Medical cannabis

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A catalog page offering Cannabis sativa extract.

Medical cannabis refers to the use of the drug Cannabis as a physician recommended herbal therapy, most notably as an antiemetic. The term medical marijuana post-dates the U.S. Marijuana Tax Act of 1937, the effect of which made cannabis prescriptions illegal in the United States.

Due to widespread illegal use of cannabis as a recreational drug its legal or licensed use in medicine is now a controversial issue in most countries.

There are many competing claims regarding the use of cannabis in a medicinal context. Some claim that it is effective for a wide spectrum of medical problems, while others limit its efficacy to a few specific circumstances. On the other side of the debate, there are those who feel that cannabis simply has no legitimate medical uses, and others who feel that there are theoretical uses that are superseded by more effective treatments using other drugs.

Cannabis was listed in the United States Pharmacopeia from 1850 until 1942, however the United States federal government does not currently recognize any legitimate medical use. (See also DEA). Regardless, Francis L. Young, an administrative law judge with the Drug Enforcement Agency, has declared that "in its natural form, (cannabis) is one of the safest therapeutically active substances known" [1].

History

Cannabis plant

Cannabis has been used for medicinal purposes for over 4,800 years. Surviving texts from Pakistan confirm that its psychoactive properties were recognized, and doctors used it for a variety of illnesses and ailments. These included a whole host of gastrointestinal disorders, insomnia, headaches and as a pain reliever, frequently used in childbirth. In India, cannabis can be definitely identified in such contexts only from about AD 1000.

Cannabis as a medicine was common throughout most of the world in the 1800s. It was used as the primary pain reliever until the invention of aspirin [2]. Modern medical and scientific inquiry began with doctors like O'Shaughnessy and Moreau de Tours, who used it to treat melancholia, migraines, and as a sleeping aid, analgesic and anticonvulsant.

By the time the United States banned cannabis (the third country to do so) with the 1937 Marijuana Tax Act, the plant was no longer extremely popular. The only opponent to the bill was the representative of the American Medical Association [3].

Later in the century, researchers investigating methods of detecting marijuana intoxication discovered that smoking the drug reduced intraocular pressure. High intraocular pressure causes blindness in glaucoma patients, so many believed that using the drug could prevent blindness in patients. Many Vietnam War veterans also believed that the drug prevented muscle spasms caused by battle-induced spinal injuries. Later medical use has focused primarily on its role in preventing the wasting syndromes and chronic loss of appetite associated with chemotherapy and AIDS, along with a variety of rare muscular and skeletal disorders. Less commonly, cannabis has been used in the treatment of alcoholism and addiction to other drugs such as heroin and the prevention of migraines. In recent years, studies have shown or researchers have speculated that the main chemical in the drug, THC, might help prevent atherosclerosis.

Malka is a little shit In 1972 Tod H. Mikuriya, M.D. reignited the debate concerning marijuana as medicine when he published "Marijuana Medical Papers 1839-1972".

Later in the 1970s, a synthetic version of THC, the primary active ingredient in cannabis, was synthesized to make the drug Marinol. Users reported several problems with Marinol, however, that led many to abandon the pill and resume smoking the plant. Patients complained that the violent nausea associated with chemotherapy made swallowing pills difficult. The effects of smoked cannabis are felt almost immediately, and is therefore easily dosed; many patients only smoke enough to feel the medical effects — many complained that Marinol was more potent than they needed, and that the mental effects made normal daily functioning impossible. In addition, Marinol was far more expensive, costing upwards of several thousand dollars a year for the same effect as smoking a plant easily grown throughout most of the world. Many users felt Marinol was less effective, and that the mental effects were far more disastrous; some studies have indicated that other chemicals in the plant may have a synergistic effect with THC.

In addition, during the 1970s and 1980s, six US states' health departments performed studies on the use of medical marijuana. These are widely considered some of the most useful and pioneering studies on the subject.

In 2003, the American Academy of Ophthalmology released a position statement asserting that "no scientific evidence has been found that demonstrates increased benefits and/or diminished risks of marijuana use to treat glaucoma compared with the wide variety of pharmaceutical agents now available."

Early studies on efficacy

New Mexico

Approved by the Food and Drug Administration, the study included 250 patients and compared smoked marijuana to oral THC. All participants were referred by a medical doctor and had failed to control vomiting using at least three alternative antiemetics. Patients chose smoking marijuana or taking the THC pill. Multiple objective and subjective standards were used to determine the effectiveness.

• Conclusion: Marijuana is far superior to the best available drug, Compazine, and smoked marijuana is clearly superior to oral THC. "More than ninety percent of the patients who received marijuana... reported significant or total relief from nausea and vomiting". No major side effects were reported, though three patients reported adverse reactions that did not involve marijuana alone. The report can be read here.

Tennessee

27 patients had failed on other antiemetic therapies, including oral THC.

• Conclusion: 90.4% success for smoked marijuana; 66.7% for oral THC. "We found both marijuana smoking and THC capsules to be effective antiemetics. We found an approximate 23% higher success rate among those patients administered THC capsules. We found no significant differences in success rates by age group. We found that the major reason for smoking failure was smoking intolerance; while the major reason for THC capsule failure was nausea and vomiting so severe that the patient could not retain the capsule.

California

A series of studies throughout the 1980s involved 90–100 patients a year. The study was designed to make it easier for patients to enter the oral THC part of the study. Patients who wanted smoked marijuana had to be over 15 years old (oral THC patients had to be over 5) and use the drug only in the hospital and not at home. Smoked marijuana patients also had to receive rare and painful forms of chemotherapy.

• Conclusion: Despite the bias towards oral THC, the California study concluded that smoked marijuana was more effective and established a safe dosage regimen that minimized adverse side effects. The full text of the study can be seen here.

A Vapor-Bong for use with medicinal herbs prescribed by a physician.

Georgia

119 patients that had failed using other antiemetics were randomly assigned to oral THC pills and either standardized or patient-controlled smoking of marijuana.

• Conclusion: All three categories were successful — patient controlled smokers at 72.2%; standardized smokers at 65.4%; oral THC at 76%. Failure of oral THC patients was due to adverse reaction (6 out of 18) or failure to improve (9 out of 18); failure of smoking marijuana was due to intolerance for smoking (6 out of 14) or failure to improve (3 out of 14).

Citations of modern medical reports on marijuana

• Report on and index of marijuana medical studies by Todd Mikuriya, M.D.]
• Cannabis-In-Cachexia-Study-Group; Strasser F, Luftner D, Possinger K, Ernst G, Ruhstaller T, Meissner W, Ko YD, Schnelle M, Reif M, Cerny T: Comparison of orally administered cannabis extract and delta-9-tetrahydrocannabinol in treating patients with cancer-related anorexia-cachexia syndrome: a multicenter, phase III, randomized, double-blind, placebo-controlled clinical trial from the Cannabis-In-Cachexia-Study-Group. J Clin Oncol. 2006 Jul 20;24(21):3394-400.
  • Cannabis in cancer-related cachexia (anorexia, weight-loss, emaciation) not better than placebo. At least no toxicity.
• Janet E. Joy, Stanley J. Watson, Jr., and John A Benson, Jr., "Marijuana and Medicine: Assessing the Science Base", Division of Neuroscience and Behavioral Research, Institute of Medicine (Washington, DC: National Academy Press, 1999).
  • "The accumulated data indicate a potential therapeutic value for cannabinoid drugs, particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation." and "At this point there are no convincing data to support (the concern that medical marijuana would lead to an increase in recreational use). The existing data are consistent with the idea that this would not be a problem if the medical use of marijuana were as closely regulated as other medications with abuse potential."
• Index of studies involving marijuana and multiple sclerosis
• Doblin et al., Marijuana as Antiemetic Medicine: A Survey of Oncologists' Experiences and Attitudes," Journal of Clinical Oncology, Vol. 9, No. 7, July 1991.
• Khamsi, R: Cannabis compound benefits blood vessels. Nature, 4 Apr 2005 (premium content).
  • THC has been found to combat formation of arterial blockages. A random survey of oncologists found that 44% had illegally recommended marijuana for the control of vomiting and that 48% would do so if it were legal; 54% thought it should be available by prescription.
• Vinciguerra et al., Inhalation Marijuana as an Antiemetic for Cancer Chemotherapy," The New York State Journal of Medicine, pgs., 525-527, October 1988
  • 56 Patients who had achieved no success with other antiemetics; 72% found success — the study also concluded that smoked marijuana was more effective than oral THC pills.
• Chang et al., Delta-9-Tetrahydrocannabinol as an Antiemetic in Cancer Patients Receiving High Dose Methotrexate; Annals of Internal Medicine, Volume 91, Number 6, pg. 819-824, December 1979
  • A double-blind controlled study found a 72% reduction in nausea and vomiting; the study also concluded that smoked marijuana was more effective than oral THC
• Foltin RW, Brady JV, Fischman MW: Behavioral analysis of marijuana effects on food intake in humans. Pharmacol Biochem Behav. 1986 Sep;25(3):577-82.; RW, Fischman MW, Byrne MF: Effects of smoked marijuana on food intake and body weight of humans living in a residential laboratory. Appetite. 1988 Aug;11(1):1-14.; and Greenberg I, Kuehnle J, Mendelson JH, Bernstein JG: Effects of marihuana use on body weight and caloric intake in humans. Psychopharmacology (Berl). 1976 Aug 26;49(1):79-84.
  • These three studies concluded that marijuana increases appetite.
• Sallan SE, Zinberg NE, Frei E 3rd: Antiemetic effect of delta-9-tetrahydrocannabinol in patients receiving cancer chemotherapy. N Engl J Med. 1975 Oct 16;293(16):795-7.
  • Study concluded that smoked marijuana was more beneficial than synthetic THC for some patients.
• Donald P. Tashkin, MD, "Effects of Smoked Marijuana on the Lung and Its Immune Defenses: Implications for Medicinal Use in HIV-Infected Patients"; Journal of Cannabis Therapeutics, Vol. 1, No. 3/4, 2001, pp. 87-102
  • "Frequent marijuana use can cause airway injury, lung inflammation and impaired pulmonary defense against infection. The major potential pulmonary consequences of habitual marijuana use of particular relevance to patients with AIDS is superimposed pulmonary infection, which could be life threatening in the seriously immonocompromised patient. In view of the immonosuppressive effect of THC, the possibility that regular marijuana use could enhance progression of HIV infection itself needs to be considered, although this possibility remains unexplored to date."
• Guy A. Cabral, PhD, "Marijuana and Cannabinoids: Effects on Infections, Immunity, and AIDS"; Journal of Cannabis Therapeutics, Vol. 1, No. 3/4, 2001, pp. 61-85
  • "However, few controlled longitudinal epidemiological and immunological studies have been undertaken to correlate the immunosuppressive effects of marijuana smoke or cannabinoids on the incidence of infections or viral disease in humans. Clearly, additional investigation to resolve the long-term immunological consequences of cannabinoid and marijuana use as they relate to resistance to infections in humans is warranted."
• Ekert H, Waters KD, Jurk IH, Mobilia J, Loughnan P: Amelioration of cancer chemotherapy-induced nausea and vomiting by delta-9-tetrahydrocannabinol. Med J Aust. 1979 Dec 15;2(12):657-9.
  • In children receiving cancer chemotherapy delta-9-tetrahydrocannabinol (THC) has an antinausea and antivomiting effect.
• Sallan SE, Cronin C, Zelen M, Zinberg NE: Antiemetics in patients receiving chemotherapy for cancer: a randomized comparison of delta-9-tetrahydrocannabinol and prochlorperazine. N Engl J Med. 1980 Jan 17;302(3):135-8.
  • THC seems to be an effective antiemetic in many patients who receive chemotherapy for cancer and for whom other antiemetics are ineffective.

Advocacy groups

Medical Marijuana of America (MMA)

Medical Marijuana of America is an online resource for medical cannabis patients and service providers. Registered members have access to resources to learn about medical cannabis, prequalify for a medical cannabis recommendation, download useful documentation, and network with others in the medical cannabis community.

MMA features in-depth court reports about federal medical marijuana cases by Vanessa Nelson.

The American Medical Marijuana Association (AMMA)

AMMA was founded in cyberspace on October 27, 1999 by Steve Kubby, Ed Rosenthal and Dr. Todd Mikurya. AMMA is a group of volunteers working together to implement, preserve and protect the rights of medicinal cannabis patients through political activism. Their platform is based on the idea of not bargaining away people's rights. They believe that individuals have different needs, which are best determined by the patient and physician. What works well for one patient may not work for another. AMMA recently received official recognition by the United States government as one of the top organization websites promoting medical marijuana law reform. This recommendation appears in a briefing by the White House and is available online at the official web site for the White House Drug Policy.

WAMM

The Wo/Men's Alliance for Medical Marijuana, founded by Valerie Corral, is a collective of seriously ill patients who work to educate the general public regarding the medical benefits of marijuana, and to ensure that patients, who have a recommendation from their physician, have safe access to legal, natural supplies of Marijuana for the treatment of terminal and debilitating illness.

Compassionate Coalition

The Compassionate Coalition is a nonprofit grassroots organization of patients, physicians, care providers, and concerned citizens who volunteer to defend the rights of medical marijuana patients and care providers through education and community participation. The Compassionate Coalition was created in April, 2004 in Sacramento, California by medical marijuana advocates seeking to defend their rights under California law. Since that time the organization has grown to include new chapters throughout the U.S., working together to defend patients' rights locally and nationally. Compassionate Coalition volunteers defend patients’ rights by: educating service organizations, policy makers and the public about medical marijuana rights; Organizing and educating the patient community; Forming local chapters to help advocates address community issues; Representing patients in city, county and state government; Providing legal and community support for patients and care providers in court; Defending physicians and care providers from unwarranted prosecution and harassment; Training patient advocates to speak to media and government; Announcing important meetings and events to media and patients; Providing a forum for patients, care providers and the public to discuss medical marijuana issues; Networking and coordinating with other reform organizations and patient-advocates.

Criticism

See also: Health issues and the effects of cannabis

Those who doubt that smoked cannabis has medical value point out that any determination of a drug's valid medical use must be based on the best available science undertaken by medical professionals. The Institute of Medicine, run by the United States National Academy of Sciences and funded by the United States federal government, conducted a comprehensive study in 1999 to assess the potential health benefits of cannabis and its constituent cannabinoids. The study concluded that smoking cannabis is not recommended for the treatment of any disease condition, but did conclude that nausea, appetite loss, pain and anxiety can all be mitigated by marijuana. While the study expressed reservations about smoked marijuana due to the health risks associated with smoking, the study team concluded that until another mode of ingestion was perfected that could provide the same relief as smoked marijuana, there was no alternative. In addition, there are more effective medications currently available. For those reasons, the Institute of Medicine concluded that there is little future in smoked cannabis as a medically approved medication. The report also concluded for certain patients, such as the terminally ill or those with debilitating symptoms, the long-term risks are not of great concern.

In a recent study by the Mayo Clinic, THC was shown to be less effective than standard treatments in helping cancer patients regain lost appetites.

Legal and medical status of cannabis

Main article: Legal and medical status of cannabis

World laws on cannabis possession (small amount). Data is from multiple sources detailed on the full source list. This map is a work in progress, please give corrections and additions here.

European laws on cannabis possession (small amount). Data is from multiple sources detailed on the full source list. This map is a work in progress, please give corrections and additions here.

Cannabis is in Schedule IV of the Single Convention on Narcotic Drugs, making it subject to special restrictions. Article 2 provides for the following, in reference to Schedule IV drugs:

A Party shall, if in its opinion the prevailing conditions in its country render it the most appropriate means of protecting the public health and welfare, prohibit the production, manufacture, export and import of, trade in, possession or use of any such drug except for amounts which may be necessary for medical and scientific research only, including clinical trials therewith to be conducted under or subject to the direct supervision and control of the Party.

This provision, while apparently providing for the limitation of cannabis to research purposes only, also seems to allow some latitude for nations to make their own judgments. The official Commentary on the Single Convention indicates that Parties are expected to make that judgment in good faith.

See also

• Health issues and the effects of cannabis
• Ed Rosenthal
• Tilden's Extract
• Sativex
• Victor Robinson
• Steve Kubby
• NORML
• California Cannabis Research Medical Group
• Cannabis Buyers Club

References

• Single Convention on Narcotic Drugs 1961, International Narcotics Control Board.
• Dominik Wujastyk, "Cannabis in Traditional Indian Herbal Medicine" in Ana Salema (ed.), Ayurveda at the Crossroads of Care and Cure, Lisbon, Centro de História del Além-Mar, Universidade Nova de Lisboa, 2002, pp.45--73. ISBN 972-98672-5-9. Early pre-publication draft.

Notes

www

External links

• RIpatients.org - Rhode Island Patient Advocacy Coalition - RI's grassroots coalition of medical marijuana supporters
• Marijuana Ro Medical Club - Marijuana Ro Medical Club - Great and HUGE Medical Information and a GREAT grow guide ! Free Medical Seeds ! Come visit our community !
• Americans for Safe Access - The nation’s largest organization promoting safe and legal access to cannabis for therapeutic use and research
• Waiting to Inhale - The first documentary to examine the movement to legalize cannabis for medical use
• The Medical Cannabis Patients Resource - www.MediWana.org
• The Antique Cannabis Book | Over 600 Pre-1937 Medical Cannabis Products Documented
• Medical marijuana | Reefer madness | Economist.com
• The Wo/Men's Alliance for Medical Marijuana
• American Alliance for Medical Cannabis
• Compassionate Coalition Medical Marijuana Information and Discussions
• "A Response to the Supreme Court Decision to Outlaw Medicinal Marijuana" by David Lawson
• "NORML - National Organization for the Reform of Marijuana Laws"
• Medical Marijuana ProCon.org - Should marijuana be a medical option now?
• Iowans for Medical Marijuana - History of the current federal classification of marijuana
• "ajnag.com" - A web service dedicated to fulfilling the needs of medical marijuana patients.
• "Weedspotter" - Medical Marijuana Forum and discussion board for patients
• "Medical Marijuana FAQ" - Cannabis FAQs and further Medical Marijuana Information