Marijuana is not physically addictive, despite what many anti-marijuana people want us to believe.  Marijuana users can use it regularly, even multiple times daily, without any problem giving it up.

A very small minority of people (heavy chronic users) who use marijuana can find that they have developed a psychological addiction. This can be as mild as some difficulty sleeping, slight irritability, and moodiness.  Since most people who use marijuana are not heavy chronic users, this is not common at all.  If you are concerned about any possibility of psychological addiction it is very easily avoided by taking time off from regular use.  For instance, if you use it every day, you should take one day off per week or take one week off every three months.  Even without taking this time off from use, the majority of people using marijuana report that they have no difficulty stopping usage.

Marijuana has the lowest risk of dependence and withdrawal potential if you compare it to other substances, such as alcohol, opiates (like Vicodin), caffeine, and other psychoactive drugs. Many of the anti-depressants (currently being prescribed abundantly) have very severe physical withdrawal symptoms which most patients are not warned about.

People who are addiction-prone can have trouble controlling their use of marijuana.  This is an issue for about 10% of users (this number comes from looking at recreational users, not those using marijuana for medicinal purposes).  A person who is considered a marijuana abuser is one who uses it to excess and finds that the use interferes with normal every day activities, like maintaining personal hygiene, going to work, having normal interpersonal relationships.  Persons who find that they cannot control their use may find abstinence is preferred.

Most medical marijuana patients find that they cannot function on the medications that they have been prescribed for pain, insomnia, depression, etc. and find that they function very well on medical marijuana.  It can be said that this ability to maintain a normal life without dependence and addiction is what is driving many patients to choose medical marijuana as their preferred medication.

Additionally, another compelling reason that most medical marijuana patients have switched from opiates (like Vicodin), antidepressants, or sleeping pills is exactly for the reason that marijuana is not physically addictive and can be easily stopped.  Some MMEC patients report that they can use marijuana for a week for a back pain flare-up, then easily stop until the next episode.  Some patients report to us that they only use it on the nights that they cannot sleep, maybe 2 -3 times per week.  If you find that you are concerned about the addictive potential of the medications that you are taking, medical marijuana may be the answer for you.  It treats a whole slew of symptoms and for the majority of those using it, no issues with dependence and addiction.  It is a much smarter and more natural choice than many of the pharmaceuticals being pushed prescribed by doctors.  And again, with vaporizers, edibles and tinctures readily available, there is no need to smoke this medication – many patients are finding the other delivery methods quite effective.

Clinical depression is a very serious illness.  People with this condition have long-term, often debilitating feelings of sadness and low self-esteem.  There can be suicidal thoughts.  Depression makes ordinary tasks such as going to work, cooking, cleaning, even personal hygiene, very difficult.

Once the symptoms have been evaluated by a doctor, prescription medications are routinely prescribed.  There are many types of anti-depressant medications:  tricyclic antidepressants, MAOs(monoamine oxidase inhibitors), SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin-norepinephrine reuptake inhibitors) and a few others.

A very recent analysis published in the Journal of the American Medical Association (Jan 2010) stated that antidepressants are only effective for those with severe depression.  Those patients with mild to moderate depression had no benefits with prescribed medications.  But these medications are prescribed with alarming frequency to those patients who may not benefit.  Pharmaceutical companies profited $9.6 billion in 2008 on antidepressants alone.  Is it about your health and well-being or about money?

To add insult to injury, the side effects from antidepressants can be serious and unacceptable for many people.  Sometimes the side effects are worse than the symptoms of depression. Here are some of the side effects for each type of medication:

• Tricyclics:  blurred vision, constipation, difficulty urinating,worsening of glaucoma, impaired thinking, fatigue, high blood pressure
• MAO inhibitors: weakness, dizziness, headaches, tremors, deadly if mixed with certain other drugs
• SSRIs:  loss of appetite, weight loss, insomnia, nausea, nervousness, insomnia, headache, sexual problems
• SNRIs: loss of appetite, weight loss, insomnia, fatigue, headache, sexual problems, liver failure, high blood pressure

With many of these medications, there is also what is called “discontinuation syndrome” – otherwise known to regular people as bad withdrawal!  You cannot just stop most of these types of medications as you can become very ill.  Patients who choose to stop these types of medications find that they must taper the dose with a physician’s supervision or they are unable to stop the medication.

Another very concerning issue regarding these medications is that there is an increased risk of suicide, especially in younger patients.  The jury is still out on this but Great Britain has banned use of antidepressants in those younger than 18, and the FDA now requires all antidepressants to carry a warning that states that they carry an increased risk of suicidal thoughts and behaviors.  Scary!

Medical cannabis has been used for centuries to treat depression.  An English clergyman named Robert Burton stated in 1621 that cannabis was helpful to treat depression.  It was used for depression over 400 years ago in India.  In the 17th century it was prescribed by physicians in England to treat depression.  In 1890, a British physician named J.R. Reynolds reviewed the previous 30 years of use of cannabis and determined that cannabis was helpful for depression and other illnesses (asthma, certain forms of epilepsy, nerve pain, painful menstrual cramps, migraines and tics).

More recently, patient surveys show that cannabis is being used by many people to treat depression with good results. Many studies also show that patients who have depression as a result of another debilitating disease, such as cancer, HIV, multiple sclerosis or chronic pain, report less depression symptoms with the use of cannabis.

Researchers have found that low doses of cannabis increased serotonin levels in the brain, which helps to improve mood.  Higher doses of cannabis tended to increase symptoms of depression because the serotonin levels were depleted.  There are many conflicting scientific studies about the use of cannabis for depression.  Currently medical cannabis is being used by many people for depression , but patients must be careful to use low to moderate doses so as not to cause worsening of symptoms.  If patients find that symptoms are worsening, cannabis usage should be curtailed.  Chronic heavy use of cannabis is not recommended, but in low doses patients may find the relief they need without the unwanted side effects from conventionally prescribed medicines.  Other treatments in combination with medical cannabis may help to improve results, such as therapy or counseling, exercise, and a healthy diet with natural foods.

One of the benefits of being a physician-approved medical marijuana patient is that you can choose which medication strain to use based on your illness and the goal of your treatment.  For example, patients with depression often find that sativa strains alleviate the symptoms that cause inactivity and sadness, while patients with anxiety and depression may find a hybrid strain to better suit their symptoms.  Patients who are using medical marijuana for sleep disorders find that the indica strains are reliable for excellent sustained sleep with no “hangover” the next day.

As always we encourage NOT smoking the plant as the toxins in the smoke can damage your lungs.  But there are many other ways to use the medication (vaporizers, edibles, tinctures) so that you can avoid the smoke-related side effects.  And of course talking with a knowledgeable physician at MMEC can help you decide if this medication would be helpful for your medical condition.

Patients with spinal cord injuries with paralysis of their legs and/or arms, often have severe chronic pain and muscle spasms. The conventional treatment for these symptoms is synthetic medications, including high dose opiates, tranquilizers, and sedatives.  These medication have significant negative side effects and can even be fatal if mixed and taken incorrectly.  Many of these types of patients have already found tremendous relief with medical cannabis use and find that they do not need prescription medications.  There have been a number of scientific studies that found THC (the main compound in cannabis) to be effective in reducing spasticity (muscle spasms).  In a survey conducted at the Veterans Administration hospitals, 88% of patients surveyed with spinal cord injuries stated that they had relief of spasticity with cannabis use.   There are many studies that have shown that patients with chronic severe pain get excellent relief with cannabis.  To sum up, those patients who suffer with paraplegia or quadriplegia often find pain reduction/elimination and relaxation of spasticity with medical cannabis use, all without the negative and unwanted side effects of conventional medications.  Remember it is all about daily quality of life.

The first time use of cannabis is unique.  Although no one yet understands why, many people don’t feel anything the first time they use cannabis.  They do feel it the second or third time. At  times the first time users are noted by the people around them to be acting differently but they themselves don’t notice it.  It has been suggested that the first time user can up his or her dose to feel the effects but this is not recommended as this greatly increases the risk of an unpleasant experience.  If you have not used cannabis before, you should proceed carefully and stick to the concept of “less is more”.  If you did not feel any effects with the first time use, you will be sure to feel it the second or third time.

Post-traumatic stress disorder (PTSD) is a type of anxiety disorder that’s triggered by a traumatic event that involved the threat of injury or death. Post-traumatic stress disorder can develop after someone experiences or witnesses an event that causes intense fear, helplessness or horror.

Many people who are involved in traumatic events have a brief period of difficulty adjusting and coping, after which they improve and get better. In some cases, though, the symptoms can get worse or last for months or even years. Symptoms can sometimes interfere with normal functioning, sleeping, and interpersonal relationships.  This is often when the diagnosis of PTSD is made.

Three groups of symptoms are required in order to make the diagnosis of PTSD:  (1) recurring re-experiencing of the traumatic event (troublesome memories, flashbacks, nightmares); (2) avoidance to the point of having phobias of places, people, and experiences that are reminders of the traumatic event and (3) chronic physical signs of hyperarousal, such as insomnia, trouble concentrating, irritability, anger, blackouts, and difficulty remembering things.  PTSD sufferers often have emotional numbing that manifests as difficulty enjoying activities that they previously enjoyed, inability to look forward to future plans, and emotional distancing from loved ones.

Conventional treatment for PTSD includes psychotherapy, learning coping skills, and family counseling.  Medications such as anti-depressants, mood stabilizers, sleep aids, and anti-anxiety medicines are often prescribed.  Some patients find relief with these treatments but it is well known in the medical community that PTSD is difficult to treat.

Cannabis has been used by many PTSD sufferers with good results, especially for insomnia and anxiety.  Cannabis can give PTSD patients a sense of well-being and serenity, and it allows them to continue to function with little to no adverse side effects.  There are a number of researchers currently exploring the science behind the use of  cannabis for treatment of PTSD and the results are promising.  For now, PTSD patients that live in states where medical use of cannabis is legal can use it to help decrease the debilitating symptoms of their illness.

Tourette’s Syndrome (TS) is a complex neuropsychiatric disorder that is characterized by involuntary tics.  The cause of this disorder is unknown.  Some patients with TS have small tics and others have debilitating tics.  It is estimated that there are 100,000 Americans with TS.  There is no known cure for TS but it is reported to improve with age.

A number of studies since 1999 have shown that TS patients have an improvement in tics and in other associated behaviors (such as obsessive-compulsive behaviors) with use of THC, the main natural medicinal compound in cannabis, and no cognitive impairment was noted.

In 2003, the previous findings were confirmed with another well-designed study that was published in the Journal of Clinical Psychiatry.  In this study, TS patients received either THC or placebo for six weeks and scored the level of daily tics.  Patients who were receiving THC had significant reduction of the tics and suffered no detrimental effects on learning, recall, or verbal memory.  Researchers concluded that for adult TS patients, “Therapy with delta-9-THC should be tried…”.  For those patients who have not found relief from symptoms with conventional therapy, who have adverse side effects from current treatment, or who prefer a natural treatment, medical cannabis is a viable  and reasonable alternative.

Sleep apnea is a medical condition characterized by frequent interruptions in breathing of up to 10 second or more during sleep.  There are three types of sleep apnea:  obstructive, central and mixed.  Obstructive sleep apnea is the most common type and is cased by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep.  This type of sleep apnea is associated with obesity.  With central sleep apnea, the airway is open, not blocked, but the brain fails to tell the muscles to breathe.  Mixed sleep apnea is when a person suffers from both obstructive and central sleep apnea.

With each apnea episode, the brain usually arouses the person with sleep apnea in order for them to start breathing again.  But this type of pattern results in disrupted sleep that is of poor quality.

Sleep apnea is estimated to occur in about 4% of men and 2% of women between the ages of 30 and 60.  The condition is associated with other disorders such as chronic headaches, high blood pressure, irregular heartbeat, heart attacks, strokes, and fatigue.

Doctors diagnose sleep apnea based on medical and family histories, a physical exam, and results from tests called sleep studies.  Usually, your primary care doctor evaluates your symptoms first. He or she then decides whether you need to see a sleep specialist.  Conventional therapy includes lifestyle changes (avoiding alcohol, losing weight, changing sleep position, quitting tobacco use), use of a mouthpiece that keeps the airway open during sleep, use of a positive airway pressure machine that one wears during sleep (CPAP), and sometimes surgery to make the airway larger or remove tonsils.

In the June issue of the American Academy of Sleep Medicine journal, scientists at the University of Illinois Department of Medicine reported that sleep apnea in rats that received cannabinoids (the natural chemicals in cannabis) was suppressed. Doses of delta-9-THC and oleamide stabilized breathing during sleep and blocked serotonin-induced worsening of the sleep apnea.  Many patients who have used medical cannabis report improved sleep quality and less fatigue the following day.  It is not known if the problems associated with sleep apnea (such as high blood pressure, heart attacks, irregular heartbeats, etc.) are affected by cannabis use and further studies are warranted to examine these issues.

i1] Investigators reported that doses of delta-9-THC and the endocannabinoid oleamide each stabilized respiration during sleep, and blocked serotonin-induced exacerbation of sleep apnea in a statistically significant manner. No follow up investigations have taken place assessing the use of cannabinoids to treat this indication. However, several recent preclinical and clinical trials have reported on the use of THC, natural cannabis extracts, and endocannabinoids to induce sleep[2,3] and/or improve sleep quality.

The big question about marijuana smoke has always been, “Will it cause cancer?”  A review of the scientific literature still does not give a definitive answer but it appears that a leading and well known pulmonologist (lung specialist) from UCLA has found that marijuana is unlikely to cause cancer.  He has also determined that COPD (chronic obstructive pulmonary disease) is unlikely as well.  Dr. Donald Tashkin, Emeritus Professor of Medicine and Medical Director of the Pulmonary Function Laboratory at the David Geffen School of Medicine at UCLA, has been studying the effects of marijuana smoke since the 1970’s.  He was the lead investigator on the initial studies that identified the toxic components in marijuana smoke.  He also reported the  the studies that showed that there is damage from the smoke to the cells that line the upper airways of the lungs.  His findings have also found that marijuana smokers are more likely than non-smokers to have cough, sputum production, and wheezing.

The National Institute on Drug Abuse gave Dr. Tashkin a grant in 2002 to study if heavy, long-term marijuana smoking increases the risk of lung and upper airway cancers.  Dr. Tashkin and his associated looked at 2,252 patients, about half of which had cancer and half did not.  The patients were matched for age, gender, and neighborhood.  Marijuana use was measured in “joint years” which means the number of years that the patient had been smoking times the number of joints per day.

The results of this study showed that increased marijuana use did not result in higher rates of lung or throat cancer, but that the use of tobacco increased the risk of cancer.  Tobacco smokers who also smoked marijuana were at slightly lower risk of getting lung cancer than tobacco-only smokers.  Although the National Institute on Drug Abuse chose not to publish the results of this study, It was published in the October 2006 issue of the medical journal Cancer Epidemiology Biomarkers & Prevention.

There was a study out of New Zealand that got more attention that Dr. Tashkin’s study even though it only looked at a total of 79 patients, of which only 21 were cannabis users.  This study reported that heavy marijuana users (14 out of the 21 included in the study) had an increased risk of cancer; Dr. Tashkin himself stated that “one has to very cautious interpreting the results due to the very small number of cases.”

A report published in the British Columbia Mental Health and Addictions Journal (Canada) stated that tobacco-related health costs are over $800 per user, alcohol-related costs are about $165 per user and cannabis-related health costs are about $20 per user.

The review, authored by researchers from the Centre for Addictions Research of British Columbia at the University of Victoria and the Canadian Centre on Substance Abuse at the University of Ottawa, stated: “Alcohol is used by a very large number of people with the vast majority of these using in low- or moderate-risk ways. Conversely, cannabis and tobacco are used by far fewer people. The majority of cannabis use is low- and moderate-risk, however, while the majority of tobacco is high-risk.”

In the conclusion of the study, the authors stated:  “The harms, risks and social costs of alcohol, cannabis and tobacco vary greatly. A lot has to do with how the substances are handled legally. Alcohol and tobacco are legal substances, which explains their low enforcement costs relative to cannabis. On the other hand, the health costs per user of tobacco and alcohol are much higher than for cannabis. This may indicate that cannabis use involves fewer health risks than alcohol or tobacco.”

The author conclude further: “These variations in risk, harms and cost need to be taken into account as we think about further efforts to deal with the use of these three substances. … Efforts to reduce social costs related to cannabis, for example, will likely involve shifting its legal status by decriminalizing casual use, to reduce the high enforcement costs. Such a shift may be warranted given the apparent lower health risk associated with most cannabis use.”

You can read the report here: http: //www.heretohelp.bc.ca/publications/visions (page down to Cannabis for the pdf copy of the Journal)

The above information was posted on the NORML web site today as well (National Organization for the Reform of Marijuana Laws).  Check them out at www.NORML.org.

Fibromyalgia is a chronic condition characterized by diffuse pain in the muscles, ligaments and tendons, with associated fatigue and multiple tender points (places on the body where slight touch causes pain).  Fibromyalgia occurs in about 2% of the US population and women are much more likely to develop this disease.  Often there is a triggering illness or emotional trauma, but sometimes no cause can be identified.

The pain associated with fibromyalgia is described as a constant dull ache, typically arising from muscles. Patients also suffer with fatigue and can have associated sleep disorders.  Patients with fibromyalgia often have other co-existing medical problems, such as Chronic Fatigue Syndrome, Lupus, Depression, IBS, PTSD, and Rheumatoid Arthritis.

Fibromyalgia isn’t progressive and generally doesn’t lead to other conditions or diseases. But patients suffer greatly with pain and this can lead to anxiety, depression and lack of sleep. These problems can then interfere with the ability to function at home or on the job, and maintaining close family or personal relationships can become difficult. Patients often end up on many medications with adverse side effects and become even more frustrated and unhappy.

Medical marijuana is being used by many patients for pain relief, improvement of mood, less anxiety, and especially for better sleep.  Marijuana is known to help with many of the symptoms of fibromyalgia without the adverse side effects of the strong pharmaceutical medications normally prescribed for this condition.  Many patients state that just the sustained restful sleep that can be had on a regular basis helps tremendously with the pain, frustration, and anxiety associated with fibromyalgia.  Since marijuana is generally known to be safe and has minimal toxic side effects (especially if taken with a vaporizer, edibles or tinctures), fibromyalgia sufferers find that its use has at least some benefit to help them get through daily life with this difficult condition.