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Medical marijuana

Medical marijuana refers to the idea that marijuana (or cannabis) has possible beneficial uses for people with certain ailments. As the drug is frequently used recreationally for non-medical purposes, this idea is very controversial.

Cannabis has been used for medicinal purposes since at least 2,000 years ago. Surviving texts from China, India, Greece and Persia confirm that its hallucinogenic properties were recognized, and the ancient 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. The earliest recorded reference to medicinal marijuana is in the Ry-Va[?] (ancient Chinese Pharmacopeia), believed to have been written in the 15th century BC. These ancient uses are well-documented, but are not proof that cannabis is a useful medicine.

Cannabis as a medicine was common throughout most of the world in the 1800s. It was used as the primary painkiller until the invention of aspirin. 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 the plant, it was no longer extremely popular. The only opponent to the bill, The Marihuana Tax Act[?], was the representative of the American Medical Association[?].

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 around 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 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. Smoked marijuana takes effect almost immediately, and is therefore easily dosed; many patients only rarely smoke enough to feel the mental effects, as this is usually far more than is necessary for 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 weed 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.

Table of contents

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 an MD 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 determing 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 (http://www.medmjscience.org/Pages/science/pierson.bhtml)
New York New York ran a large scale study using 199 patients who had not found success with other antiemetic therapies. Each patient received 6,044 marijuana cigarettes, which were provided to the patient during 514 treatment episodes
  • Conclusions: North Shore Hospital reported marijuana was effective at reducing emesis 92.9 percent of the time; Columbia Memorial Hospital reported efficacy of 89.7 percent; Upstate Medical Center, St. Joseph's Hospital and Jamestown General Hospital reported 100 percent of the patients smoking marijuana gained significant benefit. "Patient evaluations have indicated that approximately ninety-three (93) percent of marijuana inhalation treatment episodes are reported to be effective or highly effective when compared to other antiemetics."; no serious adverse side effects were reported.
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 anti-emetics. We found an approximate 23 percent 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 (http://www.druglibrary.org/schaffer/hemp/medical/ctptoc.htm).
Michigan 165 patients were randomly assigned to use either Torecan[?], an antiemetic, or smoked marijuana. The randomization process failed, however, and the patients were allowed to crossover.
  • Conclusion: 71.1% of marijuana users reported no or moderate nausea and 90% chose to continue using it; 8 out of 83 patients who had initially been randomly assigned to marijuana chose to switch to Torecan; 22 out of 23 patients randomized to Torecan chose to switch to smoked marijuana. Side effects included increased appetite (this is a positive effective) reported by 32.3%, insomnia, reported by 21% and sore throat, reported by 13 patients out of 165
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).

Current status of medical marijuana around the world

Albania

In spite of laws prohibiting growing and possessing cannabis, enforcement has been virtually nil. There have been fewer than ten arrests in five years.

Australia

After politicians in the Australian Capital Territory voted to allow doctors to determine when cannabis was appropriate for their patients, intense lobbying by the federal government resulted in the legislation being overturned.

Belgium

Though still illegal, the Belgian government has recently initiated trials to determine the effectiveness of medical marijuana, and may soon decriminalize possession of small amounts.

Cameroon

Growing cannabis for any reason is illegal, though AIDS and cancer patients are allowed to use the drug to treat their symptoms.

Canada

In Hitzig v. Canada[?], a court declared Canada's Medical Marijuana Access Regulations[?] unconstitutional "in not allowing seriously ill Canadians to use marijuana because there is no legal source of supply of the drug." In effect, this means that Canadians can not be prosecuted for using marijuana medically because the Medical Marijuana Access Regulations gives patients the right to do so, but does not set up any legal apparatus for obtaining cannabis. According to lawyer Brian McAllister, who argued the case, Canada effectively has no prosecutable laws prohibiting possession of less than an ounce of cannabis. Representatives of the United States federal government have claimed that decriminalizing cannabis in Canada may disrupt border trade and relations between the two countries; many Canadians believe that this remains the primary obstacle to decriminalization in Canada.

Germany

Like mentioned in the general part, use is legal, and possession of small amounts is not enforced.

Israel

A small number of people have been granted special permission to use cannabis for medical uses by the Health Ministry.

Jamaica

Cannabis possession remains illegal for any reason, though enforcement is scarce. A recent panel recommended legalizing possession for adults for recreation or medical use.

Japan

All THC-containing forms of cannabis have been illegal since 1948, when the occupying forces of the United States enacted the Hemp Control Law[?] after World War 2.

Luxembourg

Cannabis possession is now legal for adults for recreational or medical uses as long the possessor is not near a campus and no children are involved. A loophole in the law makes it impossible for police to search or seize cannabis, making enforcement difficult.

Netherlands

Cannabis has been legally available for recreational use in Amsterdam-area coffee shops for several years. It is also available without a prescription for medical uses. Recently, Dutch physicians have acknowledged that the coffee shops are inadequate and are working on a method prescribing cannabis to patients.

New Zealand

Health Minister Annette King[?] has stated that she is not "unsympathetic to using cannabis in a medicinal form. But that's different to saying we should let everybody smoke it." Her official position is that more conclusive studies are needed, and a method of regulating dosage is necessary before she support medical access to cannabis.

Scott David Findlay, a paraplegic, was convicted of cannabis charges. The judge, Robert Spear (Dunedin District Court) offered to allow community service instead of imprisonment, but Findlay does not recognize the validity of New Zealand's cannabis laws and would not perform community service. Judge Spear claimed this was a "hollow protest" that he was nonetheless allowed to make, and sentenced him to three months imprisonment.

Portugal

Since 2001, possession of any drug for personal use has been legal, though sale and trafficking are still criminal offenses.

Switzerland

Though all possession and cultivation remains illegal, the Upper House of Parliament has moved towards allowing for decriminalization.

United Kingdom

In 1998, a House of Lords inquiry recommended that cannibus be made available with a doctor's prescription. Though the government of the UK has not accepted the recommendations, new long-term clinical trials have been authorized. Increasingly, juries have returned verdicts of "not guilty" for people charged with marijuana possession for medical use.

In 2003, GW Pharmaceuticals, the UK company granted the exclusive licence to cultivate cannabis for medicinal trials announced the completion of its clinical trials. The company has said that it is on track for obtaining regulatory approval to license the manufacture and sale of a cannabis based medicine starting in 2004.

United States

Medical marijuana is illegal for any reason at the federal level, however thirty-three states and the District of Columbia have legislation on the books which allows for medical exemptions to state marijuana laws. Seven states have made recent attempts to enforce these regulations, with California being the most notable. Drug Enforcement Agency agents (a federal agency) has recently arrested several medical marijuana growers and sellers whose actions, while legal under state law, still violate federal law. Under Proposition 215, Californians are allowed to have access to medical marijuana. Several jurisdictions, including Oakland, California and San Mateo County[?] have announced plans to distribute medical marijuana to patients. Ed Rosenthal, who worked on behalf of the city government of Oakland, was recently convicted on marijuana charges in a federal court. Since the trial, the jurors who convicted him have unanimously spoken out arguing that the trial was not fair and that they regret their conviction, because evidence that Rosenthal was working on behalf of the city and was told by DEA agents and city officials that he was immune to prosecution was suppressed as irrelevant to the trial.

The official policy of the federal government in the United States is that medical marijuana is a myth, promulgated by activists who have the eventual goal of legalizing all drugs.

Citations of modern medical reports on marijuana

  • report on and index of marijuana medical studies (http://www.druglibrary.org/schaffer/hemp/medical/medpaper.htm) by Todd Mikuriya, M.D.
  • 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). (http://www.nap.edu/html/marimed/)
    • "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 (http://www.druglibrary.org/schaffer/hemp/medical/ms_mj_ref.htm)
  • Doblin et al., Marijuana as Antiemetic Medicine: A Survey of Oncologists' Experiences and Attitudes," Journal of Clinical Oncology, Vol. 9, No. 7, July 1991. (http://www.druglibrary.org/schaffer/hemp/mariem1.htm)
    • 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 -- a total of 92% would recommend it; 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 (http://www.medmjscience.org/Pages/science/vinciguerra)
    • 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 (http://www.medmjscience.org/Pages/science/chang.bhtml)
    • 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, R.W., Brady, J.V. and Fischman, M.W. 1986. Behavioral analysis of marijuana effects on food intake in humans. Pharmacology, Biochemistry and Behavior. 25: 577-582; and Foltin, R.W. et al., 1988 Effects of Smoked Marijuana on Food Intake and Body Weight of Humans Living in a Residential Laboratory," Appetite 11:1-14; Greenberg, et al. 1976 Effects of Marijuana use on Body Weight and Caloric Intake in Humans; Psychopharmacology 49: 79-84.
    • These three studies concluded that marijuana increases appetite
  • Sallan, S.E., Zinberg, N.E. and Frei, D., Antiemetic Effect of Delta-9-tetrahydrocannabinol in Patients Receiving Cancer Chemotherapy; New England Journal of Medicine, 293(16): 795-797 (1975).
    • 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., et al. "Amelioration of Cancer Chemotherapy-Induced Nausea and Vomiting by Delta-9-Tetrahydrocannabinol." The Medical Journal of Australia. 1979.
  • Sallan, Stephen E., et al. "Antiemetics in Patients Receiving Chemotherapy for Cancer." The New England Journal of Medicine. 1980. 302(3): 135-138.

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