9/6/2022: Gov. Newsom has signed a bill (AB 1954 – Quirk) to protect the right of patients to medical treatment if they use marijuana, and the right of physicians and clinics to treat them. The bill was sponsored by Cal NORML and co-sponsored by Americans for Safe Access. Read more.
Also see: Studies on Cannabis and Opioid Use.
7/24/2023 – MBC’s New Pain Prescribing Guidelines Advise Physicians to Break New State Law, Continue Stigma Against Cannabis Users
Although the new pain prescribing guidelines from the Medical Board of California are co-signed by Gov. Newsom, there’s no mention the law he signed last year outlawing discrimination against patients solely on the basis of the presence of THC in urine tests. Instead, it stigmatizes cannabis users as prone to overdose and opioid use disorder, and advises doctors treating cannabis users to consult with an addiction medicine specialist. The guidelines greatly downplay the scores (if not hundreds) of studies finding that cannabis use can lower need for opioid medications for pain, and state that cannabis “is a legal substance so a positive [urine test] result should not directly result in dismissal of a patient from care unless the use conflicts with the terms of the pain management agreement.” There is no such exception in the law, sponsored by Cal NORML and ASA last year.
July 2018 – Study suggests that cannabis therapy, as an adjunct a traditional analgesic therapy, can be an efficacious tool to make more effective the management of chronic pain and its consequences on functional and psychological dimension. Read more.
February 2018 – Medical Marijuana Dispensaries Save Lives, Study Finds
A bipartisan group of 20 House lawmakers sent a letter about marijuana’s potential to reduce opioid issues to Acting Health and Human Services Sen. Eric D. Hargan.
Several National Institutes of Health components announced a funding opportunity to support “elucidate the therapeutic potential of the cannabinoids and endocannabinoid system in the development of mechanism-based therapies for pain.”
September 2017 – DR. OZ: WEED MAY BE AN ‘EXIT DRUG’ FOR OPIOID ADDICTION
Effects of Legal Access to Cannabis on Scheduled II–V Drug Prescriptions
“34% of the MCP patients cease to exhibit any evidence of scheduled drug consumption and an additional 36% reduce the number of prescriptions filled for scheduled drugs by the last 6 months of our sample period.”
August 2017 – A study of musculoskeletal trauma patients who used marijuana during their recovery found that 90% believed it reduced symptoms of pain and 81% said it reduced the amount of opioid pain medication they used. (Also see: Study: Trauma Patients Report That Cannabis Reduces Their Opioid Intake)
June 2017 – A new study finds thirty percent of the sample (N = 841) reported using an opioid-based pain medication currently or in the past 6 months. Of those who have used opioids, 61% reported using them with cannabis. Ninety-seven percent of the sample ‘‘strongly agreed/agreed’’ that they are able to decrease the amount of opioids they consume when they also use cannabis.
Science Calls Out Jeff Sessions on Medical Marijuana and the “Historic Drug Epidemic”
Rolling back protections from federal interference in state legalization laws could worsen the opioid overdose crisis
Patients Are Ditching Opioid Pills for Weed: Can marijuana help solve the opioid epidemic? 2/2/17
In January 2017, the National Academy of Science released a major report on cannabis, which concluded that chronic pain is one of the few conditions for which there is “conclusive or substantial evidence” for cannabis’s effectiveness.
We need to talk about medical marijuana 12/17/2016
HelloMD and UC Berkeley Announce Launch of Largest Patient Survey Conducted On Pain and Opioid Use 9/20/2016
Medical Marijuana States See Reduced Number of Fatal Crashes Involving Opiates (particularly in those aged 21-40 years) September 15, 2016
CDC Guidelines Instruct Pain Doctors Not to Test for THC March 17, 2016
Do Medical Marijuana Laws Reduce Addiction and Deaths Related to Pain Killers? November 2015
This second NIDA-funded study, a more detailed analysis by the RAND Corporation, showed that legally protected access to medical marijuana dispensaries is associated with lower levels of opioid prescribing, lower self-report of nonmedical prescription opioid use, lower treatment admissions for prescription opioid use disorders, and reduction in prescription opioid overdose deaths. Notably, the reduction in deaths was present only in states with dispensaries (not just medical marijuana laws) and was greater in states with active dispensaries.
Study: Daily Cannabis Use for Chronic Pain is Safe, Effective September 21, 2015
The University of Washington is offering web-based, CME-accredited courses for physicians in all states on Medicinal Cannabis and Chronic Pain.
Urine Drug Test Often Gives False Results Pain News Network, April 2015
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.
JAMA: Medical Cannabis States Possess Lower Rates Of Opiate-Induced Fatalities
NIDA (National Institute on Drug Abuse) has funded two recent studies that explored the relationship between marijuana legalization and adverse outcomes associated with prescription opioids. This first study found an association between medical marijuana legalization and a reduction in overdose deaths from opioid pain relievers, an effect that strengthened in each year following the implementation of legislation. The population-based nature of this study does not establish a causal relationship or give evidence for changes in pain patient behavior.
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.
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 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