Pain, Cannabis, and Safety in a Recreational Cannabis State SEE PAGE 5 FOR DETAILS.
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Sheryl Lyss, MD, MPH Saint Louis University School of Medicine, Addiction Medicine Fellow St. Louis, MO
he people of Missouri voted to approve the use of cannabis for recreational purposes in 2022, following a previous referendum to approve cannabis for medical use in 2019. Marijuana remains illegal at a federal level, and its position as a Schedule 1 drug makes research, recommendations, and education difficult. As a result, legalization by individual states and commercialization have outpaced the development of evidence, clinical information, or recommendations to guide the use of cannabis for treating medical conditions. Thus, many family physicians are challenged to provide patient advice regarding cannabis for recreational or therapeutic use. This article briefly explores what we know and what we are learning about cannabis, particularly with regard to its use for pain, how the legalization of recreational and medical cannabis changes the landscape for family physicians and their patients, and how family physician can help patients mitigate risks of cannabis use.
Cannabis and medical use
John Hartman Saint Louis School of Medicine, Medical Student, Class of 2024 St. Louis, MO
Fred Rottnek, MD SSM Health SLUCare and Saint Louis University School of Medicine, Family Medicine, and Addiction Medicine St. Louis, MO 8
MISSOURI FAMILY PHYSICIAN October - December 2023
Cannabis contains over 100 different cannabinoids, including tetrahydrocannabinol (THC) and cannabidiol (CBD), which directly affect the endocannabinoid system and terpenes which are aromatic compounds responsible for its scent and taste.1 THC is the main psychoactive compound that is responsible for the “high” associated with cannabis use. If a cannabis plant contains ≥0.3% THC, the product is typically called marijuana; if the THC level is <0.3%, the product is hemp which has no restriction on growth or sales in the United States.2 The potency or concentration of THC in cannabis products has been increasing over the past decade because of changes in production (e.g., crossbreeding to produce cannabis cultivars with increased THC concentrations) and the use of cannabis extracts and synthetic products.3,4 Various derivatives of the cannabis plant have been used for centuries to treat pain, nausea, anxiety, depression, insomnia, and other medical conditions. A recent survey of 9003 adults identified the most common medical reasons for using cannabis as anxiety (49%), insomnia (47%), chronic pain (42%) and depression (39%).5 Patients today often seek information about cannabis from the web and through social media. Such information often portrays cannabis as a natural and safe remedy for many health conditions; yet the information provided is often anecdotal and not evidence based.6
What is the new cannabis amendment in the Missouri constitution?
Missouri Amendment 3, the Marijuana Legalization Initiative, was approved by voters in November 2022.7 It expands parameters of accessing marijuana for therapeutic use and legalizes recreational marijuana use for individuals over the age of 21. Patients certified for medical marijuana can now purchase and