Medical Marijuana

What is medical marijuana?

“Medical marijuana” is the term for using marijuana to help with symptoms related to medical conditions (not recreational purposes). The U.S. Drug Enforcement Administration (DEA) classifies marijuana as a Schedule I substance. This means that it has no currently accepted medical uses and a high potential for addiction. Because of this, healthcare providers can’t prescribe marijuana. But in states that legally allow it, providers may certify or confirm that people have a medical condition with symptoms that marijuana may treat or alleviate.

But not all hospital systems and healthcare providers certify medical marijuana in states where it’s legal. This is mainly due to the lack of thorough research and clinical trials on the medical uses of marijuana.

Marijuana analogs for medical purposes

The U.S. Food and Drug Administration (FDA) hasn’t approved marijuana to treat any medical conditions. But it has approved certain purified substances derived from marijuana (analogs).

FDA-approved analogs of marijuana include:

• Cannabidiol (Epidiolex®). This analog prevents and controls seizures in people who have Lennox-Gastaut syndrome or Dravet syndrome (two rare forms of epilepsy). This is a prescription medication, which is different from over-the-counter CBD (cannabidiol) products.
• Dronabinol (Marinol®) and nabilone (Cesamet®). These analogs can prevent and treat nausea and vomiting related to chemotherapy. Dronabinol can also help treat loss of appetite and weight loss in people with HIV or AIDS, as well as help treat agitation in people with severe dementia.

What is medical marijuana used for?

Each state in the U.S. with medical marijuana laws has specific qualifying medical conditions for which certified healthcare providers may recommend medical marijuana. In these cases, people use medical marijuana mainly to help with symptom management. It doesn’t directly treat a condition.

For example, in Ohio, these conditions include:

• AIDS or positive status for HIV
• Amyotrophic lateral sclerosis (ALS)
• Alzheimer’s disease
• Cachexia (muscle loss with or without fat loss)
• Cancer
• Chronic traumatic encephalopathy (CTE)
• Crohn’s disease
• Epilepsy or another seizure disorder
• Fibromyalgia
• Glaucoma
• Hepatitis C
• Huntington’s disease
• Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS)
• Multiple sclerosis (MS)
• Pain that’s either chronic and severe or intractable (difficult to manage)
• Parkinson’s disease
• Post-traumatic stress disorder (PTSD)
• Sickle cell anemia
• Spasticity
• Spinal cord injury or disease
• Terminal illness
• Tourette syndrome
• Traumatic brain injury (TBI)
• Ulcerative colitis

Again, these conditions vary from state to state. Research on the effectiveness of marijuana for managing various symptoms is ongoing. It’s important to have a conversation with your healthcare provider about the risks and possible benefits of using marijuana for medical purposes. You should discuss immediate and long-term side effects, possible drug interactions and alternative treatment options.

Is medical marijuana safe?

It’s complicated. But the current answer is that researchers don’t know. Researchers have extensively studied the effects of THC (tetrahydrocannabinol) and understand them. But the reasons why people respond differently to THC and the effects of other chemicals (cannabinoids) in cannabis aren’t clear.

It’s like reading a book with an unknown number of pages missing. While you may be able to answer some questions about the contents of the book, you might not be able to answer others — or don’t have a complete answer.

Here are some factors to consider about the safety of medical marijuana.

Lack of FDA approval

To date, the FDA hasn’t approved a marketing application for marijuana for the treatment of any disease or condition. In other words, medical marijuana products don’t meet the standards that the FDA uses to approve prescription drugs. FDA approval of a drug means that:

• The FDA’s Center for Drug Evaluation and Research (CDER) has reviewed the data on the drug’s effects.
• The research shows that the drug provides benefits that outweigh its known and potential risks for the intended population.

The use of cannabis products that aren’t FDA-approved can have unpredictable and unintended consequences, including serious safety risks. Also, there haven’t been rigorous clinical trials to support that these products are safe and effective for the various medical purposes for which people use them.

Instead of FDA approval, each state in the U.S. has its own requirements and regulations for medical marijuana use. For example, the Ohio Department of Commerce licenses and regulates medical marijuana cultivation, processing and testing laboratories in Ohio. And The State of Ohio Board of Pharmacy licenses and regulates the state’s medical marijuana dispensaries. Each state has different requirements regarding the quality and safety of making and dispensing of these products.

Labeling concerns

States also have different regulations on how they label medical marijuana. Many states require that the label include the amount of THC and CBD (cannabidiol) in the product, but other states have different requirements.

In addition, the concentrations of cannabinoids like THC and CBD stated on product labels are sometimes inaccurate.

The product labels for medical marijuana may appear similar to those on prescription medications, but they’re not prescription or FDA-approved medications.

Drug interaction risks

Researchers are studying how the substances in cannabis can affect how your body uses (metabolizes) certain medications. For example, studies show that using CBD and/or marijuana/THC increases your blood levels of the following medications:

• Clobazam (an antiseizure medication and benzodiazepine)
• Warfarin (an anticoagulant)
• Diclofenac (a type of NSAID)

In addition, CBD could increase blood levels of certain antipsychotic medications and antidepressants. THC can decrease brain concentrations of risperidone (an antipsychotic medication).

These are just a few examples. Researchers are still learning about other possible drug interactions. There are many unknowns — and over 500 chemical substances in the Cannabis sativa plant. So, it’s difficult to predict if medical marijuana will affect how your body uses any prescription or over-the-counter medications you take.

What are the side effects of medical marijuana?

Marijuana — including medical marijuana — affects each person differently based on several factors, like:

• Your genetics
• Your age
• Your sex
• The amount and strength of the marijuana
• How you consume marijuana/THC (smoking, vaping or ingesting)
• How long you’ve used marijuana and/or how frequently you use it
• If you’re taking medications and/or other substances

The effects you might experience from medical marijuana aren’t always the same as what someone else might feel. And different instances of marijuana use can cause different effects in the same person.

Studies show that marijuana use has certain short- and long-term effects. But researchers are still learning about these, especially long-term effects.

Some short-term effects include:

• Euphoria and mood changes
• Issues with thinking and problem-solving
• Impaired memory
• Disorientation and confusion
• Relaxation and/or sleepiness (sedation)
• Dizziness
• Issues with coordination
• Slowed reaction time
• Dry mouth
• Nausea
• Hallucinations
• Delusions (unshakable belief in something untrue)
• Psychosis — your risk of this is highest if you regularly use high-potency marijuana (high levels of THC)

What are the benefits of medical marijuana?

Scientists and healthcare providers can’t state any general benefits of medical marijuana with certainty. This is because there isn’t enough research yet about the medical benefits of these products, especially long-term effects. In addition, marijuana tends to affect different people in many different ways.

While individual people may report certain personal benefits, all of these factors make it difficult to come to any firm conclusions.