NFMCPA-Marijuana/Cannabis Survey Prelim Analysis
NFMCPA - Marijuana/Cannabis Survey Preliminary Analysis
by Jon Berner, MD, PhD
At the 2013 International MYOPAIN Meeting in Seattle, Washington, Dr. Jon Berner presented his poster "Marijuana Use in Chronic Pain Patients Inversely Correlates with Density of Comorbid Autistic Traits." When he stopped by the NFMCPA booth to discuss our organization, we struck up a conversation regarding use of marijuana as pain treatment by people with fibromyalgia. He noted that there was a lack of substantial data regarding marijuana use by this group of chronic pain patients. Through follow-up discussions, the NFMCPA decided to collaborate with Dr. Berner on a survey to determine the interest of people with fibromyalgia in utilizing marijuana as a pain medication. Following is Dr. Berner’s analysis of that survey.We are pleased to report preliminary findings from a survey distributed to the NFMCPA members this spring. Approximately 1200 members completed the survey. They provided data on their unique subtype of fibromyalgia, responses to standard medical therapy, and their experience and/or views on marijuana as a treatment for chronic pain.
- Survey results suggested substantial inexperience with medical cannabis. More than half, 56%, of respondents have never tried marijuana or cannabis for their pain. More than 75% of respondents were unaware of the pharmacological differences between the different strains of marijuana, indica vs. sativa.
- Survey results suggest excellent response to medical cannabis for sleep (8.4) and pain (8.2) relative to fatigue (6.0) defined on a 1 to 10 point scale. Approximately 22% of respondents used marijuana on a daily basis for their pain.
- Survey responses suggest that medical marijuana is often well tolerated. Most individuals, 66%, have no side effects from use. Frequent side effects limiting use in other patients include sedation (16%), cognitive dulling (6%), anxiety (5%), weight gain (4%) and addictive craving (3%).
- Survey responses suggest many barriers to use: legal concerns (52%), reliability of supplier (17%), concern regarding side effects (13%), cost (12%) and social stigma from family or friends (6%). It appears that FDA approval would address many of these concerns given reports from 89% of respondents that they would try the internationally approved nasal cannabis formulation (Sativex) if it were available in this country.
This data can be more fully appreciated in the context of the members’ experience with other medicines that treat pain. Members have better access to other commonly used agents; 96% of respondents have tried antidepressants, 86% have tried opioids, and 64% have tried gabapentin/pregabalin. Given that marijuana has been used as a medicine since before 300 BC as documented in texts from India, Persia, China, Greece and perhaps even the Bible, members might question why it is so difficult to initiate a personal trial of medical marijuana in 2014 (Russo, Hemp for Headache, 2001).
The NFMCPA suggests action from the public be directed to the FDA. Current US regulations undoubtedly slow or prevent development of new medications for chronic pain. It costs more than $1 billion to develop and bring a new drug to market today, with some estimates exceeding $2 billion. These costs may explain why medical marijuana is available in Europe, Canada and Australia but not in the United States. There may additionally be a stigma against chronic pain patients relative to other diseases.
The FDA’s own data reveals that oncology (cancer) medications are approved on the average 2.5 times faster than new pain medications through the Anesthesia, Analgesia, and Addiction Division of the FDA. This Analgesia Division consistently under performs on broad measures relative to other divisions in getting new medications to market (Dimasi, Milne & Tabarrok, FDA Report Card, 2014). Although it may seem to the members that patient advocacy with one’s senators and representatives is pointless given the size of the federal government, the historical record suggests that aggressive demand for action can greatly speed the process of drug approval. Randy Shilts book “And The Band Played On” describes very well how AIDs activists pushed the FDA out of its comfort zone, setting the stage for rapid development of retroviral medications which now making living with HIV a reality.
Please stay tuned for further developments after we analyze > 40,000 data points from the surveys. We expect to present additional information on clinical characteristics of individuals who do well or poorly on medical marijuana and discuss possible scientific implications.