Louisville Medicine Volume 67, Issue 2 - Page 18

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