By Dr. Victor S. Sierpina
Rocky Mountain high. Imagine my surprise when I returned to visit the tiny mountain hamlet in Colorado where I was in solo practice as the country doc for nearly a decade back in the 1980s and ’90s and discovered a new clinic on main street.
The town is in a mountain valley situated at 7,500 feet above sea level. So, the new clinic was appropriately and whimsically called The High Valley Cannabis Center.
Medical marijuana had come to a town long known for its aging hippies and artists who were no strangers to its usage. Many not only inhaled weed in the ’60s, but I suspect a number had never exhaled.
As more states, now numbering around 15, approve marijuana as legal for medical, or even recreational, use, as recently occurred in Colorado, we come inevitably to the question of is this a good idea for sick people or is it a social folly?
Recently, a cancer patient asked me about using marijuana as part of her plan to manage pain and nausea. I discussed with her some of the work of my colleague Dr. Donald Abrams at the University of California at San Francisco. His carefully done research on medical marijuana for more than a decade helps us sort out these kinds of questions.
Abrams, an oncologist and HIV specialist, has been funded by the federal government’s National Institutes of Medicine, provided by them with officially approved, low-potency herbal preparations and, under the blessing of science, has examined the effects of marijuana.
In his research, he uses a Volcano Vaporizer which heats and vaporizes the dried herb rather than combusting it as in the typical marijuana cigarette, joint, pipe or reefer. This avoids the delivery of carbon monoxide, various chemicals and ash that irritate the airways and are toxic. Blood levels of THC, the active ingredient, are noted within about 21⁄2 minutes with the vaporizer.
Abrams prefers this delivery system to ingested marijuana, say in muffins, brownies or cookies, since absorption is much less predictable from food sources, and THC levels don’t go up until a couple of hours or more after eating.
It turns out in both human and animal models, the cannabinoids in marijuana offer a broad spectrum of benefits, especially for cancer patients. Cannabinoids are the psychoactive or somatically active chemicals that give marijuana its clinical effects.
The human body has natural cannabinoid receptors, and there are endogenous cannabinoids even in the breast milk of women who are not using marijuana. No wonder nursing infants seem so happy.
Marijuana has multiple effects in the kinds of problems cancer patients suffer from — insomnia, lack of appetite, anxiety and depression, pain, neuropathy and nausea.
While there is a genomic variability in response, with some people getting very stoned quickly and others getting more anxious or even paranoid, it turns out that marijuana is pharmacologically very safe with little or no potential for overdose, even at high doses.
On the other hand, most cancer drugs, pain killers and prescription medicines are lethal at high doses, so at least the safety of marijuana is reassuring. I am talking about physiological safety, not about driving or doing other hazardous things while under the influence.
Medical marijuana has been legal in California for more than 17 years, and the patient and physician population there have developed a lot of clinical and street-smart experience with different species, delivery systems and dosing.
Physicians can legally counsel their cancer or chronic care patients on whether marijuana could or should be part of their treatment plan, and if so, to prescribe it. It is not for everyone. Those with a personal or genetic tendency to addiction would not be optimal candidates, except perhaps in terminal illness.
So, while the legal and moral debates on the wisdom of making medical marijuana legal rage on, some cancer patients are benefiting from his and others’ careful research on its pharmacodynamics, safety and clinical effects.
Don’t get caught using it in Texas though, as it is not legal here, at least not yet. However, it might be coming to a pharmacy near you someday soon. And please remember to exhale.
Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.