After seeing the Sanjay Gupta CNN “Weed” specials, it is difficult to deny the benefits of medical cannabis to those children and their families suffering from unrelenting seizures, or that a British pharmaceutical company, GW Pharmaceuticals, has developed “Sativex” for spasms associated with multiple sclerosis and is currently in clinical trials for cancer pain, neuropathic pain, rheumatoid arthritis and bladder dysfunction. “Epidiolex” is currently in Phase II clinical trials for childhood-onset epilepsy. Both of these medications are taken via oral spray consisting of highly purified extracts of CBD (a non-psychoactive component of the cannabis plant).
The time for a “reefer madness” mentality is past.
The present and the future for cannabinoid medications lay in the scientific approach to clinical research. The primary research has taken place in Israel under the direction of Dr. Raphael Meshoulam. He and many other pioneers in the field of cannabinoid medicines are creating new and exciting possibilities. In a 1999 report, the Institute of Medicine stated that ‘the future of medical marijuana lies in classical pharmacologic drug development”. In fact since the discovery of the endocannabinoid system in the human body, researchers around the world have developed potential medications to treat a variety of illnesses, including addictive disease.
It is time to reclassify cannabis from a Schedule I drug – (no currently accepted medical use) to a much more appropriate and realistic category.
For the past ten years or longer, the primary medical issues facing the addiction medical field are directly due to the abuse and dependence of prescription drugs. Use of hydrocodone (e.g. Lortab, Vicodin) and oxycodone (e.g. Roxicodone, Oxycontin) far exceeds any other prescription drug abuse and may be the major causative factor in accidental overdose deaths. And let’s not forget that these drugs are used in combination with other central nervous system depressants (alcohol, anti-anxiety medications, and sedatives), thus exponentially increasing the risk for fatal overdose.
Dr. Nora Volkow, head of the National Institute of Drug Abuse stated “marijuana is not a benign drug”. While some may argue that marijuana is not an addictive substance, they would be wrong. A defined withdrawal symptom complex has also been identified with precipitous discontinuation of use.
While death due to toxicity of delta 9-THC (the primary psychoactive component of cannabis) has not been observed, fatal painkiller overdoses quintupled nationally from 1999-2008. More people now die from narcotic analgesic overdose than from heroin and cocaine combined. Sales of narcotic analgesics have grown sevenfold since the 1990’s.
To date, two types of cannabinoid receptors have been identified – CB1 and CB2. CB1 receptors are found primarily in the brain and CB2 receptors are found in immune cells and in peripheral tissues in the body. Scientific research will allow development of specific medicines to treat diseases by study of these receptors and their role within regulation of the endocannabinoid system. The primary field of research is on analgesia (relief of pain). As a society, we have become over-reliant on opioid and anti-anxiety medications. According to the Nevada State Board of Pharmacy in a 2009 study, Nevada was number 1 in the United States for hydrocodone consumption and number 4 for oxycodone consumption per 100,000 people. In 2008, Nevada pharmacies filled 26 million prescriptions for alprazolam (Xanax).
Acute effects of cannabis use are generally described as a pleasant experience, although there are great variations per individual. Occasionally there may be feelings of anxiety that may progress to panic. Fear of death is a characteristic feeling in cases of overdose. The primary concern in chronic use of the drug is not due to the substance, but rather the route of administration. Smoking or inhalation of the drug by pipe or joint may cause damage to the lungs similar to the use of tobacco. It is estimated by some researchers that one cannabis cigarette is equivalent to four tobacco cigarettes. Increased medical risk factors are that the cannabis cigarette is unfiltered and that longer breath holding behaviors are the usual patterns of use. Chronic heavy users may also experience subtle impairments in memory, attention, and ability to organize complex information.
As a society, we have an opportunity to scientifically lead the world in research and development of cannabinoid medicines. This initial step in legalization of medical cannabis will provide an alternative to traditional medical and pharmaceutical choices for specific medical problems to the patient. Physicians will play a key role in offering this alternative to their patients. Due to the lack of scientific research, physicians are unable to guide their patients as to recommendations for specific strains and dosage of the drug. The dispensary is akin to a pharmacy, without the specificity usually provided by a physician or pharmacist. In my opinion the medical establishment and the patients must step up to the realities of necessary education through research regarding the use of therapeutic cannabis.
The legal consequences to the user may include criminal prosecution, obtaining the drug on the black market with unknown variability in concentration of the drug, driving under the influence of the drug with no absolute standards as to specific drug levels to determine intoxication, workplace issues with threat of termination, or no hire with positive pre-employment drug screen despite medical recommendation.
There is much work to be done
Do the medical benefits to the patient outweigh the potential risks? We don’t have the answers yet, but Nevada has an opportunity to lead the country in “doing it right”. Our citizens deserve nothing less than setting and maintaining the highest standards of care.