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?
Least controversial is the extract from the hemp plant known as CBD (which stands for cannabidiol) because this component of marijuana has little, if any, intoxicating properties. Marijuana itself has more than 100 active components. THC (which stands for tetrahydrocannabinol) is the chemical that causes the “high” that goes along with marijuana consumption. CBD-dominant strains have little or no THC, so patients report very little if any alteration in consciousness.
The most common use for medical marijuana in the United States is for pain control. While marijuana isn’t strong enough for severe pain (for example, post-surgical pain or a broken bone), it is quite effective for the chronic pain that plagues millions of Americans, especially as they age. Part of its allure is that it is clearly safer than opiates (it is impossible to overdose on and far less addictive) and it can take the place of NSAIDs such as Advil or Aleve, if people can’t take them due to problems with their kidneys or ulcers or GERD.
THC (which stands for tetrahydrocannabinol) is the chemical that causes the “high” that goes along with marijuana consumption. CBD-dominant strains have little or no THC, so patients report very little if any alteration in consciousness.
Patients do, however, report many benefits of CBD, from relieving insomnia, anxiety, spasticity, and pain to treating potentially life-threatening conditions such as epilepsy. One particular form of childhood epilepsy called Dravet syndrome is almost impossible to control, but responds dramatically to a CBD-dominant strain of marijuana called Charlotte’s Web. The videos of this are dramatic.
These stories were referring to a recent study in the American Journal of Psychiatry that found a short-term course of cannabidiol (CBD) reduced cue-induced cravings and anxiety in drug-abstinent individuals who were recovering from opioid use disorder, specifically heroin addiction.
This study is undoubtedly exciting and a welcome contribution to the scientific literature demonstrating the potentially helpful role of cannabinoids in the treatment of opioid use disorder.
That said, there is a mismatch between these headlines and the accurate interpretation of the findings from the study. And this mismatch is not trivial.
It took psychiatrist Staci Gruber four years to wrangle approval to run a clinical trial testing whether a liquid cannabinol product administered orally can ease symptoms of anxiety. She had to get the okay from the US Food and Drug Administration, the Drug Enforcement Administration, and the National Institute on Drug Abuse.
Cannabis research, she tells The Scientist, is “not for the faint of heart.”
Eleven states and Washington, DC, have legalized recreational and medical marijuana use, with Illinois being the latest to join in January 2020, and 19 have legalized medical marijuana. It is a popular drug—a survey of nearly 170,000 adults published today (September 20) in JAMA reports that around 8 percent of respondents use marijuana, and nearly 4 percent do so daily. Yet despite its ubiquity in American society, researchers say their hands remain tied by a decades-old federal law classifying cannabis and related products as Schedule 1 drugs, which are defined as having no currently accepted medical use and a high potential for abuse. (Other Schedule 1 drugs include ecstasy and heroin.)
Many countries, as well as some states in the US, have recently been taking steps to legalize the use of cannabis, but the long-term effects of using cannabinoids are still unknown. Cannibidiol (CBD), one of the compounds in the cannabis plant, is increasingly being self-administered to treat health conditions such as anxiety, chronic pain, and epilepsy without the overt effects of tetrahydrocannabinol (THC), the cannabis compound that causes a psychoactive high. The CBD industry is projected to reach $16 billion in the United States alone by 2025, and the compound is being administered to children to treat drug-resistant epilepsy in a clinical trial, according to The New York Times. The 2018 Farm Bill declassified CBD products containing less than 0.3 percent THC.
CBD is an entirely different compound from THC, and its effects are very complex. It is not psychoactive, meaning it does not produce a "high" or change a person's state of mind, but it influences the body to use its own endocannabinoids more effectively.
According to one study posted to Neurotherapeutics, this is because CBD itself does very little to the ECS. Instead, it activates or inhibits other compounds in the endocannabinoid system.
For example, CBD stops the body from absorbing anandamide, a compound associated with regulating pain. So, increased levels of anandamide in the bloodstream may reduce the amount of pain a person feels.
Sorry to break it to you, but you can't get high off hemp. The plant responsible for the ropey bracelets kids make at summer camp produces only trace amounts of the high-inducing compound, THC, or tetrahydrocannabinol. Indeed, these trace amounts of THC are some of the main characteristics that distinguish hemp from its cannabis relative, marijuana.
Still, it's not all bad for hemp: The plant produces another lucrative compound called CBD, or cannabidiol. This nonpsychoactive molecule is the key ingredient in the first-ever cannabis-based drug approved by the Food and Drug Administration. Called Epidiolex, the drug is used to treat rare forms of epilepsy in children.
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