By Shannon Pacella, DPT, PHRC Lexington
Medical marijuana. You’ve probably heard of it. You’ve maybe even used it. But what you might not know about is the tug-of-war going on between researchers and lawmakers, and how this impacts the ability of this stigmatized substance to be studied – potentially missing out on an alternative treatment option for a multitude of health issues, including pelvic pain.
Let’s start with a little background history. The two main cannabinoids (compounds) from the marijuana plant that are of medical interest to researchers are THC and CBD. CBD is a cannabinoid that is considered non-psychoactive (although it may reduce anxiety), while THC does have psychoactive properties.1 In 1970, the United States Congress placed marijuana in Schedule I of the Controlled Substances Act (CSA).2 According to the United States Drug Enforcement Administration (DEA), “Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse.”3 Sounds pretty harsh, right? Well fast-forward to present day where currently 25 states plus Washington D.C. have legalized the use of medical marijuana, and 16 other states have legalized non-psychoactive medical cannabis (CBD extract).2 Each state has specific parameters regarding the amount and forms that are considered legal.
The huge disparity between each state’s rules and regulations makes medical marijuana a complicated substance to not only obtain for personal use, but also for researchers looking to further expand what is currently known about marijuana and it’s potential benefits. On August 11, 2016, the U.S. DEA declined to move marijuana from Schedule I to a less-restrictive schedule under the CSA, but has begun the process of allowing more research to be done. The U.S. DEA has created a policy to expand the amount of DEA-registered marijuana manufacturers in order to adequately supply researchers.3
Even though there is tight regulation on the ability to conduct research regarding medical marijuana, the limited findings have yielded great results. THC has been proven to increase appetite and reduce nausea, so the FDA has approved THC-based medications for these purposes (dronabinol and nabilone).1 There have been a number of studies revealing the powerful effects that medical marijuana can have on pain as well. A patient survey of medical cannabis users (for chronic pain) revealed, “average pre-treatment pain on a zero to ten scale was 7.8, whereas average post-treatment pain was 2.8, giving a reported average improvement of 5 points. This translates to a 64% average relative decrease in pain. Others reported therapeutic benefits included relief from stress/anxiety (50% of respondents), relief of insomnia (45%), improved appetite (12%), decreased nausea (10%), increased focus/concentration (9%), and relief from depression (7%).”4 A number of studies have also revealed that medical marijuana can reduce neuropathic pain (something that many people with pelvic pain, including pudendal neuralgia may encounter).5,6,7 Another study looked specifically at men with chronic prostatitis/chronic pelvic pain syndrome who used marijuana.8 The men self-reported in person (clinic) and online. “38.6% of clinic and 75% of online respondents reported that it improved their symptoms. Most of the respondents reported that cannabis improved their mood, pain, muscle spasms, and sleep.”8 You can learn more about male pelvic pain disorders here. Cannabis is also listed as a therapeutic pharmacological treatment for endometriosis, which you can learn more about here.
Another major topic is the relationship between medical marijuana and opioid use. The Centers for Disease Control (CDC) has presented that prescription opioid overdoses have killed more than 165,000 Americans between 1999 and 2014.9 On the other hand, the CDC has reported zero deaths from marijuana overdose ever. Interestingly enough, a study published in 2014 revealed an intriguing trend: from 1999 – 2010, states that allowed medical marijuana use had an average of almost 25% fewer opioid overdose deaths each year than states where cannabis remained illegal.10 Migrating away from prescription opioid use in favor of medical marijuana for pain relief may be the way of the future.
On top of all of these great discoveries is another surprise. All of the 2016 presidential candidates can agree on something: the support of medical marijuana and the need to continue to conduct research on it. Hillary Clinton stated in an interview with Boston’s WBZ radio, “I do think on the federal level we need to remove marijuana from the Schedule I of drugs, move it to Schedule II, which will permit it to be the basis for medical research because it’s important that we learn as much as possible. And since it was a Schedule I drug we haven’t done that research. A lot of experts in the field are telling me we’ve got to learn a lot more.”11 Similarly, in an interview with Bill O’Reilly, Donald Trump said, “I do want to see what the medical effects are. I have to see what the medical effects are and, by the way — medical marijuana, medical? I’m in favor of it a hundred percent.”11
This recent push towards allowing and encouraging medical marijuana use and research will open the door to many more possibilities in alternative treatment options for a variety of medical conditions including chronic pain and neuropathic pain.
This topic is now finally being openly discussed by many medical professionals, including at the International Pelvic Pain Society conference. While attending this conference, I heard Dr. Allan Frankel give a lecture discussing utilizing cannabis for managing pain, anxiety, and sleep. To hear him summarize this presentation, click here (you can skip to 26:30). I’m interested to hear your thoughts and opinions on medical marijuana – what do you think about it? Any personal experiences with using medical marijuana for pelvic pain? You are welcome to share below in the comments!
- National Institute on Drug Abuse. Drug facts: is marijuana medicine? https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine
- United States Drug Enforcement Administration. https://www.dea.gov/
- Webb CW, Webb SM. Therapeutic Benefits of Cannabis: A Patient Survey. Hawai’i Journal of Medicine & Public Health. 2014;73(4):109-111.
- Wilsey B, Marcotte T, Deutsch R, Gouaux B, Sakai S, Donaghe H. Low-dose vaporized cannabis significantly improves neuropathic pain. J Pain. 2013;14(2):136-48.
- Ware MA, Wang T, Shapiro S, et al. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ. 2010;182(14):694-701.
- Wilsey B, Marcotte T, Tsodikov A, et al. A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. J Pain. 2008 Jun;9(6):506-21.
- Tripp DA, Nickel JC, Katz L, Krsmanovic A, Ware MA, Santor D. A survey of cannabis (marijuana) use and self-reported benefit in men with chronic prostatitis/chronic pelvic pain syndrome. Canadian Urological Association Journal. 2014;8(11-12):901-905.
- Centers for Disease Control and Prevention. http://www.cdc.gov/drugoverdose/data/overdose.html
- Bachhuber MA, Saloner B, Cunningham CO, Barry CL. Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010. JAMA Intern Med. 2014;174(10):1668-1673.
- Marijuana Policy Project. Where do they stand on marijuana policy? https://www.mpp.org/2016-presidential-candidates/