are in Research
Potential and Medical Uses of Marijuana
of Psychoactive Drugs 14 (1982): 239-241
Freedom Is Slavery
Ignorance Is Strength
George Orwell, 1984
on the facade of the Ministry of Truth, these words summarize the federal medical
and scientific policies in the field of moral pharmacology. With this most recent
groupthink revision of scientific newspeak, cannabis history now starts in 1981
in response to the introduction of a bill in Congress (H.R. 4498) "to provide
for the therapeutic use of marijuana in situations involving life-threatening
or sense-threatening illness and to provide adequate supplies of marijuana for
such use," and promises a review of the literature, which, except for one
citation in 1889, one in 1947 and one in 1953, the expunged literature is now
comprised mostly of research conducted in the 1970's. Thus, the perspective of
the Committee is based on minimal experience in therapeutic applications, deprived
of the practical experience from clinical access enjoyed by their colleagues of
half a century ago when cannabis was available by prescription.
important in therapeutic potential and medical uses of marijuana are the omissions.
Left out was the fact that cannabis presentations were widely used in Western
medicine from 1839 to the early 1940's. Omitted: concise and accurate descriptions
of the medicinal applications of cannabis that appeared in the U.S. Pharmacopoeia
and Goodman and Gilman's textbook of pharmacology, second edition (1955). Forgotten:
primary scientific, structure-activity and pharmacologic studies by Professor
S. Loewe (1950) in the 1940's and early 1950's. Neglected: comprehensive clinical
research by the Mayor's Committee on Marihuana in 1944.
reasonably fair assessment of variable results with different varieties of the
illness. Indeed, topical application would be desirable in nonneurogenic glaucoma,
but solubility characteristics of cannabinoids would appear to be intrinsically
irritating. It would appear that slow titration with natural or synthetic cannabinoids
orally (Reynolds 1890) would enhance the possibility of favorable results with
the greatest medical safety.
the discovery of cannabis as an antiemetic is a most important and truly new discovery
that was not known to medicine when it was available. It is exciting to learn
of the positive results, and one can only wonder why an inhalant cannot be developed
to deliver purified natural and synthetic cannabinoids. The inhaled route is inherently
preferable especially when nausea and vomiting are inhibiting gastrointestinal
retention and absorption. Autotitration is also made possible because of this
comparatively short latency period after administration by this route.
practitioners of more than a century ago (e.g., McMeens 1856, O'Shaughnessy 1839)
would turn over in their graves to read that a major drug for certain nervous
disorders had retrogressed to a preclinical status of "showing promise"
in a 15-subject seizure disorder study in 1980.
Muscle Relaxant Action
described in the context of utility in spasticity, this delineation being centrally
mediated would correctly fall within the domain of the anticonvulsant activity.
is encouraging to see cannabis rediscovered as an antiasthmatic agent. McMeens
(1860) and Waring (1874) noted cannabis to be useful in some cases of asthma and
hay fever where an "irritable nervous system" seemed to be involved.
Cannabis as a treatment for asthma was mentioned in India in 1954.
section by the Committee demonstrates the methodological problems involved in
translating commonly observed cannabis-use behavior into a scientific presentation
that is oriented to therapeutic utilization. This author's personal observations
of chronic users clearly show cannabis' applications to closely approximate those
of the benzodiazepines or alcohol. Like other sedatives, the onset of effects
may be an initial stimulation. Alcohol and cannabis share this property. After
the stimulation phase there is a calming effect. The intensity of the stimulation
(and sedation) is directly dose-related. Low dose (two or fewer joints/day) chronic
use of cannabis appears to have an effect comparable to five mg of diazepam (Valium®)
twice a day. Chronic cannabis users also show a slight stimulant effect with a
mental lift and an EEG shift from predominantly alpha/theta (four to 13 Hz) to
mostly beta waves (>14 Hz).
and moderate dose cannabis use appears to decrease affectual reactivity and subjective
sense of pressure with reduction of concomitant multisystem stress. The site of
activity is probably at the thalamo-cortical level, as postulated by Walton (1938).
The reddened eyes of cannabis users reflect an apparent specific meningeal/vasomotor
response. Cannabis, as compared with other psychotropics, has remarkably minimal
brain stem and other peripheral effects.
referenced nor mentioned: Animal models showing analgesic effects for cannabis
and its derivatives starting as far back as Hare (1887) and Marshall (1898), as
well as overlooking the extensive bioassay protocol utilized by the pharmaceutical
industry to standardize the strength of cannabis preparations in reference to
U.S.P. standard preparations available from the U.S. Food and Drug Administration
"mental clouding" side effect reported in 1976 when using THC as an
analgesic for cancer pain control might have been avoided by emulating Dr. J.
Russell Reynold's protocol of gradual upward titration of cannabis tincture, as
described in Lancet in 1890. (Perhaps, using a U.S.P. standard cannabis tincture
might have been more effective than THC.)
Numerous descriptions of cannabis as the treatment of choice for migraine headache,
as listed in materia medica, journals and texts with the latest (and unfortunately
last) in the Journal of the American Medical Association by Morris Fishbein (1942)
4O years, ago.
this author's limited clinical and social experience, the substitution of cannabis
as a euphoriant/sedative is possible in some cases. The success of substitution
depends on support groups of other cannabis users. Failure is usually due to denial
and rigidly habituated behavior patterns usually involving other alcoholics or
alcohol abusers. Another significant source of failure is the deterrence by its
illegal status and uncertain supply of the drug.
should be said that the reason there are no efforts to follow up on Birch's (1889)
and Mattison's (1891) early clinical experiences is because of the excessively
restrictive multiagency federal involvement. In the moral pharmacologic regulatory
reality, the treatment of discomfort brought on by the abuse of another illegal
drug is low priority.
might be construed to be antitumor in the enhancement of appetite and suppression
of nausea, but, as such, specific antioncologic activity seems unlikely.
lack of clinical experience is a serious impediment to a realistic appraisal of
the therapeutic potential of cannabinoids. The federal bias toward pushing THC
for scientific "purity" and the inability to grow or process cannabis
would appear to constitute another negative influence. It is gratifying that despite
these difficulties the Committee is in favor of further research into the medicinal
applications of cannabis.
is sufficient clinical data, both recently and historically, to warrant the restoration
of cannabis products for general prescribing. The Committee is generally correct
in their favorable findings in glaucoma and antiemetic applications, but grossly
underestimates the utility of cannabinoids as sedative, anticonvulsant and antimigraine
agents because of inadequate experimental protocol, a less than thorough review
of the medical literature and dog-in-the- manger interagency conflict-based federal
Recommendations for Research
development of nonirritating purified natural cannabinoid aerosol preparations
should be a top priority effort. The reality is that because the smoked route
is used, there will be huge numbers of chronic cannabis smokers subjecting their
tracheobronchial trees to irritation from pyrrolized impurities that technology
could prevent. Precisely how much morbidity and mortality, which could have been
prevented through appropriate research and development, remains to be answered
in the distant future.
homologues have been studied since the late 1930's. The compounds synthesized
and studied by Loewe (1950) have yet to be adequately reevaluated and would be
of potential benefit to the present knowledge of chemical structure-activity relationships
in cannabinoids - the only complex nonnitrogenous water insoluble psychotropic
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L.S. & Gilman, A. (Eds.). 1955. The Pharmacological Basis of Therapeutics.
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H.A. 1887. Clinical and physiological notes on the action of cannabis indica.
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