Ask the Doctors

Dear Doctor: I read that more women are using marijuana for morning sickness. This doesn't seem like a good idea, but for women with severe morning sickness, might it be an option? Could it really hurt the baby?

Dear Reader: Marijuana refers to the flowering annual Cannabis sativa. It's a complex plant packed with phytochemicals with a number of potential (and one recently FDA-approved -- we'll get to that in just a moment) medical applications. While it's true that smoking cannabis has been shown to ease nausea, when it comes to morning sickness, we do not recommend it. Cannabis remains illegal at the federal level, and at the state level is subject to a tangled and often conflicting patchwork of regulations. That means many of its prospective medical applications have not yet undergone the robust and rigorous study needed to ascertain efficacy, safety and dosage parameters.

For women considering smoking or ingesting cannabis while pregnant, it's important to understand that the placenta allows its psychoactive component, tetrahydrocannabinol, or THC, to reach the developing fetus. Some research has put the amount at 10 percent of what the mother receives, a concentration that rises with repeated use. Some studies have suggested a link between cannabis use in pregnant women with low birth-weight babies and impaired neurological development. As we said earlier, medical research into cannabis is in its infancy. Until we have a better understanding of the outcomes of its use during pregnancy, the recommendation from the American College of Obstetricians and Gynecologists is that women who are pregnant, as well as those who plan to be, should not use cannabis.

Switching gears, we heard from many of you after the publication of the column about CBD, or cannabidiol. CBD is one of over 100 cannabinoids found in Cannabis sativa and unlike THC, is not psychoactive. CBD has been shown to have analgesic, anti-inflammatory, anti-seizure and anti-anxiety properties, and has great therapeutic potential. We stated that despite the explosion of CBD products now available, none were FDA-approved.

At the time we wrote the column, this was indeed true. However, several weeks later -- and thank you to everyone who wrote in with updates and clarifications -- the first CBD medication received FDA approval. Called Epidiolex, it's a treatment for seizures associated with Lennox-Gastaut syndrome and Dravet syndrome, two rare and severe forms of epilepsy. The former begins between ages 3 and 5, and the latter begins in infancy. Epidiolex is the first FDA-approved use of CBD, and the only treatment for Dravet syndrome to get FDA approval.

Since cannabis remains a controlled substance, the Drug Enforcement Administration must also provide regulatory approval for Epidiolex. Once the DEA schedules its use, the question of availability moves to the state level. Many small pharmacies and at least one national chain, Rite Aid, have already stated that they will stock and sell the drug once it has cleared all regulatory hurdles. The drug, created by the British company GW Pharmaceuticals, will be manufactured in England and exported to the United States. Because Epidiolex is an FDA-approved pharmaceutical, only stores with pharmacy licenses will be allowed to sell it.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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