How Does Medical Marijuana Work?

March 14, 2011

Alyson Geller, MPH (Opinion),

Moratoriums have been placed on new medical marijuana dispensaries in Corte Madera, Fairfax and Novato; and Fairfax’s Alliance for Medical Marijuana is in murky water with the IRS, according to the Marin Independent Journal. Yet the state’s medical marijuana law is alive and well.

Sausalito physician Gene Schoenfeld wants fellow practitioners to know that they can prescribe marijuana for their patients and have no reason to be afraid of federal or state sanctions. “Many doctors are still wary of the law,” said Schoenfeld, a psychiatrist who also works in addiction medicine. Referring to California’s Compassionate Use Act of 1996, Schoenfeld emphasizes that “doctors are safe, as long as they treat the situation as they would any other medical encounter with a patient.”

What does the Compassionate Use Act mean for physicians and patients? And how does it work in Marin?

How the law works here

In 1996, California voters enacted Proposition 215. The Compassionate Use Act (HS 11362.5) legalized medical marijuana possession and use for seriously ill patients, and prohibited any physician from being punished, or denied any right or privilege for recommending marijuana to a patient for medical purposes. The act’s passage in California prompted similar initiatives in Alaska, Colorado, Maine, Montana, Nevada, Oregon, Washington, and Washington D.C. 

In 2003, Senate Bill (SB) 420 was passed as an extension and clarification of Proposition 215, establishing a voluntary state ID card system administered by county health departments and establishing guidelines as to how much marijuana may be possessed or grown. Learn more about California’s Medical Marijuana program.

“Unfortunately,” says Schoenfeld, “physicians are still afraid they may lose their license or be denied MediCal or Medicaid funding if they prescribe marijuana to their patients. “According to California Medical Board guidelines,” he says, “physicians here can recommend marijuana, but cannot provide it to patients or help them to know where dispensaries are.”

Under California’s Compassionate Use Act, seriously ill residents who have the approval or recommendation of a physician, can use marijuana without fear of criminal liability for serious medical conditions including the following:

· Acquired immune deficiency syndrome (AIDS)

· Anorexia

· Arthritis

· Cachexia

· Cancer

· Chronic pain

· Glaucoma

· Migraine

· Persistent muscle spasms

· Seizures, including, but not limited to, seizures associated with epilepsy

· Severe nausea

· Any other chronic or persistent medical symptom that either substantially limits the ability of the person to conduct one or more major life activities as defined in the Americans with Disabilities Act of 1990; or if not alleviated, may cause serious harm to the patient's safety or physical or mental health 

How does marijuana work to ease physical symptoms

There are several cells in the brain and other organs that contain specific protein receptors (called cannabinoids) that recognize and respond to THC and other compounds found in the marijuana plant. These receptors, found in the brain, spinal cord and periphery, as well as in immune system tissue, function to help lessen pain and impact a wide range of physiological functions, such as metabolism, appetite, anxiety and immune function.  

“It does not have a comparison,” says Schoenfeld, who commonly recommends marijuana for chronic pain, particularly back pain that may interfere with sleep. Cannabis has a direct effect on pain, says Schoenfeld, referring to a UC Davis study in which the substance significantly reduced neuropathic pain, such as that suffered by those with HIV, Multiple Sclerosis and severe injuries.

Cannabis can reduce a person’s pain level so significantly that they may not need to take pharmaceuticals at all, says Kris Hermes, spokesperson for the Oakland-based advocacy group Americans for Safe Access. (None of the Marin medical marijuana dispensaries or advocacy groups would respond to requests for more information.) “Or, for those who do need pharmaceuticals, cannabis can reduce the toxic load that they need to take. “

“Part of problem with chronic pain is not only the continuous pain, but a person’s fear of unrelieved pain,” Schoenfeld explains. “Pot relieves the anxiety too.”

This anxiety-reducing benefit can significantly help those who suffer from migraines, says Schoenfeld. “It does not treat the migraines once they take effect, but can prevent the migraine, which is commonly brought by stress.” There are tranquilizers to relieve anxiety, he says, but these have more serious possible side effects and more potential for addiction.

Marijuana is well known for its ‘munchie effect,’ says Schoenfeld, which provides a huge benefit to those undergoing chemotherapy. “Cannabis relieves nausea, so it can bring back appetite, says Schoenfeld.

For a comprehensive listing of conditions addressed by cannabis, visit the Americans for Safe Access Website.

What forms can marijuana take and which forms are recommended for various illnesses?

The most common form is the bud or flower, which is dried, manicured and sold in various sizes, according to Hermes. Medical cannabis can also be processed and extracted into many different concentrated forms, including hashish, resin of cannabis, oils and tinctures.  

Extracted cannabis compounds may be infused into food-based medicine, such as butter, cookies cakes or brownies. Tinctures mixed with alcohol (resembling common herbal tinctures) provide another delivery method.

Most extracted medical cannabis is digested, but some forms can be applied topically. Medical cannabis can also be vaporized, which heats the medicine below its combustion temperature so that the therapeutic components of the drug are released from the plant without the undesirable carbon compounds that come from combustion. 

“A patient with respiratory problems or pulmonary issues will likely not want a smoked form. Or a patient simply may not want to smoke,” says Hermes. Alternatively, it may be hard for a patient on chemotherapy to consume the marijuana through food. Since those patients are using marijuana as an appetite stimulant or nausea suppressant, it is important that they have it in a form that works for them.  

Edible forms will take about 45 minutes to take effect, depending on what is already in the stomach, says Schoenfeld, “however, the effects last longer when [cannabis] is taken by mouth.” Smoking will take effect in minutes and last just an hour and a half.

“There is also the issue of concentration,” says Hermes. “Those with acute, chronic pain may require higher concentrations to impact the pain. For this, people rely on extracts like tinctures or hashish.”

The person behind the dispensary counter should be well educated on the various strains and uses, says Hermes. The two main categories are Indica and Sativa – and literally thousands of strains exist within these. Most are genetically modified, explains Hermes. “This is not a nefarious scheme, but cross-breeding to achieve higher quality and sometimes target specific medical conditions.”   

If you have not used cannabis before

Schoenfeld advises first-time medical users to be cautious and use it as directed by your physician. “It is good to be in the presence of another person if a patient hasn’t used it,” he says, “and it is not advisable to combine marijuana with other psychoactive drugs or with alcohol,” which can lead to fainting, especially in crowded, hot environments. Other adverse effects can include paranoia and panic. 

An Institute of Medicine report describes marijuana as  a powerful drug with a variety of effects, yet “except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other medications.” For most people, the primary adverse effect of acute marijuana use is diminished psychomotor performance; and for a minority of marijuana users, dysphoria, or unpleasant feelings. Because of diminished psychomotor performance, driving under the influence of marijuana is against the law.

The report identified a distinctive marijuana withdrawal syndrome that includes restlessness, irritability, mild agitation, insomnia, sleep disturbance, nausea, and cramping, but concluded that the withdrawal was mild and short-lived.     

“There is not yet a system in place to regulate THC content or the strength of the marijuana sold through dispensaries,” explains Schoenfeld. “The patient has to rely on the purveyor to know the strength and effects of the given substance.”

Responsible providers, empowered patients   

Encouraging patients as well as his fellow practitioners, Schoenfeld says that the law will work as long as physicians and patients comply. Warning of fake doctors and doctors subsidized by dispensaries, he reminds patients to only see legitimate caregivers and emphasizes that physicians must provide a real medical history and thorough exam. “Only sloppy practitioners have gotten into any type of trouble,” he says.  


California’s Medical Marijuana Program

Safe Access Now – Medical Marijuana

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