Can we effectively use medical marijuana for neurological disorders? It is clear that more research needs to be done on the health risks and benefits of cannabis. Since cannabis is a Schedule 1 drug, it is difficult to do the proper testing that is needed. Therefore, many of the tests that are done primarily involve not the cannabis plant, but rather isolated THC, CBD, or some combination of the two (Ref. 1). However, other studies have shown that cannabis is greater than the sum of its parts (Ref. 2). Cannabis has 480 different compounds, including over 66 cannabinoids and around 200 terpenes (Ref. 3). What is known as the “entourage effect” is responsible for the interactions between the cannabinoids and the terpenes (Ref. 4). It is no surprise that the combination of 480 compounds can interact in complex ways that could not be predicted by studying their single counterparts.
Not only is the research limited, but the research that is done remains obscured with medical jargon and hidden in journals that often require the public to pay in order to view them. Fortunately, the experts at WoahStork are experienced academics and tokers. In this article, we look to review a study entitled “Systematic Review: Efficacy and Safety of Medical Marijuana in Selected Neurologic Disorders”.
Wikipedia is the definitive online reference for unbiased public knowledge. However, the writers of Wikipedia are ultimately human, and therefore subject to bias. A simple Wikipedia search for THC directs us to the section “Medical uses”(Ref. 5). What immediately struck the WoahStork staff as “bias” was the fact that Wikipedia splits this section up into multiple sections which all cite one article, Ref. 1, ten times across the majority of the section. The sentiment of Ref. 1 at first glance seems unbiased, but… let’s investigate further. A direct quote from Wikipedia states “The study found evidence supporting the effectiveness of cannabis extracts and THC in treating certain symptoms of multiple sclerosis, but found insufficient evidence to determine the effectiveness of cannabis products in treating several other neurological diseases.”
This somewhat inconclusive study dominates the Wikipedia page for medical uses of THC. Essentially, the only other studies quoted are squeezed into a small section titled “Other studies in humans”. If Wikipedia truly attempted to be an unbiased source of information for medicinal uses of THC and cannabis, wouldn’t the writers focus on more than one study, which primarily had inconclusive results? Perhaps the number of reputable studies remains limited.
Let us dive into the study a bit further. First of all, the title states that it is a systematic review of neurological disorders. The questions they looked to answer were essentially its efficacy for treating multiple sclerosis, dyskinesias of Huntington disease and Parkinson disease, cervical dystonia, tics of Tourette syndrome, and seizure frequency in epilepsy.
Why is it that the results were so inconclusive? The majority of the study was done on cannabis extracts and synthesized cannabinoids. Out of all of the cannabis extract brand names listed in Table 1, none of them seem to mention anything about terpenes, so we are led to assume that these extracts simply removed THC and/or CBD from the cannabis plant. It was stated that one problem with dosing was that the side effects for many patients became too severe. This is not too surprising, as studies on Dronabinol, purely synthesized THC, has undesirable side effects. It is often stated that CBD counteracts many of these side effects. While this is partially true, let us not forget about the impacts of terpenes as well. Beta Caryophyllene binds to CB2 receptors, limonene elevates the mood, which potentially reduces anxiety or paranoia associated with THC. The fact remains that there is lack of research on terpenes’ interaction with the cannabinoids, except for Refs. 2 and 4.
Furthermore, many of the studies considered had significantly too few patients, sometimes only testing a dozen. There simply is not enough data to make any statistical inference, so many of the questions posed by the survey remain unanswered. For example, consider epilepsy. A simple google search of epilepsy and cannabis brings us to the epilepsy foundation (Ref. 6). This foundation states that there is “much controversy” surrounding the efficacy of cannabis. Once again, they quote a study which had 48 patients, and it is claimed that this study had insufficient data. However, they go on to say that a study with 213 people found CBD did help epilepsy. If one study claims that they had insufficient data, and another study collects more data and find that it indeed helps, where is the controversy? It seems clear that the study with more participants is superior to the study that was inconclusive.
In this study, the only entry that involved smoked cannabis directly from the plant, it was said that the THC content used was 4%, and the dose taken was 4 puffs (See Table 1.). Many strains available on the market today have THC percentages of greater than 20%, which means that one puff of the strains on the market would already have more THC than the 4 puffs taken in this study. Many of the results of the studies with smoked cannabis were inconclusive, which should not be a surprise. If a patient were to take 1 puff of 20% THC cannabis, it should be expected that noticing a difference from no cannabis would be difficult. Perhaps if the studies tried using higher doses and tested it on more patients, they could have gotten more conclusive results.
Many people remain skeptical about the potential medical uses of cannabis. However, it seems that many of the skeptics simply quote studies that have insufficient data. Remember, if a study does not find conclusive evidence, it does not provide evidence that cannabis is not effective. It simply shows that more rigorous and thorough research needs to be performed.
There is no doubt that hard work was put into these study, but anyone who does research on cannabis in 2014 should be aware that THC and CBD are not the only aspects of cannabis. The terpenes are responsible for an entourage effect, which makes the cannabis plant fundamentally different than synthesized THC such as Dronabinol. Most of the study was done with cannabis extracts, and it remains unclear if the terpene profile was kept within the extract. This is a crucial consideration when debating the efficacy of medical marijuana for neurological disorders.
It is also stressed in the conclusion that adverse psychopathologic effects were amongst nearly 1% of the patients. While THC is predominantly known as the euphoriant in cananbis, it seems plausible that providing the proper terpene profile could remove a lot of these negative side effects. Therefore, it seems that the best course of action for medicinal cannabis users is not to use the pharmaceutical companies’ stripped down form of “cannabis”, which only has THC and/or CBD. The cannabis plant contains a far richer terpene profile that lab synthesis can provide.
One company that clearly gets it is CannaKids.
They offer lines of cannabis oil that keep cannabinoid and terpene profiles similar to the actual flower. Sometimes nature does it right. CannaKids does not simply wait for studies with sufficient data, they provide products that have beencuring kids of cancer and helping them with epilepsy for years. The response of success from CannaKids has been overwhelming, yet note that no research study has been done on these success stories. While many remain skeptical of the medicinal uses of cannabis, CannaKids is proactive in helping sick children and have met great success.
We hope that this post helped provide a greater source of hope for the use of medical marijuana for neurological disorders than what is commonly touted as “sound science” on Wikipedia. At WoahStork, we believe that every individual is unique, therefore their interaction with cannabis will ultimately be a unique experience. As sovereign adults, it is our job to become as educated as possible to make informed decisions about the choices we make. That’s why we allow users to review their experiences with strains and use machine learning algorithms to help users find strains that provide the desired effects and medicinal uses. Let WoahStork help you ultimately determine which cannabinoid and terpene profiles are appropriate for your desires and needs.
(1) Koppel, B. S. et al. “Systematic Review: Efficacy and Safety of Medical Marijuana in Selected Neurologic Disorders: Report of the Guideline Development Subcommittee of the American Academy of Neurology.” Neurology 82.17 (2014): 1556–1563. PMC. Web. 28 Jan. 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011465/
(2) McPartland, J. M., and Russo, E. B., Cannabis and Cannabis Extracts: Greater Than the Sum of Their Parts?, J Cannabis Ther 2001(3/4):103-132. http://cannabis-med.org/index.php?tpl=journal&id=228&lng=en&fid=:&red=journallist
(3) Forensic Science and Medicine: Marijuana and the Cannabinoids, Edited by: M. A. ElSohly, Humana Press Inc., Totowa, New Jersey.
(4) Russo, E. B. “Taming THC: Potential Cannabis Synergy and Phytocannabinoid-Terpenoid Entourage Effects.” British Journal of Pharmacology 163.7 (2011): 1344–1364. PMC. Web. 28 Jan. 2016. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165946/