Dr. Sulak forwards this report on Dr. Mark Wallace’s presentation at the American Pain Society’s 2018 meeting by Nancy A. Melville for Medscape:

“Describing his experience in treating pain with medical cannabis over the past 4 to 5 years, Mark S Wallace, MD, professor of clinical anesthesiology at the University of California, San Diego, said he starts with some basic criteria, including that patients have not responded to efforts for pain relief with standard therapy.

“‘Our approach in recommending medical cannabis for pain is that patients have failed to respond to conservative therapies first. However, this should be considered before chronic opioids,'” Wallace said.

This is precisely the subject of the controversial “Decision Tree” that the Medical Board of California has posted as an appendix to its “Guidelines for the Recommendation of Cannabis for Medical Purposes” —in contradiction to the guidelines themselves, which do not require that pain patients fail on pharmaceuticals before cannabis use is recommended. A letter from Stephen Robinson, MD, of the Society of Cannabis Clinicians, has called the contradiction to the attention of the board.

Wallace told the assembled Pain Specialists that advising on dosage is very complicated:

“‘Most professionals don’t know how to do it, and while I do, I don’t have the time. So I refer patients out to a doctor of naturopathic medicine who can sit down with the patient and give them dosing guidelines that they will then share with me,'” he said. 

Wallace totally acknowledges the effectiveness of cannabis in reducing opioid use.

“‘I am about 70% successful in completely weaning patient off of opioids and switching to cannabis in willing and motivated patients,’ he said.

“‘Most of the remaining patients are able to considerably wean down on their opioid dose with the cannabis, [but] for a few, it does not work.'”

Melville’s piece ends with a link to the California med board’s ‘Guidelines for the Recommendation of Cannabis for Medical Purposes’ and a note that

“Wallace reported consulting relationships with Insys and Zynerba.”

Insys is a leading manufacturer of semi-synthetic opioids (and cannabinoids). The company spends money opposing ballot measures to legalize cannabis for medical use…   Wallace is influential. Last week he was quoted at length in Pain Medical News on the absence of Cannabinoid Medicine in most medical schools’ curriculum.