Doctor optimistic that medical marijuana will help many patients with a wide variety of conditions

Prescribing medical marijuana for pain relief rather than opioids may be a way to help fight the opioid addiction crisis.

Dr. Louis van de Beek, chief medical officer with Keystone Shops, which is gearing up to open three medical marijuana dispensaries including one in Devon, one in King of Prussia and one in Upper Darby, is bullish on the benefits of medical marijuana.

Van de Beek said medical marijuana is very useful in treating pain, including pain from various conditions such as chronic neuropathy and sickle cell anemia. Doctors who have undergone four hours of additional training can prescribe medical marijuana for 17 conditions under the new state law.

The binding problem with opioids

“There are many compounds in cannabis,” said van de Beek, a Radnor resident. “The main ones being looked at are THC and CBD.”

“They all affect different receptors in the brain,” he said. “The way pain is alleviated in the brain is when a given chemical bonds with a particular receptor it binds to that receptor, thus relieving pain.”

Opioids bind to the mu receptors, he said. It can take more and more of the drug to get the needed effect, he said. Also, mu receptors are found throughout the brain and the brain stem.

“That’s where the problems lie,” said van de Beek. “The mu receptors in the brain stem are bound with opioids. If in fact the mu receptors in the brain stem are bound, that will suppress breathing. And people, who die of an overdose, generally die (due to) suppression of their breathing.”

The brain stem controls lung function. However, there are also cannabis receptors in the brain but very few cannabis receptors in the brain stem.

“Cannabis doesn’t bind to the mu receptors,” van de Beek explained. “It binds to the cannabis receptors. When the marijuana binds to the cannabis receptors, you also get the pain relief.

“The good news is if we look at the brain stem there are very close to zero cannabis receptors in the brain stem so suppressing breathing occurs with opioids. It does not occur with cannabis. That is

a very important distinction. We’re talking about a drug that is deadly versus probably a drug that can’t kill you.”

Although if someone who is high on marijuana jumps off a building they could die or if they get into a car accident while high, then they could die, he conceded.

Also, opioids are highly addictive, while with marijuana there is a risk of psychological addiction not physical addiction, he said.

“I think we’re looking at it more as an alternative to things … a relative degree of harm,” he said. “The opportunities for cannabis to create that harm are minimal. With opioids it’s maximal.”

Marijuana — treating seizures

Neurological disorders, such as seizures, ALS, autism, Huntingdon’s disease, MS and post-traumatic stress disorder can be treated with medical marijuana, said van de Beek.

“I think one of the most interesting areas that’s being explored is the treatment of refractory seizures in children,” he said. (Those are seizures not controlled by current epilepsy medications.) There are a fair number of children with seizures, epilepsy that don’t seem to respond to the existing medications. Over the past years there’s been a great deal of interest in this.”

One of his patients has a 7-year-old daughter who

suffers from intractable seizures, he said. However, the girl has responded well to CBD oil.

“The child has gone from 20 seizures in a 24-hour period to 10 seizures in a 24hour period,” he said. “It’s hardly a cure but it’s certainly a treatment. It’s particularly exciting. There was an article published fairly recently in the “New England Journal of Medicine” regarding the use of cannabis in children with refractory seizures. It was done at the New York University Langone Medical Center. It’s extremely promising.”

A lack of research

One problem with medical marijuana is that it has been illegal and is still illegal at the federal level so there is a dearth of scientific research.

“There’s a lack of really excellent applied research,” said van de Beek. “There is some research in that area but there isn’t a lot of research. The government has not been helpful in allowing research to occur.”

Since 29 states have legalized medical marijuana “people who would want to do that research now are becoming organized and involved,” he said. Up until now, information about the efficacy of medical marijuana been the experiences of patients and caregivers, “which is a little bit more than anecdotal” not double-blind experiments, he said.

When medical cannabis is prescribed

One of the 17 conditions where doctors can prescribe medical marijuana to patients is cancer. However,

it is not for the treatment of the disease itself but for side effects of chemotherapy, such as nausea and lack of appetite.

“People experiencing the horrible side effects of chemotherapy, the terrible, terrible nausea, cannabis seems to help with that,” said van de Beek. “In fact there is a synthetic on the market, Marinol, which is often prescribed for that purpose. Secondarily, it increases appetite and that is very helpful in cancer patients who have no appetite.”

In a similar fashion, medical marijuana helps AIDS patients to cope with their loss of appetite and better tolerate their medications, he said.

Also, “for those with neurological problems, it can be a huge benefit,” said van de Beek.

“I’m not telling a secret when I say, we haven’t done very well in the treatment of autism,” van de Beek said. “It’s one of the conditions that primary physicians like myself kind of shake their head and wish they could do more … If research bears out that this is effective in the treatment of autism, that would be a remarkable step forward. We haven’t done very well in the treatment of autism it’s one of those tragedies. You feel you’ll provide support the best you can without any incidence of cure. If this stuff will help it, that’s great.”

An anti-inflammatory drug

Medical marijuana is also an anti-inflammatory drug, relieving and even preventing inflammation, he said.

“Inflammation plays a major role in disease progression (and) is a major source of pain,” van de Beek said. “The anti-inflammatories we currently use are falling out of favor.” Many NSAIDS, which have long been an ulcer concern, may be linked to heart disease, he said.

“So there is a great deal of hope,” he said. “We need something new to counter inflammation. That’s the bottom line and medical cannabis may fill that role for us. It would be fantastic for pain relief.”

“Having turned 63 recently, that interests me more and more,” he joked. There are two major sources of pain: neuropathic and inflammatory; medical marijuana seems to help with both, he said.

An immunity booster

There is some evidence that medical marijuana may boost the immune system, van de Beek said. Although the mechanism for that is “not entirely understood.” It might be a mindbody reaction. “Basically, if you can make somebody calmer and more accepting, that may boost the immune system,” he said. Many studies show that state of mind has a major impact on one’s immune system, he said.

Many people van de Beek speaks to, including other doctors, are on board with medical marijuana.

“The people I meet are extremely encouraging,” van de Beek said. “People are interested and they sort of want to see this go forward, as opposed to standing in the way. It will be available and it will be available for a wide variety of conditions.”

Dr. Louis van de Beek