By Kirsten Velasco
For those who have explored cannabis history and science, it’s unfathomable how it’s still federally illegal and mostly unknown as medicine to healthcare professionals.
By scheduling cannabis as having the highest abuse and dependence potential with no medicinal value, the DEA stymied professional medical consideration or research.
Along with a very effective propaganda campaign in the 1970s, most healthcare professionals and laymen alike, accept the DEA’s classification and the stigma: cannabis aka marijuana is notorious as a mind-altering substance preferred by degenerates.
Despite the legal classifications, consumption and research continue. The safety of cannabis is readily verifiable and confirmed by NIDA’s $1.4B funding focused primarily on the risks of cannabis.
Many pharmaceutical companies have cannabinoid-based medicines in development. Researchers resolve barriers to utilizing quality cannabis plants by testing on synthetically created cannabinoids. Almost 30K cannabis studies have been published in the National Library Of Medicine. Because most of the studies are in vivo, invitro, and or small cohorts, they don’t meet the FDA’s gold standard: Double-blind, placebo-controlled, randomized, clinical trials.
That’s a whole lot of research on a plant that is classified by the DEA as having no medicinal value. Dr. Raphael Mechoulam said that any other substance that performed equally in efficacy and tolerability would have progressed immediately into human trials. Since the 1960s, Dr. Mechoulam’s team has been studying cannabis in Israel, funded by US NIH.
Even with the federal prohibition, FDA has approved a synthetic cannabinoid pharmaceutical (Marinol) for nausea and cancer pain and “orphan status” for the whole plant-derived CBD (Epidiolex) for Lennox Gasteauex and Dravets Syndrome (intractable epilepsy).
We live in two worlds simultaneously: 1) various degrees of prohibition throughout the US and abroad. 2) wealth of research documenting efficacy and tolerability without risk of death from overdose. The U.S. lost over 100k people from drug overdose deaths in ONE year: 2021.
These incongruent realities began unraveling in the San Francisco Bay area during the AIDs epidemic. In 1996, Californian patients’ right to choose cannabis was granted due to their terminal diagnosis after clearing significant legislative hurdles. By considering this an accommodation for dying patients, the interpretation overlooked the actual health improvements patients realized. Dr. Donald Abrams played a major role in treating AIDs and cancer patients with the inclusion of natural strategies.
The unraveling continues as more states modify barriers and new cannabis products emerge.
The lack of healthcare professional involvement and acceptance creates damage to trust within the patient and clinician relationship. Patients keep their behaviors secret to avoid chastizing and threatening to block service. It’s important to note the justifications for this dysfunctional pattern. Physicians seek protection from lawsuits and sanctions by complying with DEA policies. Prescribing controlled substances is regulated by the DEA. Therefore, adherence to DEA rules goes along with access to prescribing FDA-approved medicines.
Most physicians that have shifted their perceptions of cannabis do so because a friend, loved one, or patient courageously explained about healing relief of cannabis. Physicians legitimately fear rebuke by their colleagues. Many work in groups or Employed Physician Practices (owned by hospitals) and must adhere to their policies. The standard policy is to avoid entirely this federally prohibited substance, however, some hospitals have created standard operating procedures to allow admitted patients to follow their own protocols, excluding vaping or smoking. If nurses’ unions forbid the handling of cannabis, the patient self-administers and it’s documented with all other dosing protocols.
Cannabis: Safe and non-toxic but complex.
For physicians and healthcare professionals, federal prohibition provides easy cover for quick dismissal. Getting past that leads to another conundrum: the complexity and variables of plant medicine. There are no consistent and predictable dosing protocols from which physicians can make confident recommendations. Only the most seasoned veterans of cannabis medicine understand and accept these variables. Regardless of plant medicine variance, the patient’s needs and conditions change and evolve.
Acceptance is eased by recognizing the commonality of standard pharmaceuticals. If Rx is effective, it may cause negative side effects, quit working, or require higher doses from tolerance. Even with the rigors of the FDA, their results and protocols are based on an average of clinical trial participants’ reporting and results while adjusting for the placebo effect. Further, the patient’s genetics, disease, and lifestyle factors alter pharmaceutical effects. The same is true of cannabis. Dosing protocols and methods are recommended based on 1) personal experiences shared and accumulated, referred to as anecdotal evidence. 2) research on the effects of components of cannabis and, 3) patient’s conditions and lifestyle factors. The most disciplined patients integrate cannabis by starting at the lowest dose, titrating up slowly, journaling doses and effects, then after establishing a routine, occasionally introducing alternate products to refresh the effects.
Missing the opportunity to redirect common disease progression. The worst impact of physicians’ exclusion of cannabis is losing patient improvements. A common pattern of disease progression begins with an injury that limits mobility and leads to depression and weight gain. Those conditions may require 3 or more pharmaceuticals for pain, mood, blood pressure, and cholesterol. Adding cannabis at any point may divert the direction and speed of disease progression.
Hundreds of common and unique compounds. The complexity and non-conformity of cannabis are an asset. The logic of a varied diet or multivitamin is that each component helps all the others to be more effective. Similarly, cannabis has hundreds of compounds (cannabinoids, terpenes, non-cannabinoid phenolics, and alkaloids) that vary in amounts determined by genetics and growing conditions. The combination improves its effects compared to one compound in isolation.
The study of cannabis has profoundly expanded scientific understanding of biology through the discovery of the Endocannabinoid System. After isolating several cannabis compounds, the human receptor triggered by THC was discovered, leading to the revelation of human-derived compounds biomimetically similar to cannabinoids and the cell receptors they engage. These naturally synthesized compounds (AEA and 2-AG) and their receptors are found throughout the body of all mammals, humans, vertebrates, and invertebrates.
Cannabis compounds support or supplement a complex full-body stabilizing system, while pharmaceutical companies derive cannabinoid-based medicines for specific ailments. The combination of broad cellular activity and non-toxicity makes it safely accessible as a proactive health maintentence strategy. Imagine having access to microdoses daily that help us cope with inflammation and stress before they accumulate damage. An ounce of prevention is worth a pound of cure.
The public considers it the duty of healthcare professionals to continuously study and utilize the safest and most effective options available. Physicians that transcend the stigma relish the addition of another strategy or tool that prevents or diminishes pharmaceutical combinations. Their patients that consume both cannabis and pharmaceuticals can be intelligently informed of actual risks. Physicians can have honesty and trust in their relationships while giving patients confidence to consider adding cannabis to their other strategies.
As most healthcare professionals wait for DEA or FDA authorization to consider cannabis as medicine, it’s more rational to expect highly educated physicians and scientists to collectively demand changes that improve their success treating disease. Taking this stance would help repair the credibility problems of FDA, DEA, and Pharma.
While those federal agencies remain steadfast in their processes and policies, physicians overall have evolved. From recommending supplements (Magnesium, Calcium, Vitamin D, Vitamin B, etc.) to encouraging physical engagement and mental health maintenence, healthcare professionals recognize the importance and opportunity in addressing conditions with all available strategies. Eventually, cannabis will be recognized for its biological effects separately from its identity as a recreational substance. Preferably, this would happen with leadership instead of obsequies deference to the DEA and FDA.
Kirsten Velasco is a founding member of the CCC Executive Board and author of Cannabis Basics Textbook, and a veteran of cannabis education and outreach adds entrepreneurial inventor with the launch of VapeNprop.com, the accessory that adds fun, function, and protection to vapes, carts, batteries, etc. As a volunteer board member of Illinois Women in Cannabis for 5 years, she executed 12 industry events (with press coverage), and two all-volunteer statewide education campaigns while independently providing 150+ cannabis programs and submitting 150+ patient applications. She continues to strategically create concentrated, easy-to-consume information, customized to address benefits and encourage action in an attention-deprived society.
