Opioid medications have been big in the news lately. These are drugs, such as codeine and oxycontin, that have long been the go-to medications for managing severe and chronic pain. Although opioids can be effective pain relievers, they have some serious drawbacks, including the potential for addiction and fatal overdose. As rates of addiction and overdose have risen to alarming levels, the government has recently begun to revise prescribing laws, limiting the ways in which doctors may prescribe these painkillers.
While these laws will keep patients safer from addiction and overdose, many patients with chronic pain depend on opioid medications to make that pain bearable and to make it possible for them to function normally. Doctors now face the challenge of finding ways to help these patients manage their pain without opioids.
At this year’s meeting of the Congress of Neurological Surgeons, Dr. Christopher Winfree, Assistant Professor of Neurological Surgery at Columbia University, explored one potential option that neurosurgeons may be able to use to help ease their patients’ pain while avoiding opioids: medical marijuana.
If that sounds controversial, it’s because it is: Medical marijuana is not legal in all states. However, Dr. Winfree pointed out that more and more states have been changing their stance on medical marijuana. He said that as of April 2017 it is legal for doctors to recommend marijuana in 29 states and the District of Columbia.
Dr. Winfree shared some thoughts on why more states are legalizing marijuana for medical use. He said they’re doing so because marijuana is proving to be not only effective but safer than opioids for treating a wide range of illnesses, including chronic pain. He cited studies that show marijuana treatment eases the pain of rheumatoid arthritis, fibromyalgia, inflammatory bowel diseases and even cancer, as well as neuropathic (nerve) pain.
Dr. Winfree explained that the cannabis plant, which is where marijuana comes from, contains naturally occurring compounds called cannabinoids. These cannabinoids fit perfectly into receptors in the human body called, appropriately, cannabinoid receptors. One type of cannabinoid, called tetrahydrocannabinol (THC), produces a psychoactive effect when it fits into its receptor, which causes the “high” associated with marijuana use. Another cannabinoid, called cannabinol (CBD), does not produce a high but does ease severe and chronic pain.
He said the FDA has approved some drugs that are derived from cannabinoids and give some of the benefit of the whole plant without the psychoactive effects. While these drugs are useful, some people seem to benefit more from using the whole cannabis plant.
When a doctor recommends “medical marijuana” for a patient, in many states that patient may then obtain cannabis at tightly controlled purchase points. The marijuana comes dried in a form that can be smoked, but it also comes in the form of various edibles and topical applications, depending on the patient’s needs.
There are, of course, side effects to cannabis use. Dr. Winfree said the most reported side effects are motor impairment, short-term memory impairment, impairment of judgment, paranoia (at high doses) and poor school performance in young users. Although these side effects should be taken seriously, Dr. Winfree pointed out that studies show marijuana to be much less addictive than opioids, and there have been no reported marijuana overdose deaths.
What about the stigma of cannabis use? Isn’t marijuana a gateway drug to heavier drug use? Dr. Winfree explained that if this were the case, we would be seeing the rates of opioid abuse and overdose deaths go up in states where medical marijuana is legal, as users seek out the more powerful drugs. Instead, he said, statistics show that opioid overdose deaths decreased in states that legalized medical marijuana.
He cautioned that cannabis should not be prescribed unless the patient has a debilitating medical condition that clinical trials suggest will respond to medical marijuana therapy, and then only if other first-line treatments, including the FDA-approved cannabinoid-based drugs, have failed. The patient must have no problems with substance abuse, and no unstable mood or anxiety disorders. And of course the patient must reside in a state where medical marijuana is legal.
But in a world where millions of people suffer from chronic pain and the standard opioid pain medications have some serious drawbacks, Dr. Winfree thinks it might be time to consider the medical use of cannabis where it is legal to do so. It could be a promising option for chronic pain patients, with fewer risks.
Learn more about Dr. Winfree at his bio page here.
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