Qualifying Medical Conditions in Maryland

Currently, the Maryland Medical Cannabis Commission (MMCC) defines medical cannabis as a treatment option for the following medical ailments and conditions:

cachexia, anorexia, wasting syndrome, severe pain, severe nausea, seizures, severe or persistent muscle spasms, glaucoma, post-traumatic stress disorder and chronic pain (taken from: mmcc.maryland.gov. (2017). Patients. [online] Available at: http://mmcc.maryland.gov/Pages/patients.aspx [Accessed 3 Oct. 2017])

There is evidence to substantiate the use of medical cannabis for these conditions, and research is always being done to see how cannabis can be used to heal, help, and treat people every single day.

Anorexia

Anorexia is a term used frequently to refer to a lack of appetite – but more specifically it is a psychological eating disorder defined by an extremely low body weight relative to stature.

Anorexia, however, can also be associated with nausea that occurs due to medications and treatments for chemotherapy, HIV, hepatitis, and cancer. These treatments can cause a severe lack of appetite and nausea as well as other undesirable side effects.

There have been studies conducted that theorized that the endocannabinoid system is a possible target in the treatment of eating disorders and investigated the use of cannabis for treatment of anorexia.¹

Additional studies have found that cannabis-based medicines can increase appetite and enjoyment of food, elevate mood, and decrease nausea in patients suffering from anorexia.² ³


¹Gérard, N., Pieters, G., Goffin, K., Bormans, G. and Van Laere, K. (2011). Brain Type 1 Cannabinoid Receptor Availability in Patients with Anorexia and Bulimia Nervosa. Biological Psychiatry, [online] 70(8), pp.777-784. Available at: http://www.biologicalpsychiatryjournal.com/article/S0006-3223(11)00507-5/fulltext.

²Beal, J., Olson, R., Laubenstein, L., Morales, J., Bellman, P., Yangco, B., Lefkowitz, L., Plasse, T. and Shepard, K. (1995). Dronabinol as a treatment for anorexia associated with weight loss in patients with AIDS. Journal of Pain and Symptom Management, [online] 10(2), pp.89-97. Available at: https://linkinghub.elsevier.com/retrieve/pii/0885392494001174.

³Turgeman, I. and Bar-Sela, G. (2016). Cannabis Use in Palliative Oncology: A Review of the Evidence for Popular Indications. Israel Medical Association Journal, [online] 19(2). Available at: https://www.ima.org.il/MedicineIMAJ/viewarticle.aspx?year=2017&month=02&page=85.

Cachexia

Cachexia is also known as wasting syndrome, an “involuntary loss of more than 10% body weight (especially muscle mass), plus at least 30 days of diarrhea or weakness and fever.”¹

Some diseases associated with wasting syndrome include HIV/AIDS², coeliac disease³, cancer⁴, heart failure⁵, superior mesenteric artery syndrome⁶, or advanced chronic obstructive pulmonary disease (COPD).⁷

Many studies have looked at the myriad of benefits of treating cachexia⁸ or wasting syndrome with medical cannabis, including how it can help stimulate appetite and assist in weight stabilization.⁹ ¹⁰ ¹¹

From the American Society of Clinical Oncology (2006):

Cannabinoids reputedly stimulate appetite, both historically and in recent studies of human volunteers and AIDS patients. Studies of patients with multiple sclerosis or pain have evaluated oral mixtures of THC and CBD or whole-plant cannabis extract (CE), replacing smoked marijuana. Data from four dose-finding and phase II studies of 161 patients with cancer-related anorexia-cachexia syndrome (CACS) suggest cannabinoids’ potential at fixed doses of 2.5 mg of THC twice to three times daily; (JCO July 20, 2006 vol. 24 no. 21 3394-3400).¹²


¹AIDSinfo. (2017). Wasting Syndrome Definition. [online] Available at: https://aidsinfo.nih.gov/understanding-hiv-aids/glossary/750/wasting-syndrome [Accessed 15 Oct. 2017].

²Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. p. 1169. ISBN 1-4160-2999-0.

³Meresse, B., Ripoche, J., Heyman, M. and Cerf-Bensussan, N. (2008). Celiac disease: from oral tolerance to intestinal inflammation, autoimmunity and lymphomagenesis. Mucosal Immunology, [online] 2(1), pp.8-23. Available at: http://www.nature.com/mi/journal/v2/n1/full/mi200875a.html [Accessed 15 Oct. 2017].

⁴Fearon, K., Strasser, F., Anker, S., Bosaeus, I., Bruera, E., Fainsinger, R., Jatoi, A., Loprinzi, C., MacDonald, N., Mantovani, G., Davis, M., Muscaritoli, M., Ottery, F., Radbruch, L., Ravasco, P., Walsh, D., Wilcock, A., Kaasa, S. and Baracos, V. (2011). Definition and classification of cancer cachexia: an international consensus. The Lancet Oncology, [online] 12(5), pp.489-495. Available at: http://www.sciencedirect.com/science/article/pii/S1470204510702187 [Accessed 15 Oct. 2017].

⁵Anker, S. (1999). Cytokines and neurohormones relating to body composition alterations in the wasting syndrome of chronic heart failure. European Heart Journal, [online] 20(9), pp.683-693. Available at: https://academic.oup.com/eurheartj/article/20/9/683/409805/Cytokines-and-neurohormones-relating-to-body [Accessed 15 Oct. 2017].

⁶Welsch, T., Büchler, M. and Kienle, P. (2007). Recalling Superior Mesenteric Artery Syndrome. Digestive Surgery, [online] 24(3), p.151. Available at: https://www.karger.com/Article/PDF/102097 [Accessed 15 Oct. 2017].

⁷DEBIGARÉ, R., CÔTÉ, C. and MALTAIS, F. (2001). Peripheral Muscle Wasting in Chronic Obstructive Pulmonary Disease. American Journal of Respiratory and Critical Care Medicine, [online] 164(9), pp.1712-1717. Available at: http://www.atsjournals.org/doi/full/10.1164/ajrccm.164.9.2104035 [Accessed 15 Oct. 2017].

⁸Reuter, S. and Martin, J. (2016). Pharmacokinetics of Cannabis in Cancer Cachexia-Anorexia Syndrome. Clinical Pharmacokinetics, [online] 55(7), pp.807-812. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26883879 [Accessed 6 Oct. 2017].

⁹Beal, J., Olson, R., Laubenstein, L., Morales, J., Bellman, P., Yangco, B., Lefkowitz, L., Plasse, T. and Shepard, K. (1995). Dronabinol as a treatment for anorexia associated with weight loss in patients with AIDS. Journal of Pain and Symptom Management, [online] 10(2), pp.89-97. Available at: https://linkinghub.elsevier.com/retrieve/pii/0885392494001174.

¹⁰Struwe, M., Kaempfer, S., Geiger, C., Pavia, A., Plasse, T., Shepard, K., Ries, K. and Evans, T. (1993). Effect of Dronabinol on Nutritional Status in HIV Infection. Annals of Pharmacotherapy, [online] 27(7-8), pp.827-831. Available at: https://www.ncbi.nlm.nih.gov/pubmed/8395916 [Accessed 19 Oct. 2017].

¹¹Turgeman, T. (2017). Cannabis Use in Palliative Oncology: A Review of the Evidence for Popular Indications. – PubMed – NCBI. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28457056 [Accessed 19 Oct. 2017].

¹²Strasser, F., Luftner, D., Possinger, K., Ernst, G., Ruhstaller, T., Meissner, W., Ko, Y., Schnelle, M., Reif, M. and Cerny, T. (2006). Comparison of Orally Administered Cannabis Extract and Delta-9-Tetrahydrocannabinol in Treating Patients With Cancer-Related Anorexia-Cachexia Syndrome: A Multicenter, Phase III, Randomized, Double-Blind, Placebo-Controlled Clinical Trial From the Cannabis-In-Cachexia-Study-Group. Journal of Clinical Oncology, [online] 24(21), pp.3394-3400. Available at: http://ascopubs.org/doi/abs/10.1200/JCO.2005.05.1847?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed.

Chronic or Severe Pain

Chronic and severe pain is pain that results from a multitude of medical conditions, including injuries, cancer, multiple sclerosis, scoliosis, arthritis, among many others¹. Severe pain refers to the intensity of pain, while chronic pain refers to the length of time that pain persists. Chronic pain is also defined as pain that “extends beyond the expected period of healing”².

A comprehensive review of studies that examine the use of cannabis for neuropathic pain supports the use of cannabis in conjunction with other analgesics and showed statistically significant pain relief with non-serious side effects. In fact, 3 of the 6 total studies show a “clinically meaningful” decrease in pain, which is a decrease in pain scores by 30% or more.³

In addition, there are many studies that have shown the effectiveness of medical cannabis on treating chronic and severe pain, especially with neuropathic pain and pain related to HIV, arthritis, glaucoma, and more.⁴ ⁵ ⁶ ⁷ ⁸ ⁹


¹WebMD. (2017). What Causes Chronic Pain?. [online] Available at: https://www.webmd.com/pain-management/guide/cause-chronic-pain [Accessed 15 Oct. 2017].

²Turk, D.C.; Okifuji, A. (2001). “Pain terms and taxonomies”. In Loeser, D.; Butler, S. H.; Chapman, J.J.; Turk, D. C. Bonica’s Management of Pain (3rd ed.). Lippincott Williams & Wilkins. pp. 18–25. ISBN 0-683-30462-3.

³Efficacy and adverse effects of medical marijuana for chronic noncancer pain: Systematic review of randomized controlled trials. (2015). Official Publication of The College of Family Physicians of Canada; Canada Family Physician, [online] 61(8), pp.e372-e381. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26505059 [Accessed 4 Oct. 2017]

⁴Ware, M., Wang, T., Shapiro, S., Robinson, A., Ducruet, T., Huynh, T., Gamsa, A., Bennett, G. and Collet, J. (2010). Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. Canadian Medical Association Journal, 182(14), pp.E694-E701.

⁵Nurmikko, T., Serpell, M., Hoggart, B., Toomey, P., Morlion, B. and Haines, D. (2007). Sativex successfully treats neuropathic pain characterised by allodynia: A randomised, double-blind, placebo-controlled clinical trial. Pain, [online] 133(1), pp.210-220. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17997224?dopt=Abstract [Accessed 15 Oct. 2017].

⁶Wilsey, B., Marcotte, T., Tsodikov, A., Millman, J., Bentley, H., Gouaux, B. and Fishman, S. (2008). A Randomized, Placebo-Controlled, Crossover Trial of Cannabis Cigarettes in Neuropathic Pain. The Journal of Pain, 9(6), pp.506-521.

⁷Hill, K. (2015). Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems. JAMA, [online] 313(24), p.2474. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26103031 [Accessed 15 Oct. 2017].

⁸Ware, M., Doyle, C., Woods, R., Lynch, M. and Clark, A. (2003). Cannabis use for chronic non-cancer pain: results of a prospective survey. Pain, [online] 102(1), pp.211-216. Available at: https://insights.ovid.com/pubmed?pmid=12620613.

⁹Fanelli, G., De Carolis, G., Leonardi, C., Longobardi, A., Sarli, E., Allegri, M. and Schatman, M. (2017). Cannabis and intractable chronic pain: an explorative retrospective analysis of Italian cohort of 614 patients. Journal of Pain Research, [online] Volume 10, pp.1217-1224. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28579820 [Accessed 15 Oct. 2017].

Glaucoma

Glaucoma is a condition where nerves in the eyes are damaged, which can lead to blindness. Sometimes this is caused by extra fluid filling the eyes, causing optic pressure and damage to the surrounding nerves.

Studies have shown the benefits of using cannabis-based therapies for reducing the pressure of the eyes¹ and have even shown that certain cannabinoids have neuroprotective properties² ³ for the nervous system.

And while there is some disagreement in the medical community if medical cannabis is the best treatment for glaucoma, research continues to shed light on its potential.⁴


¹Qiao, Z., Kumar, A., Kumar, P. and Song, Z. (2012). Involvement of a non-CB1/CB2 cannabinoid receptor in the aqueous humor outflow-enhancing effects of abnormal-cannabidiol. Experimental Eye Research, [online] 100, pp.59-64. Available at: http://www.sciencedirect.com/science/article/pii/S0014483512001352?via%3Dihub [Accessed 15 Oct. 2017].

²Tomida, I. (2004). Cannabinoids and glaucoma. British Journal of Ophthalmology, [online] 88(5), pp.708-713. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1772142/ [Accessed 6 Oct. 2017].

³Nucci, C., Bari, M., Spanò, A., Corasaniti, M., Bagetta, G., Maccarrone, M. and Morrone, L. (2008). Potential roles of (endo)cannabinoids in the treatment of glaucoma: from intraocular pressure control to neuroprotection. Progress in Brain Research, [online] pp.451-464. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18929127 [Accessed 6 Oct. 2017].

⁴Jampel, H. (2010). American Glaucoma Society Position Statement: Marijuana and the Treatment of Glaucoma. Journal of Glaucoma, [online] 19(2), pp.75-76. Available at: http://journals.lww.com/glaucomajournal/Citation/2010/02000/American_Glaucoma_Society_Position_Statement_.1.aspx [Accessed 28 Oct. 2017].

Post-Traumatic Stress Disorder (PTSD)

PTSD is diagnosed after a person demonstrates the following symptoms: re-experiencing trauma through intrusive distressing recollections of the event; emotional numbness and avoidance of places, people, and activities that are reminders of the trauma; increased arousal such as difficulty sleeping and concentrating, feeling jumpy, and being easily irritated and angered.¹

While this period of time is typically one month, some symptoms could take more than a few months or possibly years to surface.

Cannabis has been shown as a possible treatment option for those who standard PTSD treatment options do not work², and the United States Food & Drug Administration recently approved a medical cannabis trial for military veterans suffering from PTSD³.

Martin Lee, an affiliate of the Multidisciplinary Association for Psychedelic Studies and director of Project CBD (a California-based nonprofit dedicated to promoting and publicizing research into the medical uses of cannabidiol), has stated that PTSD may be a result of endocannabinoid deficiency, specifically anandamide, which triggers the same receptors that are activated by THC and other components of cannabis.⁴


¹Adaa.org. (2017). Symptoms of PTSD | Anxiety and Depression Association of America, ADAA. [online] Available at: https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd/symptoms [Accessed 6 Oct. 2017].

²Fraser, G. (2009). The Use of a Synthetic Cannabinoid in the Management of Treatment-Resistant Nightmares in Posttraumatic Stress Disorder (PTSD). CNS Neuroscience & Therapeutics, [online] 15(1), pp.84-88. Available at: http://cannabisplus.net/cannabis-research-pdf/PTSD/Fraser%20The%20Use%20of%20a%20Synthetic%20Cannabinoid%20in%20the%20Management%20of%20Treatment-Resistant%20Nightmares%20in%20Posttraumatic%20Stress%20Disorder%20PTSD.pdf [Accessed 6 Oct. 2017].

³Tonic. (2017). The FDA Finally Approved a Marijuana Trial for Vets With PTSD. [online] Available at: https://tonic.vice.com/en_us/article/aemv44/the-fda-finally-approved-a-weed-trial-for-vets-with-ptsd-weedweek2017 [Accessed 6 Oct. 2017].

⁴Leafly. (2017). Cannabis and Post-Traumatic Stress Disorder (PTSD) | Leafly. [online] Available at: https://www.leafly.com/news/health/cannabis-and-post-traumatic-stress-disorder-ptsd [Accessed 6 Oct. 2017].

Seizures

There are many types of ailments related to seizures, and many of them have been studied in relation to medical cannabis treatment. There have been studies showing that there is a direct link between cannabis receptors in the human body and their influence in terminating seizure activity, and how that is accomplished with cannabinoid therapy.¹

Additionally, studies have been conducted around the use of cannabis to mitigate and treat issues stemming from epilepsy.² In a study conducted with eight patients dealing with epilepsy, all patients tolerated CBD (Cannabidiol) very well with no serious side effects. Half of the patients remained almost free of convulsive crises throughout the experiment and several other patients demonstrated partial improvement in their clinical condition.³

In a study published in May, in the New England Journal of Medicine, researchers gave children a liquid form of CBD called Epidiolex⁴. The 120 participants in that study, with ages ranging from two to 18, all had a serious form of epilepsy called Dravet syndrome. Researchers found that the group that took CBD had about six seizures a month instead of 12, and three people taking the cannabis-based medication stopped having seizures altogether.⁵


¹Wallace, M. (2003). The Endogenous Cannabinoid System Regulates Seizure Frequency and Duration in a Model of Temporal Lobe Epilepsy. Journal of Pharmacology and Experimental Therapeutics, [online] 307(1), pp.129-137. Available at: http://jpet.aspetjournals.org/content/307/1/129.long [Accessed 6 Oct. 2017].

²Maa, E. and Figi, P. (2014). The case for medical marijuana in epilepsy. Epilepsia, [online] 55(6), pp.783-786. Available at: http://onlinelibrary.wiley.com/doi/10.1111/epi.12610/abstract [Accessed 6 Oct. 2017].

³Cunha, J., Carlini, E., Pereira, A., Ramos, O., Pimentel, C., Gagliardi, R., Sanvito, W., Lander, N. and Mechoulam, R. (1980). Chronic Administration of Cannabidiol to Healthy Volunteers and Epileptic Patients. Pharmacology, 21(3), pp.175-185.

⁴GW Pharmaceuticals, plc. (2017). GW’s Epidiolex® Clinical Program | For Patients. [online] Available at: https://www.gwpharm.com/epilepsy-patients-caregivers/patients [Accessed 6 Oct. 2017].

⁵Devinsky, O., Cross, J., Laux, L., Marsh, E., Miller, I., Nabbout, R., Scheffer, I., Thiele, E. and Wright, S. (2017). Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome. New England Journal of Medicine, [online] 376(21), pp.2011-2020. Available at: http://www.nejm.org/doi/full/10.1056/NEJMoa1611618 [Accessed 6 Oct. 2017].

Severe Nausea

Severe nausea can happen as a result of several medical conditions, including but not limited to, chemotherapy¹, gastroparesis², gastroenteritis³, IBS⁴ or Chron’s disease⁵.

The goals of nausea treatment and medications are the reduction of discomfort from nausea and any subsequent vomiting that happens as a result. Antiemetic (anti-nausea) medications are often prescribed to treat this condition.

Over the past several decades, many studies have examined the effectiveness of cannabis-based medicine on chemotherapy-induced nausea vomiting (CINV) and it has been repeatedly shown in clinical trials that cannabis-based therapies are effective at reducing symptoms in patients suffering from CINV.⁶ ⁷ ⁸


¹Cancer.org. (2017). Chemotherapy-related Nausea and Vomiting | American Cancer Society. [online] Available at: https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/nausea-and-vomiting/chemo-and-nausea-vomiting.html [Accessed 18 Oct. 2017].

²National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Gastroparesis | NIDDK. [online] Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/gastroparesis [Accessed 18 Oct. 2017].

³WebMD. (2017). Gastroenteritis in Adults and Older Children-Topic Overview. [online] Available at: https://www.webmd.com/digestive-disorders/tc/gastroenteritis-in-adults-and-older-children-topic-overview#1 [Accessed 18 Oct. 2017].

⁴Aboutibs.org. (2017). Nausea and IBS. [online] Available at: https://aboutibs.org/nausea-and-ibs.html [Accessed 18 Oct. 2017].

⁵The 5 Types of Crohn’s Disease. [online] WebMD. Available at: https://www.webmd.com/ibd-crohns-disease/crohns-disease/5-types-crohns-disease#1 [Accessed 18 Oct. 2017].

⁶Brafford May, M. and Glode, A. (2016). Dronabinol for chemotherapy-induced nausea and vomiting unresponsive to antiemetics. Cancer Management and Research, [online] p.49. Available at: https://www.dovepress.com/dronabinol-for-chemotherapy-induced-nausea-and-vomiting-unresponsive-t-peer-reviewed-article-CMAR [Accessed 4 Oct. 2017].

⁷Smith, L., Azariah, F., Lavender, V., Stoner, N. and Bettiol, S. (2015). Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy. Cochrane Database of Systematic Reviews. [online] Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009464.pub2/abstract;jsessionid=A487FB55AB505893C5656C7D82A0D6F0.f04t03 [Accessed 4 Oct. 2017].

⁸Tramer, M. (2001). Cannabinoids for control of chemotherapy-induced nausea and vomiting: quantitative systematic review. BMJ, [online] 323(7303), pp.16-16. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC34325/pdf/16.pdf.

Severe or Persistent Muscle Spasms

Muscle spasms occur when muscles seize and constrict involuntarily and may happen as a result of many different medical conditions. Some examples of specific scenarios where muscle spasms may occur include: when patients are dealing with spinal cord injuries or other conditions affecting the nervous system; when muscles envelop the esophagus after they become inflamed due to health conditions such as reflux esophagitis; spasms occurring in the coronary artery (Prinzmetal’s angina); or a movement disorder known as dystonia.¹

Cannabis has been cited as a potential relief for muscle spasms for decades. In fact, a survey in 1982 collected data from individuals with spinal cord injuries and over 40% of respondents reported that cannabis reduced issues with muscles tensing reflexively and resisting stretching.²

One severe condition, intractable spasms related to Multiple Sclerosis, was researched in a double-blind study showing the positive effects of cannabis (in this case, cannabis is taken orally in pill form). This study also showed statistical significance in helping with the frequency of spasms, decreasing sleep disturbances due to spasms, and generally, medical providers were able to determine a positive change in symptoms.³


¹Citiva.com. (2017). Treating Muscle Spasms with Medical Cannabis | CITIVA. [online] Available at: https://citiva.com/muscle-spasms-medical-cannabis.

²Mack A, Joy J. Marijuana as Medicine? The Science Beyond the Controversy. Washington (DC): National Academies Press (US); 2000. 7, MARIJUANA AND MUSCLE SPASTICITY. Available from: https://www.ncbi.nlm.nih.gov/books/NBK224382/

³Novotna, A., Mares, J., Ratcliffe, S., Novakova, I., Vachova, M., Zapletalova, O., Gasperini, C., Pozzilli, C., Cefaro, L., Comi, G., Rossi, P., Ambler, Z., Stelmasiak, Z., Erdmann, A., Montalban, X., Klimek, A. and Davies, P. (2011). A randomized, double-blind, placebo-controlled, parallel-group, enriched-design study of nabiximols* (Sativex®), as add-on therapy, in subjects with refractory spasticity caused by multiple sclerosis. European Journal of Neurology, [online] 18(9), pp.1122-1131. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1468-1331.2010.03328.x/abstract;jsessionid=5C269022C4A67ED0155274C902CAF445.f02t01 [Accessed 6 Oct. 2017].