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Is marijuana a medical miracle? The truth is, we still don’t know

Doctors are still researching the benefits of medical marijuana Illustration: George Wylesol

Doctors are still researching the benefits of medical marijuana Illustration: George Wylesol

What’s the evidence behind medical cannabis? While many attest to its healing powers, research into the full potential has long been legally restricted

Last modified on Thu 7 Mar 2019 20.46 GMT

T he movement to legalize medical marijuana has its roots in the 1980s and early 1990s, the worst days of the US Aids epidemic. The disease was a death sentence, and stricken young men sought out marijuana for relief and solace. In San Francisco’s Castro District, a gay Vietnam veteran named Dennis Peron ran an illegal dispensary to supply them. Peron went on to co-write Proposition 215, which California passed in 1996, becoming the first state to allow medical marijuana – med for short.

Among all the things med is touted as doing, relief from wasting illnesses like Aids and cancer (especially during chemotherapy) is among the respectable. A reader in the UK writes that when his wife was dying of breast cancer, “I purchased a vaporiser for her, it quickly became invaluable for both pain relief and as a mood enhancer”. Though research is limited, a recent study found a quarter of cancer patients in Seattle use marijuana.

The concept of med is easy to mock, since so many users don’t have an urgent medical need. But while very sick people taking it to improve their quality of life isn’t medicine in the conventional sense, it doesn’t seem silly either. Thirty US states and a numerous countries have legalized med on the basis of anecdotal evidence that it can help.

While cannabis contains scores of chemicals, the most familiar are tetrahydrocannabinol (THC), which gets people high, and cannabidiol (CBD), a non-psychoactive compound often associated with medical benefits. Beyond this point, little is known about the plant’s capabilities and limitations as medicine, at least compared to any drug available in pharmacies.

Med can be understood as a folk remedy, an awkward compromise between medicinal properties and an unworkable legal situation

That’s because in much of the world, including the US, it’s long been illegal or very difficult to research the marijuana plant for medical use.

So today, med can be understood as a folk remedy, an awkward compromise between the plant’s widely acknowledged medicinal properties and an unworkable legal situation.

Among the 30 legal states, each has its own list of which conditions qualify for med access. Arizona considers PTSD a qualifying condition, but Louisiana does not. In Delaware, doctor’s recommendations are relatively difficult to obtain, but in California they’re handed out after a three-minute video chat.

Even in its more accepted uses, no government or credible medical institution I know of attempts to answer basic questions, such as: should a patient with a specific condition eat or inhale cannabis? How much they should take? What is the ideal ratio of THC to CBD? (And that’s if consistent supplies are available, which they usually aren’t.) Instead patients are left to trial and error. While this works for some, it invites companies to develop products targeting insomnia, migraine, stomach pain or other conditions.

A US study found a significant reduction in demand for pharmaceuticals to address conditions like anxiety, depression and pain, in states where med is legal. Some patients clearly prefer med. what’s not yet known is how well it performs relative to conventional medicine.

When the stakes are some form of mild discomfort, it may be tolerable to let someone experiment with med as they like. At other times more specificity is needed. US veterans groups overwhelmingly support med research following anecdotal evidence that it helps with post-traumatic stress disorder.

The future of marijuana prescriptions? Illustration: George Wylesol

Veterans have a suicide rate roughly triple the US population. In life or death situations it becomes much more urgent to study the dosages, chemical compositions and other variables which have the most benefit.

Following media reports, which have touted it as a miracle cure, there’s a growing community of parents who attempt to treat their children’s seizure disorders with CBD oil. They’ve largely had to treat these devastating illnesses based on word of mouth or information they find online.

This is one example where cannabis pharmaceuticals make more sense. The best known example is probably the UK firm GW Pharmaceuticals. The company’s first drug, Sativex, an oral spray with a 1:1 ratio of THC and CBD, has been approved in 30 countries, mainly in Europe, for MS-associated spasticity.

Next in the company pipeline is Epidiolex, a CBD formula aiming to benefit children with two rare and debilitating seizure disorders. After years of clinical trials it has been accepted for the US Food and Drug Administration’s fast-track approval process and could win final approval as soon as June. (Aside from synthetic THC used for Aids and cancer-related loss of appetite, Epidiolex would be the first cannabis derived drug available in the US)

There’s justifiable excitement about medical breakthroughs which legalization may bring. But most haven’t arrived yet.

According to the the US National Cancer Institute: “Studies in mice and rats have shown that cannabinoids may inhibit tumor growth by causing cell death, blocking cell growth, and blocking the development of blood vessels.”

What’s the evidence behind medical cannabis? While many attest to its healing powers, research into the full potential has long been legally restricted<br>

Medical Marijuana FAQ

In this Article

In this Article
In this Article
  • What is medical marijuana?
  • What is medical marijuana used for?
  • How does it help?
  • Can medical marijuana help with seizure disorders?
  • Has the FDA approved medical marijuana?
  • How do you take it?
  • What are the side effects of medical marijuana?
  • Which states allow medical marijuana?
  • How do you get medical marijuana?

While every state has laws dictating the use ofВ medical marijuana, more than two thirds of U.S. states and the District of Columbia have actually legalized it for medical treatmentsВ and more are considering bills to do the same. Yet while many people are using marijuana, the FDA has only approved it for treatment of two rare and severe forms of epilepsy, Dravet syndrome andВ Lennox-Gastaut syndrome.В

Why hasn’t more research been done? One reason is that the U.S. Drug Enforcement Administration (DEA) considers marijuana a Schedule I drug, the same as heroin, LSD, and ecstasy, and likely to be abused and lacking in medical value. Because of that, researchers need a special license to study it, says Marcel Bonn-Miller, PhD, a substance abuse specialist at the University of Pennsylvania Perelman School of Medicine.

That may not change anytime soon. The DEA considered reclassifying marijuana as a Schedule II drug like Ritalin or oxycodone, but decided ito keep it as a Schedule I drug.

The agency did, however, agree to support additional research on marijuana and make the process easier for researchers. “Research is critically needed, because we have to be able to advise patients and doctors on the safe and effective use of cannabis,” Bonn-Miller says.

He shared some background on medical marijuana’s uses and potential side effects.

What is medical marijuana?

Medical marijuana uses the marijuana plant or chemicals in it to treat diseases or conditions. It’s basically the same product as recreational marijuana, but it’s taken for medical purposes.

The marijuana plant contains more than 100 different chemicals called cannabinoids. Each one has a different effect on the body. Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are the main chemicals used in medicine. THC also produces the “high” people feel when they smoke marijuana or eat foods containing it.

What is medical marijuana used for?

Researchers are studying whether medical marijuana can help treat a number of conditions including:

  • Alzheimer’s disease
  • Appetite loss
  • Cancer
  • Crohn’s disease
  • Diseases effecting the immune system like HIV/AIDS or Multiple Sclerosis (MS)
  • Eating disorders such as anorexia
  • Epilepsy
  • Glaucoma
  • Mental health conditions like schizophrenia and posttraumatic stress disorder (PTSD)
  • Multiple sclerosis
  • Muscle spasms
  • Nausea
  • Pain
  • Seizures
  • Wasting syndrome (cachexia)

But it’s not yet proven to help many of these conditions, with a few exceptions, Bonn-Miller says.

“The greatest amount of evidence for the therapeutic effects of cannabis relate to its ability to reduce chronic pain, nausea and vomiting due to chemotherapy, and spasticity [tight or stiff muscles] from MS,” Bonn-Miller says.

How does it help?

Cannabinoids — the active chemicals in medical marijuana — are similar to chemicals the body makes that are involved in appetite, memory, movement, and pain.

Limited research suggests cannabinoids might:

  • Reduce anxiety
  • Reduce inflammation and relieve pain
  • Control nausea and vomiting caused by cancer chemotherapy
  • Kill cancer cells and slow tumor growth
  • Relax tight muscles in people with MS
  • Stimulate appetite and improve weight gain in people with cancer and AIDS

Can medical marijuana help with seizure disorders?

Medical marijuana received a lot of attention a few years ago when parents said that a special form of the drug helped control seizures in their children. The FDA recently approved Epidiolex, which is made from CBD, as a therapy for people with very severe or hard-to-treat seizures. In studies, some people had a dramatic drop in seizures after taking this drug.В

Has the FDA approved medical marijuana?

The cannabidiol EpidiolexВ was approved in 2018 for treatingВ seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome. In addition, the FDA has approved two man-made cannabinoid medicines — dronabinol (Marinol, Syndros) and nabilone (Cesamet) — to treat nausea and vomiting from chemotherapy. The cannabidiol EpidiolexВ was approved in 2018 for treatingВ seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome.

How do you take it?

To take medical marijuana, you can:

  • Smoke it
  • Inhale it through a device called a vaporizer that turns it into a mist
  • Eat it — for example, in a brownie or lollipop
  • Apply it to your skin in a lotion, spray, oil, or cream
  • Place a few drops of a liquid under your tongue

How you take it is up to you. Each method works differently in your body. “If you smoke or vaporize cannabis, you feel the effects very quickly,” Bonn-Miller says. “If you eat it, it takes significantly longer. It can take 1 to 2 hours to experience the effects from edible products.”

What are the side effects of medical marijuana?

Side effects that have been reported include:

  • Bloodshot eyes
  • Depression
  • Dizziness
  • Fast heartbeat
  • Hallucinations
  • Low blood pressure

The drug can also affect judgment and coordination, which could lead to accidents and injuries. When used during the teenage years when the brain is still developing, marijuana might affect IQ and mental function.

Because marijuana contains some of the same chemicals found in tobacco, there have been concerns that smoking it could harm the lungs. The effects of inhaled marijuana on lung health aren’t clear, but there’s some evidence it might increase the risk for bronchitis and other lung problems.

The National Institute on Drug Abuse says marijuana can be addictive and is considered a “gateway drug” to using other drugs. “The higher the level of THC and the more often you use, the more likely you are to become dependent,” Bonn-Miller says. “You have difficulty stopping if you need to stop. You have cravings during periods when you’re not using. And you need more and more of it to have the same effect.”В В Learn more about the long-term effects of marijuana use.

Another issue is that the FDA doesn’t oversee medical marijuana like it does prescription drugs. Although states monitor and regulate sales, they often don’t have the resources to do so. That means the strength of and ingredients in medical marijuana can differ quite a bit depending on where you buy it. “We did a study last year in which we purchased labeled edible products, like brownies and lollipops, in California and Washington. Then we sent them to the lab,” Bonn-Miller says. “Few of the products contained anywhere near what they said they did. That’s a problem.”

Which states allow medical marijuana?

Medical marijuana is legal in 33В states and the District of Columbia:

  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Hawaii
  • Illinois
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Missouri
  • Montana
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Rhode Island
  • Utah
  • Vermont
  • Washington
  • West Virginia

States allowing legal recreational use include: Alaska, California, Colorado, Illinois, Maine, Massachusetts, Michigan, Nevada, Oregon, Vermont, and Washington

States that allow restricted use only include: Alabama, Georgia, Idaho, Iowa, Kentucky, Mississippi, Missouri, North Carolina,South Carolina, Tennessee, Texas, Virginia,В Wisconsin and Wyoming.В

How do you get medical marijuana?

To get medical marijuana, you need a written recommendation from a licensed doctor in states where that is legal. (Not every doctor is willing to recommend medical marijuana for their patients.) You must have a condition that qualifies for medical marijuana use. Each state has its own list of qualifying conditions. Your state may also require you to get a medical marijuana ID card. Once you have that card, you can buy medical marijuana at a store called a dispensary.

Sources

Marcel Bonn-Miller, PhD, adjunct assistant professor, University of Pennsylvania Perelman School of Medicine.

National Conference of State Legislatures: “State Medical Marijuana Laws.”

National Institute on Drug Abuse: “Drug Facts: Is Marijuana Medicine?” “Is Marijuana Addictive?”

Drug Enforcement Administration: “Drug Schedules.”

Department of Health and Human Services.

Kaur, R. Current Clinical Pharmacology, April 2016.

PDQ Integrative, Alternative, and Complementary Therapies Editorial Board: “Cannabis and Cannabinoids (PDQ).”

Schrot, R. Annals of Medicine, May 2016.

Epilepsy Foundation: “Learn About Medical Marijuana and Epilepsy.”

News release, Ohio Gov. John Kasich’s office.

WebMD shows you how medical marijuana works where it’s legal, what it’s used for and what side effects it might cause.