Medical Marijuana (Cannabis) – Partnership to End Addiction

You’ve likely heard that medical marijuana (cannabis) is being used more and more frequently to treat mental and physical health problems. As its popularity has grown, so has interest in its potential benefits. But with all the noise surrounding medical marijuana, it can be hard to know what it can actually do. Read on to learn more.

Medical marijuana (cannabis) refers to the use of cannabis for medicinal purposes.^[1] Cannabis contains two primary active chemicals: tetrahydrocannabinol, (THC), which produces a “high”; and cannabidiol (CBD), which does not. Medical marijuana can include both THC and CBD, or, often, just CBD. 

Interest in CBD has increased because of its ability to produce the medicinal benefits of cannabis without the high. CBD is seen as a potential medicine without the side effects caused by THC. As a result, it’s increasingly become used as a treatment to ease chronic pain, difficulties caused by cancer treatment, epilepsy, and anxiety, to name a few. 

For some, using cannabis to treat pain is more appealing than opioids. Opioids, including many prescription pain pills and drugs like heroin and fentanyl, can be highly addictive and lead to a substance use disorder and/or accidental overdose.^[2]

Conditions that qualify for medical cannabis vary from state to state, as do the steps for obtaining a medical cannabis prescription. In New York, for example, doctors must have a license to prescribe medical cannabis. Patients then have to register with the state’s medical cannabis program to get their card.  Most states use this same process or something similar. 

In most states, patients need to have a specific illness from a designated list to qualify for a prescription. States vary in how comprehensive their lists are. In some states, like New York, patients don’t need to have a condition on the list – a licensed doctor can prescribe at their own discretion.

Medical cannabis is legal in most states at varying levels. In some states, both adult recreational use (the use of cannabis without a medical prescription) and medical use are legal. Other states have comprehensive medical cannabis treatment programs available. Still others have legalized only the use of cannabis that contains a high percentage of CBD compared to THC for medical purposes. The use of cannabis for any purpose, including anything medicinal, is still illegal at the federal level. Make sure to check your state’s laws.^[3]

Medical cannabis patients purchase their products at licensed medical dispensaries. In most states, you need to be at least 18 years old to qualify for a medical marijuana card and legally purchase it (some states, like North Dakota, require individuals to be age 19 or older). In most states, minors can be prescribed medical marijuana with parental or legal guardian consent, though they are not allowed to purchase it until they are of age.

While you will always need to check your state’s specific list of conditions and consult with a doctor to get a prescription, these are several examples of frequently covered conditions across several states: 

• Amyotrophic lateral sclerosis (ALS) 
• Anxiety  
• Alzheimer’s disease 
• Autism spectrum disorder 
• Chronic pain 
• Cancer 
• Glaucoma 
• HIV/AIDS 
• Inflammatory bowel disease (including Crohn’s disease) 
• Lupus 
• Migraine 
• Muscle spasms (caused by varying conditions, such as multiple sclerosis) 
• Opioid use disorder 
• Parkinson’s disease 
• Post-traumatic stress disorder 
• Rheumatoid arthritis 
• Seizures 
• Severe nausea 
• Terminal illness 
• Tourette syndrome 

It is very important to note that while many illnesses qualify individuals for a prescription, not all of them have been necessarily backed up by the research as conditions that can be treated through cannabis. For example, glaucoma is approved as a condition in several states. However, the American Academy of Ophthalmology does not recommend using cannabis as a treatment because its effects only last for a very short time and it can lower blood pressure, which raises the risk of developing blindness.^[4]

Pain management is perhaps the most common reason for medical cannabis use. Doctors prescribing medical marijuana will often recommend products that contain only CBD or very low levels of THC. There is evidence that cannabis can be at least moderately effective at treating and easing various kinds of symptoms, including:

• Neuropathic pain, a chronic pain caused by damaged nerves.^[5] Some research indicates that it can be relieving for those with multiple sclerosis.^[6]
• Issues related to cancer treatment, like nausea and vomiting.^[7] 
• Issues related to treatment for HIV/AIDS, like a lack of appetite. 
• Insomnia and other sleep disorders.^[8] 

Other symptoms that have the potential to be treated by cannabis but require far more research:

• Relief from symptoms caused by irritable bowel syndrome (IBS) and Crohn’s disease.^[9] 
• Other chronic pain conditions, such as headaches, back pain, and arthritis.^[10] 
• Pelvic pain and gastrointestinal issues related to endometriosis.^[11] 
• Relief from anxiety and stress (if CBD/low THC).^[12] 
• Reduction of tics related to Tourette syndrome 

There is some recent scientific consensus on the best practices for using cannabis to treat pain, which has helped increase its efficacy. Treatment protocols are like traditional medication plans in which dosage is slowly increased: ^[13] 

• Routine protocol, in which a patient is put on 5 milligrams of mostly CBD twice daily and increased by 10mg every few days until it works for the patient (a maximum of 40mg is recommended), at which point 2.5mg doses of THC can be added. This is the process for most patients. 
• Conservative protocol, in which the patient takes 5mg per day with a gradual increase to a maximum of 40mg per day, at which point 1mg doses of THC can be added. This is for patients who may be more sensitive to the effects of substances, have mental health disorders or are in a weaker spot with their health. 
• Rapid protocol, in which a patient is put on a balance of THC and CBD of 2.5-5mg once to twice daily and increases every few days until a maximum of 40 mg of THC a day. This is most often used for patients who need immediate relief from severe pain, are suffering from a terminal illness or have a higher tolerance to the effects of cannabis. 

While the FDA has not approved cannabis for medical use in any form, it has approved prescriptions that contain cannabis that can be obtained from a pharmacy.^[14] These include: 

• Epidiolex (cannabidiol) – treats seizures. This is the only approved medication directly derived from natural cannabis; all others are synthetic. 
• Marinol or Syndros (dronabinol) – treats nausea and vomiting in cancer patients and loss of appetite and weight loss in HIV/AIDS patients.^[15]
• Nabilone (Cesamet) – treats nausea and vomiting caused by chemotherapy treatments. 

It is important to note that many of the studies conducted on medical cannabis are limited and contain small sample sizes. Additionally, while its ability to relieve certain symptoms from diseases and chronic pain is evident, there is not much out there to suggest that it helps with the actual underlying disease that causes the pain. However, its demonstrated potential to decrease pain associated with chronic conditions and other health issues cannot be discounted, as it can certainly enhance a patient’s quality of life. 

Research suggests that cannabis has the potential to help treat opioid use disorder.16 While it should not take the place of medications to treat opioid use disorder (MOUD), which are the gold standard for treatment, it might be helpful if used as a supplement. 

For some, cannabis can help relieve opioid withdrawal symptoms, which can be helpful during a period of detox, as some medications require a period of abstinence before starting. Though chronic cannabis use can lead to dependence, cannabis withdrawal symptoms are also far less severe than opioid withdrawal symptoms. This could help reduce opioid cravings and the risk of relapse. 

Cannabis can also be an effective harm reduction method for those with opioid use disorder. For example, some individuals might be open to stopping opioid use and/or receiving treatment but continuing to use cannabis, which has a significantly reduced overdose risk compared to opioids.  

Again, only limited research has been conducted, and cannabis should not be relied on as the only treatment for opioid use disorder when there are medications proven to work. 

While much of the evidence for medical cannabis’s effectiveness in treating certain conditions is promising, especially for pain, there are certain things it won’t work for, particularly mental health disorders like PTSD and depression. 

The Department of Veterans Affairs (VA) strongly recommends that cannabis not be used to treat PTSD because there is not enough evidence on the benefits and risks involved.^[17] The National Center for PTSD recently published data presenting mixed results on cannabis’s effectiveness for treating PTSD, agreeing with the VA’s recommendation.^[18] 

Evidence of cannabis’s effect on depression is very mixed. While cannabis use is not necessarily associated with an increased risk of developing depression, it might not improve symptoms, either. In fact, some research has found that decreasing cannabis use is associated with a decrease in depressive symptoms.^[19] Additionally, high levels of THC have also been shown to increase anxiety in some individuals rather than alleviating it.^[20] 

Many experts agree that there is not enough evidence to recommend prescribing medical cannabis for psychiatric disorders, and, in fact, may be harmful to those with psychotic disorders.^[21]

Contrary to popular belief, consuming cannabis comes with the potential for negative mental and physical side effects.  

Because marijuana is not regulated at the federal level and every state has their own laws regarding the use of medical cannabis, there is always a risk that products obtained to help with medical issues do not contain the ingredients they claim to have or have additional ingredients that are not listed. For example, one might purchase marijuana gummies claiming to have a 2:1 CBD to THC ratio, but they could contain higher THC levels than stated, leading to an unexpected high and unpleasant side effects.

In fact, THC levels in cannabis products have increased drastically over the past few decades. Between 1995 and 2018, the average THC concentration in leaf marijuana increased nearly fourfold, from 3.96% to 15.61%. Using a cannabis product with a THC potency of over 15% is linked to a three-fold increase in the likelihood of experiencing mental health and other problems. These can include increased anxiety, suicidal thoughts and psychosis. Marijuana use is also associated with developing schizophrenia.^[22]

Marijuana use can also be very harmful for the body. One Danish study found that the use of medical cannabis was associated with a higher risk of developing new-onset arrhythmia (a condition causing the heart to beat irregularly).^[23] Like cigarettes, smoking cannabis harms the lungs. Memory, reaction time and perception can be affected in both the short- and long-term. 

Frequent marijuana use means it is possible to develop cannabis use disorder (CUD). It affects the brain’s reward system, and the likelihood of addiction increases considerably for those who start using cannabis at a younger age. 

Additionally, although a patient receives their prescription from a licensed physician, they do not purchase their products directly from a doctor or pharmacist, but at a dispensary from a “budtender.”

While employees at medical marijuana dispensaries are likely very knowledgeable about cannabis, they also probably don’t have access to your medical records. Though the prescribing doctor has likely advised the patient on what kind of marijuana to use and how it could interact with their medications, there’s no real safety check with a pharmacist like you’d get picking up a traditional medication. 

Similarly, only recently have there been studies on the actual best practices of using cannabis for medical treatment. There are questions of dosage;^[24] how often one should take it; what THC/CBD ratio and concentration is best for each person; and what the safest formula to ingest cannabis in is (e.g. edibles, salves, smoking), to name a few. These all vary based on the person taking it and the condition it is treating.^[25] 

Again, your physician can likely provide accurate information, but remember that their knowledge is probably also more limited than it would be compared to other prescriptions because there are no federal guidelines. Budtenders may also not have up-to-date medical information or research at hand.

There is significant evidence to suggest that medical marijuana helps with pain relief, and its benefits should continue to be explored. However, research is more tentative when it comes to cannabis’s effect on psychiatric disorders.  

If your loved one believes they could benefit from the use of medical cannabis, check in with their healthcare provider. Remember that only certain doctors can provide a medical marijuana prescription. Again, though research on the best way to use medical cannabis is limited, your doctor will likely advise you to start slow, ingesting it once or twice a day, and using products with low to no levels of THC. It’s always best to follow their guidance and to check in about your treatment plan with them. 

Even if adult recreational cannabis use is legal where you live, it’s always best to consult with a physician to see if it could be beneficial to your loved one and receive a proper prescription. Not only can they provide you with evidence-based guidance, but medical marijuana dispensaries are regulated, so the products there will likely be safer to use than a non-certified dispensary or illicit smoke shop. Legal marijuana is also likely to contain more CBD than THC. 

Medical cannabis is also typically slightly cheaper than recreational cannabis, as it may not be subject to the same taxes. In New York, for example, adult-use cannabis is taxed based on the total THC in the product sold; a state tax of 9%; and a local tax of 4%.^[26] As of June 1, 2024, the medical marijuana tax rate will drop from 7% to 3.15%.^[27] This might be a motivating factor to your loved one to get products legally.

If your loved one is prescribed medical cannabis or uses cannabis in general, encourage them to take steps to reduce the risks involved, like using lower-strength products and/or not combining them with other substances like alcohol. 

If you suspect your loved one has cannabis use disorder or is at risk of developing it, there are treatment programs that address this directly. Remember you can always contact us for support if you’re not sure what direction to go in next.