Dr. Michelle Weiner, DO, MPH

Dr. Michelle Weiner, DO, MPH

Dr. Michelle Weiner, is an Interventional Pain Management Physician board certified in Physical Medicine and Rehabilitation. She completed her residency and fellowship training at the University of Miami. Her specialty is focused on prevention, treatment, reversal of health deterioration, increasing function and managing pain. Dr. Weiner focuses on diagnosing and treating spine and musculoskeletal pain as well as chronic migraines at the Spine and Wellness Centers of America

Doctors Debunk the THC Cap

More than 23 million Americans age twelve and older are are having medical marijuana as a viable treatment option, a significant decrease in pharmaceuticals such as pain medications, anti-anxiety and anti-depressants and sleep aides have been seen. Many patients have been spared from numerous side effects associated with these pharmaceuticals. With the opioid epidemic plaguing the United States, every possible alternative treatment option should be made available for a patient.  In my clinical experience, as a Pain Management Physician and Cannabis advocate and educator, given that I have roughly 2,000 patients on medical cannabis, I have seen first-hand how my patients are significantly improving using the current products in our Medical Marijuana Treatment Centers in Florida.

The Centers for Disease Control (CDC) and Prevention reports that opioids (including prescription opioid pain relievers and heroin) killed more than 47,000 people in 2017. 

Interestingly, in 2014 Dr. Marcus Bachhuber et. al. published a paper in the Journal of the American Medical Association (JAMA) where they found that states with medical cannabis laws had significantly lower state-level opioid overdose mortality rates.1 

Similarly, Bradford and Bradford evaluated data on all prescriptions filled by Medicare Part D patients from 2010 to 2013 and found that the use of prescription drugs for which cannabis could serve as a clinical alternative fell significantly, once a state medical cannabis law was implemented. They found that implementing an effective medical cannabis law led to a reduction of 1826 daily doses for opioid pain relief filled per physician per year.2  

In a study done in 1975 by R. Noyes Jr., et. al, on the analgesic effect of delta-9-tetracannabinol (THC), published in the Journal of Clinical Pharmacology (15:139-143) they found that on the days when patients received the two highest doses of cannabis (pills containing 15 and 20 milligrams of THC) as compared with 0, 5, or 10 milligrams—they reported significant pain relief.3  

The reality is that there are numerous studies showing that THC helps control pain.  Cannabis with low THC levels will not provide the analgesic effect necessary for patients to reduce or eliminate the opioid consumption, an essential component of any state medical cannabis program.

Despite changes in state policies and the increasing prevalence of cannabis use and its numerous positive implications for population health, the federal government has not legalized cannabis and continues to enforce restrictive policies and regulations on research into the health benefits of cannabis products that are available to consumers in a majority of the United States. As a result of the research blockade present in the U.S., one has to look to international sources for clinical trials and results.  Israel has long been the world’s leader in cannabis research.  In fact, the discoverer of THC, Dr. Raphael Mechoulam, is an Israeli organic chemist and professor of Medicinal Chemistry at the Hebrew University of Jerusalem in Israel.

In 2011 Dr. Moshe Geitzen et. al. published a study entitled “Cannabis the Third Age – Experimental Therapy at a Nursing Home”.  In this study a species of cannabis flower measuring 23%THC, and filtered medical cannabis powder measuring 30% THC was administered to 18 residents of the Kibbutz Na’an in Israel. The results were amazing:

1. 13 of the 18 subjects reduced medications

2. According to the Modified Ashworth Scale a 50% improvement in spasticity was achieved.

3. Chronic Pain, restlessness, insomnia, and low mood improved in all, and

4. Nutritional measurements showed normal albumin and protein levels in all patients.

This study clearly demonstrated that higher levels of THC cannabis flower did not cause any adverse reactions in this elderly, frail population, and in fact was responsible for a vast improvement in the quality of life for the majority of these senior citizens.  If these geriatric patients could not just tolerate this level of THC, but actually improve from it, I see absolutely no scientific reason to limit the THC available in medical cannabis to patients and residents of Florida.

We are also aware of a pharmaceutical called Dronabinol that is greater than 98% THC by weight inside the capsule FDA approved for weight loss in AIDS patients and chemo-related nausea and vomiting. 

A study entitled, “The Association between Cannabis Product Characteristics and Symptom Relief,” published in Scientific Reports shows how a higher percentage of THC is better for symptom relief. It also proves that flower is more effective for relief than any other method.

We have to remember that association is not causation. The hypothesis exists that early psychotic symptoms lead to cannabis use rather then the other way around. What may look like causation may be related to other variables (genetic predispositions, for ex) that led to cannabis use.

To initiate a THC percentage regulation now will force many to return to the black market. We have just witnessed numerous deaths from lipoid pneumonia from patients using vape cartridges dispensed outside of the medical system. Our products must be third party lab tested with certificates of analysis demonstrating safety, free of contaminants, pesticides, etc. I fear an increase in medical and health complications if patients are forced to leave the medical program. I also worry about patient cost given they may have to use double the amount of medication to equal the same results as their current regimen. The time and cost alone to have the MMTCs breed and genetically engineer plants to contain less than ten percent THC will also be counterproductive.

Dr. Michelle Weiner, is an Interventional Pain Management Physician board certified in Physical Medicine and Rehabilitation. She completed her residency and fellowship training at the University of Miami. Her specialty is focused on prevention, treatment, reversal of health deterioration, increasing function and managing pain. Dr. Weiner focuses on diagnosing and treating spine and musculoskeletal pain as well as chronic migraines.

1. Bachhuber MA, Saloner B, Cunningham CO, et al. Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999–2010. JAMA. 2014;174:1668–1673 [PMC free article][PubMed] [Google Scholar]

2. Bradford AC, Bradford WD. Medical cannabis laws reduce prescription medication use in Medicare Part D. Health Aff. 2016;35:1230–1236 [PubMed] [Google Scholar]

3.  Noyes R Jr, Brunk SF, Baram DA, Canter A. 1975a. “Analgesic effect of delta-9-tetracannabinol.” Journal of Clinical Pharmacology 15:139-143.

Stith, S, Vigil J, Brockelman F, Keeling K, Hall B. “The Association between Cannabis Product Characteristics and Symptom Relief.” Scientific Reports Feb 2019.

SPINE AND WELLNESS CENTERS OF AMERICA

Original Article: HighLife Magazine

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Virtual Reality Effects on Pain Perception: Implications for Pain Management

Current Status: Pending

Literature suggests that the use of virtual reality distraction for adjunctive pain control has been successful. In clinical settings and experimental studies, participants immersed in a virtual reality experienced reduced levels of pain, general distress/unpleasantness and reported a desire to use virtual reality again during painful medical procedures.

There has been research into the use of virtual reality distraction for adjunctive pain control with significant success. There has been growing evidence for the use of EEG for the measurement of pain. It has also been suggested that virtual reality could be used an alternative to marijuana and opioids for pain management. Further implications have been seen specifically among chronic pain sufferers. This is especially interesting since there is a reduced risk of addiction as is seen associated with marijuana and opioid use. This study aims to investigate the effect of virtual reality distraction on pain perception.

Additionally, we intend to create a body of open source content for potential use by other investigators utilizing similar tools. 

The intervention has the potential to relieve chronic pain sufferers of their pain with a non-invasive mechanism and minimal risk. The participants may experience a temporary decrease in the perception of pain during the course of the experiment or a distraction from said pain.

Pending IRB approval at UM

Seniors Over 60 With Chronic Pain Using Medical Marijuana

Current Status: Active

 

The purpose of this study is to identify what is effective and safe for older adults with chronic pain to develop an understanding of what educational materials are required for facilitate access to appropriate products at medical marijuana treatment centers (MMTC). 

Survey older adults (> 50 years) with chronic pain who have MM access cards and receive their product from state-approved dispensaries to document: demographic/health data; patterns of use; product specifics; pain effects on daily life; pain-related medical conditions; education prior to MM purchase; helpful and problematic effects of MM use. 

The proportion of Florida’s population that is 60 and older is growing more rapidly than other components of the population. Musculoskeletal disorders with associated chronic pain are a common problem in later life. Symptom management in older adults, including chronic pain management can be challenging (Briscoe, 2018). Medications, especially opioids, can increase the risk of confusion, constipation, falls and injury (Briscoe,2018). Medical marijuana (MM) is often recommended by doctors in the treatment of these medical conditions, guided by state law that defines qualifying conditions.

Medical marijuana use among older adults is growing at a rate more rapid than younger age groups (Lum, et al, 2019). The 2016 National Survey on Drug Use and Health estimated a 2.9% prevalence of marijuana use among this older population. However, the survey did not ascertain if use was for medical or recreational purposes (Han et al., 2016). Older adults may have important differences in pathophysiology, pharmacological interaction of medications, comorbid conditions, and toxicological responses to cannabis.

There is little evidence to evaluate the differences associated with medical marijuana use among older adults, such as individual reasons for use and problems arising with use (Haug et al., 2017).

Chronic pain is a major public health problem. Approximately 178 million (41%) adults in the U.S. age 18 and older suffer from at least one painful health condition (Nahin, et al, 2019).

In Florida, there are 327,492 medical marijuana card holders and chronic non-malignant pain was the No. 1 diagnosis for which patients are registered (The Florida Department of Health, Office of Medical Marijuana Use, 2020). Yet, it is not a qualifying condition, creating challenges for physicians wishing to support patient use of MM for chronic pain.

Chronic pain accounted for nearly 34 percent of diagnoses at certified dispensaries (The Florida Department of Health, Office of Medical Marijuana Use, 2019).