Weed For Pain? Public Confidence Is High But Evidence Is Slim

Most Americans say they’re interested in using pot products to relieve pain, but they may underestimate the risks. A new online survey from the American Society of Anesthesiologists (ASA) suggests that many people hold false ideas about marijuana and pain management.

Of the more than 1,000 adults aged 18 and older, more than two-thirds have tried – or are open to – either of the primary components in the marijuana plant, cannabidiol (CBD) or terahydrocannabinol (THC) to relieve pain. Of these respondents, three-quarters believe these chemicals are safer than opioids or other pain medications. That worries Dr. Christopher Abrecht, a UCSF anesthesiologist.

“I tell patients, ‘Know that if you take this [CBD], it is unknown what is going to happen as a result,'” he says. “It may be something that we discover in a few years is superbly helpful, or we may discover that it triggers schizophrenia for certain people or age groups.”

No Safety Testing 

The U.S. Food and Drug Administration does not regulate marijuana compounds because the drug is still federally illegal – a surprise to many consumers. Forty percent of survey respondents falsely believe there’s routine safety testing for marijuana products sold at supermarkets, health food stores and dispensaries.  The only exception is one pharmaceutical form of CBD the FDA approved last year for epilepsy patients.

Thirty-three states and Washington, D.C. do allow marijuana for recreational or medical use, but the regulations vary widely within each jurisdiction.

“Cannabinoids are a big bucket,” says Dr. Edward Mariano, Stanford University anesthesiologist and chair of ASA’s Committee on Regional Anesthesia and Acute Pain Medicine. “There are over 100 chemicals in the marijuana plant, and because they’re not federally regulated, we don’t always know what goes into the different substances that people are using.”

The Wild West

Research shows the ingredients in pot products may differ wildly from label descriptions. A recent study in the Journal of the American Medical Association showed 70 percent of online products made from CBD had concentrations that differed from the amounts on their labels. The ASA also says pot products can contain dangerous synthetic compounds, pesticides and other impurities.

“It’s a little wild, wild west even in highly regulated California,”  Abrecht says.

Patients may also underestimate the potential side effects of pot. They can include liver damage, dizziness, difficulty concentrating, confusion and disorientation.

“You could even have psychosis,” Mariano says. “Plus, the number of people who actually get pain relief is probably only one in five.”

That’s why he encourages patients to have frank conversations with their doctors about all the available pain relief options.

“The good news is that until the research is completed and we fully understand the risks and potential benefits, physician anesthesiologists today can develop a personalized plan for patients’ pain drawing from effective alternatives such as non-opioid medications and other therapies, including injections, nerve blocks, physical therapy, radio waves and spinal cord stimulation,” says ASA president Dr. Linda J. Mason.