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'''Medical cannabis''', (commonly referred to as "'''Medical marijuana'''"), refers to the use of the ''[[cannabis]]'' plant as a physician-recommended [[Cannabis (drug)|drug]] or [[herbal therapy]], as well as synthetic [[THC]] and other [[cannabinoids]].
'''Medical cannabis''', (commonly referred to as "'''Medical marijuana'''"), refers to the use of the ''[[cannabis]]'' plant as a physician-recommended [[Cannabis (drug)|drug]] or [[herbal therapy]], as well as synthetic [[THC]] and other [[cannabinoids]].
There are many studies regarding the use of cannabis in a medicinal context.<ref>{{cite web|url=http://www.nap.edu/openbook.php?record_id=6376&page=13 |title=Marijuana and Medicine: Assessing the Science Base |publisher=Nap.edu |date= |accessdate=2009-04-26}}</ref><ref name="medmjscience1"/> Drug usage generally requires a prescription, and distribution is usually done within a framework defined by local laws. There are several methods for administration of dosage including vaporizing, drinking, eating and smoking the dried cannabis buds and extracts, or taking synthetic THC pills.<ref>{{cite web|url=http://cannabismd.org/reports/mjcapsules.php |title=CannabisMD Reports : Marijuana in Capsules |publisher=Cannabismd.org |date= |accessdate=2009-04-26}}</ref><ref>{{cite web|url=http://michiganmedicalmarijuana.org/node/1030 |title=Methods of ingestion &#124; Michigan Medical Marijuana Association &#124; News and Information for Michigan's medical marijuana patients and caregivers |publisher=Michiganmedicalmarijuana.org |date= |accessdate=2009-04-26}}</ref> The comparible efficacy of these methods was the subject of an investigative study by the [[National Institutes of Health]].<ref name="medmjscience1">{{cite web|url=http://www.medmjscience.org/Pages/reports/nihpt1.html |title=NIH Workshop on the Medical Utility of Marijuana - Part 1 |publisher=Medmjscience.org |date= |accessdate=2009-04-26}}</ref>
There are many studies regarding the use of cannabis in a medicinal context.<ref>{{cite web|url=http://www.nap.edu/openbook.php?record_id=6376&page=13 |title=Marijuana and Medicine: Assessing the Science Base |publisher=Nap.edu |date= |accessdate=2009-04-26}}</ref><ref name="medmjscience1"/> Drug usage generally requires a prescription, and distribution is usually done within a framework defined by local laws. There are several methods for administration of dosage including vaporizing or smoking dried cannabis buds, drinking or eating cannabis extracts,and taking synthetic THC pills.<ref>{{cite web|url=http://cannabismd.org/reports/mjcapsules.php |title=CannabisMD Reports : Marijuana in Capsules |publisher=Cannabismd.org |date= |accessdate=2009-04-26}}</ref><ref>{{cite web|url=http://michiganmedicalmarijuana.org/node/1030 |title=Methods of ingestion &#124; Michigan Medical Marijuana Association &#124; News and Information for Michigan's medical marijuana patients and caregivers |publisher=Michiganmedicalmarijuana.org |date= |accessdate=2009-04-26}}</ref> The comparible efficacy of these methods was the subject of an investigative study by the [[National Institutes of Health]].<ref name="medmjscience1">{{cite web|url=http://www.medmjscience.org/Pages/reports/nihpt1.html |title=NIH Workshop on the Medical Utility of Marijuana - Part 1 |publisher=Medmjscience.org |date= |accessdate=2009-04-26}}</ref>


Medicinal use of cannabis is legal in a limited number of territories worldwide, including [[Canada]], [[Austria]], the [[Netherlands]], [[Spain]], [[Israel]], [[Finland]] and [[Portugal]]. In the US, fourteen states have recognized medical marijuana: [[Alaska]], [[California]], [[Colorado]], [[Hawaii]], [[Maine]], [[Michigan]], [[Montana]], [[Nevada]], [[New Jersey]], [[New Mexico]], [[Oregon]], [[Rhode Island]], [[Vermont]] and [[Washington]].<ref>[http://medicalmarijuana.procon.org/viewresource.asp?resourceID=000881 13 Legal Medical Marijuana States: Laws, Fees, and Possession Limits"], ProCon.org. Retrieved April 21, 2009.</ref><ref>{{cite web|url=http://rawstory.com/news/2008/Portugals_drug_decriminalization_bizarrely_underappreciated_Greenwald_0406.html |title=Portugal's drug decriminalization 'bizarrely underappreciated': Greenwald |publisher=The Raw Story |date=2009-04-06 |accessdate=2009-04-26}}</ref>
Medicinal use of cannabis is legal in a limited number of territories worldwide, including [[Canada]], [[Austria]], the [[Netherlands]], [[Spain]], [[Israel]], [[Finland]] and [[Portugal]]. In the US, fourteen states have recognized medical marijuana: [[Alaska]], [[California]], [[Colorado]], [[Hawaii]], [[Maine]], [[Michigan]], [[Montana]], [[Nevada]], [[New Jersey]], [[New Mexico]], [[Oregon]], [[Rhode Island]], [[Vermont]] and [[Washington]].<ref>[http://medicalmarijuana.procon.org/viewresource.asp?resourceID=000881 13 Legal Medical Marijuana States: Laws, Fees, and Possession Limits"], ProCon.org. Retrieved April 21, 2009.</ref><ref>{{cite web|url=http://rawstory.com/news/2008/Portugals_drug_decriminalization_bizarrely_underappreciated_Greenwald_0406.html |title=Portugal's drug decriminalization 'bizarrely underappreciated': Greenwald |publisher=The Raw Story |date=2009-04-06 |accessdate=2009-04-26}}</ref>

Revision as of 01:25, 19 May 2009

Cannabis Indica (now referred to as Cannabis sativa subsp. indica),[1] Fluid Extract, American Druggists Syndicate, pre-1937.

Medical cannabis, (commonly referred to as "Medical marijuana"), refers to the use of the cannabis plant as a physician-recommended drug or herbal therapy, as well as synthetic THC and other cannabinoids. There are many studies regarding the use of cannabis in a medicinal context.[2][3] Drug usage generally requires a prescription, and distribution is usually done within a framework defined by local laws. There are several methods for administration of dosage including vaporizing or smoking dried cannabis buds, drinking or eating cannabis extracts,and taking synthetic THC pills.[4][5] The comparible efficacy of these methods was the subject of an investigative study by the National Institutes of Health.[3]

Medicinal use of cannabis is legal in a limited number of territories worldwide, including Canada, Austria, the Netherlands, Spain, Israel, Finland and Portugal. In the US, fourteen states have recognized medical marijuana: Alaska, California, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont and Washington.[6][7]

There are currently five US states considering medical marijuana bills in their state legislatures: Illinois, Minnesota, New Hampshire, New Jersey and New York.[8]

Cannabis has a long history of medicinal use in many cultures. The US Government as represented by the Health and Human Services Division, holds a patent for medical marijuana.[9] Yet, medical cannabis remains a controversial issue worldwide.

Indications

Partial list of clinical applications

"Victoria", the United States' first legal medical marijuana plant grown by The Wo/Men's Alliance for Medical Marijuana [10].

Medical cannabis specialist Dr. Tod Mikuriya recorded over 250 indications for medical cannabis,[11] as classified by the International Classification of Diseases (ICD-9).[12]

In a 2002 review of medical literature, medical cannabis was shown to have established effects in the treatment of nausea, vomiting, PMS, unintentional weight loss, and lack of appetite. Other "relatively well-confirmed" effects were in the treatment of "spasticity, painful conditions, especially neurogenic pain, movement disorders, asthma, [and] Glaucoma".[13]

Preliminary findings indicate that cannabis-based drugs could prove useful in treating Inflammatory Bowel Disease (consisting of Crohn's Disease and Ulcerative Colitis),[14] Migraines, Fibromyalgia and related conditions.[15]

Medical cannabis has also been found to relieve certain symptoms of multiple sclerosis[16] and spinal cord injuries by exhibiting antispasmodic and muscle relaxant properties as well as stimulating appetite. Clinical trials provide evidence that THC reduces motor and vocal tics of Tourette’s syndrome and related behavioral problems such as obsessive-compulsive disorders.[17][18]


Other studies have shown cannabis to be useful in treating: Alcoholism,[19] ADD[20] ALS (Lou Gehrig's disease),[21][22] Collagen-Induced Arthritis (CIA),[23] Rheumatoid Arthritis,[24] Asthma,[25] Atherosclerosis[26] Autism,[27] Bipolar Disorder,[28][29][30] Childhood Mental Disorders,[31] Colorectal Cancer,[32] Depression,[33][34][35][36] Diabetic Retinopathy,[37][38][39] Dystonia,[40][41] Epilepsy,[42] Gastrointestinal Disorders,[43][44] Gliomas,[45][46] Hepatitis C,[47][48] Huntington's Disease,[49] Hypertension,[50][51] Incontinence,[52] Leukemia,[53] Skin Tumors,[54][55] Morning Sickness,[56][57] MRSA (Drug-Resistant Staph Infections),[58][59][60] Parkinson's,[61] Pruritus,[62][63] PTSD (Post Traumatic Stress Disorder),[64][65][66] Sickle Cell Disease,[67] and Sleep Apnea.[68][69]

Recent studies

Alzheimer's Disease

Research done by the Scripps Research Institute in California shows that the active ingredient in marijuana, THC, may prevent the formation of deposits in the brain associated with Alzheimer's disease. THC was found to prevent an enzyme called acetylcholinesterase from accelerating the formation of "Alzheimer plaques" in the brain more effectively than commercially marketed drugs. THC is also more effective at blocking clumps of protein that can inhibit memory and cognition in Alzheimer’s patients, as reported in Molecular Pharmaceutics.[70][71]

Neuron growth

A Canadian study shows Marijuana promotes neuron growth. The Neuropsychiatry Research Unit at the University of Saskatchewan suggests the drug could have some benefits when administered regularly in a highly potent form. Whereas most "social drugs" such as alcohol, heroin, cocaine and nicotine suppress growth of new brain cells, the researchers found that cannabinoids promoted generation of new neurons in rats' hippocampi. The study held true for either plant-derived or synthetic versions of cannabinoids. The findings were published in the 2005 November issue of the Journal of Clinical Investigation.[72]

Lung cancer and COPD

THC has been found to reduce tumor growth in common lung cancer by 50 percent and to significantly reduce the ability of the cancer to spread, say researchers at Harvard University, who tested the chemical in both lab and mouse studies. The researchers suggest that THC might be used in a targeted fashion to treat lung cancer. [73]

In 2006, Donald Tashkin, M.D., of the University of California in Los Angeles, presented the results of his study, Marijuana Use and Lung Cancer: Results of a Case-Control Study. Tashkin found that smoking marijuana does not appear to increase the risk of lung cancer or head-and-neck malignancies, even among heavy users. The more tobacco a person smoked, the greater their risk of developing lung cancer and other cancers of the head and neck. But people who smoked more marijuana were not at increased risk compared with people who smoked less and people who didn’t smoke at all.[74] Marijuana use was associated with cancer risk ratios below 1.0, indicating that a history of pot smoking had no effect on the risk for respiratory cancers. In contrast, tobacco smoking had a 21-fold risk for cancer. Tashkin concluded, "It's possible that tetrahydrocannabinol (THC) in marijuana smoke may encourage apoptosis, or programmed cell death, causing cells to die off before they have a chance to undergo malignant transformation".[75][76]

Similar findings were released in April 2009 by the Vancouver Burden of Obstructive Lung Disease Research Group. The study presents that smoking both tobacco and marijuana synergistically increased the risk of respiratory symptoms and COPD. Smoking only marijuana, however, was not associated with an increased risk of respiratory symptoms of COPD.[77][78] In a related commentary, Dr. Donald Tashkin writes that "we can be close to concluding that marijuana smoking by itself does not lead to COPD".[79]

Breast cancer

According to a 2007 study by scientists at the California Pacific Medical Center Research Institute, a compound found in cannabis may stop breast cancer from spreading throughout the body.[80][81] The scientists believe their discovery may provide a non-toxic alternative to chemotherapy while achieving the same results minus the painful and unpleasant side effects. The research team say that cannabidiol or CBD works by blocking the activity of a gene called Id-1, which is believed to be responsible for a process called metastasis, which is the aggressive spread of cancer cells away from the original tumor site.[82]

HIV/AIDS

Investigators at Columbia University published clinical trial data in 2007 showing that HIV/AIDS patients who inhaled cannabis four times daily experienced substantial increases in food intake with little evidence of discomfort and no impairment of cognitive performance. They concluded that smoked marijuana has a clear medical benefit in HIV-positive patients.[83][84] In another study in 2008, researchers at the University of California, San Diego School of Medicine found that marijuana significantly reduces HIV-related neuropathic pain when added to a patient's already-prescribed pain management regimen and may be an "effective option for pain relief" in those whose pain is not controlled with current medications. Mood disturbance, physical disability, and quality of life all improved significantly during study treatment.[85][86] No serious adverse effects were reported, according to the study published by the American Academy of Neurology.[87]

Brain cancer

A study by Complutense University of Madrid found the active chemical in marijuana promotes the death of brain cancer cells by essentially helping them feed upon themselves in a process called autophagy. The research team discovered that cannabinoids such as THC had anticancer effects in mice with human brain cancer cells and in people with brain tumors. When mice with the human brain cancer cells received the THC, the tumor shrank. Using electron microscopes to analyze brain tissue taken both before and after a 26- to 30-day THC treatment regimen, the researchers found that THC eliminated cancer cells while leaving healthy cells intact.[88] The patients did not have any toxic effects from the treatment; previous studies of THC for the treatment of cancer have also found the therapy to be well tolerated. However, the mechanisms which promote THC's tumor cell–killing action are unknown.[89]

The researchers believe their findings may have therapeutic implications in the treatment of cancer, as detailed in their study, Cannabinoid action induces autophagy-mediated cell death through stimulation of ER stress in human glioma cells,[90] which appeared in the April 2009 issue of the Journal of Clinical Investigation.

Head Injuries

Medical Marijuana has been shown to display neuroprotective properties with the 2-Arachidonoyl glycerol compound. This compound has been shown in lab experiments with mice to lower the amount of secondary damages from head injuries and speed up recovery time and effectiveness.[91]

Indication Benefit
Alzheimer's
Prevents formation of "Alzheimer plaques"
Arthritis
Analgesic, antiinflammatory
Asthma
Opens up airways in lungs
Brain Cancer
Reduces tumors, kills cancer cells
Breast Cancer
Stops cancer from spreading
Depression
Brightens mood
Glaucoma
Reduces eye pressure
Head Injuries
Neuroprotective properties, speeds recovery time
HIV
Reduces neuropathic pain, improves appetite and sleep
Hypertension
Lowers blood pressure
Lung Cancer
Reduces tumors, slows cancer growth
Pain
Non-opiate, non-addictive pain killer

Medicinal compounds

Cannabidiol has many positive effects.
β-Caryophyllene has important anti-inflammatory properties.

Cannabidiol

Main article: cannabidiol

Cannabidiol, also known as "CBD", is a major constituent of medical cannabis. CBD represents up to 40% of extracts of the medical cannabis plant.[92] Cannabidiol relieves convulsion, inflammation, anxiety, nausea, and inhibits cancer cell growth.[93] Recent studies have shown cannabidiol to be as effective as atypical antipsychotics in treating schizophrenia.[94] In November 2007 it was reported that CBD reduces growth of aggressive human breast cancer cells in vitro and reduces their invasiveness. It thus represents the first non-toxic exogenous agent that can lead to down-regulation of tumor aggressiveness.[95][96] It is also a neuroprotective antioxidant.[97]

β-Caryophyllene

Main article: beta-Caryophyllene

Part of the mechanism by which medical cannabis has been shown to reduce tissue inflammation is via a compound called β-caryophyllene.[98] A cannabinoid receptor called CB2 plays a vital part in reducing inflammation in humans and other animals.[98] β-Caryophyllene has been shown to be a selective activator of the CB2 receptor.[98] β-Caryophyllene is especially concentrated in cannabis essential oil, which contains about 12–35% β-caryophyllene.[98]

Pharmacologic THC and THC derivatives

In the USA, the FDA has approved two cannabinoids for use as medical therapies: dronabinol (Marinol) and nabilone. It is important to note that these medicines are not smoked. Dronabinol is a synthetic THC medication,[99] while nabilone is a synthetic cannabinoid marketed under the brand name Cesamet.

These medications are usually used when first line treatments for nausea fail to work. In extremely high doses and in rare cases there is a possibility of "psychotomimetic" side effects. The other commonly-used antiemetic drugs are not associated with these side effects.

The prescription drug Sativex, an extract of cannabis administered as a sublingual spray, has been approved in Canada for the adjunctive treatment (use along side other medicines) of both multiple sclerosis[100] and cancer related pain.[101] This medication may now be legally imported into the United Kingdom and Spain on prescription.[102] Dr. William Notcutt is one of the chief researchers that has developed Sativex, and he has been working with GW and founder Geoffrey Guy since the company's inception in 1998. Notcutt states that the use of MS as the disease to study "had everything to do with politics."[103]

Scientists are also working on drugs that prevent naturally occurring enzymes from blocking pain-relieving cannabinoid receptors such as 2-arachidonoylgylcerol (2-AG).[104]

Medication Year approved Licensed indications Cost
Nabilone 1985 Nausea of cancer chemotherapy that has failed to respond adequately to other antiemetics $4000.00 U.S. for a year's supply (in Canada)[105]
Marinol 1992 Nausea of cancer chemotherapy that has failed to respond adequately to other antiemetics, AIDS wasting $723.16 U.S. for 30 doses @ 10 mg online[106]
Sativex 1995, 1997 The product is approved in Canada as adjunctive treatment for the symptomatic relief of neuropathic pain in multiple sclerosis, and more recently for pain due to cancer. Extracted from cannabis plants. $9,351 Canadian per year[107]

History

Ancient China & ancient Taiwan

The use of cannabis, at least as fiber, has been shown to go back at least 10,000 years in Taiwan. "Dà má" (Pinyin pronunciation) is the Chinese expression for cannabis, the first character meaning "big" and the second character meaning "hemp," a pictograph of two cannabis plants inside of a house or sheltered area.
Cannabis sativa from Vienna Dioscurides, 512 A.D.

Cannabis, called dà má (大麻) in Chinese, is known to have been used in Taiwan for fiber starting about 10,000 years ago.[108] Cannabis has been used for medicinal purposes for approximately 4,000 years.[109] In the early 3rd century AD, Hua Tuo was the first known person in China to use cannabis as an anesthetic. He reduced the plant to powder and mixed it with wine for administration.[110] Cannabis was prescribed to treat vomiting, plus infectious and parasitic hemorrhaging. Cannabis is one of the 50 "fundamental" herbs in traditional Chinese medicine.[111]

Ancient Egypt

The Ebers Papyrus (ca. 1,550 B.C.) from Ancient Egypt describes medical marijuana.[112] Other ancient Egyptian papyri that mention medical marijuana are the Ramesseum III Papyrus (1700 BC), the Berlin Papyrus (1300 BC) and the Chester Beatty Medical Papyrus VI (1300 BC).[113] The ancient Egyptians even used hemp (cannabis) in suppositories for relieving the pain of hemorrhoids.[114] The egyptologist Lise Manniche notes the reference to "plant medical marijuana" in several Egyptian texts, one of which dates back to the eighteenth century B.C.[115]

Ancient India

Surviving texts from ancient India confirm that cannabis' psychoactive properties were recognized, and doctors used it for a variety of illnesses and ailments. These included insomnia, headaches, a whole host of gastrointestinal disorders, and pain: cannabis was frequently used to relieve the pain of childbirth.[116]

Ancient Greece

The Ancient Greeks used cannabis not only for human medicine, but also for veterinary medicine.[117] The Greeks used cannabis to dress wounds and sores on their horses.[117]

In humans, dried leaves of cannabis were used to treat nose bleeds, and cannabis seeds were used to expel tapeworms.[117] The most frequently described use of cannabis in humans was to steep green seeds of cannabis in either water or wine, later taking the seeds out and using the warm extract to treat inflammation and pain resulting from obstruction of the ear.[117]

In the 5th century BCE Herodotus, a Greek historian, described how the Scythians of the Middle East used cannabis in steam baths.[117]

Medieval Islamic world

In the medieval Islamic world, Arabic physicians made use of the diuretic, antiemetic, antiepileptic, anti-inflammatory, pain killing and antipyretic properties of Cannabis sativa, and used it extensively as medication from the 8th to 18th centuries.[118]

Modern science

An Irish doctor, William Brooke O'Shaughnessy, was held mainly responsible for showing his Western colleagues about the healing properties of marijuana. He was an herb professor at the Medical College of Calcutta, and conducted a marijuana experiment in the 1830s. O'Shaughnessy created preparations and tested animal effects. He continued on to administer this marijuana to patients in order to help treat muscle spasms/stomach cramps or general pain.[119]

An advertisement for cannabis americana distributed by a pharmacist in New York in 1917.

Cannabis as a medicine became common throughout much of the world by the 19th century. It was used as the primary pain reliever until the invention of aspirin.[109] Modern medical and scientific inquiry began with doctors like O'Shaughnessy and Moreau de Tours, who used it to treat melancholia and migraines, and as a sleeping aid, analgesic and anticonvulsant.

By the time the United States banned cannabis in a federal law, the 1937 Marijuana Tax Act, the plant was no longer extremely popular.[120][citation needed] Skepticism about marijuana arose in response to the bill. [citation needed] The situation was exacerbated by the stereotypes promoted by the media, that the drug was used primarily by Mexican and African immigrants.[120]

Later in the century, researchers investigating methods of detecting cannabis intoxication discovered that smoking the drug reduced intraocular pressure.[121]

In 1972 Tod H. Mikuriya, M.D. reignited the debate concerning marijuana as medicine when he published "Marijuana Medical Papers." High intraocular pressure causes blindness in glaucoma patients, so many believed that using the drug could prevent blindness in patients. Many Vietnam War veterans also believed that the drug prevented muscle spasms caused by battle-induced spinal injuries.[122] Later medical use has focused primarily on its role in preventing the wasting syndromes and chronic loss of appetite associated with chemotherapy and AIDS, along with a variety of rare muscular and skeletal disorders. Less commonly, cannabis has been used in the treatment of alcoholism and addiction to other drugs such as heroin and the prevention of migraines. In recent years, studies have shown or researchers have speculated that the main chemical in the drug, THC, might help prevent atherosclerosis.

Medical cannabis card in Marin County, California, U.S.A.

Later, in the 1970s, a synthetic version of THC, the primary active ingredient in cannabis, was synthesized to make the drug Marinol. Users reported several problems with Marinol, however, that led many to abandon the pill and resume smoking the plant. Patients complained that the violent nausea associated with chemotherapy made swallowing pills difficult. The effects of smoked cannabis are felt almost immediately, and is therefore easily dosed.[123] Marinol (Jojel), like ingested cannabis, is very psychoactive, and is harder to titrate than smoked cannabis.[124] Marinol has also consistently been more expensive than herbal cannabis.[125] Some studies have indicated that other chemicals in the plant may have a synergistic effect with THC.[126]

In addition, during the 1970s and 1980s, six U.S. states' health departments performed studies on the use of medical marijuana. These are widely considered some of the most useful and pioneering studies on the subject.[citation needed] Voters in eight states showed their support for marijuana prescriptions or recommendations given by physicians between 1996 and 1999, including Alaska, Arizona, California, Colorado, Maine, Michigan, Nevada, Oregon, and Washington, going against policies of the federal government.[127]

Cannabis female flowers closeup with trichomes (white). These plant parts contain the highest concentration of medicinal compounds.

In May 2001, "The Chronic Cannabis Use in the Compassionate Investigational New Drug Program: An Examination of Benefits and Adverse Effects of Legal Clinical Cannabis" (Russo, Mathre, Byrne et al.) was completed. This three-day examination of major body functions of four of the five living US federal cannabis patients found "mild pulmonary changes" in two patients.[128]

On October 7, 2003 a patent entitled "Cannabinoids as Antioxidants and Neuroprotectants" (#6,630,507) was awarded to the United States Department of Health and Human Services, based on research done at the National Institute of Mental Health (NIMH), and the National Institute of Neurological Disorders and Stroke (NINDS). This patent claims that cannabinoids are "useful in the treatment and prophylaxis of wide variety of oxidation associated diseases, such as ischemic, age-related, inflammatory and autoimmune diseases. The cannabinoids are found to have particular application as neuroprotectants, for example in limiting neurological damage following ischemic insults, such as stroke and trauma, or in the treatment of neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease and HIV dementia." [129]

Historian Jacob Appel has argued that the medicinal marijuana movement bears striking similarities to the medicinal beer movement of the 1920s.[130] Both efforts attempted to muster medical expertise in the face of a national Prohibition and both pitted the rights of physicians against the authority of the federal government.

Organizational support

An increasing number of medical organizations have endorsed allowing patients access to medical marijuana with their physicians' approval. These include, but are not limited to, the following:

Criticism regarding medical cannabis

See also: Physiological effects of cannabis

A major criticism of cannabis as medicine is opposition to smoking as a method of consumption.

On 20 April 2006, the United States Food and Drug Administration (FDA) issued an advisory against smoked medical marijuana stating that, "marijuana has a high potential for abuse, has no currently accepted medical use in treatment in the United States, and has a lack of accepted safety for use under medical supervision. Furthermore, there is currently sound evidence that smoked marijuana is harmful."[132] Some prominent American societies have been reluctant to endorse medicinal cannabis. For example:[133] , the National Multiple Sclerosis Society,[134] the American Academy of Ophthalmology[135] and the American Cancer Society.[136] (Federal Register, 1992).

The Institute of Medicine, run by the United States National Academy of Sciences, conducted a comprehensive study in 1999 to assess the potential health benefits of cannabis and its constituent cannabinoids. The study concluded that smoking cannabis is not recommended for the treatment of any disease condition, but did conclude that nausea, appetite loss, pain and anxiety can all be mitigated by marijuana. While the study expressed reservations about smoked marijuana due to the health risks associated with smoking, the study team concluded that until another mode of ingestion was perfected that could provide the same relief as smoked marijuana, there was no alternative. Modern vaporizers and the ingestion of cannabis in a decarboxylated state have laid most of these concerns to rest, however. In addition, the study pointed out the inherent difficulty in marketing a non patentable herb. Pharmaceutical companies will not substantially profit unless there is a patent. For those reasons, the Institute of Medicine concluded that there is little future in smoked cannabis as a medically approved medication. The report also concluded for certain patients, such as the terminally ill or those with debilitating symptoms, the long-term risks are not of great concern. Medical Marijuana Passes House Civil Justice Committee Without Dissent by David Guard (MARCH 11, 2009) [137]

In an unpublished 2001 study by the Mayo Clinic, Marinol was shown to be less effective than the steroid megestrol acetate in helping cancer patients regain lost appetites.[138] The mechanism by which megestrol acetate works is unknown and the compound can cause "impotence, gas, rash, high blood pressure, fever, decreased libido, insomnia, upset stomach, and high blood sugar. . .," as well as "breakthrough bleeding" in women.

Harm reduction

Aspergillus fumigatus

Many medical cannabis opponents note that smoking cannabis is harmful to the respiratory system. However, this harm can be minimized or eliminated by the use of a vaporizer or ingesting the drug in an edible form or other non-smoking modes of delivery like tinctures. Vaporizers are devices that vaporize the active constituents (cannabinoids) and the fragrant aromatic substances in the preparation without combusting the plant material and thus preventing the formation of toxic substances. Studies have shown that vaporizers can dramatically reduce[139] or even eliminate[140] the release of irritants and toxic compounds.

In order to kill microorganisms, especially mold, the scientists "Levitz and Diamond (1991) suggested baking marijuana in home ovens at 150 °C [302 °F], for five minutes before smoking. Oven treatment killed conidia of A. fumigatus, A. flavus and A. niger, and did not degrade the active component of marijuana, tetrahydrocannabinol (THC)".[141]

Availability in Austria

On July 9, 2008 the Austrian Parliament approved cannabis cultivation for scientific and medical uses.[142]

Availability in Canada

In Canada, the regulation on access to marijuana for medical purposes, established by Health Canada in July 2001, defines two categories of patients eligible for access to medical cannabis. The category 1 list individuals suffering from "acute pain", "violent nausea and/or other serious symptoms caused by the following conditions: multiple sclerosis, spinal cord injury, disease of the spinal cord, cancer, AIDS/HIV infection, severe forms of arthritis and/or epilepsy. The category 2 "key applicants who have serious pathological symptoms other than those described in category 1."[143] The application of eligible patients must be supported by a doctor.

The cannabis distributed by Health Canada is provided under the brand CanniMed by the company Prairie Plant Systems Inc. In 2006, 420 kg of CanniMed cannabis was sold, representing an increase of 80% over the previous year.[144] It is also legal for patients approved by Health Canada to grow their own cannabis for personal consumption, and it is possible to obtain a production license as a person designated by a patient. Health Canada noted however that "no notice of compliance has been issued for marijuana for medical purposes."

Availability in Spain

In Spain, since the late 1990s and early 2000s, medical cannabis underwent a process of progressive decriminalization and legalization. The parliament of the region of Catalonia is the first in Spain have voted unanimously in 2001 legalizing medical marijuana, it is quickly followed by parliaments of Aragon and the Balearic Islands. The Spanish Penal Code prohibits the sale of cannabis but it does not prohibit consumption. Until early 2000, the Penal Code did not distinguish between therapeutic use of cannabis and recreational use, however, several court decisions show that this distinction is increasingly taken into account by the judges. From 2006, the sale of seed is legalized, possession or consumption is still forbidden in public places but permitted in private premises. Moreover, the cultivation of cannabis plants is now authorized in a private place.

Several studies have been conducted to study the effects of cannabis on patients suffering from diseases like cancer, AIDS, multiple sclerosis, seizures or asthma. This research was conducted by various Spanish agencies at the Universidad Complutense de Madrid headed by Dr. Manuel Guzman, the hospital of La Laguna in Tenerife led neurosurgeon Luis González Feria or the University of Barcelona.

After legislation, several cannabis clubs have been established including the Basque Country and Catalonia. These clubs, the first of its kind in Europe, are non-profit associations who grow cannabis and sell it at cost to its members. In 2006, members of these clubs were acquitted in trial for possession and sale of cannabis.

Availability in United States

Main article: Cannabis in the United States

In the United States, it is important to differentiate between medical cannabis at the federal and at the state level. At the federal level, cannabis per se has been made criminal by implementation of the Controlled Substances Act which classifies marijuana is a Schedule I drug, the strictest classification on par with heroin, LSD and Ecstasy. The United States Food and Drug Administration states "marijuana has a high potential for abuse, has no currently accepted medical use in treatment in the United States, and has a lack of accepted safety for use under medical supervision".[145][146]

At the same time, the Health and Human Services Division of the US Government holds a patent for medical marijuana. The patent, "Cannabinoids as antioxidants and neuroprotectants", issued October 2003[9] reads: "Cannabinoids have been found to have antioxidant properties, unrelated to NMDA receptor antagonism. This new found property makes cannabinoids useful in the treatment and prophylaxis of wide variety of oxidation associated diseases, such as ischemic, age-related, inflammatory and autoimmune diseases. The cannabinoids are found to have particular application as neuroprotectants, for example in limiting neurological damage following ischemic insults, such as stroke and trauma, or in the treatment of neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease and HIV dementia...."[147]

Notable pro-medical cannabis individuals

Pro-cannabis demonstrators in Los Angeles (August 2007)

Supporters of legalizing cannabis for medical use range from actors and musicians to politicians, writers, and scientists. Major activists include Steve Kubby, Ethan Nadelmann, Dennis Peron, Angel Raich, Robert Randall,[148] Keith Stroup, and Marc Emery.

Notable celebrities who are pro-medical cannabis include actors Jack Black, Drew Carey, Woody Harrelson, Penn Jillette, Bill Maher, Jeremy Miller, Joe Rogan, and Rob Van Dam, musicians Willie Nelson, Snoop Dogg, and talk show hosts Neal Boortz, Montel Williams,[149] and Bill Handel.

Politicians from multiple parties support medicinal marijuana use, such as President Barack Obama,[150] Democratic members of Congress Barney Frank, Dennis Kucinich, and Sam Farr, Republican Congress members Ron Paul, MD[151] and Dana Rohrabacher, Polish Parliament member Janusz Korwin-Mikke, the late Republican State Senator Bill Mescher, and Libertarian Loretta Nall. Researchers and scientist advocates include Jay Cavanaugh, PhD, Lyle Craker, PhD, Milton Friedman, PhD, Stephen Jay Gould, Lester Grinspoon, MD, and Carl Sagan, PhD.

Writers, such as the late William F. Buckley, Fred Gardner, Christopher Hitchens,[152] Jack Herer, Peter McWilliams, Salman Rushdie, Ann Druyan, Ed Rosenthal, Rick Steves, Samuel Thompson, and Robert Anton Wilson also support the legalization of medical cannabis.

Notable anti-medical cannabis individuals

Politicians that oppose the medicinal use of cannabis include former Drug Czars Andrea Barthwell, William Bennett,[153] Barry McCaffrey,[154] and John P. Walters, former U.S. Presidents George H. W. Bush and George W. Bush, congressmen Theodore Sophocleus[155] and Mark Souder, and former governors Mitt Romney[156] and Eliot Spitzer.

Attorney Generals Michael Mukasey, Janet Reno, and Dan Lungren also prefer cannabis to be illegal, as well as former U.S. Prosecutors Bonnie Dumanis,[157] Carol Lam, and Asa Hutchinson,[158] former Surgeon General Richard Carmona,[159] former Solicitor General Paul Clement, International Narcotics Control Board president Hamid Ghodse, Republican Senior Senator John McCain,[160] and former U.S. Secretary of Health and Human Services Donna Shalala. Conservative talk show hosts, such Rush Limbaugh[161] and Hal Lindsey, also oppose the use of medical cannabis.

European laws on cannabis possession (small amount). Data are from multiple sources detailed on the full source list
Main article: Legal and medical status of cannabis

Cannabis is in Schedule IV of the Single Convention on Narcotic Drugs, making it subject to special restrictions. Article 2 provides for the following, in reference to Schedule IV drugs:

A Party shall, if in its opinion the prevailing conditions in its country render it the most appropriate means of protecting the public health and welfare, prohibit the production, manufacture, export and import of, trade in, possession or use of any such drug except for amounts which may be necessary for medical and scientific research only, including clinical trials therewith to be conducted under or subject to the direct supervision and control of the Party.

This provision, while apparently providing for the limitation of cannabis to research purposes only, also seems to allow some latitude for nations to make their own judgments. The official Commentary on the Single Convention indicates that Parties are expected to make that judgment in good faith.

See also

References

Notes

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Further reading

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