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Anesthesia Business Consultants Discusses Medical Marijuana in Anesthesia and Chronic Pain Practice
Date:1/17/2017

JACKSON, Mich., Jan. 17, 2017 /PRNewswire/ -- Anesthesia Business Consultants (ABC), a leading provider in billing and practice management for the anesthesia and pain management specialty, discusses the use of medical marijuana, which remains a "clinical conundrum" (as described recently in Anesthesiology News) requiring anesthesia providers and chronic pain practitioners to think carefully before recommending medical marijuana for their patients.

A 395-page report by the National Academies of Sciences, Engineering and Medicine, "The Health Effects of Cannabis and Cannabinoids," released on January 12, could help pave the way for greater clarity on the issue.  Essentially, the report concludes that marijuana can be effective in the treatment of pain, spasticity, nausea and other conditions, but that the drug is not harmless.  "The growing acceptance, accessibility, and use of cannabis raise important public health concerns and there is a clear need to establish what is known and what needs to be known about the health effects of cannabis use," the report stated.

At present there are 28 states where medical marijuana has become legal, and cannabis's place in medicine poses a constellation of clinical, regulatory, cultural, research and policy questions that remain largely unresolved.  The need for more solid clinical research and the problematic blurring of distinctions between medical and recreational marijuana use prove problematic.  Despite the questions, including concerns about side effects, drug interactions and the potential for dependence, many clinicians and researchers believe that medical marijuana shows sufficient promise as a treatment for a wide range of conditions to merit further investigation.  One area of research with implications for anesthesia and chronic pain clinicians suggests medical marijuana's potential as a substitute for opioids.  Other research shows a possible connection between medical marijuana use and reduced opioid dependence.

Botanical marijuana has been used for medicinal purposes for centuries, but scientific research on it is still relatively new and inconclusive, and large, long-term, controlled studies are sparse.  The discovery of the human endocannabinoid system, which mediates cannabis's psychoactive effects, and the clarification of two chemical compounds in cannabis—tetrahydrocannabinol (THC, the euphoria-producing cannabinoid), and cannabidiol (CBD, considered to have a wide range of potential medical uses due to its lack of side effects, including psychoactivity)—have drawn considerable interest.

The drug's efficacy as an agent for the management of such conditions as chronic cancer pain, neuropathic pain and some symptoms of multiple sclerosis is fairly well established.  However, the lack of research and medications with demonstrated safety and efficacy means that the jury is still out on many other conditions.  The Food and Drug Administration (FDA) "has not approved a marketing application for a drug product containing or derived from botanical marijuana and has not found any such product to be safe and effective for any indication," the agency states on its website.

The FDA has approved two THC-based medications, dronabinol (Marinol®) and nabilone (Cesamet®) prescribed for the treatment of nausea in patients receiving cancer chemotherapy and to stimulate appetite in patients with wasting syndrome related to AIDS.  In addition, nabiximols (Sativex®) is currently available in the United Kingdom, Canada and several European countries for treating the spasticity and neuropathic pain of multiple sclerosis.  The drug may also be useful in the treatment of seizure disorders and other conditions.  These medications use purified chemicals derived from or based on those in the marijuana plant and are generally considered by researchers to be more promising therapeutically than use of the whole marijuana plant or its crude extracts, according to the National Institute on Drug Abuse (NIDA).

Research on medical marijuana has been stymied by the fact that marijuana remains classified by the Drug Enforcement Administration (DEA) as a Schedule I drug (along with ecstasy, LSD and heroin), which means it is viewed as having a high potential for abuse with "no accepted medical use in treatment" and is technically banned by federal law.  This classification means that physicians can only "recommend" marijuana for medical reasons; they cannot write a prescription for a medication that can be filled at a pharmacy.

Also, initiatives to legalize medical marijuana bypass the Food and Drug Administration's approval processes.  We recognize the broad range of opinion among pain clinicians and researchers regarding the use of herbal cannabis and the critical need for legislative standards to ensure both efficacy and safety.  Until medications can be developed that are of sufficient quality and safety to receive FDA approval, the controversy will continue.

For more information on the conditions that qualify patients for medical marijuana, please visit our full eAlert on the topic, where we also discuss the recommended questions for physicians to consider before recommending marijuana to a patient.  The use of medical cannabis is a complex issue that requires clinicians to weigh a host of factors before determining whether to recommend the drug to patients.

About Anesthesia Business Consultants
Anesthesia Business Consultants (ABC), established in 1979, is the nation's largest billing and practice management company dedicated to the complex and intricate specialty of anesthesia and pain management. The heart of our perioperative suite of products is ABC's proprietary practice management software F1RSTAnesthesia.  Our newest tool is F1RSTClient, the premier client portal that allows clients' secure and seamless access to ABC's applications.  F1RSTAnalytics, our powerful suite of dashboards and reports, provides "Insight at Your Fingertips" offering real-time data prowess and providing the data to aid in operating your anesthesia practice as an effective clinical organization and successful business.  Our solutions provide accurate, prompt and complete billing and revenue cycle management.  Our exclusive focus improves your cash flow and profitability.  Visit ABC at: www.anesthesiallc.com.

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