Feds Squash Doctor Training on Cannabis for Pain

As reported by the Associated Press, The American Academy of Pain Medicine has cancelled its plans for a webinar in July aimed at training doctors on the use of cannabis instead of opiates for pain. The cancellation followed "a request from the U.S. government agency that provided the funding." The agency was the Substance Abuse and Mental Health Services Administration, or SAMHSA, a division of the U.S. Department of Health and Human Services (HHS).

“We cannot speak to the reason that SAMHSA has asked that we not proceed with this webinar, but the webinar will no longer take place,” AAPM spokeswoman Megan Drumm said in an email to AP.

Scheduled speakers for the course, titled "Opioid Prescribing Amidst Changing Cannabis Laws,” were pain doctors from the University of Texas and the University of California, San Diego. They planned to cover how to select patients for medical cannabis, appropriate products and doses, and how to “wean opioids in patients on chronic opioid therapy,” according to the course description.

A study released in March concluded that only 9% of medical schools are teaching students about cannabis as a medicine.  “I’m not surprised by the findings,” commented Mark Steven Wallace, MD, chair of the Division of Pain Medicine at UC San Diego Health and one of the speakers scheduled for the now-cancelled webinar. Dr. Wallace said there is an opportunity for experiential learning on the topic at pain clinics like his, where medical cannabis is recommended “every day.”

Dr. Wallace has observed that some chronic pain patients arrive at the clinic after having tried and responded negatively to medical marijuana. “Quite often that’s because they have not been using the right formulation or have been using too high a dose,” he said. “We find that a low dose of a strain that combines THC [tetrahydrocannabinol] with CBD [cannabidiol] is most effective, but you won’t find that mentioned in the literature or taught in the classroom.” 

Sex Differences In Pain Relief with Cannabis

Photos by Larry Utley of a bipolar woman experiencing pain relief with cannabis.
Her face is shown pre-treatment (left) and at 30 and 60 seconds after smoking.

Less than 10% of neurological and pharmacological research is conducted on females in the US, says Dr. Rebecca Craft of Washington State University. Her lab is working to help correct that imbalance, by studying the effects of THC on male and female rats.

Craft's lab took healthy rats, 10 males and 10 females, and dosed them every 15 minutes with THC. At each dosage level, researchers did two tests for acute pain: putting the rats’ tails in 122-degree water and measuring how quickly they pulled their tails out; and applying pressure to their paws and measuring at what level of pressure they retracted their paws. As expected, the analgesic effect of THC increased at higher levels in both sexes, but to a greater extent in females.

Researchers then did a nine-day experiment, injecting the rats twice daily with THC in an amount determined to produce 80% of maximal analgesia (a lesser amount for females). The pain experiments were then repeated, in order to study to what extent tolerance to THC’s pain-relieving effects had taken place. It took more THC to show a pain-relieving response in rats that had received chronic doses, and this effect was also more pronounced in females.

Taken together with a recent study showing that women using cannabis daily reported a higher incidence of “abuse related effects” than men,  Dr. Craft’s work has been reported as being cautionary for women using cannabis medicinally. However Dr. Craft says that it’s hard to relate results, or doses, between acute pain studies in rodents and chronic pain in humans. For example, the opposite effect is found for morphine: male rats are more susceptible to its acute effects and develop greater tolerance, but the same sex difference has not been found in humans.

It’s been theorized that the hormone estradiol in menstruating females is responsible for the observed differences in cannabinoid effects, possibly through the mechanism of beta-arrestin2, an intracellular signaling molecule that interacts with the CB1 cannabinoid receptor in the brain. But some studies Craft’s lab has been working on indicate that sex hormones aren’t responsible for sex differences in tolerance to THC’s pain-relieving effects, although they may have a role in its sedative effects. Also, in rats a different enzyme metabolizes THC into its main active metabolite 11-OH-THC in males and females, but in humans, the enzyme is the same for both sexes.

Dr. Rebecca Craft of WSU

Dr. Craft’s next study will be working with a chronic pain model in rats, mimicking the inflammatory pain of rheumatoid arthritis. Chronic pain models in rodents have also been developed for neuropathic pain of the type experienced by chemotherapy patients and diabetes sufferers.

The work is important: women are more likely to present with chronic pain issues, for diseases like fibromyalgia, IBS, MS and migraine as well as the depression that comes with pain. A new study shows women find cannabis more effective than other pain-treatment modalities.

More human research is needed, Dr. Craft stresses, and also more research on females in both human and animal studies. The NIH has recently announced it will require sex-balancing in upcoming studies. Craft is encouraged by NIDA’s recent pronouncement that the agency will be providing more cannabis for research. Her work is funded by a NIDA grant.

Pointing to these developments, and to the legalization of medical and recreational marijuana that is happening across the US, Craft predicts, “We will see an explosion of information in the coming decades.”

"Benzos" and Opiates: The Deadly Combination That Killed Philip Seymour Hoffman

NPR's "All Things Considered" had an extensive story tonight about benzodiazepines, which are commonly prescribed for anxiety, and opioid drugs, which have been increasingly "co-prescribed" with "benzos" like Valium in the last several years. According to the story, 30% of opioid-related deaths also involve benzos, which contribute to the slowing of breathing that can kill heroin users.

The story was triggered by the news that the untimely and tragic death of Philip Seymour Hoffman was the result of just such a combination.

I recently re-viewed Hoffman in Almost Famous, in a key role as famed rock journalist Lester Bangs that he nailed with only an afternoon's preparation. The filmmaker has said he had no match, and it seems the world agreed. He's also great in The Talented Mr. Ripley, Charlie Wilson's War, and Boogie Nights (as well as, of course, Capote).

I was moved by the outpouring of grief for Hoffman after his death, and wonder if he knew while he was living how much he was appreciated. I really choked up when I read this piece in Elle about a woman who not-so-secretly wanted to marry him. I knew what she meant: Hoffman was a stoner girl's dream, projecting a kind of easy-going warmth and humility that are rarely seen in combination with the intelligence and prowess he possessed. Yeah, he was teddy-bear chubby and not-traditionally handsome, but, as one reviewer put it, "We can easily imagine Hoffman as an an amiably stoned anything."

The only film he directed, Jack Goes Boating (pictured), was described (in play form) by the New York Times as "a gentle portrait of pothead losers in love."

"You're likely to leave the theatre with a contact high from the ripe pleasure that Mr. Hoffman and his castmates derive from portraying everyday eccentrics," wrote the newspaper's Ben Brantley, adding, "Most particularly, though, 'Jack' is about its title character’s pursuit of perfection, of talismanic, Zen-like moments to hold against life’s chaos."

The play featured a "stoned dinner party from hell" and "the most eloquent sex scene on any stage in New York." Variety reported, "Assuming the movie follows the play, Hoffman will sport blonde dreadlocks and spend a lot of time smoking a bong and pretending to be a Rastafarian."

Hoffman also attended the LA Shadow Convention, which had a strong anti-drug-war component, while filming Last Party 2000, a documentary he made about the 2000 presidential election.

NFLer Ricky Williams, a former Paxil spokesperson who used marijuana for his Social Anxiety Disorder, pronounced it "10 times more helpful than Paxil" as a confidence builder. Paxil is an SSRI (Selective Serotonin Re-uptake Inhibitor, meaning it mimics a low dose of LSD). 

Meanwhile, California NORML is receiving another spate of desperate calls from patients whose doctors are heartlessly threatening to deny them their opioid pain medications because they use medical marijuana. This despite the fact that the US Veterans Administration announced in 2010 it would allow medical marijuana use by patients on opioid therapy. A recent study of 21 individuals with chronic pain concluded that “vaporized cannabis augments the analgesic effects of opioids without significantly altering plasma opioid levels. The combination may allow for opioid treatment at lower doses with fewer side effects.”

Geraldo Rivera issued a blistering commentary for Fox News Latino on the War on Drugs in the wake of Hoffman's death.

UPDATE 4/17: A new review study concludes "cannabis is both safer and potentially less addictive than benzodiazepines and other pharmaceuticals that have been evaluated as substitutes for alcohol." And another study finds a possible link between the use of SSRIs during pregnancy and autism.

One year later: Philip Seymour Hoffman Could Be Alive Today If The Drug War Was Over

My Interview with Courtney Love about Kurt Cobain

In January 2004 I got an email from a crew member at Kansas City's 965thebuzz.com telling me that Courtney Love, who hosted a show at the station, wanted to interview me on air about my Very Important Potheads website.

I agreed (of course!) and got up at 7 AM to appear by phone on the morning drive-time show, answering "no" to her party-boy cohosts' questions about whether or not I'd waked and baked (too early for me). Love demanded to know why she wasn't represented on the site. "I'm Courtney Love, damnit!" was the compelling reason she gave. (It was hard to argue with that.) I found myself calling her "girl" or "sister" and she asked me how old I was: it seemed she needed connection with an older female in her life. We left the jocks behind and started chatting, woman to woman.

Kurt Cobain's diaries had recently been published in Rolling Stone leading up to the 10th anniversary of his death, and I asked Love about what I'd read there: that Cobain twice went back to using heroin to quell the severe stomach pain he suffered from. Love said, "Yes, that was true and I used to say, 'Kurt let's just smoke instead.'" Apparently Cobain was one of the millions of Americans undermedicated for pain, and he turned to street drugs for relief. He even used Strawberry Quick to coat his stomach on the road.

We now know that cannabis can be helpful during withdrawal from opiate addiction, and that it works synergistically with opiates to alleviate pain and the tolerance that builds up over time, rendering prescription opiates less useful. A state-sponsored study in California found that even low-dose, vaporized cannabis is helpful with intractable neuropathic pain. Nonetheless, California NORML still hears regularly from patients whose doctors threaten to take off their pain medications because they're using medical marijuana.

We may never understand the psychic and physical pain that lead Cobain to end his life, or come to grips with what drives us to use drugs. But on a recent trip to LA I saw this angelic poster of Cobain in a cannabis club. Twenty years after his death, Kurt's music, and his image, lives on.