Pain Doctors Discriminate Against Medical Marijuana Patients
The University of Washington is offering web-based, CME-accredited courses for physicians in all states on Medicinal Cannabis and Chronic Pain.
Time for a More Rational Cannabis Policy Pain Medicine News, March 2015
A survey conducted by scientists of the Australian National Drug and Alcohol Research Centre and other institutions found that cannabis use in combination with opioids better reduces pain than opioids alone.
CalNORML often receives complaints from chronic pain patients wrongfully denied treatment by pain clinics for having failed unwarranted drug tests for medical marijuana.
In fact, there is no law requiring pain clinics or doctors to screen out marijuana users, according to legal experts. “It’s BS,” says Washington state attorney Doug Hiatt, "it's Jim Crow medicine." Not a single case is known in which any clinic or doctor has been sued, prosecuted or penalized for allowing medical marijuana.
The root of the problem is that pain clinics are under mounting pressure to monitor patient use of prescription narcotics, especially opiates. Deaths from prescription opiates have reached record levels, leading the ONDCP to proclaim them as the nation's number one drug abuse problem. Clinics are accordingly being urged to use drug urine testing to stem abuse and diversion of opiates to the illegal market. Although these problems have to do with opiates, not cannabis, many clinics wrongly assume that they are obliged to screen out marijuana users as well.
There are sound medical reasons for chronic pain patients to medicate with marijuana. A growing body of scientific research – including four published studies by California's own Center for Medicinal Research – shows that marijuana is effective in treating chronic pain. Not only that, but recent studies have shown that marijuana is a useful adjunct to opiates, working along parallel paths to enhance pain relief while actually lowering the required dosage of opiates. Knowledgeable specialists therefore regard medical marijuana as an exit, rather than a gateway, to narcotic abuse.
In an encouraging development, the Veterans Administration announced in 2010 that it will no longer remove veterans with medical marijuana recommendations who test positive for pot from its pain management programs. (However, as federal employees VA docs cannot recommend cannabis treatment.) Read more.
Unfortunately, many pain clinics remain ignorant of the medical benefits of marijuana, and wrongly assume they are legally obliged to disallow it. This seems to have increased since the DEA pulled a well-publicized action in Massachusetts in 2014, targeting doctors there who had financial interest in medical marijuana dispensaries. However, no such action has taken place in California, where doctors aren’t permitted to have any association with dispensaries. The US Supreme Court has ruled that doctors may discuss marijuana with their patients, despite federal law. These finer points are often lost on pain doctors, who are bombarded with erroneous “infomercials” in their journals about drug testing their patients.
Patients who encounter discrimination are urged to advise their clinics of the facts about medical marijuana and the law. Download a letter from CalNORML explaining the law, and the state of research. Practitioners that persist in discriminating against legal medical marijuana patients should be reported to the state medical board. Click here for a sample complaint letter
Research on Cannabis and Pain
As far back as 1997, Dr. Sandra Welch from the University of Virginia has been studying the interaction of opiods and cannabinoids, with promising results in animal studies showing that the two have a synergistic effect.
These findings were confirmed in a recent of 21 individuals with chronic pain, which concluded that “vaporized cannabis augments the analgesic effects of opioids without significantly altering plasma opioid levels. The combination may allow for opioid treatment at lower doses with fewer side effects.”
The California Center for Medicinal Cannabis Research, established by the state legislature at University of California in 2000 to conduct controlled scientific studies of medical marijuana, reported positive results in six different human clinical trials regarding chronic pain, spasticity and vaporization. CMCR director Prof. Igor Grant concluded in the report to the legislature, "There is good evidence now that cannabinoids may be a good adjunct or even first line treatment" for neuralgia. Cannabis has also been found helpful in treating intractable pain.
A 2011 clinical trial assessing the administration of vaporized plant cannabis in chronic pain patients on a daily regimen of morphine or oxycodone reported that inhaled "cannabis augments the analgesic effect of opioids." Authors concluded, "The combination [of opioids and cannabis] may allow for opioid treatment at lower doses with fewer side effects." A 2012 study from Vancouver found that increased access to medical marijuana reduced patients’ use of opiates and other addictive drugs.
Also see NORML's page on marijuana and chronic pain, and the Chronic Pain chapter of NORML's Emerging Clinical Applications for Cannabis and Cannabinoids
Photos copyright Larry Utley