CMSC: Medical Marijuana, Part 3
Dr. Allen Bowling is very familiar with the use of medical marijuana for multiple sclerosis, and is considered an expert in the field. He has been practicing integrative medicine for 20+ years and his neurology practice is located in Colorado, one of the first states that made marijuana legal for both medical and recreational use. Although he has discussions often with his patients about use of cannabis for their symptoms, he believes “to me, this is more my personal opinion but it is kind of an 1800’s approach to start with a plant.”
A complex herbal product
There are two primary parts to cannabis that are the focus of use in MS – tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the element in marijuana that will give the user a high feeling, while CBD is non-psychoactive. CBD is used in the research grade cannabis. In all, said Dr. Bowling, there are over 100 different cannabinoids in cannabis, making it a complex herbal product to study. He goes on to add that enough is known about the ingredients in cannabis that “THC and CBD can be put in set amounts in capsules” and not have to ingest or smoke marijuana. Cannabis has at least 500 different chemical compounds and 104 of them are cannabinoids, and those all have pharmacological effects. Each of those 104 cannabinoids have 5 or ten effects, so you can see how complex the issue is,” said Dr. Bowling.
Lack of oversight
Dr. Bowling has concerns that the people who dispense medical marijuana have little or no medical training and there is no oversight on the quality or purity of the products. Of the 44 states where cannabis has been legalized, none have experience with inspecting cannabis products and lack the infrastructure (money and personnel) to do inspections. “The problem known for many decades is with any herbal products you are going to get a lot of contaminants. I don’t think there is any herbal product where we fully understand the beneficial effects as well as the detrimental effects of altering these (cannabis) chemicals,” said Dr. Bowling.
I asked if perhaps it would be better if plants were grown by the person using the cannabis, and Dr. Bowling said “it has the same complexity to grow your own. The plants still have fungus. You have questions as to when do you harvest. What are the soil conditions needed and are pesticides used? We know how to do this in a different way” by manufacturing a clinical grade of THC and CBD products, he added.
Current recommendations and future study
Dr. Bowling also discussed safety concerns and said the current recommendation is to not drive within 8 hours of smoking or ingesting cannabis. The exact time cannabis remains in the system would be variable, depending on how it is taken and the strength of the product. The other concern he mentions is smoking having an impact on the brain and it has been shown that smoking is harmful especially to people with MS. How smoking cannabis compares to smoking tobacco and the impact on the brain has not been studied. All of these are points Dr. Bowling makes in questioning if cannabis is the correct way for people to control MS symptoms, but he remains open to the possibility and further discussion.
Dr. Bowling said there is a need for controlled studies and ‘the obvious study to do would be to study falls in users versus non-users of cannabis in people with MS. It’s murky how this all plays out and we may find even though it is the THC that gets you high, it may be the cannabidiols that have good therapeutic effect for MS.”