As I have certifications in mindfulness and COVID management from Canadian, American and European universities and have written on certain medical topics I receive regular webinar invitations from the MJHS Institute for Innovation in Palliative Care based in New York. MJHS conducts research and offers education and training for health professionals in palliative care. On December 14, 2022 I attended an MJHS webinar “Emerging Role of Medical Cannabis for the Seriously Ill” given by Bernard Lee, MD Director of Palliative Care Provider Practice/Hospice Access Physician MJHS Hospice and Palliative Care.
My late mother worked in palliative care in Montreal in the 1970’s and I remember her telling me of the many cancer patients smoking marijuana outside the hospital to relieve their pain and nausea from the chemo drugs they were taking. You may have surmised this was a “new use” for an illegal drug. But up to 1937 when cannabis was criminalized in the United States there were some 280 manufacturers with 2,000 different cannabis medical preparations for asthma, cough, insomnia, labour pains, migraines, throat infection, withdrawal from opium etc. in 1851 it was listed in U.S. Pharmacopeia. And for some trivia…in 1890 Queen Victoria’s personal physician prescribed cannabis for menstrual cramps.
Dr. Lee explained the first recorded medical use of cannabis was in China in 2727 B.C. In 1840 it was introduced in Europe by Dr. William O’Shaughnessy who served for the East India Trading Company. In the United States from 1937 to 1969 The Marijuana Tax Act made the possession and transfer of cannabis throughout the United States illegal excluding medical and industrial uses. In 1970 the United States Controlled Substance Act classified cannabis as having high abuse potential, no medical use and not safe to use under medical supervision. By December of 2022, 39 states and Washington D.C. have legal medical cannabis programmes and 21 states permit recreational use.
In states with medical cannabis laws there is a 24.8% lower annual mean opioid overdose mortality rate compared with states without medical cannabis laws. Cannabis remains illegal federally so even in states where cannabis is legal for medical purposes physicians can advise but prescribe.
Cannabis contains 400 chemical components and there are 120 identified phytocannabinoids (unique to cannabis) with THC and CBD the most prevalent and well studied.
THC has psychoactive effects. It can be used as analgesic (pain reducer), antispasmodic, antitremor, anti-inflammatory, and appetite stimulant. CBD is not psychoactive and can reduce the effects of THC, to control pain and inflammation and as an antioxidant.
Cannabis can be inhaled by smoking or vaping with onset anywhere from seconds to minutes with a duration of 1-3 hours while oral edibles onset is 30-90 minutes with a duration of 4 to 12 hours.
The side effects of THC are transient and nonlethal and may cause increased appetite, red eyes, dry mouth dilated pupils, dizziness, distorted perception, increased heart rate and anxiety. It may lead to “Green Outs” i.e. panic attacks, severe paranoia and fear, hallucinations and severe dizziness. Side effects can be managed by reassurance, hydration, CBD, hot baths and benzodiazepine.
Dr. Lee reviewed 7 of his clinical cases most of which showed the beneficial effects of cannabis unless his dosage recommendations were not adhered to. A common thread amongst the elderly was the potential for green outs due to the fear of cannabis. One case involved a retired Drug Enforcement Agency agent who spent his career hunting down cannabis dealers and smugglers. His wife “snuck in” cannabis for his ailment and eventually told him she was giving him cannabis. It started to cause him to question his years spent as a DEA agent as being useless! One patient was near death with cancer. After a year of taking THC and CBD he was in complete remission. In two years this patient was completely robust. One patient badly afflicted by arthritis and taking medications including opioids with cannabis managed to cold turkey off opioids.
The case studies show each condition and patient may need different and ongoing cannabis strategies.
Dr. Lee expressed concern about having elderly patients increasing the risk of falls if too much THC is taken. Cannabis has worked well for his patients suffering from insomnia but a slower and longer acting oral route is advised so the effects last throughout the night. The best benefits of cannabis seem to be with an equal ratio of THC to CBD. Over the counter CBD ranges from cheap to very expensive. Extracting CBD from cannabis plants is very expensive in order to remove contaminants so cheap CBD should be viewed with suspicion yet high priced CBD is no guarantee of purity. Higher quality controls exist for medical cannabis.
Note that medical and recreational cannabis is legal in Canada but access to it requires a medical evaluation and a prescription from a physician.
In the webinars I have attended there is a desperation element that drives the use of medical cannabis. Frequently it is a situation where no other drug is effective.
This article is not medical advice. Should you wish to become a medical cannabis user in Canada you will have to go through an evaluation by a physician. Self medication through use of recreational cannabis without medical supervision may not be effective. An experienced cannabis physician is your best bet to get the dosage of THC and CBD component that is effective. Tax credits are available to Canadian taxpayers for medical cannabis purchases in Canada
In closing Dr. Lee provided the following quote, “Marijuana in its natural form is one of the safest therapeutically active substances known to man. By any measure of rational analysis marijuana can be safely used within a supervised routine of medical care….It would be unreasonable, arbitrary and capricious for the DEA to continue to stand between those sufferers and the benefits of this substance in light of the evidence in this record.” DEA Chief Administrative Law Judge Francis L. Young, Ruling in the Matter of Marijuana Rescheduling Petition September 6, 1988.
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