The Insider’s Guide to Healthy Hawaii: What You Need to Know About the Medical Cannabis Program

The Insider’s Guide to Healthy Hawaii: What You Need to Know About the Medical Cannabis Program

Are proponents or detractors just blowing smoke?

Depending on whom you talk to, medical cannabis (also known as marijuana) is either a panacea for everything from cancer, to chronic pain, to epilepsy or it’s a dangerous and illegal drug with no place in medicine.

A study published in July 2016 in the journal Health Affairs found that Medicare Part D spending decreased by approximately $165.2 million between 2010 and 2013 in the 17 states (plus Washington, DC) that allowed for medical cannabis in 2013. The researchers found that prescriptions for drugs used to treat anxiety, depression, nausea, pain, psychosis, seizures and sleep disorders also declined in states with medical cannabis laws. Another 2014 study published in JAMA Internal Medicine found a nearly 25 percent reduction in prescription drug overdose death in states with medical marijuana laws.

Can cannabis really treat so many conditions? Read on to find out more about what medical cannabis can—and can’t—do.

Marijuana’s murky legalities 
As of October 2018, 31 states, including Hawaii, allow medical marijuana and another 15 allow limited access to cannabis derivatives. Additionally, nine states and the District of Colombia allow for recreational use of cannabis. Federally, cannabis is classified as a Schedule I drug under the Controlled Substances Act, along with drugs such as mescaline and MDMA (ecstasy). That means the federal government has found it to have a high potential for abuse, has no medical use and is unsafe. Cannabis’s status as a Schedule I drug makes getting funding for research into its medical benefits difficult, says Keith Roach, MD, Sharecare’s chief medical officer.

“I think it should be reclassified because there’s potential for marijuana to be used in other conditions,” says Dr. Roach. “Saying it has no medical validity is a mistake. Let’s study it.” Roach says the future of medical marijuana research “depends entirely on the federal government and what they choose to do. Right now, it’s very difficult for researchers to do any kind of good research.”

Elements of cannabis
There are a number of active compounds, called cannabinoids, found in marijuana. The main compound is called delta-9-tetrahydrocannabinol (THC) and is responsible for the “high” that cannabis causes.

Another compound some researchers believe has medical uses is called cannabidiol, CBD for short, which does not have psychoactive properties. In November 2017, the World Health Organization (WHO) published a report stating that CBD in its pure form is safe, with little potential for substance abuse and no evidence of harm to public health.

According to the report, not only is CBD considered safe, but it has potential health benefits, too. It can be used to treat epilepsy in both children and adults, and may benefit those with Alzheimer’s disease, Parkinson’s disease and some cancers. The federal government still classifies CBD as a Schedule 1 controlled substance, restricting its use and research.

The effectiveness of certain compounds found in cannabis are no longer in question, says Roach. “But it’s still controversial because marijuana itself has a lot of different substances in it. We try to isolate one substance and say ‘This is what’s important,’ when it may be several things acting in concert. It’s very difficult to study.”

What cannabis can (and can’t) help
According to Roach, a cannabis derivative—a form of THC called dronabinol—has been used to treat chemotherapy-induced nausea for decades and has the added benefit of often stimulating appetite.

Roach believes medical cannabis also has the potential to treat refractory epilepsy, or epilepsy that hasn’t responded to other drugs. A 2012 review of studies could not find reliable data on whether cannabis helps with epilepsy; however, a study presented at the American Academy of Neurology’s 2015 meeting that had no placebo control, found seizures decreased by an average of 54 percent in people who took CBD oil for 12 weeks.

Cancer, unfortunately, can’t be helped by cannabis. “People still ask me all the time if marijuana helps with cancer,” says Roach. “It really doesn’t.” The authors of a 2016 review of literature published in JAMA Oncology suggest that marijuana can help with chemotherapy-induced nausea and vomiting, pain from cancer and may slow the growth of tumors. However, they note that much of the research is outdated and based on either animal or small human studies, and that more research is needed.

The American Academy of Neurology has stated that cannabis can ease some symptoms of multiple sclerosis. An October of 2018 meta-analysis published in JAMA found that cannabinoids appear to be safe for use in patients with MS, though their efficacy in treating bladder dysfunction, pain and spasticity are limited. Other conditions that have been studied but deemed inconclusive include schizophrenia and bipolar disorder.

Responsible use
If you’re using cannabis for medical purposes, you need to obtain it through the proper channels. In the past, black market marijuana has been laced with other substances such as PCP. “You’re certainly better off getting something sold out in the open that has some guarantee of what it is rather than buying it on the street,” says Roach.

Cannabis impairs driving, according to the National Institute on Drug Abuse, so if you’re taking medical marijuana it’s best not to get behind the wheel. It is also particularly detrimental to teenagers’ developing brains, impairing thinking and memory for days after use.

Roach also says that more accessible cannabis may reduce instances of alcohol abuse. “It’s not clear yet, but there’s the potential that someone can take a few hits rather than drink a six pack,” he says. “In my opinion, harm from alcohol is worse.”

Hawaii’s medical cannabis program
The State of Hawaii, Department of Health administers two sister programs that handle medical cannabis: The Medical Cannabis Registry Program and The Medical Cannabis Dispensary Program. To participate, individuals with a debilitating medical condition, such as cancer, glaucoma or lupus, must have their physicians certify their diagnosis to the Medical Cannabis Registry Program. From there, individuals will complete an application to receive a 329 Registration Card. The Medical Cannabis Dispensary Program regulates dispensaries to ensure registered participants have access to safe products that are compliant with Hawaii laws.

Medically reviewed in November 2018.

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