Physician anesthesiologists warn more research is needed, concerned about public’s misunderstanding of risks, side effects

Millennials lead the escalating interest in marijuana and cannabinoid compounds for managing pain – with older generations not far behind – and yet most are unaware of potential risks. Three-quarters (75%) of Americans who expressed interest in using marijuana or cannabinoids to address pain are under the impression they are safer or have fewer side effects than opioids or other medications, according to a nationwide survey commissioned by the American Society of Anesthesiologists (ASA) in conjunction with September’s Pain Awareness Month.

More than two-thirds of those surveyed said they have used or would consider using marijuana or cannabinoid compounds – including cannabidiol (CBD) and tetrahydrocannabinol (THC) – to manage pain. Nearly three-quarters of millennials fall in that category, with 37% noting they have used them for pain. Two-thirds of Gen Xers and baby boomers expressed interest, with 25% of Gen Xers and 18% of baby boomers saying they have used them for pain.

“As experts in managing pain, physician anesthesiologists are concerned about the lack of research regarding the safety and effectiveness of marijuana and cannabinoids,” said ASA President Linda J. Mason, M.D., FASA. “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.”

ASA members express concern that patients in pain are unaware marijuana and cannabinoids may not be safer than other medications, that they can have side effects – ranging from excessive sleepiness to liver damage – and more importantly that these products are not regulated or monitored for quality.

Misunderstandings about Marijuana and Cannabinoid Safety and Oversight

Results of the nationwide survey of adults 18 or older confirm physician anesthesiologists’ concerns. When respondents who said they have used or would consider using marijuana or cannabinoids were asked why, the majority (62%) said they believe them to be safer than opioids and (57%) believe they have fewer side effects than other medications.

Marijuana and cannabinoids currently are in uncharted territory with no way for people to know exactly what they are purchasing. Even though it is widely available, CBD is not regulated. The U.S. Food and Drug Administration (FDA) has approved only one prescription version of CBD for patients with one of two rare forms of epilepsy. (No form of marijuana is approved by the FDA and the federal government considers it a controlled substance and illegal). Thirty-three states and Washington, D.C. have legalized marijuana in some form (for recreational or medical use) but all set their own regulations, which vary widely. Further, studies have shown that no matter what the label says, the actual ingredients may differ, and may contain dangerous synthetic compounds, pesticides and other impurities.

Yet the survey results reflect a significant misunderstanding of that reality. Among all surveyed (including those who said they would never use marijuana or cannabinoids):

• Only a little more than half (57%) believe more research is needed;
• More than one-third (34%) don’t feel the need to discuss using these products with their doctor;
• Nearly three out of five (58%) think they have fewer side effects than other medications;
• Nearly half (48%) think they know what they are getting with marijuana or cannabinoids; and
• 40% believe CBD sold at grocery stores, truck stops, health food stores or medical marijuana dispensaries is approved by the FDA. The younger the generation, the more likely they were to believe that is the case.

The ASA recently endorsed two bills that seek to expand research on CBD and marijuana: H.R. 601, the Medical Cannabis Research Act of 2019 and S. 2032, the Cannabidiol and Marihuana Research Expansion Act.

Alternative pain management options

People in pain looking for alternatives to opioids should know there are other options besides marijuana or cannabinoids. For example, only 13% of respondents said they have used or would consider using marijuana or cannabinoids because no other type of pain management works for them. Physician anesthesiologists and other pain management specialists can work with people in pain to develop a safe, effective pain management plan that doesn’t include opioids, marijuana or cannabinoids.