Humans have used cannabis to ease pain and suffering for more than 3,000 years. By the 19th century, cannabis showed up in many “tonics” and was considered to be something of a “cure-all” drug. Unfortunately, the potency of medicinal preparations was variable and individual responses seemed unpredictable, even erratic at times. People understood that cannabis had healing properties, but they didn’t understand how it worked.
In 1964, Dr. Raphael Mechoulam, Professor of Medicinal Chemistry at the Hebrew University of Jerusalem identified delta-9-tetrahydrocannabinol (THC), as the main component of cannabis. In 1968, UK’s Advisory Committee on Drug Dependence reported that cannabis is less dangerous than opiates, barbiturates, amphetamines, and alcohol. While scientists knew that cannabis had medicinal merit, the drug was still a mystery. Different strains had significantly different chemical profiles. Formulations lacked standardization, which still caused quality control and clinical dosing problems.
Cannabis’ complex chemical profile
Luckily, scientists kept studying cannabis, and we now know that each cannabis plant has a complex and distinct chemical profile that includes cannabinoids, mono and sesqui-terpenes, sugars, hydrocarbons, steroids, flavonoids, nitrogenous compounds and others. The effects of these chemicals regulating each other are much different than the effects of any one chemical working alone. In other words, change the strain or chemical “recipe” and you change the therapeutic effect.
New York’s allowable medical cannabis products
In an effort to standardize dosage and create a pharmaceutical grade product, NY lawmakers specified that cannabis could only be sold as liquid or oil preparations for metered administration of oral, oro-mucosal, sublingual, and inhalation administration.
To comply with regulations, NY medical cannabis producers have to grow the plant (cultivate), take it apart (extract), and reassemble the chemical compounds (manufacture) into acceptable preparations. The plant is very important, but what producers do with the flowers of the cannabis plant post-harvest is pure science and what patients and healthcare professionals should be concerned with.
Is “strain” or the “profile” of the medicine more important for New Yorkers?
What New York has done is bring to light the science behind the plant by highlighting the medicinal properties in a reproducible, standardized ratio. The chemical profile of the medical cannabis product is what matters to patients and physicians because that’s what determines therapeutic effects. To call a product by a particular brand name, the producer will have to consistently reproduce that exact chemical profile from an incredibly complex plant with hundreds of constituents.
What does that really mean? Well, unlike what the majority of patients see in other states where they have come to rely on a particular strain, patients in New York are going to rely on a brand. That brand is being defined as having a specific concentration of total THC and total CBD or ratio. Additionally, the name of that brand may not be coined, fanciful and may not include any street or slang name as well, truly a win for healthcare on this! Many patients that I know have a hard enough time asking their physician about medical cannabis. Being able to take the conversation beyond recommending a Kush, a Hope or a Web is win in my book.
While it may be comforting for patients to rely on a strain reputed to provide relief for a particular symptom or illness, there are a couple of reasons why relying on an exact chemical profile is better. One, an exact chemical profile will allow physicians and patients to consistently access the same medicine, each time they need it. Second, standardized cannabis medicines will allow insurance companies to see its documented effects which will encourage them to cover the medicine, making cannabis more affordable for vast numbers of patients.
It’s an exciting time for medical cannabis. Ongoing and future scientific studies will help us better understand this complex plant, which will allow us to better serve patients in New York and the other states that have passed medicinal cannabis legislation.
June 17, 2015 – As I stated previously, in this space I plan to share my experiences caring for patients who use medical cannabis and other treatments to alleviate their symptoms and illnesses. I also hope to educate readers about the latest NY regulations, industry advancements, and medical cannabis research. So, let’s start at the very beginning and ask, “What is medicine?” According to Wikipedia:
Medicine is the science and practice of the diagnosis, treatment, and prevention of disease. The word medicine is derived from the Latin ars medicina, meaning the art of healing. Medicine encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness.
Contemporary medicine applies biomedical sciences, biomedical research, genetics and medical technology to diagnose, treat, and prevent injury and disease, typically through pharmaceuticals or surgery, but also through therapies as diverse as psychotherapy, external splints and traction, prostheses, biologics, and ionizing radiation, amongst others. [http://en.wikipedia.org/wiki/Medicine]
Why is it important to define “medicine”?
Even though medical cannabis has been used for thousands of years to ease patient pain and treat a variety of illnesses, there is still a question as to whether we should call cannabis “medicine.” A number of physicians choose to believe that until medical cannabis has gone through the rigors of FDA approval and is officially labeled as “medicine”, we must call it a “product”. We too believe that these rigors are critical and must be answered…but also that doesn’t mean in the most basic and even complex sense that cannabis is not a medicine.
Cannabis and its compounds have been the subjects of significant medical research.
In fact, cannabis and its compounds have been the subjects of significant scientific medical research. I think it’s best to let the national experts have their say. According to Dr. Vivek Murthy, the nation’s new surgeon general, “we have some preliminary data that for certain medical conditions and symptoms, that marijuana can be helpful”, additionally the National Institute of Drug Abuse (NIDA), part of the National Institutes of Health (NIH) state that:
…scientific study of the chemicals in marijuana, called cannabinoids, has led to two FDA-approved medications that contain cannabinoid chemicals in pill form. …there is interest in the marijuana chemical cannabidiol (CBD) to treat certain conditions such as childhood epilepsy, a disorder that causes a child to have violent seizures…. the marijuana plant contains more than 100 other cannabinoids.
Are cannabinoids useful as medicine?
NIDA goes on to ask, “How might cannabinoids be useful as medicine?” Here’s their answer:
Currently, the two main cannabinoids from the marijuana plant that are of medical interest are THC and CBD. THC increases appetite and reduces nausea. The FDA-approved THC-based medications are used for these purposes. THC may also decrease pain, inflammation (swelling and redness), and muscle control problems. CBD is a cannabinoid that does not affect the mind or behavior. It may be useful in reducing pain and inflammation, controlling epileptic seizures, and possibly even treating mental illness and addictions. NIH-funded and other researchers are continuing to explore the possible uses of THC, CBD, and other cannabinoids for medical treatment.
For instance, recent animal studies have shown that marijuana extracts may help kill certain cancer cells and reduce the size of others. Evidence from one cell culture study suggests that purified extracts from whole-plant marijuana can slow the growth of cancer cells from one of the most serious types of brain tumors. Research in mice showed that treatment with purified extracts of THC and CBD, when used with radiation, increased the cancer-killing effects of the radiation (Scott, 2014). [http://www.drugabuse.gov/publications/drugfacts/marijuana-medicine]
Does it really matter what we call it?
So while I agree that we need more research as to how cannabis and cannabinoids can be useful as medicine, it’s clear that right here, right now, medical cannabis is alleviating pain and helping patients regain quality of life. I’ve seen firsthand the palliative results of medical cannabis in patients who had lost hope they’d find relief from the pain, nausea, seizures, and a host of other ailments with which they struggled. In both private and publicly funded scientific labs, the medical efficacy of cannabinoids has been documented, and this research is just beginning. So, you tell me, can we call medical cannabis “medicine”? If it’s safe and providing relief to patients who are suffering, does it really matter what we call it?
May 2015- My name is Eileen Konieczny, and I have been a registered nurse for over 20 years. I moved to the Hudson Valley in 2005 in search of a better quality of life for my family. At that time, my sister’s Stage IV Breast Cancer, which she had been battling for five years, had spread to her brain. Being the medical professional in the family, I began researching alternative treatments for her and eventually came across medicinal cannabis as a palliative therapy. What I learned astounded me. Components of the cannabis plant are medicinal in nature and cross the blood-brain barrier (the Blood Brain Barrier (BBB) maintains and regulates a constant environment for the brain, separating it from the circulatory system so that it remains protected from potentially harmful chemicals). Although cannabis has been illegal in the United States for the last 70 years, its medical history dates back thousands of years! On that day so many years ago now, I dedicated myself to learning all I could about medicinal cannabis’ ability to alleviate pain and permit dignified end-of-life care. I never looked back.
In my nursing career since then, I have witnessed cannabis’ healing effects first hand. I can say without question that cannabis alleviates pain and suffering caused by so many conditions: cancer, epilepsy, arthritis, inflammation, multiple sclerosis, neuropathy, PTSD, Crohn’s, IBD, diabetes and others we’re still discovering.
For the last five years, I have advocated for safe patient access to medical cannabis and played an instrumental role in helping 23 million people in Connecticut and New York gain access to this medicine. The regulations in New York are, to date, the strictest in the nation, which is a win-win for patients and physicians alike. Cannabis standards for purity, strength, and dosage allow physicians to feel more confident when recommending this standardized medicine to their patients. This confidence, in turn, allows them to better serve their patients.
It is my opinion that we have an obligation to ourselves, to this plant, to our planet, and yes, to humanity to educate people about this amazing plant whose components alleviate patient pain and suffering. Thank goodness laws in the United States are changing, and medicinal cannabis’s time has finally come again.
Through this blog, I hope to share my first-hand experience working with patients of all ages who have benefited from medicinal cannabis. Most of all, I want to educate. From the latest NY regulations through industry advancements and changes to the many benefits of medical cannabis, I want to provide helpful information to those seeking alternative medicine for their children, parents, families, friends and themselves.