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The medical marijuana controversy

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June 24th, 2015

medical marijuana

Marijuana has been a hot topic of debate in recent years. To some, this herb is considered an illicit drug and intoxicant. Until fairly recently, it has been against the law to carry, possess, sell, or use marijuana. “The tide is turning,” says Michael C. Minardi, J.D., lawyer and partner at Kelley Kronenberg in West Palm Beach, Fla. “Now, to a growing number of people, marijuana is good medicine.” 

The medicinal value of marijuana is related to two main chemicals called cannabinoids—tetrahydrocannabinol (THC) and cannabidiol (CBD). Both can be laboratory-made, and there are two FDA-approved pills that contain these compounds: dronabinol (Marinol) and nabilone (Cesamet). Both are used for chemotherapy-associated nausea and vomiting that does not respond to typical treatments. Dronabinol may also be used to improve the appetite of people suffering with AIDS. These medicines may also be used for other purposes at the discretion of the prescribing doctor. There is a non-FDA-approved oral spray currently being used in the United Kingdom and several other countries, mainly to relieve spasticity associated with multiple sclerosis.

Some confuse FDA approval of these pills as approval of the marijuana plant and associated products. That is not the case, but more than 20 U.S. states and Washington, D.C., have approved the use of botanically derived medical marijuana.

Benefits of use

About 20 years ago, researchers found a system within the brain that responds to a number of compounds in marijuana. This system, known as the endocannabinoid system, regulates functions in several bodily areas including the cardiovascular, gastrointestinal, neurological, endocrine, and immune systems. But the real health benefits of medical marijuana have been fraught with controversy and conflicting scientific evidence.

“From what I have determined, the science shows that cannabis can work for people over a wide range of illnesses and symptoms related to fibromyalgia, arthritis, neurological disorders, chronic gastrointestinal disorders, anxiety, cancer, HIV, and sleep and appetite disturbances,” Minardi says. 

According to the National Institute on Drug Abuse (NIDA), THC can reduce nausea and improve appetite. It may also decrease pain, inflammation, and muscle spasticity. CBD may help control epileptic seizures, pain, inflammation, and possibly be used to treat certain mental illnesses.

Clinicians can recommend (but cannot prescribe) medical marijuana when standard treatments have not helped. “Doctors have to certify that they have followed medical standards of care first, and that these treatments have failed to provide relief to the patient,” says Cheryl Ziemba, M.D., medical director at Cedar Crest, an Erickson Living community in Pompton Plains, N.J. 

Risks

Although medical marijuana may help certain symptoms, there have not been enough large-scale controlled clinical trials to weigh the short- and long-term risks and benefits of using it, according to NIDA. Some scientists think that people who are older and have chronic diseases may be particularly vulnerable to harmful effects over time.

Some research suggests that regularly smoking marijuana can interfere with memory, learning, and behavior. According to the American Thoracic Society, marijuana smoke contains many of the same chemicals as tobacco smoke and can therefore be harmful to the lungs, especially in people with lung problems including asthma and bronchitis. It is not known whether smoking marijuana can cause lung cancer. 

Few experts refute the fact that, like many other drugs, marijuana can produce dependence, but dependence is not the same as addiction. Dependence means your body has built up a tolerance to a drug, and that signs of withdrawal may occur if it is abruptly stopped. Addiction, on the other hand, is defined by the NIDA as “a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.” Research shows that fewer than 10% of people who use marijuana become addicted. 

People cannot overdose and die from marijuana use. They can, however, experience panic attacks or psychotic reactions, and some people may injure themselves because of marijuana’s effect on judgment, coordination, and perception.

Safe use

One problem with medical marijuana is that you don’t know how much of each active ingredient is in a particular product. “Medical marijuana dispensaries can usually steer people in the right direction regarding which type works for which malady,” Minardi says. “People who want to avoid mind-altering effects should use products higher in CBD because it does not tend to produce the euphoria that THC products can,” Minardi says.

Aside from herbs prepared for smoking, medical marijuana comes in many forms, including foods, liquids, creams, and tinctures. “I would suggest that older adults use other routes rather than smoking,” Ziemba says.

Minardi warns that if you don’t live in a legal-use state, don’t go over the border to buy it and bring it home. “You will be considered a criminal if you get caught possessing it,” he says. “I have many chronically ill clients whose quality of life has been ruined because they’ve been arrested and charged with marijuana possession.”

The future of medical marijuana

Research initiatives have picked up steam in an effort to determine safety and efficacy. Some companies are developing ways to detect unique genetic information from cannabis seeds in order to breed plants targeted to help specific symptoms and health conditions. 

Minardi gives partial credit to the Institute of Medicine (IOM) for changes in attitudes about medical marijuana legalization. “A 1999 report by the IOM debunked the gateway drug theory about marijuana and reviewed the evidence regarding tolerance, withdrawal, and abuse potential. They concluded that compassionate use of medical marijuana should be considered under certain circumstances.”

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