Medical Marijuana Debate Forum - MEDICAL MARIJUANA- The Debate Continues

Rebecca Roth,MD
Marijuana has been hailed as a prescription for many ills and physicians once used it to stimulate appetite, relieve chronic pain, and treat asthma and migraines. But is marijuana really a medical miracle? If so, do its clinical benefits outweigh its drawbacks? Should we legalize marijuana? Is medical marijuana really worth the risks? These are the issues one needs to think about before making the decision to legalize marijuana.

Marijuana is a drug that is derived from the dried and cut leaves of the hemp plant known as "cannabis sativa". Marijuana has a variety of street names such as "grass", "Mary Jane", "pot", "smoke", "reefer", "herb", and "weed". The active ingredient in marijuana is delta tetrahydrocannabinol (THC) (3). . Marijuana has been used throughout history and in many different cultures to change mood, perception, and consciousness (to get "high"). Its effects range from increasing creativity to provoking mystical experiences, to heightening the capacity to feel, sense and share. After alcohol, it is the most popular of what are called "recreational drugs." It has been used around the world for other purposes. In some primitive tribes of South America, Africa, and India, "cannabis" is used in religious ceremonies and for medical purposes. African mine workers have used it to ease the drudgery of their work and many Jamaicans use it at the end of the day to relieve fatigue. It has been used as an intoxicant in various parts of the world for centuries and in the United States, for the most part the 20th century. Marijuana was first described in print in a Chinese book of medicine, "Herbal," in the 2nd century B.C., and was used in China as an anesthetic 5,000 years ago. The ancient Assyrians, Persians, Greeks, Romans, and East Indians used the drug to control muscle spasms, reduce pain, and to treat indigestion. It was commonly used in folk medicines in Africa and Asia. As early as 1611, marijuana was cultivated for its fiber in Jamestown, Virginia. In 19th century America, marijuana was used by the medical profession for treating spastic conditions, headaches, labor pains, insomnia, and menstrual cramps. It is still used as a medicine in the Middle East and in Asia (9).

The controversy dealing with marijuana stems from the legalization of the drug for medical use. The written record on medicinal marijuana stretches back over 2,000 years. Yet after hundreds of studies, experiments and reports, there is still no consensus about its effects. Wildly emotional arguments rage about whether or not marijuana should be considered a legitimate medicine (2). Can marijuana relieve health problems? Is it safe for medical use? Scientific data on controversial subjects are commonly misinterpreted, overinterpreted, and misrepresented (1). Marijuana plants have been used for both herbal medication and intoxication. The current debate over the medical use of marijuana is essentially a debate over the value of its medicinal properties relative to the risk posed by its use (1). Is there a possibility that the dying may be able to use marijuana as a form of pain relief? The controversy still reigns on within congress and the medical community.

"There is not a shred of scientific evidence that smoked marijuana is useful or needed." -- U.S. Drug Czar, Gen. Barry McCaffrey, Aug. 16, 1996

"Marijuana is the safest therapeutically active substance known to man... safer than many foods we commonly consume." -- DEA Judge Francis L. Young, Sept. 6, 1988

To date, marijuana is still classified as an illegal Schedule 1 drug by the Controlled Substances Act. It is defined as having "no accepted medical use in treatment in the United States." However, many states have recognized that medical marijuana does have medicinal uses. According to the Alliance for Cannabis Therapeutics, thirty- four states have recognized the value of marijuana for medical conditions (4).

What is the supporting evidence that marijuana can be used for pain relief? Advocates contend that marijuana can alleviate symptoms of AIDS, cancer and other illnesses, but opponents maintain that patients have other alternatives and that legalizing drugs sets a dangerous precedent.

Proponents of legalizing medical marijuana contend that it is wrong to deny patients relief from the pain of debilitating disease. A study by the Institute of Medicine released in March of 1999 found that marijuana:

* Holds particular promise for alleviating nausea and vomiting in people undergoing chemotherapy.

* Shows potential for improving severe weight loss (wasting) caused by AIDS.

* Holds usefulness for chronic pain that does not respond to traditional opoids (Morphine, etc.).

Scientists at the University of California at San Francisco found that a marijuana-like drug deadens pain in rats by interacting with the same pain modulating area of the brain activated by morphine. The findings may show that cannabinoids, which include marijuana's active ingredient THC, are potent analgesics that deliver true pain relief (5). Recently, new information has emerged from studies by federal researchers at the National Institutes of Mental Health. Their reports have stated that THC and cannabidiol (CBD), a nonpsychoactive component, both appear to protect brain cells from the damage that often occurs during a stroke. When the brain's blood supply is cut, as occurs during a stroke, THC and CBD act as powerful antioxidants, protecting the brain cells from exposure to toxic levels of the brain chemical called glutamate. This finding also indicates that marijuana may hold medical value in the treatment of brain injuries and diseases such as Alzheimer's and Parkinson's (11).

Research on the medical uses of marijuana is scheduled to begin early next year. For the first time in nearly two decades, the government has approved new experiments to test whether smoking it can help patients who have multiple sclerosis or who suffer from pain in their limbs as a result of AIDS. The new approvals, granted on Nov. 28, 2001 by the Drug Enforcement Administration, do not make it legal for doctors to give their patients marijuana as treatment. They merely provide for limited use in scientific experiments. In some states, state law allows doctors to prescribe or recommend marijuana; federal law prohibits the practice, however, even in those states ( Cool

. After the passage of these proposals, scientific committees at the government-chartered Institute of Medicine and at the National Institutes of Health reported that there was little evidence that marijuana had medical usefulness, but that rigorous studies would be worthwhile. The coming experiments will compare the effects of marijuana cigarettes with the effects of placebo cigarettes (those with the active ingredients of marijuana removed).

Experiments using marijuana to stimulate appetite and prevent nausea were conducted in the United States until the early 1980's. After that, disapproving attitudes in the federal government and among research agencies led scientists to believe that financing of medical marijuana studies would be difficult to find. But after the referendums in California and Arizona in 1996, the focus shifted to the question of whether such medical use could be supported by scientific evidence ( Cool

.

There are many people who do not want the legalization of marijuana. They point to the drawbacks that marijuana has. There are the concerns that legalization can make marijuana more available for abuse, especially by children. In addition, many feel that there is still little proof that marijuana has any medicinal value. Two adequate and well-controlled studies in cancer pain compared graded doses of oral 9-THC to placebo, and one of these included graded doses of codeine as a control. Although there was evidence of analgesic efficacy, the studies indicate there is a narrow therapeutic margin between the doses that produce useful analgesia and those producing unacceptable adverse CNS effects. Many believe that there is little future for or benefit from smoked marijuana as a medically approved medication (6).

In Amsterdam, Holland, where marijuana is legal, crime and hard drug use remains a problem (7). Marijuana has serious harmful effects on the skills required to drive safely: alertness, the ability to concentrate, coordination, and the ability to react quickly. These effects can last up to 24 hours after smoking marijuana. Marijuana use can make it difficult to judge distances and react to signals and sounds on the road. While not everyone who uses marijuana becomes addicted, when a user begins to seek out and take the drug compulsively, that person is said to be dependent or addicted to the drug. In 1995, 165,000 people entering drug treatment programs reported marijuana as their primary drug of abuse, showing they need help to stop using the drug (10).

As one can see, there have been many debates over the legalization of marijuana. These debates are likely to continue. In many different cultures, marijuana has been used through the years to treat various medical conditions. Even in 19th century America, marijuana was used by doctors to treat pain. Sometimes we can learn from the past. Not all of our new drugs are better than the old. Some have proven to be quite toxic. At the very least, marijuana should be moved to a Schedule II drug (a useful drug that can be prescribed by a doctor). If marijuana can bring any amount of relief to the sick or dying, it should be given to them. We need further studies to determine if marijuana has any medicinal value. The legalization of marijuana would make it easier to fund and conduct these studies. Science and medicine should determine the question of whether marijuana has any legitimate medical purpose. The United States should do more to encourage legal and open exploration of marijuana's potential, at least among physicians and researchers.

WWW Sources
1)Institute of Medicine, Marijuana and Medicine

2)The Science of Medical Marijuana, Why is there so much controversy?

3)Pros and Cons of Marijuana Use ,

4)Medical Marijuana , Pain Management for the Dying

5)Medical Marijuana , The Pros

6)Medical Marijuana, The Cons

7)Schaffer Library of Drug Policy ,

8)Marijuana Research is Set After Two Decade Halt, New York Times Article, Nov. 28th, 2001

9)History of Marijuana,