 After three months, the Australian QUEST Initiative demonstrates that Cannabis improves the quality of life of patients with chronic health conditions.
As Cannabis use increases, questions arise as to the overall benefits of the plant. Public health authorities highlight increasing calls to poison control centers and emergency department visits. The National Institute of Drug Abuse stubbornly holds on to a failed war on “drugs” by questioning the incidence of psychological disorders among young Cannabis users. These claims are reminiscent of Reefer Madness. As with most controversial topics, there is equal or better evidence contradicting the claims. NIDA Director, Dr. Nora Volkow, might retort that studying benefits of Cannabis is not a directive. Whether NIDA's directive is valid (or not), what’s clear is that Cannabis will never go away. It's use improves health and wellness. The U.S. Cannabis community is accustomed to consuming the flower. In the U.S., Cannabis flowers are approximately 60% of sales. Cannabis flowers are difficult to prescribe. Due to variable active constituents, most flower users must apply trial and error to determine an appropriate dose. Flower consumption includes a broader spectrum of terpenes, thiols, esters, and flavonoids, constituents beyond cannabinoids. South of the equator, Australians acknowledge Cannabis use for health and wellness. Although Cannabis flower is available in Australia, researchers at the University of Sydney prefer to study the effect of a more standardized and predictable Cannabis oil. Australian physicians prescribe the oil for chronic conditions involving pain, anxiety, and depression. The oil is extracted from the flower and dispensed by dropper. The products consist of different ratios of THC and CBD in a base of medium chain triglycerides (MCT). For the QUEST initiative, physicians and patients choose four different oil formulations, including 1:20 (1 mg THC and 20 mg CBD per 1 ml), 1:1 (10mg THC and !0 mg CBD per ml), 20:5 (20 mg THC and 5 mg CBD per 1 ml), and CBD 50 (50 mg CBD per 1 ml). The Initiative evaluates patient reported outcomes from 2327 patients prescribed Cannabis oil. The patients completed a baseline and at least one follow-up survey. The average age of the participants was 51 years old, 63% were female and 37% were male. Due to their illness, 25% of the participants were either unemployed, on leave, or on limited work duties. Analysis of the data describes significant and rapid initial improvement of health-related quality of life measures maintained over three months. Pain, fatigue, anxiety, and depression all improved. However, respondents with sleep disturbance or diagnosed with insomnia did not demonstrate statistical improvement. Most of the elderly suffer from chronic pain which significantly alters daily activities and imposes a burden on health care costs. As a poor alternative, opioids lead to serious adverse events including respiratory depression and death. Anxiety and depression symptoms impair work and social functioning. In the past fifty years, despite economic growth, quality of life in the US has declined. Cannabis prohibition accounts for a minute fraction of time. US HHS Secretary Xavier Becerra’s recent recommendation to re-schedule Cannabis under the Controlled Substances Act is an indication that a century of Cannabis prohibition is nearly over. We have evolved with Cannabis. Admittedly, panaceas don’t exist. But, if we have to select a solution or remedy for all difficulties or diseases, Cannabis might be second only to water. Meanwhile, this Australian study from provides real-world evidence to quiet dissenters.  Currently, 38 states have Medical Cannabis laws, and 23 states have adult recreational laws. Whether smoking a joint to relax after a hard day of work or ingesting Cannabis oil to stop seizures, it’s clear that many consumers benefit from the health and wellness effects of using Cannabis.
A few decades ago, public attitude regarding Cannabis shifted. The notion that sick people should be allowed to use a relatively safe plant signaled the beginning of the Cannabis movement. Compassion, caregiving, and community were hallmarks. However, issues of access, safety, and consistency arose as the Cannabis industry transitioned from traditionally illegal exchange to tested, regulated, and taxed Cannabis sales. In time, consumers did not want to justify their use to a profession of uninformed and inexperienced healthcare professionals who had ignored Cannabis science despite its apparent usefulness. Consequently, recreational or adult use laws were implemented. How have the recreational laws affected access by Medical Cannabis users? Below are three stories from three different states (two states and D.C.) that highlight how recreational laws may have affected Medical Cannabis users. The first story is from Michigan with a headline that reads “Medical Cannabis Pioneered Legal Weed in Michigan. Now it’s Withering Away.” by Dustin Walsh from Crains Grand Rapids Business. In Michigan, medical Cannabis sales are down 71% from one year ago and 86% from two years ago. The average cost of an ounce is down 52% over the last year to $102. While the medical market declines, Michigan’s adult use market is hitting new heights selling $270 million in July alone and expecting to surpass $3 billion this year, second only to California’s market. Ankur Rungta, CEO of C3 Industries, a vertically integrated operator with 13 high profile dispensaries, explains, “For medical [sales] to really drive a comeback there would need to be differentiation. It’s the same product on both sides (medical or recreational).” Rungta believes that the medical market won’t revive until more research is done on Cannabis products. The second story is from Minnesota, with a headline from MinnPost. “With Legalization of Recreational Cannabis What Does That Mean for Medical Cannabis in Minnesota,” by Peter Callahagn. The story features Minnesota patient Patrick McClellan, who is excited to be installing a hydroponic system to grow his own home Cannabis. “Home grow is a game changer for patients,” says McClellan. With the passage of new recreational laws, Minnesota Medical patients have ended up with the best of both worlds. A recent law will improve access and possibly lower prices for all consumers. “Patients who have been going to two medical providers for the last nine years have been extremely limited,” says McClellan. RISE, owned by Green Thumb Industries (GTI) and GREEN GOODS, owned by Vireo Health, are the only two medical Cannabis operators in Minnesota with 8 stores each throughout the state. The new recreational bill increases access by adding more dispensaries. It was also designed to limit the market dominance of the two main operators, but a lobbying effort by GTI and VIreo convinced legislators to maintain vertical integration and allow the two largest organizations to also sell to the recreational market. “Our medical market is already pretty small,” explained State Representative Zack Stephenson. “We risked losing a medical industry all together.” The third story is from the Washington Post where the headline is “Learning the Highs and Lows of D.C.’s Medical Cannabis Lingo,” by Courtland Milloy. The author is touring a DC dispensary called Anacostia Organics in the Southeast of Washington D.C. In DC, patients pay $30 to get a self-appointed Medical Cannabis card. This past July neighboring Maryland passed a recreational law. According to dispensary owner Linda Mercado Greene, “People from DC began going to Maryland because they could buy Cannabis without spending $30 for a medical card.” (Although, carrying Cannabis across state lines is a federal offense.) Referring to Maryland’s law, Greene says, “It’s kicking our buts, but we hope things will even out soon.” Although products are the same in both recreational and medical Cannabis industries, these laws have had different effects in each state. There doesn’t seem to be much distinction between the two industries except for what laws and regulators make of it. In our exuberance for legalization, have we created a distinction between recreational and medical Cannabis that doesn’t exist? From medical to health and wellness to consumer product good industries, what we all sorely missing is more Cannabis research and education. People know why they use Cannabis. Because of a relatively good safety profile people can use it without judgment, oversight, or adverse effects. Rather than guidance by a medical industry influenced by profit over science, consumers can now grow their own. Meanwhile, it doesn’t hurt to follow the science as we apply new analysis to an old plant.  Opioid overdose deaths in the United States continue to rise. Last year, opiate overdoses toppled over 100,000 for the second year in a row. Sixty-eight percent were due to synthetic opiates, mostly fentanyl. We place our trust in the FDA and the pharmaceutical industry to inform us of impending dangers from drugs. Yet, our trust waivers as it’s revealed that pharmaceutical companies, like Purdue, and its owners, the Sackler family, played a “special role” in initiating the current opiate crisis by pursuing a marketing approach that persuaded the medical establishment to widely prescribe opiates. Decades later highly addictive synthetic opiates, like fentanyl, are fueling the crisis and addiction demands the supply of opiates from unregulated markets.
Opiate addicts are pivoting to accessible Cannabis in places where its legal. Researchers at the University of British Columbia and UCLA teamed to investigate the success of this harm reduction strategy. 205 people who use unregulated “street” opioids were selected to complete a Cannabis questionnaire. 118 participants (57.6%) reported using Cannabis to manage opioid cravings resulting in a significant reduction in their opioid use. The researchers concluded that improving the accessibility of Cannabis may be a useful strategy to mitigate the associated harms of the current opioid epidemic. The biochemical explanation for addiction involves dopamine, a neurotransmitter also referred to as the “pleasure chemical.” In response to using pleasurable drugs or after pleasurable experiences, dopamine is released into the neural pathways of the brain’s reward center. The drug or experience is not physiologically damaging. Abuse occurs when repetitive use or behavior cannot be stopped to the detriment of imperatives. The release of dopamine after a pleasurable experience reinforces its behavior by enhancing the memory of the experience noting associated environmental cues. As such, the “pleasure chemical” is a misnomer. Dopamine doesn’t cause pleasure; it reinforces experiences. At appropriate doses, THC and CBD release dopamine into the mesolimbic reward pathways. Endocannabinoids also modulate the neural reward pathway. Cannabinoid and dopamine receptors exist as a heterodimer complex, a unified receptor system. As such, the Endocannabinoid System and its association with dopamine provide an opportunity to moderate addiction. Opiate addicts have already exploited this opportunity by choosing Cannabis to reduce their cravings. There is a general belief in the Cannabis community that smoking Cannabis with a particular “fuel” or “gassy” aroma is most useful in opiate withdrawal. This aroma classification of Cannabis suggests the hypothesis that Cannabis constituents may be acting synergistically. Using an algorithm, the CESC, a Cannabis research organization, classifies Cannabis associated with aroma. The content data derived from a broad analysis of Cannabis is incorporated in the classification and used to determine which Cannabis subtypes effectively modulate behavior. Results of the investigation will benefit current victims of the opioid crisis. The study of community users plays an important role in the development of safe and efficacious Cannabis products. The Cannabis community sits on the front lines of trial and error. Their observations suggest that Cannabis subtypes matter. As a result, multi-agent pharmacology must be applied to derive the optimal qualities of Cannabis keeping in mind that the primary objective is to reduce opioid deaths.  A survey administered to military veterans over a nine-month period concluded that their Cannabis use improved their quality of life and reduced their medication use. It’s estimated that twenty percent of 19 million US Veterans have a mental illness or substance use disorder. Included are veterans with depression, anxiety, and PTSD.
This study analyzed survey data from 510 US military participants. The researchers were from the Cannabis Center of Excellence, the University of Utah, and the University of Massachusetts, There are two general approaches to research. The first applies inductive rationale to develop a hypothesis. You might remember 7th grade science when you were given two different chemical substances and asked to write down your observations. Both substances were white, but one was powdery and clumped with moisture the other was crystal-like and dissolved with moisture. You used your inductive rationale or power of observation to determine that the chemicals were different. Observational studies develop theories or hypotheses. The second approach to research applies deductive rationale to test the hypothesis developed from the first approach. You might have hypothesized that the chemical substances tasted different and then put a little in your mouth. One substance tasted like flour and the other tasted like sugar, proving your hypothesis. Cannabis research is much the same. Most scientist are applying inductive rationale or observational study to develop theories. As Cannabis products become more accessible, future studies will test the hypotheses using clinical trials. The Controlled Substances Act (CSA) currently restricts access to Cannabis for clinical trials. In this inductive observational study, 91% of those surveyed reported that Cannabis use improve their quality of life. 80% had fewer psychological symptoms and 73% had fewer physical symptoms. Furthermore, 21% reported using fewer opiates, 30% used fewer over the counter medicines, and 25% had reduced their anti-depressants. Regarding lifestyle, 46% reported consuming less alcohol and 24% less tobacco. Even to a 7th grade scientist, the hypothesis or theory should be clear. It’s been demonstrated on the molecular level how cannabinoids, one of the active ingredients in Cannabis, might reduce pain or improve moods. This study concludes that Cannabis use is associated improved quality of life and fewer mental and physical symptoms. The authors suggest that medical Cannabis use among veterans may have a role in harm reduction. Deductive studies are the next step, where double blind, randomized controlled trials can be used to guide Cannabis dosage, safety, and efficacy. When it comes to proving that Cannabis works as medicine, scientific studies are well on their way. Unfortunately, government regulators are lagging. Delaying rescheduling or de-scheduling of Cannabis ignores the science. What do you think? Is this the evidence that finally convinces government regulators to release the reigns on Cannabis research? Will regulators finally change the status of Cannabis under the CSA? A 7th grader would say yes.  Is getting high important for feeling better? A new study titled “Understanding Feeling High and its Role in Medical Cannabis Patient Outcomes” was recently published in the journal “Frontiers in Pharmacology” by researchers at the University of New Mexico. The study found that patients who reported feeling high also experienced 7.7% better symptom relief than those who did not report feeling high. Does getting high contribute to medical treatment? The researchers at UNM are the first to ask the question.
1,882 people recorded the results of 16,480 Cannabis using sessions. That calculates to an average of just more than eight recorded sessions over almost five years. Generally, I see this as a red flag. Most regular Cannabis users use daily to weekly. This study population is clearly different. The respondents reported feeling high 49% of the time. That’s an encouraging result. I would estimate, conservatively, that 75-80% of my patients are getting high. As Cannabis becomes popular and its medical benefits are realized, users may not wish to “get high” thus reflecting this study population. In this study, patient who got high reported 4.4% greater positive effects like “Relaxed” and “Chill”, as well 14.4% increase in negative effects like “Dry Mouth” and “Red Eyes.” “Feeling high is poorly defined in the scientific literature,” explains senior author and associate professor of psychology, Jacob Vigil, “but it is generally associated with both impairment and feelings of euphoria. Typically, feeling high is assumed to be the goal of recreational use, but a limitation to Cannabis therapeutic potential. In this paper we test the validity of this assumption and find that feeling high may be an unavoidable component of using Cannabis medicinally. “ Definitively, this study found a positive association between feeling high and symptom relief. The analysis controlled for THC and CBD levels, dose, mode of administration, and symptom severity. There were other interesting associations. Smoking a pipe appears to be a better predictor of symptom relief than either smoking a joint or vaporizing the flower. However, the major discovery of this study is that higher THC levels are not significant predictors of symptom relief and only become significant once feeling high is included in the analysis. As well, THC is a significant and independent predictor of negative effects. These results suggest that feeling high may be a fundamental component to effectively using Cannabis as medicine. It's all in your head, some might say. They may partially be right. The benefit of Cannabis includes a neuro-emotional component. Thus, a better perspective may be not to separate emotions from physiology. The nexus of the two worlds appears to be where Cannabis has its influences. Our Cannabis research group, the CESC, describes the challenges of understanding Cannabis therapeutics as the “many-to-many problem.” The study’s lead author and associate professor of economics, Sara Stith, also highlights the challenges of using Cannabis as medicine. “Cannabis products are extremely variable in their phytochemical composition and patients vary extensively. These complexities suggest that the future of Cannabis-as-medicine lies in highly customized treatments rather than the conventional pharmaceutical model of standardized dosing.” This study concludes with some important recommendations.
But Are the Costs Sustainable?  What happens early, happens often. In California, we’ve realized for quite some time that Cannabis is effective medicine. Our laws have progressed to make Cannabis more accessible, yet some things haven’t changed. Cannabis patients continue to exchange personally grown Cannabis at a high rate. Personal gardens are an immediate solution to high cost, low quality dispensary products. Can’t start a garden or don’t have a green thumb? Find a neighbor who is willing to share or better yet, sign up for a MediCann Membership and join their Patient Exchange Program.
Researchers in New Zealand are just discovering what we already know in California. They interviewed 213 people enrolled in New Zealand’s Medical Cannabis program. Participants were asked about the quality of Cannabis they used and its effectiveness. Findings were published in the journal Drugs, Habits, and Social Policy. As high as 96% reported that cannabis helped them with their medical conditions. Almost half (49%) said they were able to reduce or stop taking prescription drugs. Sounds to me like competition for the pharmaceutical industry. The most common therapeutic use of medical cannabis was pain relief where 96% of participants said it helped reduce their pain. Cannabis also helped those who had difficulty sleeping (97%) and those with mental health issues (98%). Of the participants who took Cannabis for other reasons, such as autism, attention deficit disorder, post-traumatic stress disorder, and difficulty eating, 98% found it helpful. According to co-author Geoff Noller,"This both reinforces that they experienced some actual effect from using Cannabis in that they ceased or decreased other medications with recognized efficacy, and in the case of many of these other medications, they reduced their use of potentially more problematic medications.” Do we need more study? Sure. But the empirical evidence is clear. As medicine, Cannabis works. Many New Zealanders find medical cannabis difficult to obtain, relying on the personal or illegal market. According to another study, only 6% of Kiwis who use Cannabis acquire it through their medical cannabis program. Many New Zealand doctors won’t prescribe medical cannabis. There are a limited number of products on the market, keeping prices high. CBD oil in New Zealand can cost a patient $150-350 per month, with other Cannabis products costing even more. "At present, current regulations create problems for many New Zealanders who otherwise report positive benefits from their use of medicinal cannabis,” says Noller. In my opinion, Cannabis users are spun by mainstream industry that has yet to decide how to capitalize. Legal products are scarce, in poor quality, and their costs are high, in New Zealand, in California, everywhere. The current cost of one gram of flower per day can be on average $300 per month or more. According to CESC Dosing ProjectTM results, pain or disordered sleep best improve with a smoked or vaporized dosage of 1 gm. These costs are not sustainable for those with low means and who require treatment every day.  Some of us may recall the “Just Say No” campaign. It started in 1984, an illustrious year highlighted by George Orwell’s literary depiction of government-industrial control. Emerging across the bay from where I’m just now sitting at Oakland, California’s Longfellow Elementary School, the “Just Say No” campaign was instituted by former actress and first lady Nancy Reagan. Speaking with school children, she introduced the “Just Say No” phrase to deter people from using street drugs, including Cannabis. She subsequently travelled to drug rehab centers, wrote guest articles, and appeared on numerous talk shows promoting the “Just Say No” message. Her relentless marketing caught on and spread internationally.
The “drugs” referenced in the “Just Say No” campaign were illicit drugs. In that era, prescription drugs were not targeted with respect to the medical industry. Fast forward 40 years… The children who heard the former first-lady’s speaking are now middle-aged adults. Prescription drugs are known to cause significant damage. After heart disease and cancer, adverse prescription drug effects are the third leading cause of death in the US and Europe. The Fentanyl overdose epidemic accounts for one in five deaths among young people in California. On the other hand, Cannabis advocates celebrate a 4.5-fold increase in Medical Cannabis from 2016 to 2020. The decade appears associated with a trend toward experimenting with plant-based alternative to health and wellness. Most research on the benefits of Medical Cannabis focuses on specific symptoms, like pain and sleep, or how Cannabis lowers the use of opioid prescriptions. A recent Australian study published in the Journal of the American Medical Association Open Network pivoted, focusing on generalized Quality of Life (QOL) measures among patients enrolled in Medical Cannabis Specialty Clinics. 3,148 patients with an average age of 56 participated in this study; that means they were all children during the “Just Say No” years. Most of the patients had chosen Medical Cannabis due to chronic pain, anxiety, or sleep. The principle investigators evaluated QOL measure every three months up to 15 times over a four-year period. Due to a paucity of clinical trials, it’s difficult to claim that a specific Cannabis formulation or active ingredient treats a specific medical condition. Despite hundreds of active ingredients, THC and CBD are the only FDA approved constituents derived from the Cannabis plant. Meanwhile, there are many multi-agent products being used for a wide variety of symptoms or conditions. It’s what our research group terms, the “many to many problem”. Our solution casts a wide net, initiating broad generalized studies to determine what patients use and how the Cannabis products affect Quality of Life. This study does just that. The study used a 36-item short form health survey with 8 distinct scales including questions on physical activity, mental health, social activities, vitality, pain, and general perception of health. Most of the participants were ingesting capsules with varied concentrations of THC and CBD. Very few also reported smoking the Cannabis flower. Starting at low doses and increasing to optimum effect, the average CBD dose climbed to 72 mg per day and stayed relatively the same throughout the four years. The mean THC dose increased throughout the four years from 6.5 to 25.8 mg per day. By the end of the study, only two serious adverse events were noted. QOL scores range from 0-100, where a 10-point change is considered clinically significant. These results demonstrated improvement in QOL with scales ranging from 6.6 to 18.31 of baseline. The results were consistent with similar observational studies. The results indicate that Cannabis effects are significantly greater in some scales than might be seen in traditional clinical trials. Double-blind, randomized trials are best used to evaluate specific formulations for specific indications. The observational studies use a broader view and establish that patients use Medical Cannabis in dose-dependent fashion because the benefits of use exceed the harms. Nancy Reagan died on March 6, 2016, a couple of years before this most recent Medical Cannabis study launched. Would she have said yes to Medical Cannabis after reading these results? In hindsight, the fundamental lesson should be that actresses, politicians, and government regulators are not always the best resource for improving Quality of Life. The community discovered Medical Cannabis despite contradictory rhetoric and traditional evidence. Community derived information is a pertinent resource. When it comes to Medical Cannabis the best advice might be to “Just Say Yes”.  Some patients tell me that Cannabis doesn’t improve pain, it just relaxes them or helps sleep. My first Cannabis patient handed me his remaining opiate prescription saying, “I don’t need these anymore.” From my perspective, that was all the proof I needed. Whether it alleviated his pain, improved his sleep, or reduced his stress, Cannabis improved his life because it was far less risky than opiates.
One in five people live with chronic pain. In some countries, chronic pain is estimated at 25% of the population. Two out of three people report that their chronic pain is moderate to severe and half of them have experienced chronic pain for more than ten years. Chronic pain often occurs with other problems, including insomnia, anxiety, depression, post-traumatic stress, and substance use disorders. A recent study by physicians in British Columbia, Canada reviewed evidence on the use of Cannabis Based Medicine on Chronic Pain. The authors specifically avoided reviewing studies on synthetic cannabinoids. They only evaluated products derived from the plant. Why? Because that’s what the community uses. Synthetic THC has been available as prescription medicine for over four decades. It’s been approved for nausea from chemotherapy. A recent study surveyed cancer patients and survivors on the Cannabis products they were using. Most respondents (60%) reported using products mostly containing THC instead of products containing CBD or both. The finding conflicts with certain regions that permit only low THC products for medical purposes. “Cannabis use is becoming more common among cancer patients and survivors, who often consume products to alleviate cancer symptoms and treatment side effects,” says the study’s senior author, Danielle Smith, PhD, MPH, Cannabis doesn’t fit the medical paradigm, yet it treats, cures, or simply reduces harm. The medical and pharmaceutical industries struggle with the variable, multi-agent botanical like trying to fit a square peg into a round hole. To me, that’s a sign that calls for innovation. Rather than reduce the plant to single agent products, let’s accept what it is and learn to work with it. That approach might work for many things in life. Let’s get to it.  The Old Toker, recently sent me a MedPage Today article on the age-old argument of Cannabis vs Tobacco. Scanning the article, I learned that MedPage Today was presenting age-old information. The article quotes a 2007 study out of Ottawa that has long been refuted. Is Cannabis smoking less or more harmful than Tobacco smoking? Once again, let’s look at the evidence. MedPage Today, you owe me. Despite a lack of updated information, Dr. Donald Tashkin, M.D., after a 30-year career as a UCLA Pulmonologist, has the definitive answer for the Tobacco vs. Cannabis question. He is well known for his studies on Cannabis smoking, emphysema, and lung cancers. In his long career, Dr. Tashkin received several grants from the NIH, specifically from NIDA, to study the effects of smoking Cannabis on lungs. In his 2013 publication titled, Effects of Marijuana Smoking on the Lungs, he concludes "...the accumulated weight of evidence implies far lower risks for pulmonary complications of even regular heavy use of marijuana compared with the grave pulmonary consequences of tobacco.” One Tashkin study even found a Cannabis using cohort had significantly less lung cancer than the Control cohort. His comment refutes the conclusion of earlier studies, including his own, and stands as the definitive response to the Cannabis vs Tobacco smoking question. That being said...Smoking anything is not a medically recommended habit. The ash debris from inhaled smoke is a lung irritant. The heat of the smoke contributes to lung tissue damage. If you can avoid the habit, I recommend it. A correlation with Cannabis smoke and chronic or recurrent bronchitis, notes Dr. Tashkin, is the only significant long-term effect to date. Many people smoke Cannabis for its acute effects. Physiologic muscle relaxation settles the body. In mere minutes cannabinoids pass through the lungs, enter the bloodstream, and rush to the brain. The immediate stress and anxiety relief after inhaling Cannabis is a welcome outcome. Molecular models explain how cannabinoids attach to receptors in the central nervous system and at the nerve-muscle junction causing these relaxing effects. Tobacco, paradoxically, produces similar results. The difference is that Tobacco works by activating the sympathetic “fight or flight” system whereas Cannabis affects the parasympathetic “rest and digest” system. The sympathetic nervous system acts in defense to danger whereas the parasympathetic nervous system repairs or heals. Is this is why Cannabis smoke is associated with a better outcome than Tobacco smoke?  In regard to the dangers of smoking, the evidence continues to pile on. Results from a prospective longitudinal lung study were recently published in Respiratory Medicine, a peer reviewed science journal The study followed a group of people from birth, testing the lung function of Cannabis and Tobacco smokers at age 21 and 30. The results align with Dr. Tashkin’s conclusion. Tobacco smoking (with or without Cannabis) restricts lung function. However, Cannabis smoking alone does not consistently affect lung function.
Does this put the question to rest? Not really. In science, there is always the pursuit of more evidence. At least MedPage Today can now report evidence that is relevant. Smoking is the most popular method of Cannabis use. However, there are other means of inhaling. Vaporizing machines can be used to inhale Cannabis flower vapor produced at lower temperatures. Vape carts or vape pens do the same but use Cannabis oils with higher potencies. There isn’t much evidence on the long-term effect from inhaling oil vapors. Vape pen users beware. In 2019, some manufacturers of Vape Pens added Vitamin E oil in their products which resulted in illness and even death. EVALI is a serious condition in which a person’s lungs become damaged from substances contained in e-cigarettes or vaping products. It’s appropriate to note that no deaths have been reported that directly result from inhaling the smoke of Cannabis flowers. Maybe, in this case, the old way is the best way.  I’m a physician from California. I provided my first Medical Cannabis recommendation in 1998. That’s 25 years ago. The patient was in chronic pain. He handed me his prescription opiates and said, “I don’t need these anymore.” That’s a rare statement from a chronic pain patient. Most are addicted to prescription opioids and usually ask for more. I asked the patient, “How are you managing your pain.” And he replied, “I use Cannabis. I just need your recommendation.”
So, 25 years later I’m reading a post from WPDE ABC 15 News in South Carolina and see it considers news that Cannabis replaces opioids and helps fight addiction. We are in an age of rapid information. Instagram, Twitter, and Tik Tok send images and messages around the world in an instant. However, the people who produce this news show appear to think it’s newsworthy that Cannabis replaces opioids and fights addiction. The article goes on to explain that 37 states have legalized Medical Cannabis and several of those states designated Opioid Use Disorder as a qualifying condition. Meaning, Cannabis can be used to fight addiction. Apparently, the people of South Carolina are aware that most of the United States has already realized the benefits of Cannabis. It has just taken them a little longer to realize the same, like 25 years longer. Matthew Campbell, C.O.O. of Cannabetter Farm out of Myrtle Beach South Carolina sells Delta-8 blunts and CBD flowers. He says, “Generally, it’s prescription opioids., Percocet, stuff like that. You hear people coming in who don’t want to take that stuff anymore because its damaging to their bodies. You hear about people that stop taking all kinds of medicine.” So, I am feeling like I’ve just come out of a time machine 25 years in the past. I look around and, no, I just in my kitchen reading this story from ABC news. “According to Recovery Research Institute, a Harvard addiction treatment center, Cannabis might have benefits to treat opioid addiction, but it has yet to receive FDA approval.” Now I get it. The good people of South Carolina are just waiting for the FDA to tell them Cannabis is safe. After evidence of thousands of years of Cannabis use and a toxicity profile that is more benign than aspirin or Tylenol, they prefer to wait. Hence the time machine perspective. South Carolina state senator Greg Hembree (District 28) says that FDA approval is crucial because politicians are not medical doctors. “If the research supports FDA approval, all you need is FDA approval, and I’m 1000% for it,” said Senator Hembree. The FDA has been pretty clear that they won’t proceed with Cannabis regulation without a federal act from Congress. Hembree feels he sees too many lobbyists – people with commercial interests – advocating for Medical Cannabis. “I would rather debate recreational Cannabis,” he says, “at least we know that’s an honest debate. That’s straight up. I wouldn’t vote for it. But, if the general assembly voted for that, I wouldn’t feel bad about that.” Rather than allowing patients to benefit without FDA approval, Hembree prefers to wait. A Medical Cannabis bill passed through South Carolina’s House committee this last month. Known as the Compassionate Use Act, the same name given to California’s bill 25 years ago, it includes conditions, such as cancer, Crohn’s disease, PTSD, Autism, and terminal illness. The bill will now head to Senator Hembree and the state senate floor. We all know that Senator Hembree is not going to vote for it. He would rather wait until the FDA approves Cannabis as safe before any dying patients in South Carolina have access to it. God forbid, they die high. So, I’m back from my visit to South Carolina. I hope things work out there. For those of you who enjoy historical trips, I recommend reading South Carolina news. Meanwhile, those who live in the other states are handing over their opiates and recovering from addiction. |
AuthorJean Talleyrand, M.D., Archives
September 2023
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