Can Marijuana Be as Effective as Medications?

Marijuana use is growing worldwide, both for medical and recreational use. There is increasing knowledge about the potential health benefits of marijuana, and some people are starting to use it instead of prescription medications. 

As more states legalize marijuana and more people turn to it in place of their prescription medications, we need to know if medical cannabis is safe and effective. 

Before quitting your prescriptions and buying from a budtender, read on to know what we really know (and don’t know) about medical cannabis. 

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Must be 21 years or older to purchase. Cannabis is not recommended for women who are pregnant or nursing or those who are suffering from bipolar disorder or schizophrenia. Cannabis use may increase risk of falls. Always consult with your doctor before beginning any new medical treatment.

What is marijuana and how does it work?

Marijuana comes from the Cannabis sativa plant, which includes both marijuana and hemp. Marijuana contains many cannabinoids, most importantly: 

• THC: acts on the brain and causes a high 

• CBD: does not cause a high, but has many other effects throughout the body

Hemp has very little THC and is federally legal under the 2018 Farm Bill. Marijuana remains federally illegal as a Schedule I controlled substance, though state laws vary. Medical cannabis refers to products derived from either hemp or marijuana and that have various ratios of THC and CBD.

What marijuana-based medications are approved by the FDA?

There are currently three FDA-approved medications that contain THC or CBD. These are approved for very specific and limited medical indications — severe seizure disorders, severe vomiting from chemotherapy, or significant weight loss from HIV/AIDS.

• Epidiolex: This is a plant-derived CBD approved for treatment of the severe seizure disorders including Lennox-Gastaut syndrome and Dravet syndrome.

• Dronabinol (Marinol): This is a synthetic THC used for nausea, vomiting, and weight loss related to chemotherapy or HIV/AIDS.

• Nabilone (Cesamet): This is a synthetic THC also used for nausea, vomiting, and weight loss related to chemotherapy.

There is another product called nabiximols (Sativex), which is an oral spray that contains THC and CBD. It is used for muscle spasms and pain associated with multiple sclerosis. It is not currently approved for use in the U.S., but it is available in Canada, Mexico, and some European countries.

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What might marijuana be used to help treat

Most commonly, people turn to marijuana products to treat chronic pain, anxiety, and depression. Studies have found that when people use marijuana as a substitute for prescription medications, they may use it in place of:

• Narcotic pain medication such as hydrocodone, oxycodone, and morphine

• Anxiety medication such as lorazepam, clonazepam, and alprazolam

• Antidepressants like sertraline, trazodone, or bupropion

Many are also turning to marijuana for other medical conditions including:

• Parkinson’s

• Alzheimer’s disease

• Anorexia nervosa

• Epilepsy

• Multiple sclerosis

• Crohn’s disease

• Glaucoma

While research tries to catch up on safety and efficacy, many people are trying it out. And it turns out, some people prefer to use cannabis rather than prescriptions from their healthcare provider. One survey found that almost 40% of people actually stopped taking a prescription when they used cannabis. Why? There are quite a few possible reasons:

• They may have more trust in medical cannabis.

• They may find it more effective than their prescription.

• They may tolerate the side effects of cannabis better. 

• They may feel it is safer.

• They may feel that it is less addictive.

• They may find cannabis more available and accessible.

• They may be better able to afford cannabis.

• They may not have access to mainstream medical care.

Can marijuana cure depression?

There is some evidence that the CBD component of marijuana could be helpful for depression. This might be related to altering serotonin levels in the brain. Most studies have been done in animals, and more research is needed to know what dose, strain, and formulation might be most effective in humans. 

But caution should be taken, because while marijuana might help alleviate symptoms of depression in the short-term, it’s also possible that it could actually worsen depression over time.

Does marijuana help with anxiety?

Marijuana, and particularly CBD, is often used to self-treat anxiety. Research suggests that in the short term, CBD may help with anxiety symptoms, particularly for public speaking and social anxiety. 

In some cases, marijuana may help decrease dependency on prescription medications such as benzodiazepines. In one study, almost half of patients discontinued their benzodiazepines after starting medical cannabis. 

Again, research is limited. It’s important to be aware that the THC component of marijuana can actually worsen anxiety. There is also the concern that marijuana could help alleviate symptoms in the short term, but it could worsen anxiety or mood over a longer period of time.

Can marijuana help with an eating disorder?

Studies suggest that cannabis could be helpful for eating disorders such as anorexia. One study showed that dronabinol helped with both weight gain and body dissatisfaction scores. While dronabinol is not approved for eating disorders, the THC present in marijuana could theoretically have the same effect. 

However, it’s also possible that marijuana use could worsen some eating disorders. Marijuana increases your appetite, which could potentially worsen binge-eating disorder or trigger a binge-purge cycle in someone with bulimia. 

Can you use marijuana to treat insomnia?

Insomnia is a big problem for a lot of people, and many may turn to marijuana to help them sleep. One study found that a large number of people using medical cannabis for sleep were able to stop their prescription sleep medications.

The evidence on marijuana for sleep is not clear. Marijuana might help people fall asleep and decrease the number of times they wake up in the night. It may help reduce nightmares in people with PTSD. 

However, we also know it can reduce rapid eye movement and there are concerns that it could actually lead to poorer sleep quality and sleep disturbances in the long run.

Is marijuana effective for pain management?

For some conditions, marijuana may be successfully used for pain management. Many use cannabis products as an alternative to opioids. The research shows that while it may not be helpful for acute pain, such as after a surgery, it may be helpful for chronic pain and especially nerve pain. 

One study showed that half of people who were reliant on opioids for chronic pain were able to stop the opioids, and a third were able to cut back on them. Also, in states where medical cannabis is legal, we’ve seen prescription opioid use decrease.

How does marijuana help with glaucoma?

Marijuana has been shown to reduce intraocular pressure in the eye, which is important for glaucoma treatment. These effects from marijuana can last several hours. In treating glaucoma, though, it’s important to have a continuous decrease in intraocular pressure, which would mean using marijuana products around the clock. There are good existing medications for glaucoma that do this effectively and are well tolerated.

And for many people with glaucoma — often older adults who have other medical conditions — the risks and side effects of marijuana may not be worth it. 

Are there any serious risks of using marijuana?

There are some risks associated with marijuana use that people should be aware of. For one, some people can have side effects, including:

• Increased heart rate 

• Elevated blood pressure

• Nausea or vomiting

• Anxiety

• Psychosis

There is also the potential that marijuana can interact with other medications, including:

• Anticoagulants like warfarin (Coumadin)

• Antidepressants like amitriptyline (Elavil) and mirtazapine (Remeron)

• Pain medications like tramadol (Ultram)

• Cholesterol medications called statins

• Blood pressure medications such as losartan (Cozaar) and valsartan (Diovan)

There are specific groups of people who may be at more risk of marijuana use, including:

• Adolescents because of the impact on brain development

• Pregnant or breastfeeding women as it can impact development of the baby

• People with heart disease because of the increased risk to the heart

Lastly, these products are not regulated by the FDA and may not be labeled accurately. There is also the potential for contamination including chemical solvents, microbes, and heavy metals. 

Because of the limited research, there are still many unknowns and it’s a good idea to talk with your healthcare provider about your individual risks and benefits.

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Written by:

Christina Palmer, MD

Christina Palmer, MD, is a board-certified family physician with a special interest in chronic care management, women’s health, mental health, and preventive care. She has over 10 years of experience in primary care research, innovation, and practice.

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