The Florida legislature recently approved a bill that lifts the state’s ban on smokable marijuana. Florida is among 33 states nationally that allows medical marijuana.
Denise C. Vidot, an assistant professor in the University of Miami’s School of Nursing and Health Studies, is conducting extensive research on the use of medical marijuana to manage HIV comorbidities in the context of cardiovascular disease risk. She provided some insights below:
What research have you conducted on medical marijuana?
Currently, collaborators and I are conducting a study on the use of medical marijuana to manage HIV comorbidities in the context of cardiovascular disease risk. HIV is a qualifying condition to obtain medical marijuana in Florida; therefore, there is a portion of HIV patients with an active prescription for medical marijuana. In this study, funded by the National Institutes of Health as a Center for AIDS Research Supplement, we are examining differences in cardiovascular disease risk among patients who have an active prescription for medical marijuana compared to those who use marijuana not prescribed by a health care professional. I also recently completed two other studies on medical marijuana. One examined differences in respiratory and cardiometabolic disease among medical and recreational marijuana users via a population-based sample of adults in the United States. The second study was a qualitative study that sought to examine stigma and perceptions of medical marijuana use by current users and those who have never used marijuana.
What is the difference between medical marijuana and recreational marijuana?
In Florida, the differences include the composition of marijuana, how it is obtained, and the route of administration (until the ban on smokable marijuana was repealed). Marijuana is composed of compounds called “cannabinoids.” The two main cannabinoids that have been studied are cannabidiol (CBD) and tetrahydrocannabinol (THC). In general, medical marijuana contains a high concentration of CBD and a low, if any, concentration of THC. CBD has been associated with the medically beneficial effects, such as reduced inflammation. Recreational marijuana tends to have a high concentration of THC, which has been identified as the psychoactive ingredient causing the “high” feeling.
What is medical marijuana used for and how does it work?
In Florida, medical marijuana can be prescribed for qualifying conditions such as cancer, HIV/AIDS, epilepsy, glaucoma, post-traumatic stress disorder, ALS, Crohn’s disease, Parkinson’s disease, and/or multiple sclerosis. Licensed physicians are also able to prescribe medical marijuana to patients who have a condition in the same class as the list of qualifying conditions, to patients who are terminally ill, or to patients who have chronic pain related to a qualifying condition. There are various ratios of CBD (cannabidiol) and THC (tetrahydrocannabinol) used within medical marijuana based on the condition.
Medical marijuana works via cannabinoids (CBD and THC), engaging with the patient’s endocannabinoid system. The body naturally produces cannabinoids; and the endocannabinoid system has been documented to play a role in regulating common processes such as appetite and pain. There are two main cannabinoid receptors found in the body, CB1 and CB2 receptors, to which cannabinoids in marijuana attach and activate. CB1 receptors are found throughout the body (i.e., brain and nervous system). THC typically binds with CB1 receptors, which can be associated with the psychoactive and mental health effects. CBD typically binds to CB2 receptors found in the immune system, which can be associated with reduced inflammatory effects.
How much evidence exists on the benefits of medical marijuana?
Evidence on the benefits of medical marijuana is growing. This is particularly true in oncology, and other fields that include medical marijuana qualifying conditions identified in the states that have legalized its medical use. I am examining differences in the health impact of marijuana use by route of administration, including various ways to smoke marijuana.
We’ve heard a lot about the benefits of medical marijuana. But what are the side effects?
There are patients who report side effects after using marijuana. Effects vary as a function of CBD and THC ratio, non-active ingredients, and route of administration. Furthermore, there are limited prospective studies examining the long-term impact of medical marijuana on health outcomes.
What impact do you see medical marijuana having on health care, and could it help solve the opioid crisis?
As marijuana becomes part of the clinician’s “toolbox” to provide care for patients, I believe health care professionals will become more engaged in the marijuana research community. In Florida, medical marijuana has begun to make an impact on pain management. Preliminary results from a pilot study I conducted found that the majority of patients who use medical marijuana do so to manage pain and/or anxiety. In the context of the opioid epidemic in the U.S., studies have suggested that medical marijuana may be an alternative to prescribing opioids.
