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October 28, 2016
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Medical Marijuana Musings

"What does pot have to do with diabetes?" The question came up in the course of a lunchtime conversation with Chris Goldstein of the Coalition for Medical Marijuana - New Jersey, as we discussed our respective advocacies. (New Jersey is currently in the middle of a medical-marijuana tug-of-war.) When the uses of medical marijuana are broached in the media, it's usually in conjunction with terminal cancer -- or intense, persistent pain. The last time I sat in on a presentation on medical marijuana, the speaker explained how it eased many of the symptoms of his late wife's multiple sclerosis. But diabetes? Tell me another one.


As it turns out, the issue is not that easily brushed off. When Chris told me that the human body normally produces its own cannabinoids (similar to the active substances in cannibis, aka marijuana) and cannabinoid receptors, and that they are responsible for controlling homeostasis, my interest was piqued -- I've been dealing with thermal control issues all winter. He specifically mentioned a non-psychoactive substance in cannabis, CBD, which appears to be more promising than THC (the substance which makes you high) for a number of therapeutic purposes. As the conversation continued, he handed me a report, Emerging Clinical Applications for Cannabis and Cannabinoids: A Review of the Recent Scientific Literature 2000-2010 and pointed me to the section on diabetes, noting that cannabinoids are showing promise in the alleviation of pain associated with diabetic neuropathy.


So far, potentially interesting, right? But the diabetes community has seen so much "snake oil" in promises of palliatives and cures that it'd be irresponsible for me to not look for a lack of supporting clinical evidence. So enter the "Devil's Advocate":


To start with, the report Chris gave me was published by NORML, the National Organization for the Reform of Marijuana Laws -- an organization which has been at times associated with "potheads" and "stoners", rather than responsible medical and recreational users. On top of that, the report's section on Diabetes starts, "Diabetes mellitus is a group of autoimmune diseases..." Yes, type 1 diabetes is autoimmune -- and I'd say kudos for getting that -- but type 2? The report's authors missed that type 2 diabetes is not always responsible for reduced insulin production, but that it is frequently responsible for the body's inability to use insulin correctly.


While researching the report, I grew concerned not just about how little the purported marijuana-diabetes connection has been studied, but also that none of the cited research has been in humans. The NORML report notes that there are no current or recent "clinical investigations of cannabis for the treatment of diabetes" (emphasis mine), but it cites a handful of preclinical papers in which cannabinoids found in marijuana were studied with respect to prevention and delayed onset of type 1 diabetes, glycemic control, protection and therapy for diabetic retinopathy, and relief of the pain associated with diabetic neuropathy. As you might guess, these investigations were all carried out on specially-bred strains of rats and mice. I used Google ("marijuana diabetes studies") to find a slew of additional links, but they led to very few additional studies, cited by almost every pro-medical-marijuana site on the Internet.


The lack of controlled studies does not mean, by itself, that the use of marijuana or its derivatives are not useful in diabetes therapy. What it does mean is that for the most part, the evidence is anecdotal -- individuals posting "marijuana works for my diabetes this way..." What it means there is insufficient scientific evidence to prove that marijuana is effective in treating diabetes and complications of diabetes. It also means that (where it is legal) it might be harder to get a prescription to use marijuana for diabetes (and/or its complications) than for terminal cancer or AIDS.


That said, I do believe that certain marijuana-based cannabinoids can be useful in the management of diabetes and complications of diabetes -- I'm just not sure they're useful for everyone who has diabetes, and I'm not sure that it's worth the risk of being incarcerated by the Federal government. Your mileage, risk aversion level, and diabetes may vary.

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