Hear Me Out: Does Research Provide Solid Evidence of Medical Marijuanas Benefits?

Originally appearing here. Each Sunday, ABC15.com debuts an Arizona issue – along with two opposing sides on the topic. Don’t worry, you always have the opportunity to make comments at the bottom of the page. Yeah, your opinion matters, too. This weekend we’re taking a look at what the research behind medical marijuana says about its benefits. Suzanne “Sue” Sisley, MD, says Arizona doctors seeking to utilize the program for their patient’s care must turn to the limited scientific literature on the efficacy of medical marijuana, and obstructive federal regulations are creating enormous barriers to new research. Physician Denise Greene says that while the majority of evidence for the therapeutic effects of cannabis is found for some conditions, no research has shown beneficial effects for psychiatric illness and that there in fact documented side effects. In November 2010 the citizens of Arizona passed Proposition 203, thereby establishing a medical marijuana program. Despite many delays, Arizona is now in the process of awarding licenses to nearly one hundred new dispensary operators. Yet as patients eagerly anticipate regulated cannabis, they find themselves in the crosshairs of a political battle they should not have to fight. Arizona doctors seeking to utilize the program for their patient’s care must turn to the limited scientific literature on the efficacy of medical marijuana. Despite great demand for more FDA-approved research from Arizona and elsewhere, obstructive federal regulations are creating enormous barriers to new research and thwarting peer-reviewed studies of medical cannabis. The call to open up marijuana research comes from a diverse cross-section of the medical community. Among the organizations seeking new research are the American Academy of HIV Medicine, the American Nurses Association, the American College of Physicians, and the Leukemia and Lymphoma Society. In June 2012, the Arizona Medical Association joined these respected organizations in requesting the elimination of barriers to research. The federal policies obstructing FDA-approved research include a redundant multi-agency review process that creates unnecessary red tape and wasteful government spending. Like other drugs, cannabis should undergo the rigorous FDA approval process. But unlike studies done for other schedule I drugs, only cannabis research must pass this additional review process before the National Institute on Drug Abuse will release the research material. By law NIDA is the sole, monopolistic supplier of all cannabis to be used for these studies. NIDA administers this additional review process and has a fundamental conflict of interest in deciding which studies it will allow. The agency’s very mission statement restricts it from approving research that may help uncover any therapeutic potential of marijuana. Thus, scientists who hope to provide relevant information to the medical marijuana community regarding dosing, administration mechanisms, and other practicalities are prevented from obtaining the necessary source material. Even researchers obtaining NIDA’s approval must still contend with ludicrously inferior and radically more expensive cannabis than is readily available from state regulated dispensaries. My research aims to address some of the unanswered questions surrounding medical marijuana, particularly the proper dosage for patients. Yet despite receiving FDA approval, our study is on indefinite hold by NIDA. To put patients rather than politics front and center, there is a desperate need to expand cannabis research. To this end activists want to utilize state funds received from dispensary and patient application fees to fund more peer-reviewed research, so that doctors can make scientifically grounded decisions when treating their patients with cannabis. Without more research, society is leaving medical marijuana open for opportunists who want to politicize the issue rather than allowing doctors to explore viable new options that work to serve the best interests of those in need – our patients. As a Physician, particularly one who treats psychiatric and addictive diseases, the concerns regarding the increased availability and use of marijuana do not stem from a legal or moral perspective but from a medical one. A clear and thorough review of the evidence will show that use of the marijuana plant is not indicated for the treatment of psychiatric illness and may actually be dangerous for some. The marijuana plant contains over 400 chemical compounds, about 60 of which are cannabinoids (most are commonly referred to as THC-short for tetrahydrocannabinol). These are very fat soluble which allows passage into the brain and storage in fat cells. Delta-9-tetrahydrocannabinol is primarily responsible for the psychological effects of marijuana. The Delta-9-THC content of marijuana is reported to have risen from 1.5% in the late 60’s, to as high as 20% in current sinsemilla (the unfertilized flowering tops from the female cannabis plant). Studies of health care use by marijuana smokers document some increased incidence of respiratory problems, even in those who do not smoke tobacco. Although acute exposure to marijuana smoke causes widening of the airways, chronic use causes inflammation and pre-cancerous changes. Marijuana smokers report more symptoms of acute and chronic bronchitis than non-smokers of either tobacco or marijuana. Different types of tumors can be induced by marijuana smoking and it is prudent to assume that chronic marijuana smoking leads to the same range of illnesses as chronic tobacco smoking, including cancer. The majority of evidence for the therapeutic effects of cannabis is found in the following conditions: allergies, migraines, pain relief, glaucoma, convulsions, muscle spasticity, bronchial asthma, nausea and vomiting (especially secondary to chemotherapy), anorexia and wasting (e.g., AIDS related). No research has shown beneficial effects for psychiatric illness. To the contrary, documented side effects have included: Acute Side Effects

  • anxiety, dysphoria, panic and paranoia
  • sedation and drowsiness
  • cognitive impairment, especially attention and memory, during intoxication
  • psychomotor impairment
  • exacerbation of pre-existing or latent psychiatric symptoms
  • relapse of chemical dependence

Chronic Side Effects

  • cannabis dependence
  • subtle cognitive impairment characteristic of frontal lobe dysfunction
  • impaired educational performance in adolescents and professional performance in adults
  • exacerbation of pre-existing or latent psychiatric symptoms

Perhaps most germane to this debate is research that demonstrates that the use of marijuana is associated with “increased rates of anxiety, depression, and schizophrenia. …High doses of marijuana can produce an acute psychotic reaction; in addition, use of the drug may trigger the onset or relapse of schizophrenia in vulnerable individuals.” There exists a growing body of research that indicates an association between early marijuana use and the development and worsening of symptoms of schizophrenia. There are many excellent medications to treat psychiatric illness. Marijuana just isn’t one of them. In this feature, Dr. Sue Sisley of Arizona is given the opportunity to explain how obstructive federal regulations are creating enormous barriers to new medical marijuana research.