What Medical Conditions can Cannabis be Used for Pt 2

A few months ago, I talked about how the conditions for which patients can use cannabis for differ from state to state. How is it that specific diseases are included in the laws of some states and not in others? At least in the case of Michigan, it seems that special interest groups and individuals with nail-patella syndrome successfully lobbied the legislature to include that particular condition by name in the legislation. Indeed, most states with medical marijuana laws have provided for a process by which new conditions can be added to the approved list. Here in Colorado, patients or physicians may petition the Department of Health to have new conditions added. Several such petitions have been filed in Colorado, but to date, none have been approved. According to press reports, this has been because the medical research on the use of cannabis in those conditions has been found to be inconclusive, incomplete or less than definitive.

Sometimes, however, medical authorities disagree about whether research supports the use of cannabis or not. According to a New York Times article of March 24, 2010, that is exactly what happened in the case of PTSD, which was designated an approved condition in New Mexico in February, 2009, but was narrowly rejected in a vote in a committee of the Colorado House of Representatives that same month.

A medical advisory committee in New Mexico recommended that PTSD be approved because “ . . . marijuana could help relieve anxiety associated with post-traumatic stress disorder,” and went on to cite a number of psychiatric and pharmacological studies they felt supported its use. The Times article quotes Dr. Alfredo Vigil, the secretary of the New Mexico Department of Health, as saying “There are hints and some indications in the medical literature that there are components of cannabis that might be helpful to some people with PTSD.”

The article also quotes Dr. Ned Calonge, the chief medical officer for the Colorado health department at that time, who interpreted the data rather differently, saying that the psychiatry departments at the Veterans Affairs hospital in Denver and the University of Colorado School of Medicine agreed that marijuana should not be recommended for treating PTSD because, in his view, “There is no evidence of efficacy of marijuana for treatment of PTSD in the medical literature.” Dr. Calonge also said that “ . . . some clinical evidence supports the drug’s effectiveness in treating those conditions for which medical marijuana is already approved in Colorado.”

Clearly, there is disagreement even among medical authorities about how to interpret medical research. According to Dr. Vigil, “All of these states are going out on a limb, trying to determine from a medical, clinical point of view, what seems reasonable.” (It should be noted that more than 25 percent of medical marijuana patients in New Mexico have been approved for use of marijuana to treat PTSD.)

The process of adding new conditions and of determining which kinds of medical research studies are acceptable and which are not seems to be persistently controversial, and it is not surprising that there is also no general agreement on just how to do either. It almost makes herding cats seem easy.

Alan Shackelford, M.D., graduated from the University of Heidelberg School of Medicine and trained at major teaching hospitals of Harvard Medical School in internal medicine, nutritional medicine and hyperalimentation and behavioral medicine. He is principle physician for Intermedical Consulting, LLC and Amarimed of Colorado, LLC and can be contacted at Amarimed.com.