Cannabis as medicine
BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2130 (Published 16 May 2017) Cite this as: BMJ 2017;357:j2130
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In a country, belonging as France to the small club of big barrels but unable to implement alcohol control policies, the pledge for using cannabis as a treatment is at best naïve.(1) Moreover, hoping for a positive benefit/harm ratio is flying in the face of evidence:
a) Happily, the pharmaceutical industry, when developing medicines, tries to avoid adverse effects on driving. This is not the case with cannabis.(2)
b) THC is a highly lipophilic compound, as amiodarone. This unusual lipophilicity, causes extensive distribution in fatty tissues following administration resulting in an inappropriate accumulation and a very long duration of activity.
c) THC is an addictive product associated with cognitive impairments, adverse course of psychotic symptoms in schizophrenia.(3) Cannabis also seriously interact with mood state.(4)
Newton-Howes claimed “evidence supports reform”.(1) Evidence is lacking, yet evidence must be based upon robust randomized controlled trials with an active comparator, on relevant clinical outcomes (quality of life, morbidity, mortality).
Last but not least, the public health issue must not be overlooked. Epidemiological data from the past 25 years confirmed earlier reports: changes in medical marijuana laws appear to be associated with increases in cannabis use and disorders among adults.(5)
1 Newton-Howes G. Cannabis as medicine. BMJ 2017;357:j2130.
2 Asbridge M, Hayden JA, Cartwright JL. Acute cannabis consumption and motor vehicle collision risk: systematic review of observational studies and meta-analysis. BMJ. 2012 Feb 9;344:e536.
3 Foti DJ, Kotov R, Guey LT, Bromet EJ. Cannabis use and the course of schizophrenia: 10-year follow-up after first hospitalization. Am J Psychiatry 2010;167:987-93.
4 Volkow ND, Baler RD, Compton WM, Weiss SR. Adverse health effects of marijuana use. N Engl J Med2014;370:2219-27.
5 Compton WM, Volkow ND, Lopez MF. Medical Marijuana laws and cannabis use: Intersections of health and policy. JAMA Psychiatry 2017 Online Apr 26. doi: 10.1001/jamapsychiatry.2017.0723.
Competing interests: No competing interests
Clinicians should be made aware at the outset that all forms of cannabis are not equal and the medicinal benefits and risks vary accordingly.
A study published by the WHO in 2015 clearly states that butane hash oil, because of the much higher THC content, has the potential to cause psychosis and addiction equal to that of cocaine.
Under normal circumstances, and because of the strains being grown, the THC content of many plants is now around 12-16%, which some consider to be of concern in itself as this is much greater than the amounts contained in plants found in nature.
However, butane hash has a THC content of around 80% (1)
This product is largely being sold unregulated and also marketed as being of medicinal value to patients looking to mitigate symptoms of various illnesses. It would though appear, that the potential side-effects are not being pointed out.
I contacted several national drug and health authorities throughout Europe and none appeared to be aware of the significance of the issue.
Unfortunately THC is the compound contained within cannabis which, few would argue, provides the medicinal benefits. But, conversely, it is also the compound which causes side-effects. Therefore the greater the medicinal benefit, the greater the risk of addiction and psychosis.
Clearly, patients and professionals alike, must be made aware that all forms of cannabis are not equal and some carry much higher risks than others. This will allow them to make an informed judgement irrespective of whether national health authorities have yet to update their own knowledge and guidelines.
(1) Update of Cannabis and its Medicinal Use. Bertha K Madras. 37th ECDD (2015)
Competing interests: No competing interests
Re: Cannabis as medicine
Recently I reported how, running in the evening, my lungs are filled with the fumes of cannabis rather than oxygen.
The run in the local park does particularly stimulate, unpleasantly, my olfactory system - acting as a good incentive to find alternative routes.
Musky, pungent, and unmistakable, the smoke of cannabis appears to be ubiquitous.
If of any interest, I can confidently say that the athletic performances do not improve on the "smoky" days - on the contrary - and that neither cognitive skills nor the sense of well-being improve.
New York investment analysts Cowen & Company forecasted $75billion profit for the cannabis industry by 2030. The market is growing wildly. We are talking big business.
Many are pushing, even in the medical world, to use cannabis for therapeutic purposes.
Miraculous medical benefits are ascribed to the use of cannabis, which is already easily available to the public.
The fact is that there is nothing new about cannabis.
Cannabis is native to Central and South Asia with its usage by humans dating back to at least the third millennium BCE.
Its therapeutic use in Western Medicine dates back to the 19th century.
John Clendinning, for instance, in 1843 wrote of his professional experience on the medicinal properties of Cannabis sativa of India in the Medico-Chirurgical Transactions Journal.
Cannabis remained available for medical use until the present, but its medical use in Western Medicine remained limited and particularly so in the subsequent century.
Over the past decades and indeed centuries, several miraculous remedies have been prompted and even announced in the first pages of magazines and newspapers.
Later on, time demonstrated that there was no miracle to be expected.
I hope that information, inquisitive thinking, and foresight, can protect the most.
However, I fear that, as for alcohol and tobacco (or opiates and many other active substances on the central nervous system; the list is a long one), the for-profit ends up prevailing by obfuscating the cards in play.
Medicine and Therapeutics are especially tricky. Patient's despair to find a solution to a problem, physician's willingness to offer necessarily a remedy, and financially driven pressures may compound.
In 10 years (or less), inevitably, the bill to be paid will be clearer.
But, as in many similar situations, collecting the pieces then will not be easy.
The freedom of choice must be safeguarded as a sacrosanct thing. The problem arises when the information is voluntarily spoiled, seriously altering the foundations on which the free decision is taken.
Competing interests: No competing interests