Considering Pot for Pain?
That’s very promising news for the 60 to 70 percent of people with diabetes who have neuropathic pain and may not be getting adequate relief from the limited arsenal of pain meds currently out there. “There’s no question that this is a legitimate option for people with chronic nerve pain,” says Lester Grinspoon, MD, Harvard Medical School professor emeritus of psychiatry and author of Marihuana: The Forbidden Medicine. “Patients are going to start putting pressure on their doctors to prescribe it.”
In the study, published in the July issue of the Journal of Pain, the researchers recruited 16 patients with pain in their feet from diabetes-related nerve damage and randomly assigned them to inhale one of three doses of cannabis or a placebo. After a two week-break, they crossed over to a different dosage and repeated the test. All the testers who inhaled cannabis reported feeling less pain—and the participants who got the highest dose reported the least pain.
Dr. Grinspoon, who developed severe diabetes about 25 years ago, not only recommends cannabis for diabetic neuropathic pain, but he takes it himself every day. In 1995, Dr. Grinspoon wrote an opinion piece in the Journal of the American Medical Association urging doctors to get to know cannabis again—it had been widely used in the 18th century before the advent of common painkillers such as acetaminophen and ibuprofen. “I wrote that there would be many patients who not only wanted cannabis but deserved it because it’s such a remarkable non-toxic drug,” Dr. Grinspoon says. “Whether you’re talking about pain from migraine headaches, multiple sclerosis or diabetes, physicians should know that cannabis is very helpful.”
Tracking Down Medical Marijuana
Obtaining marijuana for medical use is a process. Here’s what you need to know.
- Check for legality. Marijuana is still technically illegal in the United States, but 23 states have sanctioned its use for medical reasons, which vary by state. To find out where your state stands on the issue, check the website of Americans For Safe Access, a nonprofit organization dedicated to securing safe and legal access to marijuana for therapeutic uses and research. From the home page, click on “Legal,” and then “Legal Information by State & Federal Law,” to see a map of the United States. States with medical marijuana programs are in purple; states without a marijuana program are in gray. Click on your state and scroll down to “Becoming a patient in [your state]” to learn about the qualifying conditions and patient requirements. “Either it will say which conditions you’re limited to, or it will say that your doctor can decide what’s relevant,” explains Chris Brown, a spokesperson for Americans For Safe Access.
- Get a recommendation. If your state has a medical marijuana program and your condition meets its requirements for inclusion, you’ll then need a recommendation from your physician. This recommendation can be taken to a marijuana dispensary where it will be reviewed by one of the staff employees known as a "medical cannabis agent." The dispensary agent will then guide the patient on selecting a product that best suits her medical needs. However, many doctors are unfamiliar with cannabis as medicine and/or hesitant to prescribe it. Dr. Grinspoon reports that in a 2013 survey of Harvard physicians only 9% said they would sign a paper allowing their patient to use marijuana. There are a variety of reasons for this: physicians may not know the state laws, or they're reluctant to be linked to a possible adverse outcome that could also result in civil litigation. If your doc is not on board, go to Leafly.com, click on “Find Nearby” and then “Doctors” to find a cannabis-prescribing MD in your area. “Be patient,” urges Brown. “Even doctors who support medical marijuana in theory might not want to be involved in its recommendation. It can take a while to find the right doctor and you might need to go through a lot of steps.”
Even in states that have green-lighted medical marijuana, your boss can still fire you for flunking a drug test. “You’ll want to know practically speaking whether your boss does drug testing and whether any patient rights and civil protections are in place in your state,” Brown says. “For example, in Nevada there are privacy standards and reciprocity rules but nothing protecting people from employment discrimination.”
If you do manage to get a prescription, Dr. Grinspoon recommends taking your daily dose before bed to prevent any possible high from interfering with your daily functioning the next day.
Lastly, marijuana’s medicinal effects don’t lessen over time, Dr. Grinspoon reports, so you shouldn’t need to up your dose. Side effects may include increased appetite, possible sleepiness, and feeling a temporary high. “As people understand more and more about how useful cannabis is, its use is going to grow,” Dr. Grinspoon adds.