Marijuana may help with chronic pain. So may being in Minnesota's medical pot program.

The idea of using cannabis as medicine is becoming ever more popular. And as states like Minnesota widen access by legalizing recreational — not just medicinal — use of the drug, many people are wondering if weed can ease their arthritic hip or painful sciatica.

Research has shown that pot has the potential to make a real difference for people with pain that is chronic (lasting for three months or more), and that it may be able to reduce patients' reliance on opioid medications.

Even so, it's not a sure cure.

"It just depends on the individual. It depends on their body, how much they might weigh or how their metabolism works," said David Rak, research manager for the Minnesota Department of Health's Office of Medical Cannabis. "You have to go into it knowing that the person next to you might have an amazing result and you might not," he said.

Seeking relief from chronic pain is the most common reason Minnesotans are currently taking part in the state's medical cannabis program. Out of 41,183 patients enrolled, 24,270 of them — 59% — are participating to get treatment for chronic pain, said Rak.

"By far, chronic pain is what drives our program," he said.

Part of the draw for patients, Rak said, is the opportunity to try something other than an opioid medication — or to reduce the amount of this kind of drug they are taking — to deal with pain in the long term.

"People who have chronic pain, they're picking something that helps them over the course of months and years," he said. "There's a big chunk of people who are in our program who say, 'It helps me and I don't mind the side effects.' And this can be game-changing for people."

The state added chronic pain to the list of qualifying conditions for medical marijuana in 2019. Before that, it included patients suffering a narrower category of pain called "intractable," where it is impossible to fix the cause and treatments aren't working.

The Department of Health collected data from patients with intractable pain who had been using marijuana for five months in 2016 and found that 38% had been able to reduce the amount of opioid medications they were taking. They also asked patients to rank the intensity of their pain and whether it interfered with their life before and after treating it with pot, and 42% reported a significant reduction.

Other state-run medical marijuana programs, including New York's, have reported similar findings.

Still, the International Association for the Study of Pain has so far declined to endorse cannabis as a treatment for pain, saying in 2021 that more robust research is needed. And a study by Swedish neuroscientists, published in 2022, found that patients taking a placebo reported a similar amount of pain relief.

How does pot work?

University of Minnesota researchers Monica Luciana, a professor in the Department of Psychology, and Angela Birnbaum, a professor in the Department of Experimental and Clinical Pharmacology, are currently studying how cannabis interacts with the brain and nervous system when it's taken as a treatment for chronic pain.

The human body naturally produces chemicals called endocannabinoids, similar to the compounds found in marijuana. And the brain and the nerve endings in our body have receptor molecules that interact with those endocannabinoids.

"One hypothesis is that the cannabinoid compounds within the brain interact with other brain chemicals, such that when those chemicals are released, there will be pain relief," Luciana said. "There is also some evidence to suggest that cannabinoid compounds might reduce inflammation."

Using cannabis may also impact other processes in the body, making it easier to fall asleep, and helping people feel less anxious and more relaxed, all of which could, in turn, make people feel better and give them the feeling that their pain is lessened.

Pot for cancer pain

As the director of HealthPartners' Cannabis in Cancer Research and Education clinic, Dr. Dylan Zylla has found that more of his patients, even those coming in suffering constant pain from bone metastasis as part of a late-stage cancer, are seeking out marijuana because they are "leery of opioids."

Most seem to get "some degree of benefit" from marijuana, he said, although cancer-related pain levels depend on the disease's progression.

"What it's doing is it's taking the edge off of those really bad pain levels and patients seem more comfortable and at ease with managing pain," Zylla said. "I would say, roughly, 30% of patients get significant meaningful clinical improvement that lasts for many months with cannabis."

His clinic often recommends patients initially try using cannabis at night because it can help them sleep.

"Sleep is really an important factor, actually. If you're sleeping better and you wake up rested, you're more ready to start the day. You feel stronger," he said. "What cannabis does is it helps our patients feel better in the multitude of symptoms that they have,"

Patients begin by using pills or liquid cannabis extractions through the state's medical program, which makes it possible to identify milligram doses of THC, the psychoactive compound in marijuana, and CBD, another compound.

Edible products keep the cannabinoids in patients' systems at a more regular level for a longer time, said Zylla. A joint or vape may take effect more quickly, but won't last as long.

Are prescriptions better?

For people dealing with chronic pain, Rak recommends enrolling in the state's medical marijuana program instead of diagnosing yourself and buying weed.

Being part of the program will allow you and your doctor to work with a dispensary pharmacist, who will consider the effect of other medications you may be taking and how they might interact with marijuana.

Also, the companies that make cannabis products for the medical marijuana program are required to have them tested by an independent lab and approved by the state to guarantee the amounts of THC and CBD.

And while the state once charged an annual $200 fee to enroll, the program is now free, though it does require that a health care practitioner certify that you have chronic pain or one of the other qualifying conditions.

The state's law made recreational marijuana legal only for those 21 and older. But younger Minnesotans can qualify for the medicinal program. There are currently about 50 people under 18 who are participating in the medical marijuana program, Rak said.

Another plus: Medical cannabis products aren't taxed, he added, while recreational ones are.