Landmark study: Marijuana effective medicine, but has drawbacks

Marijuana can be an effective medicine in some cases for treating pain, nausea, muscle spasms and other conditions, but the drug that is wafting into the mainstream is not harmless, and more research is needed, the nation’s top scientists concluded in a landmark report released Thursday.

The nonprofit National Academies of Sciences, Engineering and Medicine issued its report, “The Health Effects of Cannabis and Cannabinoids,” summarizing the body of research into the efficacy of medical pot. The 395-page paper stands as the most official medical review of the botanical drug, which an estimated 8 percent of American adults used in the past month.

Chief among the findings, researchers criticized the U.S. government’s continued listing of marijuana as a “Schedule 1” drug, meaning it has no established medical use and a high potential for abuse. Pot ranks above prescription opioids, such as Vicodin and OxyContin, that were linked to more than 180,000 deaths from 1999 to 2015.

 

Cannabis’ Schedule 1 designation “impedes the advancement of … research,” the study found. “It is often difficult for researchers to gain access to the quantity, quality, and type of cannabis product necessary to address specific research questions on the health effects of cannabis use.”

Echoing the response to the report by medical marijuana advocates in the Bay Area and around the country, Berkeley-based physician and cannabis specialist Dr. Frank Lucido said, “Our government should de-schedule marijuana.”

The National Academies commissioned the review of research in reaction to the swift expansion of medical and adult-use pot laws in America. Twenty-eight states and Washington, D.C., have legalized medical pot, and eight states and Washington, D.C., have legalized recreational use.

“The growing acceptance, accessibility, and use of cannabis raise important public health concerns and there is a clear need to establish what is known and what needs to be known about the health effects of cannabis use,” the report stated.

The review involved 16 experts, including UCSF oncologist Dr. Donald Abrams, and was paid for by federal, state, philanthropic and nongovernmental organizations. The committee considered more than 10,700 published studies and arrived at nearly 100 research conclusions, among them that marijuana can help certain patients who use it.

Parts of the report undermine critics of legalization. It found cannabis can in some cases treat chronic pain, the nausea and vomiting associated with cancer treatment, muscle spasms associated with multiple sclerosis, and sleep disturbances. Unlike with legal tobacco or alcohol, studies show cannabis does not cause lung, head or neck cancer, the report found.

However, the report also diminishes some claims of pot advocates, finding, for instance, that there is not sufficient evidence that cannabis or its compounds can treat cancer, epilepsy or schizophrenia.

The study found “limited evidence” of a link between heavy cannabis smoking and a highly curable type of testicular cancer. There is also “limited evidence” of a link between pot smoking and heart attack or stroke.

Some opponents of broader access to marijuana celebrated the report, including Kevin Sabet, director of the antilegalization group Project Smart Approaches to Marijuana.

“This is a damning report for legalization advocates, to be perfectly honest,” Sabet wrote in an email. “This report is a wake-up call to all Americans who have been sold the false promise that marijuana use is not harmful across multiple health outcomes.”

Cannabis is a mixed bag, in many respects. Maternal cannabis smoking could be linked to lower birth weight, the review found, but there is little evidence it causes pregnancy complications or later negative outcomes in offspring.

The scientists found some evidence of a link between pot use and certain mental health conditions like schizophrenia, but the link might be explained by other variables. Speaking of the report in general, review committee chair Marie McCormick said, “There are a lot of questions, particularly around determining causality.”

The report buttresses calls for age restrictions on cannabis use, such as those in place in California, as scientists are fairly certain that teens who smoke weed increase their risk of developing “problem cannabis use” — defined as use that negatively affects school, work or relationships or is difficult to stop.

Pot also might be a gateway drug to tobacco, alcohol or other drug use, the report said, but there is limited evidence and it’s not clear whether marijuana use is the cause or merely correlated.

The report is likely to increase pressure on lawmakers to reschedule marijuana. Arizona physician Dr. Sue Sisley, who has tried for years to gain federal approval to study cannabis as a treatment for post-traumatic stress disorder in humans, said it was “unsurprising” the National Academies did not find evidence cannabis can treat cancer or epilepsy.

“The federal government has systematically impeded efficacy studies,” she said.

Lucido said the review was clearly limited by federal research barriers. “For epilepsy, it’s a slam dunk,” he said of prescribing cannabis. “That definitely helps. I’ve seen over 100 kids with seizure or autism, and a lot of them are doing much better with cannabis than multiple harmful medications in the past. It doesn’t work for everybody, but it’s been miraculous for some of the kids.”

While more intensive research must be done, the report refutes critics’ claim that there’s no current basis to legalize weed, said Paul Armentano, deputy director of the National Organization for the Reform of Marijuana Laws.

“The focus ought to be on the data we do have and do know,” Armentano said. “We’re hopeful that the publication of this report may encourage lawmakers to act different in the future.”

David Downs is the San Francisco Chronicle’s cannabis editor. Subscribe to the Chronicle’s enhanced cannabis coverage by emailing ddowns@sfchronicle.com Twitter: @davidrdowns

Marijuana’s

mixed bag

The National Academies of Sciences, Engineering and Medicine issued a review of research on marijuana, summarizing findings from more than 10,000 published studies. Find the report at: www.nap.edu/read/24625.

Here are some of the main findings:

Cannabis can in some cases treat chronic pain, nausea, muscle spasms associated with multiple sclerosis, and sleep disturbances.

The molecule cannabidiol can treat social anxiety disorder.

Marijuana does not increase risk for head, neck or lung cancer.

Cannabis improves airway dynamics and lung volume with acute use.

Pot probably treats traumatic brain injury.

Teens who use marijuana are at risk for developing “problem cannabis use” later in life.

Pot use prior to driving increases the risk of being in a collision.

There is a potential link between heavy cannabis use and psychoses, but causation has not been proved.

Smoking marijuana during pregnancy may be linked to lower birth weight.

Long-term pot smoking is associated with more frequent bronchitis.

Cannabis’ Big Entrance: Treatment of Epilepsy

Cannabis’ holistic and healing powers may be best known nowadays for their ability to fight seizures due to the media storm around the Charlotte’s Web strain that was recently revealed to the world. While only recently known by the greater populace, studies on the anticonvulsant properties of cannabis have been conducted as far back as the early 1800s.

Epilepsy presents in roughly one percent of the general population as a neurological condition with a wide variety of symptoms based on its location in the brain. Depending on where the disease is focused, patients may suffer from a full spectrum of seizure types, from almost imperceptible breaks in consciousness (or absence seizures) to total body convulsions called grand mal seizures. A period of altered behavior and sensitivity to both light and sounds will prelude most seizures, but many can happen due to simple stress, low blood sugar, sleep loss and even boredom. Epilepsy’s most common causes are anything from birth injuries to head trauma, but it can also be idiopathic (having no known cause at all).

While there are anticonvulsant drugs that exist for controlling epilepsy, they have been noted to be effective only about 60% of the time while still possessing incredibly dangerous side effects. These effects can include emotional disorders, reduced red blood cell production and bone softening. Rarer side effects can present as loss of motor controls, comas and even death.

The research into cannabis’ anticonvulsant properties has been renewed in recent years due to the discovery of cannabidiol, or CBD. This chemical, when bred to flourish while breeding out THC, can make a strain (such as Charlotte’s Web) highly effective at treating seizures and helping to relieve the devastating effects of epilepsy, with none of the dangerous side effects of anticonvulsant drugs.

How Cannabis is Crucial in the Treatment of PTSD

There still rages much debate about medical marijuana’s viability as a treatment for PTSD, or Post-Traumatic Stress Disorder, with some states like California allowing it while others like Colorado are against its use for this specific condition. With as many as 31% of veterans diagnosed with PTSD, where states stand on the matter is a subject of much importance.

Even more astounding than the fact that 31% of veterans are diagnosed with PTSD is the statistic that veterans make up almost 25% of medical marijuana patients. Though the majority of them suffer from PTSD, very few are recommended medical marijuana as a treatment for their condition.

Several studies have been conducted on the potential for cannabis to relieve PTSD, and have turned up promising results. Along with these tests, the American Medical Association is in the process of running controlled tests to determine how effective marijuana can be in treating PTSD and a handful of other conditions.

Anti-Nausea: How Cannabis Plays a Role

While not explicitly a medical condition, and rarely a life-threatening symptom, nausea is still one of the most common symptoms that occur in many dangerous diseases such as cancer and multiple sclerosis. It can even be a simple reaction to the treatment for a specific disease, such as the vomiting normally associated with chemotherapy.

Those patients undergoing chemotherapy to treat cancer are among the most in need of cannabis as relief from their nausea and as an appetite stimulant to combat the extreme loss of appetite induced by the pain and nausea of the chemotherapy treatments.

While cancer is surely the most prominent role for cannabis’ anti-nausea effects, it has uses elsewhere: marijuana has been known to relieve the nausea normally induced by morning sickness. This news may be of concern to some; for ingesting marijuana while pregnant should be dangerous, no? Surprisingly, studies in Jamaica by Dr. Melanie Dreher have shown that there was no difference between newborns and one-month-old babies whose mothers had either used or did not use cannabis during pregnancy.

When consuming cannabis during pregnancy, the best choice is usually through vaporization, as then it is able to bypass the GI tract and stay in the body, allowing it easy access to relieve the nausea of morning sickness.

Cannabinoid Power and Multiple Sclerosis!

At a rate of nearly 200 a week, people across America are being diagnosed with multiple sclerosis. This chronic degenerative condition in the central nervous system can cause muscular weakness, inflammation, and even a loss of motor control in its victims, and over time they will become permanently disabled or even die from the disease.

While a horrifying disease, there is hope on the horizon in the fight against multiple sclerosis. Cannabinoid drugs have been shown in both clinical and anecdotal trials to possess the ability to reduce and relieve the symptoms from MS, namely the pain, muscle spasticity, depression and fatigue. One of the more recent studies that have been conducted was held at UC San Diego, showing cannabis’ ability to, when inhaled, greatly relieve pain and muscle spasticity. This knowledge is reinforced by another study showing that nearly half of all MS patients utilize cannabis for therapeutic purposes.

A more recent study done in 2003 reported that cannabinoids could even possess the ability to hinder the growth of Multiple Sclerosis instead of simply managing its symptoms. To quote the study: “The results of this study are important because they suggest that in addition to symptom management, … cannabis may also slow the neurodegenerative processes that ultimately lead to chronic disability in multiple sclerosis and probably other disease.”

That same year it was discovered that oral THC may be of use in the improvement of immune system function in those who are suffering from MS, with another report in 2006 showing long-term pain relief from utilizing medical cannabis as whole plant extracts.

Insomnia: How Cannabis Can Help

Insomnia is an incredibly common symptom of millions of people, making them unable to sleep for an adequate amount of time or fail to receive the correct quality of sleep. Patients with insomnia suffer in one or both areas of quality resting: falling asleep and staying asleep. Insomnia is known to be caused by a multitude of conditions and diseases, and presents itself in three specific strains. The least problematic type is known as transient insomnia, which still has other symptoms such as mildly impaired motor skills or daytime fatigue and is commonly cause by chronic depression or anxiety.

The most difficult insomnia to deal with, known as chronic insomnia, can cause physical fatigue and even hallucinations in addition to sleep deprivation. Patients with this type of insomnia are incredibly challenged with getting to sleep, and may even wake so frequently during the night that they are hard-pressed to fall back asleep. This lack of sleep slows motor skills and causes heavy fatigue during the day, and will continue in an unending cycle that is the most common symptom of insomnia.

With over sixty million Americans diagnosed with insomnia, many over the age of 65, medications abound for the condition. Unfortunately, these medications also have side effects that include a groggy and tired feeling after waking up. This effect is present is about 70% of those who took medication for their insomnia, and eight percent of those also develop an addiction if the medication is Xanex or Valium.

Medical marijuana has been legal as a prescription for insomnia in almost all of the states that curtly allow cannabis as a medication, and has been proven to be a potent sleep medication without leaving patients tired and groggy in the morning and has a much lower addiction rate than either Xanex or Valium.

The most common type of cannabis used as a sleep aid is indica strains low in the active chemical THC, which allows them to give a better body high and have a much less potent cerebral effect. They can also aid in healing chronic pain, a known major cause of insomnia.

Liver Fibrosis: Halting Organ Failure with Cannabis

The medical journal known as Cell Death and Disease recently conducted studies on liver fibrosis and possible treatments for this horrendous condition. Liver fibrosis is an excessive tissue buildup in the liver which can cause failure of the organ and even death. The Cell Death and Disease study discovered that a chemical in cannabis called CBD (cannabidiol) is able to cause the malignant cells in the liver to undergo apoptosis, or cell suicide, and leave the rest of the liver intact.

The death of these malignant cells is able to stop and reverse the advance of liver fibrosis, and due to CBD’s unique ability to induce the effect, makes CBD a valued choice as treatment for the cell buildup. With liver fibrosis being the tenth leading cause of death in Americans, and at last count affecting over 400,000 American patients, CBD is one of the best choices for new solutions to this deadly disease.

Intraocular Pressure: Relief from Glaucoma

Due to cannabis’ possessing over 400 different chemical components, many of whose potential has not been fully researched, the plant is known for being able to aid in the treatment of multiple conditions and diseases. One of the more common conditions that cannabis is used to treat is glaucoma, a disease of the eyes whose symptoms include an intraocular pressure increase that has been shown to cause blindness. The blindness is usually a result of the pressure causing cataracts to accelerate in growth much faster than normal.

While shown to not have an increase in effect over conventional treatments and drugs, cannabis still possesses the capability to reduce the intraocular pressure in patients with primary open-angle glaucoma, or POAG. Conducted over forty years ago, several studies concluded that patients who used cannabis to treat their glaucoma were able to experience a lowered intraocular pressure for roughly three to four hours, with the only noticeable side effect being a sense of euphoria.

THC, CBD, and Crohn’s

Crohn’s disease is commonly believed to be a condition caused by a combination of genetic and environmental factors (stress, bacterial infections, and a poor diet) that causes a leak in the intestines that allows bacteria to enter the intestinal tissue and cause inflammation and severe pain. The disease has also been known to lead to Ulcerative Colitis, a further degeneration of the intestines that causes them to rupture and bleed.

Cannabis has been discovered by researchers in the United Kingdom to possess two very important chemicals that interact with the intestines: THC and CBD. This discovery has led to anecdotal evidence that medical marijuana can be administered as a treatment for multiple bowel diseases that cause inflammation, specifically Crohn’s. Research has found that the cannabinoids extracted from plants advocate tighter bonds between the cell wall of the intestines that is supposed to prevent leaking or tearing. While this specific information is relatively new, it has been widespread knowledge that medical cannabis can be used as an anti-inflammatory for many diseases like Crohn’s.

While its most noticeable benefit is relief from inflammation, medical cannabis is also prescribed to patients suffering from Crohn’s disease due to its ability to aid in gut tissue regeneration and ease cramps normally suffered from intestinal disturbance. Its appetite stimulation is vital as well, what with Crohn’s disease preventing patients from absorbing essential nutrients through the digestive process.

Pain Management With Cannabis

Chronic pain affects a huge number of patients who all suffer from a wide variety of diseases and injuries, from AIDS to cancer to multiple sclerosis and even degenerative bone disorders or severe burns. Regardless of the original problem, chronic pain will always be a symptom whose frequency and severity differ from patient to patient. The treatment for chronic pain must therefore be able to control all levels of pain in all their appearances in order to reduce its effects of depression and despair, which can by themselves lead to patient death though refusal of potentially lifesaving procedures.

For chronic pain, cannabis is a strong contender in giving relief and rest in an efficient and safe manner. Cannabis can do this because it offers true pain relief when taken either alone or with other analgesics, and also possesses the ability to control the nausea and vomiting that come not only with chronic pain, but also as side effects of the standard opiates prescribed to relieve the pain.

While it is true that opiates are the standard treatment for chronic pain, they are unfortunately very damaging to a patient’s health, in many cases inducing severe nausea that can lead to anorexia, cachexia and malnourishment as the patient’s health declines. In many cases, the patient will decline so far that they stop taking their pain medication just to find relief from the nausea.

In contrast to the many times deadly effects of opiates on patients, cannabis can also provide an almost instant relief from pain without the nausea and anorexia and is generally much more pleasant on the body, either when inhaled or taken as an extract.