PainRelief.com Interview with:
Kevin Boehnke, Ph.D. Research investigator
Department of Anesthesiology and the Chronic Pain and Fatigue Research Center
University of Michigan
PainRelief.com: What is the background for this study?
Response: Medical cannabis is legal in 33 states, and people can obtain medical cannabis licenses to treat a wide swath of conditions, including cancer, anxiety, irritable bowel syndrome, chronic pain, complications of Alzheimer’s disease, and nausea. Many observational surveys have found that many people use cannabis for chronic pain, but whether these surveys were representative of national trends was uncertain. To our knowledge, this was the first study that examined nationwide trends of patient-reported qualifying conditions based on medical cannabis state registries.
PainRelief.com: What are the main findings?
Response: This study adds to our
understanding in several ways.
First, the majority of conditions for which people use cannabis have
substantial or conclusive evidence of cannabis being an effective treatment. These
include chronic pain, multiple sclerosis, and nausea and vomiting. To us, this
was quite an important finding because medical cannabis is a controversial and
polarizing topic, in which some people claim that cannabis is a valuable
medicine for many conditions (including many that are not evidence-based) and
others claim that cannabis is merely a drug of abuse or recreation, and that
medical cannabis laws are simply a cover for potheads to get high legally.
Our findings suggest that many people are actually using cannabis for reasons
that are evidence based, and we believe that’s an important contribution to
this ongoing societal discussion.
Second, there are still quite a lot of qualifying conditions that have little
or no evidence of efficacy that are allowed under many state laws. This reveals
how disconnected the policy is from the science.
Third, we now know that chronic pain is indeed the most common qualifying
condition for which people obtained medical cannabis licenses. Given the
context of the opioid epidemic and the consistent observational studies that
report medical cannabis patients substituting cannabis for pain medications, we
now have a better sense of how widespread that practice and rationale may
be.
PainRelief.com: What should readers take away from your report?
Response: Up until this point, there
wasn’t much concrete, nationwide data about why people are using cannabis.
There’s still a lot to be learned, but this is a good starting point to build
from.
Our results also point to the massive problem of chronic pain. Indeed, chronic
pain was the most common reason that people were using cannabis. This makes
sense, because chronic pain is incredibly common, affecting tens of millions
of Americans.
However, it’s important to note a few things that may complicate this picture
and suggest some important future directions as well as limitations of the
current study.
First, chronic pain can be both a standalone medical condition (e.g.,
fibromyalgia) as well as a symptom (e.g., pain related to cancer, Parkinson’s
disease, multiple sclerosis, etc…). Because of that, it is possible that some
patients listed chronic pain as their qualifying condition, but are also using
cannabis for other symptoms or conditions that were not covered under the state
law.
Second, many chronic pain medications (e.g., opioids) come with significant
side effects, and cannabis is perceived as being relatively safe because the
risk of fatal overdose is so incredibly low. Fewer side effects is one of the
common reasons in observational studies that patients say that have substituted
cannabis for medications, which is consistent with this idea.
Third, it is possible that some people who want to have legal cover for using
cannabis recreationally used chronic pain as their qualifying condition because
pain is subjective and thus a convenient condition to use to get a
license.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: We’d like to continue following these data as more state registries come online to see whether the trends we identified here continue. There are many states that recently passed laws but don’t have registries with available data, so it’ll be interesting to see what comes of that. We also want to do a deeper dive into how cannabis and cannabinoids affect different types of pain. To that end, we have some ongoing observational studies where we follow current cannabis users over time, and we are also hoping to do some clinical trials in the future.
Disclosures: : Kevin Boehnke’s work on this article was supported by the National Institute of Dental and Craniofacial Research (Grant No. K12DE023574), and Rebecca Haffajee’s work on this article was supported by funding from the National Center for Advancing Translational Sciences (Grant No. KL2TR002241). Daniel Clauw has consulted for Pfizer Inc., Eli Lilly and Company, Tonix Pharmaceuticals, Aptinyx, Regeneron, IMC, and Intec. None of the other authors has relevant financial interests in or relationships with entities in the biomedical arena that could be perceived to influence, or that give the appearance of potentially influencing, this article.
Citation:
Kevin F. Boehnke, Saurav Gangopadhyay, Daniel J. Clauw, Rebecca L. Haffajee. Qualifying Conditions Of Medical Cannabis License Holders In The United States. Health Affairs, 2019; 38 (2): 295 DOI: 10.1377/hlthaff.2018.05266
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Last Updated on April 18, 2019 by PainRelief.com