Marijuana for Diabetic Control

For centuries, cannabis sativa, more commonly known as marijuana, has been used as a folk remedy to relieve pain, improve mood, and increase appetite.(1)

In 1937, Franklin D. Roosevelt signed the US Marijuana Tax Act that made it illegal to sell or use this herb. Nevertheless, cannabis continued to be used by a small number of citizens in the United States, including jazz musicians, entertainers, and cognoscenti desiring an altered state of mind.

During the 1960s, cannabis use became a symbol for the youth revolution. It was widely used as a mild euphoric on college campuses and among counterculture youth. I remember well coming to parties in Cambridge, Massachusetts, during that heady era and being offered the choice of an alcoholic beverage or a hand-rolled marijuana cigarette. Since then, social use of this herb has continued at a more moderate pace.

In recent years, a synthetic form of its active ingredient, delta-9-tetrahydrocannabinol (THC) (6aR-trans-6a-tetrahydro-6,6,9-trimethyl-3-pentyl-6H dibenzol(b,djpyran-a-01) has been approved by the Food and Drug Administration and is being prescribed to combat chemotherapy and acquired immunodeficiency syndrome–induced anorexia and nausea. This approved agent is named “dronabinol,” with several trade names, including Marinol (AbbVie Inc, North Chicago, Ill). On occasion, I have prescribed it to stimulate appetite and improve mood in apathetic, anorexic, and frail elderly patients, in whom it seemed to have a positive effect.

As a result of the 1937 law, as well as further criminalizing legislation passed during the Nixon administration, marijuana has become a major source of income for illegal drug smugglers. A major site of illegal drug importation is the United States–Mexico border. Hardly a week goes by here in Arizona without news reports involving seizures of large quantities of cannabis by US Border Patrol and Drug Enforcement Administration agents, who work constantly to impede the flow of this agent into the United States. The Drug Enforcement Administration has at this time spent more than 100 billion dollars trying to stop the flow of illegal drugs, including marijuana, into the United States. Unfortunately, the country continues to be flooded with illegal pharmaceuticals and marijuana courtesy of powerful drug cartels.

In recent years, 19 states and the District of Columbia, following California’s lead in 1996, have passed legislation allowing physicians to prescribe marijuana for patients with severe and difficult to control pain or nausea. Similar legislation is pending approval in other states. Marijuana continues to be widely consumed in the United States. Indeed, I can attest from clinical experience that many patients continue to abuse the use of this herb often alongside more dangerous compounds, such as methamphetamine. Anyone working on the inpatient service of a hospital in the United States today sees a daily stream of patients who admit to marijuana use or who are found to have THC in their “tox screen.”

A 2010 ABC news poll found that 81% of Americans favored medical marijuana use and its decriminalization for this purpose. Many other individuals lobby for repeal of the 1937 law forbidding marijuana sale and use. These citizens argue that marijuana should be regulated, sold, and taxed in a manner similar to tobacco and alcohol products.

Despite the ongoing debate, legislation, and current medical use of cannabis, there is a dearth of scientific, pharmacologic, and clinical studies with this agent. I reviewed more than 2070 articles catalogued by PubMed under the heading of medical marijuana and found little about the effect of THC on the metabolome.2, 3 However, there is a modest literature on the cardiovascular effects of THC, but the overwhelming number of investigations involved central nervous system effects and potential addiction.(4)

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– Joseph S. Alpert, MD

This article originally appeared in the June 2013 issue of The American Journal of Medicine.