More MS news articles for March 1999

Marijuana as Medicine

Chat With Author of New Federal Report

http://abcnews.go.com/sections/living/DailyNews/chat_benson9903.html

ABCNEWS.com

Mar. 18 - A report commissioned by U.S. drug czar Barry McCaffrey has found that marijuana's active components appear to have medicinal value. But smoking the stuff is still harmful.One of the main authors of that report was Dr. John Benson, a dean and professor emeritus of the Oregon Health Sciences University School of Medicine. He joined us today to take your questions about the report, and about medical uses for marijuana.

--------------------------------------------
Moderator at 2:03pm ET

Thanks for joining us online today. Our first question comes from Ron:
--------------------------------------------
ron from mot.com at 2:04pm ET

1. What are the medicinal benefits identified at this point?
2. What further work has been outlined for further research?
3. What are the risk factors? (I would bet they are no worse than cigarettes and alcohol.)
--------------------------------------------
Dr. John Benson at 2:11pm ET

Marjiuana has within it at least 10 active compound cannabinoids. The most psychoactive is THC, marketed and approved as a capsule Marinol. These substances are powerfully active in various ways. They really treat only symptoms and they are modestly effective, particularly when compared to approved available patients.

The three main symptoms where marijuana and its component compounds have been shown to work are the pain, nausea and vomiting from chemotherapy and cancer patients; for AIDS patients on multiple medicines; and for patients with advanced AIDS or cancer suffering from poor appetite, weight loss and wasting. Controlled trials, have to the study's satisfaction, showed these benefits. Another symptom where the study found promise was for the use of these agents in muscle spasticity in patients with multiple sclerosis. Those are the main established convincing benefits.
--------------------------------------------
Dr. John Benson at 2:16pm ET

There are two main risk areas. The study team feels that smoke is risky in terms of lung disease and when smoking during pregnancy low birth weight. Like tobacco, smoke marijuana contains carcinogenic substances like tar. We need better data on that risk. But there are cellular changes in marijuana smokes that are found in tobacco smokers. Therefore we advocate an inhaled form without smoke, such as the nebulizers used for asthma. That means nebulizing a component compound rather than the whole leaf.

The other risk area is progression to apt use of hard drugs, the so-called "gateway" phenomenon. The study wishes to distinguish between medical use and uncontrolled or recreational substance abuse. There is no convincing evidence that drugs used for medical purposes progress to the use of other drugs, to abuse, or to increased use in the population.
--------------------------------------------
Dr. John Benson at 2:20pm ET

Clinical trials of active cannabinoid drugs for symptom management should be conducted in parallel with the development with reliable and safe delivery systems such as an inhaler. Studies of those who have smoked marijuana chronically should be carried out to learn the risks of lung cancer and progression of HIV positive patients to AIDS. There are any number of detailed basic science experiments with these agents, not marijuana, that are recommended in the report.
--------------------------------------------
Jim from [199.35.160.200], at 2:21pm ET

A friend of mine with the AIDS virus (low t-cell count, high viral load) smokes marijuana every day just to avoid nausea from his various medications, and to keep an appetite. I have two questions:
1) Would Marinol achieve the same effect as smoking the marijuana?
2) He is lately having episodes of TIA, or transitory ischemia attacks. Could this be related in any way to the marijuana smoking? Thank you.
--------------------------------------------
Dr. John Benson at 2:23pm ET

Smoke marijuana is effective for Jim's friend's nausea from his medication. But there are far more effective approved medications that are available to him - for example, 90% effective. I know of no association between marijuana smoking and TIAs.
--------------------------------------------
Keith from [209.0.20.226], at 2:23pm ET

Regarding marijuana and depression: My sister suffers from severe depression. She has worked with many therapists and tried many antidepressants. However, the only drug that has consistently helped her, especially when she is suicidally depressed, is marijuana. Is there any experimental evidence or research regarding marijuana as treatment for depression?Where might I learn more?
Keith
--------------------------------------------
Dr. John Benson at 2:25pm ET

I know of no good evidence of the value of marijuana in depression. That is not to say that there are data that show that marijuana does not work, but rather that appropriate studies have not been done.

Marijuana obviously creates a euphoric "high" which may be beneficial and its side effects such as the high or sedation should not be overlooked.
--------------------------------------------
Randall Watkins from [12.7.195.67], at 2:26pm ET

I know a child in Northern California who is severely disabled from birth defects. She is a medical marijuana recipient because it seems to help with her multiple daily seizures. She gets Marinol and leaf marijuana. Is there something in your study that may support this finding?
--------------------------------------------
Dr. John Benson at 2:27pm ET

No, the evidence for benefit in seizure disorders is lacking and the study found no reason to recommend either marijuana or Marinol.
--------------------------------------------
IndigosGrrl from remote.mun.ca at 2:27pm ET

I find that marijuana eases the pain of my migraines and of my lower back pain. Has there been any research done to support this?
--------------------------------------------
Dr. John Benson at 2:29pm ET

There is insufficient evidence to recommend the marijuana compounds for migraines. In some instances, migraines have followed marijuana withdrawal. Muscle spasms may be relieved by these drugs ... so perhaps the patient is benefiting in that regard.
--------------------------------------------
Jane Weirick from [209.66.84.174], at 2:30pm ET

Are you aware of any documented cases of lung cancer specifically caused by marijuana smoking?
--------------------------------------------
Dr. John Benson at 2:34pm ET

Smoke does worry us as potentially leading to lung cancer, but specific cases have not been reported in the literature, Jane. The problem is that most marijuana smokers have used tobacco over many years, so it is hard to sort out which smoke has done the damage. Furthermore, smoking marijuana has been a relatively recent phenomenon.

Earlier in this century, most marijuana use was through teas or other means of ingesting marijuana such as cookies. So perhaps there has not been sufficient time to lead to lung cancer from smoking marijuana. But, as I have suggested, there are very clear cellular changes in the lungs of marijuana smokers that do not use tobacco that frighten doctors like me.
--------------------------------------------
Dave G. California from tnt18.sfo3.da.uu.net at 2:35pm ET

Dr. Benson, I have used this drug for about twenty five years to control temper and anger. It works well for this. Did your study indicate success in this area?
Thank you.
--------------------------------------------
Dr. John Benson at 2:35pm ET

Dave, I know of no studies to prove its value for your condition.
--------------------------------------------
Danielle Field from tafensw.edu.au at 2:36pm ET

Does smoking pot harm the growth of the brain in any way? Does it make people who smoke it slow or dumb?
--------------------------------------------
Dr. John Benson at 2:38pm ET

Danielle, marijuana does interfere with acute memory and judgement as well as coordination, so that people may seem to be living in another world and unable to drive or operate heavy machinery. But I know of no long term effect on brain size or intelligence. There is one worrisome study of children whose mothers smoked marijuana during pregnancy. These children at ages 8-12 showed poor executive function on psychological testing. So there may be long term latent effects on critical judgement.
--------------------------------------------
Hillary White from [168.191.22.172], at 2:39pm ET

In the report about medicinal uses of marijuana' I've noticed that Parkinsons disease was also mentioned. I would like to know if there has been any study on this subject, and what kind of relief can be obtained by Parkinsons patients from medical use of marijuana? Would it relieve twitching of the muscles, for example?

Would there be any drawbacks for those patients who have already slow and rigid movements? I am taking care of a patient who has Parkinsons and glaucoma at the same time, and I would appreciate any information on this subject.
Thank you.
--------------------------------------------
Dr. John Benson at 2:42pm ET

Hillary, there are better drugs for movement disorders like Parkinson's disease. In general, there are poor studies to indicate its value, even thought the sites of effect of marijuana and its compounds in the brain are in areas controlling movement. There is one clinical trial of only five patients where there was no improvement in tremor after marijuana although all five benefited in standard medications.
--------------------------------------------
Dr. John Benson at 2:46pm ET

Marijuana and its component drugs have been used in glaucoma and do reduce the increased pressure within the eyeball, whether smoked or taken by mouth. Unfortunately the compounds are too irritating to be used as eye drops but there is no evidence that these compounds or marijuana slow the natural progression of glaucoma or the visual acuity.

Furthermore, the effects of marijuana or THC last for only 3 or more hours, so frequent dosing over the lifetime of the patient increases the risk of smoke. Again there are eye drops and operations that do a better job.
--------------------------------------------
Dan Berkes from galenalink.com at 2:47pm ET

What do you see as the future potential of marijuana in medical treatment? Will new prescription medicines made from plant derivatives be developed for specific conditions, or will doctors prescribe the plant in whole for patients?
--------------------------------------------
Dr. John Benson at 2:49pm ET

Dan, the study team much prefers research on the separate cannabinoid compounds, either alone or in combination or as adjuncts to standard therapy, to smoked marijuana. Future research should be directed at those distinct measurable, quantifiable agents and the development of a safe delivery system rather than to produce a future for smoked marijuana.
--------------------------------------------
Dave from [146.96.173.90] at 2:52pm ET

In your opinion, has there been a lack of medical marijuana research because of the political stigma? Who funded your research? Is there ample funding available for the research?
--------------------------------------------
Dr. John Benson at 2:55pm ET

Dave, the Institute of Medicine study was funded by the White House of National Drug Control Policy to try to establish whether or not science shows the risks or benefits of marijuana use. Various studies of using smoked marijuana have been funded by the National Institutes of Health and federal funding was largely responsible for the development and early approval in the early 80s of Marinol. The study teams hopes that good clinical trials are sought by responsible investigators and that if peer review finds them scientifically sound they will be funded.
--------------------------------------------
John Mc from snfc21.pacbell.net at 2:56pm ET

News reports of your study said that because of the worries about smoke, you recommended developing oral ingestion (pills I guess) as well as developing inhalers. How would you expect new pills to differ from Marinol, which is largely seen as ineffective or at least much less effective by users?
--------------------------------------------
Dr. John Benson at 2:59pm ET

John, Marinol has been proven to be effective for various symptoms in excellent studies. Patients seem to prefer the high"                 as a way of titrating their dose of smoked marijuana and are reluctant to switch to oral medication. They also complain about the long term effects of oral dosing, particularly unpleasant feelings called dysphoria. In addition to inhaled delivery nasal sprays, oral lozenges and combinations in capsule form should be studied.
--------------------------------------------
Patrick Curran from [192.9.25.22], at 3:00pm ET

Hi Doctor. I heard the report released yesterday indicated there was little evidence to back up the long held theory that marijuana is a "gateway drug", that is that it leads to use of cocaine and marijuana. Can you talk about this more?
--------------------------------------------
Dr. John Benson at 3:03pm ET

Patrick, the study team strongly wishes to separate the MEDICAL use of cannabinoids from substance abuse. We are worried about the statistics of progression from marijuana from the apt use of stronger drugs or hard drugs, particularly in teenagers. To that extent, there is a gateway phenomenon. But there is no evidence that it is due to the drug itself in some effect on the brain, but probably more related to the person's social environment.

There is no convincing evidence of progression to other drugs from the MEDICAL use of psychoactive drugs like marijuana and THC. And there is no convincing evidence of progression from MEDICAL use to substance abuse.
--------------------------------------------
Moderator at 3:05pm ET

Thanks again for joining us today Dr Benson. Any final thoughts?
--------------------------------------------
Dr. John Benson at 3:07pm ET

Finally, the study team feels that its attitudes and information come down in the middle between the assertions that marijuana and its components have no medical value on the one hand, and the assertions that it is a widely effective, harmless agent.
--------------------------------------------
Moderator at 3:08pm ET

Thank you all for joining us.
--------------------------------------------
 

Copyright ©1999 ABC News Internet Ventures. All rights reserved.