General History
Throughout history cannabis sativa and cannabis indica (marijuana) has had a long anddistinguished history as a medicinal herb. The Chinese emperor Shen-nung was the first to record the medical use of cannabis in 2737 B. C. Many cultures, however, have recognized the therapeutic benefits of the cannabis plant. Among them are: India, Persia, Assyria, Greece, Africa, South America, Turkey, and Egypt.
In Western medicine cannabis enjoyed its heyday during the 19th Century. In the late 1830s, Dr. William B. O'Shaughnessy, a British physician at the Medical College of Calcutta, learned of cannabis and began experimenting with various cannabis preparations. He determined the drug was safe and effective in treating rabies, rheumatism, epilepsy and tetanus.
O'Shaughnessy published his studies in a forty page article entitled "On the preparations of the Indian Hemp or Gunjah," in 1839. This marked the beginning of an intensive period of study throughout Europe and America. More than 100 articles were published between 1840 and 1900. Many prominent physicians, including Queen Victoria's personal physician, J. R. Reynolds, studied cannabis. Reynolds declared it "by far the most useful of drugs" in treating "painful maladies."
In America, the first extensive study of cannabis in medicine was completed in 1860 by the Ohio Medical Society. Physicians reported success in treating stomach pain and gastric distress, psychosis, chronic cough, gonorrhea and neuralgia.
At the turn of the century, the drug began to fall into disuse. Cannabis was difficult to store and its extracts were variable in their effect. As new drugs were developed in the early 1900s, cannabis was less widely used but still available by prescription and in some over-the-counter preparations.
The Marijuana Tax Act of 1937, intended to prohibit marijuana's social use, was most effective in prohibiting medical use of the drug. Strict regulations governing cultivation of the plant made its production impractical. New synthetic drugs caught the fancy of physicians and cannabis was used less frequently, Finally, in 1942, the Federal Bureau of Narcotics convinced the U. S. Pharmacopeia to remove the drug from its listing.
In the 1970s, cannabis was "re-discovered" as a medical substance. Controlled studies have revealed its therapeutic utility in the treatment of cancer chemotherapy side-effects, glaucoma, and spasticity ailments. Federal regulations continue to make research with the drug very difficult, however, and many promising areas of therapeutic application have received little or no attention. These include: asthma, AIDS, epilepsy, analgesic action, tumor retardation, nervous disorders, and mental illness.
Back to Top
Federal Laws
The
Controlled Substances Act classifies cannabis as a Schedule I drug and defines
it as a drug "with no accepted medical value in treatment." Despite its long history
of use as a medication, cannabis is classified as a "new drug" and legal access
is only possible through an Investigational New Drug Application (IND) issued
by the Food and Drug Administration (FDA).
State Laws
Beginning in 1978, the states began responding to pleas from the seriously ill for legal access to marijuana for medical purposes. To date, thirty-four states have enacted laws which recognize marijuana's medical value. Federal law, however, supersedes state law. Moreover, federal authorities retain strict control of marijuana supplies. Several states developed complicated research programs which gave their citizens limited access to legal supplies of medical marijuana. These programs were short-lived, however. Complex federal regulations and the continuous intervention of federal officials made such programs too difficult for most states to administer.
For
a more complete discussion of state actions relative to medical marijuana please
see Marijuana as Medicine: A Recent History (1976-1996) with Recommendations.
Back to Top
Medical Use of Marijuana by Patients Undergoing Cancer Chemotherapy & with AIDS
Cancer chemotherapy can often prolong the patient's life by several years. In some instances, a complete "cure" can be obtained. Unfortunately, these drugs also have severe side-effects, most notably nausea and vomiting. Patients sometimes find these effects so distressing they abandon chemotherapy entirely.
People with AIDS (Acquired Immune Disease) also experience these problems. Powerful anti-viral drugs such as AZT and the new protease inhibitors can induce severe nausea, vomiting, and other gastrointestinal effects. Similarly, AIDS "wasting syndrome" can literally starve an individual to death.
Investigations with cannabis have revealed its ability to reduce (or eliminate) the nausea and vomiting associated with chemotherapy while also providing an appetite stimulus. The benefits are thus twofold: 1) the patient is able to retain food and maintain body strength, and 2) he or she can tolerate the life-prolonging chemotherapy treatments.
At least eight published studies have confirmed the ability of cannabis and its psychoactive ingredient delta-9-THC to reduce nausea and vomiting. The first appeared in 1975 in The New England Journal of Medicine. It concluded, "THC is an effective anti-emetic for patients receiving cancer chemotherapy."
The Food and Drug Administration (FDA), in February, 1980 listed 33 studies of cannabis and nausea and vomiting. Most of these experiments involve efforts to determine the proper dosage of THC and several are comparative studies with other standard anti-emetics.
In New Mexico, a state sponsored study has shown the cannabis cigarette to be 30% more effective than THC in relieving nausea and vomiting. Another study, sponsored by the National Cancer Institute (NCI), discovered that inhaled cannabis resulted in a 71% efficacy rate, as opposed to 44% with oral delta-9-THC. These controlled studies have been fortified by "anecdotal" accounts from individuals who have abandoned legal access to THC because they prefer marijuana obtained illegally. These patients report that smoking marijuana seems to bring an almost instantaneous relief.
This is not a new finding. As early as May 1978, researches at a symposium sponsored by the National Cancer Institute (NCI) concluded, "All in all, the cigarette may be the best means of administering the drug."
In
September 1988 the chief administrative law judge of the Drug Enforcement Administration
ruled that marijuana has medical value in the treatment of side-effects caused
by cancer chemotherapy. His decision was over-ruled by the administrator of the
DEA and marijuana remains illegal for medical purposes.
Cancer Bibliography
Books
Marijuana Medical Papers, Tod Mikuriya, M.D. (ed.) Medi-Comp Press, (1972).
Cannabinoids as Therapeutic Agents, Raphael Mechoulam (ed.) CRC Press, (1986).
Cancer Treatment & Marijuana Therapy, Robert C. Randall (ed.), Galen Press, (1990).
Marihuana, The Forbidden Medicine, Lester Grinspoon, M.D. and James B. Bakalar, Yale University Press, (1993).
Marijuana and AIDS: Pot, Politics & PWAs in America, Robert C. Randall, Galen Press, (1991).
Journal Articles
Cancer Treatment Reports, 566, 589-592 (1982).
"Cannabinoids for Nausea," Lancet, January 31, 1981.
Carey, M.P., Burish, T.G., & Brenner, D.E., "Delta-9-THC in Cancer Chemotherapy: Research Problems and Issues," Annals of Internal Medicine, 99, 106-114 (1983).
Chang, A.E. et al. "Delta-9-Tetrahydrocannabinol as an Antiemetic in Cancer Patients Receiving High-dose Methotrexate," Annals of Internal Medicine, 91, 819-824 (1979).
Frytek, S. & Moertel, C.G. "Management of Nausea and Vomiting in Cancer Patients," Journal of the American Medical Association, 245:4, 393-396 (1981).
Harris, L., "Analgesic and Antitumor Potential of the Cannabinoids," The Therapeutic Potential of Marijuana, Cohen & Stillman (eds.), 299-305 (1976).
Harris, L., Munson, A. & Carchman, R "Anti-tumor Properties of Cannabinoids," The Pharmacology of Marihuana, Braude & Szara (eds.), 749-762 (1976).
Neidhart, J., Gagen, M., Wilson, H. & Young, D. "Comparative Trial of the Antiemetic Effects of THC and Haloperidol," Journal of Clinical Pharmacology, 21, 385-425 (1981).
Sallan, S.E., Zinberg, N., & Frei, E. "Antiemetic Effect of Delta-9-THC in Patients Receiving Cancer Chemotherapy," New England Journal of Medicine, 293:16, 795-797 (1975).
Sensky, T., Baldwin, A., & Pettingale, K. "Cannabinoids as Antiemetics," British Medical Journal, 286, 802 (1983).
Ungerleider, J., Andrysiak, T., et. al. "Cannabis and Cancer Chemotherapy: A Comparison of Oral Delta-9-THC and Prochlorperazine," Cancer, 50, 636-645 (1982).
Vinciguerra,
V., "Inhalation Marijuana as an Antiemetic of Cancer Chemotherapy," New York
State Journal of Medicine, 525-527, (October 1988).
Back to Top
Medical Use of Marijuana by Patients with Glaucoma
Glaucoma is an eye disease which afflicts more than four million Americans and is the leading cause of blindness in the United States. According to the National Society for Prevention of Blindness, there are 178,000 new cases of glaucoma diagnosed each year.Glaucoma can strike people of all ages but is most often found among those over 65. The most common form of glaucoma is chronic or open-angle glaucoma. It is characterized by increased pressure within the eye (intraocular pressure or IOP) which can cause damage to the optic nerve if not controlled effectively. Other types of glaucoma include narrow-angle and secondary. Treatment of narrow-angle glaucoma is primarily surgical. In approximately 90% of the open-angle and secondary glaucomas topical (eyedrop) preparations along with some oral medications can effectively control the disease, but at least 10% of all cases fail to be completely controlled by available prescriptive drugs. In some instances available glaucomic medications can cause side-effects such as headaches, kidney stones, burning of the eyes, blurred vision, cardiac arrhythmias, insomnia, and nervous anxiety. These side-effects may become so severe that the patient must discontinue use.
Marijuana has shown promise as a possible glaucoma treatment in numerous published studies. In controlled studies at UCLA, it was discovered that patients smoking marijuana experienced, on average, a 30% drop in eye pressure. The reduction was dose related and lasted 4 to 5 hours. Dr. Robert Hepler, principal investigator in the UCLA study, concluded that cannabis may be more useful than conventional medications and may reduce eye pressure in a way that conventional medications do not, thus making marijuana a potential additive to the glaucoma patient's regimen of available medication.
Tolerance to conventional medications is a common problem in glaucoma control. The use of marijuana for additional IOP reduction could eliminate the need for surgical intervention. Glaucoma surgery costs Americans an estimated $8.8 million per year.
Scientists have been working to develop a marijuana eyedrop for several years. Until recently, they concentrated on delta-9-THC, marijuana's psychoactive ingredient. Some researchers, however, have begun to wonder if other constituents in the cannabis plant might be more effective in reducing IOP. This theory is bolstered by the few glaucoma patients who have continued, legal access to marijuana. In these cases, synthetic THC is only effective for a short period of time. Natural marijuana, however, consistently lowers IOP.
A number of pharmaceutical companies are investigating drugs that are chemically similar to various constituents of cannabis for possible glaucomic applications. A West Indies pharmaceutical company has developed a synthetic marijuana eyedrop but this is unavailable in the U.S.
Glaucoma Bibliography
Books
Cannabinoids as Therapeutic Agents, Raphael Mechoulam (ed.) CRC Press, (1986).
Marijuana, Medicine, & The Law, Volumes I&II, R.C. Randall (ed.), Galen Press, (1988-1989).
Marihuana, The Forbidden Medicine, Lester Grinspoon, M.D. and James B. Bakalar, Yale University Press, (1993).
Scientific Journal Articles
Hepler, R.S. & Frank, I. "Marijuana Smoking and Intraocular Pressure," Journal of the American Medical Association, 217, 1392 (1971).
Hepler, R.S., Frank, I. & Ungerleider, J. "Pupillary Constriction After Marijuana Smoking," American Journal of Ophthalmology, 74, 1185-1190 (1972).
Shapiro, D. "The Ocular Manifestation of the Cannabinoids," Ophthalmologica, 168, 366-369 (1974).
Hepler, R.S. & Petrus, R. "Experiences With Administration of Marihuana to Glaucoma Patients," The Therapeutic Potential of Marijuana, Cohen & Stillman (eds.), 63-75 (1976).
Hepler, R.S., Frank, I. & Petrus, R. "Ocular Effects of Marihuana Smoking," Pharmacology of Marihuana, Braude & Szara (eds.), 815-824 (1976).
Perez-Reyes, M., Wagner, D., Wall, M.E. & Davis, K. "Intravenous Administration of Cannabinoids and Intraocular Pressure," The Pharmacology of Marihuana, Braude & Szara (eds.), 829-832 (1976).
Goldberg, I., Kass, M. & Becker, B. "Marijuana as a Treatment for Glaucoma," Sightsaving Review, Winter issue 147-154 (1978-79).
Crawford, W. & Merritt, J.C. "Effects of Tetrahydrocannabinol on Arterial and Intraocular Hypertension," International Journal of Clinical Pharmacology and Biopharmacology, 17, 191-196 (1979).
Merritt, J.C., Crawford, W., Alexander, P., Anduze, A. & Gelbart, S. "Effects of Marijuana on Intraocular and Blood Pressure in Glaucoma," Ophthalmology, 87, 222-228 (1980).
Merritt, J.C., McKinnon, S., Armstrong, J., Hatem, G. & Reid, L. "Oral Delta-9-Tetrahydrocannabinol in Heterogeneous Glaucomas," Annals of Ophthalmology, 12, No 8. (1980).
Zimmerman, T. "Efficacy in Glaucoma Treatment: The Potential of Marijuana," Annals of Ophthalmology, 444-450 (1980).
Merritt, J.C., Perry, D., Russell, D. & Jones, B. "Topical Delta-9-Tetrahydrocannabinol and Aqueous Dynamics in Glaucoma," Journal of Clinical Pharmacology, 21, 467S-471S (1981).
Merritt, J.C., et al. "Effects of Topical Delta-9-Tetrahydrocannabinol on Intraocular Pressure in Dogs," Glaucoma, Jan/Feb., 13-16 (1981).
Merritt, J.C., Olsen, J., Armstrong, J., McKinnon, S. "Topical Delta-9-Tetrahydrocannabinol in Hypertensive Glaucomas," Journal of Pharmacy & Pharmacology, 33, 40-41 (1981).
Merritt, J., Cook, C. & Davis, K. "Orthostatic Hypotension After Delta-9-Tetrahydrocannabinol Marijuana Inhalation," Ophthalmic Research, 14, 124-128 (1982).
Merritt, J. et al. "Topical Delta-8-Tetrahydrocannabinol as a Potential Glaucoma Agent," Glaucoma, 4, 253-255 (1982).
Merritt, J. "Outpatient Cannabinoid Therapy for Heterogenous Glaucomas: Guidelines for Institution and Maintenance of Therapy," Marijuana '84: Proceedings of the Oxford Symposium on Cannabis, 681-683 (1984).
Merritt,
J.C., Shrewsbury, R., Locklear, F., Demby, K. & Wittle, G. "Effects of Delta-9-Tetrahydrocannabinol
and Vehicle Constituents on Intraocular Pressure in Normotensive Dogs," Research
Communications in Substances of Abuse, 7, 29-35 (1986).
Back to Top
Medical
Use of Marijuana for Spasticity
Cannabis
(marijuana) has demonstrated particular success in the treatment of muscular spasticity
disorders.
In 1839, Dr. William B. O'Shaughnessy was greatly impressed with the plant's muscle relaxant and anti-convulsant properties, stating his belief that in cannabis, "The (medical) profession has gained an anti-convulsive remedy of the greatest value."
An historical account alluding to the use of cannabis in the treatment of spasticity can be found in a March 22, 1890, issue of The Lancet. An article written by Dr. J. Russell Reynolds (physician to Queen Victoria) noted, "There are many cases of so called epilepsy in adults but which, in my opinion (are) the result of organic disease of a gross character in the nervous centers, in which India hemp (cannabis) is the most useful agent with which I am acquainted." Dr. Reynolds may well have been referring to multiple sclerosis (MS). The first written record of MS is noted between 1880-85.
Muscular spasticity is a common condition, affecting more than one million persons in the United States. It afflicts individuals with multiple sclerosis, stroke, cerebral palsy, paraplegia, quadriplegia, and spinal cord injuries. Current medical therapy is woefully inadequate for those individuals suffering from spasticity problems. Phenobarbital and diazepam (Valium) are commonly prescribed drugs but many patients develop a tolerance to these medications, can become addicted to the drug, or complain of heavy sedation.
Dunn and Davis reported in a 1974 issue of Paraplegia magazine that ten patients admitted using marijuana for spinal cord injury, "with perceived decrease in pain and spasticity." These anecdotal and historical accounts of marijuana's effectiveness in treating spasticity have led to a few controlled studies. Dr. Denis Petro and Dr. Carl Ellenberger completed a pilot study of the effects of delta-9 THC on multiple sclerosis patients in 1979. Seven of nine patients responded favorably to treatment with delta-9-THC. Dr. Petro reports hearing from more than one hundred individuals with spasticity problems who report relief from the use of marijuana.
The
continued classification of marijuana as a Schedule I drug has greatly impeded
research with the drug. Nevertheless, a significant
number of studies have been conducted leading Chief Administrative Law Judge
Francis Young of the DEA to conclude in September 1988 that marijuana's medical
benefits in the treatment of spasticity is "beyond question" and recommended rescheduling
of the drug to allow prescriptive access. Unfortunately Judge Young's ruling was
rejected by the administrator of the DEA.
Spasticity Bibliography
Books
Cannabinoids as Therapeutic Agents, Raphael Mechoulam (ed.) CRC Press, (1986).
Muscle Spasm, Pain & Marijuana Therapy, Robert C. Randall, Galen Press (1990).
Marihuana,
The Forbidden Medicine, Lester Grinspoon, M.D. and James B. Bakalar, Yale
University Press, (1993).
Scientific Journal Articles
Borg, J., Gershon, S. & Alpert, M. "Dose Effects of Smoking Marihuana on Human Cognitive and Motor Functions," Psychopharmacologia, 42, 211-218 (1975).
Dunn, M. & Ross, D. "The Perceived Effects of Marijuana on Spinal Cord Injured Males," Paraplegia, 12, 175 (1974).
Hanigan, W.C., Destree, R., Truong, X.T. "The Effects of Delta-9-THC on Human Spasticity," Journal of the American Society of Clinical Pharmacology & Therapeutics, 198 (Feb. 1986).
Manno, J. E., et.al. "Comparative Effects of Smoking Marihuana or Placebo on Human Motor & Mental Performance," Clinical Pharmacology & Therapeutics, 11:6, 808-815 (1970).
Meinck, H.M., et.al. "Effect of Cannabinoids on Spasticity and Ataxia in Multiple Sclerosis," Journal of Neurology, 236:120-22 (1989).
Petro, D. & Ellenberger, C. Jr.. "Treatment of Human Spasticity with Delta-9-Tetrahydrocannabinol," Journal of Clinical Pharmacology, 21:8&9, 413S-416S (1981).
Petro, D. "Marijuana as a Therapeutic Agent for Muscle Spasm or Spasticity," Psychosomatics,21:1, 81-85 (1980).
Sandyk, R., Consroe, P., Stern, L.Z. & Snider, S.R. "Effects of Cannabinoid in Huntington's Disease," Neurology, 36, 342 (1986).
Truong, X.T., & Hanigan, W.C. "Effect of Delta-9THC on EMG Measurements in Human Spasticity," Journal of the American Society of Clinical Pharmacology & Therapeutics, 232 (Feb. 1986).
Weil,
A., Zinberg, N. & Nelsen, J. "Clinical & Psychological Effects of Marijuana
in Man," Science, 162, 1234-1242 (1968).