*The translation of this article in French and Portuguese has been made through machine translation and has not been edited yet. we apologise for any inaccuracies.
The global legalisation of marijuana for both medical and recreational use has rapidly evolved over the past decade. Attitudes and legal frameworks continue to change with ongoing research, political debates, and public discussions, which help raise important questions about how legalising marijuana may impact public health, patient care, pharmaceuticals, and the healthcare industry at large.
Marijuana is a natural product made from the flowers and leaves of the Cannabis sativa L. plant which contains a wide array of chemical compounds. The most well-known components of marijuana are delta-9-tetrahydrocannabinol (THC) and Cannabidiol (CBD), with THC being responsible for its psychoactive effects. However, marijuana includes over 500 different compounds, including more than 100 cannabinoids, related to THC and its effects. These compounds have various impacts on the brain and central nervous system, which can be both beneficial and potentially harmful to the human body.
Although the use of marijuana for medical purposes dates back thousands of years, the modern legal and pharmaceutical landscape are marked by controversies and stigma surrounding ethical, political, and societal implications since its prohibition in the early 20th century.
Conducting robust scientific research on medical marijuana faces challenges due to these complexities, coupled with legal restrictions, limited funding, and the need for standardised cannabis research methodologies. Scholars and researchers have long argued that more controlled studies and sufficient clinical data are needed to properly examine risks and the potential medicinal benefits of marijuana-based therapies and cannabinoid medicines.
Despite these obstacles, research efforts are underway to better understand the therapeutic potential of marijuana and cannabinoids and their role in treating various medical conditions. The United States, with its economic and political influence, plays a significant role in shaping global discussions and initiatives concerning drug legislation.
In 2022, the United States signed The Medical Marijuana and Cannabidiol Research Expansion Act, aiming to facilitate research, improve access, and provide important information on medical marijuana and CBD. The act establishes a new registration process for practitioners and manufacturers to conduct marijuana research. It allows registered entities to manufacture, distribute, and possess marijuana or CBD for medical research purposes and allows physicians to discuss the benefits and harms of medical marijuana with patients, among other provisions.
By signing this act, the United States takes steps towards removing barriers to medical marijuana research and facilitating the FDA to approve new medicines derived from CBD or other cannabis compounds. This may open the door to an assortment of new marijuana-based therapies in the near future.
Marijuana Legal History
Marijuana became illegal through a combination of factors, including political pressure, international influence, and concerns over public health and safety. In the United States, the criminalisation of marijuana gained momentum through political campaigns in the early 20th century, ultimately resulting in the signing of the Marihuana Tax Act of 1937. This legislation imposed heavy taxes and strict regulations on marijuana, practically making it illegal. Approximately 30 years later, the subsequent Controlled Substances Act of 1970 classified marijuana as a Schedule I drug, placing it in the same category as substances like heroin and LSD, which remains unchanged to this day.
Internationally, the signing of drug control agreements, such as the Single Convention on Narcotic Drugs in 1961, further reinforced the global prohibition of marijuana. These agreements exerted increased pressure on countries to criminalise marijuana and adopt stringent drug control policies.
In recent years, there has been a growing recognition of the potential medical benefits of marijuana and a greater emphasis on evidence-based drug policies. This shift in perspective has resulted in legislative changes and shifting attitudes towards marijuana in many countries.
In the 1990s and early 2000s, several countries, including Austria, Belgium, and Luxembourg, legalised marijuana for medical purposes. Later, the Netherlands, Portugal, Malta, Czech Republic, and Croatia, among other countries, further decriminalised personal possession of marijuana or made it fully legal for medical and recreational use.
Since 2010, numerous countries, including Germany, Greece, and Ireland have established medical marijuana programs. Other countries, such as Thailand, Mexico, South Africa, and many South American countries have decriminalised marijuana or allowed limited personal use. In 2013, Uruguay became the first nation to legalise marijuana on a federal level, followed by Canada in 2018, which formally legalised the cultivation, possession, acquisition, and consumption of marijuana and its by-products.
In the United States, California took the first step of legalising medical marijuana in 1996, and in 2012, Colorado and Washington became the first two states to legalise marijuana for recreational use. Presently, 38 states have legalised medical marijuana, and over 20 states have legalised it for recreational use. However, the legality of marijuana remains a subject of heated debate, as it is still classified as a Schedule I drug under federal law.
Patient Health Benefits and Risks of Medical Marijuana
Marijuana has gained recognition for its potential to provide relief and manage symptoms in several medical conditions. One of its most well-known applications is pain management. The cannabinoids found in marijuana interact with the body’s endocannabinoid system, which plays a vital role in pain modulation. As a result, medical marijuana has shown effectiveness in alleviating chronic pain associated with conditions like neuropathy, arthritis, multiple sclerosis, and pain induced by chemotherapy.
Another notable benefit of medical marijuana is its ability to reduce nausea and vomiting. This can be particularly helpful for patients undergoing chemotherapy or those experiencing symptoms related to gastrointestinal disorders. THC, in particular, has demonstrated antiemetic properties that can help manage treatment-induced nausea and vomiting.
Marijuana has also shown promise in addressing certain neurological disorders. CBD has been found to be effective in reducing seizures in patients with severe forms of epilepsy.
It is also known for its appetite-stimulating properties. This can be beneficial for patients with conditions that result in decreased appetite and weight loss, such as individuals undergoing chemotherapy, those with HIV/AIDS, and individuals with eating disorders.
While medical marijuana offers potential benefits, it’s crucial to consider the potential risks and side effects associated with its use. One of the primary concerns is cognitive impairment. The psychoactive component of marijuana, THC, can impair cognitive function, including memory, attention, and decision-making. Prolonged or heavy use, particularly in young individuals, may lead to long-term cognitive impairments.
Another risk to be aware of is the potential for addiction and dependence. Like any substance with psychoactive properties, marijuana carries a risk of addiction and dependence. Regular use, especially in high doses, can lead to the development of dependence, withdrawal symptoms, and an increased risk of substance use disorders.
Marijuana use has been associated with an increased risk of psychiatric disorders, especially in individuals with pre-existing mental health conditions. Regular use, particularly in high doses, may worsen symptoms of anxiety, depression, psychosis, and other mental health disorders.
Due to the lack of controlled studies and clinical research, many of the health benefits and risks of medical marijuana are still debated within the medical and scientific community.
Cannabis-Based Treatments and FDA Approvals
The FDA has not approved marijuana for any medical use yet. However, some drugs that contain individual cannabinoids have been approved over the years.
- For Chemotherapy-induced Nausea (1985): A synthetic cannabinoid similar to THC that has been approved by the FDA for the treatment of nausea and vomiting associated with chemotherapy in cancer patients in 1985.
- For HIV/AIDS and Chemotherapy-induced Nausea (1985 and 2016): Two synthetic forms of THC have been approved by the FDA for the treatment of nausea and vomiting associated with chemotherapy in cancer patients and for the improvement of appetite in patients with HIV/AIDS.
- For epilepsy (2018): An oral solution containing CBD was approved by the FDA in 2018 for the treatment of certain forms of epilepsy, including Dravet syndrome and Lennox-Gastaut syndrome.
- For multiple sclerosis: An oral spray containing both THC and CBD, has been approved in several countries, including the United Kingdom, for the treatment of multiple sclerosis-related spasticity. However, it has not been approved by the FDA for use in the United States.
Ongoing research and clinical trials continue to explore the potential of marijuana-based treatments for a wide range of conditions. For example, CBD is currently being investigated for the treatment of conditions such as schizophrenia, autism spectrum disorders, and glioblastoma. With more research and changing legal frameworks, it is expected that more marijuana-based treatments will emerge in the near future.
What Do Physicians Think of Medical Marijuana?
The perception of medical marijuana among physicians plays a crucial role in determining its acceptance and use as a treatment option for patients. As the stigma surrounding medical marijuana decreases and research support grows, it is essential to understand how healthcare professionals view its therapeutic value and their willingness to recommend and prescribe it.
In a study published in Pain Practice in 2021, a comprehensive analysis was conducted to explore the perspectives of healthcare professionals regarding the clinical use and relevance of medical marijuana, particularly in the context of chronic pain. The study examined a total of 26 studies involving physicians, nurses, and pharmacists from the United States, Israel, Canada, Australia, Ireland, and Norway.
The findings of the study shed light on several important aspects related to medical marijuana. It revealed that healthcare professionals acknowledge medical marijuana as a legitimate treatment option for chronic pain. However, their perspective on its use varied depending on factors such as their clinical training, experience, and knowledge in the field.
One key factor influencing healthcare professionals’ willingness to prescribe medical marijuana is the availability of credible evidence supporting its efficacy. Concerns regarding the potential for abuse, legal barriers, and the lack of comprehensive training and clinical guidelines also impact their decision-making process. Therefore, the study highlighted the need for further education and knowledge on medical marijuana to address these concerns and facilitate informed decision-making.
The comparison between medical marijuana and opioids regarding safety was another crucial aspect explored in the study. Healthcare professionals generally perceived medical marijuana as a safer alternative to opioids, with fewer side effects and a lower risk of overdose and addiction. However, some professionals expressed concerns about the potential for addiction and abuse associated with medical marijuana, emphasising the importance of responsible use and monitoring.
The study also addressed the perceived adverse effects of medical marijuana, including risks to mental health, driving impairment, and cognitive function. Healthcare professionals pointed out the challenges in distinguishing between symptoms induced by marijuana use and underlying psychiatric disorders, underscoring the importance of comprehensive assessments and patient education.
As a physician, it is essential to reflect on these findings and consider your own views on medical marijuana. Do you believe more education and knowledge are necessary before physicians feel comfortable prescribing marijuana-based medications? Sharing your thoughts and experiences in the comment section can contribute to the ongoing discussion and enhance collective understanding of this evolving field.
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