Pittelkow - Peering through the weeds: A perspective on pain and medical cannabis (marijuana)

Jan 11, 2019 | Thomas P. Pittelkow, D.O., M.P.H. | @thomasppi


The use of cannabis (marijuana) as a medical treatment has been around for thousands of years. In its earliest form, the cannabis plant was utilized by medical healers to treat various diseases that did not have a cure, particularly challenging to treat pain syndromes, general illnesses, and rheumatism. Despite its routine use spanning the millennia, early in the mid-20th century, the regular use of cannabis as a medical treatment was disrupted by strong political influences. Ultimately, the stigma that was created from the taxation and illegality of cannabis use in the 1930s led to tight sanctions and regulations in 1970 with the creation of the Controlled Substances Act. This legislation placed cannabis on a list of drugs that were defined by the federal government to possess no acceptable medical use, have a high potential for abuse and remain illegal for general use.

Despite the tight control, advocates of the medicinal use of cannabis continued to pursue the science and understanding of the medical properties. It was eventually discovered that humans possess an intrinsic endocannabinoid system, much like the body’s natural opioid system, where certain neurobiologic chemicals were responsible for similar effects as using cannabis. When active, the neurochemicals in our body play a role in normal day-to-day processes such as inflammation, pain, and mood. Alterations to this natural system could occur if a person were to use cannabis producing the desired effects of mood enhancement, pain reduction, and muscle relaxation.

Scientific discovery and research has helped us understand that there are over 100 natural cannabinoids in the cannabis plant that likely play a role in controlling things in the body such as pain, mood, and metabolism. The two most well understood cannabinoids are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the cannabinoid most likely responsible for the psychologic effects or ‘high’ that people feel when using cannabis, but has also been shown to have pain relieving properties. CBD is the cannabinoid most likely responsible for the anti-inflammatory and pain reducing properties people experience. Despite the wholistic natural properties of plant-based cannabis, there are real serious health risks that are present with its use that can affect the body’s organs, including the heart, lungs, gastrointestinal system, and brain/nervous system.

The rich and storied history of cannabis use and illegality has been driven mostly by social and political factors and not science. Under the assertion of states’ rights, nearly 30 states and the District of Columbia have some form of medical marijuana program, despite the fact that the federal government still views cannabis as not medically useful and its use continues to be illegal under federal jurisdiction. It is encouraged that each patient understands the rules and regulations pertaining to medical cannabis use in the state in which they reside.  There are qualifying conditions that have been established (state-dependant) to obtain certified medical cannabis. Unfortunately, there are no universally accepted guidelines regarding the right time to consider medical cannabis for the treatment of pain. Given that we have very good data on most of the typical pain treatments to date, many practitioners consider medical cannabis as a last line therapy.

To summarize, the investigation, research and understanding of medical cannabis and its impact on pain continues to grow. Further studies are needed to evaluate the most appropriate doses, side-effects, and effectiveness of therapy in pain patients.

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