Doctors find Medical Cannabis Effective for Cancer, Pain, and many other Conditions but News Downplays the Results.
The Ohio Medical Marijuana Control Program published an annual report with results of physicians who recommend Medical Cannabis. 648, that’s the number of Ohio physicians actively certified for the program. The program permits 25 medical conditions that qualify for Cannabis treatment in Ohio. One of the key questions of from the report asks physicians, “How satisfied are you with the effectiveness of medical marijuana in treating your patients with the qualifying conditions”. The Physicians were asked to rate each condition with “Satisfied”, “Neutral”, “Dissatisfied”, “Other”, and “Not Applicable”
An article by Laura Hancock in Cleveland.com puzzles me. Although the results of this report are overwhelmingly positive, for some reason the story downplays it. It identifies that 59.4% of physicians were satisfied with the effect of Cannabis on chronic or intractable pain, 53.5% were satisfied with its effectiveness for cancer patients, 50.8% were satisfied for fibromyalgia and 50.3% for post-traumatic stress disorder patients. The results were much better. Only 65% of the doctors responded to the survey. If the percentage of respondents are calculated, 91% of physicians who saw patients with pain were satisfied with the results, 82% for cancer, and 77% for both fibromyalgia and PTSD. Out of the doctors seeing patients with Sickle Cell, 82% were satisfied with Cannabis. Prior studies indicate only 65 % of patients are satisfied with traditional treatment for Sickle Cell and 75% seeking alternative treatments. For every condition in this report, physicians were more satisfied than dissatisfied with Cannabis as treatment. Even for less responsive conditions, like Huntington’s Disease.
Dr. Ryan Marino, Case Western University toxicologists and addiction medicine specialist notes, “There is little evidence in the US about the effectiveness of marijuana”. When asked about the report, he backtracks and qualifies his answer by saying, “I think those conditions are anecdotally what people report success with,” and adds, “the low dissatisfaction rates are likely due to marijuana’s relative low risk.
Dr. Solomon Zaraa, president of Compassionate Cleveland, a medical Cannabis practice sees the survey results as like his own experience. He sees many chronic pain patients who prefer not to depend on opiates. He also sees PTSD patients who are less reluctant to enter therapy after they use Cannabis.
Rather than downplaying, the results of this report, we should shout it from the mountain tops. It’s promising that doctors of patients who use Cannabis are satisfied with the results. However, the stigma of Cannabis continues to be an adversary to real-world evidence. As a response, we must keep publishing survey results such as this. And as a follow up, we should probably find out what the patients themselves think of using Cannabis.
Advances in Cannabis Cancer Research
I evaluated a couple of patients this week treating cancer with Cannabis and looked at recent news to see what progress is being made in Cannabis cancer research.
Early-stage research suggests that Cannabis-derived medicines could be effective in treating various cancers.
Although those of us in the Cannabis industry may already be aware of this, the medical community is just coming around to accepting the idea.
Recent experimental treatments and small-scale clinical trials in Europe are showing the efficacy of medicinal Cannabis formulations.
THC has primarily been used in cancer treatment for palliative care, to relieve nausea, and stimulate appetite. However, early-stage research is suggesting that Cannabis, which is more than THC, is also a highly effective treatment for killing cancer cells.
So, how does it work?
Pre-clinical studies have shown that cannabinoids reduce cancer cell growth and disrupt the blood supply to cancerous cells, including brain tumors, breast cancers and prostate cancer, among others.
With, potentially, hundreds of naturally occurring constituents, there is no one magic medical Cannabis bullet in cancer treatment. Cutting edge work using artificial intelligence (AI) is being carried out to analyze Cannabis plant genetics and to determine the best combination of cannabinoids, terpenes, flavonoids, and other constituents to target and optimize the treatment of various cancers. It’s a many-to-many puzzle; many active ingredients to treat many types of cancers.
In pre-clinical studies, Cannabis cancer treatments can be tested through either 2D or 3D cell culture testing. 3D cell cultures allow researchers to recreate specific pathological environments The improvement in 3D cell culture technology has led to the generation of models that encompass more physiological and tissue-specific micro-environments,
Despite advancements in pre-clinical testing, the key to gaining full acceptance in the medical community is real human data from clinical trials. Currently, there is a small-scale clinical trial on glioblastoma (a brain cancer) in the UK and another trial on liver cancer in the Netherlands.
Scientists are also assessing the role of ‘personalized medicines. Personalized medicine recognizes that we are all physiologically unique and uses individualized DNA sequencing to target treatment. Personalized medicine is already used in the traditional treatment of cancer.
Combined,. the analysis of AI, 3D Cell Cultures and personalized medicine present a huge opportunity for medical Cannabis and the treatment of cancer.
The lifetime prevalence of post-traumatic stress disorder (PTSD) ranges from 6.1 to 9.2 percent of the general population. Does past trauma cause trouble sleeping? Yes.
A new Israeli study published in the Journal of Anxiety Disorders assesses the association between PTSD, Medical Cannabis use, and sleep. After a traumatic experience, 80-90% of people suffer from sleep disturbances. Nightmares and frequent or early awakening are common. People with sleep disturbances caused by PTSD are likely to worsen their PTSD, potentially experiencing suicidal ideations, inflicting self-injury, and becoming disabled.
Some pharmaceutical medications are effective for improving sleep in people with PTSD. However, research on Cannabis use and PTSD is limited. There’s some evidence that THC reduces the occurrence of nightmares and improves sleep quality in patients with PTSD. As well, some animal studies indicate that CBD improves sleep. Typically, studies evaluate low dose, single molecule extracts or synthetic cannabinoids. However, Cannabis is more than THC or CBD.
A recent study by Dr. Sue Sisley examined the effects of smoked Cannabis flowers and PTSD. The study was randomized, double-blinded, and placebo-controlled. However, it didn’t demonstrate any improvement in sleep. How could this be? The accounts of thousands of patients Cannabis can’t be wrong. Dr. Sisley’s study involved participants who are long term Cannabis users. During the study, they reported Cannabis withdrawal symptoms, indicating that the controlled dosage of the study was likely too low.
The Israeli study was conducted differently. Rather than control the amount used, participants were asked to keep a diary of their daily Medical Cannabis use. On average the Cannabis used by participants had higher THC levels (18%). As for the conclusion, Medical Cannabis users demonstrated a shorter time to falling asleep, less nightmares, and less early awakening. Furthermore, those who used Cannabis with a higher CBD content were less likely to wake up early.
Randomized, double-blind, placebo-controlled trials are generally considered the gold standard in single agent pharmaceutical drug discovery. However, the study of herbal Cannabis needs a paradigm shift. Real world Cannabis users have never relied on single agent cannabinoids in controlled fashion. Their herbal Cannabis use ranges widely from a few puffs to consuming a full gram or two. These contrasting studies highlight an important conclusion about Cannabis research. Controlled trials are not the best way to initiate studies on Cannabis. Non-interventional studies where participants are permitted to dose themselves have more external validity, meaning they reflect what is happening in the real world.
Herbal Cannabis has helped patients with PTSD tremendously; particularly those with insomnia and nightmares. Studies are best used to understand how herbal Cannabis works not if it works. Real world evidence, like the Israeli study, demonstrates that Cannabis works.
Jean Talleyrand, M.D.,