If you’ve been following the blog lately, you might already know Dr. David Casarett – he’s a professor at the University of Pennsylvania’s Perelman School of Medicine and the author of “STONED: A Doctor’s Case For Medical Marijuana.” He recently worked with PatientsLikeMe on a survey that asked members how they felt about marijuana, and the results were just released last week. Below, read what David had to share about the inspiration behind his novel, his thoughts on online communities like PatientsLikeMe and the intertwined future of marijuana and medicine.
What inspired you to write “Stoned: A Doctor’s Case for Medical Marijuana?”
A patient – a retired English professor – who came to me for help in managing symptoms of advanced cancer. She asked me whether medical marijuana might help her. I started to give her my stock answer: that marijuana is an illegal drug, that it doesn’t have any proven medical benefits, etc. But she pushed me to be specific, in much the same way that she probably used to push her students. Eventually I admitted that I didn’t know, but that I’d find out. Stoned is the result.
Inside the book, you say “For Caleb. I hope he found the relief he was searching for.” Can you share a little about his story and why you dedicated the book to him?
I describe my meeting with Caleb in the first chapter. He was a young man with advanced colorectal cancer who drove his RV to Colorado to get access to medical marijuana. He got there, and marijuana was legal, but he couldn’t afford it. He had access to other legal drugs like morphine and ativan through his hospice, but he didn’t use them because they didn’t work for his pain, and made him feel sick. The only thing that worked for him–marijuana–was out of reach.
Sounds like you went through some interesting research experiences while you were writing the book. (Pot wine? Marijuana paste on your leg?) How did those experiences influence your perception of marijuana as medicine?
I was trying to understand what the best way is to get the “active ingredients” of marijuana into people. I saw lots of ads for various methods, and all sorts of products are available, but I wanted to know what works. It turns out that some methods, like marijuana tea or beer or wine, aren’t very effective. But others, like vaporizing, definitely are.
What do you think is the biggest misconception about marijuana in the medical community?
The biggest misconception about marijuana in the medical community is probably that it offers no medical benefits. At least, that’s what I thought when I started researching Stoned. Actually, there have been some good studies that have shown very real benefits for some symptoms. True, there isn’t as much evidence as I’d like. But there will be more. New research is coming on line every year, and we’re gradually figuring out whether and how marijuana works.
How do you see online communities like PatientsLikeMe contributing to the medical marijuana discussion?
I think the biggest potential contribution of PatientsLikeMe is a source of crowd-sourced science. Medical marijuana science is lagging far behind the way that people are using it. For instance, in researching Stoned, I spoke with dozens of people who were using marijuana to treat the symptoms of PTSD, but there haven’t been any randomized controlled trials of marijuana for that use. That doesn’t mean that marijuana doesn’t treat PTSD symptoms, just that we don’t know (yet) whether it does.
We need randomized controlled trials, but those trials will take time, and money. That’s where communities like PatientsLikeMe come in. We can learn from PatientsLikeMe members what they’re using medical marijuana for, and how. And we can learn whether they think it’s working. Those reports can help patients learn from each other, and they can help researchers figure out what to focus on.
What did you find most interesting about the PatientsLikeMe survey results?
I was surprised that 87% of people weren’t at all concerned about becoming addicted or dependent on marijuana. We know that although the risk of addiction is small (about 10%), it’s very real. That risk probably isn’t enough to convince most people to avoid medical marijuana, especially if it’s helping them. But we should all be aware of those risks, so we can be alert for signs of dependence, like impairment of function, or effects on work or relationships.
You mention that the future of medical marijuana is the most interesting, yet hardest to answer question. But that said, what do you think the future holds for medical marijuana?
Some of the most exciting advances in the science of medical marijuana, to me, are related to what marijuana tells us about the endocannabinoid system – that’s the system of hormones and neurotransmitters and receptors in all of us. We don’t know a lot about what that system does, but we do know that marijuana ‘works’ by tapping into that system. The cannabinoids in marijuana trick the body by mimicking naturally occurring endocannabinoids like anandamide.
So although it’s fascinating to think about what marijuana could do, and although clinical trials of marijuana are essential, the really neat science of the future may focus on that endocannabinoid system – what it does, how it works, and how we can use it to promote health.
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