Pain Goes to Pot

Does medical marijuana deliver on its pain-relieving promises?

Every day, Samantha is in pain. Her elbows and knees feel inflamed. Her ankle aches. She gets cramps in her abdomen. Her lower back hurts. She suffers from fibromyalgia, gastritis, gastroesophageal reflux disease (GERD) and irritable bowel syndrome.

To feel better, Samantha uses medical cannabis — also called medical marijuana — which she buys at a dispensary near her home in Joliet. “My quality of life is not 100 percent, but the cannabis at least helps to dull the pain,” says Samantha, who requested that her last name not be used because cannabis is illegal on a federal level. “It doesn’t really get rid of the pain. It kind of helps you forget about the pain.”

Samantha, 27, got her medical cannabis card for having severe fibromyalgia, which is listed as one of 40 debilitating conditions in the Compassionate Use of Medical Cannabis Pilot Program Act, which went into effect in Illinois in 2015.

Access to marijuana is expanding. Now medical cannabis is available for pain, for those who qualify. In August 2018, it was approved in the state as a replacement for prescription opioid painkillers for patients 21 and older. And Governor J.B. Pritzker is expected to legalize recreational marijuana during his term.

Making a dent in the opioid crisis

The potential for cannabis as medicine holds promise, especially when it comes to pain. For Samantha, cannabis offers an alternative to opiates. She’s taken prescription pain pills in the past but never felt any relief from them because she was afraid she’d take too much and become addicted. She’d seen family members, including her sister, struggle with the wrenching pain of opioid addiction. “I have seen what it does to other people, and I don’t want that happening to me,” she says.

In 2016, 1,946 Illinois residents died from opioid overdoses — that’s nearly twice as many as in car crashes. Across the country, opioid-related deaths have quadrupled since 1999 and drug overdoses are the leading cause of death for people younger than 50.

Research shows that allowing cannabis as a substitute for prescription painkillers could make a difference in the opioid crisis. An analysis published by JAMA Internal Medicine compared opioid death rates in states with and without medical cannabis laws between 1999 and 2010 and found that states allowing for medical cannabis had, on average, a 24.8 percent lower mean annual opioid overdose mortality rate.

The potential for cannabis as medicine holds promise, especially when it comes to pain.”

“It is less addictive, and it does not have the horrible side effect of death,” says Leslie Mendoza Temple, MD, an integrative and family medicine physician in Glenview who previously served on the Illinois Cannabis Advisory Board.

“Cannabis has its own set of problems, like uninvited psychoactivity, driving and judgment impairment, and possible addiction about 9 percent of the time,” she cautions. “It is not a panacea, but it’s a viable tool for reducing suffering for the right patient. For young adults and children under 25 years old, it can be detrimental to the brain if used regularly before full brain maturation.”

Bringing relief

Mendoza Temple started learning about marijuana’s benefits when it became legal for medicinal purposes in Illinois. “When I saw the list of conditions that were going to be approved in Illinois, I realized that this matched my patient population: people with cancer, multiple sclerosis, fibromyalgia,” she says.

She started doing research and saw its potential to bring relief to her patients. Since the program started in 2015, she’s signed off on paperwork for more than 650 patients to register for a medical cannabis card.

Cannabis works in a couple of different ways when it comes to pain, Mendoza Temple says. In some patients, it seems to shut down the sensation of pain; in others, it allows them to disconnect from what she calls the “drama” that pain brings about, so they’re not so preoccupied with it. “They know the pain is there, but their mind feels more relaxed, releasing tension in the muscles and reducing suffering.”

Mendoza Temple says she’s seen cannabis make a marked difference for many of her patients with chronic pain from fibromyalgia. After they begin using cannabis, she says, many of them report that their pain has reduced or that their sleep has improved significantly.

Judith Paice, PhD, RN, director of Northwestern Medicine’s Cancer Pain Program in the division of hematology-oncology, has seen a growing interest from her cancer patients in using cannabis rather than opiates. She’s found that it works well for some of her patients when it comes to improved sleep, reduced anxiety and, for some, pain relief.

Paice emphasizes that cannabis is not a magical drug that works for everyone. Some of her patients have said they feel “cognitively blunted” and don’t like the sensation. Others worry that the cannabis makes them feel dizzy and fear it could lead to a fall. She’s seen some patients quit using cannabis and return to opioids, while others decide they’d rather just live with the pain.

Mendoza Temple has also had her share of patients who either don’t like cannabis or don’t see any improvement when it comes to pain. “Not everybody benefits,” she says, “but it has worked for a lot of my patients.”

Overall, Mendoza Temple has been impressed with the effects she’s seen. When she first started recommending cannabis, she conducted a survey of 166 patients who used it. She found that 29 percent experienced side effects, and they didn’t like feeling stoned and high. Some of them quit using it. But 88 percent of the patients surveyed said it helped them with something, the top improvements being sleep, pain, anxiety, seizures and nausea.

“It’s pretty good,” she says. “If you had a drug that had that kind of outcome, we would be pretty excited about that.”

Still so much to learn

One of the challenges with cannabis is the lack of understanding in the medical community. Mendoza Temple points out that cannabis has not been well researched in the United States for therapeutic purposes because of its status as a Schedule 1 drug (defined as a drug with no currently accepted medical use and a high potential for abuse).

“We haven’t had any education on this in medical school or residency except, ‘Here’s what happens when people abuse it,’” she says. “So we know what the downside is, but we don’t have training on how cannabis can act as a medicine.”

That is — slowly — beginning to change. In 2017, the National Institutes of Health (NIH) reported it was supporting 330 projects on cannabinoid research totaling nearly $140 million. But there’s still a knowledge gap — not to mention a stigma — around cannabis.

“There’s a lot of improvement that still needs to happen,” Mendoza Temple says. “Like, we don’t know what doses our patients should take. We only have general guidelines. This is not like a medicine that is one-size-fits-all. The right dose is determined by what feels right to the individual patient via trial and error. That’s not the precise medical advice physicians are accustomed to giving, and I struggle with this.”

Because of the knowledge gap, staff at dispensaries have a lot of educating to do when patients walk through the door, says Jennifer Dooley, chief strategy officer with Chicago-based Green Thumb Industries (GTI), a cannabis company that runs nine manufacturing facilities and has licenses for 72 retail locations across the United States, including locations in Joliet, Effingham, Mundelein and Naperville.

“This is really new for a lot of the doctors as well, and everyone’s different,” Dooley says. “The cannabis plant is so complex that it really does interact with people differently.”

At GTI dispensaries, which are cannabis shops that serve patients with a medical cannabis card or a physician’s authorization for pain relief, there are hundreds of cannabis options to choose from: items to smoke, topicals, creams, tinctures, edibles and more. For a first-timer, it can be overwhelming. Dooley says the team takes a “patient first” approach, starting with a consultative, one-on-one conversation. The team can look at data to see what people with specific conditions have been using and make suggestions to patients.

Dooley is elated that more patients now have access to cannabis in Illinois. She’s happy to hear people who switch from opiates to cannabis say things like, “I feel like myself again.” For her, and for so many in the cannabis industry, that’s the kind of thing that keeps them going.

For physicians like Mendoza Temple, cannabis means hope. “I will continue to certify qualified patients for medical cannabis when appropriate,” Mendoza Temple says. “Especially if they have unsuccessfully tried everything they could to feel better.”

And for patients like Samantha, medical cannabis means a return to normal life. “This is the best thing that has helped me,” she says. “It helps in so many ways.”

By Kate Silver

Ellen Ryan is a freelance writer.