With legal barriers holding up research, patients aren’t waiting for randomized trials.

PITTSBURGH — Professional football players know pain, but some say they want a way out of team-based regimens of pills and injections they say leave them feeling angry and debilitated. The way out? Medical marijuana, the focus of the first-ever World Medical Cannabis Conference & Expo — a conference that started, fittingly, the day following the traditional April 20 “pot holiday.”

As medical conferences go, it was highly atypical. Science was not at the forefront; not many American investigators feel comfortable investigating a substance that is Schedule 1 illegal, by federal law. Also, the conference was supported by a unique group of exhibitors, more than 80, ranging from marijuana growers to dispensaries to specialized laboratories to manufacturers of cannabis delivery systems, including sublingual tabs, vape pens, and edibles (with featured guest Laurie Wolf, dubbed the “Martha Stewart” of edibles).

The social momentum favoring medical marijuana is undeniable. Currently 28 (soon to be 36) states have legalized medical marijuana for conditions such as chronic pain, seizure disorders, and traumatic brain injury, and these states are busily creating safe and effective treatment networks to support its use. All this momentum culminated in the pioneering conference founded by Pittsburgh’s Compassionate Certification Centers for medical marijuana administration and its CEO, Bryan Doner, DO.

Whatever the conference lacked in science it made up for with compelling stories.

The stories, for example, of those professional football players looking to avoid the pain pill mills they see foisted upon them by teams trying to keep them on the field. Of mothers of profoundly ill children wanting relief from major side effects of standard treatments. Of sufferers from chronic pain who have been ostracized from receiving any standard treatment whatever after being discovered having experimented with cannabis.

Eben Britton, former offensive lineman for the Jacksonville Jaguars and Chicago Bears, said, “I received painkillers like Ativan, Celebrex and toradol injections before and after the game for various injuries throughout my career, and guys like me are finding these are wreaking havoc with their bodies, physically and mentally. For me, juxtaposing the use of opiates, which made me angry, irritable, and suffering withdrawal symptoms, against the use of cannabis showed me a much more healing experience. I could cope with the stress and anxiety of being isolated with injury and was able to feel both emotionally and spiritually rejuvenated, and ready to grind it out again.”

Nate Jackson, former receiver for the Denver Broncos and San Francisco 49ers, said he had started experimenting with recreational cannabis as a high school kid, “but I started playing football then and found that whatever injuries I sustained seemed to heal relatively quickly. I continued with cannabis use throughout my pro career for that reason — I just didn’t want the pills. The cannabis didn’t kill the pain, it just reframed it. To me, playing football is about dealing with pain, not avoiding it.”

Both former players are affiliated with the recently founded Athletes for Care, an organization pushing sports teams, the NFL in particular, to “lead the science” in exploring a cannabis-based alternative to chronic pain medications.

Other speakers discussed the dramatic difficulties patients can have in seeking this alternative. “Captain” Kirk Reid, a college instructor and creator of cannabis “edibles,” described a lifetime of pain treatment arising from multiple sclerosis and associated surgeries, and being denied traditional care because tests had shown prior cannabis use. “If there’s one message I have for physicians, it’s don’t cut off people from effective treatment tools just because they’ve used cannabis. It’s no cure-all and certainly won’t cure my MS, but it’s kept me off pain pills pretty successfully.”

Jane Maedler, mother of 10-year-old Rylie, the namesake for Delaware’s recently passed “Rylie’s Law” enabling qualified young patients to receive cannabis treatments in school, described problems she encountered in having Rylie treated in safe settings with cannabis oil that was therapeutically clean.

Rylie needed relief from severe seizures caused by treatment of an aggressive giant cell granuloma consuming her facial bones. Cannabis reduced Rylie’s seizure incidence significantly, but Maedler says she had to prepare for possible arrest for pursuing this alternative by keeping her husband out of the loop so that at least one parent would remain available.

Even with a legalized approach, she said it is incumbent upon her and all other parents in similar situations to test cannabis products carefully and completely at experienced, reputable labs. “Dealing with the black market is scary. I’ve seen tests come up showing everything from heavy metals to mold.”

Which leads to the dilemma practicing physicians and other professionals face when confronted by a patient seeking and possibly benefiting from cannabis use. On one hand there aren’t the comforting double-blind studies buttressing therapeutic decision-making found with traditional therapies, largely because American researchers have felt constrained by legal concerns.

On the other hand, that illegal status hangs over states that have felt confident in recent years passing the legislation, however carefully limited it is. There’s no guarantee they won’t be confronted by federal enforcement, particularly with U.S. Attorney General Jeff Sessions leaning in that direction while proclaiming the lethal dangers of the drug.

On that issue, conference keynote speaker Cyril Wecht, MD — the nationally renowned Pennsylvania-based medical examiner known most recently for his involvement in the NFL’s concussion controversy — noted that in his 40-year career involving some 20,000 autopsies, he had never seen nor heard of one death being caused by marijuana.

“We’re dealing with misinformed public policy dating back to Harry Anslinger’s 1932 Bureau of Narcotics,” he said, “and the fact that we’re still dealing with marijuana as a dangerous drug and criminalizing its users is something we Americans should be ashamed of in 2017.”

But, as several attendees noted, the “cat is out of the bag” with medical marijuana. That leaves practicing physicians on the hook. On one hand, there’s added impetus to limit medication side effects to the greatest extent possible. On the other, it might help to learn more about cannabis — its various strains and which are more psychoactive than others (and how they might be usefully combined); where to find clean, reliable sources; when cannabis might reliably replace standard, but inescapably risky, medications; and for which patients (possibly pregnant women and small children, for instance) it might it be contraindicated.

Then, after calculating those medical risk/benefit ratios, they’ll have to move on to judging the risk/benefit to their careers.

Source: Richard Peck, Contributing Writer, MedPage Today
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