Marijuana: Managing ‘Mary Jane’ as medicine

Marijuana: Managing ‘Mary Jane’ as medicine

Whether it’s weed, edibles, salves or oils, legally available marijuana-based products used as medication continues to be — pun intended — on the rise. With an aging population with multiple and often chronic conditions, it’s no huge surprise. Thus, the importance of taking its growing availability seriously shouldn’t be overlooked when considering all aspects of a patient’s medication regimen and its ongoing management.

In fact, RxLive’s pharmacists feel this fast-moving trend is so important to acknowledge that this is our third blog on the subject the past year alone (see posts in late January 2019 and May 2018).

The quickly shifting marijuana map 

Marijuana aka cannabis has a long history of human use. Many ancient civilizations used it as herbal medicine, in Asia dating back as far as about 500 BC. However, its use in more-legal ways such as part of medication therapy is a much newer phenomenon, certainly in the U.S., where alcohol was temporarily (and unsuccessfully) deemed illegal during Prohibition just 100 years ago.

To date, 10 states and the District of Columbia have legalized recreational marijuana, and 38 U.S. states and territories have legislation in place for the use of medical marijuana.

Recent updates:

Ohio began legal sales in January 2019, opening its first dispensary in late March.
• Other states such as Georgia have advanced the legality of medical marijuana sales (a bill is awaiting the governor’s signature at I write this), but still faces more hurdles before the drug becomes available.
New Jersey just tabled a vote on a major expansion of its medical marijuana program so the bill can be linked to one legalizing recreational marijuana. The bills have the support of NJ’s governor, who says he’ll push forward on expanding medicinal pot if the recreational bill doesn’t pass by May.

For your reference, here’s more information on the rapidly expanding U.S. “marijuana map,” along with links to other resources.

For or against, MJ could be a factor in patient treatment

So it’s obvious that the landscape of this long-time issue is shifting. Fast. And it’ll impact your practice, if it hasn’t already.

With a growing body of studies and anecdotal stories regarding the effects of marijuana on multiple conditions including chronic pain, many patients are seeking new options outside of traditional pharmaceuticals. But as you know, just because something is grown in nature doesn’t mean that it’s without potential adverse effects…especially if a patient is reluctant to have an honest discussion with you about something they’ve thought about, or might already be taking.

There are many thoughts on both sides of the subject of medicinal and recreational marijuana use.
Regardless of your personal opinion, your patients — whatever their disease state(s) and current medication regimen — already could be augmenting their therapy with marijuana. If you don’t know what they may already be taking or even their comfort level with raising the question of marijuana as a treatment option could limit your ability to determine their best course of treatment. Thus, as clinicians we need to know how to talk with our patients about the potential effects and adverse reactions associated with marijuana use.

Huey Lewis read your patients’ minds: ‘I Want a New Drug’

Thinking about marijuana as a medicine brought to mind the seminal hit from Huey Lewis and the News, “I Want a New Drug.” Many reasons for patients’ utilization of marijuana derive quite well from some of the song’s lyrics. If you’re unfamiliar with the song or the 1983 seven-time platinum album “Sports,” you can find it on your favorite streaming service. Here’s one version on YouTube, and a second that has the lyrics on the screen.

‘One that does what it should’

There are many different cannabinoids contained in marijuana and we don’t know exactly what each does. Some of those may assist with conditions such as (but not limited to) nausea and vomiting, weight loss from long-term disease, pain, seizures and glaucoma. There are two pharmaceutical products, dronabinol and nabilone, that are THC derivatives indicated in nausea and weight loss from chemotherapy and other diseases. Recently, cannabidiol was approved for use in some rare seizure disorders. Still, many patients are using inhaled or ingested marijuana for their potential benefits without robust data supporting their benefits.

‘One that won’t make me feel too bad, one that won’t make me feel too good’

While the effects can vary, especially based on a patient’s pharmacogenomic profile, there are potential effects and interactions a pharmacist should be able to discuss with our patients. Marijuana can have adverse effects in patients with underlying psychiatric, cardiac and/or respiratory diseases, and those with vertigo and cancer.

Marijuana can also interact with multiple medication classes including barbiturates, CNS depressants, protease inhibitors, SSRIs, TCAs, anticholinergics, sympathomimetics, alpha-agonists and lithium. Many of these drugs could be utilized for the very condition the patient may be augmenting their therapy with marijuana.

‘One that won’t make me nervous, wondering what to do’

Patients are increasingly likely to have questions about marijuana use and how it interacts with their other medications and health conditions. Healthcare providers — especially consulting clinical pharmacists — can help by keeping the lines of communication open and being ready to provide accurate clinical information about the risks and benefits of using medical marijuana. We also keep up-to-date with laws and services in their area that will be a factor. If you’re at all uncomfortable about talking about marijuana-related issues with your patients, we’re here to help.

‘One that makes me feel the way I feel when I’m with you’

This romantic notion actually makes a great closing point. Most patients really don’t want to feel “high” and unable to function capably on a daily basis; they have lives to live and things to do.

But what they do want is to feel good while they’re doing it…like how they feel when in the presence of a loved one. They want the ability to participate in life experiences to the greatest extent possible, happy to have less (or no) pain, greater mobility and the other things the right medication regimen, ongoing medication counseling and treatment plan can help provide. And increasingly, medical marijuana may be a part of your helping make that happen.

Kristen Engelen, PharmD
Kristen Engelen, PharmD, is the chief pharmacy officer of RxLive and a certified consultant pharmacist; she has over a decade of experience in retail pharmacy settings. Kristen became an RxLive co-founder because of her passion for geriatric pharmacy, with a focus on the intersection of pharmacy and aging.