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Can Marijuana Be The Answer For Pain?

Like many of her friends, Alexandra Callner, now 58, experimented with recreational marijuana when she was younger.

“I had tried it, and hated it, in my 20s,” Callner says. “When I was around pot smokers, I thought, ‘Ugh, losers.’ ”

Slideshow: Medical Marijuana

growing marijuana plant
1/12What Is It?Medical marijuana is made of dried parts of the Cannabis sativa plant. Humans have turned to it as an herbal remedy for centuries, and today people use it to relieve symptoms or treat various diseases. The federal government still considers it illegal, but some states allow it to treat specific health problems. The FDA, the U.S. agency that regulates medicines, hasn’t approved the plant as a treatment for any conditions.
thc chemical formula
2/12Key IngredientsMarijuana has chemicals called cannabinoids. Medical researchers usually focus on the health effects of two in particular: delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the substance that makes you high; CBD doesn’t have mind-altering effects.
forms of medical marijuana
3/12Forms of Medical MarijuanaThere are a variety of ways to take the drug. You can inhale a vaporized spray, smoke the leaves, take a pill or liquid, or bake it into foods. All of the types differ in terms of how often you should use them, how they’ll affect your symptoms, and side effects you may feel.
cannabinoid receptors in brain
4/12How It Works in Your BodyThe chemicals in marijuana affect you when they connect with specific parts of cells called receptors. Scientists know that you have cells with cannabinoid receptors in your brain and in your immune system. But the exact process of how the drug affects them isn’t clear yet.
conditions eased by marijuana
5/12What Does It Treat?State laws differ on the conditions that you can legally treat with medical marijuana. But you might be allowed to use it if you have Alzheimer’s, ALS, cancer, Crohn’s disease, epilepsy, seizures, hepatitis C, AIDS, glaucoma, multiple sclerosis, posttraumatic stress disorder, chronic pain, or severe nausea. But scientists aren’t sure that it helps all of these conditions. The research is most clear that it works as a painkiller, to stop vomiting during chemotherapy, to relieve some MS symptoms, and to treat a few rare forms of epilepsy.
man coughing
6/12Are There Risks?If you smoke it, you could have breathing problems such as chronic cough and bronchitis. Research has linked cannabis use and car accidents. If you use it while pregnant, you may affect your baby’s health and development. Studies also show a tie between pot and psychotic disorders such as schizophrenia.
marinol pills
7/12FDA-Approved VersionsAlthough the federal government hasn’t given its OK to marijuana for medicinal use, it has signed off on three related compounds as specific treatments. If you have nausea caused by chemotherapy, you might take a synthetic cannabinoid, either dronabinol or nabilone. Dronabinol also can help boost appetite for people with AIDS. The FDA approved cannabidiol (Epidolex) as a treatment for two rare kinds of epilepsy.
federal courthouse
8/12Laws in ConflictCalifornia was the first state to legalize medical marijuana, in 1996. Since then, more than half the states in the U.S. have done so. (Recreational weed is also legal in some places.) But the federal government still considers it an illegal drug, which can create confusion. For instance, even if you have a prescription, the Transportation Security Administration doesn’t allow cannabis in your luggage.
cannabis dispensary
9/12How Do You Get it?The rules vary, depending on where you live. Generally, you’ll need to consult with a doctor and have a condition that your state has approved for treatment with cannabis. You might get an ID card. In some areas, you buy products at a specific store called a dispensary.
woman smoking pot triptych
10/12Do People Become Addicted?Doctors don’t know much about the addiction risk for people who use the drug for medical reasons, and it needs more study. But people who use marijuana to get high can go on to have substance misuse issues. The most common problem is dependence. If you’re dependent, you’ll feel withdrawal symptoms if you stop using. If you’re addicted — a more severe problem — you’re unable to go without the drug.
marijuana medical research
11/12Why Don’t We Know More?Although cannabis has been an herbal remedy for centuries, the evidence for how well it works is lacking in many cases. Scientists prefer large studies with certain types of controls before they draw conclusions, and much of the research thus far hasn’t met those standards. Products vary in strength and it’s hard to measure doses, which has made judging the benefits of marijuana even more complicated.
hydrocodone pills
12/12An Opioid Alternative?Could cannabis help solve issues involving these powerful painkillers? In some states, prescriptions for this pain medicine fell and researchers found a link to fewer overdose deaths. But another study found a link between pot use and abuse of these narcotic drugs. Scientists need more evidence before they can say for sure.

But, that was before her knee arthritis became so bad, it robbed her sleep, night after night. She took two over-the-counter pain pills a day, but the pain would wake her up at night. And the drugs were hard on her stomach.

“It was making me kind of nauseous,” she says of the nonsteroidal anti-inflammatories. Plus, she needed to stay active to manage her dog boarding service in Pasadena, CA.

Then came another solution. “A neighbor said, ‘Try this,’ ” Callner says. It was a joint.

Callner got a medical marijuana card, and then she tried it. “I slept through the night.”

That was a year ago, and it’s now her nightly ritual. “Every night, I get into bed, read about an hour, take one or two puffs, and then I am off to sleep,” she says. “The pain is much lighter.”

About 50 million Americans like Callner live with chronic or severe pain. Patients and doctors are seeking treatments besides the potent prescription painkillers like opioids and the nonprescription medicines that Callner found tough to tolerate.

So could marijuana be the next pain reliever of choice?

Lack of Research

Donald Abrams, MD, a professor of clinical medicine at the University of California, San Francisco, helped review research on marijuana for a 2017 report from the U.S. National Academies of Sciences, Engineering, and Medicine.

There is a lack of evidence about the health effects of marijuana, he says.

Alternative Treatments for Long-Term Pain

accupuncture needles in skin
1/13AcupunctureIt may look uncomfortable, but this traditional Chinese practice doesn’t hurt when it’s done by a licensed pro. He puts thin needles just under the skin at certain points in your body. It may help ease long-term pain in your knees, lower back, and neck. You can also try it for headaches. Exactly how it does the job isn’t clear. Just believing it works may be part of it.
tumeric powder
2/13TurmericPopular in Indian cooking, this bright yellow spice does a lot more than add flavor. Curcumin, one of its main ingredients, cuts inflammation in your body. Some studies show it may treat pain from arthritis and bursitis. Turmeric in food is safe, but don’t take it in the form of pills if you have diabetes. They may lower your blood sugar to risky levels if you’re on meds for that condition.
man listening to music
3/13MusicIf you’re hurting, you might want to crank up your favorite tunes. Listening to music releases a chemical in your brain that helps control feelings of discomfort. Some people with fibromyalgia, which causes muscle and joint pain, get relief this way. It may also work if you’ve got arthritis or a nerve disorder. How long should you listen? One small study showed just 20 minutes a day gave relief to people with arthritis.
marijuana leaf
4/13Medical MarijuanaIt doesn’t work like a typical painkiller. Instead of getting rid of your hurt, it tricks your brain into believing that it’s not so bad. Studies show pot may treat some symptoms of multiple sclerosis. It may also help you sleep better if you have long-term pain. To use medical marijuana, you need to live in a state where it’s legal and get your doctor’s OK.
chopped ginger root
5/13Supplements and HerbsIf you want to go “natural,” you’ve got a few choices to ease your pain. One study shows ginger extract may be as good as ibuprofen for arthritis. Willow bark and devil’s claw may help your aching back. And fish oil can sometimes ease symptoms from Raynaud’s syndrome and lupus. Check with your doctor before you try anything. Supplements can interfere with other drugs you take, or could harm you if you’re pregnant or breastfeeding.
woman having spine adjusted
6/13Behavioral TherapyIt sounds too good to be true, but just talking about your pain with the right people can help make it improve. Cognitive-behavioral therapy (CBT) teaches you skills that let you feel more in control of what’s hurting you. It can help you get relief from back pain, headaches, and arthritis.
black pepper corns powder
7/13Essential OilsCan using a cream with essential oils put an end to your aches? There’s not a lot of research to make a case one way or the other. But what we do know is that certain scents relax you, which can put some distance between you and your pain. Lavender oil may help your headache. Black pepper, clary sage, and marjoram may soothe sore muscles.
dried alternative medicine herbs
8/13HypnotherapyThere was a time when people thought of hypnosis as a carnival sideshow. Not anymore. Now it’s used to help relieve pain from things like irritable bowel syndrome, headaches, arthritis, fibromyalgia, cancer, and sickle cell disease. A trained hypnotherapist guides you through relaxation exercises, and uses the power of suggestion to change how you think of pain. Many people see an improvement in four to 10 sessions.
woman getting neck massage
9/13MassageAnyone who’s had a back rub knows the healing power of touch. A therapist’s hands can often help ease arthritis and fibromyalgia. Here’s how it works. When your soft tissue gets moved around during a massage, electrical and chemical signals are sent throughout your body. These reduce pain, boost your blood’s circulation, rev up your defense system against germs, and cut down feelings of stress.
man doing childs pose
10/13YogaThis ancient Indian practice combines breathing exercises, meditation, and moving your body into different poses. It may help ease pain in your lower back and knees, and manage migraines, too. There’s another reason to get on the mat. Over time, long-term pain can lead to memory and emotional problems. There’s some evidence yoga can reverse that.
woman having spine adjusted
11/13Chiropractic ManipulationA “hands on” adjustment can be a great way to treat tender muscles and joints. Over time, changes in your injured tissue can lead to inflammation and make movement more difficult. By manipulating your spine or other muscles, a chiropractor can often reduce the soreness you feel. Chiropractic care can relieve lower back pain as well as some prescription drugs. It also may help treat neck pain and carpal tunnel syndrome.
meditation class
12/13Guided ImageryIt’s a way to use your imagination as an ally in the fight against pain. Focus your mind on calm, peaceful images to get a “mental escape” from what’s hurting you. It puts your body into a deeply relaxed state that promotes healing. You can’t do this on your own. You’ll need a professional to show you how, but it’s simple enough that kids can learn it. Guided imagery may help relieve tension headaches and pain from cancer and fibromyalgia.
dried alternative medicine herbs
13/13HomeopathyThe idea behind it is simple: A little bit of what’s making you sick may also cure you. Remedies, which you can buy at stores or from a trained homeopath, include diluted amounts of herbs and other plants, minerals, and animal products. While some studies show homeopathy may ease pain from fibromyalgia and chronic fatigue syndrome, there isn’t enough strong research yet to know for sure.

Adds Angela Bryan, PhD, professor of psychology and neuroscience at the University of Colorado, Boulder: “The evidence we have thus far suggests that cannabis is moderately effective for pain relief.” But most studies haven’t compared marijuana with other ways to relieve pain, she says.

Cannabis is the scientific name for the marijuana plant. Researchers prefer to use “cannabis” instead of “marijuana” because marijuana is associated with recreational use, Abrams says.

Why the lack of evidence from research in the U.S.?

Although medical marijuana in some form is legal in 30 states and Washington, D.C., it’s still illegal on the federal level. It’s classified as a Schedule I drug — putting it in the same category as other drugs of “high potential for abuse” that have ”no currently accepted medical use,” such as heroin and LSD.

That means federal rules put limits on what researchers can do.

“In the state of Colorado [which allows medical and adult private use], I can go to any dispensary and buy whatever I want to treat whatever I want,” says Bryan, who’s also co-director of the CU Change Lab, which explores health and risk behavior. “You would think that means researchers can, too. The problem is, researchers are in a federal institution [at the University of Colorado]. If we do anything in violation of federal law, we could have all federal funding withdrawn.”

Bryan’s team has grants for four research studies on marijuana, including one on lower back pain. Participants come to the university for their initial assessment, but then must go to the dispensary on their own to buy the marijuana, she says. Declassifying marijuana as a Schedule I drug would make her research easier, Bryan says, or at least as easy as alcohol research.

“If I want to do a study on alcohol, I bring someone in, give them wine, get blood [samples], and see what happens when they use alcohol.”

The problem is, researchers are in a federal institution [at the University of Colorado]. If we do anything in violation of federal law, we could have all federal funding withdrawn.Angela Bryan, PhD, professor at the University of Colorado, on why there’s so little research into marijuana.

Bryan says she could use marijuana supplied by the government. The Drug Enforcement Administration (DEA) issued a license to the University of Mississippi to cultivate marijuana for research. The marijuana from dispensaries is different and more potent  than that supplied by the National Institute on Drug Abuse farm, she says.

Patient groups, including those for veterans, are among those pushing for more research. Nick Etten, a former Navy SEAL, founded the Veterans Cannabis Project in 2017. “We are bringing stories to the Hill,” he says, ”of veterans who have found relief from their health issues through cannabis.” He reaches out to individual U.S. legislators, he says, to elevate marijuana as a health issue and to persuade them to declassify marijuana.

In 2016, the National Football League Players Association created a pain management committee to study ways to help players deal with injuries and chronic pain, says Brandon Parker, a spokesman. “Marijuana is just one of several alternative pain relievers being studied by the committee,” he says.

Research Scorecard

The National Academies’ report looked at data from 1999 on, reviewing more than 10,000 scientific studies, of which only seven were directly related to pain relief. One of the seven looked at data from 28 studies.

Abrams says the evidence on marijuana and pain is strongest for helping nerve pain (neuropathy) and cancer-related pain. The committee also concluded that certain oral cannabinoids improved muscle spasms in patients with multiple sclerosis.

Medical Marijuana
Medical MarijuanaIt comes in many forms, including an oil.

Cannabinoids are one of more than 60 chemicals in the cannabis plant. Abrams says it makes sense that marijuana may help relieve pain because the body has cannabinoid receptors, or places where the chemical attaches to cells.  

Here is a sampling of research or reviews published in the past year:

  • Israeli researchers found marijuana gave substantial pain relief to more than half of 1,200 cancer patients who used it for 6 months.
  • In a review of 16 published studies including more than 1,700 participants with chronic nerve pain, German researchers found that marijuana-based remedies increased the number of people who reported a 50% or more reduction in pain relief. But they also concluded that the risks may outweigh the benefits. People taking marijuana-based remedies were more likely to have sleepiness, dizziness, and confusion.
  • In a small study of 47 patients with Parkinson’s disease, Israeli researchers found a 27% improvement in pain with marijuana use.
  • Medical marijuana helped to ease pain in 26 patients with fibromyalgia, a condition in which the body has ”tender” points. Half the patients stopped taking any other medicines for fibromyalgia, but 30% did have mild side effects.
  • A study from the European Academy of Neurology found that cannabinoids given at various doses eased pain in migraine patients by 40% or more. It helped cut pain in people with cluster headaches, too, but only if the patient had a history of childhood migraine.
  • Marijuana and cannabinoids may have modest effects on the pain and muscle spasticity that come with multiple sclerosis, according to an Australian review that looked at 32 studies.

Not for Everyone

Experts also saw potential downsides to marijuana. The European Academy report found that marijuana use may:

  • Make you more likely to be involved in a car accident
  • Raise the chance of unintentional marijuana overdose injuries among children, something that has happened in states where marijuana use is legal
  • Lead to more frequent bronchitis if smoked on a regular basis
  • Raise the odds of having schizophrenia and, to a lesser extent, depression

Smoking marijuana is also linked to delivering a lower birth weight baby, although the relationship with other pregnancy and childhood outcomes is not clear, the report says.

Abrams says marijuana can raise heart rate and either raise or lower blood pressure. Frail older people with balance issues have a risk of dizziness and falling.

Will Marijuana Replace Opioids?

Some research suggests that marijuana could take the place of opioids. Two recent studies found that states with medical marijuana laws or legalized recreational use may have a decline in opioid prescriptions.

In another study, researchers polled nearly 3,000 medical marijuana patients, including about a third who said they had used opioid pain medicines in the past 6 months. Most said the marijuana provided relief equal to their other medications, but without the side effects. While 97% said they were able to lower the amount of opioids they took if they also took marijuana, 81% said that taking marijuana alone was more effective than using both marijuana and opioids.

Alex Jordan is an artist who works at a marijuana dispensary in the Los Angeles area.

That finding makes sense to Alex Jordan, 29, an artist who works at the Green Valley Collective, a marijuana dispensary in the Los Angeles area. She manages her chronic pain with daily use of marijuana joints and products that contain cannabidiol (CBD), a cannabinoid.

Her experience helps her guide her customers, who range from young adults to those over age 80, to an effective remedy. “I would say 60% of our users use [marijuana] to manage some kind of pain, whether it be physical or mental,” she says.

Without it, her pain is severe — usually a 4 to 7 on a 10-point scale, she says. It started after she was in a car accident in 2011. The van she was riding in hit black ice and flipped seven times. The accident left her with a broken sternum (breastbone), six broken ribs, six crushed vertebrae, and collapsed lungs, making breathing difficult. Morphine helped relieve the pain in the hospital. Later, she says, “I could get any pill I wanted” for pain relief. She wore a neck brace for 2 months and a back brace for 6, but the pain persisted.

She wanted off the potent painkillers and had used marijuana recreationally in years past. She experimented with different options until she found her current regimen. And to make access easier, she and her husband moved from New York City to Los Angeles, where recreational marijuana is legal, last year. Before the move, the pain had gotten so bad, she had trouble putting on a shirt. These days, she’s working regularly and branching out as a freelance artist.

“The lack of pain is a wonderful thing,” she says. “It brings me to tears.”

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December 2020