Protagonist or Supporting Act?
Medical cannabis is not a blockbuster drug – the plant should be considered as just one component of an overall therapy or regimen
Tomas Skrinskas | | Opinion
Imagine going to see an orthopedic surgeon for a consultation on the pain in your knee. You might hope to get it scoped – or think you need invasive surgery. The first thing the doctor will usually tell you? Reduce the stress on the joint; for example, by limiting impact activities or bringing down your weight. We often hope for a quick fix, when we need to consider the root cause of a problem. Why do we expect to simply excise, replace, or cover up the real issue? We find ourselves on a particularly slippery slope in this regard when addressing conditions with cannabis-based medicines. In my humble view, there are two ways in which “problem solving” with cannabis or cannabinoids requires a slight realignment in our collective mindset.
First, we need to understand wellness or health as a process and not as an end-point. I recently heard a leader in the evolving genetic medicine space say, “Taking a pill for an ailment or going to the doctor or hospital isn’t ‘health care’, it’s ‘sick care.’” In other words, we only go to the doctor when we feel ill. However, the idea of wellness and health in our everyday lives is increasingly important, and many of us are taking supplements, drugs, and cannabis to get well and then keep well. But what happens when we become over reliant on our crutches, neglecting root causes and forgetting to recalibrate? Polypharmacy, for one, is a concern and there might be good reason to take many supplements but it is important to ensure that reason over time.
When maintaining wellness with cannabis, we must remember – however “natural” we deem it to be – that it is exogenous – a foreigner entering your body and altering how it behaves. A case in point: I believe most doctors would not recommend daily consumption of cannabis to improve wellness. Cannabis or CBD – or the next minor cannabinoid du jour – should not be considered health supplements (whatever that means), but medicines with risk:benefit profiles and possible side effects.
Second, cannabis is not the ultimate healer but one helper. Certainly, when it comes to the use of cannabis as a medicine, there are significant medical conditions that can be treated with phytocannabinoids and the whole plant; chronic pain and spasticity associated with multiple sclerosis are just two examples where clinical evidence of symptom relief is conclusive. Moreover, deep research is emerging on subsets of very ill patients and conditions where only cannabis can help (1, 2) – but I worry that the general population may make too many extrapolated conclusions from these reports.
In truth, we cannot rely on cannabis to heal all our ills equally – or at all! And so we should keep expectations in check when administering medical cannabis – as a patient or a physician. Especially when it comes to multifaceted conditions, such as anxiety, sleep disturbances, and mental health, cannabis-based medicines should be a component of holistic treatment. Just as with psychedelic therapies, where guided or supervised treatment is the norm, cannabis and its path to combating a medical condition or its symptoms should include adjunct therapies, such as counseling in the case of mental health or balanced nutrition to address energy or sleep. Too often, people expect a quick cure (or symptom relief) for their ailment without ever addressing the root cause, which may get worse if ignored or might never go away (for example, joints tend to ache as we age, so that knee may always be sore).
In short, cannabis is far from a blockbuster drug. The plant is one potential tool in the proverbial shed that can help move the needle towards health, but the tool must be used properly. I admit to oversimplifying a complex story here – and I consider this a starting point for ongoing discussion (feel free to comment below).
I hope I am not overstepping any boundaries; rather, I want to shed light on the notion that we all have the potential to lead healthier lives by being more self-aware, taking everything in moderation (even moderation), and asking ourselves often about what drives us to make unhealthy choices.
- NHB Schräder et al, "Combined tetrahydrocannabinol and cannabidiol to treat pain in epidermolysis bullosa: a report of three cases," Br J Dermatol, 180, 922 (2019). doi:10.1111/bjd.17341
- G Pryce et al, "Neuroprotection in Experimental Autoimmune Encephalomyelitis and Progressive Multiple Sclerosis by Cannabis-Based Cannabinoids," J Neuroimmune Pharmacol, 10, 281 (2015). PMID: 25537576