Sequoiacrone
November 23rd, 2008, 02:33 PM
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Marihuana as Medicine: A Plea for Reconsideration
Grinspoon, Lester and Bakalar, James B, "Marihuana as Medicine: A Plea for Reconsideration." Journal of the American Medical Association. 1995; 273(23): pp. 1875-76.
BETWEEN 1840 and 1900, European and American medical journals published more than 100 articles on the therapeutic use of the drug known then as Cannabis indica (or Indian hemp) and now as marihuana. It was recommended as an appetite stimulant, muscle relaxant, analgesic, hypnotic, and anti-convulsant. As late as 1913 Sir William Osler recommended it as the most satisfactory remedy for migraine.
Today the 5000-year medical history of cannabis has been almost forgotten. Its use declined in the early 20th century because the potency of preparations was variable, responses to oral ingestion were erratic, and alternatives became available--injectable opiates and, later, synthetic drugs such as aspirin and barbiturates. In the United States, the final blow was struck by the Marihuana Tax Act of 1937. Designed to prevent non-medical use, this law made cannabis so difficult to obtain for medical purposes that it was removed from the pharmacopeia. It is now confined to Schedule I under the Controlled Substances Act as a drug that has a high potential for abuse, lacks an accepted medical use, and is unsafe for use under medical supervision.
In 1972 the National Organization for the Reform of Marijuana Laws petitioned the Bureau of Narcotics and Dangerous Drugs, later renamed the Drug Enforcement Administration (DEA), to transfer marihuana to Schedule II so that it could be legally prescribed. As the proceedings continued, other parties joined, including the Physicians Association for AIDS [acquired immunodeficiency syndrome] Care. It was only in 1986, after many years of legal maneuvering, that the DEA acceded to the demand for the public hearings required by law. During the hearings, which lasted 2 years, many patients and physicians testified and thousands of pages of documentation were introduced. In 1988 the DEA's own administrative law judge, Francis L. Young, declared that marihuana in its natural form fulfilled the legal requirement of currently accepted medical use in treatment in the United States. He added that it was `one of the safest therapeutically active substances known to man.' (1) (http://www.csdp.org/kz/tlcjama.html#note1) His order that the marihuana plant be transferred to Schedule II was overruled, not by any medical authority, but by the DEA itself, which issued a final rejection of all pleas for reclassification in March 1992.
Meanwhile, a few patients have been able to obtain marihuana legally for therapeutic purposes. Since 1978, legislation permitting patients with certain disorders to use marihuana with a physician's approval has been enacted in 36 states. Although federal regulations and procedures made the laws difficult to implement, 10 states eventually established formal marihuana research programs to seek Food and Drug Administration (FDA) approval for Investigational New Drug (IND) applications. These programs were later abandoned, mainly because the bureaucratic burden on physicians and patients became intolerable.
Growing demand also forced the FDA to institute an Individual Treatment IND (commonly referred to as a Compassionate IND) for the use of physicians whose patients needed marihuana because no other drug would produce the same therapeutic effect. The application process was made enormously complicated, and most physicians did not want to become involved, especially since many believed there was some stigma attached to prescribing cannabis. Between 1976 and 1988 the government reluctantly awarded about a half dozen Compassionate INDs for the use of marihuana. In 1989 the FDA was deluged with new applications from people with AIDS, and the number granted rose to 34 within a year. In June 1991, the Public Health Service announced that the program would be suspended because it undercut the administration's opposition to the use of illegal drugs. After that no new Compassionate INDs were granted, and the program was discontinued in March 1992. Eight patients are still receiving marihuana under the original program; for everyone else it is officially a forbidden medicine.
And yet physicians and patients in increasing numbers continue to relearn through personal experience the lessons of the 19th century. ...
see the entire article here:
http://www.csdp.org/kz/tlcjama.html#mark3
notes and bibliography:
Notes
1. In the Matter of Marihuana Rescheduling Petition, Docket 86-22, Opinion, Recommended Ruling, Findings of Fact, Conclusions of Law, and Decision of Administrative Law Judge, September 6, 1988. Washington, DC: Drug Enforcement Agency; 1988. (back) (http://www.csdp.org/kz/tlcjama.html#mark1)
2. Grinspoon L, Bakalar J. Marihuana, the Forbidden Medicine. New Haven, Conn.: Yale University Press; 1993. (back) (http://www.csdp.org/kz/tlcjama.html#mark2)
2a. Grinspoon, Bakalar, (pp. 133-136). (back) (http://www.csdp.org/kz/tlcjama.html#mark2a)
3. In the Matter of Marihuana Rescheduling Petition, Docket 86-22, Affidavit of Daniel Dansac, M.D. Washington, DC: Drug Enforcement Agency; 1987. (back) (http://www.csdp.org/kz/tlcjama.html#mark3)
4. Doblin R., Kleiman Mark. Marihuana as anti-emetic medicine: a survey of oncologists' attitudes and experiences. J Clin. Oncol. 1991; 9:1275-1290.
From the Department of Psychiatry, Harvard Medical School, and the Massachusetts Mental Health Center, Boston. Reprint requests to Harvard Medical School, 74 Fenwood Rd, Boston, MA 02215 (Dr. Grinspoon)
http://www.csdp.org/kz/tlcjama_files/spacer.gif
Marihuana as Medicine: A Plea for Reconsideration
Grinspoon, Lester and Bakalar, James B, "Marihuana as Medicine: A Plea for Reconsideration." Journal of the American Medical Association. 1995; 273(23): pp. 1875-76.
BETWEEN 1840 and 1900, European and American medical journals published more than 100 articles on the therapeutic use of the drug known then as Cannabis indica (or Indian hemp) and now as marihuana. It was recommended as an appetite stimulant, muscle relaxant, analgesic, hypnotic, and anti-convulsant. As late as 1913 Sir William Osler recommended it as the most satisfactory remedy for migraine.
Today the 5000-year medical history of cannabis has been almost forgotten. Its use declined in the early 20th century because the potency of preparations was variable, responses to oral ingestion were erratic, and alternatives became available--injectable opiates and, later, synthetic drugs such as aspirin and barbiturates. In the United States, the final blow was struck by the Marihuana Tax Act of 1937. Designed to prevent non-medical use, this law made cannabis so difficult to obtain for medical purposes that it was removed from the pharmacopeia. It is now confined to Schedule I under the Controlled Substances Act as a drug that has a high potential for abuse, lacks an accepted medical use, and is unsafe for use under medical supervision.
In 1972 the National Organization for the Reform of Marijuana Laws petitioned the Bureau of Narcotics and Dangerous Drugs, later renamed the Drug Enforcement Administration (DEA), to transfer marihuana to Schedule II so that it could be legally prescribed. As the proceedings continued, other parties joined, including the Physicians Association for AIDS [acquired immunodeficiency syndrome] Care. It was only in 1986, after many years of legal maneuvering, that the DEA acceded to the demand for the public hearings required by law. During the hearings, which lasted 2 years, many patients and physicians testified and thousands of pages of documentation were introduced. In 1988 the DEA's own administrative law judge, Francis L. Young, declared that marihuana in its natural form fulfilled the legal requirement of currently accepted medical use in treatment in the United States. He added that it was `one of the safest therapeutically active substances known to man.' (1) (http://www.csdp.org/kz/tlcjama.html#note1) His order that the marihuana plant be transferred to Schedule II was overruled, not by any medical authority, but by the DEA itself, which issued a final rejection of all pleas for reclassification in March 1992.
Meanwhile, a few patients have been able to obtain marihuana legally for therapeutic purposes. Since 1978, legislation permitting patients with certain disorders to use marihuana with a physician's approval has been enacted in 36 states. Although federal regulations and procedures made the laws difficult to implement, 10 states eventually established formal marihuana research programs to seek Food and Drug Administration (FDA) approval for Investigational New Drug (IND) applications. These programs were later abandoned, mainly because the bureaucratic burden on physicians and patients became intolerable.
Growing demand also forced the FDA to institute an Individual Treatment IND (commonly referred to as a Compassionate IND) for the use of physicians whose patients needed marihuana because no other drug would produce the same therapeutic effect. The application process was made enormously complicated, and most physicians did not want to become involved, especially since many believed there was some stigma attached to prescribing cannabis. Between 1976 and 1988 the government reluctantly awarded about a half dozen Compassionate INDs for the use of marihuana. In 1989 the FDA was deluged with new applications from people with AIDS, and the number granted rose to 34 within a year. In June 1991, the Public Health Service announced that the program would be suspended because it undercut the administration's opposition to the use of illegal drugs. After that no new Compassionate INDs were granted, and the program was discontinued in March 1992. Eight patients are still receiving marihuana under the original program; for everyone else it is officially a forbidden medicine.
And yet physicians and patients in increasing numbers continue to relearn through personal experience the lessons of the 19th century. ...
see the entire article here:
http://www.csdp.org/kz/tlcjama.html#mark3
notes and bibliography:
Notes
1. In the Matter of Marihuana Rescheduling Petition, Docket 86-22, Opinion, Recommended Ruling, Findings of Fact, Conclusions of Law, and Decision of Administrative Law Judge, September 6, 1988. Washington, DC: Drug Enforcement Agency; 1988. (back) (http://www.csdp.org/kz/tlcjama.html#mark1)
2. Grinspoon L, Bakalar J. Marihuana, the Forbidden Medicine. New Haven, Conn.: Yale University Press; 1993. (back) (http://www.csdp.org/kz/tlcjama.html#mark2)
2a. Grinspoon, Bakalar, (pp. 133-136). (back) (http://www.csdp.org/kz/tlcjama.html#mark2a)
3. In the Matter of Marihuana Rescheduling Petition, Docket 86-22, Affidavit of Daniel Dansac, M.D. Washington, DC: Drug Enforcement Agency; 1987. (back) (http://www.csdp.org/kz/tlcjama.html#mark3)
4. Doblin R., Kleiman Mark. Marihuana as anti-emetic medicine: a survey of oncologists' attitudes and experiences. J Clin. Oncol. 1991; 9:1275-1290.
From the Department of Psychiatry, Harvard Medical School, and the Massachusetts Mental Health Center, Boston. Reprint requests to Harvard Medical School, 74 Fenwood Rd, Boston, MA 02215 (Dr. Grinspoon)