Cannabis as Medicine: Why Not?
December 2010, Vol. 21, No. 4 , Pages 171-173 (doi:10.3109/10884602.2010.481540)
President & Co-Founder, Patients Out of Time, Howardsville, VA, USA
On a national level, Cannabis is a Schedule I drug under federal law, but is recognized as medicine in 14 states and the District of Columbia, with many more states considering similar legislation. Internationally, change is occurring in many European countries, plus Israel, Canada, Australia, as well as in Central and South America regarding the legal status of cannabis. The emerging science on the endogenous cannabinoid system or endocannabinoid system (ECS) is providing numerous clues to help our understanding of how and why cannabis is so safe and effective for a wide array of conditions and illnesses. As I write this piece, the Drug Enforcement Administration (DEA) is in receipt of the recommendations from the Department of Health and Human Services regarding a 2002 petition to remove cannabis from the Schedule I category of the controlled substances and is long overdue by its own regulations in its final decision (see www.drugscience.org).Cannabis has been used medicinally throughout the world for centuries. It was an integral part of American medicine until the passage of the Marihuana Tax Act of 1937, which was based on reefer madness myths and lies (Bonnie & Whitebread, 1974). With the passage of the Controlled Substances Act of 1970, cannabis was erroneously put into the Schedule I or “forbidden drug” listing under its “new” name of marijuana, and remains there today, despite the fact that a synthetic version of the primary psychoactive component of cannabis, delta-9-tetrahydrocannabinol or THC (Marinol®) is now in Schedule III. Cannabis remains in Schedule I despite the fact that the Shafer Commission appointed by the Nixon Administration concluded in 1972 that the harm from the prohibition of cannabis was greater than the potential harm from its use (National Commission on Marihuana and Drug Abuse). As a result of the first petition to the DEA to reschedule cannabis, filed in the early 1970s by the National Organization for the Reform of Marijuana laws (NORML) and the Alliance for Cannabis Therapeutics (ACT), the DEA's own Administrative Law judge, Francis Young, ruled in 1988 that cannabis should be moved to Schedule II. He noted that cannabis was “one of the safest therapeutic substances known to man,” but his ruling was ignored. In 1982 the Institute of Medicine published their report, Marijuana and Health, in which they concluded that the prohibition is more harmful than use of cannabis and when used as medicine it seemed to work differently than standard medications (usually a green light for research on a new medicine). Then in 1999, the Institute of Medicine published another report, Marijuana as Medicine: Assessing the Science Base, which concluded that cannabis is safe enough for medical use, n-of-1 studies should be allowed, and although research should continue on alternative delivery methods, cancer and AIDS patients should be allowed to smoke cannabis as medicine now (Joy, Watson & Benson, 1999).
Beginning in the 1990s, numerous state nurses associations started passing resolutions calling for patient access to cannabis, followed by the ANA in 2003. The American Public Health Association passed its medical marijuana resolution in 1997, despite no support from the Substance Abuse Section. The American College of Physicians passed their medical marijuana resolution in 2008 and finally the AMA took a baby step by calling for research on medicinal cannabis in 2009.
A cannabis resolution was passed by the National Nurses Society on Addictions in 1995, but was later quietly rescinded during a board of directors’ conference call. The American Society of Addiction Medicine also had a medicinal cannabis resolution released, but only a few years later the organization back-pedaled on its previous recommendations for patient access and restricted their new resolution to call for more research. One might ask, what new finding would cause these two organizations to change their stand on this issue? Was there a new study released that identified some significant risk related to the use of cannabis? No. There is no risk from cannabis greater than the range of possible risks from most pharmaceuticals in use today. Could a person become addicted to cannabis? Yes, but the risk of addiction to cannabis is much lower than the risk of addiction to opioids or benzodiazepines. So why withhold support of legal access to this medicine? My investigation concluded that these reversals came as a result of outside pressure from the Office of National Drug Control Policy under the direction of General Barry McCaffrey.
It is very clear to me that the cannabis prohibition has nothing to do with science, common sense or compassion. History shows it was used as medicine, major reviews by health care professionals object to its prohibition, leading health care organizations support its use as medicine and 14 states have disagreed with the federal prohibition. There are many in the addictions field who recognize the therapeutic potential of cannabis. Yet, there are also a number of addictions specialists who agree with the DEA and the federal bureaucrats who cling to the notion that cannabis really is a very dangerous and highly addictive drug. This editorial is aimed at this second group.
When it comes to those who maintain that cannabis is not medicine, the question before you is “Why not?” I am suggesting that nurses, who accept the placement of cannabis in Schedule I, take a close look at the foundation of their thought processes on this topic. If for some reason, you as an addictions nurse, cannot support legal access to cannabis for patients, please stop and consider each of these questions carefully. Why is cannabis in Schedule I? Where is the evidence to show that it is highly addictive? How can you say that there is no accepted medical use in the US? How can you say that it is not safe for medical use (and don't dismiss this question with the excuse that you can't support smoking a medicine)? Why does the use of cannabis as medicine have to have such a high standard, when patients die every day from the use of common prescription and over-the-counter medications?
Here is a quick review of some of the common concerns:
- It can be addictive—Fine, although the addiction rate is low for cannabis, those who have an addiction to it can get treatment.
- Medicine shouldn't be smoked—It does not need to be smoked; there are other delivery methods. However, to his surprise, the leading researcher in this area, Donald Tashkin, MD from UCLA, found that smoking cannabis does not lead to pulmonary disease.
- It can cause euphoria—That's not a bad side effect of a medication for a suffering patient.
- Today's cannabis is stronger now with a much higher THC content—First keep in mind that Marinol is synthetic THC in sesame oil and it is in Schedule III. Second, other cannabinoids in cannabis (especially CBD) tend to modulate the psychoactive effects of THC to dampen them. With proper testing, patients will be able to get the right combination of cannabinoids that meet their needs.
- It sends the wrong message to children—Forbidding a safe and effective medication to patients is the wrong message to kids.
- People will fake their illness in order to get a cannabis recommendation—They are using it anyway so they might as well be monitored by a health care professional.
- The dose may vary with the natural plant—It has such a wide margin of safety this is of little concern and under legal conditions patients and care providers will know the content.
- It could be contaminated with mold or other chemicals—This could be a very serious problem that can be solved if and only when cannabis is legal and regulated.
1For research articles and presentations by cannabis researchers and clinicians go to www.medicalcannabis.com. Also on that site, you will find a link to online continuing education featuring the National Clinical Conference on Cannabis Therapeutics series through the UCSF School of Medicine's CME website.Doesn't it seem strange and wrong for our government to actually prohibit this plant? Cannabis is one of the most beneficial plants on earth so how do you justify its eradication? Wouldn't it make more sense (and a lot less suffering) if instead all these efforts went to eradicating poison ivy?Can you actually support the arrest and incarceration of someone for simply growing this plant (and they charge the person with manufacturing a drug)? Manufacturing methamphetamine is a toxic and potentially explosive venture, thus there are concerns about illicit methamphetamine labs. Cannabis is a non-toxic, highly beneficial plant. Wouldn't it simply make more sense for our law enforcement to “protect and serve” us in times of need and therefore focus on persons who commit crimes that harm others? The cannabis prohibition goes way beyond common sense with the inclusion of hemp. When cannabis is grown as hemp for its fiber and seed, the THC content is very low. Hemp farmers would not want any cannabis grown for its higher THC content (for medicine or recreational purposes) anywhere near their hemp crop for concern of cross pollination which would negatively affect their product. Yet the DEA will not even allow hemp to be grown by our farmers. Why not? Wonderful eco-friendly hemp products (clothing, lotions and soaps, hemp seed oil, clean fuel, and more) are available to Americans at a high cost because they have to be imported since we cannot grow the plant in the US. Our farmers in ND and MN look to their northern neighbors in Canada who grow hemp and wonder why they cannot grow this crop which will make them more money and is good for their soil.
Let's get back to the medicinal grade cannabis. How do you say no to an MS patient who is able to ambulate with the help of medicinal cannabis? What do you say when a patient with chronic pain is able to get off oxycontin with the use of cannabis? How do you explain to a patient that he cannot use cannabis even if it is the only medication that is able to control his intraocular pressure and prevent blindness? How do you tell the mother of a young child diagnosed with aggressive behavior disorder that she cannot give him cannabis when it is the only medicine that calmed her child and made the “noise in his head” go away? What do you say to the 30-year-old woman who could not work or drive a car because of uncontrollable seizures, but got her life back when she began using cannabis and the seizures ended? And what do you say to a combat veteran returning from Iraq or Afghanistan, who finds that cannabis is the only medication that manages his post-traumatic stress? Do you simply dismiss them as anecdotal accounts or that they are somehow being manipulated by “legalizers.” When patients ask why they cannot use cannabis do you simply say that it is illegal and ignore the reality that it helped them feel better or function better?
As addictions nurses, we understand the devastating effects of drug addiction or alcoholism and work to prevent or treat this enormous health problem. Any formal education on marijuana has been in the context of substance abuse or addiction. I’m asking that you re-examine cannabis through the lens of a health care professional and that means reviewing the science. Countless studies on the potential risks of marijuana have been funded by NIDA for decades. No serious adverse reactions have been attributable to cannabis that exceed the normally accepted risks related to medications. When conducting patient interviews to get a medical history, do you automatically put marijuana/cannabis under the header of substance abuse history as you were probably taught to do? Or do you ask your patients why they use cannabis and list it under medications when they say they are using it as medicine? When doing a substance abuse history, do you explore what health, social, legal or other problems the patient had with cannabis? Do you differentiate the “legal” problems with cannabis use by determining whether it was caused by the effects of cannabis or simply by the cannabis prohibition? In other words, if a patient with MS used cannabis to lessen the spasticity or pain gets busted for marijuana possession, do you consider that a legal consequence of marijuana addiction/abuse or a legal consequence of the prohibition of this patient's medication? These questions are not meant to infer that cannabis abuse or addiction does not occur, but rather to ensure that you are not making unfounded assumptions about a person's use of cannabis.
Most treatment programs have a zero tolerance for illicit drug use; however there are some clinics in states that have medical marijuana laws that are honoring a patient's cannabis recommendation from a health care provider. A pilot study of some of these patients found that they did as well or better than others in the program. http://7thspace.com/headlines/337214/medical_marijuana_users_in_substance_abuse_treatment.html. This seems to indicate that a patient can use cannabis as medicine and still do well in drug treatment. Historically cannabis was used in the treatment of other addictions—either as an aid in withdrawal from other drugs or as a substitute. In recent years many compassion clubs are finding that their patients have used cannabis to quit smoking cigarettes, get off opioids or cocaine, or to prevent alcohol relapse. The emerging science on the ECS, tells us that this system is critical in helping us maintain homeostasis or balance. Dealing with trauma, poor nutrition (processed foods vs. real food), and environmental pollutants add to our daily stressors and put a huge workload on this important system. Whether it is drug addiction or other illnesses or conditions, cannabis may just be the medicine we need to get our ECS back in good working order.
If a patient has the option of taking a toxic chemotherapy medication designed to kill cells with the possibility that it may kill the patient, how can a patient be denied cannabis, a medication that cannot kill a human? So it comes down to this: Medicinal cannabis—Why not?
- Bonnie, R.J., & Whitebread, C.H. (1974). The marihuana conviction: A history of marihuana prohibition in the United States. Charlottesville: University Press of Virginia.
- Institute of Medicine. (1982). Marijuana and Health. Washington, DC: National Academy Press.
- Joy, J.E., Watson, S.J., Jr., & Benson, J.A. (1999). Marijuana and medicine: Assessing the science base. Washington, DC: National Academy Press
- National Commission on Marihuana and Drug Abuse –RP Shafer, Chairman. (1972). Marihuana: A signal of misunderstanding. New York: The New American Library, Inc.
- Young, F.L. (September 6, 1988). In the Matter of Marijuana Rescheduling Petition, Docket #86–22, Opinion and Recommended Ruling, Findings of Fact, Conclusions of Law and Decision of Administrative Law Judge. Washington, DC: US Department of Justice, Drug Enforcement Administration.
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