–But MD’s Cannot Yet Prescribe It
Medical marijuana, which comes from the cannabis plant, was legalized in California in 1996.
But doctors, such as Stuart Silverman, a clinical professor at UCLA who focuses on fibromyalgia, osteoarthritis, pain and osteoporosis, are frustrated. They cannot prescribe cannabis products and there is often no accurate labeling on existing products.
The 35-year Palisades resident recently spoke to the Optimist Club about “Cannabis, the New Normal.”
Silverman stressed that this drug could and does help many people, but because it is still considered a Schedule 1 drug by the Federal government (the same as heroin and ecstasy), he is not allowed to prescribe it.
Silverman, who serves on the advisory board for the UCLA Cannabis Research Initiative, noted that cannabis [the marijuana plant] contains 90 cannabinoids, TCH psychoactive, DBD nonpsychoactive and 100-terpenord compounds, which include essential oils.
“The major action is the synaptic connection between neurons,” Silverman said. “It acts as a neuromodulator.” He strongly supports the compound being rescheduled and more research conducted.
There are already some medications, such as Marinol, Epidolex and Sativex, which have the psychoactive compounds present in cannabis. For example, Marinol is used to treat nausea and vomiting caused by cancer chemotherapy, Epidolex is used for controlling seizures and Sativex is used for MS-related spasticity.
If parts of the cannabis plant are helpful medically, but Silverman can’t prescribe them, how do his patients get the correct medication?
He said that people go to marijuana dispensaries and speak to a “bud tender.”
“Only 10 percent of bud tenders have received any training, but 90 percent have given advice,” said Silverman, who noted that many of these employees have no medical background and may not realize that marijuana may 1) increase the effects of other drugs, 2) interact with insulin, 3) interfere with Warfarin and 4) used simultaneously with alcohol, increase the THC levels [and should be avoided].
Product quality is also a problem. “There are no requirements in California to test for pesticides and toxicides,” Silverman said. And because the “medical board does not allow me to prescribe,” he may not have quality control over what his patients try.
Silverman notes that poor product labeling does not accurately reflect the THC content, the percentage of Indica versus sative, the region the product is grown and that microbial, fungal and pesticide contamination may not have been assayed.
Silverman, who also works as a rheumatologist at Cedars-Sinai Medical Center, said “Cannaboids have been normal in the past.”
In fact, “Marijuana is not a modern medicine.” The Chinese symbol for marijuana, which is two plants growing under the roof of a shed, dates back to 1500 BC.
“Marijuana contains a complex mix of chemicals,” Silverman said, and “marijuana used as a medicine is not a recreational drug.” He points out that even breast milk contains cannaboids. “Mother nature knew what she was doing.”
Silverman said the cannabis plant was used medically in the United States until about the turn of the 19th century. According to historical records, Congress passed the Marijuana Tax Act in 1937, which essentially outlawed the drug’s sale or possession. In 1952, the Boggs Act provided stiff mandatory sentences for offenses for many drugs, including marijuana.
President Richard Nixon had the opportunity to change the classification but rejected the pro-decriminalization findings of Canada’s Le Dain Commission and the British Wootton Report. Even in 1972, the U.S. Shafer Commission’s report stated that cannabis should be decriminalized and recommended ending prohibition in favor of a public health approach.
In an April 2016 Scientific American article (“The Science Behind the DEA’s Long War on Marijuana”), the author wrote: “Experts say listing cannabis among the world’s deadliest drugs ignores decades of scientific and medical data. But attempts to delist it have met with decades of bureaucratic inertia and political distortion.”
According to that story, “In 2009 the American Medical Association recommended the DEA review marijuana’s Schedule I status. And a 2014 Medscape survey of roughly 1,500 doctors found 56 percent supported legalizing medical cannabis nationally, with 82 percent support among responding oncologists.”
“In states where you legalize Cannabis, there is a drop in opioid overdoses,” Silverman said. “People use four to ten times less opioids when they combine them with cannabis.
“In Israel, if a soldier is next to someone who is blown up, they immediately give them cannaboids to prevent PTSD,” he said, “but it is not legal in the VA or [US] military hospitals.”
Silverman said he’s currently working on a study with a patient who has Parkinson’s disease, and noted that “Cannaboids can control the spasticity of Parkinson’s.”
The bottom line: This drug should no longer be a Schedule I narcotic and doctors should be allowed to prescribe.
“We need to get the word out,” Silverman said.