Is Cannabis Medicinal?
Cannabis seems unique in its wide array of indications for use. The newly discovered ECS not only adds to our understanding of human physiology but also helps us understand how and why cannabis is safe and effective for so many indications.
Dr. Lester Grinspoon, Associate Professor Emeritus of Psychiatry at Harvard Medical School argues that cannabis is “less toxic than almost any other medicine in the pharmacopeia: it is like aspirin, remarkably versatile.”
It is important to note that Dr. Grinspoon once set out to prove the damaging effects of cannabis in his research. What he found was quite the opposite. He discovered that many people are able to get relief with very small amounts of cannabis, making it possible for them to do normal activity in comfort.
Scientific research has shown that CBD and THC may be therapeutic for many conditions, including (but not limited to) chronic pain, cancer, anxiety, diabetes, epilepsy, rheumatoid arthritis, PTSD, sleep disorders, MS, cardiovascular disease, antibiotic-resistant infections, and various neurological ailments.
History of Marijuana as Medicine – 2900 BC to Present
A very comprehensive and detailed account that is easy to understand that cannabis has been our first choice in medicine for thousands of years.
History of Marijuana as Medicine – 2900 BC to Present (opens in a new window)
Humans have learned how to use many herbal plants as medication. With more modern research, physicians have moved from using botanicals to specific chemicals within those plants or synthetic versions of those chemicals. In research studies, it is much easier to focus on a particular chemical; however, although these specific chemicals may have stronger and more direct effects, they can come with stronger and sometimes-toxic side effects.
Cannabis is not a new drug. Throughout centuries of use there has never been a recorded human death as a result of cannabis consumption. It has a remarkably wide margin of safety. The median lethal dose or LD-50 (dose at which 50% of rats using a drug will die from overdose) of oral THC was 800 to 1900 mg/kg for rats, depending on sex and strain. No cases of death due to toxicity followed a maximum THC dose in dogs (up to 3000 mg/kg) and monkeys (up to 9000 mg/kg). Stated another way, humans would have to consume 1500 pounds in 15 minutes to induce death. In other words, it is nearly impossible to overdose on this herbal plant. Compare that record to the fact that approximately 120 persons die each year from the use of aspirin.
Thousands of studies have been funded by the National Institute on Drug Abuse (NIDA) to determine the harmful effects of cannabis. Numerous claims have been made, such as cannabis causes cancer, it destroys the immune system, it’s the gateway drug that leads to heroin, and it kills brain cells, during pregnancy it will result in foetal abnormalities, and on and on.
Upon taking a closer look, many of these studies have been exposed for their flawed methodology, or the dosage was dramatically increased in an attempt to create a negative outcome. For example, there were early claims of cannabis use causing brain damage based on a study of monkeys that were exposed to cannabis smoke. However, it was discovered that the monkeys were forced to breathe only cannabis smoke for a period of time, and the damage was more likely caused by asphyxiation than cannabis smoke. No subsequent study showed such damage. Another early published study on THC and the immune system managed to show negative results but the dosage used on the rats were extremely high.
In 1974, at Virginia Commonwealth University, research was conducted on rats under the theory that cannabis was carcinogenic. Rather than causing cancer, it was discovered that cannabis was effective in killing the lung-cancer cells. The funding was discontinued and the study was never published in the literature. Early studies by pulmonologist Donald Tashkin of UCLA found that one cannabis cigarette had the same amount of carcinogenic material in its smoke as four tobacco cigarettes. The federal government held fast to this claim, but neglected to keep up with Tashkin’s work. Admittedly surprised, Tashkin completed a longitudinal study on thousands of subjects and found no pulmonary disease.
In 1999 the Institute of Medication (IOM) completed an 18-month study on the medical value of cannabis and found that cannabis is not highly addictive, is not a gateway drug, and is safe for medical use. Specifically the IOM stated that “except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other medications.” At that time, the study panel maintained some concern regarding administration of cannabis by smoking, yet they clearly noted that for patients suffering from cancer or AIDS the pulmonary risks were inconsequential compared to the disease being treated. For all other patients, the IOM panel found cannabis to be safe enough to allow physicians to conduct individual case studies. For example, if a glaucoma patient’s intraocular pressure could not be controlled by standard pharmaceuticals, the physician should be allowed to use cannabis as an individual case study with that patient.
Other Potential Risks Related to Medicinal Cannabis
Healthcare professionals are well aware of the possibility of health risks related to medications even when used under medical supervision. When using any medication, the goal is for the benefit (reason for use) to outweigh the risks (side effects and/or adverse reactions). The usual side effects that accompany the use of cannabis include a mild tachycardia, red eyes, dry mouth, short-term memory loss, relaxation, sedation, euphoria (sense of well-being), dizziness, and an increased appetite (“the munchies”). Cannabis is not a hallucinogen, but users may experience an alteration of time perception and/or an increased sensory perception.
A side effect for one user may be a desired effect for another person. A cancer patient may use cannabis to control the nausea and increase the appetite (for the benefit or desired effect), yet may also experience the side effects of euphoria (not generally a negative effect) and sedation. Dry mouth may be an undesired side effect for many people, but a desired effect for ALS patients who have difficulty managing their oral secretions. Many people in pain have reported that they never experience the euphoria or “high” that is sought by recreational users.
While cannabis is often used as an anti-anxiolytic medication, one of the most common adverse psychic effects is an acute panic reaction, which usually occurs with novice or inexperienced users or with high doses of THC. This rarely requires any pharmacologic intervention and treatment includes a quiet, relaxing environment with reassurance that the person is fine and the effects will soon wear off.
As cannabis use has increased in some populations, there has been no corresponding increase in the incidence of schizophrenia, which would be expected if cannabis was a causal factor. It is of interest to note that, independent of cannabis use, there are more cannabinoid receptors in the brains of patients with schizophrenia that in normal individuals.
THC can impair perception and psychomotor performance, which means that people may be at increased risk for accidents if operating equipment (eg, driving a vehicle). With chronic use, many patients develop tolerance to the effects that may contribute to impaired driving. For some patients, cannabis is necessary to control their symptoms so they can drive more safely.
The low risk of any serious adverse event occurring with initial use of cannabis makes it an ideal first trial medication (if it were legal) for many patients. No medication works for everyone, and if cannabis is not helpful to an individual person there is essentially no harm done in trying it.
Long-term use of cannabis has not been associated with increased mortality in animals or humans. In an animal study, rats were administered 50 mg/kg of THC for a period of 2 years and at the end of the observation the survival rate was higher among the treated rats than in the controls (a higher incidence of cancer was noted in the control rats) (Chan et al., 1996). A longitudinal study of 65,171 Kaiser Permanente Medical Care Program enrolees found no relationship between cannabis use and mortality (Sidney et al., 1997).
Some studies have shown a reduction in sperm count with chronic cannabis use, but it is reversible if cannabis is discontinued. Studies are inconclusive regarding the effects of cannabis on male and female sterility. THC readily crosses the placenta, but it appears unlikely that cannabis causes foetal abnormalities. When socioeconomic variables have been accounted for, there appear to be no significant foetal problems related to cannabis use by the mother (Dreher, 1997).
- No one has died due to over-consumption of cannabis. In fact the lethal does is unknown but suspected to be as high as consuming 800 cigarettes in 15 minutes which is not humanly possible.
- There are no serious lasting side effects. There are certainly risks and side-effects to consuming cannabis but they are milder than those of most prescription drugs.
- Side-effects generally subside in 45-minutes to an hour for inhaled cannabis and 6-8 hours for ingested cannabis depending on your body chemistry.
- Smoking marijuana does not cause lung cancer. In fact there is substantial research that smoking cannabis indicates a preventative effect on lung cancer.
- Dr. Donald Tashkin, Emeritus Professor of Medicine & Medical Director of the Pulmonary Function Laboratory at UCLA has reported that chronic cannabis smokers have a lower risk of lung cancer, followed by the group of chronic cannabis and tobacco smokers, then non-smokers, and of course tobacco only smokers were last with the highest risk for lung cancer. Watch Dr. Tashkin’s presentation and explanation of his findings.
- Cannabis does not interfere with your other medications.
- Cannabis is safer than aspirin and has 20 times its anti-inflammatory power.
- Cannabis increases the effectiveness of opiate drugs making it possible to reduce the opiate dosage thereby reducing the risk of addiction.
- Cannabis is far safer than any other intoxicant or drug.
- Cannabis does not kill healthy brain cells. It has been proven to selectively kill cancerous brain cells in test tube research.
- Cannabinoids (phyto) are one of the major groups of chemicals produced by the cannabis plant. They mimic important chemistry in our bodies called endocannabinoids (cannabinoids within) that are produced by our bodies to control, regulate or participate in all of the major biological functions of our bodies. Echinacea is the only other plant that produces cannabinoids and it only produces one.
Cannabis is not only remarkable in its wide margin of safety as a medication but also for the wide array of conditions, symptoms, or illnesses for which it is used. This may be a stumbling block for many doctors, who find it hard to believe that a medication can be effective for so many indications. Although just in its infancy, the growing understanding of our ECS helps explain how and why cannabis is so versatile. As stated earlier, the ECS is involved in numerous physiologic processes that affect how we eat, sleep, relax, protect, and forget.
Cannabis is the only plant that contains cannabinoids similar to the endocannabinoids found in humans. Delta-9-THC is the primary psychoactive cannabinoid and the most studied, but researchers are finding therapeutic potential in some of the other plant-based cannabinoids as well.
Indications for Use
While the use of cannabis for chemotherapy-induced nausea and vomiting may be the best-known and accepted use of cannabis by healthcare professionals, pain management is the most common reason for use among most people.
Eat: Studies have clearly shown that THC and cannabis are effective anti-emetics. As an anti-emetic, cannabis may be used to combat the nausea and vomiting from chemotherapy (cancer, HIV/AIDS, hepatitis treatment), postoperative nausea and vomiting related to anesthesia or intra-operative medications, motion sickness, morning sickness, and hyperemesis gravidarum.
Cannabis is effective as an appetite stimulant for cancer patients or HIV/AIDS patients with cachexia or wasting syndrome (Abrams, 2002; Schnelle and Strasser, 2002; Plasse, 2002). There have been cases of hospitalized patients on tube feedings using cannabis to start eating again. The endocannabinoid anandamide, is present in the breast milk of all female mammals. An Israeli researcher conducted several rat experiments in which she blocked the formation of anandamide. When the anandamide was blocked at the time of delivery, all of the rat litter died.
With a subsequent litter, the anandamide was blocked a day after delivery of the pups and half of the pups died, while the surviving pups were about half the weight of the control pups. There were no negative effects noted when the anandamide was blocked after 3 days, and the conclusion is that these pups received enough of the anandamide to stimulate their sucking/feeding instincts sufficiently and the pups nursed as actively as the control litter (Fride, 2005).
Sleep: Cannabis helps induce sleep and, unlike many pharmaceuticals used as sleep aid, cannabis does not leave a person feeling drugged in the morning (Russo, Guy, and Robson, 2007).
Relax: As a muscle relaxant, cannabis helps decrease the muscle spasms experienced by chronic pain patients; it can ease the spasticity in patients with multiple sclerosis or spinal cord injuries, and it can ease menstrual cramps. Cannabis can relax blood vessels and prevent migraines. Although the mechanism of action is not completely understood with glaucoma patients, cannabis can reduce the intra-ocular pressure that leads to blindness. Cannabis can relax the bowels for persons suffering from irritable bowel syndrome or Crohn’s disease. Cannabinoids help induce bronchial dilation, which is helpful for asthmatic patients. It can relax the anxious person, help reduce stuttering, and help decreases obsessive behavior with OCD patients. Cannabis has also been helpful in eliminating or reducing the frequency of seizures (Mathre, 1997; Russo and Grotenhermen, 2002).
Protect: This covers a broad array of conditions because the cannabinoids have anti-inflammatory, neuroprotective, antibacterial, antifungal, antiviral, anti-tumor, and antiproliferative properties. Cannabis may be helpful after acute injuries such as traumatic brain injury, in part through its anti-inflammatory effects. One of the cannabinoids has been found to kill MRSA in the laboratory; clearly we need further study on this action (Appendino et al., 2008). Cannabis has been helpful with phantom limb pain and other neuropathic pain conditions. It is now believed that certain auto-immune diseases may be the result of an overactive immune system and cannabis can help put it back in balance. Research on the ECS indicates that cannabinoids may prevent Alzheimer’s disease. As a bone stimulator, cannabinoids can help hasten the healing process of bone fractures and prevent osteoarthritis (Mechoulam, 2010a).
Cancer patients have used cannabis to combat chemotherapy-induced nausea and vomiting and to help manage cancer pain. Animal research is showing that cannabinoids can kill cancer cells, and there are a growing number of case studies of cancer patients who have used concentrated cannabis oils or tinctures in treating their cancer. Research on the ECS shows that one of its functions is to identify cancer cells and induce apoptosis (cell suicide), prevent angiogenesis (the formation of blood vessels that feed a tumor), and prevent the spread of cancer to other areas (Holland, 2010). This leads researchers to explore the use of cannabis as a perfect cancer chemotherapy agent—one that can actually differentiate and destroy cancer cells rather than healthy cells. Studies have shown that cannabis/cannabinoids may be helpful in cancer treatment of glioma (aggressive brain cancer), lung, pancreatic, cervical, breast, colon, prostate, thyroid, and skin cancer, as well as leukemia and lymphomas (Pacher et al., 2006).
Forget: Many jokes have been made about short-term memory loss with persons who smoke cannabis recreationally. However, research on the endocannabinoid system shows that it is involved in the process of helping us forget painful experiences, such as traumatic experiences or the pain of childbirth. Many of our combat veterans, as well as rape and incest victims, have used cannabis to help them manage their post traumatic stress symptoms. Based on research findings, Israel and Czechoslovakia now allow the use of cannabis for their Veterans who suffer from post traumatic stress (Mechoulam, 2010b).
Historically, cannabis pharmaceuticals were used to “combat habits of morphine and chloral hydrate” and to “manage delirium tremens from alcohol withdrawal.” Today, in many of the bigger compassion clubs and cannabis dispensaries, staff is noting that many patients report that cannabis has helped them get off of a drug of abuse. Philippe Lucas, of the Vancouver Island Compassion Society (VICS) in Canada, coined a new term to describe cannabis; he called it an “exit” drug (Lucas, 2004).
Rather than causing persons to use stronger drugs, patients are finding that cannabis helps them get off and stay off of drugs such as alcohol, nicotine, cocaine, methamphetamine, benzodiazepines, prescription opioids, and heroin. Some report that cannabis helped manage their withdrawal symptoms when they quit using their problem drug. Others found that if they used cannabis they could resist using their previous drug of choice and their lives became more manageable (Reiman, 2008).
Severe chronic pain is commonly treated with opioids (eg, morphine, oxycodone, methadone). Unfortunately, opioids will cause physical dependence with regular use and patients readily develop a tolerance to their analgesic effects, requiring increased dosage over time. Some of the opioids are in combination drugs (eg, Percoset, Vicodin) that also contain acetaminophen (Tylenol). Opioids carry the risk of overdose by respiratory depression, and acetaminophen carries a substantial risk of fatal liver damage with excess dosage.
Opioids present other problems as well. Many patients complain of feeling “drugged” and unable to think clearly when using opioids. Care has to be taken to avoid severe constipation as an expected side effect of opioids; some patients experience nausea and some suffer from depression (which may in part be due to the depressive effects of opioids as well as the result of living with chronic pain).
Many pain patients have found that they can significantly reduce or eliminate their use of opioids when they begin using cannabis. In addition cannabis is not constipating, prevents nausea, and can act as an anti-depressant. Thus patients report effective pain relief and no longer require additional medications to counter the side effects of opioids (Mathre, 1997; Gieringer, Rosenthal and Carter, 2008, Holland, 2010).