Cannabis as an Alternative Medication for Disease
Author:
Joseph McSherry, MD, PhD
UVM Health and Larner College of Medicine
Citation:
McSherry J. Cannabis as an alternative medication for disease [published online May 30, 2019]. Neurology Consultant.
Physicians are concerned about effects, adverse effects, and interactions with allopathic treatments when confronted with a patient using or asking to use cannabis as an alternative medication. The lack of academic coverage in most medical school curricula leaves most individuals with no accepted basis to fear the plant-based material and no security that it does not cause harm. The National Institute for Drug Abuse (NIDA) continues to fund research seeking to demonstrate harm. Research coming from Israel, Europe, and other nations shows benefits. The US Food and Drug Administration (FDA) is absent.
Cannabis entered Western medicine in 1843 with O’Shaughnessy’s article1 describing experiments on various animals and doctors in training (pre-institutional review board). Success was reported in controlling diseases from childhood epilepsy, cholera, and tetanus to symptom mitigation in patients with rabies. Use dropped off after the Federal Bureau of Narcotics and, now, the Drug Enforcement Agency decided to demonize the plant for nonmedical reasons. The lack of modern information leaves physicians with their personal beliefs, formulated in the presence of propaganda and scientific void.
For a project in a pharmacology course at the University of Vermont, I created a spreadsheet2 with 7 cannabinoids and 7 terpene/terpenoids on the vertical axis and 22 reported effects on the horizontal axis, including anti-inflammatory, analgesic, muscle relaxant, anticonvulsant, antianxiety, and so on. A (+) was added when the chemical and benefit occurred. Such a matrix would be useful if cannabis was reliably tested for these chemicals. If the desired effect is antianxiety, a chemotype with cannabidiol (CBD), limonene, and linalool seems best. For anti-inflammatory effects, a chemotype with dronabinol (THC), CBD, cannabigerol (CBG), cannabinol (CBN), pinene, linalool, caryophyllene, and myrcene seems optimal.
Medicine has come some ways since 1843, and to update O’Shaughnessy’s article, we need data. In venues where medical cannabis is legal, physicians should urge regulation—including testing not only for THC, heavy metals, and pesticides but also for the spectrum of other cannabinoids and terpenes/terpenoids. Then a physician, faculty, or group could maintain a database or spreadsheet updated by patient reports. Of course, physician biases will inform what the doctor hears from the patient. The data will be messy. Eventually different chemical-benefit profiles will emerge. Advice like CBD in the morning for pain, anxiety, and inflammation with more THC in the evening for improved sleep will be greatly enhanced with the full chemotype optimal for, say, the anxious hyperactive pain patient with insomnia.
For now, listening to the patient’s report of symptom relief and side effects, combined with as much detail as possible about the chemotype used, is state of the art. Going forward, physicians need to gather data and learn. For any who only want to prove dangers of cannabis, NIDA has worked on that for more than 40 years and got nada.
Joseph McSherry, MD, PhD, is an associate professor of Neurological Sciences at University of Vermont Health Network and Larner College of Medicine in Burlington, Vermont.
References:
- O’Shaughnessy WB. On the preparations of the Indian hemp, or gunjah (Cannabis Indica): Their effects on the animal system in health, and their utility in the treatment of tetanus and other convulsive diseases. Prov Med J Retrosp Med Sci. 1843;5(123):363-369. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2490264.
- McSherry J. 2018 cannabinoids and terpenoid profiles. https://bit.ly/2XaZfXg.