By Joanne Zieger

For most of my life I have had a complicated relationship with pain. You see, I’ve been an athlete for more than four decades, and for three of those I was considered “elite”. I raced as a professional triathlete for 12 years, and during that time, I placed 4^th in the Sydney Olympics and won the 2008 Ironman 70.3 World Championship in what was then a world record time. Elite athletes have a unique capacity to withstand the pain and suffering that inevitably occurs by pushing the body beyond what is thought humanly possible. In retrospect, I imagine that all of the training during those years were a preparation for my post-elite athlete life that occurred abruptly one November morning in 2009. On that day, I crashed on my bike during my World Championship title defense, leading to chronic pain due to my permanently damaged rib cage.

In the nearly ten years since that accident, I have been on a path of self-exploration and self-discovery with a singular goal – how can I create a more harmonious existence with my pain? Medically, I underwent nine surgeries on my chest wall to correct multiple structural and nerve abnormalities that occurred from the accident. Eventually my path led me to using medical cannabis. One bright Colorado day in 2014, shortly after recreational cannabis was legalized, I went kicking and screaming to my first dispensary. Overcoming the stigma of MARIJUANA was incredibly difficult. As a professional athlete, I was regularly drug tested and cannabis was illegal in all forms when I racing. And, I was warned of the danger of marijuana’s potential for misuse and abuse while studying the drug in adolescents and young adults during my eight years as a researcher at the Institute for Behavioral Genetics at the University of Colorado in Boulder.

Desperate times call for desperate measures, though, so I drowned out the stigma, and found myself in a dispensary inquiring about products that might help with pain induced insomnia, neuropathy, and persistent abdominal and diaphragmatic spasms. The morning after my first THC-facilitated sleep, I nearly wept with joy. In the subsequent years, I have learned about dosing, routes of administration, ratios of THC and CBD, and timing of use. I also learned that cannabis isn’t and can’t be my only line of defense against the persistent pain, inflammation, and spasms.

Part of the problem with medical cannabis use is that the supposed efficacy is often over-hyped with no real research to back-up the lofty claims that cannabis is the “be all, end all”. Certainly, there are studies to show that cannabis is effective for conditions such as fibromyalgia, multiple sclerosis, and joint pain. But, here’s the rub. Traditional pharmaceuticals are also helpful in the treatment of these conditions. As is exercise. And, meditation. Or, mental skills training that addresses poor self-esteem, positive self-talk, and learning acceptance of the disease.

During my dissertation defense, the Dean of my department of epidemiology at the Johns Hopkins Bloomberg School of Public Health, asked me this question: “How does your research fit into the big picture?” At the time I was incensed. How could a lowly graduate student such as myself possibly answer such a grandiose question. Many years later, when I looked back at that exchange, I realized he didn’t expect me to unravel the “big picture” in that moment. He merely wanted me to embark on a thought process that cast a wider net than the singular problem I was trying to solve.

In the rush to push cannabis as a cure-all medicine, the big picture has become fuzzy. Perhaps, cannabis in of itself isn’t the big picture, and the big picture looks very different. What happens, then, if cannabis becomes part of a multi-modal approach where cannabis is introduced alongside traditional pharmaceuticals, an appropriate exercise program, meditation, and improved resilience through mental skills training? A bunch of modalities that are reasonably effective alone could suddenly become a powerful combination when used together.

For a long time, I was disappointed that cannabis wasn’t the answer. That I still had symptoms that needed to be treated with powerful anti-inflammatories and even the occasional opioid. I didn’t fully understand the use of cannabis as part of a multi-modal approach. Of course, I exercise regularly, my brain craving endorphins, and my body responding positively to the movement of running. My days as an athlete taught me the fundamentals of how to apply my strong mental skills to overcoming challenges. The piece I misunderstood was the use of cannabis as an adjunct therapy to other medications. I finally had my aha moment when I attended a medical conference and heard a medical cannabis physician clarify this very notion to the audience. He explained that it is not a failing of cannabis if a patient still needs other meds, including opioids, to treat their disease; cannabis is just part of the complex process that doctors and patients are slowly learning to navigate.

My curiosity about the efficacy of cannabis to ease the burden of disease has now become my life’s work. I have taken advantage of my skills as a cannabis epidemiologist to start unraveling the use of medical cannabis to ease the suffering of those who have chronic pain as a symptom of their medical condition. My goal is to amass research-based evidence for doctors and patients on how to implement medical cannabis as part of a multi-modal approach. The research can then be used for education to teach cannabis consumers and medical professionals about proper cannabis use and how misuse can lead to adverse outcomes, which in extreme cases can cause emergency department visits for psychosis or vomiting.

Everyone who understands cannabis understands that we need more research to unravel the mysteries of this complicated plant. Cannabis professionals need to take a deep breathe and step back and make sure that cannabis is not oversold and under-promised. Research with scientific-rigor that is peer-reviewed will help unlock these mysteries and help direct treatment for those who need medical cannabis as part of a multi-modal plan to alleviate the symptoms of their disease.