Illustration by Darren Gygi
Pete LePage was among the first to sign up for Minnesota’s medical cannabis program when it went into effect last summer. Since an ATV accident left him paraplegic 21 years ago, he’s spent thousands of dollars on therapies ranging from injections to hot tubs to manage his pain and muscle spasms. But nothing helped like the illicit joint a friend slipped him one day, a few years before Minnesota passed its medical cannabis bill. He found it instantly eased his muscle spasms and relaxed his lower back and pelvis, making movement much easier.
Now LePage and the more than 1,400 other patients enrolled in the state’s medical cannabis program no longer have to break the law in their efforts to manage symptoms from a narrowly defined list of qualifying conditions. As of July 1st, 2016, that list grew to 10 with the addition of intractable pain. But some healthcare professionals remain wary, citing the impossibility of verifying a patient’s self-reported pain and the lack of conclusive research on marijuana’s efficacy in treating it.
Dr. Andy Bachman (great-great grandson of the founder of the Bachman’s garden empire) is the founder and CEO of LeafLine Labs, one of the state’s two certified medical cannabis vendors. He points to another reason to include pain on the list of qualifying conditions: an oft-cited 2014 study published in JAMA Internal Medicine that found states with medical marijuana laws had a 24.8 percent lower average annual opioid overdose death rate compared to states without such laws.
It’s a compelling statistic, considering that in 2014 more Minnesotans died from overdosing on opioids (a class that includes prescription painkillers and heroin) than from car accidents. “What we are doing presently to treat pain is not only not working, it’s causing harm,” says Bachman, “That healthcare is now the leading cause of accidental death is beyond ironic; it’s tragic.”
But is medical marijuana the solution the JAMA study suggests it may be? Dr. Charles Reznikoff, an addiction expert at Hennepin County Medical Center, points out that the study’s authors acknowledged the link between medical marijuana laws and lower opioid overdose rates was one of correlation, not necessarily causation. Reznikoff also points to Colorado, which legalized medical marijuana in 2000 and recreational marijuana in 2012, and where opioid death rates are currently ahead of the national average.
“There is no simple cure for the complex problem of opioid use disorder,” says Reznikoff. “There’s this logic that says cannabis is softer than opioids, so we’ll transfer them from one to the other. But you can’t just take opioids away, rip it off like a bandaid, and be done forever.” As the risk of overdosing increases following the reduced tolerance that results from detoxification, Reznikoff worries about the dangers of over-promising on the potential of medical cannabis as an alternative to opioids. “I worry that there are going to be patients hurt,” he says.
LePage never used opioids following his accident (he’s allergic to them), but medical marijuana has enabled him to stop taking four other prescription drugs he was using to manage his anxiety, bladder control, and muscle spasms, as well as the large doses of ibuprofen he was taking for his pain. “Medical cannabis has freed me,” says LePage. “Now I look forward to getting out of bed every day.”
Reznikoff acknowledges that medical marijuana may deserve a place in a multifaceted approach to pain management, especially as its availability will put pressure on the FDA to address the current dearth of scientific research on its risks and potential. For someone who’s already using opioids, marijuana may help ease the detoxing process or allow for decreased opioid dosages, but marijuana is not likely to easily sate an appetite for opiates that a recovering addict will likely battle for life. “It’s important to understand this is a trial,” says Reznikoff. “Go in skeptical. If you’re someone with complex suffering, don’t hope for a silver bullet.”