Is Cannabis Right for I/DD?                                                                                       
If you’ve been driving on Route 15 North recently, you may have noticed a billboard for a cannabis (marijuana) dispensary opening in Williamsport. There is also a dispensary opening soon in Shamokin. Regardless of how we feel about these products and treatments, they are likely here to stay and will only increase in availability.
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Many if not most of you may have heard that these products might help with seizures or the affects of depression, conditions which are common in the intellectually and developmentally different (I/DD) community.

Marijuana and hemp are both forms of cannabis, and the cannabidiol (CBD) oil derived from them is the main product that delivers promised relief for a variety of medical conditions, but, there’s a lot to consider when thinking of using them – either for yourself or your loved ones. CBD oils from hemp are classified as a nutraceutical and can be found in drug and other retail stores available as “over the counter”. Hemp does not contain enough of the psychoactive element of THC and other phytochemicals (phyto=plant) associated with mood enhancement to be classified the same way as marijuana. THC is the main ingredient that causes mood alteration, or a “high”. Other phytochemicals found in cannabis moderate the action of THC, so the right treatment becomes a “mix” that dispensaries specialize in. So, the main difference between hemp and marijuana is that hemp is not considered psychoactive. Hemp derived CBD oil (stuff you might find at your local Turkey Hill) might be good for treatment of pain with adults and things like chemotherapy-induced nausea and vomiting and spasticity associated with multiple sclerosis.

It’s not very likely that hemp-derived CBD will provide help with seizures or depression.

There is an anti-seizure drug that the FDA approved about a year ago called Epidiolex that you can get from your doctor to try, and that is something you can get filled at any drug store. It falls entirely under the process of approval and laws governing medicine. Therefore, it declassifies it as a schedule 1 substance, meaning it has a medical use determined, whereas schedule 1 classified substances have no determined medical use. It’s this classification which has led to State regulations and the appearance of these dispensaries, and it still applies to marijuana derived CBD oils.
To get the marijuana derived version you need to visit one of only a handful of doctors in PA who can prescribe such things, and then “fill” the prescription at dispensary. That’s where it starts to get a little wonky. Right now, you need a prescription to enter into a dispensary in PA, but places like Colorado have retail stores that adults can enter and purchase cannabis mixtures or “cocktails” for recreational use. These stores are cropping up now so they’re in place for the increasing legalization of cannabis for recreational purposes.

The reputable dispensaries train pharmacists in this mixing or cocktailing of cannabis, which is in no way part of their regular education. This mixing is much closer to herbalism than pharmacology, because the complex plant sterols are being mixed, not specific molecules that have been identified as an active drug. This difference is quite large and not a minor detail. Individuals trained in herbalism would be better suited to the task, but we lack such individuals in our current healthcare structure. States like California have more people suited to this and healthcare laws and practices that incorporate things like herbalism, but Pennsylvania has none of that.

Now, enter an I/DD self-advocate that wants help with seizures because there’s not enough relief with traditional medications, or a less toxic approach is desired, or both. Less toxic, in that it may cause fewer ill effects related to its use vs. another drug. Fewer ill effects have NOT thus far been shown in the anecdotal feedback we’ve received at The Arc Susquehanna Valley from our constituents that have tried CBD oil. One self-advocate become more ill and one, we heard had been hospitalized. In both cases, the change was recommended by their own healthcare professionals – specialists from a local health system and their own primary care physicians. That “wonky” part is where we don’t know who mixed or how the treatment was mixed for them.

The mixing, we were told recently by the physician representing “Harvest,” the firm opening a dispensary in Shamokin, is done by the pharmacists at the dispensary “because doctors don’t really know much about that part.” Basically, your physician writes a prescription that is for a specific chemical in a specific quantity that has been researched and determined to be the minimum effective amount to provide a therapeutic benefit. There is no such patient research to support the dispensing of CBD oils. This is because it’s still a schedule 1 substance.

Individuals who are I/DD are a very diverse population with physical and brain differences across a very broad spectrum. The people mixing these oils at the dispensaries do not have the breadth of knowledge or experience with the I/DD population to know what might or might not work, or, like with some of our friends, cause more harm.

Because of this very different approach to treatment and the legal barriers to better research, The Arc Susquehanna Valley does not, at this time, recommend that self-advocates experiment with this treatment option unless the specific effects of pain, seizures or depression are so debilitating even with conventional treatment, that there is no quality of life possible without trying this alternative. Instances of such debilitation in the population we serve are relatively rare.
It’s hard to say whether or not the more plant-based approach being used in cannabis dispensaries will lead to a more over-all measured and holistic approach to this and other treatments, or, if legalization will simply lead to pharmaceutical and nutraceutical solutions that will be absorbed into the current market. Only time will tell.

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