Last month, I addressed the subject of pain management in the context of opioid pain relievers such as Vicodin and Percocet.
Use of these painkillers — both by patients with legitimate prescriptions and by those obtaining them illegally — has exploded in recent years, leading many experts to speak of an “epidemic” of addiction and overdose that is claiming many lives each year.
The problem of chronic or intractable pain is a real one for many Americans, and doctors and others who encouraged wider use of opioid pain relievers a decade ago thought they were doing the right thing.
We have since learned there are more and less safe ways of prescribing and using these drugs. Educating both doctors and patients about the risks and benefits is becoming a high priority.
This month, I would like to turn your attention to a different, but somewhat related, topic much in the news: The growing acceptance of marijuana use for medical purposes — such as pain relief, boosting appetite, and slowing the progression of glaucoma.
A nationwide movement to legalize marijuana for these and other claimed medical uses has generated great support. Today, 29 states plus the District of Columbia have passed laws legalizing marijuana for certain medical conditions.
The laws vary by state. Maryland, for example, allows, but strictly regulates, medical marijuana growers and suppliers. (Though the law permitting medical marijuana was passed in 2014, patients still do not have access to it, as lawsuits by companies denied licenses have delayed their opening.)
Seven states and the District of Columbia permit its recreational use. California also legalized the cultivating of plants by individuals. Other states have decriminalized the possession of small amounts.
Interestingly, Virginia passed a law decades ago that permitted doctors to prescribe marijuana for medical purposes. But in practice, this has not led to any legal use in Virginia because federal law — which treats marijuana as a drug with no medical use — prohibits doctors from prescribing (though not from “recommending”) it.
A National Survey on Drug Use and Health found a significant jump in marijuana use among Americans over 50 in recent years — from 2.8 percent of the population in 2007 to 4.8 percent in 2013. (That’s a 71 percent increase.)
The survey didn’t ask whether the increase is due to greater recreational or medical use. To some degree, it no doubt reflects the aging of the baby boom generation into the 50-plus category. (For comparison, in 2013, 19 percent of 18- to 26-year-olds surveyed said they used pot.)
Given the apparent growing acceptance, you might wonder why the federal government still considers marijuana to have no legitimate medical use.
A recent report from the National Academies of Sciences, Engineering and Medicine — a well-regarded nonprofit, nonpartisan body of scientific experts — says there is evidence for both benefits and harms, but that more research is needed.
Reviewing studies published since 1999, the report found “strong” evidence that marijuana can treat chronic pain and ease nausea from cancer treatment, but also strong evidence that its use raises the risk of schizophrenia and other psychoses, as well as of traffic accidents.
It found “substantial” evidence that smoking pot worsens respiratory symptoms and chronic bronchitis, and “some” evidence that it can raise the risk for depression and lead to a dependence on, or abuse of, other drugs or alcohol.
Evidence that it boosts appetite in people with HIV or AIDS and eases symptoms of post-traumatic stress disorder (PTSD) was “limited.”
Researchers at New York University recently said that marijuana use in older adults can raise their risk of memory loss and falling.
In short, concern over the potential harms of marijuana use doesn’t come close to that over opioids. The latter are highly addictive: recent research indicates a single prescription lasting seven days is enough to begin a cycle into addiction. And overdoses of opioid pain relievers can and do cause death.
But there appear to be enough reasons to step back from an unconditional acceptance of marijuana use — especially among older adults — until further research is done.
One problem here is that marijuana’s official status as an illegal drug under federal law has made it difficult for researchers to obtain the product or get studies approved.
Perhaps we’ve put the cart before the horse by legalizing its use for medical purposes around the country before the evidence is there. But given that’s where we are today, it would seem to be in everyone’s interest to make research a priority at this point.