The upshot of it is meta-analyses. In the past, the have attempted to put together all the trials on medical marijuana for all purposes and basically moderate quality evidence emerges for neuropathic pain and spasticity AMS and some forms of chronic pain. But for most other indications there is not good evidence. It’s all different of preparations of can’t cannabinoids. It’s there’s uncertainty in my mind about what exactly neuropathic pain is versus chronic pain, there’s a suggestion that this is helpful for many people, there’s also a lot of information to suggest that chronic pain is very hard to treat anyway.
The treatments that we have are not the greatest for the same reasons that perhaps kind of a sort canonize are not the greatest either. So it’s one more potential option, but there is the difficulty that it’s not legal. I think that, actually it is legal in some parts of the world it can be studied to some extent, although it’s very difficult to do so in the US doctors in the US physicians are federally licensed it’s illegal federally. The states are, some of them about half have legalized it, but that doesn’t mean a doctor can prescribe because his or her license comes from the federal government. It’s a mixed-up mess. Really.
What I would say is this that, over the past 25 years, the endocannabinoid system on which the marijuana and the contents would work, has become better understood as a neuromodulator system that interacts with all the other neurotransmitter systems and there’s lots of promise there right now, something That I think gives many physicians fits is that the patient will decide, and particularly if it’s smoked cannabis. How much is the right amount rather than the doctor, and will use it to affect whatever effect they want that to be? There are also convulsant and other drugs. All of which have some benefit, but noxious side-effects, one of the articles I’m going to cite actually doesn’t. It mentions many other pain and medications, but not cannabis, and you. The conclusion, is about the same that there’s moderate evidence.
These things help that they have many side effects and problems. I I think the issue really is again what the balance is between the therapeutic benefit, if it’s pain, relief and the recreational value which was is getting high, there’s also sort of a fuzzy boundary because in some sense may be getting higher or it means you don’t Care about your pain, so much anymore. All this is really pretty amorphous. I would say the question answers itself: if a patient tries this and they report that the quality of their life is better, then that’s the subjective evidence you need. I would suppose doctors in the US can recommend it’s a funny situation.
At least marijuana probably is not as dangerous in terms of kill you immediately as opioids, although there is emerging evidence that perhaps more people have car crashes who are using that cognitive cognition is definitely affected and in adolescents and up to age 25, that brain development is Affected think that, with the terrible problem like neuropathic pain, you’re always going to be making compromises between the benefit and the the danger of the problem of the drug. One thing I’ve learned in my research is that the notion that this is you know innocuous is frankly ridiculous. I think, is really interesting about this particular compound. Is this 5,000 year history of use as a botanical and the American system for developing drugs that are approved?
Doesn’t have hardly any botanicals that have been approved, it’s complicated when the substance that the plant itself has 60 or 70 cannabinoids in it plus many other substances and there’s no drug that I’m aware of it’s smoked. My understand neuropathic pain as it doesn’t get cured. It gets managed because there is some kind of a central or peripheral damage to the nerve that can’t be fixed, but it can be ameliorated. So that’s what this would be one more thing to potentially use. I think that it’s not all 50 states. It’s a federal issue and, and what would happen at the federal level?
Would it be? It would be rescheduled it’s schedule 1, which means according to the federal government that has no medicinal value, and it’s at high risk of being abused. Even schedule 2, which would be a drug like morphine, would at least still have the same warnings about abuse potential, but also the idea it might have some benefit by rescheduling the drug. It will make it easier to do research on it, and one of the fascinating things about cannabis per se is that the the plant has its own proponents as an herbal medicine. But the notion that in the time since the plant was made Schedule, one in the US we’ve discovered all kinds of things about the endocannabinoid system means that we really could think about tailoring drugs to that system. If we understood it better, the challenge is, and – and the first paper that I read, but this topic was called blurred boundaries.
So it’s almost impossible to talk about medicinal use of those about also talking about recreational use and big, it’s the two overlap, and so on. The one hand I mean my own state came out with a very restrictive state law, but it’s so restrictive that many people just simply go to the weed they can get from their local seller or speaking about research. The rugs in the US are developed. The FDA they’re not developed the state level, so it would be a radical new idea for a state to have it down.
Also, there have been two drugs on the formulary since 1985, that are both cannabinoids, there’s Marinol, which is THC in a synthetic form and says Annette, which is a closely related THC like compound. That’s also made those exist in the formulary and they can be prescribed there. Schedule two and three but they’re taken by mouth and they have a delayed onset and a longer action. So, there’s a further argument that well the smoked or vaporized it gives you an instant response and you can get rid of the badness if it happens quickly as well.
The reality is that most of the commonly abused drugs actually have legitimate uses and are scheduled. For example, amphetamine methamphetamine is scheduled in a way that it can be prescribed. Heroin is a Schedule. One drug, but many opioid derivatives are scheduled to scan Schedule three. So it is strange – historically, there may be reasons for this that it is singled out, but the evidence supporting it as a Schedule. One drug is really not very good. Never was one of the points that I make is that the drug was made illegal. In the absence of science and the states are legalizing it in the absence of science, so there’s really no science that has gone into these decisions.