nursing

Using the input and suggestions from the peer-edited first draft, write the final version of your research paper in 2,500 and 3,000 words.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is required.  Use your chosen peer-reviewed journal for in-text citations and references.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

TITLE
Times 42 pt
A. Author1, B. Author2, C. Author3,
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1Affiliation One (Times 19 pt)
2Affiliation Two
3Affiliation Three

Project Objective
Justification
Approach
Data
Techniques
Results
Conclusions
OUTLINE
Picture Here

Subtopic 1 (Times 22)
Subtopic 2 (Times 22)
Topic 2
Subtopic 1
Subtopic 2
Subtopic 3
Topic 3
Topic 4
Topic 1 (Times 24 pt)
SLIDE TITLE Times 36 pt

Topic 1 (Times 20 pt)
Topic 2
SLIDE w/Table
Header
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RESEARCH

PAPER: FIRST DRAFT 1

The Research Paper: First Draft

Grand Canyon University:

BIO-317V

BIO-317V

NIDIA COLE

DR. MICHELLE DAVIS

11/15/20

Abstract

This paper offers an analysis and literature review in support of and the challenges associated with the legalization of cannabis for medical use. Recent peer-reviewed scientific studies progressively support historical and anecdotal evidence of the efficacy of Medical Cannabis (MC) in the treatment of many chronic health issues. The online databases CINAHL, PubMed and Medline were used to search for literature relevant to this topic. Majority of the articles show the effectiveness of MC in the management of wide-ranging medical diagnoses, but for a nuanced review, articles that reflect the challenges with this approach are also highlighted. There is growing research evidence to support the integration of MC into current therapeutic models for the management of various medical conditions, but more research is recommended for more broad-based conclusive evidence.

The Research Paper: First Draft

Cannabis (marijuana) is derived from the plant Cannabis sativa and classified as a schedule 1 drug and therefore federally prohibited for recreational and therapeutic purposes but in recent times there has been a slew of state legislations that have either legalized it for medical use and/or for recreational use as well. MC has become one of the most important public health issues of our time, because of the controversy evoked by its recreational use and the perceived effect it has on users and the society in general, but the dilemma occurs when there is at least significant anecdotal evidence of its effectiveness with users in treating or ameliorating the symptoms associated with various chronic medical conditions. While robust clinical research into the documented subjective effectiveness of MC on a myriad of health issues is lacking, the available literature points to the potential that must be explored in full to enhance the knowledge base about cannabis.

The historical antecedents and the patient-reported evidence should create the momentum to encourage scientific investigations into these observations and there is a real positive trajectory on this topic, given traction by a recent article in Salem News (2019) on the World Health Organization (WHO)’s change of position on MC. After more than 60 years of a zero tolerance stance on cannabis, this change is consequent upon the increasing scientific evidence of its therapeutic value. The report reiterates that this effectively repeals a 65-year old WHO position that cannabis should be abolished from all legitimate medical practice. This was declared a major policy breakthrough and a resounding defeat of politics by the strength of evidence.

Following prohibition since the 1970s, there have been progressive initiatives at the state and citizenry level to reinstate the use of cannabis for medical purposes. The psychoactive nature of cannabis and its addictive properties have added political, social and legal dimensions to a debate that should be driven by the science, based on evidence (Rubens, 2014). Therefore, it is valid to concede that the current wave of legalizations of MC across states in the US is more from social acceptance than from a robust increase in scientific knowledge (Marcoux, Larrat, & Vogenberg, 2013).

The use of medical cannabis as a treatment modality for a wide range of chronic medical and/or painful conditions has shown promising effectiveness especially in cases that have been refractory to current therapeutic approaches. There is an increasing body of research evidence to support this assertion and this paper is an attempt to review the evidentiary basis.

Methods

Several online databases were searched using inclusion criteria relevant to the project topic. CINAHL yielded 58 articles, PubMed, 43 and Medline 26. Of the 127 total articles available for review, 19 were eventually used for their specific relevance to the trajectory of this paper.

Historical and Cultural Perspectives

The plant cannabis sativa has been cultivated and used over several millennia by different cultures for the treatment of various ailments and even for its psychoactive properties in religious rituals (Hindu and Buddhist traditions). In their review of this history, Hand et al. (2016) argue that the cultural and medicinal uses of cannabis through a historical point of view is important to understand the imperative of its integration into modern therapeutic regimens. The authors reveal the documented records of its use from over 6000 years; the earliest recorded use for medical purposes being found in the ancient Chinese pharmacopeia Pen-ts’ao ching dating back to 2700 BC and affirmed its effectiveness in treating conditions like joint pains, gout and even as a surgical anesthetic. The authors chronicle this history over the succeeding millennia as its use spread westward through India, Arabia, Africa and the Americas. Among the earliest documented medicinal use of cannabis in the United States (US) was in 1860, as recorded by the Ohio State Medical Society in the successful treatment of various diseases like asthma, gonorrhea and rheumatic pain (p.3). However, in 1970, a federal ban on its use (recreational or medicinal) was effected by the promulgation of the Controlled Substances Act, when it was classified as a schedule 1 drug. In the state of Florida where this author resides, MC was introduced by the legislature in 2014 (Smith & Lannon, 2017).

Current Evidence-Based Science

The two main active ingredients in cannabis are delta-9 tetrahydrocannabinol (THC), a psychoactive compound and the non-psychoactive Cannabidiol (CBD). The deeper understanding of human physiologic cannabinoid system and cannabinoid pharmacology has over the last two decades, led to the development of synthetic analogues of cannabis like nabiximols, nabilone and dronabinol (Marinol) some of which are used for both research purposes as well as in the treatment of disease and symptoms.

Evidence is growing, with a slew of disease-specific studies where MC provided clinically and statistically significant improvements in patients’ symptoms and quality of life, for example, from a cross-sectional survey in the management of the side effects of post radiation therapy for patients with head and neck cancers (Elliot et al., 2016) observed both subjective and objective improvements in these side effects, like sticky saliva, xerostomia, anorexia and pain; In a multi-center retrospective study, the authors Tzadok et al. (2016) recorded significant (89%) reductions in the frequency of seizures in pediatric patients treated with MC for pediatric intractable epilepsy.

Other significant improvements were observed in their behavior patterns, motor skills, alertness and sleep. These results are encouraging because pediatric intractable epilepsy also happens to be one of the most mentioned anecdotal successes with cannabis therapy; In a survey involving over 2500 non-cancer patients, Zaki et al. (2017) showed a significant (more than 70%) reduction in symptoms from Post-Traumatic Stress Disorder (PTSD), anxiety, depression, sleep disturbances and arthritis in patients with these conditions; A similar result was obtained in a different study, with significant improvement in PTSD symptoms and overall quality of life in patients who were treated with MC (Chan et al, 2017). The import of these results on servicemen and women returning from active duty with this diagnosis cannot be overstated. Comment by Tandcass: Introducing paragraphs help the reader understand the content better.

The symptom of chronic pain (especially neuropathic pain of diverse etiology) is arguably the most common indication cited for the use of MC. Whereas opiates remain the drug of choice for pain management, there is evidentiary support from a Canadian cross sectional survey, that the use of MC in opiate-dependent patients resulted in significant reduction in the use of the opiates, as well as reduction in alcohol and other illicit drug use (Lukas, Baron & Jikomes, 2019). The authors argue that with the current opioid crisis across the US, which has turned into a public health epidemic, results like this one provide the impetus for further MC legalizations as a potential vehicle for containing the crisis.

The effect of MC on muscle spasticity associated with multiple sclerosis refractory or drug resistant to usual treatment forms has been studied widely and the results are generally impressive. 10 years of clinical evaluations were reviewed by Giacoppo, Bramanti & Mazzon (2017) on patients who received the oromucosal spray Sativex (combined delivery of THC and CBD) for this indication and observed not only the significant relief of spasticity, but a general improvement in their quality of life.

The response of inflammatory bowel disease to treatment with MC as evidenced by retrospective, prospective and randomized controlled studies revealed significant improvements in the symptoms of abdominal pain, diarrhea and nausea (Kinnucan, 2018). Even more encouraging was the observation that in patients with Crohn’s disease specifically, there was significant improvement in the Crohn’s Disease Activity Index (CDAI), with clinical remission noted in 45% of patients. However, this was not associated by a parallel improvement in the objective disease biochemical markers like C-reactive protein (CRP).

In the highly sensitive area of cancer research and treatment, the experimental study by Romano et al., (2014) on the proliferation of colorectal cancer cells, revealed the inhibitory effect of MC on colon carcinogenesis. If this is duplicable in other independent studies, its clinical importance for the management of patients with colorectal cancer cannot be overstated.

Cannabis as Complementary Alternative Medicine

In this diverse and multicultural environment where holistic and culturally competent healthcare has seen the incorporation of Complementary and Alternative Medicines (CAM) into allopathic medical therapies, some experts and studies have called for a change of mindset as regards the exclusion of MC in this category (Bruce, 2018). He argues that if patients are truly getting significant relief/remission of their symptoms or chronic medical conditions by using MC, this should be the driving force behind its legalization, at least as CAM. A corollary to this position is that legalization would free investigators to conduct full scale clinical trials, (without the impediment of regulations engendered by its current classification), further advancing and improving the existing body of knowledge about the pharmacological profile of cannabis, document unanticipated drug side effects and interactions with other medications and consequently develop correct dosing parameters for the drug (Nutt et al., 2013).

Challenges

From socio-political, ethical and legal perspectives, there are valid concerns and challenges facing the mainstream integration of MC as an accepted tool in the regimen of refractory therapeutics. For instance, even as multiple states pass legislations legalizing MC, authors like Marcoux, Larrat & Vogenberg (2013), contend that the ambiguities created by the dichotomy between states and federal laws, leave health care providers legally exposed on the implementation side of the equation. They make another important observation that public acceptance seems to be the driving force behind medical cannabis legislations, rather than clinical data and this is a legitimate concern.

Another factor not commonly discussed in the debates regarding MC is the training and preparedness of the physicians who are charged with writing the prescriptions. In their article on this subject, Evanoff et al., (2017) reveal that while over half of the states in the US have now legalized the use of cannabis for medical purposes, there is a significant lagging in the training of physicians to administer the programs, from medical school through residency and fellowship training. There appears to be an incongruence between the enthusiasm for legislative change to legalize medical cannabis and the educational preparedness of the physicians who are supposed to fill the prescriptions, which raises an obvious challenge to its effective implementation.

The medical and science communities have also raised pertinent ethical concerns about the yet undetermined respiratory and second-hand environmental effects of the smoked forms of MC, since their pharmacokinetic and pharmacodynamic characteristics through this route have not been fully elucidated (Sagy et al., 2018).

One of the major social concerns about the legalization of MC is the potential to act as a gateway drug for other illicit substance abuse, or at the minimum, the transition to recreational use. The latter fear is not unfounded, as some studies (Stolzenberg, D’Alessio & Dariano, 2016) have shown that in states that have passed MC laws, there is an increased likelihood of recreational usage among the juvenile demographic. The authors postulate that this behavior could stem from the de-stigmatization of cannabis use associated with the law, as well as the attenuation of fears of negative health effects of the drug.

To adopt and implement MC into clinical practice, Wan et al., (2017) posit that these challenges must be met by high quality scientific research validating the common anecdotal efficacies of MC and using the evidence to develop indication-specific, dose and route-adjusted drug vehicles, moving away from the unreliable and erratic characteristics inherent in the smoking forms.

Conclusion

With numerous anecdotal evidences, now supported with many and growing empirical studies, MC is showing great promise as an acceptable and effective therapeutic approach to a myriad of clinical indications that hitherto have not been amenable to current treatment modalities. However, more research is needed to develop a widely acceptable, dose-dependent drug vehicles that address the legitimate pharmacokinetic and pharmacodynamic concerns associated with the smoked form. Furthermore, the streamlining of states legislative efforts and federal statutory positions on cannabis will be necessary to remove the ambiguities associated with the interpretation of these laws and the dilemmas inherent in their implementation for health care providers.

References

Bruce, D., Brady, J. P., Foster, E., & Shattell, M. (2018). Preferences for Medical Marijuana over Prescription Medications Among Persons Living with Chronic Conditions: Alternative, Complementary, and Tapering Uses. Journal of Alternative & Complementary Medicine, 24(2), 146–153. https://doi-org.lopes.idm.oclc.org/10.1089/acm.2017.0184

Chan, S., Blake, A., Wolt, A., Wan, B. A., Zaki, P., Liying Zhang, … O’Hearn, S. (2017). Medical cannabis use for patients with post-traumatic stress disorder (PTSD). Journal of Pain Management, 10(4), 385–396. Retrieved from https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=129041542&site=eds-live&scope=site

Elliott, D., Nabavizadeh, N., Romer, J., Chen, Y., Holland, J., Elliott, D. A., … Holland, J. M. (2016). Medical marijuana use in head and neck squamous cell carcinoma patients treated with radiotherapy. Supportive Care in Cancer, 24(8), 3517–3524. https://doi-org.lopes.idm.oclc.org/10.1007/s00520-016-3180-8

Evanoff, A. B., Quan, T., Dufault, C., Awad, M., & Bierut, L. J. (2017). Physicians-in-training are not prepared to prescribe medical marijuana. Drug & Alcohol Dependence, 180, 151–155. https://doi-org.lopes.idm.oclc.org/10.1016/j.drugalcdep.2017.08.010

Giacoppo, S., Bramanti, P., & Mazzon, E. (2017). Review article: Sativex in the management of multiple sclerosis-related spasticity: An overview of the last decade of clinical evaluation. Multiple Sclerosis and Related Disorders, 17, 22–31. https://doi-org.lopes.idm.oclc.org/10.1016/j.msard.2017.06.015

Hand, A., Blake, A., Kerrigan, P., Samuel, P., & Friedberg, J. (2016). History of medical cannabis. Journal of Pain Management, 9(4), 387–394. Retrieved from https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121009947&site=eds-live&scope=site.

Kinnucan, J. (2018). Use of Medical Cannabis in Patients with Inflammatory Bowel Disease. Gastroenterology & Hepatology, 14(10), 598–601. Retrieved from https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=132393453&site=eds-live&scope=site

Lucas, P., Baron, E. P., & Jikomes, N. (2019). Medical cannabis patterns of use and substitution for opioids & other pharmaceutical drugs, alcohol, tobacco, and illicit substances; results from a cross-sectional survey of authorized patients. Harm Reduction Journal, 16(1), 1–11. https://doi-org.lopes.idm.oclc.org/10.1186/s12954-019-0278-6

Marcoux, R. M., Larrat, E. P., & Vogenberg, F. R. (2013). Medical marijuana and related legal aspects. Pharmacy and Therapeutics, 38(10), 612. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3875249/

Nutt, D. J., King, L. A., & Nichols, D. E. (2013). Effects of Schedule I drug laws on neuroscience research and treatment innovation. Nature Reviews Neuroscience, 14(8), 577.

Romano, B., Borrelli, F., Pagano, E., Cascio, M. G., Pertwee, R. G., & Izzo, A. A. (2014). Inhibition of colon carcinogenesis by a standardized Cannabis sativa extract with high content of cannabidiol. Phytomedicine: International Journal of Phytotherapy & Phytopharmacology, (5), 631. https://doi-org.lopes.idm.oclc.org/10.1016/j.phymed.2013.11.006

Rubens, M. (2014). Political and Medical Views on Medical Marijuana and its Future. Social Work in Public Health, 29(2), 121–131. https://doi-org.lopes.idm.oclc.org/10.1080/19371918.2013.821351

Sagy, I., Peleg-Sagy, T., Barski, L., Zeller, L., & Jotkowitz, A. (2018). Ethical issues in medical cannabis use. European journal of internal medicine, 49, 20-22. Retrieved from https://www.sciencedirect.com/science/article/pii/S0953620518300165

Salem News (2019). WHO Changes Position on Medical Cannabis After 60 years. A major breakthrough in international Cannabis policy is a clear victory of evidence over politics. Retrieved from http://www.salem-news.com/articles/february012019/who-cannabis-policy-change.php

Smith, P. D., & Lannon, A. P. (2017). Local Regulation of Medical Marijuana in Florida. Florida Bar Journal, 91(9), 59–63. Retrieved from https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=125905260&site=eds-live&scope=site

Stolzenberg, L., D’Alessio. S. J., & Dariano, D. (2016). Research paper: The effect of medical cannabis laws on juvenile cannabis use. International Journal of Drug Policy, 27, 82–88. https://doi-org.lopes.idm.oclc.org/10.1016/j.drugpo.2015.05.018

Tzadok, M., Uliel-Siboni, S., Linder, I., Kramer, U., Epstein, O., Menascu, S., … & Dor, M. (2016). CBD-enriched medical cannabis for intractable pediatric epilepsy: the current Israeli experience. Seizure, 35, 41-44. Retrieved from https://www.sciencedirect.com/science/article/pii/S1059131116000054

Wan, B. A., Malek, L., Diaz, P., DeAngelis, C., Chow, E., & Merrick, J. (2017). How can we advance the adoption of medical cannabis into clinical practice? Journal of Pain Management, 10(4), 331–333. Retrieved from https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=129041536&site=eds-live&scope=site

Zaki, P., Ganesh, V., O’Hearn, S., Wolt, A., Chan, S., Liying Zhang, … Blake, A. (2017). The use of medical cannabis in common medical conditions excluding cancer. Journal of Pain Management, 10(4), 363–374. Retrieved from https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=129041540&site=eds-live&scope=site

RESEARCHPAPER: FIRST DRAFT

1

The Research Paper: First Draft

Grand Canyon University

BIO-317V

Professor’s name

Date

Formatted: Font:Bold

Deleted: : BIO-317V

RESEARCH PAPER: FIRST DRAFT 2

Abstract

This paper offers an analysis and literature review in support of and the challenges associated

with the legalization of cannabis for medical use. Recent peer-reviewed scientific studies progressively

support historical and anecdotal evidence of the efficacy of Medical Cannabis (MC) in the treatment of

many chronic health issues. The online databases CINAHL, PubMed and Medline were used to search for

literature relevant to this topic. Majority of the articles show the effectiveness of MC in the management

of wide-ranging medical diagnoses, but for a nuanced review, articles that reflect the challenges with this

approach are also highlighted. There is growing research evidence to support the integration of MC into

current therapeutic models for the management of various medical conditions, but more research is

recommended for more broad-based conclusive evidence.

RESEARCH PAPER: FIRST DRAFT 3

The Research Paper: First Draft

Cannabis (marijuana) is derived from the plant Cannabis sativa and classified as a schedule 1

drug and therefore federally prohibited for recreational and therapeutic purposes but in recent times there

has been a slew of state legislations that have either legalized it for medical use and/or for recreational use

as well. MC has become one of the most important public health issues of our time, because of the

controversy evoked by its recreational use and the perceived effect it has on users and the society in

general, but the dilemma occurs when there is at least significant anecdotal evidence of its effectiveness

with users in treating or ameliorating the symptoms associated with various chronic medical conditions.

While robust clinical research into the documented subjective effectiveness of MC on a myriad of health

issues is lacking, the available literature points to the potential that must be explored in full to enhance the

knowledge base about cannabis.

The historical antecedents and the patient-reported evidence should create the momentum to

encourage scientific investigations into these observations and there is a real positive trajectory on this

topic, given traction by a recent article in Salem News (2019) on the World Health Organization

(WHO)’s change of position on MC. After more than 60 years of a zero tolerance stance on cannabis, this

change is consequent upon the increasing scientific evidence of its therapeutic value. The report reiterates

that this effectively repeals a 65-year old WHO position that cannabis should be abolished from all

legitimate medical practice. This was declared a major policy breakthrough and a resounding defeat of

politics by the strength of evidence.

Following prohibition since the 1970s, there have been progressive initiatives at the state and

citizenry level to reinstate the use of cannabis for medical purposes. The psychoactive nature of cannabis

and its addictive properties have added political, social and legal dimensions to a debate that should be

driven by the science, based on evidence (Rubens, 2014). Therefore, it is valid to concede that the current

wave of legalizations of MC across states in the US is more from social acceptance than from a robust

increase in scientific knowledge (Marcoux, Larrat, & Vogenberg, 2013).

Formatted: Font:Bold

Formatted: Indent: First line: 0.5″

RESEARCH PAPER: FIRST DRAFT 4

The use of medical cannabis as a treatment modality for a wide range of chronic medical and/or

painful conditions has shown promising effectiveness especially in cases that have been refractory to

current therapeutic approaches. There is an increasing body of research evidence to support this assertion

and this paper is an attempt to review the evidentiary basis.

Methods

Several online databases were searched using inclusion criteria relevant to the project topic.

CINAHL yielded 58 articles, PubMed, 43 and Medline 26. Of the 127 total articles available for review,

19 were eventually used for their specific relevance to the trajectory of this paper.

Historical and Cultural Perspectives

The plant cannabis sativa has been cultivated and used over several millennia by different

cultures for the treatment of various ailments and even for its psychoactive properties in religious rituals

(Hindu and Buddhist traditions). In their review of this history, Hand et al. (2016) argue that the cultural

and medicinal uses of cannabis through a historical point of view is important to understand the

imperative of its integration into modern therapeutic regimens. The authors reveal the documented

records of its use from over 6000 years; the earliest recorded use for medical purposes being found in the

ancient Chinese pharmacopeia Pen-ts’ao ching dating back to 2700 BC and affirmed its effectiveness in

treating conditions like joint pains, gout and even as a surgical anesthetic. The authors chronicle this

history over the succeeding millennia as its use spread westward through India, Arabia, Africa and the

Americas. Among the earliest documented medicinal use of cannabis in the United States (US) was in

1860, as recorded by the Ohio State Medical Society in the successful treatment of various diseases like

asthma, gonorrhea and rheumatic pain (p.3). However, in 1970, a federal ban on its use (recreational or

medicinal) was effected by the promulgation of the Controlled Substances Act, when it was classified as a

schedule 1 drug. In the state of Florida where this author resides, MC was introduced by the legislature in

2014 (Smith & Lannon, 2017).

Current Evidence-Based Science

Formatted: Indent: First line: 0.5″

Formatted: Indent: First line: 0.5″

RESEARCH PAPER: FIRST DRAFT 5

The two main active ingredients in cannabis are delta-9 tetrahydrocannabinol (THC), a

psychoactive compound and the non-psychoactive Cannabidiol (CBD). The deeper understanding of

human physiologic cannabinoid system and cannabinoid pharmacology has over the last two decades, led

to the development of synthetic analogues of cannabis like nabiximols, nabilone and dronabinol (Marinol)

some of which are used for both research purposes as well as in the treatment of disease and symptoms.

Evidence is growing, with a slew of disease-specific studies where MC provided clinically and

statistically significant improvements in patients’ symptoms and quality of life, for example, from a

cross-sectional survey in the management of the side effects of post radiation therapy for patients with

head and neck cancers (Elliot et al., 2016) observed both subjective and objective improvements in these

side effects, like sticky saliva, xerostomia, anorexia and pain; In a multi-center retrospective study, the

authors Tzadok et al. (2016) recorded significant (89%) reductions in the frequency of seizures in

pediatric patients treated with MC for pediatric intractable epilepsy.

Other significant improvements were observed in their behavior patterns, motor skills, alertness

and sleep. These results are encouraging because pediatric intractable epilepsy also happens to be one of

the most mentioned anecdotal successes with cannabis therapy; In a survey involving over 2500 non-

cancer patients, Zaki et al. (2017) showed a significant (more than 70%) reduction in symptoms from

Post-Traumatic Stress Disorder (PTSD), anxiety, depression, sleep disturbances and arthritis in patients

with these conditions; A similar result was obtained in a different study, with significant improvement in

PTSD symptoms and overall quality of life in patients who were treated with MC (Chan et al, 2017). The

import of these results on servicemen and women returning from active duty with this diagnosis cannot be

overstated.

The symptom of chronic pain (especially neuropathic pain of diverse etiology) is arguably the

most common indication cited for the use of MC. Whereas opiates remain the drug of choice for pain

management, there is evidentiary support from a Canadian cross sectional survey, that the use of MC in

opiate-dependent patients resulted in significant reduction in the use of the opiates, as well as reduction in

alcohol and other illicit drug use (Lukas, Baron & Jikomes, 2019). The authors argue that with the current

Formatted: Indent: First line: 0.5″
Formatted: Indent: First line: 0.5″

Comment [T&T1]: Introducing paragraphs help the
reader understand the content better.

RESEARCH PAPER: FIRST DRAFT 6

opioid crisis across the US, which has turned into a public health epidemic, results like this one provide

the impetus for further MC legalizations as a potential vehicle for containing the crisis.

The effect of MC on muscle spasticity associated with multiple sclerosis refractory or drug

resistant to usual treatment forms has been studied widely and the results are generally impressive. 10

years of clinical evaluations were reviewed by Giacoppo, Bramanti & Mazzon (2017) on patients who

received the oromucosal spray Sativex (combined delivery of THC and CBD) for this indication and

observed not only the significant relief of spasticity, but a general improvement in their quality of life.

The response of inflammatory bowel disease to treatment with MC as evidenced by retrospective,

prospective and randomized controlled studies revealed significant improvements in the symptoms of

abdominal pain, diarrhea and nausea (Kinnucan, 2018). Even more encouraging was the observation that

in patients with Crohn’s disease specifically, there was significant improvement in the Crohn’s Disease

Activity Index (CDAI), with clinical remission noted in 45% of patients. However, this was not

associated by a parallel improvement in the objective disease biochemical markers like C-reactive protein

(CRP).

In the highly sensitive area of cancer research and treatment, the experimental study by Romano

et al.(2014) on the proliferation of colorectal cancer cells, revealed the inhibitory effect of MC on colon

carcinogenesis. If this is duplicable in other independent studies, its clinical importance for the

management of patients with colorectal cancer cannot be overstated.

Cannabis as Complementary Alternative Medicine

In this diverse and multicultural environment where holistic and culturally competent healthcare

has seen the incorporation of Complementary and Alternative Medicines (CAM) into allopathic medical

therapies, some experts and studies have called for a change of mindset as regards the exclusion of MC in

this category (Bruce, 2018). He argues that if patients are truly getting significant relief/remission of their

symptoms or chronic medical conditions by using MC, this should be the driving force behind its

legalization, at least as CAM. A corollary to this position is that legalization would free investigators to

conduct full scale clinical trials, (without the impediment of regulations engendered by its current

Formatted: Indent: First line: 0.5″

Deleted: ,

Formatted: Indent: First line: 0.5″

RESEARCH PAPER: FIRST DRAFT 7

classification), further advancing and improving the existing body of knowledge about the

pharmacological profile of cannabis, document unanticipated drug side effects and interactions with other

medications and consequently develop correct dosing parameters for the drug (Nutt et al., 2013).

Challenges

From socio-political, ethical and legal perspectives, there are valid concerns and challenges

facing the mainstream integration of MC as an accepted tool in the regimen of refractory therapeutics. For

instance, even as multiple states pass legislations legalizing MC, authors like Marcoux, Larrat &

Vogenberg (2013), contend that the ambiguities created by the dichotomy between states and federal

laws, leave health care providers legally exposed on the implementation side of the equation. They make

another important observation that public acceptance seems to be the driving force behind medical

cannabis legislations, rather than clinical data and this is a legitimate concern.

Another factor not commonly discussed in the debates regarding MC is the training and

preparedness of the physicians who are charged with writing the prescriptions. In their article on this

subject, Evanoff et al.(2017) reveal that while over half of the states in the US have now legalized the use

of cannabis for medical purposes, there is a significant lagging in the training of physicians to administer

the programs, from medical school through residency and fellowship training. There appears to be an

incongruence between the enthusiasm for legislative change to legalize medical cannabis and the

educational preparedness of the physicians who are supposed to fill the prescriptions, which raises an

obvious challenge to its effective implementation.

The medical and science communities have also raised pertinent ethical concerns about the yet

undetermined respiratory and second-hand environmental effects of the smoked forms of MC, since their

pharmacokinetic and pharmacodynamic characteristics through this route have not been fully elucidated

(Sagy et al., 2018).

One of the major social concerns about the legalization of MC is the potential to act as a gateway

drug for other illicit substance abuse, or at the minimum, the transition to recreational use. The latter fear

is not unfounded, as some studies (Stolzenberg, D’Alessio & Dariano, 2016) have shown that in states

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Deleted: ,

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that have passed MC laws, there is an increased likelihood of recreational usage among the juvenile

demographic. The authors postulate that this behavior could stem from the de-stigmatization of cannabis

use associated with the law, as well as the attenuation of fears of negative health effects of the drug.

To adopt and implement MC into clinical practice, Wan et al.(2017) posit that these challenges must be

met by high quality scientific research validating the common anecdotal efficacies of MC and using the

evidence to develop indication-specific, dose and route-adjusted drug vehicles, moving away from the

unreliable and erratic characteristics inherent in the smoking forms.

Conclusion

With numerous anecdotal evidences, now supported with many and growing empirical studies,

MC is showing great promise as an acceptable and effective therapeutic approach to a myriad of clinical

indications that hitherto have not been amenable to current treatment modalities. However, more research

is needed to develop a widely acceptable, dose-dependent drug vehicles that address the legitimate

pharmacokinetic and pharmacodynamic concerns associated with the smoked form. Furthermore, the

streamlining of states legislative efforts and federal statutory positions on cannabis will be necessary to

remove the ambiguities associated with the interpretation of these laws and the dilemmas inherent in their

implementation for health care providers.

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