It’s no secret that cannabis can work as an alternative to other longstanding medicinal options as it pertains to curbing and treating pain and related symptoms. A number of studies have already confirmed the efficacy of cannabis and its compounds as it relates to pain management, though a new study suggests that patients believe it may be even more effective than conventional treatments.

A recent survey of German patients published in the journal Frontiers in Medicine explored experiences with cannabis products, with more than 200 anonymous participant perspectives. As with many previous studies, patients largely reported reductions in their daily pain after starting cannabis therapy along with other benefits. 

Notably, they reported “greater satisfaction” with cannabis, calling it “more effective” than their previous treatments.

Exploring German Prescription Cannabis for Pain

Researchers note that part of the intent behind the research is to explore “perspectives of patients whose experiences are not well enough known to date.” 

Using a web-based survey of prescription cannabinoid patients, conducted between May 31, 2021 and June 2022, researchers conducted the research anonymously “to reduce treatment provider influence and stigma.” Subjects were asked to complete questionnaires regarding their cannabis therapy twice in the same session, once for the time of the survey and another for the period prior to their cannabis treatment.

Participants were asked to rate their daily pain levels, along with questions around the details of the cannabinoid prescription process — namely any issues they ran into obtaining the medication — and their general attitudes around cannabis.

Chronic pain was the most common diagnosis, with 72% of participants indicating that pain relief was the primary reason for their prescriptions.

Germany is currently making waves in the global cannabis space for its pending legalization of recreational cannabis, though plant cannabis and cannabinoid treatments were legalized by prescription use in the country back in 2017. Cannabis medication is also typically only authorized when patients are unresponsive to traditional options.

Researchers also note a study finding that the most common reason for German cannabinoid prescriptions from 2017 to 2022 was for pain.

Patients Report MMJ Benefits for Pain Treatment and More, Despite Access Barriers

“The results of this cross-sectional study suggest that most of the surveyed outpatients treated with prescription cannabinoids in Germany subjectively experience health benefits and symptom reduction associated with these therapies,” researchers state in their discussion.

Across all diagnoses and symptom groups, authors report that participants shared positive effects on physical functioning, emotional states and quality of life. Additionally, they reported fewer problems around fulfilling their social roles and their pain symptoms were perceived to have a lesser impact on their daily lives. Satisfaction was rated by perceived effectiveness, side effects and overall satisfaction.

Researchers suggest that the stress-reducing effect of cannabis drugs could be a “significant mediating factor,” in that opioids may have “more ambivalent effects on stress regulation because the kappa opioid receptor signaling pathway is activated by stress stimuli that produce both aversion and dysphoria in humans and other animal species.”

Prior to cannabis therapy, participants generally had a neutral to slightly positive attitude toward cannabis, which shifted to “predominantly positive” during therapy. 

Most of the problems during the prescription process didn’t originate with physicians but rather with reimbursement issues involving health insurance providers. Approximately 25% of participants with statutory health insurance coverage reported that they opted to pay out of pocket.

“This is likely due to the current legal situation in Germany, where the prescription of cannabinoid medications is characterized by significant complexity and administrative hurdles, comparable to those encountered when prescribing off-label drugs, both for patients and practitioners,” researchers said.

‘Starting Points’ for Further Research

The study notes that comparable studies, in which German patients are directly questioned about cannabinoid therapy, are rare, with most surveys only questioning physicians. Those studies similarly found that pain was the main reason for cannabis prescriptions.

Standing apart from much of the current research in the region, researchers note risk of selection bias, in that patients may have been more willing to participate in the study due to successful treatments. They also note potential “expectation bias,” in that the high access barriers for cannabinoid therapies in Germany give many eligible patients high expectations, which could lead to a more favorable evaluation of such therapies, among other potential limitations.

“This observational study nevertheless provides starting points for further discussion in the context of planning clinical cannabinoid trials and formulating appropriate research questions, involving the patients’ perspectives,” researchers concluded.

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The Senate Appropriations Committee approved a spending bill last Thursday that includes an amendment allowing the U.S. Department of Veterans Affairs (VA) doctors to recommend medical cannabis for their patients in legal states. It will now move forward as part of the approved legislation that funds the VA for the 2024 Fiscal Year.

The amendment, which passed via a voice vote, was sponsored by Senator Jeff Merkley, a Democrat from Oregon. It will lead to the same results desired in a standalone bill refiled in the House with bipartisan backing by Representative Earl Blumenauer, a Democrat from Oregon, and Florida Republican Representative Brian Mast, who lost both legs while serving in the Army in Afghanistan. Collectively they are the co-chairs of the Congressional Cannabis Caucus. 

The more recent measure that just passed in The Senate Appropriations Committee “simply says, in states that have a medical cannabis program, that a veteran’s doctor can talk to their veteran patient about the pros and cons of medical cannabis and fill out related paperwork should a veteran decide to participate in a state program where such paperwork is required,” Merkley said. 

The amendment yields the same outcome as The Veterans Equal Access Act, which has not yet been implemented despite passing in committees and clearing floor approval multiple times with bipartisan (not to mention veteran) support. 

In December of 2022, a coalition of more than 20 veterans service organizations (VSOs) wrote a letter to congressional leaders that just about had to beg lawmakers to pass a cannabis and veterans research bill before the end of the previous Congress session. 

“For decades, many veterans have called for medicinal cannabis as an option for treating the unseen wounds of war and other injuries sustained through service,” the letter reads. “Veterans and caregivers have consistently communicated their anecdotal experiences regarding how cannabis offers effective treatment in tackling some of the most pressing health concerns they face upon returning from war.” Given what vets give for this country, and Americans now say that cannabis is safer than alcohol and cigarettes, it is more than a fair ask. 

No such legislation passed in time. However, thanks to the approval of the latest spending bill, vets can now talk to their doctors about medical cannabis. Research continues to show the valuable role cannabis can play in treating PTSD, depression, anxiety, and many other conditions that, unfortunately, are all too familiar among vets. 

Late last year, a study published in the journal Neuropharmacology by researchers from Wayne State University showed evidence that low doses of THC help treat adults with PTSD. While there is plenty of previous research on cannabis and trauma, this was the first to explore how THC affects corticolimbic brain activation. 

Additionally, for those vets with injuries or chronic pain, cannabis offers a safer and harm-reduction path to treating such pain and allows many vets to opt out of opiates. 

“We remain committed to the VA’s goal of conducting research into the efficacy of medicinal cannabis as a treatment for veterans with chronic pain, PTSD, and Traumatic Brain Injuries,” their letter continues. “However, as a Schedule I drug under the [Food and Drug Administration], research into the efficacy of cannabis has been stagnant, cumbersome, and convoluted with red tape. Federal research into cannabis faces many bureaucratic hurdles that hinder researchers.”

In related news, Representative Mariannette Miller-Meeks, a Republican from Iowa, filed different legislation in May that would promote research for treating conditions such as PTSD and chronic pain within the VA, and that’s just one of many bills currently making their way through Congress. 

In April, bipartisan House representatives and Senators also refiled bills to legalize medical marijuana for military veterans. If made into law, it would allow veterans to legally possess and use cannabis on a federal level (but following state law) as recommended by their doctor.

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Pain and insomnia reports fell. Quality of life improved.

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Republicans in the U.S. Senate voted this week to block a bill that would have directed the Department of Veterans Affairs (VA) to conduct research into cannabis as a treatment for chronic pain and post-traumatic stress disorder (PTSD). In a procedural vote on Wednesday, the Senate declined to advance the Veterans Affairs Medicinal Cannabis Research Bill (S. 326) with a vote of 57-42, falling short of the 60 votes needed to continue debate on the measure.

The bipartisan legislation was introduced by Montana Democrat Senator Jon Tester earlier this year with co-sponsorship by Senator Dan Sullivan, a Republican from Alaska. In February, the bill was approved by the Senate Veterans Affairs Committee with a vote during a closed-door session. 

Under the bill, the VA would be required to conduct a large-scale observational study that evaluates the safety and efficacy of cannabis as a treatment for PTSD and chronic pain. An identical bill (H.R. 1003) sponsored by California Democratic Representative Lou Correa is also pending in the House of Representatives, with Republican Representative Jack Bergman signed on as a co-sponsor.

The clinical study would explore the positive and negative health outcomes of cannabis use by military veterans, including whether using marijuana reduces the use of alcohol or opiates. The study would also investigate other aspects of medicinal cannabis use, including pain intensity, sleep quality, agitation, and overall quality of life. Once the study is complete, the legislation requires the VA to report back to Congress on the results and the feasibility of conducting clinical trials.

Vote Blocks New Research For Veterans’ Health

When he introduced the bill earlier this year, Tester, the chair of the Senate Veterans Affairs Committee, said in a statement that the legislation would give military veterans new choices to manage their health care.

“Our nation’s veterans deserve options when it comes to treating the wounds of war, which is why VA needs to have a better understanding of how medicinal cannabis plays a role in their healing,” he said. “Our bipartisan bill ensures VA is listening to the growing number of veterans who find critical relief from alternative treatments like medicinal cannabis, while working to empower veterans in making safe and informed decisions about their health.”

A total of 41 GOP senators voted to block the bipartisan bill, with Senate Majority Leader Chuck Schumer then changing his vote to “no” in order to keep the bill alive under the Senate’s rules. 

In a social media post, Tester wrote that “41 Senate Republicans just chose partisan political games over providing our nation’s veterans their hard-earned benefits and care. 41 Senate Republicans are telling the men and women who have defended our country that their government doesn’t value their sacrifices.”

“Not only are they blocking VA from *researching* medicinal cannabis as an alternative treatment for veterans dealing with chronic pain or PTSD—they’re blocking improvements to veterans homeownership efforts, community-based support, outreach, and more,” he continued. “It’s totally unacceptable.”

In a floor speech before the vote, Senate Veterans’ Affairs Committee ranking member Senator Jerry Moran of Kansas, one of the eight Republican senators who voted to advance the cannabis bill, said the measure “is an effort to make certain that veterans are not doing something that is harmful to them and to help them make an informed decision,” according to a report from the Military Times.

But the senators backing the bill on Wednesday were not enough to keep the measure moving forward. GOP Senator John Cornyn of Texas said that the decision to block the cannabis research bill came after “spirited debate” during a Senate Republican policy lunch before the vote.

Cornyn told CNN that there were concerns among GOP senators about the methodology of the clinical trial authorized by the bill because “this retrospective study would be done strictly through volunteers who would come forward and talk about their experience with marijuana and PTSD,” and “it depends on people to self-select and we don’t know how that would skew the results.”

The senator also said that Republicans were not given “assurances” that they would be given the opportunity to offer amendments to the legislation, adding that there were concerns about whether the bill would be taken up by the House of Representatives and the chamber’s GOP leadership.

Political concerns may have also been in play, with critics of advancing the bill suggesting that the potential success of the legislation could be seen as a win for Tester, an incumbent Democratic senator up for re-election in a conservative state.

Cornyn indicated that negotiation on the bill would continue and that the legislation could be revived in the Senate. He explained that Wednesday’s vote was “hitting the pause button” on the measure. Schumer described the vote to stop the bill as “regrettable,” adding that he hopes efforts to resurrect the legislation in the Senate at a later date are successful.

Jeffrey M. Zucker, president of Denver-based cannabis-focused business strategy firm Green Lion Partners and vice chair of the Marijuana Policy Project board of directors, expressed disappointment at the decision to delay action on the Veterans Affairs Medicinal Cannabis Research Bill.

“I’m deeply saddened to hear that the Senate Republicans have blocked a procedural vote to advance this bill. It’s frustrating to see how politics can prevent progress on an issue that could make a huge difference in the lives of veterans and should really have no controversy surrounding it,” Zucker wrote in an email to High Times. “However, I’m still hopeful that lawmakers can come together to pass a bill that allows research into medical cannabis and eventually allows veterans to enjoy the benefits of medical cannabis. Our veterans deserve the best care possible, and medical cannabis could provide much-needed relief to those suffering from chronic pain, PTSD, and other conditions. It’s time for our leaders to put aside their differences and do what’s right for our veterans.”

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Members of the Sackler family–the wealthy owners behind Purdue Pharma and OxyContin—paid upwards of $19 million in donations to The National Academies of Sciences, Engineering and Medicine, a powerful institution that advises U.S. opioid policy, according to a bombshell report by The New York Times.

The Times outlined a series of events that pose a possible conflict of interest. Dr. Raymond Sackler, his wife, Beverly, and the couple’s foundation started donating large sums of money to the Academies in 2008, according to treasurer reports. They died in 2017 and 2019, respectively. Dame Jillian Sackler also made millions of dollars’ worth of donations to the Academies beginning in 2000. The Academies invested the funds, growing to over $31 million by the end of 2021.

The allegations continue: The Pain Care Forum, a group co-founded by Burt Rosen, the Purdue lobbyist at the time, pushed for legislation introduced in 2007 and 2009 that included plans calling for an Academies report to “increase the recognition of pain as a significant public health problem.”

If the allegations are true, they present a serious conflict of interest. So the Times called upon Michael Rehn Von Korff—a medical researcher who studies the treatment of chronic pain, among other fields, for insight on the matter.

“I didn’t know they were taking private money,” Von Korff told The New York Times. “It sounds like insanity to take money from principals of drug companies and then do reports related to opioids. I am really shocked.”

Last Prisoner Project founder Steve DeAngelo posted the report on Instagram and called the revelations “disgusting.” Medical cannabis is frequently used as an alternative to opioids for some situations.

The Role of OxyContin in the Opioid Crisis

OxyContin was developed and patented in 1996 by Purdue Pharma L.P. and was originally available in multiple doses, the U.S. Department of Justice notes. At first, it appeared that OxyContin revolutionized medicine, but then the opioid epidemic unfolded. 

According to the U.S. Department of Health & Human Services, (HHS) over 760,000 people have died since 1999 from a drug overdose, with nearly 75% of drug overdose deaths in 2020 involving an opioid. The Centers for Disease Control and Prevention reports that the number of drug overdose deaths “quintupled since 1999.”

A 2011 The National Academies of Sciences, Engineering and Medicine report claims that 100 million Americans suffered from chronic pain—one-third of the entire U.S. population—and while that’s often cited by government organizations, now that number is being challenged as preposterous. That report influenced the U.S. Food and Drug Administration to approve at least one powerful opioid, Zohydro, which is a slow release hydrocodone.

In 2016, just months after the National Academies scooped up a $10 million Sackler family donation, the F.D.A. asked the institution to form a committee to create new recommendations on opioids. But the Academies were blamed for having sketchy ties to opioid makers, including Purdue Pharma. Four people were removed from the panel after that incident.

The National Academies of Sciences, Engineering and Medicine was created by Abraham Lincoln, and U.S. laws are shaped by the data it releases. For the past few decades though, the academy was utilized to combat the American opioid crisis.

The opioid crisis is complex and it’s difficult to distinguish between people who are addicted and people who genuinely have high levels of pain. But the overdose death toll is impossible to ignore as it surpasses death toll numbers from war and sickness. In 2017, the HHS declared the opioid crisis a public health emergency.

There is also another side to the story. Megan Lowry from the National Academies told The New York Times that the Sackler donations “were never used to support any advisory activities on the use of opioids or on efforts to counter the opioid crisis,” and that they are prevented from returning the Sackler donations because of legal restrictions.

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Texas is broadening its restrictive medical cannabis program to include patients fighting chronic pain, the Houston Chronicle reports, in addition to expanding approved THC dosing limits from one percent to 10mg. While that may seem shockingly low to medical patients in states with more liberal cannabis laws, currently, Texas’s medical marijuana law is CBD-only, as it allows for only one percent of THC. The new law, which goes into effect on September 1, 2023, might not win the Lone Star state stoner points, but at the least, it’s a step in the right direction. The original bill tried to cap the prescribed THC dose to 5mg but then amended the bill to a volumetric dose limit of 10 milligrams.

Legal adult-use cannabis in Texas is non-existent, so forget about strolling into a dispensary to grab some dabs anytime soon. The state’s Compassionate-Use Program, or CUP, was initially passed in 2015, limiting medical use of less-than-one-percent cannabis to intractable epilepsy. The list of qualifying conditions was expanded in 2019 and again in 2021 by the Texas Legislature to include autism, cancer, multiple sclerosis, post-traumatic stress disorder, multiple sclerosis, and several others. 

Now, Texas lawmakers drafted a bill that adds “a condition that causes chronic pain, for which a physician would otherwise prescribe an opioid” to the list. According to the CDC, 1 in 5 Americans lives with chronic pain. Per the newly passed Texas bill, the Department of State Health Services will be allowed to specify which “debilitating medical conditions” qualify for the program.

The bill, HB 1805l, was written by Republican Rep. Stephanie Klick and was approved by the House Public Health Committee with a 10-0 vote Monday, March 20. The passage of HB 1805l comes after further momentum from lawmakers in the state. Earlier in March, Texas lawmakers held a hearing on House Bill 218 from Democrat Rep. Joe Moody that, if passed, would lower the penalties for possession of cannabis and cannabis concentrates.

While Texas cannabis laws, in accordance with their other social policies, such as reproductive rights, are still highly regressive, this new bill does show that Texas is aware of the grave issue of opioid addiction and seeks to tackle it from a harm reduction perspective, by allowing chronic pain patients cannabis. According to the National Institutes of Health, more than 106,000 persons in the U.S. died from a drug-involved overdose in 2021, including illicit drugs and prescription opioids. According to The Texas Workforce Commission, there was an 80% increase in synthetic opioid-related deaths reported in Texas in 2021 compared to 2020. In addition, as Benzinga points out, a recent study shows that direct payments from opioid manufacturers to physicians have significantly decreased following the legalization of medical cannabis. And, as a reminder, even the DEA states that no deaths from cannabis overdose have occurred. While recreational cannabis is illegal in Texas, you can pick up some nasty (and fatal) synthetic THC options if you need a deadly reminder of the hypocrisy of strict marijuana laws. 

While the cannabis laws in Texas are highly restricted, they do not necessarily match the state’s citizens’ views on the plant. According to a study at the University of Houston, which conducted an online survey of 1,200 Texan adults 18 and older, 4 out of 5 adults said they would support an expanded medical marijuana program. Those surveyed also said they favor decriminalizing marijuana possession, and additionally, two-thirds of them said they would support legalizing recreational adult use. So, while the newly passed bill is a win for chronic pain patients, the state’s lawmakers have much work ahead of them if they wish to address their voter’s needs accurately.   

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A U.S. Senate panel last week approved a bill that directs the Department of Veterans Affairs (VA) to conduct research into cannabis as a treatment for chronic pain and post-traumatic stress disorder (PTSD). The bipartisan legislation, which was introduced by Montana Democrat Senator Jon Tester on February 9 and co-sponsored by Senator Dan Sullivan, a Republican from Alaska, was approved by the Senate Veterans Affairs Committee with a vote during a closed-door session on Thursday. 

Under the bill (S. 326), the VA would be tasked with conducting a large-scale observational study that evaluates the safety and efficacy of cannabis as a treatment for PTSD and chronic pain. An identical bill (H.R. 1003) sponsored by California Democratic Representative Lou Correa is also pending in the House of Representatives, with Republican Representative Jack Bergman signed on as a co-sponsor.

The observational study would explore the positive and negative health outcomes of cannabis use by veterans, including whether using marijuana reduces the use of alcohol or opiates. The study would also investigate other aspects of medicinal cannabis use, including sleep quality, pain intensity, agitation, and overall quality of life. Once the study is complete, the legislation requires the VA to report back to Congress on the results and the feasibility of conducting clinical trials.

Senate Veterans Affairs committee chair Jon Tester, a Democrat from Montana, said in a statement when he introduced the bill earlier this month that the legislation will give military veterans new choices to manage their health care.

“Our nation’s veterans deserve options when it comes to treating the wounds of war, which is why VA needs to have a better understanding of how medicinal cannabis plays a role in their healing,” Tester said. “Our bipartisan bill ensures VA is listening to the growing number of veterans who find critical relief from alternative treatments like medicinal cannabis, while working to empower veterans in making safe and informed decisions about their health.”

A New Milestone In Cannabis Policy Reform

Lawmakers in both chambers of Congress have introduced similar legislation in previous years, including a bill that was approved by the House Veterans Affairs Committee two years ago. Thursday’s approval by the Senate panel, however, is the first advancement of a veterans cannabis research bill in the upper chamber of Congress.

“Many of our brave men and women in uniform suffer from unseen wounds of war as a result of their sacrifices on behalf of our country, wounds that often manifest in post-traumatic stress,” Sullivan said in a statement when the bill was introduced. “We owe it to these courageous service members, past and present, to explore and better understand new remedies for these mental health challenges that are safe and effective, treatments that could give our suffering veterans hope.”

Tester’s bill also directs the VA to assess the ability of the agency to coordinate FDA-approved clinical trials into the safety and effectiveness of cannabis and cannabis extracts for health care among veterans. If approved by the VA, the clinical trials would provide study participants with cannabis products from federally licensed producers and compare the results with a control group.

Thursday’s approval of S. 326 by the Senate Veterans Affairs Committee is being hailed by medical marijuana and cannabis policy reform advocates as a significant step forward in the movement to end the prohibition of weed in the United States.  

“I’m heartened to see the U.S. Senate take an essential step forward on what should be a priority we all agree on — taking care of our country’s veterans and providing them with alternative treatments for things like PTSD and chronic pain management,” Steven Jung, a U.S. Army veteran and the chief operations officer of cannabis company PAX, said in an email to High Times. “Veterans are in crisis and at much greater risk of suicide than the national average, and it’s time we take action now.”

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With medical cannabis legal in the majority of states in the country, the number of adults who have turned to the treatment for chronic pain has likewise increased.

That is the finding of a new study from researchers at the University of Michigan that was published in JAMA Network Open last week. 

The researchers contacted 1,724 adults, 96% of whom (1,661) completed the full survey. 

Among them, “31.0%…of adults with chronic pain reported having ever used cannabis to manage their pain; 25.9%… reported using cannabis to manage their chronic pain in the past 12 months, and 23.2%… reported using cannabis in the past 30 days,” the researchers wrote. 

The researchers said that “more than half of adults who used cannabis to manage their chronic pain reported that use of cannabis led them to decrease use of prescription opioid, prescription nonopioid, and over-the-counter pain medications, and less than 1% reported that use of cannabis increased their use of these medications.” 

“Fewer than half of respondents reported that cannabis use changed their use of nonpharmacologic pain treatments,” they wrote in their findings. “Among adults with chronic pain in this study, 38.7% reported that their used of cannabis led to decreased use of physical therapy (5.9% reported it led to increased use), 19.1% reported it led to decreased use of meditation (23.7% reported it led to increased use), and 26.0% reported it led to decreased used of cognitive behavioral therapy (17.1% reported it led to increased use).” 

Thirty-seven states in the U.S. have medical cannabis programs on the books. Among adults living with chronic pain in those states, “3 in 10 persons reported using cannabis to manage their pain,” according to the new study.

“Most persons who used cannabis as a treatment for chronic pain reported substituting cannabis in place of other pain medications including prescription opioids. The high degree of substitution of cannabis with both opioid and nonopioid treatment emphasizes the importance of research to clarify the effectiveness and potential adverse consequences of cannabis for chronic pain,” the researchers wrote. “Our results suggest that state cannabis laws have enabled access to cannabis as an analgesic treatment despite knowledge gaps in use as a medical treatment for pain. Limitations include the possibility of sampling and self-reporting biases, although NORC AmeriSpeak uses best-practice probability-based recruitment, and changes in pain treatment from other factors (eg, forced opioid tapering).” 

The findings serve as another source of encouragement for advocates who hope patients continue to seek treatment from cannabis, rather than highly addictive prescription drugs. 

According to the Center for Disease Control and Prevention, “more than 564,000 people died from overdoses involving any opioid, including prescription and illicit opioids, from 1999-2020.”

The CDC says that the “rise in opioid overdose deaths can be outlined in three distinct waves.”

“The first wave began with increased prescribing of opioids in the 1990s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 1999,” according to the CDC. “The second wave began in 2010, with rapid increases in overdose deaths involving heroin. The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl. The market for illicitly manufactured fentanyl continues to change, and it can be found in combination with heroin, counterfeit pills, and cocaine.”

Mark Bicket, one of the authors of the new study who also serves as assistant professor in the Department of Anesthesiology and co-director of the Michigan Opioid Prescribing Engagement Network, said that the “fact that patients report substituting cannabis for pain medications so much underscores the need for research on the benefits and risk of using cannabis for chronic pain.”

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While recreational and medical legalization is sweeping the country, a recent study revealed that enrollment in medical-only programs quadrupled between 2016 and 2020.

The study on U.S. medical cannabis trends also looked at qualifying conditions listed by patients, and revealed that enrollment increased in states with only medical cannabis. States that also offer recreational cannabis use declined or stayed the same. Overall, chronic pain was the most common condition reported on applications. 

This research project, titled “U.S. Trends in Registration for Medical Cannabis and Reasons for Use From 2016 to 2020” and published with Annals of Internal Medicine, was spearheaded by lead author Kevin Boehnke, an expert on chronic pain at University of Michigan. His goal with the study was to look specifically at medical enrollment, not cannabis use overall, to determine cannabis trends. 

During his work on the study, he asked himself, “How many people are using cannabis for pain? Why are people actually using [medical cannabis]?”

With these questions in mind, Boehnke began a years-long look into what this enrollment and cannabis use looked like, using public data available from reports and state websites, meeting notes, state officials, and documents he got access to thanks to the Freedom of Information Act. He was specifically interested in what the trends looked like as they shifted under the changing medical and recreational laws across the country. 

He also published another study on the issue in 2019, “Qualifying Conditions Of Medical Cannabis License Holders In The United States,” in HealthAffairs, but this new study has an even broader scope with more access to data. 

“These changing state policies have dramatic effects on how many people might be using cannabis for medical purposes or how they might be able to do so,” Boehnke says regarding the study, according to STAT News. 

STAT News also spoke to Byron Adinoff, a drug addiction researcher and president of Doctors for Cannabis Regulation, about the study. He was happy about the results, and hopes to see more studies that highlight how key medical cannabis treatment can be. While he admits that he, like many doctors, was hesitant for a long time about prescribing medical cannabis, his views have changed as information like this becomes available. 

“I didn’t really buy into it, but, you know, after you talk to several hundred people who have benefited from it, you start to think maybe there’s something to it,” he says. “Hopefully it will get organized medicine and physicians individually to pay increasing attention to this issue,” he added.

Another substantial piece of data was how much patient enrollment increased in Oklahoma. In that state, there was more than a significant jump to report. According to the study, one in 10 residents of the state are medical cannabis patients, a record high number. This could be because the state does not require specific medical conditions to qualify for a medical card. They can get medical cannabis for any conditions a doctor deems reasonable.

All other medical states in the U.S. at this time have a list of qualifying conditions for what patients are eligible for when it comes to medical cannabis. Chronic pain is allowed in most states, so it’s no surprise that it’s at the top of the list for what patients are medicating for. 

STAT News also spoke to Silvia Martins, an epidemiologist at Columbia University specializing in substance use, who hopes this study can lead to more confidence in how cannabis can treat chronic pain. 

“Even for chronic pain, we need more evidence, but for other types of conditions, we need even more evidence,” she says regarding the information in the study. 

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After all the delays, obfuscations and denials, the British are finally taking the next obvious step toward a better understanding of the medical efficacy of cannabinoids. Namely, a highly limited medical cannabis trial dubbed Canpain focusing on chronic pain has just been announced. However, so far, despite reports to the contrary in the media, including The London Times, medical regulators have still not formally authorized a wide-spread study of cannabis and pain management.

While a small trial is a good first step, the question remains why this has taken so long to even get going, let alone why the project is so limited.

Canpain is not the first cannabis experiment in the country and is far from the largest. That distinction goes to Project TWENTY21, organized by a non-profit research organization called Drug Science. 

However, Canpain would be, upon proper launch, the first government backed trial which could also lead to patients finally being prescribed medical cannabis via the National Health Service (or NHS).

Its success remains in doubt, however, particularly given what is happening elsewhere in Europe right now. This includes Germany, the largest reimbursed medical cannabis market in the EU, where public health insurers are increasingly turning down applications for medical cannabis authorization on the basis of “just” chronic pain.

What Is Actually About to Happen

The initial “feasibility study” will be conducted by a private cannabis clinic, LVL Health, which will first enroll 100 patients as a first step of the larger experiment (which has not yet even been approved by the NHS). Canpain aims to enroll up to 5,000 adult patients who will receive cartridges with unprocessed cannabis flower on a daily basis for at least one year. 

This will not be completely free. Patients will have to pay about $300 per month to receive capsules embedded into vaping devices. 

What Is New?

The big news here is that NICE — the National Institute for Health and Care Excellence — will, once the feasibility study is reviewed, approved, and launched, examine the data to determine if the clinical evidence justifies the prescription of cannabis for chronic pain. 

In the past, NICE has specifically denied that there was any evidence supporting the use of cannabis to manage chronic pain. According to government data, one in three Britons suffers from this condition—defined as that which creates severe discomfort for more than three months.

By definition, the new Canpain trial in the offing is also admitting that their first limited medical efforts will also exclude most of the chronic pain patients in the country.

In the US, in sharp contrast, the number one reason for medical cannabis use is in fact, chronic pain.

The Slow, Shameful Pace of Cannabis Reform In the UK

Like everywhere else, cannabis reform of even the medical kind has been vigorously fought by British government authorities and agencies, even after medicinal cannabis was technically legalized here in 2018 and a larger medical trial, albeit still limited, was launched in Germany in 2017. Even fewer people have actually gotten prescriptions in the UK than Germany since then via the NHS. Even worse, thanks to the NICE intervention, chronic pain patients were explicitly excluded from receiving reimbursed care post 2018, even if they had managed to obtain such permission previously. Only 18 cannabis prescriptions were subsequently written through the NHS (for whatever reason) and only 259 private prescriptions were issued in 2019.

ProjectTWENTY21 launched in August 2020 with the goal of providing lower cost cannabis to registered patients and studying the same with the goal of providing a large-scale clinical trial that also helped patients obtain cannabis at a lower cost than is available through private medical care. Many cannabis cultivators signed up, at a considerable cost, to be able to provide lower cost cannabis via this trial. About 20,000 patients have subsequently become part of this trial which has now expanded to Australia.

It is not clear why this data has so far been ignored by government authorities.

In the meantime, both further medical and recreational reform debates continue to rage in the UK as the mayor of London, Sadiq Khan, has announced that he will launch a recreational cannabis decriminalization trial in certain parts of London.

Beyond this effort, no British national authority has taken either medical or recreational cannabis reform seriously.

As a result, British, just like other European patients are still mostly left out in the cold and stuck between outrageous monthly costs via private health care, the black market, or going untreated (which is obviously not a viable option for most patients).

The Criminalization of Legitimate Patients Continues

For all the police press releases about tackling drug crime, there is no effort currently underway to track the fates of legitimate patients who are routinely arrested and prosecuted under federal narcotics laws which they are still subject to when their applications for medical treatment are denied (for whatever reason). All of these patients must go somewhere to find another source to obtain cannabis and, when turned down by insurers, this almost always means that such individuals have to turn to illicit sources because they cannot afford private care. 

In Germany right now, insurers are routinely turning down 40% of patient applications — and for a variety of specious reasons including supposed lack of clinical evidence — even when presented with the most recent data, refusing to process complicated forms that even doctors get “wrong” or even denying patients reimbursed care because their healthcare provider sent in forms later than insurance company imposed deadlines. The only reliable way to obtain legitimate medical cannabis in Germany right now is to have enough money to obtain private healthcare or sue one’s public insurer.

Despite all the protests, and data, one thing is clear. There is a long, hard fight still ahead before the cannabis plant is normalized, anywhere.

How many more people have to face criminal charges or even die before that happens?

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