Scientists are testing lots of different medical uses for marijuana

Research on possible uses for marijuana as a medical therapy has been increasing over the past decade, as has public support for using such treatments. There may indeed be a number of medicinal uses for marijuana to treat many medical problems. And not just in a palliative sense. Marijuana is being studied to see if it can actually be used to treat different types of cancer, some neurodegenerative diseases, pain and a number of other ailments.

First, let’s look at what marijuana (and its components, extracts and synthetic forms) are used for in the US.

Marijuana’s common uses: suppressing nausea and vomiting, stimulating appetite

There are two preparations of marijuana that are available for use in the US currently.

Dronabinol (Marinol®, delta9-THC) can be prescribed for chemotherapy-induced nausea and vomiting (CINV) and anorexia with weight loss in patients with AIDS. Nabilone can be used to treat CINV, as well. Dronabinol is an isomer of THC, the chemical in marijuana that gets you high, while nabilone is a synthetic form of THC. Both medications are for oral use, and this can limit their effectiveness when used to combat nausea and vomiting. A patient vomiting frequently may not be able to retain a dose of either medication. The effectiveness of the drugs to prevent or modify CINV seems to be related to exactly which chemotherapy agents are being given to the patient in question.

There are two other medications undergoing trials prior to FDA approval. The first is is an oral medication containing cannabidiol, which is being investigated to be used for the treatment of two rare forms of epilepsy and as a possible treatment for schizophrenia. The other THC-based medication undergoing trials, nabiximols, is a pain-relieving marijuana extract prepared in the form of an oral spray. Therefore, it can be absorbed through the mucous membranes of the mouth and does not need to be swallowed. These trials are of particular interest because they are using marijuana-based medications for purposes other than suppressing vomiting or promoting weight gain, which have been the previous reasons for using them.

Studies of dronabinol have shown it’s effectiveness in reducing CINV, either when used alone or when given with other anti-emetics. It has also been used to treat radiation-induced nausea and vomiting, and is also useful for causing some weight gain in a number of patients with AIDS who have been treated with it.

Nabilone is also effective in treating CINV. Additionally, it has been used, in a limited fashion, to treat things like neuropathic pain, Parkinson’s disease, multiple sclerosis, spasticity, inflammatory bowel disease and some others symptoms and conditions.

Marijuana for pain management

In many of the above studies, the investigators could measure some physical sign to determine if the drug was working. They could measure increase in calories consumed, weight gain, fewer episodes of vomiting or some other parameter. However, it’s a bit harder to measure if a drug is effective in relieving pain. In some studies, the researchers asked the patients if their pain had decreased. This always adds a large measure of subjective bias. The patient may want to please the investigator and will say “yes” even if the pain hasn’t decreased. Or the pain may be less, or perceived as less, on a specific day for some other reason. Perhaps the pain has decreased because treatment with other drugs is succeeding. The patient may be happier because of a family visit or planned discharge from the hospital and report less pain as a result. There are some physical methods for measuring pain. For example, healthy volunteers may be used, subjected to mild, controlled pain and their limits ascertained before and after a dose of the medication being tested. There are other methods, as well. But there is always an inherent problem with measuring responses like these that may not be such of a factor in studies where purely physical factors can be weighed.

Also, when measuring pain, there can be an increase in pain tolerance as well as a decrease in pain sensitivity. With an increase in pain tolerance, the patient can take more pain before reporting that they are in pain. Some studies looked at pain tolerance. Some looked at pain sensitivity. Some at both. Some just asked the patient’s judgement as to how much pain they were in. So it may be difficult to compare one study with another because of this, and other factors. Additionally, the drug used may have differed in one study vs. another (nabilone vs. smoked marijuana), the concentration of THC in the smoked marijuana was different, the amount of marijuana smoked would vary in different trials, etc. And some of the studies used pain generated by the experimenters, while other studies used pain that the patients had from intrinsic sources.

Keeping the above in mind, there have been a number of studies run on using marijuana and cannabinoids to control pain. In a few studies, marijuana (or a medicinal version thereof) reduced pain when used on its own. Some of these were done on patients experiencing neuropathic pain, often a burning type of pain that many diabetics and some AIDS patients experience. Nabiximols seemed to be able to control cancer pain in a number of small trials, while THC didn’t give any significant relief in cancer patients. One small study showed that marijuana plus opiates produced better pain control for patients than opiates alone. At least two studies showed that the THC concentration of smoked marijuana was relatively unimportant — that is, high THC concentration produced no more pain relief than lower THC concentration. Interestingly, one study demonstrated that smoked marijuana with a high THC concentration actually increased patient’s perception of pain. Another study showed that the longer marijuana was used during the study, the more effective it was for controlling pain.

Marijuana

Marijuana via Shutterstock

Because of the caveats that I mentioned earlier, it’s not possible to make sweeping statements about the effectiveness of marijuana (or THC or other marijuana-derived medications) for pain control. They do seem to have been effective in the studies that I mentioned, for the specific types of pain that were assessed in the trials. A number of patients/volunteers in the studies reported a significant decrease in pain when treated with these drugs. Some cancer patients got pain relief when treated with some marijuana derivatives while other marijuana derivatives didn’t provide significant relief. Some cancer patients got better relief when cannabinoids were added to their opiate regime.

So, can this class of medication relieve pain? The answer is a qualified “yes.” A degree of pain relief can be achieved in some instances in a reasonable number of patients. That degree depends upon large number of factors: exact drug used, dose, frequency of dose, type of pain the patient is experiencing, concentration of THC in smoked materials and others. More research will need to be done before more concrete information is available.

Marijuana as an anti-tumor drug

Some solid tumor cells have been shown to have receptors that will allow cannabinoids and cannabinoid-like substances to bind there. When a compound binds to a receptor, it most often triggers some response by the cell. The bound material may get transported into the cell. The saturated receptor may trigger the cell’s internal organelles to produce something, or other actions could occur. Researchers have run trials using marijuana-class drugs on tumors with these receptors both in vitro and in vivo. These are early studies and others are to follow. Cancer types that have been treated with marijuana-derivative drugs include: lung, gloom (a form of brain cancer), prostate, hepatocellular cancer and some others.

In one study that tested using a marijuana-based drug to treat rats with lung cancer, the scientists showed that the lung cancer had a decreased rate of metastasis (it spread more slowly) when the rats were treated. Research on gliomas showed that it is safe to inject marijuana-derivative drugs directly into the growing brain tumor safely. As one academic review of work done using cannabinoids on gliomas said:

The anti tumor activity [of cannabinoids] included: antiproliferative effects (cell cycle arrest), decreased viability and cell death by toxicity, apoptosis, necrosis, autophagy, as well as antiangiogenic and antimigratory effects. Antitumoral evidence included: reduction in tumor size, antiangiogenic, and antimetastatic effects. Additionally, most of the studies described that the canabinnoids exercised selective antitumoral action in several distinct tumor models. Thereby, normal cells used as controls were not affected. The safety factor in the cannabinoids’ administration has also been demonstrated in vivo. The various cannabinoids tested in multiple tumor models showed antitumoral effects both in vitro and in vivo. These findings indicate that cannabinoids are promising compounds for the treatment of gliomas.

Other research has shown that cannabinoids have also has similar effects in some other tumor types like prostate carcinoma, some types of breast carcinoma and cancers.

It’s important to note that much of this research is in very early stages. Most has been done in cell culture and/or in animal models. Only a few studies have been done in humans. But there are more studies in progress. Marijuana-derived drugs may be useful to treat some types of cancer, in conjunction with other standard chemotherapy regimens, radiation and surgery, but they are not available (nor indicated) for that use today.

As mentioned above, some research on use of cannabinoids for a variety of other diseases is also in progress. These studies include ones looking at any benefits from cannabinoids on: multiple sclerosis, Parkinson’s disease, some rare forms of epilepsy, some post-stroke syndromes, inflammatory bowel disease, schizophrenia and others. As with most of the above, this research is still in its early stages and not ready for commercial use yet.

Adverse reactions with cannabinoids and marijuana

There are some potential problems with using marijuana and its fractions that may need to be considered.

Marijuana can act as an intoxicant and cause impaired driving and may increase auto accidents. In combination with alcohol, these results can be magnified.

Some researchers have found that marijuana can have negative effects on memory, motor skills, time needed to react to a novel situation, maintaining attention on a task and other skills.

Marijuana smoke produces carcinogens, as does cigarette smoking. There is thought to be a risk of developing cancer (lung, oral, throat, etc.) from marijuana smoke. But the evidence from a few studies is mixed. So whether smoked marijuana is a significant to produce cancer is unknown. It also seems, from limited data, that marijuana smoking does not cause chronic obstructive pulmonary disease (COPD), as cigarette smoking does.

So, while there are some possible contraindications for using marijuana and/or cannabinoids, they may be minimal when compared to some of the possible benefits. Those already known: anti-nausea, anti-emetic, anti-weight loss effects; and those that are possible: pain control, antineoplastic and possibly additional uses in neurologic and other diseases.


Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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  • docsterx

    Threats? Not at all.

  • Indigo

    Threats? Your bedside manner needs work.

  • docsterx

    Flamed you? No. I was just trying to raise some points that you might not have considered when making that comment.

    If I had flamed you, you’d have needed to change your user name from “Indigo” to “Charcoal.’ ;-)

  • Indigo

    Wow! Flamed by the doctor himself! Eat your heart out, Bill_Perdue!

  • docsterx

    Indigo, the infrastructure has been in place since as least the 1950s. It’s been updated, polished, electronified, packed with research data from reputable universities and from Pharma’s own research, they present it to doctors, NPs, PAs, Nurse anesthetists and others. And there saturate the airwaves demanding that the general public storm doctor’s offices to get this wonder drug, drug X, from their doctor at their next visit. Back in the company, the number crunchers have decided how much this magic pill needs to sell for in the US, and how much less it will sell for in Yemen, or Colombia or Italy. They are well-practiced in getting a drug to marked almost as soon as the FDA gives its blessing. They have a well-oiled infrastructure ready to go to get the product out to the populace. So, if, and when these drugs get rolled out, they won’t be “suddenly acceptable” as you allege. Big Pharma has al the practice it needs and has been doing this for decades. It will be acceptable because Bg Pharma will advertise and target the populace VERY effectively as it has dome for 30 years.

    Drug companies are already aware of the information I presented, above, plus more that I haven’t discussed. They’ve also done their own research and may mot have released those for us to read. They’re busily tweaking the drug to get it into it most palatable form. I mean by that juggling price, whether it will need an authorization, price discount coupons, patient assistance programs, etc.

    I’m not a friend of Big Pharma. I feel that they are guilty of a number of, as best, sleazy business deals, covering up evidence that some drugs were more dangerous than states, there have been million+ dollar suits over a variety of reasons.

    Big Pharma is always lawyered-up. They’re ready to go fight. Their PR people are working months to years in advance on advertising campaigns for new medications.

    The article makes no new suggestions that Big Pharma could capitalize on. As I said, all of that data and much more is freely available to Big Pharma. Nothing in the article suggests other diseases where the drug might be ale to be used. There’s nothing there giving them hints about how to marked the drug faster or better, I didn’t wright the article as if I, an M.D., were giving a glowing review of the possible uses of the medications a la Dr. Oz.

    Shilling would have involved doing things like presenting the best arguments and best data for use of marijuana and cannabinoids. I didn’t. The linked studies show various levels of efficacy. In one study, only about 40% of people on marijuana got significant relief and that relief was most often described as “moderate.” There were other reports where smoked marijuana increased pain. Others where THC had no effect on cancer pain. If I wanted to shill, I’d have dropped those studies completely and only presented positive ones. I would have been a cheerleader calling for Big Pharma to take over the medical marijuana sales in those states where it’s legal. SO that Big Pharma, with over 25 years in the medical marijuana field could handle the growing, extraction, purification and other facets of the process of getting FDA approved marijuana and it’s congeners approved. That didn’t happen

    No, what the article is meant to show that there may be many more uses for marijuana that were even thought of a few years age. And researchers are delving into various areas of research. That it’s not just for nausea, vomiting and weight loss now. That those in the audience who have MS, Parkinson’s disease, post stroke contractors, schizophrenia, epilepsy, pain, cancer and the other diseases I mentioned should keep an eye out for more research, announcements by the FDA and Big Pharma about drug releases that are market specifically for those conditions.

    Just to be more clear, I don’t own stock in any company that is making or developing a marijuana product or a product that is a component or marijuana. I am not involved with medical marijuana farms or dispensaries in states where it is legal (or in states where it is illegal.) I received no money, stock or goods from any member company of Big Pharma or their associates, nor did I receive reimbursement from the US Government. I’m not participating in clinical trials where marijuana is used. I have no financial interest in the above article. As a matter of fact, I wrote the article for free.

    And, Indigo, if you feel the need to imply that this article is setting things up to make things easier for Big Pharma to make obscene amounts of money, you should probably direct those remarks to the author of the article. I wrote it. Jon did a read-through, made a few changes and did me the honor of publishing it. Neither he, nor Americablog should be blamed for your thoughts on the nature of the piece.

  • I hear ya.

  • Not so much for the around half a million people charged with marijuana offenses every year in this country. Being lucky enough to get away with it doesn’t really equate to freedom.

  • Indigo

    Did you invoice them? Those conglomerates are pretty fussy about the paperwork, you know. (BTW, instead of the word “shill” in the invoice, say something like “embedded professional references.”)

  • Indigo

    My story’s about the same. The crash did me in in ways I wasn’t ready for. And since I’m well over retirement age, finding a job is an exercise in congenial futility. They’re all very nice to the old guy. We’ll call if something opens up. Uh-huh.

  • Simple really and same as you: Can’t afford to live there. The standard of living we’d had there up until 2006 when we left for India was such that I had to work my ass off, constantly.

    And remember how often John Aravosis here kept mentioning how hard it was for him to earn a living after crash at the end of the Dubya years? Well, it’s been similar in the contracting and freelancing world. What used to be a very comfortable living became doing okay, and by 2009 that had degraded to the point where I had some major tech clients trying to low-ball me into accepting rates that would, if adjusted for inflation, be lower than the salary I was earning in my first few years after college in 1985. (A rate without benefits, of course, making it even worse.)

    So when a significant portion of our retirement savings were wiped out during the crash, we looked at what was left and at what we could reasonably maintain in terms of earnings…and that meant we had to look away from California. As it turns out, we have family here in New Mexico and rather like the area…and so that’s where we ended up.

    One thing I’m thinking about doing is taking a short vacation to the state just north of us, provided I can get some time away from the project work. Not to bring anything back because that wouldn’t be legal, but just to legally get a few days relief. Maybe do some hiking, etc.

  • Thom Allen

    “They, Big Pharma, already know . . . “

  • Thom Allen

    I’m not sure that 80% of pharmaceuticals would be cause for legal impairment. At least, not when used alone. But we can go beyond your statement by saying that some people (e.g. older adults) can become impaired by taking drugs that wouldn’t cause impatient in a younger adult. http://www.addiction.com/6319/medication-cognitive-impairment-seniors/ http://www.sciencedaily.com/releases/2011/06/110624111929.htm

    Dronabinol and nabilone have been available for decades. They already know how to patent and charge for medications. With the articles cited above, and the fact that marijuana is available over-the-(specialized)counters in a number of states (and probably will soon be available in several more, I’m not sure that Big Pharma is going to be able to capitalize from marijuana as much as you think.

  • If Americablog’s acting as a shill for Big Pharma, can someone please let Pfizer know? I still haven’t received my check ;)

  • Indigo

    Which leaves me wondering, respectfully, why you don’t move back to Calif. I have ailments that medical marijuana can help too and consider moving. What’s stopping me? Money. I can’t afford to pull up roots, let alone finance my way of life in the Calif. It’s as if U.S. currency turns into old-fashioned Italian lire the moment you cross the state line. Not that Florida’s cheap but it’s manageable. And who knows, the way things are going, we probably will pass a medical marijuana bill in 2016. Meanwhile, Carl Hiaasen’s latest send-up of life in Florid’oh, “Bad Monkey,” sports this increasingly popular line: “I use medical marijuana, self-prescribed.”

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  • Knottwhole

    I will never need permission from a doctor to treat what ails me when it comes to marijuana.
    That’s freedom.

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  • There are some studies that show it being helpful for spasticity in multiple sclerosis so I would guess it might help in stroke also covering hundreds of thousands of patients yearly. Suggested uses for PTSD.

  • Speaking personally, MJ works for controlling and alleviating my migraine headache pain. Also, unlike nearly every other migraine medication my doctor in California had me try about 15 years ago, grass had no deleterious side-effects and a number of pleasant ones. One problem I often have with the more extreme migraines is nausea, to the point of vomiting. Unlike the other meds, MJ eliminates this as well.

    As far as carcinogens go, there are edibles and vaporization as alternative means of ingestion.

    Back when I was using it (legally, with a doctor’s card), there was no habituation nor physical dependence nor acquired tolerance. If a few puffs on a vaporizer gave me relief in January, come December more was not needed.

    But alas, I no longer live in a state where this is possible, as ‘migraines’ aren’t on New Mexico’s very short list of medical MJ conditions. I’m not willing to break the law. This means I’m back to where a prescription opiate (which I hate) is the only choice for the Category 10 migraines…and they make it so I cannot function, thus mostly I just suffer.

    As Nicho notes, let’s get real: Someone who is drunk on alcohol or high on Oxycontin is just as much a danger on the road as someone severely stoned on grass. Same thing though for someone who is extremely sleep-deprived. This is why the standard should be impairment, not the specific cause.

    The reasons for marijuana prohibition were rooted in the early 1900s neo-Puritanism, as well as rampant racism. What’s doubly insulting is how the position that grass belongs among the most-dangerous “no medical use whatsoever” drugs is taken as a serious argument. Alcohol and tobacco have ruined far, far more lives than marijuana ever did or ever will — yet they’re literally sold in supermarkets in most states. This is seriously fucked up.

  • Indigo

    They already know how to patent and overcharge for it; articles like this one are just putting the infrastructure in place so it’s suddenly acceptable.

  • nicho

    Marijuana can act as an intoxicant and cause impaired driving and may increase auto accidents. In combination with alcohol, these results can be magnified.

    You can say that about 80 percent of pharmaceuticals that are prescribed today.

    As soon as Big Pharma finds a way to patent and overcharge for marijuana, you won’t be able to visit a doctor without leaving with a prescription for it.

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