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Topics: Cannabis, Tetrahydrocannabinol / Pages: 5 (1139 words) / Published: Jan 25th, 2000
THC (Cannabis) Between 1840 and
1900, European and American medical journals published more than 100 articles on the therapeutic use of the drug known then as
Cannabis indica (or Indian hemp) and now as marijuana. It was recommended as an appetite stimulant, muscle relaxant, analgesic, hypnotic, and anticonvulsant. As late as 1913 Sir William Osler recommended it as the most satisfactory remedy for migraine headaches . Today the 5000-year medical history of cannabis has been almost forgotten. Its use declined in the early 20th century because the potency of oral ingestion was high, and alternatives became available -- injectable opiates and, synthetic drugs such as aspirin and barbiturates. In the United States the Marijuana
Tax Act of 1937 was passed. It was designed to prevent non medical use. This law made cannabis so difficult to obtain for medical purposes that it was removed from the pharmacopoeia. It is now confined to Schedule I under the Controlled
Substances Act as a drug that has a high potential for abuse, lacks an accepted medical use, and is unsafe for use under medical supervision. In 1972 the National Organization for the Reform of
Marijuana Laws petitioned the Bureau of
Narcotics and Dangerous Drugs, later renamed the Drug Enforcement Administration (DEA), to transfer marijuana to Schedule II so that it could be legally prescribed. As the proceedings continued, other parties joined, including the
Physicians Association for AIDS Care. It was in
1986, after many years of legal maneuvering, that the DEA acceded to the demand for the public hearings required by law. During the hearings, which lasted 2 years, many patients and physicians testified, and thousands of pages of documentation were introduced. In 1988 the DEA's own administrative law judge, Francis L. Young, declared that marijuana in its natural form fulfilled the legal requirement of currently accepted medical use in treatment in the United States. He added that it was "one of the safest therapeutically active substances known to man." His order that the marijuana plant be transferred to Schedule II was overruled, not by any medical authority, but by the DEA itself, which issued a final rejection of all pleas for reclassification in March 1992.
Meanwhile, a few patients have been able to obtain marijuana legally for therapeutic purposes.
Since 1978, legislation permitting patients with certain disorders to use marijuana with a physician's approval has been enacted in 36 states. Although federal regulations and procedures made the laws difficult to enact, 10 states eventually established formal marijuana research programs to seek FDA approval for
Investigational New Drug (IND) applications.
These programs were later abandoned, mainly because the bureaucratic burden on physicians and patients became intolerable. Growing demand also forced the FDA to Institute an Individual
Treatment IND for the use of physicians whose patients needed marijuana because no other drug would produce the same therapeutic effect. The application process was made complicated, and most physicians did not want to become involved, especially since many believed there was some disgrace on prescribing cannabis. Between 1976 and 1988 the government reluctantly awarded about a half dozen Compassionate INDs for the use of marijuana. In 1989 the FDA was overwhelmed with new applications from people with AIDS, and the number granted rose to 34 within a year. In June 1991, the Public Health
Service announced that the program would be suspended because it undercut the administration's opposition to the use of illegal drugs. After that no new Compassionate INDs were granted, and the program was discontinued in March 1992. Eight patients are still receiving marijuana under the original program; for everyone else it is officially a forbidden medicine. Many people know that marijuana is now being used illegally for the nausea and vomiting induced by chemotherapy. Some know that it lowers intraocular pressure in glaucoma. Patients have found it useful as a muscle relaxant in spastic disorders, and as an appetite stimulant in the wasting syndrome of HIV infection. It is also being used to relieve phantom limb pain, menstrual cramps, and other types of chronic pain, including (as Osler might have predicted) migraine. Polls and voter referenda have repeatedly indicated that the vast majority of
Americans think marijuana should be medically available. One of marijuana's greatest advantages as a medicine is its safety. It has little effect on major physiological functions. There is no known case of a lethal overdose; on the basis of animal models, the ratio of lethal to effective dose is estimated as 40,000 to 1. By comparison, the ratio is between 3 and 50 to 1 for barbiturates and between 4 and 10 to 1 for ethanol. Marijuana is also far less addictive and far less subject to abuse than many drugs now used as muscle relaxants, hypnotics, and chronic pain relievers. The chief legitimate concern is the effect of smoking on the lungs. Cannabis smoke carries even more tars and other particulate matter than tobacco smoke. But the amount smoked is much less, especially in medical use, and once marijuana is an openly recognized medicine, solutions may be found.
Water pipes are a partial answer; ultimately a technology for the inhalation of cannabinoid vapors could be developed. Even If smoking continued, legal availability would make it easier to take precautions against aspergilli and other pathogens. Right now, the greatest danger in medical use of marijuana is its illegality, which imposes much anxiety and expense on suffering people, forces them to bargain with illicit drug dealers, and exposes them to the threat of criminal prosecution. The main active substance in cannabis, tetrahydrocannabinol (THC), has been available for limited purposes as a Schedule II synthetic drug since 1985. This medicine, dronabinol (Marinol), taken orally in capsule form, is sometimes said to prevent the need for medicinal marijuana. Patients and physicians who have tried both disagree. The dosage and duration of action of marijuana are easier to control, and other cannabinoids in the marijuana plant may modify the action of THC. The development of cannabinoids in pure form should certainly be encouraged, but the time and resources required are great and at present unavailable. In these circumstances, further isolation, testing, and development of individual cannabinoids should not be considered a substitute for meeting the immediate needs of suffering people. Although it is often objected that the medical usefulness of marijuana has not been demonstrated by controlled studies, several informal experiments involving large numbers of subjects suggest an advantage for marijuana over oral THC and other medicines. For example, from 1978 through 1986 the state research program in New Mexico provided marijuana or synthetic THC to about
250 cancer patients receiving chemotherapy after conventional medications failed to control their nausea and vomiting. A physician who worked with the program testified at a DEA hearing that for these patients marijuana was clearly worked better than both chlorpromazine and synthetic

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