Dr. Kevin Most: Medical Marijuana
You may have seen in the news last week that Oklahoma became the 30th state to approve the use of Medical marijuana. This is great news for many individuals in that state who will now have another option for care in treating their chronic illnesses that have been shown to be helped with marijuana. The other news story out last week on this topic is not so good and highlights a major problem surrounding this topic. The story in the NY Times highlighted the VA’s stand on medical marijuana and the impact it is making on our veterans. Veterans first stop for healthcare needs is often a VA clinic, however the stand the VA is forced to take with medical marijuana is one of nonuse. Marijuana continues to be an “illegal drug” in the eyes of federal law and therefore cannot be used in federal programs, one of which is the VA system. This has forced veterans in need of medical marijuana to source it from other options.
With 30 states approving the use of medical marijuana, and over 65% of the general population supporting legalization, one would think it is time for a federal law change to remove marijuana from the list of illegal drugs. Many are lobbying for this as they see the impact it has made in people’s health. Another interesting impact of the federal law is it has also forced all hospitals from not allowing it’s use for hospitalized patients, even those who have shown safe and proven treatment. This again comes down to the federal law, as long as hospitals are caring for Medicare and Medicaid patients they must follow federal laws which supersede state laws. This is sad as the patient who has found relief from a medical condition and is in the hospital is not allowed to use marijuana as it would be considered breaking federal law.
One of the concerns on a federal level is that using marijuana will lead to use of other drugs like cocaine or heroin, thus it has been termed a “gateway drug”. 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. Proponents for the use of marijuana share that unlike cocaine and heroin, marijuana use does not have individuals “chase that next 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. Marijuana has allowed many others to decrease the use of more addicting or troublesome medications. The well-known case is Jim McMahon who openly shares that his use of marijuana has allowed him to stop taking narcotic pain medication. This fact alone should be taken into consideration as we are seeing an epidemic of opioid addictions and deaths from overdoses of opiates is hitting records daily. There have been no deaths from overdoses of marijuana.
So, Let’s discuss marijuana and share where patients have seen success in treating their medical conditions.
30 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 approved recreational use also appears to be gaining some popularity as nine states have laws in place that allow some recreational 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 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, with less side effects and actually have a much lower cost. When you look at the approved list of conditions that are approved for marijuana as a treatment option, it varies from state to state. In many cases you see trends or similarities of conditions that have shown value in decreasing symptoms or actually treating illness with medical marijuana.
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. We all have heard about Marijuana causing individuals to have the “munchies” and although we may find that funny, for many patients it has a huge impact in their quality of life as well as their 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 or muscle spasms . 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. What we are finding now is that a strain that is high in CBD but low in THC ( known as Charlotte’s Web) has an ability to dramatically lower the incidence of seizures in some children. This fact has had many families moving from a state that does not allow marijuana for medicinal purposes to pick up and move to Colorado for access to this strain of marijuana. 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. Studies have shown that marijuana may help in a decrease of re-expieriencing the trauma, less avoidance of triggers that may remind them of the trauma and decrease anxiety symptoms. Hopefully the VA will reconsider their stand and allow veterans to try this medication.
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. Treating concussions before CTE is noted may be very powerful for these patients and soldiers. 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 Crohn’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. In many cases the flare ups from these illnesses have been decreased dramatically. This is one area where more research is needed to show a true benefit
The bigger point here is the ability of marijuana to replace pain medication. A large study completed last year showed that cannabis as a substitute for opioid, showed that 97% of those using opioids for pain relief were able to decrease the amount of opioids they were taking, 80 % felt that marijuana alone was as effective as their opioid pain medications. This study coupled with the problems we are seeing with opioid addiction certainly warrants future review and research. This area of research and could impact the millions of individuals who suffer from pain that limits their activity needed to keep them healthy and minimize the addiction and overdose problems we are seeing all too regularly right now.
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.
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 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