Being at the intersection of cutting-edge (controversial) research, social prejudice, and a considerable financial stake is a recipe for profound public turmoil fueled by widespread misinformation. This is the case of medical marijuana, which has gained some degree of public tolerance in the last two decades, but this is a far cry from its rightful place in society, considering the significant benefits it could bring to the table if the surrounding myths would be dispelled.
In this article, our aim is to ascertain the scientific and legal status of medical marijuana (aided by a bit of historical context), clarify how and why medical marijuana differs from strains of the plant destined for recreational purposes, and then concentrate on the health benefits medical marijuana brings, both as an immediate solution to several medical symptoms and a possible long-term therapeutic alternative for several diseases.
Medical Marijuana – A Preliminary Discussion
Simply put, medical marijuana is cannabis prescribed by a certified physician to a patient. This is a very broad definition and for very good reason. The cannabis plant has three subspecies that have been cultivated in various parts of the world, for a number of different purposes, for millennia. These are cannabis sativa, cannabis indica, and cannabis ruderalis.
Generally speaking, in modern times the ruderalis variant has had mostly industrial application, the indica subspecies is mostly associated with the recreational purpose of cannabis, while cannabis sativa has had both. The problem with such generalizations is that hundreds (if not thousands) of strains from all variants have been isolated through selective breeding over the years.
In the last few decades, the possibility of a thorough chemical analysis of plants, along with the opportunity to extract isolated compounds have sparked unprecedented levels of experimentation with breeding methods, in order to get the most out of the cultivation of cannabis. The large majority of physicians advocating marijuana therapies are focused on strains of cannabis sativa, for reasons we will explain later in this article.
Brief History of Medical Marijuana
What we today call hemp (cannabis with a low psychoactive potential) was planted for textile fiber and seed oil as early as 10.000 years ago by the Yellow River Civilization in China. Therefore, it is not a huge leap to consider this as the first instance of marijuana being used for medicinal purposes.
From there, cannabis planting and preparation spread to ancient Egypt and the Indian subcontinent, though the best surviving written records are still from ancient and medieval China.
The Arab expansion, in the 7th and 8th centuries AD, put the Arab physicians in contact with their Chinese counterparts and, during the Golden Age of Islam (roughly the 8th to 13th centuries), cannabis was used in the major Arab urban centers as antiemetic, analgesic, and diuretic. Doctors of the period concentrated on developing more potent strains of Cannabis sativa.
Cannabis did not begin to permeate Western culture and medicine until well into the 19th century, after the British subdued India. It was mainly used for pain relief; however, the fashion was short-lived due to the availability and far more potent effect of opioids.
Marijuana’s status changed in the 20th century, with successive regulations on the use of opioids, and after World War II its popularity exploded, especially for its intoxicating effects. These developments attracted the attention of the scientific and medical communities, who began to study cannabis more carefully.
1964 saw the isolation of marijuana’s principal psychoactive agent – tetrahydrocannabinol (THC). The end of that decade marked marijuana’s inclusion in the Controlled Substances Act of 1970 as a Schedule 1 (one of the most dangerous) substance, part of the ambivalent War on Drugs[1] initiated by the administration of Richard Nixon.
This did not preclude scientists from further investigating cannabis’ structure, mode of action, and effects. Over the next four decades, pivotal scientific research led to a continuing interest increase in the medicinal properties of marijuana and cannabis extracts. Our current, progressive-leaning conception of marijuana was shaped by:
- Discovering that THC is but one of dozens related substances called (phyto)cannabinoids which act on the body through the endocannabinoid system, which regulates many physiological and psychological functions through neuromodulation, with cannabinoids binding to cannabinoid receptors located in many areas of the body, thus practically opening a whole new area of research.
- Other cannabinoids such as cannabidiol (CBD) which have the potential of delivering the benefits of marijuana without the side effects associated with THC.
The Legal Dimension of Medical Marijuana
It is no great mystery that legal provisions usually lag behind societal development, an aspect made more prominent by the accelerated development of recent decades. While marijuana’s status has not been modified at the federal level in the United States, individual states have been provided with legal loopholes – the 2003 Rohrabacher–Farr amendment being the most important – so they can implement their own medical marijuana provisions.
To date, a number of 29 states along with the District of Columbia have legalized access to medical marijuana, the first being California in 1996, and the most recent addition to that list being West Virginia in 2017.[2]
In these 30 jurisdictions, a person over the age of 18 (or under, with parental consent) can get a card for access to medical marijuana from a certified physician. In some states, this card can only be obtained for very specific conditions (like rare forms of epilepsy that do not respond well to traditional therapies), while in others the conditions are laxer. Next, the person in question becomes part of a collective, an association (purportedly of patients) formed as a legal entity where marijuana may be bought, sold, exchanged, cultivated together, etc. Many specialists advocating serious marijuana therapies decry the shady origin and composition of cannabis existing in these collectives, as the number one problem with the current state of medical marijuana legislation and practice.
The reluctance of legislating medical marijuana at the federal level can be explained by many factors, from party interests to sheer ignorance of the subject. However, the principal problem lies in the way cannabis compounds act on the human body. Most drugs approved by the Food and Drug Administration (FDA) for general use have only a handful of active components, usually one or two. There are more than 100 different cannabinoids in the Cannabis sativa plant, with the list growing at a monthly rate. More than this, experts agree that the profile of the most efficient plants features a plant rich in cannabidiol (at least 20 percent), a diversity of medicinal terpenes and flavonoids (for a potent antioxidant effect), and a non-threatening dose of THC.
The agency has nevertheless sanctioned two drugs – dronabinol and nabilone – for the alleviation of nausea in cancer patients undergoing chemotherapy. The active substances in these drugs are synthetic cannabinoids.
There are several other states where access to medical marijuana is limited though not prohibited, and the trend towards legalization in the court of public opinion has not lost its momentum, with surveys constantly placing the public in favor at a figure of 60 percent.
Administration and Possible Side Effects
Smoking has long been the preferred method when using cannabis for recreational purposes, and it has continued in these days of legalized medical marijuana. Specialists, however, note that while smoking produces powerful and almost immediate effects, the possible benefits from other cannabinoids (with the exception of THC) are short lived. This method also has all the downsides associated with smoke inhalation. To counteract this, vaporizers have been introduced.
Individuals seeking a more “scientific” approach favor oral administration, either through oils delivered sublingually or through sprays. Some people argue oral administration favors a long-term experimentation of cannabis’ effects. The problem with this technique lies in devising an adequate dose, as not everyone can examine the concentrations of chemicals in a plant thoroughly.
The least encountered manner for cannabis administration is through dermal applications of lotions and oils made from the plant because the short-term effects are practically null.
The reason that marijuana is considered a powerful and dangerous drug is the side effects associated with the consumption of high THC concentration strains. As cannabis was for a long time cultivated solely for recreational purposes, strains rich in CBD and low in THC are just beginning to be developed. Current side effects from medical marijuana are basically the same as those from its “illegal” counterpart.
Short term side effects are not life-threatening and generally mild – dizziness, impaired attention and short-term memory problems, slight impairment of cognitive functions, and (very rarely) mild psychotic episodes. Naturally, one should not drive or perform similar activities while under the influence of medical marijuana.
The topic of cannabis’ long-term effects is a controversial one. The sole definitive adverse effect refers to chronic marijuana abuse in adolescents. As the neurological development is still underway in these cases, lower IQ, memory problems, and learning difficulties later in life are to be expected. Other hypotheses centered around respiratory problems similar to those found in tobacco smokers, yet the evidence suggests that smoking marijuana is far less dangerous than traditional tobacco. After all, nine in ten lung cancers are caused by tobacco.
A final remark on this subject concerns the relationship between medical marijuana and mental health. While in the next section, we will comment on the links between cannabis and the improvement of symptoms of several mental disorders, we should also note that marijuana seems in other cases to increase the intensity of psychotic episodes in (adult) patients with schizophrenia and the profound depressive episodes of depression in patients with bipolar disorder.
Health Benefits of Medical Marijuana
As is the case with most phenomena in human life, the best approach in the case of medical marijuana is one that steers away from a black and white conception. Our advice may seem quite paradoxical, but it is better to be both optimistic and skeptical. Naturally, the benefits medical marijuana brings to patients are considerable, but many of the following assertions depend on strains of cannabis that have been previously carefully analyzed for a chemical structure in consonance with the particularities of said condition or symptom. Your best bet is to have a specialist dedicated to the advancement of cannabis research in your corner.
Symptoms Relieved by Medical Marijuana
- Seizures – by far the best known (and officially sanctioned) application of medical marijuana is in cases of seizures associated with (usually rarer) forms of epilepsy – Lennox-Gastaut and Dravet syndromes. The FDA conceded to the use of medical marijuana in these cases, especially after the American Academy of Neurology stood by it in 2015. Current positions on the matter underline that cannabidiol rather than tetrahydrocannabinol produces the decrease in the frequency of seizure. Five different seizure subtypes are thought to be reduced through the administration of medical marijuana: tonic, atonic, absence, clinic, and myoclonic.[3][4]
- Muscle Spasms – usually harmless, intensified spastic activity is the signature symptom of a number of heart disorders, and most famously, of multiple sclerosis (MS). In fact, there were a few widely reported cases in previous years, of patients suffering from MS asserting that medical marijuana was the only thing that made their lives bearable. Strains exhibiting approximately equal amounts of CBD and THC are best suited to alleviate chronic muscle spasms.[5]
- Inflammation and Pain – while the secrets of local inflammatory response have long been decrypted, generalized inflammation and disorders in the response continue to baffle scientists. Cannabis’ role in treating the pain resulting from the inflammatory response is known for millennia. Nevertheless, recent evidence points to a moderation in the response due to cannabinoid action, in cases of autoimmune disorders, alleviating some of the stress exerted on the body.[6]
- Nausea – we have already mentioned that synthetic cannabinoids are FDA-approved methods of reducing nausea resulting from chemotherapy. The problem is that there are many (acute and chronic) conditions that have nausea as their chief symptoms. The possible applications of marijuana in this area is practically endless.[7]
- Appetite Control – while the link between smoking cannabis and abnormal food cravings is by now a pop culture cliché, appetite control can be a serious problem. Recent research suggests that cannabinoids (not just THC) produce important changes in the endocannabinoid system, which has proven impact on the psychological reward of food consumption. Therefore, medical marijuana could be a future solution in disorders manifesting both overconsumption and lack of appetite, having thus both physiological and psychiatric applications.[8]
- Sleep Regulation and Insomnia – a stressful socio-economic life coupled with a diet high in fats (staples of modern life) can lead to isolated bouts or even chronic insomnia (a condition experienced by about 15 % of adults in the Western world). Cannabis high in THC has been used against insomnia since the days of the Arab Conquest, but nowadays strains with a non-psychoactive amount can do the job just as well. Medical marijuana works against many of the causes of insomnia – stress, inflammation, pain, and anxiety.[9]
- Hypertension – a majority of high blood pressure cases have their origin in the thickening of the endothelium (the epithelial tissue which constitutes the first protective layer of blood vessels) due to repetitive inflammation – a natural process that comes with age. This thickening causes the blood vessels to shrink, hence hypertension.[10]
Medical marijuana acts as a two-pronged deterrent against hypertensions, once by reducing the levels of general inflammations, and through the endocannabinoid system by relaxing muscles going into overdrive as a consequence of stress.
There are many more symptoms where medical marijuana proves to be the first and most natural solution, like abnormal ocular pressure, but those mentioned above are the most wide-spread and systemic signs of serious diseases which marijuana has proven time and again (scientific and anecdotal evidence) to work (in many instances) better than current prescription drugs.
Conditions Alleviated by Medical Marijuana
At the moment, there are over thirty conditions for which a patient may apply for medical marijuana in the state of California, where the legal status of medical marijuana is entering its third decade. Here are some of the most important, in the context of new(er) scientific discoveries in the field, and not described in the previous section:
- Epilepsy – though science had come a long way from the days when epilepsy was treated with exorcism, the causes of the disease are still not completely understood. Medical marijuana by no means cures the disorder, yet in its most aggressive forms, it helps to reduce seizure frequency dramatically. It is speculated that the endocannabinoid system regulates (to some extent) the brain’s electrical activity. The success had with epilepsy is a strong argument, in some circles, for proponents of a condition called chronic endocannabinoid deficiency[11].
- Fibromyalgia – more a set of symptoms than an actual disease, fibromyalgia could be considered the postmodern affliction par excellence. The causes of the condition are numerous. However, scientists believe that the core lies in neural imbalances. Against imbalances resulting in fibromyalgia, the cannabinoid cannabidiol works best in its alleviation. Estimated to affect as much as 4 % of the adult population in developed countries (with a high penchant for the female and elderly demographic segment), a survey initiated by the National Pain Foundation found out that 92 % of 1339 individuals affected by fibromyalgia experienced a degree of relief from medical marijuana, with 62 % of the total citing a “high degree”. This figure should be set against the background 60 % of people who found pharmaceutical solutions to be utterly useless.
- Alzheimer’s – as is the case with fibromyalgia, medical marijuana cannot cure, but it has been shown to significantly slow down the progression of the symptoms of Alzheimer’s. There are two different opinions on why medical marijuana inhibits the progression of the disease: the first is anecdotal evidence from some caregivers in California, suggesting that THC is responsible for the improvements; while the second focuses on laboratory tests on rodents that have responded well to various cocktails of cannabinoids.
- Cancer – besides the palliative support medical marijuana has in the neutralization of chemotherapy consequences, there are clues that cannabinoids could have tumor inhibition effects. THC was administered to mice suffering from aggressive tumors and resulted in substantial shrinkage of the affected Furthermore, a 2013 study conducted at the University of London alludes to three major phytocannabinoids (cannabidivarin, cannabigerol, and cannabidiol) having strong anti-tumor properties.
- Crohn’s Disease – Crohn’s is probably the best known and best studied of chronic gastrointestinal disorders. Nevertheless, the management of its symptoms is a continuous strain for both the patient and his/her doctors, with many pharmaceutical drugs (especially therapies involving corticosteroids) proving highly toxic for the liver. As we have covered in the previous section, many of the manifestations of Crohn’s can be kept in check with medical marijuana – appetite loss, weight loss, localized pain. As cannabinoid receptors abound in the gastrointestinal tract, medical marijuana could prove to be the future of treating several such problems.
- Post-Traumatic Stress Disorder (PTSD) – a sometimes life-threatening mental condition and almost always catastrophic to the quality of life, PTSD remains one of the more controversial aspects of psychiatry. A pilot program has been underway for a few years at the University of Arizona, focusing on veterans that continue to experiment intense episodes even after being subjected to mainstream therapies. Voluntarily turning to medical marijuana, they have been monitored, and a large majority has exhibited tremendous improvements, both short- and long-term.
Many advocates of medical marijuana like to suggest that “it has arrived” on the mainstream, once it has been made legal in some jurisdictions worldwide, and in more than half of US states. This article has alluded to a number of health benefits medical marijuana has and might have in situations where traditional therapy is either powerless or achieves its goals with disastrous side effects elsewhere in the body. Social myths, strongly-rooted pharmaceutical financial interests, and the approach to scientific research need to change for medical marijuana to “truly arrive.”
References