James Hamilton, M. D.
Well, I guess the topic of medicinal marijuana (MMJ) is now on the table.
First a little background. Cannabis is listed as a Schedule I controlled substance by the DEA. That means it is considered a drug that has "no acceptable medical use and has a high potential for abuse". That puts it in the same class as heroin. Do I believe that is a proper classification? No. I feel it should be a Schedule II drug which would then allow more open scientific research to be conducted without some of the numerous hoops that must be navigated by legitimate researchers now.
One of the problems with cannibis research is that in cannibis plants, especially when smoked, there are about 400 different chemicals of which about 135 are cannibinoids. The main psychoactive chemical is tetrahydrocannibinol (THC) which, as Mary Margaret pointed out, has been drastically increased in today's weed as compared to that of in the 1960's. Some of the non-psychoactive cannabinoids have been researched and have shown some efficacy for medicinal use. Dronabinol (prescription drug, brand name is Marinol) is one such cannabinoid that has use for intractable nausea and vomiting and increasing appetite in AIDS patients. Nabiximols, another category of cannibinoid, has some usefulness in cancer pain, multiple sclerosis pain and spasticity management. Unfortunately it is not available in the USA but is in Canada. I suspect research will find other cannibinoids that are useful for other conditions in the future.
Many of the medications in use today come from plants (some of which are toxic in and of themselves), bacteria, mold and fungi: digitalis (Foxglove plant), atropine (belladonna plant), botulinum toxin (Botox, bacteria), penicillin (mold) and cephalosporins (a fungus discovered in the sewers of Sicily) are but a few examples. The rain forests of Central America probably hold countless, undiscovered species that could be useful to treat many conditions.
Alcohol is often compared to MJ but I do not feel that is a fair comparison. In honesty I reveal I do like my wine and martinis - definitely in moderation, of course! The difference is that ethanol is a single chemical wheras MJ, as stated above, is a compilation of hundreds. We are all aware of the damage that can be done by excessive alcohol use and, in some situations, even minor alcohol use (pregnancy). Cigarette smoke also contains hundreds of chemicals, many of which are carcinogenic. Vaping contains some of those also.
Are alcohol and cigarettes addicting? Probably but not universally. This comes down to our genetics. And that is the latest area of medical research occurring today. It is well known that there are some teenagers who are instantly addicted to nicotine on their first experimentation with cigarettes. Alcohol addiction is common and we often see that running in families. Could there be a genetic pattern for the ability of certain individuals to become addicted to cannabis? Most likely, yes.
THC is a lipophilic substance, that is to say it is fat soluble. Fatty tissue retains chemicals for a long time. Our brain is one big convoluted yet highly organized glob of fat. Thus when one consumes MJ it stays in the body for about three weeks. Again, as Mary Margaret wrote, the brain does not fully develop until about age 25 and the last part to develop are the areas of higher function such as reasoning. To these individuals marijuana can alter their future in drastic ways.
Does MJ adversely affect the fully developed adult brain? Yes. So can alcohol. What is a "safe dose"? Unknown. Alcohol levels in the blood are fairly predictive of what impairment is in the brain. That is not known for THC.
Is MJ a "gateway drug"? For some, yes, and that may also be genetically determined. In the not-to-distant future we may have the tools to determine the susceptibility of individuals to many different substances and diseases. That is definitely on the horizon. Brave new world! Do individual patients really want to know that? I'll wager that insurance companies do!
In summary, we need a lot more research on many things, incuding MMJ. There are many anecdotal and testamonial reports to MMJ as have been expressed by Frank and Joe's daughter. There is still a paucity of rigorous, scientific, double blinded placebo controlled studies and comparative studies to existing treatments available. The few that have been done have not shown significant superiority to currently available therapies. But, again, we have no way of predicting a patient's genetic response in those trials.
In my first post on this topic I mainly was talking about the societal adverse effects that Colorado's Amendment 64 has had on our state. And I stand by that. MMJ is still in a grey area for me to say much more about it at this time.
Good night,
Jim
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