Chronic Pain Top Medical MJ Usage in California

(from California NORML Reports, Apr. 2000)

Chronic pain is emerging as the number one medical use of marijuana among Prop. 215 patients, according to a forthcoming report for the Association for Cannabis Medicine, "Medical Use of Cannabis in California," by Dale Gieringer (to be published in Franjo Grotenhermen and Ethan Russo, Ed.: Cannabis And Cannabinoids - Pharmacology, Toxicology and Therapeutic Potential, Haworth, New York).

The report includes a survey of Oakland Cannabis Buyers Cooperative members by drug researcher Jerry Mandel, who found that 40% are using marijuana for arthritis, migraines, multiple sclerosis, spinal problems, injuries, digestive disorders and other diseases characterized by chronic pain and muscle spasticity.

Mandel's survey, which covers 965 OCBC members active in the year 1998-9, shows that AIDS/HIV was the second most common use, accounting for 29% of patients. The third most common usage was for mood disorders, which accounted for 15% of patients.

In an earlier 1997 survey of OCBC members, Mandel found that AIDS/HIV was the number one use of medical marijuana (54% of members), followed by chronic pain (22%) and mood disorders (9%).

Another, 1996 survey of patients by a research group at Dennis Peron's San Francisco Cannabis Buyers' Club found that fully 85% had AIDS/HIV.

The observed decline in AIDS/HIV may be explained by a number of factors. One of them is a declining incidence of AIDS wasting syndrome due to the advent of protease inhibitors. Another may be a dispersion of AIDS patients from the OCBC to other clubs in areas with higher HIV population.

Perhaps the most important factor is the increasing use of medical cannabis for other, new uses, notably chronic pain and mood disorders. Although cannabis was widely prescribed for chronic pain and mood disorders in 19th century medicine, these applications were gradually forgotten and have not been systematically investigated in modern clinical studies. When Prop. 215 was first passed, physicians were reluctant to recommend marijuana except for cancer and AIDS, the two indications for which synthetic THC or Marinol had been approved by the FDA. Now that Prop 215 is entering its fourth year and federal threats to arrest doctors have failed to materialize, physicians are increasingly willing to recommend for other uses. The O.C.B.C. reports that 550 physicians are recommending cannabis for its members.

The most experienced medical cannabis practitioner in the state is Berkeley psychiatrist Dr. Tod Mikuriya, who has interviewed over 3,000 patients. Dr. Mikuriya has recorded more than 250 separate medical indications for cannabis, ranging from cancer chemotherapy, multiple sclerosis, and epilepsy to post-traumatic stress disorder, depression and alcoholism. The great majority of patients suffer more than one chronic complaint.

The largest category of Mikuriya's patients ? over 45% - use cannabis for diseases involving chronic pain, including arthritis and rheumatism, migraines, spinal and skeletal disorders, injury, gastrointestinal and other inflammatory disorders. Noting that these disorders tend to involve inflammation and immune system dysfunction, Mikuriya has dubbed cannabis an "immuno-modulatory anti-inflammatory analgesic."

Mikuriya's patients find cannabis useful for a wide range of rare and obscure diseases, including Henoch-Schoenlein purpura, osteochondrosis, Kaschin-Beck disease, Meuniere's disease, Tietze's disease, and patellar chondromalacia. A few patients report surprising relief from such everyday complaints as stuttering, color blindness and hypertension.

The exact population of medical marijuana users in California is unknown, but appears to be growing. The combined membership of the state's medical cannabis clubs is now over 10,000, although this figure double-counts many patients who are members of more than one club. Many other patients do not belong to any club.

Members are heavily concentrated in the northern half of the state, where most clubs are located. The Mendocino and Humboldt clubs, serving an area of Northern California with fewer than 500,000 residents, report a combined membership of 1,300 patients. This is comparable to the number in Los Angeles, a county with 8.8 million residents, where some 1,500 club members are reported.

In Oregon, where medical marijuana patients must register for legal protection, some 500 state identification cards have been issued. Oregon law does not permit medical cannabis for all diseases, in particular psychiatric disorders, though proponents are petitioning to extend the law to depression and post-traumatic stress disorder.

California NORML estimates that there are presently some 10,000 to 20,000 legal medical marijuana patients in California, less than 1% of the state's total marijuana using population.