Prescribing Cannabis for Harm Reduction
Neuropathic pain affects between 5% and 10% of the US population and can be refractory to treatment. Opioids may be recommended as a second-line pharmacotherapy but have risks including overdose and death. Cannabis has been shown to be effective for treating nerve pain without the risk of fatal poisoning. The author suggests that physicians who treat neuropathic pain with opioids should evaluate their patients for a trial of cannabis and prescribe it when appropriate prior to using opioids. This harm reduction strategy may reduce the morbidity and mortality rates associated with prescription pain medications.
Under the Federal Controlled Substance Act marihuana is illegal and classified as a schedule I substance – meaning it has a high potential for abuse and no accepted medical use. However, sixteen states and the District of Columbia have legalized cannabis for medicinal use and these include Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Michigan, Montana, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, and Washington. Each state law differs but all allow physicians to “authorize” or “recommend” cannabis for specific ailments. This “recommendation” affords legal protections for patients to obtain and use medicinal cannabis, and may be considered the “prescription.”
Between 1999 and 2006 approximately 65,000 people died from opioid analgesic overdose. Regarding fatal overdose from cannabis, Carter and colleagues write, “… this well documented fact: no one has ever died from an overdose of cannabis.” In addition, there is insufficient data to demonstrate smoking cannabis causes lung cancer but long-term use is associated with an increased risk of respiratory problems. Although, eating cannabis avoids the respiratory issues. In 2001 the total cost of prescription opioid abuse was estimated at $8.6 billion. Unfortunately, there are no comprehensive studies on the total cost of cannabis abuse. However, enforcing the prohibition on cannabis costs an estimated $7.7 billion per year. Since the federal and most state governments view any use of cannabis as abuse – including medicinal use – one might include this cost. According to a report from the Substance Abuse and Mental Health Services Administration between 1999 and 2009 admissions for treatment of nonheroin opioid abuse increased approximately 516% while admissions for cannabis saw a 53% rise.
Harm Reduction Journal 2012, 9:1