Medical Marijuana for Epilepsy: An Editorial

Epilepsy News From: Tuesday, February 23, 2016

“Marijuana works and should be available now as a standard treatment for seizures …”

“Marijuana should remain an illegal substance and has no role as a medical treatment …”

Those are the types of extreme statements I hear and read as soon as the topic of medical marijuana is brought up, be it live with patients or families, in the written press, or online.

As with other polarizing issues, I am impressed that there are too many with polarizing, extreme opinions and not enough people with a moderate reasonable position. And also, as with other polarizing issues, the extremes are not helpful because they tend to not listen to the other side. 

For almost all controversial issues, such as abortion, gun control, death penalty, entitlements, immigration, recent refugee crisis, or the israelo-arab conflict, there is almost always room for a reasonable compromise (after all, I am the son of a Jewish mother and an Arabic father). I can personally defend equally people who voted for Obama vs Romney, or Bush vs Gore, or even (futuristically) Hillary vs Trump. Yes, both sides have some valid points.

So, let’s go back to medical marijuana:

  • No to positions such as: cannabidiol (CBD) should be banned and illegal (U.S. Drug Enforcement Agency (DEA) Schedule I) in all cases and inaccessible even from research; it has no therapeutic role; it "doesn't work"; etc.
  • No to positions such as: CBD is definitely an effective treatment; it should be made readily available for epilepsy (or other diseases) for anyone, at any stage or severity, or as first line; it is the cure-all; etc.

Here is the middle-ground, reasonable approach:

  • There is currently not enough science behind it, so good research should be conducted.
  • For that to happen, it should be decriminalized (downgraded in the DEA schedule).
  • In the meantime, until we do have quality research to decide:
    • We have many patients who run out of options and have uncontrolled seizures. 
    • For such patients, provided they have received a comprehensive evaluation at a specialized center, when we have nothing else to offer, it is acceptable to use a product that shows some (preliminary or anecdotal) promise even though it has not (yet?) met scientific U.S. Food and Drug Administration (FDA) standards as a medication. 
    • That is the very definition of compassionate use, as seen in many states (Florida for example).

This moderate stance is, by the way, consistent with the position of the American Academy of Neurology (AAN) and American Epilepsy Society (AES).

Authored by

Selim Benbadis MD

Reviewed Date

Tuesday, February 16, 2016

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