Medical Marijuana – Up In Smoke?

By Laurie Long 8/05

An article on any medical treatment should review its purpose, current applications, side effects, and should include the results of clinical trials and tests. But in the case of medical marijuana, this scientific focus is almost overwhelmed by the political struggle between the opponents of this drug and those dedicated to erasing its stigma.

Proponents of medical marijuana point out that it is currently used to help the nausea of cancer patients, severe weight loss of AIDS victims, those suffering from the spasticity resulting from neurological disorders such as multiple sclerosis, and people with chronic pain. Set against this are the government agencies who insist that allowing medical marijuana is just the first step to legalizing it for everyone.

Ever since the days of the 1950’s propaganda film “Reefer Madness”, the U.S. government’s political stance on marijuana use under any circumstance has been highly negative. Marijuana was banned in 1937 under federal law, even though the American Medical Society advised against this decision. At the time it was feared that the effects of marijuana use were similar to the dangerously addictive effects of opiates such as morphine and heroin. In 1970 the Controlled Substances Act was passed, which classified drugs into groups based on their usefulness and potential for abuse. The classifications were Schedules I through V, with Schedule I drugs being the most dangerous with a high potential for abuse. Marijuana was placed into the Schedule I category, along with heroin and LSD, while drugs such as cocaine and morphine were placed in Schedule II. Numerous petitions to reschedule marijuana to level II have met with fierce resistance from the DEA (Drug Enforcement Agency), even though most recent research indicates that marijuana does not have a high potential for abuse.1

The general fear in government circles, and the central argument of opponents of medical marijuana, seems to be that any measure which softens federal policy towards marijuana would be seen as a weakening of the “war on drugs” and that legitimizing marijuana as a medicine would pave the way to eventually legalize it. Opponents to medical marijuana also contend that the case to use marijuana as a prescription drug does not have sufficient evidence as to its usefulness. The National MS Society states in its July 2005 Medical Marijuana Update: “there is not enough data to recommend cannabinoids in any form as a treatment for MS. Moreover, smoked marijuana, which contains many unknown compounds, is associated with serious long-term side effects, including lung damage. Well-tested, FDA-approved drugs are available to treat spasticity—including baclofen and tizanidine. They pose no threat to overall health.” 2

Interestingly enough, a recent flood of research in this area is coming up with different findings. Both cannabis and cannabinoids (active compounds found in cannabis) are now being studied in FDA approved trials. Scientists have discovered that the body produces its own variety of cannabinoids and that the brain actually has specific cannabinoid receptors. This has prompted research into a number of areas to determine the potential usefulness of various cannabinoids. One study states, “Cannabinoids may be useful for conditions that currently lack effective treatment, such as spasticity, tics and neuropathic pain.” 3 Researchers from another study believe, “there is reasonable evidence for the therapeutical employment of cannabinoids in the treatment of MS related symptoms. Furthermore, data are arising that cannabinoids have immunomodulatory and neuroprotective properties.” 4 Another study finds that “cannabinoids provide a novel therapeutic target, not only for controlling symptoms, but also slowing disease progression through inhibition of neurodegeneration, which is the cause of accumulating irreversible disability.” 5 In yet another study it was found that “cannibinoids can modulate the function of immune cells.” 6 In that study’s work measuring the immune system of 16 MS patients treated with oral cannabinoids the results “suggest ...inflammatory disease-modifying potential of cannabinoids in MS.” 7

Other studies found evidence that cannabinoids, “may be a promising therapeutic approach for clinical management of trigeminal neuralgia,”8 and that, “migraine, fibromyalgia, IBS and related conditions…suggest an underlying endocannabinoid deficiency that may be suitably treated with cannabinoid medicines.” 9

Almost all of the clinical trial reports recommend further studies with cannabis and cannabis extracts. Some of the tests found unwanted side effects derived from the psychoactive properties of cannabinoids. One such article explained, “Acute adverse effects following cannabis usage include sedation and anxiety…though these effects are usually transient,” and suggests, “The use of nonpsychoactive cannabinoids such as cannabidiol and dexanabinol may allow the dissociation of unwanted psychoactive effects from potential therapeutic benefits.” 10 Also, since smoked cannabis has all of the toxins of cigarettes, studies on alternate methods of delivery have been developed. In one study, supported by the Drug Policy Foundation, seven marijuana delivery devices were tested to determine which could best screen out smoked toxins while delivering the maximum amount of cannabinoids. Of these methods, vaporizers seemed to have the best delivery, with a 99% reduction in certain toxins as compared to marijuana smoke, while delivering substantial amounts of cannabinoids. 11

Some researchers, however, have found their trials stalled because of restrictions imposed by the National Institute on Drug Abuse (NIDA), which has a monopoly on the supply of research marijuana. Researchers complain that the marijuana provided through NIDA is low-potency, and also that NIDA only makes its supply available to projects it approves. One scientist tells of a research grant application to study marijuana’s potential medical benefits. NIDA turned it down. That scientist rewrote the grant to emphasize finding marijuana’s negative effects. The study was funded. 12 NIDA has also refused to supply marijuana to two MAPS (Multidisciplinary Association for Psychedelic Studies)-sponsored protocols that the FDA had already approved. In 2003, MAPS filed an application through the DEA with NIDA to buy 10 grams of marijuana (a tiny amount worth about $70) for their research. More than two years later, NIDA’s decision is still pending, and MAPS has filed lawsuits against the DEA and HHS/NIH/NIDA for obstructing their medical marijuana research.

Petitions to the DEA to allow the creation of another source of research-grade marijuana have also been delayed or denied. Many of these restrictions and delays would be removed by reassigning marijuana from a Schedule I drug to a Schedule II drug, but all petitions to reschedule have been denied by the DEA and HHS. Many of these denials cite the lack of evidence through clinical trials of the medical usefulness of marijuana. At the same time, the DEA continues to block efforts for the type of studies and clinical trials that would provide that evidence.

This political hot-potato enters yet another level of complexity over the battle between individual states to legalize marijuana for medical purposes and the federal government, which refuses to recognize the states’ rights to regulate their own medical practices. In June 2005, the Supreme Court ruled that the federal government may still enforce national anti-drug laws in the states allowing medical marijuana use. One article explains, “The decision effectively gave Congress the right to decide how to regulate marijuana, regardless of state laws.” 13

For sufferers of severe weight loss in AIDS, nausea of cancer treatments, spasticity and pain in MS and others who are unable to tolerate the side effects of approved drugs for their conditions, the continued stance of the government against any change in their current anti-marijuana policy is difficult to understand. In 1988 DEA Administrative Law Judge Francis L. Young, after reviewing all the medical evidence, declared that marijuana is “one of the safest therapeutically active substances known to man,” and stated in his recommendation that medical marijuana be reclassified to a Schedule II drug, “The overwhelming preponderance of the evidence in this record establishes that marijuana has a currently accepted medical use in treatment in the United States…to conclude otherwise, on this record, would be unreasonable, arbitrary and capricious.” 14 Judge Mark Polen, in State v Mussika, commented, “There is a pressing need for a more compassionate, humane law which clearly discriminates between the criminal conduct of those who socially abuse chemicals and the legitimate medical needs of seriously ill patients...” 15 And a 1995 editorial in the Journal of the American Medical Association said, “We are not asking readers for immediate agreement with our affirmation that marijuana is medically useful, but we hope they will do more to encourage open and legal exploration of its potential.” 16

If you are interested in finding out more about medical marijuana, please contact Green Cross Patient Cooperative of Seattle (206-762-0630) or the Washington Alliance for Medical Marijuana (206-465-9862).

Of interest: Waiting to Inhale - a documentary on the fight over medical marijuana.

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Endnotes and References

1 Gettman, John. Marijuana and the Brain. Schaffer Library of Drug Policy. High Times, March 1995.

2 National Multiple Sclerosis Society. InsideMS: Marijuana Update. NMSS 2005.

3 Cory, S. Recent developments in the therapeutic potential of cannabinoids. PR Health Sci J. 2005 Mar;24(1):19-26.

4 Trebst, C.; Stangel, M. Cannabinoids in multiple sclerosis – therapeutically reasonable? Fortschr Neurol Psychiatr. 2005 Aug;73(8):463-9.

5 Baker, D.; Pryce G. The therapeutic potential of cannabis in multiple sclerosis. Expert Opin Investig Drugs. 2003 Apr;12(4):561-7.

6 Killestein, J. et. al. Immunomodulatory effects of orally administered cannabinoids in multiple sclerosis. J Neuroimmunol. 2003 Apr;137(1-2):140-3.

7 Killestein, J. et. al. Immunomodulatory effects of orally administered cannabinoids in multiple sclerosis. J Neuroimmunol. 2003 Apr;137(1-2):140-3.

8 Liang, YC; Huang CC; Hsu, KS. Therapeutic potential of cannabinoids in trigeminal neuralgia. Curr. Drug Targets CNS Neurol Disord. 2004 Dec;3.

9 Russo, EB. Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuro Endocrinol Lett. 2004 Feb-Apr;25(1-2):31-9.

10 Croxford, JL. Therapeutic potential of cannabinoids in CNS disease. CNS Drugs. 2003;17(3):179-202.

11 Chemic Laboratories, Inc., Canton, MA. Evaluation of Volcano Vaporizer for the Efficient Emission of THC, CBD, CBN and the Significant Reduction and/or Elimination of Polynuclear-Aromatic (PNA) Analytes Resultant of Pyrolysis. Revised Final Report. Chemic Labs. Apr 15, 2003.

12 Editors of Scientific American. Marijuana Research – Current restrictions on marijuana research are absurd. Scientific American, Nov 22, 2004.

13 Zwillich, T. House Rejects Medical Marijuana Again. WebMD Medical News June 15, 2005.

14 Recommendation and opinion of DEA Administrative Law Judge Francis Young Jr., re Marijuana Rescheduling Petition (Dept. of Justice, DEA September 6, 1988). 2. See 37 Fed. Reg. 18093, September 1, 1972.

15 State v. Mussika, 88-4395 CFA 10 (Circuit Court for Broward County, Dec 29, 1988)

16 Editors of Scientific American. Marijuana Research – Current restrictions on marijuana research are absurd. Scientific American, Nov 22, 2004.

Doblin, R. Rescheduling of marijuana: Issues related to pending DEA ruling. Drugtext.org, articles 901405.

Carter, Dr. Gregory T.; et. al. The Latest Buzz on Medicinal Marijuana: A Legal and Medical Perspective. CannabisMD Reports.

Americans for Safe Access. Medical Marijuana and Multiple Sclerosis. 2004/2005.

Gieringer, Dale, PhD. Vaporizer Research: An Update. MAPS volume XIII, number 1, Spring 2003.

Pearson, H. Joint suits aim to weed out agencies’ red tape: US researchers upset over limited access to medical marijuana. Nature online: 28 July 2004; | doi:10.1038/430492a.

Zajicek J.; et. al. Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomized placebo-controlled trial. Lancet. 2003 Nov 8;362(9395):1517-26.

Ramos, JA; et. al. Therapeutic potential of the endocannabinoid system in the brain. Mini Rev Med Chem. 2005 Jul;5(7):609-17.

Wood, S. Evidence for using cannabis and cannabinoids to manage pain. Nurs Times. 2004 Dec 7-13;100(49):38-40.

Derkinderen P.; et. al. Cannabis and cannabinoid receptors: from pathophysiology to therapeutic options. Rev Neurol (Paris). 2004 Jul;160(6-7):639-49.

Drysdale, AJ; Platt, B. Cannabinoids: mechanisms and therapeutic applications in the CNS. Curr Med Chem. 2003 Dec;10(24):2719-32.

Baker, D.; et. al. The therapeutic potential of cannabis. Lancet Neurol. 2003 May;2(5):291-8.

Campbell, FA; et. al. Are cannabinoids an effective and safe treatment options in the management of pain? A qualitative systematic review. BMJ 2001 Jul 7;323(7303):13-6.

Ware, MA; et. al. Cannabis use for chronic non-cancer pain: results of a prospective survey. Pain. 2003 Mar;102(1-2):211-6.

Smith, PF. Cannabinoids in the treatment of pain and spasticity in multiple sclerosis. Curr Opin Investig Drugs. 2002 Jun;3(6):859-64.

Brady, CM; et. al. An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis. Mult Scler. 2004 Aug;10(4):425-33.

Garofoli J., ‘Smokeless’ medicinal pot has its advocates. Vaporized fumes said to be cleaner, almost toxin-free. San Francisco Chronical. June 20, 2005.

Reuters. Official US Report Backs Medical Use of Marijuana (IOM Report). National Academy of Sciences Institute of Medicine Report on Medicinal Cannabis. March 17,1999.

Derry, J.S. Grounds to Remove Marijuana from Hard Drugs Schedule: DEA Refers Marijuana Rescheduling Petition to HHS. Press release from law offices of Michael Kennedy. Jul 13, 2000.

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