An excerpt from Medical Marijuana: A Clinical Handbook.

Imagine two patients sitting in the waiting area of a clinic. The first is a man in his sunset years who has recently begun treatment for stage 2 lung cancer. His treatment involves the use of chemotherapy, which has significantly reduced his appetite and given him terrible bouts of nausea. The second is a woman in her 30s. She is a former competitive skater who continues to experience chronic joint pain because of injuries she suffered on the ice. She is also reluctant to use any pain medication that has even a moderate potential for abuse because she has a history of drug addiction.

The man reveals that he has lost more than 5 pounds since beginning chemotherapy. The woman attempts to comfort him by saying that her uncle experienced a similar problem when he underwent chemo. “You should ask the doctor about cannabis,” she says.

“Cannabis?” the man says. “You mean marijuana—like what those hippies in California smoke?

“Well, yes,” she concedes. “But you don’t have to smoke it. You can vape it, eat it, or even drink it. My uncle preferred to take it in chocolate form. He says it saved his life.”

“No thanks,” the man says. “I don’t want to get addicted, I don’t want to become schizophrenic, and I most certainly don’t want to end up moving on to something like heroin just to get my fix. It’s a gateway drug, you know.”

The woman again shakes her head. “Cannabis and schizophrenia are not related at all. Also, it’s not a gateway drug. It’s completely nonaddictive and natural. It’s from Mother Earth. I plan on asking for a prescription myself, but for CBD oil.”

“What’s CBD oil? Is that a more concentrated version?”

“No. It comes from a different species of the cannabis plant than the one that gets you high. It helps with all sorts of things, from depression to anxiety to insomnia to chronic pain to Crohn’s disease to psoriasis. It’s also totally legal.”

[…] The two patients part ways and see their respective doctors. Each describes their symptoms to their doctor, and each is told that cannabis could be used to help with their symptoms. They also discover that a large percent of what they believe about cannabis is almost comically inaccurate.

The above scenario is meant to illustrate three things.

The first is that there is no shortage of misinformation about cannabis. […] The second is that much of this misinformation exists because…opinions about cannabis are often shaped by one’s political leanings and rarely rely on data or scientific analysis, though medicinal cannabis seems to have won nearly universal acceptance in the past few years. A Quinnipiac poll from 2018 found that 93 percent of Americans support allowing patients’ access to medical cannabis.

The third and final point to take away is that the chemistry of cannabis is anything but straightforward and that its complexity has only served to fuel more misinformation.

[…] Despite the importance of THC and CBD to the use of cannabis as a medicine, focusing solely on the concentrations of these two phytocannabinoids in an attempt to predict user experience produces an incomplete picture. They are the figurative tip of the iceberg. On top of containing more than 120 phytocannabinoids that can alter the effects of either CBD or THC felt by patients, cannabis also contains a host of additional compounds…that are common to the plant world and may indirectly interact with the endocannabinoid system. Consequently, many of these compounds may not only alter a patient’s subjective experience following use but they may also prove to be beneficial for certain conditions whether used in isolation or in conjunction with other cannabinoids.

As there are literally thousands of cultivars of cannabis, each with their own phytocannabinoid and terpenic profiles that may produce distinct therapeutic effects, it is misguided to speak of cannabis in monolithic terms. It is like making broad claims about soup. By understanding just how complex the chemistry of cannabis is, one gains a greater appreciation for why such a great deal of attention has been paid to this plant for millennia.

[…] Though research into cannabis is becoming more robust, its thorny legal status has been a major impediment to its study by medical researchers for several decades. Consequently, much of the literature that celebrates it as an almost magical panacea relies on anecdotal evidence or cherry-picked data … Meanwhile, much of the literature that condemns it as a public menace either ignores research that makes provisional claims about cannabis’ benefits or spends far too much time focusing on the detrimental effects of excessive recreational use. […] Both sides of the argument often fail to see through the fog of the culture war, and both sides are at times guilty of being more intent on winning a political argument than approaching the issue with a clear head and an agenda couched solely in the tradition of empiricism and science.

Apart from being discouraged by the amount of misinformation I found on the subject of cannabis, a major impetus for this book is in part due to having more than 25 years of experience running the acute psychiatric inpatient unit at a New York City Hospital. Aside from the fact that I had an opportunity to evaluate and treat innumerable patients with severe mental illnesses, I also noticed a steady increase in the number of individuals who were struggling with addiction and opioid abuse. Many of these individuals had initially obtained a prescription to help them manage their pain but eventually became addicted to opioids. This sparked my interest in alternative treatment options, and specifically cannabis, with its application potential well beyond pain management and how cannabinoids in the plant could be used to benefit patients. This led me to begin my due diligence research into the history and science of cannabis, and I was amazed by what I discovered.

Samoon Ahmad and Kevin Hill are psychiatrists and authors of Medical Marijuana: A Clinical Handbook.

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