Medicinal Marijuana

Medical Applications of Cannabinoids.

Cannabinoids are molecules unique to the cannabis plant. There are over 60 such cannabinoids in the plant including 9 Tetrahydrocannabinol (THC), 9-THC Propyl Analogue (THC-V), Cannabidiol (CBD), Cannabidiol Propyl Analogue (CBD-V), Cannabinol (CBN), Cannabichromene (CBC), Cannabichromene Propyl Analogue (CBC-V) and Cannabigerol (CBG).

THC is the cannabinoid that has to date received most attention both from the scientific community and the general public. However, THC and other cannabinoids have been shown to have analgesic, anti-spasmodic, anti-convulsant, anti-tremor, anti-psychotic, anti-inflammatory, anti-emetic and appetite-stimulant properties. Research is ongoing into the neuroprotective and immunomodulatory effects of cannabinoids.

Below are 3 recent reports of interest:

House of Lords Science & Technology Committee - Ninth Report
Cannabis: The Scientific and Medical Evidence
(November 1998)

House of Lords Science & Technology Committee - Second Report
Therapeutic Uses of Cannabis
(March 2001)

National Academy of Sciences Institute of Medicine
Marijuana and Medicine - Assessing the Science Base
(1999)

Therapeutic Cannabis Users & the Law
There have recently been a number of high-profile cases involving the prosecution of therapeutic users of cannabis: the memorandum by the Alliance for Cannabis Therapeutics (ACT) (p. 26) has highlighted a number of them. The decision to prosecute, taken by the Crown Prosecution Service (CPS), does not seem to be consistent from region to region. Moreover, in some cases, juries have acquitted therapeutic users who do not deny the offence, but plead therapeutic use in mitigation; in other cases, defendants have been found guilty and sentenced.

Ministers sought to deny that therapeutic cannabis users were subject to "postcode prosecuting". They stressed that the number of therapeutic users who were prosecuted was extremely small when compared to the total of 89,000 cases involving cannabis in 1998.[10] He also said that the variation in the outcome of cases for therapeutic users was less than for other offences, including the recreational use of cannabis. The number of cases of therapeutic users of cannabis being prosecuted is certainly small. Exact statistics are difficult to obtain, however, as the Home Office does not maintain a record of those prosecuted for cannabis use who claim therapeutic use as a defence.

The Minister further said that he had no intention of changing the current position, whereby the decision whether or not to prosecute for cannabis-related offences is made locally by the Police and the CPS. He did, however, emphasise that discretion could be exercised at three levels of the prosecution process: by the Police; by the CPS; and by the Courts. Guidelines issued by the Association of Chief Police Officers (ACPO) on dealing with cannabis offences specifically refer to therapeutic use, and recommend that a caution is usually appropriate; the CPS guidelines require that any prosecution should be in the public interest; and the Court of Appeal issues guidance that the possession of small amounts of cannabis for personal use can often be met by a fine.

(Therapeutic Uses of Cannabis - March 2001)

AIDS Wasting Syndrome
Arthritis
Brain Injury/Stroke
Multiple Sclerosis
Nausea associated with cancer Chemotherapy
Anti-Tumor Effects
Asthma
Epilepsy
Glaucoma
Schizophrenia
Migraine
Eating Disorders
General Pain



AIDS Wasting Syndrome
AIDS wasting syndrome, a common and often fatal outcome of HIV infection, is defined as the involuntary loss of 10 percent of body weight or more that is not attributable to other disease processes. It is critical for HIV and AIDS patients to maintain a healthy appetite and body weight to avoid opportunistic infections. Medical cannabis appears to help counter the appetite loss, nausea, and pain associated with HIV and AIDS and their commonly prescribed medications. Presently, medical organizations specializing in AIDS research are some of strongest advocates for legalizing medical cannabis, calling it "potentially lifesaving medicine".


Arthritis
Arthritis refers to any more than 100 inflammatory joint disorders characterized by pain, swelling, and limited movement. Arthritis involves the inflammation and degeneration of cartilage and bone that make up the joint. Experts estimate that more than 31 million people in the United States alone suffer from various degrees of the disease. Common forms of arthritis are osteoarthritis and rheumatoid arthritis. Emerging evidence implies that cannabis can help alleviate symptoms of both conditions.

Cannabis' pain reducing properties are well documented and emerging evidence indicates that it holds anti-inflammatory qualities. Dale Gieringer, author of the paper "Review of Human Studies on the Medical Use of Marijuana," cites three animal and laboratory studies documenting cannabis' potential anti-inflammatory effects. In addition, a 1988 study by an British research team found the cannabinoid CBD (cannabidiol) ameliorated inflammation in mice.


Brain Injury/Stroke
Emerging research indicates that cannabinoids possess neuroprotective properties (1,2). Researchers at the National Institutes for Mental Health (NIMH) demonstrated in 1998 that the cannabinoids THC and cannabidiol (CBD) are potent anti-oxidants in animals. (3) Doctors rely on anti-oxidants to protect stroke and head trauma victims from exposure to toxic levels of reactive molecules, so-called "free radicals", that are produced when the brain's blood supply is cut off. Head injuries and strokes cause the release of excessive glutamate, often resulting in irreversible damage to brain cells.


Multiple Sclerosis
Multiple sclerosis (MS) is a disease affecting the central nervous system. MS exacerbations appear to be caused by abnormal immune activity that causes inflammation and the destruction of myelin (the protective covering of nerve fibers) in the brain, brain stem or spinal cord. Common symptoms of MS include muscle spasms, depression, and incontinence (involuntary loss of urine) or urinary retention.

In a 1998 review article published in the journal Drug and Alcohol Review, Drs. Linda Growing et al. observed that the distribution of cannabinoid receptors in the brain suggests that they may play a role in movement control. The authors hypothesized that cannabinoids might modify the autoimmune cause of the disease. If so, it is possible that cannabis may both relieve symptoms of MS and retard its progression.


Nausea associated with cancer chemotherapy
A large body of clinical research exists concerning the use of cannabis and cannabinoids for chemotherapy- induced nausea and vomiting. A review of the medical literature reveals at least 31 human clinical trials examining the effects of cannabis or synthetic cannabinoids on nausea, not including several U.S. state trails that took place between 1978 and 1986. In reviewing this literature, Hall et al. concluded that " THC [delta-9-tetrahydrocannabinol] is superior to placebo, and equivalent in effectiveness to other widely-used anti-emetic drugs, in its capacity to reduce the nausea and vomiting caused by some chemotherapy regimens in some cancer patients".


Anti-Tumor Effects
Emerging research indicates that cannabinoids may help protect against the development of certain types of tumors. Most recently, a Spanish research team reported in Nature that injections of synthetic THC eradicated malignant brain tumors - so-called gliomas - in one-third of treated rats, and prolonged life in another third by as much as six weeks. Team leader Manuel Guzman called the results "remarkable" and speculated that they "may provide a new therapeutic approach for the treatment of malignant gliomas". An accompanying commentary remarked that this was the first convincing study to demonstrate that cannabis-based treatment may combat cancer. Other journals have also recently reported on cannabinoids' anti-tumoral potential.


Asthma
Asthma is a breathing disorder caused by inflammation and swelling of the small airways (bronchioles) that afflicts some 10 million Americans, killing more than 4,000 annually. When the bronchioles become inflamed, swollen, and filled with mucus, the airways constrict and patients have difficulty breathing. Asthma attacks are typically treated with "bronchodilators," drugs that relax and open the bronchioles, or anti-inflammatory steroids to reduce swelling.

The Australian National Task Force on Cannabis determined, "Smoked cannabis, and to a lesser extent oral THC, have an acute bronchodilatory effect in both normal persons and persons with asthma". A handful of human studies demonstrate this effect, including one that showed smoking even low THC cannabis produced bronchodilation nearly equivalent to a clinical dose of isoproterenol. The House of Lords 1998 "Ninth Report" on cannabis acknowledged that cannabinoids seemed to work as effectively as conventional asthma drug treatments. Experiments using oral THC produced a smaller bronchodilator effect after a substantial delay, and proved to be a bronchial irritant when administered as an aerosol.


Epilepsy
Epilepsy is a common neurological disorder that afflicts nearly 2.5 million Americans. Patients suffering from epilepsy experience periodic, recurrent seizures triggered by the misfiring of certain brain cells. These seizures occur in various forms, ranging from mild to severe convulsions and loss of consciousness. Standard treatment for epilepsy involves anti-convulsants. While there are several studies and references by the Institute of Medicine, House of Lords Science and Technology Committee, Australian National Task Force on Cannabis, and others regarding cannabis' anti-convulsant properties, there are few human studies specific to epilepsy.

A double blind controlled study on the effects of the marijuana compound cannabidiol (CBD) on epilepsy yielded favorable results. "Fifteen patients suffering from secondary generalized epilepsy with temporal focus were randomly divided into two groups. Each patient received, in a double-blind procedure, 200-300 mg daily of CBD or placebo. All patients and volunteers tolerated CBD very well and no signs of toxicity or serious side effects were detected on examination. Four of the eight CBD subjects remained almost free of convulsive crises throughout the experiment and three other patients demonstrated partial improvement on their clinical condition".


Glaucoma
Glaucoma is a disorder that results from an imbalance of pressure within the eye. The condition is characterized by an increase in intraocular pressure (IOP) that progressively impairs vision and may lead to permanent blindness. Glaucoma remains second leading cause of blindness in the United States.

The aim of glaucoma treatment is to reduce interocular pressure. Several human studies demonstrate that inhaled cannabis lowers IOP in subjects with normal IOP and glaucoma. Some animal studies indicate that cannabis can also be effective when administered topically (e.g. as an eye drop.) Two of the eight legal U.S. medical marijuana patients have used government cannabis to effectively maintain their eyesight for more than a decade.


Migraine
Migraine is a type of episodic, recurrent, severe headache lasting hours to days. Migraine is typically accompanied sensitivity to light, intolerance to loud noises, and nausea or vomiting. Surveys indicate that 15 to 25 percent of women and five to 10 percent of men suffer from migraine.

A century ago, physicians commonly prescribed cannabis for migraine. Famed physician William Osler wrote that it was "probably the most satisfactory remedy" for migraine in his textbook, The Principles and Practice of Medicine.

Some patients and physicians are once again showing interest in examining cannabis' potential to treat symptoms of migraine. A recent article in the medical journal Pain (Journal of the Association for the Study of Pain) concluded that "cannabis delivered in the form of a marijuana cigarette, or 'joint,' presents the hypothetical potential for quick, effective, parenteral [non-orally administered] treatment of acute migraine." The author called cannabis a "far safer alternative" than many prescription anti-migraine drugs, and reported that a large percentage of migraine sufferers fail to respond or cannot tolerate standard therapies.


Schizophrenia
Cannabis' impact on patients suffering from schizophrenia is not well understood and often disputed. The Australian National Task Force on Cannabis cites anecdotal clinical evidence that "schizophrenic patients who use cannabis and other drugs experience exacerbations of symptoms, and have a worse clinical course, with more frequent psychotic episodes than those who do not". However, the researchers admit that "very few well controlled studies" have documented this relationship.

In his book Marihuana The Forbidden Medicine, Dr. Lester Grinspoon (with James Bakalar) cites a pair of studies that found schizophrenic patients who used cannabis responded better to the disease than nonusers. One study reported that patients who smoked marijuana had "fewer delusions and, above all, fewer of the so-called negative symptoms, which include apathy, limited speech, and emotional unresponsiveness." The other study concluded that those who used cannabis had a "lower rate of hospital admissions than those who used no drugs at all. The paticipants said that cannabis helped them with anxiety, depression, and insomnia." Grinspoon also notes that in his own clinical experience, schizophrenics who regularly use cannabis generally regard it as helpful.


Eating Disorders
Survey data beginning in 1970 demonstrated a strong relationship between inhaling marijuana and increased appetite. This data also found a majority of cannabis users reporting that "marijuana made them enjoy eating very much and that they consequently ate a lot more.") Cannabis is also documented to enhance the sensory appeal of foods.

Several human trials have established cannabis' ability to stimulate food intake and weight gain in healthy volunteers. Dr. Leo Hollister of the Veterans Administration Hospital in Palo Alto, California presided over two separate experiments that found "total food intake, as well as reports of hunger and appetite, are increased after oral administration of marihuana." A later trial of 27 cannabis smokers and ten controls concluded that marijuana smokers ate more and gained more weight than non-smokers after 21 days in a hospital research ward. The cannabis-smoking group immediately began eating less after ceasing their marijuana use.


General Pain
Pain is a sensation of physical discomfort, mental anguish, or suffering caused by aggravation of the sensory nerves. It remains the most common symptom for which patients seek therapeutic relief. Cannabis has historically been used as an analgesic, and was commonly prescribed by physicians in England and America in the 19th and 20th centuries. Many researchers now believe that cannabinoids hold promise as safe and effective pain reducers with no physical-dependence-inducing properties.

Authors of the 1999 Institute of Medicine (IOM) report, "Marijuana as Medicine: Assessing the Science Base," describe three types of pain that may be ameliorated by cannabinoids: somatic pain, visceral pain, and neuropathic pain. Researchers appear most interested in examining cannabis' ability to relieve neuropathic pain, which results from injury to nerves, peripheral receptors, or the central nervous system, because it is often resistant to standard opioids.

Disclaimer:
Much of the information contained on this website would be illegal were it to be practiced in most countries around the world - including the UK. Our intent is to educate and inform NOT to encourage anyone to break the law.

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