Why Medical Marijuana Makes Sense for Chronic Pain – A Doctor’s View (Part One)

Why Medical Marijuana Makes Sense for Chronic Pain – A Doctor’s View (Part One)

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

Dr. Gary Witman

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.

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Authored by: Allie Haroutunian

There are 9 comments for this article
  1. Brenda Trudy Myers RN at 10:05 am

    I think medical marijuana without the THC isnt worth the cost-I would stick to street plants then-its the way it helps you cope with chronic illness that is such a benefit-I tried the CDC stuff and it didnt help at all. We need to stop changing something that is wonderful. why get rid of the THC? again-alcohol is much worse!! and it only depresses people and brings out violence and stupidity-just watch the TV show cops-and almost every call is alcohol related

  2. Stephen at 7:36 am

    “The state of Georgia] spoke of isolating CBD, not use the rest of the plant, and disregard the “entourage effect”

    Georgia has had no such discussion, at least not recently. Georgia was one of the few CBD states to recognize the benefits of THC and allowed a 5% cap. Now, of course that THC limit is 100% arbitrary, but compared to the other “CBD Bandwagon” states Georgia absolutely recognized the need for THC and the benefit of the entourage effect on a variety of conditions.

    “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.”

    Dr. Witman clearly hasn’t spent much time in Georgia. Look around you Dr. Witman. Tell me what has been decriminalized in Florida, Alabama, Tennessee, North Carolina and the rest of the southern states. Exactly.

  3. Ronda at 11:02 am

    Just one Stage IV breast cancer patient here, tumors throughout my lungs and bones. Opioids in rotation for four years (my body quickly builds up a tolerance). The side effects are hell but there is nothing else available to me now to decrease my pain. Everyday survival consumes my energy. I wish I had more energy to speak out to lawmakers and DEA in favor of legalizing medical marijuana for terminally ill patients like me. I appreciate doctors fighting this battle on our behalf. It doesn’t make sense … I can have all the morphine, but not marijuana?

  4. Duncan20903 at 6:49 pm

    eric, how about a citation for that specious claim that cannabis is a causal factor in schizophrenia? No, it isn’t a smokescreen by “big pharma” but it is utter hogwash. The fact is that the percentage of schizophrenics in the US population has been more or less constant over the last century. The percentage of Americans who choose to enjoy cannabis literally sky rocketed by about 1000% in the last half of the ’60s/early ’70s. One simply does not introduce a causal factor for anything into a population without seeing a corresponding increase in the thing caused.

    GW Pharmaceuticals is conducting phase 2a research studies aimed at getting FDA approval for phytocannabinoid medicines specifically to help people living with schizophrenia.
    ================
    These findings further reinforce the potential role of cannabinoids in the field of neuropsychiatric disease,” stated Justin Gover, GW’s Chief Executive Officer. “We believe that the signals of efficacy demonstrated in this trial, together with a notably reassuring safety profile, provide GW with the prospect of new and distinct cannabinoid neuropsychiatric product pipeline opportunity. Similar to our approach for Epidiolex, we believe that our future research in this area may lie within pediatric orphan neuropsychiatric indications and we intend to explore this as a focus for future trials.”

    The multi-center, double-blind, placebo-controlled trial enrolled a total of 88 patients who were treated over a period of six weeks. Participants must have been treated for a minimum of four weeks on a first line anti-psychotic medication and still have a PANSS Total score in excess of 60. As a Phase 2a proof of concept study, there was no single primary endpoint, but a series of exploratory endpoints.

    /snip/
    This trial followed extensive pre-clinical research conducted by GW since 2007 into the effects of cannabinoids in psychiatric disease. This research showed CBD to have notable anti-psychotic effects in accepted pre-clinical models of schizophrenia, and also provides indicators that there is potential to enhance the effect of CBD with additional cannabinoids. Previously published studies have suggested that CBD may have useful efficacy either as monotherapy or in combination with first line antipsychotic agents1.

    GW’s portfolio of intellectual property related to the use of cannabinoids in schizophrenia includes a U.S. patent issued in April 2015 protecting the use of CBD and other cannabinoids in combination with other anti-psychotic medications for use in the prevention or treatment of psychosis and psychotic disorders. This patent provides exclusivity until March 2029. An additional patent has been filed based on the findings from this study.
    ================

    There are at least 30 million fans of cannabis in the United States. It can not be a valid assertion to claim that our cohort needs to be free of schizophrenia in order to prove that cannabis doesn’t cause schizophrenia. We get at least the incidence rate in the general population before causation is even reasonable to consider.

  5. Danny Hoardern at 4:40 pm

    @eric

    “the connection between schizophrenia and Marijuana use”

    You’re mixing up correlation and causation – marijuana treats schizophrenia.

  6. Dr. Roman at 3:31 pm

    @PhDScientist You are so right about that. Check out this week’s blog post just broaching the subject on my site. There is so much to talk about and its a sin to keep the medicine from patients, the future medications that will arise from it from future patients, and even worse – the incarceration and criminalization of our neighbors and family members (particularly our minority kinsmen) for essentially self-medicating themselves in a world where health care kills financially. That’s why I’m sticking up for the sick and swimming against the current. If I drown it’s cause they got me before the followers noticed my need for support. It would still be worth it for the few I’ve already helped.

  7. PhDScientist at 11:31 am

    The more I learn about Marijuana the more convinced I become that its not just a “Wonder Drug” its a whole bunch of them.

    No other medication can match its wide range of applications and no other medication can match its safety profile.

    The government has tied the hands of American Scientists, Physicians, and Pharmaceutical companies way too long.

    Go to the USPTO web site and look up GWPH’s 48 issued patents and 80 published patent applications relating to Medical Cannabis.

    Marijuana isn’t just a “Wonder Drug” its a “Rainforest in a single plant”

    The President and Congress need to move immediately to get the DEA to remove Marijuana from Schedule 1.

    Marinol, which is pure THC is already Schedule 3. So its non-sensical to have Marijuana itself be on any more restrictive schedule than schedule 4.

    Given its incredibly wide therapeutic index, it shouldn’t be on any Schedule at all.

    American patients shouldn’t be be used as “political footballs”

    If the DEA doesn’t step up immediately to correct the situation, the President and/or Congress should take action immediately.

    The DEA has a clear conflict of interest. They shouldn’t be standing in the way.

    82% of Oncologists want their Cancer patients to have the option of using Medical Marijuana.

    85% of the public wants it legalized for Medical Purposes.

    Dr. Sanjay Gupta said it best —

    “We should legalize Marijuana. We should do it nationally. And we should do it now”

  8. Brenda Myers at 10:19 am

    I dont understand how a society that allows alcohol to be bought in your corner store or beer and wine at your grocery stores would object to marijuana. Marijuana has never been linked to death, and frankly the idea of a “gateway” drug is rediculous. People who want chemical highs are going to do it with or without marijuana. I have known so very many smokers who NEVER chose chemical highs. I think that whole notion was part of propaganda put out there by a government who wanted the tabacco and firearms to keep their jobs. Its not about anyones health-cigarettes and booze are big killers-do we make it illegal? OH NO we dont!
    Its time for society and our government to grow up and see the benefits of marijuana such as the decline of alcohol abuse, the calming effect of weed will decrease spouse and child abuse. All around its a benefit to societ as a whole. We need to demand our polititians to hear us and follow through in the federal and local government levels

  9. eric at 8:42 am

    Honestly,

    The fact that is seldom discussed , by those in favor of Medical Marijuana, is the connection between schizophrenia and Marijuana use. NO. it’s no6t just a “Smokescreen by Big Pharma” my very good friend works in the review of Disability Cases, Many are by Pot Smokers that have gone Mental, Late-Cousin was a Victim of Pot induced Psychosis .

    There appears to be the Strongest Link between users that began as adolescents- w the incidence between 1 and 3%. But who knows?
    Add to that the last article I read on Fibro being a CNS/Brain issue with a solid link to, but seperate from, depression- stating Fibromayalgia patients tested werei more sensitive to pain as measured at the Brain level?
    So, we are going to give people prone to depression, who’s pain receptors are more sensitive to pain,we are going to give thgem a substance who’s THC actually builds in the brain and has a link to schizophrenia? GREAT IDEA?!!

    Oh, I know, Marijuana can be bred to limit the THS and increase the healthier “Canniboids” but, that’s not what we’re talking about, is it? Canniboids are already available legally.