How cannabis and psilocybin could help some of the 50 million Americans who experience chronic pain

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The US Drug Enforcement Agency announced its intention to do so at the end of April 2024 easing federal restrictions on cannabiscausing it to be reclassified from a Schedule I drug to the less restricted Schedule III, which includes drugs such as Tylenol with codeine, testosterone and others anabolic steroids. This historical shift signals a recognition of the promising medicinal value of cannabis.

This move comes amid growing interest in the use of psilocybin, the active ingredient in magic mushrooms, to treat depression, chronic pain and other conditions. The U.S. Food and Drug Administration granted a license in 2018 and 2019 breakthrough therapy designation for psilocybinintended to expedite drug development, as preliminary studies suggest this may be the case substantial therapeutic value than currently available therapies treatment-resistant depression And depressive disorder.

Both developments represent a dramatic change from long-standing federal policy surrounding these substances historically criminalized its use And research efforts blocked or delayed in their therapeutic potential.

Like a assistant professor of anaesthesiology and a pain researcher, I study alternative pain treatment optionsincluding cannabis and psychedelics.

I also have a personal interest in improving the treatment of chronic pain: Early 2009 I was diagnosed fibromyalgiaa condition characterized due to widespread pain throughout the body, sleep disturbances and general sensory sensitivity.

I see cannabis and psilocybin as promising therapies that can help bridge that need. Considering that an estimated 50 million Americans have chronic pain– meaning pain that lasts three months or more – I want to help you understand how to effectively use cannabis and psilocybin as potential pain management tools.

Cannabis versus other painkillers

Cannabis, also called marijuana, is an ancient medicinal plant. Cannabis-based medications have been used for at least 5,000 years for applications such as arthritis and pain relief during and after surgery.

Cannabis has been on the list of Schedule I drugs for more than 50 years, which also includes dangerous drugs such as heroin and LSD.

This use spanned from ancient times to modern times, with contemporary cannabis-based medicines for the treatment of certain convulsionspromoting weight gain for HIV/AIDS-related anorexia And treatment of nausea during chemotherapy.

As with anything you put into your body, cannabis comes with health risks: Riding while high can increase the risk of accidents. Some people develop cyclic vomitingwhile others develop motivation or dependency problemsespecially with intensive use at a younger age.

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That said, fatal cannabis overdoses are virtually unheard of. This is remarkable considering that almost 50 million Americans use it every year.

Opioids, which are often prescribed for chronic pain, on the other hand, are contributed to hundreds of thousands of overdose deaths in the last few decades. Even common painkillers such as nonsteroidal anti-inflammatory drugs, such as ibuprofen, cause tens of thousands of hospital admissions and thousands of deaths every year of gastrointestinal damage.

Furthermore, both opioids and non-opioid painkillers have limited effectiveness for the treatment of chronic pain. Medications used for chronic pain may be provide minor to moderate pain relief in some people, but many end up causing side effects that outweigh any benefits.

These safety concerns and limited benefits have led many people with chronic pain to try cannabis as an alternative to treating chronic pain. Indeed, in survey studiesmy colleagues and I show those people replaces painkillers with cannabis often because cannabis had fewer negative side effects.

However, more rigorous research on cannabis for chronic pain is needed. So far, clinical trials – considered the gold standard – have been short-term and focused on the future small numbers of people. Furthermore, my colleagues and I have shown that these studies use drug and dosing regimens they are very different by how consumers actually use products of state-licensed cannabis dispensaries. Cannabis also causes recognizable effects such as euphoria, changed perceptions and different thinking, that’s how it is difficult to conduct double-blind research.

Despite these challenges, a group of cannabis and pain specialists published a proposed clinical practice guideline in early 2024 to synthesize existing evidence and help guide clinical practice. This guideline recommended using cannabis products when pain is associated with sleep problems, muscle spasticity and anxiety. These many benefits mean that cannabis could potentially help people use a separate drug for each symptom.

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One study found that about half of those who used medical cannabis reduced their use of opioids.

Traditional obstacles to studying cannabis

Since the The Controlled Substance Act was passed in 1970, the federal government designated cannabis as a Schedule I substance, along with other drugs such as heroin and LSD. Possession of these drugs is a crime, and according to the federal definition, they “currently have no accepted medical use, with a high potential for abuse.” Because of this name and the restrictions placed on the production of medicines, cannabis is very popular difficult to study.

State and federal regulatory barriers also delay or prevent studies from being approved and conducted. For example, I can purchase cannabis from state-licensed dispensaries in my hometown of Ann Arbor, Michigan. However, as a scientist it is quite a challenge to do that legally test whether these products help pain.

Reclassifying cannabis as a Schedule III drug has the potential to substantially open up this research landscape and help overcome these barriers.

The emerging role of psychedelics

Psychedelics, like psilocybin-containing mushrooms, exist in an eerily similar environment scientific and political landscape like cannabis. Used for thousands of years for ceremonial and healing purposesPsilocybin is also classified as a Schedule I drug. It can bring about significant changes sensory perception, mood and sense of self that can lead to therapeutic benefits. And just like cannabis, so does psilocybin minimal risk of fatal overdose.

Clinical trials that combined psilocybin with psychotherapy in the weeks before and after taking the drug report substantial improvements in the symptoms of psychiatric conditions such as treatment-resistant depression And alcohol use disorder.

Risks are usually of a psychological nature. A small number of people report suicidal thoughts or self-harm behavior after taking psilocybin. Some experience it too increased openness and vulnerabilitywhat could be exploited by therapists and lead to abuse.

Colorado voted to decriminalize psilocybin in 2022, but the state is still developing regulations for “healing centers.”

There are few published clinical trials of psilocybin treatment for chronic pain. although many are still ongoingincluding one pilot study for fibromyalgia conducted by our team at the University of Michigan. This treatment can help people develop a healthier relationship with their pain thus creating greater acceptance And declining ruminants often related to negative thoughts and feelings around pain.

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As with cannabis, some states, such as Colorado And Oregonhave decriminalized psilocybin and are building infrastructure to increase accessibility to psilocybin-assisted therapies. A recent analysis suggests that if psychedelics follow a similar pattern of legalization as cannabis, the majority of states will too legalizing psychedelics between 2034 and 2037.

Challenges to come

These age-old but relatively ‘new’ treatments offer a unique glimpse into the messy intersection of drugs, medicine and society. Justified excitement about cannabis and psilocybin has led to state policies that have expanded access for some people, yet federal criminalization and significant barriers to scientific research remain. In the coming years I hope to contribute to pragmatic studies that work within these difficult parameters.

Our team, for example developed a coaching intervention to help veterans use commercially available cannabis products to more effectively treat their pain. Coaches emphasize how judicious use can minimize side effects while maximizing benefits. If our approach works, healthcare providers and cannabis dispensaries around the world could use this treatment to help clients with chronic pain.

Approaches like these can complement more traditional clinical trials to help researchers determine whether these drug classes provide benefits and whether they cause comparable or less harm than current treatments. As our society taps into the rich history of healing using these ancient medicines, these proposed changes could provide safer and substantive options for the 50 million Americans living with chronic pain.

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