Wednesday, November 08, 2006

"CHANGE IS IN THE AIR"

MEDICAL CANNABIS: PAST, PRESENT & FUTURE

By David Bearman, MD for ABC-CLIO















There are two schools of thought concerning medicinal cannabis (aka medical marijuana). It seems that even the U.S. government is torn between them, since different agencies disagree among themselves. For example, a government-ordered 1999 Institute of Medicine (IOM) report concluded marijuana has many potential therapeutic uses. Yet an April 2006 newspaper headline blared “FDA finds marijuana has no medicinal value.” But this argument is about much more than cannabis and medicine. It brings together science, history, politics, personal freedom and race.

Cannabis’ long history as a medicine, dates back at least 3,000 years to the first Indian Materia Medica written in 1100 BC. Cannabis was in the U.S. Pharmacopoeia (USP) from 1854 until 1941. Its use, recreationally as well as medicinally, was legal in the United States before the 20th century. It was found in many patent medicines. The teens and 1920s saw the U.S. medical community move from a haphazard training system with often slip-shod care to what today we recognize as modern, science-based medicine. More “scientifically” based medical care led to decreased use of herbal medicines and increased use of manufactured pharmaceuticals.

Several factors came together in the early 20th century that would result in the criminalization of marijuana use. There was a strong prohibitionist sentiment in the country at the turn of the century eventually culminating in the 18th Amendment and Prohibition in 1920. The 1914 Harrison Act was the first anti-drug legislation passed in this country, targeting cocaine and opium-based drugs. With an influx of Mexican immigrants after the Mexican Revolution ended in 1910. many Southwestern states made marijuana use illegal in the years following.

In the 1930s, marijuana was especially targeted by America’s first drug czar, Harry J. Anslinger. During his anti-marijuana campaign, Anslinger put together his so called gore files which contained many wild stories published in the Hearst newspapers change about insanity, murder, and death caused by marijuana use.

There has been much speculation that public health concerns were not the basis for this concern about cannabis or the cumbersome tax laws that followed. The main reason these historians suggest that the Marijuana Tax Act was proposed had to do with industrialists being concerned about competition from hemp with wood pulp, synthetic fibers and petrochemicals. Some texts state that industrialist Lamont Dupont met with Tom Oliphant head attorney for the Treasury Department from 1935-1937 to discuss what to do about the hemp competition..

Others believe that Anslinger was creating an issue where there was none to win fame and bureaucratic power. Part of the motivation was certainly racial. Marijuana was associated with Mexican immigrants, whom labor organizations feared were taking jobs away from Americans. Marijuana was also associated with racism against African-Americans, portrayed as users who became so unhinged by the drug that they committed terrible crimes under its influence.

Anslinger proposed legislation that effectively banned the use of marijuana: the 1937 Marijuana Tax Act. The American medical profession was caught off guard by this move. The prestigious American Medical Association opposed the Act. The AMA was not consulted in the preparation of the law. Dr. William Woodward, the AMA’s long-time spokesman, testified at the 1937 Marijuana Tax Act Hearings that “The AMA knows of no dangers from cannabis.” The Association also testified that no health-related federal agencies had been contacted for data by the Act’s proponents.

It was not only Anslinger’s anti-marijuana crusade that led to the illegalization of marijuana. In the following year,1938, the Federal Food, Drug and Cosmetics Act was passed in response to a tragedy in which 100 people were killed by a drug containing a chemical related to anti-freeze. The Act required that all new drugs be tested for safety and efficacy to gain the approval of the Food and Drug Administration (FDA). This law institutionalized the concept that single chemical compounds were superior to plants. Soon it became conventional wisdom that single chemicals acted with more specificity and presumably better than the multiplicity of chemicals found in plants. In other words, man made drugs became seen as more effective than the complex natural compounds in plants. Medicine began to move further away from natural remedies towards manufactured pharmaceutical drug treatments.

However, marijuana was too effective as a medicine to simply go away. In 1976, glaucoma patient Robert Randall fought in court for his right to smoke marijuana for his symptoms. A federal judge ruled that Randall should receive medical marijuana from the government itself. In 1978 the federal government commenced sending hand-rolled, .9 gm. cannabis cigarettes to 15 federally legal medical marijuana patients. Studies done in 8 states in the 1970’s and 1980’s document cannabis’ medicinal utility as means of fighting nausea and stimulating appetite.

That medicinal use continues up to the present day but not without controversy. In 2005, the Supreme Court ruled in Raich v. Gonzales that medical marijuana is not permitted under federal law. However, several states have legalized its use. This had led to a confusing situation, in which some patients are protected by state laws, while others have been subjected to raids by the Drug Enforcement Agency (DEA).

Despite the anti-marijuana rhetoric, research on the plant continued in the coming decades. In 1964 Dr. Raphael Mechulam isolated THC, the most pharmacologically active chemical of the 483 chemicals in cannabis. Researchers, clinicians and governments once again began to see the medical utility of cannabis and cannabinoids – chemicals derived from cannabis. More recently, cannabis has been found by many clinical researchers to be useful for treatment of pain, migraines, seizures and Irritable Bowel Syndrome (IBS).

A 1997 New England Journal of Medicine editorial supported doctors prescribing marijuana for medical purposes, calling the threat of government sanctions “misguided, heavy-handed and inhumane.” The Journal’s editor, Dr. Jerome P. Kassirer, wrote: “Whatever their reasons, federal officials are out of step with the public.” The UCSD School of Medicine was designated as headquarters for the California Marijuana Research Center (CMRC) in 2001 after the California State Legislature allocated 9 million dollars for researching the efficacy of smoked cannabis. The CMRC administers 18 FDA approved smoked medical cannabis studies at four University of California medical schools. Study results have been generally positive.

Advanced medical technologies are being applied to cannabis, converting the plant into forms that may help it to gain recognition as a medicine. GW Pharmaceuticals, a UK company specializing in plant chemicals, has six cannabis greenhouses in a secret location in the South of England. Since 1999, GW has been doing medical research on "tincture of cannabis" – marijuana chemicals in alcohol solution. GW recently introduced its cannibinoid drug Sativex, which is administered via a mouth spray. In 2005, Health Canada approved Sativex for sale in Canada. The FDA recently approved a clinical study of tincture of cannabis here in the U.S.

Change is in the air. As clinical trials on cannabis-derived drugs proceed, the U.S. government has also been requested to reclassify cannabis in the FDA's hierarchy of controlled substances. Currently, cannabis is classified as a Schedule I substance, the category containing highly addictive drugs without medical value, including heroin, Ecstasy, and LSD.

There is a movement underway to place marijuana in Schedule II (high tendency of abuse, possible medical value) or even Schedule III (less abused with recognized medical benefits). The first effort was in 1972. In 1988, Chief FDA Administrative Law Judge Francis Young ruled that cannabis should be rescheduled. His decision stated that marijuana was “one of the safest therapeutic agents known to man.” But this rescheduling recommendation was denied by John Lawn, head of the FDA under President George H.W. Bush. What will happen in the current process in unclear. The present rescheduling effort will be ruled on in 2007.