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Marijuana and Diabetes: An Overview

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Marijuana use is a frequent topic of conversation on Glu, our social forum for people who live with type 1 diabetes. To support our community, we’ve provided an overview of the current research and applicable laws on marijuana.

It is becoming increasingly common to use marijuana or marijuana-derived therapies for medicinal purposes. As it becomes legalized in more and more states, there is more research being done on its effects.¹

Unsettled law

Marijuana regulation is a grey zone, with an increasing number of states allowing its use for medicinal or recreational use, while the federal government still prohibits its use.

In 1996 California became the first state to allow the sale of marijuana for medical purposes. In response, the National Academies of Science, Engineering, and Medicine released a report that stated, “Scientific data indicates the potential therapeutic value of cannabinoid drugs, primarily THC, for pain relief, control of nausea and vomiting, and appetite stimulation; smoked marijuana, however, is a crude THC delivery system that also delivers harmful substances.”²

Federally, marijuana is still considered a schedule I drug, meaning it is considered to have “high potential for dependency and no accepted medical use.”³ Despite this, 29 states have fully legalized marijuana for medical use, and another 9 and the District of Columbia, have legalized it for adult recreational use.¹

Marijuana’s chemical profile

There are two main molecules working in marijuana – cannabidiol (CBD) and tetrahydrocannabinol (THC). Many medical benefits can be experienced just in the presence of CBD without the clichéd side effects, those come from THC. THC and CBD have an inverse relationship, meaning strains with high CBD have low THC and vice versa.⁴ This means that many of the medicinal benefits can be experienced without the physiological effects.

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Researchers have characterized marijuana as a comparatively low-risk drug that is 114 times less deadly than alcohol.⁵ About nine percent of marijuana users experience addiction, which is lower than the rate for alcohol (15 percent).⁶ From 1999 to 2010, states that legalized marijuana for medical use experienced significantly lower opioid overdose mortality rates.⁷ While marijuana is safer to use than alcohol, it can still come with dangerous long-term side effects, including lack of coordination, apathy, sedation, disorientation, loss of short-term memory, and if smoked lung damage.⁸

Research on marijuana and diabetes

No, there is no research that proves that marijuana use prevents diabetes, as might be claimed by some clickbait sites. However, preliminary research into the relationship with diabetes and cannabis use has yielded some interesting results.

While cannabis use is associated with increased acute caloric intake, it has also been found to be connected to lower overall BMI (body mass index) scores. Data from the National Health and Nutrition Examination Survey (NHANES) found that the odds of having diabetes were 64 percent lower in marijuana users when adjusted for demographics, lab results, and related conditions.⁹ There are limitations to this finding, however. While the study contained a large and representative sample, data on marijuana use and diabetes were collected at the same time, so it cannot be determined which came first. The data also did not distinguish between Type 1 diabetes and 2 diabetes.

Another study within NHANES found that marijuana was associated with lower insulin resistance in adults without diabetes.¹⁰ Because these studies are based on large population-based surveys, there is no data that could point to the underlying biological mechanisms that are driving the association.

Research on the potential medical benefits or risks of marijuana on adults with autoimmune and metabolic disorders has been limited. However, there is some research on the effect marijuana may have on diabetes complications like depression and neuropathy.

A study in rats with induced diabetes and neuropathy used cannabis sativa extract (comprised mostly of CBD) found that the extract reduced pain related to neuropathy.¹¹ A clinical trial of Sativex, a cannabis-based pain medication, in people with painful neuropathy was less conclusive. That study found that both those treated with the medication and the placebo experienced decreased pain, but there was no difference in the reduction between the two groups.¹²

Three separate randomized control trials on non-disease specific neuropathy found that cannabis cigarettes, smoked cannabis, and vaporized cannabis were all effective in reducing pain, and a 2015 study on diabetes specific neuropathy found similar results.¹³–¹⁶

There is very limited research on the association between depression and marijuana use, but one review of studies on this possible association found that cannabis use among the study participants may be associated with an increased risk for developing depression. The review only included longitudinal studies so it could be assessed the marijuana use came before a diagnosis of depression.¹⁷

Cannabis-based research has not been well funded in the past, partly because of the federal government’s stance that it is a controlled substance. More research will be needed to better define these initial findings. Despite limited research, 12 percent of respondents in a Glu poll reported that they, or the person they care for with T1D, use or have used marijuana or marijuana derived therapies for medicinal purposes.

Precautions for use

People with type 1 diabetes who choose to use marijuana, for recreational or medicinal purposes, should be aware of the potential adverse effects and take precautions. Like alcohol, marijuana alters perception and can make the user unaware if their blood sugar is low or high; frequently checking blood sugars and keeping important diabetes care equipment nearby is an important precaution. Unlike alcohol, smoked marijuana contains no carbs or sugars, but edibles and snacks consumed as a result of the “munchies” do. Remember to bolus accordingly for edible marijuana products, and if possible for anything that will be consumed while using marijuana.⁸

The purpose of this article is to provide information on marijuana use and diabetes, and is not an endorsement of marijuana use. This also should not be considered medical advice. Please consult with your diabetes health care professional about any drugs, prescription or otherwise, that you take or plan on taking.

Glu is published by T1D Exchange, a non-profit dedicated to improving care and accelerating therapies for people affected by type 1 diabetes. If you would like to donate to our mission, please click here.

References:

  1.     State Medical Marijuana Laws. National Conference of State Legislatures. http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx. Published 2018. Accessed May 15, 2018.
  2.     Institute of Medicine. Marijuana and Medicine: Assessing the Science Base. Washington, DC: National Academic Press; 1999. doi:https://doi.org/10.17226/6376
  3.     Drug Scheduling. Drug Enforcement Administration. https://www.dea.gov/druginfo/ds.shtml. Accessed May 25, 2018.
  4.     Schubart CD, Sommer IEC, van Gastel WA, Goetgebuer RL, Kahn RS, Boks MPM. Cannabis with high cannabidiol content is associated with fewer psychotic experiences. Schizophr Res. 2011;130(1-3):216-221. doi:10.1016/j.schres.2011.04.017
  5.     Lachenmeier DW, Rehm J. Comparative risk assessment of alcohol, tobacco, cannabis and other illicit drugs using the margin of exposure approach. Sci Rep. 2015;5. doi:10.1038/srep08126
  6.     Vestal C. Yes, You Can Become Addicted to Marijuana. And the Problem is Growing. Pew. https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2018/06/06/yes-you-can-become-addicted-to-marijuana-and-the-problem-is-growing. Published 2018.
  7.     Bachhuber MA, Saloner B, Cunningham CO, Barry CL. Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010. JAMA Intern Med. 2014;174(10):1668-1673. doi:10.1001/jamainternmed.2014.4005
  8.     Marijuana and Type 1 Diabetes. Beyond Type 1. https://beyondtype1.org/marijuana-and-type-1-diabetes/.
  9.     Rajavashisth TB, Shaheen M, Norris KC, et al. Decreased prevalence of diabetes in marijuana users: Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) III. BMJ Open. 2012. doi:10.1136/bmjopen-2011-000494
  10.   Penner EA, Buettner HA, Mittleman MA. The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults. Am J Med. 2013;126(7):583-589.
  11.   Comelli F, Bettoni I, Colleoni M, Giagnoni G, Costa B. Beneficial effects of a Cannabis sativa extract treatment on diabetes-induced neuropathy and oxidative stress. Phytother Res. 2009. doi:10.1002/ptr.2806 [doi]
  12.   Selvarajah D, Gandhi R, Emery CJ, Tesfaye S. Randomized placebo-controlled double-blind clinical trial of cannabis-based medicinal product (Sativex) in painful diabetic neuropathy: Depression is a major confounding factor. Diabetes Care. 2010. doi:10.2337/dc09-1029
  13.   Wilsey B, Marcotte T, Tsodikov A, et al. A Randomized, Placebo-Controlled, Crossover Trial of Cannabis Cigarettes in Neuropathic Pain. J Pain. 2008. doi:10.1016/j.jpain.2007.12.010
  14.   Wilsey B, Marcotte T, Deutsch R, Gouaux B, Sakai S, Donaghe H. Low-dose vaporized cannabis significantly improves neuropathic pain. J Pain. 2013. doi:10.1016/j.jpain.2012.10.009
  15.   Ware MA, Wang T, Shapiro S, et al. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ. 2010. doi:10.1503/cmaj.091414
  16.   Wallace MS, Marcotte TD, Umlauf A, Gouaux B, Atkinson JH. Efficacy of Inhaled Cannabis on Painful Diabetic Neuropathy. J Pain. 2015. doi:10.1016/j.jpain.2015.03.008
  17.   Lev-Ran S, Roerecke M, Le Foll B, George TP, McKenzie K, Rehm J. The association between cannabis use and depression: A systematic review and meta-analysis of longitudinal studies. Psychol Med. 2014. doi:10.1017/S0033291713001438

 

 

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