My search for an expert opinion on medicinal cannabis (MC) brings me to California. Since 1996, following a referendum, medicinal cannabis is legal in the sunny U.S. state. It is estimated that there are already more than one million California patients that use MC.
The cheerful Dr. David Bearman is an expert in the field of substance abuse. In 1971 he co-founded, in Seattle (Washington), the third US Free Clinic. He is a frequent speaker on MC, member of various advisory committees and testifies regularly as a scientific expert in court.
Patrick Dewals: How would you describe the knowledge of the endocannabinoid system of the average American doctor?
Dr. David Bearman: In the U.S., only 13 percent of medical schools teach their students about the endocannabinoid system. However, this system is the largest neurotransmitter system in our brains. As a result, the knowledge of American physicians regarding the endocannabinoid system is limited.
PD: Given the importance of the endocannabinoid system, can one be a good doctor without knowing this system?
DB: I think so, but you have to admit, however, that you do not know when a patient inquires about the endocannabinoid system and / or MC. And this is the problem: many doctors do not admit their ignorance on this topic to either their patients or others. Moreover, they often declare that medical cannabis is not a useful medicine and this is simply wrong and therefore a form of bad medicine.
PD: Do we need an adaptation of the curriculum for physicians?
DB: In the US, medical schools decide for themselves what they teach their students. But it is clear that a school that is not teaching about the endocannabinoid system is not up to date. And when a medical school is behind with such an important issue, one wonders which other issues they are ignoring as well. The U.S. government (both federal and state) should make funds available earmarked specifically for lectures on the endocannabinoid system.
PD: How did you learn about MC?
DB: Many ways. First through my father, who was a pharmacist. In the 1920s, when he was a student at the University of Minnesota School of Pharmacy, one of the class assignments was to make cannabis tincture. At that time the situation was quite different. Cannabis was a very normal substance in medicine and pharmacology. There were many different medications based on cannabis. When my father took his cannabis tincture exam it was the alcohol, which they needed for the preparation of the tincture, which was illegal, cannabis was not yet illegal.
At that time the U.S. Pharmacopoeia (handbook for drug prescriptions) included cannabis, as it had since 1854. It was recommended as a painkiller and given as a tranquilizer and sedative. When my father began as a young pharmacist there were 3 million cannabis-based prescriptions annually written by physicians in the U.S. Naturally, my father filled and sold some of these prescriptions himself. I first learned about cannabis through my father. Later I followed courses, conferences and did a lot of self-study.
PD: Can one become addicted to cannabis?
DB: Experts talk about addiction when the abuse of a substance prevents you from functioning normally in various areas. To see this in a an alcoholic it is easy. Usually it goes wrong in a domain (home, work, school, financial, …) because of his alcohol abuse. But with cannabis we do not see this or not as much. In investigations into the most ‘addictive’ or ‘dangerous’ drug cannabis systematically is dangling behind.
PD: You see a relationship between substance abuse and growing up in a dysfunctional family situation. Can you clarify this?
DB: As a small child, one experiences the people around him like giants who have all the power over the child. Growing up in a family where there is often or permanently quarrel between the parents has a very profound impact on the child. The child experiences the giants as dangerous and life threatening.
One can compare this situation with a soldier who incurs traumatic stress disorder (PTSD) in war. Often one sees that these children later come into contact with drugs. Cannabis is definitely the least harmful and, in many cases, even has a beneficial effect. This is because victims of PTSD are constantly in a hyper-alert state. So, they do experience too many incentives which in turn leads to tension and ultimately can initiate tantrums. Cannabis makes these people calmer, less alert, and unlocks the proverbial grenade. Moreover, these patients sleep much better and are spared of nightmares when they use cannabis.
PD: Does the use of cannabis cause psychosis?
DB: There are no reasonable arguments for this. Epidemiologically, we see no increase in psychoses during the 60s and 70s, however there was a dramatic increase in the global use of cannabis. Studies show that CBD (a cannabinoid in cannabis) can be used even in the treatment of psychoses. Also with the use of Sativex, which is liquid cannabis and is already approved in twenty countries, psychosis do not occur as a side phenomenon. Chris Fitchner, an American psychiatrist and author of the book “Cannabinomics” sometimes prescribes medicinal cannabis for people with psychosis.
The worst consequences that result from the use of cannabis are legal not pharmacological.
PD: For which indications do you prescribe MC?
DB: Meanwhile, I do prescribe MC for 15 years. My patients have beneficial effects in many diseases such as ADHD, Crohn’s disease, migraine, MS, pain, autoimmune diseases, PTSD, depression, epilepsy, fibromyalgia, …
PD: What do you think of the claim that cannabis could help in cancer?
DB: That cannabis can kill cancer cells has been known since 1974. Curiously, the U.S. government blocked any serious human investigation. Recently Dr. Guzmann, a Spanish microbiologist and expert in the field of cannabis, has had studies which demonstrated that cannabis can decrease the size of glioblastoma in humans. Building on his data and that of other research which has been done in Israel, Italy, the U.K. and the USA there are currently double blind studies started in three different places in the world: the U.K., Israel and San Francisco, to investigate whether cannabis can help treat cancer. The one in San Francisco examines the effects of cannabis in breast cancer and the studies in the U.K. and Israel, will study cannabis’ effect on glioblastoma , a type of brain cancer.
PD: If you must advise the Belgian Minister for Public Health on MC, what would you tell her?
DB: I would advocate to bring back medicinal cannabis into medicine and to sell it through pharmacies, as it was for over a century. MC is simply a very effective medication.
It is important to accurately label the different types of MC. The content of the most common cannabinoids like THC and CBD have to be labelled.
In addition, doctors and pharmacists must be given the necessary training to be able to provide information on the use for patients.