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The Clinical Applications of Marijuana

Published: April 20, 2011

We’ve been discussing the subject of medical marijuana, in the light of recent news that sales of the semi-legal drug have recently reached an all time high. To see the beginning of this conversation check out the archives at http://www.sacramentomenshealth.com/

In my last entry, I ended on the subject of Proposition 215 in California which in 1996 created legislation allowing licensed physicians to prescribe medical marijuana to patients suffering from a variety of acute and chronic illnesses. These illnesses include: AIDS, anorexia, arthritis, cachexia, cancer, chronic pain, glaucoma, migraine, multiple sclerosis, seizures, and severe nausea. For this installment in the series, I will be taking a closer look at the treatment of these conditions with marijuana.

Three uses of marijuana, in particular, have been shown time and time again to be effective relief. One of the oldest and most studied uses of marijuana is its effect as an antiemetic (emesis = vomit). In clinical research reaching back to the 1960s, marijuana has been shown to relieve patients of nausea when used in appropriate doses. This application of the drug is particularly useful in helping chemotherapy patients overcome the nausea associated with treatment. The second most cited use of medical marijuana is for those suffering from anorexia or cachexia (wasting syndrome) associated with infectious diseases, primarily HIV. Marijuana is an appetite stimulant (you’ve undoubtedly heard of high people with “the munchies”) and in many cases can help AIDS patients gain weight and live healthier and longer lives. Another long used and well understood use is in the treatment of glaucoma. Glaucoma is a disease where patients suffer from an increase intraocular pressure that leads to optic nerve damage, and ultimately blindness. Marijuana, in studies funded by the US National Eye Institute, was proven to reduce intraocular pressure, thus helping to resolve the disease.

These three uses of the drug are so commonplace that synthetic variants of THC have been produced in order to mimic the effects. The most common name brand is Marinol, and is a THC like compound that is delivered in pill form. Physicians have been prescribing Marinol for the previously outlined conditions for quite some time now. Many people criticize the use of medical marijuana because of the existence of synthetic variants like Marinol. Proponents for medical marijuana point out that, while THC is the primary active ingredient, the actual plant contains several secondary cannabinoids that could play a role in the drug’s effectiveness. Considering that the CB1 receptors were only discovered because researchers were looking for a receptor that THC affected, I would not place it out of the realm of possibilities that our bodies contain other, unknown receptors with a high affinity to other cannabinoids found in marijuana. Unfortunately research into that field is slim, and while those claims are valid theoretically, there has been no science done to back them up.

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The other concerns medical marijuana proponents point out, is that synthetic, pill based THC is slowly and unpredictably absorbed by the body (for some interesting research look up gut bacteria and microbiomes). This could lead to people not receiving the proper relief, or to people going against their doctor’s orders and taking too much of the drug. This claim is backed up by some pretty commonplace knowledge. Different mechanisms of inserting a drug into our bodies work at different speeds. It is well known that, next to injecting the drug into your bloodstream, inhaling a drug is the quickest way to attain its effects. When a person responds to a drug more quickly, they are able to better determine their need, and morbidity of the disease they suffer from (in most cases we’re talking cancer, AIDS, or chronic pain) is significantly decreased.

More modern research in the field of cannabinoid compounds and CB1 receptors have shown that some of the other uses of medical marijuana have a physiological backing to them as well. Anecdotally, marijuana has been known for its analgesic (pain relieving) properties. This anecdotal property has been proven effective with numerous clinical studies. THC has been shown to have analgesic properties on par with that of codine, a mild opiate. Researchers are currently exploring links between CB1 receptors and the opiate neural pathway to explore this phenomenon.

Like the other uses of medical marijuana, its analgesic properties are under attack by opponents as well. This one is getting flak from the big guys, i.e the Drug Enforcement Agency. Their opposition to marijuana use as an analgesic comes from the fact that other, federally legal analgesics already exist in the form of opiates, and NSAIDs like Advil. Proponents of medical marijuana claim that using marijuana as an analgesic has less harmful side effects, and less chance for addiction than using opiates. While the harmful side effects of opiates versus marijuana are debatable (although NSAIDs do cause significant, life threatening harm to stomach lining), there is truth to the matter in stating that marijuana is less physiologically addictive. What the DEA does admit to, however, is that when it comes to neuropathic pain, such as that experienced by people with multiple sclerosis or certain types of migraines, traditional medication fails to relieve this enigmatic type of pain. This is where marijuana has the edge on traditional analgesics, and why it is important that proper physiological research and clinical trials are preformed.

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It is pertinent at this point to mention that like all drugs, including “natural” alternative medications, marijuana should only be used under the direction of a licensed medical professional. Now, because of marijuana’s current legal status, there are no standards set in place to ensure safe, quality products that you might purchase on the black market. Different growing conditions can lead to inconsistencies in product quality, particularly THC concentration. Another concern about purchasing black market marijuana comes from the fact that, unless you know and have inspected a grower and his practices, you can’t be sure that the marijuana you receive is free of pesticides, bacteria or fungus. This is particularly dangerous for AIDS patients, whose immune systems are already compromised, and would have difficulty fighting even a mild bacterial infection.

Even if you are purchasing marijuana from a reputable, licensed facility with the recommendation of a physician there are other medical concerns that need to be addressed. Marijuana, like all other drugs, has some significant side effects. Primary among these side effects is the fact that marijuana gets you high. Psychomotor and cognitive impairments can occur while under the influences of marijuana. This means that your reflexes, reaction time and thought processes are slowed, which can impair ones ability to operate machinery or drive a motor vehicle. Really, anyone who drives while under the influence of marijuana is just fueling the opposition’s fire. Additional side effects of marijuana can be significant with novel users, and include anxiety, panic attacks, and paranoia. Furthermore, marijuana increases the heart rate, and can be dangerous for anyone with pre-existing cardiac conditions.

The side effect of being high does, however, have some therapeutic application. Particularly, marijuana can reduce inhibition and produce a euphoric effect. This can be beneficial in treating depression, a common symptom affecting many people with terminal illnesses such as cancer and AIDS.

On a final note, I would like to mention my primary concern about suggesting the use of medical marijuana. The fact of the matter is that smoking anything, not just cigarettes, can have detrimental health effects. Our lungs are designed to take in oxygen, a gas. While we have defenses in place, primarily mucous, to keep larger particles matter from causing significant harm to our lungs, our biology simply can’t handle continuous application of particulate matter from any type of smoke. Over time this damage causes a host of problems, the most devastating of which being lung cancer. Now, I don’t mean to say that marijuana is on par with cigarettes when it comes to lung damage, but if you are smoking a significant amount of marijuana over many years for chronic health problems, you will be at an increased risk of lung disease. Now there is a solution that I (in my non-licensed, non-professional opinion) would suggest, and that is the use of a vaporizer. For people who use marijuana excessively, using a vaporizer can significantly decrease the risk to your lungs. Most reputable cannabis dispensaries or smoke shops sell these devices, and although the initial investment might be a bit hefty, it is significantly less money then you will drop on hospital bills down the road if you develop lung cancer.

That is all the time and energy I have to dedicate to medical marijuana. If anyone has more/better/different information, please leave a comment on this page. I’m always eager to learn more. Or if you would rather continue the discussion in a more private manner, send an email to dougdesallesmd@gmail.com (don’t worry it’s the official email for this blog, I’m the person who checks it). Thanks for reading, now its time for a snack (for some unknown reason I am starving…)

Disclaimer:
Chris Sprott is a contributor to Sacramento Men’s Health. His background includes a B.S. in biology with an emphasis in physiology, neurobiology, and behavior. He is not a licensed physician, and by no means should his writings constitute legally acceptable medical advice. He is, however, licensed to give CPR, shop at Costco, and race rally cars, so he’s got that going for him.