Medical Marijuana: Uses, Benefits, Risks, and Legal Status in the US

Medical marijuana, also known as medical cannabis, refers to the use of the Cannabis sativa plant and its active compounds to treat various medical conditions and alleviate symptoms. As legislation evolves across the United States, more patients are exploring medical marijuana as a treatment option for chronic pain, nausea, seizures, and other health conditions.

Understanding how medical marijuana works, its potential benefits, risks, and the legal landscape is essential for anyone considering this treatment option. This comprehensive guide provides evidence-based information to help you make informed decisions about medical cannabis use.

What Is Medical Marijuana?

Medical marijuana comes from the Cannabis sativa plant, which contains over 100 different chemical compounds known as cannabinoids. These cannabinoids interact with the body’s endocannabinoid system, which plays a role in regulating various physiological processes including pain, mood, appetite, and immune function.

The two most well-known and studied cannabinoids are:

• Delta-9 Tetrahydrocannabinol (THC): The primary psychoactive compound that produces the “high” associated with marijuana. THC also has therapeutic properties including pain relief, appetite stimulation, and nausea reduction.
• Cannabidiol (CBD): A non-psychoactive compound that does not produce a high. CBD has shown potential benefits for reducing inflammation, anxiety, seizures, and pain without the mind-altering effects of THC.

Unlike recreational marijuana, medical marijuana is used specifically under healthcare guidance to manage symptoms of diagnosed medical conditions.

Legal Status of Medical Marijuana in the United States

The legal status of medical marijuana in the United States is complex, with federal and state laws often conflicting.

Federal Law

Under federal law, marijuana remains classified as a Schedule I controlled substance, meaning the U.S. government does not recognize it as having accepted medical use. This classification makes it illegal to possess, use, or distribute marijuana for any purpose under federal law.

However, CBD derived from hemp plants containing less than 0.3% THC is legal under federal law following the passage of the 2018 Farm Bill.

State Laws

Despite federal prohibition, many states have legalized medical marijuana through their own legislation. As of now, more than 35 states and several U.S. territories have established medical marijuana programs that allow qualified patients to access cannabis for therapeutic purposes.

Each state has its own:

• List of qualifying medical conditions
• Registration and certification requirements
• Possession limits
• Approved forms of medical marijuana
• Regulations for dispensaries and cultivation

It’s important to note that even in states where medical marijuana is legal, federal law still applies. This means individuals could potentially face federal prosecution, though this is rare for patients following state medical marijuana programs.

Medical Conditions Treated with Medical Marijuana

The qualifying conditions for medical marijuana vary significantly by state. Research suggests that cannabis may provide therapeutic benefits for certain health conditions, though more clinical studies are needed to fully understand its efficacy and safety profile.

Common conditions that states approve for medical marijuana treatment include:

• Chronic Pain: One of the most common reasons patients seek medical marijuana, particularly for pain that hasn’t responded well to other treatments
• Cancer-Related Symptoms: Nausea, vomiting, pain, and loss of appetite associated with cancer or chemotherapy
• Epilepsy and Seizure Disorders: Particularly treatment-resistant forms of epilepsy
• Multiple Sclerosis (MS): For muscle spasms, pain, and spasticity
• Glaucoma: To reduce intraocular pressure
• HIV/AIDS: To manage pain, nausea, and appetite loss
• Crohn’s Disease and Inflammatory Bowel Disease: To reduce inflammation and gastrointestinal symptoms
• Posttraumatic Stress Disorder (PTSD): To manage anxiety, sleep disturbances, and other symptoms
• Amyotrophic Lateral Sclerosis (ALS): For pain and muscle symptoms
• Alzheimer’s Disease: In some states, to manage agitation and other symptoms
• Parkinson’s Disease: For tremors, pain, and sleep problems
• Severe Arthritis: To reduce pain and inflammation

The specific conditions covered vary by state, so it’s essential to check your state’s medical marijuana program requirements to determine if your condition qualifies.

How Medical Marijuana Works in the Body

The therapeutic effects of medical marijuana occur through interaction with the endocannabinoid system (ECS), a complex cell-signaling system present throughout the human body. The ECS plays a role in regulating numerous functions including:

• Pain perception
• Immune system responses
• Mood and stress responses
• Sleep patterns
• Appetite and metabolism
• Memory and learning
• Inflammation

When cannabinoids from marijuana enter the body, they interact with cannabinoid receptors (CB1 and CB2) throughout the ECS. THC primarily binds to CB1 receptors in the brain and nervous system, producing psychoactive effects along with pain relief and other therapeutic benefits. CBD has a more complex interaction with the ECS and can influence various receptors without producing a high.

This interaction can help modulate pain signals, reduce inflammation, calm anxiety, stimulate appetite, and provide other therapeutic effects depending on the cannabinoid profile and dosage.

Forms and Methods of Using Medical Marijuana

Medical marijuana is available in various forms, each with different onset times, duration of effects, and appropriate use cases:

Inhalation Methods

• Smoking: Traditional method using dried cannabis flowers in cigarettes or pipes. Effects begin within minutes but smoking can irritate the lungs.
• Vaporizing: Heating cannabis to release cannabinoids without combustion, potentially reducing lung irritation compared to smoking. Effects begin quickly, typically within minutes.

Oral Methods

• Capsules and Pills: Precise dosing in a familiar format. Effects take 30 minutes to 2 hours to begin but last longer.
• Edibles: Foods or beverages infused with cannabis, such as gummies, chocolates, or baked goods. Effects are delayed but long-lasting.
• Tinctures and Oils: Liquid extracts taken orally or added to food and beverages.

Sublingual and Oromucosal

• Sublingual Tinctures: Drops placed under the tongue for absorption through mucous membranes. Effects begin faster than oral ingestion.
• Oral Sprays: Sprayed into the mouth for absorption. Offers quick onset and precise dosing.

Topical Applications

• Creams, Lotions, and Balms: Applied directly to the skin for localized relief without psychoactive effects.
• Patches: Transdermal patches that deliver cannabinoids through the skin over extended periods.

Suppositories

• Rectal or vaginal suppositories for systemic or localized effects, often used when other methods aren’t suitable.

The best method depends on your condition, desired onset and duration of effects, and personal preferences. Healthcare providers familiar with medical marijuana can help determine the most appropriate form and dosage for your needs.

Potential Benefits of Medical Marijuana

Research into medical marijuana is ongoing, but studies have shown potential benefits for various conditions:

Pain Management

Multiple studies suggest that cannabinoids can help reduce chronic pain, particularly neuropathic pain that doesn’t respond well to traditional pain medications. Medical marijuana may offer an alternative or complementary approach to opioid medications for some patients.

Nausea and Vomiting

Cannabis has well-documented anti-nausea properties, making it particularly useful for patients undergoing chemotherapy or dealing with severe nausea from other causes.

Appetite Stimulation

THC can stimulate appetite, benefiting patients with wasting syndromes associated with HIV/AIDS, cancer, or other conditions causing significant weight loss.

Muscle Spasm Reduction

Patients with multiple sclerosis and other conditions causing muscle spasticity report relief from cannabis use.

Seizure Control

CBD in particular has shown promise in reducing seizure frequency in certain forms of epilepsy, including conditions that don’t respond to traditional treatments.

Sleep Improvement

Some patients report improved sleep quality when using medical marijuana, though effects can vary based on the cannabinoid profile and individual response.

Anxiety and PTSD Symptoms

While research is mixed, some patients report reduced anxiety symptoms with certain types of medical cannabis, particularly CBD-rich products.

It’s important to note that while these potential benefits are promising, individual responses vary significantly, and more research is needed to fully understand medical marijuana’s therapeutic potential.

Risks and Side Effects of Medical Marijuana

Like any medical treatment, medical marijuana carries potential risks and side effects that should be carefully considered:

Common Side Effects

• Cognitive Effects: Impaired short-term memory, difficulty concentrating, and altered judgment, particularly with THC-rich products
• Psychoactive Effects: Feeling “high,” altered perception, euphoria, or anxiety, especially in marijuana with higher THC content
• Physical Effects: Increased heart rate, dizziness, dry mouth, red eyes, and increased appetite
• Motor Skills: Slowed reaction time and impaired coordination, which can affect driving and operating machinery
• Respiratory Issues: When smoked, marijuana can irritate the lungs and airways

Mental Health Considerations

• Marijuana use may worsen symptoms in people with certain mental health conditions
• High doses or high-THC products can trigger anxiety or panic attacks in some individuals
• There may be increased risk of psychotic symptoms in vulnerable individuals, particularly with heavy use of high-THC products
• Cannabis use during adolescence may affect brain development

Cardiovascular Risks

• Increased heart rate shortly after use
• Potential increased risk of heart attack, particularly in older adults or those with heart conditions
• Possible interactions with blood pressure and heart medications

Dependency and Withdrawal

• Regular marijuana use can lead to cannabis use disorder in some individuals
• Abrupt cessation after prolonged use may cause withdrawal symptoms including irritability, sleep difficulties, decreased appetite, and mood changes

Drug Interactions

Medical marijuana can interact with various medications, including:

• Blood thinners
• Sedatives and sleep medications
• Certain antidepressants
• Pain medications
• Seizure medications

Special Populations

• Pregnancy and Breastfeeding: Marijuana use during pregnancy may affect fetal development and is not recommended. THC passes into breast milk.
• Adolescents: Marijuana use during adolescence may impact brain development and academic performance.
• Older Adults: May be more sensitive to side effects and have greater risk of falls, confusion, and cardiovascular effects.

Before starting medical marijuana treatment, consult with a healthcare provider who understands your complete medical history and current medications to assess potential risks.

How to Obtain Medical Marijuana

The process for obtaining medical marijuana varies by state but generally involves the following steps:

Step 1: Verify Eligibility

Check whether your state has a medical marijuana program and whether your condition qualifies under state law.

Step 2: Consult a Healthcare Provider

Schedule an appointment with a healthcare provider who is registered with your state’s medical marijuana program. They will:

• Evaluate your medical condition and history
• Determine if medical marijuana is appropriate for you
• Discuss potential benefits, risks, and alternatives
• Provide a written certification or recommendation if approved

Note that healthcare providers cannot prescribe marijuana due to federal law, but they can certify or recommend it under state programs.

Step 3: Register with Your State

Apply for a medical marijuana card or registration with your state’s health department, which typically requires:

• Healthcare provider’s certification
• Proof of residency
• Government-issued ID
• Application fee
• Other state-specific requirements

Step 4: Purchase from Licensed Dispensaries

Once approved and registered, you can purchase medical marijuana from state-licensed dispensaries. Dispensary staff can help you:

• Select appropriate products for your condition
• Understand different strains and cannabinoid profiles
• Determine proper dosing
• Learn about different consumption methods

Step 5: Follow State Regulations

Adhere to your state’s regulations regarding:

• Possession limits
• Where you can use medical marijuana
• Transportation requirements
• Renewal procedures
• Reporting requirements

Dosing and Usage Guidelines

Determining the right dose of medical marijuana is highly individual and depends on multiple factors:

Factors Affecting Dosage

• The specific medical condition being treated
• Body weight and metabolism
• Previous cannabis experience
• Tolerance levels
• The form and method of consumption
• THC and CBD content of the product

General Dosing Principles

• Start Low and Go Slow: Begin with the lowest possible dose and gradually increase until you achieve desired symptom relief
• Track Your Response: Keep a journal noting doses, products used, timing, effects, and side effects
• Be Patient: Different forms have different onset times; wait to assess effects before taking more
• Maintain Consistency: Once you find an effective dose, maintain consistency in products and timing
• Regular Evaluation: Periodically assess with your healthcare provider whether medical marijuana is still appropriate and effective

Method-Specific Considerations

• Inhalation: Effects begin within minutes, making it easier to titrate dose, but effects are shorter-lasting
• Oral Products: Effects take longer to begin (30 minutes to 2 hours) but last longer; start with very low doses to avoid overconsumption
• Sublingual: Faster onset than edibles with more predictable effects
• Topicals: Used as needed for localized symptoms without systemic effects

Working with a healthcare provider experienced in medical cannabis can help you develop an effective dosing strategy tailored to your specific needs.

Medical Marijuana vs. FDA-Approved Cannabis-Based Medications

While whole-plant marijuana is not approved by the U.S. Food and Drug Administration (FDA), several cannabis-based medications have received FDA approval for specific conditions.

These pharmaceutical products undergo rigorous testing for safety, efficacy, and quality control. If you’re considering cannabis-based treatment, consult your healthcare provider about whether FDA-approved options might be appropriate for your condition. Your doctor can help you understand all available treatment options and determine the best approach for your specific situation.

Research and Future Directions

Medical marijuana research is expanding as legal restrictions ease, but significant gaps remain in our understanding:

Current Research Limitations

• Federal classification as Schedule I makes large-scale research difficult
• Most studies have been observational or small-scale
• Standardization of products and dosing varies widely
• Long-term safety data is limited
• Optimal cannabinoid ratios for specific conditions are not well-established

Areas of Active Investigation

• Pain management, particularly as an alternative to opioids
• Mental health conditions including anxiety, depression, and PTSD
• Neurodegenerative diseases
• Cancer treatment support and potential anti-cancer properties
• Inflammatory and autoimmune conditions
• Sleep disorders
• Addiction treatment

As research progresses, our understanding of medical marijuana’s therapeutic potential, optimal use cases, and safety profile will continue to evolve.

Important Considerations Before Using Medical Marijuana

Have an Honest Discussion with Your Healthcare Provider

Before starting medical marijuana, have a comprehensive discussion with your healthcare provider about:

• Your complete medical history
• All current medications and supplements
• Previous substance use history
• Mental health conditions
• Your treatment goals and expectations
• Alternative treatment options

Understand the Legal Implications

• Know your state’s specific laws and regulations
• Understand that medical marijuana use may affect employment, particularly in federally regulated industries
• Be aware that traveling across state lines with marijuana remains illegal under federal law
• Recognize that marijuana use can affect custody decisions in some jurisdictions

Plan for Safety

• Never drive or operate machinery while under the influence of marijuana
• Store medical marijuana securely away from children and pets
• Don’t combine marijuana with alcohol or other substances without medical guidance
• Have a plan for managing side effects
• Know when to seek medical attention

Financial Considerations

• Medical marijuana typically is not covered by health insurance
• Consider costs of initial certification, state registration fees, and ongoing product purchases
• Some states offer reduced fees for patients with financial hardship

Frequently Asked Questions About Medical Marijuana

Can I get fired for using medical marijuana?

Employment protections for medical marijuana users vary by state. Some states provide employment protections for registered medical marijuana patients, while others do not. Federally regulated employees and safety-sensitive positions may have additional restrictions.

Will medical marijuana show up on a drug test?

Yes, THC and its metabolites will appear on standard drug tests. Having a medical marijuana card does not guarantee protection from employment consequences related to a positive drug test.

Can I grow my own medical marijuana?

Some states allow registered patients to grow a limited number of plants for personal medical use, while others require all medical marijuana to be purchased from licensed dispensaries. Check your state’s specific regulations.

How long does medical marijuana stay in your system?

THC can be detected in urine for days to weeks after use, depending on frequency of use, metabolism, body fat percentage, and other factors. Heavy users may test positive for a month or longer after cessation.

Is CBD the same as medical marijuana?

CBD is one component of medical marijuana. Hemp-derived CBD products containing less than 0.3% THC are legal federally and available without a medical marijuana card. Medical marijuana typically contains both CBD and THC in varying ratios.

Can I use medical marijuana if I have a history of substance abuse?

This requires careful consideration with a healthcare provider who understands addiction medicine. Cannabis can be habit-forming, and individuals with substance use history may be at higher risk for developing cannabis use disorder.

Conclusion

Medical marijuana represents a complex and evolving treatment option for various medical conditions. While research shows promise for certain applications, particularly chronic pain and chemotherapy-related nausea, significant questions remain about long-term safety, optimal dosing, and appropriate use cases.

The decision to use medical marijuana should be made carefully in consultation with a knowledgeable healthcare provider who can evaluate your individual situation, including your specific condition, medical history, current treatments, and potential risks and benefits.

If you’re considering medical marijuana as a treatment option, take time to:

• Research your state’s specific laws and qualifying conditions
• Have thorough discussions with healthcare providers
• Understand both potential benefits and risks
• Consider all available treatment alternatives
• Make an informed decision based on your individual circumstances

As legislation and research continue to evolve, our understanding of medical marijuana’s role in healthcare will become clearer. Stay informed about new developments and maintain open communication with your healthcare team to ensure the safest and most effective treatment approach for your needs.

Remember that while medical marijuana may provide relief for certain conditions, it is not appropriate for everyone. Always consult with qualified healthcare professionals before starting any new treatment, including medical marijuana.

Sources:

• National Center for Biotechnology Information – Medical Cannabis: Considerations for the Anesthesiologist and Pain Physician
• U.S. Food and Drug Administration – FDA and Cannabis: Research and Drug Approval Process
• Centers for Disease Control and Prevention – Marijuana and Public Health
• National Center for Complementary and Integrative Health – Cannabis (Marijuana) and Cannabinoids
• National Conference of State Legislatures – State Medical Cannabis Laws
• National Institute on Drug Abuse – Marijuana Research Report