Cannabis to replace Pharmaceuticals
While there are a wide variety of pharmaceutical drugs, this article concerns many of those listed below:
Celexa (Citalopram), Lexapro (Escitalopram), Prozac (Fluoxetine), Paxil (Paroxetine), Zoloft (Sertraline), Cymbalta (Duloxetine), Effexor (Venlafaxine), Trintellix (Vortioxetine), Seroquel (Quetiapine), Pristiq (Desvenlafaxine), Xanax (Alprazolam), Wellbutrin (Bupropion), Abilify (Aripiprazole), Valium (Diazepam), Neurontin (Gabapentin), Atavan (Lorazepam), Percocet (Oxycodone), Vicodin (Hydrocodone), Ambien (Zolpidem), Lunesta (Eszopiclone), Trazadone, Tramadol (Cyclobenzaprine), Lamictal (Lamotrigine), Adderal (Amphetamine), Mobic (Meloxicam), Vyvanse (Lisdexamfetamine), Flexeril (Cyclobenzaprine), Vraylar (Cariprazine)
Side Effects of just one of the above: agitation, insomnia, headache, nausea, vomiting, constipation, stomach pain, dizziness, vision problems, loss of interest in sex, sore throat, muscle pain, itching, rash, sweating, tremor, changes in appetite, weight gain, joint aches, strange taste in the mouth, diarrhea, seizures. Just one of these side effects can prevent use!!!
Compounds which include cannabinoids were commonly used in medicine available at United States pharmacies before the advent of chemically manufactured pharmaceutical medications. In the 1930s, for example, cannabinoid tinctures, ointments, lotions, elixirs, pills, and suppositories were common items received from your local pharmacy. Similar compounds were used in civilization for thousands of years for various ailments and conditions over the ages. Pharmacies in the United States during the early 1900s in our country dispensed medical cannabis products for headache, gout, digestive disturbances, insomnia, menstrual cramps, fever, pain, neuralgia, and almost any other malady that patients could possibly suffer from.
The introduction and widespread use of pharmaceuticals in the middle of the previous decade, and their current development and use is of tremendous benefit to mankind and has extended life spans and improved prognosis for a wide variety of diseases and ailments. However, as these new drugs were introduced cannabis was effectively banned and outlawed from dispensaries and pharmacies. This was due to political and financial reasons and for the benefit of profits for big pharma and profits for the paper industry (financial threat of hemp). It was no longer available to use as a medicine and became villainized, stigmatized, and outlawed with criminal penalties for its possession.
Recently, and over a period of many years, this stigma is being erased and the true pharmaceutical value of cannabis is once again being recognized. This shift in policy and perceptions has led to an increased number of patients who are eager to try medical cannabis, driven predominantly by the reported safety and efficacy for a wide variety of medical issues that they may face. Media news cycles, changing laws, anecdotal reports of benefits, and overall public acceptance are all positive aspects of cannabis. This leaves a situation where many new patients are using cannabis but also may have previously been prescribed other pharmaceutical drugs for their medical conditions. While certainly, the goal is to provide a benefit in health for the patient, these pharmaceuticals may often have negative or adverse side effects, as well as the development of tolerance (where more of the drug is required to achieve an effect).
The recent and current opioid crisis in our country has led to overall mistrust in the pharmaceutical industry, and rightfully so. Modern medicine is often based upon a quick appointment with a drug or prescription often dispensed as a quick solution to a problem that could possibly be resolved without the use of pharmaceutical drugs. This approach, however, would require more effort and time to discuss more options to help the patient.
Patients often seek alternative therapies, particularly those where their drug stopped working, or the side effects became too severe or uncomfortable. Holistic treatments such as yoga, acupuncture, reiki, chiropractic care, massage therapy, reflexology, aromatherapy, and other non-traditional therapies becoming sought out by patients. This includes the use of medical cannabis.
Current pharmaceuticals used for a wide variety of illnesses and diseases may be either partially or even totally replaced using cannabis in many cases. This is a generalized statement based upon each individual patient. The way that each separate pharmaceutical drug may work concurrently with a cannabinoid can be different, whether to lower doses, or if cannabis is being used to totally replace a pharmaceutical. A general guideline is that CBD, for example, will potentiate other pharmaceutical drugs thru competitive enzyme inhibition. This refers to CBD requiring the same enzyme (Cytochrome P450) to metabolize it that is used to metabolize a pharmaceutical drug, thereby delaying the metabolism of the pharmaceutical agent and increasing the available blood levels, and also prolonging the effect of the pharmaceutical. Of course, there are exceptions to this, and some situations the pharmaceutical drug effect can be diminished by the use of a concurrent cannabinoid. This would be the case in which the metabolite of a pharmaceutical is the active agent, and the enzyme inhibition would lower the level of the metabolite thereby inhibiting the drug effect by delaying the development of the metabolite. There are also a few contraindications among some drug classes, but none are very serious. If dosages are properly managed, minimal side effects occur with the exception of high doses of THC in a naïve or new patient which may cause excessive psychoactivity.
In my clinical experience (which is perhaps mirrored across the country) there are several overall classes of pharmaceuticals that patients wish to eliminate. They would include narcotic analgesics for pain, sleep medications, and drugs used for anxiety, depression or ADHD. Some patients may seek relief using cannabis in place of one individual drug, or perhaps several. In some cases, patients will have a pocketful of drugs (often 7 or more being used!) that they are currently taking to alleviate the symptoms of their illness. This alone can obviously be hazardous due to possible interactions between these drugs. Some of these drugs are necessary and beneficial to health, but many informed patients want to reduce their pharmaceutical load, and only use what is necessary and deemed beneficial to their health and quality of life. This somewhat puts the pharmaceutical industry at odds with the cannabis industry, as they compete for profits. Profits from opioid drugs have been slashed since the truth of how the pharmaceuticals companies help create the opioid crisis, and pharmaceutical companies are trying to fill the gap with other medications. These are often marketed on TV direct to consumers through commercials, and often the side effects are horrible, sometimes including cancer and death.
Cannabis therapies can often have side effects as well, but many of these are considered pleasurable and the reason why many people enjoy using cannabis. Any negative side effects are generally mild if they occur at all. The most common side effects of cannabis can include dizziness, fainting spells, disorientation, hunger, headache, dry mouth, red eyes, increased pulse, lowered blood pressure, paranoia, and inability to perform normal job tasks. Other side effects can also occur including a sense of well-being, euphoria, an increase in sensory awareness, reduction of dream cycles, and increased ability to fall and stay asleep. Cannabis can often cause an overall sense of well-being and happiness and the reduction in the stressors often encountered in our modern interconnected society. In the words of Carl Sagan, the renowned astronomer “Cannabis helps produce the serenity and insight, sensitivity and fellowship so desperately needed in this increasingly mad and dangerous world”. In order to effectively replace a pharmaceutical drug for a patient, the skill of the cannabis provider comes into play as effective replacement therapy can vary from patient to patient, and may require time and effort to achieve. In some cases, replacement therapy is not indicated, and patients must continue on their pharmaceutical medication, perhaps supplemented with cannabis.
OPIOIDS, including prescription narcotics or illicit street narcotics, are often one class of drugs that can be eliminated or replaced through the use of medical cannabinoids. As a provider and medical professional, I have taken an oath to combat the opioid epidemic by almost entirely eliminating the prescribing of narcotics for pain. However, to combat opioid addiction or reliance on narcotics, patients require commitment and determination to follow through with recommendations. They will experience some withdrawal effects which can be mitigated with cannabinoids, particularly with CBD (cannabidiol). The concurrent use of CBD, particularly as a tincture, given along with an opioid dose can allow the narcotic dose to be lowered by approximately one-half almost immediately. This can often quickly reduce the dependence on opioids, and further reductions in dose can be accomplished as patients wean off the opioids and begin the use of cannabis. Other components in the plant, i.e. THC CBC and various terpenes can also help to reduce opioid dependence, and this can vary in each individual patient. Many clinics and treatment centers for opioid addiction exist, but are expensive and achieve limited results with relapse and recidivism by patients. Often, these patients are put on methadone, suboxone, or other drugs. Patients on suboxone already in treatment can cut their sublingual strips in half while con-currently also using a high CBD tincture.
The use of medical cannabis for narcotic addiction is not in general use or widespread, but I have seen about a 30% success rate with my own patients. These patients have either eliminated or reduced their opioid use. Some of these patients require strong or high doses of cannabinoids usually achieved with concentrates, edibles, or dabbing. These patients will experience some discomfort and withdrawal effects (sweats, chills, nausea, vomiting, insomnia, etc. However, it is markedly less than if they did not use cannabis to help them wean off narcotics. In some instances, patients totally eliminate narcotics, and in other cases, patients have reduced their doses significantly. Correspondingly, the negative side effects they may be experiencing with opioids are eliminated or reduced. The control of chronic pain is also aided by the use of medical cannabis, but in the case of an increase in pain (expected) after discontinuing opioids there are other holistic or organic techniques such as meditation, cognitive behavioral therapy, acupuncture, yoga, NSAID’S, or other non-narcotic medications.
SLEEP MEDICATIONS are in widespread use in our society, and some pharmaceuticals used here include Valium,Trazadone, Xanax, Sonesta, Lunesta, Klonopin, Benadryl, Atavan, and Ambien. Some natural products include melatonin, valerian, lavender, and tryptophan. Negative issues associated with these agents can be a hangover, sleepwalking, daytime drowsiness, allergies or liver toxicity, mental confusion, or habituation or addiction. In addition, these products often do not work effectively for patients as they continue to have difficulty staying asleep or pre-mature awakening. The ineffectiveness of current sleep medicines is a good reason to use cannabis instead. Cannabis has been shown to be remarkably effective in promoting healthy sleep patterns, and daytime alertness with no hangover effect. My experience with sleep patients has shown that in almost ALL cases beneficial sleep is a welcome side effect of cannabis use. Others using cannabis for other symptoms (anxiety, pain, PTSD, etc..) have also anecdotally reported that their sleep is much improved. If your sleep pattern is normal and you sleep well, many other issues you face during the day become easier. Interestingly the main withdrawal symptoms from the cessation of cannabis use is insomnia!! While there is research to show that sleep dependency and habituation can occur with cannabis, it is non-addictive and less harmful than any prescription sleep medicine. Terpenes in cannabis can also induce sleep and they are often more effective as a tincture rather than smoking or vaping. These would include myrcene, terpinolene, and linalool. Also, important to note that various studies show a decrease in sleep apnea for some patients who have this issue and use cannabis. Typically, dental appliances or C-Pap machines are used, and these may not be well tolerated.
ANXIETY/DEPRESSION/ADHD are very common issues faced by a wide variety of individuals in our society. A surprising number of individuals, particularly younger ones (age 20-30) present with having an issue related to anxiety, PTSD, Depression, ADD or ADHD. Modern culture, internet connectivity, computer screen activity, and societal issues seem to play a role and can upset the homeostatic balance resulting in many individuals who have difficulty with various issues in the rigors of daily life. Anxiety, depression, and ADHD are sometimes the result of this imbalance. Often there is a relevant chemical explanation or imbalance and prescription drugs are readily and fully prescribed. While these drugs can offer a positive effect for many patients, ultimately they may lose effectiveness or cause unwanted side effects and low-level addiction. Often multiple drugs are tried or used, often in combinations of several drugs.
THC is a cannabinoid that is biphasic. Low doses of THC – 5 mg - combat anxiety (anxiolytic), while high doses – 50mg - can stimulate anxiety (anxiogenic). CBD on the other hand is anxiolytic and combats anxiety in all doses. Higher doses of CBD are more effective than low doses in regards to anxiety. Sublingual use of a CBD tincture can help eliminate anxiety in a dose of anywhere from 5-50 mg. Keep in mind different patients may receive varying degrees of benefits using cannabis for anxiety based on body weight, metabolism, and mental state. Terpenes useful for anxiety are usually limonene and pinene. Because of the possibility of increased anxiety, while using THC, it is important to balance the THC with CBD. Often a 1:1 ratio, or equal amounts, of these cannabinoids can prevent any unwanted anxiety. Once again, each patient is different and may require a different dose level or method of ingestion. Depression per se is best treated with an uplifting Sativa strain low in myrcene and relatively high in THC.
Those individuals wishing to remove or lessen their anti-anxiety or depression medication must be willing to experiment with the various cannabinoids and should try multiple routes of ingestion. Due to the competitive enzyme inhibition effect, doses of CBD can potentiate most anti-anxiety drugs so lower doses can be used to reach the same blood level and therapeutic effect. This allows for immediate reduction in dose of the pharmaceutical and can lead to possible overall elimination and weaning off from the pharmacologic agent(s).
The vast majority of patients who are taking pharmaceutical drugs that are either ineffective or have serious negative side effects are possible candidates for medical cannabis. For some patients, they are doing just fine on their prescriptions and cannabis may not be necessary. However, if an individual is seeking a better quality of life by the elimination of their pharmaceutical drug burden, cannabis is worth a try. Due to the wide variety of compounds in the plant, and the varying responses in individual patients, it may take a period of experimentation to see what works best to help reduce or eliminate their prescription drugs. New patients who want to use cannabis to cut down on the pharmaceuticals often ask me “What if it doesn’t work?”. My reply is that if it doesn’t work then you will be no worse off than before. But more often than not, a surprising number of patients who return after a year for their annual medical recertification for a multitude of conditions give reports of the reduced or complete elimination of pharmaceutical drugs. Their original condition has been effectively treated with a more natural, organic, and safe product.
Dr. Stanley R. Manstof
12201 Greenridge Drive
Boyds, Md. 20841
*MMCC Certified Provider
*American Academy of Cannabis Physicians
*Member Americans for Safe Access
*Technical Writer and Editor
*Member Society of Cannabis Clinicians
*International Cannabinoid Research Society
*Certified Patient Caregiver
E Mail: firstname.lastname@example.org