Pain and Anxiety Reduced in First New Zealand Cannabis Patients

By Pat Anson, PNN Editor

A study of the first patients prescribed medical cannabis after it was legalized in New Zealand in 2017 found that cannabidiol – the non-psychoactive ingredient in marijuana -- significantly improved their chronic pain and anxiety.

Researchers at the University of Auckland analyzed the health records of the first 397 patients prescribed cannabidiol (CBD oil) at a cannabis clinic in Auckland. The patients live with a variety of chronic pain conditions, including fibromyalgia, osteoarthritis, rheumatoid arthritis, neuropathy, multiple sclerosis, migraines and cancer.

Participants were asked to rate their pain, anxiety, mobility and depression before taking CBD oil and four weeks after starting treatment. The CBD doses ranged from 40mg/day to 300mg/day. The recommended daily dose was at least 100 mg.

Patients with non-cancer pain reported significant improvement in their pain, mobility, anxiety and depression. Some also said they slept better and their appetite improved.

Patients with neurological symptoms experienced no improvement with any symptom, and patients with cancer only reported improvement in pain.

Most patients said they were satisfied with CBD oil, with 70% reporting it was good, very good or excellent; while 30% reported no benefit.

Adverse side-effects, which included sedation and vivid dreams, were reported by about 10% of participants, with two patients (0.8 percent) reporting a worsening of a pre-existing condition.

“The study has limitations due to drop-out and other factors, but the findings are consistent with other evidence and underline the need for more research to allow us to fully realise the therapeutic potential of medical cannabis,” said Professor Bruce Arroll, senior author of the study and head of the Department of General Practice and Primary Healthcare at the University of Auckland.

“Our findings show that CBD is well-tolerated in most patients and can markedly ease symptoms in a range of hard-to-treat conditions, and that there are people keen to access this and self-fund the medication.”

Some patients chose not to take CBD oil because of its cost. Patients had to pay $300 (US) for 2500 mg of CBD oil, $150 for an initial consultation, and $75 for a follow-up.

“Our evidence of CBD’s potential benefits in treating pain and anxiety, if corroborated by future clinical trials, suggests we may need to consider subsidising medical cannabis,” said co-author Dr. Graham Gulbransen, who operates the cannabis clinic in Auckland. 

Because the study was observational and relied on patients self-reporting their symptoms, it did not establish a cause-and-effect relationship. It’s also possible the improvement in symptoms was due to a placebo effect.

The findings are published in the British Journal of General Practice Open (BJGP Open).

Tolerance Reduces Sleep Benefits of Medical Cannabis

By Pat Anson, PNN Editor

Getting a good night’s sleep can be a godsend to someone suffering from chronic pain. That’s why many pain patients are experimenting with medical cannabis to help manage their sleep problems.

But a small new study found that while cannabis initially helps with sleep, regular use leads to drug tolerance that causes even more sleep problems. A second study raises doubts about the use of cannabinoids in treating cancer pain.

Researchers at the Rambam Institute for Pain Medicine in Israel enrolled 129 volunteers over age 50 with chronic neuropathic pain. About half used medical cannabis for at least a year, either by smoking (69%), oil extracts (21%) or vaporizers (20%). The other half did not use cannabis.

Sleep problems were common among both groups of patients, with about 3 out 4 having trouble falling asleep or staying asleep.

Researchers found that cannabis users were less likely to wake up during the night, compared to those who did not use the drug. But over time the benefits of cannabis were reversed, and frequent users found it harder to fall asleep and woke up more often during the night.

The findings are published in the British Medical Journal's Supportive and Palliative Care journal.

“This study is among the first to test the link between whole plant MC (medical cannabis) use and sleep quality. In our sample of older (50+ years) chronic pain patients we found that MC may be related to fewer awakenings at night. Yet patients may also develop tolerance to the sleep-aid characteristics of MC,” researchers wrote.

“These findings may have large public health impacts considering the ageing of the population, the relatively high prevalence of sleep problems in this population along with increasing use of MC.”

The study was observational and did not establish a direct causal link between cannabis and sleep.  Another weakness is that the specific timing of cannabis use by participants was unknown. Taking cannabis before bedtime may have a stronger association with sleep. The researchers said their findings were preliminary and more larger studies were needed.

Cannabinoids Not Recommended for Cancer Pain

Another study published in the same medical journal found that cannabinoids do not reduce pain in patients with advanced cancer.

Researchers at the University of Hull in the UK reviewed data from five high-quality clinical studies involving 1,442 cancer patients and found that pain intensity was no different between those taking cannabinoids and those given a placebo.

Patients using cannabinoids also had nearly twice the risk of short-term side effects such as dizziness, drowsiness, nausea and fatigue. They were also more likely to drop out of studies.  

“For a medication to be useful, there needs to be a net overall benefit, with the positive effects (analgesia) outweighing adverse effects. None of the included phase III studies show benefit of cannabinoids,” researchers concluded.

“When statistically pooled, there was no decrease in pain score from cannabinoids. There are, however, significant adverse effects and dropouts reported from cannabinoids. Based on evidence with a low risk of bias, cannabinoids cannot be recommended for the treatment of cancer-related pain.”

The American Cancer Society takes a different view, pointing out that studies have found marijuana smoking can be helpful in treating nausea from cancer chemotherapy.  Other studies have also suggested that THC, CBD and other cannabinoids slow the growth of cancer cells in a laboratory setting.

Medical marijuana is legal in 33 In U.S. states and cancer is recognized as a qualifying condition in many of them.

Questioning the New Cannabinoids

By Roger Chriss, PNN Columnist

A new cannabinoid similar to THC was announced last month in Scientific Reports. Dubbed tetrahydrocannabiphorol, or THCP for short, it is being hailed as a “breakthrough discovery” that is 30 times stronger than THC, the chemical compound in cannabis that causes euphoria.

Discovered by a group of Italian researchers, THCP has been shown to have a high affinity for the cannabinoid receptor (CB1) in the brain. Cinzia Citti from the Institute of Nanotechnology told Medical Cannabis Network that THCP likely has pain relieving effects, but pharmacological studies are needed to confirm it.

“Once all pharmacological profile of THCP has been established, I can imagine that THCP-rich cannabis varieties will be developed in the future for specific pathologies,” Citti said.

THCP’s chemical structure makes it nearly optimal for activity at the CB1 receptor. Studies on mice showed that THCP has psychoactive effects at low doses, but research is required to confirm how strongly THCP acts on the human brain.

‘Potential Game Changer’

There is already great enthusiasm for THCP, as well as cannabidiphorol (CBDP), another newly identified cannabinoid compound.

Vice states that “it’s possible these chemicals could treat certain conditions better than their counterparts,” THC and CBD.

Leafly went even further, predicting the new cannabinoids could have “immense therapeutic implications,” with THCP being a “potential game changer.”

Looking beyond the media hype, there appears to be no critical consideration of what a cannabinoid 30 times more potent than THC might mean. THC Is known to have significant negative effects on the human body. The National Institute on Drug Abuse lists side effects such as impaired breathing, increased heart rate, and mental effects such as hallucinations, paranoia and schizophrenia.

Moreover, THC is addictive. Health Canada reports that 1 out of 10 people who use cannabis will develop an addiction. The addiction odds increase to 1 out of 2 for people who use cannabis daily.

In other words, is THCP going to be 30 times more additive than THC? Will it cause 30 times more cognitive impairment? A 30-fold increase in ER visits and hospital admissions?

If THCP acts much more strongly on the CB1 receptor, then it may not really be a good thing for cannabis users or public health. These questions may seem absurd, but potent synthetic cannabinoids like K2/Spice have been a public health concern for many years. THCP may also have unknown side effects.

The difference between THC and CBD comes down to one chemical bond, but their respective effects are quite different. The apparent similarities between THCP and THC cannot be used to draw conclusions about effects in humans, good or bad.  

At present, very little is known about THCP. As Live Science points out, "while THC offers some medicinal effects, including pain and nausea relief, no one knows if THCP has these qualities."

It would be nice if even just one media outlet had mentioned the THCP could have some of the same problems that THC does, and at far lower concentrations.

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. 

Research Explores Cannabis as Treatment for MS, Alzheimer’s and Huntington’s Disease

By Pat Anson, PNN Editor

The University of Alberta is partnering with a Canadian cannabis company in three research projects exploring the use of medical cannabis for the treatment of multiple sclerosis, Alzheimer’s and Huntington’s diseases. 

Atlas Biotechnologies is investing nearly $300,000 over the next two years to fund the studies. Atlas operates a 38,000 square foot cannabis production facility near Edmonton and will supply customized blends of cannabis products to U of A researchers.

“People are touting (cannabis) for all kinds of things, but without solid scientific evidence,” said Ross Tsuyuki, PharmD, chair of the Department of Pharmacology at U of A. “But there likely are benefits for some conditions.”

The most well-known chemical compounds in cannabis are tetrahydrocannabinol (THC) and cannabidiol (CBD), but the plant has hundreds of other active biological chemicals, each with the potential of having therapeutic benefits. The goal of the research is to identify what specific compounds or combinations of compounds are effective.

“We've got to figure out the best combination of those compounds and how they're actually working in people,” Jeffrey Gossain, Atlas’ chief operating officer, told Folio, the University of Alberta's news site.  “A lot of people will tell you, 'My mom had cancer’ or, ‘My friend had an illness, and they took cannabis and it helped.’ But then for other people they don't have as effective results. 

“Part of the problem is that you don't really know what product they took, how they dosed it or the combinations of chemicals in the product that helped. It's not as simple as just saying, ‘The plant's got THC and CBD.’ You've got to get a lot more detailed than that.”

The research will examine whether CBD and other cannabinoids can relieve pain in patients with multiple sclerosis; if cannabis can reduce neuroinflammation and degeneration of the brain caused by Huntington's disease; and if cannabinoids have neuroprotective activity in models of Alzheimer’s disease.

“Alzheimer's disease, chronic pain, multiple sclerosis and Huntington's disease are all devastating conditions that don't have a lot of effective treatments,” said Tsuyuki. “If we find something, even if it works just a little, that could be an enormous advance for patients. But we have to do our homework first, and that is where we're starting.”

In addition to its partnership with the U of A, Atlas is collaborating with Harvard Medical School in developing cannabis products for pain and other neurological conditions.

A recent study found that medical cannabis is mildly effective in relieving pain and other symptoms in patients with multiple sclerosis (MS). Spanish researchers analyzed 17 clinical trials involving different combinations of THC and CBD, and found cannabis had limited effectiveness in relieving pain, muscle spasticity and bladder dysfunction.

MS is a chronic and incurable disease which attacks the body’s central nervous system, causing numbness in the limbs, difficulty walking, paralysis, loss of vision, fatigue and pain.

Study Warns of Fake Cannabis Posts on Twitter

By Pat Anson, PNN Editor

Russian trolls and bots aren’t the only ones using social media to try to sway public opinion.

A USC analysis of thousands of cannabis-related posts on Twitter found that social media bots regularly make unsubstantiated health claims that suggest that cannabis can help treat pain, cancer, sleep, anxiety, depression, trauma and post-traumatic stress disorder. 

Researchers say their findings, published in the American Journal of Public Health, illustrate how false statements can be used to drown out facts and science on social media.

"We're in a period of time where these misleading messages are pervasive online," said lead author Jon-Patrick Allem, PhD, assistant professor of preventive medicine at USC’s Keck School of Medicine. "We want the public to be aware of the difference between a demonstrated, scientifically-backed piece of health information and claims that are simply made up."

In the United States, cannabis-based medicines are only approved to treat nausea and vomiting caused by chemotherapy, to stimulate appetite in patients experiencing weight loss, and to reduce seizures caused by childhood epilepsy. Many of the tweets made by bots suggest cannabis can help with a variety of other health problems, including foot pain and Crohn's disease.

For the study, researchers identified over 60,000 cannabis-related tweets posted from May 2018 to December 2018. Then they used an academic research tool called “Botometer” to analyze the posts to determine which ones came from real people and which ones were generated by bots that use software to automatically generate posts.

‘Content Polluters’

About 9,000 of the cannabis tweets appeared to come from bots, which were twice as likely to mention health and medical benefits of cannabis than non-bots. Researchers found no references to FDA approved uses for cannabis in the tweets.

The USC study did not look at the individuals or organizations behind the bot-generated posts about cannabis.

"Raising the issue of these false claims by social bots is an important first step in our line of research," Allem said. "The next step will be to examine the self-reported levels of exposure and beliefs in these claims and perceived risks and benefits of cannabis use, intentions to use and actual use."

Another recent study found that bots and other “content polluters” were active on Twitter in fueling the debate over the health benefits of vaccines.

“Content from these sources gives equal attention to pro- and antivaccination arguments. This is consistent with a strategy of promoting discord across a range of controversial topics—a known tactic employed by Russian troll accounts. Such strategies may undermine the public health: normalizing these debates may lead the public to question long-standing scientific consensus regarding vaccine efficacy,” said lead author David Broniatowski, PhD, School of Engineering and Applied Science at The George Washington University.

In 2018, Twitter suspended more than 70 million fake accounts that appeared to be using bots to make posts.

PNN’s Twitter account was recently suspended for 12 days for violating Twitter’s rules against “platform manipulation and spam.” The account was reinstated after we appealed. PNN does not use bots or promote any products or services in its tweets.

Veteran With Chronic Pain Hospitalized After Vaping THC

By Marlene Harris-Taylor, Ideastream

As vaping has grown more popular in recent years, the trend has been fueled by the habit’s pleasurable allure: Compared with smoking cigarettes or pot, vaping is discreet and less smelly. Vaping fluids come in hundreds of flavors. There’s no tar or other byproducts of burning. And vape pens are high-tech, customizable and sleek.

But none of that mattered to Paul Lubell when he decided to try vaping. He wasn’t thinking about pleasure; he was trying to avoid pain. The retired Navy veteran turned to vaping marijuana, hoping it would help him cope with his chronic, debilitating musculoskeletal pain.

Unfortunately, it wasn’t long before he became part of the national statistics tracking an outbreak of a vaping-related lung illness that has killed more than 50 Americans and sickened 2,400. Lubell ended up in the hospital, seriously ill from vaping an oily liquid containing extracts of THC, the psychoactive ingredient in marijuana.

Lubell, who lives in the Cleveland suburb of Beachwood, is older than most of those who have contracted what is now being called “e-cigarette or vaping associated lung injury,” or EVALI.

Three-quarters of patients with the condition have been under age 35; Lubell is 59.

But like patients in the majority of those cases, he used THC. And the latest information from the Centers for Disease Control and Prevention suggests that it’s some added ingredient in THC vapes — likely vitamin E acetate — that is causing the lung disease. The CDC is warning people to stop vaping altogether, given the risk of lung illness, which puts people who vape to manage pain in a tough position.

‘My Pain Would Be Gone’

Lubell suffers from pain in his back, neck and knees. He is not sure when his problems started, but he wonders if they are related to his days on a Navy helicopter rescue team.

“It was fun. I was indestructible and good at what I did. Everybody wanted me,” he recalled, while looking at photos of his much younger self posing on top of one of the helicopters.

Lubell sometimes jumped out of the helicopter and smacked into the water during training and rescue missions. That could have been the genesis of some of his back pain, he said. Lubell has had two back surgeries, and he also suffers from serious neck pain. Every day is a struggle, he said.

Looking for relief, he has tried many medications, including opioids such as hydrocodone, but that drug is no longer an option. Lubell is a patient at Louis Stokes Cleveland VA Medical Center, and in the wake of the national opioid addiction epidemic, the VA has revised its pain-treatment protocols.

“The VA is not a friend of opioids at all,” Lubell said. “Unless you’re coming out of the hospital for surgery or something like that, they do not give vets opioids.”

“It leaves someone who is in chronic pain in a very tough situation, having to decide how to deal with it,” he added.

Lubell started using an electronic cigarette device paired with prefilled THC cartridges. Medical marijuana is legal in Ohio, as it is in 32 other states, plus the District of Columbia.

“When I say it took away pain — it was almost instantaneous,” he said. “Within the span of 10 minutes, my pain would be gone. … It made me capable of doing my daily activities.”

Lubell described his old vaping cartridges as tiny sticks that screwed on top of the vaping pen. When he inhaled at one end of the pen, it pulled the THC extract and other liquids in the cartridge over a heating element. Vaping was different from when he had smoked marijuana, Lubell said.

“It doesn’t have a stench to it. You could do it out on the streets. It doesn’t have that — what’s the word I’m looking for? — stigma,” he said.

Hospitalized With Cough And Fever

Lubell purchased the THC cartridges from a friend at what he described as a below-market price. A few months later, in July, Lubell started running a very high fever and went to the Cleveland VA Medical Center.

“He had this cough that was persistent. He just looked very, very sick,” recalled Dr. Amy Hise, who was on the team of physicians that treated Lubell.

“He was put on very strong broad-spectrum antibiotics, and yet he continued to have fevers. He continued to feel unwell. He had very flu-like symptoms,” Hise said.

After a few days, Lubell seemed to improve and was released, according to Hise. But then, he grew ill again.

Hise said she was surprised when he came back to the emergency department in late August.

By then, however, she had seen a new alert from the CDC about the vaping illness. Lubell had also seen reports in the media about health problems related to vaping.

“He was forthright that he had been vaping, and indeed what had happened is when he was in the hospital before, he’d stopped vaping,” Hise said. “He stopped for a period of time until he started to feel better. And then he started it up again, and that’s when his lung disease came back.”

The doctors at the VA switched tactics, taking Lubell off antibiotics and starting him on steroids, based on information provided by the CDC. Lubell was soon released and on the road to recovery.

No More Vaping

Even though vaping eased his pain, those two bouts of respiratory sickness were too much. Lubell said he won’t vape again, and his doctor endorsed that decision.

“I think there’s just too much that’s not known about what’s in these products to safely use them,” Hise said.

But Lubell is not alone in having turned to marijuana for pain management. Dr. Melinda Lawrence, a pain management specialist at University Hospitals, said many patients have told her they are trying marijuana to see if it will help.

“That is probably something that I get from patients every day,” Lawrence said. “And it’s not just people who are young, in their 20s. [There are] people in their 80s who are telling me they are looking to try anything to help with their pain.”

Even though some patients say marijuana helps their pain, there is not enough research to prove it’s broadly and reliably effective, Lawrence said.

“Personally, I don’t recommend it for my patients. But maybe after we have more studies, it can be something in the future” she said.

Lubell, who has an Ohio medical marijuana card, is still planning to use marijuana — but he won’t vape it. He turned over his equipment and leftover THC cartridges to health officials for analysis.

This story is part of a partnership that includes ideastream, NPR and Kaiser Health News, a national health policy news service.

Kratom vs. Nutmeg: Which Is More Dangerous?

By Pat Anson, PNN Editor

Here’s a trick question for you. Which substance is more dangerous – kratom or nutmeg?

News reports about a recent study that analyzed calls to U.S. poison control centers leave little room for doubt:

“Life-threatening kratom exposures rose by 5000% in 6 years,” is how the Daily Mail reported it.

“Poison Control Centers See Spike in Calls About Kratom Exposure,” was the headline used by WOSU Public Media.

While the headlines are technically accurate, the study published in the journal Clinical Toxicology did not focus solely on kratom. The herbal supplement was one of many naturally occurring psychoactive substances that resulted in over 67,000 calls to U.S. poison control centers from 2000 to 2017.

Marijuana was involved in about half of those calls, followed by plants and mushrooms that act as stimulants or cause hallucinations. Kratom ranked 7th on the list, behind substances like peyote and nutmeg. Yes, nutmeg.

POISON CONTROL CALLS (2000-2017)

1. Marijuana (31,628)

2. Anticholinergic Plants (14,236)

3. Hallucinogenic Mushrooms (10,482)

4. Morning Glory Plants (3,643)

5. Nutmeg (1,962)

6. Peyote (1,717)

7. Kratom (1,631)

8. Kava Kava (1,331)

9. Salvia (622)

10. Absinthe (65)

11. Khat (52)

In most cases, the calls to poison centers involved minor symptoms like upset stomachs or dizziness, but some were serious enough to result in hospitalizations and even deaths. Researchers said marijuana is particularly concerning because it is being sold in candies, cookies and other edibles that a child could get their hands on.

“These substances have been associated with a variety of serious medical outcomes including seizures and coma in adults and children,” said co-author Henry Spiller, director of the Central Ohio Poison Center at Nationwide Children’s Hospital.  “As more states continue to legalize marijuana in various forms, parents and health care providers should treat it like any other medication: locked up, away, and out of sight of children.

Why Did Kratom Calls Spike?

There were only 1,631 calls involving kratom made to poison control centers over an 18-year period. But the numbers started to rise sharply in recent years as more Americans discovered kratom — from 13 kratom calls in 2011 to 682 calls in 2017 — that’s where the 5,000% spike comes from.

The American Kratom Association estimates several million Americans now use kratom to treat chronic pain, addiction, anxiety and other medical conditions.

Side effects from kratom are relatively rare. But researchers say a high percentage of the calls to poison control centers about kratom resulted in hospital admissions and serious medical problems. The chief complaint for many of the calls, according to another study, was that kratom caused agitation, tachycardia (rapid heartbeat), drowsiness, vomiting and confusion.

Kratom comes from the leaves of a tree that grows in southeast Asia, where it has been used for centuries as a natural stimulant and pain reliever. Critics say calls to U.S. poison control centers are misleading and a poor choice for research.

“The data drawn from the Poison Control Centers are notoriously unreliable, inasmuch as they are anecdotal reports from the public that are gathered and reported in an unscientific fashion,” said Max Karlin, a spokesman for the Kratom Information & Resource Center. “In the absence of good data, you just end up with a garbage-in, garbage-out situation.”

Kratom has been banned in a handful of states, but is widely available online and in smoke shops. Spiller and his colleagues say it should be regulated in all 50 states.

“The continued rise in kratom usage coupled with the serious medical outcomes identified in our study support the need for federal regulation of kratom along with further research on this public health problem,” they concluded. “While rates of exposure to most natural psychoactive substances decreased during the study period, rates for marijuana, nutmeg, and kratom increased significantly.”

The study offered no explanation for the significant increase in nutmeg calls. Nor did it suggest that nutmeg be regulated.

Nutmeg is a spice known for its pungent fragrance and sweet taste, but in large doses it can also have a psychoactive effect.

As far back as the Middle Ages, people used nutmeg as a medicine and to get high. There is even a page for nutmeg on Reddit, where drug users swap stories and try to figure out the best way to ingest it.

“Do I need to ground them up to a powder or can I just make little pieces and swallow them with water? Can I smoke nutmeg? Can I snort it?” asked a nutmeg newbie.  Most people who tried nutmeg said it made them sleepy, nauseated and wasn’t worth the effort.

While any call to a poison control center is concerning, the number of calls about kratom and nutmeg that came in over an 18-year period pales in comparison to the calls that come in every day about children ingesting hand sanitizers, laundry detergent packets and other toxic products.

Which brings us back to our original question. Is kratom or nutmeg more dangerous?  When used in moderation and with common sense, millions of people will tell you neither one is.

Hold the CBD and Pass the Gravy

By Pat Anson, PNN Editor

You can now buy cannabis-infused juice, beer, popcorn, gummies, breakfast cereal, and just about every food and drink imaginable with CBD or even THC.  

But you know things are getting out of hand when a company starts selling cannabis-infused turkey gravy – just in time for Thanksgiving.

KIVA Confections – a California company that makes a line of cannabis chocolates and edibles -- has introduced a “groundbreaking” turkey gravy infused with 10mg of THC, the psychoactive compound in marijuana. Thanksgiving dinner will never be quite the same.

“Awkward family dinner conversation? In just under 15 minutes you’ll start feeling the effects, so you can sit back, relax, and let the holiday cheer wash over you,” said Kiva in a tongue-in-cheek blog post

The company plans to introduce a cannabis-infused hot cocoa mix by Christmas.  

KIVA CONFECTIONS

FDA Warns CBD Companies

Federal health officials are finally blowing the whistle on cannabis marketing. The Food and Drug Administration has issued warning letters to 15 companies for illegally selling and marketing cannabis infused products.

Ironically, the FDA’s focus is not on THC, but on cannabidiol (CBD), the seemingly harmless and over-hyped compound in cannabis associated with many health claims. The FDA has revised a Consumer Update to more clearly state that CBD is not recognized as safe for use in human or animal food.

“We remain concerned that some people wrongly think that the myriad of CBD products on the market, many of which are illegal, have been evaluated by the FDA and determined to be safe, or that trying CBD ‘can’t hurt.’ Aside from one prescription drug approved to treat two pediatric epilepsy disorders, these products have not been approved by the FDA,” Amy Abernethy, MD, FDA Principal Deputy Commissioner, said in a statement.

“We recognize the significant public interest in CBD and we must work together with stakeholders and industry to fill in the knowledge gaps about the science, safety and quality of many of these products.”

What most concerns the FDA is that CBD is being marketed as a treatment for chronic pain, arthritis, depression, addiction, anxiety and other medical conditions with no clinical evidence that it actually works.

Red Pill Medical of Phoenix, one of the companies that received a warning letter, claims CBD can cure cancer.

“We’ve seen CBD kill prostate cancer cells, kill colon cancer cells…there’s just thousands of anecdotal stories on the internet where people have cured themselves when they were told they had weeks or months to live using CBD,” Red Pill claims in a promotional video.

Another company, Whole Leaf Organics of Los Angeles, was warned about selling CBD products for pets.

“Beneficial and safe for both people and animals, CBD has been known to reduce inflammation, assist with chronic fatigue, alleviate joint and muscle pain, and help in regards to the management of stress and anxiety,” Whole Leaf claims on its website.

One company was warned about marketing CBD products for infants and children, while another was warned about selling CBD for food-producing animals such as chickens and cows.

This isn’t the first time the FDA has warned cannabis companies to be more discerning in their marketing. Similar warning letters were sent in March to three companies for making unsubstantiated health claims about their CBD oils, extracts and edibles.

One of the companies, NutraPure, now has a disclaimer on its website stating that its products “have not been evaluated” by the FDA and “are not intended to diagnose, prevent, treat, or cure any disease.” As PNN reported, however, that didn’t stop a NutraPure representative from recommending the company’s hemp oil to this reporter as a treatment for fibromyalgia.

The FDA says it will “explore potential pathways” for CBD products to be marketed legally and would be providing an update in coming weeks.

In the meantime, pass the gravy.

Cannabis Cuts Headache and Migraine Pain in Half

By Pat Anson, PNN Editor

Inhaled cannabis can significantly reduce both headache and migraine severity, according to a large new study that looked at patients who self-reported their symptoms. But researchers say the effectiveness of cannabis diminished over time, as patients used larger doses for pain relief and appeared to develop a tolerance to the drug.

Researchers at Washington State University analyzed data from the Strainprint app, which allows patients to track their symptoms while using medical cannabis. Data was collected from nearly 2,000 patients who used the app almost 20,000 times to track their headache and migraine pain before and after inhaling cannabis by smoking or vaping. The cannabis was obtained from licensed medical cannabis distributors in Canada.

"We were motivated to do this study because a substantial number of people say they use cannabis for headache and migraine, but surprisingly few studies had addressed the topic," said lead author Carrie Cuttler, PhD, a WSU assistant professor of psychology. "We wanted to approach this in an ecologically valid way, which is to look at actual patients using whole plant cannabis to medicate in their own homes and environments.”

The study, published online in the Journal of Pain, is the first to use data from headache and migraine sufferers using cannabis in real time. Previous studies have asked patients to recall the effect of cannabis use in the past.

Cuttler and her colleagues found that self-reported headache severity fell by 47.3 percent and migraine severity declined by 49.6 percent. Cannabis concentrates, such as cannabis oil, produced a larger reduction in headache severity than cannabis flower.

There was no evidence that cannabis caused "overuse headache," a pitfall of opioid medication and other pain relievers that can make headache pain worse over time. However, researchers did see patients using larger doses of cannabis over time, indicting they may be developing tolerance.

There was no significant difference in pain reduction among cannabis strains that were higher or lower in levels of tetrahydrocannabinol (THC) and cannabidiol (CBD). Since cannabis is made up of over 100 cannabinoids, the finding suggests that different cannabinoids or organic compounds like terpenes may play a central role in headache and migraine relief.

Cuttler acknowledged the limitations of using an app to collect data, since it relies on a self-selected group of people who may already anticipate that cannabis will work to alleviate their symptoms. It was also not possible to use a placebo control group.

"I suspect there are some slight overestimates of effectiveness," said Cuttler. "My hope is that this research will motivate researchers to take on the difficult work of conducting placebo-controlled trials. In the meantime, this at least gives medical cannabis patients and their doctors a little more information about what they might expect from using cannabis to manage these conditions."

PNN columnist Mia Maysack, who suffers from chronic migraine and cluster headache, reluctantly agreed to try cannabis after her first cluster headache lasted 54 straight days. Mia said she “almost instantaneously felt better.” Now she uses cannabis regularly.

“It helps me combat nausea, cultivate an appetite, gives a slight boost in morale, and get quality rest,” Mia wrote in a column. “Cannabis works for me about half the time.  But that goes deeper than a glass half empty or half full.  It's a matter of having a resemblance of a life or not.”   

Medical Cannabis Not Recommended for Chronic Pain in UK

By Pat Anson, PNN Editor

It was a little over a year ago that the UK’s Home Secretary announced that medical cannabis would be legalized in Britain and become available by prescription – a move that was cheered by cannabis activists.

“This is a major victory for our campaign and will mean a lot of people will have a much better quality of life,” said Clark French, a multiple sclerosis patient.

It turns out the celebration was premature. After a lengthy review, the UK’s National Institute for Health and Care Excellence (NICE) recently recommended to the National Health Service (NHS) that medications containing cannabidiol (CBD) only be used to treat epilepsy, multiple sclerosis and chemotherapy-induced nausea.

CBD was not recommended as a treatment for chronic pain, at least not yet.

“There is evidence to suggest that CBD reduces chronic pain,” NICE said. “However, where cannabis-based medicinal products reduced chronic pain, the benefit is small and economic analysis shows that this compares poorly with the high costs of (CBD products).”

Cannabis medications containing THC were also ruled out, even when combined with CBD.  Most cannabis products contain at least trace amounts of THC, the psychoactive ingredient in cannabis.

NICE said further research was needed to see if CBD can be used to treat fibromyalgia, neuropathy and cancer pain. It recommended that patients suffering from those conditions should only use CBD if they are part of a clinical trial.

One cannabis activist called the NICE guideline “a massive missed opportunity.”

“It is particularly devastating that there is no positive recommendation that the NHS should allow prescribing of whole-plant medical cannabis containing both CBD and THC in appropriate cases of intractable childhood epilepsy,” Millie Hinton, from the patient advocacy group End Our Pain, told The Guardian. “This restrictive guidance is condemning many patients to having to pay for life-transforming medicine privately, to go without, or to consider accessing illegal and unregulated sources.”

According to a recent survey, up to 1.4 million adults in the UK are self-medicating with illegal cannabis products.

The one big winner in the NICE report is GW Pharmaceuticals, the UK based company that developed Epidiolex and Sativex, two cannabis-based medicines that are used to treat childhood epilepsy and muscle spasms caused by multiple sclerosis. NICE had previously rejected Epidiolex because of its high cost, but is now recommending it.

“This is a momentous occasion for UK patients and families who have waited for so many years for rigorously tested, evidenced and regulatory approved cannabis-based medicines to be reimbursed by the NHS,” said Chris Tovey, GW’s Chief Operating Officer. “This is proof that cannabis-based medicines can successfully go through extensive randomised placebo-controlled trials and a rigorous NICE evaluation process to reach patients.”

Last year, the FDA approved the use of Epidiolex in the U.S. to treat seizures caused by two rare forms of childhood epilepsy, Lennox-Gastaut syndrome and Dravet syndrome. The initial list price per patient was $32,500 a year.

Medical cannabis has been approved in 33 U.S. states and Washington DC, but the qualifying conditions vary from state to state. Click here for a list of qualifying conditions in each state.

How CBD Helped End My Insomnia

By David Eaton, Guest Columnist

Due to a decrease in my opioid pain medication (to fall within the CDC guideline), my pain level increased to the point that I was unable to sleep. Of course, lack of sleep affects your overall health and so I began a downward spiral and needed something to break that cycle.

My son, who has been suffering acute pain from scoliosis in his neck, was having similar insomnia issues. He tried CBD oil and recommended that I do the same.

I knew little about CBD, so I talked to the very knowledgeable and helpful manager of a local CBD store. His recommendation was that I begin by researching CBD myself and then talk about it with the doctor at my pain clinic -- advice that impressed me as being very responsible.

After spending a day or two reading online articles, including some here on Pain News Network, I ran the idea past the physician’s assistant at my pain clinic.  She thought it was a great idea and asked me to try it before my next appointment with her in 4 days.

I placed another call to the manager at the CBD store and he recommended starting with a CBD infused "candy bar." My wife went there the next day and paid $25 for a white chocolate, peach and hazelnut flavored candy bar containing 120 mg of CBD.

DAVID EATON

The chocolate bar was scored in such a way that it can be divided into 4 servings, each with 30 mg of CBD. The manager’s suggestion was for me to try a single piece the first night and then take one and a half sections the following 2 nights. So that's what I did. 

Prior to trying the CBD, I had experienced a lot of pain-induced insomnia and found it difficult to sleep for more than an hour at a time.  It was not uncommon for me to wake up 10 times during a 12-hour effort to sleep. 

Most people do not realize how important a good night's sleep is to your health and well-being.  After my insomnia got severe, I installed an app on my phone (Sleep as Android) to track how much I slept each night.

After taking my nighttime meds and my last "dose" of CBD chocolate, I fell asleep around 8 pm.  According to the sleep app, which amazed me by its accuracy, I slept until 3 am, waking up feeling very rested and refreshed.

I decided to stay awake long enough to write this article before going back to sleep at 4 am. I slept until 10:45 that morning.

In all, I got about eleven and a half hours of deep sleep over the course of about 13 hours!   

As far as I am concerned, the use of CBD to reduce my pain and promote relaxation is an overwhelming success. I will be investing in a bottle of CBD oil on my next trip to town. 

David Eaton is disabled by chronic pain caused by degenerative disc disease, migraines and arthritis. He lives in Georgia.

Pain News Network invites other readers to share their stories with us. Send them to editor@painnewsnetwork.org. 

The information in this column 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.

What Are Health Risks of Vaping CBD?

By Roger Chriss, PNN Columnist

An outbreak of lung illnesses linked to vaping is raising important questions about the safety of vaping cannabis products. The cause is still unclear, but the CDC reports about 76% percent of the patients who became ill vaped products containing THC – the psychoactive ingredient in cannabis. Only about 17% reported vaping a cannabidiol (CBD) product.

At present, very little is known about CBD vaping safety. The World Health Organization’s 2017 report on cannabidiol looked at oral, sublingual and intranasal routes of administration. When the WHO wrote that “CBD is generally well tolerated with a good safety profile,” it was not considering vaping at all.

The Food and Drug Administration still considers CBD in food and drugs sold commercially to be illegal, unless the product falls under the Food, Drug and Cosmetic Act. Vaping CBD does not, and so there has been no testing or regulatory action.

There have been no good human studies on CBD vaping. Research generally looks at CBD in edibles and liquids, or smoked using traditional means.

It is not known what happens to CBD under vaping temperatures, if there are thermal degradants, or important chemical reactions between CBD and other ingredients in vaping liquids or other drugs.

A recent lung tissue study found concerning results about inhaling CBD while using steroids. CBD helps reduce inflammation, but “acts as an antagonist with steroids, overriding the anti-inflammatory potential of steroids when used in combination.”

Last year Vice reported on public health warnings in North Carolina after 90 people became sick with headaches, nausea, hallucinations and other health problems after vaping CBD products. Adulterants appear to have been the problem, and Vice noted that vape oils are poorly regulated and sometimes contain chemicals that “when heated in a vape and inhaled, can cause serious lung irritation.”

A recent study on the quality of CBD liquids used in e-cigarettes is also concerning, finding that “the quality control of manufacturers and the relative safety of these products is uncertain.”

An AP investigation last month found that in lab tests on 30 CBD vape products, ten samples contained synthetic marijuana such as K2 or spice, while others had no CBD at all.

Some states with legalized cannabis do require testing of CBD vapes. But it’s not clear what to test for, and even the lab methods for testing have yet to be validated. It is also not known which cutting agents, adulterants and contaminants should be cause for concern. Lung tissue is fragile, vulnerable in ways the GI tract is not, and not well studied. So testing regimes may ultimately require information we currently lack.

Oversight of cannabis testing is limited. California’s Sequoia Analytical Labs was found to be falsifying lab results last year. Plus, many CBD vapes come from the gray or black markets, or are home-brewed, making attempts at quality control irrelevant. As a result, CBD vaping safety is an open question, assuming it is even possible to make a safe CBD vape.

Fortunately, new research may help. Researchers are testing vaporized cannabis extracts on rats. This will allow for studying the effects of THC and CBD in animal models in a way that closely mimics human behavior.

Such information is urgently needed. Animal studies on vaping are raising concerns about lung cancer risk, but such research may not be representative of how humans vape, limiting their value.

There is ongoing debate on what CBD is good for. And now we also have to consider how CBD should be administered. It may be possible to create a low-risk CBD vape product. But at present we don’t really know how to do it.

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 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.

Has Vaping Hysteria Gone Too Far?

By Anna Maria Barry-Jester and Jenny Gold, Kaiser Health News

On Sept. 16, Tulare County in California announced the nation’s seventh death from vaping-related illness. Its advisory warned about “the dangerous effects of using electronic cigarettes, or e-cigarettes.”

As federal and state health officials struggle to identify what exactly is causing the deadly outbreak, vaping advocates are stepping into the void and crafting an alternative narrative that is being echoed broadly in online communities.

The people getting sick, according to their version of events, all vaped THC — the psychoactive ingredient in cannabis — using products bought on an illicit black market. They also contend federal officials have seized on the crisis to crack down on a nicotine vaping culture they don’t appreciate or understand, a culture proponents insist has helped them and millions of others quit smoking.

As of Oct. 1, the federal Centers for Disease Control and Prevention had identified more than 1,000 cases of vaping-related lung illness in 48 states. Eighteen people have died, including two in California. Of the 578 patients who have reported using specific products, most said they had vaped THC, but a significant portion — 17% — said they had used only nicotine.

CDC officials maintain they can’t identify one product or chemical culprit, and while they recently began emphasizing the risks of vaping THC, they continue to warn against any vape use at all.

Meanwhile, cities and states have responded with a divergent mix of warnings and bans. Michigan, New York and Rhode Island have moved to ban most flavored nicotine vaping products. The California Department of Public Health recently warned against all vaping devices, and the governor of Massachusetts issued a four-month ban on all vaping products.

The actions have sparked a backlash among hundreds of thousands of people who say they’ve been vaping for years without a problem. Compounding their distrust: the political calls to ban flavored nicotine products even though the vast majority of illnesses identified appear to involve people who were vaping THC.

They see a government out to quash nicotine vaping because its popularity with teens has caused a public outcry, ignoring the adults who find it a pleasing alternative to cigarettes. When it comes to vaping, they have stopped looking to the CDC for advice.

Debbye Saladine-Thompson is a registered nurse in Michigan who was a smoker for 32 years before she switched to vaping. She now manages the Michigan Facebook page for Consumer Advocates for Smoke-Free Alternatives Association (CASAA), a nonprofit that advocates for access to e-cigarettes and receives industry funding.

“I do not trust the CDC. Not anymore” Saladine-Thompson said. “I cannot trust an agency that says the product that I and so many people have been using for 10 years and hasn’t caused one death is now causing hundreds of illnesses. No, I do not believe that.”

Online vaping forums are roiling with accusatory messages suspicious of the government response. In Facebook groups, including one called ‘BLACK MARKET THC CARTRIDGES CAUSED THIS QUIT LYING ABOUT VAPOR PRODUCTS,’ vapers have expressed outrage over the bans on nicotine products while cigarettes remain readily available. They’re organizing phone calls to legislators and rallies at state capitols.

“We’re living and dying by these decisions,” said Kristin Noll-Marsh, the member coordinator for CASAA who moderates the group’s national Facebook group. “This vaping panic of 2019 is gonna go down in the history books as being like flat Earth, bloodletting and burning witches.”

CDC Messaging Criticized

Throughout the outbreak, the CDC has said that people who vape to quit smoking should not return to cigarettes. But the emphasis on all vaping devices drowns out that warning, said Dr. Michael Siegel, a professor at Boston University and proponent of e-cigarettes as a smoking cessation tool.

“In an outbreak investigation like this one, you have to be as specific as possible if you want people to listen. If you say ‘Just don’t vape,’ that’s not telling anyone anything they don’t already know.”

Many also are critical of the messaging used by the CDC, states and some media outlets, saying they are out of touch with vaping culture and its terminology. Public officials often use one word — e-cigarettes — to describe what to people who vape is a wide range of products with different names.

People who see headlines about illnesses linked to “e-cigarettes” may not know it applies to them, said Jim McDonald, a journalist with Vaping360, a consumer news site. “Cannabis vapers don’t use the term e-cigarettes. They never, never use that term.”

Even among e-cigarettes, a term many equate with nicotine delivery devices, people differentiate between cartridge-based devices like Juul and the handheld “mods,” which tend to be larger and produce more vapor. E-liquids can come prepackaged in ready-to-use form or can be mixed in stores or at home. Whether cannabis is legal and regulated also varies among states.

The problem with the alternative narrative, say doctors who are treating patients, is that it’s not clear whether only illicit THC is to blame. Dr. Dixie Harris, a critical care pulmonologist with Intermountain Healthcare in Utah, has been reporting five to seven cases a week for the past six weeks. While many patients have reported using illicit THC, she also has had patients who have fallen ill after using products purchased at licensed medical dispensaries in states where cannabis is regulated.

A new study looking at lung tissue samples from 17 patients found the damage resembled chemical burns and included two samples from people who fell ill before the outbreak. The findings cast doubt on a popular theory that vitamin E oil, which has been used as a thickening agent in THC oil, is the culprit.

The investigation is challenging on many fronts. Vaping — both legal and illicit, nicotine and cannabis — has exploded in the past few years with little regulation. There are hundreds of products, do-it-yourself kits and home brews. The potential culprits are many: popular flavorings in nicotine vapes never tested for inhalation. Oils used to dilute THC. Contaminants. Pesticides. Possible toxic residue from the containers themselves.

The CDC is grappling with a dearth of information. The process of alerting the many agencies and entities involved — doctors, hospitals, law enforcement, public health departments — has been slow.

Among 86 cases in Illinois and Wisconsin, where the outbreak first was identified and investigators are further along in their work, people reported using 234 different products involving both nicotine and cannabis, according to a report published last month. Those products, in turn, involved a variety of brands, numerous supply chains and packaging without listed ingredients.

Dr. Anne Schuchat, principal deputy director of the CDC, said the agency wasn’t narrowing the investigation only to cannabis, stressing it needed to “have an open mind” to understand the possible risks.

“Personally, with all the data that I’ve been seeing,” Schuchat said Friday, “I don’t know what ‘safe’ is right now.”

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

The Risks of Vaping THC

By Roger Chriss, PNN Columnist

An outbreak of vaping-associated pulmonary illness is getting national attention. Over 800 people have been sickened and 12 have died.

The CDC reported last week that vaping products containing tetrahydrocannabinol (THC) -- the psychoactive compound in marijuana – were involved in 77 percent of the illnesses. Several states responded with bans on vaping products and health alerts on vaping THC.

What do we know about the risks of vaping?

Vaping THC is so new that there is very little research. An animal study on vaping THC was published earlier this year. Performed on male and female rats, the study found that “repeated THC vapor inhalation in adolescent rats results in lasting consequences observable in adulthood."

Specifically, both sexes became tolerant to THC and male rats ate more. Interestingly, THC use did not change oxycodone self-administration in either sex, but increased fentanyl self-administration in female rats. There is no mention of lung effects.

While vaping with e-cigarettes is relatively new, inhaling THC via cannabis smoking is old. And there is an extensive literature on multiple harms.

A recent study of nearly 9,000 people found that regular cannabis use was significantly associated with greater risk of respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD) and pneumonia. The study used blood work to confirm use and had a control group, making its results more reliable than a simple population survey.

According to the National Institute on Drug Use, cannabis smoke contains multiple carcinogens and inhalation causes lung inflammation, increased airway resistance and hyperinflated lungs, a symptom of COPD

Josh Bloom at the American Council of Science and Health writes that the solubility and boiling point of THC and CBD in cannabis vaping products may play a role in the lung illnesses.

But complicating matters is the presence of other subtsances in vaping liquids and in the devices themselves. A newly published study in Scientific Reports on aerosols in tank-style e-cigarettes found levels of chromium, lead and nickel, all known carcinogens, in excess of OSHA permissible exposure limits.

Most cases of vaping-associated pulmonary illness involve illicit products. But one fatal case in Oregon involved someone who bought vaping products at two state-licensed cannabis dispensaries.

Some vaping illnesses involve people who report no use of THC products at all, though investigators are finding that these self-reports are not necessarily accurate. According to STAT News, eight patients in Wisconsin initially said they didn’t use THC products, but were later found to have used the drug.

In other words, we may not know what people were really vaping. Given that vaping THC is federally illegal and only marginally regulated in states where cannabis is legal, investigating the role of THC in the vaping outbreak is challenging.

But the emerging risks have led states like Washington to ban all flavored vaping products. And the FDA has asked the DEA to pursue criminal charges against anyone who sells illicit vaping products.

For patients who use cannabis products for pain relief, there are better alternatives than vaping. The Arthritis Foundation recently released new guidelines that recommend CBD oils and tinctures that can be taken orally.

It is not clear what this means for the cannabis industry. But Joe Tierney, known as the "Gentleman Toker,” told the Washingtonian that he would be shutting down his cannabis website.

“I don’t feel good about the industry any longer,” Tierney said. “I don’t think it’s safe to consume cannabis anywhere after all of my travels.”

Sorting out the risks of THC vaping will take time. At present there is only circumstantial evidence and intriguing ideas. It is possible that THC is one of several different causes or is just guilty by association. Beyond that, we have the unknowns of vaping itself, which may be too novel for anyone to fully understand the risks.

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 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.

Green Without Envy

By Mia Maysack, PNN Columnist

In the opinion of some, at various points in my life I could've been considered a "pothead." 

If that is how you refer to the medicinal use of a plant that grows freely in nature, I own the judgement with pride.  

I've known people who sit around and smoke loads of grass to the point of everything being funny -- but they're too stoned to laugh. That has never been my intent or relationship with marijuana.

This is another element of living with chronic pain and illness that is severely misunderstood -- the desperation we feel for relief.  After you've tried countless traditional approaches to no avail or improvement, I don't care what anyone says. Every single person reaches their absolute limit or breaking point.

When others have discovered that marijuana is part of my care plan, I've been shunned and labeled as a drug addict by the very same people who puff cigarettes, drink alcohol into oblivion, cannot get through a day without coffee, and poison themselves with food-like-products from a drive-thru window.  

Please explain how a man-made drug produced in a lab is somehow safer than marijuana. The only difference is that the drug is regulated and thereby taxed. Arguably, that’s what all of this is about: Money.  

I haven't come across anything that eases my head or body pain. I have only been able to accumulate a short list of helpful remedies that can temporarily (but not always) assist in my co-existence with pain. 

For example, marijuana helps combat nausea, which aids with proper nourishment and hydration. And when you haven’t had a good night’s sleep in days or weeks, a marijuana-induced state of relaxation can mean the difference between restful sanity or a trip to the loony bin.  

There will always be people who abuse whenever they get an opportunity, in the same way that every church has sinners and one bad pizza doesn't mean all pizza joints are bad. The unfortunate choices of a few should not outweigh the credibility of many.

When I ingested my first opioid, it lifted the agony in a way I had never experienced before. I remember like it was yesterday. I thought for sure I was too sick to make it into work but chose to attempt this pill, solely out of desperation. It left me smiling ear-to-ear on my way to my beloved nursing job.

But as I pulled into the parking lot, I was struck with an overwhelming wave of sickness and could barely make it to the trash can before completely losing it. I had an allergic reaction to opioid medication and another potential treatment was biting the dust. 

I do not touch the stuff anymore, but that doesn't change the fact that opioids have proven to be extraordinarily helpful for a countless amount of people. And these same people who were given legitimate prescriptions are now being punished by having their medication taken away, often without a follow up plan or any notice. 

Healthcare providers are balancing on a sensitive tight rope between doing no harm while attempting to avoid ruining their good legal standing or that of their practice. This is causing many patients to feel abandoned, lost and isolated, with low quality of life and high suicide rates.

Peering into the window of someone else's life and judging them simply because you don't understand their thoughts, experiences or desperation is unacceptable.

It's easy to be judgemental and not care about the crisis in pain care if you or a loved one hasn't been personally affected by it. But this is a general societal crisis that affects young and old, rich and poor. Someday it will affect you.

Mia Maysack lives with chronic migraine, cluster headaches and fibromyalgia. Mia is the founder of Keepin’ Our Heads Up, a Facebook advocacy and support group, and Peace & Love, a wellness and life coaching practice for the chronically ill.

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.