Medical Marijuana – an Update

The patient was 88 and active, but his low back disc disease was progressing. “Pain was radiating down his leg and getting worse,” says Dustin Sulak, DO, an integrative medicine physician in Falmouth, ME. The man sought help from Sulak after the opioids prescribed by another doctor weren’t working.  Sulak suggested a regimen of medical marijuana. Soon, he was functioning better, so much so that he rarely required a dose of the opioids and had decided against having a spinal cord stimulator implanted for pain relief, which had been suggested.

“He was still in pain,” Sulak says, but he was able to avoid regular use of opioids, which can be addictive quickly, and could also avoid the implantation procedure. Sulak is realistic about results to expect with medical marijuana, and about the success he’s had with patients.  “The guy is not tap dancing,” he says, but his quality of life and functioning are clearly better.

Medical Marijuana Legality

As of March, 2023, medical marijuana is legal in 37 states as well as the District of Columbia and 4 U.S. territories. Other states are considering medical marijuana legislation. (Details on states with legal recreational marijuana are here.)

States Vs. Federal: Two Views

The interest on the state level has been driven by a steady increase in evidence that medical marijuana—cannabis is the term some scientists prefer—does help for many conditions, either as an adjunct or a substitute for other regimens, according to Paul Armentano, deputy director of NORML (National Organization for the Reform of Marijuana Laws). “We are living in a time where there is an explosion in scientific interest and study specific to the health outcomes of marijuana and medical cannabis in particular,” Armentano says. It’s a challenge to keep up with the science, he says. “There are arguably 10-20 new studies published in peer-reviewed medical literature every day.”

Unfortunately, he says, the narrative about making marijuana legal on a federal level is not keeping pace.

Currently, marijuana is still illegal on a federal level, as it is considered a Schedule I substance under the Controlled Substances Act, treated the same as heroin. In the view of the Drug Enforcement Administration, marijuana has “a high potential for abuse, no currently accepted medical use for treatment in the United States and a lack of accepted safety for use under medical supervision.” While the DEA acknowledges that some states have allowed the use of marijuana for medicinal purposes, the FDA has the authority to approve drugs for medicinal use in the U.S., and to date, the FDA has not approved a marketing application for any marijuana product for any clinical indication. (The FDA has approved these cannabis-derived or related drugs.)

However, in October 2022, President Joe Biden directed the Health & Human Services Secretary Xavier Becerra and Attorney General Merrick Garland to review the scheduling of marijuana. In late March, Becerra tweeted the review is ongoing. (The final decision rests with the DEA.) Will it happen by 4/20? Stay tuned, officials say.

What the Research Says

The strongest evidence for medical marijuana for conditions often seen in adults over age 60, according to Sulak and other experts, are for chronic pain, sleep issues, anxiety and depression.

Here are findings from a host of recent studies:

Chronic pain, anxiety: Medical cannabis reduced chronic pain and coexisting anxiety, this study found, while improving quality of life. Medical cannabis can reduce the need for opioid medication, in turn reducing the risk of overdose.

Sleep issues: Medicinal cannabis improved both sleeping time and quality, researchers report.

Depression: Cannabis can help improve depression symptoms, a recent study found. However, other research suggests a bi-directional relationship, with depression driving marijuana use and marijuana use potentially worsening depression. More research is needed to clarify.

So, Ask Your Doctor?

You could, but Armentano suggested not getting up your hopes that you’d both be on the same page. “When medical professionals are asked the degree they are keeping up with the research or the extent they feel comfortable [talking about medical marijuana], the majority say they lack the information to engage in conversation with their patients.”

One study found that even healthcare providers practicing in states that have had access to medical marijuana for decades were not knowledgeable about the clinical benefits. Most likely never learned about it in medical school, and it can be tough to keep up with the research.

However, the Society of Cannabis Clinicians has an online directory of physicians and other healthcare professionals, including 448 U.S.-based members,  who are knowledgeable about medical marijuana.

Sulak is realistic and straightforward about the benefits of medical marijuana, based on the legions of patients he’s helped since 2009: “At most 10% of patients say cannabis doesn’t work [for their medical issue].” The other 90%, he says, are on a broad spectrum, with benefit ranging from slight to extensive. His site, healer.com, offers cannabis education for healthcare providers.

For a state by state status report on marijuana legality, both medical and recreational, visit ProCon.org.

Your turn

Has medical marijuana helped you? Please share in comments how, and offer any suggestions about how to approach a doctor.

 

Kathleen Doheny is a Los Angeles-based independent journalist, specializing in health, behavior, fitness and lifestyle stories. Besides writing for Senior Planet, she reports for WebMD, Medscape, Endocrine Web, Practical Pain Management, Spine Universe and other sites.  She is a mom, mother-in-law and proud and happy Mimi who likes to hike, jog and shop.

Doheny photo: Shaun Newton

This article offered by Senior Planet and Older Adults Technology Services is for informational purposes only and is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding any medical condition. If you think you may have a medical emergency call 911 immediately.