Is Marijuana a medicine? Where is the research?

[Sequoiacrone]

http://www.theory.caltech.edu/people/patricia/gifs/gscisoc3.gif
http://www.theory.caltech.edu/people/patricia/gifs/dot.gif Evidence of the medical uses of marijuana (or cannabis as it was known to American physicians before William Randolph Hearst renamed it in the press) comes in different varieties: http://www.theory.caltech.edu/people/patricia/gifs/gscisoc2.gif
http://www.theory.caltech.edu/people/patricia/gifs/dot.gif Molecular Biology: A cannabinoid revolution was sparked in the late eighties by the discovery that the active ingredients of marijuana acted through a network of chemical receptors localized in specific sites in the brain and immune system that became known as cannabinoid receptors. The natural cannabinoid manufactured and utilized by the human body is called anadamide.
http://www.theory.caltech.edu/people/patricia/gifs/dot.gif The cannabinoid receptors mediate process in the brain and immune system that match current patient claims. For more information about this, see the review article The Pharmacology of the Cannabinoid Receptor, A. Howlett, Annual Review of Pharmacology and Toxicology, Vol.35, 1995.
http://www.theory.caltech.edu/people/patricia/gifs/dot.gif Controlled clinical studies on the medical effects of marijuana are being forbidden right now by the federal government (http://www.mpp.org/FDA.html) (this link goes off-site), so we have no firm evidence as to the safety and effectiveness of marijuana in actual patients. Marijuana remains legally classified by the federal government as a Schedule I narcotic, as useless and dangerous as heroin, so the policy of the government impedes the very scientific research that could prove it false.
http://www.theory.caltech.edu/people/patricia/gifs/dot.gif Reports by physicians: A survey of American oncologists published in 1990 revealed that 44% of those surveyed had advised cancer patients to smoke marijuana for relief of nausea from chemotherapy and radiation treatments. Cannabis was first reported as a medicine by a physician 5000 years ago in an ancient Chinese apothecary, and this trend has been repeated by every society in written history where cannabis was present. This includes America up until 1937, when the first federal laws criminalizing marijuana were passed by Congress over the loud objections of the American Medical Association.
http://www.theory.caltech.edu/people/patricia/gifs/dot.gif Reports by patients: Here are web sites containing testimonials from people using marijuana to treat symptoms from cancer chemotheray, AIDS wasting syndrome and side effects of AIDS medications, pain and muscle spasms from multiple sclerosis and other serious illnesses:

Yes on Prop. 215 (http://www.marijuana.org/) by Californians for Compassionate Use
Americans for Compassionate Use (http://www.acu.org/)
Republicans for Prop. 215 (http://www.majority.com/)
Cancer Patient Doreen Bishop's Struggle for Medical Marijuana (http://www.execpc.com/%7Edoreen/)
An archive of articles and press clippings (http://www.damicon.fi/drugs/marijuana/medical/) at the Hyperreal Drug Archive


inquiring minds want to know more...
http://www.theory.caltech.edu/people/patricia/scisoc.html

[Sequoiacrone]

The 2002 Petition to Reschedule Cannabis (Marijuana)
Accepted Medical Use: Clinical Research
Results from clinical research demonstrate that both dronabinol and whole plant cannabis can offer a safe and effective treatment for the following illnesses: muscle spasms in multiple sclerosis, Tourette syndrome, chronic pain, nausea and vomiting in HIV/AIDS and cancer chemotherapy, loss of appetite from cancer, hyperactivity of the bladder in patients with multiple sclerosis and spinal cord injury, and dyskinesia caused by levodopa in Parkinson's disease.

During the 1970’s and 1980’s, several states conducted research programs comparing smoked marijuana to oral forms of THC. Musty and Rossi reviewed the data from research programs in 6 states. The results from only one of these research programs had been published in peer-reviewed journals before 1995 (Vinciguerra et al. 1988). In their 2001 review, Musty and Rossi wrote:
"Data were available on 748 patients who smoked marijuana prior to and/or after cancer chemotherapy and 345 patients who used the oral THC capsule.. . . Patients who smoked marijuana experienced 70-100% relief from nausea and vomiting, while those who used the THC capsule experienced 76-88% relief. . . . On the basis of these studies, it appears that smoked marijuana can be a very successful treatment for nausea and vomiting following cancer chemotherapy.. . .The development of smokeless inhalation devices could certainly reduce the potential harm from smoking marijuana.” (Musti & Rossi 2001)
In an experimental study with 13 healthy volunteers, smoked cannabis was effective in reducing nausea and vomiting, but the 5-HT3 (serotonin) antagonist ondansetron was significantly more effective (Soderpalm et al. 2001). The study at the Department of Psychiatry of the University of Chicago examined the antiemetic effect of smoked marijuana cigarettes containing 8.4 and 16.9 mg THC compared to 8 mg ondansetron. Nausea and emesis were induced by syrup of ipecac. Marijuana significantly reduced ratings of nausea and slightly reduced the incidence of vomiting compared to placebo. Ondansetron completely eliminated the emetic effects of ipecac. These findings support and extend previous results, indicating that smoked marijuana reduces nausea and emesis. However, its effects were evaluated to be modest relative to the highly potent antiemetic drug ondansetron.
Delta-8-tetrahydrocannabinol (delta-8-THC), a cannabinoid with lower psychotropic potency than the main Cannabis constituent delta-9-THC, was administered at doses of 18 mg per square meter of body surface in edible oil, p.o., to eight children aged 3-13, undergoing cancer chemotherapy (Abrahamov et al. 1995). The children suffered from various hematologic cancers and were treated with different antineoplastic drugs for up to 8 months. The total number of treatments with delta-8-THC was 480. The THC treatment started two hours before each antineoplastic treatment and was continued every 6 hrs for 24 hours. Vomiting was completely prevented. Observed side effects from delta-8-THC observed were negligible.
THC (dronabinol) was not superior to megestrol acetate in improving appetite in cancer patients, according to a study published in January 2002 in the Journal of Clinical Oncology (Jatoi et al. 2002). U.S. and Canadian researchers found that 49 percent of those taking THC reported improved appetite, compared with 75 percent on megestrol acetate. Only 3 percent of the dronabinol group gained weight of more than 10 percent over baseline weight, compared with 11 percent following standard treatment with megestrol. A combination of both drugs did not improve the results received by megestrol acetate alone. Patients received either 800 mg megestrol acetate, 2 x 2.5 mg dronabinol, or both drugs. Overall, 469 cancer patients with weight loss had been enrolled in the study between December 1996 and December 1999. The study was conducted as a collaborative trial of the North Central Cancer Treatment Group and the Mayo Clinic.
Several new indications for cannabinoids have been and are under study, including neuroprotection in head trauma, antineoplastic effects for the treatment of cancers, effects against disturbed behavior in patients suffering from Alzheimer's disease, Tourette syndrom, and nausea and vomiting associated with HIV therapy.
Recent research showed that THC was not only effective in reducing nausea and vomiting associated with antineoplastic medication in cancer, but also reduced nausea and vomiting associated with HIV therapy (PRNewswire of 23 October 2000). This research by Roger Anderson and colleagues of Anderson Clinical Research in Pittsburgh was presented in October 2000 at the Fifth Congress on Drug Therapy in HIV Infection in Glasgow (Scotland). 85% (23/27) of HIV/AIDS patients who added dronabinol (THC), the most active cannabinoid, to their current antiretroviral therapy had a 50% improvement in symptoms of nausea and vomiting. The study enrolled patients who were on stable antiretroviral therapy. Twenty-seven patients were randomized to receive dronabinol 2.5 mg twice-daily within one hour of taking their antiretroviral medication (14 patients) or dronabinol 5.0 mg at bedtime (13 patients) for six weeks. At study start and at six weeks, patients were assessed by questionnaire for the number of minutes they did not feel well in the previous 48 hours, the number of episodes of vomiting, and the severity of nausea during the same period. Ninety-three percent (13/14) of patients in the group taking THC twice a day had a greater than 50% improvement in symptoms of nausea and vomiting, and 77% (10/13) of patients taking THC at bedtime had a greater than 50% improvement. The severity of nausea improved by at least one grade in 96% (26/27) of patients and no severe or very severe nausea was experienced in either group after six weeks.
Clinical research in patients with Tourette syndrome was stimulated by reports of patients that they had obtained relief from smoking cannabis. Research on the efficacy of dronabinol in Tourette syndrome included a study with one patient (Mueller-Vahl et al. 1999a), followed by a randomized double-blind placebo-controlled crossover trial of delta-9-THC in 12 adults (Mueller-Vahl et al. 1999b). In the larger study, patients received single doses of 5, 7.5, or 10.0 mg THC. Using both self and examiner rating scales, there was a significant improvement in motor and vocal tics after treatment with THC compared with placebo. In addition, a self-rating scale demonstrated a significant improvement in obsessive compulsive behaviour. No serious adverse reactions occurred. Five patients experienced transient mild side effects such as headache, nausea, dizziness, anxiety, cheerfulness, tremble, dry mouth, and hot flush. All these side effects did not last longer than 6 hours. There were no significant differences after treatment with THC compared with placebo in verbal and visual memory, reaction time, intelligence, sustained and divided attention, vigilance, and mood. These studies have already been followed by a successful six-week study (unpublished, personal communication Kirsten Mueller-Vahl, 2002). 17 patients completed the entire six-week program. In some participants, THC caused a considerable decrease of symptoms, thus confirming results of the earlier study. Side effects usually were mild even with a dosage of 10 mg THC.
Available preliminary data from research currently conducted in the UK with a cannabis extract that is taken sublingualy supports the analgesic effects of natural cannabis preparations in chronic pain from various causes (Notcutt et al. 2001a-c). A double blind "N of 1" study also showed that a cannabis extract containing equal amounts of THC and CBD was superior to THC with regard to side effects (Notcutt et al. 2001d). The main pain problems of a patient with multiple sclerosis were severe urethral pain and a pain deep within her pelvis. She achieved almost total pain control with the cannabis extract. Psychological side effects were predominantly seen during the periods when she used THC alone. During the periods when she used a 1:1 mixture of THC and CBD, the incidence of side-effects fell dramatically, compared to the same THC dose taken without CBD.

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