The findings: “Smoking both tobacco and marijuana synergistically increased the risk of respiratory symptoms and COPD. Smoking only marijuana was not associated with an increased risk of respiratory symptoms or COPD.”  (Tan, et al, Canadian Medical Association Journal, 4/14/09; 180)

Despite these findings, most physicians still recommend that medical marijuana patients do not smoke their medication and instead use vaporizers, edibles, and/or tinctures.  It is clear from this study that the damage that smoking tobacco can cause is significant (which we all knew before anyway!) and it can be worsened if you also smoke marijuana.

Many MS patients are using medical marijuana as they have found that it relieves the spasticity, calms tremors, and helps with the depression and anxiety of being ill.  There are a number of scientific studies  that show that marijuana helps to reduce MS symptoms.  One study looked at 167 patients who reported less pain, less muscle spasms, and less bladder incontinence with use of cannabis.  These patients reported that they were able to control symptoms with the same dose of cannabis for a mean duration of 434 days without having to increase their dose. (Wade, Multiple Sclerosis 10:425-33, 2004) Researchers suggest that this study demonstrates that marijuana does not lead to increased tolerance requiring increased doses of medication, unlike the conventional medications used to treat MS.

Many MS patients have found that medical marijuana has improved their quality of life.  They also have found little to no side effects, no physical addiction, and overall less need for more toxic medications.  Most MS patients either use edible cannabis products, vaporizers, or tinctures so that they are not having any problems with the side effects from smoking the medication.

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.

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.

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.

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.

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 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.”