Quiz

1. If medical marijuana is legal in a state, then anyone can prescribe it.

False: Providers cannot prescribe marijuana as it is illegal at the federal level, which can result in loss of a medical license, or worse, if prescribed. In states where marijuana is legal, a provider can state that a patient has a condition that may benefit from marijuana. However, they cannot prescribe it.

2. Medical marijuana is not the same as cannabidiol (CBD).

True: Medical marijuana is whole plant marijuana used for medical purposes. CBD is a major non-psychoactive (does not get someone “high”) part of the plant.

3. Marijuana is safe because it is a plant.

False: Marijuana is broken down in a person’s liver like many medicines and can cause liver issues for some. There are also drug to drug interactions between medical marijuana and some medicines1.

4. Buying CBD products from anywhere is the same as what is being studied with the purified CBD product (Epidiolex).

False: There is no consistency, truth in labeling, or only CBD in these products. These products often have tetrahydrocannabinol (THC, the major part that causes a “high”) or other chemicals in them. Epidiolex is pure CBD oil being that is extracted from the plant and being studied.

5. It is illegal to have hemp extract with CBD shipped to a house in a state where marijuana is illegal.

True: If a product claims to have any CBD in it, it is illegal to ship or accept it via mail. It is a violation of Federal law.

6. People making marijuana products to use for medical purposes (vernacular products) do not test and show that the contents of their product are consistent and have only what is claimed in it2.

True: Because these products are under the same class as nutritional supplements, no testing or proof of consistency is required by law. They also do not have to prove they are effective or safe to treat medical illness.

7. If Epidiolex is approved by the U.S. Food and Drug Administration (FDA), providers can use their current U.S. Drug Enforcement Agency (DEA) license to prescribe it.

True: By definition, FDA approval means there is medical benefit and enough safety information to justify use of the approved product. If approved by FDA, Epidiolex will then be scheduled by DEA. Then providers will be able to prescribe Epidiolex as they do any other prescription medication.

8. Dosing is known for vernacular CBD products.

False: Since it is unclear how much CBD is in these products and there is not robust scientific data on safe and effective CBD dosing, it is not known how to dose CBD properly at this time.

9. There are zero FDA approved medications that have chemicals found in marijuana.

False: There are two FDA approved synthetic marijuana type medications (nabilone and dronabinol) that have synthetic version of THC (the major component found in marijuana)3.

10. There are many well conducted studies that show marijuana is effective to treat neurological disorders.

False: Studies thus far have been poorly designed or do not show effectiveness when done well in most neurological disorders. Only in multiple sclerosis (MS) and epilepsy is there good data showing potential benefit. For people with MS who have pain from spasticity, synthetic marijuana and other forms of plant based products appear to show benefit4. In addition, studies in epilepsy appear promising for certain types of epilepsy syndromes (Dravet and Lennox-Gastaut) where a purified CBD product (Epidiolex) demonstrated a statistically significant decrease in seizures1. Not everyone in these studies had benefit from CBD. It does not work for everyone with epilepsy.

References

  1. Devinsky O, Marsh E, Friedman D, et al. Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial. Lancet neurology 2015.
  2. Administration UFaD. 2015 Warning Letters and Test Results for Cannabidiol-Related Products [online]. Available at: https://www.fda.gov/newsevents/publichealthfocus/ucm435591.htm.
  3. Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA : the journal of the American Medical Association 2015;313:2456-2473.
  4. Koppel BS, Brust JC, Fife T, et al. Systematic review: efficacy and safety of medical marijuana in selected neurologic disorders: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2014;82:1556-1563.
Authored By: 
Anup Patel MD
Authored Date: 
Wednesday, May 17, 2017