A deeper look at the questions that continue to surround its efficacy as tool to manage pain
I have more than 30 years of experience in anesthesia and pain management, but about 12 years ago it became clear to me that the use of opioids for chronic pain were more problematic than useful. I began searching for an alternative and learned that many patients were getting relief from cannabis.
Impressed by how well they did, I began to incorporate medical cannabis into my clinical practice. But it was the startling reduction in the use of narcotics among patients substituting with medical cannabis that compelled me to join a research investigation of patients in New England who used cannabis. The results revealed a significant reduction in the use of opioids, antidepressants and alcohol for pain, anxiety and sleep. Published in the Journal of Psychopharmacology, the study is still one of the largest of its kind.
Today, it’s hard to escape the topic of medical cannabis, whether in the news, on the internet or across social media. A quick Google search for “cannabis” yields almost 200 million results in under a second. With state laws changing over the last decade, cannabis has become more widely available and interest in this powerful therapeutic continues to surge around the globe. The reason for this burgeoning demand begins with the question, “Why?”
Cannabis has been in continual use for more than 2,500 years and has played a major role in pain control and treatment of nausea and anxiety since ancient times. With the unfortunate explosion of the opioid crisis, in conjunction with research suggesting myriad beneficial health effects, the attitude of both patients and physicians toward cannabis use has broadened.
A 2016 Prevention magazine survey showed the vast majority of the U.S. population, and physicians as well, believe that medical cannabis should play a more prominent role in the health maintenance and wellness of the public.
The discovery of the endocannabinoid system revealed an extensive network of molecules and messengers in the body that regulate everything from immune function to inflammation, cancer surveillance to pain control, muscle function to the regulation of appetite. It turns out, our bodies produce cannabis-like chemicals, dubbed “cannabinoids.” This is a vast physiologic system that scientists are just beginning to understand.
The cannabis plant, Cannabis sativa L., produces more than 100 cannabinoids. While researchers are on the cutting edge of some profound breakthroughs, 33 states — despite the conflict with federal law — have passed state laws approving cannabis for medical use. Another 11 states, plus Washington, D.C. and Canada, have passed adult-use laws.
Each medical state has passed its own version of conditions that “qualify” a patient to have access to medical cannabis. By writing the law this way, physicians are absolved from breaching federal laws; they merely attest to a patient having a certain approved condition, such as cancer, post-traumatic stress disorder or other varying illnesses.
But chronic pain is the leading indication almost across the board, and the American Chronic Pain Association has designated September as Pain Awareness Month, a time to raise public awareness of issues in the area of pain and pain management.
There are few disadvantages to trying medical cannabis. (However, it is not recommended for a patient that is pregnant or has a history of mental illness or psychosis.) Many forms of it are devoid of THC, the cannabinoid that causes the “high.” Cannabidiol, also known as CBD, is non-psychoactive (meaning it does not induce euphoria), has a wide margin of safety and has great promise in the treatment of inflammation, depression, seizures and pain.
And while research is ongoing, cannabis may be far safer than many conventional medications in use today. I’ve seen firsthand the life-changing benefits of medical cannabis and I am hopeful that even more patients consider medical cannabis — a therapeutic with the potential to change lives for the better.
Corey A. Burchman, M.D., is chief medical officer of Acreage Holdings, Inc., the largest vertically integrated, multistate owner of cannabis licenses and assets in the U.S., and the parent company of Prime Wellness of Pennsylvania. He is a nationally recognized expert on clinical cannabinoid therapeutics and has chaired national and international conferences on the use of medical cannabis for therapeutic purposes. Before joining Acreage, he served as assistant professor of anesthesiology and pain medicine at Dartmouth’s Geisel School of Medicine. With dozens of journal article author credits, Dr. Burchman holds a major interest in pain management research, focusing largely on opioid and cannabinoid applications.