T
The420Guy
Guest
Medical use of this illegal plant has been a 30-year controversy.
Some argue that marijuana is an effective pain reliever and
anti-inflammatory - and now some research is showing they may be
right.
Over the past 11 years, rheumatoid arthritis (RA) has invaded Tom
Flowers' hips, knees, feet and hands and put him in a wheelchair. At
this point, he can't walk and his hands are so gnarled he's forced to
type with one finger.
He goes through a lengthy ritual each morning just to get going.
First he takes a cool shower and an array of prescription drugs that
includes Celebrex, prednisone, Arava and codeine. And then he lights
up a joint, the first of three he will smoke that day. The marijuana
helps ease his pain and especially helps with muscle spasms, Flowers
says Some others with arthritis seem to agree: A 1998 survey of about
1,000 medical marijuana users at the Oakland (California) Cannabis
Buyers Cooperative showed 14 percent were using marijuana for
arthritis or "rheumatism."
"It keeps me going," says Flowers. "I'd like to stop all of the drugs
if I could - but people don't understand that. They think if you are
using marijuana you are abusing it."
In fact, the intoxication marijuana brings him has become more of an
inconvenience than a pleasure. "I try to avoid being high all the
time," says Flowers, who has a small publishing business and consults
on horticulture. "There are other things I'd rather do, and being
high slows me down. But when you are in a lot of pain, it's worth it."
For Flowers, 50, who lives in the San Francisco Bay area, medical use
of marijuana is legal, at least for now. He buys marijuana at a
reasonable price from the Oakland buyers co-op. California is one of
eight states where medical use of marijuana is permitted to varying
degrees to relieve the symptoms of serious conditions, such as
arthritis, cancer anorexia, AIDS, chronic pain, spasticity, glaucoma
and migraine.
The other states that allow some medical use are Alaska, Washington,
Oregon, Arizona, Nevada, Maine and Hawaii.
Surveys, however, show the public does not approve of legalizing
marijuana for recreational use, is still a federal crime. So while
California's liberal laws may allow Flowers to use marijuana
medically, under federal law he's a criminal who could face years of
jail time if charged and convicted.
Research Shows Surprising Results and patients like him are at the
heart of the storm - a controversy that has been in the courts and
public consciousness for more than 30 years as individuals and groups
like the National Organization for Reform of Marijuana Laws (NORML)
have campaigned for decriminalization of medical marijuana.
But because millions of Americans use marijuana recreationally (and
illegally) for its psychoactive and intoxicating effects, acceptance
of its known or potential medical benefits has been slow. It is best
known medically for its ability to relieve the nausea, vomiting and
weight loss connected with cancer chemotherapy and AIDS. But it has
also long been used for chronic pain and a range of musculoskeletal
ills that include many kinds of arthritis.
Although marijuana research on humans has been limited, animal
studies show that its active ingredients, called cannabinoids, help
suppress pain as well as opiates like morphine, but without some of
the unwanted effects, such as addiction and nausea. Cannabinoids
could be used along with opiates to enhance pain control, lowering
the dose needed to offer relief.
A Phase I clinical trial conducted in Paris this summer found that a
synthetic derivative of tetrahydrocannabinol (THC), a major
psychoactive component of marijuana, relieved pain and reduced
inflammation without producing psychogenic effects.
In a new study released in August, the authors say their research
shows one of the cannabinoids, called cannabidiol, suppressed
progression of disease and joint damage in mice that had been
injected with collagen to produce an arthritis-like disease. The
study, from the Kennedy Institute of Rheumatology in London and
Hebrew University in Jerusalem, also showed that cannabidiol
suppressed the release of tumor necrosis factor (TNF), which is known
to contribute to RA, in test tube studies of cells from these mice.
Even though they distilled cannabidiol from a powerful, concentrated
form of marijuana called hashish, it is not psychoactive and wouldn't
make users "high."
Study author Marc Feldmann, MD, PhD, of the Kennedy Institute of
Rheumatology and a major TNF researcher, was cautiously optimistic.
"When it works in mice, you're happy," he says, "but that's no
guarantee it will work in humans. However, this is a pure
pharmaceutical compound that doesn't have psychoactive effects, so it
can be taken seriously as a drug."
Co-author Raphael Mechoulam, PhD, of Hebrew University, a natural
products chemist and pioneer in the research of medical marijuana,
says human studies have shown marijuana prevents brain damage from
head injuries and holds promise for treating stroke, rheumatoid
arthritis, multiple sclerosis, Tourette's syndrome and possibly even
Parkinson's disease.
Mechoulam has been studying medical uses of the plant at his lab in
Israel for the past 35 years. Because marijuana is illegal in Israel,
he works with confiscated cannabis supplied to him by the police. Its
legal status, he believes, has hobbled human medical research.
"The medical community for years has tried to distance itself from
marijuana and its con-stituents," according to Mechoulam. Their
attitude was, 'It's too political, marijuana is an illicit drug.'
"This attitude has probably delayed the medical uses of cannabinoids.
For example, for years I tried to get a clinical study of THC on
multiple sclerosis in this country [Israeli and none of the major
departments of neurology were willing to go ahead with it," Mechoulam
explains.
That's illogical, says Mechoulam. Morphine, which is sometimes used
recreationally, has been the major drug against pain for 100 years or
more, "and there is no stigma in using morphine medicinally," he
says. "So why should there be a stigma against another drug that may
have recreational uses?"
Mechoulam, who is sometimes called "the guru of cannabinoid
research," points out that more than half of today's drugs are
derived from natural products, and marijuana could be one of them.
Our bodies may even be wired for cannabis: Studies show that we have
brain cell receptors for cannabinoids, such as
delta-9-tetrahydrocannabinol, which is better known as THC. Our body
even makes some cannabinoid like substances called anandamides.
"The spinal cord is loaded with cannabinoid receptors," says J.
Michael Walker, PhD, chairman of psychology at Brown University in
Providence, R.I., and a professor of neuroscience.
"These cannabinoid compounds apparently reduce swelling from
inflammation," explains Walker, who has been researching marijuana
and pain for more than a decade. "But more than that, they kill the
pain from inflammation specifically. They work on the peripheral
nerves that carry pain from your joint into the spinal cord."
Mechoulam says attitudes about marijuana research in humans may be
changing, spurred in part by positive reports from prestigious
committees in several countries, such as the House of Lords Committee
in the United Kingdom and the independent National Academy of
Sciences Institute of Medicine in the United States. These have urged
more research into medical marijuana. "I do hope that with these
strong recommendations more clinical trials are to be done," says
Mechoulam.
The medical use of marijuana got a big boost last year when a panel
from the Institute of Medicine concluded that marijuana is not
addictive, does not act as a gateway to harder drug use, and can help
ease pain, nausea and appetite loss from cancer chemotherapy and AIDS.
Surprisingly, the panel of scientists, acknowledging that research
will take time, recommended that people with serious illness be given
legal access now to marijuana for medical use.
The study by Dr. Feldmann and Mechoulam prompted Stephen E. Straus,
MD, the head of the National Center for Complementary and Alternative
Medicine (NCCAM) to say cannabidiol potentially could lead to whole
new classes of medications to inhibit arthritis inflammation.
Walker agrees. "I'm not saying people should go smoke it, but there
is no doubt in my mind that the compounds of cannabinoids reduce pain
and inflammation, at least in animals," he says.
Smoking Anything Still Is Dangerous
But some powerful drawbacks tend to be downplayed by medical
marijuana proponents. The Institute of Medicine's report also found
marijuana smoke is much more toxic than tobacco smoke, and urged
research into synthetic forms and smokeless delivery systems.
Cigarette for cigarette, the smoke of marijuana is by far more
harmful to the lungs than tobacco smoke, says Donald Tashkin, MD, a
pulmonary expert who has studied the effects of marijuana on the
lungs for decades.
"Marijuana smoking deposits four times as much tar in the lungs as
tobacco smoking for the same amount of material smoked," Dr. Tashkin
says. He adds that it very likely increases the risk of lung cancer.
Dr. Tashkin also says marijuana is a powerful immune suppresser as
well, citing effects of THC on a wide variety of immune cells such as
alveolar macrophages, -which destroy bacteria and fungi in the lungs,
and T-cells, which modulate the body's defense against both infection
and cancer.
But Walker and others aren't so sure. "Cannabinoids modulate the
immune system," he says. "They have complex effects, and the full
extent of their actions isn't understood yet."
Could immune suppression be helpful to those with over-active immune
systems, as in RA? "Immune suppression is a two-edged sword," says
Dr. Tashkin. "On the one hand, there's concern about the body's
ability to mount a defense against infection; on the other hand, you
take somebody with an autoimmune disease like RA and the positive
effects may outweigh the negative. There are risks and benefits to
everything."
Bottom line: Medical marijuana needs more human research. In the
United Kingdom, studies are underway now involving humans, and in
Canada a major clinical trial with smoked marijuana will begin soon,
says Walker.
Dr. Tashkin agrees. "The way to exploit the therapeutic potential of
marijuana is to develop highly specific products that produce the
effect you want, and not the side effects. It makes no sense to
inhale thousands of ingredients in marijuana smoke you know are
carcinogens and other toxins in order to deliver one that is useful."
There is a legal alternative to smoking marijuana. A synthetic
version of pure THC is available in a pill called Marinol that has
been marketed since 1986 exclusively as an appetite stimulant or an
anti-emetic. Some patients who take it for pain - which is not an
approved use - complain that it isn't as effective, that it's hard to
judge the right dosage, and that it actually gets you "higher" than
smoked marijuana.
Walker says Marinol does have drawbacks. It's absorbed slowly and
unpredictably, he says, so you can't control the dose. And it costs
more - a lot more - than marijuana: In San Francisco, for example, a
single Marinol pill costs $4 to $16, depending on dosage.
Marijuana can be - and is - eaten, usually blended into foods. But
this method has the same problems as Marinol pills in that the dose
and effect are more difficult to calculate. It takes longer to feel
an effect, and people may take too much or too little. It also takes
more marijuana. When smoked, the user can tell almost immediately if
there is an effect, how much is needed, and when to stop, says Lester
Grinspoon, MD, a Harvard University emeritus professor of psychiatry
and expert on marijuana.
But Dr. Tashkin says he is skeptical about arguments from marijuana
proponents that smoking is better than pills. "That's a smoke screen
to legalize recreational marijuana," he says.
Scientists are looking at other methods of delivering marijuana's
medicinal materials without the carcinogens. A vaporizer that heats
the herb gently, releasing its effects at temperatures too low to
burn it, is being tried now. Other ideas include an atomizer similar
to the kind used by allergy and asthma sufferers or suppositories
that can deliver the drug without the smoke.
A project at the Albany (New York) College of Pharmacy has a $361,000
grant from the American Cancer Society to develop a transdermal patch
that would deliver active cannabinoid ingredients through the skin,
the same way a nicotine patch works. The Drug Enforcement Agency,
which regulates all research with illegal drugs, has approved the
project.
The Smoke and Fire of Debate
However, research on medical marijuana is unlikely to allay criticism
about smoking an illegal and potentially toxic substance. Many
people, including doctors and researchers, agree with the federal
government position that the medical push is a ploy for those who
want legalized recreational use. On the other hand, there are plenty
of doctors who support medical use of marijuana, according to NORML.
One of the most outspoken is Dr. Grinspoon, the author of several
books on marijuana including, Marijuana: The Forbidden Medicine. He
says marijuana is a safe and non-toxic drug that relieves a range of
symptoms and ailments. He saw marijuana's beneficial effects on
chemotherapy reactions firsthand when his son, Danny, was dying of
cancer.
"It doesn't cure anything," Dr. Grinspoon says, "But there are so
many symptoms it relieves, including pain. It has eased terrible
suffering for so many. A number of elderly people say you have no
idea how helpful this has been for their osteoarthritis or their MS
[multiple sclerosis]." Dr. Grinspoon says many users of medical
marijuana are nonsmokers whose pain finally drove them to consider
inhaling an illegal and potentially toxic herb; Some have had to be
taught to smoke by their grandchildren.
But the image of elderly people - or anybody - lighting up a joint
doesn't sit easily with many. There's such a strong stigma connected
to marijuana use that several rheumatologists contacted declined to
comment at all, as did several people using it for arthritis
symptoms. But other doctors like Robert W. Ike, MD, an associate
professor and rheumatologist at the University of Michigan in Ann
Arboi say they know arthritis patients use marijuana, regardless of
its legality.
"I have a few patients who freely admit they smoke marijuana as part
of their treatment for pain, along with [taking] prescription drugs,"
Dr. Ike says. "It's not legal in Michigan, but I'm past the point of
being shocked."
Dr. Ike's opinion? Marijuana has value as a pain reliever and
antidepressant. "I'd do it in a minute if I had arthritis," he says.
"I've seen what a devastating disease it is, and I'd turn to anything
that would help."
But other rheumatologists say they haven't seen any evidence about
marijuana that justifies using a drug that hasn't been researched for
arthritis use, and that's illegal under federal law.
"I do not advocate the use of marijuana for chronic pain," says
Robert Bennett, MD, a fibromyalgia specialist at Oregon Health
Sciences University in Portland. "A few of my patients use it, but
still require pain medication. The Institute of Medicine report on
the medical use of marijuana last year came to the conclusion that it
may have a role in the treatment of pain, but more work needs to be
done."
James McKoy, MD, a rheumatologist with Kaiser Permanente in Hawaii
and a member of the Arthritis Today medical advisory board, says he's
had numerous patients asking about marijuana, most of them baby
boomers with some experience using it or other illegal drugs
recreationally. But Dr. McKoy isn't convinced it has much to offer
over conventional drugs, and he won't recommend or prescribe it.
"I have one patient with rheumatoid arthritis who uses it for pain
and, other than getting a 'high,' it hasn't reduced any of her needs
for DMARDs [disease-modifying antirheumatic drugs], NSAIDs,
prednisone or Vicodin. I see no change in her complaints of pain,"
says Dr. McKoy.
Still a Dangerous Drug... Legally
Doctors are concerned about their legal vulnerability if they were to
recommend marijuana, but according to NORML, they are at less risk
than their patients who use the drug.
"We get many dozens of e-mails a week asking about doctors' legal
status. It's more of a risk in their minds than in reality," says
Allen St. Pierre, executive director of the NORML Foundation. Doctors
making a medical recommendation won't be prosecuted for communicating
with patients, he claims.
The shifting status of marijuana shows that the medical profession is
taking chronic pain seriously, says Walker, and willing to look into
previously taboo areas to help relieve suffering. "If you think about
the worst kind of pain imaginable - and to me that's nerve injury -
opiates don't work," he says. "The pain is so extreme that some
people commit suicide. In animals, cannabinoids are extremely
effective against these kinds of pain."
Randi Webstei 44, co-director of the San Francisco Patients Resource
Center, has been using cannabis medicinally for RA for 20 years for
pain control. She uses a water pipe at home, but otherwise has to
have people roll joints for her. "My fingers don't work so well
anymore," she says.
Webster has been arrested in the past, and recognizes that she could
be charged again, but says she and many others using medical
marijuana are not afraid to speak out.
"We're changing history here," she says, " I stand up for what I
believe in. We'll keep on being busted until we don't get busted any
more."
When all the dust settles, and when marijuana is admitted to the U.S.
Pharmacopoeia, "it will be seen as one of the least toxic drugs in
the whole compendium," predicts Dr. Grinspoon.
Marijuana Wasn't Always Illegal
Marijuana wasn't always the wicked weed. Originally from Asia,
cannabis has been cultivated and used as a helpful herbal medicine in
many cultures for more than 5,000 years.
Ancient writings recommend it for a range of ailments including
malaria, insomnia, headache, depression, childbirth pain, weight loss
and "rheumatism." Some 4,000 years ago, it was listed in a Chinese
botanical text as an herb that reverses rheumatism. A century ago, it
was generally accepted as a medicine in Europe and the United States.
It has been made into drinks, tictures and poultices, mixed into
foods and, most often, smoked. It's also been widely used as a
mood-altering and intoxicating substance.
In the mid-1800's, cannabis became a popular remedy in the West for a
range of ailments, but especially for pain. It could be bought in
some drugstores, and it's said that Queen Victoria's doctor gave it
to her to ease menstrual cramps.
However, its medical use began to fade in the early 1900's as
alternative pain drugs such as aspirin became available, and as the
invention of the hypodermic needle made it possible to inject
narcotics such as morphine for faster pain relief.
While medicinal use declined, recreational use of marijuana continued
and generated stories that "reefer madness" caused violence and
addiction (now known to be untrue). The 1937 Marijuana Tax Act
outlawed recreational use and made it so difficult for doctors to get
cannabis that medical use faded away. The liberal 1960's brought
recreational use back with a bang. By 1979, it was estimated that 30
percent of young Americans smoked marijuana. Some states were
decriminalizing it until the backlash of the War on Drugs in the
1980's led lawmakers to stiffen criminal penalties for marijuana
possesssion or sale.
But by then, its medicinal uses had been rediscovered. People
undergoing cancer treatment found marijuana could relieve suffering
from nausea and the often violent vomiting caused by chemotherapy. It
was believed to help glaucoma by lowering pressure in the eye, and
the swelling ranks of AIDS patients discovered that marijuana not
only eases pain and nausea but also helps with weight gain by
stimulating appetite.
In the 1970's, a person with glaucoma sued the federal government
after his arrest and won the right to a government-grown supply on
the grounds of medical necessity. The Compassionate Investigative New
Drug program was established to provide government-grown marijuana
for some patients, but in 1991 officials quit accepting applications
because of the deluge of requests from AIDS patients. It serves only
eight patients today, in spite of an unsuccessful class action suit
brought by 200 people.
Today, marijuana remains a controversy and a problem for those who
would use it for medical reasons. Eight states have legalized its
medical use to varying degrees, but under federal law even medical
marijuana use is a crime.
Judith Horstman is a contributing editor to Arthritis Today. She
frequently writes about alternative medicine and is the author of The
Arthritis Foundation's Guide to Alternative Therapies.
_____________________________________________
Distributed without profit to those who have expressed a prior interest in
receiving the included information for research and educational purposes.
---
MAP posted-by: Josh Sutcliffe
Newshawk: Chair Man
Pubdate: December 2000
Source: Arthritis Today
Copyright: The Arthritis Foundation
Contact: Arthritis Foundation, P.O. Box 7669, Atlanta, GA 30357-0669
Website: Arthritis Foundation | Symptoms Treatments | Prevention Tips | Pain Relief Advice
Forum: Arthritis Foundation | Symptoms Treatments | Prevention Tips | Pain Relief Advice
Author: Judith Horstman
Editor's Note: Arthritis Today does not print letters to the editor,
but invites discussion on their forum.
Some argue that marijuana is an effective pain reliever and
anti-inflammatory - and now some research is showing they may be
right.
Over the past 11 years, rheumatoid arthritis (RA) has invaded Tom
Flowers' hips, knees, feet and hands and put him in a wheelchair. At
this point, he can't walk and his hands are so gnarled he's forced to
type with one finger.
He goes through a lengthy ritual each morning just to get going.
First he takes a cool shower and an array of prescription drugs that
includes Celebrex, prednisone, Arava and codeine. And then he lights
up a joint, the first of three he will smoke that day. The marijuana
helps ease his pain and especially helps with muscle spasms, Flowers
says Some others with arthritis seem to agree: A 1998 survey of about
1,000 medical marijuana users at the Oakland (California) Cannabis
Buyers Cooperative showed 14 percent were using marijuana for
arthritis or "rheumatism."
"It keeps me going," says Flowers. "I'd like to stop all of the drugs
if I could - but people don't understand that. They think if you are
using marijuana you are abusing it."
In fact, the intoxication marijuana brings him has become more of an
inconvenience than a pleasure. "I try to avoid being high all the
time," says Flowers, who has a small publishing business and consults
on horticulture. "There are other things I'd rather do, and being
high slows me down. But when you are in a lot of pain, it's worth it."
For Flowers, 50, who lives in the San Francisco Bay area, medical use
of marijuana is legal, at least for now. He buys marijuana at a
reasonable price from the Oakland buyers co-op. California is one of
eight states where medical use of marijuana is permitted to varying
degrees to relieve the symptoms of serious conditions, such as
arthritis, cancer anorexia, AIDS, chronic pain, spasticity, glaucoma
and migraine.
The other states that allow some medical use are Alaska, Washington,
Oregon, Arizona, Nevada, Maine and Hawaii.
Surveys, however, show the public does not approve of legalizing
marijuana for recreational use, is still a federal crime. So while
California's liberal laws may allow Flowers to use marijuana
medically, under federal law he's a criminal who could face years of
jail time if charged and convicted.
Research Shows Surprising Results and patients like him are at the
heart of the storm - a controversy that has been in the courts and
public consciousness for more than 30 years as individuals and groups
like the National Organization for Reform of Marijuana Laws (NORML)
have campaigned for decriminalization of medical marijuana.
But because millions of Americans use marijuana recreationally (and
illegally) for its psychoactive and intoxicating effects, acceptance
of its known or potential medical benefits has been slow. It is best
known medically for its ability to relieve the nausea, vomiting and
weight loss connected with cancer chemotherapy and AIDS. But it has
also long been used for chronic pain and a range of musculoskeletal
ills that include many kinds of arthritis.
Although marijuana research on humans has been limited, animal
studies show that its active ingredients, called cannabinoids, help
suppress pain as well as opiates like morphine, but without some of
the unwanted effects, such as addiction and nausea. Cannabinoids
could be used along with opiates to enhance pain control, lowering
the dose needed to offer relief.
A Phase I clinical trial conducted in Paris this summer found that a
synthetic derivative of tetrahydrocannabinol (THC), a major
psychoactive component of marijuana, relieved pain and reduced
inflammation without producing psychogenic effects.
In a new study released in August, the authors say their research
shows one of the cannabinoids, called cannabidiol, suppressed
progression of disease and joint damage in mice that had been
injected with collagen to produce an arthritis-like disease. The
study, from the Kennedy Institute of Rheumatology in London and
Hebrew University in Jerusalem, also showed that cannabidiol
suppressed the release of tumor necrosis factor (TNF), which is known
to contribute to RA, in test tube studies of cells from these mice.
Even though they distilled cannabidiol from a powerful, concentrated
form of marijuana called hashish, it is not psychoactive and wouldn't
make users "high."
Study author Marc Feldmann, MD, PhD, of the Kennedy Institute of
Rheumatology and a major TNF researcher, was cautiously optimistic.
"When it works in mice, you're happy," he says, "but that's no
guarantee it will work in humans. However, this is a pure
pharmaceutical compound that doesn't have psychoactive effects, so it
can be taken seriously as a drug."
Co-author Raphael Mechoulam, PhD, of Hebrew University, a natural
products chemist and pioneer in the research of medical marijuana,
says human studies have shown marijuana prevents brain damage from
head injuries and holds promise for treating stroke, rheumatoid
arthritis, multiple sclerosis, Tourette's syndrome and possibly even
Parkinson's disease.
Mechoulam has been studying medical uses of the plant at his lab in
Israel for the past 35 years. Because marijuana is illegal in Israel,
he works with confiscated cannabis supplied to him by the police. Its
legal status, he believes, has hobbled human medical research.
"The medical community for years has tried to distance itself from
marijuana and its con-stituents," according to Mechoulam. Their
attitude was, 'It's too political, marijuana is an illicit drug.'
"This attitude has probably delayed the medical uses of cannabinoids.
For example, for years I tried to get a clinical study of THC on
multiple sclerosis in this country [Israeli and none of the major
departments of neurology were willing to go ahead with it," Mechoulam
explains.
That's illogical, says Mechoulam. Morphine, which is sometimes used
recreationally, has been the major drug against pain for 100 years or
more, "and there is no stigma in using morphine medicinally," he
says. "So why should there be a stigma against another drug that may
have recreational uses?"
Mechoulam, who is sometimes called "the guru of cannabinoid
research," points out that more than half of today's drugs are
derived from natural products, and marijuana could be one of them.
Our bodies may even be wired for cannabis: Studies show that we have
brain cell receptors for cannabinoids, such as
delta-9-tetrahydrocannabinol, which is better known as THC. Our body
even makes some cannabinoid like substances called anandamides.
"The spinal cord is loaded with cannabinoid receptors," says J.
Michael Walker, PhD, chairman of psychology at Brown University in
Providence, R.I., and a professor of neuroscience.
"These cannabinoid compounds apparently reduce swelling from
inflammation," explains Walker, who has been researching marijuana
and pain for more than a decade. "But more than that, they kill the
pain from inflammation specifically. They work on the peripheral
nerves that carry pain from your joint into the spinal cord."
Mechoulam says attitudes about marijuana research in humans may be
changing, spurred in part by positive reports from prestigious
committees in several countries, such as the House of Lords Committee
in the United Kingdom and the independent National Academy of
Sciences Institute of Medicine in the United States. These have urged
more research into medical marijuana. "I do hope that with these
strong recommendations more clinical trials are to be done," says
Mechoulam.
The medical use of marijuana got a big boost last year when a panel
from the Institute of Medicine concluded that marijuana is not
addictive, does not act as a gateway to harder drug use, and can help
ease pain, nausea and appetite loss from cancer chemotherapy and AIDS.
Surprisingly, the panel of scientists, acknowledging that research
will take time, recommended that people with serious illness be given
legal access now to marijuana for medical use.
The study by Dr. Feldmann and Mechoulam prompted Stephen E. Straus,
MD, the head of the National Center for Complementary and Alternative
Medicine (NCCAM) to say cannabidiol potentially could lead to whole
new classes of medications to inhibit arthritis inflammation.
Walker agrees. "I'm not saying people should go smoke it, but there
is no doubt in my mind that the compounds of cannabinoids reduce pain
and inflammation, at least in animals," he says.
Smoking Anything Still Is Dangerous
But some powerful drawbacks tend to be downplayed by medical
marijuana proponents. The Institute of Medicine's report also found
marijuana smoke is much more toxic than tobacco smoke, and urged
research into synthetic forms and smokeless delivery systems.
Cigarette for cigarette, the smoke of marijuana is by far more
harmful to the lungs than tobacco smoke, says Donald Tashkin, MD, a
pulmonary expert who has studied the effects of marijuana on the
lungs for decades.
"Marijuana smoking deposits four times as much tar in the lungs as
tobacco smoking for the same amount of material smoked," Dr. Tashkin
says. He adds that it very likely increases the risk of lung cancer.
Dr. Tashkin also says marijuana is a powerful immune suppresser as
well, citing effects of THC on a wide variety of immune cells such as
alveolar macrophages, -which destroy bacteria and fungi in the lungs,
and T-cells, which modulate the body's defense against both infection
and cancer.
But Walker and others aren't so sure. "Cannabinoids modulate the
immune system," he says. "They have complex effects, and the full
extent of their actions isn't understood yet."
Could immune suppression be helpful to those with over-active immune
systems, as in RA? "Immune suppression is a two-edged sword," says
Dr. Tashkin. "On the one hand, there's concern about the body's
ability to mount a defense against infection; on the other hand, you
take somebody with an autoimmune disease like RA and the positive
effects may outweigh the negative. There are risks and benefits to
everything."
Bottom line: Medical marijuana needs more human research. In the
United Kingdom, studies are underway now involving humans, and in
Canada a major clinical trial with smoked marijuana will begin soon,
says Walker.
Dr. Tashkin agrees. "The way to exploit the therapeutic potential of
marijuana is to develop highly specific products that produce the
effect you want, and not the side effects. It makes no sense to
inhale thousands of ingredients in marijuana smoke you know are
carcinogens and other toxins in order to deliver one that is useful."
There is a legal alternative to smoking marijuana. A synthetic
version of pure THC is available in a pill called Marinol that has
been marketed since 1986 exclusively as an appetite stimulant or an
anti-emetic. Some patients who take it for pain - which is not an
approved use - complain that it isn't as effective, that it's hard to
judge the right dosage, and that it actually gets you "higher" than
smoked marijuana.
Walker says Marinol does have drawbacks. It's absorbed slowly and
unpredictably, he says, so you can't control the dose. And it costs
more - a lot more - than marijuana: In San Francisco, for example, a
single Marinol pill costs $4 to $16, depending on dosage.
Marijuana can be - and is - eaten, usually blended into foods. But
this method has the same problems as Marinol pills in that the dose
and effect are more difficult to calculate. It takes longer to feel
an effect, and people may take too much or too little. It also takes
more marijuana. When smoked, the user can tell almost immediately if
there is an effect, how much is needed, and when to stop, says Lester
Grinspoon, MD, a Harvard University emeritus professor of psychiatry
and expert on marijuana.
But Dr. Tashkin says he is skeptical about arguments from marijuana
proponents that smoking is better than pills. "That's a smoke screen
to legalize recreational marijuana," he says.
Scientists are looking at other methods of delivering marijuana's
medicinal materials without the carcinogens. A vaporizer that heats
the herb gently, releasing its effects at temperatures too low to
burn it, is being tried now. Other ideas include an atomizer similar
to the kind used by allergy and asthma sufferers or suppositories
that can deliver the drug without the smoke.
A project at the Albany (New York) College of Pharmacy has a $361,000
grant from the American Cancer Society to develop a transdermal patch
that would deliver active cannabinoid ingredients through the skin,
the same way a nicotine patch works. The Drug Enforcement Agency,
which regulates all research with illegal drugs, has approved the
project.
The Smoke and Fire of Debate
However, research on medical marijuana is unlikely to allay criticism
about smoking an illegal and potentially toxic substance. Many
people, including doctors and researchers, agree with the federal
government position that the medical push is a ploy for those who
want legalized recreational use. On the other hand, there are plenty
of doctors who support medical use of marijuana, according to NORML.
One of the most outspoken is Dr. Grinspoon, the author of several
books on marijuana including, Marijuana: The Forbidden Medicine. He
says marijuana is a safe and non-toxic drug that relieves a range of
symptoms and ailments. He saw marijuana's beneficial effects on
chemotherapy reactions firsthand when his son, Danny, was dying of
cancer.
"It doesn't cure anything," Dr. Grinspoon says, "But there are so
many symptoms it relieves, including pain. It has eased terrible
suffering for so many. A number of elderly people say you have no
idea how helpful this has been for their osteoarthritis or their MS
[multiple sclerosis]." Dr. Grinspoon says many users of medical
marijuana are nonsmokers whose pain finally drove them to consider
inhaling an illegal and potentially toxic herb; Some have had to be
taught to smoke by their grandchildren.
But the image of elderly people - or anybody - lighting up a joint
doesn't sit easily with many. There's such a strong stigma connected
to marijuana use that several rheumatologists contacted declined to
comment at all, as did several people using it for arthritis
symptoms. But other doctors like Robert W. Ike, MD, an associate
professor and rheumatologist at the University of Michigan in Ann
Arboi say they know arthritis patients use marijuana, regardless of
its legality.
"I have a few patients who freely admit they smoke marijuana as part
of their treatment for pain, along with [taking] prescription drugs,"
Dr. Ike says. "It's not legal in Michigan, but I'm past the point of
being shocked."
Dr. Ike's opinion? Marijuana has value as a pain reliever and
antidepressant. "I'd do it in a minute if I had arthritis," he says.
"I've seen what a devastating disease it is, and I'd turn to anything
that would help."
But other rheumatologists say they haven't seen any evidence about
marijuana that justifies using a drug that hasn't been researched for
arthritis use, and that's illegal under federal law.
"I do not advocate the use of marijuana for chronic pain," says
Robert Bennett, MD, a fibromyalgia specialist at Oregon Health
Sciences University in Portland. "A few of my patients use it, but
still require pain medication. The Institute of Medicine report on
the medical use of marijuana last year came to the conclusion that it
may have a role in the treatment of pain, but more work needs to be
done."
James McKoy, MD, a rheumatologist with Kaiser Permanente in Hawaii
and a member of the Arthritis Today medical advisory board, says he's
had numerous patients asking about marijuana, most of them baby
boomers with some experience using it or other illegal drugs
recreationally. But Dr. McKoy isn't convinced it has much to offer
over conventional drugs, and he won't recommend or prescribe it.
"I have one patient with rheumatoid arthritis who uses it for pain
and, other than getting a 'high,' it hasn't reduced any of her needs
for DMARDs [disease-modifying antirheumatic drugs], NSAIDs,
prednisone or Vicodin. I see no change in her complaints of pain,"
says Dr. McKoy.
Still a Dangerous Drug... Legally
Doctors are concerned about their legal vulnerability if they were to
recommend marijuana, but according to NORML, they are at less risk
than their patients who use the drug.
"We get many dozens of e-mails a week asking about doctors' legal
status. It's more of a risk in their minds than in reality," says
Allen St. Pierre, executive director of the NORML Foundation. Doctors
making a medical recommendation won't be prosecuted for communicating
with patients, he claims.
The shifting status of marijuana shows that the medical profession is
taking chronic pain seriously, says Walker, and willing to look into
previously taboo areas to help relieve suffering. "If you think about
the worst kind of pain imaginable - and to me that's nerve injury -
opiates don't work," he says. "The pain is so extreme that some
people commit suicide. In animals, cannabinoids are extremely
effective against these kinds of pain."
Randi Webstei 44, co-director of the San Francisco Patients Resource
Center, has been using cannabis medicinally for RA for 20 years for
pain control. She uses a water pipe at home, but otherwise has to
have people roll joints for her. "My fingers don't work so well
anymore," she says.
Webster has been arrested in the past, and recognizes that she could
be charged again, but says she and many others using medical
marijuana are not afraid to speak out.
"We're changing history here," she says, " I stand up for what I
believe in. We'll keep on being busted until we don't get busted any
more."
When all the dust settles, and when marijuana is admitted to the U.S.
Pharmacopoeia, "it will be seen as one of the least toxic drugs in
the whole compendium," predicts Dr. Grinspoon.
Marijuana Wasn't Always Illegal
Marijuana wasn't always the wicked weed. Originally from Asia,
cannabis has been cultivated and used as a helpful herbal medicine in
many cultures for more than 5,000 years.
Ancient writings recommend it for a range of ailments including
malaria, insomnia, headache, depression, childbirth pain, weight loss
and "rheumatism." Some 4,000 years ago, it was listed in a Chinese
botanical text as an herb that reverses rheumatism. A century ago, it
was generally accepted as a medicine in Europe and the United States.
It has been made into drinks, tictures and poultices, mixed into
foods and, most often, smoked. It's also been widely used as a
mood-altering and intoxicating substance.
In the mid-1800's, cannabis became a popular remedy in the West for a
range of ailments, but especially for pain. It could be bought in
some drugstores, and it's said that Queen Victoria's doctor gave it
to her to ease menstrual cramps.
However, its medical use began to fade in the early 1900's as
alternative pain drugs such as aspirin became available, and as the
invention of the hypodermic needle made it possible to inject
narcotics such as morphine for faster pain relief.
While medicinal use declined, recreational use of marijuana continued
and generated stories that "reefer madness" caused violence and
addiction (now known to be untrue). The 1937 Marijuana Tax Act
outlawed recreational use and made it so difficult for doctors to get
cannabis that medical use faded away. The liberal 1960's brought
recreational use back with a bang. By 1979, it was estimated that 30
percent of young Americans smoked marijuana. Some states were
decriminalizing it until the backlash of the War on Drugs in the
1980's led lawmakers to stiffen criminal penalties for marijuana
possesssion or sale.
But by then, its medicinal uses had been rediscovered. People
undergoing cancer treatment found marijuana could relieve suffering
from nausea and the often violent vomiting caused by chemotherapy. It
was believed to help glaucoma by lowering pressure in the eye, and
the swelling ranks of AIDS patients discovered that marijuana not
only eases pain and nausea but also helps with weight gain by
stimulating appetite.
In the 1970's, a person with glaucoma sued the federal government
after his arrest and won the right to a government-grown supply on
the grounds of medical necessity. The Compassionate Investigative New
Drug program was established to provide government-grown marijuana
for some patients, but in 1991 officials quit accepting applications
because of the deluge of requests from AIDS patients. It serves only
eight patients today, in spite of an unsuccessful class action suit
brought by 200 people.
Today, marijuana remains a controversy and a problem for those who
would use it for medical reasons. Eight states have legalized its
medical use to varying degrees, but under federal law even medical
marijuana use is a crime.
Judith Horstman is a contributing editor to Arthritis Today. She
frequently writes about alternative medicine and is the author of The
Arthritis Foundation's Guide to Alternative Therapies.
_____________________________________________
Distributed without profit to those who have expressed a prior interest in
receiving the included information for research and educational purposes.
---
MAP posted-by: Josh Sutcliffe
Newshawk: Chair Man
Pubdate: December 2000
Source: Arthritis Today
Copyright: The Arthritis Foundation
Contact: Arthritis Foundation, P.O. Box 7669, Atlanta, GA 30357-0669
Website: Arthritis Foundation | Symptoms Treatments | Prevention Tips | Pain Relief Advice
Forum: Arthritis Foundation | Symptoms Treatments | Prevention Tips | Pain Relief Advice
Author: Judith Horstman
Editor's Note: Arthritis Today does not print letters to the editor,
but invites discussion on their forum.
