Medical Cannabis: Know the facts

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While the drug therapy is becoming more widely available, the science is still not clear on how it may help.

Medical marijuana has been approved in 28 states and the District of Columbia, but researchers are still trying to connect the dots as to how, and if, it works.

“Unfortunately, there are almost no uses of medical marijuana that have been subjected to the kind of rigorous testing you’d want for a pharmaceutical,” says Dr. Kenneth Mukamal, associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center. “This does not mean that it has no benefits, but only that the lack of human studies prevents us from being sure if medical marijuana can really help.”

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Medical marijuana: Know the facts

Medical marijuana: Know the facts

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Human Endocannabinoid System

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For most of history, the effects of cannabis on the human body were little understood. Then, in the 1990’s, scientists discovered endocannabinoids, the natural cannabis-like molecules produced by the human body. Scientists began to realize cannabis exerted its effects, in part, by mimicking our endocannabinoids. It appears the main function of the endocannabinoid system is to maintain bodily homeostasis—biological harmony in response to changes in the environment.9 Taxonomic investigation pevealed that the endocannabinoid system is incredibly old, having evolved over 500 million years ago. Moreover, it is present in all vertebrates—mammals, bird, reptiles, amphibians, fish, etc, all produce endocannabinoids!10

 

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Human Endocannabinoid System

Human Endocannabinoid System

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Medical Cannabis

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Ailments people commonly use medical Cannabis for.

Arthritis
A study of 58 patients using the derivatives of marijuana found they had less arthritis pain and slept better. Another review of studies concluded marijuana may help fight pain-causing inflammation.

Asthma
Studies are contradictory, but some early work suggests it reduced exercise-induced asthma. Other cell studies showed smoking marijuana could dilate human airways, but some patients experienced a tight feeling in their chests and throats. A study in mice found similar results.

Cancer
Animal studies have shown some marijuana extracts may kill certain cancer cells. Other cell studies show it may stop cancer growth, and with mice, THC, the psychoactive ingredient in marijuana, improved the impact of radiation on cancer cells. Marijuana can also prevent the nausea that often accompanies chemotherapy treatment used to treat cancer.

Chronic pain
Some animal and small human studies show that cannabinoids can have a “substantial analgesic effect.” People widely used them for pain relief in the 1800s. Some medicines based on cannabis such as Sativex are being tested on multiple sclerosis patients and used to treat cancer pain. The drug has been approved in Canada and in some European countries. In another trial involving 56 human patients, scientists saw a 30% reduction in pain in those who smoked marijuana.

Crohn’s disease
In a small pilot study of 13 patients watched over three months, researchers found inhaled cannabis did improve life for people suffering from ulcerative colitis and Crohn’s disease. It helped ease people’s pain, limited the frequency of diarrhea and helped with weight gain.

Epilepsy
Medical marijuana extract in early trials at the NYU Langone Medical Center showed a 50% reduction in the frequency of certain seizures in children and adults in a study of 213 patients recently.

Glaucoma
Glaucoma is one of the leading causes of blindness. Scientists have looked at THC’s impact on this disease on the optic nerve and found it can lower eye pressure, but it may also lower blood pressure, which could harm the optic nerve due to a reduced blood supply. THC can also help preserve the nerves, a small study found.

Multiple sclerosis
Using marijuana or some of the chemicals in the plant may help prevent muscle spasms, pain, tremors and stiffness, according to early-stage, mostly observational studies involving animals, lab tests and a small number of human patients. The downside — it may impair memory, according to a small study involving 20 patients.

AIDS/HIV
In a human study of 10 HIV-positive marijuana smokers, scientists found people who smoked marijuana ate better, slept better and experienced a better mood. Another small study of 50 people found patients that smoked cannabis saw less neuropathic pain.

Alzheimer’s
Medical marijuana and some of the plant’s chemicals have been used to help Alzheimer’spatients gain weight, and research found that it lessens some of the agitated behavior that patients can exhibit. In one cell study, researchers found it slowed the progress of protein deposits in the brain. Scientists think these proteins may be part of what causes Alzheimer’s, although no one knows what causes the disease.

Cannabis contains over 500 distinct compounds, which include cannabinoids, terpenoids, flavonoids, and omega fatty acids. Terpenoids are responsible for the aroma of cannabis and other flowering plants. Studies have shown terpenoids to have diverse physiologic effects, and terpenoids may be contributing to the observed effects of cannabis. 6

Cannabinoids are compounds unique to cannabis, and there have been over 100 different cannabinoids identified. The most well known cannabinoid is delta-9-tetrahydrocannabinol (THC), which is responsible for the “high” of cannabis and can affect perception, mood, emotion, cognition, and motor function. But there are also cannabinoids like cannabidiol (CBD) which are non-psychoactive yet have been demonstrated to possess medically useful properties. 7 CBD rose to mainstream attention in 2013 after it was featured in Dr. Sanjay Gupta’s CNN special report “Weed”, which reported on children with severe seizure disorders who anecdotally benefitted from CBD. 8

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Cannabis and its Compounds

Cannabis and its Compounds

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Medical Marijuana

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There are few subjects that can stir up stronger emotions among doctors, scientists, researchers, policy makers, and the public than medical marijuana. Is it safe? Should it be legal? Decriminalized? Has its effectiveness been proven? What conditions is it useful for? Is it addictive? How do we keep it out of the hands of teenagers? Is it really the “wonder drug” that people claim it is? Is medical marijuana just a ploy to legalize marijuana in general?

These are just a few of the excellent questions around this subject, questions that I am going to studiously avoid so we can focus on two specific areas: why do patients find it useful, and how can they discuss it with their doctor?

Marijuana is currently legal, on the state level, in 29 states, and in Washington, DC. It is still illegal from the federal government’s perspective. The Obama administration did not make prosecuting medical marijuana even a minor priority. President Donald Trump promised not to interfere with people who use medical marijuana, though his administration is currently threatening to reverse this policy. About 85% of Americans support legalizing medical marijuana, and it is estimated that at least several million Americans currently use it.

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Medical marijuana

Medical marijuana

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Cannabidiol (CBD) — what we know and what we don’t

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Cannabidiol (CBD) has been recently covered in the media, and you may have even seen it as an add-in booster to your post-workout smoothie or morning coffee. What exactly is CBD? Why is it suddenly so popular?

How is cannabidiol different from marijuana?
CBD stands for cannabidiol. It is the second most prevalent of the active ingredients of cannabis (marijuana). While CBD is an essential component of medical marijuana, it is derived directly from the hemp plant, which is a cousin of the marijuana plant. While CBD is a component of marijuana (one of hundreds), by itself it does not cause a “high.” According to a report from the World Health Organization, “In humans, CBD exhibits no effects indicative of any abuse or dependence potential…. To date, there is no evidence of public health related problems associated with the use of pure CBD.”

Is cannabidiol legal?
CBD is readily obtainable in most parts of the United States, though its exact legal status is in flux. All 50 states have laws legalizing CBD with varying degrees of restriction, and while the federal government still considers CBD in the same class as marijuana, it doesn’t habitually enforce against it. In December 2015, the FDA eased the regulatory requirements to allow researchers to conduct CBD trials. Currently, many people obtain CBD online without a medical cannabis license. The government’s position on CBD is confusing, and depends in part on whether the CBD comes from hemp or marijuana. The legality of CBD is expected to change, as there is currently bipartisan consensus in Congress to make the hemp crop legal which would, for all intents and purposes, make CBD difficult to prohibit.

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Cannabidiol (CBD) — what we know and what we don’t

Cannabidiol (CBD) — what we know and what we don’t

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