April 10, 2000
By LAWRENCE K. ALTMAN
IOWA CITY, April 9 -- By cultivating marijuana and testing the most promising of its more than 100 ingredients, a British pharmaceutical company hopes to develop drugs for a variety of ailments, a company official said at the first national conference for health professionals about the medical uses of marijuana.
The privately owned company, GW Pharmaceuticals Ltd. of Salisbury, England, is "trying to turn an illegal plant into a pharmaceutically regulated product" by developing cannabis-based medicines that are not smoked, said Dr. David C. Hadorn, the company's North American medical director.
GW is studying what it believes will be the most promising ingredients of marijuana in a structured research program.
Earlier this month, the British government approved the company's plans to advance to the next stage of testing, for effectiveness, among people with multiple sclerosis, spinal cord injury and other conditions that produce severe pain and muscle spasms.
Six healthy volunteers had taken four different preparations several times over a period of several weeks in the earliest phase of testing, for safety.
Full-scale testing will eventually involve about 2,000 patients in England, Canada and the United States, and the hope is to develop a licensed product by 2003, Dr. Hadorn said.
The University of Iowa's colleges of nursing and medicine sponsored the two-day conference to help health care professionals and providers learn how to obtain and properly use medical marijuana.
Melanie C. Dreher, the nursing school's dean, said the conference was needed because thousands of Americans use marijuana medically even though it is illegal in most states. Voters in at least seven states (Alaska, Arizona, California, Colorado, Nevada, Oregon and Washington) have approved initiatives intended to make marijuana legal for medical purposes. But many doctors are afraid to recommend it because the federal government has threatened to prosecute them.
Dr. Dreher, who has researched marijuana use for many years, spoke in an interview of one of her nurses' experience with the father of a man with cancer.
The father told the nurse that marijuana had eased his son's nausea and pain at home. Taking the hint, the nurse rigged the son's intravenous tubing to a wheelchair to allow them to go off while the son smoked a marijuana cigarette. The therapy allowed the son a more comfortable death.
All drugs have both potential hazards and benefits. But a critical problem in the case of marijuana is that doctors and nurses have not been trained in its medical use.
"The challenge is to quit using illegality as an excuse not to discuss medical marijuana," said Mary Lynn Mathre, an addictions nurse at the University of Virginia and co-director of the Iowa conference.
With her husband, Al Byrne, Ms. Mathre founded Patients Out of Time, a nonprofit group based in Virginia that promotes the legal use of medical marijuana and that helped organize the conference.
The American Medical Association supported the conference by awarding doctor participants credits toward their continuing education.
No government officials were among the 250 patients, doctors, nurses and lawyers who attended the conference here and at telecasts in seven medical centers in the United States and Canada. Dr. David Satcher, the surgeon general of the Public Health Service, declined an invitation, Ms. Mathre said.
In a government-commissioned study a year ago, the Institute of Medicine of the National Academy of Sciences said that some of the ingredients in marijuana were potentially effective in treating pain, nausea and severe weight loss from AIDS. The institute also urged rigorous testing of marijuana for other ailments.
Dr. Hadorn of GW Pharmaceuticals said his company was concentrating on eight principal ingredients of marijuana. The amount of these ingredients, which are members of the cannabinoid group, varies in each naturally grown plant. To standardize the amounts, GW has cloned, cultivated and harvested tens of thousands of marijuana plants in a greenhouse at a secret location in England.
"We are the only people in the world licensed to grow pharmaceutical-grade cannabis," Dr. Geoffrey Guy, who founded GW Pharmaceuticals in December 1997, said in a telephone interview today. He added that the National Institute on Drug Abuse in the United States grows marijuana, but that it is not standardized for pharmaceutical grade.
By cultivating cannabis under highly controlled indoor conditions, GW hopes to satisfy criteria set by the Food and Drug Administration and similar governmental agencies worldwide so it can eventually market the most effective combination of ingredients as prescription drugs. Dr. Guy estimated that it would cost at least $16 million to market the first marijuana product.
To avoid the dangers associated with smoking, GW Pharmaceuticals aims to develop nonsmoke delivery systems like inhalers and nebulizers. The company is starting with products that are absorbed after being sprayed under the tongue and is initially concentrating on the components known as THC (tetrahydrocannabinol) and CBD (cannabidiol), Dr. Hadorn said.
GW Pharmaceuticals hopes to start testing on a small number of people in the United States later this year, Dr. Guy said. The company has held discussions with all appropriate American agencies, but Dr. Guy declined to say where the tests would be conducted.
Dr. Juan Sanchez-Ramos of the University of South Florida in Tampa said he learned about GW's efforts at the meeting.
He said he hoped eventually to determine whether an ingredient of marijuana could help in Parkinson's disease by controlling the unwanted constant twisting movements that often develop among users of a drug called L-Dopa.
Dr. Sanchez-Ramos said Parkinson's disease patients who claimed relief
after smoking marijuana gave him the idea of studying the drug for that