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Medical Marijuana: What does it all mean?

Medical Marijuana is now legal in Pennsylvania!  It is now an obtainable option for the management of many chronic medical conditions, which affect the quality and health of patients in need. In April of 2016, Governor Tom Wolf signed into law the legalization of medical marijuana for 17 specific medical conditions.  This began the creation of a process by which growers, processors, distributers and pharmacies could legally distribute the product to patients.  In addition, physician education and certification has been put in place that would allow a patient to be medically evaluated by a certified physician for the appropriateness of use and qualify a patient for the recommended use of this class of medication.

Patients often ask….”Why is medical marijuana different?  How can it help me?”  Well, the answer is actually very complicated and depends on a number of factors.  It can be dependent on the patient and the disease that is being treated.  It can vary based on the strain of the medical cannabis chosen and the delivery system. It can vary by a patient’s genetic makeup and how the body reacts.  It can be affected by the other medications a patient takes and by other medical issues the patient is managing, especially if there is organ impairment such as renal or liver impairment.

It is NOT a one size fits all drug and should not be regarded as such.  Like most medicine, identifying the right prescription of medical cannabis is an ART and not simply a mathematical formula that one follows.  In developing and fine tuning the prescription, the pharmacist and the patient’s medical team need to encourage the patient not to become discouraged if results are not as positive as hoped with the first experience, as often adjustments and modifications are warranted.

First, let’s begin with an understanding of some basic chemistry. Cannabis, or medical marijuana, contains several key compounds, also known as cannabinoids that target the endocannabinoid system of the brain to produce different effects, such as how we regulate pain, mood, memory, appetite, sleep, etc.   CBD (cannabidiol) and THC (tetrahydrocannabinol) are two compounds that are the most well-known and best understood as to how they work within the endocannabinoid system in the brain.

The endocannabinoid system of the brain is comprised of cannabinoid receptors, the best studied of which are CB1 and CB2.  These compounds, when absorbed by the brain, target the cannabinoid receptors, CB1 and CB2, either directly, as in the case of the THC, or indirectly as with the CBD to effect a change in the brain chemistry.  The greatest concentration of the CB1 and CB2 receptors is found within the central nervous system; however, due to the widespread location of these receptors and neurotransmitters, various forms of the medical marijuana will work including topicals, oils, orals and vaporized forms. (This topic will be further discussed later in the article.)

There are typically over one hundred substances or cannabinoids within the average medical marijuana plant.  The significance of many of these remains unknown and is still being discovered and researched.  As noted above, CBD, which is one of the most well-known and researched cannabinoid, has anti-inflammatory effects. There have been additional studies that suggest that it can help with anxiety, chronic pain syndromes, and medical conditions including seizures and migraines.  The other well-known cannabinoid substance, THC (tetrahydrocannabinol), is the chemical that has been linked with the psychogenic effects of marijuana.  There have been many case reports of patients noting improvements in their appetite, sleep, and overall anxiety when using the combined CBD/THC formulations.

Other lesser known, yet chemically effective compounds include CBG (cannabigerol) and THCV (Tetrahyrdrocannabivarin).  CBG has been shown to assist with glaucoma patients in helping with reducing eye pressures.  THCV also has been shown to be helpful in patients with metabolic disorders including diabetes as well as neurological disorders such Parkinson’s.

Another important question that patients often ask is. “How will I know what kind of medical marijuana to ask for?”  Once securing the medical card qualifying them as a candidate for medical cannabis, the patient should identify goals for treatment such pain management, insomnia, appetite stimulation, etc.  Entering the pharmacy with these goals in mind, the pharmacist will be better able to make recommendations for choosing not only the medical marijuana delivery method, but also the strength and strain.

Medical marijuana falls under the plant genus Cannabis.  There are 3 main species that are derived from this genus, C. sativa, C. indica, and C. ruderalis.  From these strains, the growers create different varieties, with different ratios of CBD and THC targeting different effects and systemic symptoms.  One of the keys to the success of this therapy is finding the right fit for the patient, so as the process evolves, growers and processors continue to refine the product to effect better outcomes with greater benefits.   The feedback that a patient and pharmacist provide in this process is crucial and considered important in the success of this program in the short and long term for not only that patient but also for those to follow.

As mentioned earlier, medical marijuana has a variety of delivery systems available through pharmacies in Pennsylvania.  These are inhaled vaporizers, topicals, tinctures, oral capsules or tablets, and oils.  The pharmacist can work with the patient and determine what symptoms one is seeking to address and then choose the best product for the patient.  Typically, the best way to begin using these products is to “start low and go slow,” titrating up on the medication to achieve the symptom management and control the symptoms that the patient is seeking to treat.  It is important that the patient have open lines of communication with the pharmacist as well as with their physicians, making them aware of any side effects or symptoms that they may be experiencing in order to limit and avert any potential issues or cumulative drug side effects.  For example, it is very common for patients to experience dry eye and dry mouth, which can be exacerbated when using a number of other prescription medications.  When knowing this, proper counseling can help manage this side effect.

In summary, medical marijuana remains a very controversial and complicated topic spanning many social, medical, ethical and physical realms.  There are varying opinions about the efficacy of medical marijuana as a form of medicine.  Regardless of personal opinions as to its ethical or legal appropriateness, it is important for potential patients to become educated on the topic itself and understand how it works, what effects it can have,  both positive and negative on the medical conditions for which people seek treatment, and what impact it may have on the future of medicine which continues to evolve day by day.

 

“PA.GOV.” PA.Gov, Commonwealth of PA, www.pa.gov/guides/pennsylvania-medical-marijuana-program/.

 

Schatman, Michael E. “Medical Marijuana: The State of the Science.” Medscape , Medscape, 2 Feb. 2015, www.medscape.com/viewarticle/839155_13.

Pollio, Antonino. “The Name of Cannabis: A Short Guide for Nonbotanists.” US National Library of Medicine National Institutes of Health, U.S. National Library of Medicine, 1 Oct. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5531363/.

 

Wilcox, Anna. “10 Best Medical Cannabis Strains You Should Be Using.” HERB, HERB, 2 Nov. 2017, herb.co/marijuana/news/10-best-medical-cannabis-strains.

 

DePietro, MaryAnn. “Medical Marijuana | Definition & Patient Education.” Healthline, Healthline Media, 21 July 2016, www.healthline.com/health/medical-marijuana.

 

Jikomes, Nick. “What Is the Endocannabinoid System and What Is Its Role?” Leafly, Leafly, 21 Dec. 2017, www.leafly.com/news/science-tech/what-is-the-endocannabinoid-system.

 

“THC vs. CBD: What’s The Difference?” Leaf Science, 22 Nov. 2017, www.leafscience.com/2017/11/22/thc-cbd-difference/.