What is Medical Marijuana?
Due to the prohibition against good medical research on marijuana as a medicine, scientific evidence from the U.S. is
incomplete, and there are many rumors and superstitions spread by word of mouth and on the Internet. The following
information is based on my understanding as a biochemist, physician, and someone familiar with a scientific approach
to American herbal medicine in general. Disclaimer: I am not in the OMMP, and I do not use marijuana in any form.
Some of the information in this paper may surprise you. For example:
• Medical marijuana that many people characterize as "weak" or "low-quality" may actually have a very robust
therapeutic effect, while "strong stuff" might not have as much medicinal value, outside of its psychotropic
effects.
• Smoking marijuana is not the best way to use the medicine under most circumstances - not because it's bad
for your lungs, but for other reasons.
• You can and should prepare and administer medical marijuana the same way you'd prepare any similar herbal
medicine - the same way you'd prepare and administer echinacea, milk thistle, or arnica, for example.
• Organically grown medical marijuana is probably a safer medicine than most of the prescription medicines we
use to treat the same conditions, and usually leads to people using fewer addictive substances, rather than
more.
Active ingredients
Everybody knows about THC in marijuana - it's the stuff that gets you high. For most medical purposes, getting high is
not therapeutic (although it may be very valuable for treating psychiatric conditions).
Here are the main active ingredients and their functions:
•
THC: tetrahydrocannabinol ("TET-ra-HIGH-dro-can-NAB-in-ol").
Psychotropic (gets you high).
Reduces seizures. Reduces nausea. Stimulates appetite.
•
CBD: cannabidiol ("ca-NAB-uh-DYE-all").
NOT psychotropic (does NOT get you high).
Reduces nausea. Relieves pain. Relaxes muscles and relieves muscle spasms. This effect includes
arterial muscles, so it gently lowers blood pressure. Also relaxes the airway muscles in asthma and
other reactive airway conditions (bronchodilation). "Neuroprotective" - may protect nerve cells in
diseases like Alzheimer's, Parkinson's, and Multiple Sclerosis. Reduces the effects of THC.
CBC: cannabichromene ("ca-NAB-uh-CHROME-een").
NOT psychotropic (does NOT get you high).
Anti-inflammatory, and relieves pain through this route. Has antibiotic and antifungal properties.
Strengthens the effects of THC.
CBC is not present in as high quantities as CBD and THC are, and currently is not very valued
medicinally, so I won't say much more about it.
There are lots of other ingredients, but they're not very plentiful, and as far as we can tell they mainly contribute to the
smell, flavor, and appearance of the plant.
•
How they work
THC and CBD (and CBC) are called cannabinoids ("ca-NAB-in-oids"). They bind to receptors in the body called
cannabinoid (CB) receptors. This means that they float through your bloodstream to physically attach to particular
areas, called receptors, on your cells. When they attach or bind to the receptors, they cause changes inside the cell,
which produce an effect in your body.
There are two important kinds of cannabinoid receptors, producing variable effects in your body:
• CB1 (found mainly in the cells of the central nervous system - brain and spinal cord)
• CB2 (found mainly in the cells of the rest of the body).
Even without ever using marijuana, your body naturally makes chemicals that bind to these receptors. Your own
natural chemicals are called "endo-cannabinoids," meaning self-made cannabinoids.
Endocannabinoids (self-made cannabinoids) are found in most, if not all, mammals, and in all body fluids, including
mother's milk. One example is an endocannabinoid called anandamide ("a-NAN-da-mide"), which is a
neurotransmitter. Acetaminophen (Tylenol) works by slowing down the natural breakdown and recycling of anadamide,
to reduce pain and fever.
Cannabinoids that are found in medical marijuana and other plants (including echinacea, cocoa, the broccoli family,
etc.), stimulate the same cannabinoid receptors that your natural endocannabinoids do, producing very similar effects.
• THC mainly binds to CB1 receptors, on the cells of the central nervous system.
• CBD (and CBC) mainly bind to CB2 receptors, on the cells of the rest of the body.
For medicinal purposes, CBD is probably the most important ingredient in medical marijuana. Until recently, this
cannabinoid was under-researched, because most research performed by the government was concerned with
preventing people from getting high, and therefore focused on THC. However, more recent investigations in the U.S.
and other countries have begun to figure out the therapeutic value of CBD.
From plant to medicine
For generations in the U.S., people have cultivated marijuana to maximize the amount of THC in it, in order to get high.
This has produced very strong strains that can be challenging for medical patients, who by definition are very sick, to
use on a daily basis.
It appears that when a marijuana plant is bred to be very high in THC, it is correspondingly lower in CBD overall, and
vice-versa. It also appears that when most of a plant's THC is concentrated in its flower buds, its CBD may remain
distributed throughout the rest of the plant. This has important implications for growing and preparing marijuana as
medicine.
There are three main species of marijuana: cannabis sativa, cannabis indica, and cannabis ruderalis which is usually
used as a variety of hemp. However, what we call "hemp" may include various strains of cannabis that have extremely
low THC contents. Hemp has traditionally been cultivated as a fiber, oil, and food crop. There is some evidence that
hemp, being low in THC, may be correspondingly high in CBD, and may be useful as a non-psychotropic medicine.
Issues in preparing medical marijuana
I first started working on this project because I had several patients using medical marijuana to control their eyeball
pressures in glaucoma, usually on top of multiple eyedrops daily. They found that if they smoked marijuana before an
eye exam, they had normal eye pressures, but if they didn't, they didn't, if you see what I mean.
We know that when marijuana is smoked, the blood levels of THC rise very rapidly, but they don't last very long. (See
Pharmacokinetics and pharmacodynamics of cannabinoids, Grotenhermen F. Clin Pharmacokinet. 2003;42(4):32760.) My concern was that these patients' eyeball pressures might be going up and down, up and down all day and
night - which would not be good for the optic nerve. What is needed is a way to use this effective medicine so it stays
at a reasonably stable baseline level all day and all night.
Taking the medicine by mouth, which many people do in the form of "pot brownies" or "herbal cookies," is a good way
to provide a long-lasting therapeutic level. However, many of my patients are diabetic, or are trying to lose weight, or
have kids in the home who are naturally attracted to snacks. I thought, why shouldn't marijuana be prepared like any
other herbal medicine is?
Some herbal medicines, like peppermint, chamomile, and ginger, have active ingredients that are best extracted in hot
water as a simple tea. Others, like milk thistle (liver protectant) and cat's claw (anti-inflammatory), have active
ingredients that aren't very water-soluble, and need to be extracted in a strong alcohol (or other chemical) solution. I
looked up the solubilities of the active ingredients in medical marijuana, and found that these are like the latter. So a
good way to prepare medical marijuana might be as an herbal tincture, using a strong alcohol solution to extract the
active ingredients - especially CBD.
While doing this research, I found news about a medical marijuana extract that is approved for medical use in the UK
and Canada, and which is in the approval process for the rest of the European Union, and is in clinical trials here in the
US as well. (See http://www.gwpharm.com for more.) This commercially made product is basically a tincture that is a
50:50 mixture of CBD and THC, and is administered as an oral spray, absorbed directly through the tissues of the
mouth, as well as entering the digestive tract. In my opinion, it would be easy to make a similar preparation at home.
(See my website, and many others online, for basic instructions for making herbal tinctures.)
When a patient uses a homemade medical marijuana tincture, they can place a dropperfull (or appropriate dose) in a
cup of hot tea, allowing the alcohol to evaporate away. In this form, the medicine contains almost no calories or
alcohol, and is safe for sick people to use. (Examples: diabetics, who shouldn't ingest a lot of carbohydrate; people
with liver disease, who shouldn't ingest alcohol.) The dosage should be the minimum amount needed, to avoid
psychoactivity.
Many patients make homemade medical-marijuana oil or butter which they directly take by mouth (rather than adding
to foods). Dosages are very small.
Caution: oral administration of dried marijuana is at least twice as strong,
and 2-4 times longer lasting, than inhaled.
This has obvious advantages: one obtains more medicinal effect from smaller amounts of plant matter.
Using raw plant
Quite a few patients have begun juicing the plant, using a wheatgrass juicer, and adding it to vegetable and fruit juices
daily, like any other nutritious fresh plant. "Bhang" is a South Asian beverage, sold widely in India, which is made from
fresh marijuana leaves and flowers ground together with sugar and almonds, and added to a yogurt-rosewater mixture.
The marijuana plant is not particularly psychoactive in raw form, yet still contains therapeutic cannabinoids.
Dosage
In the absence of scientific research for guidance, patients are obliged to experiment at home with preparation and
administration methods. I recommend keeping careful records. If you prepare your medicine the same way every time,
and use the same amount every time, you should get the same effect every time.
To determine dosage of any oral preparation, experiment on a weekend or other time when you do not need to go to
work or school, drive a car, or do anything complicated. Start with a very tiny dose, and wait an hour. If there is
absolutely no effect, repeat the same dose and wait another hour. If those two doses helped to relieve symptoms, then
after 4-6 hours, take them together. Keep records of your dosages.
The most common mistake people make is underestimating the plant and taking too much. (Example: "I ate one
brownie, then I had to go to bed for the rest of the day.") Too strong a dose can cause confusion, lightheadedness,
sedation, and nausea, but is not medically dangerous, and goes away by itself. The best treatment is to drink a large
glass of water and go to sleep.
For most medical uses, dosages should be taken on a scheduled basis, three or four times daily - just as you would do
with a pharmaceutical medication. In this way, you can maintain a therapeutic blood level, and the mind will become
accomodated to any low-level psychoactive effect. In other words, you can consistently treat your condition (lower your
eye pressure, raise your seizure threshold, reduce nausea, minimize pain and spasticity, etc.) while not feeling "high,"
dopey, or sedated.
This is similar to the approach we take with prescription medications, from narcotic pain relievers to anti-seizure
medications; if you only took those in high doses once in a while, they would be unpleasantly mind-altering. When
taken in minimal effective amounts, on a scheduled basis, they do not have that effect.
(A note for home chemists: there is lively chatter on the internet about "decarboxylation" of marijuana. The theory is
that THC and CBD are present in fresh plant material as acid forms (THCa, CBDa) that must be heated, for the acid to
escape as water and carbon dioxide (decarboxylation), in order to be "activated." It is thought that the psychoactive
properties of THC are unavailable without decarboxylation - that THCa does not bind to CB1 receptors in the central
nervous system, the same way THC does.
However, many patients seek to minimize psychoactive effects, so decarboxylation might be undesirable, and they
might therefore prefer to make tinctures from fresh plant, rather than dried-and-heated "cured" marijuana.
I am unable to find any scientific data about CBDa binding to CB2 receptors throughout the body, to produce the
multiple therapeutic effects of CBD. Therefore, it is unclear to me whether CBD should be decarboxylated. I think only
individual experimentation with different tincturing methods can determine this; however, I'd caution against the
presumption that psychoactivity is the same thing as, or even a useful marker for, medicinal benefit.)
Topical use
A large number of people use medical marijuana as an effective topical preparation - a salve or liniment, applied to
painful joints and muscle spasms. Used in this form, it appears to have no psychoactive potential, but still has a painrelieving effect, making this form useful for controlling pain safely during workdays. It is not absorbed in appreciable
amounts into the general circulation, so I'd expect that it would not appear in laboratory drug tests as well.
Salves are made by grating fresh beeswax into warm oil. Coconut oil, which is a semisolid at room temperature, may
also be used to make medicinal marijuana oil for topical or internal use. Liniments are alcohol tinctures applied to the
skin. It is said that a traditional Mexican athritis remedy was a marijuana-tequila tincture rubbed on the hands.
Why inhale?
Inhaling combusted marijuana (as smoke or vapor) may be useful for acute nausea and vomiting, in which a rapid
effect is necessary and the stomach is out of order.
Please note: The reason I recommend oral rather than inhaled use is not because inhaling it is bad for your lungs.
Smoked marijuana is less harmful than most other smoked substances - especially tobacco. (High temperatures and
particulate matter, regardless of the source, are not as healthy as plain fresh air, obvuiously.) The problem with inhaled
marijuana is that it is too short-acting, and usually too psychoactive, to be of practical medicinal value. See
"Association between marijuana exposure and pulmonary function over 20 years", Pletcher, M, et al. JAMA.
2012;307(2):173-181, for recent findings on lack of harm to lung tissues.
Marijuana as Medicine
Medical Marijuana in Oregon
In the State of Oregon, it is legal for medical patients with certain conditions to self-medicate with marijuana. The
Oregon Medical Marijuana Program (OMMP) was established in 1998. Only a few specific medical problems make a
person legally qualified to be in the program - but many, if not most, have mutliple qualifying diagnoses.
People also qualify when the side effects of treatment for a medical problem make them meet one or more of the
qualifying criteria. Some examples: a person with cancer, and nausea and weight loss caused by their cancer
treatments; a person with a spinal cord injury causing intractable pain as well as muscle spasms, as well as persistent
nausea and weight loss caused by their pain medications.
Currently in 2012, the OMMP serves more than 57,000 medical patients.
95% of these patients have pain as one of their qualifying diagnoses.
• 1,150 have cachexia (unable to retain body weight, despite normal diet).
• 8,176 have severe nausea.
• 2,088 are cancer patients.
• 743 have HIV/AIDS.
• 1,411 have a seizure disorder.
• 15,051 have persistent muscle spasms (including those caused by multiple sclerosis).
• 832 have glaucoma.
• 57 have agitation (combativeness impeding care) related to dementia.
I think that medical marijuana, used properly, compares well, in terms of safety and effectiveness, with the usual
prescription medications that are available for these qualifying conditions. In some cases, the usual medications are
simply not effective for that patient, or have side effects that make it impossible to use them. Many medications are
prohibitively expensive, even if effective.
People who come to the program usually have complicated situations, with medical and financial constraints that are
as individual as the patients themselves. Many people experience one injury (example: car crash) or illness (example:
rheumatoid arthritis), which snowballs into additional conditions, due to the initial problem and/or side effects of
treatment.
In our current medical system, people who have conditions that significantly limit their daily functioning very, very often
lose their jobs and their health insurance, yet may not qualify for public aid (Medicaid or Social Security).They are
obliged to pay out of pocket for the tests, treatments, and medications they need.
For example:
• Patients for whom migraine headaches make them lose productivity and miss workdays, but for whom
migraine medications are ineffective and/or prohibitively expensive. Medical marijuana often effectively
controls the nausea, vomiting, and severe head pain of migraines, limiting their duration. (One injection of
sumatriptan = approx $56 (two per headache may be needed); nine oral tablets - all that insurance will allow more than $250/month. All prices from Lexicomp, 1/2012.)
•
Patients whose seizures are not controlled by multiple antiepileptic drugs, and/or who could not afford to buy
antiepileptic drugs. Their breakthrough seizures are often controlled with medical marijuana. (Examples:
Topamax, $625+/month; /Keppra, $850+/month. )
•
Patients with medical problems who are unable to suppress vomiting and keep from wasting away, with the
usual medications we prescribe (and/or they can't afford them). These include cancer, HIV, and other patients,
who are often paying very high costs just for basic treatment of their condition/s. (Megestrol/Megace weight-
gain drug, $150-300/month. Anti-vomiting drugs: promethazine/Phenergan, an antihistamine, ~$44/month;
prochlorperazine/Compazine, an antipsychotic, ~$112/month; ondansetron/Zofran, the most effective,
~$164/month.)
•
Patients with inflammatory bowel disease (Crohn's and ulcerative colitis), who may have intractable pain,
persistent nausea, and difficulty maintaining normal weight. They might need the above meds, in addition to
the medication to treat the IBS itself (Asacol ~$260-650/month depending on severity, Pentasa ~$704/month).
•
Patients with intractable muscle spasms that are not controlled with the usual antispasmodic medications, a
frequent problem in multiple sclerosis and cerebral palsy. (Muscle relaxers for MS: baclofen, ~$108/month;
tizanidine, ~$126/month. Typical weekly interferon injection, to treat MS: ~$3029/month.)
Marijuana for chronic pain
Chronic pain patients often turn to medical marijuana because of special complications involved in controlling their
symtpoms, so that they are able to work and care for their families and themselves.
• They often urgently need to reduce or eliminate the narcotic pain medications they have been prescribed.
(Most chronic pain opioids, ~$150-300/month.)
• They may no longer be able to take NSAIDs (like ibuprofen), due to gastritis and stomach ulcers.
• They're also often taking anti-nausea medicines, which may be poorly effective, to combat the side effects of
pain medications.
• They often also want to stop taking the over-sedating muscle relaxers, prescribed for spasms that arise from
spinal problems.
• Many patients who have chronic daily pain are also taking a lot of sleeping medicines - from over-the-counter
melatonin, antihistamines, and herbal remedies, to multiple prescriptions for sleeping pills - because simply
turning over in bed causes enough pain to jolt them awake.
Skepticism often arises when chronic pain patients seek treatment, regardless of modality (opioids or medical
marijuana). It is often difficult for the observer to imagine chronic pain, or what it would be like to experience it.
However, it is very common. In 2011, the Institute of Medicine estimated than 116,000,000 people in the US live with
chronic pain, and stated, "All people are at risk of chronic pain." (Relieving pain in America: A blueprint for transforming
prevention, care, education, and research. National Research Council. Washington, DC: The National Academies
Press, 2011)
Patients I know personally in this condition include:
• people with spinal and other musculoskeletal injuries, including compression fractures due to osteoporosis
• people with cancer-related pain due to tumor invasion of organs and bones
• people with inflammatory joint problems like chronic gout, rheumatoid arthritis, and osteoarthritis
• people with nerve pain due to diabetes, zoster, and other neuropathies
• people with central pain syndromes such as those related to stroke, Parkinson's, and multiple sclerosis
• people with persistent postoperative pain, such as that from thoracotomy (chest surgery), postmastectomy
pain, and phantom limb phenomena
• people with genitopelvic pain such as chronic prostatitis and vulvodynia
• people with chronic headache syndromes
• people with and hard-to-characterize pain syndromes like fibromyalgia and reflex sympathetic dystrophy
Chronic pain should not be ignored or denied; it doubles the risk of suicide. (See the IOM paper cited above.)
Currently, Israel appears to be the world leader in research on medical marijuana for use in traumatic disorders which
also are associated with serious psychological risks. Israel has the highest rate of medical marijuana use in the world,
and the Israeli Health Ministry oversees its cultivation and distribution.
Interactions with other medications
We do not find that medical marijuana interacts with the other medications patients take - even the medications that
usually interact with everything. For example:
• Patients on blood thinners do not show changes in their blood tests, when they start using medical marijuana.
• As previously noted, medical marijuana often augments anti-epileptic medication, rather than reducing its
effectiveness.
• We have not seen a rash of birth-control failures when women enter the OMMP, and menopausal women do
not tell us that their hormone replacement therapy has become less effective.
• Antibiotics work just as well for OMMP patients as for other patients.
• Patients who take multiple strong pain medications and muscle relaxers do not become over-sedated by
combining them with medical marijuana. For example, a recent study by Abrams et al., in Clinical
Pharmacology & Therapeutics (Dec 2011), found that co-administration of morphine or oxycodone with
medical marijuana did not change blood levels of the opioids, but did reduce pain significantly. For chronic pain
patients, this usually means they are able to achieve better function in life (working, caring for self and family)
without increasing their pain meds, or that that are able to reduce their pain meds while maintaining the same
level of function.
Prescription marijuana
Other nations use marijuana to treat a variety of conditions under controlled medical conditions. These include:
• Israel, which first approved marijuana in 2008, and entered it into its National Health Ministry guidelines by
prescription in 2011.
• Canada licensed a prescription-only oral form in 2005, and the United Kingdom in 2010.
• Spain, Germany, Denmark, and most of the EU followed suit in 2011.
These nations have performed the medical research necessary to establish the medication as safe and effective for its
indicated uses. The same oral preparation used in the UK is currently in clinical trials (for pain) in the US.
Dronabinol/Marinol, a synthetic form of THC (one of the several medicinal compounds in marijuana), was licensed for
prescription use in the United States in 1986, but remains very difficult to obtain and not usually covered by insurance
(~$959-$1918/month). (Prescription medications in other nations are generally covered by national health plans.)
Interestingly, Rimonabant, a drug that was developed as an endocannabinoid blocker to suppress appetite, was
removed from the market because it cuased depression, anxiety, and suicides. This drug worked by blocking the CB1
receptors which are naturally stimulated by THC-like compounds in the body. It appears that CB1 receptor activation
is necessary for normal growth, development, and function.
But what about the children?
All major medical organizations have issued statements warning against the use of marijuana during pregnancy or
breastfeeding, and against the administration of marijuana to children. These statements, like most marijuana-related
policies, are based on poor or absent scientific evidence. It is simply unknown what the effects of marijuana use may
be, on a developing fetus, a nursing infant, or a child's physical or intellectual development. Until more is known,
medical marijuana should not be used under these circumstances, unless standard treatments are unavoidable and
known to be harmful - which almost never occurs.
Medical marijuana can be an important adjunct for children, like adults, who are undergoing cancer treatment that
causes intractable vomiting and weight loss. There is some research ongoing into possible use of medical marijuana
for autistic spectrum disorders in children. This is a case where standard treatments are often unacceptable. A few
well-publicized cases of parents self-treating their children have been encouragingly successful, as well as responsible
- utilizing minimal dosages of oral preparations.
Politics
Historically in the US, there has been undue concern about marijuana acting as a "gateway drug" or a trigger for
addiction, independent of user characteristics. However, this notion has long been debunked, including by Richard
Nixon's own National Commission on Marijuana and Drug Abuse, which reported forty years ago, in 1972, that "there
is little proven danger of physical or psychological harm from the experimental or intermittent use of the natural
preparations of cannabis" and "The actual and potential harm of use of the drug is not great enough to justify intrusion
by the criminal law."
Nixon's Comission, like almost all American studies, investigated marijuana as a recreational drug, not a medical
therapy, and it said that "the use of drugs for pleasure or other non-medical purposes is not inherently irresponsible;
alcohol is widely used as an acceptable part of social activities." Use of marijuana as a medical treatment is not
equivalent to its recreational use, but either form of use appears to be benign, particularly in comparison with use of
alcohol or nicotine, which are widely used and accepted.
In 2012, legislation is underway to establish medical marijuana programs in Alabama, Idaho, Illinois, Indiana, Iowa,
Kansas, Massachusetts, Maryland, New Hampshire, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, West
Virginia and Wisconsin. Florida and Missouri have it on their ballots for 2012's election year.
The following states have medical marijuana programs (years enacted in parentheses): Alaska (1998), Arizona (2010),
California (1996), Colorado (2000), DC (2010), Delaware (2011), Hawaii (2000), Maine (1999), Michigan (2008),
Montana (2004), Nevada (2000), New Jersey (2010), New Mexico (2007), Oregon (1998), Rhode Island (2006),
Vermont (2004), Washington (1998).
In 2009, the Justice Department stated that they would no longer seek to prosecute patients and caregivers complying
with state medical marijuana laws. Their statement was called the "Ogden Memorandum." In 2011, however, they
began targeting states (with large-scale raids and mass arrests) that license cultivation and dispensing of marijuana for
medical use. This has resulted in multiple lawsuits and pending legislation to remove marijuana from the list of
Federally controlled substances, where it is classified the same way as heroin or methamphetamine.
As I mentioned previously, the hemp plant - which does not get you high - may prove to be the best source of CBD for
medicinal use. This is an intriguing possibility, because hemp is regulated differently than marijuana in the United
States at this time. It may lawfully be imported, and the US is the world’s largest importer of hemp, shipped from
Canada, China, New Zealand, and Europe (Western and Eastern). It is currently used for fiber (fabric, rope, etc.), oil
(for cosmetic and industrial use), and many other purposes - including cultivation in chemical and radioactive disaster
areas to "soak up" contaminants. (It was used after the Chernobyl nuclear disaster, in this way.)
Unfortunately, laws written during industrial wars in the early 20th century continue to influence hemp cultivation today.
(In a nutshell, Hearst and paper made from trees, and DuPont, and fuel and plastic made from oil, won - Ford, and fuel
and plastic made from plant matter, and millions of American farmers, lost.) Cultivation of industrial hemp (which does
not get you high) is illegal under Federal law. However, it has been liberalized under state laws in North Dakota,
Hawaii, Kentucky, Maine, Oregon, California, Montana, West Virginia and Vermont. Nearly every other state has
legislation pending, as this crop could replace lost revenues from tobacco and other cash crops fallen on hard times.
A last word from medical groups
It is only a matter of time until the United States stops wasting money and lives on the marijuana drug war. It's
especially urgent that medical marijuana be decriminalized, in order to allow proper scientific invesitgation of its
potential as a medication. Major medical groups are beginning to recognize this.
In 2009, the American Medical Association (AMA), the Institute of Medicine (IOM), and the American College of
Physicians (ACP) issued a statement calling for the study of marijuana's therapeutic potential. This statement
concluded,
"Only a small number of randomized, controlled trials have been conducted on smoked cannabis. These trials were
short term and involved a total of ~300 patients. Results of these trials indicate smoked cannabis reduces neuropathic
pain, improves appetite and caloric intake especially in patients with reduced muscle mass, and may relieve spasticity
and pain in patients with multiple sclerosis. Substantially better alternatives than smoked cannabis are available to
treat patients with glaucoma or chemotherapy-induced nausea and vomiting.
"Smoked cannabis has not been subject to any sort of rigorous study in any other indication. Results obtained from
oral cannabinoid products (including botanical extracts) are not directly applicable to smoked cannabis for a number of
reasons including substantial differences in constituents, pharmacokinetics of active ingredients, and active metabolite
patterns. However, development of botanical extracts as prescription medications lends further credence to the
therapeutic potential of components of the cannabis plant.
"There is a contrast between the relatively small number of patients who have been studied over the past 30 years in
controlled clinical trials involving smoked cannabis and survey data from patients with chronic pain, multiple sclerosis,
and amyotrophic lateral sclerosis that indicates a significant use of cannabis for self management. Additionally,
surveys of patients with HIV or hepatitis C infection suggest that smoked cannabis is used to relieve a constellation of
symptoms (pain, nausea, appetite suppression, sleep disorders) and as a source of palliation from antiviral medication
side effects.
"...The fact that cannabis is prone to nonmedical use does not obviate its potential for medical product development.
Many legal pharmaceutical products that are used for pain relief, palliation, and sleep induction have more serious
acute toxicities than marijuana, including death.
"...Physicians who comply with their ethical obligations to "first do no harm" and to "relieve pain and suffering" should
be protected in their endeavors, including advising and counseling their patients on the use of cannabis for therapeutic
purposes."
See http://bit.ly/HIjHp6, to read the statement.
Updated 4.2011 by Leigh Saint-Louis MD