Author:
Joseph McSherry, MD, Ph.D.
UVM Health and Larner College of Medicine

Quote:
McSherry J. Cannabis as an alternative medicine for the disease [published online May 30, 2019]. Consultant in Neurology.

Doctors are concerned about the effects, side effects, and interactions with allopathic treatments when faced with a patient using or asking to use cannabis as an alternative medicine. The lack of academic coverage in most medical school programs leaves most individuals with no accepted basis for fear of the herbal material and no security that it will not cause harm. The National Institute for Drug Abuse (NIDA) continues to fund research aimed at demonstrating the harm. Research from Israel, Europe and other countries shows benefits. The United States Food and Drug Administration (FDA) is absent.

Cannabis entered Western medicine in 1843 with O’Shaughnessy’s article¹ describing experiments on various animals and doctors in training (pre-institutional review committee). Success has been reported in controlling diseases ranging from childhood epilepsy, cholera and tetanus to alleviating symptoms in patients with rabies. Use dropped after the Federal Bureau of Narcotics and now the Drug Enforcement Agency decided to demonize the plant for non-medical reasons. The lack of modern information leaves physicians with their personal beliefs, formulated in the presence of propaganda and a scientific vacuum.

For a project in a pharmacology course at the University of Vermont, I created a spreadsheet² with 7 cannabinoids and 7 terpenes / terpenoids on the vertical axis and 22 effects reported on the horizontal axis, including anti-inflammatory, analgesic, muscle relaxant, anticonvulsant, anxiolytic, etc. A (+) was added when the chemical and benefit occurred. Such a matrix would be useful if cannabis were reliably tested for these chemicals. If the desired effect is anxiolytic, a chemotype with cannabidiol (CBD), limonene and linalool seems preferable. For anti-inflammatory effects, a chemotype with dronabinol (THC), CBD, cannabigerol (CBG), cannabinol (CBN), pinene, linalool, caryophyllene and myrcene seems optimal.

Medicine has advanced since 1843, and to update O’Shaughnessy’s article we need data. In places where medical cannabis is legal, doctors should demand regulation, including testing not only for THC, heavy metals, and pesticides, but also for the spectrum of other cannabinoids and terpenes / terpenoids. Then a physician, faculty or group could maintain a database or spreadsheet updated by patient reports. Of course, the doctor’s biases will inform what the doctor hears from the patient. The data will be messy. Eventually, different chemical benefit profiles will emerge. Tips like CBD in the morning for pain, anxiety, and inflammation with more THC in the evening for better sleep will be greatly improved with the optimal full chemotype for, say, the anxious overactive pain patient with insomnia.

For now, listening to the patient’s report on symptom relief and side effects, combined with as much detail as possible on the chemotype used, is state of the art. In the future, doctors need to collect data and learn. For anyone who just wants to prove the dangers of cannabis, NIDA has worked on this for over 40 years and got nada.

Joseph McSherry, MD, PhD, is Associate Professor of Neurological Sciences at the University of Vermont Health Network and Larner College of Medicine in Burlington, Vermont.

The references:

1. O’Shaughnessy WB. On preparations of Indian hemp, or gunjah (Cannabis Indica): Their effects on the healthy animal system, and their usefulness in the treatment of tetanus and other convulsive diseases. Prov Med J Retrosp Med Sci. 1843; 5 (123): 363-369. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2490264.
2. Cannabinoid and Terpenoid Profiles McSherry J. 2018. https://bit.ly/2XaZfXg.