Cannabis has been used for many years as a medication in modern times. Research, when stripped of bias, has shown that it can be effective and safe for a range of illness1. United States Food and Drug Administration (FDA) approved versions of cannabis medications have existed for decades and non-drug products appear to be even more effective.
Yet, most physicians are not even aware of the potential of cannabis medication for their patients and are sadly lacking in comfort to prescribe it when it would be helpful. Here are the top 5 reasons that clinicians should get familiar with this option and comfortable prescribing it.
1. Cannabis Medication Is Effective
Cannabis contains an array of chemicals of which Tetrahydrocannabinol (THC) and Cannabidiol (CBD) are best known2. Synthetic THC and plant-derived CBD are FDA-approved drugs, Dronabinol (Marinol) and Epidiolex, respectively. Observational studies have demonstrated that non-drug cannabis products are more effective than THC alone3-4. While there are many more chemicals that appear to be crucial to the benefit of cannabis that are still poorly characterized, the evidence supports the benefits of cannabis.
Cannabis or cannabinoids have been clearly demonstrated as a therapeutic option for treatment of pain1. Similarly, insomnia is amenable to treatment with cannabis medication5. Some mood disorders like Generalized Anxiety Disorder and unipolar Depression have good, though not definitive, evidence to support use6. Other illnesses, like nausea and vomiting, or appetite deficiency are well supported as well7.
2. Cannabis Medication Is Lower Risk
In many instances cannabis or cannabinoid medication presents less risk than conventional options. The obvious example is opioid medication for pain control. For example, opioid use in the general population presents a 25% risk of dependence compared to 7% for cannabis8.
However, this benefit is not limited to a discussion of pain. Cannabis is significantly safer than benzodiazepines that may be used for sleep and/or for anxiety control8. It has a milder side effect profile compared to phenothiazines commonly used for control of nausea.
3. Useful for Conditions Not Well Treated with Conventional Medications
Many conditions do not have good therapeutic options in the convention armamentarium. Treatment of insomnia with benzodiazepines, antihistamines, and Zolpidem is not only higher risk, but not very effective. Similarly, treatment of anorexia with steroids like Megace or anti-psychotics like Mirtazapine have limited success and significant potential complications. Cannabis medication presents another, more successful approach to these illnesses.
4. Patients Are Using It Anyway
The fact that patients are using cannabis for medical purposes without most of their physicians’ awareness is actually a significant problem. No medication that does anything is without some risk. While the risk from cannabis is generally lower than many of the medications it is being used to replace or reduce, it is not without risk. As with all medications, the risk is proportionate to how it is being used and how much is being used. In non-medical (ie recreational) use, patients are often not aware of their dose nor the reason they should pay attention to dose.
Physicians need to understand cannabis as both potentially positive and negative so that they can have honest conversations with their patients. Steering patients toward medical use, when medically appropriate, focused on route of administration, dose, and frequency will lead to best outcomes. Steering patients toward healthy use patterns under non-medical conditions will decrease their risk of dependence, escalating tolerance, and developing use-disorders.
5. Greater Attention Will Lead to More Research and Drug Development
There is no question that cannabis and cannabinoids need more research. Unlike most conventional medications, which are hard enough to develop and test, cannabis presents many chemicals which are felt likely to interact with each other while providing their effect. This is a new drug development paradigm.
Nonetheless, as we’ve addressed here, there are ample data to support use as a therapeutic currently. As we use cannabis or cannabinoids more in our patient population, more and better research will be done. Ultimately, cannabis-based products with give way to more specific cannabinoid drugs that have gone through the full FDA new drug pathway with its associated research requirements.
Cannabis medication offers significant advantages as an adjunct to conventional medications and will shortly be conventional medications. Clinicians should be aware of these benefits, but also aware of the risks in context and compared to other options. Engaging with your patients to enable them to get these benefits safely, or to mitigate risk for non-medical users, is a crucial role for all providers. We at ACS encourage all clinicians to be educated on this topic and provide courses to ease the process.
Consult with a Qualified Boston Medical Marijuana Expert Today
Those considering using THC, CBD, or any type of medicine found in cannabis to help manage their condition should consider speaking to a trained medical expert who is knowledgeable about using cannabis therapeutically. Massachusetts medical marijuana doctor Jordan Tishler, M.D. sits on the faculty of Harvard Medical School and has years of experience helping patients treat pain and other ailments using cannabis. He and the team at InhaleMD stand ready to assist patients in determining whether medical marijuana is right for them.
For more information, or to set up a virtual consultation with the team at InhaleMD, call us at (617) 477-8886 today.
References
- Practice, H., Division, M., & Academies, N. (2017). The Health Effects of Cannabis and Cannabinoids. https://doi.org/10.17226/24625
- Zagzoog, A., Mohamed, K. A., Kim, H. J. J., Kim, E. D., Frank, C. S., Black, T., … Laprairie, R. B. (2020). In vitro and in vivo pharmacological activity of minor cannabinoids isolated from Cannabis sativa. Scientific Reports, 10(1), 1–13. https://doi.org/10.1038/s41598-020-77175-y
- LaVigne, J. E., Hecksel, R., Keresztes, A., & Streicher, J. M. (2021). Cannabis sativa terpenes are cannabimimetic and selectively enhance cannabinoid activity. Scientific Reports, 11(1), 8232. https://doi.org/10.1038/s41598-021-87740-8
- Vigil, J. M., Stith, S. S., Brockelman, F., Keeling, K., & Hall, B. (2023). Systematic combinations of major cannabinoid and terpene contents in Cannabis flower and patient outcomes: a proof-of-concept assessment of the Vigil Index of Cannabis Chemovars. Journal of Cannabis Research, 5(1), 4. https://doi.org/10.1186/s42238-022-00170-9
- Vigil, J., Stith, S., Diviant, J., Brockelman, F., Keeling, K., & Hall, B. (2018). Effectiveness of Raw, Natural Medical Cannabis Flower for Treating Insomnia under Naturalistic Conditions. Medicines, 5(3), 75. https://doi.org/10.3390/medicines5030075
- Ferber, S. G., Namdar, D., Hen-Shoval, D., Eger, G., Koltai, H., Shoval, G., … Weller, A. (2019). The “Entourage Effect”: Terpenes Coupled with Cannabinoids for the Treatment of Mood Disorders and Anxiety Disorders. Current Neuropharmacology, 18(2), 87–96. https://doi.org/10.2174/1570159×17666190903103923
- Schleider, L. B.-L., Mechoulam, R., Lederman, V., Hilou, M., Lencovsky, O., Betzalel, O., … Novack, V. (2018). Prospective analysis of safety and efficacy of medical cannabis in large unselected population of patients with cancer. European Journal of Internal Medicine, 49, 37–43. https://doi.org/10.1016/J.EJIM.2018.01.023
- Robson, P. (2011). Abuse potential and psychoactive effects of δ-9-tetrahydrocannabinol and cannabidiol oromucosal spray (Sativex), a new cannabinoid medicine. Expert Opinion on Drug Safety, 10(5), 675–685. https://doi.org/10.1517/14740338.2011.575778