Medicinal marijuana (cannabis sativa)
"The medicinal cannabis user should not be considered a criminal in any state and the DEA and our legal system should be using science and logic as the basis of policy making rather than political or societal bias." --Gregory T. Carter, MD, MS, Aaron M. Flanagan, MD, Mitchell Earleywine, PhD, Donald I. Abrams, MD, Sunil K. Aggarwal, MD, PhD, and Lester Grinspoon, MD
The above statement is from the article "Cannabis in Palliative Medicine: Improving Care and Reducing Opioid-Related Morbidity." [Am J Hosp Palliat Care. 2011 Mar 28. PubMed] This is an excellent article that is written by a group of highly renowned physicians.
"Marijuana is currently classified by the federal government as a Schedule I controlled substance with no value as a therapeutic agent, a designation that normally requires scientific evaluation and input before being imposed." --Peter Cohen MD, JD
The above statement by Dr. Cohen was made in his recent article titled "Medical marijana: It's time to fix the regulatory vacuum." [J Law Med Ethics. Fall 2010;38(3):654-66. PubMed] Sadly, Dr. Cohen died when the article went to print. He enjoyed a long and highly acclaimed career in medicine and law. And this article is an example of his numerous outstanding published works. After the above statement, Dr. Cohen continued and wrote that "However, the usual review process under the Controlled Substances Act when Congress itself assigned this status to marijuana. In addition to declaring that marijuana has no value as a therapeutic agent, this designation significantly impeded research into the therapeutic and palliative uses of the drug, since this requires investigators to obtain a special license from the Drug Enforcement Agency (DEA) before they may undertake any clinical investigations of marijuana and indirectly calls upon the National Institutes of Drug Abuse (NIDA) to provide marijuana for such studies. These requirements, as well as financial proven to be major roadblocks to investigators’ ability to conduct scientific studies of the potential medical utility of Cannabis." He also pointed out that scientists and clinicians suggest marijuana might be a safe and effective medication by stating that "There is now considerable evidence in the peer reviewed scientific literature that smoked marijuana has legitimate therapeutic and palliative uses that are not accompanied by dangerous side effects." And one of his more provocative statements was "It is time to stop playing games with medical marijuana and to regulate it in the same way that we do any other FDA-approved controlled substance, such as morphine, Demerol®, or Valium®."
Although the USA is now many decades behind in research of cannabis, there is abundant anecdotal evidence provided by millions of people who have found immediate therapeutic benefits from using marijuana.
"Cannabinoids present an interesting therapeutic potential as antiemetics, appetite stimulants in debilitating diseases (cancer and AIDS), analgesics, and in the treatment of multiple sclerosis, spinal cord injuries, Tourette’s syndrome, epilepsy and glaucoma." --Dr. Mohamed Ben Amar
The above statement is from the meta-analysis article "Cannabinoids in medicine: A review of their therapeutic potential." [J Ethanopharm. 2006;105:1-25. PubMed] This is a good review article because it provides a review of 10 studies of cannabis, as well as detailed information about cannabis. For instance, Dr. Amar described some of the history of cannabis by writing that "Originating from Central Asia, cannabis is one of the oldest psychotropic drugs known to humanity. The beginnings of its use by humans are difficult to trace, because it was cultivated and consumed long before the appearance of writing. According to archeological discoveries, it has been known in China at least since the Neolithic period, around 4000 BC. There are several species of cannabis. The most relevant are Cannabis sativa, Cannabis indica and Cannabis ruderalis. Cannabis sativa, the largest variety, grows in both tropical and temperate climates. The two main preparations derived from cannabis are marijuana and hashish. Marijuana is a Mexican term initially attributed to cheap tobacco but referring today to the dried leaves and flowers of the hemp plant. Hashish, the Arabic name for Indian hemp, is the viscous resin of the plant." And some history in Western medicine: "In 1854, cannabis is listed in the United States Dispensatory. It is sold freely in pharmacies of Western countries. It would be available in the British Pharmacopoeia in extract and tincture form for over 100 years. However, after prohibition of alcohol was lifted, the American authorities condemned the use of cannabis, making it responsible for insanity, moral and intellectual deterioration, violence and various crimes. Thus, in 1937, under pressure from the Federal Bureau of Narcotics and against the advice of the American Medical Association, the U.S. Government introduced the Marihuana Tax Act: a tax of $1 per ounce was collected when marijuana was used for medical purposes and $100 per ounce when it was used for unapproved purposes." He also describes the composition of cannabis by noting that "Cannabis contains more than 460 known chemicals, more than 60 of which are grouped under the name cannabinoids. The major psychoactive ingredient of cannabis is delta-9-tetrahydrocannabinol, commonly known as THC." He then provides details of some physical properties of cannabinoids, such as "Cannabinoids exert their actions by binding to specific receptors: theCB1 cannabinoid receptors, discovered by Devane et al. (1988), then cloned by Matsuda et al. (1990) and the CB2 cannabinoid receptors, identified by Munro et al." There was also a summary of how cannabis can be ingested and it's effects, that is "Cannabis is generally taken by smoking or ingestion. When inhalated, the bioavailability of THC varies from 18 to 50%, the onset of action is rapid (3–5 min), maximal effects are obtained within 30–60 min and euphoria is intense and might last 2–4 h. When cannabis is administered orally, the bioavailability ranges from 6 to 20%, the onset of action is slow (30–60 min), euphoria is less pronounced and effects are progressive and last longer." There is also a summary of how cannabis can be prepared and delivered, such as "To maximize the benefits (efficacy) and reduce the undesirable effects (toxicity), new formulations for administering and delivering cannabinoids are currently under investigation. These are smokeless oral inhalers (aerosols), sublingual preparations, nasal sprays, transdermal patches and rectal suppositories. The intravenous route is excluded because cannabinoids are insoluble in water. The sublingual spray is a compromise between the inhaled and oral routes: compared to the oral administration, it reduces the first-pass metabolism, thus increasing the bioavailability of the drug and allowing a greater dose-titration." This work is a meta-analysis that provides a careful review of all of most pertinent studies to date that are about the medical use of marijuana. He chose 10 published studies for this meta-analysis and in the results part of the article he wrote "The meta-analysis identified 10 pathologies in which controlled studies on cannabinoids have been published: nausea and vomiting associated with cancer chemotherapy, loss of appetite, pain, multiple sclerosis, spinal cord injuries, Tourette’s syndrome, epilepsy, glaucoma, Parkinson disease and dystonia." He then provides details about each of the studies, including a number of tables comparing results of each the studies. In the concluding remarks, he wrote that ""There is insufficient evidence on the efficacy of cannabis and its derivatives to control epilepsy. Further clinical trials, well-designed, carefully executed and powered for efficacy, are essential to clearly define the role of cannabinoids as appetite stimulants, as well as in the treatment of multiple sclerosis, spinal cord injuries, Tourette’s syndrome and glaucoma. For each pathology, it remains to be determined what type of cannabinoid and what route of administration are the most suitable to maximize the beneficial effects of each preparation and minimize the incidence of undesirable reactions."
"Cannabis also has properties applicable to symptom management of ALS, including analgesia, muscle relaxation, bronchodilation, saliva reduction, appetite stimulation, and sleep induction." --Gregory T. Carter, MD, MS, Mary E. Abood, PhD, Sunil K. Aggarwal, PhD, and Michael D. Weiss, MD
The above statement is from the review article "Cannabis and Amyotrophic Lateral Sclerosis: Hypothetical and Practical Applications, and a Call for Clinical Trials." [Am J Hosp Palliat Med. 2010;27(5)347-56. PubMed]
"Although most cannabis users experience at least transient cognitive impairments, only a small minority develop psychosis or become dependent on the drug." --Drs. Celia J. A. Morgan, Gra´ inne Schafer, Tom P. Freeman and H. Valerie Curran
The above statement is from the article "Impact of cannabidiol on the acute memory and psychotomimetic effects of smoked cannabis: naturalistic study." [British J Psych. 2010;197;285-90. PubMed] In the abstract of the article, the opening statement reads "The two main constituents of cannabis, cannabidiol and D9-tetrahydrocannabinol (THC), have opposing effects both pharmacologically and behaviourally when administered in the laboratory. Street cannabis is known to contain varying levels of each cannabinoid." The authors' of this study provide some important evidence regarding psychosis-related effects of smoked marijuana, as well as some interesting and important features of this botanical drug. For instance, "Although most cannabis users experience at least transient cognitive impairments, only a small minority develop psychosis or become dependent on the drug. This begs the question of what determines vulnerability to the harmful effects of cannabis. One critical factor may be the type of cannabis actually consumed. ...Cannabis contains a myriad of different chemicals, around 70 of which are unique to the plant and called cannabinoids. The main psychoactive ingredient is D9-tetrahydrocannabinol (THC) and this produces the effects that users seek. When given intravenously to healthy humans, THC produces psychotic-like and anxiogenic effects. In contrast, cannabidiol, another major constituent of cannabis, appears to have antipsychotic properties, is anxiolytic and may be neuroprotective in humans. The relative THC/cannabidiol ratio of cannabis varies greatly. Levels of cannabidiol can range from virtually none to up to 40%. Higher levels of THC are found in hydroponically grown varieties like skunk and in cross-bred strains that are increasingly common throughout Europe and beyond. We have recently found evidence to suggest that use of strains richer in cannabidiol may protect cannabis users from the chronic psychotic-like effects of THC. Given the opposing neuropharmacological actions of THC and cannabidiol – the former is a partial agonist whereas the latter is an antagonist at CB1 and CB2 receptors – we hypothesised that cannabidiol may also protect users against other harmful effects of the drug such as cognitive impairment and psychosis-like effects. The current study set out to test these hypotheses by employing a novel methodology that enabled analysis of cannabinoids in the cannabis actually smoked by each individual user." And the remarkable results of this study: "The main findings of this study were acute deficits in recall of prose in individuals who had smoked cannabis containing a low percentage of cannabidiol. Higher levels of cannabidiol in cannabis appeared to protect against any memory impairment, as the high-cannabidiol group performed at the same level when they were acutely intoxicated as when they were sober.' Another remarkable statement was "Importantly, however, people in our study who smoked higher cannabidiol strains of cannabis did not show any acute deficit. Indeed their performance when intoxicated was virtually indistinguishable from that when drug free." The methodology of the study was explained as "This was a naturalistic study and, without giving out cannabis of different varieties – in effect, ‘supplying’ a drug – to be smoked, it could not employ double-blind procedures. On the other hand, a key strength of this study was that it objectively assessed cannabinoid content of whatever cannabis each participant actually chose to smoke in real life." A final very important statement they made was "The constituents of street cannabis have changed over the past 20 years with high THC, low-cannabidiol strains now dominating the market. Our findings suggest that this increases the cognitive harms to cannabis users. The research reported here also contributes to the growing body that suggests a range of potential therapeutic uses of cannabidiol, including the ability to modulate the acute amnestic effects of THC."
Similar studies such as the above cannot currently be conducted in the USA because of the senseless classification of marijuana as a schedule 1 drug. Important findings (and discoveries) like this probably could have been revealed decades ago if the USA could become involved in prescribing and studying cannabis.
"The federal Controlled Substances Act (CSA) classifies marijuana as a Schedule I drug — one with a high potential for abuse and “no currently accepted medical use” —and criminalizes the acts of prescribing, dispensing, and possessing marijuana for any purpose." --Diane E. Hoffmann, J.D., and Ellen Weber, J.D.
The above statement is from the perspective article "Medical Marijuana and the Law." [NEJM. 2010 (April);362(16);1453-57. PubMed] The article provides a perspective about how the current classification of marijuana as a schedule 1 substance has created a circus like situation with its medical use and study in the USA. Although marijuana should be classified by the CSA as a schedule 2 drug, like many other equivalent or greater dangerous drugs, it is classified as a schedule 1 drug. And because of the lack of authority of US government agencies, "The U.S. legal landscape surrounding “medical marijuana” is complex and rapidly changing. Fourteen states — California, Alaska, Oregon, Washington, Maine, Hawaii, Colorado, Nevada, Vermont, Montana, Rhode Island, New Mexico, Michigan, and most recently, New Jersey — have passed laws eliminating criminal penalties for using marijuana for medical purposes, and at least a dozen others are considering such legislation." They pointed out that a number of big medical associations--who actually know something about marijuana) are "Criticizing the patchwork of state laws as inadequate to establish clinical standards for marijuana use, the AMA has joined the Institute of Medicine, the American College of Physicians, and patient advocates in calling for changes in federal drug-enforcement policies to establish evidence-based practices in this area."As it stands "A 2005 Supreme Court decision (Gonzales v. Raich) made clear that regardless of state laws, federal law enforcement has the authority under the CSA to arrest and prosecute physicians who prescribe or dispense marijuana and patients who possess or cultivate it." And the reason states are doing this is because the situation was put in limbo because "Nevertheless, in October 2009, the Department of Justice issued a memorandum to U.S. Attorneys stating that federal resources should not be used to prosecute persons whose actions comply with their states’ laws permitting medical use of marijuana." So what we now have is "All the state laws allow patients to use and possess small quantities of marijuana for medical purposes without being subject to state criminal penalties. Furthermore "Most laws protect “qualifying” patients, who are variously defined as those who have received a diagnosis of a debilitating medical condition and have written documentation (or, in one case, an oral recommendation) from their physician indicating that they might or would “benefit from the medical use of marijuana” or that the “potential benefits of medical use of marijuana would likely outweigh the health risks.” Definitions of “debilitating medical condition” vary by state but typically include HIV–AIDS, cachexia, cancer, glaucoma, epilepsy and other seizure disorders, severe nausea, severe and chronic pain, muscle spasms from multiple sclerosis or Crohn’s disease, and other conditions." And what is silly about this situation is "State laws do not regulate marijuana’s quality or potency, and most don’t address ways of obtaining the drug." But one of the more concerning things about this situation is that "Missing from many state laws is a requirement that physicians recommending medical marijuana to adult patients provide the rudimentary disclosure of risks and benefits necessary for informed consent, although such disclosure is generally required for patients who are minors. In Canada, the first country to decriminalize medical marijuana, regulations require that physicians discuss the risks with their patients, yet the lack of relevant clinical trials of smoked cannabis makes it difficult for physicians to comply with the law." In their final statement, they revealed one of the most troubling aspects of this situation by stating that "Although the current Justice Department may not prosecute patients if they use marijuana in a manner consistent with their states’ laws, the federal law remains unchanged, and future administrations could return to previous enforcement practices."
"One of the most exciting new areas of research on cannabis and cannabinoids revolves around their ability to inhibit the growth and vascular supply of cancers of various types." --Bill H. McCarberg, MD
The above statement was written by a physician who is a pain specialist, and the name of the article is "Cannabinoids: Their Role in Pain and Palliation." [J Pain Palliat Care Pharm. 2007;21(3):19-28. PubMed] But what really exciting about cannaboids in medicine is that "Synergy between opioids and cannabinoids may produce opioid-sparing effects, as well as extend the duration of analgesia and reduce opioid tolerance and dependence." On top of that "Cannabidiol has been shown to be analgesic, anti-convulsant, anti-psychotic, and anti-inflammatory and, in addition, seems to attenuate THC-induced psychoactivity, tachycardia and other adverse effects." Of concern, "However, CBD [cannabidiol] has been bred out of most cannabis strains, particularly in North America, in order to enhance the plant’s psychoactive potential. Currently available pharmaceutical products comprise only pure synthetic THC (dronabinol) or a THC analogue (nabilone)." For concluding remarks, Dr. McCarberg wrote that "A developing body of literature suggests that cannabinoids may have a role to play in the treatment of chronic pain and a variety of terminal conditions, including cancer and degenerative diseases. The benefits of cannabinoids in a number of symptom complexes may contribute to improved patient care, especially as adjunctive agents, but also as primary interventions."
"Many of the drugs used in palliative care belong to categories of high toxicity and have potentially lethal effects, whereas THC and other cannaboids have remarkably low toxicity and no lethal doses in humans have yet been described." --Anita J Green, D.Nursing, MA, BA, RCNT, RGN, RMN, and Kay De-Vries, PhD, MSc, PGCEA, BSc, RGN
The above statement is from the article "Cannabis use in palliative care – an examination of the evidence and the implications for nurses." [J Clin Nurs. 2010;19:2454-62. PubMed] The two doctorate nurses who wrote this review article provided some general information about how marijuana is used by writing that "Cannabis is usually smoked alone or with tobacco in the form of a ‘joint’. The tobacco in a joint helps burning. Cannabis smokers tend to inhale more deeply than a cigarette smoker and hold in the smoke to maximise absorption into the lungs. Cannabis can also be consumed through a bong (a glass container filtering device or home-made pipe), eaten when included in food such as cakes and stews or drunk as a tea. Smoking tends to be preferred because of the rapid absorption after inhalation, which takes effect in minutes; maximum brain concentration is reached in 15 minutes. Smoking is often the preferred route of intake for medicinally used cannabis, usually because the rapid absorption of the drug allows self-titration. Taken orally the therapeutic window is limited, because the way it is slowly absorbed by the gastrointestinal tract and metabolised by the liver. Blood concentrations reach approximately 25–30% of the same dose smoked and the effect could be delayed by up to two hours. THC is sequestered in fatty tissues and slowly released back into the blood stream and to the brain reaching peak concentrations in four-five days. The half-life is eliminated at approximately seven days. Complete elimination of a single dose can take up to 30 days."
"In the most recent issue of O'Shaughnessy's, one doctor reported that his cannabis patients had either stopped or cut back their use of "analgesics of all kinds [including] Tylenol, aspirin, and opioids; psychotherapeutic agents including anti-anxiety medications, anti-depressants, anti-panic, obsessive-compulsive, anti-psychotic, and bipolar agents; gastrointestiminal agents including antispasmodics and anti-inflammatory medications; migraine preparations; anticonvulsants; appetite stimulants; immunomodulators and immunosuppressives; muscle relaxants; multiple sclerosis management medications; ophthalmic preparations; sedative and hypnotic agents; and Tourette's syndrome agents." --Roger Parloff
The above was stated in an excellent review article titled "How pot became legal." [Fortune. Sept 2009;160(6):140-2. PubMed] And most of the latest development in "legalization" started because "In 1996 a group of marijuana activists in California got enough signatures to put a legislative initiative on the ballot known as Proposition 215. It called for permitting medical marijuana patients or their "primary caregivers" to possess marijuana on the "recommendation or approval" of a physician. The measure passed with a 56% majority, and California became the first medical marijuana state. Precisely what that meant, though, remained totally unclear. Prop. 215 did not specify how much pot patients could possess, and it said nothing about the way patients would obtain it. Nothing in the initiative explicitly legalized sales or distribution of any kind." But marijuana (and industrial hemp seed cultivation) is actually not legal in the USA since the federal government has not changed their laws, which can supersede state laws. And the state laws do not permit physicians to prescribe marijuana, as was noted that "Like most medical marijuana states, California permits doctors to "recommend" marijuana use for patients who suffer from specific serious diseases. (Drafters of the law avoided the word "prescribe" in an attempt to sidestep conflict with federal law.)"
"Hempseed possesses excellent nutritional value. It is very rich in essential fatty acids (EFAs) and other polyunsaturated fatty acids (PUFAs). It has almost as much protein as soybean and is also rich in Vitamin E and minerals such as phosphorus, potassium, sodium, magnesium, sulfur, calcium, iron, and zinc." --Delfin Rodriguez-Leyva, and Grant N Pierce
The above is a statement from the article "The cardiac and haemostatic effects of dietary hempseed." [Nutr & Metab. 2010;7:32-41. PubMed] This was a review article detailing the substantial nutritional value and safety of hempseed from cannabis sativa. For starters, they helped define what this botanical product is by writing that "Cannabis sativa L. is an annual plant in the Cannabaceae family. It has been an important source of food, fiber, medicine and psychoactive/religious drug since prehistoric times. Two main types of Cannabis Sativa L. must be distinguished, the drug and non-drug types. The first is also known as marijuana, hashish or Cannabis tincture and contains Δ9-Tetrahydrocannabinol (THC) in concentrations between 1-20%, high enough to exhibit psychoactivity. The second type of Cannabis Sativa L. is industrial hemp with THC concentrations < 0.3% so it has no psychoactive properties. Canada, Australia, Austria, China, Great Britain, France and Spain are among the most important agricultural producers of hempseed. In the United States, it is not legal to cultivate hempseed. This is primarily because many believe that by legalizing hemp they may lead to a legalization of marijuana. Other governments have accepted the distinction between the two types of Cannabis and, while continuing to penalize the growing of marijuana, have legalized the growing of industrial hemp." Hempseed oil is sold in nutritional stores, along with flax seed oil, and is considered a superior product (although considerably more costly due to it's being imported from outside the USA).
Dietary hempseed oil caused significant changes in plasma fatty acid profiles and improved clinical symptoms of atopic dermatitis. --Drs. JAMES CALLAWAY, URSULA SCHWAB, ILKKA HARVIMA, PIRJO HALONEN, OTTO MYKKA¨NEN, PEKKA HYVO¨ NEN & TOMI JA¨ RVINEN
The above was a statement was a conclusion from the study "Efficacy of dietary hempseed oil in patients with atopic dermatitis." [J Dermatolog Treat. 2005 Apr;16(2):87-94. PubMed]
"One promising source for biodiesel production is the fiber crop Cannabis sativa Linn, known as industrial hemp." --Drs. Si-Yu Li, James D. Stuart, Yi Li, Richard S. Parnas
The above is a statement from the study article "The feasibility of converting Cannabis sativa L. oil into biodiesel." [Bioresour Technol. Nov 2010;101:8457-60. PubMed] In their introduction, they stated that "Industrial hemp is an annual herb and its cultivation has a low cost and a low environmental impact. Hemp seeds have high oil content, ranging from 26% to 38%. Hemp seed oil is often used as a nutrition supplement due to its high percentage of poly-unsaturated fatty acid. In addition, hemp has another advantage as a fuel source. It has a high biomass content which can be fermented to create low carbon fuels, such as bioethanol or biobutanol. Moxley et al. has successfully recovered 96% of the glucose from the hemp’s cellulosic hurds, which allows for the recycling of this hemp fiber industry waste product. In fact, industrial hemp is one of the few plants that produce high yields of both oil and biomass, which means it can be used to produce both biodiesel and bioethanol. In order to test hemp seed oil’s feasibility as a biodiesel source, hemp seed oil was converted to biodiesel and several fuel properties were determined." But due to unwarranted and very stiff restrictions--even for industrial cannabis--the USA will not be able to capitalize on developing this type of promising biodiesel fuel.
What if cannibis cured cancer. This is an excellent documentary film that was released in July 2010. It provides expert testimony of the enormous medicinal properties of cannabis, including its property of being a natural anti-cancer product. The film describes how research has shown that cannabis contains a number of cannabinoid products that can cause multiple therapeutic responses in the human body, since cannabinoid receptors are located throughout the human body. The film also revealed a study conducted in 1975 by Dr. Albert Munson (et. al) that demonstrated how the oral administration of cannabinoids in mice retared their tumor growth in the lungs, breast, and in virus-induced leukemia. Unfortunately, the government subsequently "Shut down the University of Virginia's further research of this area of study." The title of the study article cited in the documentary is "Antineoplastic activity of cannabinoids." [J Natl Cancer Inst.1975 Sep;55(3):597-602. PubMed] Each of the five investigators who were involved in this study did continue further research in studying the effects of THC and other cannabinoids. The film can be purchased at Amazon.com.
Grass (1999): Another documentary film. The history of the American government's war on marijuana in the 20th century. This reveals the waste of approximately $1 trillion dollars by the US government during the past 70 years to combat the war against the personal use of marijuana.
www.viennadeclaration.com/: Vienna Declaration
www.cannabinergy.com/: Cannabinergy: Dr.Sunil Kumar Aggarwal’s goal with cannabinergy is to translate the current and new scientific discoveries of this 37-million year old plant so that a broader section of the world’s societies will have an opportunity to discern myth from fact.