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Medical Marijuana (Cannabis)

Overview: In states where it is legal, using marijuana for relief of symptoms from illness or cancer treatments is becoming more common. However, it remains controversial, because medical marijuana is not currently legal under federal law.

Main Points: This article explains how medical marijuana works: what the active ingredients are, which conditions and symptoms may benefit from treatment, the various forms of medical marijuana and how they are used, and possible side effects. A review of legal considerations and precautions to take when using medical marijuana is also included.

Caregiver Considerations: All caregivers who care for patients who use medical marijuana will first need to become very familiar with the laws in their state regarding medical marijuana. In addition, information is provided here on the legal rights for caregivers, what may be needed to obtain medical marijuana, and how to decide what strain of marijuana works best for the patient.

About Marijuana and Medical Marijuana

Marijuana, also known as cannabis, is a plant. Although marijuana use is thought to be fairly modern, it has actually been used around the world for over 3000 years to relax and to treat various health conditions.

Medical marijuana is the use of either the whole plant, or the chemical extracts (parts) of the plant known as cannabinoids, to help treat symptoms from illness or disease treatment (such as chemotherapy.) Currently, using marijuana in any form is considered illegal according to federal US law. However, certain states have passed laws that allow marijuana to be used for medical and/or recreational purposes.

How Medical Marijuana Works

In the past, people most commonly thought of marijuana as an illegal “party drug,” known for the feelings of happiness and enjoyment it produces. However, the chemical extracts of marijuana can be used as effective medication to treat certain illness symptoms. Using marijuana for the sole purpose of treating illness is called medical marijuana.

There are over 100 cannabinoids (the chemical parts of the plant) found in marijuana. The two cannabinoids that have been found to be most effective (so far) in treating illnesses are:

  • THC (scientific name: delta-9-tetrahydrocannabinol): This is the main extract in marijuana that makes people feel relaxed, happy, or “high.” THC also helps reduce nausea, and can increase appetite. It is useful in decreasing pain, reducing muscle control problems, and reducing swelling and inflammation.
  • CBD (scientific name: cannabidiol): This chemical does not have any mind-altering effects, and will not cause people to feel high. CBD is useful in treating pain and swelling, and has been shown to help kill cancer cells (without harming normal cells), and prevent cancer tumors from growing. CBD has also been found to be effective in controlling epileptic seizures in children and treating certain types of mental illness.

There is still much more research that needs to be done to understand how marijuana works in the body, and its potential medical benefits. However, marijuana is currently classified as a Schedule I drug under the U.S. Controlled Substances Act. (The government considers any drugs in this Schedule I category to be unsafe, and to have no medical benefit. Many people, including some medical professionals and scientists, disagree with this classification, and are trying to have it changed.) As a result, this classification currently makes it more difficult for US scientists to conduct research on cannabis.

Conditions that May Be Treated by Medical Marijuana

To date, there have been limited studies on the potential effects and benefits of cannabinoids in treating certain symptoms from diseases or medical therapies such as chemotherapy. (Cannabinoids have only been used to help treat symptoms; they are not a cure for any disease.) Some of the conditions that are being reviewed for treatment with medical marijuana include:

  • AIDS
  • Alzheimer’s disease / dementia
  • Amyotrophic lateral sclerosis (ALS)
  • Arthritis
  • Autism
  • Cancer
  • Crohn’s Disease
  • Diabetes
  • Epilepsy
  • Hepatitis C
  • Huntington’s Disease
  • Multiple Sclerosis
  • Parkinson’s Disease
  • Tourette’s Syndrome

Medical Marijuana Medications

How medical marijuana is used

Medical marijuana may be taken in a variety of ways. These include:

  • Oral use
    • Pills, capsules, or liquid medication (legally distributed through a pharmacy where legal)
    • Tea (Dry herb steeped and made into an herbal tea)
    • Edibles (Baked into edible foods or candies)
    • Tincture (Dry herb soaked in liquid such as alcohol or vinegar, and then taken in a dropper)
  • Smoked in a pipe or paper-rolled cigarette as a dried herb
  • Inhaled with a vaporizer (A vaporizer is a small device that fits in the palm of the hand. Some are shaped like pens. Rather than burning marijuana, the vaporizer will heat the dry herbal marijuana or an oil made from marijuana. Vaporizers produce very little smoke or smell, and are less harsh on the throat than smoking.)
  • Transdermal patches (applied to the skin)
  • Topical creams (applied to the skin)

When smoked or inhaled, marijuana goes from the lungs to the bloodstream very quickly, and produces an immediate effect. Patches or creams applied to the skin also enter the bloodstream fairly rapidly. Marijuana that is taken in pills, foods, teas or tinctures will take longer to take effect, and may last for a longer period of time.

Synthetic Drugs

The US Food and Drug Administration has approved and licensed the following drugs based on cannabinoids:

  • Dronabinol – Used to treat nausea and vomiting from chemotherapy treatments. It is also used to treat loss of appetite and weight loss in people who have AIDS. Dronabinol comes in two forms:
    • Marinol® – Taken in capsule form
    • Syndros® – Taken as a liquid
  • Nabilone – Marketed as Cesamet®, and used to treat nausea and vomiting from chemotherapy treatments. It is taken as a capsule before, during, and after chemotherapy treatment.

Both Dronabinol and Nabilone contain THC. Because THC causes side effects that affect the mind (such as feelings of extreme relaxation, happiness, or temporary lack of ability to think very clearly), Dronabinol and Nabilone are usually only prescribed after other medications that do not affect the mind are tried first.

In other countries (such as Canada, the United Kingdom, and other European countries) a mouth and throat spray made from the chemical parts of marijuana called nabiximols has been licensed to help treat pain in patients with multiple sclerosis and cancer. However, this spray is still being studied in the US, and is not currently legally available here.

Side Effects of Medical Marijuana

Depending on the type of cannabinoid medication used, and how it is ingested (for example, pills vs. smoking), there may be some side effects to medical marijuana. (The side effects are generally short-term, and usually last only a few hours.) These include:

  • Rapid beating of the heart
  • Feeling tired
  • Low blood pressure
  • Muscle relaxation
  • Bloodshot eyes
  • Slowed digestion and movement of food by the stomach and intestines
  • Dizziness
  • Decreased ability to make decisions
  • Reduced short-term memory

If smoked, marijuana may worsen respiratory (breathing) problems or lung conditions such as bronchitis. Long-term, heavy users may possibly experience anxiety, paranoia (fear that is often not rational) or hallucinations (seeing or sensing things that are not real), or depression.

Legal Issues

As noted above, use of marijuana is currently illegal under federal law. However, certain states have passed laws that do allow use of medical marijuana and/or marijuana for recreational use. To view a map of the states and territories where use of medical marijuana is legal, click here: https://www.cancer.gov/images/cdr/live/CDR774100.jpg (Information current as of Dec. 20, 2017)

The specifics of these laws vary widely from state to state. Anyone who is planning to use medical marijuana should carefully research the laws in his/her state to ensure that all use complies with state law. A good resource for reviewing state laws regarding marijuana can be found at:
NORML. State laws and information. http://norml.org/states.

What Caregivers Should Know about Medical Marijuana

If you are a caregiver who will be caring for a patient or loved one who will be using medical marijuana, the first thing you should do is learn the laws in your state about medical marijuana use. Some factors you will need to consider include:

  • Legal rights of caregivers: In states where medical marijuana is legal, most laws allow the patient to choose a caregiver. The chosen caregiver is allowed to buy, transport, and in some cases grow marijuana for the patient. These rights are legally protected by a law called the Rohrabacher-Farr Agreement.
  • Qualifications of caregivers: There may be certain restrictions on who can become a caregiver for patients taking medical marijuana. These restrictions vary in each state, but may include minimum age requirements, no felony convictions, and a requirement that the caregiver is a legal resident of the state. There may also be restrictions on how many patients a caregiver can care for.
  • Learning what works best: Only synthetic drugs (Dronabinol and Nabilone) are regulated. Since all other forms of medical marijuana are not controlled or regulated, there will likely be a good deal of trial and error in finding the strain of marijuana that works best for the patient’s symptoms. (A “strain” refers to the different varieties of cannabis plants. Different strains are grown to enhance certain chemical effects or to make stronger medical treatments.) For example, a person who needs to take medical cannabis to reduce nausea or improve appetite will use a different strain than a person who needs to reduce swelling. You may want to ask advice from a licensed professional who has experience with cannabis for suggestions on which strain to choose. Additionally, people at the dispensary where you buy the marijuana (called “budtenders”) may also be very knowledgeable in helping choose a strain for a particular symptom. There are many different strains, but certain ones may be more popular and available in most dispensaries.

In addition, check with the person you are caring for to find out how he/she felt after using marijuana.You may want to ask questions such as:

  • Did the pain decrease – and if so, how much?
  • Did this strain make you feel anxious?
  • Did this strain make you feel intoxicated? Was this uncomfortable?
  • Did you notice any other symptoms such as headaches, dizziness?

Information about obtaining medical marijuana

If medical marijuana is legal in your state, here are some other things to know about the process of obtaining medical marijuana:

  • Working with a doctor to obtain medical marijuana: Pills that are made from the chemical parts of marijuana (Marinol®, Syndros®, or Cesamet®) can be prescribed by a doctor in states where medical marijuana is legal. However, since medical marijuana is still not approved by the federal government, the patient’s doctor cannot write a standard prescription for any other form of marijuana. Instead, he/she will need to write a “recommendation.”
    A recommendation is a statement signed by the doctor that confirms that the patient has a condition that may benefit from using marijuana. Although the recommendation cannot include usage instructions or dosage amounts, it will enable the patient to apply for a medical marijuana card (if required by their state) or to buy medical marijuana in a dispensary (see below.)
  • Registration or marijuana cards may be needed in some states: Some states may require patients to formally register, or have a card, to buy medical marijuana. There may be a fee to obtain a card.
  • Where to buy medical marijuana: Medical marijuana is bought at state-approved dispensaries. (A dispensary is a legal store that sells marijuana.)
  • Insurance: Medical marijuana will not be covered by insurance.

For further information on how to become a state-authorized patient, legal rights, talking to the doctor about cannabis, and how to use cannabis, go to:

Medical Marijuana (Cannabis) Overview: In states where it is legal, using marijuana for relief of symptoms from illness or cancer treatments is becoming more common.

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