Medical marijuana products1.jpg

Medical marijuana comes in a variety of forms, from buds and patches to candy and extracts.

(Lynne Terry/Staff)

A conference at Oregon Health & Science University will tackle a tricky topic that makes many doctors squirm: medical marijuana.

Now that recreational marijuana is legal in Oregon, physicians are facing a volley of questions. Many patients want to know if it would help ease various symptoms.

The scientific jury is still largely out on marijuana's benefits. Large-scale clinical trials are lacking, and the drug remains banned by the federal government. But there is some research, which will be shared at a town hall Sunday focusing on its use to treat fibromyalgia, a chronic condition that affects about 5 million people nationwide.

Most patients are women, often diagnosed in their 20s or 30s. They usually appear normal, but can suffer from debilitating symptoms, including chronic pain, insomnia, anxiety, fatigue and memory and concentration problems.

The Food and Drug Administration has approved three drugs to treat fibromyalgia symptoms: Pregabalin (Lyrica), duloxetine (Cymbalta) and milnacipran (Savella). But they're no panacea.

"They only help 50 percent of patients to get about 30 percent better," said Kim Jones, an OHSU researcher, president of the Fibromyalgia Information Foundation and conference organizer. "We need to continue to look for ways to treat it effectively."

Carolyn Morse, a 51-year-old patient in Northeast Portland, found relief with medical marijuana.

She would have never touched the stuff, but in 2010, a year after being diagnosed and suffering through chronic pain and insomnia, she hit rock bottom.

On the urging of friends, she took her first puff. She said it changed her life.

"I now look forward to every day," Morse said.

Unlike Morse, most fibromyalgia patients do not have medical marijuana cards, Jones said.

Dr. Ginevra Liptan, founder of The Frida Center for Fibromyalgia in Lake Oswego, is one of the few physicians in the metro area specialized in treating fibromyalgia patients.

She tackles symptoms with a multi-faceted approach that includes medication, exercise and dietary changes to reduce pain and inflammation. If that doesn't work, she prescribes opiates. As a last resort, she recommends marijuana.

"Once cannabis is more regulated and truly available with medicinal qualities, I would probably then skip opiates and just recommend cannabis," she said. "But for right now, it is not medicalized enough for me to feel comfortable."

Town hall

A conference on medical marijuana for fibromyalgia will be held at OHSU.

When: Sunday, 1 to 3 p.m.

Where: OHSU School of Nursing, first floor, 3455 S.W. US Veterans Hospital Road

Registration required:

Two analyses published in June in the Journal of the American Medical Association found that cannabis or cannabinoids, the therapeutic components in marijuana, eased chronic pain, neuropathic pain and spasticity from multiple sclerosis in some clinical studies. Cannabinoids were found to be less effective to treat vomiting and nausea from chemotherapy, weight loss associated with HIV and AIDS, sleep disorders and Tourette syndrome.

Clinical trials on the use of medical marijuana for fibromyalgia are lacking. The Food and Drug Administration has approved two synthetic cannabinoid drugs - nabilone (Cesamet) and dronabinol (Marinol) - that help some fibromyalgia patients, Liptan said. But they're often not covered by insurance, costing about $1,000 a month. That compares with about $80 a month for medical marijuana, she said.

To get a card in Oregon, patients must get a supporting statement from a doctor. They can recommend medical marijuana for various conditions, including cancer, glaucoma and HIV/AIDS. They can also certify patients suffering from severe pain, nausea, seizures and muscle spasms.

But doctors have no guidelines on products and dosing.

"There is really nothing medical about medical marijuana," Liptan said. "As a doctor, I have no idea what dispensary to recommend or what strain or form. There is a million different ways to take it."

That leaves patients at the mercy of dispensary staff. And though the state requires that all products be tested for mold, mildew, pesticides and two active compounds -- THC, or tetrahydrocannabinol and cannabidiol, or CBD -- results can be unreliable, as an investigation by The Oregonian/OregonLive has shown.

"Stuff that passes one lab doesn't pass another," said Matthew Walstatter, co-owner Pure Green, a Portland dispensary. "Labs are not licensed or regulated by the state."

That will happen next year, he said.

Liptan has found that patients do better on strains high in CBD. But what doctor wants to recommend a medication called Charlotte's Web or Purple Kush, Liptan said.

"You see why doctors feel uncomfortable?" she said.

OHSU does not permit medical marijuana on campus. Neither does Providence Health & Services, which discourages its physicians from recommending its use. Last year, OHSU changed its policy to allow its doctors to sign for patients, provided they craft a treatment plan and discuss the risks.

Those include anxiety, psychosis, dependence and intoxication. Patients can overdose if they mix marijuana and sedatives.

Dr. Melissa Weimer, an internist and addiction and pain specialist at OHSU, worries about patients getting into car wrecks or killing themselves by overdosing.

She's seen patients become trapped by marijuana, finding it difficult to quit.

"It's a double-edged sword because initially they might have some benefits but over time it worsens those conditions," Weimer said. "That leads to the ongoing use of marijuana."

Weimer saw that first-hand at a recent clinical trial at CODA, an addiction treatment center in Portland where she also works as medical director. The trial studied the use of a drug to treat people with a marijuana addiction.

"We were the No. 1 recruiting site in the country," Weimer said.

The risks have prompted doctors at OHSU's internal medicine clinic to opt against medical marijuana even though the university allows them to certify patients.

"The evidence to support the use of medical marijuana is not robust enough and it appears that the risks of the use of medical marijuana exceed the benefits," Weimer said.

If her patients get another doctor to sign the statement, she still treats them but will not prescribe opioids.

"They would have to make a choice one way or the other," Weimer said.

The pros and cons will be discussed at the conference along with information about dispensaries. Dozens are expected to show up. But they could leave with as many answers as questions.

"It will be a conference without a conclusion," Jones said.

-- Lynne Terry