Is the use of marijuana for chronic pain leading us down a familiar path?

By Oscar de Leon-Casasola, MD    Dec 5, 2016

The coach of the NBA’s Golden State Warriors, Steve Kerr, recently spoke about his failed attempt to control his chronic pain after back surgery with marijuana in a USA Today article published Dec. 3rd.

"A lot of research, a lot of advice from people, and I have no idea if maybe I would have failed a drug test. I don't even know if I'm subject to a drug test or any laws from the NBA, but I tried it and it didn't help it all,” Kerr was quoted as saying. He added, “But it was worth it because I'm searching for answers on pain. I've tried painkillers and drugs of other kinds as well, and those have been worse. It's tricky." 

Coach Kerr’s experience illustrates the need for marijuana to be downgraded from Schedule I to Schedule II, so that we can appropriately study not only its clinical efficacy potential, but - just as importantly - the short and long-term side effects.

This is precisely the message that the ASRA Board of Directors is sending with its “Position on the Use of Cannabis for Medical Purposes,” which was approved September 30, 2016. The position specifically calls for rescheduling marijuana and conducting more clinical outcome research on the substance’s effects on chronic pain as well as managing side effects.

A session at ASRA's 15th Annual Pain Medicine Meeting, held November 17-19, 2016, in San Diego, CA, discussed this very same subject. Francesca Filbey, PhD, presented her research on the long-term effects of marijuana use in the mesocorticolimbic system that raise concerns about the need to have more studies before we embark in recommending this alternative to our patients without having a full picture of what may happen to a chronic user.

This situation reminds me of the '90s when we embraced opioid use for the treatment of non-cancer chronic pain without the appropriate long-term studies. I hope that we are not making the same mistake with marijuana now.  

Dr. de Leon-Casasola is the president of the ASRA Board of Directors. He is also the Senior Vice-Chair and Professor of Anesthesiology (Tenure Track), Department of Anesthesiology, and Professor of Medicine at the University at Buffalo, School of Medicine and Biomedical Sciences and Chief of the Division of Pain Medicine and Professor of Oncology at Roswell Park Cancer Institute, both in Buffalo, NY.

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