A Physician’s Perspective on Legalized Cannabis

. November 30, 2018.
ISS_4266_06577

On Tuesday, November 6th, Michigan became the 10th state to legalize cannabis for recreational use. Ten years ago, we had become the 13th state to legalize Cannabis for medical use. I voted for the medical cannabis law years ago because, in my view, cannabis is not a dangerous product, and too many people were being imprisoned for its use. At that time, however, I did not subscribe to the argument that there were legitimate medical uses for cannabis. How things have changed.

Prescribed for centuries

Driven by the needs and requests of my patients, educated myself on the benefits and uses of cannabis. I discovered that cannabis has been used for medical purposes for hundreds (if not thousands) of years. In the 1930’s when legislation made cannabis illegal, one of the proponents of keeping it legal was the American Medical Association.

With few useful medications at the time, the Association argued that cannabis represented a safe, useful treatment for a variety of conditions from muscle spasms and anxiety to multiple forms of pain. Driven by a campaign to demonize cannabis, the substance was ultimately relegated to the most restrictive schedule (Category I) by the Controlled Substances Act of 1973. This category, limited to substances that have no recognized medical use, includes heroin and LSD. Many national leaders have spoken out, saying that cannabis should remain on this restrictive schedule—that it is a dangerous drug that is addictive, serves as a gateway to other drugs, and has no medical use. None of those statements has merit or has been shown to be true.

A gateway drug or safe substitute for opiates?

In January, 2017, at the behest of Congress, the Academies of Science, Engineering, and Medicine (in this case also known as the Institute of Medicine, or IOM) published a report, “The Health Effects of Cannabis and Cannabinoids,” which commented on the over 10,000 scientific studies that had been published on cannabis to that point. The report’s conclusions found multiple indications for medical cannabis use, including treatments for pain, mental health issues, cancer and respiratory diseases.(National Academy of Sciences, 2017). Other studies have demonstrated that states with medical cannabis laws have experienced huge reductions in the use of narcotic pain medications. A study from Michigan in 2016 demonstrated a 64% reduction in the use of narcotic pain medications in patients that were using medical cannabis (Boehnke, Litinas, & Clauw, 2016). The key to ending our current opiate epidemic definitely will include the use of medical cannabis.

What legalization means for cannabis as medicine

So what does the new law mean for physicians recommending the use of cannabis as medicine? The most important thing is that it allows us to consider its use for more than the 11 medical conditions currently on the statutory list in Michigan. Laws passed in 2016 also mandate that all cannabis grown in Michigan for sale in authorized dispensaries be tested for THC, CBD, and terpenes, as well as a list of contaminants. All of this makes cannabis much more compelling for recommending physicians—physicians who are used to recommending specific amounts of drugs or herbs, which has historically been difficult with a natural product like cannabis where, previously, the amount of active ingredient can vary widely depending on the plant and how, and where, it was grown. Hopefully, the combination of the increased demand that legalization should produce along with the mandated quality control measures will allow patients greater access to quality products without contaminants that will improve the treatment of medical conditions.

Boehnke, K. F., Litinas, E., & Clauw, D. J. (2016). Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain. J Pain, 17(6), 739-744. doi:10.1016/j.jpain.2016.03.002 National Academies of Sciences, E., and Medicine. (2017). The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. Washington, DC: The National Academies Press.

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