A PHYSICIAN SPEAKS: WHAT MOST PEOPLE DON’T KNOW ABOUT MEDICAL MARIJUANA

By Kaaren Nichols, MD, with Catherine Hiller

If you think using medical marijuana will make you stoned all the time, think again. Most strains of medical marijuana are high in CBD (cannabidiol), a non-psychoactive compound that promotes healing, and low in THC (tetrahydrocannabinol), the molecule that gets you high. This is contrary to many recreational strains, which have greater amounts of THC and can result in certain psychotropic effects. For example, children who use Charlotte’s Web cannabis oil, which contains less than .3% THC and helps reduce the incidence of seizures, do not feel or act stoned. They have nothing in common with the recreational user, who relishes an altered mental state.

People should also rethink the idea that medical marijuana has to be smoked. Patients are using it as an edible, a tincture (a liquid placed under the tongue), or, frequently, as a topical (a lotion or a cream applied to the skin). In New York State, medical marijuana is only available in these forms. So even if you’re opposed to smoking, you can still use medical marijuana.

There are hundreds of cannabis strains, all of which have different effects. Some are good for pain, others diminish nausea, and others help people with Post-Traumatic Stress Disorder (PTSD). New strains are constantly being developed for different conditions, including Parkinson’s Disease and Alzheimer’s Disease. Much cannabis research is being legally carried out in Israel and Canada.

Even though the U.S. is home to much groundbreaking medical research, very little has been done in this country on marijuana specifically. In the Forties, a federal official classified marijuana as a Schedule 1 drug (meaning it has no accepted medical use–and a high potential for abuse). This classification meant that for decades marijuana could be studied or prescribed only with enormous difficulty, and thus developed a stigma. Today, however, doctors in 29 states and Washington, D.C., can prescribe medical marijuana for certain conditions.

I am a Family Practice physician in Washington State. The most frequent reason I authorize medical marijuana to my patients is to relieve intractable pain. Many of my patients had been using pharmaceutical opioids (such as OxyContin), which can have undesirable side effects such as severe constipation, nausea, and addiction. By using medical marijuana instead of opioids, they have been able to decrease and even stop their opioid use. For instance, my patient Beverly* was riding her bicycle when she was struck by a car, which fractured her pelvis and both legs. Three years later, she was still using OxyContin to manage her severe pain. After I prescribed her medical marijuana, she was able to decrease her painkiller usage from six pills a day to just one.

OxyContin addiction is extremely serious. Once you stop using, symptoms include itching, sleeplessness, paranoia, and a strong fear of impending death. At this point, many people will seek relief by using heroin, so the medical marijuana option is a huge benefit that may prevent people from experimenting with heroin and other opiates. Use of medical marijuana stops the symptoms of withdrawal at the same time as it diminishes intractable pain.

Another reason I sometimes authorize medical marijuana is for nausea. Just last week, Stephen* came into my office to obtain an authorization. He had recently been diagnosed with lung cancer and was undergoing chemotherapy, which left him extremely nauseated and with no appetite. I recommended that he obtain a marijuana strain developed to help both conditions. He called my office yesterday to tell me that his nausea was completely gone, he was enjoying his meals again, and he was gaining back the weight he had lost.

Medical marijuana is also effective in relieving the nausea experienced by HIV and migraine patients. However, it is not to be used during pregnancy, as it might negatively affect the developing fetus.

The number of conditions that medical marijuana can alleviate is extraordinary.  My 69 year-old patient, John David*, was diagnosed with glaucoma two years ago. His ophthalmologist prescribed him the appropriate eye drops, but after several weeks of use, he found the drops irritated his eyes. He stopped using them and began using a specific strain of marijuana instead. When his doctor tested his eye pressure, he found that it was in a normal range. My patient Betsy* was diagnosed with MS when she was 46. She has been using a strain of medical cannabis that alleviates her symptoms, and she has had no progression of her disease in several years. Eric* returned from Afghanistan and was diagnosed with severe PTSD. He has found that medical marijuana reduces his symptoms so that he can function normally.

Unfortunately in Seattle, where I practice, it has become much more difficult for patients to obtain the medical marijuana they need, even after I authorize it. The closing of medical marijuana dispensaries has deprived patients of the knowledgeable staff who are able to recommend the most effective new strains for various conditions.

Furthermore, since July 1, 2016, patients must pay a high excise tax for their cannabis medicine. Many of my patients live in poverty and rely on social security benefits; these costs are prohibitive. By enacting SB5052, which raised the tax on medical marijuana from zero to 37.5%, the Washington State legislature has forced them to seek non-regulated black-market cannabis, with deleterious results to their health (the ratios of CBD-to-THC are no longer precise) and added risk of arrest. These patients are being denied safe access to specific strains. I hope the government will remove the restrictions it has imposed on this multipurpose medicinal plant.

When penicillin was first discovered, it was hailed as a wonder drug because it was safe, cheap and effective in treating many different conditions. Lester Grinspoon, Associate Professor Emeritus of Psychiatry at Harvard Medical School, writes that “marijuana, for the same three reasons, will eventually be hailed as a wonder medicine.”

Kaaren Nichols, MD, has practiced medicine in the Seattle area for over 35 years. She currently works at a clinic where she authorizes medical marijuana when appropriate.

*Names have been changed