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Dr. Kevin Most: Is CBD Oil made of marijuana?

Dr. Kevin Most

On May 31st the governor signed a bill making Illinois the  11th state in the country to legalize recreational marijuana. Many other states are considering it as well. The Midwest Wisconsin is the only state where it’s use is strictly banned. Now many find it interesting that we were the first state in the nation to legalize it without a voter initiative. This was approved in Illinois thru a Tax Act that went thru the house and Senate. The new law will allow for adults over 21, to possess 30 grams of marijuana, and to grow 5 plants at home. We will also see an increase in companies looking for license approval to grow and distribute here in Illinois.

The implications are wide, from the legal side, anyone convicted for possession of less than 30 grams will be pardoned, and others with more than 30 grams will have the ability to have this expunged from their record.

The scope of this may be huge, estimates are that 25 million people in the US will use marijuana each month. Recent studies have shown some decline over the past five years in High School aged students, many have concerns that this will now rise dramatically as the legalization of both medicinal and recreational use has exploded.

From the medical side the reviews are mixed, some physicians are totally against this and have significant concerns, others are supportive of the law and the impact it will make on their patients. Those against the legalization are concerned that this may be a gateway drug to other more powerful illegal drugs. Proponents for the law say this has not been proven and certainly has not been proven in a state where marijuana is legal. Those in support actually feel it may slow the tide of individuals using illegal drugs as they will not be buying from a drug dealer who may offer other drugs to the individual or sell marijuana that is laced with other drugs to shift the use to a more powerful drug.

We have talked about the success many are having with CBD oil and one would only expect that this will increase as marijuana will be considered legal. The CBD industry has expanded and will continue to as individuals become more comfortable with the common use of marijuana.

Those supportive of the law include many Oncologist, the doctors who care for cancer patients. Chemotherapy is very difficult on many people and one of the side effects is nausea. We currently have great legal medications for nausea however some cancer patients do not get the relief needed from these medications and will turn to marijuana for their relief from nausea. Marijuana has been known as a strong medication for nausea and also has the additional benefit of stimulating appetite which in cancer patients is very important.

Another interesting aspect of this law from the medical side is that Marijuana continues to be illegal under federal law to possess or use. Hospitals and doctors work under federal DEA licenses, so allowing the use of a prohibited Schedule 1 drug is concerning for many hospital administrators. Although it has been approved at a state level many hospitals  refrain from allowing their patients to use marijuana even medicinal as federal law trumps state law for any hospitals that care for Medicare and Medicaid patients as these are funded with federal funds and license to hold and distribute medication comes from the federal DEA license the hospital holds.

Another concern is the issue of having a drug free work place. Hospitals all have drug screening policies as well as drug free workplace cultures. These will need to be reviewed as the law on possession and use has changed. The goal is to make sure that individuals in the hospital are not caring for patients while under the influence of illegal substances or substances that can impact their ability to care for patients. Alcohol is a good example of how this works. For the concern of alcohol use, we have measurement guidelines that set a level for impairment, we use that measurement for DUI arrests as well as for impairment in the workplace. This unfortunately is not true with Marijuana. We can certainly test for Marijuana with very specific lab testing but unlike alcohol testing a positive result does not equate with impairment only use, what is even more confusing is that THC from the Marijuana is stored in fat cells in the body and thus can be positive for up to 30 days after quitting for the regular user. The employee who tests positive does not mean they were smoking at work or even recently, it may have been days earlier. Many companies will not have to struggle to see where Marijuana use fits in their company policy.

Many studies have shown that marijuana significantly impacts judgement, motor control and reaction times. These are 3 qualities that are used daily when driving. There have been many studies that have shown the impact of marijuana on motor vehicle accidents. Other studies have shown that the combination of alcohol along with marijuana will more than double your risk of being in a fatal accident.

On the medical side we look at the impact of legalization thru the lens of patients and their needs. Each year there are over 500,000 visits to Emergency rooms where marijuana use was mentioned in the medical record.  In Colorado the legalization of recreational marijuana made an impact on adolescents that no one saw coming. The ER’s in Colorado showed a sharp increase in ER visits of adolescents following ingestion of marijuana as well as coingestion with alcohol. The availability of Marijuana in public many think will increase the use in adolescents.

Some physicians will appreciate the legalization as they have patients that will benefit from the use of Marijuana but the doctor did not want to go thru the hassle of applying to be able to write for medicinal marijuana.  We know the state of Illinois had an extensive list of conditions for medicinal marijuana. It has been shown to relieve pain, relax muscles, stimulate appetite, stop nausea, stop seizures and in some cases help with allergies. Many patients will now be able to self-treat some conditions as they try marijuana for a medical condition they used to treat with conventional treatment and medications. It may give many patients relief beyond the relief that they receive currently.

There are some physicians who have concerns including surgeons and anesthesiologists as marijuana use immediately before surgery has some risks. It may cause an irregular heart rate, some reported cases of heart attacks and strokes and some anesthetic concerns. Most surgeons will request even tobacco smokers to refrain from smoking for weeks leading up to an elective surgery, now the focus will need to be on both cigarettes as well as marijuana use. Physicians are now pressing for research trials on marijuana as in the past this has been difficult or impossible to run or control.

There is always the debate of marijuana being addictive. Medical studies show that marijuana can certainly show a dependence on the drug. This shows when patients have some withdrawal symptoms after stopping regular  use of marijuana. These symptoms include irritability, sleep disorders, physical discomfort. Addiction can occur as the definition includes an individual being unable to stop using the drug even though it interferes with many aspects of their lives including family, work and financial

Hopefully the control of growth and distribution will help decrease some of the adverse events we are seeing with marijuana that is sold off the street and is laced with powerful illegal drugs. It will also help in the safety of the transaction, having patients with cancer finding a drug dealer and interacting with them has led to bad outcomes in many cases, having safe and regulated distribution will be very important for those patients who use this for a medical condition.

One would hope that Tax dollars are used to advance the science on this drug and CBD as well.

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