In the fall of 2012, 9 months after starting chemotherapy for Stage 3 colon cancer, Shannon Flowers of Seattle developed nerve pain in her hands and feet that was so intense she couldn’t sleep at night. Two commonly prescribed medications for neuropathy – Lyrica and gabapentin — certainly helped, but the side effects, she remembers, were “horrible,” everything from severe swelling in her extremities to mood swings, chronic exhaustion and hunger.
Fed up with the side-effects of conventional medications, Flowers turned to an unconventional but increasingly popular (as well as legal) alternative: medical cannabis, commonly referred to as medical marijuana.
In 1999, only three states – Alaska, California and Maine – had laws permitting the use of medical marijuana. Today, 21 states and the District of Columbia authorize the use of medical marijuana, primarily to help people with chronic conditions alleviate the severe side effects of the conventional medications they take for cancer treatment, glaucoma, HIV infection, nerve pain, nausea, epilepsy, Crohn’s disease, multiple sclerosis and other chronic conditions.
Many of the estimated 2.5 million Americans who have used medical marijuana have even been able to reduce their dependence on prescription medicine by adding cannabis to their treatment regimen.
Once a prominent opponent of medical marijuana, Sr. Sanjay Gupta, CNN’s Chief Medical Correspondent, famously reversed course in August 2013 after touring the country and seeing how cannabis was helping people fight illness and lessen their need for prescription medicines, including a 3-year-old Colorado girl who was experiencing 300 seizures a week despite being on 7 different medications. Medical marijuana, he says, “calmed her brain,” and lowered her seizure count to 2 to 3 a month.
Medicinal use of cannabis dates back at least 3,000 years, when people in China and Egypt were using it to treat such problems as leprosy, pain and inflammation. In the United States, federal law still classifies marijuana as an illegal narcotic, yet states have been allowed to pass their own medical marijuana laws.
So far, 21 states, as well as the District of Columbia, have already legalized medical marijuana for a broad variety of medical problems, many of which are severe reactions to traditional medications. According to the Marijuana Policy Project, a Washington, D.C-based advocacy group, medical marijuana has most often been approved for treating cancer, glaucoma, nerve pain (or neuropathy), the wasting syndrome that often comes with HIV infection, severe chronic pan, severe nausea, and the often hard-to-treat spasticity — or muscle stiffness – that may affect more than 70 percent of multiple sclerosis sufferers.
Laura Oxley, a spokeswoman for the Arizona Department of Health Services, said that while her state’s current data gathering system doesn’t allow health officials to know exactly which drugs medical marijuana is replacing or supplementing, there is “tremendous public support” for medical cannabis use in general. So far, 70 medical marijuana dispensaries are open in Arizona, and the state has approved another 85 new facilities.
The Challenges of Researching Federally Banned Substances
Despite strong public support for medical marijuana use, some studies suggest that medical marijuana’s therapeutic effects are modest at best, while others indicate it may be most useful for helping those individuals who aren’t getting help from conventional drugs, or who can’t deal with the side effects of those medications. Some physicians, meanwhile, caution that because marijuana is still a federally banned substance, the science behind medical marijuana is emerging slowly; larger and more rigorous clinical studies are needed. In laboratory and animal studies, for example, the active chemicals in medical marijuana either kill or inhibit cancer cells, yet clinical studies so far have not looked at medical marijuana as a cancer treatment for people, except for a small but promising study on glioblastoma.
“It’s being prescribed for conditions for which there is no scientific basis to know that it works,” said Dr. J. Hampton Atkinson, the Co-Director for the Center for Medicinal Cannabis Research at the University of California, San Diego.
Julie Falco of Chicago was taking 30 drugs to help with the painful symptoms of MS. She traded them in for just one: medical marijuana. “The cannabis didn’t eliminate anything (like tremors), but within the first week I noticed an improvement so I could walk a little better, and also I wasn’t feeling as depressed,” she said, adding that the only side effect so far has been dry mouth, which she treats by drinking more water.
Still, many medical marijuana users remain firmly committed to the therapy. In Washington State, where medical cannabis has been legal since 1998, Shannon Flowers is using a syringe or dropper to take tiny amounts of either “hash oil” or a marijuana-based tincture orally to help fight her nerve pain (smoking marijuana is not an option because she’s asthmatic). Early on, she discovered the cannabis was just as effective at relieving the pain as the Lyrica and gabapentin, but side effects usually included only a feeling of lightheadedness, as well as “the munchies,” the snacking urge that’s also common with recreational marijuana use.
“My pain now is only about a third of what it was before, and also it’s more of a cramping, rather than a constant pain,” said Flowers recently.
So far, many of the most rigorous studies that have looked at the benefits of medical marijuana use have focused on using it to treat nerve pain, which can be a byproduct of not just cancer, but also of diabetes, HIV infections, spinal cord injuries, and multiple sclerosis.
In a series of a half-dozen studies coordinated by the Center for Medicinal Cannabis Research in California, researchers found that smoked or inhaled marijuana could provide an extra level of pain relief to people who were already taking other pain medicines (like codeine, morphine, or gabapentin) for their nerve pain.
“Roughly half of the patients in these studies got at least a 30 percent reduction in the intensity of their pain, and 30 percent is a standard that’s generally associated with having a better quality of life,” said Dr. Atkinson.
THC and Chemo
Cannabinoids are the chemicals that give medical marijuana its drug-like effect. One of the most abundant cannabinoids in marijuana is tetrahydrocannabinol, or THC. It’s responsible for marijuana’s distinctive high, while a second cannabinoid – cannabidiol – is known to relieve pain and inflammation without causing a high.
In the United States, federal law already allows the use of two cannabinoid drugs that are taken as pills and that are often referred to as “synthetic” forms of marijuana. The drugs, dronabinol and nabilone, are available generically, although they were first sold under the respective brand names of Marinol and Cesamet. They are now prescribed most often for treating chemotherapy-related nausea and vomiting in individuals who have cancer and AIDS, and who haven’t responded to standard therapies. According to the National Cancer Institute, both drugs work as well or better than some of the weaker drugs now used to treat these conditions.
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Sana is a New York-based science and business journalist who has written for national publications, including The New York Times, Business Week and Discover. She teaches journalism at St. John’s University in New York City.