The advantages and disadvantages of medical marijuana use

Medicinal Marijuana

The Advantages and Disadvantages of Medicinal Marijuana

The purpose of this paper is an evaluation of the advantages of medicinal consumption of marijuana compared with the disadvantages of consumption. There is a tremendous body of evidence in recent years supporting the use of cannabis for medicinal purposes, particularly with regard to chronic pain treatment and treatment of certain central nervous system disorders such as multiple sclerosis.

Likewise however an equal number of researchers have continually pointed out the potential negative effects of marijuana use, whether for recreational, religious or medicinal purposes. It is unclear at this point in time whether the advantages of medicinal cannabis outweigh the disadvantages; one thing is clear: use of marijuana whether for medicinal purposes or otherwise is a highly controversial subject.

This study examines the most recent literature available on both sides of the issue, with the conclusion that marijuana will need to be studied more comprehensively in the long-term before health care agents and government officials are likely to approve widespread use of cannabis as a medication.

Introduction

Since the dawn of time health care representatives have been using cannabis to treat a variety of ailments and chronic diseases. Much like any natural form of therapy or herb, medical literature has documented the use of cannabis to treat a variety of orders varying from mild to moderate in nature. There is even some evidence suggesting that marijuana may improve one's cognitive and mental ability, despite modern reports that it might do otherwise.

The use of marijuana is however at best a controversial issue. As with any drug, prescription or otherwise, there are advantages and disadvantages to using it. Some of the more common disadvantages cited with use of medicinal marijuana include the potential for addiction and withdrawal symptoms with prolonged or even short-term use. There are those however that believe the advantages outweigh the disadvantages and vice versa.

The purpose of this study is an examination of the exact advantages of cannabis use compared with the disadvantages, in an attempt to discern whether or not the benefits of cannabis use outweigh the risk.

Background to the Problem

Marijuana has been a subject of controversy for some time, but particularly since people have been taking an active interest in using marijuana for medicinal purposes. The federal government has long been opposed to the use of marijuana for any purposes, whether medicinal or otherwise. Some states however, are beginning to recognize the potential merits of medicinal marijuana.

In November of 1996 California voters passed what is known as the Compassionate Use Act, which "permits the use of marijuana for medicinal purposes where that medical use is deemed appropriate and has been recommended by a physician (Christenson, 174). Federal law however prohibits physicians from prescribing cannabis to any patients, and suggested that is should only be obtained legally through "strictly controlled, federally approved research programs" (Christenson, 174).

For physicians to prescribe the drug in California, they must first acquire a registration from the DEA (Drug Enforcement Agency) (Christenson, 174).

Shortly after this act was passed the White House Office of National Drug Control Policy responded indicating that recommending use of marijuana was "not consistent with public interest" and may result in revocation of a prescribing physician's registration (Christenson, 174). Herein lies the debate. Do the benefits of medicinal marijuana outweigh the potential risks, and if so should Congress pass a federal bill allowing marijuana to be legalized?

This is a debate that has continued for some time. One thing is certain, further research is necessary before consumers, health care representatives and government officials are able to make a clear decision one way or another.

The purpose of this paper is to identify what specifically the advantages of medicinal marijuana are compared with the disadvantages, so that individuals may make a clear decision for themselves regarding the efficacy or potential harm of medicinal cannabis use.

Advantages Medical Marijuana

There are a variety of benefits associated with the medicinal use of marijuana. Smoked cannabis can "clearly help alleviate some medical problems" according to a large body of research, and typically costs far less than other more intensive therapies (Earleywine, 167). This is part of the reason that healthcare providers are starting to view marijuana as a potential treatment for a variety of disorders. Some of the disorders that are currently under consideration for treatment with medicinal marijuana include chronic pain, cancer, HIV and central nervous system disorders (Earleywine, 167).

As mentioned cannabis is a consideration for many because of its low expense. In fact, cannabis may be one of the least expensive drugs to produce and manufacture as well as supply clients. This is perhaps the single biggest benefit of the drug. However this is also a concern for legislators that are aware that marijuana is so easy to manufacture that independent citizens can literally grow it in their back yard (Earleywine, 167). In fact, if marijuana is one of the few drugs that few people understand the need for regulation and prescription use of (Earleywine, 167).

Historically private citizens and healthcare representatives have used cannabis for centuries particularly for the treatment of chronic illnesses. Cannabis has in fact been used dating as early as 2737 B.C. when it was used by Shen Neng, a Chinese emperor and pharmacologist to treat al manner of disorders including gout, malaria, beriberi and even memory problems (Earleywine, 168).

Historically marijuana has been used the world over to help reduce pain and other illnesses. It is most well noted for its ability to modify pain receptors and reduce chronic pain in patients suffering from this debilitating condition (Earleywine, 168). Chronic pain has historically been one of the most difficult illnesses to treat, because very often the exact cause of pain in a patient cannot be determined; this is why modern prescription drug therapy has so often failed patients with chronic pain (Earleywine, 168). Opponents of medicinal cannabis use may argue that the substance is addictive and may result in withdrawal symptoms, however the majority of medications currently available to treat this condition and other debilitating conditions resulting in pain are also highly addictive and have numerous side effects.

In modern times a majority of the studies that have shown the advantages of medicinal cannabis have focused on the potential anti-nausea, pain relieving and muscle relaxing effects marijuana has on the body (Earleywine, 167). Most studies that examine these effects find that cannabis use has a positive effect on patients, with few if any adverse side effects aside from a slight high in some patients. May patients report that this is a welcome side effect compared with some of the more severe side effects of traditional therapies, which may include headaches, vomiting, slurring, physical disorders and other impairments (O'Brien, 11).

Perhaps the largest problem opponents have with medicinal cannabis use is the fact that many of these side effects are cognitively oriented, or rather relate to ones mental efficacy and well being (O'Brien, 11). However an equal number of advocates will argue that these 'adverse' effects are in fact no more severe than a person having a glass of beer (O'Brien, 11).

There are some cases where marijuana may help a patients realize a reduction in troubling symptoms when other medications fail. This was exemplified by a case reported in May of 2001, when a seven-year-old boy who had been hyperactive and aggressive his entire life was medicated with marijuana. Previous to this the body had been diagnosed with numerous disorders including post traumatic stress disorder, bipolar disorder and impulse control disorder.

The drugs the boy had been on included Ritalin, Dexedrine, adderall, depakote, thioridazine and tegretol to name a few. The young boy had slobbered, been unable to walk and slurred his speech due to overmedicated, and hospitalized more than 3 times. The mother began delivering a dose of marijuana to the boy in a muffin twice per day, under the guidance of the boy's pediatrician. Thus far the results have been positive, with the boys behavior completely turning around (O'Brien, 11).

Many have argued the risks associated with cannabis use are similar if not less than the risks associated with prescription drug use in many cases (O'Brien, 11). For that reason alone many argue that marijuana is advantageous. Why wouldn't a physician choose to use a medication that might offer extreme benefits without the potential serious adverse effects of some other well-known medications? This seems to be the biggest benefit marijuana has to offer, not to mention it is relatively easy to manufacture and considered relatively low cost to produce (O'Brien, 11).

Pryce & Baker (2005) point out that the use of marijuana for numerous conditions has been well documented for thousands of years. Their studies suggest that abundant experimental data "have reinforced the anecdotal claims of people who perceive medicinal benefit from use of cannabis" (273). Further they suggest that discovery of endogenous system of receptors and ligands for cannabis supports the use of cannabis as a treatment for diseases, particularly those like multiple sclerosis (Pryce & Baker, 274).

De Jong, Prentiss, McFarland, Machekano & Israelski (2005) note in one study that medicinal marijuana use may be particularly useful in patients suffering from HIV with moderate to severe nausea. There study points out that adherence to antiretroviral therapy (ART) is an essential and critical component for successful treatment of HIV infections. Further a recent study conducted by the researchers suggest that smoking marijuana improves adherence to ART, and thus leads to more successful treatment of HIV infections in patients (De Jong, et. a, 44).

The relationship that existed in this study was confirmed using a multivariate analyses controlling "for the interactions between nausea and marijuana use" in which "other illicit drug use remained a factor related to nonadherence" (De Jong, et. al, 44). This study confirms the notion that medicinal cannabis may be beneficial where other therapies or drugs have not. However to demonstrate further benefits or a more causal relationship the researchers do acknowledge that longitudinal and controlled studies would be required.

In another study conducted by Wade, Makela, Robson, House & Bateman (2004) the effects of medicinal extracts of cannabis are examined on specific symptoms associated with the disease multiple sclerosis. The double blind, randomized, placebo-controlled study of patients showed that use of medicinal cannabis reduce spasticity among patients and other troublesome symptoms including fatigue and patients self-assessment of their disability (435). The side effects patients experienced during the study were generally considered mild, with only minimal adverse effects on cognition and mood noted.

The results of studies related to medicinal use of marijuana and chronic pain are perhaps the most promising, because chronic pain historically has been so difficult to treat. Berman, Symonds & Birch (2005) conducted a randomized study with the objective of investigating the effectiveness of cannabis-based medicines for the treatment of chronic pain, particularly that associated with brachial plexus root avulsion. The researchers claim that this type of pain is an "excellent human model of central neuropathic pain" because with regard to anatomical location, it represents a "homogenous group" (Berman, Symonds & Birch, 300).

The results of their study show that cannabis is relatively well tolerated among all patients experiencing pain with only minimal adverse side effects, including "intoxication type reactions" which typically "resolved spontaneously" (Berman, Symonds & Birch, 301). Further the study suggests that quality of life assessments from patients improved, which is a difficult achievement when dealing with chronic pain candidates.

Smith (2004) conducted a study to determine the potential use of medicinal extracts of cannabis specifically to help relieve pain and spasticity in patients suffering from multiple sclerosis. Whereas previous to 2002 there had been relatively few studies supporting cannabis extract for medicinal purposes, since then there has been a large number of studies including this one that support the use of cannabis for treatment of pain and pain related disorders. The results of Smith's 2004 study suggest that the "endogenous cannabinoid system" may help regulate spasticity and pain in multiple sclerosis patients, and is thus worthy of further exploration.

Disadvantages Medical Marijuana

Despite the numerous reported advantages of medicinal cannabis, there have also been a number of studies which have focused on the disadvantages. A majority of these studies have focused on the adverse effects associated with cannabis use, including impaired cognitive functioning in some cases. Additionally, many of the disadvantages associated with cannabis use focus on the fact that medical marijuana may not help all medical conditions and situations where standard medications may be the treatment of choice, and there is not enough research on many if not most medical applications of cannainoids in order for scientists to draw firm conclusions regarding its efficacy (Earleywine, 167).

Many believe that allowing marijuana for medicinal purposes sends a message particularly to young people and children that marijuana is acceptable to use and may even provide positive benefits (O'Brien, 11). There is in fact a large movement of citizens and parents as well as community representatives that claim the disadvantages of marijuana are all minimal with the exception of the potential negative effect acceptance of the drug may have on young people (O'Brien, 11). Because marijuana can so easily be produced and distributed, there is a real risk that it will become more readily available to young people that are not well equipped to judge appropriate use of the drug. Withdrawal, dependency and toxicity issues are much more likely to be severe among this population than the population at large. Many opponents of medicinal cannabis argue that it would be far to difficult to establish adequate safety measures to ensure that children were not overly exposed to cannabis if it were to be legalized for any purpose (O'Brien, 11).

One of the disadvantages or risks associated with medicinal use of marijuana include the relatively few empirical studies that have been conducted of the drug. There have been a number of studies that show that medicinal cannabis may provide some benefits, but few of these have examined the long-term and long reaching effects of use, including the number of individuals that are likely to develop dependency issues after long-term treatment with cannabis (O'Brien, 11).

In one study conducted on the use of cannabis in the UK, subjects reported that medicinal marijuana was more likely to be used for patients suffering from chronic pain, multiple sclerosis and depression (Ware, Adams & Guy, 292). All three of these conditions have historically been difficult to treat effectively, particularly chronic pain and multiple sclerosis, which for many have no cure (Ware, Adams & Guy, 292). However even this study is limited, with the authors concluding simply that medicinal cannabis use is more likely among people that are male and younger; they further suggest that caution "must be exercised in interpreting data" and point out that further clinical studies are a necessity particularly with standardized and quality controlled products (Ware, Adams & Guy, 292).

As with any drug, standardization is a key element that will determine the drugs efficacy and safety in the long-term. This may be problematic in the case of medicinal marijuana, unless a huge investment is made in long-term clinical studies of cannabis and cannabinoids (Ware, Adams & Guy, 294).

Still other studies suggest that medicinal marijuana studies, particularly those of the nervous system, show no convincing evidence of the effectiveness of the drug (Renckens, 380). It is important to note however that though this is a disadvantage, it is one that is seen in many different medications. Many medications are touted for their effectiveness when in reality they may only be effective in treating a certain percentage of the population with a specific disorder. Every person is unique, as is there body chemistry, thus the manner in which one person reacts to a drug is not the same as the way in which another will. This can also disadvantage medicinal marijuana seekers, as it would be extremely difficult to regulate and perhaps standardize the effects of the drug.

There are some studies that have pointed out that marijuana has potentially psychosis inducing effects on some patients (Leweke, Gerth & Klosterkotter, 895). Specifically in patients with a predisposition toward certain mental conditions, use of cannabis may result in longer lasting or persistent schizophrenia like disorders (Leweke, Gerth & Klosterkotter, 895). Admittedly researchers investigating this phenomena point out that cannabis has been used since the dawn of tie for medicinal and recreational as well as religious purposes; however they also note that there have been several reports of adverse effects that result from or are associated with consumption of cannabis including psychotic episodes, that might be short or longer term lasting (Leweke, Gerth & Krosterkotter, 895).

More research is needed to determine what strategies might be used to combat these negative side effects. At this time adequate case management strategies have not yet bee adopted, as a better understanding of the psychological effects of cannabis must be examined.

Walsh, De Gier, Christopherson & Verstraete (2004) suggest that introduction of medicinal marijuana increases the risks of not only toxicity in the long-term but also increases the risks of patients using drugs and driving, thus potentially harming innocent victims. Their studies suggest that laws need to be established that specifically hinder drugged drivers before medicinal marijuana can be legalized, because the drug affects drivers behaviors, analytical techniques and general demeanor (Wash, et. al, 242). The researchers like many others suggest that simply too few studies have been conducted of the long-term studies in order to support use of marijuana for medicinal purposes, particularly because the risks of this drug with regard to traffic safety may be too high.

As with any narcotic substance, there is the risk of dependency and withdrawal symptoms with use of cannabis (Bursetin, Karst, Schneider & Zurier, 1515). While the psychotropic effects of medicinal use are typically reported as much less severe than unregulated use, many patients still report some adverse effects.

There are relatively few empirical analyses available at this time that have effectively measured the potential long-term withdrawal and addiction issues that might be associated with marijuana use. Still, one must also recognize that many prescription medications have the ability to produce similar effects, and according to some patients, side effects that might be considered more troublesome than those associated with use of medicinal marijuana (Burstein, et. al, 1515). Still, any side effects are still worthy of further investigation to determine whether or not they outweigh the potential therapeutic effects of the drug.

The medicinal effects of cannabis may not be as long lasting as the effects of some prescription drugs available to treat common disorders, as at this time there is no time released mechanism for administering medicinal cannabis (Burstein, et. al, 1516). The increased dosing that may be required to maintain the efficacy and advantageous effects of cannabis may lead to increased dependency and withdrawal issues, one reason that certain healthcare providers are hesitant to prescribe cannabis even in the best of circumstances (Burstein, et. al, 1515).

One of the disadvantages thus may be seen as the need for further studies to be conducted to determine the potential long-term benefits of marijuana use. The studies that have been conducted at this point in time do reveal short-term benefits of cannabis consumption for certain disorders including treating chronic pain. However few of these studies have examined patients in the long-term.