Medical cannabis or Pharmaceutical Medications?
This is a question that I am often asked by my patients. Luckily there is growing research to support the medicinal value of cannabis these days. Progress in this area has been slow, and there are only a few drugs available on the market that are based on cannabis. The drugs Marinol and Cesamet are THC based drugs that are used in the treatment of cancer, and Epidiolex which has recently been approved for the treatment of two different kinds of seizure disorders in children. Another cannabis-based drug currently being studied in this country is Sativex, which is a one-to-one ratio of CBD to THC. This drug is already available for use in the United Kingdom, Canada, and some European countries for the treatment of pain.
The approach of the drug companies is similar in all of the pharmaceutical compounds. They purify or synthesize the cannabinoids and seek a silver bullet, rather than use the whole plant in the treatment of a disorder. They cite many reasons for this, including the lack of control over strength, and confusion based on the properties of other compounds in the whole plant. They are having a difficult time developing accurate and consistent dosing when using whole plant products, which is why they are focusing on the single molecules. Critics of medical cannabis use cite the lack of research on the long-term effects of cannabis on age and health related problems. It is interesting that the harmful effects of opioids are already known and cited in research, yet these drugs are still widely over prescribed.
Opioid deaths in states where medical marijuana laws have been enacted have decreased, and trends from the period of 1999 through 2010 show a 21% reduction in these deaths. In a study by the Journal of Alternative and Complementary Medicine, they state that medical marijuana users take less prescription medications overall. This includes opiates pain medications, and respondents to their survey note that cannabis worked faster for pain with fewer side effects then prescription medications. Uses were reported that included anti-inflammatory and anticonvulsant properties, as well as replacing over the counter pain relief products. The authors state that they believe conditions like post-traumatic stress disorder, cancer, and fibromyalgia can effectively be treated using medical cannabis.
According to the Journal of the American Medical Association, states with medical marijuana laws have a 25% lower opioid death rate. In a study by the University of Georgia, they noted that there were decreased opioid-related deaths in areas where there dispensaries. The authors note that a surprising finding of their study was that people are now taking control of their own health. However, they also caution that there is a lack of knowledge about this plant, which leads us into the “wild west of medical marijuana claims”. More research is obviously needed on the medicinal effects of cannabis.
My recommendation to people based on my clinical experience is to start medical marijuana as an adjunct to the traditional therapies. The goal would be to incorporate cannabis into your daily medical regime, use practices of mindful consumption and journaling to gain insight, and then work with a trained professional to develop a treatment plan. With the help of the clinician patients can begin to titrate, or step down from their pharmaceutical medications one drug at a time. This is an essential part of the process, as the clinician will monitor for negative effects from discontinuing the pharmaceutical medications. Once again, I warn patients against discontinuing essential medications without consulting their doctor first, as withdrawal symptoms or other life-threatening symptoms may occur.
For people not on major medications for serious conditions, they can experiment with stretching times between doses, or skipping doses of certain medications. For example, I have worked with clients using tranquilizers such a Xanax and opioids to create a step down plan such as the ones described above. For clients wishing to experiment with this on their own, I suggest that knowledge of the cannabis plant and all of its properties are essential. We must not only educate ourselves through reading, but we must also gain insight through journaling and mindful consumption of this medicine. Patients must build a foundation of knowledge regarding the cannabis plant, their bodies, their medical conditions, Etc. From that point, this knowledge is built in a stepwise fashion to a point of focus. The quotation “Knowledge is Power” seems to apply here.
To summarize my views on this point, we don't have enough research at the moment to say for sure that cannabis is a stand-alone treatment for any particular disorders that are life-threatening in nature. Anecdotal evidence seems abundant, but when our lives are on the line it's better to err on the side of caution and use both, medical cannabis as well as the traditional Therapies. Medical cannabis at the very least can help a person tolerate higher levels of chemotherapy and radiation, as well as minimize the recovery time from those interventions. Whether or not medical cannabis is curative for those conditions that a person has is uncertain at the moment, but research shows that the outcomes are improved when both are used together.
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