Research examining the risks and benefits of marijuana use for pain has made strides in recent years. As of July 2010, not all the questions have been answered, but a number of influential medical associations are beginning to issue statements in support of marijuana and its derivatives for pain management.

Current Status

Marijuana is the leading cash crop in the US and a Schedule I drug under the Controlled Substances Act of 1970. This designation means it has a lot of potential for abuse, and no medicinal value. Yet, Marinol, a medication approved by the FDA, is classified as a Schedule III drug. Marinol contains a synthetic version of THC, the active ingredient in marijuana. As a Schedule III drug, Marinol is regarded as medicinal, with less potential for abuse. The FDA approved Marinol to help stimulate the appetite in people with AIDS and to treat nausea due to chemotherapy. According to the Americans for Safe Access Foundation, a pro medical marijuana advocacy group in Oakland, California, the natural form of this drug contains many more cannabinoids (in addition to the THC) than synthetic Marinol, and consequently delivers more therapeutic benefits. Cannabinoids are other active ingredients found in marijuana.

In recent years, there’s been increased activity on the part of the scientific community in the area of cannabinoids for pain and other medical conditions. A number of prominent health organizations have issued favorable statements regarding the benefits and lack of side effects of medical marijuana. For example, Britain’s House of Lords says:

There is scientific evidence that cannabinoids possess pain ­relieving properties, and some clinical evidence to support their medical use in this indication.

In a 2001 Amicus brief supporting medical marijuana in Northern California, the American Public Health Association says:

Recent government sponsored commissions have concluded that marijuana has therapeutic properties not replicated by other currently available medications…the side effects of marijuana are typically less severe than side effects associated with currently authorized medications.

Research has shown that overall the safety profile of medical marijuana is good. But smoking anything is bad for your health. Several companies are now developing alternative routes of administration for medical marijuana. In the future, you may be able to take medical marijuana under your tongue or by inhaling a fine mist for your pain.

Background

The use of medical marijuana began in 2700 BC, coinciding with the birth of Chinese medicine. It continued uninterrupted for centuries. In the 19th century, Queen Victoria’s doctor prescribed it to her (for menstrual cramps). About the drug he wrote, “When pure and administered carefully, [it is] one of the of the most valuable medicines we possess.” Medical marijuana was widely prescribed in the US until around 1900.

According to the Americans for Safe Access Foundation, the first US federal law prohibiting medical marijuana was enacted in 1937. The AMA opposed the legislation, citing no evidence of danger associated with its use, and perhaps great benefits. In 1942, it was taken off the market. ASAF reports that the US currently grows and provides marijuana for a handful of patients left over from a now defunct compassionate-access research program begun in 1976.

According to the Marijuana Policy Project, every major commission on the subject recommends that possession not be treated as a crime. But possessing or using even a very small amount is a felony under federal law, and can result in at least a year in jail.

Since 1976, 36 states have enacted laws favorable to medical patients seeking to use marijuana. Many of these laws are symbolic and won’t protect you if you are caught using the drug. But 14 states have decriminalized marijuana for medical patients who use cannibals under doctor supervision. As of July 2010, the 14 states are: California, Alaska, Oregon, Washington, Maine, Hawaii, Colorado, Nevada, Vermont, Montana, Rhode Island, New Mexico, Michigan, and New Jersey. These states have made laws that override the federal law. In most, you can also grow your medicinal marijuana.

Recently the Dept. of Justice sent a memo to practicing US attorneys saying that law-abiding medical marijuana users who live in decriminalized states should not be prosecuted by the federal government. Most marijuana arrests are made at the local and state levels, anyway. Federal marijuana law enforcement efforts are generally focused on large growing operations. Just the same, it’s important to note that on the record at least, the federal law does not make exceptions for medical patients.

State laws are great for protecting you from penalty if you use medical marijuana, but they don’t play a role in creating or maintaining drug standards. State laws don’t guarantee purity, potency, quality or accurate labeling of any medical marijuana product.

Evidence for Medical Marijuana

In 1999, the Institute of Medicine (IOM) issued an evidence-based report on medical marijuana. It listed conditions that may be helped by cannabinoids, including neuropathic pain, acute pain, spinal cord injury, post operative pain, cancer pain, multiple sclerosis, nausea and appetite control among others.

The report says that discovery of a cannabinoid receptor in the parts of the nervous system that detect and control pain perception means that marijuana is a very promising source of pain relieving medications in the future.

The IOM found that cannabinoids are capable of giving mild to moderate pain relief comparable to codeine. In one study cited in the report, 10 milligrams of THC (marijuana’s active ingredient) yielded the same amount of pain relief as 60 milligrams of codeine. Side effects were similar with both drugs, but the THC seemed to be more sedating than the codeine. The patients taking the THC reported a greater sense of well-being and less anxiety.

The IOM also found that by combining cannabinoids with an opioid, the opioid may work better. This may decrease the dose of addictive narcotics needed to control pain.

The IOM says that opioids are not effective enough for pain, and new medications are “welcome.”

What’s your opinion? Is medical marijuana use be approved for pain conditions?

Medical Marijuana Side Effects

As mentioned earlier, side effects from using marijuana are few. In many cases, they are significantly less than the narcotic pain relievers back pain sufferers take to keep their pain under control.

Dizziness is the most common side effect of all types of marijuana and its extracts and synthetic derivatives. Also, it’s possible to develop tolerance to or a dependence on the drug.

In Marinol, the synthetic version of THC used for nausea and appetite stimulation mentioned earlier, cardiovascular symptoms such as syncope and tachycardia (video) have been noted. The FDA recommends exercising caution in taking Marinol by people at risk for heart disease or stroke. But research has shown little effect on the risk for heart disease or stroke by marijuana users, even for those who are already at risk. More studies are needed on this important topic. In the meantime, people with increased risk for cardiovascular problems should speak with their doctor before taking marijuana.

The FDA also recommends caution for those with a history of substance abuse, drug or alcohol dependency, depression, mania or schizophrenia, and it recommends against drinking or taking other sedatives, psychoactive drugs or hypnotic drugs along with Marinol. The effects of Marinol have not been studied in pregnant women, nursing mothers or kids, so these people should not take the drug. People under the influence of Marinol shouldn’t drive or operate heavy machinery, as dizziness is one of the main side effects. All cautions listed here also apply to smoking marijuana.

Marijuana is usually smoked, which does present a risk to health. Smoking increases the risk for lung cancer and heart disease, for example. Also, the unprocessed marijuana plant contains more toxins than a filtered cigarette. Granted, people usually inhale less marijuana than tobacco (for various reasons) but the Institute of Medicine still does not recommend this drug delivery method. The IOM says that smoked marijuana is not a modern medicine. While their recommendations do call for studies on smoked marijuana, they are quick to clarify their intention by saying, “studies on smoked marijuana will be used as a first step in developing non-smoked ways of taking it.” Some of those new drug-delivery methods include inhaling a fine mist and taking it under your tongue.

Where It Stands

The IOM says its priorities are to develop safe, rapid onset delivery of marijuana-related drugs. It also plans to learn more about how the active ingredients affect the body, including psychologically. And it plans to evaluate the risks of smoking medical marijuana.

Scientists are now are in the lab developing new medicines based on marijuana. According to Dr. Mohamed Naguib, cannabinoid researcher at University of Texas Anderson Cancer Center, “When there’s a nerve injury, the body typically overcompensates, creating even more nerve damage. Our research shows that the addition of a certain type of cannabinoid turns off the overcompensation, reducing the likelihood of this type of pain.”

Concerns about drug abuse and dosing amounts are obstacles to the drug-development effort.

Although most medications currently used for pain work better than marijuana, the IOM acknowledges that everyone is different, and for some, the best choice for relief may be cannabinoids. What’s your opinion?