Can marijuana really replace prescription opioids for pain? Some get relief but ‘it’s not a home run’

Marijuana advocates were overjoyed this week when Illinois Gov. Bruce Rauner legalized medical cannabis as a substitute for prescription painkillers. The Marijuana Policy Project called it a “big win” for patients, and officials say it will greatly expand the number of patients, possibly saving lives.

But the new state law begs the question: How effective is cannabis for treating pain? And how well does it work to reduce opioid use and overdose deaths?

The answers, of course, depend on whom you ask, be it doctors, researchers or patients. Some pain physicians love it. Many addiction specialists, not so much. The National Institute on Drug Abuse has decades of research on 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’re grateful for an alternative to pain pills that some say make them groggy.

That result is one that Dr. Mark Wallace runs into commonly at his pain clinic: patients who try to self-medicate with marijuana but use too much, and their pain increases.

Wallace is an anesthesiologist who conducts cannabis research at the University of California at San Diego and he’s on the board of the American Pain Society in Chicago.

“I see patients every week wanting off opioids,” he said. “It’s a drug that will grab hold of a patient and will not want to let them go. Their life revolves around their next dose. That behavior changes when I put them on cannabis.”

He cites research and his own patients’ experience showing there is a therapeutic window for cannabis — where high CBD and low amounts of THC, around 4 percent — can reduce pain, but high amounts make it hurt more. For some patients, marijuana takes the edge off withdrawal symptoms and helps them sleep, which is a big benefit.

“After years of (prescribing) both, I believe we should use cannabis before an opioid,” Wallace said.

Doctors need training on dosing before they will feel comfortable certifying patients to use cannabis, he said.

“If you don’t do controlled dosing,” he said. “patients will get worse.”

As for what the manufacturers of opioid-based prescription painkillers think of marijuana as a substitute, and of Illinois’ new law, the industry has been tightlipped. More than a half dozen companies or industry groups contacted by the Tribune provided no response.

A spokesman for the one company that did, Purdue Pharma, which makes OxyContin, said only that it supports patient access to FDA-approved medications.

Tribune reporter Ted Gregory contributed.

Twitter @RobertMcCoppin


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