On the Spot: Dr. Abrams Responds

As part of our new On the Spot web feature, Dr. Donald Abrams, the new director of clinical programs at the Osher Center for Integrative Medicine and an expert in complementary therapies, agreed to answer your questions. Below we've published some of the questions you've asked of Dr. Abrams, along with his responses. As questions and comments continue to come in, this story will be updated with Dr. Abrams's additional responses. If you'd like to submit a question of your own to Dr. Abrams, you may do so here. Faculty in other disciplines also are "On the Spot" to answer your questions. Please remember that we may not be able to answer all questions or address all comments. Nor can we or the participating faculty member offer specific medical advice. For medical advice, you should always contact your personal physician. Medicinal Marijuana Q. In regard to medicinal marijuana, does marijuana smoke or secondhand exposure affect the lungs or throat like cigarette smoke or secondhand exposure? A. With regards to secondhand marijuana smoke, I do not believe that such studies have been done. In general, inhalation of products of combustion is not the ideal way to deliver a medicine. Donald Tashkin at UCLA has spent nearly 40 years investigating the harmful effects of inhaled marijuana on the lungs-from the electron microscopy level to airway responsiveness to the development of cancer. He has made some interesting observations. Chronic marijuana use seems to be associated with an increased risk of chronic bronchitis. Tobacco smokers who also smoke marijuana, however, seem to have less of a risk to develop emphysema. Most recently he has done a case control study of over 1,300 lung cancer patients in Los Angeles and has found that regular marijuana smoking does not lead to an increase in lung cancer, and may actually be associated with a decreased risk of lung cancer. How is that possible, you may ask? Well, actually this seems to support an animal study and a previous epidemiologic cohort study which suggests the same. It may be that the anti-inflammatory and anti-oxidant effects of some of the components of marijuana are coming into play to explain this finding. There was one study that suggested that chronic marijuana smoking could be associated with an increased risk of head and neck cancers; however, that study was flawed by not controlling for the impact of tobacco smoking, which is a known risk. More and more basic science studies are demonstrating that cannabinoids-the active ingredients in marijuana-may actually be worth investigating as anti-cancer agents! So that is a whole new line of interesting research that may be bearing fruit in years to come! Q. Is it illegal for clinicans to prescribe marijuana? A. To actually "prescribe" marijuana one needs to have a Schedule 1 license from the Drug Enforcement Administration and even then it is only being "prescribed" for research studies. I have a Schedule 1 license to be able to "prescribe" the marijuana that I get from the National Institute on Drug Abuse (NIDA) to participants in my research trials. Since 1996, California physicians have had the right to discuss and recommend the use of medicinal marijuana with their patients. Generally, for their patients to be able to access marijuana from a dispensary (of course you cannot go to a pharmacy and get marijuana in this country), the doctors need to write a letter or sign a form saying that it is ok with them if their patients seek and utilize medicinal marijuana, and that they will continue to follow and care for the patient. So that is not exactly prescribing. And again, there is no official place patients can go to get their "prescription" filled except the local dispensaries, which the Federal Government is not necessarily happy about so they keep shutting them down! Not an ideal situation. Q. I know that marijuana is advised for AIDS/HIV and Cancer patients. Could it be useful in treating things like severe headaches, high blood pressure, low back pain and stress? If not, why not? A. All of those conditions you listed have been found to be helped by cannabis. If one looks at the law in California, Proposition 215, it allows for the recommendation of medical marijuana where use has been deemed appropriate and recommended by a physician for use in "treatment of cancer, anorexia, AIDS, spasticity, glaucoma, arthritis, migraine or any other illness for which marijuana provides relief." Are there clinical trials that have generated the evidence that marijuana is beneficial in all these conditions? No, largely because it has been virtually impossible to do such studies until recently. The creation of the UC Center for Medicinal Cannabis Research provided really the first mechanism for investigators to look at marijuana as a possible therapeutic agent. Before the CMCR was established, there was no easy way to obtain cannabis to study, other than as a substance of abuse. As you can see if you visit the site, CMCR has funded a number of studies investigating pain and spasticity uses of medical marijuana. Many of the other purported benefits have come from anecdote. Like any other medication, people who are using cannabis for medicinal purposes should do so under the supervision of a physician and be aware that side effects and drug-herb interactions are possible. Herbal Q. What herbal/botanical alternatives are available for treatment of high blood pressure (herbal/botanical)? A. Although my integrative medicine practice is largely focused on people living with and beyond cancer, we did get extensive training in the Program in Integrative Medicine on interventions that may be useful in the control of blood pressure. Obviously there are many different causes of and types of hypertension, so definitely there is not one intervention that will work for all. I like to think of diet and exercise interventions that may be useful prior to herbs. Many people who are overweight or obese have elevated blood pressure. By watching caloric intake and increasing energy output through exercise, people are taking important steps in controlling their blood pressure. Keeping added salt to a minimum and eating a plant-based diet with lower levels of animal fat (particularly red meat and dairy products) are ways to drop some extra pounds. Garlic-which has many healthful properties-has been suggested to be useful in lowering blood pressure as well as cholesterol levels. Again, 30-60 minutes of exercise 5 days of the week will go a long way towards weight reduction and improving tone. Before turning to herbal interventions, I would consider some mind-body work to assist with decreasing stress that may be contributing to elevated blood pressure. Breath work, meditation, mindfulness-based stress reduction, yoga, tai chi, even self-hypnosis could be very useful in stress reduction that may assist with lowering blood pressure. I send most of my patients to one of our Traditional Chinese Medicine practitioners at the Osher Center, as I feel that TCM has a long and rich history of caring for people and maintaining their wellness. So I would consider a visit to a TCM practitioner as well. Related Links: Osher Center for Integrative Medicine The UCSF Guide to Integrative Medicine, 2006 edition (pdf) University of California Center for Medicinal Cannabis Research