Although many in the medical community believe cannabis can reduce pain patients’ dependence on opioids, some say barriers to marijuana research still exist
After watching a generation of
patients fall victim to overdoses and addiction from the mass
prescribing of pain pills, researchers seeking alternatives to
prescription opioids are turning more frequently to a drug the federal
government has long said is neither safe nor effective for the treatment
of any medical condition.
A
growing consensus in the scientific and medical community points to
marijuana having the potential to reduce patients’ dependence on
prescription painkillers and help roll back the opioid epidemic ravaging
communities across the United States.
Although
some government agencies, such as the National Institutes of Health,
are slowly evolving their stance on cannabis, others like the Food and
Drug Administration and the Drug Enforcement Administration aren’t
convinced of its medical potential. They classify marijuana as a
Schedule I drug, alongside drugs such as heroin and ecstasy, and say
more clinical trials are needed to demonstrate an accepted medical use
for the plant and its extracts.
Some
researchers who spoke with NBC Bay Area called it a bit of a catch-22.
The government wants to see more tests, but because it’s a Schedule I
drug, researchers studying the therapeutic effects of marijuana are
subject to tight controls and limited federal funding.
“I’m
a total believer,” said Marin County pain management doctor Michael
Moskowitz, who has practiced medicine for 40 years. “I’m not a believer
like I believe in the religion of marijuana. I’m a believer in the
science of it.”
Moskowitz has been
tracking the results of 78 patients using medical cannabis in
conjunction with prescription opioids. His data shows more than half of
those patients were able to reduce their dependence on opioids, and five
have stopped taking them altogether.
“I
was listening to people say they are lowering their medicines, but when
I actually looked at the data, I was blown away,” Moskowitz said.
One
of those five patients is an East Bay grandmother who suffered through a
decade of sometimes unbearable chronic pain after neck surgery, a car
crash and breast cancer. She asked her name be kept private over
concerns her career in healthcare could be impacted, despite the recent
legalization of marijuana in California.
“I feel like if I pulled all of my hair out it would be better than what I was going through,” she said.
Just like tens of millions of other Americans, she relied on a bevy of prescription painkillers to get her through each day.
According to federal data,
more than one-third of people in the United States age 12 and over took
prescription pain killers in 2015. Even in the Bay Area, where the
epidemic is mild compared to other parts of the country, state data shows about 1,200 people have died from prescription opioid overdoses between 2011 and 2015.
The
grandmother says she took the drugs responsibly and never developed any
dependency issues, but remained wary after a career in healthcare
exposed her to their potential harm.
When
Moskowitz approached her about trying medical cannabis, she was nervous
at first. She had no interest in "getting high." But faced with the
alternative of chronic pain and a dependence on prescription
painkillers, she decided to dip her toes in the water, and started with a
strain low in THC, the principal psychoactive component of cannabis.
“I
wasn’t sure if it would work or not,” she said. “I was nervous and shy
about the whole process until I began to realize I was getting better.”
Moskowitz
refers patients to Synergy Wellness, a medical cannabis collective in
Marin County that specializes in products that heal without the high.
Owner Leonard Leinow says half his members are patients seeking medical
marijuana to get off their pain pills.
Although
Moskowitz has seen success with his own patients and believes marijuana
should have a prominent place in treating pain, he says more clinical
trials are needed to sway the greater medical community.
That’s
exactly what Dr. Donald Abrams, chief of hematology and oncology at
Zuckerberg San Francisco General Hospital, is working on right now.
“Most doctors have adopted the stigma that [cannabis] is a substance of abuse and has no accepted medical use,” Abrams said.
Abrams
became interested in studying cannabis in the early 1990’s and has
since become one of the world’s foremost experts on its therapeutic
potential. In 2016, he was part of a committee at the National Academies of Sciences, Engineering, and Medicine that spent six months reviewing all of the published literature on the health benefits of cannabis and its compounds.
“It’s
very difficult to find published studies in the literature looking for a
potential benefit of cannabis,” Abrams said. “As an oncologist in San
Francisco for three-plus decades, I can tell you that I’ve seen my
cancer patients decrease the doses of opiates or wean totally of them
altogether by using cannabis.”
Abrams
said there’s a need for more randomized, placebo-controlled studies to
gain a full understanding of the plant and convince the greater medical
community of its potential. Now, Abrams is running just one of eight
clinical human trials in the country funded by the National Institutes
of Health that study the medical benefits of cannabis or one of its
compounds.
This
is the kind of study officials at the FDA and DEA want to see more of
before accepting cannabis as a drug with medical benefits.
“The
FDA’s scientific and medical evaluation has determined that the
marijuana plan continues to have high potential for abuse and does not
meet the criteria outlined by the Drug Enforcement Agency (DEA) for
currently accepted medical use, requiring its continued placement in
Schedule I under law,” FDA spokesperson Michael Felberbaum said in a
written statement.
But some
agencies within the federal government, such as the National Institute
on Drug Abuse (NIDA), are slowly shifting their positions on cannabis. A recently posted entry on NIDA’s website discussed the potential of cannabis to reduce prescription opioid use in pain patients.
“Research
into the effects of cannabis on opioid use in pain patients is limited,
but data suggest that medical cannabis treatment may reduce the dose of
opioids required for pain relief. In addition to its research portfolio
on the roles of the cannabinoid and opioid systems in pain, NIDA is
funding additional studies that will provide data relating to medical
marijuana and opioids,” it says.
This
position represents a significant policy shift for the agency, which
prior to 2015, only funded studies on the potential harm of cannabis.
Another
recent NIDA study looking at Medicare prescription drug data found that
opioid prescriptions were significantly down in states with access to
medical cannabis.
Even the DEA, which has yet to budge on its position that marijuana should remain a Schedule I drug, recently began approving
more growers to meet the rising demand from researchers. As of now, the
only approved source of cannabis for research purposes is a lab at the
University of Mississippi.
Yet
others in the federal government, including Attorney General Jeff
Sessions, remain unconvinced that tight controls on marijuana should be
lifted.
"I am astonished to hear
people suggest that we can solve our heroin crisis by legalizing
marijuana so people can trade one life-wrecking dependency for another,"
Sessions said at a recent conference for Virginia law enforcement officials.
For
researchers like Abrams, the strict controls on cannabis limit his
ability to study the drug. He not only needs to get approval from a
handful of government agencies, but it can also take a long time to
obtain the product and there are limited strains available for testing.
“As long as we have the DOJ making decisions as opposed to scientists and physicians, something is broken,” he said.
But Abram says those hoops are worth jumping through given the potential he sees in the plant.
“It’s
a lot of work and there are a lot of barriers, but I still think that
they’re worth trying to overcome to answer important questions,” he
said.
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