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by the American Public Health Association
November, 1995
Attached is the full text of last November's resolution by the American Public Health Association, an organization with 50,000 members nationwide. This resolution was approved much more quickly than most and by a wider majority than typical.
The address is:
American Public Health Association
1015 Fifteenth Street, NW --- Suite 300
Washington, DC 20005
Phone: 202-789-5600
Fax: 202-789-5661 or 5681
My contact has been Jeff Jacobs of the Government Affairs/Affiliate Relations unit. His direct number is 202-789-5645.
Note: The underbars (_) are used to bracket boldface or italicized text. Within the
references, they represent italics; in the titles, they represent boldface. Also, items in
brackets [] are reference numbers, which are superscripted in the original text.
_9513: Access to Therapeutic Marijuana/Cannabis_
The American Public Health Association,
Being aware that cannabis/marijuana has been used medicinally for centuries and that cannabis products were widely prescribed by physicians in the United States until 1937 [1,2]; and
Being aware that "marijuana" prohibition began with the Marihuana Tax Act of 1937 under false claims despite disagreeing testimony from the AMA's representative [3,4]; and
Being further aware that the Controlled Substances Act of 1970 completely prohibited all medicinal use of marijuana by placing it in the most restrictive category of Schedule I, whereby drugs must meet three criteria for placement in this category: 1) have no therapeutic value, 2) are not safe for medical use, and 3) have a high abuse potential [5]; and
Being cognizant that the Drug Enforcement Administration's own administrative law judge ruled in 1988 that marijuana must be removed from Schedule I and made available for physicians to prescribe [6-8]; and
Knowing that 36 states have passed legislation recognizing marijuana's therapeutic value [9,10]; and
Also knowing that the only available access to legal marijuana which was through the Food and Drug Administration's Investigational New Drug Program has been closed by the Secretary of Health and Human Services since 1992 [11]; and
Understanding that while synthetic Tetrahydrocannabinol (THC) is available in pill form, it is only one of approximately 60 cannabinoids which may have medicinal value individually or in some combination; and
Understanding that marijuana has an extremely wide acute margin of safety for use under medical supervision and cannot cause lethal reactions [6,32,34]; and
Understanding that marijuana has been reported to be effective in: a) reducing intraocular pressure in glaucoma [12,13]; b) reducing nausea and vomiting associated with chemotherapy [14-16]; c) stimulating the appetite for patients living with AIDS (acquired immunodeficiency syndrome) and suffering from the wasting syndrome [17-19]; d) controlling spasticity associated with spinal cord injury and multiple sclerosis [20-25]; e) decreasing the suffering from chronic pain [26-28]; and f) controlling seizures associated with seizure disorders [29-31]; and
Understanding that marijuana seems to work differently from many conventional medications for the above problems, making it a possible option for persons resistant to the conventional medications [32,33]; and
Being concerned that desperate patients and their families are choosing to break the law to obtain this medicine when conventional medicines or treatments have not been effective for them or are too toxic [34,35]; and
Realizing that this places ill persons at risk for criminal charges and at risk for obtaining contaminated medicine because of the lack of quality control; and
Realizing that thousands of patients not helped by conventional medications and treatments may find relief from their suffering with the use of marijuana if their primary care providers were able to prescribe this medicine; and
Concluding that cannabis/marijuana was wrongfully placed in Schedule I of the Controlled Substances Act depriving patients of its therapeutic potential; and
Recognizing that APHA adopted a resolution (7014) on Marijuana and the Law which urged federal and state drug laws to exclude marijuana from classification as a narcotic drug [36]; and
Concluding that greater harm is caused by the legal consequences of its prohibition than possible risks of medicinal use; therefore
1. Encourages research of the therapeutic properties of various cannabinoids and combinations of cannabinoids;
2. Encourages research on alternative methods of administration to decrease the harmful effects related to smoking;
3. Urges the Administration and Congress to move expeditiously to make cannabis available as a legal medicine where shown to be safe and effective and to immediately allow access to therapeutic cannabis through the Investigational New Drug Program.
References:
1. Abel EA. _Marijuana: The First Twelve Thousand Years_. New York: McGraw-Hill Book Company, 1982.
2. Mikuriya TH, ed. _Marijuana: Medical Papers 1839-1972_. Oakland, CA: Medi-Comp Press, 1973.
3. Bonnie RJ, Whitebread II CH. _The Marijuana Conviction: A History of Marijuana Prohibition in the United States_. Charlottesville, VA: University Press of Virginia, 1974.
4. National Commission on Marihuana and Drug Abuse (RP Shafer, Chairman). _Marihuana: A Signal of Misunderstanding_. New York: The New American Library, Inc., 1972.
5. Controlled Substances Act of 1970 (Pub.L. 91-513, October 27, 1970, 21USC801 et seq.).
6. In the Matter of Marihuana Rescheduling Petition, Docket 86-22, Opinion, Recommended Ruling, Findings of Fact, Conclusions of Law, and Decision of Administrative Law Judge, September 6, 1988. Washington, DC: Drug Enforcement Agency, 1988.
7. Randall RC. _Marijuana, Medicine and the Law_. Washington, DC: Galen Press, 1988.
8. Randall RC. _Marijuana Medicine and the Law, Vol. II_. Washington, DC: Galen Press, 1989.
9. Alliance for Cannabis Therapeutics. No accepted medical value?? _ACT News_. Spring, 1995;4.
10. Grinspoon L, Bakalar JB. Marihuana as medicine: A plea for reconsideration. _JAMA_. 1995;273(23):1875-1876.
11. Government extinguishes marijuana access, advocates smell politics. _JAMA_. May 20, 1992;267(19):2673-2674.
12. Colasanti BK. Review: Ocular hypotensive effect of marihuana cannabinoids: Correlate of central action or separate phenomenon. _J Ocular Pharmacol_. 1986;2(3):295-304.
13. Hepler RS, Frank IM. Marihuana smoking and intraocular pressure. _JAMA_. 1971;217:1392.
14. Sallan SE, Zinberg NE, Frei III E. Antiemetic effect of delta-9-tetrahydrocannabinol in patients receiving cancer chemotherapy. _New Engl J Med_. 1975:293(16):795-797.
15. Sallan SE, Cronin C, Zelen M, Zinberg NE. Antiemetics in patients receiving chemotherapy for cancer. _New Engl J Med_. 1980;302:135-138.
16. Vinciguerra V, Moore T, Brennan E. Inhalation marijuana as an antiemetic for cancer chemotherapy. _NY State J Med_. 1988;88:525-527.
17. Nelson K, Walsh D, Deeter P, et al. A phase II study of delta-9-tetrahydrocannabinol for appetite stimulation in cancer- associated anorexia. _J Palliative Care_. 1994;10(1):14-18.
18. Regelson W, Butler JR, Schultz J, et al. Delta-9-THC as an effective antidepressant and appetite stimulating agent in advanced cancer patents. In _Int Conf Pharmacol Cannabis_, S Szara, MC Braude, eds. Savannah: Raven, 1975.
22. Meinek H, Schonle PW, Conrad B. Effect of cannabinoids on spasticity and ataxia in multiple sclerosis. _J Neurol_. 1989;230:120-122.
23. Petro D. Marihuana as a therapeutic agent for muscle spasm or spasticity. _Psychosomatics_. 1980;21:81-85.
24. Petro D, Ellenberger C. Treatment of human spasticity with delta-9-tetrahydrocannabinol. _J Clin Pharmacol_. 1981;21:413S-416S.
25. Ungerleider JT, Andyrsiak T, Fairbanks L, et al. Delta-9-THC in the treatment of spasticity associated with multiple sclerosis.
26. Johnson MR, Melvin LS, Althius TH, et al. Selective and potent analgesics derived from cannabinoids. _J Clin Pharmacol_. 1981;21:271S-282S.
27. Maurer M, Henn V, Dittrich A, et al. Delta-9-tetrahydrocannabinol shows antispastic and analgesic effects in a single case double-blind trial. _Eur Arch Psychiatry Clin Neurosci_. 1990;240:1-4.
30. Feeney D. Marijuana use among epileptics. _JAMA_. 1976;235:1105.
31. Karler R, Turkanis SA. The cannabinoids as potential antiepileptics. _J Clin Pharmacol_. 1981;21:437S-448S.
32. Institute of Medicine. _Marijuana and Health_. Washington, DC: National Academy Press, 1982.
33. Mechoulam R, ed. _Cannabinoids as Therapeutic Agents_. Boca Raton, FL: CRC Press, 1986.
34. Cannabis clubs open for medicinal business. _USA Today_. October 1, 1993:B1, B5.
35. Berger J. Mother's homemade marijuana: A plan to aid her son leads to arrest and push for change. _The New York Times_, October 11, 1993.
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