Jerry W. Mitchell, MD
Researchers are continuously looking for chronic pain relief regimens to counter the painful side effects of cancer treatments. For example, medical marijuana is currently being suggested as an alternative option to traditional opioid medications.
“The only tool for chronic pain that we have is opioid medication, which has many challenges,” said Jerry W. Mitchell, MD. “They can be effective pain-control agents, but have many downsides. We need more tools for chronic pain, such as medical marijuana.”
In a study that was published in the New England Journal of Medicine
, researchers concluded that marijuana was effective in reducing seizures for patients with Dravet syndrome. The median frequency of convulsive seizures per month decreased from 12.4 to 5.9 with marijuana compared with a decrease of 14.9 to 14.1 with placebo.
In an interview at the 2017 OncLive®
State of the Science SummitTM
on Hematologic Malignancies, Mitchell, a hematologist at Mount Carmel Health System, discusses the use of medical marijuana as a chronic pain relief for patients with hematologic malignancies ad other tumor types.
OncLive: Please provide an overview of your talk on medical marijuana.
One of the key points from my presentation is that marijuana is not 1 medicine; it is 85 different medicines. What matters is the concentration of tetrahydrocannabinol versus the concentration of cannabidiol. That ratio differs based on what type of plant or material you have and how it's being taken in. It emphasizes the importance of having a regulated market because, otherwise, it is hard to get a consistent product.
I also wanted to emphasize that there are good randomized data for marijuana. It's been shown to be effective in Dravet syndrome, which is rare. There are 23 trials that have shown its effectiveness for chronic pain.
Can you explain medical marijuana from a palliative care standpoint?
The biggest area that we have data for its utilization is in chronic pain. I treat patients with cancer as an oncologist, but I also treat patients for palliative care that are primary patients with cancer. The only tool that we have for chronic pain is opioid medication, which has many challenges. They can be effective pain control agents but have many downsides. We need more tools for chronic pain, such as medical marijuana.
Like any tool, it must be used in its right place. It's not going to be effective for everybody, but what is important is that the medical marijuana comes from a regulated environment so that you know exactly what you’re getting.
What is the current state of medical marijuana in Ohio and how it be used?
I am practicing in Ohio and am currently serving on the Ohio Medical Marijuana Advisory Board, which is implementing the new medical marijuana laws in Ohio. I have a good understanding of this state but, right now, all the laws are state by state.
The substance is still illegal from a federal level, but all the states have made their own laws. In Ohio, it is not going to be legal recreationally, it will only be legal upon the recommendation of a physician who has an endorsement on their medical license. It can only legally be obtained through the system that the state has set up, which tracks the marijuana from seed to sale from the cultivators to the dispensary. It is going to be electronically followed with the patient and the physician. It's a very good regulatory structure. They're going to test the product so you'll always know exactly what you're getting.
The state of Ohio has done a good job of making sure that this market is regulated and that the patients know what they're getting.
How difficult do you think it will be for this to spread nationwide?
In my opinion, the only way that it is going to be able to spread nationally is a different look from the federal level. Since it is still illegal at the federal level, this causes many problems with patients and their healthcare providers. They might have to worry about the federal dollars they receive, either from a grant for the institution or from CMS.