If you do a google search for cannabis and health problems, you only see polarized
information on the internet. One side has elevated it to a “miracle cure” and the other
side has vilified it for its negative effects. The truth, however, lies somewhere in
between.
Cannabis is placed uniquely because it is one of the very few plants that acts on the
endo-cannabinoid system (ECS). This is a relatively new discovery. Where we have
known how plants like poppy (opium) act on our body since the last 150 years, we have
known about cannabis only since last 30 years. Since it acts on ECS, it potentially has
multiple clinical uses, which elevated its status to a miracle drug.
Human trials using cannabis are showing slightly different results. If you take chronic
pain, for example, a sizable population is using it for pain relief. However, only a
percentage of that (30-70 percent) is experiencing reduction in pain. Roughly one-third
of them are not experiencing pain relief. The following reasons can be attributed to this:
Firstly, no drug is 100 percent effective, hence it should not come as a surprise that this
isn’t either. Any drug for chronic pain like morphine, COX-inhibitors, etc. will have a
failure rate.
Secondly, India doesn’t have a standardization protocol and the quality checks with the
manufacturing companies are approximate at best. India doesn’t have standardized raw
material procuring process either, which makes the initial biomass highly variable in its
potency. The extraction process also varies among manufacturers and cannabis being a
sensitive plant, shows variable results. Due this heterogeneity, sometimes changing
brands can show different results.
Thirdly, there is no universally accepted dose. Dose-titration is a norm with cannabis, as
is with morphine. This type of dosing is very new to patients and doctors and hence
requires educating them on the same.
Fourthly, all drugs have one active molecule, but cannabis has more than 100 active
molecules and this increases the complexity of its clinical use. While this complexity is
part of the reason for its unique clinical effects, it is also the reason why some effects
cannot be fully understood or explained. More research in this area is the need of the
hour.
Lastly, adjusting patient expectations. Most of the patients turn to medical cannabis only
when all other routes have been exhausted. In such a situation, one cannot help but get
hopeful that this might do the miracle for them. So, when patients ask questions like
“will this cure my cancer?” or “will this cure my pain?”, the answer can never be an
emphatic yes. The clinical picture is more nuanced and this has to be understood by
both the patient and the doctor.
In summary, medical cannabis is still in its infancy. There is a huge body of evidence to
support its use but clinical effects are nuanced and yet to be fully understood. It can be a
miracle drug for someone and yet not show any clinical effects in another. This
dichotomy needs to be accepted and addressed.
Comments