Medical Cannabis and Pharmaceuticals

What if we had a solution the opioid epidemic? What if we had a solution to drug overdose? According to the Center for Disease Control, in 2014, nearly 2 million in the US abused or were dependent on prescription opioids. I am not a medical professional, but here is some of the research I've done into replacing medications with the more natural option of cannabis. Cannabis is a plant that can be used to replace opioids, as well as anti-seizure medication, anti-depressants, and anti-anxiety medication. Rx drug overdose in 2014 was up nearly four times what it was in 1999 (National Institute on Drug Abuse). With statistics like those, I think it is best to replace pharmaceuticals with cannabis whenever possible.

Carbon dating shows the use of wild hemp as early as 8000 B.C., while cultivation of hemp goes back to 800 A.D. in Great Britain. In the 1600s in American colonist farmers were required by law to grow hemp, and was used as legal tender. By the end of the 1700s, medical journals in America had suggested the use of hemp seeds and roots for a variety of medical issues(Bushak). To many native American tribes, cannabis is a sacred herb. Cannabis was made illegal originally by the Marijuana Tax Act of 1937; the Mexican Revolution had just ended, and many Mexicans immigrated to America(“History of Hemp”). The Mexican people referred to it as Marijuana, and Americans who were unhappy with the influx of immigrants started to associate the term with the “invading” and “disruptive” Mexicans, despite the widespread use of cannabis as a medication in America (Burnet). However, in recent times the cannabis movement has been spreading; as of 2017, 29 U.S. states have legalized medical cannabis. Cannabis is viewed in a much more positive light to many people, but still remains a scapegoat to many in America.

Research for cannabis remains difficult to find due to federal laws in America, but all the evidence about cannabis so far has been very promising and is supported by hundreds of years of personal accounts of medical use. Despite the lack of scientific evidence, the International Journal of Drug Policy has found that people “[use] cannabis to effectively address diverse symptoms”. People all over the world use cannabis to treat a wide variety of illness, some cannabis has been scientifically proven to treat, and some are anecdotal tales passed through the community. According to a 2014 survey of medical cannabis patients in Canada, 53% of participants used cannabis to treat pain, 15% for various mental health problems, gastrointestinal disorders 11%, insomnia 7%, and multiple sclerosis 4%. According to another study done in the New England area of medical cannabis patients who reduced the use of pharmaceuticals with cannabis, 76.7% reduced opioid use, 71.8% reduced anxiety medication use, 66.7% reduced migraine medication use, 65.2% reduced sleep medication use, 42% reduced alcohol use, and 37.6% reduced use of depression medication use, however, depression medication use cannot be replaced as often, because it has to be taken on a schedule, while the other medications are taken on an as needed basis(Lucas and Walsh).

According to a review published in the Journal of the American Medical Association of 28 studies of cannabinoids as treatment for pain problems, using cannabis as to treat chronic pain. Seizures are a serious medical problem affecting children and adults all over the world. 214 people received 99% cannabidiol (CBD) extract to treat their seizures that did not respond well to other medications, and seizures decreased by an average of 54%. It has been proven in rodents that appetites can be influenced by the presence of the cannabinoid anandamide, and believed to be the same in humans(“History of Hemp”). Anandamide can be found in many cannabis strains, which people can consume to stimulate appetite when illnesses and medications cause appetite loss. A lack of anandamide is also a cause of PTSD symptoms, and by consuming cannabis strains that include that endocannabinoid, it can replenish the receptors and help relieve PTSD symptoms(Rahn). While the idea of smoking to help asthma seems ridiculous, cannabis is actually a bronchodilator, meaning it opens up the bronchial tubes which become inflamed and swollen by asthma, and allows more oxygen to reach the lungs (“Can Marijuana Help Treat Asthma”).

Mental health problems are another area with low research to support cannabis treatment, but many people use it to treat mental health problems. THC increases dopamine concentrations in the brain, so despite the lack of research, in theory, cannabis consumption should alleviate ailments related to a lack of dopamine, such as depression, ADHD, schizophrenia, bipolar, and parkinson's (Oleson and Cheer; Alban). The idea has been raised that cannabis can kill cancer; little research has been done on the topic, but in labs cannabis has been shown to kill cancer cells and some human trials have resulted in decreased tumor growth (Guzman). Last, but not least, cannabis treats glaucoma by lowering intraocular pressure or "IOP", which causes a pressure buildup in the eye, eventually leading to damage to the eye and vision loss. These are only a few of the most common uses of cannabis, there are still many more unproven or unexplored ailments which cannabis may be able to treat.

The side effect of opioid withdrawal can be as bad as the symptoms they’re meant to treat. A popular drug given to patients detoxing from opioids is Methadone, which is another opioid, talk about out of the frying pan and into the fire. Popular side effects of opioid withdrawal are nausea, pain, restlessness, and insomnia, all of which are things cannabis can treat. As well, cannabis relieves pain, which opioids are prescribed for, meaning not only can cannabis lessen detox effects, but it can also replace the opioid use entirely. According to a study by JAMA International Medicine, states that had medical cannabis laws on average had 24.8% lower annual opioid overdose death rate that the states with no medical cannabis laws. Alexis, a medical cannabis patient I interviewed, gave me a first hand account of how they used cannabis beverages, tinctures, edibles, and smoking flower to detox and replace her fibromyalgia medications: hydrocodone, vicodin, flexeril(a muscle relaxer) and reduced gabapentin (nerve pain medication) by half. Alexis said initially she only planned to use cannabis to help replace the pain medication, but found it was the most helpful thing to detox (which she has done four times in her life) because it was able to eliminate many of the withdrawal symptoms entirely, such as nausea, and muscle cramping, and even alleviate the emotional symptoms. In the past she has smoked higher doses of street cannabis to help with the anxiety side effects of detox, but this time she refined the selection of terpenes to alleviate the specific symptoms brought on by the detox.

Medications in America have created an outbreak of addiction and overdose problems. Opioids by themselves killed more than 33,000 people in 2015, while more than 1000 people everyday are in emergency departments for incorrect use of opioids. Almost half of all opioid overdose deaths involve a prescription opioid (methadone, hydrocodone, or oxycodone, as opposed to heroin), and one in four people who are given opioid prescriptions for pain will struggle with addiction.(Center for Disease Control)

These problems are not limited to opioids: a popular anti-seizure drug named Aptiom was suggested to be put on the Hazardous Drug List for serious side effects including suicidal thoughts and behaviors, neurological reactions, liver damage, and abnormal thyroid reaction, among others. Many anti-seizure drugs, including diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin) and Clobazam (Onfi) have a potential for addiction as well. Benzodiazepines-anti anxiety medication-were involved in 6,497 deaths in 2010, and antidepressants were involved in 3,889 deaths (CDC). Side effects from anti-anxiety medication often include nausea and vomiting, weight gain, diarrhea, sleepiness, sexual problems, as well as more dangerous side effects such as thoughts about suicide or dying, new or worsening depression, new or worsening anxiety, feeling very agitated or restless, panic attacks, insomnia, new or worsening irritability, acting aggressively, being angry, or violent, acting on dangerous impulses, unusual changes in behavior or mood (National Institute of Mental Health).

A study was done to find the Margin of Exposure (MOE) for a variety of prescription and recreational drugs, including THC in cannabis. According to Scientific Reports, “the MOE is defined as ratio between toxicological threshold and estimated human intake” (1). According to this study, and as seen in the diagram, the amount of human intake needed to become toxic is almost one thousand times the average daily consumption, while cocaine lies around 10 times average daily consumption, and amphetamine, nicotine, and methamphetamines lie under 100 times average daily consumption.

With such high overdose and abuse rates, a substitute to these harmful medications is necessary to keep these drug abuse rates from spiraling out of control. Medical cannabis can be used to replace many of these medications, and it doesn’t have the negative side effects and abuse rates that many medications have. Most plants, including cannabis, contain terpenes, oils that give plants their characteristics, most often giving plants their smell. What’s unique about cannabis is that different strains include different terpenes, so medical patients can find the terpenes they need for what they’re trying to treat, and can pick a strain that would best help their ailment.

Nearly everything about cannabis is beneficial to one medical problem or another. Even to people who consume cannabis recreationally, the consumption is still beneficial by helping them relax, or treat low level problems like pain and anxiety that are not severe enough to take heavy medications. Another major benefit of cannabis is what is called the entourage effect. Cannabis usually contains CBD, THC, and over 400 compounds, and these compounds work together to magnify the effect of the components and terpenes of the plant, to make the union of these terpenes and compounds much more beneficial than consuming the individual terpene in other plants.

The large variety of consumption of cannabis makes it an excellent substitute for patients who can’t have medicine in a conventional way, such as if they cannot swallow pills. This also gives different onset times and effects for patients using cannabis for different ailments, as well as letting patients medicate discretely or in nonsmoking areas. The most common consumption of cannabis is smoking the dried flowers. Smoking gives an immediate onset and last up to three hours, and gives the most control of the strain and cannabinoids, but for those who need high doses of cannabis to treat more severe symptoms, it can be hard to consume that amount only through smoking. Vaporizing or vaping is a common up and comer in the cannabis community. A vaporizer (often a vape pen) is used to heat a part of the plant and inhale the vapor. Vaping gives the same immediate onset and last for a few hours, as smoking does but without the negative effects the smoke can have on the lungs, and is also much more discreet than smoking the flower. One of the newest methods of consumption is called dabbing. Dabbing includes heating a small “dab” of a concentrate, then inhaling the burned concentrate. Dabbing is used by those with high tolerance or who need high doses of cannabis as treatment, because these concentrates can contain up to 80% THC, giving consumers an immediate onset of a dosage that would take multiple hits off of a pipe.

Edibles have been popular for more than forty years in America. The THC is metabolized in the liver, instead of absorbed into the bloodstream in the lungs, meaning all of the THC is metabolized giving more of a “high” feeling with a smaller dose and is longer lasting, meaning it is very helpful for patients needing long term relief. Beverages are very similar to edibles, often times just considered an edible itself, but while both of them are very difficult to give a dosage, beverages are a little easier to dose. Cannabis tinctures have been popular since the late 19th century. They are probably the easiest cannabis product to dose, and are a good product for people who do not want to smoke, but want a quick onset. Rick Simpson Oil (RSO) is an oil concentrate that people, including its namesake Rick Simpson, claim has cured cancers and tumors. RSO typically lasts 4-10 hours, and many say help greatly with pain.

Topicals are a very good choice for pain and arthritis patients. They’re often a lotion or salve absorbed into the skin for a localized relief, and can last upwards of 12 hours with no psychoactive effects. Bath salts are also available, and usually include other herbs, such as lavender meant to help further healing. Transdermal patches are also available for long term, localized relief, but can fall off due to sweat or dirt. Topicals are one of the best products for younger patients to use because they generally do not have any side effects, psychoactive or otherwise.

The strongest argument against any medication is the side effects and if they are worth the treatment of the illness. Taking a look at 31 different studies on cannabis, 96.6% of the “adverse events” were common and not serious, mostly dizziness. There were only 164 serious adverse events, the most recurring being relapse of multiple sclerosis, vomiting, and urinary tract infection, however there was not a significant difference in the number of serious events when comparing the control group to the treatment group, making it inconclusive whether the results were related to the medical cannabis consumption(Borgelt et al.). Alternatively when looking at pharmaceuticals, each medication comes with its own list of side effects, ranging from minor - constipation, skin rash, diarrhea, dizziness, drowsiness, dry mouth, headache, insomnia, and nausea - to severe - suicidal thoughts, abnormal heart rhythms, internal bleeding, and cancer(Nordqvist). The possibility of drowsiness is much more favorable than possibly fatal side effects.

According to the Proceedings of the National Academy of Sciences, when cannabis use begins in adolescence and proceeds into midlife, neuropsychological decline across various brain functions occur. However, according to the University of Michigan, less than 20% of 8th graders had tried cannabis and the perceived risk of using cannabis regularly has been on a steep decline. The stigma related to cannabis is one problem many people have to using it, and it connects back to the history of using cannabis as a scapegoat for societies unhappiness with incoming immigrants and the lower class. This stigma has gone on so long that many people choose to ignore miraculous uses of the plant and judge it by its racist roots.

A very popular argument against cannabis is that it is a “gateway drug” meaning it will open a gate to the consumer being addicted to more dangerous drugs. However, that is because illegal cannabis must be obtained from a dealer of some sort, who constantly push harder, addictive drugs onto their black market consumers so that they will get addicted and continue to come back. By legalizing cannabis, you diminish the dealers and black market, proving that cannabis is not a gateway drug, and reducing the amount of black market sellers and consumers. According to the National Institute on Drug Abuse, most cannabis consumers don’t move on to “harder” drugs.

Prescription medications are causing severe problems in our country. We have an epidemic of opioid abuse and prescription drug death, and these prescriptions can come with some lethal side effects. Cannabis is a great alternative that not only treats multiple ailments, but has almost no side effects, and is extremely difficult to overdose on.

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