canada africa partner reservation How cannabis and psilocybin could help some of the 50 million Americans who experience chronic pain

How cannabis and psilocybin could help some of the 50 million Americans who experience chronic pain


Michigan Michigan (USA), May 12 (The Conversation) The US Drug Enforcement Agency announced in late April 2024 that it plans to relax federal restrictions on cannabis, reclassifying it from a Schedule I drug to the less restricted Schedule III, which includes drugs such as Tylenol with codeine, testosterone and other anabolic steroids. This historical shift signals a recognition of the promising medicinal value of cannabis.

This move comes amid growing interest in the use of psilocybin, the active ingredient in magic mushrooms, to treat depression, chronic pain and other conditions. In 2018 and 2019, the U.S. Food and Drug Administration (FDA) granted breakthrough therapy status to psilocybin, intended to accelerate drug development as preliminary studies suggest it may have substantial therapeutic value over currently available therapies for treatment-resistant depression and depressive disorders.

Both developments represent a dramatic change from long-standing federal policies surrounding these substances, which have historically criminalized their use and blocked or delayed research efforts into their therapeutic potential.

As an assistant professor of anesthesiology and pain researcher, I study alternative options for pain management, including cannabis and psychedelics.

I also have a personal interest in improving the treatment of chronic pain: In early 2009, I was diagnosed with fibromyalgia, a condition characterized by widespread pain throughout the body, sleep disturbances, and generalized sensory sensitivity.

I see cannabis and psilocybin as promising therapies that can help bridge that need. Given that an estimated 50 million Americans have chronic pain—that is, pain that lasts three months or more—I want to help understand how cannabis and psilocybin can be used effectively as potential pain management tools.

Cannabis versus other painkillers Cannabis, also called marijuana, is an ancient medicinal plant. Cannabis-based medicines have been used for at least 5,000 years for applications such as arthritis and pain relief during and after surgery.

This use spanned from ancient times to modern times, with contemporary cannabis-based medications used to treat certain seizure disorders, promote weight gain in HIV/AIDS-related anorexia, and treat nausea during chemotherapy.

Like anything you put into your body, cannabis comes with health risks: driving while high can increase the risk of accidents. Some people develop cyclical vomiting, while others develop motivation or dependency problems, especially with heavy use at a younger age.

That said, fatal overdoses from cannabis are virtually unheard of. This is remarkable considering that almost 50 million Americans use it every year.

In contrast, opioids, which are often prescribed for chronic pain, have contributed to hundreds of thousands of overdose deaths in recent decades. Even common painkillers such as nonsteroidal anti-inflammatory drugs, such as ibuprofen, cause tens of thousands of hospitalizations and thousands of deaths each year due to gastrointestinal damage.

Furthermore, both opioids and non-opioid analgesics have limited effectiveness in treating chronic pain. Medications used for chronic pain may provide minor to moderate pain relief for some people, but many ultimately cause side effects that outweigh any benefits.

These safety concerns and limited benefits have led many people with chronic pain to try cannabis as an alternative to treating chronic pain. In fact, in survey studies, my colleagues and I show that people often replaced painkillers with cannabis because cannabis had fewer negative side effects.

However, more rigorous research on cannabis for chronic pain is needed. Until now, clinical trials – considered the gold standard – have been short-term and focused on small numbers of people.

Furthermore, my colleagues and I have shown that these studies use medications and dosing regimens that are very different from the way consumers actually use products from state-licensed cannabis dispensaries.

Cannabis also causes recognizable effects such as euphoria, altered perceptions and different thinking, making it difficult to conduct double-blind studies.

Despite these challenges, a group of cannabis and pain specialists published a proposed clinical practice guideline in early 2024 to synthesize existing evidence and help guide clinical practice. This guideline recommended using cannabis products when pain is associated with sleep problems, muscle spasticity and anxiety. These many benefits mean that cannabis could potentially help people use a separate drug for each symptom.

Traditional Barriers to Studying Cannabis Since the Controlled Substance Act was passed in 1970, the federal government has classified cannabis as a Schedule I substance, along with other drugs such as heroin and LSD. Possession of these drugs is a crime, and according to the federal definition, they have “no currently accepted medical use, with a high potential for abuse.” Because of this designation and the restrictions placed on drug production, cannabis is very difficult to study.

State and federal regulatory barriers also delay or prevent studies from being approved and conducted. For example, I can purchase cannabis from state-licensed dispensaries in my hometown of Ann Arbor, Michigan. However, as a scientist it is quite a challenge to legally test whether these products help pain.

Reclassifying cannabis as a Schedule III drug has the potential to substantially open up this research landscape and help overcome these barriers.

The Emerging Role of Psychedelics Psychedelics, such as psilocybin-containing mushrooms, occupy an eerily similar scientific and political landscape as cannabis. Psilocybin has been used for thousands of years for ceremonial and healing purposes and is also classified as a Schedule I drug.

It can cause substantial changes in sensory perception, mood, and sense of self that can lead to therapeutic benefits. And like cannabis, psilocybin has minimal risk of fatal overdose.

Clinical trials combining psilocybin with psychotherapy in the weeks before and after taking the drug report substantial improvements in symptoms of psychiatric conditions such as treatment-resistant depression and alcohol use disorders.

Risks are usually of a psychological nature. A small number of people report suicidal thoughts or self-harm behavior after taking psilocybin. Some also experience increased openness and vulnerability, which can be exploited by therapists and lead to abuse.

There are few published clinical trials of psilocybin treatment for chronic pain, although many are ongoing, including a pilot study for fibromyalgia conducted by our team at the University of Michigan.

This treatment can help people develop a healthier relationship with their pain by creating greater acceptance of it and reducing the rumination that is often associated with negative thoughts and feelings around pain.

As with cannabis, some states, such as Colorado and Oregon, have decriminalized psilocybin and are building infrastructure to increase the accessibility of psilocybin-assisted therapies. A recent analysis suggests that if psychedelics follow a similar legalization pattern to cannabis, the majority of states will legalize psychedelics between 2034 and 2037.

Challenges for the Future These age-old, but relatively “new” treatments offer a unique glimpse into the messy intersection of drugs, medicine and society. Justified excitement about cannabis and psilocybin has led to state policies that have expanded access for some people, yet federal criminalization and significant barriers to scientific research remain.

In the coming years I hope to contribute to pragmatic studies that work within these difficult parameters.

For example, our team developed a coaching intervention to help veterans use commercially available cannabis products to more effectively manage their pain. Coaches emphasize how judicious use can minimize side effects while maximizing benefits.

If our approach works, healthcare providers and cannabis dispensaries around the world could use this treatment to help clients with chronic pain.

Approaches like these can complement more traditional clinical trials to help researchers determine whether these drug classes provide benefits and whether they cause comparable or less harm than current treatments. As our society taps into the rich history of healing using these ancient medicines, these proposed changes could provide safer and substantive options for the 50 million Americans living with chronic pain. (The conversation) PY PY

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