Very soon you will be hearing this inquiry from your patients. The role of delta 9 THC in the Endocannabinoid System in mammals has been defined since in 1964. I would suggest it be integrated as a part of every Medical School curriculum as are the Cardiovascular and the Musculoskeletal Systems, to name just two. As a Family Physician, I have sought out the expertise of my colleagues for some of the most difficult clinical cases. Gratefully, I, as well as my patients, have been rewarded by your expertise.Many times, I have found that it is the lack of safe and efficacious treatments for these difficult cases that keep me awake at night. The following are clear indications for the usefulness and necessity for medical cannabis in the treatment of these conditions:
Alzheimer’s Disease: Cannabinoid receptors are important in the pathology of AD and the cannabinoids may succeed in preventing the neurodegenerative process. We do have safe modalities in cannabis to treat and hopefully prevent AD. The emotional and financial implications in doing so are enormous. It has been postulated that 1 in 4 Baby Boomers may suffer from some form of neurodegenerative disorder … who will take care of them? Who will pay for this care? Much smarter is to prevent the onset, if possible. I would ask that you undertake an internet search on the US Patent # 6630507. It will be very surprising to you as it was to me! The latest information is that the raw plant material of cannabis may provide the most neuroprotection with specific strains high in specific terpenoids.
End Stage Delirium: I have felt myself cringe upon entering a facility with patients who suffer severely and are in extremis as there is no pharmacological agent that is successful in management of this condition. Narcotics and anxiolytics, as we know do not succeed. There have been many cases in Israel that have been successfully treated and families who now demand that their loved ones be given cannabis to assist these patients.
PTSD: The suicide rate is said to be 22 Veterans per day, however, the number is likely higher as they utilize MVA’s to enable the survivors to receive insurance policies. There is no successful pharmacological treatment and most of the current treatment modalities include anxiolytics and opiates, with their own addictive properties. There are known CB1 receptors in the brain that modulate fear extinction. Yes, clinical studies are about to begin in Arizona and at John Hopkins with Dr. Sisley…., the other Veterans cannot wait. High delta 9 THC treatment has been very successful in modulating the night terrors and has also diminished the intake of opiates in these patients. Dr. Greg Gerdeman’s research sheds the ray of hope as there may be new neural pathways that can be created with cannabis therapy.
Glioblastoma Multiforme: Cannabinoids selectively inhibit proliferation and induce death of the GBM cells through effective down regulation mechanisms. The fact that these tumors do respond to cannabinoids should be first line therapy, before surgery and radiation. First, Do No Harm.
Multiple Sclerosis: There is so much literature about the efficacious use of cannabis to treat the spasticity and pain of this debilitating disease, I respectfully refer you to Dr. Ethan Russo’s work. The clinical trials of Sativex® for U.S. use is underway. Additionally, studies of whole plant extract have shown relief of neuropathic pain, spasticity, and bladder incontinence.
Diabetic Cardiomyopathy & Cardiac Ischemia: CBD attenuates cardiac dysfunction, oxidative stress, fibrosis, inflammation, and cell death signaling pathways. Acute administration of CBD suppresses ischemia-induced cardiac arrhythmias and reduces infarct size. It is not imagination that I would see part of ER protocol that an IV drip of specific cannabinoids be given for patients arriving with evidence of ischemia.
Traumatic Brain Injury: Cannabinoids protect against excitotoxic damage as well as provide anti-inflammatory effects. They inhibit the production and action of tumor necrosis factor and other cytokines. Another protectant and perhaps possible protocol to be developed with the High School Athletics, NCAA, and the NFL?
In closing, I hope that I have suggested the emanate possibility of safe and effective treatments for these conditions. Our patients will be asking …
