Can marijuana save the day?
But Americans in pain are already turning to the marijuana plant.
The hope: One day you’ll have a choice of varieties or formulations of compounds in marijuana — called “cannabinoids” — that bring relief, aren’t addictive, and leave your mind clear.
“Cannabinoids will replace opioids for chronic pain in 5 to 10 years,” said Dr. George Anastassov, chief executive officer of AXIM Biotec, which is developing several products.
There are roles for opioids, medical marijuana, and related drugs in chronic pain treatment, added Dr. Mary Lynch, a pain researcher and practicing clinician at Dalhousie University in Canada.
People vary, so a “large part” of the treatment’s effectiveness is genetic, she said.
“Opioids are appropriate in a significant subpopulation with chronic pain, probably 18 percent,” Lynch told Healthline. “Some do better on cannabinoids.”
Millions of people — including more than 40 percent of older Americans — live with back issues, headaches, arthritic joints, and other forms of chronic pain, defined as pain lasting at least three months.
If the pain is severe, critics say it’s too easy to get a prescription for Vicodin, Percocet, OxyContin, and other opioids.
Most people use their medication safely.
In figures reported by the National Institute of Drug Abuse, misuse occurs in 21 to 29 percent of chronic pain patients. Between 8 and 12 percent develop a problem.
But as the number of prescriptions increased, so did deaths from overdoses.
Opioids are highly addictive. More than 2 million Americans now have an “opioid disorder.”
Experts agree that the boom in prescription painkillers triggered the rash of deaths from opioids in the United States today.
Even if you trust yourself, there are other reasons to avoid opioids. Among them is the possibility that your teen may raid the medicine cabinet looking for a party drug.
Or your prescription may never have been the right treatment.
In 2016, the Centers for Disease Control issued a guideline for primary care doctors, stating there was “insufficient evidence” to back the usefulness of opioids long-term for chronic pain.
The American Academy of Pain Medicine responded that opioids are “an important option” for those with chronic pain.
Using marijuana to treat pain
Marijuana may already be saving lives.
A study published in April concluded that new medical marijuana laws reduced hospitalizations for opioid problems in those states by 23 percent. Hospitalizations for overdoses also dropped 13 percent.
In an earlier study analyzing data from 1999 to 2010, states with medical marijuana laws had, on average, 25 percent fewer opioid deaths than states where marijuana was illegal.
People also seem to fill fewer prescriptions in states with medical marijuana laws.
Among people with an opioid painkiller prescription for long-term use, up to 39 percent also use some form of marijuana.
However, they’re jumping in with little science to back them up, according to a U.S. Veterans Health Administration (VA) review published today in the Annals of Internal Medicine.
That study looked at research about chronic pain and “cannabis,” the botanical name for the marijuana plant.
The VA report stated: “Virtually no conclusive information exists about the benefits of cannabis in chronic pain populations.”
The team did find “low-strength” evidence that marijuana or extracts help people with neuropathy, pain from damaged or misfiring nerves.
A growing group of patients, doctors, and scientists hope that research will dramatically change that picture.
Rules strictly limiting research have been a significant obstacle. In 2013, the American Academy of Pain Medicine called for changes in federal law.
The future of cannabis
The marijuana plant comes in many strains and contains hundreds of molecules.
The terms you hear most often are “THC” (tetrahydrocannabinol) and “CBD” (cannabidiol), which doesn’t make you “high.”
THC is most prized in the recreational versions. It also contributes to pain relief.
Any one cannabis plant affects people in many ways, tapping into the “endocannabinoid system,” receptors throughout the body.
“Your body makes its own marijuana-like chemicals similar to endorphins,” Lynch said. Those chemicals are involved in pain and inflammation as well as other functions.
Marijuana helps relieve a number of hard-to-treat conditions: migraine; irritable bowel syndrome, which causes abdominal cramps; and fibromyalgia, muscle pain throughout the body.
One theory has it that people with these conditions share “endocannabinoid deficiency.”
Dr. Daniel Clauw, a chronic pain specialist at the University of Michigan who works with fibromyalgia patients, agrees that cannabinoids are promising.
“We don’t know which of the ingredients are most active, or what the optimal strength and combination are,” he told Healthline. “It is almost certain that there is an optimal ratio of THC and CBD for pain that is not in any of the preparations” now available.
When people switch from using a plant to pure THC, they “don’t think it is nearly as effective or it has way more side effects,” he said.
The first prescription medicine derived from cannabis, Sativex, contains half THC and half CBD. It’s won approval outside of the United States for the treatment of spasticity from multiple sclerosis. But that ratio has had mixed results.
AXIM is testing a controlled-release chewing gum containing 50 milligrams of CBD to treat irritable bowel syndrome. The company is also testing a gum containing both THC and CBD to treat pain and spasticity from multiple sclerosis.
In June, it filed for a patent on a gum that it says can relieve pain and opioid addiction.
High doses are needed to get relief from CBD alone, reports Gary Hiller, president and chief operating officer of Phytecs, a Los-Angeles-based biotech firm.
By adding fluorine, he’s seen the CBD effect boosted up to 20-fold, he told Healthline.
Phytecs is also looking into entirely different ways to tap into the endocannabinoid system.
Clauw and Lynch turn to other medications, such as amitriptyline, duloxetine (Cymbalta), and pregabalin (Lyrica).
Clauw suggests patients with widespread muscle pain speak to their doctors about cyclobenzaprine (Flexeril).
Marijuana, he says, would be next best, followed by opioids.
If you’ve had more than one pain problem in your life, he observes, you may have been physically active earlier and cut way back to avoid pain.
Find ways to safely move again. Aerobic exercise is a potent pain reliever.
Therapy can help to change your thinking when you feel pain, moving away from fear and toward acceptance.
Says Hiller, “There’s a clear need for new therapeutic strategies to safely manage acute and chronic pain.”
But cannabis-related treatment will go beyond pain, he adds: “The 4,500-plus years of reported therapeutic use of cannabis is merely the opening chapter to something much more significant.”