Saturday, September 21, 2013

Medical Marijuana: Separating Fact from Fiction

Medical Marijuana is a hot topic in my community at the moment. Vermont  legalized medical marijuana and has issued three of four licenses for dispensaries. With the 4th one up for grabs, and an organization interested in locating a dispensary in the small town where I live, there has been a lot of discussion about medical marijuana and its usefulness.   

One of the first things I’ve noticed, in trying to understand more on this topic, is that there are a lot of personal stories about the effectiveness of medical marijuana. As discussed before on this blog, what works for you, may not work for someone else and vice versa. A lot of healing is individualized. That noted, I’ve been looking for well-designed studies as a means of trying to understand what may or may not be valid regarding medicinal marijuana.

Marijuana or cannabis, in the seed and seed oil form,  has been used medicinally for around 5,000 years. For recreational, cannabis is smoked or ingested and is the largest illegal drug used in the US.  A good overview of how cannabis has been used, and the legal issues surrounding it through history, is available on-line at the Medical Marijuana ProCon site. 

Currently, 20 of the 50 states and DC have legalized the medical use of marijuana. Those in favor argue that it’s safe and effective for treatment of a number of symptoms and conditions, while those opposed point out that it is addictive, could lead to harder drugs and that long term use leads to a variety of serious health issues.

With that in mind, consider the following:
• Marinol, a synthetic version of the active ingredient in marijuana- tetrahydrocannabinol (THC)- is available in pill form with a prescription. Its primary uses are for weight loss in patients with AIDS and nausea and vomiting associated with cancer chemotherapy in patients who failed to respond adequately to conventional antiemetic treatments.

• Marijuana can be addictive. It is estimated that nine percent of people who use marijuana will become dependent on it. Anthony, J.; Warner, L.A.; and Kessler, R.C. Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey. Exp Clin Psychopharmacol 2:244–268, 1994. The number increases to about 1 in 6 for those who start in their teens and to 25-50% in daily users. Hall, W.; and Degenhardt, L. Adverse health effects of non-medical cannabis use. Lancet 374:1383–1391, 2009. Hall, W. The adverse health effects of cannabis use: What are they, and what are their implications for policy? Int J of Drug Policy 20:458–466, 2009

Interestingly there is now Marijuana Anonymous

• The National Institute of Drug Abuse has identified the following health issues from smoking marijuana:
  • -       Elevation of heart by 20-100% shortly after smoking. One study found a 4.8 fold increase in the risk of heart attack in the first hour after smoking the drug. Risk may be greater in older individuals or with cardiac histories.
  • -       Mental illness: A series of large studies showed a link between marijuana and the development of psychosis.
  • -       Use during pregnancy is associated with increased risk of neurobehavioral problems in babies.  This can include problems with attention, memory and problem solving.
  • -       It has been linked in a few recent studies with an increased risk of an aggressive type of testicular cancer in young men.
  • -       Long term marijuana users report lower life satisfaction, poorer mental and physical health, relationship problems, and less academic and career success compared to matched peers.
  • -       Regular marijuana use among adolescents can have long-lasting negative impact on the structure and function of their brains.

• Marijuana can suppress the body’s immune system. Venkatesh L. Hegde, Mitzi Nagarkatti and Prakash S. Nagarkatti. Cannabinoid receptor activation leads to massive mobilization of myeloid-derived suppressor cells with potent immunosuppressive properties. European Journal of Immunology, 2010; 40 (12): 3358-3371 DOI: 10.1002/eji.201040667

• Smoking marijuana makes sperm less fertile-even if the woman is the one who smokes it. To learn more about the effects of marijuana on fertility read Smoking Marijuana Lowers Fertility: Sperm burn out, less potent when men-or women-smoke marijuana. 

• Pulmonary (lung) complications associated with the regular smoking of cannabis are “relatively small” and far lower than those associated with tobacco smoking. Marijuana does, however, "cause visible and microscopic injury to the large airways that is consistently associated with an increased likelihood of symptoms of chronic bronchitis that subside after cessation of use. Tashkin, Donald Annals of the American Thoracic Society June 2013.

• According to the National Cancer Institute, A number of studies have yielded conflicting evidence regarding the risks of various cancers associated with Cannabis use. 

• It is not clear if marijuana is a “gateway” drug. In other words, does using marijuana lead users to try cocaine, heroin etc.? It is known that those who use marijuana are more likely to try other drugs. Does this happen because these individuals are more prone to use other drugs or does smoking pot cause further drug use?

Even though marijuana is widely thought to be helpful in people with glaucoma, the American College of Physicians noted in 2008 that large doses of cannabinoids are required to reduce eye pressure. This effect is short lived, and side effects, such as a reduction in blood supply to the optic nerve, may cancel out the benefit over the long term. Other medicines are generally more useful for people with glaucoma.

• In the 2008 American College of Physicians report Supporting Research into the Therapeutic Role of Marijuana and concludes Evidence not only supports the use of medical marijuana in certain conditions but also suggests numerous indications for cannabinoids. Additional research is needed to further clarify the therapeutic value of cannabinoids and determine optimal routes of administration. The science on medical marijuana should not be obscured or hindered by the debate surrounding the legalization of marijuana for general use.
• The Office of National Drug Control Policy commissioned the Institute of Medicine (IOM) to assess the potential health benefits and risks of marijuana. The IOM is an independent research body affiliated with the National Academy of Sciences. The IOM issued its final report in 1999 and offered several conclusions regarding marijuana's usefulness. It found that scientific data indicate that cannabinoids, particularly THC, have some potential to relieve pain, control nausea and vomiting, and stimulate appetite. American Cancer Society 
• The American Cancer Society has a very good review of medical marijuana, maybe among the best I’ve read so far,  and is worth taking the time to read. The medical use of marijuana is limited because different strains of the plant contain different amounts of various compounds, which makes effects hard to predict. Medical researchers have isolated substances from the plant (cannabinoids) that can be used in precise doses alone and in combinations with other medicines to achieve more predictable effects. .... Relying on this type of treatment alone and avoiding or delaying conventional medical care for cancer may have serious health consequences.

After reading a variety of research and position papers, it would seem that medical marijuana may be beneficial in certain situations. While it may have been used for thousands of years, there are now many medications on the market that effectively target a particular condition or symptom, thereby making marijuana less useful then it was in previous generations.  Case in point- marijuana does help with glaucoma, but eye specialists aren’t routinely recommending it because current medications are far more effective. This also maybe true for Parkinson’s Disease (PD), where it appears marijuana may be helpful with tremors. However, it can impact memory in a negative way, potentially compounding instead of alleviating issues for a person with PD.

If you are living with a chronic condition and wonder if marijuana might be helpful for you consider the following:
• Contact the condition specific organization (e.g. Parkinson’s Disease Foundation) and ask them for information about whether medical marijuana could be helpful.  

• Discuss this with your medical provider as marijuana can negatively react to medications you may be taking.

• Know the rules in the state where you live.

•  Medical marijuana can be expensive so check for clinical trials that you might be eligible for. Check Clinical

• If you want to use marijuana as a way to reduce stress and chill out, consider mindfulness based stress reduction.  It’s legal, free and has a proven track record.

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