Fewer Opioids Prescribed in Medical Marijuana States

By Pat Anson, Editor

The availability of medical marijuana has significantly reduced opioid prescribing for Medicaid and Medicare patients, according to two large studies published in the Journal of the American Medical Association (JAMA).

In one study, researchers at the University of Georgia looked at Medicare Part D prescription drug data from 2010 to 2015. They found that the number of daily doses prescribed for morphine (-14%), hydrocodone (-10.5%) and fentanyl (-8.5%) declined in states with medical marijuana laws. However, daily doses for oxycodone increased (+4.4%) in those same states.

The drop in opioid prescribing was most pronounced in states that have medical marijuana dispensaries, as opposed to those that only allow home cultivation of cannabis for medical purposes.

“We found that prescriptions for hydrocodone and morphine had statistically significant negative associations with medical cannabis access via dispensaries,” wrote lead author W. David Bradford, PhD, Department of Public Administration and Policy at the University of Georgia.

“Combined with previously published studies suggesting cannabis laws are associated with lower opioid mortality, these findings further strengthen arguments in favor of considering medical applications of cannabis as one tool in the policy arsenal that can be used to diminish the harm of prescription opioids.”

The second study, by researchers at the University of Kentucky, looked at Medicaid prescriptions from 2011 to 2016, and found a 5.88% decline in opioid prescribing in states with medical marijuana laws.  Opioid prescribing for Medicaid patients fell even more -- by 6.38% -- in states where the recreational use of marijuana is legal.

“These findings suggest that medical and adult-use marijuana laws have the potential to reduce opioid prescribing for Medicaid enrollees, a segment of population with disproportionately high risk for chronic pain, opioid use disorder, and opioid overdose,” wrote lead author Hefei Wen, PhD, University of Kentucky College of Public Health.

One weakness of both studies is that they did not determine if Medicaid and Medicare patients reduced their use of opioid medication because they were using cannabis.  They also only included patients that were elderly, poor or disabled. And they were conducted during a period when nationwide opioid prescribing was in decline.

A recent study by the RAND corporation found little evidence that states with medical marijuana laws experience reductions in the volume of legally prescribed opioid medication. RAND researchers believe some pain patients may be experimenting with marijuana, but their numbers are not large enough to have a significant impact on prescribing. 

"If anything, states that adopt medical marijuana laws... experience a relative increase in the legal distribution of prescription opioids," the RAND study found. "Either the patients are continuing to use their opioid pain medications in addition to marijuana, or this patient group represents a small share of the overall medical opioid using population." 

Although 29 states and the District of Columbia have legalized medical marijuana and a handful of states allow its recreational use, marijuana remains illegal under federal law.

Medical Cannabis Effective for Elderly Pain Patients

By Pat Anson, Editor

Medical marijuana can significantly reduce chronic pain in elderly patients without adverse effects, according to a new study by Israeli researchers that found many patients were also able stop or reduce their use of opioid medication.

Researchers at the Ben-Gurion University of the Negev (BGU) surveyed over 2,700 patients 65 years or older who received medical cannabis. Over 60 percent of the patients were prescribed cannabis for chronic pain due to cancer, Parkinson's disease, post-traumatic stress disorder, ulcerative colitis, Crohn's disease, multiple sclerosis or other medical issues.

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After six months of treatment, more than 93 percent of respondents reported their pain dropped from a median of eight to four on a 10-point pain scale. Nearly 60 percent who originally reported "bad" or "very bad" quality of life said their lives had improved to "good" or "very good." And over 70 percent reported moderate to significant improvement in their medical condition.

About a third of the patients used cannabis-infused oil, about 24 percent smoked marijuana, and about six percent used a vaporizer. The most common side effects from cannabis use were dizziness and dry mouth, researchers reported in The European Journal of Internal Medicine .

"We found medical cannabis treatment significantly relieves pain and improves quality of life for seniors with minimal side effects reported," said Victor Novack, MD, a professor of medicine at BGU and head of the Soroka Cannabis Clinical Research Institute.

"While older patients represent a large and growing population of medical cannabis users, few studies have addressed how it affects this particular group, which also suffers from dementia, frequent falls, mobility problems, and hearing and visual impairments."

The survey found that nearly one in five patients stopped using opioid medication or reduced their dose. The findings are at odds with a recent study by the RAND Corporation, which found that medical marijuana laws in the U.S. have not reduced demand for prescription opioids.

Medical marijuana has been legal in Israel since the early 1990s. Israel’s Ministry of Health still considers cannabis a “dangerous drug,” but adds “there is evidence that cannabis could help patients suffering from certain medical conditions and alleviate their suffering.”

A recent survey found about 27 percent of Israeli adults have used cannabis in the past year, one of the highest rates in the world.

Medical Marijuana Not Reducing Demand for Rx Opioids

By Pat Anson, Editor

A new study by the RAND Corporation is throwing some shade on theories that medical marijuana reduces demand for prescription opioids and saves lives by lowering rates of opioid overdoses.

RAND researchers analyzed data from 1999 to 2010 and found a 20 percent decline in opioid overdose deaths associated with the passage of state medical marijuana laws. That is in line with previous studies. However, when researchers extended their analysis through 2013, they found that the association between medical marijuana and lower rates of opioid deaths completely disappeared.

Researchers say there are two possible explanations for this. First, states that recently adopted medical marijuana laws are more tightly regulating dispensaries -- which may have reduced access to cannabis. Second, beginning in 2010, the primary driver of the overdose crisis became illicit opioids such as heroin and fentanyl, not prescription opioids.

“This is a sign that medical marijuana, by itself, will not be the solution to the nation's opioid crisis," said Rosalie Liccardo Pacula, co-director of the RAND Drug Policy Research Center and co-author of the study published in the Journal of Health Economics.

"Before we embrace marijuana as a strategy to combat the opioid epidemic, we need to fully understand the mechanism through which these laws may be helping and see if that mechanism still matters in today's changing opioid crisis."

The RAND study also found little evidence that states with medical marijuana laws experience reductions in the volume of legally prescribed opioid medication.

"If anything, states that adopt medical marijuana laws... experience a relative increase in the legal distribution of prescription opioids. This result suggests that our findings are not driven by a decrease in the legal supply of opiioids," researchers found.

While many patients are using medical marijuana products to treat their pain, researchers say they do not represent a significant part of the opioid analgesic market.

"Either the patients are continuing to use their opioid pain medications in addition to marijuana, or this patient group represents a small share of the overall medical opioid using population," said Pacula.

Although 29 states and the District of Columbia have legalized medical marijuana and a handful of states allow its recreational use, marijuana remains illegal under federal law. Attorney General Jeff Sessions recently ordered U.S. Attorneys to resume enforcing federal laws that outlaw the cultivation, distribution and possession of marijuana. Session rescinded the Cole memo, a lenient policy adopted by the Justice Department in 2013 that instructed U.S. Attorneys not to investigate or prosecute marijuana cases in states that have legalized cannabis..

Lawmakers Ask Trump to Restore Marijuana Policy

By Pat Anson, Editor

A bipartisan group of lawmakers led by Sen. Elizabeth Warren (D-MA) and Rep. Jared Polis (D-CO) has urged President Trump to reinstate an Obama-era policy that instructed U.S. Attorneys not to investigate or prosecute marijuana cases in states that have legalized cannabis.

Earlier this month, Attorney General Jeff Sessions rescinded the so-called Cole memo, the lenient marijuana policy adopted by the Justice Department in 2013.  Sessions, who is a longtime critic of marijuana legalization, said the Colo memo was “unnecessary” and “undermines the rule of law.” He authorized U.S. Attorneys to use their own discretion in investigating and prosecuting marijuana cases.

In a letter to President Trump signed by 54 members of Congress (51 Democrats and 3 Republicans), the lawmakers said Sessions’ order will “have a chilling effect” in states where medical or recreational marijuana has been legalized.

“This action has the potential to unravel efforts to build sensible drug policies that encourage economic development as we are finally moving away from antiquated practices that have hurt disadvantaged communities. These new policies have instead helped eliminate the black market sale of marijuana and allowed law enforcement to focus on real threats to public health and safety,” the letter said.

The letter also pointed out that Trump promised during the 2016 campaign that he would not change the federal enforcement policy on marijuana.

“I wouldn’t do that, no,” Trump said in an interview. “I think it’s up to the states. I’m a states’ person. I think it’s up to the states, absolutely.”

“We trust that you still hold that belief, and we request that you urge the Attorney General to reinstate the Cole Memorandum. This step would create a pathway to a more comprehensive marijuana policy that respects state interests and prerogatives,” the letter from lawmakers said.

Although 29 states and the District of Columbia have legalized marijuana in some form, federal law still prohibits its sale or possession under the Controlled Substances Act.

According to a recent Gallup Poll, 64% of Americans believe marijuana should be legalized. The issue has broad bipartisan support, with 51% of Republicans and 72% of Democrats supporting legalization.

New Jersey Gov. Philip Murphy (D) signed an executive order this week instructing the state health department to expand access to medical marijuana. Although cannabis has been legal in the state since 2010, New Jersey’s medical marijuana law was so rigid that only 15,000 patients qualified for it in a state with 9 million people.

Murphy’s order directs the health department to lift restrictions on doctors that can prescribe cannabis, review the number of medical conditions for which it can be prescribed, allow more dispensaries to open, and consider the sale of edible marijuana products.

Medical Cannabis Laws Cause Confusion for Travelers

By Roger Chriss, Columnist

Health problems do not care about maps. But the patchwork of medical marijuana laws in different states does make a map handy for anyone who travels and uses cannabis for a medical condition.

The recent decision by Attorney General Jeff Sessions to resume enforcing federal marijuana law further muddies this already complicated landscape. Even if medical cannabis remains insulated from prosecution by the Rohrabacher-Blumenauer Amendment, there is one important issue for people with chronic pain and related disorders that remains unaddressed.

What happens when someone who is using medical cannabis lawfully for an approved use in their own state has to travel to another state for diagnosis or treatment?

The rarer a medical condition is, the more likely local healthcare providers will prove inadequate and travel will be necessary. A wide range of disorders, including inborn errors of metabolism like porphyria, muscle diseases like nemaline myopathy, and hereditary neuropathies like Charcot-Marie-Tooth disease, require visits to specialists for evaluation and diagnosis. These specialists are often not nearby, making travel an essential step in medical care.

But state rulings on the approved uses for medical cannabis vary significantly and are changing rapidly.

In Colorado, for example, a person simply has to have “severe pain” to be considered for medical cannabis. By contrast, Connecticut and Illinois maintain extensive and detailed lists of dozens of qualifying medical conditions, from rheumatoid arthritis to Hepatitis C to Tourette syndrome.

Oregon compromises by giving examples of what it calls “debilitating medical conditions” and allows for specific symptoms such as cachexia and severe pain.

Moreover, states like Minnesota, Pennsylvania and Washington define intractable pain as pain unrelieved by standard medical treatments or medications. But they do not agree on what constitutes standard care, with Pennsylvania including “opiate therapy” while Minnesota does not.

Thus, a person could be in full compliance with his or her own state’s laws and regulations, but be unable to qualify for medical cannabis in another state. This would impact out-of-state travel for medical care.

In general, traveling with medical cannabis is very challenging. State governments can only pass laws within their borders. This means that air travel is effectively out of the question, because federal law says that it is illegal to carry marijuana in airline baggage or transport it across state lines.

Obtaining medical cannabis outside of one’s home state is similarly problematic. Some states accept out-of-state medical cannabis cards, but the number remains small and acceptance is at the discretion of the dispensary owner. Each such state has its own rules about medical cannabis possession as well, and these rules change frequently.

All of this creates a difficult landscape for people trying to navigate the U.S. healthcare system outside their home state. As state laws now stand, people with chronic pain disorders could end up breaking both federal and state law while seeking medically recommended cannabis products.

Further, a person who is on a stable regimen of medical cannabis in one state may not be able to visit or relocate to another state without losing that regimen. This may impact education and professional opportunities in a way presumably not intended by state laws.

Medical science and clinical practice should not change with state boundaries. State laws and accepted indications for medical cannabis need to be revised in order to create an environment that benefits people in need and does not inadvertently create legal conflicts or pitfalls. At present, there is simply too much room for error and harm.

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.

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.

Little Evidence Cannabis Can Treat Chronic Pain

By Roger Chriss, Columnist

There is an abundance of research on medical cannabis. Everything from basic science to clinical trials and even major reviews have been conducted on the effectiveness of cannabis in treating chronic pain and other conditions. But the results don’t necessarily say what people want to hear.

As Leafly shows in a comprehensive list, most states in the U.S. that have legalized medical cannabis include chronic pain or painful conditions among the accepted indications for use. But these same states also note that research supporting medical cannabis for chronic pain is thin.

Minnesota, for example, accepts “intractable pain” but then says that “the literature assessing the effects of medical cannabis treatments for non-cancer chronic pain is sparse and patchy.”

Similarly, the California Medical Association’s “Physician Recommendation of Medical Cannabis” states that the approved list of 12 serious medical conditions that cannabis can be used for “is broad, and in most cases not supported by solid clinical research.”

In other words, medical cannabis has been approved for use, despite having not been rigorously demonstrated to be useful.

The existing research supports this view. A recent systematic review of two dozen clinical trials published in the journal Pain Physician found that “the majority of studies did not show an effect.” The review concludes that cannabis-based medications “might be effective for chronic pain treatment, based on limited evidence, primarily for neuropathic pain (NP) patients.”

Another recent review of randomized placebo-controlled studies of smoked cannabis published in the journal Pharmacotherapy found that “cannabis did not outperform placebo on experimentally evoked pain.”

And a systematic review of the efficacy of cannabis in patients with neuropathic pain, multiple sclerosis or receiving  chemotherapy concluded that “there is incomplete evidence of the efficacy and safety of medical use of cannabis” and that “confidence in the estimate of the effect was again low or very low.”

Even reviews of medical cannabis for disorders that involve a chronic pain component are lackluster. A 2017 systematic review looked at randomized controlled trials of cannabis and its derivatives in treating psychiatric, movement, and neuro-degenerative disorders. The review found that "definitive conclusion on its efficacy could not be drawn” because the trials were low quality and had methodological limitations.

These results run contrary to the public perception of cannabis efficacy and the exuberance of media coverage about marijuana in any form. This has not escaped the notice of researchers. A 2017 study from Europe found that “public perception of the efficacy, tolerability, and safety of cannabis-based medicines in pain management and palliative medicine conflicts with the findings of systematic reviews and prospective observational studies conducted according to the standards of evidence-based medicine.”

Moreover, the Pain Physician study notes another significant trend: More recent studies tend to report more favorable results. It is not clear why this is happening, though a shift in cultural attitudes, ongoing advocacy in favor or cannabis legalization, and changes in the available strains of cannabis have been suggested. In particular, an increasingly positive attitude toward cannabis among study participants may be augmenting the placebo effect.

There are other limitations to the existing research -- from problems with blinding, lack of a good placebo and small study size – that make it open to criticism. Much of the commentary on cannabis research seems to have less to do with a close reading of the literature than with a desire for cannabis to gain widespread acceptance.

There is, of course, growing evidence for the use of cannabis in the treatment of some disorders, such as epilepsy and chronic neuropathic pain.  Medical cannabis may also have some value for people who are not benefiting from or cannot tolerate pharmaceutical drugs and other established therapies. So cannabis should remain an option -- intractable pain is sufficiently horrible that we need as many options as possible.

Medical research is about accumulating evidence through clinical trials and laboratory study. One trial is rarely ever enough to demonstrate efficacy. Even one major review is not sufficient. But an abundance of reviews all pointing in one direction should not go ignored.

Medical cannabis certainly merits further study. But the above reviews clearly show that efficacy is limited in many cases. Cannabis may well prove useful in treating certain disorders, but it is not a panacea and not likely to outperform existing treatments.

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.

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.

Sessions Resumes Enforcement of Marijuana Laws

By Pat Anson, Editor

Attorney General Jeff Sessions has followed through on his threat to resume enforcing federal laws that outlaw the cultivation, distribution and possession of marijuana.

Session has rescinded the Cole memo, a lenient policy adopted by the Justice Department in 2013 that instructed U.S. Attorneys not to investigate or prosecute marijuana cases in states that have legalized cannabis. Although 29 states and the District of Columbia have legalized marijuana in some form, federal law still prohibits its sale or possession under the Controlled Substances Act.

ATTORNEY GENERAL JEFF SESSIONS

In a one-page memorandum sent to U.S. Attorneys around the country, Sessions called the Cole memo “unnecessary” and authorized prosecutors to use their own discretion in investigating and prosecuting marijuana cases.

"It is the mission of the Department of Justice to enforce the laws of the United States, and the previous issuance of guidance undermines the rule of law and the ability of our local, state, tribal, and federal law enforcement partners to carry out this mission," Sessions said in a statement.

"Therefore, today's memo on federal marijuana enforcement simply directs all U.S. Attorneys to use previously established prosecutorial principles that provide them all the necessary tools to disrupt criminal organizations, tackle the growing drug crisis, and thwart violent crime across our country."

“This change will allow any US Attorney who is looking to make a name for themselves to take unilateral action, thus depriving any semblance of certainty for state-lawful consumers or businesses moving forward," said Justin Strekal, NORML Political Director.

Sessions released his memo just three days after California legalized the recreational use of marijuana by adults – the eighth and largest state to do so. California was the first state to legalize medical marijuana in 1996.

It is not yet clear how rigidly Sessions plans to enforce federal marijuana laws. Since 2013, Congress has attached a rider to the Justice Department budget that prevents it from using federal funds to enforce federal law in states where medical marijuana is legal. The Rohrabacher-Blumenauer amendment is still in force, but is set to expire on January 19 unless it is extended by Congress.

Sessions’ memo drew a swift and angry response from some members of Congress.

“This reported action directly contradicts what Attorney General Sessions told me prior to his confirmation. With no prior notice to Congress, the Justice Department has trampled on the will of the voters in CO and other states,” Sen. Cory Gardner (R-CO) said in a tweet. “I am prepared to take all steps necessary, including holding DOJ nominees, until the Attorney General lives up to the commitment he made to me prior to his confirmation.”

“This is outrageous. Going against the majority of Americans -- including a majority of Republican voters -- who want the federal government to stay out of the way is perhaps one of the stupidest decisions the Attorney General has made,” said Rep. Earl Blumenauer (D-OR), one of the co-authors of the Rohrabacher-Blumenauer amendment.

“One wonders if Trump was consulted -- it is Jeff Sessions after all -- because this would violate his campaign promise not to interfere with state marijuana laws.”

In an interview during the 2016 campaign, President Trump said he would not change the federal enforcement policy on marijuana. “I wouldn’t do that, no,” Trump said. “I think it’s up to the states. I’m a states’ person. I think it’s up to the states, absolutely.”

According to a recent Gallup Poll, 64% of Americans say marijuana should be legalized. The issue has broad bipartisan support, with 51% of Republicans and 72% of Democrats supporting legalization.

“The rollback of this policy towards state legalized marijuana will only create chaos and confusion for an industry that is currently responsible for creating over 150,000 American jobs and generating countless millions in state tax revenue. This instability will only push consumer dollars away from these state sanctioned businesses and back into the hands of criminal elements," said Erik Altieri, NORML Executive Director.

"This is not just bad policy, but awful politics and the Trump Administration should brace itself for the public backlash it will no doubt generate."

Enthusiasm for Medical Marijuana Ahead of Science

By Roger Chriss, Columnist

There is a tsunami of enthusiasm for medical cannabis. Rolling Stone is touting “medical pot” as the best hope to fight the opioid crisis. Newsweek has introduced the world to the “father of marijuana research” and even offered suggestions for using cannabis in holiday cooking.

But underlying all this cannabis coverage are confusing claims about the efficacy of medical marijuana for chronic pain and other conditions.

Although still in its infancy, the science behind medical cannabis is growing rapidly.  ClinicalTrials.gov lists 139 research studies underway. PubMed.gov lists 5,615 articles about “medical cannabis” and over 25,000 articles about “marijuana.” By comparison, PubMed lists only 112 articles about kratom.

The results of these thousands of studies involving scores of medical conditions are mixed, with an extensive list and reviews of clinical studies available on Cannabis-Med.org.  

The National Academy of Science released “The Health Effects of Cannabis and Cannabinoids” report in January 2017, stating that there is “evidence to support that patients who were treated with cannabis or cannabinoids were more likely to experience a significant reduction in pain symptoms.”

But a review article from September 2017 called "Cannabinoids in Pain Management and Palliative Medicine" concluded that public perceptions about the effectiveness of cannabis in providing pain relief “conflicts with the findings.”

"There is limited evidence for a benefit of THC/CBD spray in the treatment of neuropathic pain. There is inadequate evidence for any benefit of cannabinoids (dronabinol, nabilone, medical cannabis, or THC/CBD spray) to treat cancer pain, pain of rheumatic or gastrointestinal origin, or anorexia in cancer or AIDS," German and Canadian researchers reported.

This apparent contradiction is often a result of limited research findings. Studies on medical cannabis are usually small-scale, preliminary, methodologically poor and statistically underpowered, and thus of limited value for drawing general conclusions.

The biggest issue in many studies is the lack of a good placebo for marijuana, as described in a recent JAMA Internal Medicine article: “Many trial subjects can distinguish between active cannabis and placebo.” This means that blinding subjects to obtain unbiased results is difficult, which makes the findings insufficient to get FDA approval as a medication.

"Unfortunately, there are almost no uses of medical marijuana that have been subjected to the kind of rigorous testing you'd want for a pharmaceutical," says Dr. Kenneth Mukamal, associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center.

But there is progress. As the JAMA Internal Medicine study noted, “Some of the strongest evidence is for neuropathic pain, spasticity associated with multiple sclerosis, and anorexia in the setting of serious illness.”

A recent phase III clinical trial supports this.  Nearly 250 patients with moderate to severe neuropathic pain from multiple sclerosis saw “clinically relevant” reductions in pain intensity due to dronabinol, a synthetic marijuana derivative.

Marijuana Not Risk Free

Studies are also showing that medical cannabis is not risk-free. Some media reports state that there is no known instance of a fatal overdose involving marijuana. This is accurate, but fatal overdose is not the only measure of risk for a substance. Non-fatal toxicity, including cannabinoid hyperemesis syndrome (recurring nausea, vomiting and stomach pain), and other side effects are not trivial risks.

“Chronic effects of cannabis use include mood disorders, exacerbation of psychotic disorders in vulnerable people, cannabis use disorders, withdrawal syndrome, neurocognitive impairments, cardiovascular and respiratory and other diseases,” researchers warned in a 2014 article in the journal Current Pharmaceutical Design.

Research on the long-term effects of daily marijuana use is also limited. Fortunately, the National Institutes of Health is sponsoring major research on medical cannabis, including a 5-year study to see if medical cannabis reduces opioid use in adults with chronic pain. Similar efforts are underway at the UCLA Cannabis Research Initiative and elsewhere.

Therefore, it is premature to assume that medical cannabis is a thoroughly understood substance that will safely solve all chronic pain problems. Chronic painful conditions are complex, and the treatments that work for one condition may be contraindicated for another. Moreover, not everyone tolerates cannabis, just as not everyone tolerates NSAIDs or opioids. And a person’s medical condition and treatment plan may or may not be able to accommodate cannabis.

Medical cannabis has the potential to become another resource for pain management. It is showing promise for some neuropathic pain disorders, but does not seem to be as effective for visceral or rheumatic pain. In time, we will know how to use medical cannabis safely and reliably. But the present enthusiasm is running ahead of the science, and conclusions are preceding analysis.

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.

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.

Medical Marijuana Will Not Cure the Opioid Crisis

By Roger Chriss, Columnist

There is a strong push underway to utilize medical marijuana as an alternative to opioid pain medications.

“There’s a large group of patients who have chronic pain who rely on opioids,” Dr. Charles Bush-Joseph recently told the Chicago Tribune. “Those are the patients who would benefit from medical cannabis.”

Indeed, medical marijuana and synthetic forms of cannabis are showing promise in treating chronic pain and related disorders. Recent research has shown that the marijuana-based medication dronabinol is effective in the management of neuropathy in multiple sclerosis. Similarly, another novel cannabidiol made by GW Pharmaceuticals has been found to help manage treatment-resistant epilepsy.

But while medical marijuana is showing potential in treating many medical problems -- including chronic pain conditions -- it will not have a significant impact on the rate of opioid addiction or overdoses.  

Media reports from outlets like Big Think erroneously associate the opioid crisis with chronic pain management and misinterpret recent studies on opioid overdose rates in states with legal medical cannabis.

In fact, chronic pain management is not a significant causal factor in the opioid crisis. The National Institute on Drug Abuse estimates that between 8 and 12 percent of people on long-term opioid therapy develop some form of opioid use disorder.  A Cochrane review put the number even lower – with less than 1% of chronic pain patients becoming addicted.

In other words, people who need opioid pain medication are rarely the ones who become addicted and reports of doctor-shopping pain patients are greatly exaggerated.  It is also clear from recent reports by the CDC that the prescribing of opioid pain medication has been dropping steadily since 2010 and that the main drivers of the opioid crisis are now heroin and illicit fentanyl.

Moreover, research only shows an association, not a causal relation, between legal medical cannabis and opioid overdose rates. A recent study from the University of New Mexico showed that people with chronic musculoskeletal pain preferentially used medical cannabis over opioid analgesics. But this result is only preliminary and small-scale, and is unrelated to opioid addiction or overdose.

A 2014 study in JAMA also found an association between medical marijuana laws and a decline in opioid overdose mortality rates. But the authors of the study were careful to note that “our findings apply to states that passed medical cannabis laws during the study period and the association between future laws and opioid analgesic overdose mortality may differ.”

Recent data from Colorado, which legalized medical cannabis in 2000, shows the number of newborns in the state addicted to opioids jumped 83 percent from 2010 to 2015, a result that suggests rising levels of opioid use. Similarly, significant increases in fatal overdoses involving opioids are emerging in Washington state, where medical marijuana has been legal since 1998.

Opioid overdoses are also increasing in other states that recently legalized cannabis, although the increase is most likely caused by heroin and illicit fentanyl, not opioid pain medication.

Medical cannabis has been mentioned as potentially helpful in treating opioid addiction. But a small new observational study from Washington State University concludes that cannabis use by patients in an addiction treatment program may actually strengthen the relationship between pain, depression and anxiety.

"For people who are using cannabis the most, they have a very strong relationship between pain and mood symptoms, and that's not necessarily the pattern you'd want to see," said lead researcher Marian Wilson, PhD, of the Washington State University College of Nursing. "You would hope, if cannabis is helpful, the more they use it the fewer symptoms they'd see."

About two-thirds of the 150 patients surveyed by Wilson said they had used marijuana in the past month.

"Some are admitting they use it just for recreation purposes, but a large number are saying they use it to help with pain, sleep, and their mood," Wilson said. "We don't have evidence with this study that cannabis is helping with those issues."

None of this is meant to downplay the potential of cannabis in pain management or other areas of medicine. Medical cannabis has long been recognized for its use in treating chemotherapy-induced nausea, in loss of appetite due to end-stage cancer, and in treating pain in disorders like multiple sclerosis. More research will help clarify what else medical cannabis may be able to do.

But the legalization of medical cannabis is not going to cure the opioid crisis. Instead, the excessive and uncritical enthusiasm for it in some recent media reports and research publications is creating unrealistic expectations. These expectations could be used to justify reductions in pain medications that are working, complicating the lives of people with intractable pain disorders for no good reason.

If medical cannabis works, let's use it. But let’s make sure we’re using it for the right reasons.

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.

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.

DEA Gives Final Approval to Synthetic Marijuana Drug

By Pat Anson, Editor

The U.S. Drug Enforcement Administration has approved a synthetic form of THC (tetrahydrocannabinol) – the active ingredient in marijuana that makes people “high” – as a Schedule II controlled substance. The move is the final regulatory hurdle for dronabinol (Syndros), an oral solution already being prescribed for the treatment of nausea and vomiting in chemotherapy patients, and as an appetite stimulant for AIDS patients.

Schedule II substances include oxycodone, hydrocodone and other drugs that have an accepted medical use, but a high abuse potential.  

The DEA announced the scheduling of dronabinol in a notice quietly published in the Federal Register the day before Thanksgiving. The agency adopted an interim rule classifying dronabinol as a Schedule II substance in March, and the Food and Drug Administration approved a new drug application for dronabinol in July, recommending that DEA make its rule final.

This week’s action was not unexpected, but is weirdly ironic on several levels.

The classification of dronabinal as a Schedule II substance means that a synthetic version of marijuana can be legally prescribed throughout the country, while real marijuana is still classified as a dangerous Schedule I substance and remains illegal under federal law – except in the 29 states and the District of Columbia where medical cannabis is legal.

Dronabinol is sold under the brand named Syndros by Insys Therapeutics, a controversial Arizona drug maker beset by allegations that another one of its products – a potent fentanyl spray called Subsys – is responsible for hundreds of overdose deaths.

The DEA has been aggressively going after doctors who prescribed Subsys and accepted speaking fees from Insys, and several company officials have been indicted on fraud, racketeering and kickback charges.

Snydros is similar to Marinol, another medication derived from marijuana that comes in pill form.

insys therapeutics photo

The DEA's action is also notable because it gives Insys the exclusive right to manufacture and sell its liquid formulation of dronabinol without having to worry about competition. Any other synthetic version not sold as Syndros will still be considered a Schedule I substance, on par with LSD, heroin and marijuana.

 “It should be noted as a preliminary matter that any form of dronabinol other than in an FDA-approved drug product remains a schedule I controlled substance, and those who handle such material remain subject to the regulatory controls, and administrative, civil, and criminal sanctions, applicable to schedule I controlled substances set forth in the CSA (Controlled Substance Act) and DEA regulations,” the DEA said.

According to Healthcare Bluebook, a one-month supply of Syndros will cost about $2,000 at major pharmacy chains. A "fair price" for Syndros is listed as $1,000.

Insys Thereapeutics drew the ire of marijuana advocates last year when it donated $500,000 to a campaign against the legalization of marijuana in Arizona.

The company is worried about the medical use of “natural cannabis,” but has petitioned the DEA to reschedule another synthetic cannabidiol (CBD) that is derived from marijuana from Schedule I to Schedule IV.

Most Cannabidiol Oils Sold Online Mislabeled

By Pat Anson, Editor

With opioid medication increasingly harder to obtain and other types of pain relievers often ineffective, many chronic pain sufferers have turned to cannabidiol-based medication for relief.

But a new study published in JAMA has found that nearly 70 percent of all cannabidiol (CBD) products sold online are either over or under-labeled. Researchers say a number of CBD products that are used to treat pain, anxiety, epilepsy and other medical conditions also contain high-levels of tetrahydrocannabinol (THC), the substance in marijuana that makes people high.

“The biggest implication is that many of these patients may not be getting the proper dosage; they’re either not getting enough for it to be effective or they’re getting too much,” said lead author Marcel Bonn-Miller, PhD, an adjunct professor of psychology at the Perelman School of Medicine at the University of Pennsylvania

“This is a medication that is often used for children with epilepsy, so parents could be giving their child THC without even knowing it.”

Like THC, CBD is one of the active ingredients in marijuana, but it is not generally known to produce euphoria or make people high. CBD is currently classified as a Schedule I controlled substance by the federal government, even though it has been legalized for medicinal use in 29 states and the District of Columbia.

DRUG POLICY ALLIANCE

Bonn-Miller says the mislabeling and poor quality control of CBD products is a direct result of inadequate regulation.

“The big problem, with this being something that is not federally legal, is that the needed quality assurance oversight from the Food and Drug Administration is not available. There are currently no standards for producing, testing, or labeling these oils,” Bonn-Miller said. “There is no way to know what is actually in the bottle. It’s crazy to have less oversight and information about a product being widely used for medicinal purposes, especially in very ill children, than a Hershey bar.”

Bonn-Miller and his colleagues searched the Internet and purchased 84 CBD products from 31 different companies. They found that four out of ten products were under-labeled, meaning they contained a higher concentration of CBD than indicated. Another 26 percent of products purchased were over-labeled, meaning they contained a lower concentration of CBD than indicated.

Only 30 percent of CBD products purchased contained an actual CBD content that was within 10% of the amount listed on the product label. THC was detected in 21% of the samples.

“This is a wake up call for the CBD industry to standardize their products,” said co-author Jahan Marcu, PhD, Chief Science Officer for Americans for Safe Access (ASA).

“CBD product manufacturers need to adopt best practices and accept guidance from AHPA (American Herbal Products Association) and other groups to improve consistency and safety for consumers.”

ASA and AHPA supports the Patient Focused Certification (PFC) program, a non-profit, peer reviewed, third party certification program for the medical cannabis industry. Products that carry the PFC label have met their standards and been certified.

“I am constantly contacted for suggestions for a safe company that sells CBD - and it would be helpful to steer people in the right direction,” said Ellen Lenox Smith, a medical marijuana user, advocate and PNN columnist.

“Although less or more CBD won't hurt you, it makes sense to develop a method for people to know they are getting the correct product that is being claimed. If THC is found in the product, then someone out there is not abiding by the law and is using a form of cannabis, thus breaking the law.”

The problem isn’t limited to CBD oils and extracts. In a previous study, Bonn-Miller and his colleagues analyzed cannabinoid dose and label accuracy in edible marijuana products and found similar discrepancies. He hopes this and future studies will call attention to the impact of inconsistent cannabis product labelling.

“Future research should be focused on making sure people are paying attention to this issue and encouraging regulation in this rapidly expanding industry,” Bonn-Miller said.

Can Marijuana Improve Your Sex Life?

By Roger Chriss, Columnist

A new study by researchers at Stanford University, published in the Journal of Sexual Medicine, shows that marijuana use is associated with greater sexual frequency in both men and women. There has been a lot of enthusiasm about the findings, but relatively little understanding of what the research actually says.

Marijuana has intriguing medical potential, from symptom relief in terminal cancer patients to pain management in chronic conditions. And the possibility that it may improve sexual function is enticing in particular for people with health problems. Thus, it’s important to understand what any new results are really saying. So let’s use this paper as a case study on how to read a research paper.

We start with the study methodology. Because the gold-standard of a double-blind placebo-controlled randomized prospective trial is not possible with marijuana, the authors had to engage in data mining, the process of using an existing data set to ask new questions.

For a data source, the study uses the National Survey of Family Growth (NSFG), a large database assembled by the CDC. The study results were drawn from an analysis of 28,176 women (average age = 29.9 years) and 22,943 men (average age = 29.5).

It is important not to be impressed by these large numbers. Increasing a sample size beyond a certain point offers no additional reliability, and it may create more problems with confounding variables and hidden biases. Because the authors did not assemble this data themselves, there was no way for them to address these issues.

A sanity check of the data is the next step. This study looks at sexual frequency at various levels of marijuana use. A check of the International Encyclopedia of Human Sexuality shows that “on average, men and women engage in sexual intercourse approximately six times per month.”

This is consistent with the Stanford study findings, but with a caveat: recall of the previous month’s sexual activity or marijuana use may be imperfect. Some researchers try to get around this problem by having participants keep written logs or by using apps, but this study did not.

It is also important to keep in mind that the study variable of sexual frequency is an imperfect number. You cannot have sex 0.73 times!  Any change in sexual frequency has to occur in increments of one per unit time. In this study, the unit time is a 4-week period. The increase reported in the study represents the smallest possible increase, or one additional sexual event. The authors found that regular marijuana use was associated with one more sexual event every four weeks.

The study mentions the use of the NSFG data as a limitation. The authors note that “survey responses were self-reported and represent participants only at a specific point in time.” But there is a deeper issue here. As noted above, the data set may contain flaws, biases, or other issues beyond the control or even the awareness of the authors. Formally speaking, randomness is lost. In election polls, for instance, pollsters follow strict protocols to ensure randomness because doing so makes for more reliable results.

In practice, large data sets often contain many associations because life is complicated and even seemingly simple activities like sex are subject to a variety of influences. So posing questions to large data sets requires caution, or as statisticians sometimes say, “give me a large enough data set and I can prove anything.”

The Stanford study’s conclusion is that a “positive association between marijuana use and sexual frequency is seen in men and women across all demographic groups.”

But in an interview with The Washington Post, the authors qualify that by noting that the study “doesn't say if you smoke more marijuana, you'll have more sex,” appropriately warning that correlation is not causation.

Spurious Correlations

But the mantra of “correlation does not imply causation” is simplistic. In reality, association does not even imply direction. It is equally reasonable here to say that greater sexual frequency is associated with increased marijuana use. But changing the word order alters the implication.

The second problem is that the association may be meaningless, an artifact of our data-rich world. Such spurious correlations can even be a source of entertainment. For instance, coital frequency may be correlated with living in an even-numbered zip code or marijuana use may be associated with banana slug activity.

Not to make light of overdoses, but there is even a spurious correlation between deaths caused by opioids and the price of potato chips:

SOURCE: TYLERVIGEN.COM

These associations could be tested, but a positive result would probably not get the kind of media attention the Stanford study is receiving.

Moreover, sexual activity is influenced by a wide range of factors. It is possible that regular marijuana users have a lifestyle more conducive to sex, making lifestyle a lurking variable that affects both sexual frequency and marijuana use. Or it may be that daily marijuana users have more disposable income, more time to enjoy the effects of marijuana, and a more drug-tolerant work situation. In this case, marijuana use would act as a proxy for other potentially causal factors that influence coital frequency.

Because these issues are always found in large data sets, the potential for finding meaningless associations is ever-present. Or as statisticians say, “if you torture the data enough, you can get it to confess to anything.”

Thus, a study of this nature has inherent limitations that mean its results must be interpreted with caution. As the authors note in their conclusion, “the effects of marijuana use on sexual function warrant further study.”

So our final task is to consider what would constitute further study. Obviously, this result needs to be confirmed, ideally with a prospective study that controls for confounders. If the result is reproduced, then the hard work of identifying the causes begins. Once identified and confirmed through human testing, then and only then can we say that marijuana increases sexual frequency. For now the best we can do is read such studies with care and caution.

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society.

Roger is a technical consultant in Washington state, where he specializes in mathematics and research.

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.

Sessions Seeks to End Protection for Medical Marijuana

By Ellen Lenox Smith, Columnist

If you’re one of the millions of Americans who uses medical marijuana, you need to be aware of something going on in Congress that could affect your legal right to use cannabis.  

A few months ago, Attorney General Jeff Sessions wrote a letter to congressional leaders urging them to ditch an amendment that effectively prevents the Department of Justice from investigating or prosecuting cannabis users or sellers in states where medical marijuana is legal.

The Rohrabacher-Farr amendment first became law in 2014. It forbids the Justice Department from using any funds to prevent states from “implementing their own State laws that authorize the use, distribution, possession, or cultivation of medical marijuana.” Last year the Ninth Circuit Court of Appeals ruled that the provision protects marijuana growers, patients and dispensaries who are complying with medical marijuana laws in 29 states and the District of Columbia.

Those of us involved in our own state's medical marijuana programs felt safe and legally protected – until the Attorney General wrote his letter.

ATTORNEY GENERAL JEFF SESSIONS

Although the amendment has been attached to spending bills for years, Sessions wants to make sure it’s not in appropriations legislation for 2018. He stated in his letter that the court ruling gives dangerous criminals a loophole to protect themselves from prosecution. 

Sessions says the country is “in the midst of an historic drug epidemic and potentially long-term uptick in violent crime,” and the Justice 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.” 

Sessions appears to be deliberately equating medical marijuana use with the so-called opioid epidemic. But an emerging tide of research indicates otherwise. Opioid overdoses have actually declined in states where marijuana is legal and many pain patients prefer cannabis over opioid medication.

John Hudak of the Brookings Institution called Session’s letter a "scare tactic” that just might work. He told The Washington Post that Sessions "could appeal to rank-and-file members or to committee chairs in Congress in ways that could threaten the future of this Amendment."

So far Session’s arguments haven’t gained much traction in the U.S. Senate. In July, the Senate Appropriations Committee voted to keep the Rohrabacher–Farr  amendment in the appropriations bill for 2018.

“The federal government can't investigate everything and shouldn’t, and I don’t want them pursuing medical marijuana patients who are following state law,” Vermont Sen. Patrick Leahy (D) told The Hill. “We have more important things for the Department of Justice to do than tracking down doctors or epileptics using medical marijuana legally in their state."

But the Senate and House must work out a compromise, and it’s unclear how the House will vote. Last month the House Committee on Rules voted to remove the amendment from the House appropriations bill after Republican leaders said it was too “divisive.”

In the past, there has been broad bipartisan support for the amendment in Congress. One of its sponsors, California Rep. Dana Rohrabacher, is a conservative Republican who has long supported marijuana legalization. Without his amendment, Rohrabacher says Congress would be undermining the rights of states to make their own laws.

“The status quo for four years has been the federal government will not interfere because the Department of Justice is not permitted to use its resources to supersede a state that has legalized the medical use of marijuana,” Rohrabacher told his colleagues.

Many Americans agree. Support for medical marijuana is at an all-time high, reaching as much as 94 percent in one poll. 

Where do you stand? Where does your congressman? Should medical marijuana be protected from federal prosecution in states where it is legal?

I, for one, depend on cannabis for life. And will do all I can to let my voice be heard.

Ellen Lenox Smith lives with 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, 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.

Is Medical Marijuana Causing More Fatal Crashes?

By Rochelle Odell, Columnist

Medical marijuana’s role in fatal auto accidents is a subject that’s rarely addressed by those who support full legalization of cannabis. But I found numerous articles about it online and all show there is cause for concern.

An NBC News story warned that “Pot Fuels Surge in Drugged Driving Deaths” back in 2014, the year after Colorado became the first state to legalize recreational marijuana:

“During each shift at her drive-through window, once an hour, Cordelia Cordova sees people rolling joints in their cars. Some blow smoke in her face and smile.

Cordova, who lost a 23-year-old niece and her 1-month-old son to a driver who admitted he smoked pot that day, never smiles back. She thinks legal marijuana in Colorado, where she works, is making the problem of drugged driving worse.”

“Drugged driving” is a term I had not heard before. Police agencies and medical professionals usually refer to it as driving under the influence or operating a vehicle while intoxicated. It is a perfect description, not only for marijuana, but for any substance that alters your ability to safely operate a vehicle.

The NBC News story quotes researchers at Columbia University, who looked at toxicology reports on over 23,000 dead drivers in six states were medical marijuana was legal. Cannabis was detected in the bodies three times more often in 2010 than in 1999.  

"This trend suggests that marijuana is playing an increased role in fatal crashes, said Dr. Guohua Li, co-author and director for Injury Epidemiology and Prevention at Columbia University Medical Center.

But alcohol was the most common mind-altering substance detected, appearing in the blood of nearly 40 percent of the drivers who died in 2010.

Research on this subject can be somewhat contradictory. A second study at Columbia found that states with medical marijuana laws had an 11 percent decrease in traffic fatalities. They also found there were fewer alcohol related accidents, suggesting that some younger drivers were substituting marijuana for alcohol.

Marijuana, like opiates and alcohol, should never be consumed by someone intending to drive. Even cannabidiol (CBD) based medications, which marijuana supporters tout as safe, may contain trace amounts tetrahydrocannabinol (THC), the chemical ingredient in cannabis that makes people high.

I am not an active proponent of medical marijuana, although I realize there are those who benefit from its use. But cannabis is not always the "magic bullet" when it comes to pain relief, and not all pain patients support it.

I tried CBD medication for three weeks and it did nothing for my pain. Being asthmatic precludes me from smoking or vaping, and I have been told using edibles in the amount required to achieve pain relief would require a large amount. Medical marijuana is also costly and can be cost prohibitive for those of us on fixed incomes.

I did vote for full legalization last year when it was on the California ballot. I also believe those who buy it from medical marijuana dispensaries have a right to know where it is cultivated, along with what pesticides, fertilizers or other harmful substances may have been used in its cultivation. People are going to use marijuana whether it is legal or illegal, so state and federal governments should legislate accordingly.

Studies show that Colorado, Oregon and Washington State have all seen an increase in car crashes since they fully legalized marijuana, although the number of fatal crashes has remained about the same. A recent analysis by the Denver Post found the number of drivers in Colorado who tested positive for marijuana after fatal crashes has risen by 145 percent since 2013.

Like everything else, we can draw our own conclusions from these statistics. I only ask that readers who are medical marijuana users check your state’s laws before smoking or vaping, consuming CBD, or ingesting the popular edibles.

THC is a known psychoactive and can affect your ability to safely operate a vehicle. CBD can also show up in toxicology reports and will reflect on the driver if they’re involved in an accident. Please educate yourself and be sober from any substance, legal or illegal, before driving.

Rochelle Odell lives in California. She’s lived for nearly 25 years with Complex Regional Pain Syndrome (CRPS/RSD).

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.

Strong Support for Cannabis Rx in Comments to FDA

By Pat Anson, Editor

The Food and Drug Administration may have gotten more than it bargained for when it asked for public comments about the medical value and abuse potential of 17 different drugs.

The agency wound up getting over 6,400 comments in the Federal Register, the vast majority of them from people advocating for cannabidiol (CBD) -- one of the active ingredients in medical marijuana.  

Unlike tetrahydrocannabinol (THC), the substance in marijuana that makes people high, CBD-based oils and medications relieve pain, and are increasingly being used to treat a variety of medical conditions.  

“CBD's are not a way to get high as THC is. These oils have so many beneficial uses for anxiety, stress, pain, joint issues, muscular issues, arthritis, seizures, Parkinson's, cancer,” wrote Tami Camp in her public comment. “We need natural herbs, not man-made poisons!”

“CBD helps me with my chronic nerve pain, in a way that prescription medications can't match,” wrote Jason Turgeon.

“I've been consistently using CBD oil now for three months and have noticed an uptick in my moods, a reduction of joint pain, and my sleeping cycles at night have improved as my sleep is deeper and I wake up feeling refreshed,” wrote Kerry Meier.

Public opinion polls show that these are not isolated comments or marijuana supporters trying to game the system by flooding the Federal Register with comments. A recent poll by CBS News found 85% of Americans favor medical marijuana use.

drug policy alliance photo

But while medical cannabis may be legal in 29 states and the District of Columbia, marijuana is still classified as an illegal Schedule I controlled substance by the Drug Enforcement Administration, right alongside heroin and LSD.

The FDA opened the cannabis can of worms at the behest of the World Health Organization (WHO), which is not only reviewing the safety and effectiveness of CBD, but 16 other drugs -- including pregabalin, tramadol, ketamine, and several chemical cousins of fentanyl, a synthetic opioid blamed for thousands of overdose deaths. 

WHO is seeking input from the FDA on whether international restrictions should be placed on any of the drugs. Under the Controlled Substances Act, the FDA was required to seek public comment in the Federal Register before responding to WHO -- perhaps not anticipating the overwhelmingly positive response that CBD would get. 

“Cannabidiol should not be restricted because CBD is not addictive, nor does it have the potential for abuse nor should it be tied to hallucinogenic drugs. Therefore, no international restrictions should be placed on CBD,” wrote Steve Easterly.

“For cannabis to be scheduled as a class I drug is ludicrous especially when the entire prohibition of cannabis was based on lies,” wrote Mike Copple. “What a shameful spectacle that we the people still have to argue about the usefulness of the cannabis plant. Cannabis has and continues to help me in many ways both physically and mentally.”

“I want cannabis to be legalized and available for over the counter sale. I have known several people who have benefited for various conditions from anxiety, depressions, MS, arthritis and epilepsy,” wrote Nancy Scott-Puopolo.

The public comment period ended on Wednesday. You can look at other responses in the Federal Register by clicking here. 

Mixed Reviews of Lyrica

There were only a few dozen comments about pregabalin (Lyrica), a prescription medication that millions of Americans take for fibromyalgia, neuropathy and other chronic pain conditions. As PNN has reported, WHO is investigating reports that pregabalin is being abused by addicts.

“Patients are self-administering higher than recommended doses (of pregabalin) to achieve euphoria, especially patients who have a history of substance abuse, particularly opioids, and psychiatric illness,” WHO told the FDA..

The public comments about pregabalin were mixed at best.

“I have been on several medications prior to being switched to Lyrica about six months ago. I actually feel nothing while taking the drug, and assume you would indeed have to take lots to maybe feel high,” wrote Mary. “Not sure if it helps my fibromyalgia or not since I still have lots of pain.”

“I take pregabalin in Lyrica form twice a day currently for nerve pain and fibromyalgia. I cannot accurately express the relief this has brought me,” wrote Renee.

“I have tried many, many medications. When I tried Lyrica, the side effects were horrible. I couldn't even lift my head without severe dizziness and the room spinning,” said Lora Berry.  

“I take Lyrica and all I got from it was fatter,” said Debra Winegar. “CBD oil is wonderful. Take a few drops under the tongue and I'm good to go. Narcotics are needed when my pain is out of control. I'm tired of waiting to be pain free. Legalize pot now!”

Will the FDA now report to WHO that thousands of American citizens want CBD-based medications fully legalized?  The FDA notice in the Federal Register only notes that public comments “will be considered” when the FDA prepares its scientific and medical evaluation. The FDA report to WHO is due September 30.