Marijuana in Medicine: Part 1: Cannabis Series

What is medicinal marijuana?

In 2020, 14% percent of Canadians aged 16 years and older indicated that they used cannabis for medical purposes. The popularity of medical cannabis is increasing because it has shown to be effective for reducing chronic pain. Cannabis is also much safer than opiates because it is less addictive and far harder to overdose on, making it a less risky alternative. Medical cannabis is a derivative of the cannabis plant, which contains cannabinoid and terpene compounds that assist patients with certain medical symptoms. Cannabis contains numerous active compounds, with the main two being delta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the principal psychoactive component of cannabis and produces a euphoric effect. CBD enhances the positive effects of the cannabinoids originating in the body.

Who benefits from medicinal marijuana?

 Medical cannabis is used to alleviate symptoms for a range of conditions. Although it does not specifically treat any conditions, it’s used to alleviate the painful symptoms associated with a variety of diseases and disorders. Evidence has shown that it can effectively treat chemotherapy-induced nausea, and may also reduce muscle spasms associated with multiple sclerosis and decrease neuropathic pain. At a low dosage, the side effects of medical marijuana are minimal and include dry mouth and fatigue. Many clinical trials are underway to discover more benefits to medical cannabis use. However, at higher doses, side effects can include dizziness, paranoia, and psychoactive effects. The key difference between medical and recreational usage is that recreational involves taking cannabis for its euphoric effects. On the other hand medical cannabis is used for alleviation of symptoms while minimizing intoxication and is authorized by a prescriber. In 2001, Health Canada permitted regulated access to medical marijuana for licensed patients. On Oct. 17, 2018, cannabis became legal for all adults 18 and over in Canada, making it the second country to legalize recreational use of the drug.

How does medicinal marijuana work?

Cannabis produces mind-altering effects as it’s chemicals run through your body. THC travels from the point of administration to the bloodstream, reaching the brain, and starting its effects. THC binds to cannabinoid-specific receptors on neurons in different areas of the brain, disrupting the regular physical and mental processes. Cannabinoid receptors play an important role in many body processes, including metabolic regulation, pain, anxiety, and immune function. This disruption produces the common euphoric and relaxing effects of marijuana. 

The effects of recreational legalization:

Over the past couple of years, there has been an upwards trend in the general use of cannabis products in Canada. This is heavily influenced by the legalization of recreational use in October 2018. Statistics Canada gathered data in this time period and surveyed the population from ages 15 and older, asking about their cannabis use in the past 3 months. It was reported that the prevalence of use went from 14.9% in 2018 prior to legalization, to 16% in 2019 after legalization.

How can you get medicinal marijuana?

In Canada, medical cannabis can be prescribed by doctors or nurse practitioners. They must consider the consequences of prolonged use, and the possible risk of dependence in patients using it to alleviate symptoms of another medical problem. Many doctors are hesitant towards prescribing cannabis, which may be due to negative personal views or the concern that the drug may be abused. Research continues to be conducted on the topic, and the coming years will shed more light on the best approach when making this prescription.

There are many ways that a person who needs medical cannabis can obtain it legally. The patient must always have a prescription from an approved source, being a doctor or a nurse practitioner, that contains all the information required by the Government of Canada. Importantly, this prescription contains the recommended usage per day as directed by the health care worker. Then, the patient can decide if they want to purchase from a licensed seller, grow the cannabis themselves, or designate another person to grow it for them. For each of these three methods, a registration form needs to be sent to the government to receive proper approval. You are sent a certificate, which you must be able to provide if asked by a law enforcement officer. There are still possessional limits when using cannabis for medical reasons, which differs from the limits imposed on non-medical use. A person is permitted to possess up to 150g, or the equivalent of 30 days of use, in addition to the 30g allowed for recreational use. People who use medical cannabis tend to use a consistent amount daily, so being able to carry a larger quantity is valuable.

Stigma around medicinal marijuana use

With all the benefits of using medicinal marijuana, why the accompanying stigma? Even with the government approval of using cannabis as a remedy for elevating different symptoms, many negative stereotypes and ideas around the psychoactive drug seemed to hold. A Canadian study performed in 2013 aimed to explore the perception of cannabis as a stigmatized medicine. Semi-structured interviews were conducted with twenty-three individuals who used cannabis for therapeutic purposes and their responses were recorded to analyze their experience as users. The study found three main aspects of stigma associated with the use of medicinal marijuana: the view of cannabis as a recreational drug, illegal activity surrounding cannabis use, and vulnerabilities related to poverty and illnesses or disabilities.

The legalization of marijuana uplifted some barriers that users experienced with law enforcement as the questioning of the legitimacy of their Health Canada license decreased. However, the Cannabis Act coming into force also produced negative effects on medical cannabis users. For example, a comparative study found that recreational legalization was associated with a 26% increase in prevalence of cannabis use for medical reasons in cancer patients. Even with the increase, only a third of the users had the medical authorization necessary for accessing the official medical access system both prior and after legalization. The process of registering with federally licensed producers of cannabis is a lengthy process, so some users have chosen to bypass this step and use illegal methods instead. Data collected in the past 10 years show that the number of registrations gradually rose until it hit its peak around the time recreational use was legalized but has fallen lower in the past couple of years. This creates a discrepancy between the appropriately prescribed products and the cannabis that users are starting to consume, ultimately leading to an improper treatment of symptoms. 

Moreover, the creation of a legal access system to recreational marijuana also creates a confusion when distinguishing between the medical and recreational use of cannabis. This leads to further stigmatization by those who look down upon recreational use and can lead to the questioning of the legitimacy of diagnosis or the cannabis treatment of those using it for health benefits. Overall, the legalization of cannabis has had both positive and negative effects on medical users and the best way that the stigma around the treatment can be fought is through the education of the public about the health benefits and necessities that it provides.

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