Alva Review-Courier -

Cannabis: from criminal to medicinal?

• In rural and small-town Oklahoma, strong in its traditions and in upright living, a new breed dares to stake out new territory in health care

 

Kathleen Lourde

In Cherokee, Home Town Dispensary co-owner Mike Hensley polishes his glass front door before opening the store to customers in the morning.

On a dusty side street in Cherokee under a wide blue Oklahoma sky punctuated by a rusting grain elevator, an old-fashioned brick building stands solid, a survivor of some wrecking ball in days past. But there it still stands, looking strong enough to outlast any storm.

This old building, with its hint of a false front and some interesting brickwork, contains a new participant in one of Oklahoma's newest industries: Home Town Dispensary sells medical cannabis.

LaDonna Hensley, a co-owner of Home Town, also fits the metaphor of having survived storms to come out stronger. Medical cannabis is part of that renewed strength.

She has a number of serious health conditions – enough that at one time she took 50 pills a day, she said. But since medical marijuana was legalized, she said she's been able to reduce that number to just five.

We sit and talk in comfortable chairs under the store's broad plate glass windows that the sunlight streams through, brilliant on the clean white floors, gleaming on the polished glass display cabinets. The store feels light, refreshing. It has a faint scent of cannabis. It looks much more like a health foods store than a head shop.

Hensley and her husband, Mike, opened Home Town on June 6. While they do have a few glass containers of cannabis "flower" (what used to be called "buds"), their main focus is providing a wide variety of cannabis products as possible, to meet the very varied health conditions people need to treat.

"Not everything works the same on everybody," LaDonna said. So Home Town has all kinds of non-smokable products such as hard candies, tinctures and drops to put under your tongue, teas and coffees, oils and lotions, jars of honey made by local bees and infused with cannabis, edibles in a variety of dosage levels, and much more.

"We try to carry a little of everything," she said, "and if someone comes in looking for something we don't have, we'll try to find it for them."

The Hensley's also make sure their products are tested, so that the consumer can see exactly how much THC (the cannabinoid that causes a relaxing or lightly euphoric sensation) or other cannabinoids (that provide health benefits but don't cause an alternation in mood) each product contains. And they're ready with advice as to what might work best for a given person, while also referring them to where they might find more information.

In fact, LaDonna says she tells her customers to do research themselves before they decide what to purchase.

How Do You Know if Cannabis Would Help You?

You'd think your family doctor would be the best place to turn for advice, and many sites – like Harvard University's Harvard Health Blog and Healthline, whose articles are reviewed by MDs, repeatedly tell readers considering using medical cannabis to talk with their doctors first.

But as some health care professionals in northwest Oklahoma told me, few thought Oklahoma would make medical cannabis legal any time soon, if ever. In addition, because cannabis is still illegal at the federal level, many are reluctant to get involved in this in the event the federal Drug Enforcement Agency decides to get involved and revoke licenses or shut down clinics.

Further, northwest Oklahomans voted a resounding "NO" in response to the state question, and so the majority of people in this area most likely would not think well of a local doctor known to recommend cannabis as a treatment to some of their patients.

And further, federal restrictions have prevented cannabis being studied at the same level as pharmaceuticals are, according to Wes Glinsmann, executive director of the Oklahoma State Medical Association.

"That's one of the big problems we're facing," Glinsmann said, "because it's still technically illegal at the federal level, there are serious restrictions on how much testing can be done. So there's not a lot of good medical evidence yet on what medical marijuana can be good for."

So, talking about medical marijuana with your doctor is made even more difficult because doctors don't have access to the high quality medical evidence that they rely on to make good treatment recommendations to their patients.

"Both the state medical association and the American Medical Association have both lobbied to reclassify marijuana out of Schedule I," Glinsmann said, "just so everybody involved has some good information about what conditions it's useful for."

Studies Are Out There

Some studies have been done, Glinsmann said, particularly in the U.K. and in Israel. "To the extent that you can – if this is something you're doing – seek out those sources that are out there," such as some pretty convincing studies indicating a benefit for children with seizures.

The National Academies of Sciences, Engineering and Health (NASEH) gathered more than 1,000 studies on the effect of cannabis, in its various forms, on a long list of health conditions. The organization assessed the quality of the studies and, focusing on the best of them, released a 486-page report that identified conditions with conclusive or significant (as well as moderate, limited, or insufficient) evidence of cannabis' effectiveness in treating them. That report is available online at http://nap.edu/24625.

Cannabis Helps Chronic Non-Acute Pain, Studies Say

The National Academies' research found "conclusive or substantial evidence" that cannabis is effective in treating chronic pain in adults, particularly the kind of chronic pain suffered as we age.

A 2018 report by Australian researchers who analyzed 104 studies on the topic, found that cannabis had a "moderate effect" on improving chronic non-cancer pain.

A small Israeli study last year studying chronic nerve pain, such as sciatica, found that THC may disrupt signals between areas of the brain that process sensory signals and emotions. CBD (another cannabinoid), however, may work differently, according to Canadian researchers. Their study, using rats as test subjects, found that CBD bound to receptors in the brain involved in pain and anxiety (which is a common symptom of chronic pain).

Cannabis, though, may not work as well with acute pain, like sunburn, or for post-surgery pain; in fact, some evidence exists that cannabis may increase sensitivity to acute pain.

A study in this month's Journal of Pain found that 80 percent of 1,321 medical cannabis users reported substituting it for prescription pain medications such as opioids, or for benzodiazepines such as Xanax or Valium. They reported the cannabis had fewer side effects and helped them manage their pain better. Eighty-eight percent said their pain level had improved.

But for people who've become addicted to opiates, the National Academies found insufficient evidence – neither pro nor con – that cannabis eases withdrawal.

Dr. Daniel Clauw, director of the University of Michigan Chronic Pain and Fatigue Research Center, when speaking at a forum on health and cannabis last year, cautioned patients hoping to replace their opioid pain medications with cannabis to avoid the very high-THC strains of cannabis products. "These are not at all the strains that people should be using for most of the medicinal effects of marijuana, especially the analgesic or pain-relieving effects," he said.

Skin Diseases May Benefit from Cannabis Use

Studies indicate that cannabis' anti-inflammatory properties inhibit the over-production of skin cells that occurs with psoriasis.

A study from a U.K. medical school showed that cannabis inhibits skin cell proliferation, and so could have "therapeutic value in the treatment of psoriasis." Psoriasis is an inflammatory disease in which skin cells multiply excessively.

These findings were supported by another study published in the British Journal of Pharmacology, which found that both CBD and THC cannabinoids directly reduced keratin 10 mRNA, which is the genetic spot at which mutations occur in keratin-producing skin cells. "These findings show that phytocannabinoids (plant-derived cannabinoids) ... can control cell proliferation and differentiation," which is when a cell turns into a different kind of cell – mutates. "This indicates that they – especially cannabidiol (CBD) – have the potential to be lead compounds for the development of novel therapeutics for skin diseases," the authors wrote.

Some Evidence Cannabis May Be Good for Diabetics

Peter Grinspoon, MD, of Harvard Medical School's Harvard Health Blog writes "There is some interesting evidence" that cannabis can be beneficial for people diagnosed with both types 1 and 2 of diabetes, especially for those who suffer complications.

An article on the topic by Healthline reported that Harvard epidemiologists, along with researchers from the University of Nebraska's College of Medicine and Beth Israel Deaconess Medical Center have found that cannabis – which is notorious for giving users the munchies – can in fact help moderate blood sugar levels, waist size, and body mass index by decreasing insulin resistance. Their research, which studied cannabis effects on nearly 5,000 diabetes patients, was published in the 2013 American Journal of Medicine.

Can You Overdose On Cannabis?

The popular consensus seems to be that you can't overdose on cannabis. It may be true that few, if any, cases of death from a cannabis overdose have been recorded, but according to the National Academies report (see main story) there is "moderate evidence" indicating overusing cannabis increases the risk of overdose injuries, such as respiratory distress, among pediatric populations. However, the study found nothing to indicate – or refute – the possibility that cannabis overdose could result in death.

Other Health Conditions

The National Academies report found conclusive or substantial evidence of effectiveness that cannabis use can

• control chemotherapy-induced nausea and vomiting.

• improve self-reported multiple sclerosis spasticity symptoms

They found moderate evidence of effectiveness that cannabis use can:

• improve sleep disorders associated with obstructive sleep apnea syndrome, fibromyalgia, chronic pain, and multiple sclerosis, and

• improve cognitive performance among individuals with psychotic disorders and a history of cannabis use.

Kathleen Lourde

Some of Home Town's many non-smoking cannabis products.

However, they also found substantial evidence that smoking cannabis while pregnant results in a lower birth weight in the baby.

Much More Research Needed

These findings are hopeful for some conditions, and what research has been done has indicated that a great many more conditions could possibly be helped by cannabis, once it's better understood and its properties better tailored to address specific medical issues.

It's a new world out there, said Glinsmann. Be sure to include your doctor in this journey into unfamiliar territory, he emphasized.

"The big thing for doctors is to have that conversation with your patients and really try," he said. "Like with any other medical issue, the real key is the physician-patient relationship and having a dialog about what works and what doesn't."

 

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