IN-TRAINING/STUDENT
CATEGORY
WINNER
2019 RICHARD SPEAR, MD,
MEMORIAL ESSAY CONTEST
SHOULD MEDICAL MARIJUANA HAVE A PLACE
IN KENTUCKY HEALTH CARE?
M
AUTHOR Ahmed Saleh
edical marijuana, or medical
cannabis, has been a subject
of discussion in the media for
years; 33 states and the District
of Columbia have legalized mar-
ijuana’s use for medical purposes
(1). Yet there is still much we do
not know about the plant and its efficacy in
medical practice. Recently, Kentucky state
representatives have introduced a bill in favor of legalization. With
this in mind, it is important for Kentuckians to consider marijua-
na’s place in Kentucky health care.
A BRIEF HISTORY OF MEDICAL MARIJUANA
The history of medical marijuana dates as far back as 2,737 BCE
in ancient China. That was the year that the Chinese emperor and
pharmacologist Shen-Nung documented a text describing its use
as an ailment. He designated it as a treatment for many conditions
including constipation and gout (2). Almost 2,000 years later, Chi-
nese physicians used the plant as a surgical anesthetic (3). It was
also used by the ancient Greeks and Romans as a treatment for ear
inflammation (4).
The use of cannabis in early modern medicine began with Dr.
William Brooke O’Shaughnessy in 1830. He was an Irish physician
who discovered the herb during his professorship at the Medical
College of Calcutta. He later went on to use it as a treatment for
chronic pain, vomiting and a multitude of other conditions. In
1860, cannabis found popularity amongst American physicians
for its medicinal properties (5). However, that popularity waned in
the U.S. at the turn of the century. The Marihuana Tax Act of 1937
introduced physician fees and regulations for prescribing canna-
bis (6). Then-President Richard Nixon introduced the Controlled
Substance Act (CSA) in 1970.
The CSA deemed marijuana a Schedule I controlled substance.
16
LOUISVILLE MEDICINE
It is a classification for drugs known to be addictive, abusive and
devoid of any accepted medical use [7]. Other drugs with Schedule
I classifications include heroin, LSD and MDMA. This legislation
marked the beginning of the “war on drugs” which criminalized
and demonized the perception of marijuana. It still stands today
and has proven to be obstructive to the use of medical marijuana
in legalized states. It has also introduced challenges for researchers
interested in investigating its use as a drug.
MARIJUANA AS A MEDICINE
The major compounds within marijuana are delta-9-tetrahydro-
cannabinol (THC) and cannabidiol (CBD). But these are not the
only chemicals found within the plant. There are over 400 active
chemicals within cannabis (8). Many of those compounds vary
depending on the strain.
THC causes most of the psychoactive effects associated with
marijuana. These effects occur through activation of the endo-
cannabinoid system. Although researchers have discovered many
of THC’s mechanisms of action, much is still unknown. Those of
CBD are even less understood. What researchers do know is that
THC and CBD often have different effects. Both compounds have
similar roles in reducing inflammation, nausea, vomiting and sei-
zure activity. Yet there are many differences between the effects of
the two chemicals. For example, administration of CBD does not
induce transient psychotic symptoms or increase levels of anxi-
ety, intoxication and sedation like THC. Nor does CBD have an
effect on behavioral changes like its counterpart. Administration
of THC also causes heartrate and blood pressure to increase, while
CBD causes a decrease in those same metrics (8).
Despite what we know about THC and CBD’s effects, it is un-
certain if treatment with medical marijuana is advantageous for
patient use (9). This is because the Food and Drug Administra-
tion does not regulate marijuana products. Without regulation
protocol, the content of seemingly identical products may actually