Photo by Marcy Stamper Fresh Greens received a delivery from a local grower and processor of marijuana.

Photo by Marcy Stamper
Fresh Greens received a delivery from a local grower and processor of marijuana.

Users point to results, doctors cite lack of research

By Marcy Stamper

Some people say marijuana extracts have helped soothe muscle aches from over-exertion. Arthritis sufferers say rubbing it into their joints has reduced pain and given them greater mobility. Others say tinctures have kept cancerous tumors stable for years. Still others say a little drop of marijuana under the tongue helps them sleep.

Now that it is legal for people over 21 to purchase marijuana for either therapeutic or recreational uses in Washington state, some of these people simply buy marijuana at a retail store. Others obtain an authorization from a health care provider to grow marijuana plants themselves or to possess larger quantities.

However, because of concerns about the lack of solid, scientific research and no way to ensure standard doses, most physicians and health care providers in the Methow Valley decline to provide the medical authorizations.

None of the practitioners at Confluence Health authorizes marijuana for health issues, said Mike Tuggy, a family physician at the Winthrop clinic. Tuggy said they had not found marijuana useful for patients’ complaints and are concerned about other effects of the drug and about someone who uses marijuana for nausea and then drives.

Besides, there are traditional medicines that work better for nausea and that are more targeted, said Tuggy. “The medical indications [of marijuana] are pretty thin, as far as we know,” he said.

Family Health Centers (FHC) has a policy against prescribing or authorizing marijuana, said Allison Fitzgerald, a family medicine physician at FHC’s Twisp clinic.

Although she occasionally authorized marijuana for patients when she worked in Seattle, Fitzgerald said she has never been comfortable with it because there is no control over how patients use it. Fitzgerald also pointed to the absence of good studies about medical applications and to the inconsistent lab results.

Health effects vary depending on the form of marijuana someone uses. “Smoking is not good for you at all,” particularly for someone with a chronic illness, said Fitzgerald.

Beneficial alternative

But some patients who have found no relief from traditional pharmaceuticals or treatments have turned to marijuana.

Photo by Marcy Stamper Monica Bernhard said topical marijuana has been highly beneficial in relieving arthritis pain.

Photo by Marcy Stamper
Monica Bernhard said topical marijuana has been highly beneficial in relieving arthritis pain.

Monica Bernhard first obtained authorization to grow and process marijuana about five years ago after her husband was diagnosed with late-stage thyroid cancer. He received conventional treatment for his condition but began using marijuana, with his doctor’s approval, as “complementary medicine,” she said.

Bernhard also began using a lotion to relieve her arthritis. She finds it reduces joint pain and stiffness on a long-term basis, which has increased her mobility. Its anti-inflammatory properties are “super-beneficial,” she said.

Bernhard grows plants in a greenhouse and cooks them down in alcohol to create a highly concentrated oil, which she mixes with food-grade glycerin and peppermint or other oils to make tinctures (for droplets to be placed under the tongue), or with coconut oil to be rubbed into the skin. The tinctures are wonderful for sleep, she said.

Like most people using marijuana for health reasons, Bernhard seeks out strains that have no psychotropic effect. “People are so worried about getting high or not being in their right mind, but I never feel high,” she said. She has never used it recreationally. “It just wasn’t my thing,” she said.

Raleigh Bowden, a retired oncologist and director of the Lookout Coalition, which supports people in the Methow Valley with health decisions and end-of-life care, provides authorizations to clients, most of whom are desperate for relief from pain or are unable to sleep.

These people don’t want to be spaced out, but they need something to control their pain or stimulate their appetite, said Bowden. “People participate in all sorts of alternative things. The people I help don’t have good solutions for their problems,” she said.

One client uses it every day to manage stage-4 cancer, said Bowden. Another swears by marijuana for dementia because it improves mood and quality of life.

Supporting clients

Some people believe the marijuana is keeping their disease stable, since Western medicine had nothing to offer them, said Bowden. “People have all sorts of figments of imagination about how biology works,” she said. “I tend to be willing to support clients who want to try things.”

Many of Bowden’s patients are elderly and had no previous experience with marijuana. “But they heard it might help and are pretty desperate,” she said. Some tried just a few drops and didn’t like the feeling, but others have found it helpful.

As people educate themselves about different strains of marijuana, they are finding different applications. Indica strains are said to have an overall relaxing effect and are beneficial in helping people sleep. Sativa is used by people who want more energy, since it produces a peppy response, more like caffeine, said Jacob Giesen, manager of Fresh Greens, the retail marijuana store in Winthrop. Giesen and other employees received the required state training for Fresh Greens to become a medically authorized store.

Giesen is also a massage therapist. While massage therapists are not permitted to use marijuana-infused oils or creams in their practice, Giesen has tried it on friends. “It relaxes muscles but doesn’t get you high. It settles the mind so you’re not thinking about what hurts,” he said.

Kyle Northcott, a massage therapist in Twisp, has had a personal medical authorization for several years and uses topical marijuana on himself for pain relief. There are products derived from marijuana that relax the muscles – particularly when combined with a cooling or heating rub like Ben Gay – that don’t give you any kind of buzz, he said.

“It could be an amazing drug if we knew all the scientific information and ways to apply it, just like for every drug in the medical industry,” said Northcott. “Half of the reports are anecdotal and half are scientific – there’s just not enough research.”

Nevertheless, Bowden remains skeptical about anecdotal reports. “It’s not well regulated or studied,” she said. Doctors are more comfortable prescribing pharmaceuticals that they know are effective, particularly because the chemical proportions in marijuana can vary from batch to batch, she said.

Dosage questions

All marijuana sold commercially in Washington is tested in a laboratory and packages are labeled with the percentages of different components and chemicals. But because one crop of the same strain could produce a more potent plant, health care providers are concerned about fluctuations in doses. Even topical applications can be highly variable and are not reliable, since the penetration of the skin depends on the patient and age, said Tuggy.

There has also been research into the potential for using marijuana to help with symptoms and progression of Alzheimer’s disease and other forms of dementia. Many medications approved by the federal Food and Drug Administration for treating Alzheimer’s have serious side effects, and some studies suggest that marijuana can help with cognitive or physical performance by increasing confidence or boosting energy, according to a medical practitioner who has been following the research.

Early studies have found that very small doses of THC (the psychotropic component in marijuana) can slow the production of the proteins believed to contribute to the progression of Alzheimer’s, according to the online community But another study found no difference between a marijuana pill and a placebo. Moreover, most of the studies have involved only small numbers of patients.

Sierra Breitbeil, a naturopathic doctor at the Methow Valley Wellness Center in Winthrop, sees a few dozen patients a year for marijuana, primarily people dealing with chronic pain. “Chronic pain is the No. 1 reason I am referring for marijuana … then, muscle spasms like those associated with multiple sclerosis,” said Breitbeil by email.

Breitbeil has seen people with spinal problems derive enough relief from marijuana that they are able to walk. She has also provided occasional referrals for medical marijuana for people with post-traumatic stress disorder (PTSD).

“It seems a much better substance to use for those in chronic pain than narcotics for those who are habituated to some of the downside experiences of marijuana” – downsides such as feeling too high to be grounded, productive or social, said Breitbeil by email.

Marijuana can be preferable to regular narcotic use for pain control, because narcotics can slow the gastrointestinal system and cause other chronic problems, said Breitbeil. But because of the lack of standardization, patients must do ongoing experimentation to find the right dosage, she said. Giesen tells customers to keep a detailed log of different products and the way they made them feel.

Limits on uses

Washington updated its medical marijuana laws in July, integrating the 28-year-old medical program with the 3-year-old recreational market. The recreational marijuana industry in Washington is regulated by the state Liquor and Cannabis Board, but the Department of Health also has oversight for medical marijuana.

Under state law, physicians don’t formally prescribe marijuana, but write a letter of authorization for people who want to try it. Health care providers including doctors, physician’s assistants, and advanced registered nurse practitioners may provide the authorizations.

The authorization form lists 13 specific terminal or debilitating conditions that marijuana can be used for, including cancer, HIV, intractable pain, PTSD, multiple sclerosis and wasting disease. Bipolar disorder, depression and anxiety are not on the list because of a lack of scientific evidence supporting improved health outcomes, according to the Department of Health. New medical uses can only be added by legislation or initiative.

Being in the medical database is voluntary, but people who register may buy up to three times the current limit at a medically endorsed store and get tax breaks on purchases.

Health care practitioners may authorize the use of marijuana for any patient, even those under 21, as long as it is medically appropriate and approved by a parent or guardian.

“People are desperate and have tried everything,” said Bowden. “I try to help people make the best decisions for themselves.”

Bernhard said her husband’s tumor has been stable for about five years – it hasn’t gone away, but it also hasn’t grown, she said. A friend with a brain tumor had experienced similar results, although Bernhard knows other people who tried it but still succumbed to their disease.

“I’m proud of the fact that we are using complementary medicine to treat horrible diseases,” said Bernhard. “I would do it again, in a heartbeat.”