Medical Marijuana Initiatives

Are They Justified? How Successful Are They Likely to Be?

Abstract

The principal constituent of cannabis, Δ9-tetrahydrocannabinol (THC), is moderately effective in treating nausea and vomiting, appetite loss, and acute and chronic pain. Oral THC (dronabinol) and the synthetic cannabinoid, nabilone, have been registered for medical use in the US and UK, but they have not been widely used because patients find it difficult to titrate doses of these drugs. Advocates for the medical use of cannabis argue that patients should be allowed to smoke cannabis to relieve these above-mentioned symptoms.

Some US state governments have legislated to allow the medical prescription of cannabis, but the US federal government has tried to prevent patients from obtaining cannabis and threatened physicians who prescribe it with criminal prosecution or loss of their licence to practise. In the UK and Australia, committees of inquiry have recommended medical prescription (UK) and exemption from criminal prosecution (New South Wales, Australia), but governments have not accepted these recommendations. The Canadian government allows an exemption from criminal prosecution to patients with specified medical conditions. It has recently legislated to provide cannabis on medical prescription to registered patients, but this scheme so far has not been implemented.

Some advocates argue that legalising cannabis is the only way to ensure that patients can use it for medical purposes. However, this would be contrary to international drug control treaties and is electorally unpopular. The best prospects for the medical use of cannabinoids lie in finding ways to deliver THC that do not involve smoking and in developing synthetic cannabinoids that produce therapeutic effects with a minimum of psychoactive effects. While awaiting these developments, patients with specified medical conditions could be given exemptions from criminal prosecution to grow cannabis for their own use, at their own risk.

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References

  1. 1.

    Grinspoon L, Bakalar J. Marihuana, the forbidden medicine. New Haven (CT): Yale University Press, 1993

    Google Scholar 

  2. 2.

    Mechoulam R. The pharmacohistory of cannabis sativa. In: Mechoulam R, editor. Cannabinoids as therapeutic agents. Boca Raton (FL): CRC Press, 1986

    Google Scholar 

  3. 3.

    Nahas G. Toxicology and pharmacology. In: Nahas G, editor. Marihuana in science and medicine. New York: Raven Press, 1984: 109–246

    Google Scholar 

  4. 4.

    Kalant H. Medicinal use of cannabis: history and current status. Pain Res Manag 2001; 6(2): 80–91

    PubMed  CAS  Google Scholar 

  5. 5.

    Mechoulam R, Hanu L. The cannabinoids: an overview: therapeutic implications in vomiting and nausea after cancer chemotherapy, in appetite promotion, in multiple sclerosis and in neuroprotection. Pain Res Manag 2001; 6(2): 67–73

    PubMed  CAS  Google Scholar 

  6. 6.

    Iversen L. The science of marijuana. Oxford: Oxford University Press, 2000

    Google Scholar 

  7. 7.

    Hall W, Degenhardt L, Lynskey M. The health and psychological consequences of cannabis use. Canberra (ACT): Australian Publishing Service, 2001

    Google Scholar 

  8. 8.

    Goani Y, Mechoulam R. Isolation, structure and partial synthesis of an active constituent of hashish. J Am Chem Soc 1964; 86: 646–7

    Article  Google Scholar 

  9. 9.

    Institute of Medicine. Marijuana and medicine: assessing the science base. Washington, DC: National Academy Press, 1999

    Google Scholar 

  10. 10.

    Ashton HC. Biomedical benefits of cannabinoids? Addict Biol 1999; 4(2): 111–26

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Bagshaw SM, Hagen NA. Medical efficacy of cannabinoids and marijuana: a comprehensive review of the literature. J Palliat Care 2002; 18(2): 111–22

    PubMed  Google Scholar 

  12. 12.

    House of Lords Select Committee on Science and Technology. Cannabis: the scientific and medical evidence. London: Stationary Office, 1998

    Google Scholar 

  13. 13.

    Williamson EM, Evans FJ. Cannabinoids in clinical practice. Drugs 2000; 60(6): 1303–14

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Walker JM, Huang SM. Cannabinoid analgesia. Pharmacol Ther 2002; 95(2): 127–35

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Campbell FA, Tramer MR, Carrol D, et al. Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review. BMJ 2001; 323(7303): 13–6

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Tramer MR, Carroll D, Campbell FA, et al. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ 2001; 323(7303): 16–21

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Soderpalm AHV, Schuster A, de Wit H. Antiemetic effect of smoked marijuana: subjective and behavioural effects on nausea induced by syrup of ipecac. Pharmacol Biochem Behav 2001; 69(3-4): 343–50

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Beal JE, Olson R, Laubenstein L, et al. Dronabinol as a treatment for anorexia associated with weight loss in patients with AIDS. J Pain Symptom Manage 1995; 10(2): 89–97

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Beal JE, Olson R, Lefkowitz L, et al. Long-term efficacy and safety of dronabinol for acquired immunodeficiency syndrome-associated anorexia. J Pain Symptom Manage 1997; 14(1): 7–14

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Pertwee RG. Cannabinoids and multiple sclerosis. Pharmacol Ther 2002; 95(2): 165–74

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Consroe P, Musty R, Rein J, et al. The perceived effects of smoked cannabis on patients with multiple sclerosis. Eur Neurol 1997; 38(1): 44–8

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Clifford DB. Tetrahydrocannabinol for tremor in multiple sclerosis. Ann Neurol 1983; 13(6): 669–71

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Petro DJ, Ellenberger Jr C. Treatment of human spasticity with delta 9-tetrahydrocannabinol. J Clin Pharmacol 1981; 21(8-9 Suppl.): 413S–6S

    PubMed  CAS  Google Scholar 

  24. 24.

    Ungerleider JT, Andyrsiak T, Fairbanks L, et al. Delta-9-THC in the treatment of spasticity associated with multiple sclerosis. Adv Alcohol Subst Abuse 1987; 7(1): 39–50

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Smith PF. Cannabinoids in the treatment of pain and spasticity n multiple sclerosis. Curr Opin Investig Drugs 2002; 3(6): 859–64

    PubMed  CAS  Google Scholar 

  26. 26.

    Killestein J, Hoogervorst EL, Reif M, et al. Safety, tolerability, and efficacy of orally administered cannabinoids in MS. Neurology 2002; 58(9): 1404–7

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Romero J, Lasstres-Becker I, de Miguel R, et al. The endogenous cannabinoid system and the basal ganglia: biochemical, pharmacological and therapeutic aspects. Pharmacol Ther 2002; 95(2): 137–52

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Muller-Vahl KR, Schneider U, Koblenz A, et al. Treatment of Tourette’s syndrome with delta-9-tetrahydrocannabinol (THC): a randomized cross-over trial. Pharmacopsychiatry 2002; 35: 57–61

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Alward WL. Medical management of glaucoma. N Engl J Med 1998; 339(18): 1298–307

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Crawford WJ, Merritt JC. Effects of tetrahydrocannabinol on arterial and intraocular hypertension. Int J Clin Pharmacol Biopharm 1979; 17(5): 191–6

    PubMed  CAS  Google Scholar 

  31. 31.

    Green K. Marijuana smoking vs cannabinoids for glaucoma therapy. Arch Ophthalmol 1998; 116(11): 1433–7

    PubMed  CAS  Google Scholar 

  32. 32.

    Jarvinen T, Pate DW, Laine K. Cannabinoids in the treatment of glaucoma. Pharmacol Ther 2002; 95(2): 203–20

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Swift W, Hall W. Tolerance, withdrawal and dependence. In: Grotenhermen F, Russo E, editors. Cannabis and cannabinoids: pharmacology, toxicology and therapeutic potential. New York: Haworth, 2002: 257–68

    Google Scholar 

  34. 34.

    Tashkin DP. Airway effects of marijuana, cocaine, and other inhaled illicit agents. Curr Opin Pulm Med 2001; 7(2): 43–61

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    GW Pharmaceuticals. Drug delivery technologies [online]. Available from URL: http://www.gwpharm.com/rese_drug_index.html [Accessed 2002 Dec 3]

  36. 36.

    Goutopoulos A, Makriyannis A. From cannabis to cannabinergics: new therapeutic opportunities. Pharmacol Ther 2002; 95(2): 103–17

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    DuPont RL. Examining the debate on the use of medical marijuana. Proc Assoc Am Physicians 1999; 111(2): 166–72

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Report of the working party. Sydney (NSW): Working Party on the Use of Cannabis for Medical Purposes (NSW), 2000

  39. 39.

    Pacula RL, Chriqui JF, Reichmann DA, et al. State medical marijuana laws: understanding the laws and their limitations. J Public Health Policy 2002; 23: 411–37

    Article  Google Scholar 

  40. 40.

    Conboy JR. Smoke screen: America’s drug policy and medical marijuana. Food Drug Law J 2000; 55(4): 601–17

    PubMed  CAS  Google Scholar 

  41. 41.

    Gieringer D. The acceptance of medicinal marijuana in the US. J Cannabis Ther 2003; 3: 53–65

    Article  Google Scholar 

  42. 42.

    Barnes RE. Reefer madness: legal & moral issues surrounding the medical prescription of marijuana. Bioethics 2000; 14(1): 16–41

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Reuter P, Burnam A. Drug warriors and policy reformers: the debate over medical marijuana. Rand Drug Policy Res Cent Newsl 1997; 6(1): 1–6

    Google Scholar 

  44. 44.

    US General Accounting Office. Marijuana: early experiences with four states’ laws that allow use for medical purposes: GAO-03-189. Washington, DC: US General Accounting Office, 2002 Nov

    Google Scholar 

  45. 45.

    Moffat AC. The legalization of cannabis for medical use. Sci Justice 2002; 42(1): 55–7

    PubMed  Article  CAS  Google Scholar 

  46. 46.

    Health Canada Office of Cannabis Medical Access. Medical access to marijuana: how the regulations work [online]. Available from URL: http://www.hcsc.gc.ca/hecs-sesc/ocma/bckdr_1-0601.htm [Accessed 2002 Aug 30]

  47. 47.

    Abraham C. Medicinal-marijuana harvest on hold. The Globe and Mail 2002 Apr 22; Sect. A: 1 (col. 3–6), 6 (col. 1–2)

  48. 48.

    Hall WD, Degenhardt LJ, Currow D. Allowing the medical use of cannabis. Med J Aust 2001; 175(1): 39–40

    PubMed  CAS  Google Scholar 

  49. 49.

    MacCoun R, Reuter P. Drug war heresies. New York: Cambridge University Press, 2001

    Book  Google Scholar 

  50. 50.

    Hall W, Babor T. Cannabis use and public health: assessing the burden. Addiction 2000; 95(4): 485-90

    PubMed  Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors served respectively as Chair and Research Officer for the New South Wales Working Party on the Use of Cannabis for Medical Purposes. We thank the members of this group for improving our understanding of the scientific, regulatory and political issues raised by proposals to allow the medical use of cannabis. We thank Eva Congreve for help in locating literature, Heather Niven for helping to format the paper and Sarah Yeates for help in checking references.

The preparation of this work was supported by core funding for the National Drug and Alcohol Research Centre at the University of New South Wales from the Commonwealth Department of Health and Aged Care; funding from the NSW government for Louisa Degenhardt’s salary to prepare the Report of the Working Party on the Use of Cannabis for Medical Purposes; and by the Vice Chancellor’s Strategic Fund at the University of Queensland. The views expressed are those of the authors. There are no potential conflicts of interest other than the authors’ involvement with the NSW Working Group on the Use of Cannabis for Medical Purposes.

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Correspondence to Prof. Wayne Hall.

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Hall, W., Degenhardt, L. Medical Marijuana Initiatives. CNS Drugs 17, 689–697 (2003). https://doi.org/10.2165/00023210-200317100-00001

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Keywords

  • Cannabis User
  • Medical Purpose
  • Criminal Prosecution
  • Nabilone
  • Dronabinol