What's Medical About Marijuana?

CORRECTED November 14, 2022 // An earlier version of this article misspelled the name of Lev Spivak-Birndorf. It has since been corrected.

I was in the exam room, saving my big question for last, as one does.

It was my first meeting with my new GP in Colorado, and I was impressed with his fluid citations and advice from recent studies on heart disease, exercise injuries, and musculoskeletal pain–three of my major sore points.

So far, so good.

Then I ventured my last question. "I've been having sleep difficulties ever since my older son was born." (Note: That was during the first Bush administration.) "But now that I'm in Colorado, I wonder if cannabis might help me through the night? I hear it's good for that."

Suddenly, my doctor clammed up.

"I've heard some things, too," he told me. "But I can't advise you on that, because I could lose my license." He could no more recommend cannabis than he could heroin or ecstasy — because all are designated Schedule 1 drugs on the federal level. (Though that could change, given President Joe Biden's recent moves toward marijuana reform.)

So now I had a choice: I could "just say no to drugs," as Nancy Reagan encouraged me to do. Or I could begin experimenting. As a health journalist for two decades, I know anecdotal evidence is often no more than wishful thinking. And yet, my standards slip when I stare at the ceiling at 3 a.m., and dawn is a long way off.

In an age of red-versus-blue discord, cannabis is one of the few arguably purple issues. Thirty-seven states, DC, and three territories — including such conservative hotbeds as Oklahoma and Alabama — have passed comprehensive medical marijuana laws, permitting treatment for 42 conditions. Twenty-one states, DC, and two territories allow adults to use it for whatever reason, from pain relief to partying. Which leaves only Kansas, Nebraska, and Idaho standing with federal lawmakers from 1970, in agreeing that cannabis is just as addictive and dangerous as heroin, cocaine, LSD, and ecstasy.

Dr Erik Smith

"Most physicians are not trained in cannabinoid medicine," says Erik Smith, MD, a Philadelphia doctor and physician partner with Veriheal, a healthcare technology company that provides personalized cannabis education to patients. "And they're under a lot of pressure from the healthcare system, because cannabis is a Schedule I drug. So patients have to go by word of mouth, outside the realm of medicine."

When I was an editor at a health magazine, the surest way to kill any story idea was to dismiss it as being based on mere "anecdotal evidence," which we regarded as a synonym for "fairy dust" or "snake oil."

No double-blind study, no deal.

Smith didn't have that luxury. He took his training in obstetrics and gynecology. And when his pregnant patients came to him with refractory nausea and vomiting, he went off the books, and told them, "I know somebody who can help you."

Right: a cannabis dealer.

And while you register shock that an M.D. would recommend an extra-pharmaceutical treatment, consider this: Opioids are an approved drug, and they killed 68,630 people via overdoses in 2020 alone, according to the CDC. Deaths by cannabis overdose are either nonexistent or exceedingly rare.

That was part of Smith's calculation, when he took over a roster of patients who were (a) pregnant, and (b) self-medicating with opioids and other drugs, to the point of addiction.

"Nobody wanted to touch these patients," he says. "We started with addiction specialists and began working with the synergistic effects of cannabis to help our patients go off opioids. There were better outcomes, and they were able to deliver their babies."

The Politics of Pot

Smith wasn't the only one listening to patients' experiences with cannabis. After California approved medical marijuana in 1996, momentum began to build. The movement went national in 2013, when Sanjay Gupta, MD, on CNN, told the story of Charlotte Figi, a five-year old Colorado girl with Dravet Syndrome, a form of epilepsy. She was suffering 300 grand mal seizures a week, until her staunchly anti-drug parents heard about a California boy whose seizures were stopped by a cannabis strain high in cannabidiol, or CBD.

In desperation, they worked with a cannabis producer in Colorado Springs to grow a high-CBD strain that would be called Charlotte's Web. Her seizures stopped, and a DIY movement was born, often among people who, like the Figis, were surprised to turn to a notorious drug for help and healing. (Sadly, Charlotte died in 2020, likely due to Covid.)

Dr G. Malik Burnett

G. Malik Burnett, MD, is an addiction medicine specialist in Baltimore, and co-author of a study called "Policy Ahead of the Science: Medical Cannabis Laws Versus Scientific Evidence." That sums up the problem with cannabis therapies today: The treatment cat is out of the medical-research bag, and running all over the 42-odd conditions that justify a medical marijuana card — and a hundred others that do not.

As Burnett's study says: "US medical cannabis laws are in conflict with federal law and often with science as well."

And yet, Burnett is far from a cannabis naysayer. In his study, he notes that the most commonly included conditions on state lists — cachexia/weight loss, muscle spasticity associated with multiple sclerosis, nausea and vomiting, chronic pain, and seizures — are also the ones with the most evidence that cannabis therapy works. But the lists also stray into areas where there is no evidence (ALS, arthritis, cancer), limited evidence (autism, HIV/AIDS, opioid-use disorder), or even evidence of potential harm (glaucoma, depression, PTSD).

Burnett recently testified before Congress in support of decriminalizing cannabis at the national level. His reasoning: to address the prejudicial way drug laws have been applied against people of color, and to help clear the 100-year logjam against medical studies of marijuana. Only then will the evidence sort itself out into what works and what doesn't.

Cannabis was common in patent medicines in the early 1900s, but as the plant began to travel north with immigrant workers from Mexico, U.S. officials woke up to the "threat." With mounting hysteria, they passed increasingly draconian laws to prohibit cannabis use for anything at all, including better health. The Marihuana Tax Act of 1937, passed over the protests of the American Medical Association, began the demonization process. (Regulators insisted on calling it "marihuana," in fact, to emphasize that foreign people were using it, and that it was suspect for that reason.)

Charlotte's dramatic tale led to lots of personal testimony before state legislatures, by people whose stories were hard to ignore: veterans suffering from post-traumatic stress disorder, parents of kids with epilepsy, people with AIDS, chronic pain sufferers, and people recovering from drug addiction. All of these, and more, were flouting federal law by using cannabis to treat their afflictions. Clinical trials were unavailable because cannabis research was illegal, too. But word of mouth proved powerful, and legalization took off at the state level.

The Healing History of Cannabis

For all the federal chest-pounding against cannabis, there's a certain irony there, too. The first U.S. patent for cannabis-as-medicine is held by none other than the Department of Health and Human Services. They applied for the patent in 1999 for cannabinoids to be used as anti-inflammatories and neuroprotectants. Something was in the air, and not just at Grateful Dead revivals.

The high-producing ingredient in cannabis — delta-9-tetrahydrocannabinol, or THC — was first isolated in 1964, by Israeli researcher Raphael Mechoulam and his team at the Hebrew University of Jerusalem, who were free to chase their research wherever it might lead. (Israel remains the world leader in cannabis research, says Smith.) Twenty years later, they discovered that the human body has a multitude of cannabinoid receptors in the brain, gut, skin, immune system, organs, and reproductive system.

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