Marijuana and Epilepsy

Types of Cannabis

Cannabis has 483 chemical ingredients, of which 85 are cannabinoid compounds.

The two most common cannibinoids are:

• Tetrahydrocannabinol (THC), the chemical that produces the “high” feeling.
  • Possibly increases risk of seizures.
• Cannabidiol (CBD), which may affect behavior and reduce anxiety.
  • Possibly reduces the risk of seizures.

There are three types of Cannabis plants:

• Cannabis ruderalis has nearly no THC, so it is not considered a good source of medical marijuana. It is very fibrous and is used in hemp products.
• Cannabis sativa grows taller and is bushier with darker olive green leaves. It has a higher THC to CBD ratio. It has more mind-altering effects and is stimulating. It can give “the munchies.”
• Cannabis indica grows like trees and the leaves are more of a spring green color. This has a lower THC to CBD ratio. This may be more sedating or relaxing.

Most marijuana grown is a hybrid of C. indica and sativa. The flowering bud of the plant, which is used, can have varying degrees of THC and CBD. Only certified lab testing can determine the true quantity of CBD.

Smoke it or Eat it?

Cannabis can be found in a variety of forms including the bud itself, oils, and creams/ointments.

Cannabis requires heating to activate the cannabinoids. How you use cannabis determines how much exposure to THC and CBD you have, as well as how fast it works.

The following are popular ways to consume cannabis:

• Breathing in cannabinoids will reach the bloodstream quicker, making you feel the effect sooner.
• Eating it will result in reduced amounts of cannabinoids being absorbed and reaching the bloodstream.
• Oil drops will result in a faster absorption rate.
• Creams or ointments result in lesser amounts being absorbed through the skin.

Does Pure CBD Work in Epilepsy?

Medical and street marijuana products boasting pure CBD are of many different varieties and manufacturers, and are untested in clinical trials.

Epidiolex is a purified, 99% oil-based CBD extract from the cannabis plant and is produced by GW Pharmaceuticals. It was just been approved by the FDA in June, 2018.

A study conducted in 2015 by Devinsky et. al, did an open-label trial (meaning that the doctors and patients knew they were receiving the drug) on 214 patients, ranging in age from 1-30 years with severe, intractable, childhood-onset, and treatment-resistant epilepsy who were all on traditional anti-epileptic medications.

In that study conducted over 3 months, the monthly motor seizure reduction was 36.8%.

Side effects recorded during the trial included:

• About 79% of patients reported side-effects to the drug, most of which was sleepiness, decreased appetite, diarrhea, fatigue, and increased seizures.
• Five patients had to stop the medication.
• One person died of SUDEP (not related to study drug).
• Nine patients went into status epilepticus (continuous seizures that did not stop).

Cannabis Side Effects

Social and long-term effects of cannabis:

• Concern for medical marijuana becoming a “gateway drug” to harder drugs has no evidence to support it.
• Suggestion that heavy use of cannabis may lead to infertility.
• Regular use during pregnancy is associated with increased risk of low birth weight (<2.5 gram, OR 2.6) and possible preterm labor in white women (OR 1.9) .
  • There is further evidence that cannabis use during pregnancy can cause language and memory development problems in children.

Laws and Medical Marijuana

Some states in the U.S have laws legalizing the use of medical marijuana, but not all.

Marijuana is a Schedule 1 substance: it is illegal to carry medical cannabis across state lines.

Under the Controlled Substances Act (CSA 21 U.S.C. § 811), marijuana is considered an illegal substance.

In 2005 the United States Supreme Court held that the federal government has authority to prohibit marijuana for all purposes in Gonzales v. Raich.

In 2016, the Department of Justice issued a guidance memo making it clear that prosecuting state-legal medical marijuana cases is not a priority.

Test Your Knowledge

Next Section: SUDEP