Is Cannabis a Proven Medicine for All Ailments?
With medical marijuana being legal in numerous states, one country, and many municipalities throughout the world, it would be very helpful to ascertain which medical conditions cannabis appears to have its strongest applications.
One of the biggest problems that has emerged in the post-MMJ movement is trying to address which conditions are effectively treated or helped by using medical-grade marijuana. No matter where you look, each state or country that recognizes cannabis as medicine, has its list of medical applications. Yet each country, state or region has a different list. How can we make sense of this finding?
HOW SCIENTIFIC ARE MEDICAL PANELS?
The lists that these medical review panels assemble are by no means complete or even accurate. In fact, some applications appear to be nearly arbitrary. In other cases, some authorities appear to lack common sense, and refuse to list the most basic and promising uses of pot such as in the treatment of chronic pain or spasticity for example. In the US and probably elsewhere, programs that overlook common sense applications never do very well.
In other words, if you are going to have an MMJ program be sure to include the best indications and the greatest number of patients — that usually means including chronic pain as the number one indication.
PROBLEMS WITH THE HERB ITSELF
Paraphrased from the editorial piece published in JAMA, Medical Marijuana Is the Cart Before the Horse? Dr Deepak D’Souza:
In other words, there are inconsistencies in how medical conditions are qualified for medical marijuana use within a state or between states or in countries with MMJ programs in place.
There are also problems in dealing with the unusually high variability of cannabis strains. The ratios of CBD to THC and the other cannabinoids and terpenes, offer a bewildering array of choices and approaches. Patients have to experiment with different varietals to achieve optimal success.
Currently there are no guidelines offered to patients when using smoked marijuana. Each patient has to figure it out for themselves on how to dose their medicine. Moreover, with chronic dosing, tolerance may develop along with downregulation of CB1 receptors. Scientists do not yet know what this might do to the health of regular cannabis users.
Lastly, Dr D’Souza reminds us that aside from treating pain syndromes, spasticity from MS and chemo-induced nausea and vomiting, there remain only poor quality studies. This includes medical marijuana indications for hepatitis C, Crohn’s disease, Parkinson’s disease or Tourette syndrome.
That’s because much of our knowledge on this medicine is incomplete. And of course, the reason it’s incomplete is because it’s still illegal. I’ve talked about this catch 22 for months since it’s the biggest detriment to accepting and mobilizing MMJ into the mainstream.
In spite of this underwhelming fact, the journal of the American Medical Association (JAMA) published several studies including a meta-analysis on the most robust studies that have investigated the various healing attributes of cannabis.
It’s long overdue and it’s really just a start but we finally have a little ‘science’ from which we may draw helpful conclusions on cannabis as medicine.
MARIJUANA IS NOT A PHARMACEUTICAL DRUG
First let’s make sure we are all on the same page: in the US, and throughout the world, marijuana is not government (FDA in the US) approved for any medical condition. In Europe it’s essentially the same — it is not considered a ‘true’ medicine in the same way we that we view pharmaceuticals.
To receive FDA drug approval more rigorous, carefully controlled, trials must be performed on each disease application. Furthermore, only one cannabinoid at a time is evaluated, not the ‘essential oil.’ In other words, it’s going to take years — decades actually, before we really understand the power of this remarkable plant, and where it may best serve patients suffering from a multitude of illnesses.
There are two synthetic cannabinoids that are currently available by prescription that further confuse the issue: they are dronabinol and nabilone. They are primarily used for nausea and vomiting due to chemotherapy side effects. Dronabinol may also be used for anorexia, weight loss and wasting due to HIV/AIDS.
Most patients prefer the essential oil or smoking the flowers which appears to make more efficacious. This may have to do with the power of ‘whole-plant’ and the Entourage Effect.
This list of studies, one authored (as a continuing education course) by Dr. Amy Thompson provides us with a roadmap of cannabis applications. But, sadly, it is a surprisingly small map. Let’s go over what the current consensus of research provides. Based on these and several other JAMA publications, the primary uses for which there exists clinical evidence of usefulness is provided below.
CANNABIS IS A PROVEN PAIN RELIEVER
Dr. Thompson continues: we have evidence that pot can be used to treat chronic pain, and a special type of pain called neuropathic pain. Other applications are in treating muscle spasticity due to motor paralysis or multiple sclerosis (MS). Pot appears to be effective in treating pain due to MS.
Neuropathic pain is particularly difficult to treat. It generally does not respond well to opiates. This is one indication where weed may be particularly valuable.
In addition, she adds that pot, like all drugs, has potential risks. It causes an increased heart rate which may be detrimental in some classes of patients such as those with heart disease. Also she adds that regular smoking of marijuana is associated with breathing problems such as cough and an increased risk for ‘lung infections.’ It can also be addicting and can interfere with work, school, and relationships.
From another JAMA publication, Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems. A Clinical Review, Dr Hill’s conclusions are essentially the same:
Findings. Use of marijuana for chronic pain, neuropathic pain, and spasticity due to multiple sclerosis is supported by high-quality evidence. Six trials that included 325 patients examined chronic pain, 6 trials that included 396 patients investigated neuropathic pain, and 12 trials that included 1600 patients focused on multiple sclerosis. Several of these trials had positive results, suggesting that marijuana or cannabinoids may be efficacious for these indications.
Conclusions and Relevance. Medical marijuana is used to treat a host of indications, a few of which have evidence to support treatment with marijuana and many that do not.
COMPREHENSIVE META-ANALYSIS. UNIVERSITY HOSPITAL, BRISTOL, UK.
Dr. Penny Whiting hails from the UK’s University Hospital, Bristol. She completed the most extensive meta-analysis to date investigating the evidence for MMJ in the treatment of numerous conditions. Her conclusions regarding the treatment of pain syndromes and nausea are provided below (see conclusions). Additionally, I listed most of the other conditions she evaluated.
Dr Whiting’s JAMA publication entitled Cannabinoids for Medical Use. A Systematic Review and Meta-analysis several other disorders were evaluated. Let’s go through the main indications:
Depression. There were no studies that fulfilled the criteria for inclusion in this study.
Anxiety Disorder. This was one small, probably biased, study. This trial reported an improvement in a simulated public speaking test. There may be a greater benefit of cannabinoids in the treatment of anxiety but more studies are needed.
Sleep Disorder. There was some evidence that cannabinoids may improve sleep in these patient groups. Cannabinoids (mainly nabiximols) were associated with a greater average improvement in sleep quality …and sleep disturbance… One trial assessed THC/CBD, all others assessed nabiximols, results were similar for both cannabinoids.
Psychosis. Two highly biased studies found no difference in outcomes between treatment groups. However, only CBD was used not THC or whole plant derivatives.
Glaucoma. This trial found no difference between placebo and cannabinoids on measures of intraocular pressure in patients with glaucoma.
Tourette Syndrome. Two small placebo-controlled studies suggested that THC capsules may be associated with a significant improvement in tic severity in patients with Tourette syndrome. (see YouTube for dramatic improvements in some patients).
Adverse Events (AEs). There was an increased risk of short-term AEs with cannabinoid use. Common AEs included asthenia, balance problems, confusion, dizziness, disorientation, diarrhea, euphoria, drowsiness, dry mouth, fatigue, hallucination, nausea, somnolence, and vomiting.
Conclusions. There was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity. There was low-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain in HIV, sleep disorders, and Tourette syndrome.
Keep in mind that for sleep disorder, anxiety disorder, glaucoma, and Tourette Syndrome the sample size was so small that these studies generally lacked the power to detect differences between treatment groups.
Therefore, when we encounter long lists of indications for medical grade marijuana there are little data or sometimes nothing at all that supports pot’s use except in those conditions listed above. That means that PTSD, anxiety, insomnia, sciatica, low back pain, migraine, cancer and many others simply do not have a firm medical foundation for acceptance into an MMJ treatment program.
That does not mean that cannabis can’t seriously help the dozens of disorders that cannabis users will swear by. It only means that we have to wait for the ‘science’ to catch up and prove, one way or the other, that it is useful.
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