CANNABIS CULTURE – About six years ago I decided to become what some might call a “medical marijuana doctor”. It wasn’t necessarily one occasion that triggered me to start believing “cannabis is medicine”, but rather patient-after-patient coming to me in pain, and the only thing that I could offer them – the only thing I was trained to offer – was opioids.
For many people, this lead to addiction, “zombification”, and essentially just replacing one form of pain with another.
It’s difficult to say precisely the day and date I started to think of cannabis as a medicine. Sure, I was an open-minded youth but, as soon as I got to medical school, like many people I had to put away youthful endeavours and concentrate on my medical career. Cannabis was not treated as a medicine and, other than a few studies, the medical establishment very firmly treated cannabis as a “drug”. Whilst I always believed that listing cannabis as a schedule I drug was and is ridiculous, at the same time I never thought of cannabis necessarily as a “medicine”.
I knew a change was needed in the way we treated pain, especially long-term pain and different types of pain (e.g. neuropathic pain, which doesn’t reduce with opioid use). Using opioids as a “catch all” for treatment all types of pain was problematic and, frankly, somewhat unethical. I couldn’t carry on prescribing opioids for any and all kinds of pain, when I knew that they wouldn’t necessarily help anyone, and indeed could even prove to be just as damaging if not more damaging to the patient’s health than the pain they were suffering from!
So, why cannabis specifically? There were several studies on the efficacy of cannabis for conditions such as epilepsy, AIDS/HIV, glaucoma, multiple sclerosis and cancer throughout the 60s, 70s and 80s, but these were usually from more obscure sources, or had limitations due to sample size, confidence levels, the lack of other studies to back up any conclusions reached, federal restrictions and so on. Yes, there was Raphael Mechoulam’s groundbreaking work, but his and his department’s studies were not widely-read by the medical establishment in America. This is further compounded by American Medical Association’s (AMA) attitude of “If it’s not a study from the U.S., it’s not acceptable.”
Then came the late 80s and early 90s. Mechoulam had isolated and identified tetrahydrocannabinol (THC), anandamide and 2-arachidonoyl glycerol (2-AG), but we didn’t know precisely how cannabis works. Enter Raphael Mechoulam again, as well as William Devane and Dr. Lumir Hanus. By 1992 (when the endogenous cannabinoid anandamide was discovered), we found out that the body produces its own cannabinoids, and that there was a system regulating all of this, namely the Endocannabinoid System (ECS) and the CB1 and CB2 receptors. The jigsaw pieces were getting filled in, and we started to get a fuller picture of how cannabis works on the brain and the body.
Then came Dr. Ethan Russo’s work and the concept of the clinical endocannabinoid deficiency (CEDC) was developed. There were people suffering from all sorts of conditions putting up their hands and saying “cannabis helps me”, whether it was fibromyalgia, migraine, irritable bowel syndrome, epilepsy and so on. The concept of the CEDC gave us the theoretical framework with which to understand why cannabis helps for so many different conditions. More and more evidence has started to come out supporting this theory, and it is now entirely feasible for any doctor to say with some confidence that “Cannabis could well be the future of medicine.”
Sadly, federal legislation makes finding out the precise medical potential of cannabis difficult, but we hope this will change significantly within the next several years. In the meantime, we can use some logic, rationality and supposition in order to try and “join the dots” between various studies and come up with “educated guesses”. This is not necessarily good enough for making definite medical statements, but it’s certainly a place to start.