Thanks to a few pioneering states, legal medical marijuana is becoming increasingly mainstream. Each year, more states approve it, and today, research that would have been impossible a decade ago is being carried out at labs across the country. Likewise, conversations that would have been taboo in medical circles outside of medical cannabis states are now possible. This month, NPR interviewed Dr. David Casarett, author of "Stoned: A Doctor's Case for Medical Marijuana."
It's a book that would not have been accepted just a few years ago, and, in fact, Dr. Casarett admitted that when he started "Stoned," he thought medical marijuana was a joke. Over the course of the project, however, he dug into the studies examining medical marijuana's use, talked to patients using it to treat a variety of ailments, and even tested it on himself. He came away convinced that medical marijuana is real medicine, that it is a legitimate treatment, and it isn't just about stoners trying to get high.
"There's a fair amount of science behind it," Casarett told NPR in his interview on the "Fresh Air" news program. He went on to discuss how some of the best evidence for marijuana as medicine is in the treatment of neuropathic pain, nerve pain caused by disruption of or damage to the nerve cells themselves. It's common in several chronic conditions such as diabetes, and conventional treatment options are limited.
"In my experience as a palliative care physician," says Casarett, "it [neuropathic pain] doesn't respond nearly as well as more traditional nociceptive pain does to drugs like morphine. So there really is a need to find newer, better treatments." Medical marijuana might be that treatment. He also discussed using medical marijuana without getting high, especially in the case of neuropathic pain.
He said some researchers are becoming increasingly convinced that it might actually be cannabidiol (CBD) rather than THC that is responsible for marijuana's effect on neuropathic pain. The concept is currently being tested in clinical trials using lower amounts of THC and elevated amounts of CBD. The low-THC treatments seem to have the same effect on pain as normal THC doses.
This is important because CBD doesn't cause the euphoric "high", or physco-activity associated with THC. If CBD alone has therapeutic benefits, said Dr. Casarett, "there are enormous opportunities for figuring out how to use that appropriately and productively for those people -- and there are a lot of them -- who really don't want to feel high. They don't want any of that recreational marijuana feeling. They really just want relief of pain or nausea." In the interim, he suggested that medical marijuana users who want to avoid the "high" associated with THC ask for a low-THC, high-CBD strain at their dispensary.
During research for the book, he tried medical marijuana himself for back spasms and found that dosage is extremely important. It's very easy, he said, particularly in the case of edibles, for the inexperienced to overmedicate. While edibles are a simple way to get the active ingredients of medical marijuana without smoking it, it takes a much longer time -- anywhere from half an hour to an hour -- to begin to feel the effects. In addition, people metabolize cannabinoids at different rates, so there is no one-size-fits-all time frame for how long it takes ingested marijuana to work. New patients may take one dose, feel no effects after 15 minutes, take another, and another, so that when the full effect does hit them an hour later, then they've taken too much. Dosing yourself with edibles, he suggested, takes some trial and error to get it right.
The so-called war on drugs, he added, has set back medical marijuana research by decades. Dr. Casarett believes that the potential for a great deal of good is there, and that the current climate allowing such research is a good thing. The fact that doctors are no longer afraid to speak up about the benefits of medical marijuana shows how far we've come in a short time. Speaking up in print and on national media takes us one step further.