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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 purposesMarijuana
as a drug?
In order for a product to be
recognized as a drug in the pharmacopoeia, it must meet at least three criteria:
Because of the lack of rigorous
clinical studies using recognized protocols, whole marijuana has not yet met
these criteria. There are a number of reasons for this. First, the research
protocols needed to test drugs involve double-blind tests with control groups
and randomly selected subjects, all conditions that are hard to achieve with
marijuana. Second, the current legal climate limits the potential for such
studies in terms of both the availability of marijuana and test conditions.
Third, the marijuana provided by the National Institute of Drug Abuse (NIDA)
for medical research – including research conducted by Health Canada – is of
dubious quality:[1][20] THC concentration may be a determining
factor in the quality of the therapeutic effects, yet NIDA marijuana contains
only 1.8% to 5% THC. Moreover, weaker marijuana requires more draws and
releases more CO than marijuana with a higher THC content. Other cannabinoids
are not measured, yet they are known to also have a bearing on the medical
properties of marijuana. The paper in which the marijuana is rolled is of poor
quality. The marijuana is often more than two years old and may not have been
stored under conditions that would preserve all its qualities. Finally, the
marijuana contains many seeds and other plant debris. Fourth, it is difficult
to control the amount of marijuana actually absorbed by the subjects: the way a
person draws on the cigarette, whether or not the person is accustomed to
smoking, the subject’s preferences and the length of time the subject inhales
are factors which can affect the test conditions and which researchers have not
yet been able to measure accurately. It must also be possible to answer
the following and other questions:
In recent years, analyses of the
scientific literature have been conducted by the Institute of Medicine in the
United States and the British Medical Society and in various government reports
in England, the Netherlands and elsewhere. The Institute of Medicine concluded
that there is evidence of the therapeutic potential of marijuana as an
analgesic, antiemetic and appetite stimulant. It noted, however, that smoking
is a difficult way to control the ingestion of marijuana and also has side
effects related specifically to its carcinogenic potential and the link with
respiratory diseases. The institute also found that the psychoactive effects of
marijuana are sometimes, but not always, beneficial for some patients. Finally,
the institute pointed out that smoking marijuana should not be recommended over
the long term because of the potential mental effects, but could be prescribed
for persons with terminal or degenerative diseases, where long-term
considerations are secondary. In the Netherlands, the National Health Council
issued a notice in 1995 stating that scientific evidence on medical use of
marijuana was insufficient because of poor research and uncertainty as to the
properties of smoked marijuana. The council also noted that marijuana could
have therapeutic applications in the following areas: nausea and vomiting
related to chemotherapy, appetite stimulation for people with AIDS or cancer,
multiple sclerosis and glaucoma. In 2001, the Netherlands created a medical
marijuana bureau in the ministry of health and began clinical studies. In
England, the House of Lords has taken a position similar to that of the
Institute of Medicine in the United States, and the Ministry of Health is
currently conducting at least one clinical study. Clearly, not enough is known about marijuana to establish it as a drug in the
strict sense of the word, and we only have partial knowledge of cannabinoids.
Most cannabinoids are a single cannabinoid compound, whereas marijuana contains
many substances the effects of which interact to produce the therapeutic
effects. Yet researchers have still not specifically identified the role of the
various cannabinoids. Patients who use synthetic dronabinol or nabilone-based
compounds generally report not feeling the same beneficial effects as when they
smoke marijuana. It may take longer for the effects to be felt, and the effects
may be less specific. Further, isolating only one of the components of marijuana
could, according to some studies, increase the risk of panic attacks and even
marijuana-induced psychosis. A
significant benefit of whole marijuana is that it can be delivered in smoked
format, with a rapid onset of action and a tritable effect by the patient. […]
In practice, both patients and oncologists report that smoked marijuana is
somewhat more effective than and as safe as the legally available oral
cannabinoids. Another major difference between marijuana and THC, besides the
availability of a smokeable, titratable delivery system with whole marijuana,
is that 9-THC alone can produce the relatively common effects of anxiety
disorder and panic attack. […] The adverse effects can also occur with
marijuana use, but are felt to be diminished by the presence of cannabidiol, a
nonpsychoactive compound with antipsychotic properties. [2][21] Finally, the cost of synthetic
compounds, which is much higher, has to be taken into account. The advantages of smoked marijuana
are that patients can determine the necessary dose on their own and feel the
effects more quickly, while limiting the adverse side effects other than the
effect on the respiratory system. It should be noted in passing the importance
of self-regulation by patients: most of the clinical cases reported and most of
the testimony from compassion club representatives agree that patients prefer
to use marijuana with a higher THC content than recreational marijuana but only
ingest the quantity they need to achieve the calming effects. However, the
problems related to specific knowledge of the effectiveness and quality of
marijuana limit the ability of physicians to prescribe the appropriate dose.
More advanced knowledge of smoked marijuana pertains to the degree of safety,
although there is variation in interpretation of the data. We generally concur
in the finding of Professor Scholten: Cannabis
use for medicinal reasons by patients with a somatic disease is relatively
safe, on condition that it is not smoked; when smoked it has the same carcinogenic
potential as tobacco. The alternatives are oral administration or inhalation
using a vaporiser. The
acute toxicity of cannabis is very low; it is almost impossible to die of an
overdose (users would have to eat or smoke their own weight in fresh cannabis,
or 7,500 grams of dried cannabis to achieve this). The principal side effects
in therapeutic use are psychosis and euphoria. Little is known about this
drug’s addictive effect in medical use, though experience with the use of
morphine for pain relief has shown that the risk of psychological addiction is
low – much lower than when used as a stimulant. As the addictive effect of
cannabis is also quite low when used as a stimulant, it may be assumed that
this will always be very low in a medical setting. When
estimating the chronic toxicity of cannabis, it should be borne in mind that
the doses used in therapeutic applications will probably be lower than those
used for "recreational" purposes, decreasing the risks of side
effects. [3][22] Does this mean that medical use of
marijuana, smoking in particular, should be discouraged or even banned? The
last section addresses this question. [1][20]
Russo, op.cit, discusses these
weaknesses in greater detail. [2][21]
Gurley, R.J., R. Aronow and M. Katz (1998), “Medicinal marijuana: A
comprehensive review”, Journal of
Psychoactive Drugs. Vol. 30, No. 2, page 139. [3][22]
Scholten, W.K. (2002), “Medicinal cannabis: A quick scan on the therapeutic
use of cannabis”, in Pelc, I. (ed.), International
Scientific Conference on Cannabis, Brussels. |