Medical cannabis or medical marijuana is a term used to denote either cannabis plant itself or extracted cannabinoids that are recommended and prescribed by the medical experts as a treatment or relief for different medical conditions. But, you already knew that, didn’t you? And it’s no surprise. Despite being legally sanctioned, prohibited and forced to the margins of public attention for decades, cannabis is present in western societies much longer than most of us assume.

In the recent years, resurgent interest in marijuana’s medical application and subsequent legalization for medical purposes in numerous countries throughout Europe and the Americas brought this question back to the centre of attention, prompting heated debates with numerous groups voicing their opinion, either for or against legalization.

Medical Marijuana legalization

As of now, medical cannabis has been legalized in numerous European countries, including Germany, Greece, Czech Republic, Poland, Italy, Finland, Sweden, Denmark and many others. For most of them, this includes the legality of possession of marijuana for medical purposes, while some countries with stricter laws, such as UK and France, allow the possession and use of specific cannabinoids approved and extracted for medical application in forms of prescription-only medicines such as Sativex.

The trend towards legalization of medical marijuana we are witnessing recently is grounded in – and this might come as a surprise to many – a convention hammered out at the United Nations back in 1961. Specifically, article two of the Single Convention on Narcotic Drugs allows countries to outlaw different substances except for medical or research purposes if the prevailing opinion is that it would be more beneficial for the public health and welfare.

What this means is that every single country can legalize medical cannabis according to the international law, as long as the decision is supported by the parliament. So, when is medical cannabis coming to your country? The good news is – it’s up to the voters to decide!

Cannabis effects

The effects of cannabis can be divided in two large groups – the psychological effects, also known colloquially as “high” which can vary significantly depending on the person, tolerance, prior experiences, type of cannabis consumed and mode of administration and physiological effects which are rooted in the biochemical interaction between cannabinoids and human organism.

The medical properties of marijuana were discovered very early in history and the historians and archaeologists found hard evidence in form of ancient writings to prove this claim. For example, a Chinese book describing the time of the mythological emperor Shen-Nung from 2737BC includes references to the medical properties of cannabis, which is no surprise since marijuana seeds were extensively used in diet of prehistoric China. Similarly, the Eber Papyrus form 1550BC describes use of medical cannabis in Ancient Egypt. Even in the Islamic world, medical marijuana was widely used between 8th and 18th century AD.

However, despite the lack of hard evidence which exists in other cases, scholars suspect that cannabis was first used in different ways and for different purposes in the present day India. However, this claim is based mostly on linguistic evidence and the fact that cannabis is often mentioned in ancient Hindu texts.

Psychological Cannabis effects

Psychological effects are rather well known due to important place cannabis has in contemporary popular culture. Among other, more person-specific effects, they include:

  • General alteration of conscious perception
  • Euphoria
  • Anxiety
  • Relaxation
  • Stress reduction
  • General wellbeing
  • Increased sensuality and creativity
  • Abstract or philosophical thinking
  • Increased appetite
  • Enhanced enjoyment of humour and art
  • Distortions in perception of time

Psychological effects of cannabis are at the root of its great popularity and are usually the goal of recreational use. However, some of these effects are also used in medical treatment, especially relaxing properties of marijuana, or increased appetite. More about this will be said in the sections below.

Physiological effects of Cannabis

Physiological or somatic effects of cannabis are also enjoyed by recreational users, but they are more closely connected to the medical application of the herb. Some of them are very well known, like dryness of the mouth or reddening of the eyes, while some of them are less popular among the general public, but are of great interests to scientists and medical experts. These include effects such as:

  • Pain relief (especially when used for treatment of chronic pain)
  • Stopping muscle spasms and muscle relaxation
  • Reducing nausea
  • Decreased blood pressure
  • Improving sleep

Many of the somatic and medical effects of cannabis are still somewhat unclear, mostly due to the lack of funds or will for comprehensive and long-term scientific research. Because of that, many other beneficial effects such as effectiveness in treating neurological problems such as epilepsy, multiple sclerosis and some movement problems. However, while the positive impact of cannabis treatment has been documented, not enough research has been conducted in order to provide us with a clear picture of what exactly happens within the body.

As of now, the chemical and biochemical properties of cannabinoids are the best starting point for researchers. Neurologist, chemists and biochemists, as well as medical experts, have all contributed to our greater understanding of the mechanism of action of cannabinoids. However, the lack of experimental research and clinical trials makes this knowledge more rooted in general biochemistry and theoretical consideration than in practice.

What are Cannabinoids?

Contrary to popular belief, cannabinoid is not a single substance, but a class of diverse chemical compounds that affect cannabinoid receptors in the brain cells that in turn alter neurotransmitter releases within the brain. Cannabinoids can be categorized to three different groups depending on their origin:

  • Endocannabinoids (produced naturally within the body)
  • Phytocannabinoids (produced in cannabis plants)
  • Synthetic cannabinoids (manufactured artificially)

Certainly, the most notable cannabinoid is tetrahydrocannabinol, better known as THC. Alongside THC and Cannabidiol (CBD) there are additional 111 phytocannabinoids identified in the cannabis plants. However, THC is widely considered to be the primary psychoactive compound of cannabis, with the THC-CBD ratio being the primary factor determining the exact nature and intensity of psychological effects and potential for medical application of any specific cannabis strain.

Tetrahydrocannabinol (THC)

With chemical name, (−)-trans-Δ⁹-tetrahydrocannabinol, THC is a lipid thought to have evolved as a defence mechanism for the plant, protecting it from insects, but also from ultraviolet light and environmental stress. Who would have known that this defensive mechanism will play such a prominent role in modern society!

The mechanism of action of THC stems from its partial agonist activity at the cannabinoid receptor CB1 located in the central nervous system and CB2 receptor mainly expressed in the cells of the immune system. Its psychoactive effects are primarily mediated by the activation of cannabinoid receptors which result in a decrease in the concentration of the second messenger molecule cAMP through inhibition of adenylate cyclase.

In the UK, THC has been officially approved (albeit in an extract) for treatment of multiple sclerosis, neuropathic pain, spasms and overactive bladder.

Cannabidiol (CBD)

Although it’s not considered to be “principal” psychoactive ingredient of cannabis, CBD is a major phytocannabinoid, accounting for up to 40% of the plant extract and playing a significant role in shaping the subjective experience of intoxication which strongly depends on the THC-CBD ratio.

Unlike THC, CBD doesn’t strongly affect cannabinoid CB1 and CB2 receptors, but it acts as an indirect antagonist of these receptors, thus contributing to the greater potency of THC effects. Some researchers suggested that CBD may also produce its effects through its inhibition of fatty acid amide hydrolase (FAAH for short), which may in turn increase the levels of naturally produced endocannabinoids.

Similarly to THC, CBD too was tested, but as with cannabis research in general, additional trials are needed before final statements are made. As of now, there have been strong indications that CBD is very effective in addiction treatment, as an anti-inflammatory medicine and has also shown promising results in the treatment of epilepsy and Dravet syndrome.

What are the medical benefits of Cannabis?

With the in-depth research still lacking, the current knowledge of medical benefits of marijuana is limited, to say the least. However, this does not mean that some trials haven’t been conducted and some effects documented, just that the volume of those trials is still lower than required for other substances with suspected medical value. Stigma associated with marijuana use played a big part in this, and there is an increasing number of voices within the medical community that advocates putting prejudices aside and seriously approaching to medical cannabis research.

So far, moderate evidence exists to support the claim that cannabis use helps in chronic pain and muscle spasms treatment, as well as in the alleviation of symptoms caused by chemotherapy (nausea), HIV/AIDS (lack of appetite) or Tourette syndrome (tics). Some medical experts also argue that, when usual treatments are ineffective, cannabis should be prescribed for improving sleep, treating anorexia, arthritis, migraine and glaucoma.

Marijuana against nausea

Some studies have confirmed that cannabis is rather effective in the treatment of chemotherapy-induced nausea and vomiting (or CINV for short), even more effective than usually prescribed antiemetic medicines. However, 2016 Cochrane review claimed that in spite of the effectiveness of cannabis in treating this condition, its use is not recommended due to “high side effect profile” which, according to the review, include drowsiness, dizziness, altered mood and increased appetite, or, in other words, the “high” people experience from consuming marijuana.

Marijuana and appetite

Probably everybody is familiar with the “munchies”, a slang term denoting a sudden increase in appetite after consuming marijuana. However, this property of the herb can have an obvious medical value – treating lack of appetite as a symptom of many serious conditions, including HIV. Anorexia associated with AIDS is an identified condition that is rather common in patients suffering from HIV. Certain studies and experiments have underlined a profound impact of cannabis on the appetite of the affected patients, helping them prevent weight loss and subsequent anorexia.

Due to this property, some experts have also proposed to prescribe cannabis to people affected by anorexia, claiming it could, in parallel to other more conventional treatments, lead to a breakthrough in the field.

However, as of 2013, the research in these topics has been deemed insufficient due to “small sample size” and “lack of long-term data” – both of which are the result of the taboo associated with cannabis research and the absence of state-sponsored large-scale tests and studies.

Marijuana and high blood pressure

Due to the drowsiness and slowness usually associated with “being stoned”, people usually assume that by consuming cannabis you simply bring your blood pressure and/or blood rate to rock bottom. However, that is not necessarily the case. The effect of marijuana on blood pressure has been well-documented both in human and animal studies – cannabis usually increases the blood pressure for a short amount of time, just after consumption, and then gradually brings it down.

At the same time, in order to make up for the lower pressure, the heart rate increases. So, while cannabis shows some promise for the treatment of hypertension (increased blood pressure), at the same time it also causes an increase in heart rate. What this means is that additional research is needed to precisely identify that increase and find out whether this effect is caused by THC, CBD or some other of the 113 identified cannabinoids. Some studies conducted so far claim that despite this increase in heart rate, there is no direct link between cannabis consumption and cardiovascular diseases. 1

But, on the other hand, the medical community has reached an absolute consensus when it comes to the benefits of hemp seed food products when it comes to cardiovascular health.2

  • Reduce bad cholesterol levels
  • Decrease risk of blood cloths
  • Promote fat burning

Marijuana and pain management

Similarly to appetite improvement, pain relief effect of cannabis was known through experiences of recreational users, and has only later been linked to the fact that cannabinoids are structurally similar to the endocannabinoids, produced by the body which are involved in processes such as appetite, memory, movement and pain. Studies and trials conducted so far have proven that marijuana can be very helpful in relieving pain, especially chronic pain and that caused by muscle spasms.3 But, sadly, additional research in this topic has been on a halt ever since.

Marijuana and glaucoma

Treatment of glaucoma was once of the first benefits of medical marijuana to catch the public’s attention. This fact is circulating through popular culture for years now and it’s rare that a sitcom doesn’t include a scene where one of the character is mentioning the plant he needs for his glaucoma. But, beneath all that fuss, there are hard medical facts that back this claim.

Glaucoma is a disease of the optic nerve tasked with carrying the visual information from the eye to the brain, so this condition can have very severe consequences such as partial or full loss of sight. Glaucoma is closely related both to the high blood pressure (hypertension – another condition that has a potential to be treated by medical cannabis in the future) and increased pressure in the eye. This is why most conventional therapies are based on lowering eye pressure. Cannabis is proven to be capable of doing the same, but without the hassle and dangers of operation!

However, don’t run off to roll a blunt just yet! As with all other condition “the side effects” of the treatment, also known as “getting high” for recreational uses, have been mentioned as reasons against this treatment. Aside from this rather common remark, the medical experts have also mentioned the fact that marijuana will lower not only eye pressure, but blood pressure in general which might in turn have an adverse effect on the condition, negating the positive effects. Medical experts agree that additional research is needed before any conclusions are made.4

Marijuana and childhood epilepsy

As opposed to previously mentioned potential treatments, the beneficial effects or marijuana on the treatment of childhood epilepsy are rooted not in THC, but in CBD cannabinoid. Although it is considered to be one of the two “major cannabinoids”, comprising a majority of the plant extract, CBD, when administered by itself without THC or other cannabinoids does not produce the intoxicating effects which are often a stumbling block for marijuana treatment.

Due to this fact, potential cannabis-based childhood epilepsy treatment will be determined by the possibility of developing a new strain of CBD-only cannabis and making CBD-rich oil which will, in turn, be used for the treatment.5

 Marijuana and multiple sclerosis

Another treatment that is well-known to be successfully treated by medical marijuana is certainly multiple sclerosis. But, as with all other cases, there is a huge discrepancy between the reported improvements and the amount of serious research conducted on the question. This is why, again, we encounter a situation where not enough is known in order to give any conclusive assessments.

However, the studies conducted so far seem promising in numerous aspects. For one, marijuana was proven to significantly contribute to the relief of pain, muscle stiffness and spasms as well as to the increased sleep quality.6At the same time, the studies have shown that sometimes the subjectively perceived improvements could not be backed by physicians and medical experts and their experiments and tests. This is why additional research is much needed in this promising topic of medical marijuana application.

Medical Cannabis and cancer

A very controversial topic, the potential beneficial impact of cannabis on cancer, has not been researched nearly as thoroughly as one might expect. As a matter of fact, most of the studies that have managed to provide us with some knowledge on this question were actually conducted – on mice.

But, despite this, they provided some valuable insights. Among others, these tests have shown that, at least when mice are concerned, marijuana treatment can actually kill certain types of cancer cells and slow down the growth of others, and this is especially true for a brain tumour. Both THC and CBD extracts have been proven to boost the cancer-killing potential of radiation when used in parallel with that approach.

Other conditions

Aside from the conditions mentioned here, marijuana is a potential treatment for numerous others where any research is lacking and all assumptions are based solely on subjective experiences of patients, or studies with only a limited sample size. These conditions that might be treated with medical cannabis include:

  • Alzheimer’s disease
  • Appetite loss (various causes)
  • Crohn’s disease
  • Eating disorders
  • Parkinson’s disease
  • Wasting syndrome (cachexia)

In addition, certain experts in the field of mental health, psychology and psychiatry have also commented on the potential use of cannabis in the treatment of mental and psychiatric conditions. However, any significant studies or tests aimed at proving or disproving these claims are, with the current legislature, years away from reality. However, we can mention some conditions that will probably be first on the list to be tested once research of that kind is legalized. Those conditions include:

  • Anxiety
  • Post-traumatic stress disorder (PTSD)
  • Schizophrenia
  • Depression

How does medical Marijuana work?

Due to the limited research, not much is known about the exact mechanism of action of cannabis. And this question gets only more complex once we take into consideration the fact that there are 113 identified cannabinoids that can all play a part in treating different condition. So far, the research has been mostly aimed at two so-called “major cannabinoids”, namely THC and CBD and even with them, the studies so far were far more concerned with how these substances produce the well-known “high” than how this substances help improve certain condition.

With this in mind, not much is known about how medical cannabis truly works within the body. The leading theories so far, backed by some hard medical evidence, claim that the basis of cannabis’ effectiveness lies at the structural similarity between phytocannabinoids (produced by the cannabis plant) and endocannabinoids (produced by the human body). According to some, phytocannabinoids serve as catalysts of a sort for endocannabinoids, enhancing their effects.7 Others claim that medical benefits of marijuana can be traced to similar mechanism of action that causes the “high” for recreational users – the structural similarity allows phytocannabinoids to stimulate cannabinoid receptors within the brain, which in turn triggers a change in the balance of neurotransmitters. This network of reactions, according to that theory, will produce, among other things, the effects which are of great interest to medicine.

Using medical Marijuana

As with recreational use, there are many different modes of administration of medical marijuana. However, unlike recreational use, medical application usually relies on methods other than smoking due to two reasons – inhaling hot smoke and ash particles is harmful to the lungs and it is not as easy to ensure proper dosage when smoking. This is why medical experts prefer extracts in the form of pills or oral spray, something that is, according to the statistics, mostly limited to the realm of experts, since absolute majority of medical cannabis users prefer smoking as a mode of administration.

Smoking

As mentioned, the biggest drawbacks of smoking cannabis are the damage to the lungs caused by hot particles of smoke and ash and unreliable dosing of the herb. The first of those problems can be mitigated by using a bong or a water-pipe which will cool down the smoke and “capture” the ash particles prior to inhalation. According to many, the use of vaporizers will yield the same results, since the patient will end up inhaling aerosol and not smoke.

However, neither of these methods will solve the problem of dosage. Even with the use of precise instruments and standardized strains of the plant, the concentration of active compounds within flowering parts of cannabis plants can vary significantly.

If you do decide to consume cannabis this way, as most do, then you should take precautions to ensure the safety of the practice, which includes using bongs or water-pipes in order to cool down the smoke and keep the harmful ash particles away from your lungs.

Oral Cannabis consumption

Oral consumption of medical cannabis usually relies on pills and liquid extracts (in the form of oromucosal spray) and only rarely on the “edibles” that are popular for recreational use, due to the fact that extracts ensure precise dosage. However, oral preparations still remain troubling due to the fact that there is a significant uptake of cannabinoids into fatty tissue from which they are released slowly, so the effects appear gradually which might have an impact on the total effectiveness of treatment. What’s more, this gradual onset leaves more time for THC to get broken down in the liver, effectively reducing the dose. Due to variables involved in this process, this makes precise dosing rather hard.8

Where can you buy medical Marijuana?

Within Europe, you can legally buy medical marijuana in those countries that have made it legal to do so. What’s more, due to current legislations, every company that wants to engage in trading medical cannabis needs to register at the level at which it wishes to operate – meaning, if they want to work within country’s borders, the process of registration and obtaining a licence will be somewhat different that for the companies that want to provide medical marijuana throughout the EU.

However, as of writing this article, most of the time, only cannabis-based medicines can be legally purchased, since they are approved by the EMA9. At the same time, in numerous countries in Europe, possession of small quantities of cannabis for personal use is decriminalized (or essentially legal), so there is the possibility for the treatment in that way, albeit without prescription.

One of the biggest stumbling blocks for the complete legalization of medical cannabis is the danger of smoking – inhaling hot smoke and ash particles which can damage one’s lungs. What’s more, very often, cannabis is mixed with tobacco prior to consumption in order to make it burn easier, which further increases the health risks, given the known harmful impact of tobacco smoke. This is why most relevant institutions still refrain from making smoking cannabis legal, even for medical purposes, arguing instead that in that case, the risks outweigh the potential benefits.

Legal status of Cannabis in Europe – Comparison

Below, you will find a short overview of the legal status of cannabis in different European countries. Different aspects will be considered, including possession, sale, transport and cultivation.

Country Possession Sale Transport Cultivation
Austria Decriminalized for personal use Illegal Illegal Illegal
Belgium Decriminalized (3 grams limit) Illegal Illegal Decriminalized (one plant)
Bulgaria Illegal Illegal Illegal Illegal
Croatia Decriminalized for medical use For medical use only Illegal Illegal
Cyprus Illegal Illegal Illegal Industrial hemp
Czech Republic Decriminalized (15 grams limit) Medical use only Medical licence or up to 15g Up to five plants or for medical purposes subject to licence
Denmark Medical use only (unenforced) Medical use only With government licence With government licence
Estonia Decriminalized Illegal Illegal Illegal
Finland Medical use only Medical use only Medical use only Medical use only
France Illegal Illegal Illegal Illegal
Germany Medical use only, recreational use considered self-harm Medical use only With licence With licence
Greece Medical use legal, small quantities decriminalized Illegal Illegal Illegal
Hungary Illegal Illegal Illegal Illegal
Ireland Illegal Illegal Illegal Illegal
Italy Decriminalized Illegal Illegal Illegal
Latvia Illegal Illegal Illegal Illegal
Lithuania Illegal Illegal Illegal Illegal
Luxemburg Medical use only, decriminalized Illegal Illegal Illegal
Malta Decriminalized (up to 3.5 grams) Illegal Illegal Illegal
Netherlands Decriminalized (up to 5 grams) Unenforced Unenforced Decriminalized for up to 5 plants
Poland Medical use only Medical use only Illegal Illegal
Portugal Decriminalized Illegal Decriminalized Decriminalized
Romania Medical use only Illegal Illegal Illegal
Slovakia Illegal Illegal Illegal Illegal
Slovenia Decriminalized Illegal Illegal Industrial hemp only
Spain Legal Illegal Decriminalized Legal in private space
Sweden Illegal Illegal Illegal Illegal
UK Illegal Illegal Illegal Illegal

Pros and cons, myths and realities of medical Marijuana

As is evident from the current situation related to the legislative processes involving the official status of medical cannabis, one of the biggest obstacles for successful and thorough research in medical potential of marijuana is the stigma still associated with the herb. The idea that marijuana is a banned substance, a drug, a narcotic, still has a strong impact on the way we think about this substance. And even though the body of evidence corroborating the possibility of application of cannabis in the treatment of numerous medical conditions is growing by the day, the opposition still mainly comes from the idea that marijuana is harmful because it is a banned substance.

However, the legal status of marijuana is related only to the legislative process. Unlike substances based on opioids which are widely used for pain relief across the world, cannabis does not cause physical addiction and even the claims that it causes psychological addiction are far-fetched with the very term “psychological addiction” being questioned. Aside from being non-addictive, an overdose on cannabis is not a known possibility. Truth be told, the lethal dose of cannabis does exist – since every substance can cause overdose in sufficiently large quantity, including even water! For cannabis specifically, that would mean that a person would have to smoke 1.28 kilograms of marijuana in one hit in order to get an overdose. Good luck achieving that! Along same lines we can say that you can overdose on consuming 6 litres of water all at once, or 118 coffees.

Short-term Cannabis side effects

Other arguments mention impaired judgement and cognition during marijuana intoxication. While no one sensible would claim that it’s safe to drive while “high”, the same can be said for alcohol. In fact, there are numerous government campaigns all over the globe against drunk driving and the fines are very severe in most European countries. Without going into distinction between alcohol and cannabis intoxication, one could argue that despite countless deaths produced by bad decisions made while drunk, the legal sanctioning of alcohol possession is not even considered.

The “high” produced by marijuana intoxication is not dangerous in itself. One might have a bad experience, will probably have a slower reaction time and a temporary, yet somewhat annoying habit to dwell on the chain of thoughts behind everyday objects. The bottom line is – yes, marijuana causes altered states of consciousness, but is not harmful, especially not in the short term. And the question of whether altered states of consciousness are harmful is something that falls in the domains of both ethical considerations and scientific research – with the latter being prevented due to the former.

It is worth mentioning that cannabis intoxication does lower blood pressure and increases heart rate, although not enough to pose a clear and present danger for an individual’s health and wellbeing. So, if you have been diagnosed with some heart-related condition or think you might be diagnosed in the future, an open talk with a doctor might be a good option, just to be sure! But, to state it clearly – cannabis does temporarily increase the risk of heart attack, and by pure coincidence only, an otherwise healthy individual has the same chances of having a heart attack when “high” as one has when having sex. An interesting coincidence indeed!

Long-term Cannabis side effects

The situation is somewhat different when it comes to long-term cannabis effects. Due to the lack of thorough studies, this question is still largely open. Some experiments with mice have shown that there might be some impact on cognition and memory, but those side effects manifested only if the mice were regularly exposed to cannabis since before reaching full maturity. Mice who were administered cannabis chronically after reaching full maturity exhibited fewer side effects, with all of them diminishing within two weeks after stopping the exposure to marijuana.

Preliminary readings of these experiments move in the direction of claiming that in humans too, chronic cannabis consumption can cause long-term side effects only if the person involved has been consuming is since before puberty. There is an unsure agreement that most probably if a person starts smoking cannabis in their late 20s, any side effects can disappear after a period of abstaining from marijuana consumption. However, the lack of detailed studies and very limited scope of experiments leaves a lot to be desired. Much more scientific research is needed before there is any credible answer to these questions.

References:

  1. Cannabis and cardiotoxicity – PubMed – NCBI
  2. Hemp Seed Food Products Can Bring Heart Health Benefits – Leafly
  3. Cannabis and Pain: A Clinical Review – PubMed – NCBI
  4. Marijuana To Treat Glaucoma – Glaucoma Research Foundation
  5. Marijuana as Medicine – National Institute of Drug Abuse
  6. Medical Marijuana (Cannabis) – National Multiple Sclerosis Society
  7. Medical Marijuana – Web MB
  8. Cannabinoids for Tourette’s Syndrome – Cochrane Library
  9. Cannabis Legislation in Europe – EMCDDA

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