Researchers in Pennsylvania are preparing to launch a major study designed to detail the benefits of medical marijuana as an alternative to opioids for pain management.
Marijuana, referred to medically as cannabis, is increasingly available to patients, with 29 states legalizing the drug as a medical therapy. However, the medical literature on the use of marijuana for pain management is relatively thin.
Ari C. Greis, DO, a clinical assistant professor in the Department of Physical Medicine and Rehabilitation at the Rothman Institute, part of Thomas Jefferson University, will lead the study. He told MD Magazine this will be the first of several studies looking at cannabis as a pain management strategy.
“There are already several observational studies showing a relationship between cannabis use and reduced opioid intake,” Greis said. “But we clearly need more high-quality, prospective studies to assess the effects of specific cannabinoid preparations on common pain conditions.”
The first study will focus on patients with lower back and leg pain associated with compression of spinal nerves or sciatica.
Greis said he believes cannabis can be an important part of a multimodal approach to pain management. He said the evidence for marijuana as a pain management treatment is mounting, even as new research is calling into question the efficacy of opioids.
“Recent studies are showing that opioids don’t work well for chronic pain, and the available literature on cannabis for pain is very promising,” he said. “Having access to cannabis seems to reduce opioid use and related overdose mortality rates. We must find safer alternatives to opioids.”
If cannabis helps reduce the use of opioids, it would hopefully also reduce rates of dependence on opioids, Greis said.
The Rothman Institute is one of the country’s largest orthopedic practices. For funding, it will partner in the study with Franklin BioScience, a Colorado-based medical marijuana company that recently began operating a dispensary in Pennsylvania. Pennsylvania’s medical marijuana program officially started in February.
The study is being run out of Thomas Jefferson University’s Lambert Center for the Study of Medicinal Cannabis and Hemp. Greis said his colleagues are championing innovation and are eager to find better alternatives to opioids. However, Greis conceded that some physicians he speaks to at other clinics are still cautious about cannabis.
“But I also hear from many pain management physicians who fear prosecution from the Drug Enforcement Agency if they recommend cannabis or allow cannabis use while on opioids,” Greis said. “And that’s very unfortunate in my opinion.”
Greis said he does not believe marijuana deserves to be classified as a Schedule I drug, and he suspects most physicians agree with him. Greis said there is ample evidence to suggest that society should err on the side of increased access to marijuana, even as researchers continue to study the drug and its effects.
David L. Nathan, MD, DFAPA, the current president of the board of directors of Doctors for Cannabis Regulation, agrees. He told MD Magazine that “federal legalization will increase patient access, but perhaps more importantly it will help remove the stigma that continues to prevent patients—including many on high doses of potentially lethal opioids—to avail themselves of a potentially better tolerated medication.”
As of March 2, 2018, the State of Pennsylvania stated that 21,000 patients had applied to be part of the state’s medical marijuana program, with 6000 of those patients already approved by their physicians. Just over one-third of those patients—2200—had received medical marijuana through one of the state’s dispensaries as of March 2.
