Medical marijuana is a term for derivatives of the Cannabis sativa we use to alleviate severe and chronic symptoms. It is not easy to evaluate medical marijuana research for each disease. Because the Federal Government’s prohibition makes it difficult for government-supported data collection. Observational studies – in which consumers report their experiences – may seem optimistic. Studies that include animals and test tubes may also sound promising. But many things that help mice or groups of cells in a Petri dish might not help humans. Despite these obstacles, there are some health problems and diseases for which marijuana is a useful treatment. For others, not so much. So, our today’s article is about the benefits of medical marijuana.
Medical Effects of Cannabis in Various Diseases:
More than 600,000 people in the United States are turning to cannabis to relieve chronic pain. There is strong scientific evidence for its effectiveness. According to the 2017 report by NASEM, in landmark randomized clinical trials with some people. They had terrible health problems. These problems were peripheral neuropathy, spinal cord injury, HIV, complex regional pain syndrome, cancer, rheumatoid arthritis, and multiple sclerosis. Cannabis reduced pain by 40%.
In a recent Canadian study, cannabis even calmed arthritic lab rats. Surprisingly, there is (still) little evidence from human studies for the most common type of arthritis, osteoarthritis, and diseases that affects 50% of adults 65 and older. Clinical trials are underway. But who is waiting? In a 2019 survey in Colorado, arthritis was the top reason older adults used cannabis, followed by back pain. Overall, 79% said it helped.
McKnight, the retired sales executive from Ocala, says the herb allowed him to stop taking opiates for arthritis in his hip. “I never got addicted, but I never liked it,” McKnight says of hydrocodone, as he and his wife sat in the waiting room of the Trulieve medical marijuana dispensary near The Villages in Florida. Now, I don’t feel so sore. I sleep better. It is a miraculous plant”.
NASEM classifies the scientific evidence on whether you sleep better when using cannabis as only “moderate.” But that hasn’t slowed down older users. More than one in three people in a Colorado survey tried marijuana to sleep; 86% said it helped. “I have had peripheral neuropathy in my left foot for decades. The shooting pain kept me from sleeping,” says Paul Kinder. Recently he attended a seminar on medical marijuana near his home in The Villages to learn more. “Now, I am using cannabis, and I can sleep. I can play golf several times a week. I never thought I would use marijuana. Yet here I am. “
Choosing cannabis for sleep can be tricky. A little THC helps, but too much might keep you awake. According to a recent Palo Alto University study, insufficient CBD may interfere with good sleep. At the same time, a higher dose may help you sleep longer and wake up fewer times during the night.
Depression, anxiety, and PTSD
In a recent survey, one in five older adults surveyed used medical marijuana to alleviate low moods and ease chronic tension. More than 90% said it helped. Meanwhile, the treatment of post-traumatic stress disorder (PTSD) is emerging as another main use.
A Scientific Explanation:
So far, there is little data for these mental health problems. We will know more soon. At least seven studies of cannabis for anxiety or depression are ongoing in the United States and worldwide. Scientists also did at least six studies for PTSD. For now, small studies and surveys are hinting at benefits and problems — particularly for depression.
Cannabis has the potential for people with PTSD. THC and CBD could attenuate the “bad memories” that flood the brain in response to PTSD triggers (such as a sudden loud noise), according to researchers at the National Center for PTSD in Palo Alto, California. For 47 people with PTSD who participated in a clinical trial in Canada in 2009, taking THC at night meant having fewer and less intense nightmares.
In June, outside a dispensary in central Florida, a Vietnam veteran in his dog tags and camouflage shorts said that using an e-cigarette helped him when nothing else could. “It gives me too much anxiety. Taking Xanax, Prozac, Zoloft, or Valium didn’t help,” says John, who asked that his last name be omitted. “But I can go home, smoke a few puffs, and calmly take care of my mother, who lives with me. When I feel angry at the whole world — and I get so angry that I get to fight with people — it helps me.”.
Soon, more scientific data could help steer the Department of Veterans Affairs away from its anti-cannabis policies and stances and help veterans who may need it most to obtain medical marijuana. The first US clinical trial of cannabis for post-traumatic stress disorder symptoms – conducted in collaboration with the FDA and DEA – ended in January. The results are expected to be published soon.
Nearly 1 million people in the United States, including many aged 45 and over, live with the debilitating muscle spasms and pain of multiple sclerosis. According to a 2017 survey, up to 66% of them could be using medical marijuana. They have probably cut back on drugs for this disease as well. Those with multiple sclerosis are the second-largest medical marijuana users in the United States, after those with chronic pain. There is strong scientific evidence for the ability of cannabis to reduce the muscle spasms of multiple sclerosis.
Meanwhile, other people are considering a possible cannabis-based drug for multiple sclerosis. MMJ International Holdings Corp., a cannabis research and development company, hopes to test an experimental drug soon – a highly purified plant extract with THC and CBD in a gelatin capsule – to treat multiple sclerosis the United States.
“At first, it scared me. I am not going to lie. I never used marijuana and didn’t like it. Moreover, I thought it just made you feel dizzy,” says Lisa Mahal, 54, of Daytona Beach, Florida. She left the Liberty Health Sciences medical marijuana dispensary in Summerfield, Florida, with her favorite products: sleeping capsules. She placed this liquid under the tongue. For nausea and massage oil to relieve muscle pain and exhaustion.
Mahal has stage IV metastatic colon cancer, a heartbreaking relapse of early-stage cancer found with a colonoscopy and for which she was treated in 2015. “Without medical marijuana, I couldn’t sleep. I would have no appetite. I would be exhausted and in pain. With her, I can enjoy my life — walk on the beach, have dinner with friends, spend time with my husband. I spoke to my doctor about this. I want others to do the same and not be afraid to try it. “
Effects of Cannabis in Cancer Pain:
Cannabis is very effective for cancer pain and cancer treatments’ side effects, such as nausea, vomiting, loss of appetite, and weight loss. According to Donald Abrams, an oncologist and professor of medicine at the University of California San Francisco and a long-time advocate of medical marijuana. “It certainly works,” says Abrams. “I was on the NASEM committee that analyzed the tests.”
The strongest evidence in the medical literature was nausea and vomiting caused by chemotherapy and cancer-related pain. “I work with patients undergoing cancer treatment,” says Abrams. “I tell them, ‘Go to the clinic, tell them what you’re trying to treat, and ask what works best.’
But according to Abrams, physicians should not use cannabis as a treatment for cancer. “The saddest and most frustrating thing for me is meeting patients who have taken six months to come because they heard that marijuana treats cancer, and they wanted to try it first. For some, it is too late for proven treatments like surgery, chemotherapy, and radiation that prolong and save lives. “Don’t be fooled by online hints that it does work, Abrams says, based on vague anecdotes and dubious research.
Cardiovascular Effects of Cannabis
The cardiovascular effects of marijuana use range from mild to severe effects, in a blinded study of a series of patients, where the effects of marijuana with high and low doses of THC were compared in young and healthy men. Tachycardia was induced beginning at the time of inhalation and persisting for at least 90 minutes after that. The maximum heart rate reached was at 30 minutes. The study also found a significant elevation in systolic and diastolic blood pressure and the presence of premature ventricular contractions (PVC) in subjects who received the highest dose.
These studies showed a close correlation between dose and tachycardia and cardiovascular disorders —the study by Malit et al. Regarding the effects of intravenous THC. He found that most patients exceeded 100 beats per minute. Moreover, he experienced intermittent spikes in heart rate, with a possible etiology of psychological distress. Beaconsfield et al. postulated a beta-adrenergic stimulation mechanism for tachycardia since it was possible to block the tachycardia using propranolol. At lower or moderate doses, marijuana produces sympathetic activity, reducing the parasympathetic. Moreover, it increases heart rate, cardiac output, and blood pressure.
In high doses, the parasympathetic system tends to produce bradycardia and arterial hypotension. Studies in animals support the hypothesis that sympathetic inhibition occurs due to the bioactive component of the effects of cannabis on CB1 receptors. Cannabis use was related to the development of atrial flutter and atrial fibrillation, while other studies have reported the presence of sinus bradycardia and auricular ventricular block ( AVB ). Aronow et al. found that when comparing marijuana with placebo, cannabis causes an increase in carboxyhemoglobin, resulting from a higher oxygen demand to the myocardium, thus producing an induction in platelet aggregation.
Neurological effects of Marijuana
Marijuana works as a risk factor for stroke. More than 80 cases have been described. Patients who use marijuana chronically have a higher prevalence of ischemic-type strokes. Oscillations in blood pressure and reversible cerebral vasoconstriction may be the likely result of vascular accidents. However, there are no firm conclusions in this regard. The association of other drugs that the patient consumes simultaneously has not conclusively demonstrated him. Therefore there is no direct association.
The most common route of administration of marijuana is the inhaled route, through smoking cigarettes of this plant, generally manufactured in a “homemade” way. It’s individual or artisan manufacture makes it a cigarette of an unfiltered nature, compared to commercially available cigarettes. Therefore, the amount of tar that enters the upper VA increases by approximately three times the inhaled tar produced from cigarette smoke. In the same way, it contains a higher concentration of phenanthrenes and benzopyrenes., a substance described as carcinogens. The marijuana cigarette is also described as a third greater inhalation. Moreover, it’s a third deeper inhalation and four times longer breath, common practices to maximize its absorption and consumption.
Schwartz theorized that the high temperatures at which you can burn marijuana, compared to tobacco, can increase mucous membranes’ irritation. The higher temperature of the cigarette combustion is a possibility. Roth et al ., Demonstrated that cannabis smokers had significantly increased bronchitis symptoms, an increase in the incidence of bronchitis symptoms such as wheezing and productive cough were present. It was resulting from epithelial damage of the major airways, edema, and erythema of the same.
On mucosal biopsy, goblet cell hyperplasia showed increased secretions, loss of ciliated epithelium, and metaplasia. Squamous cells were present in 97% of smokers. Therefore, they concluded that marijuana use has a relation with chronic inflammation of the airway (VA). Besides, it’s similar to a chronic tobacco smoker’s inflammation. Based on their literature review, Bryson also concluded that pulmonary complications in chronic marijuana smokers are equivalent to those seen in chronic tobacco smokers. At the same time, Wu et al. estimated that 3 to 4 cannabis cigarettes daily are equivalent to about 20 tobacco cigarettes in terms of damage to bronchial tissue.
Impact of marijuana on anesthesia
The prevalence of marijuana use is evident in all patient populations. Mills et al. Reported that the rate of marijuana use through self-report responses was 14% among surgical patients in 2003. It led the authors to conclude that questions about illicit drug use should be routine in the surgical patient, as part of the anesthetic evaluation, especially in patients where the anesthesiologist has difficult situations due to anxiety or other psychological manifestations.
A Series of Case Reports by Guarisco
In a series of case reports, Guarisco presented three patients who suffered from respiratory distress due to uvulitisIsolated, a low-incidence disease usually associated with infection or traumatic irritation from instruments used in the airway. In further investigation, all three patients were found to have inhaled large amounts of cannabis within 6-12 hours of the onset of symptoms. Therefore, they concluded a possible correlation with inhaled irritants such as cannabis. Due to the possible link with marijuana, the authors suggest that urine and blood toxicology studies should be performed for THC as part of routine anesthesia examinations or especially in young patients with clinical data of upper airway infections.
Another case represents the adolescents who developed acute uvular inflammation after acute marijuana use, h in Sloan’s series having smoked at least three marijuana cigarettes. In 1971, a cohort study was conducted in which a large amount of marijuana (more than 100 grams) was smoked for several months. In 31 subjects, almost half suffered from recurrent rhinopharyngitis and developed acute uvular edema after the heavy marijuana inhalation lasting approximately 12-24 hours. These findings highlight the importance of maintaining the airway during anesthesia after acute marijuana use due to the potential airway obstruction.
Pertwee recommended that elective operations should be avoided entirely if a patient was recently exposed to cannabis smoke. This recommendation seems reasonable when considering life-threatening bronchospasm leading to suffocation, brain damage, or death. A proposal for these acute intoxication situations before surgery and anesthesia has been the therapeutic use of steroids. Hawkins et al. Recommended that dexamethasone should be administered as a first-line drug, 1 mg/kg every 6-12 hours for one to two days, at the first signs of airway obstruction. However, Mallat et al., Concluded that although marijuana inhaled induces edema of the uvula, this situation represents a serious complication and potential of obstruction of the airway, for which the surgery should be postponed until the effects of the inflammation of the upper respiratory tract pass and receive treatment based on steroids.
Multiple observations have been made, showing cross-tolerance to drugs and marijuana, barbiturates, opioids, prostaglandins, chlorpromazine, and alcohol. Furthermore, animal studies have shown additive effects among all of them, except alcohol. These drug interactions have led to further exploration of their reactions to other groups of medications. And it’s because of fat sequestration and subsequent slow elimination of tissues. The cannabinoids may be present to interact with multiple anesthetic agents.
Symons’ Case Report
In the Symons case report, the patient required multiple propofol boluses and two additional midazolam doses to achieve adequate sedation. In a prospective, randomized, single-blind study of 60 patients, chronic marijuana users required significantly higher propofol doses to facilitate the laryngeal mask’s successful insertion. This has led to the suggestion that increasing the dose of various medications is a practice common in chronic marijuana users and can be a requirement to lead a patient to loss of consciousness and jaw relaxation, and reflex airway depression. The authors postulated that variations in the level of delta 9-THC might explain the variations in propofol responses. Cannabinol and atropine administration during anesthesia.
In a review written in the American Association’s Nurse Anesthetists Journal, Dickerson reported on the synergistic effects of cannabis, showing enhancement of non-depolarizing muscle relaxants, norepinephrine enhancement. Increased effect of any drug that causes cardiac depression, a more profound response to inhaled anesthetics, and sensitization of the myocardium to catecholamines due to the increased epinephrine level. THC depletes acetylcholine reserves on the subject of muscle relaxants and exerts an anticholinergic effect and therefore creates a potentiation of non-depolarizing muscle relaxants.
Hall et al., Explored the interaction of THC with drugs that affect heart rate and blood pressure, found that due to the cardiovascular effects of cannabis, it can interact with drugs such as beta-blockers, anticholinergic, and cholinesterase inhibitors. Due to these potential pharmacological effects of marijuana and its potential complications, such as psychiatric complications and perioperative withdrawal reactions and its interference with inducers of anesthesia. An extensive history of drug use should be had at the time of preoperative evaluation, including frequency of use and time of the last cigarette. Still, physicians avoid anesthesia in any patient with recent acute cannabis use in the last 72 hours.
Considering that the retina and CNBS express CB1 and CB2. Through the activation of these receptors could reduce the increase in intraocular pressure typical of glaucoma. Moreover, these avoid the decrease in a visual capacity.
Due to their potential antiemetic effect and ability to increase appetite, cannabinoids have been suggested to reduce nausea and vomiting in cancer patients treated with antineoplastic drugs or reduce cachexia in AIDS patients who maintain chronic, antiretroviral compound treatments. Both effects seem to deal with the activation of CB1 receptors present in certain brain regions involved in the control of emesis and appetite.
CNBC has some analgesic effect, especially for chronic pain. This is a consequence of CB1 receptors in the regions that participate in the control of nociception, both at the spinal and supraspinal levels. There is also an intense interaction between endocannabinoid and opioidergic transmission, and synergistic effects have even been demonstrated, which has led to the suggestion that CNBS could reduce morphine doses in chronic pain treatments without reducing the analgesic effect. But with a reduction in the addictive potential of the opiate.
There is a high density of CB1 receptors in the basal ganglia and the cerebellum; Following the role that the endocannabinoid system seems to play in the control of movement, a potential beneficial effect of direct or indirect agonists of CB1 receptors has been suggested in diseases characterized by hyperkineses such as Huntington’s chorea and Huntington’s syndrome. By Gilles de la Tourette, CB1 receptor antagonists could be useful as adjuvants in treating Hypokinetic Syndromes such as Parkinson’s disease.
Popular myths around marijuana justify its medicinal use by considering it a soft drug. Referring to the fact that it is a natural and medicinal substance. Therefore, it does no harm, does not produce addiction or withdrawal syndrome. It seems to have harmless consequences. Remember that the effects of marijuana are dose-dependent. However, it is THC that is responsible for most of the adverse effects at the brain level. It generates structural and functional changes in the nervous system. These changes are the impaired ability to remember information, alterations in time perception, increase heart rate. Moreover, these are increases the risk of psychiatric disorders and decrease immune responses. It accumulates in the adipose tissue and stays there for several weeks. So, during that time, if you administer it constantly, it will continue to accumulate. It also alters motor coordination and produces psychotic states at higher doses.