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Marijuana and Multiple Sclerosis

In recent years a wealth of sound scientific information has become available to support the use of marijuana for medical purposes. Many countries and states now recognize the legitimacy of marijuana as a therapeutic medication. Individuals with serious or life threatening diseases unresponsive to traditional therapies should be permitted to avail themselves of this therapeutic option.

Marijuana, the common name for Cannabis sativa, is a plant which contains more than 400 separate chemicals. Delta-9 tetrahydrocannabinol is the principal psychoactive component of marijuana. However, other chemicals, in addition to the cannabinoids, may be responsible for some of the effects of marijuana. Marijuana which is smoked has a variety of psychoactive effects, including a sense of euphoria, increased talkativeness, and periods of laughter alternating with periods of introspection, lethargy and sleepiness. These common effects are not relevant to the medical use of marijuana, and, unfortunately, have come in the way of an objective evaluation of the beneficial effects of the cannabinols. In order to clarify the confusion, the prestigious Institute of Medicine, an organization chartered by the National Academy of Sciences, obtained a grant from the Office of the National Drug Control Policy to study the data concerning the medical use of marijuana. In 1999 they published an objective analysis of the scientific data relating to the effects of marijuana. Reviewers from such prestigious institutions as Harvard Medical School, Johns Hopkins University, Columbia University, Stanford University, and a host of other universities were enlisted in order to maintain objectivity. They evaluated all of the data relating to the medical use of marijuana, and are considered the gold standard for objective analysis. Some of their conclusions are presented below.

According to the Institute of Medicine, “the most encouraging clinical data on the effects of cannabinoids on chronic pain are from three studies of cancer pain.” They noted that cancer pain may be caused by a number of problems, and that it may be severe and persistent. Often, it is not effectively treated with opiods, such as morphine. However, in a well designed, double-blind, placebo controlled study Noyes found that Tetrahydrocannabinol (THC), the most active ingredient in marijuana, produced significant analgesia in this hard to treat group of patients. None of the study patients developed nausea or vomiting, which are common side effects with morphine, and other narcotics. Most of the patients had an increase in appetite, which can be very beneficial for cancer patients. Most pain killers have no effect on appetite, and many can cause a decrease in appetite. The Institute of Medicine stated “In conclusion, the available evidence from animal and human studies indicates that cannabinoids can have a substantial analgesic effect.”

Tetrahydrocannabinol has long been recognized to be an effective anti-emetic, especially for people with chemotherapy induced nausea. In fact, THC has been marketed in the United States for this use, and is sold under the brand name Marinol. Recent studies have shown that “there are numerous cannabinoid receptors in the nucleus of the solitary tract, a brain center that is important in the control of emesis”. Many effective medications act on receptors that exist in the human body, and in fact, new drugs are designed specifically to target known receptors. Thus, since there are already cannabinoid receptors in the brain, it is no surprise that marijuana is so effective at reducing nausea. There are, however, two problems with the oral form of THC. Patients who have severe nausea may not be able to keep a pill down. Inhaling a few puffs of marijuana is not a problem in this si/tuation. Also, the pill is slowly absorbed, while the inhaled form is rapidly absorbed, reducing the nausea more quickly.

With the development of newer, highly effective oral and intravenous anti-emetics, THC may be less useful for the relief of chemotherapy induced nausea and vomiting. However, Marijuana should still be available for these very sick patients, if standard treatments are ineffective, and they should not have to risk going to jail in order to take a medication which enables them to stop vomiting. The Institute of Medicine concurs, stating: “Until the development of rapid-onset antiemetic drug delivery systems, there will likely remain a subpopulation of patients for whom standard antiemetic therapy is ineffective and who suffer from debilitating emesis. It is possible that the harmful effects of smoking marijuana for a limited period of time might be outweighed by the antiemetic benefits of marijuana, at least for patients for whom standard antiemetic therapy is ineffective and who suffer from debilitating emesis.” The Canadian Cancer Society has also recognized the numerous benefits of marijuana, stating “The combination of cannabinoid drug effects (anxiety reduction, appetite stimulation, nausea reduction, and pain relief) suggests that cannabinoids would be moderately well suited for certain conditions, such as chemotherapy-induced nausea and vomiting, and AIDS wasting.”

Since marijuana is well known to be an appetite stimulant, its use has been studied in patients with the wasting syndrome. The wasting syndrome, which is defined as the involuntary loss of more than 10% of body weight, is a common finding in the end stages of some fatal diseases, such as AIDS and metastatic cancer. In 1992 the FDA approved Marinol for use in patients with the wasting syndrome due to AIDS. However, some patients find that inhaled marijuana is more effective than purified THC (Marinol). According to the Institute of Medicine report, “in controlled laboratory studies of healthy adults, smoked marijuana was shown to increase body weight, appetite, and food intake.” They conclude, “Nausea, appetite loss, pain, and anxiety are all afflictions of wasting, and all can be mitigated by marijuana.”

Marijuana has also been reported to be beneficial for a variety of neurological problems. Multiple sclerosis is a severe, often fatal, progressive degenerative neurological disease affecting more than 2.5 million people. About 90% develop spasticity and pain is a common and severe complication. Numerous reports indicate that marijuana reduces this pain and spasticity. Patients with spinal cord injuries also report that muscle spasms are reduced by marijuana. The Institute of Medicine concludes that “Basic animal studies have shown that cannabinoid receptors are particularly abundant in areas of the brain that control movement and that cannabinoids affect movement and posture in animals as well as humans. The observations are consistent with the possibility that cannabinoids have antispastic effects.”

Marijuana has also been tried in Parkinson disease and Alzheimer’s disease. In Parkinson’s disease it is concluded that marijuana may reduce chorea and dystonia, which are unpleasant movement disorders associated with the disease. In Alzheimer’s disease patients treated with Marinol showed substantial weight gains and a decrease in disturbed behavior.

Marijuana has also been shown to be dramatically effective in glaucoma, a disease of the eyes characterized by increased pressure in the eye. Untreated glaucoma often leads to blindness. Marijuana reduces the pressure in the eye by about 25%, providing dramatic relief for some patients.The Institute of Medicine concludes, “Scientific data indicate the potential therapeutic value of cannabinoid drugs.”

Many other well respected organizations throughout the world support the clinical use of marijuana. The AMA House of Delegates concludes, “Adequate and well-controlled studies of smoked marijuana should be conducted in patients who have serious conditions for which preclinical, anecdotal, or controlled evidence suggests possible efficacy, including AIDS wasting syndrome, severe acute or delayed emesis induced by chemotherapy, multiple sclerosis, spinal cord injury, dystonia, and neuropathic pain.” The British Medical Association takes a similar position. The National Institutes of Health states, “For at least some potential indications, marijuana looks promising enough to recommend that new controlled studies be done….To the extent that the NIH can facilitate the development of a scientifically rigorous and relevant database, the NIH should do so.”

In 2001 the Canadian Cancer Society stated that it “supports the government in its effort to provide clear criteria so that patients who qualify to use marijuana to alleviate symptoms of cancer or side effects of treatment will be permitted to do so. Whether or no a person chooses to use marijuana to help them with their experiences with cancer is an individual’s choice and the Society encourages people to discuss this with their doctor.”

Even the prestigious New England Journal of Medicine has come out in support of the medical use of marijuana. In 1997 they stated that “it is also hypocritical to forbid physicians to prescribe marijuana, while permitting them to use morphine.” According to the Journal, “Federal authorities should rescind their prohibition of the medicinal use of marijuana.”

While it is clear that marijuana is beneficial for a variety of serious medical problems, in many locales it is still restricted as a dangerous drug. Many spurious arguments have been made to restrict the availability of medicinal marijuana. Some have said that marijuana is highly addictive, and that people can’t stop taking it once they have started. The facts do not support this contention. According to the Institute of Medicine’s review of the world literature, “A distinctive marijuana and THC withdrawal syndrome has been identified, but it is mild and subtle compared with the profound physical syndrome of alcohol or heroin withdrawal” The Canadian Cancer Society concludes “withdrawal symptoms can be observed in animals, but appear to be mild compared to opiates of benzodiazepines, such as Valium.” Others state that once a person starts taking marijuana, it will only be a matter of time before that person progress to more harmful and addictive drugs. Again, the data do not support that opinion. According to the available research “it does not appear to be a gateway drug to the extent that it is the cause or even that it is the most significant predictor of serious drug abuse.” Another argument is that if you make marijuana legal for medical reasons people will think it is safe to use for recreational reasons. Again, this is untrue. Even though codeine and morphine are commonly used to treat pain, people do not think it is safe to take narcotics for fun. Also, in 1976 the Netherlands legalized the possession of small amounts of marijuana for personal use. Over the next seven years there was no increase in marijuana use. Thus, the truth is clear. Legalizing marijuana for medical use, by prescription only, will not increase the illegal use of marijuana, nor will it lead to the illegal use of other drugs.

While the United States Federal government has not legalized the use of marijuana for medical purposes, the position of the public is clear. In 1996 the ACLU conducted a nationwide survey of 1,001 registered voters. Eighty-three percent agreed with the statement, “People who find that marijuana is effective for their medical needs, like treating glaucoma and relieving nausea from chemotherapy, should be able to use it legally.” In March 2001 a Pew Research Center poll found that 73% of Americans favor the legalization of marijuana for medical purposes. In 1998 ballot initiative supporting legalization of the medical use of marijuana passed by substantial margins in Alaska, Colorado, Nevada, Oregon and Washington. Arizona, California and Hawaii have also adopted initiatives permitting the medical use of marijuana.

Despite overwhelming evidence to support the use of marijuana for medical purposes, and the overwhelming support of the public, the government refuses to act. As far back as 1988 the DEA’s own administrative law judge stated “Marijuana has been accepted as capable of relieving distress of great numbers of very ill people, and doing it with safety under medical supervision. It would be unreasonable, arbitrary, and capricious for DEA to continue to stand between those sufferers and the benefits of this substance in light of the evidence of record.” Four years later the DEA rejected the judge’s opinion, and continued to classify marijuana as a Schedule I drug. thereby continuing to classify marijuana as a dangerous drug which cannot be legally prescribed.

As noted in the New England Journal of Medicine, “Federal officials are out of step with the public.” They are also out of step with the scientific evidence, and the numerous national and international authorities who have concluded that the evidence clearly supports the medical use of marijuana. They are out of step with the 8 states that have attempted to supercede Federal law by permitting the medical use of marijuana in their states. Clearly it is time to correct the inequities that have so long persisted.