Many more American states legalized the use of cannabis for medical concerns like chronic neck pain in 2014, but new research shows that in those states where medical marijuana is legal, visits to the emergency room for cannabis-related crises have increased. The same study also found an overall increase in the use and misuse of cannabis as well, so is it worth the risk to use medical marijuana for neck pain relief?
50% Increase in Medical Marijuana ED Visits
Colorado was one of the first two states to legalize medical and recreational cannabis use and in this latest study emergency department visits involving cannabis use rose 50.4% in Colorado between 2007 and 2012. ED visits also rose in states where only medical use is legalized, with the largest increase in Hawaii, where visits related to cannabis rose by 55% from 2007 to 2012. New Jersey saw a 49.1% increase in visits, and Arizona had a 32% rise in the number of ED visits involving cannabis.
In some states where marijuana use remains illegal, even for medical purposes, there was also a significant increase in ED visits; in Texas, for example, there was a 43.2% increase in cannabis-related ED visits. In Oklahoma and South Carolina however, the increase was only 7.21% and 0.75%, which makes you wonder what’s going on in Texas.
The Cost of Cannabis for Pain Relief
The impact of cannabis on the health care system appears to be increasingly significant, with the author of this study, Dr. Rai, also presenting figures related to the costs of cannabis-related hospital stays. An average nationwide increase of 13.3% in cannabis-related hospital admissions was higher than that for alcohol abuse (8.6%), and the average hospital charge increased 39% for cannabis-related issues, compared to 29.5% for alcohol abuse. Interestingly, there was a 67.9% decrease in the percentage of visits related to cocaine use, but there was a 42% increase in visits related to opioids.
This is Not Your Mother’s Marijuana
One of the problems with cannabis is that there is such a wide variety available that users may be unaware of the strength and potential toxicity of their drug of choice. As well as the plant matter itself, cannabis oil and liquids have become popular, and there have even been incidents of serious explosions from home-based laboratories cooking up high-potency THC oil, which produces highly volatile gases.
Getting a prescription for medical marijuana may have become simpler in recent years, but with so many options available for users it is now increasingly complex to decide what product to choose and how to ingest it. This means that many people are ending up in the emergency room because they have taken too much and are overintoxicated.
This may be especially true for those who used marijuana recreationally in their youth and who are now using it medicinally some 30 or 40 years later, without appreciating that selective breeding of the plants has dramatically increased the level of THC and other active constituents. Essentially the cannabis now available is not that of the 70s, 80s or even the 90s. In fact, the authors of this study note that today’s cannabis is around four times as potent as cannabis of the 1970s.
Who Uses Medical Marijuana?
In a 2003 paper published in the journal Pain, Ware and colleagues reported that those surveyed who used cannabis for pain relief were more likely to be younger and to also use tobacco, and that the largest group of patients using cannabis did so for pain related to trauma and/or surgery. Some 68% of the patients were using cannabis to relieve neck pain or upper body pain, with 65% using it to treat myofascial pain (which can also involve neck pain).
The majority of these patients (53%) used 4 puffs per dose of cannabis for pain, 25% smoked a whole joint, and 12% smoked more than one joint at each dose. Most patients used it only on rare occasions (28%), 25% used it weekly, 16% used it daily, and 22% used it more than once a day for pain relief. The patients most often reported improvements in pain, sleep and mood with the use of the drug, with the most common side effects being feeling high and having dry-mouth.
Can Cannabis Relieve Neck Pain?
In a more recent study, patients with central and peripheral neuropathic pain were given vaporized cannabis at a 3.53% or 1.29% THC dose, or a placebo and their pain was assessed using a visual analog scale. Wilsey and colleagues also looked at any psychoactive side effects and the patients’ neuropsychological performance. The two active groups had no significant differences in analgesic response, and the number needed to treat was comparable in both cases to that of traditional medications for neuropathic pain.
Psychoactive effects were deemed to be minimal and reversed within 1 to 2 hours, suggesting that vaporized cannabis may be an effective option for relief of neuropathic pain resistant to other forms of treatment.
How Cannabis Helps with Chronic Pain
THC, or tetrahydrocannabinol, is the active pain-relieving cannabinoid in medical marijuana, but its psychoactive effects limit its use, as does the typical method of delivery (smoking). Other cannabinoids also have analgesic effects however, including oral doses of cannabidiol and beta-caryophyllene, which appear to have a higher level of safety and limited adverse effects.
These drugs act on the endocannabinoid system, including CB(1) receptors in the spinal cord which process and modulate nociceptive information. In addition, CB(2) receptors appear to be a primary cause of the anti-inflammatory effect of endocannabinoids, which also helps relieve pain locally. Specifically, these CB(2) receptors may affect mast cells and neutrophils (immune system cells), which then helps prevent pain related to an inflammatory response.
What these studies suggest is that there is evidence in support of the use of cannabis for relief of pain such as neuropathic neck pain, but that it is increasingly important to find safe delivery mechanisms, and to put in place regulatory systems that help patients to choose more wisely when using medical marijuana.
American Academy of Addiction Psychiatry (AAAP) 25th Annual Meeting: Abstracts 20 and 52, presented December 5, 2014.
Rice AS, Farquhar-Smith WP, Nagy I. Endocannabinoids and pain: spinal and peripheral analgesia in inflammation and neuropathy. Prostaglandins Leukot Essent Fatty Acids. 2002 Feb-Mar;66(2-3):243-56.
Fine PG, Rosenfeld MJ. The endocannabinoid system, cannabinoids, and pain. Rambam Maimonides Med J. 2013 Oct 29;4(4):e0022. doi: 10.5041/RMMJ.10129. eCollection 2013.
Wilsey B, Marcotte T, Deutsch R, Gouaux B, Sakai S, Donaghe H. Low-dose vaporized cannabis significantly improves neuropathic pain. J Pain. 2013 Feb;14(2):136-48. doi: 10.1016/j.jpain.2012.10.009. Epub 2012 Dec 11.
Ware MA, Doyle CR, Woods R, Lynch ME, Clark AJ. Cannabis use for chronic non-cancer pain: results of a prospective survey. Pain. 2003 Mar;102(1-2):211-6.
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Data shows that emergency department visits involving synthetic marijuana have more than doubled in recent years. Could this prompt yet more states to alter legislation, especially as those states where medical cannabis has been legalised have reported lower levels of opioid overdose deaths?
Due to growing disenchantment with so-called BigPharma, many people are turning to natural drugs like Thunder God Vine and marijuana to combat chronic pain caused by conditions such as arthritis. Synthetic cannabinoids are not the same as the real thing, however, and are increasingly recognised as a significant risk to public health.
These fake versions of marijuana accounted for 28,531 visits to emergency departments in the US in 2011, up from 11,406 in 2010. Such substances are known as ‘spice’ or ‘K2’, as well as other monikers, and have been found to contain a variety of chemicals, many of which are classes as contaminants that may be harmful to the health of users.
The common misconception that marijuana is safe, and that synthetic marijuana may actually be safer, is just that, a misconception. Many people who would not otherwise use illicit drugs are compelled to do so because of the popularity of the idea that natural herbs are better than pharmaceuticals. While this may be true for some natural supplements, as regards safety, those that have not been rigorously tested, and those that are not well regulated so as to screen for contaminants present unknown risks.
Negative Effects of Synthetic Marijuana
Adverse reactions attributed to synthetic marijuana include:
- Anxiety and intense agitation
- Nausea and vomiting
- Heart palpitations (racing pulse)
- Elevated blood pressure
- Tremors and seizures
- Hallucinations and paranoia
Not only have synthetic cannabinoids been linked to such effects, many of those who use these drugs regularly will also experience withdrawal symptoms when/if they stop. As many users are living in states where marijuana is illegal, this likely means that those experiencing these undesirable effects are not getting medical help or assistance in weaning themselves off the drugs.
Four-Fold Increase in Drug Use in 18-20 Year-Olds
Indeed, the myth that marijuana is safe can lead patients with chronic pain to think that their symptoms are unrelated to the drug, reducing the likelihood of them reporting the negative effects. Those most at risk are thought to be younger users of synthetic marijuana who accounted for 7584 emergency room visits in 2011 (up from 3780 in 2010). There was a four-fold increase in such visits from those aged 18-20, from 1881 in 2010 to 8212 in 2011.
Emergency department visits by women experiencing negative effects of synthetic marijuana rose three-fold between 2010 and 2011, although men still accounted for around 79% of all such visits.
Is Synthetic Marijuana Illegal?
In states where marijuana remains illegal, even for medical purposes, some people may begin using synthetic marijuana, believing it to be legal or less problematic than the real thing. The Synthetic Drug Prevention Act of 2012 specifically prohibits the sale or possession of some synthetic cannabinoids however, putting them in the same category as ‘bath salts’ – the drugs that have attracted plentiful attention for their undesirable side effects.
The illegality of synthetic marijuana actually makes it all the more dangerous because those manufacturing the drugs are continually altering the composition of their product in order to evade the law. Such tinkering with these compounds will not only affect the potential benefits for pain attributed to synthetic marijuana, but also the safety of the products. Buyers hardly ever know exactly what is in each batch and if it will be the same as previous batches.
Legalisation of Drugs for Pain
Natural marijuana is increasingly popular as a way to manage chronic pain, but even this is still of questionable merit. At least in those states where it is legal people are more likely to discuss its use with the physician and promptly address any difficulties experienced with the drug. Legalisation also makes it easier for researchers to investigate the efficacy and side effects of marijuana and better warn patients about potential safety concerns as well as identify those particularly susceptible to the drugs’ effects.
In the meantime, there needs to be better education regarding awareness of the dangers of synthetic cannabinoids, dispelling the myth that these are safe ways to manage chronic pain. This needs to be coupled with improved treatment options for neck pain and other conditions that prompt people to turn to street drugs when disenchanted with mainstream medicine.
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