Just watch the horizon: the landscape regarding medical marijuana, or cannabis, is rapidly changing.

The winds of change first swept in with the passage of Proposition 215, California’s landmark 1996 ballot measure that legalized marijuana for therapeutic use. Currently, 20 states and the District of Columbia have enacted legislation governing the use of cannabis for medical purposes, and the trend appears poised to continue.

It’s a dynamic environment: federal and state governments wrangle to assert power and control; the medical community debates a wide range of research and ideologies; and local counties struggle to enact guidelines for distribution.

In the midst of this controversy, and regardless of where you stand on the issue, the legalization of medical cannabis is gaining momentum.

What are the medical benefits of cannabis?

In states where it is legal, medicinal cannabis is prescribed for a long list of often chronic ailments and diseases, and to ease pain and improve quality of life for the terminally ill.

Dr. Rodger Orman, an anesthesiologist who works in the Pain Management Center in San Andreas, said he prescribes marijuana on occasion for various ailments.

“It’s one tool in a toolbox,” he said. “It’s not going to be good for everybody, but for selected patients, it can help – especially with nausea, vomiting and chronic pain.

“For selective patients it works well but for others, it doesn’t work. It’s one of those medications that is worth trying.”

Pain management

There has long been a belief that cannabis provides an analgesic quality to those suffering from chronic pain. Those suffering from neuropathic – commonly caused by amputation, spinal surgery, HIV or multiple sclerosis – often turn to medical cannabis as a source of relief. Some types of pain, such as peripheral neuropathy, respond better to marijuana than conventional pain relievers.

People in severe pain, such as late-stage cancer patients, commonly become addicted to traditional opioid drugs, which can lead to severe side effects or even overdose. In such cases, medical marijuana may be an alternative to alleviate suffering without addiction and allow patients to be productive members of society. There is sufficient research to show the benefits of medical marijuana in these circumstances outweigh potential side effects.

Muscle tension and spasm

Another effect of cannabis is to relax muscle tension. According to the National Multiple Sclerosis Society, people with multiple sclerosis who used cannabis – in a liquid extract form containing THC and cannabidiol – experienced a decrease in muscle spasms, tremors and muscle stiffness.

Loss of appetite

Medicinal cannabis has been shown to stimulate appetite, which can be essential for patients with difficulty maintaining adequate nutrition. For some patients, drugs intended to boost appetite simply don’t work; other patients are tired of using medications that can be considered narcotic, addictive, dangerous, or that produce unpleasant side effects.

Nausea and vomiting

One common use of medical cannabis is to ease the symptoms of nausea. In trials conducted by National Cancer Institute, two FDA-approved cannabis-based drugs, dronabinol and nabilone, helped to reduce chemotherapy-related nausea and vomiting in cancer patients. When taken orally, the drugs worked as well as or better than some of the weaker FDA-approved drugs to relieve these symptoms.

Insomnia

In addition to relaxation and pain reduction, many use medicinal cannabis to relieve anxiety and certain sleep disorders such as insomnia. According to the National Cancer Institute, studies testing the effectiveness of cannabis showed that test subjects who inhaled marijuana had improved mood, improved sense of well-being and less anxiety. Additionally, patients who ingested a cannabis plant extract spray (administered under the tongue) reported more restful sleep.

Epilepsy

For children with epilepsy, the evidence of marijuana’s benefits is slowly accumulating. A handful of studies have suggested that cannabidiol (not psychoactive), one primary ingredient of marijuana, might reduce the frequency of seizures. An imminent study at Massachusetts General Hospital for Children and four other national hospitals will test cannabidiol on young patients who have seizures that do not respond well to traditional drugs.

How does medical cannabis work to treat these conditions?

There are two types of receptors in our bodies that allow us to take in the effects of medical cannabis: CB1 receptors that are found primarily in the brain, spinal cord, and periphery, and CB2 receptors that are found on the immune tissues. When coming into contact with cannabis, the body produces endocannabinoids, its own natural version of cannabinoids, that interact with these CB1 and CB2 receptors and produce the euphoric state that helps to dull our senses to various symptoms.

In 1972, Congress placed marijuana in Schedule I of the Controlled Substances Act because politicians considered it to have no accepted medical use. The medical society currently supports, at the federal level, changing marijuana from a Schedule 1 drug to a Schedule 2 drug. The Schedule 1 designation prevents it from being extensively studied as a potential medicine. Making marijuana a Schedule 2 drug would open the door to more research and clinical trials concerning its medical benefits.

“It’s been my opinion for many years that cannabis, in all forms, should be made a Schedule 2 drug so more studies could be done on it,” Orman said. “We don’t completely understand how the drug works on certain receptors to activate portions of the brain that control things like nausea, epilepsy and pain. We are just beginning to understand which molecules stimulate which receptors so we can maximize health benefits.”

Are there risks to using medicinal cannabis?

The use of medicinal cannabis is not without risk. In part because it is a Schedule 1 drug, it has not been thoroughly tested to find out how it interacts with medicines, foods, herbs or supplements. In studies, cannabinoids have been linked with depression, paranoia and hallucinations; people prone to mental illness may have more serious mental and emotional effects.

Physical side effects can include low blood pressure, fast heartbeat, dizziness, slow reaction time and heart palpitations. On rare occasions, marijuana may also serve as a trigger for a heart attack, usually within an hour after smoking. Women who are pregnant or breastfeeding should not use marijuana. Allergic reactions, some severe, have been reported.

Orman said that every patient is different and marijuana certainly doesn’t work for everyone.

“The side effects are not trivial and should not be ignored,” he said. “A lot of people become paranoid and can exhibit psychosis instead of feeling euphoric. Some people become demotivated and allergic reactions are possible. Cyclic vomiting syndrome can also be a side effect. Some people see benefit from marijuana, others don’t.”

Calaveras County Public Health Officer Dr. Dean Kelaita said if marijuana is used in moderation, he doesn’t often see adverse side effects.

“If people overdo anything, there can be side effects,” he said.

Marijuana smoke is believed to contain known carcinogens that can cause cancer much like those in tobacco smoke, however, Orman said a recent study by Dr. Donald P. Tashkin, emeritus professor of medicine at the University of California, Los Angeles, David Geffen School of Medicine, showed that light-to-moderate marijuana use did not cause lung cancer. This surprised Orman, but he added the study said the verdict is still out on heavy use.

It took 50 years for American attitudes about marijuana to dramatically shift, careening from “Reefer Madness” and “Just say no” to pragmatic acceptance of medical marijuana and legalization of recreational use in Washington and Colorado.

Stay tuned. Issues surrounding medical cannabis aren’t just smoke and mirrors; change is in the air.

“As we learn more about cannabis and study it more, I think it will be more accepted,” Orman said. “I hope that we are able to study it more so physicians will know where it fits in our armament of treatments – what it’s good for and what it’s not good for – so we can understand the drug and better use it to help people.”

Judy Georgiou is a freelance writer and can be contacted at jlgeorgiou@gmail.com.