Medical Marijuana

 Medical Uses of cannabis

By Dr. Girivar Singhal


In the west, cannabis use for medicinal purposes dates back at least 3,000 years. It was re-introduced to the West in the 1840s by W.B. O’Shaughnessy, a surgeon who learned of its medicinal properties while working in India for the British East Indies Company. Its use was promoted for reported analgesic, sedative, inflammatory, antispasmodic, and anticonvulsant effects.

             Marijuana administrated as a cigarette or as a synthetic oral cannabinoid (dronabinol), has been proposed to have a number of properties that may be clinically useful in situations. These includes antiemetic effects in chemotherapy recipients, appetite–promoting effects in AIDS, reduction of intraocular pressure in glaucoma, gastrointestinal illness  and reduction of spasticity in multiple sclerosis and other neurologic disorders. With the possible exception of AIDS- related cachexia, none of these attributes of marijuana compounds is clearly superior to other readily available therapies. On the National Cancer Institute website, the National Institutes of Health (NIH) stated that cannabinoids found in marijuana appear to have significant analgesic and anti-inflammatory effects, antitumor effects, and anticancer effects, including the treatment of breast and lung cancer. The anti-cancer effect is due to the presence of cannabidiol (CBD) in the plant, an anti-cancer agent that does not cause euphoria.

In the east, marijuana has been used for medicinal purposes for more than 4,800 years. Doctors in ancient China, Greece and Persia used it as a pain reliever and for gastrointestinal disorders and insomnia. Laboratory research has elucidated the far-flung endocannabinoid system that modulates neurotransmitter networks throughout the body through cannabinoid-1 (CB1) receptors that are preferentially distributed in the brain and cannabinoid-2 (CB2) receptors that are prominent in gut and immune tissues. Among dozens of cannabinoids in raw marijuana, two show medicinal promise. The first, Δ9-tetrahydrocannabinol (Δ9-THC), is the CB1 ligand that recreational users prize. The second, cannabidiol (CBD), acting on CB2, lacks psychoactivity but works synergistically with Δ9-THC to minimize “highs” and maximize analgesia.
Medical use of cannabis for Insomnia

           Insomnia is the complaint of inadequate sleep; it can be classified    according to the nature of sleep disruption and duration of complaint. Insomnia is subdivided into difficulties falling asleep (sleep onset insomnia), frequent or sustained awakening (sleep maintenance insomnia), early morning awakening (sleep offset insomnia), or persistence sleepiness despite sleep of adequate duration (nonrestorative sleep). Insomnia affects all age groups and it is more common in woman than man. Stress very commonly triggers short-term insomnia.  If it’s not properly addressed, short-term insomnia can develop into chronic insomnia. Chronic insomnia is often linked to an underlying medical condition – such as chronic pain of all varieties, chronic fatigue syndrome, acid reflux, and others.  Common psychological problems that may lead to insomnia include anxiety, stress, bipolar disorder, and depression.

Treatment of insomnia generally includes non-medical as well as   pharmacologic components.  Studies have shown that such a combined approach in treating insomnia usually works best.

Non-pharmacologic or non-medical therapies for insomnia include such things as improved sleep hygiene, relaxation therapy, stimulus control, and sleep restriction.  Improved sleep hygiene includes things such as avoiding alcohol, caffeine and exercise before bedtime, creating a comfortable bedroom environment, and following a regular sleep schedule. Alcohol and nicotine can interfere with sleep, despite the fact many patients use them to relax and promote sleep. Alcohol ingestion prior to sleep is contradicted in patient with sleep apnea because of the inhibitory effects of alcohol on upper airway muscle tone. Actually amphetamines and cocaine suppress both REM sleep and total sleep time, which returns to normal with chronic use. Withdrawal leads to REM sleep rebounds. A number of prescribed medications can produce insomnia. Antidepressant, sympathomimetics and glucocorticoids are common cause. In addition, severe rebound Insomnia can result from the acute withdrawal of hypnotics, especially following the use of high doses of benzodiazepines with the short half –life.

As an alternative to these prescription drugs, medical cannabis has also been found to be very effective in treating insomnia.  In some cases, tiredness from medical cannabis can be a side effect.  At night-time, however, it can be a very beneficial effect.  Many patients report that when compared to conventional sleep medications, medical cannabis works better, is not habit-forming, and leaves them feeling better the next day.  And there has never been a death from a medical cannabis overdose.

When using medical cannabis for insomnia, it is important to keep in mind which strain to use.  Most patients find that Indica strains are more relaxing with a pronounced sedative quality.  Sativa strains generally tend to be more energizing.  For some patients, either strain works well.

Scientific evidence supports these reports.  One study determined that the cannabinoid CBD helped with sleep better than THC.  Cannabinoids such as CBD and THC are just two of over one hundred such molecules found in the cannabis plant which provide medicinal actions. Inhaled cannabis– preferably smoke-free vapor – generally provides an immediate effect and lasts for about 3–4 hours.  Edible or ingested cannabis, on the other hand, takes up to an hour to work, but lasts for up to 6–8 hours.  Therefore, an edible cannabis product, taken about an hour before bedtime, can work very well to help get a full night’s sleep.

The study was published in 1973 by researchers in the United   States and involved 9 test subjects that were given varying doses of THC – 10, 20 and 30mg – once a week over a 6 week period. According to the results, each dose was able to reduce the time it took to fall asleep (sleep latency), with the most effective dose being 20 mg. 20 mg of THC was found to reduce the average time it took patients to fall asleep by more than an hour.

Overall, THC was found to be more effective in helping patients fall asleep once they got into bed, as opposed to getting them into bed sooner. Interestingly, the highest dose of THC (30mg) was found to be less effective than the 20mg dose, suggesting that the 30mg dose may have been too intoxicating. According to the study’s authors, the effects of being too high can outweigh the desire to sleep or simply make it harder to fall asleep.

The study also showed that THC could decrease the number of sleep interruptions that insomniacs experience, but only during the early part of the night. THC also seemed to increase the amount of time that patients spent sleeping – higher doses of THC were correlated with longer periods of sleep. Patients also reported a “hang over” effect in the morning, particularly at the 30 mg dose. On the other hand, 20 mg didn’t seem to negatively affect patients the next day.


Medical use of cannabis for Glaucoma

           This is the slowly progressive, insidious optic naturopathy, usually associated with chronic elevation of intraocular pressure. The pressure inside the eye is sufficiently elevated to cause optic nerve damage and result in visual field defects. Normal intraocular pressure (IOP) is 10-21mmHg. Some type of glaucoma can result in an IOP exceeding 70mmHg. Glaucoma is the second commonest cause of blindness worldwide and the third commonest cause of blind registration in UK.

Glaucoma is usually painless (except in angle closure glaucoma).Foveal acuity is spared until end- stage disease is reached. For these reasons, severe and irreversible damage can occur before either the patient or physician the diagnosis. Screening of patients for glaucoma by nothing cup-to-disc ratio on ophthalmoscopy and by measuring intraocular pressure is vital. Glaucoma is medically treated with topical adrenergic agonists, cholinergic agonists, beta blockers and prostaglandin analogues. Occasionally, systematic absorption of beta blocker from eye drop can be sufficient to cause side effects of bradycardia, hypotension, heart block, bronchospasm or depression. Tropical or oral carbonic anhydrase inhibitor is used to lower intraocular pressure by reducing aqueous production. Laser treatment of the trabecular meshwork in anterior chamber angle improves aqueous outflow from the eye.

The only way to control glaucoma and prevent vision loss is to lower your IOP levels. Studies conducted that marijuana can be helpful in treating glaucoma. Smoking marijuana lowered the IOP of people with glaucoma. As a result of this research, additional studies were conducted examining whether marijuana or its active ingredient, a compound known as THC, could be used to keep IOP lowered. This research was supported by the National Eye Institute, a division of the federal National Institutes of Health. The research found that when marijuana is smoked or when a form of its active ingredient is taken as a pill or by injection, it does lower IOP. However, it only lowers IOP for a short period of time—about three or four hours.

This short period of time is a major drawback for the use of marijuana as a glaucoma treatment. Because glaucoma needs to be treated 24 hours a day, you would need to smoke marijuana six to eight times a day around the clock to receive the benefit of a consistently lowered IOP. Because of marijuana’s mood-altering effect, smoking so much of it daily would leave you too impair As scientists learn more about glaucoma, they have also come to understand that IOP is not the only factor that damages the optic nerve. Recent studies characterize glaucoma as a neurologic disease similar to Parkinson’s or Alzheimer’s. And, there is increasing evidence that reduced flow of blood to the optic nerve may also cause damage in patients with glaucoma. Unfortunately, marijuana not only lowers IOP, but it lowers blood pressure throughout the body. As a result, it has the potential to lower the blood flow to the optic nerve, effectively canceling out the benefit of a lowered IOP. Scientists are still exploring whether the active ingredients in marijuana may yet offer a glaucoma treatment. However, such developments require much more research and are many years from becoming a reality. So, while marijuana can temporarily lower your IOP; it’s not recommended for treating glaucoma. Prescription, medication and surgical treatment have been tested and proven as effective treatments for the condition.


Medical use of cannabis for Alzheimer’

Alzheimer’s disease (AD) is an illness of the brain. The brain is the common site of amyloid deposition, although it is not directly affected in form of acquired systematic amyloidosis. Intracerebral and cerebrovascular amyloid deposits are seen in Alzheimer’s disease. Amyloid deposits are frequently found in the elderly, particularly cerebral deposits of A4 protein. Age is the main risk factor for Alzheimer’s disease as incidence increases exponentially with the age. Head trauma and vascular risk factors also increase Alzheimer’s disease risk. Epidemiological studied show that taking anti-inflammatory over a long period may confer some protection.

Cannabinoids, the active chemical components of marijuana, can regulate inflammation in the brain and promote neurogenesis — the growth of new neural pathways — even in cells damaged by age or trauma. As more research has indicated that brain inflammation appears to be a cause of several degenerative diseases, marijuana has been getting a closer look as a potential preventive medication. THC, the chemical compound responsible for marijuana’s high, “could be considerably better at suppressing the abnormal clumping of malformed proteins that is a hallmark of Alzheimer’s disease than any currently approved prescription.” The research team predicted that cannabinoid-based medications “will be the new breakout medicine treatments of the near future.”


Medical use of cannabis for HIV

            Since the first description of AIDS in 1981 and the identification of the causative organism HIV in 1984, more than 20 million people have died. At least 40million people worldwide are living with HIV. Human immunodeficiency virus (HIV) is a lentivirus (slowly replicating retrovirus) that causes acquired immunodeficiency syndrome (AIDS), a condition in humans in which progressive failure of the immune system allows

Life-threatening opportunistic infections and cancers to thrive. Infection with HIV occurs by the transfer of bloodsemenvaginal fluidpre-ejaculate, or breast milk. Within these bodily fluids, HIV is present as both free virus particles and virus within infected immune cells.

HIV infects vital cells in the human immune system such as helper T cells (specifically CD4+ T cells), macrophages, and dendritic cells. HIV infection leads to low levels of CD4+ T cells through a number of mechanisms including: apoptosis of uninfected bystander cells, direct viral killing of infected cells, and killing of infected CD4+ T cells by CD8 cytotoxic lymphocytes that recognize infected cells. When CD4+ T cell numbers decline below a critical level, cell is lost, and the body becomes progressively more susceptible to opportunistic infections.

The antiretroviral therapy on survival during HIV infection, there is an increasing need to manage symptoms and side effects during long-term drug therapy. Cannabis has been reported anecdotally as being beneficial for a number of common symptoms and complications in HIV infections, for example, poor appetite and neuropathy. HIV-positive individuals attending a large clinic were recruited into an anonymous cross-sectional questionnaire study. Up to one-third (27%, 143/523) reported using cannabis for treating symptoms. Patients reported improved appetite (97%), muscle pain (94%), nausea (93%), anxiety (93%), nerve pain (90%), depression (86%), and paresthesia (85%). Many cannabis users (47%) reported associated memory deterioration. Symptom control using cannabis is widespread in HIV outpatients. A large number of patients reported that cannabis improved symptom control.

The collective results demonstrated statistically significant improvement in half or more patients in symptoms of nausea, anxiety, nerve pain, depression, tingling, numbness, weight loss, headaches, tremor, constipation, and tiredness. Symptoms that were not improved included weakness and slurred speech, and statistically significant memory deterioration was recorded in 47% of users.

The sedative properties of cannabis, it is important to assess whether evening dosing for cannabinoid therapies is more useful or appropriate. Its sedative effects may be helpful at this time but none were reported as predominant. Presumably there is tolerance to these types of effects. More importantly, reduction of pain, anxiety, and gastrointestinal upset appears to be the constellation of symptom control sought by these HIV patients.


Medical use of cannabis for Cancer

Cancer, is a term for diseases in which abnormal cells divide without control forming malignant tumors and invading nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue, such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are that begin in the tissues of the brain and spinal cord. Also called malignancy.

Cancer patients can benefit from using medical marijuana, whether as an alternative cancer treatment or to help mitigate unpleasant side effects of chemotherapy. Even lung cancer patients can use medical marijuana– studies show that smoking marijuana does not cause cancer. In fact, studies show that marijuana slows the invasion of cervical cancer and lung cancer cells. Cannabidiol, one of the five cannabinoids found in medical marijuana, also inhibits tumor growth in   Leukemia and breast cancer.

Cannabinoids activate specific receptors found throughout the body to produce pharmacologic effects, particularly in the central nervous system and the immune system. Commercially available cannabinoids, such as dronabinol and nabilone, are approved drugs for the treatment of cancer-related side effects. Cannabinoids may have benefits in the treatment of cancer-related side effects.

Patients undergoing cancer treatment often use medical marijuana to reduce vomiting and nausea, for which purpose it is highly effective. In a review conducted by the University of Arkansas, cannabinoids significantly reduced vomiting and nausea in breast cancer patients following breast surgery. In addition, medicinal marijuana can serve as an appetite stimulant to improve cancer treatment related anorexia.

Dr. Girivar Singhal for The Marijuana Company

Before using Marijuana for medical purposes, consult with a physician.