The Science Behind Medical Cannabis
Various studies, anecdotal reports, and scientific literature summaries have been reviewed to the best of the Physician’s ability. Given that the FDA will not approve medical marijuana or its extracts for traditional pharmaceutical use, we are obligated to share the warning that this therapy option is not a guarantee, and is not indicated as a cure, preventative measure, diagnostic tool, or means to mitigate a medical condition. We must keep in mind that some studies are more subjective in comparisons; conclusions of “some benefit” may mean that while the study did not find it statistically significant, while others may still benefit. The best type of study is a randomized clinical trial with humans, but research is banned basically in the US except for special programs; therefore, much data is brought from international sources, invitro or with animal research.
All this being said, with our philosophy to support a patient’s choice in a setting that minimizes risks/harms, we intend to educate based on the science available and provide recommendations. As new data is revealed about the potential benefits of medical marijuana or the risk of side effects, the information below will be updated so that you and your physician can make the best healthcare decisions together. Studies have primarily been done with patients having a terminal condition, and now we are realizing the benefits can also relate to other more common conditions, as long as the correct ratio of CBD and THC are used. Finally, while there is a lot of evidence that medical marijuana can be help numerous conditions, we keep entertain the science with an open mind but will comply with the regulations foremost related to Amendment 2.
- Pain: relief from severe pain caused by neuropathies or visceral/somatic pains from cancers, by itself or as adjunct with opiate medications (which have cardiopulmonary and GI risk issues not found with medical marijuana.)
- Muscle Spasm: studies showed good benefit for patients with Multiple Sclerosis when in ratio of 1:1 THC and CBD in studies using mucosal doses and capsules
- Nausea: calming of nausea to prevent vomiting associated with chemotherapy, through indirect activation of 5HT91a receptors in dorsal raphe nucleus, though studies report variability in benefit
- Anorexia: studies with dronabinol (synthetic THC) were of smaller doses with statistically neutral effects, used most commonly in patients with HIV/AIDS to prevent wasting
- Cancer: no clinical data yet to suggest direct anti-cancer effects (replication is independent of CB1 and CB2 receptors), however an abundance of pre-clinical data suggest an anti-proliferative and pro-apoptotic (self destruction counter attack) that affects cell migration, adhesion, and invasion. The animal tissues studied so far included cancers like breast, brain gliomas, lymphoma/leukemia, lung, prostate, and colon cancer.
- Seizure: anticonvulsant proprieties have long been known of medical marijuana but the mechanism is still under investigation. Early studies showed that high dose THC could actually increase seizure activity but the CBD component provides better results and safety profile. It’s believed that CBD affects many transporter receptors such as the ENT, GPR55, TRPV1, 5HT1a, a3 and a1 glycine receptors to work directly on the nerves to reduce the excitability and transmission of signals, as well as through anti-inflammatory paths TNFa or affecting adenosine uptake to prevent seizure potentials. Many participants or parents of children who were included in these studies using cannabis extract also reported improvement in developmental skills (motor, language), alertness or sleep, and mood.
- Psychiatry: acts on limbic system to help regulate mood (borderline personality, PTSD, anxiety more than depression, affective disorders), stress, and reward. It may be used as therapy for dystonia, a side effect of some psychotropic medications. For those with sleep disorders these studies showed medical marijuana was weakly beneficial.
- Anti-inflammatory – decreased TNFa. Very high doses would not be good for an immunocompromised patient.
- Neuroprotective – possible mechanisms include prevention of oxidative damage, moreso than would Vit C or E. Additional theories suggest an increase cerebral blood flow, with potential for improved stroke recovery.
- Immunomodulatory- the CB2 receptors in skin have shown such autoimmune conditions like psoriasis, as well as mice having less joint destruction from similar rheumatoid disease.
- Glaucoma – potential to reduce the optic pressures moderately, benefit with protection of the nerves of the eyes
- Metabolic – surveys of regular medical marijuana users revealed that they were actually less likely to develop Metabolic Syndrome, meaning lower BMIs, and subsequently less incidence of diabetes (less insulin resistance) and cholesterol issues (with better HDL). The biological pathways are yet to be discovered.
- Other- the Florida Medical Association Certification course for Physicians also detailed some emerging science yet to be validated in human studies, but these include to potential to increase blood flow to the heart after a heart attack (increased perfusion in mice) or after stroke (less MCA infarct volume). The serotonin system may have a role in this process.