Marijuana As Medicine Essay, Research Paper
Marijuana as Medicine
Introduction
Marijuana is a drug made from the dried leaves of the Hemp plant. Marijuana is also known as cannabis, which comes from the scientific name of the Hemp plant or Cannabis sativa. These dried leaves are usually smoked in rolled cigarettes or pipes to achieve a psychological feeling of euphoria or well-being. The marijuana plant contains more than 460 known compounds, of which more than 60 have been identified as cannabinoids. The most studied cannabinoid, _9-tetrahydrocannabinol, or THC, is present in large amounts in marijuana. Researchers believe that THC is the cannabinoid that is responsible for the psychoactive effects of marijuana. Because of this euphoric feeling associated with the use of marijuana, it is the third most commonly used drug in the United States (behind tobacco and alcohol). The cultivation, distribution, possession or consumption of marijuana is a violation of both federal and state laws in the United States. Although the government denies the fact, it is widely regarded in the medical community that marijuana also has a great deal of medicinal benefits. Scientific studies have been published that show marijuana is an effective treatment for a wide range of ailments from migraines (El-Mallakh, 1987) to the treatment of mental illness (Kotin, 1973).
History
Throughout history, cannabis has been used as a medicinal herb. The Chinese were the first to record the use of marijuana as medicine, but many cultures have recognized the beneficial qualities of the hemp plant. The first published studies in the United States came in 1860 by the Ohio Medical Society. These physicians reported that cannabis was successful in treating stomach pain, gastric distress, psychosis, chronic cough, gonorrhea and neuralgia (Marijuana as Medicine, 1997). The Marijuana Tax Act of 1937 worked to diminish the study of marijuana as medicine until the early 1970s, when cannabis was “re-discovered” as a medical substance and was tested in treating such conditions as glaucoma, cancer treatment side-effects, and other ailments. Current promising areas of marijuana research include AIDS, epilepsy, nervous disorders, asthma, pain relief and, ironically enough, mental illness.
Medical Uses
Glaucoma
The initial scientific study of marijuana as a potential for medical treatment in the 1970s was for the condition of glaucoma. Glaucoma is a eye disease that strikes more than 178,000 Americans per year and it is estimated than four million Americans are currently suffering from glaucoma. Glaucoma is the leading cause of blindness among Americans (World Book, 1997). Glaucoma can be found in all age groups, but most commonly strikes adults over the age of 65. Glaucoma is characterized by increased pressure behind the eye, called intraocular pressure. This pressure causes great damage to the optic nerve, thus leading to blindness. Glaucoma is treatable in about 90% of the sufferers. In some cases, surgery is needed. However in most cases, topical eye drops combined with daily oral medication is prescribed. However, the current oral medications have some severe side effects that cause some patients to discontinue use. These side effects include migraine headaches, kidney stones, blurred vision, cardiac problems, insomnia and nervous anxiety (Marijuana as Medicine, 1997).
An alternative to the oral medications used to treat glaucoma is marijuana. Dr. Robert Hepler at UCLA began studying marijuana and its effect on intraocular pressure after hearing police testimony about the pupil dilation commonly observed in marijuana smokers. He published a small brief in the Journal of the American Medical Association in 1971 which made the bold statement “It is our hope that further investigations by clinicians and basic scientists will be stimulated by our observations” (Hepler, 1971). These early studies show results of a controlled study where 11 study subjects were given marijuana. The physicians performed ocular examinations one before and one hour after the smoking of the marijuana. Substantial reduction in intraocular pressure was recorded for each subject. Hepler and his colleagues followed this brief with a full study report on 21 adults and the effects of marijuana smoking on intraocular pressure. The study reported “a substantial reduction in intraocular pressure” and called for intensive research for the use of marijuana in the treatment of eye diseases (Hepler, 1972).
Follow-up studies conducted by Merritt et al administered marijuana (through patient smoking) to 18 subjects with glaucoma. The age range was 28 to 71 years of age, with 12 males and 6 females. All were currently on both topical and oral medications and 11 patients had previous eye surgeries. All patients were asked to discontinue the oral and topical medications 48 hour prior to beginning the study. Merritt and his group also verified Helper observations and made the statement “our study verifies that marijuana lower intraocular pressure…in a heterogenous glaucoma population” (Merritt, 1980).
Muscular Spasticity
The treatment of convulsions was the first major medicinal application of marijuana in Western Medicine (Grinspoon, 1993). The use of marijuana has demonstrated success in the treatment of muscular spasticity disorders. Muscular spasticity (or spasm) 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 in lacking for these individual because two of the most prescribed medications, phenobarbital and diazepam (Valium+) produce drug tolerance in most patients or the patients complain of undesirable side effects, such as heavy sedation (Marijuana as Medicine, 1997). Dunn et al reported in 1974 that patients who admitted smoking marijuana for their spinal cord injuries had a “perceived” decrease in pain and spasticity (Dunn, 1974). Follow-up case reports and studies have also shown that THC reduces the muscle spasms associated with multiple sclerosis (Petro, 1980 and Meinck, 1989). Relative to muscular disorders, the use of marijuana has been shown to reduces the effects of such diseases as epilepsy, Tourette’s Syndrome, Huntington’s disease and Parkinson’s disease (Cunha, 1980 and Gieringer, 1996).
Cancer Chemotherapy
Another area which has received support for marijuana research is in the treatment of the side effects associated with cancer chemotherapy. The THC in marijuana has shown to have antiemetic properties which reduce the Nausea and vomiting which accompany chemotherapy agents. A study was conducted in 1975 by Sallan et al where 22 persons currently undergoing cancer chemotherapy treatment were either given oral THC (THC formulated in capsules with sesame oil) or a oral placebo (sesame oil alone). The study as a double blind study – neither the subject nor the physician where aware of which patient received the placebo medication. The results from the study clearly showed that the oral THC had reduced the Nausea and vomiting associated with the chemotherapy treatment and acknowledged that THC was an effective antiemetic medication for cancer chemotherapy treatment (Sallan, 1975). Further studies in 1979 conducted in Australia found that THC was a “significantly better” antiemetic medication than the prescription drugs Maxolon+ and Stemetil+ used to combat Nausea and vomiting. Follow-up comparative studies were complete by Sallan et al in 1980, comparing oral THC to Compazine+, one of the most widely prescribed antiemetic drug in the United States. Again, THC was indicated by the patients as being more effective in reducing the vomiting and Nausea that accompanies cancer chemotherapy (Sallan, 1980).
These studies comparing marijuana to legal prescription drugs were impressive to the medical community. In 1990, a random sample of 1035 clinical oncologists (doctors specializing in the treatment of cancer) were surveyed about their attitudes and opinions of marijuana as a potential antiemetic medication. More than half of the physicians (54%) reported that approved antiemetic medication caused significant problems within their patient population and 21% of the physicians reported that approved antiemetic medications, such as Compazine+ provided no relief to their patients. The physicians surveyed were aware of marijuana’s antiemetic effects, with over 70% of the physicians reporting that at least one patient in their practice regularly used marijuana as an antiemetic and had observed or discussed the benefit of marijuana with that patient. A surprising 44% has even recommended marijuana to at least one patient. Almost half (44%) of the physicians surveyed believed that marijuana was a safe and efficacious drug and 53% believed that marijuana should be available as a prescription (Doblin, 1991).
AIDS and AIDS-related symptoms
Since the late 1980s, AIDS has dominated the health care arena. Due to the political nature of this disease, federal officials have blocked several research proposals to investigate the use of marijuana in treating AIDS-related symptoms. It is ironic, however, that the federal government did nothing to block the approval of a pharmaceutical composition comprised of THC for an Ohio-cased pharmaceutical corporation. Marinol+, the brand name for dronabinol, which is a pharmaceutical compound derived from the THC from cannabis plant, was approved by the Food and Drug Administration in 1985 and has been on the market since that time. Marinol+ is manufactured and marketed by Roxane Laboratories in Columbia, Ohio. The FDA labeling allows Marinol+ to be indicated for anorexia associated with weight loss in patients with AIDS and also, Nausea and vomiting associated with cancer chemotherapy (PDR, 1997). Studies with Marinol+ have shown that HIV-infected persons have significant improvement in appetite, fat intake, and weight gain with a treatment dose of 5mg twice daily (Struwe, 1993). However, some medical experts look at research on Marinol+ as a corporate marketing scheme and question its scientific value. Wesner from the University of Hawaii undertook a survey study on 123 PWAs (people with AIDS) in Honolulu. The survey examined the possible therapeutic uses of marijuana by PWAs. Included in this survey were questions about the person’s individual knowledge or marijuana for medical use, their preference between Marinol+ and marijuana cigarettes for indications such as appetite stimulation and Nausea/vomiting relief. The results were devastating to the manufacturer of Marinol+; of those participants that had tried both Marinol+ and marijuana cigarettes, 87% preferred marijuana cigarettes (Wesner, 1996). Complaints about Marinol+ ranged from the cost of the drug ($400 per month) to its non-effectiveness (”8 out of 10 times did nothing”).
Marijuana Legislation
Currently, the United States and Canada have federal regulations that prohibit the cultivation, distribution, possession and use of marijuana for personal consumption. The prohibition of marijuana began in 1937 with the Marijuana Tax Act, which taxed the use of marijuana and required anyone who used marijuana to register their use. This registration process, in conjunction with the high taxes, made marijuana virtually prohibitive to use.
In the 1960s, marijuana use rose sharply as people began to use the drug for recreational purposes. This increased legislative concern, and in 1970’s Congress passed the Controlled Substance Act, which assigned drugs to certain schedules based on the drug’s potential for abuse and level of medical use. Schedule I drugs were considered to have no medical use and the high abuse potential. Marijuana was classified as a Schedule I drug (in the same category as heroin and LSD).
Many organizations have tried to institute legal proceedings to allow hearings to have marijuana transferred to Schedule II so that it may be prescribed for physicians for supervised, medical use (NORML, 1972). Lester Grinspoon attended one such BNDD (Bureau of Narcotics and Dangerous Drugs) hearing where he had waited for his chance to present his case in favor of having marijuana transferred to Schedule II. Before him, a case was being presented to place a drug called Talwin+ on the schedule of dangerous drugs. Talwin+, a drug manufacturer by Winthrop Pharmaceuticals, was a synthetic opiate based drug with a history of several hundred cases of addiction, a number of cases of death by overdose and considerable evidence of abuse. Winthrop Pharmaceuticals sent six corporate lawyers to defend their product and to ensure that Talwin+ was not placed on the schedule of drugs. They succeeded in part; the drug was placed on Schedule IV. Dr. Grinspoon then presented his case on cannabis – no evidence of overdose deaths or addiction and a great deal of scientific evidence showing the medicinal value of marijuana (presented by both patients and physicians). The BNDD refused to transfer the drug to Schedule II (Grinspoon, 1993). In this decision, they made a legal error – they failed to open the hearings to the public as was mandated by law.
Due to this legal mistake by the BNDD, the organizations desiring the schedule change filed suit to have their case heard again. By this time, the BNDD had become the Drug Enforcement Agency (DEA). The DEA refused public hearings and tried to placate the organizations by placing synthetic THC (i.e. Marinol+ – a drug recently approved by the FDA and manufactured by a pharmaceutical company) on Schedule II, but leaving marijuana as a Schedule I drug. Finally, the public hearings were held in May of 1986.
With his ruling on September 6, 1988, Administrative Law Judge Frances J. Young dealt a blow to the efforts of the DEA and others who consistently fought the schedule change. Judge Young made the following statements:
1. Approval by a significant minority of physicians in the United States was enough to meet the standard of “currently accepted medical use” established by the Controlled Substances Act for a Schedule II drug
2. He stated that “marijuana in its natural form, is one of the safest therapeutically active substances known to man…”
Young went on to recommend that, based on the guidelines for medical use set forth by the Controlled Substances Act, that the drug be transferred to Schedule II. However, the DEA rejected the decision of its own judge and refused to transfer marijuana to Schedule II (Grinspoon, 1993).
Today, thirty four states have approved the use of marijuana for medical use with a prescription and under a doctors’ supervision. One of those states is Virginia, which does allow physicians to prescribe marijuana for glaucoma and cancer and allows pharmacists to dispense prescriptions for marijuana. However, it offers no provision or source for supply. So the catch-22 is clear — where many doctors may supervise their patient using marijuana and write that patient a prescription, there is no legal source for marijuana in the United States, with the exception of Marinol+. Marinol+ can be obtained through a doctor’s prescription from a pharmacy. However, the cost of this drug is prohibitive. The cost for a monthly regimen of Marinol+ (5mg, twice daily) costs $280.00 in Norfolk and it is not covered by most insurance plans (Schreibner, 1997).
However, through searches on the Internet, one can find sources of medical marijuana operating illegally. Sources such as Cannabis Buyer’ Club in San Francisco openly supplies thousands of patients with prescription marijuana, as well as several places in Europe routinely accept mail, fax and email orders for marijuana. It is not, however, their responsibility whether or not your order will be intercepted and confiscated by the DEA.
Support of Medical Access of Marijuana
Who supports medical access to marijuana?
+ Thirty four states, including Virginia
+ American Medical Association
+ American Academy of Family Physicians
+ American Medical Students Association
+ American Public Health Association
+ Several State Nurses Associations
+ Physicians Association for AIDS Care
+ Northern New England Psychiatric Society
+ National Organization for the Reform of Marijuana Laws (NORML)
+ Alliance for Cannabis Therapeutics (ACT)
+ Conference on Episcopal Bishops
+ National Association on People with AIDS
+ Mothers Against Misuse and Abuse
Physician support for the medical use of marijuana is overwhelmingly. The American Medical Association, a group of practitioners from all disciplines, have made their support for medical marijuana research known. In a highly public statement, the AMA has called for federally funded research in the efficacy of marijuana for medical treatment (Johnson, 1996). A group of physicians and patients have filed a class-action lawsuit against the government claiming that the federal government has violated their constitutional rights by threatening to sanction and even criminally prosecute physicians who recommend and patients who use marijuana to alleviate their medical conditions.
Lake Research conducted a public opinion poll to ascertain whether Americans favored the medical use of marijuana. Decisively, Americans favored 2 to 1 the medical use of marijuana and , in addition, Americans don’t believe that physicians should be penalized for prescribing marijuana for medical use.
Conclusion
The medicinal value of marijuana is well-documented. Modern studies have reconfirmed historical cases of the benefits of marijuana use for some diseases. Federal law prohibits marijuana use and the government, due to its political nature, refuses to heed advice from physicians and even its own administrative body and seriously ill Americans are suffering needlessly. This conflicts leads physicians to advise their patients to break the law and send them to the street to obtain their medicine. While the political debate continues, AIDS and cancer patients continue to lose weight and experience Nausea and vomiting, glaucoma continue to go blind while approved medications fail and victims of other diseases that could benefit from medicinal marijuana agonize over ineffective treatment.