---Uses and limitations of medical cannabis

Reuel S. Amdur

On April 24, Caroline Bond, a registered practical nurse and Regional Manager (Quebec and Eastern Ontario) of Canadian Cannabis Clinics, gave a virtual presentation to SWAG (Social Workers in Aging and Gerontology) in Ottawa about cannabis (marijuana), its nature, uses, and problems.  As one who has used it, I was particularly interested.  Let me begin with my experience, which highlight some of the things she had to say.

I have an on-and-off affair with arthritic back pain.  While I have found osteopathy to be especially helpful, I have tried other things. When a friend gave me some capsules of marijuana, I tried them.  Result: a mild improvement, similar to what I got with acupuncture.  Then I bought some gummies.  No impact whatever.

Bond said that effectiveness is dependent on various factors.  What are the strength and other characteristics of the particular product taken?  In my case, who knows?  I may have taken too low a quantity of the active ingredients.  Parenthetically, I had a social work client in Ottawa who takes cannabis for anxiety, depression, and PTSD.  He has to shell out money in four figures every month to get the results he needs.  He has medically-prescribed cannabis.  I took it for medical reasons but it was not prescribed and was in fact illegal.  I don’t use it anymore. 

Our speaker explained that the rules for medical cannabis are uniform across Canada, while those for recreational use vary from province to province.  Medicinally, it is prescribed for many different conditions, commonly to relieve depression and promote sleep.

Different elements in cannabis serve different outcomes.  THC produces euphoria, while CBD does not.  Often prescriptions combine the two, frequently with a small amount of THC combined with a greater quantity of CBD. 

Prescriptions that are mainly CBD have been written for Crohn’s disease, seizures, depression and some other mental disorders, inflammation, migraines, and shingles.  My partner uses it as a body rub for shingles.  It is usually taken orally for that condition, but here we come to one of the cautions that Bond raised: It interacts with other medications.  Since she takes a number of others, taking it orally would present with unknown risks.

THC is sometimes prescribed for glaucoma, cerebral palsy, and insomnia, and to increase appetite.  Both THC and CBD are used to treat pain, anxiety, and nausea.

Terpenes are another element in cannabis, occurring as well in many other plants.  There are many different ones in cannabis.  Terpenes may augment or diminish the impact of THC or CBD.  Among the terpenes are found some that promote relaxation and enhance positive mood.  One is a bronchodilator and anti-inflammatory.  Anti-fungal and antibacterial properties are found in some. 

Flavonoids are also found in cannabis, and they may act as anti-inflammatory, anti-fungal, and antioxidant agents and tend to fight cancer.  Some also serve to protect the heart, to help the immune system, and when applied to the skin to treat irritation.  

There are three kinds of cannabis. One kind occurs naturally in our bodies.  The one we have been considering is biological.  The third kind is produced in the laboratory.  There are two species of biological cannabis: sativa and indica.  Claims about differences in effects have been questioned, and some strains combine the two.

While cannabis has a variety of uses, there are contraindications.  They are not suitable for patients with psychosis and unstable mental conditions generally.  The oils can produce diarrhea.  Very high doses of CBD may possibly damage the liver.  And, as previously noted, drug interactions are reason for caution around use.  There are also side effects from withdrawal.

Popular notions around addiction are, however, overblown.  Alcohol, tobacco, and opioids are all much more addictive.

So what is the bottom line?  Cannabis has many effects, somatic and psychological.  There are matters to be worked out around composition and quantification of the prescription, modalities of treatment, and the specificity of these for the particular condition.  There are no clear answers as to the desirability of treatment with cannabis as compared to other approaches.  It may be a matter of trial and error in the specific case.  Care needs to be taken in compatibility with other medications.  Clearly much more research is needed to establish the desirability of treatment for the various conditions currently considered and as noted to drug interactions.  Then there is the matter of cost and coverage in drug plans and provincial formularies.  Cannabis is often excluded.