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Embracing Marijuana

If the subject of medical marijuana comes up no matter where or when–there’s no doubt that it stirs up strong emotions among everyone from doctors, government and, of course, the public. The first concern is its safety. From there, the questions go on and on. Is it addictive? What conditions does it help? Is it really effective? And last but not least, should it be legalized? Last fall, Senator Orrin Hatch, the conservative 83-year-old Utah Republican introduced the Marijuana Effective Drug Study Act of 2017 or MEDS Act to improve the process for conducting scientific research on marijuana as a safe-and -effective medical treatment. His speech on the Senate floor about the problem was filled with puns relating to the support of medicinal cannabis and legislation to expand research. Beginning by saying it’s “high time” Congress addressed the issue, Hatch called his bipartisan initiative a “joint effort” that would allow scientists to delve into the “weeds” of the effectiveness and safety of medical marijuana.

“To be blunt,” he said, “we need to remove the administrative barriers preventing legitimate research into medical marijuana.” Hatch’s efforts were music to the ears of those people suffering with chronic medical conditions. Marijuana is currently legal,
on the state level, in 29 states and Washington, D.C. It is still illegal from the federal government’s perspective. About 85 percent of Americans support legalizing medical marijuana, and at least several million Americans currently use it for chronic conditions. Marijuana itself has more than 100 active components.

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THC (tetrahydroncannabinol) is the chemical that causes the “high” that takes place when one consumes marijuana, in any form. Least controversial is CBD (cannabidiol), the extract from the hemp plant that has little, if any, intoxicating properties. Because the CBD dominant strains have almost no THC, there is very little effect to one’s consciousness. from relieving insomnia, anxiety and pain to treating conditions such as epilepsy. In fact, one particular form of childhood epilepsy called Dravet syndrome, responds dramatically to a CBD-dominant strain of marijuana called Charlotte’s Web. “We find that CBD is most successful for seizures,” says Dave Manzanares, who, with his wife, Dieneka, own Sweet Leaf Pioneer, a medical and recreational marijuana provider in Eagle. “We’ve had the best results for seizures, with patients as young as seven years old.” The most common use of medical marijuana is for pain control. While it isn’t strong enough for severe pain, for example post surgical pain or a broken bone, it is very effective for chronic pain. And because it is clearly safer than opiates people find it very alluring. Marijuana, sometimes referred to as the “flower,” by professionals in the cannabis industry as a replacement word for “weed,” appears to ease the pain in general, specifically of many diseases including cancer, Parkinson’s and fibromyalgia, to name a few.

A promising new area of research is its use is for PTSD for veterans who are returning from combat zones. “People get confused about the use of marijuana for pain relief,” explains Dieneka. “With things like ibuprofen, relief comes within an hour or so…

That’s why you have to make the commitment and use it regularly. In this way, you get a supplement buildup of the CBD. It needs to be treated like a supplement.” There are many forms of cannabis that are used by medicinal patients, including capsules, edibles, patches, creams and tinctures for under the tongue that have a fast reaction time. If those patients in severe pain who need more, a method called “dabbing” is available.

This process involves placing a small amount of concentrate (or “dab”) onto a heated surface of an oil rig pipe, which is immediately vaporized and inhaled by the user. Essentially, it’s when the flower is processed into hash and becomes very concentrated.

“They’re finding dabbing opens up the appetite of cancer patients–for about five minutes–who are not eating because of the metallic taste in their mouth from treatment,” says, Piper Ward, Sweet Leaf Pio-neer’s medicinal patient specialist. “When you have cancer, your body is tired and hungry, and marijuana helps with that. It’s a great compliment to pharmaceuticals.” Right now, however, there are no guidelines for physicians.

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“It’s like trying to prescribe St. John’s Wort instead of Prozac,” says John Norris, III, M.D., of the Florida Medical Association.

“Further complicating matters,” Norris, continues, “is the fact that you have no idea of the concentration of the active ingredients which vary, depending on when and where the plant was grown. This applies to the edibles and other products as well that contain marijuana, because we don’t know the manufacturing process.”

A 2013 study published in the Journal of the American Board of Family Medicine shows that lack of education is the primary cause of physicians’ discomfort in recommending medical marijuana to their patients. The study, based on data from family physicians in Colorado, showed that 80 percent believed that this education should be included in family practice residency training, and 92 percent agreed that continuing medical education on medical marijuana should be made available to them.

Currently, physicians who want to learn more about medical cannabis and its potential clinical applications can take courses from organizations like IMCI Global, which offers an online curriculum. The course, titled Clinical Cannabinoid Medicine, was developed by the Society of Cannabis Clini- cians (SCC) and is the “first comprehensive curriculum designed to educate the practicing clinician on both the research and clinical practice aspects of the therapeutic us of cannabis.” And while the information might be helpful, physicians are still unable to help their patients explore their options. Dr. Donald Abrams, an oncologist at the University of California, San Francisco, said, he finds medical marijuana to effectively address a wide range of patient complaints.

“A day doesn’t go by that I don’t see a cancer patient that doesn’t have nausea, pain, depression, and insomnia,” he told Health Magazine writer, Karen Weintraub. “I can recommend that they try one therapy, [marijuana], as opposed to six or seven different medications that may all interact with each other or the chemotherapy that I’m prescribing.“

Yet, still, there are many patients who want to discuss medical marijuana with their physicians, but are not comfortable bringing it up as they don’t know what the response will be.

This is because the medical community has, so far, been somewhat hesitant about the issue. “My advice for patients is to be entirely open and honest with your physicians and to have high expectations of them,” says Peter Grinspoon, M.D., author of the memoir Free Refills: A Doctor Confronts His Addiction, who is proudly 10 years clean, is on the staff at Massachusetts General Hospital and teaches medicine at Harvard Medical School. “Tell them that you consider this to be part of your care and that you expect them to be educated about it, and to be able to at least point you in the direction of the information you need.” Grinspoon goes on to say, “My advice for doctors is that whether you are pro, neutral or against medical marijuana, patients are embracing it, and although we don’t have rigorous studies and ‘gold standard’ proof of the benefits and risks of medical marijuana, we need to learn to about it, be openminded and, above all, be non-judgmental.

Otherwise, our patients will seek out other, less-reliable sources or information; they will continue to use it, they just won’t tell us, and there will be that much less trust and strength in our doctor-patient relationship. “I often hear complaints from other doctors that there isn’t adequate evidence to recommend medical marijuana, but there is even less scientific evidence for sticking our heads in the sand.”