Dr. Kevin Most: Medical Marijuana
29 states have approved the use of medicinal marijuana, even though federal law still prohibits it. Many of the other states that have not approved its use are studying it now and will probably move to some accepted use soon. The term medical The approved recreational use also appears to be gaining some popularity as seven states have laws in place that allow some recreational use. Last year California, Massachusetts, Maine and Nevada took measures to legalize recreational use of marijuana, this brings the total to 7 states and the District of Columbia as areas where the use of marijuana has extended beyond medicinal use.
Let’s focus on the medicinal side of marijuana vs the recreational side to begin with. So the big question is does it have a place in medicine, does it add value or fill a void that we have? What is the drug and how and why does it work.
So the basics, Marijuana is obviously a plant that contains a chemical tetrahydrocannabinol or THC, and Cannabidiol or CBD. These are the two active chemicals that carry medicinal properties. The interesting thing about this drug is the vast array of medical conditions that it can actually help. Some of the conditions it will help have traditional medications or therapies that are currently being used. Advocates for marijuana use will show that marijuana actually works better than some of those treatments and actually have a much lower cost. When you look at the approved list that varies from state to state, you start to see the proposed conditions that have shown value in decreasing symptoms or actually treating illness.
The concern that marijuana is a gateway drug, actually swings both ways. Some will argue that using marijuana exposes the individual to other drugs thru the drug dealers. Many argue that the drug is not a gateway drug but the distribution is actually the gateway. Make it legal and remove the drug dealer attempting to promote other products and the gateway goes away. It is argued also that marijuana does NOT make you “chase that high” like cocaine and opiates do. There are actually many cases where the use of marijuana has allowed individuals to actually stop taking the opiates that they were addicted to. The well-known case is Jim McMahon who openly shares that his use of marijuana has allowed him to stop taking narcotic pain medication. It is also noted that states where medical marijuana was legal, that a sharp decline in deaths due to opioid overdoses was found when compared to states where marijuana was not legal. This is very important as we have discussed in the past and know about the opioid epidemic in this country. So the gateway drug argument may in fact be just the opposite.
Let’s touch on a few illnesses where marijuana has been proven to help.
One that has been the value of treating nausea for patients undergoing chemotherapy for cancer or hepatitis treatment. THC aids in a few ways here, it minimizes and in some cases eliminates the nausea and vomiting. It also stimulates appetite and thus helps cancer patients maintain or lose less weight. This is important as maintaining good caloric and protein input is important in the healing process. Although we have some good medications for nausea, some are expensive and some have side effects that are undesirable. We do have some actual medications that are used and are based on THC, however as in most cases the cost of this extends well beyond the cost of basic marijuana.
We all may have also heard about using marijuana to treat glaucoma. Glaucoma is a common cause of blindness, it is caused by increased pressure in the eyeball, which puts pressure on the optic nerve which results in blindness. Marijuana has been shown to decrease the pressure in the eye and will slow the impact of glaucoma. This has been known since the 70”s and has held true thru many studies. We do have medication for glaucoma, some decrease the amount of fluid going into the eye, others allow for an increase in out flow. Most of these drugs are eye drops and fortunately many of them are prepared in generic format which lowers the cost, some of the newer drugs which are dosed once a day are more expensive. Many of these medications require administration 4 times a day. Couple this with the ability of a senior to place eye drops properly and remember to dose them often leads to inadequate treatment.
Another important use is the ability for it to control seizures in many patients. Seizures are life changing from a social as well as a professional view. The ability to minimize or eliminate seizures can change a person’s life. We have known since 2003 that both THC and CBD can help control seizures by binding to the brain cells that control how our muscles spasm and relax. Although we do have many medications and even do surgery now for some seizures the cost and side effects are difficult to deal with. There is much research going on as to the use of deep brain stimulation surgery may help a lot of patients who have seizures, again it is cost that may come into play. This finding has been extended to Parkinson’s patients who saw improvement with fine motor skills and with pain relief in patients with MS
We also know that it helps with anxiety which comes into play with anxiety disorders as well as PTSD. This is one that has a little controversy as it is known that higher dose or uses can cause anxiety and paranoia.
Other uses that many may not be aware of are very interesting and could potentially have a large impact on many illnesses. For some reasons which are unclear at this point, show that marijuana appears to not only protect the brain in many cases but also appears to help heal an injured brain as well. This thought is being studied in many areas with surprising results. We are finding that marijuana may help the brain limit the damage seen from a stroke and from concussions. As more studies are done on this the impact may be huge. This currently is being studied in animal studies with human studies in the process of being started. One of the more exciting area being studied is the impact it may make in slowing the progression of Alzheimer’s disease. Each of these showing the potential healing properties of marijuana on the brain.
What about uses outside of the brain? Some of these may surprise you as well. We have talked in the past about Ulcerative colitis as well as Chron’s disease. Both of these are difficult for individuals to deal with and the treatment options are limited and often not fruitful. Studies out of England show that THC actually can interact with the cells in the intestines that play an important role in gut function.
A large study in 2011 showed that marijuana actually helps with the inflammation and pain caused by arthritis. The study showed that it relived pain and discomfort and also promoted sleep. This is an important finding as the medications we are currently using for arthritis are either very hard on the stomach or very expensive infusions. This is another area of research and could impact the millions of individuals who suffer from this illness that limits their activity needed to keep them healthy.
So do doctors write prescriptions for marijuana? Do patients go to Walgreens to pick up their marijuana? Not exactly. Physicians in Illinois write a medical referral after reviewing and documenting that the patient has one of the approved conditions on the state list. The doctor is also expected to follow the patient for the monitoring and treatment of the patient overall. This certification allows the patient to go to a state approved site for the purchase of marijuana. The state has tight controls on the quality (marijuana purchased on the street has been known to be laced with other drugs) as well as the distribution to only approved individuals with a medical condition present on the list. Many clinicians are still a bit gun shy or have not been convinced that this is a proper treatment option.