In this Tuesday, Aug. 6, 2019 photo, Anthony Guarisco Jr., 80, who has glaucoma, takes his first drops of prescribed medical marijuana at the Willow Pharmacy, a Louisiana medical marijuana dispensary in Madisonville, La. When Anthony Guarisco proposed Louisiana’s first medical marijuana bill in 1978, the former state senator never intended to use it himself. He pushed for it after the mother of a child with seizures told him it was the only thing that brought the child relief.
When Anthony Guarisco proposed Louisiana’s first medical marijuana bill in 1978, the former state senator never intended to use it himself. He pushed for it after the mother of a child with seizures told him it was the only thing that brought the child relief.
“I didn’t have no idea in my wildest revelry that I would get glaucoma in 2013,” said Guarisco, now 80.
Medical marijuana is now approved to treat glaucoma and a number of other conditions in Louisiana. Guarisco said his doctor hopes it will keep the pressure in his eyes stable and reduce inflammation to potentially slow down or halt the disease, which can progress to blindness.
On Tuesday, Guarisco joined other patients at Willow Pharmacy in Madisonville who were able to get their hands on medical marijuana, which is only available in tinctures taken by mouth, for the first time since the drug was approved in the state.
Louisiana joins more than 30 other states in dispensing marijuana. But even as patients with debilitating diseases line up to get the drug, experts say the public approval for marijuana has outpaced the evidence that it’s the best treatment available to some patients.
“Voters typically will vote for medical cannabis. They don’t want to keep valuable medicine out of the hands of patients who are suffering. But at the end of the day, we don’t have as much evidence as we would like,” said Dr. Kevin Hill, director of addiction psychiatry at Beth Israel Deaconess Medical Center in Boston and professor of psychiatry at Harvard Medical School.
The drug has been approved since 1978, but the Louisiana bill was not enacted until 2015, leaving many patients to take treatment and dosage into their own hands. A lot of that has to do with the polarizing effect of the topic of cannabis, Hill said.
Physicians typically fall into one of two camps: They either “feel like cannabis is a panacea” or “believe it is a sham,” he said. “Unfortunately, there are times patients can get caught in the middle.”
Studies for the drug are underfunded because it’s still illegal under federal law and is classified as a Schedule 1 drug, meaning that the federal government says it has a high potential for abuse and no medical use.
That classification has been shown to be untrue, but it still makes legal marijuana very difficult to study, said Dr. Alfonso Romero-Sandoval, an associate professor at Wake Forest University in Winston-Salem, N.C., who has studied the use of cannabis to combat chronic pain.
Cannabis has been shown to reduce nausea and vomiting related to chemotherapy, and some find it reduces specific types of pain, Romero-Sandoval said. Because the government has not moved to declassify the drug, “states have taken initiatives to make it legal,” he said. “But it’s been legalized in different frameworks in a disorganized, rushed manner.”
As a result, the evidence is thin for some of the approved conditions. And that’s a problem, considering that many people are turning to marijuana products to treat a wide variety of illnesses.
“There is research being done, but not at the rate and scale it should be,” Hill said. “When you have millions of Americans looking online and trying to buy CBD products that are not regulated, we really should be moving forward and trying to figure out the safety of these products.”
According to a study published in JAMA by researchers from Penn State University, almost 70 percent of cannabis-derived products containing CBD have labels misstating the amount they actually contain. Almost a quarter of them contained THC, the psychoactive component in marijuana.
CBD, the non-psychoactive ingredient in marijuana, is widely available and is billed as safe enough to warrant an influx of products like CBD lattes and bath bombs. “That’s worrisome. CBD could be given to kids,” said Romero-Sandoval.
He warns that patients should not self-dose and should seek out medical professionals who have a larger scope of practice than just recommending weed. The dosage of cannabis shown to be effective for pain is in the 5% THC range, he said; recreational marijuana is usually 15% or more. “There are problems with psychosis, anxiety, memory problems, that could be more prominent in younger adults,” he said.
“We need more research,” said Romero-Sandoval. “It looks like cannabis has the potential to provide an alternative for these patients that don’t have drugs available to treat their pain. We need to study better to provide a safer or a more effective treatment.”
Patients with chronic, debilitating disease, however, don’t have the time or stamina to wait for more evidence.
“I’ve tried pretty much everything — essential oils, cupping, all kinds of acupuncture. I had my chakras aligned, regular neurological medicine, Parkinson’s medication,” said Claire Morgan, of Covington, who has a rare neurological autoimmune disease called stiff person syndrome that causes painful and life-threatening muscle spasms. Her doctor, Chad Domangue, is one of the 80-some doctors in Louisiana licensed to recommend medical marijuana.
For Domangue, marijuana is “another tool in (his) toolbox” for “people who have exhausted all options.”
“It doesn’t have the side-effect profile that all these other things have,” said Domangue. “The ability to have an organic, plant-based product — it’s exciting.”
It’s also an alternative to opioids, which do not have evidence for long-term use for chronic pain and have a high potential for abuse, according to the Agency for Healthcare Research and Quality.
Domangue acknowledged that marijuana has potential adverse effects: “It can make you sleepy, impair your judgment at times; you can have weight gain if taking it in a high quantity. If you’re taking medical marijuana, you have to make sure you’re not taking other drugs with sedative effects.”
But those effects are peanuts in comparison to the risks associated with other legal substances, said Domangue.
“When you look at the alternatives and stuff that is sitting on our shelves, it’s comical what the layman and politicians see as OK and not OK,” he said.