Medical Marijuana and Epilepsy
March 26 was Purple Day, a day dedicated to increasing awareness of epilepsy worldwide. An estimated 50 million people around the world have epilepsy, making it one of the most common neurological conditions on earth. For most patients, dealing with epilepsy is a life-long challenge, an attempt to keep symptoms in check while mitigating serious side effects and interactions that can limit activities and reduce quality of life. People with epilepsy are always looking to improve that balance, and they tend to be proactive in seeking out new treatments that can help them get there.
Cannabinoids, the active compounds in medical (and recreational) marijuana have emerged as promising treatments for epilepsy. Cannabidiol (CBD) appears to have the greatest anti-seizure efficacy out of the 100+ cannabinoids found in cannabis plants. In 2018 Epidiolex, an oral CBD solution, was approved by the FDA as the first cannabinoid medication for epilepsy in the United States, a substantial stamp of legitimacy for medical cannabis. However, for reasons I'll detail below, Epidiolex is not currently an option for most patients suffering from seizure disorders.
Multiple states have legalized both medical and recreational use of cannabis and its derivatives, enabling more people with epilepsy to experiment with cannabinoids as a way to help manage their conditions. Many patients report significant relief, but federal marijuana prohibition in the US hampers serious study and analysis of the effectiveness of cannabinoids in the community.
The Marihuana Tax Act of 1937 effectively criminalized use of cannabinoids; later, the 1970 Controlled Substances Act codified marijuana as one of the most dangerous illicit drugs, listing it as a Schedule I substance. There it remains to this day, alongside heroin, LSD, and ecstasy (the less restrictive Schedule II includes cocaine and methamphetamine). This regulatory regime sharply limits researchers’ ability to study the effects, positive or negative, of cannabis-based medication, and may be depriving people with epilepsy of an important tool to help manage their condition.
Some may point to Epidiolex, mentioned above, and ask why patients with epilepsy don’t just use that treatment? Two reasons:
1. Epidiolex has very narrow indications—that is, reasons it can be prescribed. It’s currently approved for two rare seizure disorders, Lennox-Gastaut syndrome and Dravet syndrome.
2. It’s expensive: up to $32,000 annually, which your insurance may not pay if a patient doesn’t have one of the conditions listed above.
For most patients with epilepsy, Epidiolex is not going to be part of their treatment plan. But the fact that it helps patients with severe seizure disorders is reason for hope, and a call to action. An end to marijuana prohibition will open the door to more research, and more knowledge on how people can use cannabinoids to manage epilepsy and other conditions. It’s time to move past punitive policies and embrace the potential of cannabinoids as medicine.
Suggested reading:
Information on medical marijuana and epilepsy from the Epilepsy Foundation
National Organization for the Reform of Marijuana Laws (NORML)
