Researchers Seek Answers on Medical Marijuana

By Jennifer Thomas, HealthScoutNews
Source: USA Today

When Irvin Rosenfeld was a boy, he was stricken with a rare disease that caused tumors to grow on his bones, leaving him in constant, crippling pain. He underwent several surgeries to remove the tumors, but new ones grew back. He was prescribed all sorts of painkillers and muscle relaxants, but still he ached.
Then, as a college student, Rosenfeld smoked marijuana for the first time. Almost immediately, he felt better than he had in years.

Now a 48-year-old stockbroker in Fort Lauderdale, Fla., Rosenfeld still has multiple congenital cartilaginous exostosis, a rare and painful genetic disease. And he believes the 12 marijuana cigarettes he smokes each day enable him to live a productive life.

"Without it, I would be on disability and homebound," says Rosenfeld, one of eight Americans who legally smoke marijuana as part of an obscure federal initiative called the "compassionate care" program. The program began in the 1970s but has since been closed to new participants.

The use of marijuana to treat illness is still one of the thorniest issues confronting both the U.S. medical community and its legal system.

And the volume on the debate is certain to be increased by Canada's action last month, when it become the first country to permit severely ill patients with a doctor's approval to apply to federal authorities for permission to grow and use the drug.

American proponents of "medical marijuana" say it's an unfairly vilified drug, one that can ease the nausea caused by chemotherapy, calm the tremors and muscle spasms of multiple sclerosis, and jump-start the appetite of people with AIDS who suffer from severe weight loss.

Advocates also say the drug can relieve pressure in the eye that causes glaucoma, alleviate the pain of migraine headaches and arthritis, and ease the symptoms of a range of health problems, from insomnia to depression to pre-menstrual syndrome.

Skeptics, however, say the drug's supporters are doing little more than blowing smoke. Smoking pot, the opponents note, increases your risk of lung cancer and emphysema. It can also produce serious side effects, including memory impairment and severe anxiety.

"We are afraid promoting marijuana as medicine will give the wrong message to kids that marijuana is good for you and it solves every problem," says Alyse Booth, spokeswoman for the National Center on Addiction and Substance Abuse at Columbia University in New York City.

Now, medical researchers are trying to determine once and for all whether marijuana has any beneficial properties. In laboratories around the world, they're seeking to tease out marijuana's precise effects on the body and whether there's a way to deliver the potential benefits without the harmful smoke.

The University of California San Diego is home to the nation's first institute to study the medical uses of marijuana. Over the next three years, the Center for Medicinal Cannabis Research will give out $9 million to researchers to conduct tests on the therapeutic value of marijuana. The initial studies include:

Two by researchers at UCSD and the University of California San Francisco, to test marijuana's ability to relieve the pain of peripheral neuropathy, a burning, tingling sensation that's the result of nerve damage in people with AIDS. Peripheral neuropathy has been difficult to treat with conventional methods, says Dr. Igor Grant, director of the cannabis research center.

One to examine whether smoking marijuana can relieve the painful muscle spasms and stiffness of multiple sclerosis.
Another to look at whether marijuana affects the driving ability of people with AIDS or multiple sclerosis.
Many of the studies will involve smoking marijuana obtained from a National Institute on Drug Abuse marijuana farm at the University of Mississippi.

The debate over medical marijuana gained urgency in 1996 when California voters passed Proposition 215, a referendum that legalized use of the drug for medical purposes. Since then, Alaska, Arizona, Hawaii, Maine, Oregon, Washington, Colorado and Nevada have passed similar laws, and several other states are considering them.

In California and other states, so-called "cannabis clubs" opened, dispensing marijuana to the ill. But there was still disagreement over who qualified for the drug and how it should be distributed. Many of the clubs later closed, shut by local authorities or sued by the federal government.

In May, the U.S. Supreme Court ruled that one of the clubs, the Oakland, Calif., Cannabis Buyers' Cooperative, violated federal anti-drug laws by dispensing marijuana to patients whose doctors said they needed it.

But the decision was limited to the Oakland cooperative's ability to distribute marijuana. It did not overturn Proposition 215 or similar initiatives passed by the other eight states.

Meanwhile, researchers are trying to steer clear of the political and legal wrangling and let science supply the answers. Passage of Proposition 215 prompted the state of California, which is funding the UCSD marijuana research center, to launch a serious review of the drug, Grant says.

"The idea was that we really ought to have the best information available whether marijuana is useful or not," before clearing the way for marijuana distribution to occur, Grant says.

Even most anti-drug advocates think it's OK to study marijuana's usefulness as a medicine. Narcotics such as morphine are legitimate medicines when dispensed properly, Booth says.

But she suspects that many medical marijuana advocates have an ulterior motive -- the legalization of the drug. "A lot of marijuana activists have been smoking pot for a long time and think of it as a benign drug, and they don't want any legal repercussions," Booth says.

Many pro-marijuana activists don't dispute this. Allen St. Pierre, executive director of the NORML (National Organization for the Reform of Marijuana Laws) Foundation, says there's already ample scientific proof that marijuana is safe and effective.

"There are over 12,000 government and private studies already published in medical journals about marijuana," St. Pierre says. "All they are going to keep doing is proving that marijuana is reasonably benign."

One such report was released by the National Academy of Sciences' Institute of Medicine in 1999. After an 18-month review of already published research on medical marijuana and testimony from doctors and patients, the report's authors concluded that the active components in marijuana appear to be helpful in treating pain, nausea, AIDS-related weight loss and muscle spasms in multiple sclerosis.

The report also called for clinical trials to develop a means of administering marijuana without having to smoke it.

But Grant says almost all the studies of medical marijuana have been small, involving few patients, and more research is needed, particularly in light of the recent Supreme Court ruling.

"The fact is, there have not been clinical trials meeting modern standards," Grant says. "It's becoming very clear that you need very strong medical science to back up the claim that cannabis is useful."

Part One of Two Parts

What To Do:

Visit the National Organization for the Reform of Marijuana Laws for its defense of medical marijuana. Opponents' positions can be viewed by visiting Focus on the Family, or the League Against Intoxicants.
http://www.fmr.no/eng/ecad-medicine.html http://www.natlnorml.org/medical/index.shtml http://www.family.org/cforum/research/papers/a0013707.html

You can also read the Institute of Medicine's Report http://www.nap.edu/readingroom/books/marimed


Medical Marijuana: Help Without the High

By Jennifer Thomas, HealthScoutNews

As the battle over medical marijuana intensifies, researchers are quietly trying to come up with a way to dodge the bullets. Their aim: Develop a form of the drug that will treat pain but not get you high.

In laboratories and greenhouses around the world, they are are experimenting with pills, inhalers, patches and even suppositories that would deliver marijuana's pain-killing effects without the psychoactivity.

Scientists hope the new products will quiet critics who believe the medical marijuana movement is nothing more than a bid to eliminate penalties for smoking pot for fun.

Researchers also believe the products will be popular with doctors and patients. For sufferers of chronic diseases who use marijuana to treat pain, getting high is an undesirable side effect.

"Recreational users smoke pot to get high," says Mark Rogerson, a spokesman for GW Pharmaceuticals Ltd. in England, which has a permit from the British government to grow marijuana plants for medical research.

"People who are ill smoke it so they can get on with their jobs, make supper for the kids, go to the supermarket. Feeling high and light-headed is not what they want," he adds.

Irvin Rosenfeld, who smokes 12 marijuana cigarettes a day to dull the pain of a crippling bone disorder, agrees.

"Smoking marijuana lets me do my job and live my life," says the 48-year-old stockbroker from Fort Lauderdale, Fla. He has multiple congenital cartilaginous exostosis, a rare and painful genetic disease that causes tumors to grow at the ends of his bones.

Advocates of medical marijuana contend it can ease the nausea triggered by chemotherapy, soothe the tremors and muscle spasms of multiple sclerosis, rekindle the appetites of people with AIDS who suffer severe weight loss and also is useful with glaucoma, migraines, arthritis and even depression symptoms.

But bringing medical marijuana to your local pharmacy won't be easy. Getting U.S. Food and Drug Administration approval for many drugs is a long and expensive process, and marijuana poses some unique challenges, researchers say.

First, because marijuana grows in nature, it can't be patented. Big drug companies are hesitant to spend millions of dollars on research and clinical trials on a product they can't own outright, says Sumner Burstein, a professor of biochemistry and molecular pharmacology at the University of Massachusetts in Worcester.

Second, a drug manufacturer would need to come up with a way to administer marijuana other than through smoking it, because marijuana smoke is considered at least as toxic as cigarette smoke.

Further complicating matters, marijuana is a highly complex plant that contains more than 400 chemicals. Although marijuana contains 60 chemicals called cannabinoids that could play a role in its painkilling effects, only one - tetrahydrocannabinol, or THC - is the compound that researchers believe is responsible for those painkilling effects.

And THC is also the compound responsible for the psychoactive high that recreational marijuana users crave.

Researchers are experimenting with different combinations and dosages that would deliver the painkilling effects without the mind-bending ones.

After 10 years of research, Burstein says he has the answer. He has developed and patented a synthetic form of THC called CT-3 that he says works as well as marijuana for pain relief but is not psychoactive.

"There is a critical need for a drug that is potent but does not have the bad side effects," Burstein says. "We think we've found it."

Burstein was funding the research out of his own pocket until recently, when he licensed CT-3 to Atlantic Technology Ventures Inc., a small New York City company that is trying to get a major drug company interested in continuing the clinical trials. Completing the trials to get FDA approval would cost about $100 million, he estimates.

There is already a synthetic form of THC called Marinol that has been available by prescription since the mid-1980s.

But some patients complain that Marinol, a pill, takes too long to work because it has to be absorbed through the digestive system, a company spokeswoman says. Marijuana that is smoked delivers its effects almost instantly, and some patients say they can regulate the dosage of smoked marijuana more easily.

Unimed Pharmaceuticals of Deerfield, Ill., the company that makes Marinol, is addressing those issues by working on an aerosol spray that would deliver quick pain-relief similar to smoked marijuana.

England's GW Pharmaceuticals is taking yet another approach in the quest.

The company was granted a license by the British government in 1998 to grow 40,000 cannabis plants in secret greenhouses for research. Although plants in the wild can be chemically different from one other, the plants grown in GW's greenhouses are bred to be identical so scientists can be sure exactly what chemicals are in them.

Armed with that information, scientists are working to develop a plant extract that has a low dose of THC and another component of marijuana, cannabidiol (CBD). Researchers believe cannabidiol mitigates the psychoactivity of THC, Rogerson says.

GW's scientists are currently testing under-the-tongue sprays that have varying amounts of THC and CBD. The aim is to strike the right balance that would produce pain relief without the high, Rogerson says.

The firm plans to have a prescription ready by 2003, he adds. The spray will have a mechanism, possibly a microchip, that prevents the user from taking more than the prescribed dose, Rogerson says.

"What will happen is, you'll get pain relief quickly at a dosage level well below the amount you'd need to get high," he says.

Second of Two Parts

What To Do:

To read studies on medical marijuana, visit the Schaffer Library of Drug Policy, or the National Institute on Drug Abuse.
http://www.nida.nih.gov/Infofax/marijuana.html http://www.druglibrary.org/schaffer/hemp/medical/medical.htm

Newshawk: Jack D.
Source: USA Today (US)
Author: Jennifer Thomas, HealthScoutNews
Published: August 10 - 17, 2001
Copyright: 2001 USA Today, a division of Gannett Co. Inc.
Contact: editor@usatoday.com
Website: http://www.usatoday.com/

Related Articles & Web Sites:

UK Medicinal Cannabis Project http://www.medicinal-cannabis.org/

Medical Marijuana Information Links http://freedomtoexhale.com/medical.htm