As clinical cannabis is rapidly becoming accepted as a treatment for an array of chronic diseases and disorders, there is a growing and pressing need for clinical education surrounding medical marijuana—and alternative treatments for pain control. The use and acceptance of medical cannabis continues to evolve, as demonstrated by the growing number of states that now permit its use and applications for specific medical indications.
While the marijuana plant contains over 100 different chemicals—or cannabinoids—each one produces a different effect on the body. Tetrahydrocannabinol (THC) was originally identified by Raphael Mechoulam, who later also described and named anandamide: a naturally occurring endogenous cannabinoid neurotransmitter that binds to cannabinoid receptors. The human endocannabinoid system is a biological system involved in regulating a variety of physiological and cognitive processes, including appetite, pain sensation, mood, memory, fertility, etc. The CB1 receptor (THC) occurs in the central and peripheral nervous system, while the CB2 receptor is located on immune cells, and the peripheral nervous system. Cannabidiol (CBD) does not have the psychotropic effects of THC, nor does it have the memory impairment or appetite effects; the two main chemicals used in medicine are THC and CBD.
The most common use for medical marijuana in the United States is for pain control: while marijuana is not strong enough for severe pain (i.e. post-surgical pain or a broken bone), it is said to be highly effective for the chronic pain that plagues millions of Americans, particularly as they age. Part of its attraction is that it is clearly safer than opiates—almost impossible to overdose, and far less addictive—and it can take the place of NSAIDs such as Advil or Aleve, if people cannot take them due to problems with kidneys, ulcers, or GERD.
Marijuana specifically appears to ease the pain of multiple sclerosis, and nerve pain in general. This is an area in which few other options exist; moreover, 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 drugged or disengaged. Marijuana is also said to be a highly effective muscle relaxant; many users swear by its ability to lessen tremors in Parkinson’s disease. Other successful clinical applications include fibromyalgia, endometriosis, interstitial cystitis, and most other conditions where the final common pathway is chronic pain.
Further users of marijuana include management of nausea and weight loss, and treatment for glaucoma. A highly promising area of research is its use for PTSD in veterans who return from combat zones. Many veterans and respective therapists have reported drastic improvements, recommending more research and studies, and a loosening of governmental restrictions on its study. Medical marijuana is also reported to help patients suffering from pain and wasting syndrome associated with HIV, as well as irritable bowel syndrome and Crohn’s disease.
Despite lingering controversy, use of botanical cannabis for medicinal purposes represents the revival of a plant with historical significance reemerging in today’s healthcare system. Legislation governing use of medicinal cannabis continues to change quickly, necessitating that pharmacists and other clinicians stay abreast of state regulations and institutional implications. Ultimately, as the medicinal cannabis landscape continues to evolve, hospitals, acute care facilities, clinics, hospices, and long-term care centers must consider the implications, address logistical concerns, and explore the feasibility of permitting patient access to this treatment.
Senior Vice-President of A4M/MMI Joseph Maroon, MD—Clinical Professor and Vice Chairman in the Department of Neurosurgery at the University of Pittsburgh Medical Center, and expert in clinical cannabis therapies—has published a white paper on the neurological benefits of cannabinoids.
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