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Major Studies of Drugs and Drug Policy | ||||
Canadian Senate Special Committee on Illegal Drugs | ||||
Volume I - General Orientation |
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Chapter 9 - Use of marijuana for therapeutic purposesContemporary
knowledge
Two questions strike us relevant
here. The first is whether marijuana in fact has the therapeutic effects that
have been ascribed to it traditionally and more recently in the personal
stories of people suffering from chronic pain and other conditions. If those
benefits are real, the second question, altogether different and based on
different criteria, is whether marijuana should be considered a drug. Therapeutic
uses
Knowledge of the mechanics of
cannabinoids and the endogenous cannabinoid system allows a number of
observations to be made. Generally, and bearing in mind what was written in
Chapter 5, the action of cannabinoids can be described as follows: […]the overall effect is that of a cellular
inhibition rather than cellular activation. It settles down nerve firing
through a number of different types of reactions, primarily through changes
that lead to changes in the flow of ion channels, which changes the firing
behaviour of the cell which then changes how it communicates with other cells
down the line. Opening
of potassium channels with decreased cell firing and closing of calcium
channels with decreased release of neurotransmitters or overall cellular inhibition,
which quiets things down. Those could have major therapeutic implications in
certain clinical situations, such as pain and spasticity. They have
implications in settling down nerve firing within pain conducting systems. [1][14] More specifically, cannabinoids act
on various neurophysiological systems associated with pain, either alone or in
combination with the endogenous opiate system.[2][15] Cannabinoids affect the release of
serotonin, which is itself associated with different types of pain, migraines
in particular. Anandamide and other cannabinoid antagonists block the release
of serotonin and ketanserin, both of which are linked to migraines, suggesting
the potential effect of THC. Cannabinoids are also related to the dopamine
system, which has been linked with migraines and other types of pain. Further,
cannabinoids inhibit prostaglandin, producing an anti-inflammatory effect. Some
studies have shown that THC is in that sense a more powerful analgesic than
aspirin or even cortisone. Interacting with the endogenous opioid systems,
cannabinoids increase the production of beta-endorphins, which reduce the
effect of migraines. According to some studies, THC may have greater
therapeutic potential than morphine, either because the applications would be more
specific in some cases, because in other cases morphine aggravates some
symptoms, or because THC lacks the sedative properties of morphine. Moreover,
THC may have an antinociceptive effect on the periaqueductal grey. Finally, THC
acts as a glutamate blocker and thereby reduces muscle and inflammatory pain. Italian
researchers Nicolodi, Sicuteri and colleagues have recently elucidated the role
of NMDA antagonists in eliminating hyperalgesia in migraine, chronic daily
headaches, fibromyalgia, and possibly other mechanisms of chronic pain.
Gabapentin and ketamine were suggested as tools to block this system and
provide amelioration. Given the above observations and relationships, it is
logical that prolonged use of THC prophylactically may exert similar benefits,
as was espoused in cures of chronic daily headache in the 19th
century with regular use of extract of Indian hemp. [3][16] In
real terms, these mechanisms mean that cannabinoids can be beneficial in a
number of situations that involve pain, but not pain alone The following are
foremost among them.
[1][14]
Dr. Mary Lynch, Director, Canadian Consortium for the Investigation of
Cannabinoids, Professor, Dalhousie University, testimony before the Special
Senate Committee on Illegal Drugs, Senate of Canada, first session of the
thirty-seventh Parliament, June 11, 2001, Issue 4, page 49. [2][15]
The following information is taken primarily from Russo, op. cit., Hartel, C.R., “Therapeutic
Uses of Cannabis and Cannabinoids”, in Kalant, H. (ed.), The Health Effects of Cannabis, Toronto: Addiction Research
Foundation, and INSERM (2001), op. cit. [3][16]
Russo, op. cit., page 365. [4][17]
Dr. Mary Lynch, op. cit., page
52. [5][18]
R.D. Hartel, op. cit., page
465. [6][19]
Russo, E.B., et al. (2002), “Chronic
cannabis use in the compassionate investigational new drug program: An
examination of benefits and adverse effects of legal clinical cannabis”, Journal of Cannabis Therapeutics, Vol.
2, No. 1, page 45. |