LAS VEGAS—Medical marijuana, or medicinal cannabis, has a legitimate place in pain management, yet physicians in states where it is legal are reluctant to prescribe it, according to Michael E. Schatman, PhD, Executive Director of the Foundation for Ethics in Pain Care in Bellevue, Washington. As a
result, patients who could benefit from medical marijuana seek out potentially more dangerous alternatives to ease their pain. They may turn to recreational marijuana, which typically is not as effective as therapeutic cannabis in relieving pain.
The pain relief offered by medical marijuana comes largely from cannabidiol, a cannabinoid with potent antiinflammatory properties, he explained. The ideal medical marijuana has a relatively high content of cannabidiol and low content of tetrahydrocannabinol (THC), the cannabinoid responsible for the euphoric effect of cannabis. Recreational marijuana typically has a relatively high THC content and an extremely low cannabidiol content, he said.
Dr. Schatman spoke about legal and ethical issues related to medical cannabis use in a session titled, “Medical Marijuana: Science, Practice, Policy, & Ethics.” Also in this session, Gregory T. Carter, MD, MS, of the University of Washington in Seattle, gave attendees pointers on the clinical use of medicinal cannabis (see article, Medicinal Cannabis in Clinical Practice below). Although cannabis has been well studied, scientific research on medicinal cannabis has been limited, Dr. Schatman said. “It’s hard to conduct medical marijuana research because who’s going to fund it?” said Dr. Schatman, adding that investigators need to have a special license to conduct the research. The available research data, however, and a considerable number of anecdotal reports support its clinical efficacy in pain management, he said.
SAFER THAN OPIOIDS
“We certainly have less efficacious and more dangerous medications out there being used for chronic pain—opioids, for example,” Dr. Schatman said. “I’ve been using medical marijuana with my patients for a number of years to help them reduce their levels of opioids.” Each year, 18,000 unintentional deaths from opioid overdose occur in the US, and not even one death from marijuana overdose, he said. Although medical marijuana use is now legal in 20 states and Washington DC, it is still considered illegal by the US government, which classifies marijuana as a Schedule I drug. Drugs in this category—which also includes heroin, LSD, methamphetamine, and others—are deemed to have no currently accepted medical use and a high potential for abuse.
FEDERAL LEGALIZATION NEEDED
The state-by-state approach to legalization, while better than nothing, is not the answer, Dr. Schatman said. State medical marijuana laws vary greatly, with variations in standards for patient qualification, practitioner requirements, and possession limits. Cannabis use for pain management should be legalized at the federal level, Dr. Schatman said, adding that lobbying by the pharmaceutical industry and lawmaker ignorance and biases would be major impediments. Cannabis would first need to be moved out of Schedule I, something Dr. Schatman sees as unlikely in the near future due to opposition by special interest groups. Rather, a feasible solution would be to use an opioid-addiction model proposed by Claire Frezza, JD, of Georgetown University in Washington, DC, in which the use of medicinal cannabis would be treated like methadone for opioid addiction. Patients in methadone treatment are required to visit specially accredited clinics for their medication.
Methadone is a Schedule II drug, but the federal government shifted oversight of this medication from the FDA to the Substance Abuse and Mental Health Services Administration. “That makes it possible to get around the scheduling issue,” Dr. Schatman said. “Why not do this with medical marijuana?”