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Medical marijuana overview
- Medical marijuana means the use of marijuana for medical purposes like treating diseases and medical conditions. It is not used to get high, but rather to ease medical symptoms and alleviate any health problems.
- Marijuana also called cannabis, grass, ganja, hash, pot, or weed is obtained from the dried parts of the plant Cannabis.
- Cannabis belongs to the family Cannabaceae and has three species namely Cannabis sativa, Cannabis indica, and Cannabis ruderalis. Medical marijuana is commonly produced from C.sativa and C.indica.
- It contains more than 100 different chemicals called cannabinoids that cause both short or long term changes in mood and consciousness depending on how much, how long, and how often it is used.
- The policy of Marijuana is rapidly evolving in the United States and elsewhere, with full legalization and regulation and permitting its use for medicinal purposes in many countries after a license or permit is issued to a patient.
Pharmacology of marijuana
- The main components of cannabinoids in medicine for therapeutic use are THC (delta-9 tetrahydrocannabinol) and CBD (cannabidiol).
- Our body has its own cannabinoid system called endocannabinoids (eCBs). The endocannabinoids present in the body stimulates the primary endogenous G protein-coupled cannabinoids receptors (GPCRs) called,
- CB1 found in central and peripheral nervous systems inducing psychoactive effects, and
- CB2 is present mostly in the immune system that modulates pain and inflammation.
- Both THC and CBD bind to these receptors and are responsible for the several effects of cannabinoids in the body.
- THC is the psychoactive component that makes individuals feel “high” (such as euphoria, hallucination, etc.) but it also has medical benefits such as pain relief.
- CBS is a non-hallucinating compound that helps to reduce seizures and inflammations and has fewer intoxication effects.
- Successful treatment is achieved by maintaining a proper ratio of each component so that the maximum effect and fewer side effects are produced.
- Due to the high-fat solubility of many cannabinoids it allows a large volume of distribution and long half-life of elimination from the body. Also, they readily cross the blood-brain barrier and placenta and hence causing teratogenicity impairing fetal neural development.
Recreational use of marijuana in the USA
- It is the most commonly used illicit substance and among the adolescents, the second most common substance used after alcohol in the United States and other developed countries.
- Incidence: Marijuana is consumed by approximately 147 million individuals or nearly 2.5% of the global population according to the World Health Organization (WHO), among which approximately 22.2 million Americans are 12 years of age or older. Each year 2.4 million people try it for the first time.
Methods of use
Different methods work differently in the body. Each has a different duration of onset and effects on the body. Inhalation has the fastest onset of action. Commonly used methods are-
- Inhalation: Smoking as cigarette or cigar or vaping in electronic vaporizers. Onset of action: 10–30 minutes after smoking
- Oral: Mixing with food or infusing in tea/coffee/soda or prepared as pills. Onset of action: 1–3 hours after ingestion.
- Topical: Apply to skin in the form of lotion, spray, oil, or cream
- Sublingual: placing a few drops under tongue
- Rectal
Health benefits of medical cannabis
- Produces euphoria
- Reduces anxiety
- Reduces inflammation and thus relieves pain
- Reduces nausea and vomiting caused by cancer chemotherapy
- Destroys cancer cells and slows any tumor growth
- Relax muscles in people with Multiple Sclerosis
- Improves appetite and weight gain in people with cancer and AIDS
- Modulating the immune system
Medical conditions where marijuana is used
Marijuana is legalized for treating specific medical conditions. It is not a cure, but it is used therapeutically for symptoms relief. Medical Marijuana must be considered last-line therapy when all other conventional therapies have failed.
- Inflammatory bowel diseases (Crohn’s disease or ulcerative colitis)
- Cancer and AIDs patient to increase appetite and improve wasting syndrome (Cachexia)
- Nausea and vomiting after cancer chemotherapy
- Epilepsy in children
- Glaucoma
- Alzheimer’s disease
- Posttraumatic stress disorder (PTSD)
- Chronic pain- migraine, fibromyalgia, arthritis
- Muscle relaxant for
- Muscle spasms
- Multiple sclerosis
- Parkinson’s disease
Legalization of medical marijuana in the USA
- There has been significant progress in Marijuana legalization over the years and also several controversies have aroused regarding legal issues of marijuana use.
- It is still illegal in many countries, but some nations have legalized it for medicinal use. A doctor’s certification and patient marijuana card are generally required.
- European countries are among the most progressive with the medical use of cannabis.
- Here you can find the list of countries where medical use of marijuana is legal: List of countries.
Medical marijuana in U.S.
- The first U.S state to legalize medical marijuana was California in 1996.
- Even though the federal government still considers it an illegal drug, many states in the U.S. have authorized its use for the treatment of specific diseases.
- The use of medical marijuana is legalized in 33 U.S. states and Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands. 33 states include- Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Utah, Vermont, Washington, and West Virginia.
The U.S. Food and Drug administration approved marijuana use
- Marinol and Syndros (dronabinol) released in 1985 containing synthetic THC for use as antiemetic to control nausea and vomiting associated with cancer chemotherapy.
- Cesamet (nabilone) also released in 1985 containing THC analog and used for AIDS-related weight loss and anorexia
- Sativex (Nabiximols) released in 2005 for spasticity and neuropathic pain associated with multiple sclerosis. It contains 1:1 THC+CBD and other cannabinoids.
- Epidiolex is a liquid and plant-derived pure CBD for treating very severe or hard-to-treat seizures associated with epilepsy, Lennox-Gastaut syndrome and Dravet syndrome. It was approved recently in 2018.
How to get medical marijuana?
- To use medical marijuana, a marijuana card is required that must be given by a licensed healthcare professional with a written recommendation in states where it is legal.
- First of all, a patient needs to visit a state-certified or trained medical professional.
- A medical professional will determine if the patient has a qualifying medical condition.
- A medical professional cannot prescribe medical marijuana but can provide formal approval.
- A patient would then apply to the state registry which will issue a medical marijuana card that allows the purchase of marijuana at dispensaries/pharmacies where they sell medical marijuana products in a variety of forms.
Side effects of Medical Marijuana
The use of marijuana is not suitable for children under 25 years, individuals with a history of schizophrenia or other mental illness and pregnant women. The side effects are minimal when used at low doses.
Short-term effects
- Fatigue
- Delirium
- Hallucinations
- Impaired short-term Memory
- Dizziness
- Confusion
- Decreased concentration
Long-term effects
- Depression
- Sensation of time slowing
- Psychosis
- Perceptual alterations affecting judgment and impaired motor coordination, which could lead to accidents and injuries.
- Smoking may cause lung problems such as chronic cough and bronchitis.
- Mental retardation, low IQ in children, and delayed growth and development in children if taken during pregnancy.
- Vascular conditions, such as hypertension, myocardial infarction, stroke, and transient ischemic attack
- Psychological dependence and addiction
Addiction to Medical marijuana
- The amount of marijuana used for medical purposes is at a low therapeutic dose that usually does not cause any permanent cognitive impairment or addiction in adults.
- But long-term treatment should be carefully monitored as they are more susceptible to develop psychological dependence especially in the case of adolescents.
- Controlled medical administration of cannabinoids is less likely to cause any addictions or withdrawal symptoms.
- One of the most common side effects of using long-term marijuana is dependence due to higher levels of THC leading to its addiction.
- It is suggested by the National Institute on Drug Abuse that 30% of marijuana users may develop some degree of “marijuana use disorder” and it is 4 – 7 times more likely to develop in people who use marijuana before the age of 18.
Withdrawal symptoms
Withdrawal symptoms are quite common if the drug is suddenly stopped after a long-term treatment causing withdrawal effects that last for at least 1 day after last use and even after 1 month among adolescent users.
- Fatigue
- Difficulty in sleeping
- Irritability
- Dizziness/yawning
- Anxiety
- Depression
- Psychomotor retardation
Since marijuana policy has evolved rapidly and now the drug has become more readily available, it is important for clinicians to recognize the long-term health hazards and neuropsychiatric consequences of its regular use. Hence, proper counseling should be done before recommending and irrational recommendation of marijuana should be avoided.
