Medical Marijuana Confusion Causing Problems?

Medical Marijuana Confusion Causing Problems?

While 23 states and the District of Columbia have approved marijuana for medical use - and the momentum for more states approving it appears to be building - there’s a backlash in Montana. The Washington Post filed this story that indicates the use of medical marijuana in the Treasure State is under siege.

While it’s surprising what’s happening in Montana, given that the momentum toward expanded medical marijuana use appears to be accelerating nationally, the rules for it still vary from state to state. The USA Today has a story out talking about that very topic.

This confusion is not being helped by the federal government - at all. Because marijuana remains a Schedule 1 drug, federal agencies do not offer any guidance or medical protocol for state medical marijuana programs.

FDA approval of marijuana would require “carefully conducted studies (clinical trials) in hundreds to thousands of human subjects to determine the benefits and risks of a possible medication,” according to the National Institute on Drug Abuse. Of course, those studies by and large aren’t happening because of the federal designation. The lack of science frustrate leaders in the treatment of pain.

“It is long past time that we do more serious scientific research into the medicinal efficacy of marijuana,” Daniel S. Bennett, M.D., CEO of the National Pain Foundation told us recently. “Anecdotal evidence that marijuana helps in chronic pain conditions has been mounting. The DEA’s monopoly on research supply is hurting science and perhaps by extension, many of the 100 million chronic pain patients in the U.S.”

The National Conference of State Legislatures approved a resolution supporting the amendment of the Controlled Substances Act and other federal laws to explicitly allow states to set their own marijuana and hemp policies without federal interference.

Marijuana possession, cultivation, and sales are illegal under federal law, but the Department of Justice has indicated that it will not allocate resources toward enforcing federal marijuana laws in cases involving individuals or businesses that are acting in compliance with state laws.

In addition to states that have approved medical marijuana,  four states - Alaska, Colorado, Oregon, and Washington - have adopted laws that make marijuana legal for adults and regulate it similarly to alcohol. And more states, notably California, are expected to vote for legalization of marijuana, not medical use - but outright legalization.

Why are states moving toward legalization? People’s attitudes toward marijuana have softened in the last decade. And there’s one other thing - tax revenue. Colorado has already raised $60.7 million in revenue associated with its marijuana sales. They tax it in three ways: the state sales tax of 2.9 percent, a 10 percent special sales tax only applied to marijuana sales and a 15 percent excise tax on wholesale marijuana transfer. State legislators in other states are noticing.

There’s another issue, raised recently by National Pain Report’s Allie Haroutunian, a chronic pain patient who moved from Georgia back to her home state of Nevada because medical marijuana was easier to access in Nevada. She writes that while marijuana still may be approved for medical use, finding it in one’s system can be a problem at the job and other aspects of “real life.” As Allie pointed out in this column even when medical marijuana is legal, often it isn’t. 
The confusion over medical marijuana continues. 
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Authored by: Ed Coghlan

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Thank you for your comment Mark. Dr. Bennett is correct - the number is staggering, and is growing. Below are a few different sources (there are several out there).
American Academy of Pain Medicine
National Institute of Health
US Pain Foundation

I honestly don’t understand why there needs to be all this confusion. Why do they have to make it so difficult? They “waved a wand” and made gay marriage legal nationwide, so why not do the same for marijuana or at least MMJ? It’s not like doing so would unleash some crazy dangerous drug across the US and people are going to start overdosing and dying or something. At worst you’d notice a spike in Doritos sales…

Mark Knudson

“100 million chronic pain patients in the U.S.”

I hope this was misquoted, because if true it would be incredible. If not Dr. Bennett just lost credibility. Nearly one third of Americans are chronic pain patients? What has he been smoking?

Seriously though, instead of complaining about the Federal law against marijuana, put your efforts toward changing the law. Use some of the vast fortunes from the sales of medical and “legal” pot to fund the research so that the Feds will be convinced. States apparently feel they can do whatever they want, but it’s still the United States.

There is great confusion about medical marijuana (MMJ) and how it works for specific kinds of pain in the minds of many who are seeking it, especially young adults in that all important demo of 18 to 35 year-olds.

MMJ can be helpful for certain kinds of pain — for example, the ache of fibromyalgia. The anti emetic and opioid sparing properties of MMJ make it an effective adjunct to chronic opioid therapy. And because MMJ helps many to sleep, it is beneficial in a common co-condition to chronic pain — insomnia.

MMJ contains two important classes of neuroactive proteins: tetra-hydro cannabinoids (THC) and cannabidiols (CBD).

It is safe to assume that every red-blooded American who tunes into the news has understands that THC is the psychoactive compound in MMJ, but many Americans, including people seeking an answer to their pain, are unaware of the role of CBD in pain management.

CBD, especially compounds that activate the CBD-2 neuroreceptor, are believed to play a role in pain control, and may have an effect on mu-opioid receptors, which initiate the major analgesic cascade that leads to opioid agonist-based pain relief. Pain writer Zyp Czyk has an interesting article that explores the role of CBD-2 on the glial cells that have been linked to pain sensitization and chronic pain’s public enemy number 1 — opioid tolerance.

But in a state of Washington study of MMJ last year reported in the Journal of Pain Research, MMJ samples from around the state contained very low quantities of CBD compounds in a chromatographic analysis, while THC content tested very high.

In Washington, here in Colorado, and in other MMJ states, medical consumers have little if any scientific information on the fraction of CBD in their ‘medicine.’ This is a huge problem for someone like me who needs more analgesia out of a limited dose of their opioid-based pain medication due to a high tolerance developed in over 20 years of treatment.

I wrote of how people are losing their medications because of misinterpretation of UDT for the National Pain Report last month.

The other big problem experienced by many people in pain who use MMJ to help fight their pain is that urine drug testing, which is part of the “universal precaution” protocol used in virtually every pain management office in America, tests for a wide spectrum of pharmaceutical and illegal drug metabolites, and pain doctors know when their patients use MMJ.

Many pain management offices have a zero-tolerance policy when it comes to illegal drugs, so the patient who is utilizing the beneficial effects of MMJ risks losing their access to opioid-based medications.

I’d suggest that people who are not clear on their pain practitioner’s policies regarding MMJ have a serious discussion with their doctor to prevent any misunderstanding and the loss of their opioid analgesics.