Medicinal Marijuana Use

Medicinal Marijuana Use

Facts:

The active ingredient in marijuana is D ⁹tetrahydrocannabinol but there are more than 460 chemicals in raw marijuana.
Marijuana is currently classified as a Schedule I drug under the Controlled Substances Act, indicating that marijuana "has a high potential for abuse, lacks an accepted medical use, and is unsafe for use under medical supervision." (JAMA, June 21, 1995, p. 1875) Schedule II drugs have a high potential for abuse, have and accepted medical use and "abuse of the drugÖmay lead to severe psychological or physical dependence." (NEJoM, Aug.7, 1997. P. 438)
There is a FDA-approved, commercially available form of synthetically produced pure THC on the market called dronabinol, sold under the brand name of Marinol.
Marijuana smoke has more tar and particulates than tobacco smoke.
There has been no reported case of death from marijuana overdose (not to be confused with overuse; I donít know to what extent marijuana smoke would increase heart disease or lung cancer). The estimated ratio of effective dose to lethal dose for marijuana is between 20,000 and 40,000 to one as compared to between 4 and 10 to one for pure ethanol. This is equal to smoking about 1500 pounds of pot in fifteen minutes. This data has been extrapolated from animal models. (NEJoM, Aug.7, 1997. P. 438)
There are currently eight people in the U.S. who can legally smoke marijuana according to the federal government. These patients fall under a former government program called the Compassionate Investigational New Drug program which was discontinued in 1992 after it was ruled that it was in conflict with the governmentís "war on drugs." These eight remain under the original program, but no new requests are granted.
Initiatives and referendums in California and Arizona passed in November 1996 "that gave doctors the right to prescribe marijuana for some patients." but this still did not make it legal in the eyes of the federal government for them to do so, nor for patients to use it. Barry McCaffrey, the national drug policy director, "Health and Human Services Secretary Donna Shalala and Attorney General Janet Reno said that doctors who prescribed marijuana risked losing their licenses to prescribe drugs and might face prosecution." (Newsweek, Jan. 13, 1997, p.60)

Political History

The government currently still seems predominantly against medicinal marijuana, but divided as well. After the initiatives in California and Arizona passed last year the government allotted $1 million for a review of all literature on marijuana. JAMA (Journal of the American Medical Association) reports that a panel of the National Institutes of Heath (NIH) that convened this spring, also in response to the voter initiatives, states additional studies are needed to determine the medicinal value of pot.

The political history of the issue shows occasional dissension. The movement for the legalization of marijuana began in the 1970ís and continued into the 80ís. In 1988, the administrative law judge for the DEA, Francis Young, "declared that marihuana in its natural form fulfilled the legal requirement of currently accepted medical use in treatment in the United States." Although he ordered the drug to be reclassified as a Schedule II drug, the DEA itself overruled this decision. (JAMA, June 21, 1995, p. 1875)

"Since 1978, legislation permitting patients with certain disorders to use marihuana with a physicianís approval has been enacted in 36 states. Although federal regulations and procedures made laws difficult to implement, 10 states eventually established formal marihuana research programs to seek Food and Drug Administration (FDA) approval for Investigational New Drug (IND) applications. These programs were later abandoned...." "Growing demand also forced the FDA to institute an Individual Treatment IND (commonly referred to as a Compassionate IND) for the use of physicians whose patients needed marihuana because no other drug would produce the same therapeutic effect." (JAMA, June 21, 1995, p. 1875)

Effects and Potential Uses of Marijuana

Some studies indicate that marijuana may interfere with sperm production (New England Journal of Medicine, Feb2, 1995. v332 (n5). p. 312) as well as lead to babies with lowered birth weight if smoked during pregnancy (79g decrease in BW on average compared to the non-user; 0.5cm decrease in length) (New England Journal of Medicine, March 23, 1989. p.762). Pot use is also associated to a small degree with a relatively rare temporary growth and development of the breasts in men (New England Journal of Medicine, Feb18, 1993).

Pot has about three to four common medical uses: (1) to combat nausea from chemotherapy; (2) to lower eye pressure in patients with glaucoma; (3) to treat AIDS-related wasting syndrome in order to stimulate appetite; (4) and to a lesser degree to combat pain and muscle spasms in patients with diseases such as multiple sclerosis, epilepsy, and Huntingtonís disease. Perhaps the most realistic of these is the treatment of nausea associated with chemotherapy. In a study of oncologists in 1991 "48 percent said they would prescribe is if they could and 44 percent said they had recommended it to patients" (Newsweek, Jan. 13, 1997. p.60) although the response rate to this survey by the Journal of Clinical Oncology was only 43% (National Review, Aug. 11, 1997). One advantage to smoked marijuana in this case is that there is no pill for the patient to swallow. In every case, however, there are alternative legal drug therapies available. The following table is taken out of Newsweek, January 3, 1997. P.60:

Alternatives to the Alternative

Advocates support several medicinal uses for marijuana, all with some evidence to back them up. Below, some of the disorders and their conventional, legal treatments:

AIDS-Related Wasting Syndrome	Experimental therapies involving anabolic steroids may allow people with AIDS to regain muscle mass more effectively than appetite stimulants like Megase or marijuana.
Cancer Chemotherapy	Drugs like Zofran can reduce nausea and are administered intravenously, for patients who canít eat. Smoked marijuana is also effective.
Glaucoma	Many drugs reduce pressure inside the eye, but with side effects like pain or dimming of vision. A new drug, Xalatan, is easier to use and wonít lower blood pressure like marijuana.
Pain and Muscle Spasm	Many different drugs and therapies work, but marijuana may also alleviate symptoms.

The primary evidence that pot is preferred over the Marinol pill seems to be founded on patient preference. Patients have complained of Marinolís delayed onset of relief, prolonged duration of effects, and getting too high. The dosage and duration of action are said to be easier to control with pot. Proponents also state that other ingredients in pot may modify the effects of the THC, while opponents say that these additional cannabinoids could be artificially synthesized without compromising the anti-illicit drug stand but still offering the safe effects.