What Should I KnowAboutMedical Cannabis ?

Michael A. Incze, MD, MSEd; Deepika Slawek, MD,MS, MPH; Chinazo O. Cunningham, MD,MS

The JAMA Internal Medicine Patient Page, Online : February 11, 2020

doi : 10.1001/jamainternmed.2020.0018

 

What Is Cannabis and How Is It Used ?

• Cannabis (ie, marijuana) is a plant that contains a complex mixture of chemicals called cannabinoids. Examples of cannabinoids include tetrahydrocannabinol (THC) and cannabidiol (CBD).

• Whereas THC is primarily responsible for the psychoactive effects (euphoria) of cannabis, CBD may decrease pain but causes far fewer psychoactive effects than THC.

• Cannabis is used medically as purified cannabinoids (eg, CBD), synthetic cannabinoids (eg, dronabinol), or parts of the whole plant.

• Cannabinoids are typically smoked or vaporized; ingested as pills, tinctures, oils or edibles; or applied to the skin ascreamsor patches.

How Is Cannabis Regulated in the United States ?

Most stateshavelegalizedcannabis use formedical conditions.Some states have legalized cannabis for recreational adult use. The federal government considers cannabis use to be illegal. However, clinicians
and patients who act in accord with state laws on medical use of cannabis are are not likely to be federally prosecuted. Typically, cannabis contents, potency, and safety are not regulated by the government even in states where it is legal.

Are There Proven Benefits to Using Medical Cannabis ?

Patients with spasticity related to multiple sclerosis, rare forms of childhood epilepsy, or nausea associated with chemotherapy have been shown to benefit from medical use of specific cannabinoids. Substantial evidence demonstrates that cannabis helps to modestly reduce pain. Themost consistent benefit is seen in nerve pain. Cannabis is often portrayed as a treatment for conditions like anxiety, opioid addiction, and insomnia. There is not conclusive evidence to know if it helps with these conditions.

Is Using Cannabis Dangerous ?

No deaths have been conclusively linked to cannabis or cannabinoid overdose. However, there are some risks associated with cannabis use even for medical purposes. Cannabis acutely impairs memory, judgment, and motor skills. Driving under the influence of cannabis affects driving ability. It may be associated with an increased risk of automobile accidents. Deaths from vaping associated lung illness have been reported in some individuals using vaped cannabis product. It is not clear what role cannabis plays in this illness. Cannabis can be habit forming over time and lead to unhealthy use. Long-term daily use, starting at a young age, and using large amounts may be associated with negative social and health consequences.
Smoking cannabis over time is associated with chronic breathing problems. These often improve after stopping. Frequent cannabis use during adolescence is associated with increased risk of developing long-term psychiatric conditions. Cannabis use during pregnancy is associated with lowbirthweight and other complications.

More study must be done to fully understand if there is an association of lung cancer or heart disease with smoking cannabis.

How Can My Doctor Help Me ?

• Open communication with your clinician will help you have a better understanding of the potential benefits and risks of cannabis use based on your medical history and current medications.

• Talk to your clinician aboutwhy you think youwould benefit from cannabis.Theremaybe other effectiveways toaddress your health concerns.

• Your clinician can inform you how to legally obtain cannabis in your state.

FOR MORE INFORMATION

National Institutes of Health
https://www.drugabuse.gov/publications/drugfacts/marijuana

National Cancer Institute Page on Medical Cannabis
https://www.cancer.gov/about-cancer/treatment/cam/patient/cannabis-pdq

 

jamainternal_incze_2020_pg_200001