19 Jan Is Medical Marijuana Good Medicine?
When Jeananne Rausch’s doctor first suggested that medical cannabis might ease her chronic pain from her severe hip damage, fibromyalgia, and social anxiety, she was somewhat surprised. The 54-year-old had never smoked anything and hadn’t considered the drug’s use as an option for herself, despite seeing it work well for her husband after his surgery for a ruptured disk in his neck. “I had no interest in cannabis, but my naturopath urged me to try it,” says Rausch, who was missing so many days on the job at a state-operated call center that she was considering taking a leave of absence in December 2012.
Rausch, who resides in Washington—one of the 22 states and the District of Columbia that has legalized medical marijuana—first tried cannabis in an edible form, but she didn’t like the way the drug made her feel. However, she continued to do research and learned at a local smoke shop about a website that focused on vaporization. For the past 18 months, she has been using a vaporizer to deliver a strain of cannabis that she has tested to make sure she knows exactly what she is getting.
Her anxiety and brain fog from her pain have eased considerably, and she rarely calls in sick now. “My job is highly technical and using cannabis helps me focus better for my work,” she says. “The inflammation in my body is so much better that I was recently able to get my bike out of storage after 10 years. Cannabis has made a world of difference in my quality of life. It’s nothing at all like the crazy stories that I’d heard. I don’t even suffer from the munchies. I’ve noticed that it makes me more aware of when I’m actually hungry versus eating because I’m bored or anxious.”
She notes that she’s actually lost a pound since using the drug. “Cannabis is one of the plants we’ve been blessed with,” she says. “It’s another herbal remedy, and we need to get rid of misinformation.”
No one argues that the growing use of medical marijuana is without controversy. Adding to the cloud of confusion hanging over medical marijuana is the push toward legalizing marijuana for recreational use.
The number one thing about medical marijuana that Bonni Goldstein, M.D., wishes people knew is that it can be used safely. “People who are using it for medical conditions can use it safely with little to no side effects,” says Dr. Goldstein, who has been involved in the specialty practice of medical cannabis since 2008 and is currently the Medical Director of Canna-Centers, a Member of the International Association for Cannabis as Medicine, the International Cannabinoid Research Society, and the Society of Cannabis Clinicians. “Patients can dial it in to address the specific issues that they are dealing with and get the effects that they want without risk of addiction, overdose, or toxicity.”
Because the field is so new and the regulations vary so much from state to state, county to county, and city to city in the states where marijuana has been legalized for medical usage, Dr. Goldstein is one of the many doctors heavily focused on patient education. “You can take ten medical marijuana patients, and each one of them will have a different mode of delivery that works for them,” she says. “They may smoke it, use a vaporizer, put a tincture oil under the tongue, put a topical rub into their joints, eat brownies, drink cannabis tea, or whatever works for them. I can’t tell what you are going to prefer and what is going to work for your body with your system.”
Dr. Goldstein is the medical director of the Ghost Group, which helps patients find legitimate dispensaries, enhance their experience with the drug, and give doctors access to a series of lectures that helps prospective patients gain a better understanding of the medical cannabis. “People need a credible source, so they can make an informed choice,” she says. “Most of my patients lived through the 60s. They never thought they’d have a medicinal need for marijuana, but they have arthritic joints and chronic pain; some have gastrointestinal dysfunction like irritable bowel syndrome; others have anxiety disorders or cancer. They want to know the science and understand how the drug will address their issues. But that’s a complex question because each person has a completely different DNA makeup. That’s why it takes some experimentation to figure out what works best for you.”
She estimates that about 75% of her patients are already on prescription medications—opiates, anti-anxiety medications, sleeping pills, and anti-depressants. “Many of those prescriptions can be highly toxic to your system and have far more side effects than cannabis,” she says. “Currently many growers are able to produce plants low in THC, which produces the psychotic effects, and boost the level of CBD, a cannabidiol previously thought to be inactive that has proven to be anti-inflammatory, anti-convulsive, and anti-anxiety. It also has neuro-protective properties that appears to protect the brain from injury or insult.”
TESTED MEDICINE IS AVAILABLE
In the states where medicinal marijuana has been legalized, testing sites have popped up where the potency of the plant—levels of THC and CBD present—is measured. Plants are also checked for pesticides, molds, solvents, and other chemical-based compounds. “My patients often already have compromised immune systems, so the purity of the drug is really important,” says Dr. Goldstein.
Salwa Ibrahim, founder and executive director of Blum, is a licensed dispensary for medical marijuana in Oakland, California, which was the first city in the country to mandate testing. She is partners with Derek Peterson, co-founder of Terra Tech, a publicly-traded company that is launching testing sites in states where the drug is legalized, and in some states applying for licenses that will allow Terra Tech to create a closed-loop process where the company will grow and test the product to ensure quality.
“We test everything, and create detailed reports,” says Ibrahim, comparing the role of her experienced buyers to that of a sommelier. “Drawing parallels to wine is a good way to wrap your brain around all the nuances that exist with cannabis. When product comes in our experienced buyers can look and tell if it was grown indoors or outdoors, whether it has any mold or impurities. They can tell you if something went awry like a light went out or the air conditioning quit during the growth cycle.”
If the product passes the first visual inspection, a batch of random buds is sent to a testing company and generates an emailed report showing the ratios of the active ingredients in that particular batch. “Then we are able to put it on the shelf and populate our menu with the results, so our patients know exactly what they are getting. “Different types of cannabis have different ratios can have a different effect on an individual’s body.”
One of the more curious mythbusters to come out of the studies being done on patients using medical cannabis is a long-term one from Harvard that shows that for some 4,500 patients tested, it helps improve carbohydrate metabolism. “Those patients have a smaller waistline,” says Dr. Goldstein, who practices in suburban Los Angeles. “Nobody knows the exact mechanics, but the cannabinoid receptors appear to have control over metabolism and energy and lower insulin resistance. It’s archaic to deny the thousands of studies done that prove the benefits for patients and to keep cannabis illegal is crazy. People should not have so much angst about taking a drug that is far less toxic than many of the medications out there. But there is such a terrible stigma associated with it. It’s not magic fairy dust. I am a big believer in the medicinal value of cannabis and policy should change.”
She explains that the compounds found in cannabis mimic the naturally occurring compounds in our brain that triggers the area that perceives pain. “If you can trigger those receptors with the correct dose, it can alter your perception of pain, which is the number 1 reason I see patients using medicinal cannabis,” she says. Her patients use cannabis to ease chronic pain from a number of conditions: degenerative disc disease, migraines, arthritis, and fibromyalgia. She also treats patients with anxiety, depression, and sleeplessness. “I see a lot of crossover.” In pediatric patients, she primarily uses it to address intractable seizures and epilepsy.
One of the more controversial uses for the drug right now is for people diagnosed with ADHD. “A lot of my ADHD patients find that cannabis helps them focus and counteracts the side effects of stimulant medication,” she says. “Combination therapy is very helpful.”
Medical cannabis is used on an as-needed basis, and a patient will be given a letter by a doctor good for one year that allows the patient to access the drug. “A lot of times patients are doing so well with their migraines or other conditions that they think they are cured and let the letter lapse,” notes Dr. Goldstein. “Then their pain goes out of control. Often it doesn’t take much cannabis to rein in their discomfort.”
“Thanks to this drug, I have patients who feel well, are getting good results, and are able to have a better quality of life and participate more fully in their lives despite chronic medical conditions. The science exists for us to understand this plant. We don’t need to be fearful, and we don’t need to propagate misinformation spread in the 1930s and 1940s when it was outlawed. We know better now.”
A NATURAL PAINKILLER
Michael D. Halperin, M.D., who specializes in interventional pain management, notes that the first documented use of medical cannabis was at least 10,000 years ago. “All cultures have had access to cannabis,” he says. “The Chinese wrote about it as 3000 B.C. The Romans, Egyptians, and Persians all referenced it. Almost every society has used it. In the 20th century, it was an additive to a lot of mainstream medications and was promoted by the early FDA. Then in the mid-1930s, a change in government politics led to it being outlawed.”
The active ingredient that causes most of the negative effects associated with marijuana—memory loss, anxiety, mood swings, psychosis—is THC. “Cannabis strains in which THC is minimal are extraordinarily useful for a variety of things: depression, anorexia, end-stage HIV and cancer, nausea, diabetics with gastroparesis,” says Dr. Halperin, who often prescribes the herb for patients in hospice. “A recent poll found that 52% of Americans favor decriminalizing medical marijuana. I’m always looking for ways to lessen my patients’ pain levels, and the herb itself is useful because it contains a broad number of medicinally active ingredients.”
“In pain management, we used to treat patients with very potent opiates, but I’ve found that many patients respond well to just a few puffs or vaporization of marijuana. Their mood improves and within 30 minutes, their depression lessens. Pain is the only experience that we all have in common yet we all react differently to it.”
Like Dr. Goldstein, Dr. Halperin doesn’t favor smoking cannabis as the ideal delivery method. “Vaporization is superior to direct smoking,” he says. “Some studies show that smoking it can be just as harmful as smoking tobacco. With vaporization the active ingredients in the herb are volatized in such a way that all the bad things are eliminated, and the pure cloud comes out with volatized compounds that removes the health hazards of developing cancer or COPD. This mechanism is heating a compressed herb that is packed into a tiny little pellet and vapors are brought through water. We can mitigate those side effects of smoking, and tightly control exactly what the patient is getting.”
The Oakland, California-based doctor, who in addition to his pain management and palliative care practice is a surgeon and anesthesiologist, says heated vaporization, which has exploded in popularity in the last year, provides a more comfortable solution to consuming medical marijuana or other natural herbs, such as?spearmint, lavender, and chamomile. “The simplicity of use, the portability, and?reliability of newer ‘desktop’ vaporizers is a step further towards the goal?of rapid targeted medication delivery through inhalation, which, in many?ways, acts in much the same way as the administration of volatilized general?anesthetics in common use,” says Dr. Halperin.
A recent national survey of doctors nationwide by WebMD showed broad support for legalization of medical marijuana although it varied by specialty. The doctors most positive about the drug’s benefits were oncologists and hematologists at 82%. Rheumatologists ranked the lowest on the question regarding medical marijuana’s benefits with just 54% saying it delivers benefits. At 70%, neurologists reported getting the highest number of inquiries from patients in regard to the drug’s usefulness for their conditions.
In some fields, medical marijuana’s reputation outstrips its usefulness. For example, ophthalmologists are being swamped with calls from glaucoma patients who think the drug can ease eye pressure. “I get inquiries all the time regarding marijuana efficacy in this potentially blinding disease,” says Benjamin H. Ticho, M.D.,?Associate Professor?University of Illinois at Chicago Eye & Ear Infirmary and?The Eye Specialists Center. “The goal of most glaucoma treatments is to reduce intraocular pressure, either by reducing aqueous inflow or increasing outflow. And yes, marijuana use can reduce eye pressure, but it is not a predictable or practical way of doing so. Glaucoma eyedrops have to be used every day, often two or even three times a day, to maintain efficacy. These drops lower eye pressure much better than marijuana, with far fewer side effects.”
Still, many healthcare professionals tout the drug’s usefulness. Vivian Eisenstadt, 41, M.A.P.T. O.C.S., a Pilates-based orthopedic physical therapist in Los Angeles who suffered with chronic fatigue syndrome/Epstein-Barr for 20 years and is now in remission, has seen plenty of patients for whom marijuana has eased anxieties or chronic pain symptomology. “They know exactly how much to take to address the symptoms without abusing it,” says Eisenstadt. “A good friend’s mother who has been dealing with cancer for over 10 years stumbled upon marijuana for her symptoms. Now she makes money creating chocolates and brownies and peanut butter cups with marijuana oil to help others suffering from cancer at UCLA. Abuse of marijuana can be compared to abuse of any substance, such as alcohol.”
Dr. Halperin predicts that the use of medicinal cannabis will go mainstream in the next five to 10 years and lose the stigma currently associated with it: “Cannabis is not a panacea, but it is another arrow in the quiver.”
THE EDUCATED PATIENT
In September 2014, Potbotics will introduce two products meant to help patients and their doctors make more educated decisions in regard to what cannabis and what delivery method best suits a patient’s need. BrainBot allows a patient to don a special helmet that tests what effect different strains of cannabis and different delivery systems have on the brain using brain imaging. “Our founder is working off 20 years of data doing pre-Alzheimer’s testing,” says David Goldstein CEO of Potbotics, the first biotech company to merge robotics and artificial intelligence with cannabis. “Our EEG gives a recommended prescription based on positive reactions the brain has to specific ratios and delivery systems within just a few minutes. It’s not like the old days when you had to shave a small patch of your hair and deal with electrodes and gels. This allows doctors to better recommend specific strains.” Goldstein estimates that the cost of the test will range between $75-$150.
The bi-coastal company, with operations in New York City and Palo Alto, is also launching a mobile app called PotBot that will allow a potential patient to plug in what issues she is experiencing and interact with an avatar to determine what strain and what ratio would best address those issues. “For example, a person might have insomnia but also suffer from anxiety,” says Goldstein. “Our app would recommend the best prescription and even guide the patients to the closest dispensary that carriers that strain.”
BENEFITS OF ACTIVE INGREDIENTS IN MEDICINAL MARIJUANA
Cannabidiol (CBD) appears to:
- Prevent Convulsions
- Relieve Some types of Inflammation
- Reduce Anxiety
- Relieve Nausea
- Reduce Insomnia
CBD has also been shown to:
- Have a calming effect
- Act as an antipsychotic for people suffering from schizophrenia
- Offer some relief for those suffering from multiple sclerosis, fibromyalgia, and epilepsy
- Inhibit cancer cell growth
- Prevent the memory impairment and disorientation associated with THC (the psychoactive ingredient in marijuana)
CBN promotes uninterrupted sleep.
MAJORITY OF DOCTORS SUPPORT LEGALIZING MEDICAL MARIJUANA
Here’s a look at the survey numbers for doctors asked about medical marijuana:
- 69% say it can help with certain treatments and conditions.
- 67% say it should be a medical option for patients.
- 56% support making it legal nationwide.
- 50% of doctors in states where it is not legal say it should be legal in their states.
- 52% of doctors in states considering new laws say it should be legal in their states.
Source: April 2014 survey by WebMD/Medscape of 1,544 doctors
PHOTOGRAPHY BY Sam Kaplan