Medical Cannabis in the District
Jun 01, 2013 04:48AM
In 2010, the District of Columbia (DC) became one of 18 states to legalize the use of marijuana (cannabis). Although Amendment Act B18-622 was passed with a 13—0 vote, qualified DC residents were unable to obtain medical marijuana until April 2013, when Capital City Care became the first licensed DC medical cannabis distribution center. It is now anticipated that several other distribution centers will soon be licensed to sell two main strains of cannabis—C. Sativa and C. Indica.
Medical Properties of C. Sativa and C. Indica
While both plants are used medically, they vary in their relative ratios of two main active ingredients—tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the most psychoactive of the two and the recreational strains are selected for high THC content. The medical uses of THC and CBD differ as well. THC is selected more for its antiemetic (anti-nausea and vomiting), analgesic (relief from pain), and appetite stimulation properties, while CBD, with no psychoactive effects, is thought to have anxiolytic (anti-anxiety and anti-panic), anti-inflammatory, antioxidant, and even anti-cancer properties, though unproven to date. Some experts, including one of the world’s best known integrative oncologists, Dr. Donald Abrams from University of California San Francisco (UCSF), believe that “cannabidiol should be studied for potential anti-cancer properties”.
Medical Research Results
Since early 2000s number positive small, but well made, randomized trials on the use of medical cannabis for chronic neuropathic pain have been published—several in high quality journals such as Neurology. One of the largest research institutions presently studying medical marijuana is the University of California Center for Medicinal Cannabis Research (CMCR). CMCR conducted two trials, which both showed consistently positive results—Cannabis significantly reduced pain intensity by about 40% compared to 20% on placebo. Moreover a significantly greater proportion of individuals reported at least 30%, which is relevant since 30% decrease in pain intensity is generally associated with reports of improved life quality.
Medical Conditions that Benefit from Cannabis
There are at least 20 different medical conditions where cannabis may have a beneficial role. Those supported by positive clinical trials are: neuropathic pain (in patients with cancer or HIV), Glaucoma, Spasticity in patients with multiple sclerosis, AIDS relative to severe weight loss (cachexia), and Chronic cancer or HIV related nausea or vomiting. These are the indications covered under DC medical cannabis law. Additionally, other conditions that are chronic, long-lasting, debilitating, or that interfere with the basic functions of life may also be covered under DC medical cannabis law and benefit patients undergoing treatments such as chemotherapy and radiotherapy.
Other medical conditions where cannabis can potentially be helpful, but not yet proven, are Alzheimer’s dementia, posttraumatic stress disorder, seizures, stroke recovery, fibromyalgia, Myasthenia Gravis, Parkinson’s disease, ulcerative colitis, hypertension, rheumatoid arthritis, urine incontinence, chronic pruritis (itching), sleep apnea, Amyotrophic Lateral Sclerosis (ALS), and others. It also appears that medical cannabis may be one of the best palliative care prescriptions for a variety of conditions—nausea, pain, lack of appetite and depression—which patients often face in end of life.
Proven Side Effects
No intervention is free of side effects and cannabis is not an exception. The proven side effects of cannabis are increased risk of car accidents if driving under influence, chronic cough, increased risk of psychosis and early onset schizophrenia as well as impaired short-term memory. Surprisingly, the expected risk of lung cancer has not been proven, unless cannabis was mixed with tobacco in chronic users. It is believed that while cannabis carries the same carcinogenic substances similar to tobacco, there are several active ingredients that have cancer protective activity, which may explain lack of increased risk of lung cancer even with long-term daily use.
To Smoke or Not to Smoke
While clinical data comes from a variety of sources such as oil solutions, vaporized products, sublingual drops, and others, smoking appears to be the cheapest, easiest, and fast acting form for consuming cannabis. The projected DC cost of 1 ounce of dried cannabis is $100-120, which is similar to the street value. Medical insurance coverage is not expected.
DC Department of Health Criteria
To qualify for a patient registration identification card, an applicant shall be a bona fide resident of the District of Columbia at the time of application and remain during a treatment with medical marijuana; have a “qualifying medical condition” or be undergoing a “qualifying medical treatment”; have a signed, written physician’s recommendation for the use of medical marijuana meeting the regulatory requirements and if the qualifying patient is a minor, a signed written consent of his or her parent or legal guardian is required. The maximum monthly-allowed dose is two ounces of dry cannabis. Although this dosage may not be enough for some patients, who need to use cannabis multiple times per day, there is nothing in the law that would allow patients to legally obtain a higher amount. In contrast to many other states, DC does not allow qualified residents to grow their own cannabis plants at home, which would have decreased the cost dramatically.
Within the medical community the acceptance of a medical use for cannabis has been slow. It has gone from disbelief and skepticism regarding the misperception that marijuana was a gateway drug, which led to the use of heavier illegal drugs such as cocaine or heroin—to curiosity and acceptance of a need to look into sound medical cannabis research. While ongoing research efforts will be met with anticipated difficulties it is clear that medical use of cannabis will continue to grow leading to a larger body of clinical knowledge resulting in wider acceptance and clearer clinical indications. While we do expect pharmaceutical industry attempt to utilize purified active ingredients as drugs it is unlikely that this will substitute for the use of the full plant.
Mikhail Kogan, MD is assistant professor of Medicine at George Washington University and Medical Director of GW Center for Integrative Medicine where he sees patients for integrative medicine consultations and primary care visits. For more information, call 202-833-5055 or visit GWCIM.com.