Pot for Pain: The Good, The Bad, and the Down-Right Scary

legalization cheech chongRemember the good old days, when we giggled about doobies, pot-brownies, and the munchies and laughed out loud at the antics of Cheech and Chong in “Up in Smoke?”  Talk of marijuana was a bit taboo, and while we all “knew people” who did a little weed now and then, it really wasn’t a big deal.  For the most part, it wasn’t big business either, except perhaps, for that hippie down the street who sold it out of his van. And it certainly didn’t cause a political stir, quite simply, because everyone knew the facts: marijuana is a drug and it is (was) illegal.

Well, times, they are a’changin’.  As of November 11, 2016, twenty-nine states have laws on the books legalizing the use of marijuana for medicinal purposes, with seven of those states and the District of Columbia adopting more expansive laws legalizing marijuana for recreational use. Four out of five states aiming to legalize marijuana for recreation succeeded this fall, and there is a strong push among lobbyists in several states to legalize and expand the industry.

The topic of medical marijuana comes up from time to time in my clinic, with patients asking my opinion and trying to sway me one way or the other.  I’m guessing, depending on your location and patient population, it comes up in your clinic too. Proponents tout it as a safe alternative to opioids, and the media provides sensational stories of lives changed since the legalization of it. I have one patient who loves to bring me stories from newspapers and the internet proving pot is the end-all-be-all answer to pain. Maybe he is hoping to drum up some business, assuming Wisconsin turns green one of these days. Considering the substantial buzz on the topic, medical marijuana is something we now discuss in our advanced Therapeutic Neuroscience Education courses.  And, it’s a topic we should all be prepared to discuss intelligently.

The Good:

There is some compelling research advocating the medical use of cannibus.  For instance, in a 2015 systematic review published in JAMA, KP Hill found “Use of marijuana for chronic pain, neuropathic pain, and spasticity due to multiple sclerosis is supported by high-quality evidence. Six trials that included 325 patients examined chronic pain, 6 trials that included 396 patients investigated neuropathic pain, and 12 trials that included 1600 patients focused on multiple sclerosis. Several of these trials had positive results, suggesting that marijuana or cannabinoids may be efficacious for these indications.”

In fact, there is a movement to re-schedule and re-brand marijuana, described by Carter et al. in a 2015 article . The authors’ state: “The field of pain medicine is at a crossroads given the epidemic of addiction and overdose deaths from prescription opioids. Cannabis and its active ingredients, cannabinoids, are a much safer therapeutic option. Despite being slowed by legal restrictions and stigma, research continues to show that when used appropriately, cannabis is safe and effective for many forms of chronic pain and other conditions, and has no overdose levels. Current literature indicates many chronic pain patients could be treated with cannabis alone or with lower doses of opioids. To make progress, cannabis needs to be re-branded as a legitimate medicine and rescheduled to a more pharmacologically justifiable class of compounds.”

The Bad:

However, before we get too excited and order green prescription pads for our offices, we need to look a little closer at what the literature has to say about the diagnoses for which cannabis is effective, and compare that to the types of patients we see in the clinic.  Belenduik et al. provides a review of the safety and efficacy of marijuana for the treatment of common state-approved medical and psychiatric disorders in this free article.( According to the authors, common medical conditions for which marijuana is allowed (i.e., those conditions shared by at least 80 percent of medical marijuana states) were identified as: Alzheimer’s disease, amyotrophic lateral sclerosis, cachexia/wasting syndrome, cancer, Crohn’s disease, epilepsy and seizures, glaucoma, hepatitis C virus, human immunodeficiency virus/acquired immunodeficiency syndrome, multiple sclerosis and muscle spasticity, severe and chronic pain, severe nausea…and post-traumatic stress disorder.

As it turns out, research on musculoskeletal pain and marijuana is quite limited.  Rather, according to Belenduik et al., pain-specific clinical trials have examined smoked and oral administration of cannabinoids on different types of pain (e.g., neuropathic, post-operative, experimentally induced) in multiple patient populations (e.g., HIV, cancer, and fibromyalgia). Areas of concern arose concerning dosage, as some studies have found that higher doses of smoked marijuana are associated with improved analgesia, whereas other studies show that higher doses of smoked marijuana increase pain response.  In addition, one meta-analysis showed that marijuana increased the odds of altered perception, motor function, and cognition by 4 to 5 times.  After reviewing the two meta-analyses that explore the association between marijuana and pain, the authors conclude that “Although there is preliminary support to suggest that marijuana may have analgesic effects, there is insufficient research on dosing and side effect profile, which precludes recommending marijuana for the management of severe and chronic pain.”

The Down-Right Scary:

As the push to legalize marijuana for medical purposes gains momentum and acceptance in the mainstream, we need to look at what we know about the side effects of the drug on individuals and ask ourselves: Would marijuana be helpful for our patients already struggling with the effects of a brain on pain?  Remember the Pain Neuromatrix?  A brain that is enslaved to pain commonly already has difficulty with focus, problem solving, fear, memory, body maps, motor control, stress responses, and motivation. Consider some of these facts about marijuana, which are outlined in the Surgeon General’s Report on Alcohol, Drugs, and Health:

  • Long-term health consequences of marijuana use:  mental health problems, chronic cough, frequent respiratory infections, increased risk for cancer, and suppression of the immune system.
  • Other serious health-related issues stemming from marijuana use: breathing problems; increased risk of cancer of the head, neck, lungs, and respiratory tract; possible loss of IQ points when repeated use begins in adolescence; babies born with problems with attention, memory, and problem solving (when used by the mother during pregnancy).
  • Increased risk for traffic accidents:  Marijuana use is linked to a roughly two-fold increase in accident risk.
  • Increased risk of schizophrenia:  The use of marijuana, particularly marijuana with a high THC content, might contribute to schizophrenia in those who have specific genetic vulnerabilities.
  • Increased risk of addiction from high-potency marijuana available in legalized states:  Concern is growing that increasing use of marijuana extracts with extremely high amounts of THC could lead to higher rates of addiction among marijuana users.
  • Permanent Loss of IQ:  One study followed people from age 13 to 38 and found that those who began marijuana use in their teens and developed a persistent cannabis use disorder had up to an eight point drop in IQ, even if they stopped using in adulthood.

The report notes that, “While laws are changing, so too is the drug itself with average potency more than doubling over the past decade (1998 to 2008). The ways marijuana is used are also changing – in addition to smoking, consuming edible forms like baked goods and candies, using vaporizing devices, and using high-potency extracts and oils (e.g., “dabbing”) are becoming increasingly common. Because these products and methods are unregulated even in states that have legalized marijuana use, users may not have accurate information about dosage or potency, which can lead and has led to serious consequences such as hospitalizations for psychosis and other overdose-related symptoms.”

Smart Approaches to Marijuana, SAM, is an alliance of organizations and individuals dedicated to a health-first approach to marijuana policy.  They refer to the marijuana industry as Tobacco 2.0, and they make a strong case against the commercialization and normalization of marijuana.  Their concern is not only for the effect on individuals, but on general public health and society as well. Their fact list on the consequences of marijuana use and legalization is sobering (sources for all facts and stats cited below available on SAM’s website.

  • One in every six 16 year-olds (and one in every eleven adults) who try marijuana will become addicted to it.
  • Today’s marijuana is not your “Woodstock weed” – it can be 5-10 times stronger than marijuana of the past. The psychoactive ingredient in marijuana, THC, has increased almost 6-fold in the past 30 years.
  • Adolescents who smoke marijuana once a week over a two-year period are almost six times more likely than nonsmokers to drop out of school and over three times less likely to enter college.
  • Emergency room admissions for marijuana use now exceed those for heroin and are continuing to rise.
  • The link between suicide and marijuana is strong, as are car accidents – many of which result in death.
  • Regular marijuana use is associated with lower satisfaction with intimate romantic relationships, work, family, friends, leisure pursuits, and life in general.
  • In most states that permit the use of medical marijuana, less than 2-3% of users report having cancer, HIV/AIDS, glaucoma, MS, or other life-threatening disease.
  • We know that most people who use pot won’t go onto other drugs; but 99% of people who are addicted to other drugs started with alcohol and marijuana. So, indeed, marijuana use makes addiction to other drugs more likely.
  • Beginning in the 1980s, scientists have uncovered a direct link between marijuana use and mental illness. According to a study published in the British Medical Journal, daily use among adolescent girls is associated with a fivefold increase in the risk of depression and anxiety. Youth who begin smoking marijuana at an earlier age are more likely to have an impaired ability to experience normal emotional responses. The link between marijuana use and mental health extends beyond anxiety and depression. Marijuana users have a six times higher risk of schizophrenia, are significantly more likely to develop other psychotic illnesses.
  • Residents of states with medical marijuana laws have higher odds of marijuana use and marijuana abuse/dependence than residents of states without such laws.
  • Cannabis food and candy is being marketed to children and are already responsible for a growing number of marijuana-related ER visits. Edibles with names such as “Ring Pots” and “Pot Tarts” are inspired by favorite candies of children and dessert products such as “Ring Pops” and “Pop Tarts.” Moreover, a large vaporization industry is now emerging and targeting youth, allowing young people and minors to use marijuana more easily in public places without being detected.

SAM asserts that the marijuana industry consistently puts corporate profit and addiction ahead of public health.  Amazingly, Colorado has more marijuana businesses than McDonalds and Starbucks combined!  In one of the most disturbing trends they are tracking, our youth seem particularly vulnerable.  Consider the brain of a teen, ripe for neuroplastic change, becoming exposed to what young people commonly believe is “safe marijuana”…after all, it’s medicine! The Monitoring the Future Study found that over one third of 12th graders who use marijuana use someone else’s medical marijuana, and 60% view it as not harmful. The MTF report also found that 6.5% of current high school seniors are using marijuana daily, compared to just 2.3% in 1993. That is a 300% increase in 20 years.

colorado national averagecolorado use 2010 2015

SAM articulates the following stance on medicinal marijuana: Medical marijuana should really only be about bringing relief to the sick and dying, and it should be done in a responsible manner that formulates the active components of the drug in a non-­smoked form that delivers a defined dose. However, in most states with medical marijuana laws, it has primarily become a license for the state-sanctioned use of a drug by most anyone who desires it. Developing marijuana-­based medications through the FDA process is more likely to ensure that seriously ill patients, who are being supervised by their actual treating physicians, have access to safe and reliable products.

At ISPI, we see smoking marijuana as a behavioral issue, similar to smoking, illicit or prescription drug abuse, alcohol abuse and surgery: medical marijuana is yet another passive way to treat pain.  The normalization of passive approaches to pain (meds, modalities, injections, surgeries) has done us no favors in helping people get their lives back.  In addition, we know there is a proliferation of canniboid receptors, and that tolerances, like opioids, can increase over time, leaving us with many long-term questions.

We know it’s the active approaches that work best in the treatment of chronic pain: understanding how pain works, getting regular cardiovascular exercise, practicing good sleep hygiene, setting goals, cognitive behavioral therapy, establishing a plan, etc.  Trying to foster these practices through the haze of marijuana seems challenging at best, non-sensical at worst.  Physical therapy is active, safe, and to the best of my knowledge, has no risk of inciting a schizophrenic episode in someone genetically predisposed.

As we look at the whole patient, remembering it’s always about the patient, we need to ask, is marijuana, medical or recreational, legal or illegal…is marijuana in this person’s best interest?  Will it help them get their lives back?  And as we look at our society, we need to slow down and ask ourselves, is this really where we want to go as a country.  SAM will make no bones about it, and after my initial study on the topic, neither will I.  The new face of marijuana is not Cheech and Chong.  It is executives in three-piece suits looking to make a fortune at the expense of the brain cells of our youth, people in pain, and an unsuspecting nation.

What do you think?  This is a juicy topic, and I’d especially love to hear from any of my colleagues in Colorado or Washington who have experience working in areas where marijuana has been legal medicinally for some time and is now legal across the board!

 

 

25 responses to “Pot for Pain: The Good, The Bad, and the Down-Right Scary

  1. Adriaan Louw says:

    Jessie

    I have to applaud you for bringing this topic out to mainstream. As we teach this material in our classes and ask therapists what they think of medicinal marijuana the answer, overwhelmingly is: “I don’t know.” Sure, you may get some backlash from a few but this is a great piece, lots of research and a good place for all to start.

    One last added part: If you look at the epidemiology and suffering associated with various musculoskeletal pain disorders, countries who have legalized medicinal marijuana for decades (i.e., The Netherlands), suffer the same pain and disability we do – which provides some nice long term data on it’s limited efficacy on the condition our readers specialize in: musculoskeletal pain….

    Great job!

  2. Thanks, Adriaan. I think we have a lot at stake with this issue. It’s good to look at the data from other countries and ask ourselves if we think we will somehow be any different. Given our track record with opioids in this country, if we do see a difference long term, it may not be for the better. Sometimes I think the new American dream is “Go big or go home.” It appears, with the marijuana industry, that the push to “Go big…” has gained considerable momentum.

    I appreciate your input, as well as your willingness to bring this up in ISPI courses. It is worthy of discussion!

    Jessie

  3. Colleen Louw says:

    PhD research prospects: Untapped potential here!!

    1. Jessie Podolak says:

      I agree, Colleen! Are you volunteering? :-)

      Jessie

  4. Ian Mitchell says:

    There are a number of significant errors in this article, which lead me to believe you are relying too much on Project SAM’s information. Lets start with cancer. You report an increased risk of cancer, yet the recent National Academy of Sciences report did not indicate any increased risk in head and neck, or lung cancers. I did not find any mention in your report of the 45% decreased risk of bladder cancer associated with marijuana use, which seems to be a selective omission.

  5. Ian Mitchell says:

    You quote outdated information regarding the risk of traffic accidents associated with cannabis use. The correct increase in risk is 1.3-1.4 , about the same as someone with a BAC of 0.03-0.04 (Rogeberg & Elvik, 2016)

  6. Ian Mitchell says:

    Permanent loss of IQ – anytime you mention that this is something that was found in one study, you should also mention that this study has been widely critiqued – this is called showing balance. https://www.ncbi.nlm.nih.gov/pubmed/23319626

  7. J minger says:

    SAM is a joke.

    You need to do more research on that organization outside of their self-righteous webpage.

    Legalize. Tax. Regulate. Educate. Reduce harm.

    1. J-

      Thank you for weighing in on the conversation and for your suggestion. Points taken. When/if/as it becomes legalized from state to state, most definitely, tax, regulate, educate and reduce harm.

      Respectfully,
      Jessie Podolak

  8. Ruben Solvang, Norway says:

    Hi Jessie,

    Your article is a good starting point for discussing the topic further, although I was a bit surprised to find that you use the lobby-group SAM as a source. Their perspective is of a political nature and they do cherry pick their facts. Not that other organizations advocating the opposite view don’t do the same, but I would not recommend SAM as a neutral source of knowledge for the medical community.

    Cannabis, like all other drugs, has potential unwanted side effects. This is especially true when smoked. In fact, several of the unwanted effects that is mentioned in the “Downright Scary” section is only related to smoked cannabis (respiratory problems, cancer etc). Why doctors in America recommend smoking it at all is beyond me, they should actively discourage it and promote safer ways to administer the drug, like they do in The Netherlands (tea, vaporizing).

    I also want to direct your attention to the newly released review by The National Academies of Sciences, Engineering, and Medicine – one of the most comprehensive to date – which draw slightly different conclusions than the U.S. Department of Health & Human Services.

    1. Ruben Solvang, Norway says:

      Oh, I forgot to mention a recent development taking place here in Europe–at the British Medical Journal to be more specific. They have taken a clear stance regarding drug policy reform and have made a considerable effort address the bigger picture regarding drugs, addiction, abuse and health.

      I recommend reading their editorial and related articles regarding this topic: http://www.bmj.com/war-on-drugs

      1. Ruben,

        Thank you so much for your constructive feedback. It is much appreciated. I found the review by the National Academies of Sciences, Engineering and Medicine you suggested to be excellent (and yes, more balanced than SAM and perhaps even the surgeon general’s report). Thank you for the suggestion and the kindness with which you delivered it. The slide show (http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2017/Cannabis-Health-Effects/Cannabis-public-release-slides.pdf) was a very nice summary. I encourage anyone reading this to check it out for a good overview! I look forward to examining the other references you provided in more detail.

        There is a great deal of information out there on this topic, and sorting through it all is beyond the scope of my intention for this particular blog. As you so aptly pointed out, it was intended to be a conversation starter :-). I really appreciate your contribution to the dialogue as I (along with many of my PT peers here in the U.S.) seek to more fully understand the pros and cons of marijuana use for pain-relief purposes. My hope is that we can all engage in an informed, balanced and respectful conversation with colleagues and patients as this topic comes up with increasing frequency.

        Just out of curiosity, other than the issues you mentioned, do you have any thoughts you are interested in sharing on using marijuana for chronic musculoskeletal pain? (Active vs. passive treatment, etc.). If not, no worries, but that is the topic, at the heart of the matter, that I am most interested in, and you very much sound like you have a well-rounded understanding from which I can learn!

        Warm Regards,
        Jessie Podolak

  9. Ian Mitchell says:

    As a practicing emergency physician in an area of both high heroin and cannabis use, I find the notion that “Emergency room admissions for marijuana use now exceed those for heroin and are continuing to rise.” to be laughable. I am not able to find the specific reference for this on the Project Sam website, but such an outlandish claim should be accompanied by at least one reference.

  10. Ian Mitchell says:

    Any article such as this lacks context without mentioning the 4 decade long blockade of research into the benefits of cannabis. The DEA and NIDA have restricted research, so that only harms have been allowed to be studied. It has been impossible to do research on the benefits of cannabis, so the research has been massively skewed. https://www.scientificamerican.com/article/the-science-behind-the-dea-s-long-war-on-marijuana/

  11. Mark Wascher says:

    I would be careful when taking this article to heart.

    Consider some of these “facts” about marijuana, which are outlined in the Surgeon General’s Report on Alcohol, Drugs, and Health:

    These so called “facts” are unsupported and in most cases complete bullshit. For every bullet point “fact” there is an actual study that supports the contrary. For instance there is absolutely so evidence that pot causes cancer of ANY kind. In fact there are studies that indicate it actually reduces tumors and inhibits metastasization.. All those bullet points are politically biased and not based on empirical studies. I would be very careful promulgating this article to your colleagues or anybody for that matter.

    Read this:
    https://www.cancer.gov/about-cancer/treatment/cam/hp/cannabis-pdq

  12. Dear Dr. Mitchell,

    Thank you for taking the time to read this blog and for your responses. I respect your point of view and appreciate the feedback. I will indeed seek out a broader variety of sources should I tackle a controversial topic such as this in the future.

    In regards to your question about the ER marijuana vs. heroin visits, that data was referenced deep in the SAM website in a press release. I was quite surprised when I first read that claim as well, and I did check it before posting. Here is the original data. However, as you have pointed out, caution must be used when viewing information.

    https://www.drugabuse.gov/publications/drugfacts/drug-related-hospital-emergency-room-visits#references

    “National estimates on drug-related visits to hospital emergency departments (ED) are obtained from the Drug Abuse Warning Network (DAWN),1,2 a public health surveillance system managed by the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). DAWN data* are based on a national sample of general, non-Federal hospitals operating 24-hour Emergency Departments (EDs). Information is collected for all types of drugs—including illegal drugs, inhalants, alcohol—and abuse** of prescription and over-the-counter (OTC) medications and dietary supplements…

    In 2009, almost one million visits involved an illicit drug, either alone or in combination with other types of drugs. DAWN estimates that—

    cocaine was involved in 422,896 ED visits
    marijuana was involved in 376,467 ED visits
    heroin was involved in 213,118 ED visits
    stimulants, including amphetamines and methamphetamine, were involved in 93,562 ED visits
    other illicit drugs—such as PCP, ecstasy, and GHB—were involved much less frequently than any of the drug types mentioned above.

    1. The DAWN Report: Highlights of the 2009 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits. Rockville, MD, December 28, 2010.
    2. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Drug Abuse Warning Network: Detailed Tables: National Estimates, Drug-Related Emergency Department Visits for 2004–2009. Rockville, MD, December 28, 2010.

    (Admittedly, the data is dated).

    Regarding the information on bladder cancer, that was not an intentional omission. I was unaware of that bit of information and I appreciate you bringing it to light. I obtained my information on the risks of marijuana use from the surgeon general’s report and from SAM. I also did a brief literature search on PubMed and found mixed information.

    I am curious, as a physician, do you consider the use of marijuana to be a good option for patients with chronic musculoskeletal pain, and if so, what parameters do you suggest for patients (i.e. what mode of delivery do you recommend? Dosing suggestions?)? What are your thoughts on the concern raised that marijuana use is yet another passive coping strategy versus a more active approach to addressing pain and function?

    As I noted towards the end of the blog, this was my initial study on the topic, I have pretty grave concerns. That said, I am open to learning from other perspectives, as at the end of the day, I believe we are all aiming for the same thing: offering options to the patients we serve to equip them to lead healthier and more whole lives.

    Looking forward to hearing your thoughts.

    Sincerely,
    Jessie Podolak

  13. Eve Naumann says:

    As someone who suffers from chronic pain I really appreciate your concise and easy to understand article. While there are a lot of bad side effects the ‘brain fog’ sticks out for me. It’s such a struggle to do normal things already, why add something that will make it even harder? Then throw in other worse side effects, no thanks.

  14. Ian Mitchell says:

    In the current opiate rich environment, you must remember that the rate of opiate overdose deaths drops by 25% when medical marijuana is introduced. There is also a decrease in traffic fatality rates, as well as decrease in male suicide. (Rees and Anderson) Consumption of opiates and antidepressants drop. (Bradford and Bradford) Of course no one should smoke….that is what vaporizers are for. As far as a passive coping strategy, that would apply to all medications that people take chronicly- antidepressants, amphetamines, antiinflammatories, opiates, gabapentins. I understand if you believe that no one should take any long term medications as a coping strategy, but it is only stigma that leads you to demonize cannabis in particular. You may also want to do a bit of reading around cannabidiol and its applications for brain injury, arthritis and osteoporosis. You are going to be hearing about it from your football players. http://www.denverpost.com/2016/06/27/cbd-research-for-nfl-players-spurs-productive-dialogue-with-nflpa/

    Some more reading
    http://www.leafscience.com/2015/11/20/vaping-safe/
    http://www.leafscience.com/2016/05/18/vaporizing-marijuana-temperature-best/
    https://issuu.com/glacierspecialtypublishing/docs/lift_cannabis_fall_2016/32
    https://news.lift.co/hotboxing-minivan-new-face-drugged-driving/

    1. Dr. Mitchell,

      Thank you for these resources and for your time in engaging in this conversation. I agree: we absolutely need an alternative to opiates, and I appreciate your efforts to seek alternatives for patients in pain.

      Through this conversation, I am realizing that one of the biggest challenges surrounding the use of cannabis for medical purposes has to do with concern over the next “logical” step for the industry: recreational use. It becomes difficult to separate the two, and I believe that is where the sense of alarm in the U.S. (and for me personally) comes from. We Americans do have a tendency to “go big or
      go home” with nearly all commercial enterprises.

      Indeed, the US leads the world in opioid addiction, which is no wonder, given that we allow nearly free reign of pharmaceutical advertising. We have so normalized the use of narcotics for pain that commercials for Movantik (a drug marketed to relieve opioid induced constipation) regularly pop up during commercial breaks for NFL games, including the most highly viewed games of the season. I just saw one during the NFC championship game two weeks ago…very discouraging!

      In comparing current policies on marijuana legalization among various countries, Spithoff et al. state that, “The states have set few controls over other demand drivers. Washington and Colorado permit all forms of promotion (advertising, branding and sponsorship) with few limits except on promotion to youth. Colorado asks industry “to refrain from advertising where more than approximately 30 percent of the audience is reasonably expected to be under the age of 21.”50 Washington’s regulations state that youth under age 21 should not be exposed to mass-media advertising, but they do not explain how this is to be done.54 The states are hampered in creating stricter regulations by constitutional protection of commercial free speech.55,56

      Because the states have limited control over supply and price, and permit promotion, there is little to stop the rise of Big Cannabis and its associated lobbying and marketing power. Washington State may be somewhat protected with limits it has placed on producer size and production. The states are at risk of an increase in cannabis use over time. On the positive side, these states should see a reduction in crime, harms to cannabis users (from incarceration and marginalization), and policing, court and prison costs.17” (Spithoff S, Emerson B, Spithoff A. Cannabis legalization: adhering to public health best practice. CMAJ 2015;187:1211–6.).

      Your comments have given me pause, and while I remain concerned about the passivity of treatment and the potential for cannabis to become Tobacco 2.0 in the U.S., I do appreciate your point of view. Perhaps we shouldn’t “throw the baby out with the bath water” when it comes to using “pot for pain.” Rather, we, as a medical community need to educate ourselves on the facts, seeking to find as much non-biased information as possible, and continue work within our scope of practice to find safe, effective ways to aid patients suffering from chronic pain.

      Respectfully,
      Jessie Podolak

  15. Ian Mitchell says:

    Overall, you have given far more credence to Project SAM than they deserve. They should be considered a biased source. This is most clear when examining their website for beneficial effects of cannabis. A bleak landscape that demonstrates their focus on harms, as the research has been directed for the last four decades. While research is likely to remain stalled in the US under your current president, research in Canada on the effects of cannabis on PTSD, arthritis and cancer are underway.
    For a less biased view by experts in drug policy, evidence based medicine and drug research, check out the International Center for Science in Drug Policy https://d3n8a8pro7vhmx.cloudfront.net/michaela/pages/61/attachments/original/1440691041/Using_Evidence_to_Talk_About_Cannabis.pdf?1440691041

  16. Bryan Lang says:

    Thank you for bringing up the discussion of marijuana. I own a physical therapy practice in Portland, Oregon. Marijuana, both for medical and recreational use is legal. We’re finding a growing number of clients asking us about the use of marijuana for their pain. We’ve had to have discussions about use of marijuana while at a physical therapy session. I do believe that there is tremendous potential for marijuana to be an effective alternative treatment to the mainstream narcotics, However, I do question the tactics I have some clients who have chosen to self-medicate without talking to a healthcare provider. We try to refer them to a primary care provider to discuss their plan for managing pain with marijuana so that we as physical therapists can work collaboratively with it as a medication.

  17. This is a great article. Thanks for sharing this.

  18. Yendor says:

    Cannastrips is smoke free, exact dosage , quick acting pain relief absorbed directly into the blood stream. Best product ever

  19. Daniele Merkov says:

    I’ve been suffering severe anxiety for almost a year now and been given a prescription for Benzodiazepines for my medication. But i heard alot of people telling me that marijuana helps relieve anxiety but im not im not sure if its true so i came up to search something about this idea and came across this marijuana strain from https://www.bonzaseeds.com/blogs/strain-reviews/fucking-incredible it says that i can discard all forms of stress and its euphoric buzz it delivers often is useful in combating anxiety and depression. I wanted to hear your thoughts about this guys and if you can give me any tips that can help me with my anxieties. Thank you!

  20. Jessie Podolak says:

    Daniele,

    I’m sorry that you have been struggling with anxiety. I know how difficult that can be. I would encourage you to discuss the marijuana option with your physician. From a medical marijuana standpoint, I believe prescribing it for anxiety may be considered “off-label” use. If you look at the website you linked here, one of the side effects mentioned is possible anxiety, which would be counter-productive in your situation. Any discussion of medications is best had with your physician.

    From a physical therapist’s standpoint, there are many non-pharmacological strategies to combat anxiety that can be very helpful. Breathing exercises, mindfulness, cardiovascular exercise, movement exercise such as yoga or Feldankrais, spirituality practices such as prayer or meditation… One technique that I have recently been exploring with patients is the use of heart rate variability (a unique form of biofeedback). You can learn about this by going to http://www.heartmath.com. My patients who struggle with anxiety have found the tools with heart math very effective, natural, and safe.

    I hope this helps you on your journey and wish you the best.

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