Mayo Clinic: Teens with chronic pain should not use medical marijuana

By Michelle Castillo / CBS News/ June 17, 2013, 2:56 PM

Teens with chronic pain should not be prescribed medical marijuana, according to the Mayo Clinic.

Due to a lack of information on the risks and benefits of medical marijuana for adolescents, the Mayo Clinic is not recommending that youth be given pot for pain conditions. While the drug may help alleviate some of their other conditions or symptoms, marijuana can lead to some negative short-term side effects including fatigue, impaired concentration and slower reaction times.

"The consequences may be very, very severe, particularly for adolescents who may get rid of their pain — or not — at the expense of the rest of their life," commentary co-author Dr. J. Michael Bostwick, a Mayo Clinic psychiatrist, said in a press release.

The commentary will be published in the July issue of Mayo Clinic Proceedings.

Marijuana is the most commonly used illegal drug in the U.S. according to the 2008 National Survey on Drug Use and Health. About 15.2 million users used marijuana in the month before they completed the questionnaire.

The plant may provide benefits for people with medical conditions, such as improving mood, reducing pain and increasing appetite for patients. Seventy-six percent of doctors who were surveyed for a May study in the New England Journal of Medicine said they approve of medical marijuana use. Currently, 19 states and the District of Columbia allow people to be in possession of marijuana with a doctor’s prescription, and Washington and Colorado have legalized pot for recreational purposes.

Smoking too much marijuana can also carry risks, including distorted perceptions, difficulty with coordination, difficulty problem solving and having a hard time learning and memorizing. Marijuana can also cause dizziness, anxiety, sedation, fatigue and a lack of motivation, the Mayo Clinic reported.

About one out of 10 marijuana users will become addicted, and younger people under 25 are more prone, Bostwick pointed out.

In their argument, the authors bring up the cases of three teens who were being treated at Mayo Clinic’s pediatric chronic pain clinic. Despite their regular pot use, their pain only got worse. In addition, the young patients found it harder to function and had more problems being socially active.

The researchers pointed out that weed use before the age of 16 has been linked to earlier development of psychosis in patients prone to the psychological disease. A 10-year study published in March 2011 in the British Medical Journal showed that adolescents and young adults who smoked pot doubled their risk of having psychotic symptoms.

In addition, an August 2012 study revealed that smoking marijuana more than once a week as a teen was connected to a drop in IQ later in life, while those who started consistently smoking as an adult did not have their IQs affected. Subjects who admitted to smoking pot regularly by the age of 18 had their IQ drop an average of 8 points between the ages of 13 and 32. However, a January PNAS study showed that education, occupation and other socioeconomic factors may have attributed to the subjects’ IQ dips.

The Mayo Clinic recommended that teens who have chronic pain be screened for marijuana use, and they should be offered alternative treatments like biofeedback, acupuncture and physical therapy, in addition to education about marijuana’s risks.

Said Bostwick, "People have to learn to get on with their lives even despite the pain."

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From the Mayo Clinic: Cannabis/Marijuana

Marijuana (Cannabis sativa)

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Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Chronic pain

Cannabinoids have been reported to reduce chronic pain associated with a variety of conditions. Cannabinoids have also been used in patients for whom other pain relief medications are not working. The active components in cannabis exert their effects on the central nervous system and immune cells. Cannabis is approved in some European countries and Canada. In the United States, it is an investigational drug for pain relief in cancer patients.
A

Multiple sclerosis (symptoms)

Research suggests that cannabinoids may improve some symptoms associated with multiple sclerosis (MS), specifically neuropathic pain, muscle spasms, and urinary symptoms.
A

Eczema

Early studies suggest that taking hemp seed oil by mouth may reduce symptoms of eczema, a skin rash also referred to as atopic dermatitis. Additional research is needed before a conclusion can be made.
C

Epilepsy

Early research suggests that epileptic patients may experience fewer seizures when taking cannabidiol (CBD) together with antiseizure medication. Further studies are required before a conclusion can be made.
C

Glaucoma (high fluid pressure inside the eye)

Glaucoma can result in optic nerve damage and blindness. Limited evidence suggests that tetrahydrocannabinol (THC) taken under the tongue may reduce eye pressure. Additional research is needed before a conclusion can be made.
C

Huntington’s disease

Huntington’s disease is a degenerative nerve disorder associated with uncoordinated, jerky body movements and mental deterioration. Early studies suggest that cannabidiol (CBD) may not aid in reducing the severity of uncoordinated body movements associated with Huntington’s disease. Further studies are needed before a firm conclusion can be made.
C

Insomnia

Limited research suggests that cannabidiol may improve sleep quality in those with insomnia (difficulty getting to sleep or staying asleep). More research is needed before a conclusion can be made.
C

Appetite/weight loss in cancer patients

Clinical studies have shown no effect of cannabis-based therapies in the treatment of weight loss associated with cancer. Further studies are necessary before a conclusion can be made.
D

Schizophrenia

In limited research, no effect of cannabidiol (CBD) was seen on symptoms of schizophrenia in patients for whom other treatments were not working. Additional research is needed before a conclusion can be made.
D

Key to grades
A Strong scientific evidence for this use
B Good scientific evidence for this use
C Unclear scientific evidence for this use
D Fair scientific evidence against this use (it may not work)
F Strong scientific evidence against this use (it likely does not work)

 

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Acne, addiction, allergies, Alzheimer’s disease, angina (chest pain), angioedema (swelling under the skin), arthritis, antiaging, antidepressant, anti-inflammatory, antioxidant, anxiety prevention, appetite stimulant, asthma, attention-deficit hyperactivity disorder (ADHD), autoimmune diseases, bipolar disorder (mental disorder), blood thinner, bronchodilation (widens airways and eases breathing), burns, cancer, candidiasis (yeast infection), circulation improvement, constipation, cough, detoxification (removal of toxins), diabetes, digestive aid, diuretic (improves urine flow), dystonia (muscle disorder), energy metabolism, fatigue, gastric acid secretion stimulation (increases stomach acid), general health maintenance, genitourinary tract disorders (disorders of the reproductive and urinary systems), hair growth promoter, heart disease, high blood pressure, hormone regulation, immune suppression, increased muscle mass, increasing breast milk, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), intermittent claudication (pain in arms or legs due to inadequate oxygen), interstitial cystitis (bladder disorder), irregular heartbeat, leukemia (cancer of blood cells), lipid lowering (cholesterol and triglycerides), liver protection, lymph flow enhancement, menopausal symptoms, migraine, muscle relaxation, nausea and vomiting, nerve disorders, neural tube defects (birth defects), osteoporosis (bone loss), painful menstruation, pregnancy and labor, psychosis, rheumatism (joint disease), sedative, sexual performance, skin conditions, spinal cord injury, stomach spasms, stroke, tendonitis, uterine stimulant, varicose veins, vitamin C deficiency, weight gain (patients with HIV or cancer), wound healing.

 

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

For nausea and vomiting, five milligrams/m 2 of body mass of dronabinol (Marinol®) has been taken by mouth before and after chemotherapy, for a total of 4-6 doses daily.

For weight loss and malnutrition associated with cancer, 2.5 milligrams of tetrahydrocannabinol (THC) with or without one milligram of cannabidiol has been taken by mouth for six weeks.

For eczema, hemp seed oil has been taken by mouth for 20 weeks.

For chronic pain, 2.5-120 milligrams of cannabis has been taken by mouth in divided doses.

For epilepsy, 200-300 milligrams of cannabidiol (CBD) has been taken by mouth daily for up to 4.5 months.

For insomnia, 160 milligrams of cannabidiol (CBD) has been taken by mouth.

For symptoms of multiple sclerosis, 2.5-10 milligrams of dronabinol (Marinol®) has been taken by mouth daily for three weeks. Capsules containing 15-30 milligrams of cannabis extract has been taken by mouth for 14 days. Two and one-half milligrams of tetrahydrocannabinol (THC), together with 0.9 milligrams of cannabidiol (CBD), has been taken by mouth. Cannabinoid-based Sativex® mouth spray has been used at a dose of 2.5-120 milligrams in divided doses. Eight sprays in three hours and up to 48 sprays in 24 hours have been used.

For schizophrenia, 40-1,280 milligrams of cannabidiol (CBD) has been taken by mouth daily for up to four weeks.

For glaucoma (high fluid pressure in the eye), single doses of five milligrams of tetrahydrocannabinol (THC) or 40 milligrams of cannabidiol (CBD) placed under the tongue have been used.

Children (under 18 years old)

There is no proven safe or effective dose for cannabis or cannabis-containing products in children.

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