June 5, 2017

Cannabis for Chronic Pain

New York State finally got on board with offering another alternative to the chronic pain dilemma. Chronic pain is now a qualifying condition for the New York State medical cannabis program. New York’s program1 began in 2016 and has been grossly underutilized largely due to the glaring omission of one of the most prevalent conditions, chronic pain.

When the program was first announced, optimism loomed large as initial estimates for the number of people who would benefit from the program were somewhere between 200,000 and 400,000. To date only 15,000 patients and 911 registered practitioners are part of the program in New York State. This is due, in part, to Gov. Cuomo’s efforts to severely curtail access to medical cannabis based on qualifying conditions. Now that chronic pain is a qualifying condition, perhaps there will be a shift in usage of New York’s program.

There is an ever-growing body of research demonstrating the effectiveness of medical cannabis for many of the conditions currently being treated with opioids.2-4 While the evidence mounts, there is a parallel concern among physicians about the safety of cannabis and the stigma attached to prescribing it.

The fact is the majority of New York’s certified medical marijuana doctors still operate in a clandestine manner due to the prevailing federal status of marijuana as a Schedule 1 controlled substance. David C. Holland, the legal director for Empire State NORML, offers hope with this statement: “Doctors who are in compliance with the New York State statute can feel comfortable believing that they will not be the target of a federal investigation because of the well-regulated state-level framework.”

With the ever-increasing media attention regarding the burgeoning problem of opioid addiction and deaths, there is an urgent push by the FDA and other government and healthcare agencies to find non-pharmacologic alternatives. Preliminary research indicates that medical marijuana use may, in fact, help reduce opioid abuse and deaths associated with that abuse.5 When practitioners are empowered to overcome the stigma associated with prescribing cannabis for pain, we may find the clinical outcomes that further validate the safety and effectiveness of cannabinoids.

The good news is that on Sunday, April 30, 2017, Congress voted on a budget that did not include any money to go after states that have legalized medical marijuana or where the recreational use of the drug is legal. As a practitioner in the great state of New York, I am advocating for the investigation, through practice, of the use of medical marijuana in our quest to reduce opioid dependence and the tragic death toll that it takes on people.

Integrative practitioners who see patients dealing with chronic pain realize how difficult this condition can be to treat. Because we are automatically inclined to “first do no harm” and search for safer treatments for our patients, it makes sense to keep an open mind about the controversial yet highly effective botanical known as cannabis.

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