Judith Paice discusses many of the misconceptions that people have about the use of medical marijuana for patients with cancer.
The use of medical marijuana, which is available in more than a dozen states across America, is surrounded by stigma, questions and misconceptions.
After polling our readers on what they would like to know about the substance and its use for patients with cancer, CURE interviewed Judith Paice, Ph.D., R.N., research professor, Medicine, Hematology and Oncology at the Feinberg School of Medicine at Northwestern University.
What are some of the common misconceptions that people have around medical marijuana?
Paice discussed the process, cost, usage and benefits of marijuana usage for patients with cancer.There is often an assumption that this is somehow more potent than what's on the streets or somehow more effective than what is available through other, illicit means. In actuality, it is fairly similar to what is obtained on the street. The advantage is clearly that this would be unadulterated, and so it is definitely a preferred method of obtaining the product if people think that this is something that might benefit them.
What is the cost like for these patients?
It's also amazing how many people think it's covered by insurance. They make that assumption because it's medical, but it's actually not covered. It varies from state to state. As you know, this is still a schedule 1 narcotic, and so federally, it's still illegal. That's important for people to know. People can't take it across state lines. If they were found to have the drug in one of those states where it's not legal, it is a federal offense. People don't understand that because they think, "Gee! I got it from a medical dispensary!" It doesn't matter.
What is the process like to get the prescription and then the actual product?
The cost is somewhat comparable to what people would be paying for the illicit marijuana. It's generally a couple hundred dollars a month. Since it is a federal offense, the doctors don't actually prescribe it. In states where it is “legal,” if you will, the physician typically certifies the patient. What that means is they're certifying that the patient has one of the diagnoses that's approved in that state. Cancer is clearly at the top of the list. They certify that the patient has that disease and, in their best judgement, could benefit from the palliative use of marijuana and also that the doctor has a sustained relationship with that patient. This is not someone who just set up a booth somewhere and is signing off for people they don't know.
When they certify, the patient fills out a form, the doctor has to fill out a form, and all of that information goes to the state. In different states there are different requirements. For instance, some states require a patient to get fingerprinted or get passport photos. The patient also has to determine which dispensary they're going to go to, and they have to keep going to that same dispensary. I'm often telling people, "Check out the dispensaries. Which ones are easily accessible you, and which ones have the products that you think may be more useful to you."
Then they get a card from the state and that card has the dispensary listed on it. That serves as their "prescription." So, they technically don't actually have a prescription. Patients can then go to the dispensary with this card and get their supply of marijuana.
There's so much fear and concern right now. With the opioid epidemic that got so much media attention, people are worried that if we make these compounds more accessible, we're going to have the same diversions as with opioids. It's hard to predict what's going to happen.
With all the red tape around getting this product medically and legally, do you see many people just going on the streets to illegally buy marijuana?
What are the different forms in which you could get medical marijuana, and what are the adverse effects?
Yes. They're either buying it themselves or borrowing it from friends to determine if it is really helpful before they go through the time and expense. There is a delay. In Illinois, it's taking about four to eight weeks to get the authorization card. What about the patient who has lung cancer and says, "Oh my gosh, I never thought I would smoke?” Well, once you do get the phytocannabinoids, the plant product, here's the deal: you can either smoke it, you can ingest it and then there are the oils. Some people rub the oils on the skin, but there's no data whatsoever about that. And with ingesting it, again, no data.
Let's focus on smoking and eating. As an oncology nurse, I never thought I would encourage someone to smoke, so I get where that patient is coming from, but when you smoke marijuana, you get a much more rapid response. People get plasma levels in two to 10 minutes. What patients tell me is that they'll smoke and then after just one or two puffs, they feel better. Their anxiety is reduced, maybe they can relax and sleep a little bit, and for some people, maybe even get a little pain control. It happens quickly, and they don't even have to smoke the entire joint or whatever they're smoking.
But when you eat the product, like a brownie or candy bar, for example, the time to get that response is one to six hours. There have been some kind of amusing, but also cautionary editorials. One was in the New York Times, where a columnist talks about going to Colorado, one of the four U.S. states where it's recreational. She had a bite of a candy bar and didn't feel anything, so she took another bite, and after about an hour she could barely walk, started to pant, feel paranoid and hallucinate. This had been reported, in Colorado, in particular. With ingestion, in particular, the onset is so delayed that it's difficult to titrate the dose. So when you talk about adverse effects, that's where we're seeing them.
What is medical marijuana currently being used to treat?
My general perception in talking with patients who are using it is that it does help with anxiety, mood,sleep and relaxation. For others it helps with pain and even appetite. Those are the two side effects I most commonly see people using medical marijuana for.
I think what's most intriguing, and this is in the laboratory only, it's not really moved into whole human models yet, is that it does look like it alters inflammation and immune responses. This means it might be helpful for people with autoimmune disorders. Future research will help clarify that for us.
What tips or advice would you give to someone considering medical marijuana?
When you are inhaling a joint, for example, you are getting a whole lot of other products. We don't know their mechanism of action. What I do recommend for folks who are thinking of using this product and inhaling, we do recommend that that they use a vaporizer, which will help reduce the amount of other unknown substances entering your body significantly. You can find those on the internet.