|
|
 
Issue
#5 July/August 2003
The Pharmaceuticalization
of Marijuana
Cover
Photo:
The cover picture of
Dr. Grinspoon was recently
taken by his son David
when they were visiting
the San Luis Valley
in Colorado. Davids
new book, Lonely Planets:
The Natural Philosophy
of Alien Life will be
published this fall
by Harper-Collins.
Table
of Contents
go
there Corrections
and Notes:
go
there
Editorial
go
there
Feature Story - Dr.
Lester Grinspoon
- The Pharmaceuticalization
of Marijuana
go there
IACM
- The International
Association for Cannabis
as Medicine
go
there Dr.
Ethan Russo
- Who Is Dr. Ethan
Russo?
go
there Medically
NORML
- Physicians weigh
in at NORML conference
go there
Vancouver
Island Compassion Society
- Compassion Club
does more research than
Health Canada
go
there
Dr. Dave West - Genetics
101.2
- The Hawaii Hemp
Project
go there
Canadians
for Safe Access
- Protecting Canadians'
safe access to medical
marijuana
go
there Kudos
go
there
Legal
Eagle
- Supreme Court of
Canada Appeals
go
there Medical
Marijuana Class Action
- Compensation for
medical users
go
there What
to do if you get busted
-Alan Young advises
on how to handle it
go
there
Updates
go
there
Advanced
Research for Advanced
Nutrients
- University of Mississippi
research
go
there Jeffery's
Journey
- A determined mother's
battle for medical marijuana
for her son
go
there McGill
Research for Health
Canada
go
there
Cannabis
Classifieds
|
|
NOTE:
In
the GW Pharmaceuticals article in
issue 4, we did not give the full
name of Valerie Corral of WAMM,
in the middle of the photo, between
Matt Elrod on the left and David Hadorn
on the right. The picture was taken
on the Sunshine Coast while attending
Rene Bojees wedding. WAMM was raided
a few months earlier by federal agents
who were later prevented from leaving
the WAMM property by members blocking
the driveway. Members took down the
blockade when, after being released,
Val asked them to. It was sort of
a hostage exchange. Coincidental to
the picture, Val and WAMM collaborated
with GW on a whole cannabis strain
analysis. WAMM recorded patient impressions
of different strains for treating
various symptoms.
Editorial:
May 24th was truly a landmark day;
a whole day of national TV coverage
of Canada's new national drug strategy.
I am at home, finally, sitting in
my comfortable chair, as over the
past two months I have spent 45 days
in hospital, had two major surgeries
and cancer. My last minor procedure
is tomorrow, but today I am glued
to the television. Never have we seen
such a high level of discussion in
this country. The logic and the arguments
by one credible witness after another
lay to rest the myths. Not to be deterred
by science or the facts, the usual
proponents of prohibition rise to
the challenge and frankly sound like
idiots. Several times in the midst
of the discussion, the interviewer
would say something like, now let
me get this straight, the smoker gets
a fine, and where exactly are people
suppose to get this marijuana? Forced
to back off, the interviewer finally
gets the message and realizes: None
of this plan makes rational sense.
I
see this move by the Liberals as a
positive step in the wrong direction.
We need to recognize that having politicians
debating this without making awkward
pot jokes is a breakthough. We have
moved from total pot paranoia to treating
possession like a speeding ticket.
On May 26th, despite the unworkability
of the whole plan, or maybe because
of it, public acceptance of cannabis
went up. It is now bonified news and
the issues are being discussed as
current events in grade 11. More and
more the debate is sophisticated,
considerate and intellectual.
My
forced sabbatical over the past two
months placed me outside the bubble
of the cannabis movement and my life
collided with a large number of health
care people and non-movement individuals.
I am pleased to report that through
education we are winning over the
hearts of the public. My thanks and
appreciation to the medical staff
in Grand Forks and in Kelowna who
provided excellent care and were respectful
of the use of cannabis in my recovery.
Special appreciation to Barb and all
of the staff for the great job they
have been doing, publishing the journal
and nursing me back to health. It
is heartening that our common cause
has momentum and the commitment of
so many. Have you wondered why (the
US) is spending such inordinate amounts
of money and time on controlling this
relatively innocuous substance that
Canada is about to decriminalize.
News that the US has similar or even
more lenient decriminalization laws
in place in 12 states has finally
caught peoples attention. Yes, marijuana
is the most important drug in America,
not because it is addictive, or a
gateway, but because, if the prohibitionist
lobbyists loose the pot war they will
be forced to admit they are wrong
and have perpetrated massive lies
and deception. This is not your father's
pot, this is about the breakdown of
the whole drug mind set. Could Canadas
new laws be the slippery slope? I
certainly hope so!
This
edition contains a number of well
written and timely submissions by
experts in their respective fields.
Good advice for Canadian politicians
as they make this move to further
remove the fear of pot. Bless the
thin edge of the wedge. BT
Letters
Love the mag, great job
Dear Brian: I've a little story to
tell you while I subscribe to your
journal. As a section 56 exemptee
since Oct. 19/01 expiring July 18/03
(6 month extension) I've seen the
medical marijuana issue become so
complicated, it is failing those in
need the most. I've told H.C. (Health
Canada) that their red tape was killing
me. Their lies didn't help. One of
my doctors pointed out to me that
in 1990 marijuana was the ultimate
pain killer. It's the only substance
I know of that has caused no deaths,
compared to pharmaceuticals. Cindy
Cripps has informed me that on Feb.
7/03 H.C. has issued 541 authorizations
to possess, and 257 have made the
crossover to the M.M.A.R. My odyssey
of applying has made me so mad that
I will take it to the steps of the
House of Commons. I'm a citizen living
in Northumberland County, Ont. and
Iım not allowed to talk to my M.P.
I have received some help from M.P.
Dr. Keith Martin - Esquimalt/Juan
de Fuca in dealing with H.C. It is
now up to me to stand up for what
I believe. In short, the medical system
has failed me and marijuana is the
only medication that I can tolerate
without adverse side effects. It's
one substance for all my ailments
and it grows out of the ground. (WOW!)
Looking forward to witnessing your
success as an informative journal.
Gordon Strickland
A
Miraculous effect
I'm sending this letter hoping some
of the many people suffering from
the never-ending agony of muscle,
joint and bone pain that prescription
drugs, including morphia, don't relieve.
I've been smoking marijuana since
1977 to control glaucoma in both eyes.
Recently, by chance, I obtained a
strain called Hash Plant, that is
having a miraculous effect on an extremely
painful condition diagnosed as Fibromyalgia.
The severity of the pain has kept
me bedridden, 18 to 20 hours a day
since 1982. Iım not completely pain
free, however, 80 to 90% of the pain
has gone, allowing me to function
again. On behalf of my family and
myself, thank you to whomever is responsible
for providing a Miracle. Anonymous
- due to social stigma of pot.
Dr Grinspoon
and his grandchildren Zachary and
Emma Sohpia
Dr. Lester Grinspoon
MD is on the faculty (emeritus) of
the Harvard Medical School in the
Department of Psychiatry. He has been
studying cannabis since 1967 and has
published two books on the subject.
In 1971 Marihuana Reconsidered was
published by Harvard University Press.
Marihuana, the Forbidden Medicine,
co-authored with James B. Bakalar,
was published in 1993 by Yale University
Press; the revised and expanded edition
appeared in 1997 and is now translated
into 10 languages. (Medical Uses rxmarijuana.com
Uses of Marijuana
marijuana-uses.com)
The
Pharmaceuticalization of Marijuana
by Dr. Lester Grinspoon MD
The government of the United States
has a problem where medical marijuana
is concerned. While there are many
thousands of patients in the United
States who currently use cannabis
as a medicine, only seven are allowed
to use it legally by the federal government.
They are the survivors of the several
dozen patients who were awarded Compassionate
Use INDs during a period of time (from
1976 until 1991) when the government
half-heartedly acknowledged that marijuana
has medicinal properties. This program
was discontinued because of the exponentially
growing numbers of Compassionate IND
applications; the official reason
was provided by James O. Mason, then
chief of the Public Health Service:
"It gives a bad signal. I don't
mind doing that, if there is no other
way of helping these people But there
is not a shred of evidence that smoking
marijuana assists a person with AIDS".
Each of the surviving IND recipients
receives monthly a tin containing
enough rolled marijuana joints to
treat his or her symptoms for that
month. Because the quality of the
cannabis is poor, it requires more
inhalation than a superior quality
medicinal cannabis would. In fact,
some of the recipients have been known
to supplement this Government Issue
with better quality street marijuana.
Because
of increasing pressure from the many
patients who find cannabis useful
for the treatment of a variety of
symptoms and syndromes, and the passage
of Proposition 215 in California in
1996, the U.S. government funded the
Institute of Medicine of the National
Academy of Science to study the question
of cannabis' utility as a medicine.
It's report, "Marijuana and Medicine:
Assessing the Science Base" (published
in 1999) timidly acknowledged that
cannabis does indeed have therapeutic
value. The growing understanding that
cannabis is useful as a medicine presents
a problem to the United States government:
how can it make it possible for people
who need it as a medicine to have
unfettered access to marijuana, while
at the same time prohibiting it to
people who wish to use it for purposes
the government does not approve of.
A possible solution to this problem
might be found in the "pharmaceuticalization"
of cannabis: the development of prescribable
isolated individual cannabinoids,
synthetic cannabinoids, and cannabinoid
analogs. The IOM Report states that
"...if there is any future for
marijuana as a medicine, it lies in
its isolated components, the cannabinoids
and their derivatives." It goes
on: "therefore, the purpose of
clinical trials of smoked marijuana
would not be to develop marijuana
as a licensed drug, but such trials
could be a first step towards the
development of rapid-onset, non-smoked
cannabinoid delivery systems."
Actually,
the first attempt at pharmaceuticalization
occurred in 1985 when the Food and
Drug Administration (FDA) approved
dronabinol (Marinol) for the treatment
of the nausea and vomiting of cancer
chemotherapy. Dronabinol is a solution
of synthetic tetrahydrocannabinol
in sesame oil (the sesame oil is meant
to protect against the possibility
that the contents of the capsule could
be smoked). Dronabinol was developed
by Unimed Pharmaceu-ticals Inc. with
a great deal of financial support
from the United States government.
This was the first hint that the "pharmaceuticalization"
of cannabis might be what the government
hoped would solve its problem with
marijuana as medicine, the problem
of how to make the medicinal properties
of cannabis (insofar as the government
believes such properties exist) widely
available, while at the same time
prohibiting its use for any other
purpose. But Marinol did not displace
marijuana as "the treatment of
choice"; most patients found
the herb itself much more useful than
dronabinol in the treatment of the
nausea and vomiting of cancer chemotherapy.
In 1992, the treatment of the AIDS
wasting syndrome was added to dronabinolıs
labeled uses. Again, patients reported
that it was inferior to smoked marijuana.
Marinol has not solved the marijuana-as-a-medicine
problem, because so few of the patients
who have discovered the therapeutic
usefulness of marijuana use dronabinol.
In general, they find it less effective
than smoked marijuana, it cannot be
titrated because it has to be taken
orally, it takes at least an hour
for the therapeutic effect to manifest
itself and even with the prohibition
tariff on street marijuana, Marinol
is more expensive. Thus, the first
attempt at pharmaceuticalization proved
not to be the answer. In practice,
for many patients who use marijuana
as a medicine the doctor-prescribed
Marinol serves primarily as a cover
from the threat of the growing ubiquity
of urine tests.
Some
cannabinoid analogs may indeed have
advantages over whole smoked or ingested
marijuana in limited circumstances.
For example, cannabidiol may be more
effective as an anti-anxiety medicine
and an anticonvulsant when it is not
taken along with THC, which sometimes
generates anxiety. Other cannabinoids
and analogs may prove more useful
than marijuana in some circumstances
because they can be administered intravenously.
For example, 15 to 20% of patients
lose consciousness after suffering
a thrombotic or embolic stroke, and
some people who suffer brain syndrome
after a severe blow to the head become
unconscious. The new analog dexanabinol
(HU-211) has been shown to protect
brain cells from damage when given
immediately after the stroke or trauma;
in these circumstances, it will be
possible to give it intravenously
to an unconscious person. Presumably,
other analogs may offer related advantages.
Some of these commercial products
may also lack the psychoactive effects
which make marijuana useful to some
for non-medical purposes. Therefore,
they will not be defined as "abusable"
drugs subject to the constraints of
the Comprehensive Drug Abuse and Control
Act. Nasal sprays, vapourizers, nebulizers,
skin patches, pills, and suppositories
can be used to avoid exposure of the
lungs to the particulate matter in
marijuana smoke. The question is whether
these developments will make marijuana
itself medically obsolete. Surely
many of these new products would be
useful and safe enough for commercial
development. It is uncertain, however,
whether pharmaceutical companies will
find them worth the enormous development
costs. Some may be (for example, a
cannabinoid inverse agonist that reduces
appetite might be highly lucrative),
but for most specific symptoms, analogs
or combinations of analogs are unlikely
to be more useful than natural cannabis.
Nor are they likely to have a significantly
wider spectrum of therapeutic uses,
since the natural product contains
the compounds (and synergistic combinations
of compounds) from which they are
derived. For example, the naturally
occurring THC and cannabidiol of marijuana,
as well as dexanabinol, protect brain
cells after a stroke or traumatic
injury.
The
cannabinoids in whole marijuana can
be separated from the burnt plant
products (which comprise the smoke)
by vapourization devices that will
be inexpensive when manufactured in
large numbers. These devices take
advantage of the fact that finely
chopped marijuana releases the cannabinoids
by vapourization when air flowing
through the marijuana is held within
a fairly large temperature window
below the ignition temperature of
the plant material. Inhalation is
a highly effective means of delivery,
and faster means will not be available
for analogs (except in a few situations
such as parenteral injection in a
patient who is unconscious or suffering
from pulmonary impairment). It is
the rapidity of the response to inhaled
marijuana which makes it possible
for patients to titrate the dose so
precisely. Furthermore, any new analog
will have to have an acceptable therapeutic
ratio. The therapeutic ratio (an index
of the drugıs safety) of marijuana
is not known, because it has never
caused an overdose death, but it is
estimated, on the basis of extrapolation
from animal data, to be an almost
unheard of 20,000 to 40,000. The therapeutic
ratio of a new analog is unlikely
to be higher than that; in fact, new
analogs may be much less safe than
smoked marijuana, because it will
be physically possible to ingest more
of them. And there is the problem
of classification under the Comprehensive
Drug Abuse and Control Act for analogs
with psychoactive effects. The more
restrictive the classification of
a drug, the less likely drug companies
are to develop it and physicians to
prescribe it. Recognizing this economic
fact of life, Unimed Pharmaceuticals
Inc. has fairly recently succeeded
in getting Marinol (dronabinol) reclassified
from Schedule 2 to Schedule 3. Nevertheless,
many physicians will continue to avoid
prescribing it for fear of the drug
enforcement authorities.
Now
that the federal government has embarked
on a cruel and so far successful campaign
to close down buyers' clubs, what
options are available to the many
thousands of patients who find cannabis
of great importance, even essential,
to the maintenance of their health?
They can either use Marinol, which
most find unsatisfactory, or they
can break the law and use marijuana.
Why is a government, which considers
itself compassionate ("compassionate
conservatism"), criminalizing
these patients? What is the government's
problem with medical marijuana? The
problem, as seen through the eyes
of the government, is the belief that,
as growing numbers of people observe
relatives and friends using marijuana
as a medicine, they will come to understand
that this is a drug which does not
conform to the description the government
has been pushing for years. They will
first come to appreciate what a remarkable
medicine it really is; it is less
toxic than almost any other medicine
in the pharmacopoeia; it is, like
aspirin, remarkably versatile; and
it is less expensive than the conventional
medicines it displaces. They will
then begin to wonder if there are
any properties of this drug which
justify denying it to people who wish
to use it for any reason, let alone
arresting more than 700,000 citizens
annually. The federal government sees
the acceptance of marijuana as a medicine
as the gateway to catastrophe, the
repeal of its prohibition. Insofar
as the government views as anathema
any use of plant marijuana, it is
difficult to imagine it accepting
a legal arrangement that would allow
for its use as a medicine, while at
the same time vigorously pursuing
a policy of prohibition for any other
use.
A
somewhat different approach to the
pharmaceuticalization of cannabis
is being taken by a British company,
G. W. Pharmaceuticals. It is attempting
to develop products and delivery systems
which will skirt the two primary popular
concerns about the use of marijuana
as a medicine: the smoke and the psychoactive
effects (the "high"). To
avoid the need for smoking, G. W.
Pharmaceuticals has developed an electronically
controlled dispenser to deliver cannabis
extracts sublingually in carefully
controlled doses. The company expects
its products (extracts of marijuana)
to be effective therapeutically at
doses too low to produce the psychoactive
effects sought by recreational and
other users. My clinical experience
leads me to question whether this
is possible in many, or even most,
cases. The issue is complicated by
tolerance to the psychoactive effects.
Recreational users soon discover that
the more often they use marijuana,
the less "high" they experience.
A patient who smokes cannabis frequently
for the relief of, say, chronic pain
or elevated intra-ocular pressure
will experience little or no "high".
Furthermore, as a clinician who has
considerable experience with medical
cannabis use, I have to question whether
the psychoactive effect is always
separable from the therapeutic. And
I strongly question whether the psychoactive
effects are necessarily undesirable.
Many patients suffering from serious
chronic illnesses report that cannabis
generally improves their spirits.
If they note psychoactive effects
at all, they speak of a slight mood
elevation - certainly nothing unwanted
or incapacitating.
The
great advantage of the administration
of cannabis through the pulmonary
system is the rapidity with which
its effects are experienced. This
in turn allows for the self-titration
of dosage, the best way of adjusting
individual dosage. With other routes
of delivery the response time is longer
and self-titration becomes more difficult.
Thus, self-titration is not possible
with oral ingestion of cannabis. While
the response time for sublingual or
oral mucosal administration of cannabis
is shorter than it is with oral ingestion,
it is significantly longer than that
from absorption through the lungs
and therefore a considerably less
useful route of administration for
self-titration. Furthermore, the design
of the G. W. Pharmaceuticals dispenser
negates whatever self-titration capacity
sublingual administration may have.
The device has electronic controls
that monitor the dose and prevent
delivery if the patient tries to take
more than the physician or pharmacist
has set it to deliver during predetermined
time windows. The proposal to use
this cumbersome and expensive device
apparently reflects a concern that
patients cannot accurately titrate
the therapeutic amount or a fear that
they might take more than they need
and experience some degree of "high"
(always assuming, doubtfully, that
the two can easily be separated, especially
when cannabis is used infrequently).
Because these products will be considerably
more expensive than natural marijuana,
they will succeed only if patients
are intimidated by the legal risks,
and patients and physicians consider
the health risks of smoking marijuana
(with and without a vapourizer) much
more compelling than is justified
by either the medical or epidemiological
literature and they believe that it
is essential to avoid any hint of
a psychoactive effect.
In
the end, the commercial success of
any psychoactive cannabinoid product
will depend on how vigorously the
prohibition against marijuana is enforced.
It is safe to predict that new analogs
and extracts will cost much more than
whole smoked or ingested marijuana
even at the inflated prices imposed
by the prohibition tariff. I doubt
that pharmaceutical companies would
be interested in developing cannabinoid
products if they had to compete with
natural marijuana on a level playing
field. The most common reason for
using Marinol is the illegality of
marijuana, and many patients choose
to ignore the law for reasons of efficacy
and cost. The number of arrests on
marijuana charges has been steadily
increasing and has now reached more
than 700,000 annually, yet patients
continue to use smoked cannabis as
a medicine. I wonder whether any level
of enforcement would compel enough
compliance with the law to embolden
drug companies to commit the many
millions of dollars it would take
to develop new cannabinoid products.
Unimed is able to profit from the
exorbitantly priced dronabinol only
because the U.S. government underwrote
much of the cost of development. Pharmaceutical
companies will undoubtedly develop
useful cannabinoid products, some
of which may not be subject to the
constraints of the Comprehensive Drug
Abuse and Control Act. But, it is
unlikely that this pharmaceuticalization
will displace natural marijuana for
most medical purposes.
It
is also clear that the realities of
human need are incompatible with the
demand for a legally enforceable distinction
between medicine and all other uses
of cannabis. Marijuana use simply
does not conform to the conceptual
boundaries established by twentieth
century institutions. It enhances
many pleasures and it has many potential
medical uses, but even these two categories
are not the only relevant ones. The
kind of therapy often used to ease
everyday discomforts does not fit
any such scheme. In many cases, what
lay people do in prescribing marijuana
for themselves is not very different
from what physicians do when they
provide prescriptions for psychoactive
or other drugs. The only workable
way of realizing the full potential
of this remarkable substance, including
its full medical potential, is to
free it from the present dual set
of regulations - those that control
prescription drugs in general and
the special criminal laws that control
psychoactive substances. These mutually
reinforcing laws established a set
of social categories that strangle
its uniquely multifaceted potential.
The only way out is to cut the knot
by giving marijuana the same status
as alcohol - legalizing it for adults
for all uses and removing it entirely
from the medical and criminal control
systems. Two powerful forces are now
colliding: the growing acceptance
of medical cannabis and the proscription
against any use of the marijuana plant,
medical or non-medical. There are
no signs that the U.S. is moving away
from absolute prohibition to a regulatory
system that would allow responsible
use of marijuana. As a result, we
are going to have two distribution
systems for medical cannabis: the
conventional model of pharmacy-filled
prescriptions for FDA-approved cannabinoid
medicines, and a model closer to the
distribution of alternative and herbal
medicines. The only difference - an
enormous one - will be the continued
illegality of whole smoked or ingested
marijuana. In any case, increasing
medical use by either distribution
pathway will inevitably make growing
numbers of people familiar with cannabis
and its derivatives. As they learn
that its harmfulness has been greatly
exaggerated and its usefulness underestimated,
the pressure will increase for drastic
change in the way we as a society
deal with this drug.
I.A.C.M.
Franjo
Grotenhermen, M.D.,
Chairman of the IACM
The International
Association for Cannabis as Medicine
(IACM) is a young scientific society
dedicated to the improvement of the
situation for the medical use of cannabis
and the cannabinoids, through promotion
of research and dissemination of information.
Among the members of the IACM are
scientists working in the cannabinoid
field, doctors from hospitals and
private practices, pharmacists, lawyers,
and patients who use cannabis or THC
medicinally. We encourage an exchange
of knowledge and experience between
these groups and between individuals
from different countries with different
national backgrounds. The foundation
of an international scientific society
was initiated by members of the German
ACM (Association for Cannabis as Medicine)
in 2000 after suggestions by people
from other countries to expand the
ACM to an international organization.
Still, most members of the IACM are
from the German-speaking countries,
but gradually membership is becoming
more international.
Cannabis
preparations have been used as remedies
for thousands of years. Today the
potential medical applications of
natural cannabis products or individual
pharmacologically active ingredients
are considerably restricted by existing
laws and decrees. An important strategy
to change this situation is to increase
the knowledge on cannabis, cannabinoids
and the cannabinoid system of the
human body and to make this knowledge
available to the public, journalists,
lawyers and lawmakers, so that they
are able to argue on an informed basis
and to make informed decisions.
One
of the major obstacles to an accepted
medical use of natural cannabis is
the dearth of well-designed clinical
studies. And even for THC (dronabinol)
- which is approved for medical use
in several countries, among them the
USA, Canada, the UK and Germany -
there is not much scientific knowledge
available on the medical efficacy
in many ailments, e.g. spasticity
in multiple sclerosis, epilepsy, neuropathic
pain or depression. This sometimes
causes a situation of considerable
disparity between the experience of
individual patients and doctors who
see that cannabis and THC do work,
and the low level of scientific evidence
resulting in misunderstandings and
different judgments.
For
several reasons this situation is
improving today, (1) because of the
discovery of a neuromodulator/neurotransmitter
system with specific cannabinoid receptors
in man and animals and endogenous
cannabinoids (endocannabinoids) that
bind to these receptors, (2) because
several respected institutions such
as the House of Lords in the UK in
1998 and the Institute of Medicine
in the U.S. in 1999 conducted thorough
investigations into the therapeutic
potential of cannabis, and (3) because
large clinical trials with different
preparations (smoked cannabis, under-the-tongue
spray, capsules filled with cannabis
extract), are under way in several
European countries and North America.
It
is now well established that the endogenous
cannabinoid system plays an important
physiological role. It is involved
in pain perception, short-term memory,
immun-omodulation, regulation of muscle
tone, blood pressure, intra-ocular
pressure, appetite, in reproduction
and various other body functions.
Insight into the natural and pathological
function of this endocannabinoid system
has fundamentally facilitated our
understanding of the therapeutic actions
of plant cannabinoids, as well as
their possible detrimental effects,
and it has increased the credibility
of patients who claim therapeutic
effects from cannabinoids that are
in agreement with this new area of
basic science.
In
recent years moves to allow the medical
use of cannabis in many countries
have been increasingly successful,
but the ways to realize access to
the drug differ. While Canada and
several U.S. states exempt some qualified
patients from the cannabis laws, allowing
them the medical use of the drug which
they have to find or grow themselves,
the Netherlands allow pharmacists
to supply cannabis to patients with
a doctor's prescription, which is
paid by the health insurance. It is
expected that in the UK an under-the-tongue
cannabis spray will be approved for
medical use by the Medicines Control
Agency by the end of 2003 or in 2004,
and in Germany the government wants
to make a cannabis extract available
in pharmacies, which is standardized
on THC and cannabiol (CBD) according
to a formula of the German association
of pharmacists. The Swiss government
intends to control cannabis use similar
to the use of alcohol and cigarettes,
making private use by adults legal
and taxing the drug, without distinguishing
between recreational and medical use.
The
IACM is promoting exchange of political
information and scientific knowledge
by different means, mainly by the
IACM bulletin and scientific conferences.
A bi-weekly internet newsletter is
available in seven languages (English,
French, German, Spanish, Italian,
Dutch and Swedish). Unlike the scientific
conferences of the ICRS (International
Cannabinoid Research Society) which
are much more concentrated on basic
research, the scientific meetings
of the IACM are more focused on clinical
research and experiences of the efficacy
of cannabis and cannabinoids in the
treatment of patients. ICRS and IACM
may best be regarded as complementary
societies and several scientists are
members in both.
We
are happy about several co-operations,
among them an alliance with Haworth
Press which is publishing the Journal
of Cannabis Therapeutics, edited by
our board member Ethan Russo, the
official journal of the IACM, and
with other groups and individuals
working on common aims
Office:
IACM Arnimstrasse 1A 50825 Cologne
Germany Phone: +49-221-9543 9229 Fax:
+49-221-1300591 E-mail: info@cannabis-med.org
Website: http://www.cannabis-med.org
Board
of Directors
Franjo Grotenhermen, MD, Germany,
1st Chairman,
Kirsten Müller-Vahl, MD, Germany,
2nd Chairwoman,
Ethan Russo, MD, USA , William Notcutt,
MD, UK , Ulrike Hagenbach, MD, Switzerland,
Kurt Blaas, MD, Austria, Martin Schnelle,
MD, Germany, Ricardo Navarrete-Varo,
MD, Spain, Patient Representative
Clare Hodges, UK, Alliance for Cannabis
Therapeutics
Advisory
Board
Rudolf Brenneisen, Switzerland, Greg
Chesher, Australia, Vinzeno di Marzo,
Italy, Hinderk M. Emrich, Germany
Robert Gorter, Germany, Geoffrey Guy,
UK, Manuel Guzman, Spain, John McPa
rtland, New Zealand, Raphael Mechoulam,
Israel, Tod Mikuriya, USA, Richard
Musty, USA, Roger Pertwee, UK
2003
IACM 2nd Conference on Cannabinoids
in Medicine in Cologne, on 12-13 Sept.,
2003
 |
Who
Is Dr. Ethan |
Ethan
Russo, MD, is a board-certified child
and adult neurologist with Montana
Neurobehavioral Specialists in Missoula,
MT, and researcher in migraine, ethnobotany,
medicinal plants, cannabis and cannabinoids
in pain management, and the therapeutic
applications of Schedule I plants
and chemicals. Dr. Russo holds faculty
positions as adjunct associate professor
in the Department of Pharmaceutical
Sciences of the University of Montana,
and clinical associate professor in
the Department of Medicine of the
University of Washington. He has published
numerous articles in scientific journals
and is the author of Handbook of Psychotropic
Herbs: A Scientific Analysis of Herbal
Preparations for Psychiatric Conditions.
He is co-editor with Franjo Grotenhermen
of the book Cannabis and Cannabinoids:
Pharmacology, Toxicology and Therapeutic
Potential, and author of the novel
The Last Sorcerer: Echoes of the Rainforest,
all from Haworth Press. Dr. Russo
is the founding editor of Journal
of Cannabis Therapeutics: Studies
in Endogenous, Herbal and Synthetic
Cannabinoids, whose charter issue
was released in January 2001. Two
double-issues are also published as
books, Cannabis Therapeutics in HIV/AIDS,
and Women and Cannabis: Medicine,
Science and Sociology. He has published
over two dozen articles on topics
of neurology, clinical cannabis, and
medicinal plants. Dr. Russo has served
as a consultant for private pharmaceutical
companies, medical-legal cases, and
in conservation policies with regards
to medicinal herbs. He lives in the
Blackfoot River Canyon surrounded
by nature, is married to a pediatric
nurse practitioner, and has two teenage
children.
 |
Cannabis
and Cannabinoids Pharmacology,
Toxicology and Therapeutic Potential
Cannabis and Cannabinoids |
Edited
by: Franjo Grotenhermen, MD, Nova-Institut
GmBH, Hurth, Germany And, Ethan Russo,
MD, Montana Neurobehavioral Specialists,
Missoula, Montana Study the latest
research findings by international
experts in this comprehensive book
compiled by two of the worldıs leading
authorities on the subject of Cannabis
and Cannabinoids. This book contains
state-of-the-art scientific research
on the therapeutic uses of cannabis
and its derivatives. A glance at the
table of contents shows the book not
only covers the chemistry and history
of the plant, but also follows through
with detailed information on medical
uses and the extensive research being
conducted. All too often discussions
of the potential medical uses of Cannabis
are distorted by political considerations
that have no place in a medical debate.
This book offers fair, equitable discussion
of this emerging and controversial
medical topic by the world's foremost
researchers. The book deals with health
aspects of the cannabis plant and
the cannabinoids while mainly factoring
our societal aspects. Some authors
refer to social topics that require
discussion even within the bounds
of a narrow handling of medicinal
aspects. Cannabis and Cannabinoids
examines the benefits, drawbacks and
side effects of medical marijuana
as a treatment for various conditions
and diseases. This book discusses
the scientific basis for marijuanaıs
use in cases of pain, nausea, anorexia,
and cachexia. It also explores its
possible benefits in glaucoma, ischemia,
spastic disorders, migraine and many
other medical conditions. "Scientists
with different views on the therapeutic
benefits of the cannabis plant and
with different assessments of the
potential harms get a hearing, so
that the book reflects and considers
the frictions and controversies surrounding
many themes in this area. "Leading
experts in their fields have contributed
to this volume. Most are members of
the International Cannabinoid Research
Society, which includes about 200
scientists. Some of them are also
members of the International Association
for Cannabis as Medicine, which deals
particularly with the medical use
of cannabis and the cannabinoids."
(from Cannabis and Cannabinoids, Preface.)
This reference work is destined to
be indispensable to physicians, psychologists,
researchers, biochemists, graduate
students, and interested members of
the public. Great to recommend to
your doctor who is supporting you
with medicinal marijuana, or to friends
who may be doctors or psychologists.
|
Ask
Dr. Ethan Russo
Medicine
is an ever-changing science.
While suggestions for therapeutic
use of cannabis or other drugs
may be made herein, this forum
is designed solely for educational
purposes, and neither the author,
publisher, nor other parties,
will assume any liability whatever
for application or misapplication
of any information imparted.
We cannot claim scientific proof
or accuracy of the material
discussed, and no warranty,
expressed or implied is advanced
with regard to the information.
Cannabis is illegal in most
jurisdictions, and the reader
must apply awareness of this
fact when considering its usage.
Medical use of cannabis may
or may not be a viable legal
defense where you reside. Canadian
clinical cannabis patients are
encouraged to seek exemptions
under existing law from Health
Canada. The proper forms and
procedures are available on
their website. Full disclosure
and discussion of medical issues
with your health care providers
is encouraged, as is proper
education with respect to effects
and side effects of existing
medication.
|
Q
1: I have epilepsy and I have
heard that marijuana is good for people
with epilepsy. I was wondering if
this is true and if I could get some
info on that if you have any. I used
to use marijuana but have not for
a few years now and have noticed my
epilepsy to be worse. Any info would
be greatly appreciated. Thank you
A 1:
Epilepsy, or seizure disorder, is
a heterogeneous disorder producing
convulsions or other alterations of
consciousness that affects 0.5% of
the population at any given time.
However, about 5% of people will experience
one or more seizures during their
lifetime. The issue of cannabis use
in epilepsy is controversial, but
increasingly should be less so as
we learn more. Once again, you can
find numerous attestations to its
benefit from Dr. Grinspoon:
http://www.rxmarihuana.com/_vti_bin/shtml.exe/search.htm
We know that the cannabis component
CBD is anticonvulsant, as was determined
in pioneering studies in Brazil, but
reviewed here: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=
12412831&dopt=Abstract Previously
it was thought that THC was neutral
with respect to seizures, or was even
pro-convulsant (made them more likely).
However, recent work done in Virginia
by a brilliant young scientist, Melisa
Wallace, conclusively demonstrates
that THC also reduces the likelihood
of seizures: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=
11779037&dopt=Abstract The most
famous patient with seizures who uses
cannabis is probably Valerie Corral
of the Wo/Men's Alliance for Medical
Marijuana: http://wamm.org/
Their selfless work on behalf of patients
was thwarted by a DEA raid last fall.
As a neurologist, I can vouch for
the fact that many of my seizure patients
find cannabis to be a useful adjunct
in controlling their seizures, occasionally
as a sole agent. Unfortunately, it
remains illegal in most areas of the
world and "more formal study"
will be necessary to convince physicians
of its potential in this regard.
Q
2: My
name is Meghan and I was diagnosed
with Lupus over 4 years ago. I take
eight 2.5mg tabs of methotrexate once
a week and was wondering if smoking
marijuana would react harmfully to
this drug.
A
2: Systemic lupus erythematosus
is a very complex autoimmune disease
more common in women. It may affect
any of 14 organ systems in the body.
Common manifestations include arthritis,
chronic pain, skin eruptions, psychiatric
manifestations, seizures, and digestive
disturbances. Although little or no
formal investigation has taken place
with respect to cannabis in its treatment,
many affected patients do employ it
to apparent advantage. Please go to
Dr. Lester Grinspoonıs site, Marihuana,
the Forbidden Medicine: http://www.rxmarihuana.com/search.htm
and put the word "lupus"
through the search engine. You will
find interesting testimonials as to
its value as a painkiller, anti-inflammatory,
mood modulator, and digestive aid.
There is very solid evidence behind
these claims. Recently, the anti-inflammatory
|
