Medical Marijuana: New Issues for an Old Cure

States could play a role in expediting its approval as a therapy.

Sixty-two percent of Americans reportedly support legalization of cannabis. Thirty-one states allow medical marijuana and nine states have sanctioned recreational use.

Cannabis is a very old medicine. Archeological evidence shows it was used 4,200 years ago in China. There are records from 300 BC showing cannabis being traded between India and Egypt, which at the time was the largest population center in the West. Cannabis is not a narcotic, nor a depressant, stimulant, anesthetic, or hallucinogenic. Studies show it has the same dependence level as nitrous oxide or caffeine.

The psychoactive ingredient is tetrahydrocannabinol, known as THC.

Cannabinoid neuro-receptors are built into the human brain and nerve system. Smoking cannabis can throw this cannabinoid receptor system into chaos by influencing the amount of dopamine or other neuro-transmitters that flow across synapses.

Depending on the location of the affected neurons, we see different effects. The cannabinoid receptors in the brain stem may influence nausea. The same is true elsewhere: receptors in the hypothalamus influence eating and sex; the spinal cord influences pain; the amygdala influences emotions such as fear or anxiety; and the hippocampus influences learning and memory. Cannabinoid receptors in other parts of the brain, such as the frontal cortex, can stimulate philosophical thinking, introspection, and meta cognition.

When used in a form in which the psychoactive ingredients are stripped out, cannabis has emerged as a painkiller that carries with it some hope of alleviating the opioid crisis.

In states where cannabis is legalized for medical use, the patient obtains a certification from a doctor. This is not a prescription, because doctors may not write prescriptions for illegal drugs. With the certification, the patient obtains a medical marijuana card that they present with their ID when legally purchasing the drug.

Will Cannabis be Covered by Medicare?
There is a conflict between federal and state law. Under the Controlled Substances Act, the Food and Drug Administration (FDA) classifies marijuana as a Schedule I drug, which is the same class as LSD and heroin.

In terms of therapeutic benefit, at this time, cannabis is not approved as a safe and effective drug for any indication whatsoever.

In order for it to enter the mainstream of healthcare, the FDA will need to approve its use and move it to Schedule II or III. More importantly, healthcare protocols for dosage and indications will need to be worked out before it can be incorporated into mainstream medical practices.

Protocols take time to develop. The hope for many is that they will be worked out quickly so that cannabis will become available for a full range of uses, including:

• Reduction of nausea and vomiting during chemotherapy;
• Assisting HIV patients to maintain their appetite during retroviral therapy;
• Alleviation of chronic pain and muscle spasms; and
• Perhaps providing assistance in the hospice setting.

Once these approvals come, cannabis will be accepted not only by Medicare, but by all insurance companies.

The Expected Timeline
Right now, scientists are conducting extensive research on the molecular biological mechanisms of cannabis. We can expect that years more of research will be needed before this old drug is fully understood. Even then, we know that new drugs always are slow to be accepted, and cannabis will be no different.

But when the time comes, experiences in the states may contribute to a faster learning curve on the protocol side.