This past weekend, I attended the Academy of Nutrition and Dietetics Annual Food and Nutrition Conference & Expo (FNCE). It was a great conference this year – including the academy’s centennial celebration, record breaking attendance (over 12,000 RDs, NDTRs, students and interns), and many innovative educational sessions.
One of the sessions that encouraged “thinking outside of the box” included a lecture called “Going Green: Use of Medical Cannabis in Medical Nutrition Therapy (MNT)”. The most recent research and practical applications were presented by a pharmacists and fellow registered dietitian, that both recommend medical marijuana use with some of their patient populations; when nothing else has worked. The room where this educational session was held was HUGE, and it was about half full; indicating that this topic is of increasing interest to physicians, pharmacists, dietitians, and other health care professionals. The attention, statements, and questions from attendees also exemplified that clinicians are seeking alternative methods of managing acute and chronic disease, rather than the traditional prescription drug approach.
During the FNCE session, the presenters discussed the endocannabinoid system in the human body, the cannabinoid receptors in our brain, immune system, and gut, and how tetrahydrocannabinol (THC) and cannabidiol (CBD) interact with these receptors. The also talked about the safety and efficacy of the different products on the current market, the preferred CBD:THC ratio for management of different illnesses, and explained that there are some conditions that warrant medical marijuana use for bodily homeostasis. What are some of these conditions?
In Michigan specifically, medical use of marijuana has been legal since 2008 and there are certain qualifying conditions, including Alzheimer’s disease, cancer, cachexia, chronic pain, Crohn’s disease, glaucoma, HIV/AIDS, nausea, PTSD, and more. But what is the literature showing? Unfortunately, research on marijuana’s potential for medicinal use has been hampered for years by federal restrictions, even though nearly half of the states and the District of Columbia have legalized medical marijuana in some form. In fact, 29 states have legalized the use of medical marijuana, and 8 states have legalized marijuana for recreational use. Most recently, the World Anti-Doping Agency (WADA), the foundation initiated by the International Olympic Committee to coordinate and monitor drug use in sports, will be removing CBD from its list of banned substances in 2018. Wow.
There is conclusive or substantial evidence that cannabis or cannabinoids are effective for:
- Chronic pain in adults
- Multiple sclerosis spasticity symptoms
- Chemotherapy-induced nausea and vomiting
Due to the federal restrictions on funding and institutions electing not to participate, there is insufficient evidence for other illnesses. This means ongoing research is needed in these areas:
- Increasing appetite and/or decreasing weight loss for HIV/AIDS
- Improving Tourette’s syndrome symptoms
- Improving social anxiety
- Post-traumatic stress disorder
- Cancer-associated anorexia cachexia syndrome
- Anorexia nervosa
- Irritable bowel syndrome
- Amyotrophic lateral sclerosis (ALS)
- Parkinson’s disease
What is my take on this? I am not necessarily pro-cannabis; however, I am pro research, and we need good science to prove the efficacy of medical marijuana. Unfortunately, this research is impeded by the government. I am interested in this research because it appears that our traditional prescription drug approach is not working, especially for individuals with anxiety, depression, and suicidal ideations. Patients are pumped full of anti-psychotics (Abilify, Risperdal, Zyprexa, Clozapine), and opioids (hydrocodone, oxycodone, morphine, fentanyl, codeine) and sent home; only to return a month later with a plan to walk into traffic. In fact, within 30 days, 15% of initial inpatient stays for mood disorders are readmitted. In addition, the American Society of Addiction Medicinefound that of the 20.5 million Americans that had substance use disorders in 2015, 2 million had a substance use disorder involving prescription pain relievers. To make matters worse, drug overdose is the leading cause of accidental death in the US, with opioid addiction driving this epidemic, at 20,101 overdose deaths related to prescription pain relievers in 2015.
Why not give something else a try?
Corey-Bloom, J., Wolfson, T., Gamst, A., Jin, S., Marcotte, T. D., Bentley, H., & Gouaux, B. (2012). Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial. Canadian Medical Association Journal, 184(10), 1143-1150.
Fraser, G. A. (2009). The use of a synthetic cannabinoid in the management of Treatment‐Resistant nightmares in posttraumatic stress disorder (PTSD). CNS neuroscience & therapeutics, 15(1), 84-88.
Heslin, K. C., & Weiss, A. J. (2015). Hospital readmissions involving psychiatric disorders. Healthcare Cost and Utilization Project, 1-17.
Hill, K. P. (2015). Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: a clinical review. Jama, 313(24), 2474-2483.
Machado Rocha, F. C., Stefano, S. C., De Cassia Haiek, R., Rosa Oliveira, L. M. Q., & Da Silveira, D. X. (2008). Therapeutic use of Cannabis sativa on chemotherapy‐induced nausea and vomiting among cancer patients: systematic review and meta‐analysis. European journal of cancer care, 17(5), 431-443.
National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. National Academies Press.