Therapeutic use of cannabis means different things to different people depending on their circumstances. To some it means relief from pain, nausea or anxiety. To others it means a good night’s sleep. To many regular users of cannabis it’s a way to get through the day, a better way to do life.
Research shows that the number one reason for using cannabis across all demographics is “to relax.” We also know that cannabis use is not confined to one demographic and the type of person using cannabis for whatever reason is rapidly diversifying. Recent studies show that more than half of all cancer patients have tried some form of cannabis therapy.
More and more, I hear regular users calling their use ‘therapeutic,’ and I concur because cannabis helps me focus, sleep and eat. Plus, there are things I usually do high, for example, write, and things I never do high, for example, work out. This is a trade-off that keeps my use in check. But can I call my use therapeutic?
THE ROLE OF THE ENDOCANNABINOID SYSTEM
Today, we have a better understanding of what constitutes therapeutic use of cannabis thanks to 30 years of research. Dr. David Allen is a cardiac surgeon and a member of the International Cannabinoid Research Society (ICRS) where he serves as a cannabinoid research scientist. In this video he explains that when the endocannabinoid system (ECS) was discovered its significance was not understood.
He calls the ECS a “chemical communication system,” similar to the endocrine system, and the body makes its own cannabinoids known as endocannabinoids that perform “miraculous” functions. In essence, the ECS is responsible for homeostasis, which keeps physiological systems in balance, acting as a control system that manages everything from mood, sleep, appetite and pain.
But more than that, new research shows that the ECS can be manipulated to control a variety of conditions including diabetes and cancer, and determine the outcome of a heart attack or stroke. Dr. Allen says the discovery of the ECS is so important it could potentially save more lives than the “application of sterile surgical technique.” But what about the therapeutic use of cannabinoids in practice?
DEFINING A MEDICAL APPROACH TO CANNABIS
Janna Champagne is a professor and author who teaches cannabinoid science at university level, and defines therapeutic use as a prescribed dose based on cannabinoid content to provide specific benefit for example relief from pain. She says that patients benefit most “when their use is guided to support an optimal medical approach.”
“The medical approach to cannabis entails an assessment to determine specific needs, considerations, and risk factors with pharma interactions being the primary risk. Through this process, individualized guidance provides insights, including which product profiles may be optimal for reaching health goals, whether spacing from pharma doses is indicated, with scheduling to ensure the potential for functional impairment is managed,” she says.
With this approach, patients can expect a “reduced reliance on pharma” and an “improved quality of life and function.” She points out that assessments must be carried out by “competent medical pratitioners,” which she defines as a doctor with a background in cannabinoid science and experience in clinical application. However, “since, most medical schools omit this subject from their curricula, competence entails taking the initiative to seek alternative knowledge.”
PROBLEMATIC V. THERAPEUTIC USE OF CANNABIS
“Specific to cannabis use disorder (CUD), cannabis competence provides the practitioner insights as to how a patient’s cannabis use may become problematic. The DSM criteria for CUD includes decreased function, which is often easily mitigated by recommending the use of non-intoxicating cannabinoids for daytime use, and assessing/addressing escapism tendencies,” she explains.
Another criteria is “daily use,” which she says, “a competent practitioner will understand may be appropriate for those suffering Clinical Endocannabinoid Deficiency,” meaning it’s not “automatically cause for concern.” So, when is daily use a cause for concern and how is it assessed? Is it possible that someone who uses daily has an undiagnosed condition? Or is this person just a functioning addict?
“That’s the exact scenario where referring patients to a competent resource allows for an in-depth assessment, to determine whether their cannabis use is problematic, and guide to improve if there is concern. Only once this occurs with ongoing concern should a patient be diagnosed with the addiction disorder label CUD. Practitioners lacking knowledge are not qualified to perform this service competently,” she says.
KNOWLEDGE GAP IN CANNABIS
Champagne points out that, “clinical mentorship is sought-after, to better understand individual considerations, risks and best approaches for specific conditions or needs. [However] since only 20% of medical schools are even mentioning the Endocannabinoid System in their anatomy curricula, it’s fair to say that competent practitioners are still the minority, and most in the medical field are clueless about the potential benefits of cannabis therapy.”
A 2019 study at a Chicago-based family practice sought to understand the quality of care received by more than 100 medical marijuana patients. The study identified five barriers to providing better care and also suggested solutions to overcome those barriers. The barriers include:
1. Inadequate scientific knowledge regarding effectiveness, dosage, delivery mechanisms, indications and drug interactions in humans
2. Lack of educational standards for dispensary and medical staff
3. Lack of communication and coordination of patient care
4. Inconsistent availability of dosing options
5. Barriers to access for patients seeking therapy
One solution is to provide standardized evidence-based educational programs for medical and dispensary staff. To that end, programs have been developed by various bodies, for example, The National Academy of Science. However, integration of this education is still an issue. The study highlights the importance of a trained pharmacist on staff in dispensaries.
In some instances, cultural, personal and religious bias prevent phsicians from discussing cannabis therapy or patients from requesting it. This is good-old cannabis stigma at play, and the study suggests the best way to tackle it is to reschedule cannabis from its restrictive Schedule 1 classification in recognition of its medical benefits. In August 2023, this move was recommended by the U.S. Department of Health and Human Services (HHS.)
The reality is that in the meantime most of us are just winging it, coming up with dosages that work for us or using as suits. How cool would it be to have a test that showed your cannabinoid activity and whether or not you needed a top up? Either way, until we have trained practitioners in place, who facilitate open discussion and offer advice, this area remains a minefield of misinformation.
The Healthy Hashhead 