The Pitt Prescription: Exploring medical marijuana as alternative medicine

The Pitt Prescription is a bi-weekly blog where student pharmacist and Senior Staff Writer Elizabeth Donnelly provides tips on how to stay healthy in college. This edition was reviewed by Karen S. Pater, PharmD, CDCES, BCACP.

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April 20, otherwise known as 4/20, is a day commonly associated with marijuana, and although the origin of this is not completely clear, many people are familiar with this connection.

More states are beginning to legalize the use of medical marijuana (AKA medical cannabis) and some patients are getting the opportunity to try new therapies for previously difficult to treat conditions.

Unfortunately, alternative routes of therapy aren’t often talked about within the medical community due to a lack of adequate research or clinical studies. Health care professionals typically stick to traditional therapies consisting of medications approved by the Food and Drug Administration. As a first-year student pharmacist, the concept of alternative treatments for chronic conditions is quite interesting to me. However, I am not very knowledgeable about them — so I turned to an organization here at Pitt that is. 

This past semester, the University of Pittsburgh School of Pharmacy established the first ever chapter of the Student Society of Cannabis Pharmacists. SSCP is the first pharmacy school organization in the nation that works to educate its members on the endocannabinoid receptor system, which is the system in which medical marijuana exerts its effects.

Endocannabinoids and their receptors are dispersed throughout the body in the organs, tissues, immune cells and the nervous system. This system plays a major role in maintaining bodily homeostasis, which basically means it helps keep your body in balance. This system is known to maintain balance for functions like eating, sleeping, memory and relaxation. The two main active ingredients of medical marijuana, THC and CBD, can both work with receptors in this system to help shift your body back to a balanced state. 

The FDA has even approved some medications that use THC derivatives and CBD as their active ingredients, but the FDA has not approved the use of medical marijuana on its own. In Pennsylvania, CBD oil derived from the hemp plant can be purchased without a medical marijuana card and is not associated with the medical marijuana process.

Pennsylvania legalized medical marijuana in 2016, and dispensaries began seeing patients in April 2018. Currently, Pennsylvania has 23 approved conditions — ranging from anxiety disorders to terminal illness — that qualify patients to receive a medical marijuana card. Pennsylvania allows card holders to purchase capsules/tablets, oils, gels, creams, ointments, tinctures, liquid and plant forms (for vaporization). However, combustion (AKA smoking) of medical marijuana is prohibited. 

The founder of SSCP, third-year student pharmacist David Katz, works as a Patient Care Specialist at the Cresco Labs dispensary in the Strip District. He works hand-in-hand with pharmacists and other certified experts to assist patients with finding the product that would work best for them.

He compares medical marijuana cards to driver’s licenses, explaining they have similar roles in purchasing their respective counterparts. 

“The MMJ card is similar to a driver’s license, but instead of driving a car, one can possess and use marijuana,” Katz said. “Just like driving a car, there are specific rules to the road. In particular, how cannabis can be obtained and consumed. There are single-day and 30-day limits on how much cannabis someone can buy.” 

Katz explains that medical marijuana cards are not technically considered prescriptions since marijuana is still a schedule 1 controlled substance, which means it’s illegal federally, and is not an FDA-approved medication. Therefore, the cards act differently than typical prescriptions written by doctors. 

MMJ cardholders are able to purchase any type or strength of product at a dispensary — just like when you receive your license, you can buy any type of car. The physician, pharmacist or patient care specialist will then assist consumers in choosing a product best suited for them. Insurance does not cover any of the processes that go into getting a MMJ card or buying products. Each patient has to pay out of pocket for their initial and yearly doctor visits, as well as every formulation or product they need. 

“You go to a specialized doctor who has completed training for certifying patients to use medical marijuana,” Katz said. “He or she examines your past medical history and, if appropriate, will then certify you to be a medical marijuana patient. You will go through this process annually because the certification is valid for a maximum of one year.”

While in possession of the MMJ card, patients can go to any Pennsylvania dispensary to receive counseling and pick up products. Pennsylvania Act 16 requires that every “dispensary shall have a physician or a pharmacist onsite at all times during the hours the dispensary is open to receive patients and caregivers.” The pharmacists onsite are typically responsible for evaluating the safety and efficacy of products and providing patient education. 

A concern for some medical marijuana patients is that they are not entirely protected from job discrimination for the duration of their treatment. Pennsylvania’s law states that organizations cannot take action against employees or members “solely on the basis of the employee’s status as an individual who is certified to use medical marijuana.” This means that patients with cards cannot be fired or disciplined solely for owning a card, but if they fail a drug test and have marijuana in their system, they are no longer protected. 

“Cannabis doesn’t have the same relationship between blood concentrations and intoxication effects, and for that reason, any cannabis [found via drug test] means you’re considered intoxicated and can get fired,” Katz said. 

There is no way to tell how impaired someone is solely by looking at THC (the active ingredient in medical marijuana that causes the “high”) concentrations in the blood, so organizations can take action against anyone with even the slightest levels present. Possession of a MMJ card, however, does protect patients against legal repercussions, meaning they cannot be prosecuted for having cannabis in their system. 

Pitt’s code of conduct strictly states, “The use or possession of marijuana (medical or otherwise) in the workplace and on campus is restricted by federal laws, such as the federal Safe and Drug Free Schools and Communities Act and the Drug-Free Workplace Act. Accordingly, the University of Pittsburgh prohibits the use or possession of marijuana on campus.”

Many health professionals are trying to get organizations as well as the government to recognize the benefits associated with medical marijuana. Dr. Peter Grinspoon, a contributor to Harvard Health, says medical marijuana has proven to be quite effective for pain control as well as management of many other chronic conditions like Parkinson’s disease, fibromyalgia, endometriosis, interstitial cystitis, glaucoma and even PTSD. 

Grinspoon urges medical professionals to keep an open mind and learn more about this route of therapy because it could significantly help patients. When patients don’t receive accurate and safe medical information, they often turn to online platforms to try to educate themselves, which could lead to serious consequences.

Katz spoke about an experience he had with a mother whose son was diagnosed with autism. He was excited to hear that medical marijuana was helping her son significantly, but he realized she was misinformed when it came to the frequency, dosing and product best fit for her child. She had made therapy decisions for her son based on anecdotal information she found on autism Facebook groups and forums. 

“It is, unfortunately, a common practice for cannabis users to base their own therapy on what has worked for others,” Katz wrote on his website. “To mitigate the dangers of misinformation, I believe healthcare providers should emphasize thorough patient education on the proper use of cannabis.” 

Although marijuana is still federally illegal, it seems that more states are beginning to open their doors to medical marijuana and its benefits. While it is not a first-line treatment option for most diseases or chronic conditions, it can be an alternative to consider when nothing else is working for a patient. It is important to keep in mind that the use of medical marijuana, like any medication, should be evaluated on a patient-to-patient basis to check for any potential interactions with medications the patient is currently taking. 

“For chronic pain and many other conditions, I have learned conventional therapy options can have high risk but a low reward,” Katz said. “For that reason, the time to start discussing cannabis openly in our health care community is overdue.”