeous young man crippled from the joys of life by severe medical issues. Stryder barely noticed us and was not conversing. He was pale and exhausted.

We talked with Angela, gave her a donation of our night indica oil (not made from any high CBD plants) and carefully gave directions on how to use it.

They were sharing a room with a woman, and Angela told us Stryder had driven the woman crazy with the seizures he had during the night. But, after the second night of trying the oil, she asked Angela in the morning what she had done differently. When she told her the truth, the woman was amazed with the changes.

Stryder was a different boy. He was talking and interacting like he hadn’t before. Angela believes this was caused by a combination of sleep and brain rest from the seizures. Stryder was alert, smiling, walking, and even went off to play with other children at the conference.

Today, Angela says Stryder is a legal marijuana patient in his state, takes his oil based medication in a dropper and sometime uses cannabis candy to suck on. He is sleeping better at night and is happier.

Angela advocates for medical marijuana to help others get educated with correct facts. When someone said they were against putting cannabis in candy, here is how she responded:

“Would you rather a child smoke it? The drugs that these kids are put on for seizures are devastating, have a lot of side effects and are addicting,” Angela said. “Children are often told to just suck it up when it comes to pain management and that's just not fair. Stryder's success has been unmatched and I will always be an advocate for something that is natural and less harmful as well as effective.”

Maureen - Postural Orthostatic Tachycardia Syndrome (POTS)

The day Maureen arrived to our house, we wondered how she even made it driving to us. Her POTS (a syndrome that causes an abnormally high blood pressure and heart rate) was so severe, she was shaky and extremely pale. Her cardiologist had wanted her try marijuana since he had observed other POTS patients get relief from it.

Maureen’s POTS was diagnosed at age 54, where she was working as an ER technician.  She chose to use the oil and the tincture as needed, until she was put into an experimental cardiac rehab program and began getting saline infusions.  After several months, she found that this helped to keep her blood pressure at a normal level and made her symptoms less severe.

“When you're sick every day for a long period of time, anything that helps is worth it; not just for the physical symptoms but for your mental state as well,” Maureen told me.  

Today, at age 57, she no longer has to use marijuana at all. She keeps her symptoms under control with exercise and saline infusions. However, if the need arrives again, Maureen says she wouldn’t hesitate to use marijuana again.   

Bonnie - Pudendal Neuralgia and Post-Fusion Pain

At 75, retired college professor Bonnie arrived at our home in severe pain. After much education and consideration, she decided to give medical marijuana a try.

In time, as she gained her confidence, Bonnie found that eating brownies with marijuana, along with taking indica oil at night, provided her relief from unrelenting pain.  It also provided some hope, thus improving her outlook on life.

"The only real relief I have had from my pain has been with medical marijuana.  My medicine allows me to enjoy life again," Bonnie says.

Elizabeth - Chronic Regional Pain Syndrome, EDS and Chiari Malformation

29-year old Elizabeth was sent to us by a pain clinic doctor. This beautiful, terribly thin, and discouraged young lady and her mother arrived at our home and it broke our heart. Elizabeth’s CRSP was so severe on her head that she was no longer able to touch it, let alone consider running a comb or brush through her hair.

Elizabeth was a former piano teacher and a recording artist, struggling to hold onto her career.  She clearly wanted to get back control of her life. While in our home, she started to rub our topical on her scalp and we were startled when she said she felt some immediate relief. So began her magical way to help get some quality of her life back.

Elizabeth now administers her medical marijuana in a variety of ways. She eats it with edibles, drinks it, massages her joints with it, vaporizes it, and occasionally smokes it.  She enjoys using a Magical Butter machine that it makes potent tinctures and oils, and appreciates the "no heat" option, which she uses to make CannaMilk.  

Elizabeth found she requires high doses of THC, because she doesn’t absorb it at a normal rate.  As a slow absorber, she doesn't get a big peak in relief, followed by a sharp drop-off. Instead it gives her a pretty consistent relief and doesn’t make her feel “stoned."

drug policy alliance

With medical marijuana, she feels her muscles are not as rigid. She can relax, sleep better, and can touch areas of her skin that used to be too sensitive to touch.

“It has changed my life for the better,” Elizabeth says.

Melvin - Renal Failure, Degenerative Lumbar Disc, PTSD, Headaches

43-year old Melvin is employed as an agricultural-inspector. We met this very intelligent, kind man at our home a few years ago and hoped that using medical marijuana would provide the relief he needed to be able to function better in life.

Melvin did a lot of research about how to use marijuana, what strains to consider, and in time found the best way for him to administer it was with vaporizing and using extracts.

He found that his PTSD was mostly relieved by using the higher CBD strains. Melvin’s PTSD causes unwanted and uncontrollable visions and thoughts. Marijuana slows them down, without triggering emotional responses. Its’ not a cure for his PTSD, but has made it more manageable.

There are two damaged discs causing nerve pain which radiate down Melvin’s legs – making them feel numb, burning and painful. He alleviates this pain using marijuana strains like Bubble Gum, Lucy and Pineapple Express. Without them, Melvin says his back would be in constant pain and he would have to lie in bed for most of the day. With marijuana, he is a functioning employed worker.

“With a huge help from my caregiver I was able to find the correct THC to CBD ratio that works for my PTSD and disc/nerve degeneration. Medical marijuana is my freedom!” Melvin says.

Bill - Cardiac Issues

We met Bill and his wife, Joan, a few years ago. Despite his failing health, the love and commitment between them was so clear. We hoped that medical marijuana would provide the relief needed to allow Bill dignity with the time left in his life.

A former firefighter for 30 years, Bill was diagnosed with just 20% cardiac output. This caused him severe pain while breathing.

Bill found that administering the marijuana in an oil night and using the tincture during the day gave him relief. He was able to sleep again for more than one or two hours. For the severe pain in the center of his ribcage, due to an unhealed fracture, the topical cream gave Bill relief that lasted for hours.

Bill used this form of medication for about a year and wished he had been able to use it even sooner, so that he could have had a better quality of life.  

Sadly, Bill recently passed away at the age of 73.

drug policy alliance

Diana - Ehlers-Danlos Syndrome

53-year old Diana was a national award-winning composer, pianist, singer, violinist, dancer, and actress. She had to turn down a Master's fellowship because of her recurrent back, shoulder, and elbow/wrist pain.  Instead, she worked as lab technician.

Cortisone shots and bed rest were the "treatment" for her pain. For five long years, she wore hard braces from her wrists to her elbows, yet also managed to perform lead roles in musicals (with braces hidden beneath costumes).  

After she was finally diagnosed with EDS, she turned to medical marijuana two years ago. Now, every night, Diana uses an indica oil. Without it, she would sweat throughout the night profusely.  Medical marijuana has also reduced her pain from EDS.

Sally - Stage IV Cancer

Courageous 71-year old Sally has been successfully using medical marijuana for over five years. She began using it after being diagnosed with Stage IV uterine cancer.

Sally has defied all odds by remaining active and engaged in life. She found that using the oil at night gave her much needed quality sleep and lowered her pain. For daytime relief, she found vaporizing controlled her nausea.

“Marijuana has few, if no side effects. It is benign in terms of overall functioning,” she says.

Sally, who was recently told by her doctors that she doesn’t have much time left.

Sally, who was recently told by her doctors that she doesn’t have much time left, is a role model to us all; determined, positive and caring. She touches lives in a positive way and will always be in the hearts of those that have had the honor to know her.

These are just a few of the amazing success stories that I have experienced with patients using medical marijuana. Most people that try marijuana are able to find relief from the different conditions they are striving to live a better life with. 

We look forward to the future when more research is allowed in our country.  This, in turn, would provide the needed support and education for those in the medical field, so they could understand and encourage their patients to try marijuana. Not as a last resort, but as the first choice.

Ellen Lenox Smith suffers from Ehlers Danlos syndrome and sarcoidosis.

Ellen and her husband Stuart live in Rhode Island. They are co-directors for medical marijuana advocacy for the U.S. Pain Foundation and serve as board members for the Rhode Island Patient Advocacy Coalition. For more information about medical marijuana, visit their website. 

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Medical marijuana is legal in 23 U.S. states and the District of Columbia, but is still technically illegal under federal law. Even in states where it is legal, doctors may frown upon marijuana and drop patients from their practice for using it.

Marijuana Effective for Diabetic Neuropathy Pain

By Pat Anson, Editor

New research shows that inhaled medical marijuana can significantly reduce pain from diabetic neuropathy within minutes of treatment.

The study, published in The Journal of Pain, also found there was a dose dependent reduction in pain depending on the strength of marijuana used.

Researchers at the University of California San Diego followed 16 patients with diabetic peripheral neuropathy (DPN) in a double-blind study as they were exposed to low, medium and high doses of tetrahydrocannabinol (THC), the psychoactive compound in marijuana that makes people “high.”

Patients used a Volcano vaporizer to inhale marijuana with 1%, 4% and 7% THC, as well as a placebo. A vaporizer was used because it is less harmful than smoking and delivers THC into the bloodstream rapidly.

“We hypothesized that inhaled cannabis would result in a dose-dependent reduction in spontaneous and evoked pain with a concomitant effect on cognitive function,” said lead author Mark Wallace, MD, professor of anesthesiology, University of California San Diego School of Medicine. 

Results showed that the highest dose of THC reduced pain by nearly 70%, with the analgesic effect starting within minutes of inhaling and reaching its peak about an hour after treatment. The analgesic effect of the low and medium doses of THC was slightly lower.

All of the patients experienced either euphoria or somnolence, regardless of the dose, with modest effects on attention, memory and impairment.

“These findings along with previous studies suggest that cannabis might have analgesic benefit in neuropathic pain syndromes, including treatment-refractory DPN,” said Wallace.

Nearly 26 million people in the United States have diabetes and about half have some form of neuropathy, according to the American Diabetes Association.  Diabetic peripheral neuropathy causes nerves to send out abnormal signals. Patients feel burning, tingling or prickling sensations in their toes, feet, legs, hands and arms.

There are only two drugs approved by the Food and Drug Administration to treat DPN -- Cymbalta and Lyrica – and many patients say they don’t work or have unpleasant side effects.

Marijuana Helps Heal Broken Bones

Meanwhile, researchers in Israel have discovered that a compound in marijuana can help heal fractures and rebuild bones.

In an animal study published in the Journal of Bone and Mineral Research, researchers at Tel Aviv University reported that cannabinoid cannabidiol (CBD) – a non-psychoactive ingredient in marijuana – significantly enhanced the healing process in rats with broken legs.

Earlier studies by the same research team found that cannabinoid receptors in the human body stimulate bone formation and inhibit bone loss. The findings suggest that cannabinoid based drugs could be used to treat osteoporosis and other bone-related diseases.

"The clinical potential of cannabinoid-related compounds is simply undeniable at this point," said Dr. Yankel Gabet of the Bone Research Laboratory at the Department of Anatomy and Anthropology at Tel Aviv University.

The researchers injected one group of rats with CBD alone and another with a combination of CBD and THC. They found that CBD by itself provided the most therapeutic benefit.

"We found that CBD alone makes bones stronger during healing, enhancing the maturation of the collagenous matrix, which provides the basis for new mineralization of bone tissue," said Gabet.

"Other studies have also shown CBD to be a safe agent, which leads us to believe we should continue this line of study in clinical trials to assess its usefulness in improving human fracture healing.”