11-29-23 PTL - Flipbook - Page 7
A Special Advertising Section of Baltimore Sun Media Group | Wednesday, November 29, 2023 7
cases, though, oral ingestion can be better
because the effects are longer lasting compared with inhalation.”
He then describes some of the problems,
issues and concerns connected with making
medical grade marijuana. “It starts with consistency. Because marijuana – cannabis sativa
L. – is a plant, there can be variations based on
where it is grown, the soil, etc. Then, to make
it acceptable as a medication, there are lots of
aspects of the plant and production that have
to be tested and codified.”
For instance:
• How will it be administered? Miran
smoked it, which worked for her. But
should it be a pill? A gummy? An edible?
And what impact does the route of
administration have on both the product
and the effect on the patient?
• What dose works most effectively? And
for what illness or physical issue or…?
Depending on what physical or mental
problem is being addressed, the dose
may make a difference.
• What is the exact chemical composition
of the cannabis products and the resultant drug effects?
• And what about pharmacokinetics –
how the eventual medication moves in,
through and out of the body. How will
it be absorbed, distributed, affect the
metabolism, and, eventually, excrete
(leave) the body? These are critical elements.
Vandrey then summed it up.
“Pharmacokinetic properties change based
on the answers to all these questions. Lots
of questions and, so far, not enough answers.
And we have to answer all these questions for
THC, CBD, and the myriad other elements of
the cannabis plant.”
Production problems
In 2015, Vandrey did a study on edibles
and found that “the vast majority of edible
cannabis products sold in a small sample of
medical marijuana dispensaries carried labels
that overstated or understated the amount
of delta-9-tetrahydrocannabinol (THC).” This
doesn’t bode well for purchasers of these
products because they can never be sure of
what they are getting. Even if they find something that provides relief, they can’t be sure
the next batch will act the same way on them.
Marijuana and Maryland
As of July 1, 2023, purchase and possession of cannabis for personal adult-use
became legal in Maryland for adults 21-plus.
Existing medical dispensaries are permitted to
pay a conversion fee and sell both adult-use
and medical cannabis.
According to the Maryland Cannabis
Administration, “Any individual who lives in
the state of Maryland whose provider recommends medical cannabis as a treatment
option for a qualifying medical condition is
eligible to register with the Maryland Cannabis
Administration (MCA) as a patient.
“Qualifying medical conditions include
cachexia, anorexia, wasting syndrome, severe
or chronic pain, severe nausea, seizures,
severe or persistent muscle spasms, glaucoma, post-traumatic stress disorder (PTSD),
or another chronic medical condition which
is severe and for which other treatments have
been ineffective.”
Miran consulted with the advisory committee that crafted the marijuana law for Maryland.
She points out that the last condition on the
list, “another chronic medical condition which
is severe and for which other treatments have
been ineffective,” is a boon to those with
issues that cannot be anticipated. People in
hospice, for instance, who don’t want morphine, can use marijuana instead for pain relief
during their last stages. Other applications
include chronic or inflammatory pain.
Vandrey warns, “Just remember: If you
purchase something outside a controlled environment, you’re taking a chance.”
Vandrey wraps up the discussion.
“Everything is up in the air, starting with
legalization. Some states approve medical
marijuana, some don’t. In many cases, we are
talking about the same chemicals at different
levels of risk. How far do we go? Ultimately, we
have to ensure the safety of the user, so they
know what they are getting. And, of course,
dose label accuracy is a big challenge.”
This whole discussion is akin to the tip of
an iceberg. There are so many aspects to be
considered. Investigators have been looking at
psychedelics for years. So many remedies we
use came from natural resources, so this is just
another step in that continuum. But be careful.
Whether it’s recreational or medical, consider
your source and stay safe.
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