Tag Archives: medical marijuana

Credit: Pixabay.

Most oncologists recommend medical marijuana, although they admit they’re not informed enough

A new survey suggests that almost half of all oncologists recommend medical marijuana clinically, but less than 30% actually feel equipped with enough knowledge to make such recommendations.

Credit: Pixabay.

Credit: Pixabay.

Researchers at the Dana-Farber Cancer Institute (DFCI) surveyed oncologists from across the United States in order to examine their attitudes, knowledge, and practices regarding the use of medical marijuana in a clinical setting. Medical marijuana largely refers to whole-plant marijuana, which can contain hundreds of active compounds with complex synergistic interactions, rather than pharmaceutical cannabis, which refers to isolated cannabis compounds such as CBD or other cannabinoids.

Cannabinoid pharmaceuticals, which are available with a prescription, have been the object of considerable research. The same cannot be said about medical marijuana, however, whose medical utility in cancer and other diseases is still understudied. At the same time, medical marijuana is legal in over half of the states in the country, with cancer being one of the main conditions under which cannabis can be prescribed.

This discrepancy between evidence of marijuana’s viability in oncology and its wide dispensation around the country seems to be mirrored by specialists as well. According to Ilana Braun and colleagues at DFCI’s Division of Adult Psychosocial Oncology, 80% of the oncologists they surveyed discussed medical marijuana with patients and nearly half recommended the use of the agent clinically, despite the fact that less than 30% of all respondents actually consider themselves knowledgeable enough to make such recommendations.

There are very few other instances where a doctor would offer clinical advice about a topic on which the specialist is not knowledgeable enough. So what’s going on? Although the survey wasn’t designed to investigate the rationale behind the oncologists’ answers, researchers believe an almost unique climate of marijuana prevalence may be responsible for the results. “Non-medical variables affect how oncologists approach medical marijuana: these include region of practice, practice setting, and the volume of patients they see,” Braun said.

“Unfortunately, our survey wasn’t designed to drill down into the rationale behind oncologists’ decision-making regarding medical marijuana. For that, future surveys are clearly in order! Our survey did yield a few clues though. For instance: when asked about the comparative risks of medical marijuana and opioid pain medication, 75% of the oncologists we surveyed believed that medical marijuana was safer than opioids with regard to overdose risks, and 52% believed it to be safer than opioids with regard to risk for addiction,” Braun told ZME Science.

“I think the results of this survey invite comparative effectiveness trials comparing medical marijuana to standard of care for certain cancer-related symptoms; also, research into how best to inform oncologists about this salient topic,” she added.

The relatively large gap between the physicians’ knowledge on the topic and their recommendations shows there is a lot of room for improvement when it comes to medical marijuana. This does not mean that medical marijuana might not work for some patients suffering from cancer; it’s just that many doctors around the country, according to this survey, seem to be making decisions based on limited studies that are either small or poorly designed. To date, there has been no randomized clinical trial that examines whole-plant medical marijuana’s effects in cancer patients.

 

Marijuana legalization helps decrease opioid consumption, research shows

Every day, 90 Americans die from opioid overdoses, according to existing research. Two new studies published in the journal JAMA Internal Medicine now show that in states where marijuana is legal, opioid prescriptions decreased significantly.

Image credits Flickr / Jeffrey Beall.

Researchers have analyzed prescription data from Medicare Part D and Medicaid from the past five years and discovered that opioid prescriptions and the average daily dose of opioids patients took were significantly lower in areas where marijuana is legal.

“In this time when we are so concerned — rightly so — about opiate misuse and abuse and the mortality that’s occurring, we need to be clear-eyed and use evidence to drive our policies,” said W. David Bradford, an economist at the University of Georgia and an author of one of the studies.

“If you’re interested in giving people options for pain management that don’t bring the particular risks that opiates do, states should contemplate turning on dispensary-based cannabis policies.”

Previous research suggests the same. A 2014 paper discovered that in states where cannabis use is legal for medical purposes, nearly 25 percent fewer deaths from opioid overdoses occurred.

One of the studies revealed that Medicare patients filled 14% fewer opioid prescriptions after medical cannabis use became legal. The other study, which monitored Medicaid opioid prescriptions, found that participants filled nearly 40 fewer opioid prescriptions per 1,000 people (4%) each year after their state passed laws that made cannabis accessible — states that legalized both medical and recreational marijuana showed greater falls in opioid prescriptions.

With the arrival of fentanyl on the black market, doctors fear we’ll see even more cases opioid overdose. This powerful opioid is up to 100 times more potent than morphine. Due to its powerful effect, fentanyl doses are very small, which is actually a problem. Overdoses usually occur when miscalculating the amount of drug administered, and it’s easier to go wrong with smaller doses. When fentanyl became a go-to drug for dealers, opioid deaths immediately spiked due to its high potency at low doses. Basically, people did not know that surpassing the dosage with only a few micrograms might be fatal.

So, the findings seem positive from a public health point of view. Marijuana is generally perceived as ‘safe’, and according to The National Center for Biotechnology Information, there is insufficient evidence to support or refute a statistical association between cannabis use and death due to cannabis overdose — in other words, there’s not enough data to say that cannabis use can or cannot be fatal, which, relative to fentanyl, makes it super-duper safe.

One recent paper even suggested that opioids didn’t provide any more relief for chronic arthritis pain than over-the-counter painkillers.

The studies also discovered differences in decline in opioid prescription between the states that legalized medical marijuana: states with dispensaries open for business saw the greatest decrease in opioid prescriptions, while states without active dispensaries saw a far less dramatic decline — about 14% and 7%, respectively

Bradford said that this made sense. The difference between picking up ready-to-use marijuana and growing your own plant with little support from the authorities is huge.

One impediment in substituting opioids with marijuana is that neither Medicaid nor Medicare will reimburse people for the money they spend on marijuana.

“I did a back-of-the-envelope calculation that suggested that a daily pain management dose of hydrocodone would be about $10 out of pocket in the U.S,” Bradford said, although Medicare Part D plans cover much of that.

Last year, a daily dose of marijuana cost around $6 — and that sum should be smaller by now, Bradford said. “It’s becoming relatively comparable in cost.”

“I know policymakers are often skeptical of cannabis. But we need to be terrified of things like fentanyl, and we need to be willing to use evidence-based approaches to help address that,” Bradford added. “Cannabis looks like it could be one,” he concluded.

cannabis

Medical cannabis helps one third of chronic pain patients quit prescription opioid drugs

Medical marijuana is helping patients dealing with chronic pain by replacing their use of prescription drugs. These opioid drugs can be fatally dangerous when abused. They killed more people last year than guns or car accidents, causing health professionals to signal that America is deep in an opioid crisis, which is why these latest findings come as great news.

cannabis

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The study performed by researchers at the University of New Mexico (UNM) involved 37 patients enrolled in the New Mexico Medical Cannabis Program (MCP) and 29 participants who used opioids alone. The MCP participants used both opioids and legally supplied medical cannabis.

Ten months later, MCP participants had significantly reduced their prescription drug use. Most impressively, more than a third of the MCP patients stopped using prescription drugs altogether compared to only two percent of the non-MCP group, the authors reported in the Journal of the American Medical Directors Association. 

MCP participants also reported “improvements in pain reduction, quality of life, social life, activity levels, and concentration, and few side effects from using cannabis one year after enrollment.”

Although this wasn’t a randomized trial and the sample size was rather small, the UNM team concludes that medical cannabis is significantly associated with “opioid prescription cessation and reductions”, as well as “improved quality of life”.

Mean prescribed daily opioid dosage by month. Credit: PLOS One

Mean prescribed daily opioid dosage by month. Credit: PLOS One

The UNM researchers followed the patients for two whole years, including the six months during which opioid use was tracked before patient enrollment in the marijuana program. It wasn’t until months 16 through 24 that medical marijuana began to significantly displace opioids in the MCP group.

Previously, scientists at the University of Michigan reached a similar conclusion, also reporting that chronic pain patients saw a large reduction in opioid use and improved quality of life once they started using medical marijuana. Another study found that doctors working in states where medical marijuana is legal prescribe fewer opioids to patients than in those states where medical marijuana is illegal.

All of these findings suggest that medical marijuana might become a worthy ally in the nation’s fight against opioid drugs. Every day, more than 90 Americans die after overdosing on opioids. The Centers for Disease Control and Prevention (CDC) estimates that the total “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year, including things like treatments and reduced productivity. Last month, President Trump “declared the opioid epidemic a national public health emergency.”

marijuana legal

Marilize Legajuana: most Americans support lifting cannabis ban. Only a decade ago the reverse was true

marijuana legal

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The most recent Pew Research poll that surveyed sentiment on marijuana legalization found Americans are largely supportive of lifting the ban. Today, 57 percent of Americans say they are in favor of making marijuana legal across the nation while 37 percent reckon it ought to stay illegal. It’s like the poles have reversed. Only a decade ago almost the reverse was true with only 32 percent favoring legalization while 60 percent were opposed. What on Earth happened in the mean time?

Medical marijuana spreads its wings and flies high

As early as 2737 B.C., the mystical Emperor Shen Neng of China was prescribing marijuana tea for the treatment of gout, rheumatism, malaria and, oddly enough, poor memory. Later, in American medical journals from the 19th century we can find doctors recommending hemp seeds and roots to treat inflamed skin, incontinence, and venereal disease. But then in 1937, the Federal Government passed the Marihuana Tax Act, which made nonmedical use of marijuana illegal. In the 1950s Congress passed the Boggs Act and the Narcotics Control Act, a legal framework which laid down mandatory sentences for drug offenders, including the possession and distribution of marijuana. Later, Nixon came to power and we all know what happened next.

Credit: Pew Research

Credit: Pew Research

But then a flame was lit. California was the first to legalize medical marijuana in 1996 when it passed Proposition 215, also called the Compassionate Use Act. Now, the use of marijuana for medical purposes is permitted in 25 states, and recreational use is legal in four states — Alaska, Colorado, Oregon, and Washington. In June, Ohio became the 25th state.

The shift in public opinion can be traced around the time the first US states made medical marijuana legal. It’s not clear whether people actually changed their opinions or were more confident to come out of the proverbial pot closet. For instance, twice as many American use pot than ten years ago, which can’t be accounted for expanded market availability. But right now marijuana feels at home in the United States like never before in the last hundred years.

According to Pew Research, young adults disproportionately support the legalization of the herb. However, marijuana legalization support has risen across all generations. Millenials, defined as the generation of those aged 18 to 35 today, are twice as likely to want the ban lifted than ten years ago (71% today, up from 34% in 2006). More than half of Gen Xers (57 percent) or those aged 36-51, support legalizing pot although only 21 percent thought so in 1990. Most Baby Boomers (56%), 52 to 70 of age, support legalization, up from only 17 percent in 1990.

Also from the report, we learn that there’s a great divide in legal pot sentiment based on partisan and ideological outlook. Democrats favor legalizing marijuana over having it be illegal (66% vs. 30%). Contrary, most Republicans (55%) oppose marijuana legalization, while 41% favor it.

When looking at race, Hispanics are the least supportive of legalizing pot. Some 49 percent of Hispanics say pot should be illegal while 46 percent believe the opposite. Whites and Blacks agree in a 59 percent majority that pot ought to be legal.

Credit: Pew Reserach

Credit: Pew Reserach

This November, Americans in nine states are expected to attend ballots that will establish whether or not marijuana should become legal in their states. Judging from the most recent surveys, it looks like an unanimous vote in favor for all states.

 

 

medical marijuana

Medical Marijuana benefits are largely unproven and poorly documented, study finds

An extensive meta-analysis of 79 trials that studied the medical benefits of marijuana found that the various cannabinoid compounds did not improve nausea, vomiting, or appetite, but slightly improved chronic pain and plasticity. Moreover, most of the studies were poorly made, lacking control or placebo groups and also showing increased risk of bias. In short, this rigorous analysis found no conclusive evidence that supports the much heralded added benefits of medical marijuana. Side effects were common and included dizziness, dry mouth and sleepiness. The authors note that this doesn’t mean that marijuana compounds aren’t working as advertised, it’s just that the science so far is inconclusive – mainly because of bad reporting and investigative techniques. They suggest more research is necessary, along with more support from the authorities and other able bodies given that we’re talking about an extremely widespread drug ingested by millions of Americans each day, legally or not.

medical marijuana

Photo: AP/Damian Dovarganes

“It’s not a wonder drug but it certainly has some potential,” said Dr. Robert Wolff, a co-author and researcher with Kleijnen Systematic Reviews Ltd., a research company in York, England.

Wolff, Penny Whiting, of University Hospitals Bristol NHS in England and their colleagues looked for randomized, controlled trials testing cannabis, or cannabinoid-based medications and eventually settled with 79 trials with 6,462 participants. Patients included those suffering from chemotherapy-related nausea and vomiting, HIV/AIDS-stunted appetite, chronic pain, or paraplegia, or spasms related to multiple sclerosis (MS). The researchers concluded that of these studies only 5% had a low risk of bias, and 70% were considered high risk mostly due to lack of double-blinding and placebo controls.

Poor cannabis science

Concerning nausea and vomiting in chemotherapy patients, 28 of the trails discussed treating these conditions with marijuana compounds like nabilone, dronabinol, nabiximols, levonantradol, and THC. The effects were compared with other drugs like prochlorperazine, chlorpromazine, domperidone, alizapride, hydroxyzine, metoclopramide, and ondansetron. Again, the researchers note the unreliability of the reported studies: 23 of these trials have a high risk of bias, while the other five are unclear. As for results, compared with placebo in three of the trials, chemotherapy patients who were on dronabinol or nabiximols were more likely to have nausea or vomiting.

In the case of HIV/AIDS patients, those studies that assessed improved appetite following cannabis consumption had “limited findings” and high risk of bias. Most research was done on treating chronic pain (28 of the trials)  with smoked, vaporized or other forms of cannabis compound consumption. With one exception, all of these studies were placebo controlled. Whiting’s team reported that only two of the studies had a low risk for bias, and 17 had a high risk. Nevertheless, most studies reported a slight improvement in pain when ingesting cannabinoids, but the results bore little statistical relevance. Patients who smoked THC reported the greatest reduction in pain, especially when dealing with neuropathic pain.

On a federal level, cannabis is illegal but twenty-three states and Washington, D.C. have laws permitting medical marijuana use. In the published paper in the Journal of the American Medical Association, the authors warn that medical marijuana approval was based on poorly conducted studies, patient testimonials and other evidence borderline-scientific at best. For instance, marijuana is approved as a medical drug for treating Alzheimer’s disease, epilepsy, glaucoma, kidney disease, lupus and Parkinson’s disease despite there’s little evidence to support such a measure.

Marijuana “is a complex of more than 400 compounds including flavonoids and terpenoids and approximately 70 cannabinoids other than delta-9-tetrahydrocannabinol (THC),” they wrote, (most FDA approved drugs contain one to several compounds, not hundreds). “These cannabinoids have individual, interactive, and even entourage effects (effects of a compound that are only appreciable in the presence of other compounds) that are not fully understood and that contribute to the net effect of marijuana.”

“If the states’ initiative to legalize medical marijuana is merely a veiled step toward allowing access to recreational marijuana, then the medical community should be left out of the process, and instead marijuana should be decriminalized,” they wrote. “Evidence justifying marijuana use for various medical conditions will require the conduct of adequately powered, double-blind, randomized, placebo/active controlled clinical trials to test its short- and long-term efficacy and safety.”

It’s not just the benefits that are inconclusive. The same applies to the adverse events as well. In 62 of the studies, adverse events were reported, and Whiting’s team stated that they did not see much difference in adverse events based on the type of cannabinoid used or study design. These include dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucination.

So, what’s going on? Why is a drug so widely used in the US and abroad so poorly studied? Well, even now when there’s medical marijuana freely available in most states, getting approval from the FDA and DEA to perform studies with cannabis is extremely difficult and involves a cumbersome process, which sounds stupid. Well, it is. Things might improve soon as the Department of Health and Human Services made it a little easier for privately funded medical marijuana research to get approved. Whatever the future will hold, I can only hope we’ll see rigorous research and more support.

“Perhaps it is time to place the horse back in front of the cart,” Drs. Deepak Cyril D’Souza and Mohini Ranganathan wrote in the editorial.

In other marijuana related news, another paper published in the same journal found that the medical marijuana to eat and drink doesn’t contain advertised THC levels. After analyzing the contents of 47 brands, including candy, baked goods and drinks, sold in dispensaries in Los Angeles, San Francisco and Seattle, the researchers found 1 in 4 had higher amounts than labeled. Oppositely, 60% of the products contained less THC than advertised. Some barely contained any cannabis, which sounds like a rip-off.