T
FEATURE
he term ‘Medical’ Marijuana has
a long history but, except for ap-
proved uses for pharmaceutical
THC, it has little support. FDA ap-
proval for oral cannabinoids exists
for chemotherapy induced nausea, anorexia
with AIDS, and glaucoma, and these do carry
an evidence base to support use. Evidence is
otherwise anecdotal and unsecured for the
use of cannabinoids for other disease states. control and are inadequately labeled. This has led to accidental
and unintentional poisonings, psychotic episodes and emergen-
cy room visits. ER visits in 2011 were 456,000, an increase of 21
percent from 2009.
Marijuana contains the primary cannabinoids of delta nine THC
and cannabidiol, but also greater than 85 other cannabinoids and
over 500 other chemicals. In considering its proposed therapeutic
use, we must consider both sides of the controversy: benefits vs.
consequences. Arguments for the efficacy of treatment of seizures,
spasticity in Multiple Sclerosis, mental health disorders such as
psychosis and PTSD, and pain, although controversial and con-
flictual, hold some weight, but beg for more data. 1. There are acute cognitive effects, worse with early age onset
of use.
Alternatively, consider the risks. Marijuana is used by 61 percent
of all persons with Substance Use Disorders (SUD), 22.2 million
in 2015. Approximately nine percent will develop Cannabis Use
Disorder (CUD). This rises to 17 percent for those who initiate use
in adolescence and to more than 25 percent with daily use. Although
it is noteworthy that teen use has stabilized, the incidence of CUD
has increased from 30.2 to 35.6 percent. With identified tolerance
and withdrawal, THC does produce dependence and addiction
per DSM criteria. 6. There is an association between exposure to cannabinoids and
various psychotic outcomes.
In the field of Addiction Medicine, it has been a foundation to
consider a goal of treatment as completely drug free, that is, no use
of mood-altering substances. Surely in these days of the opioid crisis,
harm reduction approaches reach more relevance, as do medica-
tions for treatment of SUDs. Yet if we accept that SUDs follow a
chronic, progressive and often fatal course, it is not acceptable to
compromise on an unapproved use of any such substance. Science
must more clearly delineate benefits vs. consequences. 11. Cannabidiol (CBD) has activity against seizures.
The neuropsychiatric effects of marijuana are well documented.
Clearly there is evidence of acute cognitive effect with use, and
the suggestion of altered brain function and structure. Psychosis,
anxiety and panic have been identified. Functional studies show
altered brain development, impaired neural connectivity, dimin-
ished activity in the prefrontal cortex, and reduced volume in the
hippocampus.
Learning difficulty and reduced academic performance have
been established, as is decreased workplace productivity. These
studies do need replication.
Medical complications to be considered are pulmonary effects,
carcinogenicity and immune suppression. Not to compare alcohol
with cannabinoids, but both play a significant role in impaired
driving and resultant motor vehicle accidents.
Edible products pose additional questions as does use by smok-
ing and inhalation. Edibles have varied THC content, lack quality
A national meeting sponsored by the NIH in March 2016 was
titled “Marijuana and Cannabinoids: A Neuroscience Research
Summit.” It tried to answer these questions: what do we know, how
do we know what we think we know, and what do we still need to
know? Some of the conclusions are as follows:
2. Questions exist regarding widespread changes in brain struc-
ture.
3. Use adversely affects learning.
4. Use adversely affects memory and attention.
5. These can improve with abstinence.
7. Cannabis has addiction potential.
8. CUD resembles other SUDs.
9. Changing laws and regulations will impact the development
and prevalence of CUD.
10. Compared to either drug alone, the concurrent use of alcohol
and THC leads to binge drinking, SUD and major depression.
12. CBD seems to be effective at controlling specific cardinal
symptoms of Multiple Sclerosis.
13. Cannabis is the most common illicit drug identified in motor
vehicle accidents and fatalities in the U.S.
Let us all use strong scientific evidence to guide the process for
any therapeutic use of cannabinoids. Only when it can be deter-
mined which components show efficacy, that the benefits outweigh
harm, that the overall economic impact has been firmly established,
can we then move forward in using cannabinoids as a therapeutic
tool. Not until this time can we properly use the term ‘Medical’
for any cannabinoid.
References available on request.
Dr. Jorrisch is currently practicing Addiction Medicine and is Medical Di-
rector of MORE Center, a nonprofit, Louisville Metro Health Dept. Opioid
Treatment Program, Medical Director of BHG Lexington OTP, Medical
Director of Addiction Treatment Services at OLOP, and President of the
Kentucky Society of Addiction Medicine.
The counterpoint article was written by Dr.
Don Stacy and published in the August issue
of Louisville Medicine.
OCTOBER 2017
13