Part 1 of 4 – Read Part 2

by Dionetta Hudzinski MN, RN

The issue of marijuana use has been around for most of my lifetime and it is not going away.  Since 1996, laws in 23 states have been enacted to give individuals with certain diagnoses the right to obtain (or grow) and consume marijuana products. They may smoke it, eat it or drink tinctures of it to relieve their distressing symptoms such as pain, spasticity, nausea, loss of appetite, and insomnia.  Add to this the most recent passage of laws in Colorado and Washington State to legalize recreational use of marijuana, which has muddied the waters of opposing opinions and you have the perfect storm…perhaps Pandora’s box that has been opened and unleashed on society.  Once open you cannot easily lasso or re-capture what has been set free.  So where do we go from here?  In the next month or so TPC will be publishing at least four blogs on various aspects of medical use of marijuana.  Our hope is to dispel some myths, pass on some useful information and stimulate a lively discussion around marijuana use for medical purposes.

So let’s get started. First, let’s talk about words, terms and slang.

Marijuana vocabulary:

• Marijuana (MJ) – Common name
• MMJ – Medical Marijuana
• Cannabis Sativa – Scientific name
• Cannabis – Technical name
• Marinol (Dronabinol) – Pharmaceutical grade, synthetic marijuana
• Hemp– Commonly used term for high-growing varieties of the cannabis plant and its products: fiber, oil, and seed; can be refined into products like: hemp seed foods, hemp oil, wax, resin, rope, cloth, pulp, paper, and fuel.

Street names:

• Pot, ganja, weed, Mary Jane, herb – refer to the substance itself.
• Hashish, hash – refer to higher potency forms of marijuana
• Joint, reefer, blunt, backwood, bud, bong – refer to the way Marijuana is smoked
• More slang

The history of marijuana can be traced back thousands of years and was only declared an illegal drug during the 20^th Century by the federal government. Twenty-three states so far have legalized medical use of marijuana for certain designated diseases and symptoms. MMJ must be recommended by a licensed healthcare provider (HCP) for a clear medical purpose. The person using MMJ must carry with them an MMJ card or a letter from their HCP which states they are authorized to possess and consume MMJ products.  A future blog in this series will discuss the laws surrounding MMJ in more detail.

Chemical compounds in Marijuana

THC (Tetrahydrocannabinol) is only one of hundreds of chemical compounds within marijuana that is responsible for its intoxicating effects. CBD (Cannabidiol) another compound in marijuana does not produce euphoric effects.  CBD has been used for pain (specifically neuropathic pain caused by damage or injury to nerves), seizure disorders, nausea and/or anorexia (loss of appetite), tremors of Parkinson’s disease, and insomnia.

Strains of Marijuana

There are two main strains of marijuana. They are Indica and Sativa.  From these two strains a variety of hybrids are cultivated. Sativa strains grow very quickly and can reach heights of 20 feet in a single season. They can take anywhere from 10 to 16 weeks to fully mature. On the other hand, Indica strains have more chlorophyll than Sativa strains. They grow and mature faster and will mature in 6 to 8 weeks and do not grow as tall, thus suitable for indoor growing.

According to the Medical Marijuana Learning Center:

Pure sativas can precipitate paranoia and irregular heart beats, therefore is a poor choice for medicinal use.  Whereas,“hybrid Sativas are coveted as medicine for the motivational properties they possess, often without the paranoia associated with pure Sativa. Sativa hybrids rarely have any pain blocking attributes and shouldn’t be used as such. These types have anti-depression and appetite stimulation qualities, so can be valuable as medicine in that regard.” Common Sativa hybrids include Haze, kali Mist, Jack Herer, and Willy Nelson.

“Indica plants have by far the most narcotic and pain blocking qualities so they are highly coveted by medical patients with any sort of pain. As a result of their higher CBD levels they are also helpful as a sleeping aid for those suffering with insomnia.) The most common Indica’s are Afghani, Pakistani, Hashplant, Herijuana, Hindu Kush and G-13.

The majority of medical marijuana is hybrid Indica. A few examples of hybrid Indica include: OG Kush, Master Kush, Purple Kush, White Rhino, Romulan, Blueberry, Dutch Treat, Grapefruit and Northern Lights.

Problems with past research

It is difficult to get federal approval for research; it might take up to 18 months or longer to obtain the necessary approvals.  The current research is weak in that most only have 50 participants or less and conducted for short periods of time.  Age of the participants is also an issue as most of the research done has been on college age individuals.  Another impediment is that cannabis is classified as an illegal drug by the federal government (FDA and DEA) with a classification of Schedule I controlled substance which also includes such drugs as heroin, LSD, ecstasy and peyote.  Schedule I drugs are considered to have no acceptable medical use and have a high potential for abuse.  In contrast, Schedule II controlled substances include cocaine and methamphetamine which are considered by the federal government to have some medical use and less abuse potential.

As long as cannabis remains classified illegal by the federal government it is more difficult to obtain legal supplies of cannabis for legitimate research purposes, thus the conundrum. Since 1968, Ole Miss (University of Mississippi) had been the sole producer of federally legal marijuana for research purposes in the United States. A provision in the 2014 federal Farm Bill has allowed for universities and state departments of agriculture to begin cultivating industrial hemp for limited purposes. According to State Industrial Hemp Statutes, this law allows universities and state departments of agriculture to grow or cultivate industrial hemp if:

1. “the industrial hemp is grown or cultivated for purposes of research conducted under an agricultural pilot program or other agricultural or academic research; and
2. the growing or cultivating of industrial hemp is allowed under the laws of the State in which such institution of higher education or State department of agriculture is located and such research occurs.”

The law also requires that the sites used by universities and agriculture department be certified by—and registered with—their state.

In my search for research, I found there are plenty of anecdotal stories which tout the positive effects of cannabis on a variety of symptoms and diseases.  These anecdotal stories cannot be discounted but certainly does not hold the status of strict research studies. The studies that do exist in the treatment of pain are small, though promising. Here is a sampling:

• University of California San Francisco: Patients with chronic pain may experience greater relief if their doctors add cannabinoids – the main ingredient in cannabis or medical marijuana – to an opiates-only treatment (December 2011).
• University of Montreal: Three Puffs a Day Helped People With Nerve Pain, Study Finds (Aug 2010)
• Weed 3: The Marijuana Revolution: Sanjay Guptah MD for CNN; Some animal and small human studies show that cannabinoids can have a “substantial analgesic effect.” (April 2015)

I believe that we are all an experiment of one when it comes to finding what works for our particular pain syndrome.  What works for one person may not work for all persons with the same pain syndrome.  If it works and does not cause harm then I believe we should be allowed to continue to use it for our particular pain syndrome or other symptoms. Without a doubt I believe everyone would agree that more strenuous research is needed to support the use of cannabis for various diseases and distressing symptoms.

What are your thoughts about this topic? Please share your experience or concerns and watch for part 2 of this series of 4 blogs.