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Chapter 1

Introduction

Unexpected and unplanned-for ailments arise in life, no matter how healthy a person’s lifestyle. Imagine waking in the night to shooting pain and uncontrollable spasms in your legs, only to discover it is the beginning stages of multiple sclerosis (MS). What if you begin to experience severe abdominal pain and your physician diagnoses you with Crohn’s disease? Alternatively, what if you survive a serious auto accident only to be left with a permanent pain in your legs?

Additionally, less serious but still troublesome health problems become issues for everyone at some point in their lives. Glaucoma, arthritis, migraine headaches, and depression are all examples of extremely common, usually non-life-threatening, health problems that often occur spontaneously and without explanation.

Unfortunately, you’re left to choose between feeling better and breaking the law.

Now suppose you realize that the most effective treatment for your disorder is marijuana? Unfortunately, you’re left to choose between feeling better and breaking the law. You may have been taught that only degenerates and delinquents use illegal drugs. Now you found an illegal drug that eases your pain and suffering. What will you do? You may be hesitant about trying it for your own condition. After all, it is not available in regular pharmacies and there is so much controversy surrounding it. In addition there may be legal implications.

Medical Marijuana 101 explores the science and history of the marijuana plant and provides a solid foundation to form an educated decision about whether you could benefit from this medicine.

Humans have used marijuana therapeutically for thousands of years.

Humans have used marijuana therapeutically for thousands of years because the herb controls or alleviates a wide variety of medical symptoms. We’ll explore the science of how marijuana works and its medical uses and effects. We’ll also examine its history, how it’s produced and the politics, economics, and legality of marijuana.

What is marijuana?

Marijuana is a flowering plant with many different varieties sharing many chemical characteristics. However the varieties have different effects that provide targeted benefits for a wide range of medical conditions. Marijuana is a hearty plant that adapted to many different climates and growing conditions. You may be familiar with the common image of the five-fingered marijuana leaf. These leaves grow along strong branches that extend laterally from the main stem. The flowers develop along the ends of the branches, forming thick clusters that are usually thin and long or bulky. They produce a sticky crystalline resin and have a strong, sweet-to-pungent aroma. Some varieties grow tall and lanky, while others grow short and bushy. Each variety has its own growth rate, appearance, and medical usefulness.

The term “buds” refers to the dried flowers of the female plant. Buds contain the medicinal compounds and are the part of the plant that is typically used. The leaves are used to make extracts because they contain small quantities of the active ingredients found in marijuana.

Marijuana is different from other annual plants because it is “dioecious,” meaning male and female flowers grow on separate plants. When the female plants are not pollinated the flowers remain seedless. These seedless buds are known as “sinsemilla,” Spanish for “without seed”. These sinsemilla buds are distributed in medical marijuana dispensaries. Marijuana growers select only female plants so the plants produce only seedless buds. Chapters 7 and 8 describe the different varieties of marijuana and the basics of marijuana horticulture

Why is marijuana an effective medicine?

Marijuana has beneficial uses for many medical conditions. You may have heard jokes about the “munchies,” slang term for the increase in appetite that often follows use of marijuana. For many sick people, appetite stimulation is an important step toward wellness. Proper nourishment is required for us to be healthy, so a substance that increases appetite and eating is essential to the recovery of patients who suffer from anorexia, for example.

Marijuana reduces nausea and vomiting, which often accompanies chemotherapy. Cannabis eliminates the nauseous, sick-to-the-stomach feeling and prevents vomiting, which is violent and physically taxing. Nausea and vomiting lead to dehydration and weight loss, extending recovery time because the body doesn’t retain enough nutrients to heal properly. Since marijuana can be inhaled or used as a tincture, it is more effective against nausea than ingesting a pill, which is often regurgitated.

Marijuana is an effective pain reliever, especially in cases of neuropathic or “burning and shooting” types of pain. The anti-inflammatory properties of the active ingredients of the marijuana plant have also proven useful in treating many medical conditions including arthritis and glaucoma.

One of the most important factors in choosing marijuana as a medicine is its safety. There are no fatalities from marijuana and an overdose usually leads to a desire to lay down and go to sleep. In comparison, many prescription and over-the-counter pain medicines are extremely toxic and addictive. Marijuana provides a natural alternative to some of these dangers with comparatively low addictive potential.

How does marijuana affect these symptoms? The simple explanation is your body responds to the active ingredients of marijuana, known as cannabinoids, much like it responds to your body’s own naturally produced endocannabinoids. Endocannabinoids are found in the brains and bodies of all animals except insects and have evolved over millions of years. The effects of the active ingredients of the marijuana plant, the cannabinoids, mirror the effects of our own internal endocannabinoids. We’ll explore specifically how marijuana creates beneficial and palliative effects on physically debilitating symptoms in Chapter 3.

When I’m asked, “Why is marijuana an effective medicine?” I usually answer, “Because it works.” It is a natural plant substance that can be as effective, or in some cases more effective, than many commonly prescribed, side effect loaded synthetic drugs. As with any medication, always consult your physician before using marijuana to replace any medicine or to confirm its safety when taken in conjunction with other medications.

How do you know marijuana is safe?

Because of the decades of misinformation about the perceived dangers of marijuana, people often question its safety as a medicine. The undeniable truth is marijuana is extremely safe. Consider this: Marijuana has never caused a single recorded fatal overdose.

Animal studies have shown that a lethal dose of cannabinoids would be in the neighborhood of 40,000 times the typical human dose. This would be like in taking 40 to 80 pounds of marijuana buds or their extracts all at once. This amount is impossible to consume, so death is not a risk when using marijuana. You don’t need to worry about dying from an overdose of marijuana unless you plan to smoke a telephone-pole-sized joint in 10 minutes or less.

There are certain dangers related to using marijuana. Patients report adverse effects such as feeling overwhelmed, panicked, paranoid, or experiencing an increased heart rate. Some strains, especially those with extremely high THC content, are more likely to affect new patients in these ways. Strains with high CBD content modulate the effects of THC, so they are less likely to have these adverse affects. Sometimes it’s unclear a complaint relates to an adverse reaction or if it is due to the patient’s mental state.

Many people have deep-seated fears about using marijuana because of the criminality associated with it. This fear alone can raise your heartbeat. As with many medicines, marijuana affects everybody a bit differently. Marijuana is not a good option for some people, just as with all medicines.

Another potential concern when considering marijuana as medicine is that it is an herb, and if you did not grow it yourself you don’t know how it was grown. Unhygienic practices, such as the use of chemical pesticides, leave harsh residues on the plant that are dangerous to ingest or inhale. Molds and fungus also pose a risk to some patients. For these reasons it’s best to know where your medicine is coming from. Chapter 4 discusses these issues in more detail.

Any substance can be unsafe if used incorrectly or abused and marijuana is no different. Its effect on some users make them incapable of driving a car, operating machinery, or executing other tasks that require a high level of concentration. Marijuana should always be used in a responsible and controlled setting. If you adhere to basic safety protocols and manage your dosage effectively, you will have a completely safe experience.

Why then is marijuana illegal?

In 1937, the Marihuana Stamp Tax Act made the commercial cultivation, distribution, and use of marijuana and hemp products illegal in the United States without first obtaining a government-issued tax stamp. Since the authorities issued very few stamps, the Stamp Tax Act effectively outlawed marijuana. Thirty-three years later Congress passed the Controlled Substances Act (CSA), enacted into law as Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970. The CSA, among other things, created legislation surrounding banned drugs including marijuana and commissioned the Drug Enforcement and Food and Drug Administrations (DEA and FDA) to create “schedules” to classify all drugs. Marijuana was classified a Schedule I substance, which is described as a drug with “a high abuse potential and no currently accepted medical use in treatment in the United States, and a lack of accepted safety for use of the drug or other substance under medical supervision.” This classification, which places marijuana in the same category as heroin and a long list of other opiates is incorrect and unjust. Marijuana has a myriad number of medical applications and despite overwhelming evidence to the contrary, federal lawmakers do not yet recognize the therapeutic values of marijuana.

Some states have passed legislation permitting medical use of marijuana under controlled circumstances. The situation is fluid and more states are passing ballot initiatives and enacting legislation to legalize and or decriminalize the medical use of marijuana. Many states have enacted laws to set up and regulate marijuana distribution systems for patients to access marijuana as a prescribed medicine. It is your responsibility as a patient to know the laws that govern the medical use of marijuana in your area—courts in a state that does not recognize medical marijuana will probably not be sympathetic if you are arrested for marijuana possession and claim it was for medicinal purposes.

As time goes on and more people demand safe access to medical marijuana, it will be increasingly difficult for the federal government to continue the criminalization of its medical use. Additionally, in every election cycle new states legalize it, which puts more pressure on the federal government to loosen the prohibition of marijuana.

One might reasonably conclude that marijuana’s illegality is clearly a mistake. Yet an unwise law is a law nonetheless, and all medical marijuana users must act with caution when obtaining and using their medicine. Chapter 9 addresses your legal rights as a medical marijuana patient.

What do doctors say about medical marijuana?

Many doctors agree that marijuana possesses viable medicinal properties, but because many other doctors are unaware of current medicinal marijuana studies, they hesitate to recommend it as medicine, even where it is legal. Increasingly, however, doctors and organizations are recognizing the therapeutic medical benefits of marijuana in the face of experience and a growing body of research.

In fact, most major medical organizations, including the American Medical Association (AMA) and the American College of Physicians (ACP), endorse the rescheduling of marijuana to reflect its medicinal properties and to open the door to further research. The American Public Health Association (1995) and the American Nurses Association (2003) are also both strong supporters of patient access to marijuana.

The ACP stated, “[We] urge review of marijuana’s status as a Schedule I controlled substance and reclassification into a more appropriate schedule, given the scientific evidence regarding marijuana’s safety and efficacy in some clinical conditions. ... Given marijuana’s proven efficacy at treating certain symptoms and its relatively low toxicity, reclassification would reduce barriers to research and increase availability of cannabinoid drugs to patients who have failed to respond to other treatments.”

The AMA adopted the report “Use of Marijuana for Medicinal Purposes” from the Council on Science and Public Health (CSAPH). The report affirms marijuana has medicinal values and calls for expanded research in this area. It concludes “short term controlled trials indicate that smoked cannabis reduces neuropathic pain, improves appetite, and caloric intake especially in patients with reduced muscle mass, and may relieve spasticity and pain in patients with multiple sclerosis.” In 2010, the AMA called for a review of the Schedule I status of cannabis in order to advance its use as a medicine.

For a current list of supporting organizations including health care professionals, visit the Patients Out of Time Web site, a totally volunteer organization, at www.MedicalMarijuana.com. There are hundreds on their current list. If your doctor is uninformed or has a knee-jerk response to your questions, seek out a doctor more familiar with marijuana therapies before deciding if it is right for you.

Is there credible research on marijuana as a medicine?

Yes. Reliable studies have been conducted to determine the efficacy of marijuana as a medicine. In the United States only a few institutions have been allowed to pursue research, because of the Schedule I status of the plant. The results of studies at one of these institutions, the Center for Medical Marijuana Research at the University of California San Diego, found it to be an effective treatment for pain and spasms associated with multiple sclerosis and other neurological afflictions. In Canada the McGill University Health Centre reported similar results in a study published in the Canadian Medical Association Journal. The study confirmed that people suffering from chronic neuropathic pain from nerve injury found relief by using controlled dosages of smoked marijuana. They also reported improved moods and better sleep. Both studies validated that low doses of the cannabinoid THC provided good results with minimal psychoactive side effects.

Over 6,500 peer reviewed reports in international medical journals confirm marijuana’s medicinal value. These publications addressed the various effects of marijuana use including its capacity to retard cancer cell growth, its ability to alleviate the pain and nausea of chemotherapy, and the effectiveness of different delivery methods. Some clinical studies have been disregarded as invalid because they were not sanctioned FDA-approved clinical studies. However, the U.S. federal government has long stifled any significant amounts of “approved” research in this field. One way the government impedes research is by controlling the supply of marijuana used in these studies.

It is virtually impossible to pursue research into marijuana because of the circular and nonsensical rules imposed by the U.S. government. To be allowed to do marijuana research, one must have a government grant; to get a government grant, one must do pilot research; to do pilot research, one must have marijuana; to get marijuana in the laboratory, one must have a government grant.

Researchers and institutions must have the proper Schedule I accreditations to be allowed even to possess such “dangerous compounds,” and the DEA regulates such licensure with an equally restrictive attitude. Researchers face one final challenge: The marijuana provided by the U.S. government for research is clearly of lesser quality and potency than the marijuana commonly available from public dispensaries for legal medicinal use. The consistency of the samples and the strains also affects the outcome of the research. These hurdles make the federal government’s position quite clear regarding its overall concern for legitimate medicinal marijuana research: It doesn’t want to discover or distribute the truth.

Still, a large body of peer-reviewed controlled studies indicate the great potential for medicinal marijuana. Only when the stranglehold on marijuana research is ended will researchers be free to explore all its potential medical benefits.

How do I know if marijuana is a good medicine for me?

Maybe you’ve tried marijuana in the past but never really considered its medicinal qualities. Or maybe you’ve never tried marijuana. The first issue to consider is medical need. Do you have a condition that use of marijuana might benefit? Chapter 3 considers specific conditions for which marijuana can be helpful.

It is your decision to make, and ultimately it is your health at stake.

Always discuss whether marijuana is a good choice with a trusted medical professional. Be aware of local laws and learn about the drug testing regimen used by employers. Because marijuana is reemerging into society as a legitimate medicine, it is less taboo than it once was, but there are still social and cultural factors that may affect your decision. Friends’ and family’s concerns and misunderstandings can be overcome with basic education, but you still may experience skepticism from people who have spent their lifetimes hearing that marijuana is a “dangerous,” “illicit” drug only used by felons and reprobates. It is your decision to make, and ultimately it is your health at stake.

Your decision may be influenced by the knowledge that many people find great relief from this natural and powerful plant. Don’t decide hastily or under pressure. If marijuana makes you feel better chances are it is a good choice for you. If it is does not contribute to your well being, however, or if you experience adverse effects when using it, it is obviously not a good option for you. If using marijuana will cause you to lose your job or alienate your loved ones, it’s obviously not a good alternative for you. Only you can answer these questions and make the best decision for your situation.