Medical marijuana’s acceptance as a legitimate treatment for chronic pain may be reaching a tipping point.
Approximately 100 million Americans—one third of the U.S. population—lives with chronic pain. Around 25 million have moderate to severe chronic pain that limits activities and diminishes quality of life. The total societal costs of pain, measured in missed workdays and medical expenses, is estimated at $560 to $630 billion per year.
To manage chronic pain 5 to 8 million Americans use opioid prescription painkillers such as morphine, oxycodone, and methadone. While the risks of opioid abuse and addiction are well understood, new research suggests that opioids actually worsen chronic pain. And despite widespread use of opioids for chronic pain, there is very little clinical data supporting their long-term use.
Research on medical marijuana is trending in the opposite direction. New research suggests not only that cannabis significantly improves chronic pain, but also that long-term use of medical cannabis is safe. In addition, cannabis, when used to treat chronic pain, has been shown to reduce opioid use.
All of this bodes well for the future of medical marijuana and the millions of pain patients who are seeking safe, effective treatment for chronic pain.
A (Not So) Silent Epidemic
Opioid drug use has increased dramatically in recent years, spurring an uptick in opioid harm that some experts have called a “silent epidemic.”
From 1991 to 2011 opioid prescriptions for pain management rose from 76 million to 219 million. Between 2000 and 2010 hospitalizations for prescription opioid addiction quadrupled to more than 160,000 per year. Currently, more than 75 Americans die each day from opioid overdoses.
Opioid harm often extends beyond the patient population. More than half of people who abuse painkillers receive them from a friend or relative. Non-medical use of opioids has also been linked to the heroin abuse epidemic in the U.S.
(Not surprisingly, BigPharma has its fingerprints on the opioid abuse epidemic, as drug companies have aggressively marketed prescription opioids and profited handsomely. Purdue Pharma, the maker of high-addictive OxyContin, made $31 billion in revenue off the drug and lied about its duration of effectiveness to preserve revenue.)
Damning New Opioid Research
The societal costs of opioid drugs have been rationalized on the basis of their effectiveness for helping millions to manage chronic, disabling pain. Clinical assumptions about these drugs, however, are being undermined by new research.
A systematic review of opioid therapy literature published in 2015 concluded that there is insufficient evidence to determine the effectiveness of long-term opioid therapy for improving chronic pain and function. According to the review, most opioids are approved on the basis of short-term trials lasting less than 12 weeks (chronic pain is defined as pain lasting 3 months or more). The review found data supporting a dose-dependent risk for serious opioid harms, including overdose, abuse, bone fractures, motor vehicle accidents, sexual dysfunction, and heart attack.
Even more devastating to prevailing opioid wisdom is a 2016 study out of the University of Colorado at Boulder which found that opioids increase chronic pain. The effect has to do with immune cells in the spinal cord known as glial cells. Opioids appear to overstimulate glial cells, leading to nerve signaling than can increase and prolong pain.
“The implications for people taking opioids like morphine, oxycodone and methadone are great, since we show the short-term decision to take opioids can have devastating consequences of making pain worse and longer lasing,” said Linda Evans of CU-Boulder. This is a very ugly side to opioids that had not been recognized before.”
The finding could also help to explain a mechanism of addiction whereby opioid use temporarily relieves pain but in the end leads to worse pain that necessitates longer drug regimens—which in turn makes drug dependence more likely.
Medical Marijuana for Pain Management
Anecdotal evidence of marijuana’s analgesic properties has been around for thousands of years. As the drug undergoes clinical scrutiny the case is getting stronger that marijuana belongs in the discussion about safe, effective pain medications.
Medical Cannabis Safety
A Canadian research team found in 2015 that marijuana has a reasonably good safety profile compared to the effects of other pain medications. The study—the first and largest study of the long-term safety of medical cannabis for pain management—followed 215 adult patients with chronic pain who used medical pot daily for one year. Minor side effects (such as headache, dizziness, and sleepiness) were observed, but these are a far cry from the potentially fatal side effects of opioids
(Side note: for those worried about marijuana’s psychoactive side effects, researchers are exploring the pain-fighting effects of cannabidiol, or CBD, a cannabis compound that does not get users high. Early results are promising.)
Medical Cannabis Effectiveness
In terms of effectiveness, a large body of research supports the idea that medical marijuana reduces chronic pain. For example, cannabis was shown to improve neuropathic pain in a 2013 FDA-approved study published in The Journal of Pain. The study demonstrated that at low doses, cannabis provided an analgesic effect the study authors deemed “clinically significant.” Importantly, the effect was achieved at low drug doses and produced “minimal and well tolerated” side effects.
A 2014 Israeli clinical trial reported that a single dose of medicinal cannabis produced a 45% reduction in pain intensity and was well tolerated.
Two reviews of these and other studies both concluded that medical marijuana is effective for pain management. One, published in the British Journal of Clinical Pharmacology, concluded “[I]t is reasonable to consider cannabinoids as a treatment option for the management of chronic neuropathic pain with evidence of efficacy in other types of chronic pain such as fibromyalgia and rheumatoid arthritis as well.” Another, published in The Clinical Journal of Pain, concluded, “based on the existing clinical trials database…Incorporating cannabinergic medicine topics into pain medicine education seems warranted and continuing clinical research and empiric treatment trials are appropriate.”
A final bit of good news: medical marijuana could help patients to reduce opioid use—and potentially avoid opioid adverse effects.
Researchers with Hebrew University in Israel studied chronic pain patients who were unresponsive to conventional pain medications and observed improvement in pain symptoms as well as a decline in opioid consumption of 44%. In two separate studies published by the Journal of the American Medical Association and the National Bureau of Economic Research, data indicated states with medical marijuana dispensaries experience far fewer opioid-related deaths than states that states without dispensaries.
None of this is to say that medical marijuana is a panacea for chronic pain management. All drugs have risks and benefits that demand a patient-specific approach. However, as the evidence supporting the use of medical marijuana and the use of opioids head in different directions, it’s safe to say that cannabis deserves serious consideration from anyone dealing with long-term pain.
Brian Eckert is a consumer activist and wellness writer. He has been speaking out against BigPharma and medical device companies for more than a decade and aims to empower people to make better healthcare decisions by sharing his knowledge. www.classaction.com.