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Facebook Dr. Anil Home pageMarijuana is derived from seeds, flowers, leaves and stem of the plant Cannabis sativa. In its resin form, hashish is the commonest drug of abuse across the world.
Generally acceptable indications for marijuana use are variable, subject to local and federal laws and include following:
- Certain subsets of patients with cancer, AIDS, multiple sclerosis, seizure/epilepsy
- Glaucoma
- Severe weight loss/wasting syndrome
- Severe unrelenting chronic pain
- Severe nausea especially induced by cancer chemotherapy
- Post-traumatic stress disorder or PTSD
I have previously written about role of marijuana in digestive diseases in another post.
Marijuana or cannabis like chemicals are found normally in healthy human body and play an important role in day to day body functioning.
Biological effects of indigenous cannabis-like chemicals called cannabinoids:
- Suppress pain
- Reduce movements of intestines during periods of inflammation
- Reduce intestinal permeability or leaky gut
- Increase appetite
- Decrease nausea and vomiting
- Block inflammation
- Block unrestrained growth and prevent cancer
Features of cannabinoid/marijuana-induced hyperemesis syndrome
- Occurs after prolonged use
- More among males
- Repeated vomiting frequent hot baths
Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health
Treatment of Cannabinoid/marijuana-induced hyperemesis syndrome includes:
- Hydration
- Sedatives
- Anti-emetic (anti-nausea/vomiting) agents like Zofran
- Pain control using non-narcotic pain-killers
- Antidepressants over long term
- Long term treatment includes gradually stopping marijuana use, anti-anxiety drugs, and relaxation therapy.
Practical implications of cannabis use
- Not used as first line drug
- Potential for cannabinoid induced hyperemesis syndrome
- Some regard the efficacy to be less than pharmaceutical anti-emetic agents.
Role of cannabis/marijuana in cachexia (wasting and malnutrition)
This may occur in the setting of AIDS and cancer etc.
Clinical effects of cannabis/marijuana:
- Stimulates appetite
- Increases food intake
- Patients with HIV or cancer show increased food intake and weight gain. Use of medicinal cannabis (dronabinol) increases food intake greater than smoking marijuana.
Cancer
- Laboratory research indicating that cannabis suppresses tumor growth is countered by some studies showing actually increased tumor growth.
- In one clinical trial of injecting THC into the brain of patients with a particular form of brain tumor (glioblastoma multiforme) who had failed conventional treatments showed that THC suppressed tumor growth.
While cannabis cannot be routinely recommended for use in cancer per say, it does play a beneficial role in chemotherapy induced nausea/vomiting, as well as beneficial effects in controlling pain and improving appetite.
Epilepsy
Animal data
- Animal studies indicate that marijuana suppresses seizures and reduce seizure related deaths.
- On the other hand, cannabis can lower seizure threshold and increase risk for seizures.
Human studies
- Human trials have been conducted using cannabidiol.
- Some, but not all demonstrated reduced frequency of seizures.
At the present time, there is insufficient evidence to endorse or refute the use of cannabis for epilepsy and seizure disorders.
Glaucoma
Smoking marijuana reduces pressures in the eyes in majority of the subjects.
- The duration of effect is short, hence is required multiple times a day.
- Side-effects can be overwhelming in many patients necessitating withdrawal.
- Smoking marijuana especially abruptly may paradoxically worsen the pressures in the eyes.
Based on current medical evidence, marijuana use does not appear to be safer or superior to currently available medicines for glaucoma.
Hepatitis C
While smoking marijuana is associated with some progression of disease, it’s use also helps against side-effects induced by hepatitis C therapies. The latter however may not be consequential since the newer hepatitis C treatments are relatively less toxic, there is much less need for strategies to overcome si8de-effects. Given the overall clinical situation, marijuana use should not currently be routinely undertaken in the context of hepatitis C.
HIV/AIDS
Patients use marijuana to overcome medication induced side-effects like nausea, weight loss, pain and neuropathy.
- There is beneficial effect on mood and appetite.
- Weight gain has been reported.
A systematic review by Dr. Lutge and colleagues concluded that the “evidence for the efficacy and safety of cannabis and cannabinoids” in HIV/AIDS is lacking. Likewise, “evidence for substantial effects on morbidity and mortality is currently limited.”
Muscle spasticity due to multiple sclerosis
Medicinal cannabinoids taken by mouth or under the tongue reduce severity of muscle spasms and the effects are sustained over long term. Results with smoked marijuana have however been conflicting. Marijuana use does adversely affect cognitive function and can be a problem in patients with already compromised brain.
American Academy of Neurology does not recommend marijuana use for neurological diseases.
Post-traumatic stress disorder (PTSD)
Cannabinoid system in the human body plays a role in causing and sustaining the PTSD. Marijuana use is higher among PTSD patients. The purported beneficial effects may be related to action of marijuana on our own endo-cannabinoid system.
There are no large scale studies to confirm or refute the benefit. One small study from Canada demonstrated that nabilone therapy reduces trauma associated nightmare in military personnel.
Mashiah and colleagues from Israel presented promising data at a conference showing that marijuana smoking has beneficial effects on PTSD in combat veterans and the effects can be seen as long as one year.
Sleep problems common among PTSD patients. Quitting marijuana smoking results in poorer sleep patterns. are associated with unfavorable results upon stopping marijuana.
Severe chronic pain
Dr. Martín-Sánchez and colleagues from the Castile-La Mancha Health Research Foundation (FISCAM), Toledo, Spain. conducted a systematic review pf cannabis use for chronic pain in 18 double-blind randomized controlled trials. They concluded that “cannabis treatment is moderately efficacious for treatment of chronic pain.”, However, the beneficial effects may be more than offset by the associated adverse effects like altered perception and cognitive function.
Phillips and colleagues conducted a systematic review of therapies helpful for HIV-associated neuropathic pain. Smoked marijuana was one oif the only three remedies that were effective. No benefit was demonstrated fro4 commonly used medications like antidepressants, gabapentin, etc.
Dr. Minocha's Comments
While there is plenty of literature on possible adverse effects related to marijuana, there is paucity of well done large studies related to its efficacy and comparisons to other therapies. At the same time, when the issue of harm is considered, one cannot just assume that available pharmaceutical agents were devoid of side-effects.
The other issue that bothers a lot of people is the harmful effects since people may start using it for recreational purposes. In this context, one should compare it to the widely available alcohol as a social drink and many people argue that smoking marijuana may pose less risk for harm than the socially acceptable alcohol use.
Caution: This post is for information only. Nothing in this writing should be interpreted as an endorsement by Dr. Minocha. Talk to your doctor; do not break any laws!
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Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health
