Medical Marijuana Is An Exciting Therapeutic Tool – But Watch Out Where You Get Your Advice

No disrespect to budtenders, but they’re not the ones you should be talking to when you’re talking medical marijuana — or any other cannabinoid remedy, for that matter.

Rather, people suffering from conditions ranging from opioid addiction, arthritis and chemotherapy’s side effects, to epilepsy and PTSD, need to be talking to a cannabis-certified M.D.

That’s a major message of author Rebecca Siegel’s new resource book, The Brain on Cannabis (Citadel Press). Siegel is a New York-based M.D. and board-certified psychiatrist who for several years has also been a state-certified prescriber of medical marijuana.

“My side gig,” Siegel joked in a recent interview. But in her book, she’s deadly serious about the perils as well as the promise of medical marijuana. Reason: Lacking FDA regulation and extensive research, today’s medical products come in all kinds of potencies and from all kinds of origins – some sketchy. Some also carry unproven claims, trusted unfortunately by uninformed consumers desperate to relieve their pain.

“In the course of research for my book,” Siegel wrote, “I learned that the cannabis landscape is changing rapidly, and it’s difficult for patients to keep abreast of how these developments might impact their own condition and course of treatment.”

Indeed, her book starts small with the basics, like CBD versus THC, but moves on to new developments in the field that are less well-known. These include:

·     Already-approved cannabis-based drugs: Although marijuana remains federally illegal, the FDA has actually approved four drugs made from THC simulations or cannabis extract: Marinol, Cesamet and Syndros all curb nausea and vomiting for chemo patients; Syndros also stimulates appetite in AIDS patients. CBD-based Epidiolex is for children with severe seizure disorders. And another cannabis-derived drug, Sativex, is being looked at by the FDA for the spasticity and nerve pain of multiple sclerosis.

·     Unexpected potency: THC concentrations in the ’70s, ’80s and ’90s averaged 10 percent. Today, that average is up to 20 percent, with one strain in 2016 containing 32 percent. “Today’s high-potency marijuana is not your mother’s or your grandfather’s marijuana,” Siegel writes. Such potency, she says, makes accurate dosing difficult for physicians, and – if patients themselves obtain recreational cannabis for health complaints — potentially lethal.

·     Restrictions on doctors: Physicians faced with the legal uncertainties of cannabis may be restricted by their states from “prescribing” a remedy as they would a pharmaceutical drug. Instead, they may only “recommend” it.

·     Allowable conditions: States may specify exactly which conditions qualify for certified cannabis meds. This makes things murky when patients seek help for conditions not on the list.

Siegel practices at Amen Clinics with psychiatrist  Daniel Amen, the celebrity brain disorder specialist and author, seen often on public television, who wrote the book’s forward. Following are edited excerpts from the interview with Siegel, talking about The Brain on Cannabis:

Why did you write this book?

I want to increase awareness and education. When my first patient came to me asking about cannabis, she had found a product of which she said, “This has helped me ease my insomnia,” in lieu of pharmaceuticals. I said, “Wow, this is amazing!” It turned out she’d gone to a legal recreational dispensary in Denver, and her edible chocolate bar changed her life. She said, “Can you help me do this?” And I said, “I don’t know. Maybe.”

You write you’ve seen countless individuals treated with cannabis find relief from physical and emotional conditions. Can you describe some of these cases? People after all are still leery …

A healthy leery! People should be wary and cautious. So I’ve seen people get helped with chronic pain, a big amorphous condition. The other thing is [the condition being presented has] to fit into the medical model of what diagnoses I’m allowed to certify for. And a condition like insomnia in New York State is not certified; that’s not a “condition.” Nor is anxiety. But there are a lot of people who come to me and say, “This is what [cannabis] has helped me for.” That’s me walking a very fine line. I don’t want people getting cannabis off the street; that’s dangerous.

What have I seen? A woman with breast cancer, one of my first patients, and she was struggling with the idea that she was going to do chemo, and it was going to impact her with nausea. Another, older woman who’d had a really serious stroke and serious seizures and was impaired. [She was subsequently certified for medical CBD, not THC]. I heard from her nephew that the seizures could not be controlled by pharmaceutical medication and gave her terrible side effects. [But CBD] helped her tremendously.

What is it that people don’t know about the potency and origins of the stuff they buy off the street?

You don’t know anything! You’re taking huge risks, meaning the strength of it. Since the 1960s, potency has tripled, quadrupled, and it’s scary to me because teens using it for the first time, or anybody, is taking a very potent cannabis product, whether it’s for vaping, smoking or edibles. Not everybody is going to have a bad experience, but I’ve had many patients come to me who have – [reactions like] anxiety, paranoia, psychosis. There’s a big disagreement going on within the scientific and research community about whether marijuana is a “gateway” drug… I know that a lot more research has to be done.

You write about “Chronic Use Disorder,” or CUD — where people become addicted to marijuana. You dismiss the common belief that marijuana, unlike, say, heroin or cocaine, is nonaddictive, and harmless.

In the psychiatric community, addiction is a hard thing to quantify. One person’s addiction may not be another’s. For some people, [marijuana] may cause de-motivation; others say it helps them focus.

[On the myth of harmlessness]: It’s where you talk about causation and correlation, where you say, “Using cannabis, there’s a much higher risk of psychosis or schizophrenia,” or, “If my daughter or son tries it, they will be way more likely to get addicted to it or go on to harder drugs.” It’s very complicated to set up. Could it possibly be that for some, marijuana is harmless? Maybe. But as a physician I do not recommend it for anybody [younger than 25] whose brain is still maturing and developing.

Good luck with that!

I know! I have three daughters!

What would your message be to young people their age, or anyone, about how they consume marijuana?

Smoking and vaping with our pandemic: You don’t want to be putting anything through the lungs that is going to compromise them. The other thing is that anyone with any pre-existing condition – asthma, COPD or any respiratory condition — you don’t want to be putting anything through your lungs.

For business owners in the cannabis business: What is it that they may not know when it comes to advising customers?

Everyone that walks through the door is an individual. It’s not a one-size-fits-all drug – I hate to use the word “drug”! — But if you’re the owner, you want to have people working for you who are educated about it. People will come in and get information, and you want to have people who know what they’re talking about, not the local tenders. That scares me.