Marijuana is classed as a schedule I drug—defined as a drug with no current accepted medical use and a high potential for abuse. The DEA also states that it can create severe psychological and/or physical dependence. However, on August 29th of this year, the Department of Health and Human Services recommended that the DEA reschedule marijuana from schedule I to schedule III—defined as having “a potential for abuse less than the drugs … in schedules I and II” and “a currently accepted medical use.”
Why the change of heart?
Currently, there is plenty of research to suggest that marijuana and cannabis products are of the medical grade. Some medications, such as Dronabinol and Nabilone (both FDA aproved) include a derivative of THC, which is the primary psychoactive cannabinoid extracted from the cannabis plant.It is used to treat cancer-related nausea, and pain, as well as seizures.
Cannabis’ therapeutic properties begin at the molecular level, where cannibinoids interact with their respective receptors. The most prominent ligands at cannabinoid receptors are tetrahydrocannabinol (THC) and cannabidiol (CBD). The two isotypes of cannabinoid receptors, CB1 and CB2 can be found throughout the human body in various organs and tissues. THC, tetrahydrocannabinol, is most associated with psychotropic effects, whereas CBD, cannabidiol, is more associated with anti-inflammatory, anti-epileptic, and anti-emetic effects, among others.
The consumption methods of cannabis vary, but the most common route is via smoke inhalation. When cannabis is smoked, the components are absorbed into the endothelial lining of the alveoli of the lungs, and from there, delivered to the central nervous system (CNS). It is important to recognize that the ability to control or dose cannabinoid delivery via smoke inhalation is problematic due to variable distribution and control of the active components present. Now, pharmaceutical companies are looking for other routes of administration/consumption.
Cannabis users have long reported therapeutic properties of the plant, and now pharmaceutical companies are investigating further—ongoing drug development could provide promising benefits from the endocannibinoid receptor agonism and the cannabinoid receptor agonism .
In patients with multiple sclerosis, or (MS)-related spasticity, short-term use of oral cannabinoids improves patient-reported spasticity symptoms.
In patients with cancer-related pain and other chemotherapy induced symptoms, oral cannabinoids are effective antiemetics and assist in managing pain. This also reduces the use of opioids in these patients, which can deter drug-related adverse affects and long-term opioid use.
In patients with non-cancer related pain who were treated with cannabis or cannabinoids are more likely to experience a clinically significant reduction in pain symptoms.
There are plenty of conditions in which medical cannabis can provide therapy, including PTSD, epilepsy, degenerative neurological conditions, amongst a list of others.
Of course, there are concerns with the use of marijuana, as there is with any drug. According to the DEA, effects of marijuana are responsible for impairments in learning, associative properties, and psychomotor behavior. Long term and regular use can lead to physical dependence and withdrawal after discontinuation. There are multiple side effects including dizziness, nausea, facial flushing, dry mouth, tremor, tachycardia, merriment, enhanced sensory perception, impaired judgement, and more. However, these side effects are not indicated for medical marijuana.
For healthcare providers, either for or against the use of marijuana or cannabis for therapeutic purposes, there is plenty of information that must be understood and read up on in order to advance the field and come to a greater understanding of the drug and it’s medicinal uses.
Healthcare providers should take the time to be open-minded and non-judgmental when it comes to a conversation about medical marijuana. There are several million users of marijuana in the United States alone, both medical and recreational. Although it is controversial, it has entered the space of scientific conversation and we must embrace it in order to comprehend it better and come to a conclusion on it’s appropriate uses.
Sources:
Urits, I., Borchart, M., Hasegawa, M. et al. An Update of Current Cannabis-Based Pharmaceuticals in Pain Medicine. Pain Ther 8, 41–51 (2019). https://doi.org/10.1007/s40122-019-0114-4
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda.
Washington (DC): National Academies Press (US); 2017 Jan 12.
Ng T, Gupta V, Keshock MC. Tetrahydrocannabinol (THC) [Updated 2023 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563174/
