When the Government Promotes Medical Marijuana Use for Pain

Brandon Cohen

Disclosures

November 28, 2018

A new law in Illinois encourages patients to request marijuana as a substitute for prescribed opiates. A recent article on Medscape described the initiative and asked healthcare professionals for their opinions. The responses came quickly and ardently.

Many were completely in favor of the new idea. A physician's assistant saw it as an issue of basic decency:

We have an epidemic of undertreated pain. This suffering is cruel and unnecessary. Just because a small percentage of people who use opioids end up abusing them isn't justification for withholding pain management for the patients who need it.

An internist continued in this vein:

Cannabis has the safest therapeutic index of any scheduled drug. It is safer than acetaminophen and NSAIDs... As a physician who has seen the broad scourge of the opiate epidemic decimate towns all over the land, I find this therapeutic substitution not only timely but essential.

But more than a few were worried about how well-regulated marijuana would be. One primary care physician spoke for many:

I live in a state where marijuana use has been legalized, and I watch people using it on a daily basis in my community with less instruction than what you receive on a bottle of ibuprofen... Who is going to support my prescribing, or is this off-label and I'm naked here?

Another physician saw dark forces at work:

Use marijuana for chronic pain, and make the patient so brain-addled that even if he feels no pain, he'll be useless as a member of society. Opiates, properly dosified, leave the patient's mind clear to pursue his/her life normally. Once marijuana is legal all over, we'll have a doped-up population easy to manipulate by the very few who make money out of that particular drug trade and are smart enough not to use it at all themselves.

An anesthesiologist relied on dramatic phrasing to hammer home the point:

What could possibly go wrong? Two words: opioid epidemic. Will this social experiment with cannabis be the same? The evidence is not there yet for prescribing cannabis for chronic pain.... This is madness.

A primary care physician added:

With the known or suspected dangers associated with marijuana use, such as increased risk for schizophrenia and cardiac conditions, it seems extraordinarily irresponsible to substitute one addictive substance for another with unproven benefit.

But a clinical nurse specialist was appalled by this view:

You are more worried about a potential risk for schizophrenia and cardiac conditions based on limited data [than you are about] leaving surgical patients with untreated pain. There are robust data available from other countries that haven't done the over-the-top prohibition that we have in the United States. Opioid deaths are down in states with medical marijuana availability, such as Colorado and Oregon.

And an obstetrician put it succinctly: "It's weed; it's not killing people."

A clinical nurse specialist shot back:

Tell that to the young woman's family who was hit by a car and killed by someone stoned on pot.

Another professional found this unconvincing:

This is not an argument against cannabis use; it's about being responsible! The facts are that cannabis has never killed anyone via overdose. The same can't be said about opioids, sleeping medications, and even insulin.

A medical administrator thought a completely drug-free lifestyle was best:

My best pain management course is a healthy diet [and] a healthy weight. I exercise daily and take physical therapy once a week.... This is where we need to look to fight the opiate addiction. Stop thinking that the only pain management plan is a drug. Prescribing another drug in place of opioids is not the answer.

But quite a few found this reasoning a bit myopic. Another administrator shot back:

Well, lucky you.... My doctors are no longer comfortable prescribing opioids because of the present climate. So I get nothing. Well, at least I'm in no danger of becoming a 66-year-old addict. All I had to do was give up my quality of life. Thanks a lot.

A physician felt that marijuana was not quite ready for medical use:

There is a lack of research regarding which components [of marijuana] and what ratios provide the best therapeutic effects with the least side effects.

But another professional saw this as a strength rather than a weakness:

Part of the beauty of the increased flexibility here in Oregon is that growers can experiment with different strains to get different intended effects. The THC/CBD that is useful for daytime use without cognitive effects isn't the same thing I'd recommend for someone whose pain wakes them up at night.... The variety of strains...allow patients to carefully titrate the intended effect without undue side effects.

The final word goes to a nurse who leaned into stoner stereotypes and pondered the effects marijuana could have on the ability to give a serious business presentation:

[I was addressing] people from China, San Francisco, Los Angeles, and San Diego. I have migraines and chronic pain. I cannot be wrong; I have to go into great detail, and I have to make everyone in the room understand. I can just see me on marijuana trying to accomplish this: "Hey, dude, what's up?" Or, "Excuse me, I have to smoke a joint."

The full article can be found on Medscape.

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