Despite thousands of years of human consumption and a growing international body of professional studies, the modern Western medical profession is still grasping at straws, trying to get its head around the medical use of cannabis. The problem is deeply rooted in ideology — pharmaceuticals have ruled for more than 100 years and remain the basis of Western medicine, and are the reason Western medical professionals know very little about diet, lifestyle and so-called alternative non-drug therapies.
Unfortunately, research is expensive and is usually not conducted unless there is a marketable outcome, such as a new drug or medical device. In the case of cannabis, the distraction of new drug development has widened the information gap about how humans are actually utilizing cannabis today, leaving little professional direction for those who choose to use it.
Understanding Mechanisms Of Marijuana Action
Studies on cannabis, cannabinoids and the human endocannabinoid system have been ongoing, though they are usually aimed at new drug development. Researchers are beginning to understand exactly how cannabis works in the body, but the financial incentive of a new drug tends to guide research in directions that aren’t necessarily helpful to patients.
Dr. Giovanni Marsicano is a neurologist and endocannabinoid system (ECS) researcher at the Université de Bordeaux in France, and is considered to be one of the leading ECS researchers in the world. Marsicano presented the keynote speech at this year’s Marijuana for Medical Professionals conference in Denver, a symposium for doctors to earn continuing medical education credits.
Marsicano’s research has illuminated what the scientific community knows about how cannabis works in the brain, but as well-known American doctor and cannabis expert Dr. David Bearman pointed out, the research is based on a flawed premise — treating “cannabis addiction.”
When the CB1 receptors in the brain are stimulated by THC, the brain produces a hormone called pregnenolone that binds allosterically to the receptors at the same time as the THC, naturally limiting the intoxicating effects. Marsicano’s team of researchers have uncovered this mechanism of action and are using it to develop drugs that could combat “cannabis addiction.”
“There is an enormous amount of research out there that contradicts your conclusion. … Cannabis has a specific dependency [risk] that is less than coffee. So, do we need to start treating cannabis dependency?” Bearman asks. “[My colleague] looked at six different recreational drugs: alcohol, cocaine, heroin, tobacco, coffee and cannabis. Cannabis has the least dependency risk — not that it has no dependency risk — but its dependency risk is lower than any of those other products.”
“Cannabis use disorder” does in fact exist, per the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), but the addiction profile is less than coffee and the side effects of use and withdrawal are comparably milder.
While this sort of research is essential to understanding how cannabis and synthetic cannabinoids interact with the human body, it does little to explain medical successes achieved with laymen administration of the plant and it does little to bring the desired relief to patients in need.
This is just one of the ways — although perhaps the most glaring — that the medical profession is falling short on cannabis, especially when it comes to treating the most vulnerable patient populations: Pregnant and breastfeeding mothers, and children with serious medical conditions. Because so little is known about the effects of actual cannabis — that is, not isolated or synthetic plant compounds — doctors tend to err on the side of extreme caution and dissuade botanical cannabis use. In the meantime, real humans who are suffering, dying and getting no relief from available pharmaceutical options are rejecting medical advice in favor of whole plant cannabis, with little guidance from the medical profession and seemingly no studies to understand what they are doing and the long-term effects.
Cannabis Use In Pregnancy And While Breastfeeding
Women have historically used cannabis to ease the pain and discomfort of menstruation, pregnancy, childbirth and breastfeeding. According to a 2017 study in the Journal of the American Medical Association, cannabis use during pregnancy is on the rise, with as much as four percent of expectant mothers in the US using it, with higher rates among teenage mothers. Other studies put the estimate as high as 28 percent in states where cannabis is legal.
Still, very little is known about the effects of cannabis use during pregnancy and subsequent child development. Dr. Laura Borgelt conducted a study with the University of Denver to better understand what can be proven by science. She presented her findings at the Marijuana for Medical Professionals conference: Neither doctors nor the cannabis industry has appropriate answers on the topic.
Borgelt surveyed hundreds of available studies on the topic from around the globe and found no significant evidence to prove that cannabis consumption during pregnancy causes disruption of fetal development, birth defects, or cognitive defects in adolescent brain development. While some studies point in the direction of adolescent cognitive defects, those studies were flawed because they did not account for other significant confounding factors such as socioeconomic status, mental health conditions, nutrition and access to health care.
According to Borgelt, the lack of conclusive evidence of developmental and birth defects is a positive conclusion, but until definitive research is done that takes into account the reality of how mothers are already consuming cannabis, she recommends against cannabis use in pregnancy.
As for the effects of cannabis use during breastfeeding, Borgelt acknowledges even less is known with the available studies.
Human breast milk contains endogenous (produced within the body) cannabinoids, which can account for the sleepy “high” babies get after a meal. While these natural cannabinoids in breast milk are safe, Borgelt warns that very little is known about phytocannabinoids (i.e., exo cannabinoids sourced from cannabis) in breast milk.
“We have very little information. What we can say is that THC readily passes into the breast milk and there are numerous studies to confirm that,” she says. “Chronic users will have up to eight times more THC in the breast milk than in the plasma.
“It is about the potency and the impact being higher and longer. When I have patients that ask about that, I will fully acknowledge that our body makes its own endocannabinoids, but the exogenous are far more potent and last longer on receptor sites than what our body does normally.”
When It Comes To Cannabis Consumption, What About The Kids?
Although most researchers and medical professionals can agree that there is little to no risk in adult cannabis use, there is still quite a bit of concern about medical cannabis use by people under the age of 25, at which time the human brain is typically considered to be fully developed.
The cautious approaches taken by Western medical professionals are contrasted by the real-life stories of patients — particularly children — who don’t have the luxury of time to wait for more studies. Since 2013, many parents of severely and terminally ill children have relocated to Colorado to treat their children with cannabis.
Erin Holt relocated from Arizona with her autistic son Kreed. It wasn’t until she started giving Kreed high doses of THC — against doctors’ advice — that he was able to relax and communicate the pain and suffering he had been feeling his whole life. Holt addressed doctors at the Marijuana for Medical Professionals conference alongside leading cannabis and autism researcher Dr. Judy Mikovits, as well as other parent advocates for cannabis use in treating autism.
Unfortunately, Holt says that by the time they started giving Kreed high doses of THC, it was too late. He passed away in 2016 of a previously undiagnosed medical condition that the use of THC helped unveil.
“We moved [to Colorado], and he gets a diagnosis, but it was too late. Maybe we could have saved him in Arizona, but we will never know because they kept saying it was just autism and cannabis was not an option,” Holt says. “That’s why it is so important that we don’t just see our kids raging or in pain, but we figure out why those kids are raging or in pain. Cannabis helps facilitate that.”
For most of his 16 years, Kreed could only communicate through self-destructive rages. He had such extreme neuropathy that he tried to bite off his own toes. Because of the rare, undiagnosed genetic disorder, he was unable to take in enough oxygen while sleeping, which led to fits of rage that sometimes included him trying to ram his own head into a wall. Doctors continued to tell his mother that the symptoms were normal for autism and pushed her toward various pharmaceutical drugs that did little to alleviate the symptoms — and sometimes made them worse. Because Holt bucked medical advice and started giving her son high doses of THC, the last four months of Kreed’s life were his best.
“He tried to hurt himself because he couldn’t deal with the pain. So, when we got to Colorado and started using cannabis, he actually started telling us…” Holt pauses, crying. “He started telling us, ‘My chest hurts,’ for the first time because he was on cannabis and not raging instead.”
Using anywhere between 300 and 500 milligrams of THC in a whole plant extract, Kreed was able to communicate for the first time and was able to move more comfortably and play. She says she advocates for other parents to try cannabis much earlier in treatment because of her experience.
“I tell people, ‘Don’t be afraid. What is the worst that could happen?’ If he starts laughing instead of bashing his head in — OK, I am good with that,” Holt says. “If he gets the munchies and wants a pizza rather than bashing his head in, that is OK.
“Had he not had cannabis the last four months of his life he would have been sedated and restrained until he died. Instead, he actually had a pretty good life, even though we were in the hospital. He ran around on scooters and honestly had a blast before he died, which was great. If we had not had him on cannabis, we would not have figured out what was wrong with him or even known he was dying. That’s why it is so important for so many kids with autism — because a lot of times we don’t know what’s wrong.”
“I think it is important also to realize that Kreed needed THC,” says registered nurse Jennie Stormes. She herself relocated from New Jersey to Colorado to treat her autistic son Jackson.
Stormes points out that the majority of parents and medical professionals in Colorado treating children with cannabis usually push for CBD-dominant formulations because they are non-intoxicating and not considered by medical professionals to potentially cause brain damage in underage users the way they suspect THC does. Stormes is trying to fight the stigma that THC is not “the good cannabinoid” and instead push for better understanding of botanical cannabis use in all disorders. She also points to the doctor-parent relationship as a cause of poor treatment outcomes.
“Parents also need to be able to communicate with the doctors and say, ‘Hey, this is what I need,’ and not be blown off or treated like we are stupid,” Stormes adds.
Parents of autistic children have gotten little reprieve from state governments — even in Colorado, where autism is not a qualifying condition for medical use. Parents treating their autistic children with cannabis products are currently purchasing them from the recreational marketplace.
The likes of Holt and Stormes lobbied the state to add autism as a critical condition. While they were able to get legislators to pass a bill through both Houses, it was vetoed by Governor John Hickenlooper, according to The Denver Post.
Hickenlooper said he rejected the bill because he “could not ignore overwhelming concerns from the medical community.”
“If we sign that bill we end up, without question, in some way encouraging more young people to look at this as an antidote for their problems,” he told reporters.
Not Enough Time To Research The Positive Effects Of Medical Marijuana
Hickenlooper was swayed, however, to sign into law a bill that allows Colorado students who are medical marijuana patients to consume cannabis at school the way they would other prescribed drugs.
The law, dubbed Jack’s Law, was passed in honor of Stacey Linn’s son Jack Splitt, who died shortly after it was signed in 2016. Linn began giving cannabis to Jack to treat seizures and pain associated with a rare genetic disorder and cerebral palsy that left him wheelchair-bound and on a ventilator. He also suffered from auditory neuropathy, which rendered him mostly deaf. Linn says he needed around-the-clock care.
When she tried cannabis as a treatment for Jack, it worked immediately. She is frustrated by Western doctors’ lack of understanding toward cannabis use for children like Jack.
“All the opiates, anti-seizure meds and antipsychotics they used experimentally. I get this a lot from medical professionals who say, ‘Cannabis is experimental,’ and I am like, ‘Yes, but so is every single medicine given to him.’ Not one medicine was FDA approved for my child’s disease and his age,” Linn points out. “When you tell me to use this drug [instead], and it has well-known and documented [side effects], like probably causing my teenage child to try to commit suicide — those are documented and provable things.”
While on pharmaceutical drugs, Jack attempted to end his life multiple times by plugging his breathing tube.
“I know that cannabis has never killed anyone,” Linn says. “You know that these drugs cause harmful, life-ending side effects. The only reason the people who oppose cannabis don’t want it is because there are not enough studies.
“Well, I have studies. About 300 pediatric patients who are part of Cannability [a foundation set up in Jack’s honor], and even more I meet every day, are the study. They are the walking, living, breathing study.”
Because of a lack of professional medical support, Linn says she had to be her own doctor. She says she’s happy she bucked their advice because she was able to give her son a higher quality of life at the end of it. At 15 years old, he improved so much that he was able to return to school with a physical aid and the use of cannabis patches.
When a school nurse discovered he was wearing the patches, they were ripped off his body, and Linn was told he cannot bring his medicine on campus. The incident motivated her to call local media and her state representative, which led to Jack’s Law passing through the legislature. Jack personally testified and met with legislators, leading to 93 of 100 voting in favor of passage.
The deaths of Jack Splitt and Kreed Holt highlight the flawed logic the medical industry has applied to cannabis use, as well as the huge information gaps among medical professionals that prevent other children from receiving appropriate care. Until real studies are conducted on children and pregnant mothers who use botanical cannabis, patients will continue to suffer. In the meantime, financially incentivized studies tend to push researchers to develop drugs that interact with the ECS, rather than understanding how the cannabis plant does it.
But parents aren’t giving up.
“We will continue to keep those fights going for all of the children who need this access,” Linn says. “For all the parents and patients who are tired of struggling harder than they already have to struggle.”