June 5th, 2002 6:57 PM
By Steve Mitchell
UPI Medical Correspondent
From the Science & Technology Desk
Marijuana appears to be very effective for treating pain and a variety of other conditions, particularly in patients who have not been helped by prescription drugs, its advocates claim, despite the debate about the legality of using the drug as a medication.
"It's a very effective medication for many people who have failed to get good results from standard medications and that's why so many people are devoted to it and risking their lives and career to get this drug," Ethan Russo, a neurologist in private practice in Missoula, Mont., who has studied medicinal marijuana, told United Press International.
Nine states -- Alaska, Arizona, California, Colorado, Hawaii, Maine, Nevada, Oregon and Washington -- have legalized the drug for medicinal purposes, but the U.S. Drug Enforcement Agency has been raiding centers distributing the drug in California. This has resulted in patients, who the raids left unable to obtain marijuana, filing a lawsuit against DEA alleging the raids were unconstitutional.
However, Adam Eidinger of Americans for Safe Access, which is organizing a protest at DEA offices around the country, told UPI he expects the decision, which could come as early as Thursday, to uphold the legality of the raids.
Russo noted some of his patients use marijuana to treat symptoms associated with arthritis, multiple sclerosis and migraine. The drug is also useful for reducing nausea associated with chemotherapy in the treatment of cancer, wasting in AIDS patients, glaucoma and nausea associated with medications used to treat AIDS.
"I won't tell you that it's a panacea or that it is 100 percent effective," but many patients experience relief from their symptoms, Russo said. For example, many of his multiple sclerosis patients who have used marijuana "find it superior to any of the pharmaceuticals they have employed" and up to 80 percent of people who have tried it for migraines find it very effective."
In addition, he said, "Many, many people get excellent results for treatment of glaucoma."
Russo said the raids in California are depriving patients of beneficial medication and causing them "needless pain and suffering."
Steve Gust, special assistant to the director of the National Institute on Drug Abuse, told UPI that NIDA is providing marijuana cigarettes to researchers to study its use in treating nerve pain associated with HIV infection, muscle spasticity in multiple sclerosis patients, cancer pain and chemotherapy-induced nausea.
Although the efficacy of medicinal marijuana is still under debate, Gust said the reason NIDA provided researchers with marijuana is there is some indication of a "potential benefit."
NIDA's official position, however, is, "There may be some benefit to purified cannabinoids (the active components of marijuana) ... but that it's unlikely smoked marijuana will ever be an approved medication," Gust said.
The reason for this, he noted, is it is very difficult to standardize marijuana as a plant and ensure each cigarette is delivering the same amount of active components. A more feasible method, Gust said, would be to single out the compounds in marijuana that appear to have beneficial effects and develop them as drugs.
An oral medication called Marinol, which consists primarily of a compound found in marijuana called THC, is already on the market and in use for treating nausea due to chemotherapy, Gust said.
Russo countered that he has "never had a patient who had tried both Marinol and smoked marijuana and preferred Marinol. "Many patients will get too high even if they use Marinol at the lowest dose," he said.
When THC is taken orally it goes to the liver, which converts the chemical to a metabolite that is five to eight times more active than when it is smoked. In addition, smoked marijuana contains compounds that block the conversion of THC to the more active metabolite, he said.
Most people who use marijuana as a medication smoke it, but it can also be eaten or converted to a tincture that can be placed under the tongue.
There are some concerns about the negative consequences of smoking the drug. One way to avoid these consequences but still obtain the beneficial effects is to vaporize it, Russo said. In this method, a vaporizer is used to boil off THC and other active components without producing smoke.
Addiction is not a problem with medical marijuana, Russo said. "Medical users do not elevate their dose ... and they do not experience withdrawal effects," he said. "A lot of responsible people use this as a medication."
Russo recently conducted a study of medicinal marijuana's long-term effects in the seven patients who legally receive the drug under a federal program that stopped enrolling new patients in 1992. The patients, who had been taking marijuana for conditions including chronic pain, multiple sclerosis and glaucoma, have exhibited no signs of negative long-term effects on lungs, cognition or other areas, he said.
Irvin Rosenfeld, 49, the longest living patient involved in the federal program, told UPI the drug has been "tremendously effective" for treating severe pain associated with his congenital condition that causes tumors to form on the ends of his bones.
Rosenfeld, a stockbroker in Ft. Lauderdale, Fla., who has been using marijuana as a medication for 31 years, said it has allowed him to discontinue the use of morphine, quaaludes and other drugs he previously required to alleviate the pain. Marijuana is the only medication he has used for the past 12 years aside from an occasional mild painkiller such as Vioxx or Celebrex.
Although Rosenfeld obtains his marijuana from the government, he has at times had to resort to purchasing the drug on the street -- although the street variety is actually more potent than the government-grade, he said.
Russo noted much of the medical community remains skeptical about the benefits of marijuana and "many doctors fear that if they discuss this with patients they'll be subjected to sanctions." In an ongoing case, Conant vs. McCaffrey, currently in the 9th circuit U.S. District Court in California, doctors filed suit against former drug Czar Barry McCaffrey. The doctors claim McCaffrey's public threat to revoke the DEA license of any physician who discussed marijuana treatments with his or her patients was unconstitutional.
Despite the doubts in the medical community at large, Russo said he believes marijuana eventually will gain acceptance as a valid medication. "I think it's going to happen. Its just a question of 'when,' not 'if.'"
Russo predicted "Within a year, licensed cannabis preparations will
be available in Western Europe and Canada. If that occurs, I think the
public will demand that it be made available here."
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