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The concerns I hear voiced most often by people considering the program are side effects, cost, and stigma. Side effects are overwhelmingly mild to moderate in intensity and can often be avoided by starting at a low dose and increasing the dosage slowly. THC is the cannabinoid (cannabis chemical) most responsible for making people feel “high.” Patients wanting to avoid this could try products that emphasize a different cannabinoid, CBD, which does not make people high. Out-of-pocket costs for the medical cannabis products can be quite high, but most patients get a pretty good idea of how helpful medical cannabis products are for them within a few weeks. So, if they aren’t very helpful, a different product can be tried or use of the products can be discontinued. Unfortunately, some participants in the program report judgmental attitudes from others about participation in the program. This seems to be due to a residual reputation of marijuana as “something only bad people use.”

What’s been the most surprising thing you have run into so far in your work as research manager of the program?

How do you respond to those who fear that medical cannabis is a gateway to addiction and more powerful drugs?

What can you tell patients about what lies in the future for medical cannabis?

There is some epidemiologic and animal-model data suggesting that use of marijuana in adolescence could influence multiple addictive behaviors in adulthood. But there is another potential explanation for the observed pattern of adolescents using marijuana (or alcohol or tobacco) first, and then additional drugs later. It could be that people more susceptible to drug-taking behavior are more likely to start with marijuana (or alcohol or tobacco) because of its accessibility and that the subsequent social interactions with other drug users increases their likelihood to try additional drugs. Both explanations could have some truth to them.

Within the next decade or two I am quite sure there will be a whole category of “ECS modulators” used routinely in medical care—some with FDA approval. A portion of these will be extracted from the cannabis plant and some will be synthetic. In parallel to this, some patients will continue to prefer use of whole-plant cannabis for medical purposes. Organizations are now developing to test and certify cannabinoid and terpene content in dried whole plant material, as well as freedom from contamination. These could allow more certainty about the content and safety of whole plant preparations.

When I was in medical school we weren’t taught about the endocannabinoid system (ECS) because it hadn’t been discovered yet. The ECS is a complex set of receptors spread throughout the body and chemicals—similar to those found in the cannabis plant—that activate those receptors. The ECS helps regulate appetite, sleep, alertness, and pain, among other things. Since taking this position I have been surprised by the large scope of research that has been done in laboratories to learn more about the ECS. Clinical research—research on humans—to find ways to manipulate the ECS for therapy is also developing rapidly.

Certifying health care practitioners describe a high level of benefit for many.



MN Healthcare News March 2017  
MN Healthcare News March 2017  

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