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Medical Marijuana: The Good, the Bad, the Ugly

Marijuana is in the news a lot lately, what with Washington state and now Colorado making recreational pot legal and readily available.  As of the writing of this entry, 20 states and the District of Columbia have legalized marijuana for medical purposes, including our home state of Illinois.  Our goal isn't to discuss the controversy or debate about if pot should be illegal, rather shed some light on what people living with chronic illness think about it, how often they use it and for what conditions, and some of the side effects it can have.
In 2009, worldwide marijuana use, medical or recreational, was between 3 and 5%; in the United States, rates were around 11%.  Unfortunately marijuana isn't the panacea that it's biggest supporters claim, but it does have documented health benefits.  It isn't the calamity that it's biggest opponents claim, either.  Like with everything, the reality lies somewhere in the middle.  There are several potential negative effects of chronic marijuana use, and while it is not as addictive as many other drugs, people can get hooked on it.  Just like we can get addicted to anything that makes us feel good and happy - including food, gambling, and candy crush.

I'm here to discuss the use of medical marijuana in the chronic illness-sphere, rather than it's implications in things like schizophrenia, anxiety, or cognitive functioning.  That's for another time or blog.

First, what diagnoses are approved for medical marijuana use?  According to the US Government Accountability Office, these:  Alzheimer's Disease, Anorexia, AIDS, Arthritis, Cachexia, Cancer, Crohn's Disease, Epilepsy, Glaucoma, HIV, Migraine, Multiple Sclerosis, Nausea, Pain, Spasticity, and Wasting Syndrome.  What does the (limited) research say about marijuana's effectiveness in some of these conditions?
  • A May 2013 poll found that 85% of Americans think that adults should be allowed to use marijuana for medical purposes if a physician prescribes it.  
  • A 2013 informal poll in the New England Journal of Medicine found that 76% of clinicians who responded to a case report about medical marijuana use for a cancer patient stated they thought marijuana should be available and used for medicinal purposes.
  • A 2013 study of 292 patients with Inflammatory Bowel Disease found that 12% actively used marijuana and 39% had used it at some time in the past.  However, only 16% of these patients said they used marijuana for treating their IBD symptoms.  Those who used marijuana to directly treat their symptoms rated it as "very helpful" in controlling abdominal pain, nausea, and diarrhea.  50% of the "never users" reported they'd be interested in trying it if it were legally available.  
  • For patients with HIV/AIDS, marijuana is used to treat loss of appetite and related weight loss.  A 2013 review of research in this area found that the evidence that marijuana significantly helps people gain weight was lacking. 
  • While marijuana may not help with weight loss, researchers at the Mount Sinai School of Medicine recently found that some of the chemicals found in marijuana may inhibit the activity of the AIDS virus, HIV.  
  • Many patients with multiple sclerosis report that marijuana helps with symptoms like spasticity and tremor.  The research is mixed, with some studies finding some benefit and others showing conflicting reports between the MS patient, who said their symptoms were better, and their doctors who rated them as not significantly different.  A 2011 study did find that MS patients who used medical marijuana showed negative effects on their thinking ability, scoring significantly worse on measures of information processing speed, working memory, and executive functions. 
  • A 2006 study evaluated medical marijuana to treat Rheumatoid Arthritis in 58 patients and found that over a five-week period the group using marijuana reported significant improvements in morning pain on movement and sleep quality compared to the placebo group.
  • What about marijuana's role in treating chronic pain?  Especially neuropathic pain due to nerve damage? A review of 18 clinical trials that included 766 people who used marijuana for non-cancer-related pain. 

 Fifteen of the 18 studies found that marijuana worked better than a placebo for pain relief.  Four four trials reported that marijuana improved sleep. Most of the studies reported that side effects were mild enough that people did not drop out of the studies.
What's the take-away?  Medical marijuana appears to be helpful for some people, although some studies show marginal effectiveness.  In some cases, marijuana can make a condition's symptoms worse, like in cognitive functioning in MS patients.  Medical marijuana is here to stay as it becomes more widely accepted by patients and providers alike.  We'll be posting more about this emerging area this year.

Dr. T.

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