What is medical marijuana?

The term medical marijuana refers to using the whole, unprocessed marijuana plant or its basic extracts
to treat symptoms of illness and other conditions

Why isn’t the marijuana plant an FDA-approved medicine?

The FDA requires carefully conducted studies (clinical trials) in hundreds to thousands of human subjects
to determine the benefits and risks of a possible medication. So far, researchers haven't conducted
enough large-scale clinical trials that show that the benefits of the marijuana plant (as opposed to its
cannabinoid ingredients) outweigh its risks in patients it's meant to treat.

What are cannabinoids?

Cannabinoids are chemicals related to delta-9-tetrahydrocannabinol(THC), marijuana’s
main mind-altering ingredient that makes people "high." The marijuana plant contains
more than 100 cannabinoids. Scientists as well as illegal manufacturers have produced
many cannabinoids in the lab. Some of these cannabinoids are extremely powerful and
have led to serious health effects when misused

How might cannabinoids be useful as

medicine?
Currently, the two main cannabinoids from the marijuana plant that are of medical
interest are THC and CBD. 

THC can increase appetite and reduce nausea. THC may also decrease pain,
inflammation (swelling and redness), and muscle control problems.

Unlike THC, CBD is a cannabinoid that doesn't make people "high." It may be useful in
reducing pain and inflammation, controlling epileptic seizures, and possibly even
treating mental illness and addictions.

Many researchers, including those funded by the National Institutes of Health (NIH),
are continuing to explore the possible uses of THC, CBD, and other cannabinoids for
medical treatment.
 Photo by ©iStock.com/AlexRaths

For instance, recent animal studies have shown that marijuana extracts may help kill
certain cancer cells and reduce the size of others. Evidence from one cell culture study
with rodents suggests that purified extracts from whole-plant marijuana can slow the
growth of cancer cells from one of the most serious types of brain tumors. Research in
mice showed that treatment with purified extracts of THC and CBD, when used with
radiation, increased the cancer-killing effects of the radiation. 8
Scientists are also conducting preclinical and clinical trials with marijuana and its
extracts to treat symptoms of illness and other conditions, such as:

 diseases that affect the immune system, including:

 HIV/AIDS

 multiple sclerosis (MS), which causes gradual loss of muscle control

 inflammation

 pain

 seizures

 substance use disorders

 mental disorders
What medications contain cannabinoids?
Two FDA-approved drugs, dronabinol and nabilone, contain THC. They treat nausea
caused by chemotherapy and increase appetite in patients with extreme weight loss
caused by AIDS. Continued research might lead to more medications.

The United Kingdom, Canada, and several European countries have approved
nabiximols (Sativex®), a mouth spray containing THC and CBD. It treats muscle control
problems caused by MS, but it isn't FDA-approved.

Epidiolex, a CBD-based liquid drug to treat certain forms of childhood epilepsy, is being
tested in clinical trials but isn't yet FDA-approved.

Points to Remember

 The term medical marijuana refers to treating symptoms of illness and other

conditions with the whole, unprocessed marijuana plant or its basic extracts.
 The FDA has not recognized or approved the marijuana plant as medicine.

 However, scientific study of the chemicals in marijuana called cannabinoids has

led to two FDA-approved medications in pill form, dronabinol and nabilone, used to
treat nausea and boost appetite.
 Cannabinoids are chemicals related to delta-9-tetrahydrocannabinol (THC),
marijuana’s main mind-altering ingredient.
 Currently, the two main cannabinoids from the marijuana plant that are of
interest for medical treatment are THC and cannabidiol (CBD).
 The body also produces its own cannabinoid chemicals.

 Scientists are conducting preclinical and clinical trials with marijuana and its
extracts to treat symptoms of illness and other conditions.
Opioids vs. Medical Cannabis — Which Is
Better For Chronic Pain?
With his recent announcement that opioid abuse amounted to a public health
emergency, President Trump acknowledged a fact already sadly apparent to
millions of Americans. In 2016, 64,000 people died from drug overdoses (with
prescription and illicit opioids responsible for the majority of drug overdoses).
For Americans under 50, drug overdose is the leading cause of death.

With some 140 Americans dying each day from opioids — and the powerful
dependance patterns long-term users develop — finding a solution is no simple
task. (Notably, while opioid-induced fatal drug overdoses are skyrocketing, the
Drug Enforcement Agency notes that no death from cannabis overdose has
ever been reported.)  
Given the comparative low toxicity and low potential for abuse of cannabis, is
cannabis superior to opioids to treat chronic pain?
Medical Cannabis May Save Lives Lost to Opioid
Addiction
From a public health perspective — given the relative safety of cannabis
compared to opioid medications — it seems clear: With a much lower risk of
dependence than opioids and virtually no risk of fatal overdose, cannabis
trumps opioids. Hands down.
To underscore the point, earlier in 2017, WeedMaps, a California company
that publishes an online dispensary rating guide, launched a creative billboard
marketing campaign. On a simple black background on the billboards, the text
read:
“States that legalized marijuana had 25% fewer opioid-related deaths.”
The message was stark and unforgettable, and it sparked heated controversy in
some neighborhoods hard hit by the opioid crisis.
The WeedMaps data was based on a 2014 study published in JAMA Internal
Medicine. Dr. Mark S. Brown and Marie J. Hayes, opioid abuse researchers and
authors of the study, commented: “The striking implication is that medical
marijuana laws, when implemented, may represent a promising approach for
stemming runaway rates of unintentional opioid-analgesic-related deaths.”
Cannabis in History: A Long Track Record as Safe
Medicine
Neither cannabis nor opium—the plant from which synthetic opioids are
derived—are new additions to the medicine cabinet. Cannabis has been used to
treat chronic pain, stomach ailments, anxiety and a host of other conditions
for at least 4,000 years.
Opium’s medical use dates back even further, to at least 3400 BCE. If it was
recognized early for its powerful pain-killing properties, it was also understood
to be habit-forming by at least the 18th century, if not long before.
By comparison, cannabis remained in the American pharmacopoeia as an
accepted folk remedy until the early 20th century, when the rising tides of
both the Temperance movement and anti-immigrant sentiment—marijuana
was widely linked with an influx of Mexican migrant workers—led to its being
banned in most states, and eventually on the federal level in 1937.
Marijuana Medicine: Is it “Strong Enough” to Stop
Pain Compared to Opioids?
While cannabis has a long and historical track record of being used to treat a
variety of ailments, and the evidence clearly suggests cannabis is far safer, less
addictive, and less potentially destructive than opioids, the question remains:
Can cannabis actually treat chronic pain more effectively than opioids?
With the wave of medical cannabis legalization showing no signs of stopping, a
flood of research is uncovering cannabis’ potential as a treatment for chronic
pain. And it turns out the physicians of millennia past were on to something.
Let’s look at the science:
Patients seem to prefer using cannabis in place of opioids, many claiming it
works better for them than opioids. A paper published in the Journal of
Cannabis and Cannabinoid Research used data from a group of 2,897 medical
cannabis patients.
 34 percent reported having used opioid pain medication in the previous
six months. A majority of patients reported that cannabis was just as
effective or more effective than opioids — but without undesirable side
effects.
 Of the patients reporting having used opioids, 97 percent reported
having been able to reduce or eliminate opioids.
 And, 81 percent reported using cannabis alone was more effective
opioids.
The authors of the study concluded: “Cannabis can be an effective treatment
for pain, greatly reduces the chance of dependence, and eliminates the risk of
fatal overdose compared to opioid-based medications. Medical cannabis
patients report that cannabis is just as effective, if not more, than opioid-based
medications for pain.”
A 2015 Harvard-led review (a meta-analysis) of 28 studies examining the
efficacy of cannabinoids to treat various pain and medical issues, drew similar
conclusions. The authors concluded, “Use of marijuana for chronic pain,
neuropathic pain, and spasticity due to multiple sclerosis is supported by high-
quality evidence.”
The following year, a study by the University of Michigan found that cannabis,
among other things:
 Decreased the side effects from other medications
 Improved subjects’ overall quality of life
 Reduced use of opioids, on average, by 64%
Findings from recent research validate the vast amount of anecdotal
evidencestrongly supporting cannabis’ efficacy in treating chronic pain.
Cannabis Can Take a Little Trial and Error
While cannabis may seem like a godsend — and for many patients it is — for
some it takes a little bit of trial and error to find the right cannabinoid ratio and
intake method. Cannabis is not a single drug; it’s a highly complex plant with
hundreds of cannabinoids and terpenes working together synergistically to
influence its effects.
For chronic pain, we find most patients opt for products higher in THC. I
caught up with Dr. Stephen Dahmer, Vireo’s chief medical officer, and asked
him what most chronic pain patients experiences were like:
What we’ve seen in chronic pain is that a patient will gravitate a little bit more
towards a higher THC product. They’ll move in that direction if they’re not
responding to the treatment that’s given. So, generally, in terms of dosing, we’ll
slide them towards higher THC, but also increase the amount of CBD. That could
potentiate [extend the duration of] the THC while offsetting potential side effects.
In pain, most of the scientific research is going to back this up. If you look at the
randomized double-blind control studies done specifically with neuropathic pain,
it’s higher THC strains that have the best evidence behind them. But, we will also
find in practicality if a patient is not responding to increasing levels of THC,
sometimes we’ll flip things upside down and give them a high CBD, and particularly
in inflammatory disorders, patients might respond well to that, where they may not
respond well to a higher THC.
So, a combination of science and trial and error, and a lot of feedback. Very close
feedback with the patient, making sure they’re getting the most optimal effects
with the fewest side effects.
So while most patients seem to respond better to products with higher THC
levels, others find a 1:1 (THC:CBD) or a high CBD product works great.
Likewise, some people prefer inhalation (finding vaporizing delivers the fast
relief). Others find inhalation can exacerbate their pain, and prefer oral
administration (e.g. capsules or tinctures).
There’s no “one size fits all,” but at Vireo we developed the Vireo Spectrum to
make it easier finding the right cannabinoid profile (cannabinoid profiles are
color coded correlating to the levels of THC and CBD). Dr. Dahmer explains:
“[The Vireo Spectrum] provides a visual, allowing us to maximize efficacy in
terms of treatment of the symptoms that they’re bringing to the table while
minimizing side effects.
https://www.drugabuse.gov/publications/drugfacts/marijuana

https://www.washingtonpost.com/news/wonk/wp/2014/10/01/92-of-patients-say-medical-marijuana-
works/?utm_term=.0e3e3329f6d5

https://edition.cnn.com/2018/01/22/health/medical-marijuana-school-illinois/index.html

https://www.nbcnews.com/health/health-news/cannabis-drug-reduces-seizures-severe-epilepsy-cases-
n764381

https://www.providr.com/cannabis-can-treat-crohns-disease/?
utm_source=Athela&utm_medium=facebook&utm_campaign=providr

Marijuana and Cancer

Marijuana is the name given to the dried buds and leaves of varieties of the Cannabis sativa plant,
which can grow wild in warm and tropical climates throughout the world and be cultivated
commercially. It goes by many names, including pot, grass, cannabis, weed, hemp, hash,
marihuana, ganja, and dozens of others.

Marijuana has been used in herbal remedies for centuries. Scientists have identified many
biologically active components in marijuana. These are called cannabinoids. The two best studied
components are the chemicals delta-9-tetrahydrocannabinol (often referred to as THC),
and cannabidiol (CBD). Other cannabinoids are being studied.

At this time, the US Drug Enforcement Administration (DEA) lists marijuana and its cannabinoids as
Schedule I controlled substances. This means that they cannot legally be prescribed, possessed, or
sold under federal law. Whole or crude marijuana (including marijuana oil or hemp oil) is not
approved by the US Food and Drug Administration (FDA) for any medical use. But the use of
marijuana to treat some medical conditions is legal under state laws in many states.
Dronabinol, a pharmaceutical form of THC, and a man-made cannabinoid drug called nabilone are
approved by the FDA to treat some conditions.

Marijuana
Different compounds in marijuana have different actions in the human body. For example, delta-9-
tetrahydrocannabinol (THC) seems to cause the "high" reported by marijuana users, and also can
help relieve pain and nausea, reduce inflammation, and can act as an antioxidant. Cannabidiol
(CBD) can help treat seizures, can reduce anxiety and paranoia, and can counteract the "high"
caused by THC.

Different cultivars (strains or types) and even different crops of marijuana plants can have varying
amounts of these and other active compounds. This means that marijuana can have different effects
based on the strain used.

The effects of marijuana also vary depending on how marijuana compounds enter the body:

 When taken by mouth, such as in baked goods, the THC is absorbed poorly and can take
hours to be absorbed. Once it’s absorbed, it’s processed by the liver, which produces a
second psychoactive compound (a substance that acts on the brain and changes mood or
consciousness) that affects the brain differently than THC.
 When marijuana is smoked or vaporized (inhaled), THC enters the bloodstream and goes
to the brain quickly. The second psychoactive compound is produced in small amounts, and
so has less effect. The effects of inhaled marijuana fade faster than marijuana taken by
mouth.
How can marijuana affect symptoms of cancer?
A number of small studies of smoked marijuana found that it can be helpful in treating nausea and
vomiting from cancer chemotherapy.

A few studies have found that inhaled (smoked or vaporized) marijuana can be helpful treatment
of neuropathic pain (pain caused by damaged nerves).

Smoked marijuana has also helped improve food intake in HIV patients in studies.

There are no studies in people of the effects of marijuana oil or hemp oil.
Studies have long shown that people who took marijuana extracts in clinical trials tended to need
less pain medicine.

More recently, scientists reported that THC and other cannabinoids such as CBD slow growth and/or
cause death in certain types of cancer cells growing in lab dishes. Some animal studies also suggest
certain cannabinoids may slow growth and reduce spread of some forms of cancer.

There have been some early clinical trials of cannabinoids in treating cancer in humans and more
studies are planned. While the studies so far have shown that cannabinoids can be safe in treating
cancer, they do not show that they help control or cure the disease.

Relying on marijuana alone as treatment while avoiding or delaying conventional medical care for
cancer may have serious health consequences.

Possible harms of marijuana

Marijuana can also pose some harms to users. While the most common effect of marijuana is a
feeling of euphoria ("high"), it also can lower the user’s control over movement, cause disorientation,
and sometimes cause unpleasant thoughts or feelings of anxiety and paranoia.

Smoked marijuana delivers THC and other cannabinoids to the body, but it also delivers harmful
substances to users and those close by, including many of the same substances found in tobacco
smoke.

Because marijuana plants come in different strains with different levels of active compounds, it can
make each user’s experience very hard to predict. The effects can also differ based on how deeply
and for how long the user inhales. Likewise, the effects of ingesting marijuana orally can vary
between people. Also, some chronic users can develop an unhealthy dependence on marijuana.

Cannabinoid drugs
There are 2 chemically pure drugs based on marijuana compounds that have been approved in the
US for medical use.

 Dronabinol (Marinol®) is a gelatin capsule containing delta-9-tetrahydrocannabinol (THC)

that’s approved by the US Food and Drug Administration (FDA) to treat nausea and vomiting
caused by cancer chemotherapy as well as weight loss and poor appetite in patients with
AIDS.
  Nabilone (Cesamet®) is a synthetic cannabinoid that acts much like THC. It can be taken
by mouth to treat nausea and vomiting caused by cancer chemotherapy when other drugs
have not worked.
Nabiximols is a cannabinoid drug still under study in the US. It’s a mouth spray made up of a whole-
plant extract with THC and cannabidiol (CBD) in an almost one to one mix. It’s available in Canada
and parts of Europe to treat pain linked to cancer, as well as muscle spasms and pain from multiple
sclerosis (MS). It’s not approved in the US at this time, but it’s being tested in clinical trials to see if it
can help a number of conditions.

How can cannabinoid drugs affect symptoms of cancer?

Based on a number of studies, dronabinol can be helpful for reducing nausea and vomiting linked to
chemotherapy.

Dronabinol has also been found to help improve food intake and prevent weight loss in patients with
HIV. In studies of cancer patients, though, it wasn’t better than placebo or another drug (megestrol
acetate).

Nabiximols has shown promise for helping people with cancer pain that’s unrelieved by strong pain
medicines, but it hasn’t been found to be helpful in every study done. Research is still being done on
this drug.

Side effects of cannabinoid drugs

Like many other drugs, the prescription cannabinoids, dronabinol and nabilone, can cause side
effects and complications.

Some people have trouble with increased heart rate, decreased blood pressure (especially when
standing up), dizziness or lightheadedness, and fainting. These drugs can cause drowsiness as well
as mood changes or a feeling of being “high” that some people find uncomfortable. They can also
worsen depression, mania, or other mental illness. Some patients taking nabilone in studies reported
hallucinations. The drugs may increase some effects of sedatives, sleeping pills, or alcohol, such as
sleepiness and poor coordination. Patients have also reported problems with dry mouth and trouble
with recent memory.

Older patients may have more problems with side effects and are usually started on lower doses.

People who have had emotional illnesses, paranoia, or hallucinations may find their symptoms are
worse when taking cannabinoid drugs.
Talk to your doctor about what you should expect when taking one of these drugs. It’s a good idea to
have someone with you when you first start taking one of these drugs and after any dose changes.

What does the American Cancer Society say about the use of
marijuana in people with cancer?
The American Cancer Society supports the need for more scientific research on cannabinoids for
cancer patients, and recognizes the need for better and more effective therapies that can overcome
the often debilitating side effects of cancer and its treatment. The Society also believes that the
classification of marijuana as a Schedule I controlled substance by the US Drug Enforcement
Administration imposes numerous conditions on researchers and deters scientific study of
cannabinoids. Federal officials should examine options consistent with federal law for enabling more
scientific study on marijuana.

Medical decisions about pain and symptom management should be made between the patient and
his or her doctor, balancing evidence of benefit and harm to the patient, the patient’s preferences
and values, and any laws and regulations that may apply.

The American Cancer Society Cancer Action Network (ACS CAN), the Society’s advocacy affiliate,
has not taken a position on legalization of marijuana for medical purposes because of the need for
more scientific research on marijuana’s potential benefits and harms. However, ACS CAN opposes
the smoking or vaping of marijuana and other cannabinoids in public places because the
carcinogens in marijuana smoke pose numerous health hazards to the patient and others in the
patient’s presence.