It’s estimated that chronic non-malignant pain (CNMP) affects 20% of the world’s population.[1] Unfortunately, medical cannabis is not viewed as a viable treatment option for CNMP (chronic non-cancer pain) by most high-level healthcare providers (M.D/D.O. and Advanced Practice Clinicians). This is despite the data which supports chronic pain being the most common condition being cited by patients utilizing medical cannabis. [2]  In the following, I dispel the myth that medical cannabis is not an effective treatment option for chronic-non cancer pain.
Cannabis, specific to the Cannabis sativa plant, was used for centuries throughout the world to alleviate symptoms related to disease and disorders. It was recognized as a traditional treatment for pain in the United States until it was outlawed in 1937 laws enacted on the basis of racially motived biases. Cannabis became more known as a recreational drug and was promoted as a dangerous one by uninformed regulators and misguided politicians who not basing their founding of federal law on evidence-based science.
The National Academies of Sciences, Engineering, and Medicine (NASEM) made a profound claim in its report The Health Effects of Cannabis and Cannabinoids with Conclusion 4-1: There is substantial evidence that cannabis is an effective treatment for chronic pain in adults.
Cannabinoids are chemical compounds found in the cannabis plant which have medicinal effect and were first identified in the 1930s by R.S. Cahn. The two primary cannabinoids, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) were discovered in the 1940s. In the mid-1960s to early 1970s saw the growth of research into the pharmacology of cannabinoids. Israeli researcher Dr. Ralph Mechoulam and his colleagues isolated the chemical structures of THC and CBD. Their research propelled cannabis science research. The 1990s were a time of rapid growth of research in the US and internationally led by the discovery of the endocannabinoid system (ESC), a system which regulates homeostasis in the human body. [3] These important discoveries and following research led the shift in the thinking of the properties of cannabinoids for therapeutic reasons. During the late 1990s, 13 US states of the established laws which permit cannabis for medical necessity, requiring to be recommended by physicians. Today, there are 33 states and the District of Columbia which have medical cannabis programs which underscores a dramatic shift in a traditional treatment paradigm. The National Academies of Sciences, Engineering, and Medicine (NASEM) made a profound claim in its report The Health Effects of Cannabis and Cannabinoids with Conclusion 4-1: There is substantial evidence that cannabis is an effective treatment for chronic pain in adults. [4]
Prescribing opioids has been the standard treatment for chronic pain if NSAIDs are deemed ineffective. While cannabis isn’t strong enough for severe pain, e.g. post-surgical pain or a broken bone, it is quite effective for CNMP that plagues millions of Americans. The use of opioids for CNMP is controversial as well as dangerous. It’s launched an opioid epidemic in America. Cities and towns across the US have been ravaged by the epidemic and Americans recognize the danger of opioid use and are turning to medical cannabis to treat their CNMP as well as decrease their use of opioids. According to data released in 2018 by the CDC, 128 people die every day in the US because of opioid overdose.
Opioids bind to opioid receptors in the cardio-respiratory and pulmonary systems in the brain stem and activates them which produces respiratory-depressing effects because of a lack of oxygen. There are no cannabinoid receptors in the brain regions which control these systems, so there is zero risk of a fatal overdose using cannabinoid therapy. This is a powerful endorsement for the use of cannabis for local chronic pain management.
Cannabis is classified as a Schedule 1 drug and as such, FDA approved and gold standard randomized studies for medical research on the use of medical cannabis and its impact of decreased opioid use are limited yet powerful. Pain control is the most common use for medical cannabis in the United States. In 2013, Ilgen et al reported that 87% of participants in their study were seeking medical marijuana (sic) for pain relief. [5]
Between November 2013 and February 2015, Boehnke et al conducted a conducted a cross-sectional retrospective survey of 244 medical cannabis patients with CNMP who made their purchases at a Michigan-based dispensary.[6] Per the report, data was collected including demographic information, changes in opioid use, quality of life, medication classes used, and medication side effects before and after the initiation of cannabis use. Among study participants, medical cannabis use was associated with a 64% decrease in opioid use, decreased number and side effects of medications, and an improved quality of life.
Whiting et al. (2015) reviewed and reported on 79 trials and 28 data bases which was published in the Journal of the American Medical Association (JAMA) summarized 28 trials and made the conclusion that there is evidence to support the use of cannabinoids for the treatment of chronic pain.[7]
Physicians and advanced practice clinicians are key stakeholders to impact a much needed and outdated approach to medical cannabis.
Dr. Eric P. Baron concluded in a report that there is accumulating evidence that has an exhaustive report, therapeutic benefits of cannabis/cannabinoids, especially in the treatment of pain, which may also apply to the treatment of migraine and headache.[8] He cited more than 35 studies. These studies demonstrated positive outcomes in chronic neuropathic pain in fibromyalgia, rheumatoid arthritis, MS, upper motor neuron syndrome/spasticity, unspecified chronic non-cancer pain, chronic neuropathic pain from HIV, complex regional pain syndrome (CRPS), trauma, or surgery.
Despite the stigma and myth held onto by physicians and advanced practice clinicians for decades that medical cannabis is a dangerous and ineffective treatment disorders and disease symptoms of chronic pain, there is mounting and clear evidence that this myth is exactly that, a myth. Physicians and advanced practice clinicians are key stakeholders to impact a much needed and outdated approach to medical cannabis. It’s beyond time to change the federal illegal status of cannabis so that FDA gold-standard clinical trials and research moves forward to underscore what their patients and numerous studies demonstrate: medical cannabis is an effective therapy of various chronic pain disorders.
CannabizMD is hosting Cannabis Science + Therapeutics Provider Education Forum October 3, 2020.
Resources
[1]RD Treede, et al. A Classification of Chronic Pain https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450869/ Accessed June 5, 2020.
[2] National Academies of Sciences E and M, Health and Medicine Division, Board on Population Health and Public Health Practice, Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: National Academies Press; 2017. Chronic Pain. Pages 87-90.
[3] Roger G Pertwee, Cannabinoid Pharmacology: the first 66 years. Accessed June 13, 2020.
[4] National Academies of Sciences E and M, Health and Medicine Division
[5] Ibid
[6] Ibid
[7] Penny F. Whiting, et al: Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA, Accessed June 13, 2020.
[8] Eric P. Baron, D.O., Medicinal Properties of Cannabinoids, Terpenes, and Flavonoids in Cannabis, and Benefits in Migraine, Headache, and Pain: An Update on Current Evidence and Cannabis Science. Headache. July/August 2018.
