Let’s be frank, or rather….blunt. Pun intended.

We have been at a crossroads on the benefits vs the risks of marijuana since the early 1900’s in the US.

Wait! What? Are you telling me that people were able to use it medically prior to this?

Yes. Yes, they were. And now we’ve come ALMOST full circle.

 

The legal definition of medical marijuana is the use of cannabis as a physician-recommended form of medicine or herbal therapy. It’s been used for thousands of years, by cultures all over the world for both religious and medicinal purposes. AND, fun fact: the world’s oldest marijuana stash was found in a 2,700-year-old grave in the Gobi Desert in 2008. That, my friends, is some ancient weed!

 

What exactly is Marijuana and aren’t there multiple types?

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Marijuana comes in 2 primary strains: sativa (contains more THC) and indica (contains more CBD). What the heck does this really mean? THC (tetrahydrocannabinol) gives more of a euphoric or “high” effect along with sleep induction, appetite stimulation, confusion, and paranoia. CBD (cannabidiol) has a lower euphoric effect, modulates the effects of THC, and has multiple clinical uses. Back in the day, marijuana was merely a smokable. Today, we find multiple formulations like edibles, topicals, tinctures, concentrates, oils, vapes, patches and even in wines and beer! Each of these forms have different onsets of action and different durations. With so many options available, this is where your physician and/or dispensary may help find the right form.

 

What are the main clinical uses?

I know, you’re anxious for me to get to the good stuff. The info of all info. What are the main clinical uses, you ask? Let me tell you, medical marijuana has been used for seizures, sleep disturbances, anorexia, analgesic treatment, nausea and overall better quality of life. Wow! It sounds like a cure-all for the hospice and palliative care patient! This sub-section of patients typically experiences many of these symptoms. But I’m hanging on to the QUALITY OF LIFE (QOL) improvement. Let’s be honest, isn’t that what we’re trying to help our patients achieve in the end stages of their life? Did you know studies show that after 6 months of treatment in the elderly, 94% reported improvement in QOL and pain levels were reduced from a median of 8 down to 4 on a scale of 0-10. That’s HUGE! Even bigger news: 18% stopped using their opioid analgesics or at a minimum, reduced their dose. CBD seems to have more medical benefit over THC and it appears to be relatively safe and effective for a variety of conditions.

 

Where is marijuana currently being used in medicine?

As of this article, there are 31 legal medical marijuana states & DC and 9 legal recreational marijuana states & DC. Each state has its own registration and training requirements along with regulations on qualifying conditions, approved dispensaries, transporting, etc. Because of this, there may be some speed bumps in your state that may make it more difficult, though not impossible, for your patient to obtain medical marijuana. And, because it is not federally approved, funds from the Medicare Hospice Benefit can NOT be used to cover the cost so the patient has to pay out of pocket.

In the end, and as a clinical pharmacist, I do believe it’s worth the while to learn more about your states regulations and how you can help your patients obtain medical marijuana legally to improve QOL.

So, stick that in your pipe and smoke it!

DiGi Graham

Director of Clinical Operations and Pharmacy Development at Palliative Drug Care

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