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Medical cannabis refers to the use of the drug Cannabis as a physician-recommended herbal therapy, most notably as an Antiemetic . The term '''''medical marijuana''''' post-dates the U.S. Marijuana Tax Act of 1937, the effect of which made cannabis prescriptions illegal in the United States.

Due to widespread illegal use of cannabis as a Recreational Drug and several other reasons, its legal or licensed use in medicine is a controversial issue.

There are many studies regarding the use of cannabis in a medicinal context.http://www.medicalmarijuanaprocon.org/pop/studychart.htm http://www.norml.org/index.cfm?Group_ID=3376 http://www.mpp.org/site/c.glKZLeMQIsG/b.1086505/k.AF5A/About.htm 1 Cannabis was listed in the United States Pharmacopeia from 1850 until 1942. The United States federal government does not currently recognize any legitimate medical use, although there are currently seven patients receiving cannabis for their various illnesses through the Compassionate Investigational New Drug program that was closed to new patients by President [http://www.fda.gov/ola/2004/marijuana0401.html or comparable public authorities in any Western European country as a licensed medicine for any disease.


HISTORY

plant]]Cannabis has been used for medicinal purposes for over 4,800 years.http://www.zauberpilz.com/golden/g31-40.htm Surviving texts from Ancient India confirm that its psychoactive properties were recognized, and doctors used it for a variety of illnesses and ailments. These included a whole host of gastrointestinal disorders, insomnia, headaches and as a pain reliever, frequently used in childbirth.

Cannabis as a medicine was common throughout most of the world in the 1800s. It was used as the primary pain reliever until the invention of and Moreau De Tours , who used it to treat Melancholia , Migraine s, and as a sleeping aid, Analgesic and Anticonvulsant .

By the time the United States banned cannabis (the third country to do so) with the 1937 Marijuana Tax Act , the plant was no longer extremely popular. One of the main opponents to the bill was the representative of the American Medical Association .http://www.marijuanalibrary.org/AMA_opposes_1937.html

Later in the century, researchers investigating methods of detecting cannabis intoxication discovered that smoking the drug reduced intraocular pressure.http://www.zauberpilz.com/golden/g31-40.htm High intraocular pressure causes blindness in Glaucoma patients, so many believed that using the drug could prevent blindness in patients. Many Vietnam War veterans also believed that the drug prevented muscle spasms caused by battle-induced spinal injuries. Later medical use has focused primarily on its role in preventing the wasting syndromes and chronic loss of appetite associated with Chemotherapy and AIDS , along with a variety of rare muscular and skeletal disorders. Less commonly, cannabis has been used in the treatment of Alcoholism and Addiction to other Drugs such as Heroin and the prevention of Migraine s. In recent years, studies have shown or researchers have speculated that the main chemical in the drug, THC, might help prevent Atherosclerosis .

In 1972 Tod H. Mikuriya, M.D. reignited the debate concerning marijuana as medicine when he published "Marijuana Medical Papers 1839-1972".

Later, in the 1970s, a Synthetic version of THC , the primary active ingredient in cannabis, was synthesized to make the drug Marinol . Users reported several problems with Marinol, however, that led many to abandon the pill and resume smoking the plant. Patients complained that the violent nausea associated with chemotherapy made swallowing pills difficult. The effects of smoked cannabis are felt almost immediately, and is therefore easily dosed.http://www.lycos.com/info/cannabis--effects.html Marinol (Dronabinol), like ingested cannabis, is very psychoactive, and is harder to titrate than smoked cannabis.http://www.ardpark.org/reference/synmjcompare.htm Marinol has also consistently been more expensive than herbal cannabis.http://www.medicalmarijuanaprocon.org/pop/cost.htm Some studies have indicated that other chemicals in the plant may have a synergistic effect with THC.http://www.cannabis-med.org/membersonly/mo.php?aid=2001-03-04&fid=2001-03-04-7&mode=a&sid=

In addition, during the 1970s and 1980s, six US states' health departments performed studies on the use of medical marijuana. These are widely considered some of the most useful and pioneering studies on the subject.

In May 2001, "The Chronic Cannabis Use in the Compassionate Investigational New Drug Program: An Examination of Benefits and Adverse Effects of Legal Clinical Cannabis" (Russo, Mathre, Byrne et al) was completed. This three-day examination of major body functions of four of the five living US federal cannabis patients found "mild pulmonary changes" in two patients.http://www.medicalcannabis.com/PDF/Chronic_Cannabis.pdf


EARLY STUDIES ON EFFICACY


New Mexico


Approved by the Food And Drug Administration , the study included 250 patients and compared smoked cannabis to oral THC. All participants were referred by a medical doctor and had failed to control vomiting using at least three alternative antiemetics. Patients chose smoking cannabis or taking the THC pill. Multiple objective and subjective standards were used to determine the effectiveness.

  • Conclusion: cannabis is far superior to the best available drug at the time of testing, Compazine , and smoked cannabis is clearly superior to oral THC. "More than ninety percent of the patients who received cannabis ... reported significant or total relief from nausea and vomiting." No major side effects were reported, though three patients reported adverse reactions that did not involve cannabis alone. The report can be read here .



Tennessee

27 patients had failed on other Antiemetics therapies, including oral THC.

  • Conclusion: 90.4% success for smoked cannabis; 66.7% for oral THC. "We found both marijuana smoking and THC capsules to be effective antiemetics. We found an approximate 23% higher success rate among those patients administered smoked marijuana. We found no significant differences in success rates by age group. The major reason for THC capsule failure was nausea and vomiting so severe that the patient could not retain the capsule."



California

A series of studies throughout the 1980s involved 90–100 patients a year. The study was designed to make it easier for patients to enter the oral THC part of the study. Patients who wanted to smoke cannabis had to be over 15 years old (oral THC patients had to be over 5) and use the drug only in the hospital and not at home. Smoked cannabis patients also had to be receiving rare and painful forms of chemotherapy to qualify.

  • Conclusion: Despite the bias towards oral THC, the California study concluded that smoked cannabis was more effective and established a safe dosage regimen that minimized adverse side effects. The full text of the study can be seen here .




Georgia

119 patients that had failed using other antiemetics were randomly assigned to oral THC pills and either standardized or patient-controlled smoking of cannabis.

  • Conclusion: All three categories were successful — patient controlled smokers at 72.2%; standardized smokers at 65.4%; oral THC at 76%. Failure of oral THC patients was due to adverse reaction (6 out of 18) or failure to improve (9 out of 18); failure of smoking cannabis was due to intolerance for smoking (6 out of 14) or failure to improve (3 out of 14).




HARM REDUCTION

Many medical cannabis opponents note that smoked cannabis is harmful to the respiratory system. However, this harm can be minimalized or eliminated by the use of a Vaporizer or Ingesting the drug in an Edible form or other non-smoking modes of delivery like Tinctures . Vaporizers are devices that vaporize the active constituents ( Cannabinoids ) and the Fragrant Aromatic substances in the preparation without combusting the plant material and thus preventing the formation of toxic substances. Studies have shown that vaporizers can dramatically reduce''Cannabis Vaporizer Combines Efficient Delivery of THC with Effective Suppression of Pyrolytic Compounds'' By D. Gieringer et.al. Journal of Cannabis Therapeutics, Vol. 4(1) 2004, [http://www.maps.org/mmj/Gieringer-vaporizer.pdf] or even eliminate''Evaluation of a Vaporizing Device (Volcano) for the Pulmonary Administration of Tetrahydrocannabinol''. By A. HAZEKAMP, R. RUHAAK, et.al. JOURNAL OF PHARMACEUTICAL SCIENCES, VOL. 95, NO. 6, JUNE 2006 [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16637053&query_hl=1&itool=pubmed_docsum abstract] the release of irritants and toxic compounds.


INDICATIONS

According to a survey on the recommendation of cannabis in CaliforniaDale Gieringer, "Medical Use of Cannabis in California," in Franjo Grotenhermen, M.D. & Ethan Russo, M.D., ed., Cannabis and Cannabinoids: Pharmacology, Toxicology and Therapeutic Potential, Haworth Press, 2002
{Link without Title} , cannabis is indicated for over 250 conditions. Cannabis is most importantly indicated as an Antiemetic for the treatment of Nausea and Anorexia associated with treatments for Cancer , AIDS , and Hepatitis .
Cannabis also acts as an antispasmodic and anticonvulsant and is indicated for neurological conditions such as Epilepsy , Multiple Sclerosis , and Spasms . As an analgesic and an immunomodulator it is indicated for conditions such as Migraine , Arthritis , spinal and Skeletal Disorders . As a Bronchodilator it is beneficial for Asthma . It also reduces the Intraocular Pressure and is indicated for Glaucoma . Cannabis is also used to treat some Mood Disorders such as Post Traumatic Stress Disorder , Clinical Depression , Obsessive-compulsive Disorder , Panic Disorder , and Bipolar Disorder . It is also indicated for Premenstrual Syndrome , Hypertension , and Insomnia .

In the United States, the Federal Food, Drug, And Cosmetic Act makes the Food And Drug Administration (FDA) the sole government entity responsible for ensuring the safety and efficacy of new prescription and over-the-counter drugs, overseeing the labeling and marketing of drugs, and regulating the manufacturing and packaging of drugs. The FDA defines a drug as safe and effective for a specific indication if the clinical benefits to the patient are felt to outweigh any health risks the drug might pose. The FDA has not approved smoked cannabis as a legitimate medicine for any disease. [http://www.fda.gov/bbs/topics/NEWS/2006/NEW01362.html Cannabis remains illegal throughout the United States and is not approved for prescription as medicine, although 12 states - Alaska, California, Colorado, Hawaii, Maine, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont and Washington - approve and regulate its medical use. (The federal government continues to enforce its prohibition in these states.) However, there are also 2 states, Arizona and Maryland, whose drug laws are favourable towards the medicinal use of marijuana, but which still explicitly ban it.


NOTABLE PRO- AND ANTI- MEDICAL CANNABIS INDIVIDUALS


Proponents

  • Mary Lynn Mathre, RN, MSN, CARN. President, Patients Out of Time; Cannabis spokesperson for the Virginia Nurses Association. Editor, "Cannabis in Medical Practice: A Legal, Historical and Pharmacological Overview of the Therapeutic Use of Marijuana."




Opponents




PHARMACOLOGIC THC AND THC DERIVATIVES

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