Tag: Medical marijuana

Nov. 10, 2022 – I was in the exam room, saving my big question for last, as one does. 

It was my first meeting with my new primary care doctor  in Colorado, and I was impressed with his fluid citations and advice from recent studies on heart disease, exercise injuries, and musculoskeletal pain – three of my major sore points. 

So far, so good.

Then I ventured my last question. “I’ve been having sleep difficulties ever since my older son was born.” (Note: That was during the first Bush administration.) “But now that I’m in Colorado, I wonder if cannabis might help me through the night? I hear it’s good for that.” 

Suddenly, my doctor clammed up. 

“I’ve heard some things, too,” he told me. “But I can’t advise you on that, because I could lose my license.” 

He could no more recommend cannabis than he could heroin or ecstasy — because all are designated Schedule 1 drugs on the federal level. (Though that could change, given President Joe Biden’s recent moves toward marijuana reform.)

When I was an editor at a health magazine, the surest way to kill any story idea was to dismiss it as being based on mere “anecdotal evidence,” which we regarded as a synonym for “fairy dust” or “snake oil.” 

No double-blind study, no deal. 

Smith didn’t have that luxury. He took his training in obstetrics and gynecology. And when his pregnant patients came to him with refractory nausea and vomiting, he went off the books, and told them, “I know somebody who can help you.” 

Right: a cannabis dealer. 

And while you register shock that an MD would recommend an extra-pharmaceutical treatment, consider this: Opioids are an approved drug, and they killed 68,630 people via overdoses in 2020 alone, according to the CDC. Deaths by cannabis overdose are either nonexistent or exceedingly rare. 

That was part of Smith’s calculation, when he took over a roster of patients who were (a) pregnant, and (b) self-medicating with opioids and other drugs, to the point of addiction. 

G. Malik Burnett, MD, is an addiction medicine specialist in Baltimore, and co-author of a study called “Policy Ahead of the Science: Medical Cannabis Laws Versus Scientific Evidence.” That sums up the problem with cannabis therapies today: The treatment cat is out of the medical-research bag, and running all over the 42-odd conditions that justify a medical marijuana card — and a hundred others that do not.

As Burnett’s study says: “U.S. medical cannabis laws are in conflict with federal law and often with science as well.” 

And yet, Burnett is far from a cannabis naysayer. In his study, he notes that the most commonly included conditions on state lists — cachexia/weight loss, muscle spasticity associated with multiple sclerosis, nausea and vomiting, chronic pain, and seizures — are also the ones with the most evidence that cannabis therapy works. But the lists also stray into areas where there is no evidence (ALS, arthritis, cancer), limited evidence (autism, HIV/AIDS, opioid-use disorder), or even evidence of potential harm (glaucoma, depression, PTSD). 

The Healing History of Cannabis

For all the federal chest-pounding against cannabis, there’s a certain irony there, too. The first U.S. patent for cannabis-as-medicine is held by none other than the Department of Health and Human Services. They applied for the patent in 1999 for cannabinoids to be used as anti-inflammatories and neuroprotectants. Something was in the air, and not just at Grateful Dead revivals. 

The high-producing ingredient in cannabis – delta-9-tetrahydrocannabinol, or THC — was first isolated in 1964, by Israeli researcher Raphael Mechoulam and his team at the Hebrew University of Jerusalem, who were free to chase their research wherever it might lead. (Israel remains the world leader in cannabis research, says Smith.) Twenty years later, they discovered that the human body has a multitude of cannabinoid receptors in the brain, gut, skin, immune system, organs, and reproductive system. A study in Cerebrum called it “literally a bridge between body and mind.” These receptors are activated by endogenous cannabinoids. That is: cannabinoids produced by the body’s own internal dispensary. Soon the endocannabinoid system, or ECS, took its place alongside the circulatory system, nervous system, immune system, and endocrine system, as a primary body regulator. 

Users Ahead of the Research

His mother was expected to live for just 5  more months, and the treatments were debilitating. So Young and his mother decided to “try something new.” Young researched protocols for people with wasting syndrome, which impacted many AIDS patients during that pandemic. Through his connections in the cannabis community, where he counseled non-violent drug offenders, he found a concentrated form of cannabis oil that might help his mom. Her doctors backed off from the unfamiliar therapy, telling them: “We can’t work with you.”

But they persevered. “In only 2 months, there was a reversal of what I had seen. She was back up to 95 pounds,” Young says. “I had my mom back.” 

Experimenting with Cannabis: Finding the Right Plan for You

So what about me and my health issues? I really did want to talk to a doctor, so I turned to Veriheal (the cannabis-education company Smith consults for). 

For $110, Veriheal will arrange a telehealth consultation with a medical professional. In my case, it was Carlie Bell, ND. She’s a naturopathic physician in Houston, having completed undergraduate studies in pre-med, plus a four-year graduate program in therapies that help the body heal itself. Bell is also a cannabis educator at Saint Louis University, working with practitioners who want to give better answers than my doctor did. 

She crackled to life on my computer via a telehealth app, and soon we were deep in the weeds of my sleep issues. Bell listened to my sleeplessness woes, cited research on the ECS, and recommended that I commence a protocol using full-spectrum CBD (meaning it’s derived from whole-flower cannabis). She proposed that I take it in tincture form, 2 hours before bedtime, and hold it under my tongue for 45 seconds to a minute. The benefits: The CBD would be absorbed through mucous membranes in my mouth, for an immediate calming effect, but the amount that I swallowed would work its way through my digestive tract, for a longer-lasting soporific effect.

I experimented based on the advice and found a plan that worked for me: I start the night with a prescription to help with my restless legs syndrome, then use a sublingual cannabis if I am wakeful in the middle of the night. It hasn’t cured my insomnia, but it has given me treatment options I didn’t have before. I awake refreshed, with no grogginess — a common problem I had when I was taking prescription sleeping pills.

Bell reiterated cautions I was to hear half a dozen times, as I completed research for this story:

• Start low, go slow. When experimenting with psychoactive forms of cannabis– those with THC – take a minimum dose several days in a row, before titrating up until you receive the desired effect. CBD won’t make you high, but you should be wary of dosing there, as well. Taking too many cannabinoids may cause arousal, not sleep. 
• Choose preparations that are easy to measure, use, and adjust as needed. A calibrated eyedropper can help you dial in a dose, a cannabis cookie not so much. A vape pen allows you to start with one inhalation, see how you feel, and move up (two puffs) or down (a shallower puff). 
• Beware of edibles. Just like candy, right? Yes, but with a crucial difference. It can take up to 2 hours for a THC edible to take effect, which leads some to double dose while waiting for the first one to kick in. That kind of double whammy can lead to a miserable 12 hours of feeling “too high,” and only time can relieve it.
• Quality counts. Compare makers. Some apply rigorous standards to their cannabis products, including making sure that doses are uniform, and that they’re uncontaminated by pesticides or toxins. Unscrupulous formulators let it slide. You need to know the difference.
• Take a deep dive into studies about treating your condition with cannabis. You can start with the chart above from “Policy Ahead of the Science,” which will give you an up-to-date idea of how strong, or weak, the evidence is that you can gain help from cannabis. Realmofcaring.org also has an online research library, and condition-specific websites (sleepfoundation.org, for instance) can guide you as well. Use Reddit and chat groups at your own risk. 
• Consult your doctor and pharmacist. As legalization spreads, so does training among healthcare providers. If your doctor can’t speak knowledgeably (or at all) on the subject, you may want to supplement their advice through Realm of Caring, Veriheal, or a local doctor who specializes in natural remedies. Pharmacists will know if cannabis might clash with other medications. (In Pennsylvania, every dispensary is required to have a pharmacist on staff.) The budtender in a dispensary can help with suggestions based on personal experience, as well. But it’s kind of like asking your 13-year-old for computer advice: Results may vary.