Marijuana as Medicine

With the news that there are two medical marijuana initiatives currently collecting signatures for inclusion on the Ohio ballot in November, I thought it might be a good idea to examine some of the science behind medical marijuana. This is certainly not a medical journal, and my goal is to make some of the scientific and legal aspects of medical marijuana as simple as I can — both for my benefit and the reader’s. None of this, of course, is medical advice — I’m not a doctor. Talk to your doctor about your specific treatment options.

Unfortunately, there has not been much research done on medical marijuana, at least not at the level that would be appropriate for some other prescription drugs. This is fora few reasons: (1) it’s hard for researchers to procure the amount of marijuana they need to conduct this research, given the plant’s legal status; (2) it’s hard for researchers to get the funding they need to complete the studies; (3) it’s hard to find a plant with the consistent chemical makeup; and (4) patient responses regarding pain alleviation may be clouded by the euphoria, or “high,” that may result from using medical marijuana.

Cannabinoids

However, there are certain things that we do know. To start, the main reason for using marijuana as medicine is its cannabinoids — the group of chemicals that causes the physiological effects when a person uses the drug. These cannabinoids can also be found in other animals or plants or made synthetically. The one that has everybody talking is known as THC (tetrahydrocannabinol), since it is the most psychoactive of the bunch. THC is responsible for the resulting “high” after marijuana use.

There are other active cannabinoids, though, that have different effects. Some are responsible for suppressing a person’s immune system (known as immunosuppressive cannabinoids). Suppressing an immune system sounds dangerous, but in some circumstances it can be beneficial. For example, patients with multiple sclerosis have an immune system that attacks their own bodies. For those patients, a suppressed immune system may be just what the doctor ordered.

Marijuana and Prescription Drugs

Medical marijuana can also be used to combat some of the nausea and vomiting associated with chemotherapy, as was recognized by the Institute of Medicine. In fact, there are some drugs on the market now that make use of the anti-nausea cannabinoids, like Marinol, Cesamet, Zofran, and Emend. These drugs can combat the nausea and vomiting without producing the high associated with marijuana use. Unfortunately, no tests exist that compare the effectiveness of marijuana to the modern anti-nausea drugs like Zofran and Emend.

The fact that the modern drugs don’t have the psychoactive effects of marijuana is beneficial when a physician is only trying to treat nausea or vomiting, but we all know those aren’t the only symptoms associated with cancer or chemotherapy. In fact, having cancer can cause a person to experience great anxiety or dread — normally treated by anti-anxiety benzodiazepines like Xanax or Valium. However, the euphoric high experienced when using marijuana can therapeutic in that it helps to relieve that same anxiety or dread. Many patients might prefer using one drug (marijuana) to treat multiple symptoms, rather than being prescribed multiple drugs to treat multiple symptoms.

After treatment has ended, a patient may become dependent on the drug used to treat his or her symptoms. That patient is likely to experience more severe withdrawal symptoms after using benzodiazepines than would be the case if the patient was treated with marijuana. Withdrawal symptoms associated with marijuana-dependent individuals may last 1-3 weeks while withdrawal symptoms may last for months after stopping use of benzodiazepines.

Marijuana is currently listed as a Schedule I drug under Ohio and federal law, meaning it has a high potential for abuse without any recognized medical benefit. I have not read any studies regarding the likelihood of dependency or abuse of marijuana compared with benzodiazepines. If you are aware of studies of that nature, I would certainly be interested in reading them or getting your take on the results.

Conclusion

In my mind, the question is no longer whether marijuana has a medical benefit. Rather, researchers are attempting to determine the extent of those benefits. These are questions better answered by doctors, patients and scientists — not legislators or bureaucrats.

I relied heavily on the article “The Cannabis Conundrum: Medication v. Regulation,” written by Moira Gibbons. It was published in the ABA Health Law Section: The Health Lawyer in December of 2011. And yes, I’ve noticed that the title of her article is similar to the symposium the Journal of Law & Health sponsored in March 2011. Apparently attorneys can’t avoid alliteration. (see what I did there?)

I’d love to hear your comments on medical marijuana, so be sure to post them below.