Into the Weeds: What You Need to Know About Medical Marijuana & CRC - Part I

While the use of marijuana has been around for thousands of years, it has only become legal in 24 states and the District of Columbia within recent history. As more states continue to approve marijuana for medical purposes, it’s important to separate the myths from the facts surrounding this drug.

This blog is the first in the series.

A Brief History

While the use of medical marijuana dates back at least 3,000 years, it wasn’t introduced into Western medicine until the 1840s. Here’s a brief timeline of the history of medical marijuana in the United States:

• 1937 – The U.S. Treasury Department institutes the Marihuana Tax Act
  • The act imposes a $1/ounce levy on the medical use and a $100/ounce levy for recreational use of marijuana
  • The new costs and processes discourages physicians from prescribing marijuana to their patients

The American Medical Association opposes the act citing, “Objective evidence that cannabis was harmful was lacking, and that passage of the act would impede further research into its medicinal worth” (NCI Cannabis and Cannabinoids for Health Professionals).

• 1951 - Congress passes an act that classifies cannabis with narcotic drugs
• 1970 - With the passage of the Controlled Substance Act, marijuana is classified as a Schedule I narcotic, indicating that marijuana does not have any medical use and has a high potential for abuse
  • Other  schedule I drugs include LSD, heroin and mescaline
• 1978 - Under the newly established Compassionate Use Investigational New Drug program,  the federal government distributes cannabis on a case-by-case basis (Cannabis is still considered a Schedule I narcotic, and it is against federal law to sell, buy, grow or use marijuana)
• 1996 – California becomes the first state to legalize medical marijuana
  • Within the next ten years, twelve more states follow suit
• 2016 – As of the original date of this blog’s publishing, 24 states and the District of Columbia had legalized medical marijuana

“As more states approve marijuana use for medical indications, physicians will be asked by their patients for more information regarding the risks and benefits of use” (JAMA Oncology, published online March 17, 2016).

What is Medical Marijuana?

The term medical marijuana refers to treating a disease or its symptoms with the whole unprocessed marijuana plant or its basic extracts.

There are more than 545 chemical compounds in marijuana; 104 of them are the cannabinoids, which are the active ingredients in cannabis (cannabis is how marijuana is referred to when it is in plant form). The ingredients between different plants and species vary—the two cannabinoids that have been studied are delta-9 tetrahydrocannabinol or THC, and canabindiol, or CBD. THC is probably best known for being the psychoactive ingredient in marijuana, while CBD is non-psychoactive. In other words, CBD can’t get you high.

While disappointing to recreational users, this unique feature of CBD is what makes it so appealing as a medicine.

Medical Marijuana: Top Considerations

1. Impact on treatment: Regardless of whether or not marijuana is legal in your state, it is important to tell your doctor if and how you use marijuana, either recreationally or medically, and the frequency of your use. Marijuana interferes with the metabolism of many drugs, including chemotherapeutic agents and herbal supplements. Marijuana is metabolized in the liver as are many chemotherapy agents.
2. Side effects: Evaluate whether the side effects and adverse effects of medical marijuana outweigh the perceived benefits. Medical marijuana, along with many FDA-approved drugs and alcohol, all have adverse effects. It is important to weigh the pros and cons.
3. Not a cure-all: If you choose to use medical marijuana for chemotherapy-induced nausea and vomiting, it is best to use it along with standard treatments.
4. False hope: Cannabis in any form, including oil, does not cure cancer. Additionally, there is no evidence that it prevents cancer. The oil can actually be toxic due to the high concentrations of chemicals. If you are going to use medical marijuana, do not think of it as a cure-all.
5. No quality control: Just because it is natural does not mean it is safe. Medical marijuana is not guaranteed to have the compounds that may be specified because there is no regulatory body monitoring medical marijuana manufacturing.
6. Variance by state: The list of acceptable conditions and the amount of medical marijuana a person is allowed to have and/or grow depends on the state in which you live. Make sure you know your state’s laws.
7. Addiction: It's better not to use medical marijuana if you have a history of substance abuse. Approximately nine percent of adults who use marijuana become addicted.

Medical Marijuana & Federal Law: Why Your Doctor May Not Prescribe It

Although the medical use of cannabis (the plant) is legal in several states and the District of Columbia, it is still against federal law for doctors to prescribe it. That means, legally speaking, your doctor cannot write you a prescription for cannabis.

Instead, your doctor can write an endorsement, attestation or certification of the possible efficacy of medical marijuana in treating your particular condition (Cannabis and Cannabinoid Research, Volume 1.1 2016 pg. 42).

However, not all physicians will be comfortable with signing a certificate. In many states, there are certain physicians available to review your individual case for a medical marijuana card. To apply for a card, the attestation of a doctor is required. Each state will charge a different fee for the card.

Information on legal limits and state requirements can be found here. (Be sure to scroll down the page for full information.)

We also need to discuss some doctors’ “don’t ask, don’t tell” attitude toward medical marijuana. With medical options approved by the Food and Drug Administration (FDA) being available, and nearly half of all states legalizing medical marijuana, this doesn’t help patients navigate their integrated or complementary medicine options with confidence. It is best to have a provider who is comfortable and informed, because there may be an interaction with other treatment options you are pursuing.

Want More Information? 

Register for our upcoming Into the Weeds webinar on Wednesday, May 18!

Be on the lookout for Part 2 of our Into the Weeds blog series tomorrow where we’ll look at the myths and misconceptions surrounding medical marijuana.

The Colon Cancer Alliance does not endorse or recommend any specific treatment or screening method for colorectal cancer; rather we serve as a source of scientifically accurate medical information to help empower patients and their caregivers to make informed decisions in consultation with their health professionals.