Contrary to the position in Maryland, three dozen other states and the District of Columbia, cannabis (marijuana) should not yet be considered medication. Yes, cannabis has medicinal properties that might be useful in the treatment of all sorts of diseases and disorders, from Parkinson’s disease and multiple sclerosis to post-traumatic stress disorder and anorexia nervosa. And, yes, doctors and patients dealing with these diseases and many others should have every reasonable treatment option available to them. But pharmacological research into cannabis is dangerously lacking.
Legitimate medicine is bought at a pharmacy. It comes in plain bottles. It has specific instructions on how to use and not use it. The pharmacist selling the medication warns patients of potential side effects and interactions between the prescription and other medications the patient is also taking. The medications come in set strengths that the doctor selects based on what will be appropriate and safe for the patient.
In Maryland, cannabis must be bought from a dispensary where no other medications are sold. A “budtender” will show the patient different products in brightly colored packages with names like “Wedding Cake” and “Reboot.” They may describe the effects of the cannabis that some people experience, but they have no way of knowing if the patient will also experience those effects. They might caution a patient about high levels of THC, the main psychoactive compound in cannabis, but they have no reference for warning of potential interactions between the cannabis and other drugs the person might be taking, like antidepressants or blood pressure medication. And, most importantly, it is rare that budtenders instruct a person on when to take the cannabis, how much to take and how often. In the end, a patient is largely left to determine for themselves what constitutes a reasonable medication regimen and dosage that will both treat their ailments and not develop into dependency.
Does this sound well-regulated to you?
Cannabis’ medicinal properties come from unique naturally occurring chemicals called cannabinoids. The most powerful of these is also the best known — Delta-9 THC, or just THC for short — although other cannabinoids, like CBD, may also have health consequences. THC is the chemical that sometimes results in a feeling of euphoria, altered sensory perception, and increased pain tolerance among users. However, not all users have all of these, potentially, useful, pleasant experiences. Some users may experience paranoia, heightened anxiety or have psychotic episodes. Science has yet to determine why cannabis effects different people differently or why a user might have one effect during one period of use and a different effect the next. Medicine’s current best guess is that it may have something to do with the cannabis’ THC content, the amount the person consumes, how the person consumes it (smoking, vaping, or eating), whether the person ate a meal recently, or even the different chemicals (called terpenes) in different cannabis strains that give each their unique smells and tastes.
One of the reasons why we know so little about the effect of cannabis on humans, and on animals for that matter, is because cannabis and THC are classified by the federal government as “schedule I” drugs. This makes doing legitimate laboratory research on it more difficult and bureaucratic than studying morphine and cocaine, which are “schedule II drugs.” According to the federal government cannabis is more dangerous and less potentially beneficial to the public than cocaine. Maryland correctly understands that this designation is nonsense and that cannabis could be beneficial to some people. But the means by which Maryland is administering cannabis to those who may legitimately benefit from it illuminates the fact that cannabis is not yet a legitimate medicine at all.
This problem is not specific to Maryland or other states. The decades-long lack of cannabis research is the result of federal policies, not state ones. I feel strongly that people facing a wide variety of serious illnesses should have the option to try cannabis alongside other medications. It may be a more effective and safer alternative than opiates or anti-anxiety medications that run a greater risk of the patient developing dependency. But there needs to be medically based guidance for health care providers and patients on cannabis and, right now, there just isn’t any.
D. Ryan Schurtz (email@example.com) is an associate professor in the School of Humanities and Social Sciences at Stevenson University.