Indications and contraindications of medicinal marijuana

In countries where Medical marijuana has been approved, it is supplied to patients through marijuana dispensary or through producers who sell to patients at retail. However, before receiving the product, it is essential that a doctor make an evaluation of the patient and propose the recommendation to start the product for medicinal purposes.

As in the treatment of any disease or symptom, the physician who recommends therapeutic marijuana to a patient must adhere to the basic principles of clinical practice that include

* Obtain the clinical data of the patient, the disease and the symptoms present through an in-depth interview

* Perform a physical examination aimed at the disease and symptoms present

* Evaluate the complementary tests available (or request them when necessary)

* Analyze the treatment that the patient currently receives and those that he has followed in the past, noting its effectiveness (or lack of)

* Treatment proposal including initial doses and continuation plan.

When prescribing medicinal marijuana, as in any other clinical treatment, it is essential to take into account certain basic principles such as the scientific evidence available for its use, the possible contraindications that the patient may present, the potential side effects and complications that the product may cause, the interactions with the other treatments that the patient takes and finally the basic precautions that the patient or their caregiver should take when following the treatment.

What is the goal of medical marijuana treatment?

Currently there are more obvious indications than others and, taking into account how little is known about medicinal marijuana at a scientific level, it is advisable to stick to those that are available before venturing into less explored therapeutic fields.

Likewise, it is important, from a scientific and clinical quality control point of view, that the doctor documents in the medical record the desired therapeutic effects and those obtained in order to be able to make a reliable evaluation of the efficacy of the proposed treatments.

Has the patient tried other treatments with better scientific evidence in the past? Were these trials adequately conducted in terms of dose and duration?

There is still no scientific evidence to justify the indication of medical marijuana as the first medical option to treat a symptom or disease.

Before considering medical marijuana as an alternative, it is important that other approved and better studied treatments have been used.

Indications for the use of medicinal marijuana

The indications for the use of medicinal marijuana are multiple and the explanation lies in the important role that the endocannabinoid system plays in the functioning of our body in health and in disease.

Where endocannabinoids play a role, medical marijuana can potentially play a role as well, which is why medical marijuana is currently perceived by the general population as a miracle cure that is widely used for multiple indications.

Nowadays, many patients use marijuana and the benefits obtained are undeniable even for the most skeptical clinicians.

However, modern medicine relies on the conclusions of clinical studies to make the decision to add a treatment to the list of valid alternatives.

Thanks to rigorously conducted clinical studies, it has been possible to identify the beneficial role of medicinal marijuana in the treatment of certain diseases and symptoms such as chronic pain and in particular that associated with cancer or neuropathic pain, for neuromuscular spasticity, particularly in patients with multiple sclerosis multiple , and as relief for nausea and vomiting in patients receiving chemotherapy.

For these three clinical circumstances, the American Academy of Sciences, Engineering, and Medicine decided to regard the evidence as positive, substantial, and conclusive .

This does not mean that every patient with these symptoms should be given medical marijuana, but rather that if the doctor were to consider this option, the available scientific evidence would support this decision.

Unfortunately, this evidence does not guarantee that the treatment will be successful.

Second, and with positive but moderate evidence , the American Academy mentions transient sleep problems in patients with diseases such as fibromyalgia, multiple sclerosis, obstructive sleep apnea, and chronic pain.

Finally, and with a positive but limited recommendation, medicinal marijuana is proposed as a treatment to increase appetite and prevent weight loss in AIDS patients, for the treatment of symptoms of multiple sclerosis, symptoms of Tourette’s syndrome and anxiety improvement in patients with social anxiety syndrome and post-traumatic stress.

There is no doubt that more studies will be published in the future that will help add other indications to this list. This will only be achieved by supporting rigorous and reliable clinical research.

Contraindications to the use of medical marijuana

It is not entirely fair to talk about the contraindications of marijuana since the plant has multiple chemical compounds and the contraindications should be directed more to the chemical product in detail than to the plant in general.

As an absolute rule, science advises contraindicating it in patients who have had a history of allergy to marijuana.

The second absolute contraindication is administering medicinal marijuana to a pregnant or lactating woman, since cannabis crosses the placenta and is excreted in breast milk, and the risk it can cause to the fetus or the lactating baby is also unknown.

For patients who are prescribed marijuana with THC (Tetrahydrocannabinol) content, contraindications are family or personal history of hallucinations such as in schizophrenia or bipolar disorder. THC (Tetrahydrocannabinol) can cause and aggravate hallucinations in particularly sensitive patients such as those mentioned.

THC (Tetrahydrocannabinol) exerts an effect on the heart and cardiovascular system, particularly at high doses, causing tachycardia and arterial hypotension, which is why its use is discouraged in patients with unstable heart disease.

Beyond the contraindications mentioned, there are others that are probably based more on common sense, but that must be taken into account, such as avoiding the inhalation of marijuana by smoking in patients with severe lung disease, high doses of THC (Tetrahydrocannabinol) in patients with a tendency to substance abuse and unstable psychiatric illness and the use of high doses of THC (Tetrahydrocannabinol) in young patients whose brain is developing.

There are other considerations that, although not contraindications per se, must be taken into account when prescribing medical marijuana to a patient.