Cannabis: debate or debacle?
Dagga is not the panacea it is being made out to be, writes Shaquir Salduker
ISN’T it amazing how information is disseminated these days? Journals, magazines and even the radio are coming in second to social media. I was recently informed by one of my patients that they had stopped their chronic medication after reading a post on Facebook (written by a nutritionist!).
The fact that the condition had relapsed and months of hard work had gone to pot, didn’t seem to matter.
It got me worrying about what is being put out as “legitimate” information and who monitors or controls this process, especially when it pertains to health or illness.
In a similar vein, there has been a ton of information posted about cannabis recently.
The lawmakers in our country are weeks away from legalising the medicinal use of this drug.
The impression out there is that it’s a miracle treatment for all sorts of ailments and that there is a concerted effort from the “big business/pharma” community in collusion with that august, patriarchal, stuffy old boys’ club – doctors – to mislead the public and withhold this pure, natural panacea drug.
More and more I see young patients (15 to mid-20’s) with significant illnesses in the brain who quote the “research “that proves cannabis is safe and adamantly refuse to stop using it. It’s very worrying! The cannabis plant has been around forever.
It has been used in ancient civilisations as medicinal treatment for multiple ailments from pain to nausea to mental illnesses. More recently medical science has discovered the presence of an internal cannabinoid receptor system in the brain and in the body.
What this means essentially is that we now sort of know where the chemical works at a micro cellular level and we are starting to learn what its effects are. The cannabinoid receptor system was only discovered in the 80s and we know of two type of receptors, CB1 and CB2, thus far with postulates that there may be many more receptor subtypes waiting to be discovered.
We also know that the body produces its own cannabis-like substance, which plays multiple roles in its normal function. It’s very similar to the painkillers called opioids where the body produces potent opioids called endorphins, and man has tried to mimic this effect with external chemicals known as opiates like morphine, codeine, etc.
Scientists have shown that activation of the cannabinoid system in the brain helps with pain, nausea and anxiety, to some extent.
The have also isolated some cannabis receptors in the body linked to immune cells and various organs.
Some researchers have also postulated that there are cannabis receptors on some cancerous growths.
The cannabis plant – Cannabis Sativa – widely grown worldwide, has been shown to have about 130 types of cannabinoid subtypes, most notable of which is Delta 9 Tetrahydrocannabinol – the active ingredient in the commonly abused (smoked, vaporised, eaten, brewed) version. Laboratories are also synthetically growing this plant in an attempt to finetune the subtypes and effects.
All of this new research is great. We need new and better ways to ease human suffering and treat illnesses.
But the problem is, we are not there yet with cannabis.
The disconnect between the science and the popular belief is growing.
As a practitioner who has seen thousands of mostly young people afflicted by the use and abuse of this substance, it scares the hell out of me that it’s being seen as okay to use.
Lots of research has gone into trying to understand the effects of cannabis, especially in the young brain, and a lot of it from KZN (S. Paruk et al) which shows quite convincingly that the use of cannabis in a young (14 onwards) person has a seriously damaging effect on the development of the brain.
It has been linked both as a secondary and primary factor in major psychotic illnesses like schizophrenia.
More ominously (because it’s often missed) it has been shown to impact on higher brain function called cognition, which is essentially learning, memory, concentration and intellectual development, as well as motivation.
These are the very faculties that are most in need in that age group. I fear that if the misperception gets entrenched, we are going to have possibly an entire generation of “brain damaged” adults before the penny drops.
The effect does not appear to be as harmful when first used in the fully developed brain in adults.
As we pass from the age of information into the age of wisdom, our greatest challenge will probably be to filter out the barrage of opinions masquerading as science that penetrates our most intimate spaces.
Stories of patients who opt to stop traditional cancer treatments and use cannabis oil and attain miracle cures appeal to the desperate and helpless. However, there is no accountability when it fails.
There is no back-up system, no science and no recourse. If we were talking about investing and losing money as the currency of this transaction, then that would be okay. But we are talking about life and health and quality of life.
As a pain practitioner working in a pain clinic I have seen many anecdotal cases where cannabis has been more effective than traditional agents. It has helped many cancer patients with pain relief, mood elevation, nausea and appetite. But these are cases where they have gone through the process of trying the traditional approaches, which still work very, very well in many, many patients. There are also many cases where cannabis oil has not helped at all and in some cases made the patients more unwell. So it’s not a panacea drug. It does not cure everything that it’s claimed to cure. It’s still a work in progress and it is exciting from that perspective.
In many countries cannabis has been approved for “medicinal” use. The debate around legalisation and subsequent control of production, distribution and taxation has been held, in many languages.
The one common factor in these countries where it has been approved is an increase in recreational use. There is no convincing data to suggest that it has changed the medical landscape dramatically and brought down the incidence of illness and suffering.
Many have compared it to alcohol use and effects and yes, I agree, alcohol is a devastatingly harmful, destructive substance that has permeated norms in almost all societies worldwide. But we should be looking at regulating the use of alcohol rather than exposing people to another potentially harmful substance.
There are potentially many benefits that will arise from cannabis research, and it should be legalised for research use and controlled medical use, but there has got to be a clear message put out that its not the same as the substance that is being smoked, eaten, vaporised and brewed in teas.
The danger is that if it’s being used medicinally we have no idea of what dose is being administered, what subtype of cannabinoid is present and in what proportion, or the potential side effects (it can cause changes in blood pressure, pulse rate, paranoia, extreme anxiety and panic attacks, etc).
There seems to be a belief that if the oil is used, it is medicinal as compared with smoking the weed (they are essentially the same compound). We also don’t know much about its drug-to-drug interactions with normal chronic medications.
So until it has been properly researched, subtypes isolated and cleaned up and safety assured, it cannot be handed out willy-nilly and promoted as a “naturalistic or homeopathic” treatment. There are many medical doctors who are dishing it out indiscriminately, and this does not make it okay either.
Parents of teens who have been affected; treating professionals who have been involved in their care; hospitals and rehabilitation centres will all testify to the potentially devastating effects of this substance if it is misused.
Let us not get confused and turn this debate into a debacle, which many will regret in years to come.