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Delegitimizing Cannabis Because of Its Recreational Use is the Real Lie

Yafai, Sherry MD

doi: 10.1097/01.EEM.0000719140.02630.89
    Figure
    Figure:
    Cannabis

    Five years ago, I too may have espoused opinions that medical marijuana was a lie, but after continual experiences in the ED and talking to cancer and geriatric patients, I found that Cannabis could be a tool to reduce patient suffering.

    I began researching Cannabis and speaking with patients to understand more about this unusual plant, and I was compelled to change my perspective. I sincerely believe my colleagues can (and I urge them to) do the same: Listen to patients and other respected physicians who are seeing patients who use Cannabis and read the research. You may be surprised.

    As emergency physicians and junior toxicologists, we are trained to see drugs and medications for their worst side effects and potential complications. As practitioners whose profession is advanced by and benefits from scientific research, however, we are duty-bound to accept legitimate research to improve our profession.

    Figure
    Figure:
    ED Visits for Drug Misuse on an Average Day for Patients 65 and Older

    New data about the endocannabinoid system are emerging regularly, including advanced knowledge about external phytocannabinoids (tetrahydrocannabinol [THC], cannabidiol [CBD], cannabigerol [CBG], etc.) and how they affect the body. Could this dysfunctional endogenous system actually be aided by outside plant medicine? Could this be the missing link for previously misunderstood diagnoses like fibromyalgia, headaches, and chronic pain?

    Technology's ability to break down Cannabis into hundreds of its chemical components compels us as physician scientists to consider this newfound knowledge. Unfortunately, the message that “medical marijuana is a dangerous lie” and its implication that all Cannabis uses are automatically recreational is sadly a horrible (and harmful) mischaracterization of facts. (“Medical Marijuana Is a Dangerous Lie,” EMN. 2020;42[8]:2; https://bit.ly/30pmmS1.) I have been writing about medical Cannabis for EMN for a couple of years now, and urge readers to consider the evidence. (http://bit.ly/CaseforCannabis.)

    THC, CBD, and mixed ratio THC:CBD have been found, for example, to have multiple medical indications for use, including managing nausea and vomiting for chemotherapy, HIV, and AIDS patients as well as for treating epilepsy, pain in palliative care, and multiple sclerosis, to name a few—with governmental and pharmaceutical approval. A partial list of indications for THC, all of which have pharmaceutical options for treatment, includes anorexia in HIV, AIDS, and cancer; chronic pain, specifically for cancer and end-of-life diagnoses; spasticity (multiple sclerosis); arthritis; migraine and headache; and neuropathic pain. A lot of off-label use of medications for treating these currently exist, which means there are no studies showing efficacy. CBD can be used for epilepsy, arthritis, heroin withdrawal (thanks to Yazmin Hurd, MD, for her research), social and performance anxiety and Parkinson anxiety, chronic pain, and dementia. Other cannabinoids are currently under study for treating an even more diverse range of pathology.

    Delegitimizing medications based simply on their potential for recreational use or abuse is a dangerous and uninformed approach for physicians. The validity and efficacy of medicine are not automatically disproven by its potential for misuse. If that were the case, then opioids, benzodiazepines, gabapentinoids, stimulants, ketamine, and even erectile dysfunction drugs would all be marked as “lies” because they are all abused, and their misuse can be far more damaging than their intended use, as the opioid epidemic has shown us.

    Opioid pain relievers contributed to 45 percent of drug poisoning deaths in Kansas in 2014. (Kansas Vital Statistics, Bureau of Epidemiology. https://bit.ly/2ExNSEV.) The lie here is that opioids play a great role in patient health and are not killing people daily. There has never been such a statement made about cannabinoids because Cannabis does not have a lethal dose in consumption or by inhalation for humans.

    Table
    Table:
    An Apples-to-Apples (Simplified) Comparison

    Consider another medication that is truly recreational: Viagra for erectile dysfunction. Viagra's only indication is to engorge the male penis for sexual purposes. It does not benefit individuals who are unable to conceive. If sex isn't recreational, I don't know what is. But it is an important and vital part of our general health and happiness, a way to connect intimately. Does that mean it is a lie and shouldn't be covered by health care dollars at a low cost? No, it does not.

    The point is that there are acceptable and unacceptable recreational medications. Have an alcoholic drink—is that still acceptable? Are we still under the impression that “marijuana causes white women to seek sexual relations with Negroes, entertainers, and others,” as Harry Anslinger, the Federal Bureau of Narcotics' first commissioner, said in 1930? (Timeline. Feb. 28, 2018; https://bit.ly/2VL59zV; Cannabis Cannabinoid Res. 2020;5[1]:2; https://bit.ly/31sqHEN. Also see my article, “The Racial Undertones of Marijuana,” EMN enews. July 28, 2020; https://bit.ly/3jMud3J.)

    Education and research are key here, and we have a lot of it. There were more than 7640 CBD studies on PubMed in August. (https://bit.ly/3bddy5F.) I urge everyone to look at them. We have university programs dedicated to studying the pros and cons of Cannabis at UCLA, UCSD, UCI, Berkeley, Boulder, and the University of Nevada, to name a few.

    If Cannabis medication is so harmful, why is there no antidote? Why is there no focus on creating an alternate pathway for addiction? Why isn't there a clinic for Cannabis addiction on every corner in Malibu like there is for opioids and alcohol addiction? If there are millions of users everywhere, why aren't we treating their addiction problems, terrible overdoses, and resulting chronic diseases in large numbers the way we do alcohol and opioid addiction in the emergency department? (See graph.)

    It's time to rethink things.

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    Dr. Yafaiis an emergency physician, the medical director of the ReLeaf Institute, an adjunct assistant professor at the John Wayne Cancer Institute, and a vice president of the Society of Cannabis Clinicians. Find more information atwww.thereleafinstitute.com/conferences. Read her past columns athttp://bit.ly/CaseforCannabis.

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