Medical marijuana

It is necessary that we all know the benefits and risks of using marijuana to treat health problems. Also that we are aware that more scientific research is required in this regard.

On August 17, 2015 Judge Martín Santos granted an injunction to allow the parents of Graciela, a girl of just eight years of age, to import a medicine with cannabidiol, a substance obtained from marijuana plants and is prohibited by the General Health Law of Mexico. Graciela suffers from Lennox-Gastaut syndrome, which causes about 400 seizures per day and gets worse over time. Shortly thereafter, in November 2015, the Supreme Court of Justice of the Nation of Mexico issued a historic resolution: granted an amparo to four applicants, authorizing them to plant, grow and consume marijuana for recreational and non-recreational purposes. profit. These two legal decisions opened the doors to a debate to discuss the relevance of legalizing marijuana.

On January 25, 2016 the Chamber of Deputies inaugurated a series of forums to hear opinions related to this matter; the next day, the federal executive did the same and in the afternoon of the same day, the leader of the bench of the Institutional Revolutionary Party in the Senate declared: “In this period the legalization of marijuana for medicinal use will be resolved, every time that the currents in public opinion have changed and are in favor of it. ”

If it is almost a fact that the medicinal use of marijuana is about to be legalized, we believe it is important that we all have a solid base of information that allows us to express our opinion and make decisions about it, as a society, as individuals and, above all, as potential patients.

Effects of medications

Most medications have more than one effect on the body. Thanks to this there are medicines that can be administered to treat various ailments, such as aspirin, which has analgesic action and also helps reduce fever. However, all people are different and not all medications can be administered in all circumstances. Another effect of aspirin is to thin the blood, that is, make it less viscous and flow more easily. This can help reduce blood pressure, so the cardiologist of a patient with hypertension may prescribe regular aspirin. In contrast, in a patient with hemophilia (a condition that reduces coagulation) this same medication may increase the risk of bleeding. In addition, aspirin is metabolized in the liver,

Even something as seemingly innocuous as aspirin should be managed taking into account the risks and benefits. The first step is, of course, to read the warnings printed on the package; but it is always recommended to go to a doctor, especially for more complex diseases that require several medicines or medicines that should only be administered with a prescription, such as antibiotics or the most powerful analgesics, for example, opiates.

What we know about the primary and secondary effects, contraindications and precautions of the drugs we have learned through pharmaceutical research surrounding the production of these substances. In addition, rigorous controls and rules have been established internationally to ensure that any medication that reaches the market is safe, do what it says it does and that all its side effects and contraindications are known so that doctors can consider them at the time of prescribing them.

Marijuana as medicine?
Marijuana is not a single plant, but a complete family, the cannabáceas (family Cannabaceae). Of these, Cannabis sativa L. and Cannabis indica L. are the ones that get used to smoking because they have the highest concentration of substances called cannabinoids. These chemical compounds, in particular tetrahydrocannabinol (THC) and cannabidiol, produce effects in the body, some of which affect brain function. In general, THC depresses the central nervous system, that is, it generates a feeling of well-being and tranquility, reduces anxiety and can cause euphoria. In addition, it can stimulate appetite and reduce nausea and spasms (antispasmodic action). Finally, it can cause drowsiness and reduce the perception of pain.

Cannabidiol reduces anxiety, can help attack cancer cells in breast cancer and has anticonvulsant action, which is of particular interest in the case of diseases such as epilepsy or Graciela. There is a case study reported by Edward Maa and Paige Figi (mother of the child studied) in 2014 in the magazine Epilepsy, in which they report that Charlotte Figi began having epileptic seizures at three months of age, which worsened in intensity and frequency until at five years she reached 50 attacks per day. The parents (and the doctors) were already giving up, when Maa started treating her with a mixture of cannabis extract with cannabidiol and THC by sublingual administration, keeping the THC level below the psychotropic doses. After 20 months of treatment, Charlotte had only two or three night attacks per month, a substantial improvement. However, given the complexity of the mixture administered (as in almost all cases in which marijuana is used against epilepsy), neither the exact composition nor the mechanism of action has been determined. Even so,

In Mexico the popular custom has been to prepare a rudimentary extract of marijuana putting the plant in medicinal alcohol and letting it rest for at least a couple of weeks. With this liquid, the areas affected by rheumatic, joint or muscular pains are rubbed; the pain diminishes sensibly and, in some cases, disappears altogether for periods that can be prolonged. Marta Duran and her collaborators reported in the journal Medicina Clínica de Barcelona, in 2004, on studies that show the efficacy of marijuana against pain due to cancer, nervous system diseases and surgeries, as well as the evaluation of drugs made from standardized extracts of cannabis to treat the symptoms of rheumatoid arthritis and of intestinal inflammatory diseases. In that year, the studies were in phase II, that is, they had between 100 and 300 patients each and were performed under controlled conditions to compare the effects of the drug with the effects of a placebo (see How do you see? No. 187) .

Studies have been conducted on the efficacy of marijuana in the treatment of the symptoms of various diseases, in particular cancer, HIV / AIDS, multiple sclerosis, epilepsy and cases of chronic or neuropathic pain. A meta-study (research that collectively analyzes the results of other studies) published in the Journal of the American Medical Association (JAMA)in 2015 it indicates that, in general, the results have been positive but not conclusive; This means that more research is needed to know in what conditions marijuana is effective. According to this study, there are many researches that specifically evaluate the efficacy of cannabinoids to reduce the side effects of chemotherapy, radiotherapy and surgeries in cancer patients. Most are promising. In general, a cancer patient has to deal with severe nausea and vomiting during and after chemotherapy. The doses can be weekly or even daily. Loss of appetite, difficulty sleeping for pain and anxiety are also common. It has been proven that cannabinoids reduce nausea, pain and anxiety, stimulate appetite and help you fall asleep.

Finally, after an invasive surgery to remove an organ or cut a limb, very powerful opioid analgesics are prescribed, such as hydrocodone, oxycodone, morphine and tramadol. These drugs can have side effects ranging from nausea to addiction, plus the risk of death from overdose increases as the body develops tolerance. In a study funded by the National Institutes of Health of the United States and published in 2014 in the journal JAMA, Dr. Marcus Bachhuber and his collaborators reported that in the states of that country in which the use of medical marijuana is allowed, there are about 25% fewer deaths due to an overdose of opioid analgesics than in states where it is not allowed. The research also indicates that 60% of this type of death from overdose occurs in individuals who obtain the drugs legally, with the appropriate prescription and from a single authorized distributor. Without establishing a direct cause relationship, Bachhuber and his colleagues suggest that patients who can use both opiates and cannabis reduce their dependence and tolerance to such opioids, which reduces their risk of overdose; But researchers insist on the need to do more research in this regard.

In another study published in JAMA, in 2015, Dr. Kevin Hill conducted a review of existing studies regarding the medical use of marijuana and concluded that “medical marijuana is used to treat many conditions, there is evidence to support its use in a few cases, in many other No. Physicians should inform their patients about medical marijuana to make sure it is used properly and is beneficial. ” Again, we need more research to be able to more accurately and statistically document the range of benefits that cannabis can offer to patients in general, not just cancer. At the same time, we need to know what are the ills or symptoms that marijuana can not treat so as not to expose itself to its side effects and risks.

Side effects and risks
Although those who consume marijuana for recreational purposes may not seem very serious side effects, if our intention is to seriously treat cannabis as a medicinal plant, it is very important to document and take them into account.

Marijuana presents, in the first instance, the psychoactive effect of THC, which although can cause feelings of well-being and euphoria, in larger doses can also lead to states of anxiety, loss of attention, dissociation, paranoia, panic attacks and psychosis. Physically, there can also be a sensation of thirst and increased heart rate. If marijuana is swallowed, the effects occur more slowly, but last longer. The feeling of loss of control over the mind and body is common, which in turn produces anxiety, fear, increased heart rate and other negative effects. The School of Medicine of Harvard University warns that all these symptoms are more noticeable in people who have never used marijuana, because in addition to not having developed tolerance, It is difficult to calculate the dose with which the most serious effects occur. They also warn that there have been investigations that show that cannabis is an addictive substance and causes physical and psychological dependence.

In the long term there are also potential risks directly related to the way that cannabinoids act in the brain. The functioning of the brain is due in part to neurotransmitters, molecules that carry messages from one neuron to another and are accommodated in specific neuroreceptors for the different types. One of these types of receptor is for the so-called endocannabinoids, substances that are molecularly very similar to THC and cannabidiol, but which are produced in our brain. The receptors for these natural cannabinoids of the body (endogenous) are used by the cannabinoids that enter the organism when marijuana is consumed (exogenous), causing similar sensations; but when they are in greater quantity, they are of greater intensity and duration.