Many adults with chronic pain use medical marijuana to relieve their symptoms, but marijuana is not a good treatment option for teens who suffer from pain, according to researchers at the Mayo Clinic.
“The consequences may be very, very severe, particularly for adolescents who may get rid of their pain — or not — at the expense of the rest of their life,” says J. Michael Bostwick, MD, a Mayo Clinic psychiatrist who co-authored a commentary in the July issue of the journal Mayo Clinic Proceedings.
Bostwick says there have been few studies on the pros and cons of adolescents using medical marijuana. While medical marijuana may help improve appetite and relieve pain, its adverse effects can include fatigue, impaired concentration and slower reaction times.
The researchers described the cases of three high school students at the Mayo Clinic’s pediatric pain clinic who said they used marijuana regularly. Pain worsened for all three teens despite their marijuana use. None attended school full time, and they reported impaired functioning and difficulty being socially active.
Marijuana use before age 16 has been linked to psychosis and smoking marijuana more than once a week has been connected to persistent cognitive damage in adolescents. About 1 in 10 marijuana users become addicted and people under 25 are more susceptible to addiction, according to Bostwick.
“If you’re a pain patient, and you’re using this drug or others, narcotics as well, one of the side effects is to be ‘out of it’ when the goal of a pain rehab program is actually to get you into it,” Bostwick says. “The whole point is function restoration, not further functional decline.”
“If you will not work on your life until your pain is gone, then you’re probably going to be stuck for a very long time, because the kinds of chronic pain that show up in pain clinics tend to not ever completely go away. They tend to be managed. People have to learn to get on with their lives even despite the pain.”
That view was echoed in a recent commentary by Gerald Aronoff, MD, past president of the American Academy of Pain Medicine, who is wary of prescribing medical marijuana to any pain patient — whether a teenager or adult.
“Even if marijuana were 100% legal, I would still have qualms about its use in patients with chronic pain,” Aronoff wrote in Pain Medicine News.
“This is especially true in settings that require their complete attention, alertness, and mental acuity, as is always true while driving and frequently true at the workplace. The use of marijuana by patients in these situations also may put the prescriber and his or her medical practice at increased risk for adverse outcomes.”
In his own practice, Aronoff says he requires a urine or oral drug screen for all new pain patients, and then conducts tests randomly. If marijuana is detected, he refuses to write any new prescriptions for the patient for controlled substances, including opioid analgesics.
“From a risk-management perspective, it is foolhardy to continue writing opioids for patients known to be using/abusing marijuana or other substances deemed to be illegal,” said Aronoff.
“In the event that the patient in question has a work accident or motor vehicle accident in which there is an injury or death, the clinician writing the prescription for the controlled substances with full knowledge that the patient was abusing an illicit drug capable of causing mental status changes, judgment, and perceptual problems would be in a position that is difficult to defend. The physician could potentially be held liable.”
Not all doctors feel that way. A recent survey by the New England Journal of Medicine (NEJM) found that most physicians would be willing to prescribe medical marijuana to ease the pain of an older woman suffering from advanced breast cancer.
The online survey, published in the May 30 edition of the NEJM, found that 76 percent of the 1,446 doctors who responded would give the woman a prescription for medical marijuana.
Voters in Washington and Colorado voted last year to decriminalize marijuana. Medical marijuana is legal in 18 states and the District of Columbia.