Proponents of marijuana were overjoyed this week when Illinois Government Bruce Rauner legalized medicinal cannabis as an alternative to prescribed painkillers. The marijuana policy project called it a "big win". for patients, and officials say it will significantly increase the number of patients, possibly saving lives.
But the new state law raises the question: how effective is cannabis for the treatment of pain? And how well does it work to reduce the use of opioids and overdose deaths?
The answers are of course dependent on who you ask, whether they are doctors, researchers or patients. Some pain doctors love it. Many addiction specialists, not so much. The National Institute on Drug Abuse has for decades researched the negative effects of marijuana, while the Center for Medical Cannabis Research in San Diego has mostly positive reports. And patients have their own preferences.
Some patients said they are grateful for an alternative to painkillers, some of which say they are groggy.
But Joe Ruzich, who has a nervous disease that sometimes made him scream, said he only survived thanks to an electrical stimulator and an opioid pump. He worries that doctors are being pressured to cut off opioid medication.
"It helps people like me to live a normal life," said Ruzich, who previously wrote for the Tribune as a freelance reporter but had to quit because of his illness. "I am happy that people have more choice, but to present it as an alternative to opioids does not seem right to me."
As with many aspects of marijuana, research has yielded mixed results. The short answer is, yes, marijuana can help alleviate the pain, but not for all patients with all conditions. Some states with medicinal cannabis have also reported reductions in narcotics, maltreatment and overdose deaths – although these associations do not prove that marijuana caused these changes.
Doctors agree that more research is needed. But the evidence to date has not prevented the champions on both sides from praising cannabis as a remedy for everything from cancer to gout, or condemning it as a pest that can make users psychotic.
With an election for the governor in November, the subject has become a campaign issue, in which Rauner opposes legalization for recreational use and against the democratic opponent J.B. Pritzker who supports it. Activists and opponents have lobbied to influence public opinion.
The day after the new medical cannabis law was approved, an Illinois producer, Cresco Labs, announced a related marketing campaign, including a vending machine installed at the Thompson Center in Chicago, which looked like narcotic pills, but instead promotes medical cannabis. .
As Dr. Ajay Wasan explained in his recent article from MedPage Today: "I did not study medicine to prescribe weed," many doctors are still reluctant to authorize medical marijuana use. But he welcomes the opportunity to try a promising new treatment with the necessary caution.
Wasan is an anesthetist and a professor at the University of Pittsburgh and sits on the board of the American Academy of Pain Medicine in Chicago. Pennsylvania has a new law similar to that in Illinois, which is trying to man the use of marijuana patients from opioids.
Most people who legally use prescription painkillers do not abuse their medicines, he said. Approximately 30 percent of patients were successful in reducing or eliminating the use of opioids using cannabis under the care of a physician. Some, he said, do not like marijuana at all and prefer not to use it.
"It is not home flight, but the balance tilts to the positive," said Wasan. Certain types of pain, such as pain related to nerve damage, have a much greater chance of responding than others, such as fibromyalgia.
And for those who use illegal opioids, there are not enough data to show that marijuana helps them to stay clean.
"That's a dangerous practice because you're probably replacing one addictive substance instead of the other," said Wasan.
Research to date has generally supported claims for some types of pain relief. In the most recent comprehensive assessment of the effects of marijuana, the National Academies of Science, Technology and Medicine last year found evidence that patients who used cannabis had a greater chance of a "significant" reduction in pain.
Marijuana also reduced muscle spasms in some people with multiple sclerosis and reduced nausea and vomiting in some cancer patients who received chemotherapy. But the review also found indications that the drug probably increases the risk of schizophrenia, other psychoses and social anxiety disorders – and there was moderate evidence that marijuana is linked to abuse of other substances.
Large medical groups such as the American Medical Association and the American Academy of Family Physicians are against the medical marijuana laws of the state. The American Society of Addiction Medicine says that all cannabis products must be subject to the same standards and federal approvals of prescription drugs, and that smoking as a delivery method must be rejected because of the health risks.
Dr. Norm Wetterau, president of the New York Society of Addiction Medicine, said that cannabis "helps with terminal cancer pain" but that lawyers "say it's good for everything you save. There's no evidence."
The FDA has approved two synthetic versions of THC, the primary psychoactive component of marijuana, and this year for the first time approved an oil containing the non-psychoactive component cannabidiol or CBD for the treatment of rare forms of epilepsy.
But federal law still classifies the marijuana plant as a highly addictive scheme I substance with no accepted medical value, the same category as heroin and LSD. Meanwhile, opioids killed an estimated 70,000 people in the United States last year – about 40 percent of them from legal drugs such as hydrocodone, oxycodone, codeine and morphine.
There is a lack of controlled studies on the use of cannabis to make narcotics disappear. But a survey of almost 500 patients using marijuana for medical purposes in Canada found that 80 percent reported replacing the drug with drugs. Skeptics point to a recent Australian study in The Lancet magazine that showed that people who used marijuana for chronic pain for several years were more painful than those who did not.
That result is one where Dr. Mark Wallace often runs into his pain clinic: patients who try self-medication with marijuana, but use it too much and increase their pain.
Wallace is an anesthetist who does cannabis research at the University of California in San Diego and is on board the American Pain Society in Chicago.
"Every week I see patients who want opioids," he said. "It's a medicine that takes a patient and does not want to go, their life revolves around their next dose, that behavior changes when I put them on cannabis."
He quotes research and the experience of his own patients that there is a therapeutic window for cannabis – where high CBD and low amounts of THC, about 4 percent, can reduce pain, but high amounts make it more painful. For some patients, marijuana abrogates the withdrawal symptoms and helps them to sleep, which is a big advantage.
"After years of (prescribing) both, I think we should use cannabis for an opioid," Wallace said.
Physicians must be trained before they feel comfortable in certifying patients to use cannabis, he said.
"If you do not do a controlled dose," he said. "patients will get worse."
What the manufacturers of painkillers on the basis of opioids think marijuana is a substitute, and the new Illinois law, the industry has closed its lips. More than half a dozen companies or industry groups that the Tribune contacted did not answer.
A spokesman for the only company that did that, Purdue Pharma, which OxyContin makes, said only that it supports patient access to medicines approved by the FDA.