Weighing the Pros and Cons of Medical Marijuana

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“IT’S REALLY the wild west,” said Penn psychologist Marcel Bonn-Miller–referring to medical marijuana, both to its use for treating everything from cancer to chronic pain, insomnia, anxiety and depression, and to the unregulated production of hundreds of marijuana formulations.

(Medical marijuana is legal and available in more than half of US states and DC, but all marijuana use remains illegal under federal law.)

Experts lament the dearth of research on medical effects of marijuana.  Speaking about its best-documented health benefit—treating childhood epilepsy—Iowa clinical pharmacist Timothy Welty said, “This is really the only area where the evidence has risen to the point where the FDA has said this is acceptable to approve a new drug.”

Meanwhile, physicians are prescribing marijuana for everything from nausea to Parkinson’s Disease.  And anecdotes abound—most about pain-reduction and a few very dramatic, such as the guy who takes one day off every spring to imbibe “a lot” of marijuana, which he credits for bringing his otherwise-unbearable springtime allergies to a full-stop.

Medical marijuana use among Americans age 50 and older increases every year.  In states where marijuana is legal for medicinal or recreational use, 12 percent of those 50 and over have used it in the past six months, with 19% of these citing pain relief as their primary reason and 16% citing relaxation.

One AARP survey found 6% using it for medical reasons, a percentage considered by the study’s researchers to be “relatively high,” compared with prior studies and a “tipping point for medical marijuana.”

Among the concerns of poll director, University of Michigan professor Preeti Malani is the lack of standardized doses for medical marijuana. Also, more than half the respondents using it did not tell their primary care physician—a risk because at least one marijuana ingredient, CBD, can make a patient’s other medications more or less effective.

“We already worry about memory loss with this population,” Malani said: “Is it accelerated in older adults who use medical marijuana?”

The existence of a system of endocannabinoid receptors in the body appears to indicate a natural pathway for cannabinoids found in marijuana (including THC and CBD) to affect the body.  But as most people who have tried marijuana know, personal reactions can fall anywhere between two extremes: exhilaration, relaxation, amusement and pleasurable munchies—and depression, fatigue and over-eating.

Such a range is similar to the way different drugs—in particular, anti-depressants—and different diets work well or not so well for different individuals.  In addition, the effects of marijuana vary widely depending on different strains and formulations.

CBD, for example—one of dozens of cannabinoids that does not produce a psychoactive response and has been used for “thousands of years” to treat pain and insomnia—varies in effect by levels of the compound found in different plants, which depends in turn on how the plant is bred; by different methods used to extract the compound; and by different formulations.

CBD content—in edibles, like chocolates or gummies; tinctures, placed under the tongue using droppers; and topicals—is unreliable.  In a 2017 study of CBD products led by Bonn-Miller, 43% contained less CBD than labeled while 26% contained more. In earlier testing by the FDA, some products contained no CBD at all.

(Another complicating factor: while CBD can be extracted both from hemp plants, which are legal, and marijuana plants, which are illegal under federal law, medical marijuana cardholders can typically access CBD products containing much higher concentrations of cannabidiol than hemp-derived CBD products.)

While CBD is popular because of its lack of psychoactive properties, what’s known as the “entourage effect” means that an array of compounds from the plant can have a more beneficial effect than CBD alone —and products with the best-reported benefits contain THC, the ingredient that can cause both euphoria and depression.

After childhood epilepsy, the next most promising application for CBD is countering inflammation, but good research results come from animal studies: the most-often cited, using a topical CBD gel, showed “significant drop in inflammation and signs of pain”—when applied to rats.  And pain is both notoriously difficult to measure objectively and susceptible to the placebo effect.

What appeals to many people about medical marijuana is the purported absence of side-effects and development of tolerance, although reviews have noted the risk of tiredness, diarrhea and weight gain or loss, as well as increased liver enzymes suggesting possible liver damage.  Furthermore, “cannabis-dependent” is listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition (DSM IV).

Getting a “medical marijuana card” in DC is an ever-changing process with many steps, which can be facilitated by a local dispensary. You must visit a “marijuana doctor,” who provides a “marijuana recommendation”—in my case, for arthritis pain.  That costs around $50.  Then you fill out forms, provide identification and proof of residency and mail everything to the DC Department of Health.

The dispensary, Takoma Wellness, helped me do all this—for which I paid $100 that could be used as credit for purchasing products once the card was obtained (although that is no longer true).  The entire process must be repeated every year.  After a year sampling recommended products, most making me too tired to judge pain reduction or to continue taking them, I don’t plan to renew my card.

But I’m hopeful marijuana won’t disappear from my life entirely.  When I purchased gummies and sampled them during a visit to Denver, my iTunes music collection sounded better than ever before and led to an unusually deep and refreshing sleep.  Because marijuana products are illegal to transport out of state and gummies are not offered in DC dispensaries, any future use must await changes in federal law.

Until then, marijuana-infused Epsom salts make a hot bath feel both relaxing and pain-relieving. Although originally purchased at the DC pharmacy, these are easy to prepare from marijuana plants growing (legally) in our DC garden.

—Mary Carpenter

Every Tuesday in this space Mary Carpenter reports on well-being, taking on topics like living longer, the dangers of  homeopathy and psychedelic therapy.