Nabiximols is a cannabinoid drug still under study in the US. It’s a mouth spray made up of a whole-plant extract with THC and cannabidiol (CBD) in an almost one to one mix. It’s available in Canada and parts of Europe to treat pain linked to cancer, as well as muscle spasms and pain from multiple sclerosis (MS). It’s not approved in the US at this time, but it’s being tested in clinical trials to see if it can help a number of conditions.
Smoked marijuana delivers THC and other cannabinoids to the body, but it also delivers harmful substances to users and those close by, including many of the same substances found in tobacco smoke.
Marijuana is the name given to the dried buds and leaves of varieties of the Cannabis sativa plant, which can grow wild in warm and tropical climates throughout the world and be cultivated commercially. It goes by many names, including pot, grass, cannabis, weed, hemp, hash, marihuana, ganja, and dozens of others.
There have been some early clinical trials of cannabinoids in treating cancer in humans and more studies are planned. While the studies so far have shown that cannabinoids can be safe in treating cancer, they do not show that they help control or cure the disease.
Older patients may have more problems with side effects and are usually started on lower doses.
At this time, the US Drug Enforcement Administration (DEA) lists marijuana and its cannabinoids as Schedule I controlled substances. This means that they cannot legally be prescribed, possessed, or sold under federal law. Whole or crude marijuana (including marijuana oil or hemp oil) is not approved by the US Food and Drug Administration (FDA) for any medical use. But the use of marijuana to treat some medical conditions is legal under state laws in many states.
Like many other drugs, the prescription cannabinoids, dronabinol and nabilone, can cause side effects and complications.
This is not intended to be an inclusive list, but rather to give a brief survey of the types of conditions for which medical marijuana can provide relief. As with all remedies, claims of effectiveness should be critically evaluated and treated with caution.
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?
In particular, marijuana appears to ease the pain of multiple sclerosis, and nerve pain in general. This is an area where few other options exist, and those that do, such as Neurontin, Lyrica, or opiates are highly sedating. Patients claim that marijuana allows them to resume their previous activities without feeling completely out of it and disengaged.
Uses of medical marijuana
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.
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?
My advice for patients is to be entirely open and honest with your physicians and to have high expectations of them. Tell them that you consider this to be part of your care and that you expect them to be educated about it, and to be able to at least point you in the direction of the information you need.
Marijuana is currently legal, on the state level, in 29 states, and in Washington, DC. It is still illegal from the federal government’s perspective. The Obama administration did not make prosecuting medical marijuana even a minor priority. President Donald Trump promised not to interfere with people who use medical marijuana, though his administration is currently threatening to reverse this policy. About 85% of Americans support legalizing medical marijuana, and it is estimated that at least several million Americans currently use it.
Nearly 1 million Americans, including many 45 and older, live with the debilitating muscle spasms and pain of multiple sclerosis. Up to 66 percent of them may be using medical marijuana, a 2017 survey found. It’s likely they’ve cut back on MS medications, too. In fact, people with MS are the second-largest group of medical marijuana users in the U.S., behind chronic pain sufferers. There’s substantial science for cannabis’ ability to reduce MS muscle spasms. Meanwhile, others are looking at a potential cannabis-based drug for MS. The cannabis research and development company MMJ International Holdings Corp. hopes to test an experimental medication — a highly purified, liquid plant extract with THC and CBD in a gelatin capsule — for MS in the U.S. soon.
En español | Evaluating medical marijuana research disease by disease is not easy, hampered as it is by the federal government’s ban on government-supported data collection. Observational studies — in which users simply report their experiences — may look rosy. Animal and test-tube studies also can sound promising. But plenty of stuff that helps mice or a clump of cells in a petri dish may not help us humans. Despite these obstacles, there are some conditions and diseases for which cannabis is clearly a useful treatment. Others, not so much.
For now, small studies and surveys hint at benefits and problems — especially for depression. The good news: In a 2018 Washington State University online survey of 3,151 medical marijuana users with depression, in-the-moment symptoms improved by 50 percent after just two puffs of generally low-THC, high-CBD pot. As with any drug, dosage matters: More wasn’t better. The bad news: Over time, their ongoing depression worsened somewhat. Regular use may change cannabinoid receptors in the brain, boosting vulnerability to dark moods, the researchers note. Stopping can reverse it.
In a recent Canadian study, cannabis even soothed arthritic lab rats. Surprisingly, there’s little evidence (yet) from human studies for the most common form of arthritis, osteoarthritis — the wear-and-tear joint disease affecting 50 percent of adults age 65-plus. Clinical trials are underway. But who’s waiting? Arthritis was the top reason older adults used cannabis in a 2019 Colorado survey, followed by back pain. Overall, 79 percent said it helped.
by Sari Harrar, AARP, September 3, 2019 | Comments: 0
But cannabis should never be used to treat cancer, Abrams says. “The saddest and most frustrating thing for me is to meet patients who’ve delayed coming in for six months because they heard marijuana treats cancer and they wanted to try it first. For some, it’s too late for proven treatments like surgery, chemotherapy and radiation that extend and save lives.” Don’t fall for hints online that it does work, he notes — they’re based on sketchy anecdotes and questionable research, like one tiny human study that dripped cannabis into the brains of people with brain cancer.
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