Marijuana for Medical Use:
What Does the Research Say?
How do Doctors Feel about Marijuana for Medical Use?
The results from a recently published survey, published in the New England Journal of Medicine found that more than three-quarters of physicians would prescribe marijuana for medical use by their patients if they could. The survey, which was held in a feature section of the journal, received 1,466 votes from 56 states and provinces in the U.S. and the Americas, as well as 72 countries.
In their report researchers said the results showed "physicians in favor of medicinal marijuana, and often focused on [their] responsibility as caregivers to alleviate suffering." Continuing, they noted, "Many pointed out the known dangers of prescription narcotics, supported patient choice, or described personal experience with patients who benefited from the use of marijuana."
Cancer and Chemotherapy
Research on marijuana for medical use and cancer has focused on the ability of marijuana for medical use to alleviate the symptoms of chemotherapy. Patients who utilize marijuana for medical use report that it helps them to feel better while they are enduring heavy drug treatment to combat their cancer. Patients who feel well and minimize the side effects of the chemotherapy treatment are likely to have better outcomes and the potential for cannabinoids to reduce the growth of certain types of cancer.
Research indicates that cannabinoids (a beneficial compound found in marijuana) relieve negative symptoms in cancer patients by preventing nausea, vomiting and pain and by stimulating appetite. In addition to helping with the side effects of chemotherapy, several studies have suggested that cannabinoids may stop many kinds of cancers from growing and spreading. The most promising results show improvements in pancreatic, lung, leukemic, melanoma, breast, oral, and lymphoma.
A significant number of oncologists support marijuana for medical use as an option for their patients. Survey data from a 1990 study shows that 44% of oncologists had recommended cannabis to at least some of their patients, and more said they would do so if the laws were changed. These doctors were recommending marijuana for medical use long before the laws had changed in many states. A majority of doctors in this same survey 54% thought cannabis should be available by prescription. It is likely that with the recent advancements in scientific research, along with Massachusetts legalization of marijuana for medical use, the state will see an even greater number of doctors discussing the benefits of marijuana for medical use with their patients.
Marijuana for medical use has been effective in treating both the symptoms of HIV/AIDS and the side effects of some of the medications used to treat it. In particular doctors who treat this disease report that marijuana for medical use has been an effective way to relieve neuropathic pain, a common symptom among those living with HIV/AIDS. In a double blind randomized clinical trial, Ellis et al found the proportion of subjects achieving at least some pain relief was significantly greater with cannabis (46%) compared to placebo (18%). Marijuana for medical use also seems to help with nausea and weight loss among people living with HIV/AIDS. In a 2005 survey of HIV positive, marijuana users 93 percent said the drug helped decrease nausea and other symptoms. In that same survey, 56 percent said their nausea was “much better”, while 37 percent said it was a “little better". In a 2005 double blind clinical trial published in JAIDS Haney et. al. found that HIV positive marijuana smokers increased daily caloric intake and body weight with few adverse effects. Finally, a recent study by researchers at Mt. Sinai Hospital suggests that marijuana has the potential to inhibit a type of human immunodeficiency virus (HIV) found in late stage AIDS.
They found that marijuana receptors located on immune cells called cannabinoid receptors CB1 and CB2 can influence the spread of the virus. Clearly, there have been several scientific discoveries indicating that marijuana for medical use can alleviate the pain and suffering typically experienced by HIV/AIDS patient
There has been a lot of research showing that marijuana for medical use can reduce spasticity and the debilitating pain suffered by multiple sclerosis (MS) patients. For example, in a randomized controlled trial, Rog et al found that cannabis based medicine is effective in reducing pain and sleep disturbance in MS patients with central neuropathic pain. Similarly, double blind randomized controlled studies demonstrated significant improvements in spasticity as well as in measures of disability, cognition, mood, sleep and fatigue among patients taking cannabis-based medications. A 2004, study also found that cannabis helped alleviate problems with bladder dysfunction in MS patients and improved patient self assessment of pain, spasticity and sleep quality. There are currently several studies under-way to further investigate the potential benefits of marijuana for medical use by MS patients
Irritable Bowel Syndrome (IBS) and Crohn’s Disease
Recent research suggests that cannabis may also be useful for patients with irritable bowel syndrome (IBD) or Crohn’s disease. A 2012 study found that patients who were treated for three months with inhaled marijuana improved quality of life measurements, disease activity index, and gained weight. Another recent study suggests that cannabis can help alleviate the severity of disease symptoms and reduce the need for other medications and/or surgery. Often patients find that marijuana for medical use can alleviate some of their symptoms and has less side effects than they typically experience with pharmaceutical medications. Individuals who suffer from a chronic disease are often ingesting several different medications each day. Over time, this type of medicating can take a toll on other organs in the body.
Numerous studies have affirmed the pain reduction effects of marijuana for medical use. In his recent review of the literature, Kraft concluded that, while the evidence did not support the use of marijuana for acute pain, “in chronic pain and (painful) spasticity, an increasing number of randomized, double blind, placebo controlled studies have shown some efficacy of cannabinoids.” Marijuana has been especially effective for reducing neuropathic pain. Neuropathic pain is a specific type of pain caused by damage or disease that affects the somatosensory system. Symptoms often include abnormal sensations and patients often experience extreme sensitivities where normal movements are found to be painful. Neuropathic pain can be continuous, or fluctuating. Common qualities include burning or coldness, "pins and needles" sensations, numbness and itching.
In another study conducted by a group of neuroscientists at Oxford, researchers concluded that THC provides relief from pain in ways that differ from traditional pharmaceutical medications. Participants in the study were offered marijuana for medical use immediately followed by brain MRI testing. The results of their research, published in the journal Pain, indicate that marijuana for medical use might not make the pain go away, like other more commonly prescribed pain killers, but it helps patients in their ability to endure pain with fewer side effects. According to the lead author of the publication Michael Lee, “Brain imaging shows little reduction in the brain regions that tend to code for the sensation of pain, which is what we see in drugs like opiates. Instead cannabis appears to mainly affect the emotional reaction to pain in a highly variable way.”
Therefore, a person might have the same level of pain after receiving marijuana for medical use, but it simply does not bother them as much. The ability to make a patients pain more bearable suggests that marijuana might be beneficial as a pain detractor, more than a pain reliever. Since patients reported feeling more comfortable, and less focused on their pain, the scientists suggest that marijuana for medical use could be an effective pain treatment medication.
Several studies also show that marijuana for medical use is effective in treating chronic pain. Chronic pain is defined as pain that has lasted for a long time. The distinction between acute pain and chronic pain is often determined by the amount of time since onset. In most cases pain that persist for 3-6 months is considered chronic pain. Currently scientists are looking at marijuana for medical use as a possible therapy in treating patients who experience chronic pain. These findings could benefit patients who suffer from migraine headaches, arthritis, MS, spinal chord injuries, lupus, and several other conditions characterized by pain.
Health Risks Associated with Marijuana for Medical Use
Marijuana for medical use is generally safe, well tolerated, and produces few side effects in patients who use it. Like any medication, it poses some risks. We strongly encourage all patients consider these risks, and require that you consult with your doctors to determine if marijuana for medical use is right for you. Smoking of any sort can cause inflammation in the lungs. It should be avoided in patients with compromised lungs.
However, a recent JAMA article based on a 20 year longitudinal pulmonary health study suggests that some of these risks may have been overstated. The research looks more specifically at the impact of inhaled marijuana and the possible negative health consequences. The results from the study show that, “marijuana may have beneficial effects on pain control, appetite, mood,and management of other chronic symptoms. Our findings suggest that occasional use of marijuana for these or other purposes may not be associated with adverse consequences on pulmonary function.” Patients can avoid all of the risks associated with smoking marijuana for medical use by choosing a different method which can deliver the same results without the risks associated with smoke inhalation. Marijuana for medical use patients are encouraged to use vaporizers, or ingest the medicine through edible baked goods or food products.
Compared to other synthetic medications offered, marijuana is thought to be extremely safe. There are no known cases of overdose or death from marijuana. A review of deaths from the FDA Adverse Reporting System between 1997 (the year the first marijuana for medical use program began) and 2005 showed 196 deaths from anti-emetics (medications to prevent nausea and vomiting) and 118 deaths from antispasmodics (medications that suppress muscle spasms). Opioid pain medications, which are widely prescribed, are now responsible for more accidental deaths than traffic accidents; almost 15,000 people died from prescription pain medications in 2008 alone. Some researchers have begun looking to marijuana for medical use as safer and less addictive alternative to prescription opioids. For example, in a recent article in the American Journal of Hospice and Palliative Care the authors call for reclassifying cannabis. They argue that it would improve the care we offer patients, and it would reduce opioid abuse, addiction, and opioid deaths. In a survey of marijuana for medical use patients, Reiman found that 66% had utilized marijuana for medical use as a substitute for other prescription drugs. Patients report experiencing fewer adverse side effects, better symptom management, and less severe withdrawal symptoms.
Is Marijuana Addictive?
While marijuana use can become a problem for some, a 1999 NAS study reported that: “few marijuana users become dependent on it and marijuana dependence appears to be less severe than dependence on other drugs.” The National Institute for Drug Abuse reports that approximately 9 percent of those who try marijuana become addicted. These statistics are low compared to 32 percent of tobacco and 15 percent of alcohol users. Research has also negated the widely held theory that marijuana is a “gateway” drug. Scientist have concluded that there is no evidence to support the idea that individuals who smoke marijuana are more likely to eventually try harder drugs.
Pharmaceutical Alternatives to Marijuana for Medical Use
Marinol is a prescribed oral medication that is currently available and is sometimes prescribed by doctors who believe their patients would benefit from the medicinal compounds found in marijuana. Unfortunately it is not a viable solution for many patients.
Marinol contains 100 percent delta-9 THC (versus the 20 percent THC found in natural cannabis). Most patients find Marinol is too sedating, too strong, and makes them feel far too medicated than they desire. Research has also shown that Marinol is often poorly absorbed, and patients complain that dosage is hard to monitor and control. In addition several patients benefit from marijuana for medical use because they suffer from severe nausea and they simply can not keep oral medication down long enough for it to absorb. Smoked or vaporized marijuana provides a fast and effective system for delivering THC (one of the active ingredients in marijuana). This rapid onset of effects, not only provides more immediate relief, but also allows patients to carefully control their dose to relieve their symptoms.
Does Legalizing Marijuana for Medical Use Increase Overall Drug Use?
Research suggests that overall marijuana use would NOT increase under the tightly regulated system proposed in the bill. The 1999 NAS report found that: “There is broad social concern that sanctioning the medical use of marijuana might increase its use among the general population. At this point there are no convincing data to support this concern. The existing data are consistent with the idea that this would not be a problem if the medical use of marijuana were as closely regulated as other medications with abuse potential... No evidence suggests that the use of opiates or cocaine for medical purposes has increased the perception that their illicit use is safe or acceptable.”Since that report, several other analyses, including a 2012 study published in the Annals of Epidemiology examined whether or not passing marijuana for medical use laws impact adolescent marijuana use. The authors concluded that marijuana for medical use laws had no discernible effects on marijuana use: “If anything our estimates suggest that reported adolescent use may actually decrease after passing marijuana for medical use laws.” (Harper, Strumpf, Kaufman)
In another study entitled “Medical Marijuana Laws and Teen Use,”, researchers used data from the national and state Youth Risk Behavior Surveys. They compared current trends in marijuana smoking among youth to see if there was a connection between higher rates of smoking in states that had legalized marijuana for medical use. The research results found no association between marijuana for medical use laws and increased teen marijuana use. They concluded that their findings were not consistent with the hypothesis that legalization leads to increased use of marijuana by teenagers.
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Where Does All This Science Come From?
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Organizations in Support of Medical Marijuana
American Medical Student Association
National Association of People Living With AIDS,
AIDS Action Council
American Public Health Association
American Academy of Family Physicians
American Nurses Association,
Federation of American Scientists
New England Journal of Medicine
National Association for Public Health Policy
California Medical Association
Whitman- Walker Clinic, the Lymphoma Foundation of America
American Preventive Medical Association
American Society of Addiction Medicine
British Medical Association
Lymphoma Foundation of America
National Institutes of Health (NIH) Workshop on the Medical Utility of Marijuana
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