Cannabis Extract Provides ‘Superior Pain Relief’ Compared to Opioids

By Pat Anson

A German pharmaceutical company has released the results of two late-stage clinical trials, showing that a cannabis extract called VER-01 significantly reduces chronic lower back pain. The full spectrum extract, derived from cannabis sativa, provided better pain relief to patients in a head-to-head comparison with low doses of opioids.

Vertanical hopes to get regulatory approval of VER-01 in Europe and with UK regulators in 2026. If granted, VER-01 would be the first cannabis-based medicine approved for use in treating chronic pain. Another study of VER-01 is planned in the U.S. next year, which would be a step towards getting FDA approval.

Findings from the two Phase 3 studies were published separately in the journals Nature Medicine and Pain & Therapy.

“These findings provide powerful evidence that VER-01 could in the future transform how we care for patients with chronic lower back pain,” co-author Charles Argoff, MD, Professor of Neurology at Albany Medical College and past president of the American Academy of Pain Medicine, said in a press release.

“The results of the Phase 3 studies bring hope to millions living with chronic pain that VER-01, once approved, may provide effective pain relief without the risks and harms associated with existing therapies.”

Chronic lower back pain (CLBP) affects more than half a billion people worldwide and is the leading cause of disability. Current treatment options for CLBP are typically limited to physical therapy and non-steroidal anti-inflammatory drugs (NSAIDs), which often don’t work.

In the Phase 3 study, 820 patients with CLBP were given either a placebo or VER-01 over 12 weeks. Those who received the extract had an average pain reduction of 1.9 points on a zero-to-ten pain scale. After six months, pain intensity decreased by 2.9 points, which was sustained over 12 months. Participants also reported improvements in neuropathic pain, sleep quality and physical function.

The other Phase 3 study involved 384 patients with CLBP, who received either VER-01 or opioids for six months. Opioid doses started with a mean daily average of nearly 27 morphine milligram equivalents (MME) and were titrated up to an average of nearly 32 MME, a dosage range that would be considered low or moderate. Opioid options included tramadol, oxycodone, hydromorphone, morphine, and transdermal fentanyl or buprenorphine.

VER-01 was more effective in relieving pain than opioids, especially for patients with severe pain. The average pain reduction with VER-01 was 2.5 points on the pain scale, compared to 2.16 points with opioids. Patients taking VER-01 also had better sleep quality and were less likely to be constipated.

VER-01 was generally well tolerated in both studies, with no evidence of dependence or withdrawal. Side effects such as dizziness and nausea were mild and short-term. Although it contains THC, the main psychoactive substance in cannabis, patients did not become “high” or intoxicated. Each dose of VER-01 contained 2.5 mg of THC, as well as cannabinoids, terpenes and other bioactive compounds that were administered twice daily.

“This study provides robust evidence that VER-01 offers better tolerability, as well as superior pain relief and sleep quality compared to opioids in patients with CLBP. These findings highlight its potential as a promising new pharmacological option within a multimodal treatment approach that could fundamentally shift the paradigm in the treatment of chronic pain,” researchers concluded.

It approved, VER-01 would be sold under the brand name Exilby and be taken orally in drops. Vertanical is also studying VER-01 as a pain treatment for patients with osteoarthritis and peripheral neuropathy.

Research into the pain-relieving properties of cannabis has been slow in the U.S., in large part because of marijuana’s status as an illegal Schedule 1 controlled substance. Although the DEA allows more cannabis to be used for research purposes, the agency has dragged its feet about reclassifying marijuana as a Schedule 3 substance that could be used for medical purposes. Until marijuana is rescheduled, VER-01 is unlikely to get FDA approval. 

Medical Cannabis Helps Insomnia Patients Sleep and Reduces Pain

By Pat Anson

Insomnia patients taking medical cannabis reported better sleep quality, as well as less anxiety, depression and pain, according to a new study published in PLOS Mental Health.

The study is notable because it showed sustained improvement in symptoms over 18 months of treatment with medical cannabis. Most previous studies are much shorter.

Researchers at Imperial College London followed 125 patients diagnosed with an insomnia disorder who were prescribed medical cannabis and enrolled in the UK Medical Cannabis Registry. Participants either ingested cannabis oil, smoked dried flower, or a combination of the two. Improvements in sleep and other symptoms were observed after one month of treatment and continued over the 18-month course of the study.

However, the magnitude of improvement declined over time, suggesting that some patients developed tolerance to cannabis. Less than 10% of patients reported mild side effects, such as dry mouth, insomnia and fatigue.

“Over an 18-month period, our study showed that treatment for insomnia with cannabis-based medicinal products was associated with sustained improvements in subjective sleep quality and anxiety symptoms. These findings support the potential role of medical cannabis as a medical option where conventional treatments have proven ineffective,” said co-author Simon Erridge, a PhD candidate at Imperial College and Research Director at Curaleaf Clinic, a cannabis dispensary.

“Conducting this long-term study provided valuable real-world evidence on patient outcomes that go beyond what we typically see in short-term trials. It was particularly interesting to observe signs of potential tolerance over time, which highlights the importance of continued monitoring and individualised treatment plans.”

The researchers say larger clinical trials are needed to confirm their finding of long-term efficacy. Most of the researchers are either employees or medical practitioners at Curaleaf Clinic.

A previous study conducted in Israel also found that cannabis helps with sleep, but regular use lead to drug tolerance and even more sleep problems. Over time, the benefits of cannabis were reversed, with frequent users finding it harder to fall asleep and waking up more often during the night.  

Most Pain Patients Stop Using Medical Cannabis Within a Year

By Crystal Lindell

A small new study found that most pain patients taking medical cannabis stopped using it within one year. 

The research – which was published in PLOS One  – looked at 76 patients diagnosed with chronic musculoskeletal pain, such as back, shoulder and knee pain. The patients were all certified for medical cannabis use at the Rothman Orthopaedic Institute in Pennsylvania between 2022 and 2024

By the first 3-month check-in, 44.7% (34 patients) had already stopped using medical cannabis, which researchers described as “a considerable early drop-off.” 

“This early discontinuation could point to initial expectations not being met, potential side effects, or insufficient symptom relief, which are common reasons for discontinuation in medical treatments,” wrote lead author Sina Ramtin, MD, who was a Research Fellow at the Rothman Institute. 

“Despite the growing acceptance of MC (medical cannabis) as a therapeutic option for chronic musculoskeletal pain, significant gaps remain in understanding its long-term efficacy. While some patients report significant pain relief, others experience dissatisfaction, intolerance, or prefer more definitive treatments, such as surgery or joint injections.” 

By one year, another 10 patients stopped using medical cannabis, which resulted in a total discontinuation rate of 57.9% (44 patients).  

Age was the biggest factor researchers found that separated those who continued using medical cannabis from those who didn’t. The patients who discontinued cannabis tended to be older (mean age of 71.5 years) than those who continued with cannabis therapy (64.5 years).

The researchers think age-related concerns about cognitive side effects, dizziness, or drug interactions may have played a role in decisions to stop using cannabis. Another possible explanation for the high discontinuation rate in elderly patients is that they are more likely to have more advanced pain conditions, such as degenerative disc disease and osteoarthritis, which are more difficult to treat.

The origin of pain, health insurance, and a patient’s race did not seem to have a significant impact on cannabis use, although a higher proportion of patients in the discontinued group reported low back pain. The research team attributed this to “the complexity of managing chronic pain conditions with medical cannabis alone.” 

Interestingly, the researchers did not find much difference in the health outcomes between those who continued using medical cannabis and those who didn’t. They looked at physical and mental health scores for patients, and found that there were no significant differences between the two groups.

“These findings suggest that while MC may offer benefits for some patients, further research is needed to better understand the long-term effects of MC on pain management and patient satisfaction, as well as the factors influencing treatment adherence,” the authors said. 

There has been a strong push over the last decade to reduce the use of prescription opioids, leaving patients little choice but to experiment with “alternative” pain treatments such as medical cannabis. Research like this reinforces the idea that cannabis is not always a perfect option for treating chronic pain.

“The relatively high early discontinuation rate indicates that MC may not provide immediate or sustained relief for all patients and highlights the need for better patient selection and management strategies in the early stages of treatment,” said Ramtin.

Also, while the study doesn’t delve into this, the cost of medical cannabis is often a huge barrier for pain patients. Medical cannabis can be much more expensive than the cash price of generic opioids, and is usually not covered by insurance.

Many of the patients in the study may have found more relief with opioids, but it’s unclear how many were given that option. 

At the end of the day, patients deserve a real choice when it comes to how they treat their pain. That means having access to different medications and therapies. Only then will people truly be able to find what works best for them.  

Cannabis Use by Older Adults Linked to ‘Younger Brains’ and Improved Cognition

By Crystal Lindell

A new study suggests that cannabis use by older adults slows the aging of their brains and may even improve cognitive function.  

An international research team analyzed extensive health data on over 25,000 adults in the UK, looking at the relationship between cannabis use, aging, and cognitive function. They found that cannabis users had brain characteristics “typically associated with younger brains “ and “enhanced cognitive abilities.” 

“Cannabis users exhibited superior performance across multiple cognitive domains, and interestingly, the effects of cannabis and cognition are presented concurrently across a range of brain systems,” the authors said.

“These findings suggest that cannabis use may be associated with a deceleration of neural aging processes and the preservation of cognitive function in older adults.”

It’s important to note that the study is a preprint, published in Research Square, which means the findings have not yet been peer-reviewed by a medical journal and may undergo changes. 

While it’s common knowledge that cannabis can alter mood, cognition and perception, researchers wanted to look at other potential impacts, particularly in older adults. Most previous studies investigating the effects of cannabis on brain function focused on adolescents and young adults.

Due to legalization, cannabis is increasingly being used by older adults and there’s a growing recognition that cannabis can be used therapeutically to treat pain, insomnia, depression and other conditions associated with old age.  

Normal aging typically involves a gradual decline in cognitive abilities, but when researchers compared the cognitive performance of cannabis users and non-users, they found that  cannabis use had positive effects on most cognitive functions compared to normal aging.

Cannabis users performed better in various cognitive tasks, including problem solving, planning skills, numeric memory, intelligence, and vocabulary. The effects — where cannabis users outperform non-users — were evident across different age groups, starting in middle age (45–55 years) and continuing into old age (66 + years)

Researchers think cannabis enhanaces cognitive performance by improving how different parts of the brain communicate with each other, a process known as functional network connectivity (FNC).

“Our findings reveal that cannabis usage and healthy aging are associated with overlapping brain network configurations, particularly within the FNC between subcortical and sensorimotor regions, as well as between subcortical and cerebellar areas, albeit with significantly reversed effects,” they said.

The enhanced performance of these brain regions may be due to higher concentrations of cannabinoid receptors in brain tissue, which makes them more responsive to cannabinoids such as tetrahydrocannabinol (THC) and cannabidiol (CBD).

Researchers say their findings could lead to further research into whether cannabinoids and endocannabinoids could be used to treat multiple sclerosis, Parkinson's disease, Alzheimer's disease, and other neurodegeneration diseases.

Large Study Finds Medical Cannabis ‘Effective Treatment’ for Chronic Pain

By Pat Anson

Medical cannabis is an “effective treatment option” for chronic pain and significantly improves quality of life in long-term users, according to a large new study.

Researchers at George Mason University and the medical cannabis telehealth company Leafwell analyzed healthcare trends for over 5,200 chronic pain patients. Those who had used medical marijuana for at least one year reported fewer unhealthy days and significantly better quality of life. They also had slightly fewer emergency department and urgent care visits than non-users.

“The findings of this study suggest, in line with existing research, that medical cannabis is likely an effective treatment option for patients with chronic pain. Moreover, we found that, in addition to an increase in QoL (quality of life), medical cannabis exposure is associated with lower risk of urgent care and ED visits, when comparing patients who used medical cannabis for at least one year to cannabis-naïve patients,” researchers reported in the journal Pharmacy.

“This underscores the potential for not only QoL gains associated with medical cannabis use, but also positive downstream effects on the healthcare system resulting from treatment.”

The study did not distinguish between the types of medical cannabis consumed or what kind of chronic pain conditions that participants had. Most of the researchers work for Leafwell, which helps patients get medical marijuana cards in states where it is legal. The company does not manufacture or sell cannabis products.

Pain Relief #1 Reason for Use 

Pain relief is the most likely reason for people to use cannabis for medical reasons, followed by those seeking help with sleep, anxiety and stress, according to a new survey of over 4,000 cannabis users in California.

There were distinct differences between participants who used cannabis solely for medical reasons and those who used it for both medical and recreational purposes.

Medical users were more likely to be female, and to live in households with children. Their average age at first use was 34, compared to 23 among combined users, who were more likely to be male.

Medical users spent less money on cannabis, about $127 per month, compared to combined users ($186), and used it far less frequently (1-3 times a week vs. multiple times a day).

Medical users also had less desire to “feel the high” from cannabis (42% vs. 75%).

Medical/recreational users were more likely to smoke dried flower (65%), while medical users preferred edibles (48%), topical ointments (28%) and oils (18%).

“Cannabis use is growing with expanding legalization, necessitating more research to understand the ramifications of increased access, and better understand the factors influencing the choices and options available to users. Special attention should be given to medicinal users, who may represent a vulnerable group seeking symptom relief,” researchers at UC San Diego reported in the Journal of Cannabis Research.

While medical cannabis is gaining in acceptance, many healthcare providers still take a dim view of it. The American College of Physicians (ACP) recently released a cautious new guideline that recommends against the use of medical cannabis for most patients with chronic noncancer pain. Medical cannabis may produce small improvements in pain, function and disability, according to the ACP, but potential harms include addiction and cognitive issues, as well as cardiovascular, gastrointestinal and pulmonary problems.

THC-Dominant Cannabis Effective in Treating Anxiety and Depression

By Pat Anson

As many pain sufferers already know, anxiety and depression are common when you live with poorly treated chronic pain.

A recent study found that 40% of adults with chronic pain have clinical symptoms of depression or anxiety. Pain sufferers with fibromyalgia were particularly vulnerable to emotional stress, along with those who are younger and female.   

New research suggests that medical cannabis could be an alternative to antidepressants and anti-anxiety drugs like Xanax. The small observational study, recently published in the Journal of Affective Disorders, found that adults with and without pain experienced significant and sustained relief from anxiety and depression after they started using medicinal cannabis.

Researchers at Johns Hopkins University School of Medicine and La Trobe University followed 33 volunteers in Maryland over a six-month period. Participants completed assessments of their anxiety and depression at the start of treatment, and at one, three, and six months after beginning cannabis use.

Most participants selected cannabis products containing tetrahydrocannabinol (THC), the psychoactive ingredient in cannabis, and experienced clinically significant reductions in anxiety and depression within three months. Acute or immediate relief was dose-dependent, with participants who ingested 10–15 mg of oral THC or at least 3 puffs of vaporized cannabis reporting the most relief from anxiety and depression.

There are some caveats about using higher doses. Participants reported feeling “high” using THC-dominant cannabis, and some were so impaired it affected their driving abilities. But overall, the results were positive.

“Initiation of THC-dominant medicinal cannabis was associated with acute reductions in anxiety and depression, and sustained reductions in overall symptom severity over a 6-month period. Controlled clinical trials are needed to further investigate the efficacy and safety of medicinal cannabis for acute anxiety and depression symptom management,” researchers reported.

Previous studies have also suggested that medical cannabis is most effective when it also contains THC.

A recent study of 64 patients in Germany with inadequately treated chronic pain found that a cannabis extract with equal parts THC and CBD (cannabidiol) substantially reduced their self-reported pain intensity.

“Our findings indicate that treatment with medicinal cannabis improves both physical and mental health in patients with chronic pain,” researchers reported in the journal Advances in Therapy. “The results suggest that medicinal cannabis might be a safe alternative for patients who are inadequately treated with conventional therapies.”

In a 2019 analysis of self-reported health data from over 3,300 cannabis users, researchers reported that THC was more effective than CBD alone in treating chronic pain, insomnia and other medical conditions. Cannabis products containing higher doses of THC provided the most relief.

Another small study conducted in Israel found that “microdosing” small amounts of THC significantly reduced pain levels in patients suffering from neuropathy, without the risks of impairment and other cognitive issues.

Seniors Should Be Cautious Using Gummies and Other Cannabis Products

By Paula Span, KFF Health News

Benjamin Han, a geriatrician and addiction medicine specialist at the University of California-San Diego, tells his students a cautionary tale about a 76-year-old patient who, like many older people, struggled with insomnia.

“She had problems falling asleep, and she’d wake up in the middle of the night,” he said. “So her daughter brought her some sleep gummies” — edible cannabis candies.

“She tried a gummy after dinner and waited half an hour,” Han said.

Feeling no effects, she took another gummy, then one more — a total of four over several hours.

Han advises patients who are trying cannabis to “start low; go slow,” beginning with products that contain just 1 or 2.5 milligrams of tetrahydrocannabinol, or THC, the psychoactive ingredient that many cannabis products contain. Each of the four gummies this patient took, however, contained 10 milligrams.

The woman started experiencing intense anxiety and heart palpitations. A young person might have shrugged off such symptoms, but this patient had high blood pressure and atrial fibrillation, a heart arrhythmia. Frightened, she went to an emergency room.

Lab tests and a cardiac work-up determined the woman wasn’t having a heart attack, and the staff sent her home. Her only lingering symptom was embarrassment, Han said. But what if she’d grown dizzy or lightheaded and was hurt in a fall? He said he has had patients injured in falls or while driving after using cannabis. What if the cannabis had interacted with the prescription drugs she took?

“As a geriatrician, it gives me pause,” Han said. “Our brains are more sensitive to psychoactive substances as we age.”

Unclear Benefits

Thirty-nine states and the District of Columbia now allow cannabis use for medical reasons, and in 24 of those states, as well as the district, recreational use is also legal. As older adults’ use climbs, “the benefits are still unclear,” Han said. “But we’re seeing more evidence of potential harms.”

A wave of recent research points to reasons for concern for older users, with cannabis-related emergency room visits and hospitalizations rising, and a Canadian study finding an association between such acute care and subsequent dementia.

Older people are more apt than younger ones to try cannabis for therapeutic reasons: to relieve chronic pain, insomnia, or mental health issues, though evidence of its effectiveness in addressing those conditions remains thin, experts said.

In an analysis of national survey data published June 2 in the medical journal JAMA, Han and his colleagues reported that “current” cannabis use (defined as use within the previous month) had jumped among adults age 65 or older to 7% of respondents in 2023, from 4.8% in 2021. In 2005, he pointed out, fewer than 1% of older adults reported using cannabis in the previous year.

What’s driving the increase? Experts cite the steady march of state legalization — use by older people is highest in those states — while surveys show that the perceived risk of cannabis use has declined.

One national survey found that a growing proportion of American adults — 44% in 2021 — erroneously thought it safer to smoke cannabis daily than cigarettes. The authors of the study, in JAMA Network Open, noted that “these views do not reflect the existing science on cannabis and tobacco smoke.”

The cannabis industry also markets its products to older adults. The Trulieve chain gives a 10% discount, both in stores and online, to those it calls “wisdom” customers, 55 or older. Rise Dispensaries ran a yearlong cannabis education and empowerment program for two senior centers in Paterson, New Jersey, including field trips to its dispensary.

The industry has many satisfied older customers. Liz Logan, 67, a freelance writer in Bronxville, New York, had grappled with sleep problems and anxiety for years, but the conditions grew particularly debilitating two years ago, as her husband was dying of Parkinson’s disease. “I’d frequently be awake until 5 or 6 in the morning,” she said. “It makes you crazy.”

Looking online for edible cannabis products, Logan found that gummies containing cannabidiol, known as CBD, alone didn’t help, but those with 10 milligrams of THC did the trick without noticeable side effects. “I don’t worry about sleep anymore,” she said. “I’ve solved a lifelong problem.”

But studies in the United States and Canada, which legalized nonmedical cannabis use for adults nationally in 2018, show climbing rates of cannabis-related health care use among older people, both in outpatient settings and in hospitals.

In California, for instance, cannabis-related emergency room visits by those 65 or older rose, to 395 per 100,000 visits in 2019 from about 21 in 2005. In Ontario, acute care (meaning emergency visits or hospital admissions) resulting from cannabis use increased fivefold in middle-aged adults from 2008 to 2021, and more than 26 times among those 65 and up.

“It’s not reflective of everyone who’s using cannabis,” cautioned Daniel Myran, an investigator at the Bruyère Health Research Institute in Ottawa and lead author of the Ontario study. “It’s capturing people with more severe patterns.”

But since other studies have shown increased cardiac risk among some cannabis users with heart disease or diabetes, “there’s a number of warning signals,” he said.

For example, a disturbing proportion of older veterans who currently use cannabis screen positive for cannabis use disorder, a recent JAMA Network Open study found.

As with other substance use disorders, such patients “can tolerate high amounts,” said the lead author, Vira Pravosud, a cannabis researcher at the Northern California Institute for Research and Education. “They continue using even if it interferes with their social or work or family obligations” and may experience withdrawal if they stop.

Among 4,500 older veterans (with an average age of 73) seeking care at Department of Veterans Affairs health facilities, researchers found that more than 10% had reported cannabis use within the previous 30 days. Of those, 36% fit the criteria for mild, moderate, or severe cannabis use disorder, as established in the Diagnostic and Statistical Manual of Mental Disorders.

VA patients differ from the general population, Pravosud noted. They are much more likely to report substance misuse and have “higher rates of chronic diseases and disabilities, and mental health conditions like PTSD” that could lead to self-medication, she said.

Current VA policies don’t require clinicians to ask patients about cannabis use. Pravosud thinks that they should.

Moreover, “there’s increasing evidence of a potential effect on memory and cognition,” said Myran, citing his team’s study of Ontario patients with cannabis-related conditions going to emergency departments or being admitted to hospitals.

Compared with others of the same age and sex who were seeking care for other reasons, research shows these patients (ages 45 to 105) had 1.5 times the risk of a dementia diagnosis within five years, and 3.9 times the risk of that for the general population.

Even after adjusting for chronic health conditions and sociodemographic factors, those seeking acute care resulting from cannabis use had a 23% higher dementia risk than patients with noncannabis-related ailments, and a 72% higher risk than the general population.

None of these studies were randomized clinical trials, the researchers pointed out; they were observational and could not ascertain causality. Some cannabis research doesn’t specify whether users are smoking, vaping, ingesting or rubbing topical cannabis on aching joints; other studies lack relevant demographic information.

“It’s very frustrating that we’re not able to provide more individual guidance on safer modes of consumption, and on amounts of use that seem lower-risk,” Myran said. “It just highlights that the rapid expansion of regular cannabis use in North America is outpacing our knowledge.”

Still, given the health vulnerabilities of older people, and the far greater potency of current cannabis products compared with the weed of their youth, he and other researchers urge caution.

“If you view cannabis as a medicine, you should be open to the idea that there are groups who probably shouldn’t use it and that there are potential adverse effects from it,” he said. “Because that is true of all medicines.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues.

More Australians Are Trying Medical Cannabis for Chronic Pain

By Suzanne Nielsen and Myfanwy Graham  

More Australians than ever are being prescribed medicinal cannabis.

Medicinal cannabis refers to legally prescribed cannabis products. These are either the plant itself, or naturally occurring ingredients extracted from the plant. These ingredients, such as THC (tetrahydrocannabinol) and CBD (cannabidiol), are called cannabinoids. Some cannabinoids are also made in labs to act like the ones in the plant.

Medicinal cannabis comes in different forms, such as oils, capsules, dried flower, sprays and edible forms such as gummies.

Since regulatory changes in 2016 made medicinal cannabis more accessible, Australia’s regulator has issued more than 700,000 approvals. Around half of the approvals have been for chronic pain that isn’t caused by cancer.

In Australia, chronic pain affects around one in five Australians aged 45 and over, with an enormous impact on people’s lives.

So what does the current evidence tell us about the effectiveness of medicinal cannabis for chronic pain?

Limited Benefits

A 2021 review of 32 randomised controlled trials involving nearly 5,200 people with chronic pain, examined the effects of medicinal cannabis or cannabinoids. The study found a small improvements in pain and physical functioning compared with a placebo.

A previous review found that to achieve a 30% reduction in pain for one person, 24 people would need to be treated with medicinal cannabis.

The 2021 review also found small improvements in sleep, and no consistent benefits for other quality of life measures, consistent with previous reviews.

This doesn’t mean medicinal cannabis doesn’t help anyone. But it suggests that, on average, the benefits are limited to a smaller number of people.

Many pain specialists have questioned if the evidence for medicinal cannabis is sufficient to support its use for pain.

The Faculty of Pain Medicine, the professional body dedicated to the training and education of specialist pain physicians, recommends medical cannabis should be limited to clinical trials.

Guidance from Australia’s regulator, the Therapeutic Goods Administration (TGA), on medicinal cannabis for chronic non-cancer pain reflects these uncertainties. The TGA states there is limited evidence medicinal cannabis provides clinically significant pain relief for many pain conditions. Therefore, the potential benefits versus harms should be considered patient-by-patient.

The TGA says medicinal cannabis should only be trialled when other standard therapies have been tried and did not provide enough pain relief.

In terms of which type of medical cannabis product to use, due to concerns about the safety of inhaled cannabis, the TGA considers pharmaceutical-grade products (such as nabiximols or extracts containing THC and/or CBD) to be safer.

This evidence may feel at odds with the experiences of people who report relief from medicinal cannabis.

In clinical practice, it’s common for individuals to respond differently based on their health conditions, beliefs and many other factors. What works well for one person may not work for another.

Research helps us understand what outcomes are typical or expected for most people, but there is variation. Some people may find medicinal cannabis improves their pain, sleep or general well-being – especially if other treatments haven’t helped.

Side Effects and Risks

Like any medicine, medicinal cannabis has potential side effects. These are usually mild to moderate, including drowsiness or sedation, dizziness, impaired concentration, a dry mouth, nausea and cognitive slowing.

These side effects are often greater with higher-potency THC products. These are becoming more common on the Australian market. High-potency THC products represent more than half of approvals in 2025. In research studies, generally more people experience side effects than report benefits from medical cannabis.

Medical cannabis can also interact with other medications, especially those that cause drowsiness (such as opioids), medicines for mental illness, anti-epileptics, blood thinners and immunosuppressants. Even cannabidiol (CBD), which isn’t considered intoxicating like THC, has been linked to serious drug interactions.

These risks are greater when cannabis is prescribed by a doctor who doesn’t regularly manage the patient’s chronic pain or isn’t in contact with their other health-care providers. Since medicinal cannabis is often prescribed through separate telehealth clinics, this fragmented care may increase the risk of harmful interactions.

Another concern is developing cannabis use disorder (commonly understood as “addiction”). A 2024 study found one in four people using medical cannabis develop a cannabis use disorder. Withdrawal symptoms – such as irritability, sleep problems, or cravings – can occur with frequent and heavy use.

For some people, tolerance can also develop with long-term use, meaning you need to take higher doses to get the same effect. This can increase the risk of developing a cannabis use disorder.

Like many medicines for chronic pain, the effectiveness of medicinal cannabis is modest, and is not recommended as a sole treatment.

There’s good evidence that, for conditions like back pain, interventions such as exercise, cognitive behavioural therapy and pain self-management education can help and may have fewer risks than many medicines. But there are challenges with how accessible and affordable these treatments are for many Australians, especially outside major cities.

The growing use of medicinal cannabis for chronic pain reflects both a high burden of pain in the community and gaps in access to effective care. While some patients report benefits, the current evidence suggests these are likely to be small for most people, and must be weighed against the risks.

If you are considering medicinal cannabis, it’s important to talk to your usual health-care provider, ideally one familiar with your full medical history, to help you decide the best approaches to help manage your pain.

Suzanne Nielsen, PhD, is a Professor and Deputy Director of the Monash Addiction Research Centre at Monash University in Melbourne, Australia.  Suzanne has been a registered pharmacist for over 20 years. Her clinical experience in the treatment of substance use disorders includes working in specialist drug treatment and community-based alcohol and drug treatment settings in Australia and the United Kingdom.

Myfanwy Graham is a Postgraduate Scholar and Researcher at the Monash Addiction Research Centre. She has been a registered pharmacist for over 17 years and was a consultant to the United Nations Office on Drugs and Crime, the World Health Organization, and the National Academy of Sciences, Engineering and Medicine.

This article originally appeared in The Conversation and is republished with permission.

New Guideline Cautions Against Use of Medical Cannabis for Chronic Pain

By Pat Anson

One of the nation’s largest medical organizations has released a cautious new guideline that recommends against the use of medical cannabis for most patients with chronic noncancer pain. The American College of Physicians (ACP) represents over 160,000 internal medicine doctors and medical students in the United States.

The ACP’s “Best Practice Advice,” recently published in the Annals of Internal Medicine, is based on a review of medical cannabis in over three dozen randomized controlled trials and observational studies.

It urges physicians to warn patients that the harms of cannabis and cannabinoid use outweigh their potential benefits. Medical cannabis may produce small improvements in pain, function and disability, but potential harms include addiction and cognitive issues, as well as cardiovascular, gastrointestinal and pulmonary problems.

“This Best Practice Advice is important for practicing physicians when counseling our patients on the potential use of cannabis and cannabinoids to treat their chronic noncancer pain,” said Isaac Opole, MD, President of the ACP.

“As the use of cannabis for medicinal purposes grows it’s critical to open that dialogue and review the emerging evidence related to benefits and harms. We need to raise awareness and get the word out to ensure that patients have the information they need to make informed decisions.” 

The use of cannabis has steadily grown in recent years, with polls showing that nearly one in four U.S. adults have used medical or recreational cannabis at least once in the past year. Although chronic pain is the most common reason patients use medical cannabis, most have never discussed it with their physicians. Many get their information about cannabis from dispensary workers, who typically do not have any medical training.

The ACP recommends against the use of cannabis for chronic pain by young adults and adolescents, patients with substance use disorders, patients with a serious mental illness, patients who are pregnant or breastfeeding, and frail patients at risk of falling. Inhaled cannabis is not recommended for any patients.

There is some evidence that patients with painful neuropathy may benefit from using cannabis products that contain equal amounts of CBD and THC. 

“Evidence shows that in patients primarily with chronic noncancer neuropathic pain, a cannabis formulation with comparable THC–CBD ratio probably results in small improvements in pain severity (about 0.5 to 1.0 points on a zero to 10 pain scale) and function or disability (about 0.4-point improvement on the pain scale),” the ACP said.

“However, the evidence is insufficient to show benefit for other types of chronic noncancer pain. High THC–CBD ratio synthetic or purified products may result in small improvements in pain severity (about 0.5- to 1.0-point on the pain scale) but no change in overall function or disability.”

Currently, 24 states in the District of Columbia have legalized cannabis for adult recreational and medical use. It is legal for medical use only in an another 14 states. 

Research into the pain-relieving benefits of cannabis has been slow in the U.S., largely due to marijuana’s status as a Schedule 1 controlled substance, the same category as LSD and heroin. The DEA dragged its feet on implementing a request from the Biden Administration to reclassify marijuana as a Schedule 3 controlled substance that could be used for medical purposes. Rescheduling marijuana does not appear to be a priority for the Trump Administration.

There are only three cannabis-based medicines approved for use by the FDA: dronabinol and nabilone, which are used to treat nausea and loss of appetite, and a concentrated form of CBD used to control seizures from childhood epilepsy.

A German biotech company is in preliminary talks with the FDA about approving an experimental cannabis extract for chronic low back pain. A recent study in Australia found patients with chronic pain and other health conditions showed significant improvement in their quality of life, fatigue and sleep after taking cannabis oil over a one-year period. There were also small improvements in pain, anxiety and depression.

Cannabis Oil Has Long-Term Benefits for Chronic Health Conditions

By Pat Anson

Patients suffering from chronic pain and other chronic health conditions showed significant improvement in their quality of life, fatigue and sleep after taking cannabis oil over a one-year period, according to a new Australian study published in the journal PLOS One. Anxiety, depression and pain also improved during the course of the study, one of the first to demonstrate the long-term benefits of medical cannabis.

Researchers at the University of Sydney followed over 2,350 patients from across Australia who ingested cannabis oils containing both THC and CBD. Nearly two-thirds of the participants suffered from chronic musculoskeletal or neuropathic pain. Others lived with insomnia, depression, fatigue and anxiety. Participants did not get adequate relief from conventional treatments.   

Researchers found that the initial improvements in health over three months were maintained over 12 months. Because there was no control or placebo group, the improvements can’t be directly attributed to cannabis oil. But researchers noted that most of the participants stopped or reduced their use of opioid pain medication by the end of the study.

“This is promising news for patients who are not responding to conventional medicines for these conditions," said lead author Margaret-Ann Tait, a Research Manager and PhD Student at Sydney Nursing School, University of Sydney. 

The ratio of THC and CBD in the cannabis oil varied. Patients with conditions like fatigue or insomnia did better with oils that contained more THC; while those with chronic pain did better with higher ratios of CBD.

“We observed differences in the degree of improvement in fatigue, insomnia, anxiety, and depression depending on the ratio of CBD and THC in average daily MC (medical cannabis) doses. For these outcomes, average daily doses of THC-dominant MC was associated with greater odds of improvement than CBD:THC-balanced MC,” researchers said.

“Our findings suggest that people with chronic pain conditions experience better outcomes over time on lower doses of CBD when combined with smaller amounts of THC at a ratio of 10:1.”

Because this was an observational study, with different ratios of THC and CBD, researchers said they could not draw definitive conclusions about which ratios work best for each condition. The oils are made by Little Green Pharma , which funded the Quality of Life Evaluation Study (QUEST).

A 2023 survey of Australian patients with chronic illness found significant improvements in their physical and mental health after they started using medical cannabis. Most of the cannabis products in that study were oils containing CBD and/or THC.   

Nearly All Hemp Products Could Get You High

uy Crystal Lindell

The promise of legalized hemp products was always that you couldn’t high on them, and they would be more regulated and thus safer for consumers. But a new white paper reveals that most hemp products contain intoxicants like THC, synthetic cannabinoids, kratom or even hallucinogenic mushrooms.

Hemp products have only been sold legally in the United States since 2021, the result of hemp being legalized as part of the 2018 Farm Bill. The thinking at the time was that hemp contained such minuscule amounts of THC that farmers could grow hemp again as a cash crop to make things like rope, fuel and horse feed. 

But it didn’t take long for the cannabis industry to figure out how to tweak the chemical composition of hemp to make delta-8 tetrahydrocannabinol (THC) and other potent synthetic cannabinoids, which you can get high on.

The white paper, called The Great Hemp Hoax, examined the composition and potency of hemp products sold in two southern California counties, focusing on chemically synthesized cannabinoids. The results reveal the hemp market has evolved far beyond what lawmakers and regulators intended. 

In an analysis of 104 hemp-based products from 68 brands, researchers found that 95 percent contain synthetic cannabinoids, which are illegal in California. These compounds are often far more potent than naturally occurring THC.  

More than half of the tested products exceeded the federal 0.3 percent THC limit, technically classifying them as cannabis rather than hemp under federal law. In fact, researchers found that many of these products vastly exceeded THC potency limits imposed on regulated cannabis products. 

Some hemp gummies contained up to 325 milligrams of synthetic THC per serving — which is way over the 10mg cap in California’s legal market.

You could also get high on hemp-derived vape products, which had an average THC equivalency level 268% above the state’s threshold for adult-use cannabis.

Some hemp products — such as Cheech & Chong’s “Kosmic Chews” — even contain psychoactive additives like kratom, while others include hallucinogenic mushrooms.

THE GREAT HEMP HOAX

“Much of what’s being sold as ‘hemp’ today isn’t hemp at all — it’s a cocktail of synthetic intoxicants and illicit THC masquerading as a natural, legal product. It's essentially the ultra-processed junk food of cannabis, but far more dangerous," said Tiffany Devitt, Director of Regulatory Affairs at Groundwork Holdings, which helped establish the cannabis industry in California and is trying to protect it from hemp competitors. 

"These companies aren't just skirting regulations – they're putting consumers at serious risk with designer drugs that look a whole lot more like ‘Spice’ than natural hemp."

Devitt and other authors of the white paper believe the contamination is not accidental. They said that filtering out or reducing the amount of delta-8 or delta-9 THC in hemp products is inefficient and cost-prohibitive, incentivizing companies to not do it.

“Because of these inefficiencies, most so-called ‘hemp-derived’ THC products are, in reality, synthetic cannabis — reminiscent of illegal products like ‘Spice’ that flooded California a decade ago,” they wrote. 

The lack of oversight also results in tax evasion. Over 90% of the hemp products analyzed were sold without collecting California’s sales tax, and none of the vendors paid the state’s cannabis excise tax. 

“The failure to ensure tax accountability allows unregulated ‘hemp’ products to undercut the legal cannabis market while depriving the state of revenue meant for public health, environmental mitigation, and enforcement,” the authors concluded. 

The white paper calls for all hemp products containing THC to be regulated as cannabis within California, to protect consumers and workers.

“These illicit operations aren’t just dangerous — they’re undercutting California’s regulated cannabis businesses and workers,” said Kristin Heidelbach, Legislative Director of the United Food and Commercial Workers Union, which helped pay for the white paper.

“While licensed cannabis businesses provide good union jobs and comply with strict labor standards, many synthetic ‘hemp’ producers manufacture out-of-state or import from overseas, dodging California’s labor laws and tax obligations.”

This isn’t just a California issue. A recent study found that nationwide sales of hemp products reached $2.8 billion in 2023. They are legally sold to minors in many U.S. states, even in those where cannabis is illegal. In 2023, about 11% of 12th graders said they had used hemp products containing Delta-8 THC.  

Experimental Cannabis Extract Has ‘Potential to Replace Opiates’

By Pat Anson

A German biotech company says it is seeking regulatory approval in Europe and the United States for an experimental cannabis extract that could be an alternative to opioid pain medication.

Vertanical recently completed two Phase 3 studies of its new drug – called VER-01 – on over 1,000 patients with chronic low back pain who didn’t get sufficient relief from non-opioid analgesics.

One study compared VER-01 to a placebo, while the second trial compared the drug’s safety and tolerability to patients treated with opioids. The company told The Times it was awaiting publication of the studies’ findings in The Lancet before making them public.

“VER-01 reduces pain without creating dependency or having an abuse potential,” said Clemens Fischer, MD, Vertanical’s CEO. “It has the full potential to replace opiates as it’s more effective. It’s a real alternative for chronic patients — the first one.

“Pain patients around the world are trapped in a vicious cycle of pain, insomnia, limited mobility, and depression. VER-01 has the potential to successfully break this cycle.”

VER-01 is a “full-spectrum” extract derived from cannabis sativa leaves and flowers. Although it contains THC, the main psychoactive substance in cannabis, Fischer says patients enrolled in the studies didn’t become high or intoxicated. About 25 percent did “feel a bit dizzy” for two weeks after they started taking it.

Participants also didn’t get “the munchies” or gain weight, a well-known side effect of cannabis.

“We were looking very carefully, because that’s what we hear from cannabis smokers — that the appetite increases as well their weight. But we haven’t seen any increase in weight,” Fischer told The Times.

Vertanical is seeking regulatory approval of VER-01 in Europe and with the UK’s Medicines and Healthcare Products Regulatory Agency. If granted, VER-01 would be the first cannabis-based medicine approved for chronic pain. It would be sold under the brand name Exilby and be taken orally in drops.

The timeline for approval in Europe may be as soon as this summer, but it’s likely to take longer in the U.S.

“We are seeking regulatory approval in the US and are in talks with the FDA. For approval in the US, a further phase 3 study with US patients in the indication of chronic low back pain will start in Q2 2025,” Merit Renner, Senior Manager of Business Development at Vertanical, told PNN in an email. “This, together with the phase 3 study successfully conducted in Europe, will form the basis for approval in the US.”

Vertanical also plans further studies of VER-01 on patients with osteoarthritis and peripheral neuropathy.

Research into the pain-relieving properties of cannabis has been slow in the U.S., in large part because of marijuana’s status as a Schedule 1 Controlled Substance, the same classification as LSD and heroin. The DEA recently allowed more marijuana to be used for research purposes, but has dragged its feet about reclassifying marijuana as a Schedule 3 substance that could be used for medical purposes. Until marijuana is rescheduled, VER-01 is unlikely to get FDA approval.

Some recent studies have shown that certain cannabinoids found in marijuana -- cannabidiol (CBD), cannabigerol (CBG), and cannabinol (CBN) – block pain signals in the peripheral nervous system, not the brain, and don’t have a psychoactive effect that could lead to abuse.

“These findings open new avenues for the development of cannabinoid-based therapies,” said Mohammad-Reza Ghovanloo, PhD, lead author of a study published in PNAS and a research scientist at Yale School of Medicine. “Our results show that CBG in particular has the strongest potential to provide effective pain relief without the risks associated with traditional treatments.”

The cannabinoids in the Yale study interact with a protein in cell membranes called Nav1.8, which blocks peripheral nerves from transmitting pain signals. Inhibiting Nav1.8 is the same method used by Journavx (suzetrigine), a non-opioid analgesic recently approved by the FDA for relieving moderate to severe acute pain in adults.

CBD Is a Scam. Will New Cannabinoid Products Be Any Different?

By Crystal Lindell

CBD didn’t do anything for me. I tried different brands, different formats, and different price points because I really wanted it to work. 

I like to describe my experience like this: Wine and grape juice are both made from grapes – but that doesn’t mean a glass of Welch's has the same effect as a glass of wine.

From the beginning, CBD always sounded a little too good to be true. Touted as the “cannabis that doesn’t get you high, but treats chronic pain,” it was supposed to be the new holy grail of pain medicine. After all, doctors are looking for something to give patients that doesn’t give them any pleasurable mental effects, but does actually treat their pain. 

Unfortunately, CBD was too good to be true because the marketing and hype are fake. 

For a while, CBD seemed to be sold in every gas station, supermarket and convenience store. Filling shelves with everything from candies to liquid elixirs. 

But I’ve noticed over the last couple years that a lot of those CBD display cases have either shrunk or disappeared completely. 

It’s not just in my head. A 2023 article from SupplySide Supplement Journal was among the first to report on the downward trend in the sector. 

Headlined: "Major CBD brands report steep annual sales declines,” it focused on the fact that two major brands, CV Sciences and Charlotte’s Web, reported depressed earnings and “significant downsizing initiatives.”  

Almost a year later, The New York Times published a similar article, with the headline “Companies Were Big on CBD. Not Anymore.” 

The article blamed the sales decline on a “lack of federal regulation and a mishmash of state laws [that] made selling products featuring the cannabis-derived ingredient not worth the trouble.” 

I think that’s just generous industry framing. Sales declined because CBD products were not good and inordinately expensive. CBD did not do much of anything for most people, and the price points were astronomical. 

A 2024 study at Bath University in the U.K. makes the point directly. The subhead on a press release reads: "There is no evidence that CBD products reduce chronic pain, and taking them is a waste of money and potentially harmful to health, new research finds." 

“CBD presents consumers with a big problem,” said Professor Chris Eccleston, who led the research at the Centre for Pain Research at Bath. “It’s touted as a cure for all pain but there’s a complete lack of quality evidence that it has any positive effects. It’s almost as if chronic pain patients don’t matter, and that we’re happy for people to trade on hope and despair.”

Eccleston is definitely right there. The views of chronic pain patients are often dismissed. That’s why many doctors are happy to push placebos and snake oils on us, as long as it means they can avoid prescribing any opioids. 

The decline in CBD’s popularity hasn’t stopped the medical industry from trying to find other ways to use cannabinoids to treat pain without causing the mental high. 

Last week, researchers at Stanford University and Washington University School of Medicine in St. Louis announced that they designed a new compound to potentially treat chronic pain by targeting type 1 cannabinoid (CB1) receptors in the peripheral nervous system.

In a paper published in Nature, the researchers said the compound “could effectively treat multiple types of pain in mouse models without causing the psychoactive side effects typically associated with the CB1 receptor or causing the mice to build up a tolerance to it.”

So it’s still being studied in mice, which means it’s a long way off from being offered to humans, if it ever is. 

While this is a synthetic version of a cannabinoid – as opposed to the natural version – I’m skeptical of anything that claims to treat physical pain without psychoactive side effects.  

It’s also frustrating to see researchers still trying to push for this at all. 

In a news release about the study, co-author Alexander Powers,  who conducted the work while earning his PhD in chemistry at Stanford, said: “This molecule shows that we can get a separation between the side effects and the analgesic effects – we can target the CB1 receptor and get the good effects without the bad.”

The most telling part of that quote is at the very end: “without the bad.”

The implication is that psychoactive effects are inherently bad. I disagree. When you’re in extreme pain, it impacts you emotionally and mentally. So it only makes sense that medications that treat pain also improve your mood. That’s a good side effect. 

Maybe research like that coming out of Stanford will lead to new breakthroughs. Maybe they will finally discover the holy grail of pain medication that they desperately seek. But I remain skeptical of any research from people who frame positive effects of pain medication as “bad.” 

You Can Get High on Hemp, Even Where Cannabis Is Illegal

By Katharine Neill Harris

In Texas, where I live, marijuana has long been illegal. Yet on a busy street in my Houston neighborhood, at least five stores within a half-mile of each other sell cannabis products that promise a strong high.

Texas isn’t alone. Due to a mix of recent legal changes and an uncertain policy landscape, residents in roughly half of American states have easy access to impairing hemp products that bear a strong resemblance to marijuana and are far less regulated.

As hemp sales soar – reaching nearly US$3 billion in 2023 – a number of states are tightening their restrictions, while experts are analyzing the public health implications. That’s why I analyzed hemp policies in all 50 states with some of my colleagues at Rice University’s Baker Institute, where I’m a drug policy fellow.

Same Plant, Different Policies

Marijuana and hemp are both varieties of cannabis sativa, a plant with many uses that produces thousands of compounds. Among them is the popular intoxicant delta-9 tetrahydrocannabinol, or delta-9 THC.

Hemp is widely valued as an industrial crop, and for most of American history, farmers freely cultivated it. But by the mid-20th century, lawmakers had grown increasingly opposed to marijuana and were concerned by hemp’s similarity to its impairment-causing cousin.

In an effort to permit hemp cultivation while prohibiting production of a psychoactive plant, the Agricultural Marketing Act of 1946 defined hemp as all parts of the cannabis plant with less than 0.3 percent concentration of delta-9 THC by dry weight. Cannabis that exceeded this threshold was considered marijuana.

The 1970 Controlled Substances Act ushered in the modern era of prohibition of marijuana and other drugs. Hemp remained technically legal, but because of its similarity to marijuana, it was listed as a Schedule I drug, alongside heroin and other substances deemed to have a high potential for abuse and no medical value.

Because of hemp’s Schedule I status, the Drug Enforcement Administration tightly regulated its production. But hemp farmers have long argued that these regulations were excessive – and in 2018, Congress agreed. That year, lawmakers passed a farm bill that removed hemp from the Controlled Substances Act and legalized the manufacture and sale of hemp and its derivatives.

Crucially, the 2018 bill still defines hemp as all parts of the plant and its derivatives that have less than 0.3 percent delta-9 THC. But it left a loophole: While delta-9 is the most well-known form of THC, it’s not the only one.

Other forms of THC, known as THC isomers, have similar effects. These isomers, like delta-8 and delta-10 THC, can be derived from the hemp plant, and like delta-9 THC, they can cause impairment. The 2018 Farm Bill legalized all of them.

In 2023, sales of hemp-derived cannabinoids reached US$2.8 billion. Market growth has been accompanied by a rise in adverse health events. Chemists have expressed alarm at how some hemp products are made, and analyses of commercially available products have found them to contain heavy metals, residual solvents and pesticides.

Given the lax regulatory environment, many public officials now question the lack of guardrails on this burgeoning hemp industry. As a result, officials and governments across the country are now enacting or considering policy changes.

Some States Have Age, Advertising and Potency Limits

In 2023, 11.4% of 12th graders said they had used hemp-derived delta-8 THC in the past year. Easy access to any substance can encourage use, and THC can have negative impacts on the adolescent brain.

While federal law prohibits the sale of tobacco and alcohol to individuals under 21, there is no similar national requirement for hemp. But at least 27 states that permit the sale of hemp-derived products now have minimum age requirements, and several others have pending legislation.

Lessons from the tobacco market also demonstrate that advertising restrictions can reduce the use of legal but potentially harmful products. Most efforts to curtail hemp advertising focus on youth. Sixteen states restrict the use of packaging and marketing materials that may appeal to minors. Meanwhile, federal regulations also limit youth-targeted marketing.

There are fewer restrictions on advertising to adults. The Food and Drug Administration does prohibit using unverified health claims to sell hemp products, but this standard gives the industry plenty of leeway. Hemp ads often tout their purported physical benefits, like reducing pain or improving sleep, or portray them as mood-boosters that can make one feel euphoric and aroused, with few downsides.

The use of products high in THC has been linked to greater risk of cannabis dependence and adverse mental health outcomes. Concerns about product potency have led all states with recreational marijuana markets to limit the amount of delta-9 THC in edible products. This threshold is typically around 10 milligrams, a dose that’s strong enough to affect most people.

Hemp is a different story. To satisfy federal requirements, hemp just has to have less than 0.3% delta-9 THC by weight. This limit sounds low, but the weight-based metric does not account for heavier products, like food and drinks.

For example, a 50-gram candy bar – roughly the size of a Snickers bar – with 150 milligrams of hemp-derived delta-9 THC is legal in the 34 states that don’t have milligram caps on hemp products. This is a dose 15 times higher than what any recreational marijuana market allows. Meanwhile, states that only restrict hemp’s delta-9 content also leave the door open to products with high amounts of other forms of THC.

At least 13 states have responded to potency concerns by adding milligram caps on the total THC permitted in a single serving of a hemp product. Some of these limits are so low – 1 milligram or less in Connecticut, New York, Montana and Rhode Island – that one serving is unlikely to cause impairment.

Enforcement Is a Wild Card

Only regulations that are enforced are effective, and states differ in the level of energy they devote to industry oversight.

In Virginia, the Office of Hemp Enforcement has issued over $12 million in fines to noncompliant hemp retailers since its creation in 2023. On the other end of the spectrum, Massachusetts considers hemp-derived THC products illegal, but it has not provided local jurisdictions with funding for enforcement, resulting in continued availability of prohibited products.

Some states with legal hemp markets have added additional sales taxes to help fund enforcement. In Nebraska, Missouri and Connecticut, attorneys general have sued hemp retailers for selling illegal items, marketing to minors and engaging in deceptive trade practices.

As the hemp industry expands, so will concerns about how to protect public health. The demand for THC, and the market to supply it, continues to grow. If lawmakers want to develop industrywide safety standards or deal with the challenges of online marketplaces that sell hemp products to minors, it will take action from Washington. In the meantime, many states and policymakers are exploring an expansive middle ground between unfettered access and blanket bans.

Katharine Neill Harris, PhD, is a Fellow in Drug Policy at Rice University’s Baker Institute for Public Policy. Her current research focuses on cannabis policy and the response to the overdose crisis.

This article originally appeared in The Conversation and is republished with permission.

6 Things to Try If Your Doctor Won’t Prescribe Opioid Pain Medication

By Crystal Lindell

Many doctors are extremely resistant to prescribing opioid pain medication for any reason these days. Whether it’s for post-operative pain, chronic pain or even pain from terminal cancer, patients are finding that doctors shrug their shoulders and tell them to go home and take ibuprofen.

Unfortunately, over-the-counter pain medication is just not effective in many cases, and that can leave patients in desperate situations. 

As someone who’s been navigating my own chronic illness for more than a decade, as well as helping my loved ones with their health issues, I do have some very realistic advice I can offer.

If you ever find yourself in extreme pain, but your doctor won’t give you pain medication, here are 6 things you can try. 

1. Doctors Expect You To Negotiate

Many doctors now have an unwritten policy where they will only give you opioid medication if you ask a certain number of times, especially when it comes to acute trauma like a broken bone or post-op pain. 

Doctors believe that this helps them to make sure that you really need it. 

So just because your doctor tells you no one time, two times or even three times, that doesn’t mean you should just accept the response. If your pain is severe enough that OTC medication is not working, then ask again. And again. Ideally, they eventually relent and will send in at least a small opioid prescription for you. 

This also helps future patients. Many doctors assume that if patients don’t ask repeatedly for pain medication after a surgery then that means that the surgery doesn’t result in severe pain for anyone. By showing them that you need it, you make it more likely for doctors to believe the next patient.  

2. Tell Your Doctor You’re Unable To Work Due to Pain

Unfortunately, under our current financial structures, much of our worth as humans is still tied to our ability to be productive at our jobs. So telling your doctor that you’re in too much pain to work may inspire them to finally send in an opioid prescription for you. 

They do not want you missing work, which could mean you losing health insurance and being unable to pay them. 

3. Threaten To Go to the ER

Another option when your doctor refuses to give you opioid medication is to tell them that you’re going to go to the emergency room then. This will often spur them to send in a prescription.to your pharmacy.

When it comes to something like post-surgical care, many doctors feel like it makes them look bad when their patients have to go to the ER for after-care. 

I have also seen this work for chronic pain as well, especially if you’re in their office when you bring it up. One time, for example, after explaining that I was going to go to the ER because my pain had spiked, my doctor gave me stronger pain medication in his office.

As an aside: Just make sure that if you get something very strong, like a hydromorphone shot, that you also get medication for nausea, like Zofran. While most ERs do this as a matter of policy, sometimes a doctor will skip it if it’s administered in their office. 

This is something I learned the hard way after an in-office hydromorphone shot left me vomiting for more than 24 hours because I wasn’t used to the strength of the medication. The whole thing could have been prevented with some Zofran.

4. Go to the Emergency Room

If telling your doctor that you want to go to the ER doesn’t motivate them to send in an opioid prescription, then the next step is to actually go to the emergency room. 

In my experience, ER doctors will, at the very least, usually give you a dose of pain medication to take on site. That can help you get the pain down to a level where you can at least think clearly and then figure out next steps and/or get some needed sleep. 

Depending on the situation, sometimes you can also convince ER doctors to give you a small prescription for at-home use too, especially if it’s for something like post-op pain or a severe injury.  

5. Consider a Pain Management Doctor 

If you have chronic pain, many times your best option is getting a referral to a doctor who specializes in pain management. 

This is not ideal because pain management doctors tend to be quite different from primary care doctors. That’s because many pain specialists believe they are being watched by the Drug Enforcement Administration. The DEA has no medical expertise, but has targeted hundreds of doctors for what it calls “unlawful” opioid prescribing.  

Because of that, many pain management doctors act more like probation officers than medical professionals, requiring invasive and expensive monitoring like drug tests and pill counts on a regular basis. This means the patient experience tends to be more like being on probation than getting healthcare. The only thing missing is an ankle monitor.

That said, pain specialists are usually willing to prescribe a low-dose opioid if it doesn’t exceed medical guidelines, which could get them in trouble. For many patients, even a low dose can literally be life saving. 

If you can’t get pain treatment anywhere else, then it can be worth it to put up with the draconian atmosphere. 

6. Try Kratom or Cannabis

The two most effective pain treatments you can get without a prescription are kratom and cannabis, although your mileage may vary and their legal status varies a lot by jurisdiction. 

While I am not sure how effective kratom or cannabis is at treating short-term intense pain, like a broken bone, I have personally found kratom to be the only substance I can get without a prescription that helps my chronic intercostal neuralgia pain. I would describe kratom as having an extremely mild opioid effect. 

Personally, I use it by taking a spoonful of kratom powder with a swig of Gatorade, as I find that to be the most effective delivery method. However, there are many options, ranging from capsules to kratom candy and even kratom seltzer. 

I also know many others who have found relief by using cannabis, which is thankfully legal in many places now. THC gummies seem to be especially helpful to anyone who’s new to cannabis use and doesn’t want to smoke. Cannabis dispensaries are also usually staffed with knowledgeable, friendly employees who are happy to guide you to the best option. 

I always say pain will make you crazy much faster than you expect. Within just three days of severe pain, I have seen people openly saying they were ready to die. 

It’s a true shame that in 2025, when effective and cheap pain medication exists, so many people are still left to suffer simply because of opioid-phobia and an overzealous DEA. 

However, that doesn’t mean you should be forced to suffer through pain just because you may not know how to navigate the healthcare system. You do have options. 

And if you’re in a situation where you’re denied pain care that you need, I hope you’ll use it to inspire more compassion in yourself. Pain treatment is a human right, and the more people who support it, the more likely we are to get it.