How to Ask Your Doctor about Trying Medical Marijuana for Pain
Do your research on CBD and THC and be honest about why you may want to try cannabis for pain.
Doctors and patients alike may feel unsure of how to approach the subject of medical marijuana, or cannabidiol (CBD), as part of a pain management strategy during a clinical visit. While many physicians believe that cannabis can offer a legitimate medical therapy, one-half of primary care physicians (PCPs) surveyed in a new study either were not ready to or did not want to answer questions from patients on this topic.
Given the current concerns about overprescribing of opioids and efforts at all levels to reduce the number of individuals who may misuse, abuse, or overdose from these drugs, 1 clinicians and patients are looking for other treatment options when it comes to managing chronic pain and related symptoms. In February 2019, the World Health Organization (WHO) proposed “rescheduling cannabis within international law to take account of the growing evidence for medical applications of the drug, reversing its position held for the past 60 years that cannabis should not be used in legitimate medical practice.” 2
Despite this move, many knowledge gaps remain around marijuana for medical use, including how the body’s endocannabinoid system works (that is, the group of compounds naturally synthesized by the body that activate the same receptors as delta-9-tetrahydrocannabinol, also known as THC, which has psychoactive properties). Other knowledge gaps include the actual benefit of cannabis on a range of conditions; the optimal dosing and delivery methods (there is no consensus to date on starting strains or doses so “low and slow” is often advised); and potential side effects, interactions, and toxicities, including long-term use of the substance.
The questions are urgent enough that the National Academies of Sciences, Engineering and Medicine (NAM) undertook a priority comprehensive review of recent medical literature on the health effects of cannabis and cannabinoids. 3 Its report focused on 11 areas, among them therapeutic effects, cancer incidence, cardio-metabolic risk, respiratory disease, injury and death, and problematic cannabis use. The committee identified and prioritized a number of gaps and barriers to research. Add to this the fact that most doctors simply are not taught about cannabinoids in medical schools (continuing education courses and professional certificates in this field are growing, but the subject is still missing from the basic clinical curriculum). In a survey, two-thirds of medical school deans reported that their graduates were not at all prepared to prescribe medical marijuana and one quarter reported that their graduates were not at all prepared to answer questions about medical marijuana. 4
So, how should patients go about raising the subject of medical marijuana use for pain management and related symptoms, such as anxiety or disturbed sleep? Below are a few recommendations. *
Being honest with your doctor about wanting to try opioid alternatives such as medical marijuana, or cannabis, may open new doors to relieving your chronic pain. (Source: 123RF)
Catch Up on Cannabis Research for Pain
Start by doing your homework. Become familiar with some of the evidence for using medical cannabis for pain management, particularly which types of pain appear to respond better to the substance. Also, develop a basic knowledge of the key components of cannabis (eg, THC and CBD) and how they may affect the body, as well as available forms in which medical marijuana, cannabis, and hemp (which is a different plant and contains 0 to 3% THC) may be available (see details in “Navigating Cannabis Options for Chronic Pain”). Organizations like Patients Out of Time and the Marijuana Patients Organization, and mobile apps such as LEAFLY, also offer good resources.
Once you’ve done some research, David Bearman, MD, recommends printing it out and showing to your physician to get the conversation started. Dr. Bearman specializes in pain management and has more than 50 years of experience in the substance abuse treatment and prevention field. He serves as vice president of quality assurance and credentials at the American Academy of Cannabinoid Medicine. Ask if medical marijuana may be an option for you. If your physician is unwilling or unable to discuss cannabis as a pain treatment option, Dr. Bearman advises asking for a referral to a local physician or clinic that is knowledgeable about treating patients with medical marijuana.
Share Your Personal Experience with Marijuana
In a recent PPM online poll, just over half of respondents said they had tried medical marijuana to alleviate chronic pain or related symptoms (See the full results).
Be up front about whether you’ve tried cannabis for pain already. Did it help? What form did you use and how much did you take? This transparency will only help your doctor understand your specific experience, but also evaluate the risks and harms of medical marijuana given your full health picture — including other pain medications, like opioids. (Read how one patient uses a journal for her medical marijuana use in treating fibromyalgia and related symptoms. And see what other types of natural plants may help with chronic pain).
Move Forward with Caution
Finally, be vigilant. The evidence around the safety and efficacy of THC and CBD is still being researched. Studies to date have associated marijuana use with increased risk of death from hypertension, higher rates of acute ischemic stroke, and respiratory issues when used long-term. Potential harms in patients with psychotic and mood disorders have been increasingly documented. There may also be a link between marijuana use and the development of a substance dependence or abuse disorder with other substances including, alcohol, tobacco, and illicit drugs. 5-9
*These tips do not represent official nor medical advice nor clinical recommendations. Learn which states have legalized medical marijuana and always speak with your doctor before trying any new cannabinoid product.
Medical Marijuana for Back Pain
Elizabeth I. Molina Ortiz, MD, is board-certified in family medicine. She is a primary care provider with Atrius Health in Boston and was the medical director of Charles River Community Health.
Our understanding of the risks and benefits of medical marijuana use has been increasing in recent years. Although as of 2016, not all the questions have been answered, a handful of states have set up dispensaries and passed laws protecting patients who use this drug from prosecution. These programs are far from complete. But the good news is some spine conditions and types of chronic neck or back pain are included by a few of the more forward-leaning states as conditions for which medical marijuana can be prescribed.
Find out where your state stands in the medical marijuana for back and neck pain issue.
About Medical Marijuana
Marijuana is the leading cash crop in the US and a Schedule I drug under the Controlled Substances Act of 1970. This designation means it has a lot of potential for abuse (i.e. addiction), and no medicinal value.
Yet, Marinol, a synthetic marijuana-based medication approved by the FDA, is classified as a Schedule III drug. Marinol contains a synthetic version of THC, which is the active ingredient in marijuana. As a Schedule III drug, Marinol is regarded as medicinal, with less potential for abuse. The FDA approved Marinol to help stimulate the appetite in people with AIDS and to treat nausea and vomiting due to chemotherapy.
Cannabinoids and Pain
According to the Americans for Safe Access Foundation (ASAF), a pro-medical marijuana advocacy group in Oakland, California, the natural form of marijuana contains many more cannabinoids (in addition to the THC) than does the synthetic Marinol, and consequently delivers more therapeutic benefits. Cannabinoids are naturally occurring chemicals in the cannabis plant. The University of Washington says over 480 cannabinoids exist, and these can be further sub-divided. Some of the sub-divided compounds are more psychologically active than others. THC, which is perhaps the best known of the cannabinoid sub-classes is very psychologically active. Others are not as active as THC but are nonetheless valuable for treating certain medical conditions, for example, seizures in children.
As far as pain is concerned, ASAF reports that taking a combination of cannabinoids yields more pain control than taking THC alone. Americans for Safe Access says that cannabis has at least two roles to play in the management of chronic pain, including neck and back pain.
First, it can relieve the pain itself—either alone or in combination with other pain-relieving drugs. And second, it can control nausea associated with long-term pain and also with taking opioids, a narcotic pain reliever.
ASAF also says that because inhaling leads to better absorption and fewer complications, it is the most common and preferable way to take cannabis.