I find it ironic that after spending my professional life focused on the dangers posed to individuals by psychoactive substances and working to help them not use these substances, I am being asked to present information about the therapeutic use of cannabis. Now that medical cannabis is available in Maryland as well as DC, patients are looking for guidance from clinicians – who have received little or no information about this substance in their formal training. Furthermore, much of the information being offered about the dangers and benefits of cannabis tends to be distorted positively or negatively according to the philosophical orientation of the source.
In trying to provide balanced, evidence-based information, I have written articles for medical organizations and presented lectures for clinicians. Here are the major points that I make:
- Cannabis has medical value. The evidence is strongest for chronic pain (especially neuropathic), nausea and vomiting from chemotherapy, and muscle spasticity from multiple sclerosis. One component of cannabis – cannabidiol (CBD) – may be useful for childhood seizure disorders, but the evidence is still being collected.
- Cannabis use can be dangerous. The most common problem is impaired driving, especially when alcohol is also used. If used heavily before the age of 18, it may cause a permanent decrease in IQ as well as other cognitive problems. Heavy use at any age can cause addiction.
- Our internal cannabinoid system, which is activated by the use of cannabis, is extremely complex and extensive, influencing pain, inflammation, mood, stress, movement, appetite, immunity, bone density, and tumor surveillance.
- Information about the cannabinoid system is limited because of both its complexity as well as the obstacles to legitimate scientific research created by the U.S. government, in particular, the Drug Enforcement Administration and the Department of Justice. Efforts to reduce these obstacles, including U.S. congressional legislation, have thus far been unsuccessful.
- Development of conventional pharmaceutical preparations of cannabis has also been retarded by federal law enforcement agencies. Increased public interest in and acceptance of the medical benefits of cannabis have led to a state-level system of artisanal, herbal preparations being distributed through a newly established system of dispensaries which operate in parallel to conventional pharmacies. Unresolved issues related to product quality and dosing make this “workaround” problematic.
For those interested in more details, a video recording of the latest version of my cannabis talk was made by Sheppard Pratt…
Here is the slide deck from the presentation…