My last column on why pharmacists should have control on medical cannabis certainly sparked debate. I got my share of critical comments on one social media thread and supportive comments on another. In pharmacy, there is a great schism on the topic. Some see cannabis as properly classified as a Schedule I drug. Others could not care less and see the benefits to patients and a state’s coffers, finding it laughable that it is not legal for (at least) medical use. There were a few reasons given as to why cannabis should not go medical, and I would like to address them, so when cannabis does go federally legal for medical use, you will be better informed.
It was said that concentrations of THC can’t be standardized in a plant. Allow me to disagree. Strains of cannabis are grown to maintain the potency of the originating plant. Cannabis users are sticklers for quality control. The amount of THC in a particular strain of cannabis is well documented. Pharmacists, since the dawn of the chemically-manufactured tablet, have been against plants, their extracts, and various natural remedies. I know; I was one of them. Nonetheless, I reflected on my education at the Philadelphia College of Pharmacy and Science and the teachings of Ara DerMarderosian, PhD, in his amazing field of pharmacognosy which is “the branch of knowledge concerned with medicinal drugs obtained from plants and other natural sources.” This is where pharmacy began! The Greeks knew of the power of digitalis for centuries. If it’s not made in a lab, why are we, as a profession, so afraid of it?
Smoking, and rightly so, is viewed as a negative in healthcare. Smoking is not the only way to get THC and the other cannabinoids from cannabis. In fact, ingestion is a far superior, albeit more expensive, method of extracting the active ingredients from the plant. The effect is greater, and the duration of action is far longer than if THC was inhaled. If inhalation is to be the method, then vaporization (which heats the flowers to release its medication instead of burning it) is a far safer alternative.
Another comment stated that the “high” is the only benefit from cannabis. In treating glaucoma, the high has nothing to do with the ocular effects produced by THC and its sister compounds. In other cases, the “high” is just what we’re looking for.
When I had shoulder surgery, I was in sheer agony when the nerve block subsided. I took oxycodone and hydrocodone for analgesia. They did not take the pain away. They did, however, alter my perception and kept me from caring about it. How is that any different than this “high” that you reference? Another case in point is in the treatment of mental illness. Anti-depressant drugs produce “highs”—that is why they are anti-depressants. When an ADHD patient takes amphetamines for their condition, they do not get “high” from the medicine. The drug gives them what they need to function properly in life. The same thing happens to medical cannabis patients being treated for mental illness. It doesn’t get them “high,” it balances them out.
Someone asked a valid question: why not just use dronabinol capsules in place of cannabis, since it’s the same thing? It is, indeed, not the same thing. As previously stated, cannabis plants have other psychoactive compounds besides THC. Some strains have as many as 500. It is that synergy that makes the cannabis plant so much more effective than plain THC alone. A patient of mine who uses dronabinol as part of his psych regimen (quite cutting edge, I must say) likened it to diet cola when compared to the real thing—one calorie; not enough. When we make a capsule containing cannabis extract, then we’ll be doing something right.
I realize that I’m not going to convince everybody in the profession that this is a good idea. Much like dispensing emergency contraception or insulin syringes to heroin addicts, this is a field that not every pharmacist will be willing undertake, and that is okay. Just be a little more open-minded to those who see this as a viable treatment option. Peace.
Jay Sochoka, RPh, is open-minded.