Medical Cannabis

The term ‘medical cannabis’ is a broad one and people can interpret it in several ways, but it basically means any cannabis-based medicine that is used to relieve symptoms.

The chemical constituents in cannabis that have been studied most for their medical benefits are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the main psychoactive constituent of cannabis, responsible for giving the drug ‘high’ to users whereas CBD is not psychoactive and so does not.

US federal law prohibits the use of medical cannabis, and they consider it a Schedule I drug (high potential for abuse and no accepted medical use) under the Controlled Substances Act. However, most states have their own laws regarding its use, but they vary greatly on how they define and regulate it, as well as how it can be prescribed and sold. Some states have also approved it for recreational use, although it is not allowed at the federal level. This makes for a confusing situation. Therefore, it’s very important to become familiar with the laws in your state before acquiring medical or recreational cannabis. The Justice Department will not prosecute individuals if they are using cannabis in accordance with their state’s regulations. You can find your states regulations by visiting the website of the National Conference of State Legislatures at: https://www.ncsl.org/health/state-medical-cannabis-laws.

Medical cannabis is usually only considered by your doctor when other treatments are not suitable or have not helped. Depending on the state, you may qualify if you have certain conditions, such as:

• Severe and chronic pain
• Multiple sclerosis (MS) and muscle spasms
• Crohn’s disease
• Glaucoma
• Epilepsy and seizures
• HIV and AIDS

There are three forms of cannabinoids that are FDA-approved and can be obtained on prescription in the US.

Nabilone (Cesamet)

This medication is used to treat the nausea and vomiting that can occur during chemotherapy (treatment for cancer) when other treatments have not worked. Taken as a capsule, it is a ‘man-made cannabis’ which acts in a similar way to THC – the ingredient that produces the cannabis ‘high’.

Cannabidiol (Epidiolex)

Used for children and adults with severe epilepsy (specifically the rare forms called Dravet syndrome and Lennox-Gastaut syndrome) this is taken as a liquid and contains highly purified CBD – the substance in cannabis that appears to provide most medical benefit. Because it does not contain any THC, there is no ‘high’ from using it.

Dronabiol (Marinol, Syndros)

This medication is a synthetic form of THC that is used for nausea and vomiting due to cancer chemotherapy and for anorexia associated with weight loss in AIDS patients.

Nabiximol, also known as Sativex, is given as a mouth spray and is used to treat the muscle stiffness and spasms linked to multiple sclerosis where other treatments have failed. This medication is not FDA-approved in the US.

You can obtain a medical cannabis card if your state allows it. Requirements will vary, but you will need your doctor’s approval. You will then apply to your state’s medical marijuana registry. Once you receive your card you can use it at any approved dispensary.

Is medical cannabis safe?

If a product (such as Epidiolex) contains only CBD and no THC, it has none of the risks that may occur with those that do contain THC (and the long-term risks of using products that contain THC are unclear). In general, the greater the concentration of THC in the product, the greater the potential risks. One significant risk is of becoming dependent on the medication (although in a controlled setting and when under the supervision of a specialist doctor this risk is small), and another is of psychosis. There is evidence that the regular use of street cannabis (especially the high strength form) can trigger psychotic illnesses such as schizophrenia in some people. The most dangerous form of cannabis is that bought from drug dealers where the strength and ingredients are unknown.