Cannabis sativa (C. sativa) or medical marijuana, is the entirety of the plant and the internal chemicals. We have cannabinoid receptors within our cells, which allows the cannabis substances to act in order to cause effects. The two major chemicals are Tetrahydrocannabinol, the causation of the psychoactive “high” effects, and Cannabidiol, which has shown positive effects on some functions of the body, and would be the one primary one to reduce of seizures. Epilepsy is referred to as being one of the most common neurological diseases, according to International League Against Epilepsy. It is defined as a brain disorder represented by perturbation of the cerebral physiological function which engenders episodes of excessive neuronal activity caused by a neuronal hyper-excitability, as well as psychological, social, and cognitive corollary. Although, there is still limited quality evidence of marijuana actually making an impact, there is some.
The Ethical Dilemmas behind Using Marijuana for Epilepsy The discovery of cannabinoid receptors in the CNS, led to searching for endogenous substances and the receptors interacting, and identifying ‘endogenous cannabinoids’, the more important ones being; arachidonic acid derivatives anandamide and arachidonoyl glycerol. Evidence has shown that endocannabinoids are very important when it comes to controlling the synaptic transmissions and regulation rates of neuronal firing. In the CNS, the CB1 receptors expressed pre-synoptically on glutamatergic and GABAergic interneurons, and activation of these receptors causes inhibition of transmission. The endo-cannabinoid signal pathways’ involvement in the pathophysiology is inferred by clinical and experimental observations. Seizures mostly affect the endocannabinoid system. Marijuana has two neuro-active components: tetrahydrocannabinol (THC), which is psychoactive, and cannabidiol (CBD) which is not, but they both influence the endocannabinoid system to counteract the seizure.
History and Research
The Ethical and Unethical Appeals
In every situation, controversial issue or not, there are two sides, within those side there are subcategories. What appears to be positive and/or ethical, and that which appears to be negative and/or unethical, being the two main categories. However, these ‘right or wrong’ principles are to be used as a guide to make good moral judgements when solving moral issues. The Double Effect focuses on four constraints to be met in order for the ending effects to be ethically warranted. The first being: if the act’s effects are weighed individually, it must be either neutral or positive, the second being: the negative effect must not be a means of the positive yield, he third being: the negative effect is unintentional, and the fourth being: the reasoning behind preforming the act, must be commensurate. (Kelly G., Medico-Moral Problems) When looking at the ethics of a dilemma such as this, it is important to look at every angle.
The Ethical Appeals
Medical marijuana is used as a way to treat body issues, and in this case to help lessen the suffering of a person who deals with episodic spasms, the cannabis is simply used for relieving the person of their pain, which justifies it for the first constraint. The relief of the pain is not, in turn, caused by a negative act which meats the second constraint. The third is met via the up-holding of a physician-patient relationship by being able to discuss, recommend, and educate their patients and the patient having the right of informed consent. The fourth is met by the question of whether or not the relief of a patient’s pain is worth more than the potential harm that could come to be. The only thing is, with this situation, there is only some in-depth data, but very little in the way of repetition of studies and data collection of marijuana’s effects on epilepsy.
The Unethical Appeals
According to the Drug Enforcement Agency, cannabis and products derived from it is considered Schedule I drugs. Drugs in this category is often abused and not accepted for medical use currently. They are also considered to be the most dangerous drugs of the drug schedules, and could cause severe psychological or physical dependence, despite it being less so than benzodiazepines and opiates. Hence the concerns regarding accurate placement and information. Due to this federal regulations, legal problems, and the lack of cannabidiol, research is difficult, meaning the data is not necessarily accurate. Also the use of cannabis in children brings up the concern of potentially risking their developing brains with severe and negative consequences, which begs the question of potential dismissal regarding of the Principle of No Maleficence. A popular question is; how do you know what the product says it is, is actually what you get, well FDA testing or oversight is not required; the FDA has issued warning letters to some producers after testing some products and finding that the label was not accurately portrayed, so one does not know what they get at times. Additionally the lack of human case studies comes into play regarding the lack of reconfirming data and evidence of the causes and effects of using cannabis for epilepsy.
Relations to Colorado
Marijuana has been legal here since 2000, and one of the leading techniques used in helping with seizures using cannabis called “Charlotte’s Web” developed by Edward Maa: the Chief of the Comprehensive Epilepsy Program at Denver Health and Hospitals. Children’s Hospital Colorado has also lead a few studies in which they found that; of the pediatric epilepsy patients who used a CBD-related treatment, 33% of 75 experienced at least a 50% seizure reduction. Also, due to our advancements over time, and cannabis being legal, many people move here just for the treatments.
References
MACEDO, A. L. S. P., MACEDO, B. S. P., NEIVA, G. R., & DE MORAIS NEIVA, V. A. (2019). Use of Cannabidiol in Epilepsy Treatment: Literature Review. Brazilian Journal of Surgery & Clinical Research, 27(3), 69–70. Retrieved from https://libdb.ppcc.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=138164556&site=ehost-live&scope=site
Perry, M. S. (2019). Don’t Fear the Reefer—Evidence Mounts for Plant-Based Cannabidiol as
Treatment for Epilepsy. Epilepsy Currents, 19(2), 93–95.
https://libdb.ppcc.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=135815382&site=ehost-live&scope=site
Khan, A. A., Shekh, A. T., Khalil, A., Walker, M. C., Ali, A. B., & Shekh-Ahmad, T. (2018).
Cannabidiol exerts antiepileptic effects by restoring hippocampal interneuron functions in a temporal lobe epilepsy model. British Journal of Pharmacology, 175(11), 2097–2115. https://libdb.ppcc.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=129815691&site=ehost-live&scope=site
Kolikonda, M. K., Srinivasan, K., Enja, M., Sagi, V., & Lippmann, S. (2016). Medical Marijuana
for Epilepsy?. Innovations in clinical neuroscience, 13(3-4), 23–26.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911937/
Perucca E. (2017). Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last?. Journal
of epilepsy research, 7(2), 61–76. doi:10.14581/jer.17012 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5767492/
Rosenberg, E. C., Tsien, R. W., Whalley, B. J., & Devinsky, O. (2015). Cannabinoids and
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604191/