For the first time ever, the New York State Assembly’s one-house budget proposal included more expansive plans to approve the use of  medical marijuana.  In a recent poll 88% of New Yorkers felt that medical marijuana should be legalized, and both republican and democrat senators are listening.

In order to make a decision on whether a drug should be available, we look to the science (peer-reviewed research) to help us decide whether the benefits of the drug are worth the risks.  Some studies show marijuana is effective for pain relief (especially the neuropathic pain which accompanies disorders like Multiple Sclerosis[1]) and for improving sleep for those with painful disorders.[2]  Other studies also found that smoking marijuana helped to increase pain tolerance, with a greater effect observed for those who were not novice users.[3]

In a study in which individuals smoked marijuana cigarettes containing different amounts of THC (one of the active components that is responsible for many of Marijuana’s effects), they found that too small a dose did not provide any analgesic benefit, and too large a dose actually increased pain.  In this study, cigarettes containing 4% THC experienced the most pain relief.  This suggests that there is an optimal dosage of marijuana to relieve pain.4

Despite the apparent benefits, there are short and long-term adverse effects.  Marijuana can cause anxiety and panic, and, at very high doses, psychotic symptoms.  Patients using marijuana should not drive while taking it.  Long-term users can show signs of dependence and subtle cognitive impairment.[4]

Marijuana may be useful in a variety of painful conditions, but most studies currently available are not large enough to draw useful conclusions.  Legalization will allow larger scale studies to be done so that we can be more confident about both the positive and negative effects.  Like any other potent drug, it needs to be carefully regulated and only used when appropriate.

Anti-seizure, or anti-epileptic, medications have commonly been used to treat pain, especially nerve-related pain. Examples include pregabalin (Lyrica), gabapentin (Neurontin), topiramate (Topamax), and carbamazepine (Tegretol/Carbatrol). The exact mechanism in which these medications work is not completely clear. Anti-seizure medications help decrease hyperactivity of the nerves that cause seizures; therefore, it is thought that these medications can have a similar effect with decreasing the activity of the nerves that cause pain.

As with all medications, there are side effects – most common side effects are dizziness, drowsiness, nausea, vomiting,  blurred or double vision, and weight gain. Therefore, if you are not having reasonable pain relief with one of these medications, it shouldn’t be continued. It is generally a good idea to stop these medications slowly, since abruptly stopping in someone who is seizure prone could cause a seizure.