Part Two: Where We Stand Today
Now, we find ourselves in relatively uncharted territory.
Although the production, use, and sale of Cannabis Sativa remains illegal at the federal level, most states have relaxed their own restrictions to one degree or another, many having passed laws allowing for the medical (and even the recreational) use of the plant. And at least for now, the federal government appears to have turned the other cheek. The Rohrabacher-Blumenthal Amendment, which was originally introduced in 2001 and eventually passed in 2014, forbids the use of federal funds by the Justice Department to interfere with individual state medical cannabis programs. In 2017, then-Attorney General Jeff Sessions proposed a repeal of the amendment, indicating that, in his view, it impedes the Justice Department’s ability to enforce the Controlled Substances Act passed by Congress under President Nixon (who was famously opposed to marijuana in all its forms). For the time being, however, the amendment remains in place and continues to protect state medical cannabis programs.
Many clinical trials are underway to test marijuana and its extracts. Studies have already demonstrated significant benefits, particularly for certain forms of chronic pain, including that associated with multiple sclerosis, cancer and nerve injuries. Cannabis is safer than narcotic pain medications, as the risks for overdose or dangerous drug withdrawal symptoms are virtually nil. It can serve as an alternative to the chronic use of anti-inflammatory medications such as ibuprofen, diclofenac, celecoxib and naproxen for people who cannot take them because of the risks they pose to our kidneys, stomach lining and cardiovascular system. It is less sedating than other prescription pain medications like gabapentin (Neurontin), pregabalin (Lyrica) and most opioids. It has muscle relaxant qualities that can benefit patients with Parkinson’s disease. It has been shown to reduce symptoms of PTSD (post-traumatic stress disorder) in military veterans. It has helped patients with symptoms associated with irritable bowel syndrome and inflammatory bowel disease (like Crohn’s disease and ulcerative colitis), HIV/AIDS, fibromyalgia, glaucoma, autoimmune forms of arthritis, and chemotherapy-induced nausea and weight loss. Research continues in these and other spheres, such as in the areas of inflammation and inhibition of cancer growth. The most prominent studies continue to be focused on chronic pain and on evaluating whether marijuana is a safer and less addictive alternative to opioids.
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Interest continues to grow, as evidenced by the abundance of research currently underway, the legitimization of medical cannabis by individual state agencies and the exponential growth of the consumer market. And although the research thus far has been promising, it’s important to keep in mind that an insufficient number of large, human clinical trials have been conducted to definitively demonstrate the benefits of cannabis to the satisfaction of the FDA and other regulatory and political bodies, and vigorous debate within the medical community continues. Much remains unknown about its bioactive substances, including tetrahydrocannabinol (or THC, the primary psychoactive compound in the plant), cannabidiol (or CBD, considered to be one of the primary anti-inflammatory components) and the over 500 other potentially-medicinal cannabinoids found in the plant. That said, many states (including Connecticut) have already concluded that there is sufficient evidence to date to allow for the medicinal use of cannabis for a number of medical conditions. My anecdotal experience has been that many patients with these conditions respond favorably to medicinal cannabis, and none in my memory have discontinued it due to adverse effects.
We still know relatively little about optimal dosing ranges and the best routes of administration (e.g., by mouth, inhaled, topical or sprayed under the tongue). For many medical conditions, experienced practitioners will often start with preparations that contain THC and CBD in a one-to-one ratio, thereby minimizing the psychoactive effects of the THC while maximizing the therapeutic benefit of the totality of cannabinoids contained within the product. Many medicinal cannabis products contain multiple cannabinoids, as THC and CBD are not the only cannabinoids purported to have therapeutic effects. In the field, this phenomenon- wherein the benefits of a combination of cannabinoids in a given product are found to be greater than the sum of its parts due to their potentiating effects- is known as the “entourage effect.” Side effects may range from minor (these are most common, and may include dry mouth, dizziness and enhanced appetite) to more severe (like increased heart rate, impaired mental function or difficulty concentrating, lung problems and panic). It is also unclear to what extent cannabis products may interact with other medications. Mood changes often arise, with relaxation or euphoria being commonly reported. Anxiety or paranoid feelings can also arise. Users can experience heightened sensory awareness (i.e., a greater appreciation of visual and auditory stimuli), an altered perception of time or lack of motivation to complete tasks. The effects can vary significantly between individuals.
A brief comment on the recreational front
Is marijuana the “gateway drug” that many presume it to be? Not if we consider alcohol and nicotine (in the form of tobacco), both of which are legal, generate significant tax revenues, and are unquestionably deadly. Alcohol destroys lives and families; marijuana does not. Cigarettes kill almost half a million Americans each year, while marijuana kills approximately none (aside from deaths resulting from illegal trafficking and trade). This is not to say that using marijuana is risk-free. It can have negative cognitive or emotional impacts on those who use it in large amounts on a regular basis, and especially in those whose brains have not yet fully matured. When marijuana use begins in the teen years, it can impact brain development and decrease brain activity. It can impair motor function and coordination, which can increase the risk of motor vehicle and industrial accidents. Although the science suggests that cannabis is far less dangerous than other recreational substances—including (and especially) alcohol and nicotine—it is nonetheless a drug and should be handled with care.
So there you have it in a nutshell…I hope you found this helpful. As we move toward more comprehensive and universally-recognized standards for the use of medicinal (and recreational) cannabis, it will be increasingly important that we have structures and policies in place which enable us to monitor the contents and quality of the available formulations, ensure that they are being used appropriately, and encourage and facilitate ongoing scientific research so that we may continue to most safely and effectively reap the benefits of this age-old natural resource.