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Medical marijuana is gaining traction as a pain-management alternative to opioids, but some experts are sounding the alarm about the lack of studies on marijuana addiction and the correct dosages to relieve the pain of injured workers.
What was once true about opioids when doctors, urged by pharmaceutical firms in the 1990s, began prescribing them essentially as miracle drugs for pain is now considered true about medical marijuana.
“When the doctors were told that opioids were not addictive and (that) there was no ceiling to the doses or whatever else doctors were told … things got way out of control,” said Dr. David C. Randolph, a Milford, Ohio-based occupational physician.
“This is a bad idea,” he said of marijuana’s rise to the top of the pain management alternative list.
Dr. Randolph participated in a study, On Opioids: The Doctors’ Perspective, conducted by the Boca Raton, Florida-based National Council on Compensation Insurance providing a retrospective look at the opioid crisis that, according to the National Institute of Drug Abuse, kills 115 people a day.
The study, released in April, revealed four top reasons opioid prescriptions became so prevalent in U.S. health care: opioids were assumed to be nonaddictive; the drugs were the preferred option in curing pain; there was a lack of knowledge about opioids in addiction science; and a lack of clarity on dosing.
“(Opioids were) so promoted and they said it was so positive to receive these drugs, they worked so well and so on,” said Dr. Steven Feinberg, a pain expert and founder of the Palo Alto, California-based Feinberg Medical Group, which helps injured workers manage pain. “I see lots of problems on the horizon” with medical marijuana.
Political push overshadows proof
A 2017 survey found that 83% of Americans said doctors should be able to prescribe marijuana to patients, while 14% opposed legalizing medical marijuana and 4% had no opinion, according to the survey conducted by Yahoo News and The Marist Poll.
Now legal for medical uses in 30 states and the District of Columbia, marijuana as of May 25 remained illegal at the federal level — a Schedule I drug classification that placed its leaves and derivatives that come in the form of oils, liquids, candies and pills, in the same category as street drugs.
The laws vary state to state. In some states, it can only be used in certain forms and for certain ailments, such as cancer or epilepsy. Pain management isn’t on the list in a few states, although use for “severe pain” is approved.
“We don’t really know enough about marijuana to know about pharmaceutical reactions,” said Dr. Suzanne Novak, a physician in Austin, Texas, who wrote the pain management section for the Official Disability Guidelines and who was among the physicians interviewed for the NCCI study.
“We really know shockingly little,” Dr. David Deitz, a managed care consultant and founder of David Deitz & Associates L.L.C. in Westport, Massachusetts, said at the NCCI’s Annual Issues Symposium in May, speaking about the future of medical marijuana.
With medical marijuana illegal at the federal level, studies that could prove its efficacy are limited. As of May 25, the U.S. Drug Enforcement Agency has approved one site for marijuana cultivation for research: a 12-acre farm on the University of Mississippi campus.
That specific chemical makeup of marijuana provided for research is different from strains countrywide, Dr. Deitz said.
The National Academies of Sciences, Engineering, and Medicine concluded in 2000 that cannabinoids, a part of marijuana’s makeup, have “shown significant promise in basic experiments on pain.”
Several experts question whether such an endorsement is enough.
“I recommend an open-minded and cautiously optimistic approach regarding medical marijuana,” said Silvia Sacalis, a Tampa, Florida-based licensed pharmacist and vice president of clinical services for Healthesystems L.L.C. “There are some potential benefits, such as clinical evidence for pain management in certain scenarios, and some additional recent studies that opioid usage has been reduced in states that allow medical marijuana. However, there are concerns that need to be addressed, such as workplace safety.”
Experts doubt the current administration would reschedule the drug to promote testing.
The federal government has not earmarked any funding in 2018 toward fighting state availability of marijuana, but U.S. Attorney General Jeff Sessions has made many public statements about marijuana having no medical use.
Meanwhile, doctors that manage pain are perplexed as to how to handle medical pot.
“If an injured worker comes in here and says I am using X amount a day (of medical marijuana), I don’t know what that means … I don’t know what kind. Is it tainted with anything?” said Dr. Feinberg.
And medical marijuana could complicate return to work, experts say.
“Drug treatment of chronic pain in the long term is not effective,” said Dr. Deitz, drawing a parallel between opioids — which can cause intoxication — and many forms of marijuana.
“It’s a passive treatment. Nobody is going to get off the couch and go back to work on cannabis.” Yet it could be safer, experts say. Nobody stops breathing as the result of marijuana, Dr.
Deitz said. That’s how opioids kill — the drug slows breathing, he said.
The addiction potential of marijuana is unknown, but abuse of the drug could be inevitable, according to one medical professional.