Breaking down the cannabis debate (part 1)

Medical cannabis has been legalized in more than half of the United States, but questions remain about the risks and benefits of cannabidiol (CBD). CDB-only products are primarily being used for pain management, and users claim they do not have the same intoxicating effects as products with high levels of tetrahydrocannabinol (THC). More research is needed.

EDITOR’S NOTE: This is the first in a three-part series to examine the impact of cannabis on our health, our economy and our communities.

RBC | There are few subjects that stir up stronger emotions among doctors, policy makers and the public than cannabis—aka marijuana. (Cannabis is the actual name of the plant species which includes hemp. Marijuana refers to the dried flowers of the cannabis plant.)
People have used cannabis for a variety of health conditions for at least 3,000 years. More recently, individual components of cannabis or similar synthetic substances—called cannabinoids—have begun to be used for health purposes. Currently, the two main cannabinoids of interest for medical treatments are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the deriviative responsible for the characteristic “high” associated with marijuana.
Since medical and recreational legalization of cannabis in Colorado and other states, many products have been developed which have limited quantities of THC and high levels of CBD. It’s often these CBD-only products users claim help with pain, anxiety, insomnia and more—without the intoxicating effects of THC.
While the U.S. Food and Drug Administration (FDA) hasn’t approved the cannabis plant for treating any health problems, it has approved three cannabinoids as drugs. In 2018, the agency approved Epidiolex (CBD) oral solution for the treatment of seizures associated with two rare, severe forms of epilepsy. The U.S. Library of Medicine released a study about one particular form of childhood epilepsy called Dravet syndrome which is almost impossible to control, but responds dramatically to a CBD-dominant strain of marijuana called Charlotte’s Web. The FDA has also approved the synthetic cannabinoids dronabinol and nabilone to treat nausea and vomiting associated with chemotherapy in people for whom other medicines to treat these symptoms have not produced good results. Dronabinol is also approved to treat loss of appetite and unwanted weight loss.  
Whether the potential therapeutic benefits of cannabis outweigh its health risks is uncertain. At the February Rio Blanco County Board of Health meeting Pioneers Medical Center CEO Ken Harman reported that his medical care providers are prescribing fewer opioids for pain management due to the opioid epidemic.
Nationwide, many Americans are turning to other pain management options as opioid prescriptions are reduced or abandoned by medical care providers. According to the Harvard Health Blog, the most common use for medical cannabis in the United States is for pain control. While cannabis isn’t strong enough for severe pain (for example, post-surgical pain or a broken bone), it is effective for the chronic pain that plagues millions of Americans, especially as they age. Part of the appeal is that cannabis is clearly safer than opioids (fatal overdose is unlikely and it’s far less addictive) and it can take the place of NSAIDs such as Advil or Aleve for people can’t take them due to problems with their kidneys, ulcers or reflux disease (GERD).
Additional research is needed to know if cannabis is better or worse for pain relief than other pain management options, such as over-the-counter drugs like ibuprofen or alternative treatments like occupational therapy, and how effective these products are in treating other ailments like anxiety disorders, insomnia, glaucoma, even high blood pressure. Studies to determine ideal dosages, side effects, and long-term risks and benefits need to be done.
With more than half of the United States legalizing medical cannabis it is no wonder scientists around the globe are scrambling to conduct preclinical and clinical trials to provide data to verify both benefits and risks.

FAST FACTS
The Centers for Disease Control (CDC) claims about 1 in 10 cannabis users will become addicted. For people who begin using before the age of 18, that number rises to 1 in 6. 
Impact depends on many factors and differs for each individual:
– the amount of THC ingested (i.e. potency or strength)
– frequency of use
– age of first use, and whether other substances (e.g., tobacco and alcohol) are used at the same time.
Heavy users can have short-term problems with attention, memory, and learning, which can affect relationships and mood. Cannabis also affects brain development. When marijuana users begin using as teenagers, the drug may reduce attention, memory and learning functions and affect how the brain builds connections between the areas necessary for these functions. These effects may last a long time or even be permanent.
Studies indicate that cannabis use by mothers during pregnancy may be linked to later problems with attention, memory, problem-solving skills and behavior problems in their children.
The way in which cannabis is inhaled or ingested can cause its own set of complications. Smoking delivers THC and other cannabinoids to the body, but also delivers harmful substances to users and those close by, including many of the same substances found in tobacco smoke, which are harmful to the lungs and cardiovascular system. Researchers have also found limited evidence of an association between current, frequent or chronic cannabis smoking and testicular cancer (non-seminoma-type). 
Edibles—food and drink products infused with cannabis and ingested—have different risks, including a greater risk of poisoning. Edibles can take from 30 minutes to 2 hours to take effect, causing some people to ingest too much, which can lead to poisoning and/or serious injury. Some users have been caught off-guard by the strength and long-lasting effects of the THC in edibles. Cannabis affects children differently than adults. Since legalization in some states, children have accidentally eaten cannabis products—usually those containing THC—that looked like candy or treats, and required emergency medical care.

By Roxie Fromang | Special to the Herald Times

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