Learning to embrace marijuana as medicine

Photo by Todd Wiseman

A crucial component of helping my patients is guiding them toward realistic expectations so that we not only avoid disappointment but also prepare for the best possible outcome.

When it comes to the healing potential of cannabis, I have been focused on figuring out what cannabis can do for people suffering from epilepsy rather than what it might be able to do.

As the state of Texas stands on the precipice of its first legal cannabis planting, I’m celebrating an important first of my own: I’d like to say, for the first time publicly, that I believe cannabis is medicine, a conviction I developed gradually based on cumulative anecdotal evidence, but now more firmly rooted in recent research. Like all medicine, cannabis must be subjected to rigorous, double-blind, placebo-controlled, peer-reviewed studies so that we can best ascertain how to integrate cannabis-containing products into our treatment regimens in the most responsible way.

I didn’t always see cannabis this way. When you’re entrenched in the treatment of epilepsy, it’s inevitable that you’ll encounter CBD, also known as cannabidiol, one of the active cannabinoid compounds found in cannabis. But when my patients first came to me years ago with the idea that CBD could be a game-changer, my initial reaction was to tell them, “Don’t believe what you’re seeing on the news.”

I was skeptical, and I didn’t expect much to come of it.

When Compassionate Cultivation — one of only three businesses awarded a license in Texas to grow CBD-rich, low-THC cannabis — approached me in early 2017 to ask if I would work with them, I immediately agreed to offer input, but I had to dig deeper on the question of a more public declaration of support.

There’s still a fair bit of stigma regarding cannabis in the medical world, and I had to better understand what was known and what was not yet known. I had to convince myself that I could stand behind advocating for CBD as an option for therapy, regardless of how that might impact my professional reputation. After doing more research and discussing the idea with my partners at Child Neurology Consultants of Austin, I came to the conclusion that I did very much want to be involved.

The good news is that in the process of assisting Compassionate Cultivation with its license application, the legitimacy of this endeavor became much clearer to me. More rigorous data have finally started trickling out, including trial results on drug-resistant seizures published in the "New England Journal of Medicine". The timing of this publication was quite fortuitous, since this is exactly the condition we will be legally able to treat with CBD in Texas starting in 2018.

That publication meant everything because it was a legitimization of the effectiveness of CBD for the treatment of epilepsy at a level of scientific proof that hadn’t been there before. Given promising case reports and successful results in groups of patients treated in open trials without placebo controls, there are many controlled studies being initiated in the effort to confirm the efficacy of CBD, including a collaboration between the National Institute on Neurological Disorders and Stroke and the National Institute on Drug Abuse.

It helps, too, that Colorado and California are channeling cannabis tax revenues to fund high-level studies on the use of cannabis as a treatment to a variety of conditions.

As a board-certified pediatrician, child neurologist and epilepsy specialist, I understand better than most that you can write anecdotal reports until the cows come home, but physicians won’t give that any credence until there’s more controlled data out there. But now that we’re starting to see legitimate data, I’d like to encourage my fellow physicians and prescribers to review this important research.

I myself have gone from cautioning patients not to expect too much from CBD to saying, “Let’s see what happens,” to realizing that, for many patients, CBD not only meets their needs but exceeds all of our expectations. And now I look forward to 2018, when we’ll finally be able to deliver this important plant-based medicine to the Texans who need it most.

Karen Keough

Child neurologist and epileptologist

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