The explosion of coverage on opioid abuse has been chilling for many chronic pain patients who use opioids responsibly to manage their pain. In many cases, with heightened scrutiny over its merits of use, reduced access becomes an issue.
Many chronic pain sufferers have turned to medical marijuana, which has far fewer side effects than opioids. The problem there is also access. Medical marijuana is only available in 23 states and the District of Columbia and, of course, there are complications because the federal government still deems marijuana illegal so people in the federal health care system (like the VA and Medicare for instance) often can’t get medical marijuana prescribed.
Dr. Gary Witman is an internist and former emergency room physician who now practices in the Fall River location of Canna Care Docs, which are located in several states in the northeast. His practice focuses on opioid replacement therapy—substituting medical marijuana for opioids.
He agreed to share his thoughts with the National Pain Report on the issue of medical marijuana.
National Pain Report: What do you feel is the biggest hurdle?
Dr. Witman: The fact that the DEA has classified medical marijuana as a schedule one agent. Now I am completely opposed to the usage of recreational marijuana. I believe it should be closely monitored by physicians with specific classifications of criteria for which would provide the greatest clinical benefits.
National Pain Report: Why hasn’t Congress changed the rules about medical marijuana?
Dr. Witman: Because I think that people believe that there is a slippery slope, they believe that individuals, who start with medical marijuana, or any marijuana, will want to go to drugs such as cocaine and heroin.
National Pain Report: Do you think the DEA and the federal government’s auxiliary agencies and nongovernmental agencies like American Board of Medical Specialties have a stake in keeping medical marijuana illegal and un-researched?
Dr. Witman: It would be my goal, my wish for the DEA to welcome applications to their agency to perform appropriate clinical trials. Yes they are keeping it illegal right now. I have absolutely no understanding of why they’re keeping it illegal. I mean I think we’re up to 37 states now that allow us to provide this particular drug treatment to a qualified patient population. Hopefully soon it will be 50 states.
National Pain Report: What evidence then is going to be sufficient enough for them to say, ok we know that maybe this not a gateway drug or this is not a slippery slope. Is it anecdotal evidence or is it research that is needed?
Dr. Witman: No, I think that all we’re looking for is the usage of this drug for medical indications. I think that congress, in general, believes that we’re looking for this for recreational usage, and to get high. Remember most strains of medical marijuana right now are CBDs rather than THC. We’re not looking for high THC’s…we’re looking for only those strains which provide medical benefits. And I don’t think that congress has been adequately educated about what forms of medical marijuana physicians are looking or requesting to have legalized.
National Pain Report: Why do you think there has been no serious study on medical marijuana for chronic pain?
Dr. Witman: Because there’s been a lack of funding to provide for the most appropriate clinical trials.
National Pain Report: If there is adequate funding — where would that come from?
Dr. Witman: That would come from the National Institutes of Health
National Pain Report: How are [National Institutes of Health] persuaded then, to start this research?
Dr. Witman: They would need to do a prospective clinical trial, and I have one in mind. It would be in patients with brain tumors. Medical marijuana has been demonstrated in cancer cell lines to cause apoptosis, which is program cell death, plus effects on angiogenesis. It inhibits the production of new blood cells and I think that would be an important clinical trial. And it would demonstrate that it would be no decrease in benefit, in fact, I believe it will improve survival rates for persons with brain cancer.
National Pain Report: Do you think that the research will change people’s minds and is that the only thing that will change their minds?
Dr. Witman: Well, I think that will be the best way, yes. I don’t think anecdotal materials are important. I think that clinical based evidence on a sufficient cohort of subjects is necessary to be able to reach a conclusion.
National Pain Report: Is anecdotal evidence any less factual?
Dr. Witman Not at all, it just doesn’t provide sufficient, in the subject’s eyes, any statistical…you acquire enough individual with demonstrable clinical benefit before you can say with any medical certainly that something in fact is true.
National Pain Report: do you think the federal government changes and then the states follow?
Dr. Witman: It’s really the south that has been most resistant. In virtually the entire northern portion of the United States have welcomed the introduction of marijuana treatment. but it’s the south that has been most resistant.
National Pain Report: The state of Georgia] spoke of isolating CBD, not use the rest of the plant, and disregard the “entourage effect”…all of the things you probably shouldn’t be doing — trying to synthesize it and replicate its [properties]. I found that astonishing and steeped within the culture of the south and within their own social attitudes against it.
Dr. Witman: First of all, I think you’re in a tough state, Georgia, to be able to move forward very far. I think there is some great resistant in Georgia to provide dispersement of medical marijuana products. If you can get it through in Georgia, God bless you.
The second part of our interview with Dr. Witman will discuss differences between vaporizing and smoking, his recommended way to consume cannabis, and how proposed monitoring of patients will work.