Kenneth Finn, MD, Karen Randall and Libby Stuyt
Marijuana has been around for thousands of years and has been reported to have medical benefits. Colorado has had a medical marijuana program since 2001 for compassionate care. Since 2009, medical marijuana dispensaries have multiplied to the point they outnumber Starbucks and McDonald's combined, and El Paso County has more that 20 percent of Colorado's medical marijuana patients.
The science of cannabis supports that components of the plant may have potential medical value. It is critical that, as a medication, cannabis meet the rigor of scientific study, just as every other plant-based medication has, like aspirin, some heart medications, and a variety of chemotherapy agents.
In January 2017, National Academies of Science, Engineering, and Medicine released a paper and misleadingly concluded that "there is evidence that cannabis is an effective treatment for the treatment of chronic pain in adults". To clarify, it was noted that the most noted medical condition was nerve pain and that the majority of studies used products that are not available in the United States or pharmacy grade, purified synthetic cannabinoids. They further note only a handful of studies evaluated benefit of dispensary cannabis in the U.S. and that little is known about dosing, routes of administration, or side effects of dispensary cannabis.
In August, The Annals of Internal Medicine released a paper that further clarified that the medical literature may support the use of cannabis in nerve and cancer pain, and there is little evidence to show benefit in common pain conditions. Finally, in February, The College of Family Physicians of Canada sent a simplified guideline for prescribing medical cannabinoids in primary care to 30,000 physicians in their country.
They did a very intensive medical literature review and came to the same conclusions and recommended strongly against the use of medical cannabinoids for acute pain, headache, osteoarthritis, and back pain. They recommended that if recommending for pain, utilize a pharmaceutically developed product. Unfortunately, in our fragmented medical system, "off label" use of a pharmacy grade cannabinoid is not permitted and expensive, and natural, pharmacy grade cannabinoids are not available in the U.S. (Sativex).
The "God's plant" cannabis was about 0.5-3 percent THC concentration. Plants and concentrated products of today are 15 percent-90 percent+ THC concentrations. Cannabis does have addictive potential and reported addiction rates are about 9 percent in adults and 18 percent in adolescents, and is based on 1990s cannabis where the THC content was about 6-8 percent.
We do not know the addiction rates of today's cannabis. Cannabis use disorder is one of the most common diagnoses for adolescent substance use treatment in Colorado, and we know there are well-documented mental health effects including anxiety, depression, and psychosis.
Not everyone who uses cannabis will experience this, but with increased use will be increased numbers of people effected. Cannabis is the most common substance found on toxicology in completed suicide, not only in our teens, but across all age groups, and the prevalence is skyrocketing over time, according to CDPHE.
CBD, the nonpsychoactive component of the cannabis plant, is showing some promise as a medical treatment, particularly in pediatric seizure. It is important to know that when looking at CBD products, which are available online, 31 percent were accurately labeled (JAMA Nov. 7, 2017 Volume 318, Number 17) and in regulated markets (California and Washington), a similar study showed that only 17 percent were accurately labeled as to CBD content (JAMA June 23/30, 2015 Volume 313, Number 24). It is imperative that testing for purity and potency is for public safety, and contaminated "medical marijuana" has been reported in patient deaths.
Marijuana has potential medical benefit. Just like any medicine, it should meet the muster of scientific rigor and research. Products which are free of contaminants, tested consistently, and purified could benefit many patients; however, science, not public opinion, or anecdotes should determine what is best for patient health and public safety.
This opinion column was submitted by: Kenneth Finn, MD, Pain Medicine, Karen Randall, MD, Emergency Medicine and Libby Stuyt, MD, Psychiatry.