Cannabis & Cannabinoids in the Treatment of Chronic Non-Cancer Pain

My 90 year old patient with spinal stenosis, diffuse osteoarthritis and now polycythemia vera was in for an office visit. He had been to see his hematologist and had been phlebotomized removing a unit of blood to control his overproducing bone marrow. He mentioned that the hematologist had sent him to a medical marijuana clinic run by a pain physician colleague of his.

The patient proudly showed me his marijuana registration license. “It doesn’t work you know. In fact I feel poorly after I take some. I have tried the oils and some edibles but it really doesn’t affect my pain in a positive way.”

Many of my patients now are licensed to receive medical marijuana for chronic pain. It’s a big business here in the state of Florida where senior citizens with chronic aches and pains are always looking for that magical pill to restore their vitality and youthfulness. His experience is unfortunately supported in the medical literature. In the May 25, 2018 issue of Pain magazine which looked at the pain relief of patients with rheumatoid arthritis, fibromyalgia, neuropathic pain and 48 other non-cancer pain conditions. The study was a literature review looking at the 104 studies published on this subject.

The findings were sobering and disappointing. They found that cannabinoids had no appreciable positive impact on pain relief. In addition it didn’t help sleep, there was no positive impression of change and there was no significant impact upon physical or emotional functioning.

I am not an anti-marijuana crusader. I see its positive impact in treating glaucoma. I see the studies citing it is more effective to deliver by smoking it than eating it or taking it in pill form.

The review studies included all forms of administration of cannabis. I just want to make sure that when authorities legalize a substance for use in pain control it is effective and not just profitable snake oil for a strong lobby of well-healed and crafty businesspeople.

Does Marijuana Smoking Contribute to Stroke?

Marijuana LeafMedical marijuana and now recreational use of marijuana are becoming legalized around the United States. Is it safe and can it lead to serious health consequences?

At an International Stroke Conference in Hawaii, reported on in MedPage Today, researchers found relationship between smoking pot and having an ischemic stroke. P. Alan Barber, MD., PhD, professor of clinical neurology at the University of Auckland in New Zealand, told of seeing a 30 year old stroke patient who had none of the traditional risk factors for a stroke. The patient smoked cannabis or marijuana regularly. This led to the doctor reviewing the records of all his younger stroke patients. They found a high proportion of tests positive for marijuana use in younger stroke victims and decided to expand their study.

The current study looked at 160 stroke patients with an average age of 45.  Sixteen percent (16%) of the stroke patients tested positive for cannabis whereas only 8% of the control patients tested positive. When the researchers used detailed statistical analysis to review the data the only risk factor associated with ischemic stroke, or TIA, was marijuana use. “The study provides the strongest evidence to date of an association between cannabis and stroke.”

This was a preliminary study and it could not account for the tobacco use of the control subjects. Most of the marijuana users were tobacco smokers as well. The study did not delineate the extent of the pot smoker’s use of marijuana in terms of quantity and frequency of use. Barber went on to say that more detailed and extensive studies would be coming. He feels there is a definite link between pot smoking and stroke citing the fact that cannabis constricts brain vessels and can be associated with palpitations and atrial fibrillation which is a risk factor for stroke.

As the political pressure builds on states to legalize marijuana, tax it and use it as a revenue source; it would be nice to find out the consequences of its use and its effect on future illness and health care costs? Is it the marijuana? Is it the method of delivery by smoking it rather than pill form? These questions should be addressed in future studies.