Few topics elicit stronger emotions in physicians, scientists, researchers, policymakers, and the general public than medical cannabis. Is it secure? Is it legal? Decriminalized? Is its efficacy established? Under what circumstances is it beneficial? Is it physically addictive? How are we going to keep it out of the hands of adolescents? Is it truly the “miracle medicine” that some claim it to be? Is medical cannabis only a smokescreen for the wider legalization of cannabis?
These are only a few of the wonderful questions that have been raised about this issue, which I will studiously sidestep in order to focus on two specific areas: why do patients find it useful, and how can they address it with their doctor.
Marijuana is currently allowed on a state-by-state basis in 29 states and the District of Columbia. From the federal government’s standpoint, it remains unlawful. Obama administration made prosecuting medical cannabis a non-starter. President Donald Trump promised not to meddle with medical cannabis users, however his administration is now threatening to reverse this policy. Around 85% of Americans support medical cannabis legalization, and it is estimated that at least several million Americans use it now.
Marijuana without the psychoactive effect
The extract from the hemp plant known as CBD (short for cannabidiol) is the least contentious, as this component of cannabis has little, if any, psychoactive qualities. Marijuana contains about 100 active ingredients. THC (short for tetrahydrocannabinol) is the molecule responsible for the “high” associated with cannabis use. Because CBD-dominant strains include little or no THC, patients report experiencing little, if any, change in consciousness.
Patients do, however, report several benefits of CBD, ranging from the relief of insomnia, anxiety, stiffness, and pain to the treatment of potentially fatal illnesses like as epilepsy. Dravet syndrome is a rare form of infantile epilepsy that is nearly impossible to control but responds drastically to Charlotte’s Web, a CBD-dominant strain of cannabis. The videos depicting this are quite dramatic.
Medical cannabis applications
In the United States, medical cannabis is most frequently used to treat pain. While cannabis is not strong enough to treat severe pain (such as post-surgical pain or a broken bone), it is highly successful at treating the chronic pain that affects millions of Americans, particularly as they age. Part of its appeal is that it is unquestionably safer than opiates (it is difficult to overdose on and significantly less addictive) and that it can be used in place of NSAIDs such as Advil or Aleve if patients are unable to take them owing to kidney, ulcer, or GERD problems.
Marijuana appears to be particularly effective at relieving the pain associated with multiple sclerosis and nerve discomfort in general. There are few additional treatments available in this area, and those that do, such as Neurontin, Lyrica, or opiates, are extremely sedating. Patients assert that cannabis enables them to resume previous tasks without feeling fully disoriented or disconnected.
In this vein, cannabis is claimed to be an excellent muscle relaxant, and users swear by its ability to alleviate tremors associated with Parkinson’s disease. I’ve also heard of its successful use in the treatment of fibromyalgia, endometriosis, interstitial cystitis, and the majority of other illnesses with a shared final pathway of chronic pain.
Marijuana is also used to treat nausea, weight loss, and glaucoma. A particularly promising area of research is its use to treat post-traumatic stress disorder in veterans returning from battle zones. Numerous veterans and their therapists claim significant improvement and call for additional research and a relaxation of regulatory constraints on its study. Additionally, medical cannabis has been reported to benefit individuals suffering from HIV-related discomfort and wasting syndrome, as well as irritable bowel syndrome and Crohn’s disease.
This is not an exhaustive list, but rather a brief overview of the illnesses for which medicinal cannabis may be beneficial. As with any remedy, efficacy claims should be assessed critically and with caution.