Medical Marijuana/Cannabis – What you need to know
What is Marijuana?
Marijuana is best known as a drug that people smoke or eat to get high. It is derived from the plant Cannabis sativa. According to history and various traditions, it has been used throughout the world medically, recreationally and spiritually for about five (5) millennia. It was believed to be one of the fundamental herbs used in Chinese medicine.
In the US, from the mid – 19th century to the 1930s, physicians prescribed it for a plethora of indications until the federal government started imposing restrictions on its use, culminating in 1970 with the US Congress classifying it as a Schedule I substance, illegal, and without medical value. Also, Marijuana is listed by the Drug Enforcement Agency (DEA) as an illegal Schedule I drug which has no currently accepted medical use. As a result of this prohibition, marijuana became the United States’ most widely used illicit recreational drug, a substance generally regarded as pleasurable and relaxing without the addictive dangers of opioids or stimulants.
However, on March 17, 1999, 11 independent scientists appointed by the Institute of Medicine reported that medical marijuana was effective in controlling some forms of pain, alleviating nausea and vomiting due to chemotherapy, treating wasting due to AIDS, and combating muscle spasms associated with multiple sclerosis. This proclamation paved the gateway for researches to be conducted in this direction and allowed development of cannabinoid – based medicine in most developed countries. This form of marijuana is referred to as medical marijuana defined as using marijuana to treat certain medical conditions.
In 1995, California became the first of the 25 US states to legalize marijuana for medical use but possession of marijuana is still illegal under federal law. Despite the fact that there was no evidence that using marijuana would increase illicit drug use or that it was a “gateway” drug the DEA is yet to reclassify marijuana as a Schedule II drug, which would allow physicians to prescribe unadulterated and standardized forms of marijuana.
What’s the difference between medical marijuana and marijuana?
Medical or medicinal marijuana refers to the use of marijuana for medical purposes. This is not the type of marijuana consumed. However, not all marijuana and marijuana products produce a “high,” and, often, those products are taken to treat medical conditions
What medical conditions qualify to be treated with medical marijuana?
Acceptable medical conditions vary between states and countries but the most common ones are to:
- Ease pain.This includes different types of chronic pain, including pain from nerve damage.
- Control nausea and vomiting.The most common use is for nausea and vomiting caused by chemotherapy for cancer.
- Make a person feel like eating.This helps people who do not eat enough and lose weight due to other illnesses or cachexia (wasting diseases) such as HIV/AIDS and cancer.
Some small studies show that marijuana might relieve symptoms in people who have:
- Multiple sclerosis
- Crohn disease
- Inflammatory bowel disease
- Epilepsy and seizures
- Parkinson’s disease
- rheumatoid arthritis
- Hepatitis C
- multiple Sclerosis
However, a review of the most stringent medical marijuana studies did not find sufficient evidence marijuana actually benefits patients suffering from most conditions it is used for. The study, published last June in the Journal of the American Medical Association, found the strongest evidence supported use for chronic pain and for muscle stiffness in Multiple Sclerosis.
The researchers called for more high-quality studies, which thus-far have been limited by federal regulations on marijuana research.
What are the possible side effects of using medical marijuana?
Possible physical symptoms from using marijuana include:
- A fast or irregular heartbeat
- Slow reaction times
Possible mental or emotional side effects include:
- A strong feeling of happiness or well-being
- Short-term memory loss
- Trouble concentrating
- Decreased or increased anxiety
How does Medical Marijuana work?
Marijuana contains hundreds of chemical compounds called cannabinoids the two most well-known of which are cannabidiol (CBD), and tetrahydrocannabinol (THC). Cannabinoids produce a reaction on endocannabinoid receptors in the brain and throughout the body which can affect the brain as well as change mood and consciousness.
Medical marijuana may be smoked, vaporized, eaten or taken as a liquid extract.
However, different varieties of marijuana contain different amounts of cannabinoids. This sometimes makes the effects of medical marijuana hard to predict or control. The effects also may differ depending on whether it is smoked or eaten.
What’s the difference between CBD and THC?
CBD is non-psychoactive, which means it does not produce a “high.” Research has shown CBD may effectively treat epilepsy, anxiety, depression, and inflammation. THC attaches to receptors in the brain and affects motor coordination, appetite, pain sensitivity, and emotions. THC is used primarily to increase appetite and reduce nausea, but is also used to decrease pain, inflammation, and muscle control problems.
Some marijuana plants have been bred to contain low amounts of THC and high amounts of CBD.
Do doctors allow patients to smoke marijuana?
Smoking marijuana delivers the fastest effects but it produces many of the same carcinogens as smoking tobacco. Many patients opt to consume marijuana infused food (edibles), lotions, tinctures, oils and transdermal patches.
Doctors cannot prescribe marijuana as they do other medications because it is illegal federally. Instead, in legal states, doctors “recommend” marijuana for patients with certain conditions which courts have said falls within physicians’ First Amendment right to freedom of speech.
Can marijuana be put in pill form?
Yes. In fact, two pharmaceutical drugs containing synthetic THC have been approved by the FDA and are prescribed by doctors. These are:
- Dronabinol (Marinol):treats nausea and vomiting caused by chemotherapy and loss of appetite and weight loss in people with HIV/AIDS.
- Nabilone (Cesamet):treats nausea and vomiting caused by chemotherapy in people who have not had relief from other treatments.
Unlike medical marijuana, the active ingredient in these drugs can be controlled, so you always know how much you get in a dose.
A third drug, Epidiolex, has been approved by the FDA for medical trials in Ohio and other states. Epidiolex contains CBD extracted from marijuana and is being studied in children with treatment-resistant epilepsy.
Who should not use Medical Marijuana?
Doctors are not allowed to prescribe medical marijuana to people younger than age 18. Other categories of people who should not use medical marijuana include:
- People with heart disease
- Pregnant women
- People with a history of psychosis
Other concerns linked to marijuana use include:
- Dangerous driving or other risky behaviours
- Lung irritation
Dependence or addiction to marijuana
What type of health care provider can recommend marijuana for qualifying conditions?
Any licensed health care provider including but not necessarily, your primary physician, can write you a recommendation. It can be more time efficient and is generally suggested to first talk with your primary or treating physician, however, if this fails, there are some doctors who exclusively see patients for medical marijuana evaluations (often referred to as medical cannabis doctors). Here’s a good read on “Tips for Finding a Reputable Marijuana Clinic.”
Below is a list of various health care providers who can write medical marijuana recommendations in legal states (Please note: Each legal state may have varying forms of this list).
- Medical Doctor (MD)
- Physician Assistant (PA)
- Osteopathic Physician (DO)
- Osteopathic Physician Assistant (OA)
- Naturopathic Physician (ND)
- Advanced Registered Nurse Practitioner (ARNP)
How do people get Medical Marijuana?
In states or countries where medical marijuana is legal, you need a written statement from your doctor to get the drug. It must explain that you need it to treat a medical condition or to ease side effects. Your name will be put on a list that lets you buy marijuana from an authorized seller.
What is the next step after I receive a Doctor’s recommendation?
Once you receive a recommendation, you are qualified to buy, possess, consume, transport and grow cannabis, up to limits specified by each state. You are also entitled to apply for a Medical Marijuana Identification Card, although it is not required.
The next step is to find a nearby dispensary. On your first visit to a dispensary, you must bring in either the doctor’s recommendation or a Medical Marijuana Identification Card (MMIC) along with an I.D. that verifies proof of identity as well as state residency. With a recommendation, many dispensaries, upon your first visit, will call the recommending physician for verification.
The next step after finding a dispensary is deciding which type and strain of medical marijuana is best for treating your condition and needs. There are hundreds of different types and strains of medical marijuana as well as different products, such as edibles, tinctures, tonics, etc. Dispensary staff members will help you explore the best kind of cannabis as well as help you decide which method of using medical marijuana is best for you.
Why get a medical Cannabis/Marijuana Card?
A medical marijuana card can be used to validate you are legally allowed to possess medical marijuana. If law enforcement encounters you in possession of the approved amount of medical marijuana or less, you can show your card and they can immediately check its validity against the national on-line registry. A card also gains you access into dispensaries anywhere in the state.
Note that a card provides some legal protection at the state level, however you still are not protected from federal prosecution as the government still classifies it as a Schedule I drug.
Do I have to have a medical Cannabis/Marijuana Card?
No, if you are a qualifying patient, a valid written recommendation from your health care provider is enough. As mentioned before, however, upon your first visit to a dispensary, the letter has to be verified by the physician either by phone or online.
What do medical associations and the FDA say about medical marijuana?
The American Medical Association says “cannabis is a dangerous drug and as such is a public health concern” but encourages additional research on the plant and its possible medical benefits.
In 2013, the association urged federal officials to review marijuana’s status as a Schedule I drug, which means it has no accepted medical use, and to fund and support well-controlled cannabis studies.
The American Academy of Pediatrics also opposes legalizing medical and recreational marijuana use and urges further research. But the organization says exceptions should be made for children with debilitating or life-limiting diseases who cannot wait for “a meticulous and lengthy research process.”
The FDA has not approved marijuana as a safe and effective drug and warns the purity and potency of marijuana may vary considerably. But FDA approval is needed to undertake federally sanctioned or funded marijuana research. Most federal research has focused on marijuana abuse and addiction.
American Academy of Neurology (2015). Medical Marijuana in Certain Medical Disorders. www.aan.com/Guidelines/Home/GetGuidelineContent/650.
American Cancer Society (2015). Marijuana. www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/herbsvitaminsandminerals/marijuana.
Gerich. M, Isfort, R, Brimhall, B, and Siegel, C., 2014. Medical marijuana for digestive disorders: High time to prescribe? Am J Gastroenrerol. PMID: 25199471 www.ncbi.nlm.nih.gov/pubmed/25199471.
- Michael Bostwick, 2012. Available on http://dx.doi.org/10.1016/j.mayocp.2011.10.003
Lutge EE, Gray A, Siegfried N., 2013. The medical use of cannabis for reducing morbidity and mortality in patients with HIV/AIDS. Cochrane Database Syst Rev. 2013;4:CD005175. PMID: 23633327 www.ncbi.nlm.nih.gov/pubmed/23633327.
Naftali T, Bar-Lev Schleider L, Dotan I, Lansky EP, SklerovskyBenjaminov F, Konikoff FM., 2013. Cannabis induces a clinical response in patients with Crohn’s disease: a prospective placebo-controlled study. ClinGastroenterolHepatol. 11(10):1276-80
Naftali T, Mechulam R, Lev LB, Konikoff FM., 2014. Cannabis for inflammatory bowel disease. Dig Dis. 32(4):468-74.
National Cancer Institute (2015). Summary of the Evidence for Cannabis and Cannabinoids. www.cancer.gov/cancertopics/pdq/cam/cannabis/healthprofessional/page7.
National Center for Complementary and Integrative Health (2015). Medical Marijuana. nccih.nih.gov/health/marijuana.
National Institute on Drug Abuse, 2015). Is Marijuana Medicine? www.drugabuse.gov/publications/drugfacts/marijuana-medicine.