Non-steroidal Anti-inflammatory drugs, often referred to as NSAIDS, are very commonly used for minor aches and pains as well as for treatment of inflammatory conditions. This group of medications includes aspirin, ibuprofen, and naproxen (all available over-the-counter) and a number of prescribed drugs, such as diclofenac and celecoxib. Most people don't think twice about taking a couple of ibuprofen for a back-ache or for a sports injury, however there are real risks with these drugs and they should be avoided if possible.

A study published in the journal Circulation - Cardiovascular Quality and Outcomes in 2010 investigated the use of NSAIDS by over 1 million healthy people in Denmark over a nine year time frame (1997 - 2005). The results are shocking. Ibuprofen was found to have a 29% increased risk of fatal or nonfatal stroke, diclofenac had a 91% increased risk of cardiovascular death, rofecoxib had a 66% increased risk of cardiovascular death and celecoxib had inconclusive findings although the authors felt that there was a trend for increased cardiovascular risk. FYI: Rofecoxib (brand name Vioxx) was taken off the market in 2004 due to the high rate of stroke and heart attack.

Another study published in January 2011 by the British Medical Journal reported that all NSAIDS had an increased risk of heart attack, stroke and cardiovascular death. (British Medical Journal 201; 342:c7086)... and yet another study reported that NSAIDS were associated with an increased risk of atrial fibrillation or flutter (British Medical Journal, 2011; 343:d3450)

NSAIDS are also known to have high risks of causing gastrointestinal bleeding. It is estimated that over 100,00 Americans are hospitalized each year due to GI bleeds and ulcers from NSAIDS, and that about 15,000 to 20,000 die from this side effect. The elderly are particularly at risk for these complications.

Although many people rely on over-the-counter NSAIDS for treatment of pain and inflammatory conditions, the data presented above makes it clear that there are significant risks associated with this class of medications. Many of my patients choose to avoid these drugs when they hear about or experience these side effects. Many find that use of medical cannabis can substitute for NSAIDS with good results and little to no side effects. Many find that they can reduce or eliminate their use of NSAIDS.

THC, the main compound in cannabis, has both pain-relieving and anti-inflammatory properties. CBD (cannabidiol), the second most commoncannabinoid in cannabis, has been found to not only work as an anti-inflammatory and enhance the pain relieving properties of THC but has also been shown to reduce the chemicals that the body makes that add to inflammation. CBD is not psychoactive, that is, it does not add to the high feeling from THC. Many patients are now choosing cannabis that has lower THC levels and higher CBD levels which gives a better anti-inflammatory effect without causing too much alteration in thinking (meaning less "high").

How is it that doctors routinely recommend and prescribe NSAIDS? How is it that a natural medicine that has proven science behind it (educate yourself about the endocannabinoid system if you doubt the science), as well as a well-established safety profile, continues to be stigmatized and ignored? Cannabis may not be for everyone, but it is certainly worth a try considering the tremendous risks associated with other medications.

All adult patients in pain should be able to choose what they use to treat their pain. Patients deserve a real discussion about ALL the medications available, including the risks and benefits. For those that choose to not risk stroke, heart attack, ulcers, GI bleeding and death, cannabis is a very reasonable and effective option and doctors should educate themselves and their patients about it. In my practice, I have found that the majority of my patients are responsible adults who have found cannabis to be effective with little to no side effects and it is clear that they are benefiting from using it.

For more reading about CBD and the other cannabinoids, check out this great article: "Non-psychotropic plant cannabinoids: new therapeutic opportunities from an ancient herb" author A. Izzo, et al. (2009) ( http://www.ncbi.nlm.nih.gov/pubmed/19729208 )