VA Studies Find Little Evidence for Medical Cannabis

By Pat Anson, Editor

There is not enough evidence to support the effectiveness and safety of cannabis and cannabinoid products in treating chronic pain or post-traumatic stress disorder (PTSD), according to a pair of new studies published in the Annals of Internal Medicine.

Researchers at the U.S. Department of Veterans Affairs reviewed 27 clinical studies on the benefits and harms of cannabis in treating chronic pain, and found most of the studies were small, many had methodological flaws, and the long-term effects of cannabis were unclear because there was little follow-up in most of the studies.

None of the studies directly compared cannabis with opioid pain medication and there was no good-quality data on how cannabis affects opioid use, according to researchers.

“Although cannabis is increasingly available for medical and recreational use, little methodologically rigorous evidence examines its effects in patients with chronic pain. Limited evidence suggests that it may alleviate neuropathic pain, but evidence in other pain populations is insufficient,” wrote lead author Shannon Nugent, PhD, VA Portland Health Care System.

“Even though we did not find strong, consistent evidence of benefit, clinicians will still need to engage in evidence-based discussions with patients managing chronic pain who are using or requesting to use cannabis.”

Medical marijuana is legal in 28 states and the District of Columbia, and many patients are using it for pain relief. Up to 80 percent of people who seek medical cannabis do so for pain management and nearly 40 percent of those on long-term opioid therapy for pain also use cannabis. Veterans Affairs policy currently doesn’t allow for cannabis use in the huge VA healthcare system, even in states where it is legal.

According to a 2014 Inspector General’s study, more than half of the veterans being treated at the VA have chronic pain, as well as other conditions that contribute to it, such as PTSD.

‘Very Scant Evidence’ on Cannabis for PTSD

More than a third of the patients who use cannabis in states where it is legal list PTSD as their primary reason. But, as with chronic pain, VA researchers found “very scant evidence” to support the use of cannabis to treat PTSD.

“Despite the limited research on benefits and harms, many states allow medicinal use of cannabis for PTSD. The popular press has reported many stories about individuals who had improvement in their PTSD symptoms with cannabis use, and cross-sectional studies have been done in which patients with more severe PTSD reported cannabis use as a coping strategy,” wrote lead author Maya O’Neil, PhD, VA Portland Health Care System.

“However, it is impossible to determine from these reports whether cannabis use is a marker for more severe symptoms or is effective at reducing symptoms, or whether the perceived beneficial effects are the result of the cannabis, placebo effects, or the natural course of symptoms.” 

Clinical evidence may be lacking, but supporters of medical marijuana say they’ve seen plenty of anecdotal evidence that cannabis works for both pain and PTSD.

“They claim no benefits are shown but with the number of people we have met with PTSD that have been able to function and improve with the use of cannabis, I would say the ‘proof is in the pudding.’ Seeing their lives improve tremendously says a lot about success,” said Ellen Lenox Smith, a PNN columnist who is co-director of cannabis advocacy for the U.S. Pain Foundation and a caregiver under Rhode Island’s medical marijuana program. 

“We have not met a person yet that has not been enjoying the improved quality of their life using cannabis for PTSD. We fought a long hard battle to have it included as a qualifying condition and it was worth the battle. Patients are finding peace and calm they were not experiencing before using cannabis. Sleep has improved and without a good night rest, anyone's next day is a terrible struggle.”

Like it or not, the “horse is out of the barn” when it comes to cannabis use, according to an editorial also published in the Annals of Internal Medicine.

“Even if future studies reveal a clear lack of substantial benefit of cannabis for pain or PTSD, legislation is unlikely to remove these conditions from the lists of indications for medical cannabis,” wrote Sachin Patel, MD, Vanderbilt Psychiatric Hospital.

“It will be up to front-line practicing physicians to learn about the harms and benefits of cannabis, educate their patients on these topics, and make evidence-based recommendations about using cannabis and related products for various health conditions. In parallel, the research community must pursue high-quality studies and disseminate the results to clinicians and the public.”

Is It Safe to Use Cannabis with THC?

By Ellen Lenox Smith, Columnist

I am constantly reading about people interested in medical marijuana who are seeking information on cannabis products high in CBD for their medical issues.  I’ve also noticed many stating they do not want any THC in these products.

I’ve found that I need both. 

Tetrahydrocannabinol (THC) and cannabidiol (CBD) are chemical compounds, called cannabinoids, found in the marijuana plant. There are well over a hundred different cannabinoids in marijuana, and they all interact with receptors in the brain and body, causing various effects.

THC is the most widely known cannabinoid, due to its abundance and psychoactive qualities. For centuries, marijuana has been used recreationally because of THC’s ability to make people feel “high” or euphoric.

But as cannabis has become more accepted for medical use, some are concerned that they will get high or stoned if their cannabis has any THC in it. Many have turned to cannabis products that primarily contain CBD. 

Personally, I have learned to look for products that contain both THC and CBD, as they are more effective in easing my pain and helping me sleep.

DRUG POLICY ALLIANCE

Personally, I have learned to look for products that contain both THC and CBD, as they are more effective in easing my pain and helping me sleep.

Many patients became interested in CBD after learning that epileptic seizures could be reduced or even stopped by utilizing cannabis products high in CBD content.  This was discovered when the parents of Charlotte Figi, a 5-year old girl suffering from severe seizures, learned of a cannabis strain that was loaded with CBD. This was what they wanted to try with their daughter, because it was completely non-psychoactive, unlike THC. The results were amazing, not only reducing Charlotte’s seizures, but also opening up the possibility of helping patients with other conditions such as spasms, anxiety and chronic pain.

Like me, many patients with chronic conditions have found that they need to use medical cannabis extracted from either a high CBD variety or one with more THC. If you find a high-CBD strain, it does not mean it will be THC-free. Many strains advertised as “high-CBD” still contain some psychoactive cannabinoids. This should not scare you.

I am 67 years old and have been using cannabis since 2007 for two incurable painful conditions.   Like many patients, I had no desire to experience the psychoactive effects of THC, so at one point in my treatment I tried a high CBD strain containing only trace amounts of THC. The pain relief just didn’t happen, so I switched back to cannabis products that combined CBD and THC.

Recently, after reading that CBD can help with cancer, lupus, nicotine addiction, Parkinson’s disease, osteoporosis and other chronic conditions, I decided to grow plants high in CBD to add to the oil I take orally at night. I now make an oil with a combination of strains that include this higher CBD strain, along with higher THC plants.

I want you to know that I do not get “high” or stoned, as some assume. What I get is pain relief.

But remember, as with any medication, you can take too much and get a negative reaction, so be careful to take the dose that is right for you. Don’t be concerned if you are like me and need THC to get relief from your pain. Each body requires something different and we all need to find the correct match for safe relief.

Ellen Lenox Smith suffers from Ehlers Danlos syndrome and sarcoidosis. Ellen and her husband Stuart live in Rhode Island. They are co-directors for medical marijuana advocacy for the U.S. Pain Foundation and serve as board members for the Rhode Island Patient Advocacy Coalition.

For more information about medical marijuana, visit their website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

9 out of 10 Patients Prefer Cannabis Over Opioids

By Pat Anson, Editor

A survey of nearly 3,000 medical marijuana users has found that 9 out of 10 patients prefer cannabis over opioid medication when managing their chronic pain. A similar number prefer cannabis over non-opioid pain relievers such as Tylenol or Advil.

The survey was conducted by researchers at the University of California Berkeley and HelloMD, a website that links patients to doctors in California and New York that prescribe medical marijuana. The survey was administered by email to a HelloMD database of cannabis patients who were asked how marijuana affected their consumption of opioids and other pain relievers.

Eighty percent of those surveyed said that cannabis was more effective at relieving pain than opioid medication and 97 percent said they decreased their opioid use when using cannabis. The latter finding supports previous research that found use of prescription pain medication declining in states where medical marijuana is legal.

“The results of our study were striking, showing 97% of people were able to decrease the amount of opioids that they used in conjunction with cannabis use. This was more than double the amount shown in any previous studies conducted,” said Perry Solomon, MD, Chief Medical Officer of HelloMD.

DRUG POLICY ALLIANCE

“The (study) clearly showed that chronic pain is one of the medical conditions that cannabis can be used for with great efficacy. Our study not only supports this but also goes further in that the clear majority of patient’s state that they prefer it. Hopefully this will awaken the public, medical professionals and legislatures to the fact that there is a safe, non-addictive product available to help fight the opioid epidemic, and that is cannabis.”

Other key findings from the survey of medical marijuana users:

• 93% said they prefer cannabis to opioids
• 92% said cannabis' side effects were more tolerable than side effects from opioids
• 90% said cannabis works well with non-opioid pain relievers
• 96% said they need fewer non-opioid pain relievers when using cannabis
• 89% said cannabis was more effective than non-opioid pain relievers

"With cannabis not only becoming more accepted in the mainstream but also coming in a variety of preparations, some of which are nonintoxicating, more people are looking at cannabis as a viable treatment for everyday ailments such as muscle soreness and inflammation,” wrote Amanda Reiman, PhD, of UC Berkeley and the Drug Policy Alliance, lead author of the study published in the journal of Cannabis and Cannabinoid Research.

“Participants in this study overwhelmingly supported the notion that they would be more likely to use cannabis as a substitute for pain medication if it were less stigmatized and more available, suggesting that there are populations of people who could benefit from this practice but are shying away due to the stigma and legal restrictions related to cannabis use.”

The survey should not be considered a scientific study on the effectiveness of cannabis, because participants were self-selected and reported their perceptions about cannabis use, as opposed to an objective measurement by a third party. There was also no control group of pain patients who only had access to opioids and other pain relievers.

A small study last year by the University of Michigan found that nearly two-thirds (64%) of medical marijuana patients reported a reduction in their use of prescription pain medications.

A 2014 study published in JAMA Internal Medicine found that opioid overdoses declined by nearly 25 percent in states where medical marijuana was legalized.

Cannabis Formula Just as Effective as Migraine Drug

By Pat Anson, Editor

An experimental medication made from marijuana is just as effective as a widely used pharmaceutical drug in the treatment and prevention of migraine, according to two new studies by Italian researchers.

In the first study, a research team led by Dr. Maria Nicolodi found that combining two cannabinoids, tetrahydrocannabinol (THC) and cannabidiol (CBD), in a 200mg dose reduced acute pain by 55 percent in a group of 48 migraine sufferers. The medication, which was taken orally, contained 19% THC and 9% CBD.

In a second phase of the study, researchers then gave a group of 79 chronic migraine patients either the 200 mg THC-CBD combination or a 25mg dose of amitriptyline – a tricyclic antidepressant commonly used to treat migraine.

After three months of daily treatment, researchers found that the group taking the THC-CBD combination had a 40.4% reduction in migraine attacks, which was slightly better than the amitriptyline group (40.1%). 

The cannabinoids reduced migraine pain intensity by an average of 43.5 percent. Female patients also reported a decline in stomach ache, colitis and musculoskeletal pain.

"We were able to demonstrate that cannabinoids are an alternative to established treatments in migraine prevention,” said Nicoldi, who recently presented her findings at the 3rd Congress of the European Academy of Neurology in Amsterdam.

Migraine is thought to affect a billion people worldwide and about 36 million adults in the United States, according to the American Migraine Foundation. It affects three times as many women as men. In addition to headache pain and nausea, migraine can also cause vomiting, blurriness or visual disturbances, and sensitivity to light and sound.

Previous research has also found that cannabis is effective in treating migraines. A 2016 study by the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of Colorado found that inhaled and ingested cannabis significantly reduced the number of headaches in a group of migraine sufferers. Inhalation appeared to provide the fastest results, while the edible cannabis took longer to provide pain relief.

Senate Bill Would Protect Marijuana Use in Legal States

By Ellen Lenox Smith, Columnist

A group of bipartisan U.S. senators has announced plans to reintroduce a bill that would allow state medical cannabis laws to supersede the current federal prohibition. The bill would also greatly expand opportunities for medical and scientific research of medical marijuana.

The Compassionate Access, Research Expansion and Respect States Act – also known as the CARERS Act – is being sponsored by Senators Kirsten Gillibrand (D-NY), Cory Booker (D-NJ), Al Franken (D-Minn.), Rand Paul (R-KY), Lisa Murkowski (R -Alaska), and Senator Mike Lee (R -Utah). The House version is sponsored by Reps. Steve Cohen (D-Tenn.) and Don Young (R-Alaska). 

"The fact is our marijuana laws in America are broken," Sen. Booker said at a press conference. "They are savagely broken, and the jagged pieces are hurting American people."

The CARERS Act was originally introduced in 2015, but did not move forward. Back then, the bill only had three sponsors: Sen. Booker, Sen. Gillibrand and Sen Paul.

A big change from 2015 is that a new administration now occupies the White House and there are fears the Justice Department could once again start enforcing federal marijuana laws in states where it is legal.

Some in Congress do not want the feds messing around again with legal cannabis.

“The people have been pretty clear that this is something they don’t want the federal government to interfere with,” said Rep. Earl Blumenauer (D-Oregon).

If passed, the CARERS Act would leave in place laws legalizing medical marijuana in 30 states, the District of Columbia, Puerto Rico and Guam, and protect their citizens from federal prosecution. The bill would also allow veterans to access legal cannabis in those states. Currently, there are federal regulations that bar doctors in Veterans Affairs hospitals from prescribing cannabis to their patients. Veterans caught with marijuana in the system are also being denied access to opioid pain medication.

While running for president, President Trump said marijuana laws should be decided at the state level, but then he tapped Jeff Sessions to be his Attorney General. It is clearly known through his words and actions that Sessions does not believe marijuana should be considered a legitimate medicine, despite the beneficial impact noted by medical professionals across the globe.

In fact, Sessions sent a letter to Congressional leaders back in May, asking them to undo a provision in federal law that bars the Justice Department from going after legal marijuana businesses.

"I believe it would be unwise for Congress to restrict the discretion of the Department to fund particular prosecutions, particularly in the midst of an historic drug epidemic and potentially long-term uptick in violent crime," Sessions wrote. "The Department must be in a position to use all laws available to combat the transnational drug organizations and dangerous drug traffickers who threaten American lives."

But supporters of the CARERS Act feel Sessions' thinking is very wrong, especially when it comes to people gripped with chronic pain or conditions such as epilepsy.

Clinical studies have found that cannabidiol, or CBD as it's commonly known, can reduce epileptic seizures in children and young adults as much as 45 percent. The CARERS Act would take CBD off the list of controlled substances, thus allowing children in states where medical cannabis isn't legal to access the life changing oil.

"I dare him (Sessions) to sit down with families and listen to their stories and then pursue a policy like he's advocating for now," says Sen. Booker.

An uphill battle is expected, but the effort is picking up steam. Many red states have now passed some form of legal cannabis.

"I believe things are changing and they're changing fast," Sen. Gillibrand told Rolling Stone. "I think we will get the support we need."

Let’s write and/or call our Senators and ask them to not only support, but also co-sponsor the CARERS Act. To reach their D.C. offices, you can contact the Capitol switchboard at 202-224-3121. To send an email, check this website for their email addresses.

You can also go to this link set up by Americans for Safe Access to contact your Senator.

Ellen Lenox Smith suffers from Ehlers Danlos syndrome and sarcoidosis. Ellen and her husband Stuart live in Rhode Island. They are co-directors for medical marijuana advocacy for the U.S. Pain Foundation and serve as board members for the Rhode Island Patient Advocacy Coalition.

For more information about medical marijuana, visit their website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

How Medical Marijuana is Gaining Acceptance

By Ellen Lenox Smith, Columnist

There are articles being written around the country about the utilization of medical cannabis as an effective treatment for chronic pain and a broad range of other health problems.

I have been clipping these articles and saving them, for I think it is important that we support medical cannabis with “real” information from legitimate sources to defend against the scare tactics that undermine the truth about marijuana. I would like to share some of these exciting and encouraging cannabis stories.

A recent article in The New York Times looked at how New York City’s nursing homes are helping residents use medical marijuana under a program to treat illnesses with alternatives to pharmaceutical drugs.

It allows residents to purchase medical cannabis from a dispensary, keep it in locked boxes in their rooms, and take their medication on their own. In Washington State, at least a dozen assisted living facilities have also adopted formal medical marijuana policies due to patient demand.

Americans for Safe Access has helped open a research center in the Czech Republic to evaluate the impact of cannabis on the elderly. They realized that there has been little research on cannabis use by seniors, although places like Israel have been treating the elderly with it for years. Also, the Center for Medicinal Cannabis research at the UC San Diego is making seniors a research priority.

The New York Times also reported that no nursing home have lost financing or been penalized for allowing the use of cannabis by the Centers for Medicare and Medicaid Services. This is good news because the elderly tend to be reactive to prescription drugs and marijuana offers them an alternative.

The Washington Post reported on a survey of 37,000 middle and high school students in Washington State, which found that full marijuana legalization had no effect on the students’ propensity to use cannabis. The data coming from both Washington and Colorado strongly suggests that legalization in those states has not caused a spike in marijuana use among teens. In fact, in Colorado there has been a decrease.

An article by the Associated Press shared an amazing story of compassion in Georgia. State representative Allen Peake shepherds cannabis oil to hundreds of sick people who are allowed by state law to use medical marijuana but have no legal way of obtaining it. In Georgia, one is not allowed to cultivate, import or purchase cannabis.

Peake makes a monthly donation to a foundation in Colorado that supports research of medical cannabis. It adds up to about $100,000 a year. And each month a box full of cannabis products arrives at his office. Peake isn’t buying or selling marijuana – that would be a felony in Georgia. He skirts state law by giving it away for free.

An article in the Providence Journal tells the story of a young woman who sued a fabric company after it refused to hire her as an intern because she was a registered medical marijuana user. A judge recently ruled in favor of the woman.

“This decision sends a strong message that people with disabilities simply cannot be denied equal employment opportunities because of the medication they take,” said an ACLU attorney who represented the woman.

Does your state protect you? If not, you should consider contacting your state lawmakers to work on legislation to protect your right to use medical marijuana.

I understand there are significant frustrations about the cost of marijuana, lack of insurance coverage, limited distribution centers, and a shortage of doctors willing to write a marijuana prescription. But we have to keep up the advocacy to correct these injustices. Feel free to use these articles to help your cause and let’s look forward to the day that we are all treated equally across the country with access to affordable medication.

Ellen Lenox Smith suffers from Ehlers Danlos syndrome and sarcoidosis. Ellen and her husband Stuart live in Rhode Island. They are co-directors for medical marijuana advocacy for the U.S. Pain Foundation and serve as board members for the Rhode Island Patient Advocacy Coalition.

For more information about medical marijuana, visit their website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Marijuana Medication: Hope or Hype?

By Pat Anson, Editor

A Las Vegas company that is developing a new cannabis-based treatment for chronic pain has lost money since its inception and there is “substantial doubt” about its ability to survive, according to reports filed with the Securities and Exchange Commission (SEC).

But don’t give up on GB Sciences just yet, says its new chairman and CEO.

“We’re not as financially lame as you might suspect,” John Poss told PNN. “We’ve really done some interesting and groundbreaking research into cannabis.”

Last week GB Sciences issued a press release touting an application by its subsidiary, Growblox Life Sciences, for a patent on new treatments for chronic pain and heart conditions. The company claims to be developing “novel pain formulations” that are substantially free of delta-9 tetrahydrocannabinol (THC), the psychoactive ingredient in cannabis.

"These new chronic pain and heart formulas adhere to GB Science's strategy of commercializing complex mixtures of cannabis-derived compounds whose pharmaceutical activity does not require THC,” Poss said in the news release.

But a review of GB Sciences’ most recent quarterly report with the SEC could raise some doubts among pain patients and investors about whether the company has the resources to develop a cannabis medication. At the end of 2016, GB Sciences had no revenue and over $28 million in debt and liabilities.

“These factors, among others, raise substantial doubt about the Company's ability to continue as a going concern,” the quarterly report says.

But Poss maintains GB Sciences turned a corner in March after raising $9 million from investors. A marijuana grow facility in Las Vegas has also come on line and will soon be producing revenue. Poss thinks the company will be breakeven in cash flow by early next year and could launch a small pilot study of its cannabis medication.  

“Either we have something or we don’t. And we’ll find out within a year. If we have something or at least a strong indication that we have something, then our ability to raise money to do a formal clinical trial is greatly enhanced,” said Poss, who hopes to eventually partner GB Sciences with another larger company.

“Before we make bold statements about spending $100 million, we need to spend half a million and find out if it works, which not everyone can do. And we can do that.”   

GB Sciences’ stock (GBLX) trades on the over-the-counter “Pink Sheet” market for about 26 cents a share. Historically, the company paid its executives, creditors, and partners with millions of new shares, stock options and warrants, which diluted the value of existing shares. It also gave the company a reputation as a “pump and dump” operation, which Poss says he is working hard to change.

Where is Cannabis Science’s Pain Patch?

Another financially challenged company is California-based Cannabis Science, which claims to be developing a variety of cannabis-based pain therapies. When we first told you about this “fundamentally unsound company” last November, it had just released a press release announcing plans to develop a cannabis-based skin patch to treat fibromyalgia and diabetic neuropathy. 

In February, another press release was issued by Cannabis Science saying the company was working on the “final packaging” of the pain patch and would be distributing it to marijuana dispensaries in California “very soon.”

In March, a third press release said the pain patches “are about to hit the market.”

There’s been no further word from Cannabis Science about the pain patch, although the internet is full of stories about the “revolutionary” pain patch “that delivers powerful pain-fighting medicine through the skin and into the bloodstream.” There’s even a creepy video on YouTube in which a robotic computer-generated voice claims “there’s a strong possibility that the patches even cure these health problems.”

Which would be terrific news – if the patches actually existed. Calls and emails to the company asking for an update on the patch were not returned. 

At the time of its first press release on the pain patch, Cannabis Science stock (CBIS) was trading for less than six cents a share. Three months later – no doubt fueled by the hype over its pain patch -- the stock doubled in value to nearly 13 cents a share. During that time, company insiders sold over 12,000,000 shares for over $500,000.  

That’s not a bad take for executives working for a company that generated only $9,263 in revenue during all of 2016 and posted an operating loss of nearly $10 million.

“At this time, our ability to generate any significant revenues continues to be uncertain.  There is substantial doubt about our ability to continue as a going concern,” Cannabis Science says in its annual report to the SEC, which was filed last month.

“The Company is undercapitalized, and will be reliant on outside financing from sales of securities or issuance of debt instruments.  Management expects many traditional lenders will be reluctant to provide the Company with capital in light of its financial condition and the nature of its expected business; so that any financing activities will likely be expensive and result in dilution to stockholders of the Company.”

All of this should be no surprise to people familiar with Cannabis Science CEO Raymond Dabney, who is no stranger to accusations of stock manipulation. In 2005, Dabney admitted issuing 22 bogus news releases to promote another penny stock in Canada. For that he received a five year trading ban from British Columbia’s Securities Commission, according to Forbes and the Vancouver Sun.

At various times in its history, Cannabis Science has gone under the name Patriot Holdings, National Healthcare Technology, Brighton Oil & Gas, and Gulf Onshore.

“I'm not sure if Cannabis Science is a biotech firm, an oil and gas exploration company, an educational university or a pot distributor, the only thing I am certain of is that Cannabis Science is in the business of moving money from public investors to executives' pockets,” wrote John Brody Gay in a lengthy analysis published by Seeking Alpha, an investing website.

Gay and other analysts say Cannabis Science is a classic pump and dump penny stock that produces little revenue, only a steady stream of press releases to promote its business activities, which never seem to come to fruition.

Often other websites are hired by pump and dumpers to publish their press releases or write glowing reviews about a company known as “advertorials.” The publicity generates a flurry of interest in the company’s stock, which is when executives and other insiders often sell their shares.

In 2014, the SEC issued an investor alert about marijuana stock scams, warning specifically about false and exaggerated claims made in press releases. The advice still holds true today for investors, as well as pain patients.

“Fraudsters often exploit the latest innovation, technology, product, or growth industry – in this case, marijuana – to lure investors with the promise of high returns.  Also, for marijuana-related companies that are not required to report with the SEC, investors may have limited information about the company’s management, products, services, and finances.  When publicly-available information is scarce, fraudsters can more easily spread false information about a company, making profits for themselves while creating losses for unsuspecting investors,” the SEC said.

In March, the SEC charged the founder of a California--based marijuana company with fraud for falsely touting “record” revenue numbers in press releases.

Medbox founder Vincent Mehdizadeh bragged in a text message that “the only thing we are really good at is public company publicity and stock awareness.  We get an A+ for creating revenue off sheer will but that won’t continue.” 

Mehdizadeh settled the SEC charges by agreeing to pay $12 million in penalties.

Prescriptions Plummet in Medical Marijuana States

By Pat Anson, Editor

Medical marijuana is giving some serious competition to the prescription drug industry. A new analysis of Medicaid claims found that prescriptions to treat pain, nausea, seizures, psychosis and depression plummeted in the 23 states and District of Columbia where medical marijuana was legal in 2014.

If all 50 states had medical marijuana laws that year, researchers say the potential savings to Medicaid and taxpayers would have been over a billion dollars.

“We found statistically and economically meaningful reductions in prescription drug use associated with the laws. This finding suggested that patients in states with such laws were substituting medical marijuana for prescription drugs,” W. David Bradford and Ashley Bradford, a father-daughter team of researchers at the University of Georgia, reported in the journal Health Affairs.

Previous studies have shown that prescriptions for opioid pain medication have fallen in states where medical marijuana is legal.

The new study was more comprehensive and included nine clinical areas that cannabis could be used to treat: anxiety, depression, glaucoma, nausea, pain, psychosis, seizures, sleep disorders, and spasticity (muscle spasms).

Five of the nine clinical areas had significant drops in prescribing where medical marijuana was legal:

• 17% decline in anti-nausea medication
• 13% decline in antidepressants
• 12% decline in psychosis medication
• 12% decline in anti-seizure drugs
• 11% decline in pain medication

The study found no significant association between medical marijuana laws and drugs used to treat anxiety, glaucoma, sleep disorders or spasticity.

“There is no question that we see patients constantly turning to cannabis, to get off their other medications, mainly to eliminate the side effects they are experiencing.  At this time, this is a huge advantage to us all -- we get a healthier solution to help us with our medical issues and Medicare and Medicaid are seeing a reduction of costs,” said Ellen Lenox Smith, a PNN columnist, medical marijuana user and caretaker in Rhode Island.

“However, until we are able to receive insurance reimbursement like Germany started providing in March, we have to still pay out of pocket. So until we are treated fairly like this in the U.S., we will continue to be paying more for this safer help than if we went to the pharmacy to purchase medication with our co-pays. For me, however, the cost is worth the quality of life I have been able to achieve using cannabis.”

In the current study, researchers cautioned that using fewer prescription drugs is not necessarily a good thing for every marijuana user.

“Our findings do raise important questions about individual behavior. For example, it is plausible that forgoing medications with known safety, efficacy, and dosing profiles in favor of marijuana could be harmful under some circumstances,” said the Bradfords. “In addition, patients who switch from a prescription drug that requires regular physician monitoring to marijuana may interact with their doctor less often, and their adherence to other important treatment regimens could suffer.”

Previous studies have found a significant decline in use of opioid medication by patients who use marijuana and that marijuana users are not at greater risk of alcohol and drug abuse.

Currently medical marijuana is legal in 29 states and the District of Columbia.

Is Your Medical Marijuana Safe to Use?

By Ellen Lenox Smith, Columnist

When you smoke, ingest or administer medical marijuana into your body, it is important to know that it is safe to use. Ideally, the marijuana was grown organically and is pesticide free.

Here are simple tips that might help you to determine where you stand.

Purchasing from a Private Grower:

• Be sure to check with them to see what products they use for the soil and nutrients, to be sure the plants are growing organically.
• Most growers will at some point have to face a bug infestation. Make sure they got rid of them by using an organic product. You do not want to ingest toxic substances.
• You also need to know how they work on being consistent in creating their oils, tinctures, topical ointments and edibles. It is important when you find a medication that is compatible with your body, and that you be able to purchase it again and have similar results.

Purchasing from a Marijuana Dispensary:

If you are going to a medical marijuana dispensary or compassion center to purchase cannabis, you have the right to ask those same questions.

• Do they know who their suppliers are and where the marijuana was grown?
• Do their suppliers grow organically?
• Ask how they make sure there is consistency in creating their tinctures, oils, edibles, drinks, etc.

Americans for Safe Access (ASA) has created standards for medical marijuana called Patient Focused Certification (PFC), a non-profit, peer reviewed, third party certification program for the medical cannabis industry.

PFC addresses product and safety concerns “to promote the adoption of safe and reasonable industry standards and regulations from seed to consumption.”

If you see a marijuana package carrying the PFC label, like the image to the right, it has met their standards and has been certified.

Don’t be shy. This is your life and your body. Be sure to know that whoever you purchase your medication from, that it is being grown safely for you!

Ellen Lenox Smith suffers from Ehlers Danlos syndrome and sarcoidosis. Ellen and her husband Stuart live in Rhode Island. They are co-directors for medical marijuana advocacy for the U.S. Pain Foundation and serve as board members for the Rhode Island Patient Advocacy Coalition.

For more information about medical marijuana, visit their website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Pain Patients Prefer Marijuana over Opioids

By Pat Anson, Editor

A small study by Canadian researchers has found that nearly two-thirds of patients who use marijuana medically prefer cannabis over prescription drugs to treat their chronic pain, anxiety and depression.

An online survey by researchers at the University of British Columbia and University of Victoria asked 271 patients about their marijuana use. About half reported having chronic pain, while the remainder suffered from mental health issues, gastrointestinal problems, insomnia or multiple sclerosis.  

Overall, 95 percent of patients said cannabis was very effective at treating their symptoms and 63 percent reported using cannabis as a substitute for opioids, benzodiazepines, anti-depressants and other prescription drugs.

The study, published in International Journal of Drug Policy, was funded by Tilray, a medical marijuana production and research company.

“The finding that patients using cannabis to treat pain-related conditions have a higher rate of substitution for opioids, and that patients self-reporting mental health issues have a higher rate of substitution for benzodiazepines and antidepressants has significant public health implications,” wrote co-author Zach Walsh, PhD, an assistant professor of psychology at the University of British Columbia.

“In light of the growing rate of morbidity and mortality associated with these prescription medications, cannabis could play a significant role in reducing the health burden of problematic prescription drug use.”

Vaporizers were the most common method for using cannabis, followed by smoking, edibles, water pipes, and topical lotions. Most patients reported using 2 grams or less of marijuana. Many said cannabis was safer and had fewer adverse side effects than their medications.

A recent study in Canada found that a significant increase in the use of marijuana coincided with a decline in the use of opioid pain medication and benzodiazepines such as Xanax and Valium.

“The finding that medical cannabis is used primarily to treat chronic pain is consistent with past research. However, the extensive self-reported use to treat mental health conditions and associated symptoms represents a novel and interesting trend, and suggests that the conceptualization of cannabis as deleterious to mental health may not generalize across conditions or populations,” Walsh said.

Medical marijuana has been legal in Canada since 2001, but only to treat certain conditions. Cannabis is currently prescribed to over 65,000 patients.

A small study conducted at the University of Michigan last year also found a significant decline in the use of opioids by pain patients using medical marijuana.  Nearly two-thirds (64%) reported a reduction in their use of pain medications and almost half (45%) said cannabis improved their quality of life.

Previous research also found that opioid overdoses declined by nearly 25 percent in states where medical marijuana was legalized.

Last week, a spokesman for the Trump administration suggested there could be a crackdown in the U.S. on the use of marijuana recreationally.

"There's two distinct issues here, medical marijuana and recreational marijuana," said press secretary Sean Spicer. "I think that when you see something like the opioid addiction crisis blossoming in so many states around this country, the last thing that we should be doing is encouraging people."

Although 28 states have legalized medical marijuana and a handful of states also allow its recreational use, marijuana is still illegal under federal law.  Spicer suggested there could be “greater enforcement” of federal law under Attorney General Jeff Sessions, a longtime opponent of marijuana use.

A Safe Way to Healthy, Restorative Sleep

By Ellen Lenox Smith, Columnist

For many of us suffering from chronic pain, coping with our medical issues can be physically and emotionally draining. Often, the lack of healthy sleep is the culprit.

Living with Ehlers Danlos syndrome (EDS) and sarcoidosis, I used to constantly wake up in the middle of the night with so much pain it was impossible to get any form of rest. When I was teaching, I somehow went for years trying to teach on “empty” due to a chronic lack of restorative sleep.

I remember having to cheat and use a seating chart to remember the names of my wonderful students, who were sitting right in front of me. These were students I had known, loved and taught for months. It was embarrassing, heartbreaking, and created a sense of loss and hopelessness.

Thankfully, those days are gone. I have gone from years of almost no quality sleep to being someone who goes to bed at night and wakes up in the morning feeling well rested. I don’t even remember any dreams, so I am getting the real REM sleep!

How did I do it? A teaspoon of oil made from medical marijuana. I take it before bedtime, mixed with a little applesauce or a small amount of food.

Within an hour, my body is ready for bed and sleep. 

For years I made this oil at home on top of the stove, but today enjoy using the Magical Butter machine. We find that oil made from the indica strain of marijuana works best for sleep. Directions for making the oil can be found on our website. 

I am now both a medical marijuana patient and a caregiver in the state of Rhode Island. Patients visit us with a variety of different illnesses, but the one thing they all have in common is lack of sleep. Without sleep, you lose hope and courage to move forward with your life. Each patient that has tried this oil has found that it gives them rest and hope.

Recently, a young woman and her husband came to our home. Living with both EDS and Chronic Regional Pain Syndrome (CRPS), she had a difficult life, but was hoping to find something to make it easier. We have the same pain doctor and he suggested she get in touch with us to learn about cannabis. 

The first night that she tried the oil, she slept for eight hours and was both thrilled and shocked. She said even her face looked calmer and more rested.  She is now happier, hopeful and has more strength to get through the day.

There was another patient sent to us who was a paraplegic in constant pain. He was angry, miserable and wished he hadn’t been given life-saving surgery after his accident. He was at a loss as to what to do to cope with the life he was now given. 

He tried the oil and was shocked what it did for him. From that point on, the desperate man who first called me and couldn’t even be understood due to his level of pain, was happy, laughing and finding some meaning in his difficult life. He later passed, but the oil gave him a better quality of life and a sense of purpose again.

We have seen one success after another of pain patients getting real quality sleep and rest. We have seen it work for cancer patients, and those suffering with post-traumatic stress disorder, multiple sclerosis, back pain, fibromyalgia, arthritis and other conditions.

For those of you who are caught up in opioid hysteria and can no longer get medication, I hope you take a moment and think about trying cannabis oil at night for rest. I have used it safely for a decade, since I am not able to metabolize even an aspirin or Tylenol, let alone any opiate. May you find the courage to try it and get the same results.

Ellen Lenox Smith suffers from Ehlers Danlos syndrome and sarcoidosis.  Ellen and her husband Stuart are co-directors for medical marijuana advocacy for the U.S. Pain Foundation and serve as board members for the Rhode Island Patient Advocacy Coalition.

For more information about medical marijuana or to contact the Smith's, visit their website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

‘Substantial Evidence’ Marijuana Relieves Chronic Pain

By Pat Anson, Editor

A major new study released today on the health effects of medical marijuana has found “substantial evidence” that cannabis is an effective treatment for chronic pain in adults.

The lengthy study by a committee of the National Academies of Sciences, Engineering, and Medicine looked at over 10,000 scientific reports on marijuana and its active chemical compounds. The committee studied a range of possible impacts marijuana can have on pain, cancer, mental health, injuries and other health conditions.

Marijuana is now the most popular illicit drug in the United States, although it is legal under state law in 28 states and the District of Columbia.

A recent survey found over 22 million Americans have used marijuana in the past month, with nine out of ten users saying their primary use was recreational. Only about 10 percent reported they used cannabis solely for medical purposes. 

“For years the landscape of marijuana use has been rapidly shifting as more and more states are legalizing cannabis for the treatment of medical conditions and recreational use,” said Marie McCormick, the committee chair and a professor of pediatrics at Harvard Medical School.

“This growing acceptance, accessibility, and use of cannabis and its derivatives have raised important public health concerns.  Moreover, the lack of any aggregated knowledge of cannabis-related health effects has led to uncertainty about what, if any, are the harms or benefits from its use.  We conducted an in-depth and broad review of the most recent research to establish firmly what the science says and to highlight areas that still need further examination.”

The committee could find only five good-to-fair quality studies on whether cannabis was an effective treatment for chronic pain.  In all five studies, the cannabis was either smoked or vaporized, and did not include other delivery methods such as food, creams or oils infused with cannabinoids.  

“Thus, while the use of cannabis for the treatment of pain is supported by well-controlled clinical trials... very little is known about the efficacy, dose, routes of administration, or side effects of commonly used and commercially available cannabis products in the United States. Given the ubiquitous availability of cannabis products in much of the nation, more research is needed on the various forms, routes of administration, and combination of cannabinoids,” the committee found.

"It is wonderful to see that what I experience is now being recognized and respected in the medical community," said Ellen Lenox Smith, a PNN columnist who uses marijuana to relieve pain from Ehlers Danlos syndrome.

"I have been allowed nightly rest due to a simple teaspoon of oil at night. Somehow, the next day I rarely need to turn to more, for it continues to calm the body into the next day for me."

Others have also found that cannabis reduces their need for pain relievers. In states where medical marijuana is legal, the committee found growing evidence that users were replacing opioids with cannabis.

“Recent analyses of prescription data from Medicare Part D enrollees in states with medical access to cannabis suggest a significant reduction in the prescription of conventional pain medications,” the committee found. “Combined with the survey data suggesting that pain is one of the primary reasons for the use of medical cannabis, these recent reports suggest that a number of pain patients are replacing the use of opioids with cannabis, despite the fact that cannabis has not been approved by the U.S. Food and Drug Administration (FDA) for chronic pain.”

For adults muscle spasms caused by multiple sclerosis, the committee said there was substantial evidence that short-term use of oral cannabinoids – marijuana-based products that are orally ingested – improved their symptoms.  In adults with chemotherapy-induced nausea and vomiting, there was also conclusive evidence that oral cannabinoids were effective in treating those symptoms.

There was a lack of data on the effects of cannabis on the immune system, and insufficient evidence to support or refute a link between cannabis and adverse effects on the immune status of individuals with HIV.  Limited evidence does suggest that regular exposure to cannabis smoke may have anti-inflammatory effect.

Regarding the link between marijuana and cancer, the committee found evidence that suggests smoking cannabis does not increase the risk for cancers often associated with tobacco use. However, the committee did find that smoking cannabis on a regular basis was associated with more frequent chronic bronchitis, coughing and other respiratory issues.

To download a free copy of the study, click here.

How to Ask Your Doctor About Medical Marijuana

By Ellen Lenox Smith, Columnist

If you are considering medical marijuana as an alternative treatment for your chronic pain or other medical issues, you might be uncomfortable about approaching your doctor.

There are so many stories circulating about patients being judged by their doctor or being labeled a “drug seeker” if they ask about marijuana, that many have chosen not to engage in a conversation they really wish to have.  

So, what can you do to make this as comfortable as possible?

First, take the time to understand your state’s medical marijuana law. Over half the states have now legalized medical marijuana, but the rules are different for doctors and patients in each state. Click here to see a summary of medical marijuana laws in all 28 states and Washington DC.

Here in Rhode Island, residents can approach any doctor -- not only in Rhode Island -- but in the adjacent states of Connecticut and Massachusetts. If you have no success with the doctors that treat you, then we have a few locations in Rhode Island that you can turn to. These specialty doctors evaluate your medical issues and can sign you on.  

The one negative for using these facilities is that there is a fee that must be paid upfront and you must return yearly to confirm your continued need for medical marijuana. A regular doctor’s appointment only means a co-pay, depending on your insurance.

Second, you want to approach a doctor you believe might be the most open to considering marijuana. How do you figure that out?

Some states require doctors to take a marijuana course before being allowed to sign for someone. Check and see if your doctor is on that list. If they are not, ask your state health department for a list of qualified doctors you can turn to. You can also ask other patients already in the program what success they had with your doctor or see if they know another doctor in the area who would be better. 

If you think your doctor might be open to this discussion, consider calling their office in advance and sound out where the doctor stands on marijuana before going in. If it sounds hopeless, then turn to a different doctor that treats you.

If your state has set up distribution centers or marijuana dispensaries, they may also be able to guide you to a doctor willing to sign you on, if you have no luck with your own personal doctors.

Third, when you finally approach the doctor, come to the appointment with some knowledge to share. Be ready to educate them. Google your health condition and medical marijuana to see if cannabis has been used to treat it. Feel free to use our website to download articles about the successful use of marijuana with your condition.

Dr. Stephen Corn has a wonderful website for doctors called “The Answer Page” where they can turn to for education on this topic and also submit questions they might have. I would encourage you to share the link with your doctor.

Be sure to share with your doctor what medications you have already tried to help cope with your condition. Explain why they have not worked for you. Remind them that they are not writing a script or prescription for marijuana, but simply confirming you have one of your state’s qualifying conditions for it.

Share with the doctor that you don’t expect them to guide you in how to administer marijuana, and that you will be educated at the dispensary or by a caregiver.

I know it feels intimidating to consider asking your doctor to support you, but if this is a possible solution for your life, take the time to prepare for the meeting and go for it.

There are risks involved with using marijuana without telling your doctor. They could be caught by surprise and discharge you if marijuana unexpectedly shows up in a drug test. That’s happened to some patients, even though the CDC specifically warns that “clinicians should not dismiss patients from care based on a urine drug test result because this could constitute patient abandonment and could have adverse consequences for patient safety.”

I have turned my life around with a simple teaspoon of a marijuana-based oil at night -- and had to be convinced by my own doctor to give it a try! Once I realized what this was doing for my quality of life, I had to share my success with others.  I hope that others may find this natural and safe option to be successful for them too.   

Ellen Lenox Smith suffers from Ehlers Danlos syndrome and sarcoidosis. Ellen and her husband Stuart live in Rhode Island. They are co-directors for medical marijuana advocacy for the U.S. Pain Foundation and serve as board members for the Rhode Island Patient Advocacy Coalition.

For more information about medical marijuana, visit their website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

NBA Coach Tried Marijuana for Back Pain

By Pat Anson, Editor

Steve Kerr may have inadvertently started a national conversation about sports and medical marijuana. They’re certainly talking about it in the NBA.

The 51-year old coach of the Golden State Warriors revealed in an interview Friday that he smoked marijuana to see if it might relieve his chronic back pain. Medical marijuana has been legal in California since 1996.

“I guess maybe I can even get in some trouble for this, but I’ve actually tried it twice during the last year and a half, when I’ve been going through this chronic pain that I’ve been dealing with,” Kerr said on The Warriors Insider Podcast.

STEVE KERR

Kerr missed most of the 2015 regular season after two back surgeries that not only failed to relieve his pain, but resulted in a spinal fluid leak that gave him chronic headaches, nausea and neck pain. Kerr took a leave of absence for four months and started trying various pain relievers, including narcotic painkillers and pot.

“A lot of research, a lot of advice from people, and I have no idea if maybe I would have failed a drug test. I don't even know if I'm subject to a drug test or any laws from the NBA, but I tried it and it didn't help it all. But it was worth it because I'm searching for answers on pain. I've tried painkillers and drugs of other kinds as well, and those have been worse. It's tricky," Kerr said.

It’s even trickier if you’re a professional athlete.

If an NBA player is caught using marijuana – either recreationally or medically – the league requires the player to enroll in and complete a substance abuse treatment program.

A second infraction results in a $25,000 fine. The penalties escalate after that, with a third offense resulting in a 5-game suspension, followed by a 10-game suspension for a 4th infraction.  

The NFL and Major League Baseball have similar marijuana policies, with baseball players facing the ultimate penalty after a 4th infraction: Banning from the league.

Even though Kerr is a coach now – he had a lengthy career as a player – it took some courage for him to speak so openly about marijuana.

“I’m not a pot person. It doesn’t agree with me. I’ve tried it a few times, and it did not agree with me at all. So I’m not the expert on this stuff,” Kerr said. “But I do know this: If you’re an NFL player, in particular, and you’ve got a lot of pain, I don’t think there is any question that pot is better for your body than Vicodin. And yet athletes everywhere are prescribed Vicodin like its Vitamin C, like it’s no big deal.

“I would hope, especially for these NFL guys, who are basically involved in a car wreck every Sunday – and maybe four days later, the following Thursday, which is another insane thing the NFL does – I would hope that league will come to its senses and institute a different sort of program where they can help these guys get healthier rather than getting hooked on these painkillers.”

Some of Kerr’s player welcomed his comments about a controversial issue.

''Steve's open-minded, and obviously with the way the world's going, if there's anything you can do that's medicinal, people are all for it, especially when there's stuff like Crohn's disease out there, glaucoma, a bunch of stuff, cancer,” said Klay Thompson. “But not recreationally, that should not be of its use ever. There's obviously a medicinal side to it that people are finding out, especially people with really high pain.''

“I think it makes a lot of sense what he said,” said Draymond Green, adding that he has never tried marijuana and “doesn’t really know how it feels.”

“From what I hear from football guys, I think a lot of them do it because of all the pain they go through,” Green said. “It makes a lot sense. It comes from the earth. Any vegetable that comes from the earth, they encourage you to eat it. So I guess it does make a little sense, as opposed to giving someone a manufactured pill. The way some of these pills take the pain away, it can’t be all good for you.”

Although the NFL has a reputation for regular drug testing and watching for signs of drug abuse, some former players say about half the league is currently using marijuana for pain relief.  Many grew tired of using painkillers, which one player calls “a scourge in the locker room.”

Steve Kerr says professional sports needs to re-evaluate its relationship with painkillers and marijuana.

“Having gone through my own bout with chronic pain, I know enough about this stuff – Vicodin is not good for you. It’s not,” said Kerr. “It’s way worse for you than pot, especially if you’re looking for a painkiller and you’re talking about medicinal marijuana, the different strains what they’re able to do with it as a pain reliever. And I think it’s only a matter of time before the NBA and NFL and Major League Baseball realize that.”

Medical Marijuana Could Help Treat Addiction

By Pat Anson, Editor

Can marijuana be used to treat addiction?

Not according to the U.S. Drug Enforcement Administration, which classifies marijuana as a Schedule I controlled substance with “a high potential for abuse.” Adults who start using marijuana at a young age, according to the DEA,  are five times more likely to become dependent on narcotic painkillers, heroin and other drugs.

But a new study by Canadian researchers found that marijuana is helping some alcoholics and opioid addicts kick their habits.

"Research suggests that people may be using cannabis as an exit drug to reduce the use of substances that are potentially more harmful, such as opioid pain medication," says the study's lead investigator Zach Walsh, an associate professor of psychology at the University of British Columbia’s Okanagan campus.

“In contrast to the proposition that cannabis may serve as a gateway (drug) is an emerging stream of research which suggests that cannabis may serve as an exit drug, with the potential to facilitate reductions in the use of other substances. According to this perspective, cannabis serves a harm-reducing role by substituting for potentially more dangerous substances such as alcohol and opiates.”

In their review of 31 studies involving nearly 24,000 cannabis users, Walsh and his colleagues also found evidence that marijuana was being used to help with mental health problems, such as depression, post-traumatic stress disorder (PTSD) and social anxiety.

The review did not find that cannabis was a good treatment for bipolar disorder and psychosis.

"It appears that patients and others who have advocated for cannabis as a tool for harm reduction and mental health have some valid points," Walsh said.

With medical marijuana legal in over half of the United States and legalization possible as early as next year in Canada, Walsh says it is important for mental health professionals to better understand the risk and benefits of cannabis use.

"There is not currently a lot of clear guidance on how mental health professionals can best work with people who are using cannabis for medical purposes," says Walsh. "With the end of prohibition, telling people to simply stop using may no longer be as feasible an option. Knowing how to consider cannabis in the treatment equation will become a necessity."

The study was recently published in the journal Clinical Psychology Review. Walsh and some of his colleagues disclosed that they work as consultants and investigators for companies that produce medical marijuana.

Previous studies have found that use of opioid medication declines dramatically when pain patients use medical marijuana. Opioid overdoses also declined in states where medical marijuana was legalized..