Medical Marijuana: Real Medication or Just Recreation?

Introduction

• The presentation explores whether medical marijuana is a legitimate medication or merely recreational.
• The speaker's expertise is in women's health and patient safety, with a focus on patient education regarding marijuana use.
• The presentation is educational, with no financial ties or strong positions for or against marijuana.

Objectives

1. Review various dosage formulations of medical marijuana.
2. Describe clinical pharmacology of botanical marijuana.
3. Evaluate clinical studies on effectiveness of botanical medical marijuana.
4. Identify adverse effects, psychiatric implications, and potential drug interactions.

Patient Case

• A 47-year-old man with chronic pain using marijuana for pain relief reported improved pain management from 8/10 to 4/10 on the pain scale.
• Concerns include legality, effectiveness, adverse effects, and healthcare provider communication.

Marijuana Formulations and Administration

• Single Molecule Pharmaceuticals: Dronabinol (Schedule 3) and Nabilone (Schedule 2).
• Botanical Cannabis: Cannabis sativa, a Schedule 1 substance.
• Administration Routes: Smoking, vaporization, oral (edibles), tinctures (buccal absorption), and topical applications.

Regulatory Background

• Marijuana was outlawed in the U.S. in 1937 and remains a Schedule 1 drug under federal law.
• Medical use legal in some states under physician supervision; Colorado and Washington allow recreational use.

Cannabinoids and the Body

• Endocannabinoid System: Comprises CB1 and CB2 receptors.
• Main Cannabinoids: THC (mind-altering effects) and CBD (pain and inflammation management).
• Receptor Effects: Influence homeostasis, body movement, memory, and more.

Pharmacology

• Lung Absorption: Rapid onset similar to IV bolus, with effects felt within seconds to minutes.
• Oral Absorption: Variable absorption and bioavailability, with a slower onset and longer duration.
• Dosing Challenges: High variability due to different plant strains and concentrations.

Clinical Effectiveness

• Primary Use: Pain management is the most common reason for medical marijuana use.
• Evidence: Meta-analysis and small clinical trials show modest efficacy, especially in neuropathic pain.
• Study Limitations: Small sample sizes, publication bias, and subjective outcomes.

Adverse Effects and Safety

• Common adverse effects include sedation, dizziness, dry mouth, and nausea.
• Psychiatric risks like cannabis-induced psychosis and potential for schizophrenia in vulnerable populations.
• Potential for drug interactions primarily through cytochrome P450 metabolism.

Role in Pain Management

• May reduce opioid use due to cumulative analgesic effects.
• No direct deaths reported from marijuana use, though risks remain.

Conclusion

• Medical marijuana presents potential benefits for pain, especially refractory cases, but has risks and side effects.
• Healthcare providers should foster open communication about all drug use with patients.
• Continued research is necessary to optimize therapeutic use and understand risks better.