From "Safe Use of Cannabis" by Tod H. Mikuriya, M.D.
www.mikuriya.com/althealt...a.html#Can RX
Cannabis, ingested safely, is one of the most useful of medicines for a variety of conditions. These include: pain, spasticity, anxiety, depression, headache, nausea, anorexia, epilepsy, asthma, dysmenorrhea, premenstrual tension, withdrawal from other drugs, and glaucoma.
Ignorantly or imprudently used, cannabis can be harmful.
From "Safe Use of Cannabis" by Tod H. Mikuriya, M.D.
NEW: Added 04/23/00 Marijuana Medical Papers, originally published in 1972, long out of print...available now on line.
MedicoLegal The link to follow if you are looking for an expert witness/consultant on issues relating to the medical use of cannabis.
Dependency and Cannabis Submitted for publication 10 99. A nice summary of the historical overview combined with recent clinical experience. A decent retort to those who view cannabis as a "gateway drug". In many cases cannabis is a "gateway" back.
Medicinal Uses of Cannabis Written in 1998, this piece ties together historical medical texts concerning cannabis with Dr. Tod's own clinical findings since the passage of the California Compassionate Use Act of 1996 for a new look at the medicinal uses of cannabis.
Click here to browse Dr. Tod's writings that have been published elsewhere on the WWW. If you know of other web published writings that could be linked here, e mail Dr. Tod.
Visit Dr. Tod's links page, a few of the people and organizations that are making things better for the rest of us.
Clinical Review: 3000 Cases, presented at The First National Clinical Conference On Cannabis Therapeutics, Iowa City, Iowa April 7, 2000, this file is an updated synopsis of the following paper. This is a small html file.
Medical Uses of Cannabis in California ; presented at the 1999 Symposium on the Cannabinoids, International Cannabinoid Society. A 10 page pdf file. Must have acrobat reader to access.
A Proposal for Comprehensive Rational Drug Abuse Control Originally published in three consecutive issues of Sinsemilla Tips beginning with Vol 8 #4, Summer 1989. PDF format, must have Acrobat Reader to access.
More will be added periodically, come back and visit. Also visit the California Compassionate Use Act of 1996 web site at www.drugsense.org/CCUA/.
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Dependency and Cannabis
Tod H. Mikuriya, M.D.
Pre Prohibition
OShaughnessy in 1839 visited cannabis buyers centers in India and mingled with the dissolute and depraved to learn about the preparations of this social drug for clinical medical trials finding it to be useful in the treatment of tetanus and seizures.
Cannabis substitution for more harmful medicines In 1843 Clendinning utilized cannabis substitution for the treatment of alcoholism and opium addiction. Potter recommended full dose Squibb cannabis extract for withdrawal from opium addiction .
The Indian Hemp Drugs Commission Report in 1894 recognized the comparative safety of cannabis. Its unsurpassed ethnographic studies within different cultures, voiced a concern that if prohibited would cause the use of more dangerous drugs.
Cannabis combination with other medicines: decrease of dose, suppression of side effects Mc Meens citing Fronmueller in 1860 described the use of cannabis either alternating or combined with opiates reduced harm from increased dose, tolerance, dependence, and side effects. Cannabis was confirmed as useful in the treatment of delirium tremens and alternative to opium for analgesia . Dutt independently described the comparative safety in Materia Medica of the Hindus . Yeo warned about addiction to morphine in the treatment of neuralgia and suggested cannabis as an alternative.
Cannabis and mood disorders
The connection between dependency on drugs and mood disorders may represent unsuccessful attempts to self medicate uncomfortable feelings with the cure causing more harm and aggravation of the underlying condition.
Moreau described cannabis as being useful in the treatment of depression in 1845. The drug is listed in medical texts and pharmaceutical catalogs for treatment of melancholia or mania.
Patients report that cannabis facilitates both anti mania and antidepressant medications. Cannabis used in combination with antidepressants appears to decrease the side effects of nervousness, muscle tension, and nausea for SSRI type antidepressants. Other patients report that cannabis is complementary. A typical report is that the SSRI elevates mood overall and cannabis improves affectual responsivity. Cannabis can either diminish the dosage needs for sufferers of bipolar disorders or substitute altogether for anti-mania medications. With symptoms of mania or agitation cannabis appears to decrease affectual lability.
Cannabis substitution for more harmful non-medical drugs Notwithstanding some polysubstance abusers who maladaptively combine cannabis with other psychoactives, there appears to be a significant number of persons who have learned that cannabis can be totally substituted for other, more harmful, substances..
Following the therapeutic path of Clendinning, throughout the 19th and early 20th century, cannabis was found useful in the treatment of opiate and sedative abuse. Brunton describes use of cannabis for the treatment of opiate dependence or as a substitute when opiates were not tolerated. Shoemaker finds in some instances cannabis to be useful for the cure of opium or chloral habit. Birch advocated for the use of Indian Hemp in the treatment of chronic chloral and opium poisoning. Mattison, an early addiction specialist, recommended cannabis as a substitute of morphine and cautioned his fellow physicians about hypodermic use of the drug.
Alcohol abuse, stimulant, sedative, and opiod abuse and dependence are conditions potentially treatable with cannabis substitution. All of these conditions involve management of mood and emotional reactivity. While there have been numerous synthetic homologs developed, short acting psychotropics continue to have high potential for dependency and abuse. The quality of immediacy for mood management would appear to be inseparable from abuse potential, however cannabis appears to be the exception because of lesser or milder withdrawal symptoms.
Pharmacologic mechanisms
This may be accounted for by the lipophillic water insolubility of the tetrahydrocannabinols that appears to act through the prostaglandins as eicosanoids, precursors, whose structures are similar. While largely unknown in specific details, tetrahydrocannabinols appear to modulate the behavior of the CNS either directly, or through the adrenopituitary axis. Additionally, eicosanoid peripheral physical activity in specific organ systems like lung tissue has been demonstrated in animals.
California cannabis center members and patients in my private practice independently rediscovered and confirmed cannabis as a safer substitute for prescribed and non medical psychoactive drugs in the control of depression, anger, and anxiety. Cannabis substitution may be a gateway drug back to sobriety and dealing with the underlying psychopathologic etiologies.
Gieringer summarized 2479 California cannabis users interviewed by the author noted 5.5% (136) described that the use of cannabis to be less harmful than alcohol, opiate, and other drug dependencies as primary presenting illness. For this group of self medicators cannabis has found to have far fewer adverse effects than opioids, sedatives, and stimulants. This small percentage represents only dependencies as primary conditions, and, as such, grossly underreports dependencies in chronic pain conditions.
Antabuse (disulfiram) and alcoholism
I have personally successfully treated two patients suffering severe alcoholism with a combination of disulfiram and cannabis substitution. This carrot and stick approach appears to address the needs of pharmacologic management of mood and avoids relapse with emotionally stressful events.
Posttraumatic Stress Disorders- A specialized category of dependencies Adult children of alcoholic families are doubly harmed by abuse and functional ignorance. Violence, sexual abuse or emotional absence by one or both parents is compounded by failure to provide coping skills to deal with normal feelings and pathologic role models. Alcoholism and polysubstance dependence is significant with destructive and symbiotic family involvements.
Vietnam veterans and other survivors of horrific experiences of adulthood suffer from living nightmares and flashbacks triggered by certain specific stimuli that cause overwhelming fight-flight reactions. Chronic depression with insomnia and fearfulness frequently incapacitate and isolate.
Many of each group have come to realize that cannabis is less toxic or harmful than alcohol, opiods, and other psychotropics in their continuing struggles with indelible memories and their physiologic concomitants. Cannabis is used to relieve depression, decrease emotional overreactivity, and sleep deficit.
The alternative medical movement represents a populist rebellion against conventional medicine for treating chronic relapsing illness that include alcohol and other drug dependencies. Cannabis self-medication has been discovered to be a viable alternative to treat these conditions and may enhance or substitute forconventional pharmacotherapy.
American Drug Policy, Dependencies, and Cannabis
The complex interplay of cannabis use with physiology and psychology challenges research. Outcomes are combinations of pharmacology, expectations, setting, personal and social forces. The contemporary ambiguity, a product of ignorance from deprivation of contemporary clinical experience, may be somewhat assuaged by two facts: Firstly, cannabis has been used for millennia by numerous cultures without serious adverse consequences. Secondly, neither the composition of cannabis nor the physiology of humans have changed since the drug was taken from the armementarium of medicine.
Perceptions of cannabis and its effects--distorted by sixty years of prohibition--are embedded in official policy . The Controlled Substances Act of 1970 classifies cannabis as Schedule I: high potential for abuse, no currently accepted medical use, and lack of accepted safety. A 1999 Institute of Medicine report favorably compares the psychophysical profile of cannabis to other conventional medication in chronic pain and spastic conditions but avoids any recommendation of using cannabis for the treatment of alcohol and drug dependencies.
To circumvent prohibition censorship and dissimulation of contemporary official propaganda a review of medical and pharmaceutical literature prior to the passage of the Marihuana Tax Act in 1937 is mandatory. Cannabis was available and utilized extensively in medical practice until its removal from availability. There was an overall decline in its use with the development of newer synthetic sedative, stimulant, and analgesic drugs.
Criminalization of dependencies in the United States began in 1869 when the Temperance party became the Prohibition party. The ensuing state by state war of the drys against the wets culminated 1919 with the passage of the Vollstedt Act and the Prohibition of alcohol.
The Harrison Narcotics Act of 1914 criminalized non medical use of opiates and cocaine. In 1921 the Federal Prohibition Commissioner criminalized the maintenance of unconfined narcotic addicts. The subsequent demonization and persecution of narcotic addicts, and physicians that sought to treat them, significantly limited treatment . Methadone maintenance programs, available since the 1970s, remain heavily bureaucratized and functionally rationed. Alcohol and drug dependency treatment remain frequently unavailable. The last to be funded, first to be cut from public budgets and often not covered by private insurance. In America drug policy is controlled by the Attorney General- not the Surgeon General. Drug dependencies are defined as moral defects and not medical problems. Police become the armed pharmacologists. Drug Awareness and Resistance Education celebrated its 17th birthday with uniformed police in the class rooms.
Meanwhile, television and print media tell us to ask your physician about Paxil (paroxetine), a SSRI antidepressant.
THM Berkeley, CA 10/6/99
Medicinal Uses of Cannabis
Tod H. Mikuriya, M.D.
(c)1998
Hemp is used in various forms, by the dissipated and depraved, as the ready agent of a pleasing intoxication. In the popular medicine of these nations, we find it extensively employed for a multitude of affections. But in Western Europe, its use either as a stimulant or as a remedy, is equally unknown. wrote W.B. OShaughnessy in 1838. Over 150 years later cannabis prohibition causes the drug to be largely unknown as a remedy. In certain segments of contemporary California cultures its therapeutic properties are being independently reaffirmed and elaborated.
Until the initiation of the cannabis buyers clubs in 1992 there has been minimal opportunity for clinical research. Since removal from prescriptive availability in 1937 therapeutic experience with the drug has been minimal. Removal of cannabis from prescriptive availability in 1937 plunged the medical and scientific community into a dark world of clinical ignorance; with prevailing realities and definitions hostage to police, prosecutors, and (unbeknownst to the public) the covert agencies. Despite continuing official stories to the contrary, anecdotal accounts of therapeutic efficacy could not be entirely suppressed. Under covert community contracts a synthetic d 1-9 tetrahydrocannabinol was synthesized in quantity by a federal contractor to the CIA and made available under the trade name, dronabinol (Marinol) in 1986. Additionally, there was legislative recognition that cannabis drugs had therapeutic potential and the California Research Advisory Panel (CRAP) was set up in 1969 . The agency was installed in the Attorney Generals office. The secretary, Edward P. OBrien, Assistant Attorney General strictly interpreted the law and inhibited the panel from carrying out its legislative mandate of affording compassionate access. The 22 year old autocracy was unsuccessfully challenged in August 1990.
The panel, exclusive of OBrien, attempted to publish an executive summary which, among other things, recommended the decriminalization of marijuana. The executive summary was expurgated from the annual report. UCSF professor of pharmacology, Frederick Meyers, M.D., was obliged to publish it privately. Significant research did take place with Reese Jones, MD at UCSF proved the safety of high dose THC and marijuana which contributed to the release of Marinol as a schedule II controlled substance. The National Organization for the Reform of Marijuana Laws (NORML) brought suit against the Drug Enforcement Administration (DEA) in 1972 to reclassify marijuana to make it available for prescription After two years of hearings and testimony down scheduling of crude cannabis from schedule I to schedule II was recommended by administrative judge Francis L. Young on September 6, 1988. The DEA appealed this and in October 1991 was told to facilitate the decision making process or better justify retention in schedule I. James O. Mason, M.D. Assistant Secretary for Health in May, 1991 terminated the compassionate Investigative New Drug (IND) for cannabis. AIDS activist protesters led opposition to this which resulted in the INDs continuing until November 18, 1991 when he again announced suspension.
Mason stated that cannabis has no legitimate medicinal use an that use of marijuana promoted disinhibition leading to unsafe sex. Another claim of was that natural cannabinoids may expose immunocompromised individuals to harmful contaminants like fungi, molds, and bacteria. While there are no cases reported as yet, these were the rationalizations for his decision. Dr Donald Abrams and a respected team at University of California, San Francisco at the San Francisco General Hospital have been finally successful in obtaining approval after 5 years delay to research the comparative utility of Marinol and cannabis in AIDS patients.
In 1992 the first Cannabis Buyers Clubs were started in San Francisco, New York, and Washington, DC with originated by gay community activists after informal meetings in Washington, DC at the 1991 annual Drug Policy Foundation conference. Of the buyers clubs, the San Francisco CBC was the largest. It grew from a few hundred to twelve thousand before it was raided and closed in August, 1996 by the California State Bureau of Narcotics. Currently, known CBCs are throughout the greater San Francisco Bay area operating autonomously with varying admission requirements and protocol. Since the closing of the San Francisco CBC, the procedures, for the most part, tended to be cautious and exclusive until the passage of Proposition 215. Notwithstanding official statements that the medicinal usefulness were yet to demonstrated in opposing Proposition 215 , the Compassionate Use Act of 1996, the initiative passed 55% to 44% and became California Health and Safety Code section 11362.5. Because little preparation for the eventuality of its passage, enforcement of California marijuana laws has become problematic.
While cannabis law reform activists celebrated by conspicuously self-medicating, institutional response was anxious perplexity. From the White Office of National Drug Control Policy, and Drug Enforcement Administration to the California Attorney Generals Office, and the California Medical Association, all trying to determine responses to the legalization of medical marijuana. Meanwhile, California marijuana law anarchy. De facto partial legalization. Cannabis, however, had a ninety year history of clinical use in the U.S. since the mid 1840s until removal from clinical availability by the Marihuana Tax Act. Pre 1937 Cannabis Therapeutic Uses
1. Analgesic-Hypnotic
2. Appetite stimulant
3. Antiepileptic-antispasmodic
4. Prophylactic and treatment of the neuralgias, including migraine and tic doloreux
5. Antitussive
6. Antidepressant-tranquilizer
7. Antiasthmatic
8. Oxytocic
9. Topical anesthetic
10. Withdrawal agent and substitute for opiate, chloral, and alcohol dependence
11. Childbirth analgesic
Unapproved Clinical Research: California Cannabis Center Interviews
Because the use of marijuana is illegal, usual institutional channels of support are blocked and funding unavailable. U.S. Analytical laboratories are forbidden to analyze specimens from extralegal sources. Notwithstanding these impediments the cannabis buyers clubs afford unique clinical research opportunities in therapeutic uses of cannabis. CBCs are communities of persons who seek the drug for self-medication. Gaining entry to a CBC requires proof of illness and a written referral from a physician.
Interviews at the CBCs in San Francisco, Santa Cruz, Oakland and in my office confirm descriptions in the pre prohibition medical, pharmaceutical and scientific literature. Clinical phenomena once known to medicine and treated by the physician are rediscovered by persons self medicating with cannabis. Additional unreported conditions are encountered.. Despite the lack of information of forgotten medical intelligence there appears to be frequent spontaneous discovery of medicinal utility. A typical story goes: A person in their forties Oh yes, I did it a few times in high school but never used it again until recently and to my surprise the symptom improved!
A pilot study of interviews with 57 San Francisco Cannabis Buyers Club members in 1994 was done using an outline derived from pre-prohibition medical literature citations and personal clinical observations Interviews with over 200 CBC members have led me to certain overall clinical findings: Cannabis therapeutic effects appear to be at least six categories.
1. Psychotherapeutic: Antidepressant/Anxiolytic
2. Antispasmodic Anticonvulsant
3. Analgesic immunomodulator
4. Harm reduction substitute
5. Appetite stimulant
6. Hypothermogenic
1. Psychotherapeutic: Antidepressant/Anxiolytic
Before it was taken away from physicians for prescribing in 1937 cannabis had a long history as a drug for the treatment of melancholia or depression with and without agitation. The ancient Greek, Indian, Persian, writings are replete with descriptions of antidepressant properties. Homers Odyssey describes Helen using a potion obtained from Polydamna that lifted the spirits at a morose gathering by slipping Nepenthe in the wine. Nepenthe means against sorrow . Sanskrit and Hindi writings characterize cannabis: Before the 8th century an anti phlegmatic, Circa 1050: victorious (Vijaya), and victorious in three worlds (Trailokyavijaya).
1300 A.D. in The Rajanighantu of Narahari Pandita: the light hearted (Capala), the joyful (Ananda), the rejoicer (Harsini), speech giving (vakpradatva) inspiring of mental power (medhakaritva), and a most excellent excitant (cresthadipanatva). 17th Century Materia Medica The Rajavallabha: It creates vital energy, the mental powers, and internal heat, corrects irregularities of the phlegmatic humour, and is an elixir vitae.
In contemporary terms a case of severe and chronic depression may have been successfully treated through self medication with cannabis.
The Persian physician Mirza Abdool Rhazes wrote: The oldest work in which Hemp is noticed is a treatise by Hasan, who states that in the year 658 (Mahometan era)(1258), the Sheikh Djafar Shirazi, a monk of the order of Haider, learnt from his master the history of the discovery of Hemp. Haider, the chief of ascetics and self-chasteners, lived in rigid privation on a mountain between Nishabor and Romah, where he established a monastery of Fakirs. Ten years he had spent in his retreat, without leaving it for a moment, till one burning summers day, when he departed alone to the fields. On his return an air of joy and gaiety was imprinted on his countenance; he received the visits of his brethren, and encouraged their conversation.
On being questioned, he stated that: struck by the aspect of a plant which danced in the heat as if with joy, while all the rest of the vegetable creation was torpid, he had gathered and eaten of its leaves. He led his companions to the spot, all ate, and all were similarly excited. A tincture of the Hemp leaf in wine or spirit seems to have been the favorite formula in which the Sheikh Haider indulged himself. An Arab poet sings of Haiders emerald cup; an evident allusion to the rich green colour of the tincture of the drug. The Sheikh survived the discovery ten years, subsisting chiefly on this herb, and on his death his disciples by his desire planted it in an arbour about his tomb. From this saintly sepulcher the knowledge of the effects of
Hemp is stated to have spread into Khorasan.
In 1845 J.J. Moreau de Tours, a French psychiatrist utilized cannabis in the treatment of depression described the drugs effects: It seems that nothing can hurt you in this peace of mind, that you are inaccessible to sadness. I doubt that the most unfortunate news could draw you out of that imaginary bliss, which can only be appreciated through experience. I have just attempted to give an idea of the delights that hashish produces. I hasten to add that I have presented them here in no more than raw form, as it were, and at their simplest. It will depend upon external circumstances to confer upon these feelings of happiness still greater intensity by directing them toward a determined goal and by concentrating them on a single point. One imagines what reality can add to this state of bliss and how much the joys of hashish can be enhanced by external impressions, by direct sensory excitations, or by the stirring of passions through natural causes. At that time, the rapture of hashish intoxication, taking shape and form, will assume the dimensions of delirium. This disposition of the mind, linked with another which I will discuss later, was, I feel, the fertile source from which the fanatic inhabitants of Lebanon derived that happiness, those ineffable delights for which they gladly sacrificed their lives.
It is necessary here to clarify what I have just said. It is really happiness that hashish gives, and by that I mean mental joy, not sensual joy as one might be tempted to believe. This is indeed very curious, and one can draw strange conclusions- this one among others, that all joy, all contentment, even though its cause is strictly mental, deeply spiritual, and highly idealistic, could well be in reality a purely physical sensation, developed physiologically, exactly like those caused by hashish. At least, if one relies on inner feelings, there is no distinction to be made between these two orders of sensations, in spite of the diversity of the causes to which they are related for the hashish user is happy, not in the manner of the glutton, of the ravenous man who satisfies his appetite, or even of the hedonist who gratifies his desires, but in the manner, for example, of the man who hears news that compounds his joys, of the miser counting his treasures, of the gambler whom luck favors, or the ambitious man whom success intoxicates.
However, the preceding remarks were not intended to raise a psychological question. I am merely recording observations, and have no other pretension than that of being the faithful and exact historian of my sensations. This characterization of the antidepressant effects of the drug in contemporary contexts would be unthinkable pro drug sedition and would never be found in any advertisement today . Depression as one of the conditions listed for treatment appeared in general Materia Medica, or medical texts , , ,
Subsequent clinical use in depression is described as having variable results. Clouston in 1871 from the Cumberland and Westmoreland asylum reported on five cases of melancholy with some success in four and marked improvement in one. Villard describes similar variable results in melancholia by physicians in France.
The Indian Hemp Drugs Commission in 1894 reviewed medical literature, testimony by both indigenous medical practitioners and Western trained physicians and described cannabis to be used as a tonic to increase stamina.
Cannabis decreases emotional reactivity and intensity of affect while increasing introspection as evidenced by the slowing of the EEG after initial stimulation. The unique anti depressive effects of cannabis are experienced immediately with the alteration in cognition. Obsessive and pressured thinking give way to introspective free associations when in relaxed circumstances. Emotional reactivity is smoothed out, worries are less pressing. Used on a continuing basis, cannabis used to hold the depressive symptoms at bay. Agitated depression appears to respond to the anxiolytic component of the drug . The poorly modulated emotional control seen in bipolar disorder with its overreactive affectual responses are diminished with cannabis.
The treatment of depression with cannabis may be difficult because of differences in individual makeup, need for continuous dose levels, expense, availability, and illegality. Hostile attitudes of clinicians who are ignorant of cannabis therapeutic properties are a significant impediment to its appropriate use in the treatment of depression with and without anxiety. Cannabis appears to be effective both adjunctively and alone in bipolar disorders by decreasing affectual overreactivity., In schizoaffective disorder, dysthymic disorders, and major depressions cannabis appears to lessen feelings of alienation and blocking of ideation. In any disorder cannabis sedative properties help with problems of insomnia.
Posttraumatic stress disorders are particularly helped by cannabis which afford control of symptoms more effectively than other psychotherapeutic agents because of the absence of incapacitating or debilitating side effects. The modulation of mood response prevents or significantly decreases the symptoms of anxiety attacks, mood swings, and insomnia. The short term memory loss effects that may be undesirable in other contexts are therapeutic in controlling obsessive worry ignited by the triggering stimuli.
Cannabis while possibly adversely interacting with tricyclic antidepressants appears to have either no interaction with SSRI antidepressants or possibly act synergistically. A 43 year old female graphics artist reported that while fluoxetine relieved her subjective depression, she needed cannabis to stimulate the flow of ideas. Others find cannabis useful in suppressing side effects of tenseness or anorexia from the SSRIs.
Individual psychotherapy may focus on problems secondary to feelings of marginalization because of criminal status and alienation from judgmental therapists and family.
2. Anticonvulsant-Antispasmodic
Another of the significant contributions to medicine by William Brooke Oshaughnessey, M.D. was the discovery that cannabis was useful in the treatment of seizures and spasticity. So important was this discovery that his nonpareil monograph ON THE PREPARATIONS OF THE INDIAN HEMP, OR GUNJAH presented in 1839 was subtitled: THEIR EFFECTS ON THE ANIMAL SYSTEM IN HEALTH, AND THEIR UTILITY IN THE TREATMENT OF TETANUS AND OTHER CONVULSIVE DISEASES.
These findings were confirmed by Clendinning in 1843 who described efficacy in both tetanic spasticity and irritability of the central nervous system. The latter secondary to alcohol withdrawal symptoms. Christison in 1851 described two cases of tetanic muscle spasms alleviated. Willis in 1859 reported success in the treatment of puerperal convulsions and delirium tremens. The Ohio State Medical Society convened a committee that reported on the medicinal properties of cannabis in 1860. W.P. Kincaid reported: I have treated four cases of epilepsy with the hemp; two were permanently benefited (at least to the present time); one temporarily, and one not at all. Major pharmaceutical firms listed epilepsy as one of the conditions for which cannabis was indicated either alone or as an ingredient in combination preparations.
The Indian Hemp Drugs Commission in 1894 listed brain fever, cramps, convulsions of children,...neuralgia, and tetanus. The U.S. Dispensatory of that year lists convulsions as one of the indicated conditions recommended for treatment. After the onset of marijuana prohibition in 1937, citations in medical literature all but disappeared and only isolated mentions in the scientific literature.
Cosroe both described a case of epilepsy controlled by smoked marijuana and demonstrated the efficacy in blocking experimentally induced seizures in rats. Similarly, anticonvulsant activity was demonstrated in mice using various constituents of cannabis.
Findings from secret research on cannabinoids as an incapacitation agent for chemical warfare produced the useful side effect of reconfirming the use of cannabis as an anti seizure medication. Van M. Sim, M.D. then director of the Edgewood Arsenal Chemical Warfare declared: Marijuana...is probably the most potent anti epileptic known to medicine today. and Harold Hardman described significant hypothermogenic activity.
Despite these disclosures in 1971 to date there has been no efforts to exploit these beneficial medicinal properties.
3. Analgesic Immunomodulator
Gabriel Nahas, M.D. Columbia University Anesthesiology professor long time antimarijuana activist, and others have alleged adverse effects of cannabis on the immune system supposedly decreasing the immune response as represented by numbers of one of the white blood cells, the T lymphocyte. Their discredited thesis of immunocompromise caused by cannabis, nonetheless adversely affected clinical research by turning attention away from possible beneficial effects on the immune system by the drug. More recent studies show much more complex effects.
Lipid metabolic pathway of the Eicosanoids, arachidonic acid compounds, precursors to production of Prostaglandin and decrease of release of PG. Inhibition of healing of viral skin infection may be related to pulsatile elevations in circulating cortisol. Antagonism of marihuana mental effects by indomethacin, an anti inflammatory drug with side effects of suppressing production of leukocytes also indicates the complexity of the effects of cannabis on the immune system..
First described by OShaughnessy in the treatment of acute and chronic arthritis in 1839, Clendinning confirmed the findings in 4 of his 18 patients in 1843. Acute rheumatism was successfully treated by Buckingham in 1858 Clinical interviews of over 150 members at cannabis buyers clubs and patients in my psychiatric practice lead to this generalization: Cannabis appears to be a unique immunomodulator analgesic that is useful in the control of autoimmune inflammatory illnesses that include:
Autoimmune Inflammatory Illnesses
Musculoskeletal
Posttraumatic Arthritis, Rheumatoid, and Osteoarthritis, Fibromyalgia, Nail-patellar-tooth disease, Melorheostosis
Cardiopulmonary
Asthma, chronic cough
Cystic fibrosis
Central and Peripheral Nervous System
Seizure Disorders, Degenerative diseases of the CNS and PNS: Cerebral Palsy, Multiple Sclerosis, Charcot Marie Tooth,
Post viral encehalophathy and neuropathies, Tic doloroux, Diabetic Neuropathy, Post CNS and PNS injury pain.
Glaucoma, Intraocular hypotensive, conjunctivitis, drusen of the optic nerve, Oculomotor post congenital spastic blindness,
Menieres disease, Migraine headache.
Gastrointestinal System
Gastritis, Duodenal Ulcer, Regional Enteritis, Crons Disease, Colitis, Spastic and Ulcerative, Hepatitis, Peutz-Jeghers disease.
Genitourinary
Cystitis, dysmenorrhea, orchitis, epididimitis, prostatitis
Endocrine
Thyroiditis, Amyloidosis, Scleroderma, Lupus, Premenstrual syndrome (PMS)
Skin
Allergic Rashes, Dermatitis, Psoriasis, Intractable Itching
Ear, nose and throat
Menieres Disease, Motion Sickness, Sinusitis, Allergic Rhinitis
Possible Therapeutic Mechanisms of action
Clinical interviews in over 800 cases lead me to certain impressions regarding how cannabis produces therapeutic effects.
Therapeutic mechanism of action appears to be bimodal involving both central nervous system and peripheral sites. There appears to be cognitive change affecting the perception of pain that produces relief or amelioration. The control of emotional reactivity diminishes the cognitive response to the stressor or aggravating stimulus. In persons with spastic conditions, the decrease in muscle tension or sympathetic nervous system activity, the physical effects appears to come before the cognitive or perceptual changes.
The Body- mind Link
There appears to be a distinct physical component of the effect that is different from cognitive changes. While there is contiguity of both, physical sensation appears, at least when cannabis inhaled, to start a minute or less before the onset of cognitive changes. I have a sense of physical release. Something that was getting tighter let go and the migraine attack was avoided. Articulated a lawyer in his late 40s. The decreased emotional reactivity is synergistic with cognitive changes to interdict the obsessive thinking driven by the physical discomfort mediated by emotional reaction. This appears to be the body-mind link.
The initial increase in the flow of ideas appears to be related to increase in cerebral blood flow. Decreased peripheral resistance in the capillary bed of the cerebral cortex and vasodilation of the meninges. The latter may be observed by reddened eyes sclera that are extensions of the meninges.
It would appear that cannabis affects local inflammation by playing some role in the prostaglandin production and release behavior of the immune system. This would also explain relief of spasticity both in skeletal and smooth musculature. The Mind-body link The mind-body link appears to be altered time perception as it impinges on short term memory. This alteration of cognition then modifies the perception of pain. The pain appears to fade into the distance or other description of altered perception of the physical sensation is the other mechanism of cannabis analgesia. Harm Reduction by substitution for more toxic drugs Over half of 57 randomly selected San Francisco Buyers Club members interviewed used cannabis to avoid or diminish the use of alcohol, cocaine, amphetamine, and opiates.
4. Cannabis Substitution- Gateway drug back.
The substitution of cannabis for more harmful drugs- especially alcohol and opiates - is one of the early and important therapeutic applications described in preprohibition literature. In 1843 Clendinning , a clinic physician in Edinburgh, used cannabis for the detoxification of alcoholics and opiate dependent. He also described the drug to be effective in both inflammatory and spasmodic pain. . With the invention and popularization of synthetic and purified drugs such as the barbiturates, heroin, and amphetamine, the use of cannabis drugs declined.
The use of cannabis in acute alcoholic withdrawal has yet to be reevaluated. Doubtless, there are some that have probably used the drug in this application but reports are unlikely from any institution at this time.
Cannabis as a substitute for alcohol.
A significant number of alcoholics have discovered mood management with cannabis to be significantly less toxic than alcohol. They have been able to avoid being caught up in the enabling of a dysfunctional group to aggravate this chronic progressive serious illness. Certain alcoholics may need the additional pharmacological support to resist impulse to relapse through the use of Antabuse (disulfiram).
Carrot and Stick Intervention
In the county alcoholism clinic some years ago I met a terminal chronic alcoholic woman with a lengthy history of treatment failures and non compliance. She confide to me that she was able to avoid drinking if she could smoke marijuana. I encouraged this substitution but added the use of disulfiram which prevented her drinking through threat of a severe histamine reaction if she drank. This carrot and stick pharmacologic intervention helped her to be clean and sober for seven years before her death from breast cancer. During this period of recovery she was able to heal the painful alienated relationship with her son caused by her alcoholism.
At the Santa Cruz Cannabis Buyers club a 40 year old musician with a degree in engineering has been functionally disabled since his mid 20s by a gradually encroaching chronic alcoholism. He exhibited serious medical problems including cirrhosis and peripheral neuropathy. His personality deterioration and organic mental symptoms produced continuing conflict with his girl friend (now fiancee) was on the verge of making him homeless again.
Carrot and stick therapy was implemented with an ongoing arrangement where he receives three days worth of cannabis in exchange for taking his disulfiram tablet under direct observation by the CBC staff. Over one year has passed and not without incident. There have been incidents involving conflicts with the couple and the CBC staff that have diminished in frequency and intensity as recovery has progressed.
Clinical medical reality is represented by a bell shaped distribution of drug interactions, covering the entire spectrum from those who should avoid the use of cannabis altogether to those who should never be without the drug. Misuse of cannabis is also a real and legitimate concern, and must be recognized as a symptom of emotional discomfort that must be treated. Cannabis itself is a tool without intrinsic moral properties. Development of Harm Reduction Support Groups The milieu at the CBCs itself appears to have a salutary effect upon the healing process. Informal and videotaped clinical interviews repeatedly make reference to the CBC as a sanctuary. The cohesiveness from the illicit nature of the activity is, no doubt, a significant factor. An extension of that is the opportunity for social contact with others. The non judgmental inclusive egalitarian style of interactions are sufficiently desirable to members to linger rather than just make their purchase and leave. A familiar theme in the interviews is the feeling of sanctuary and acceptance. The therapeutic benefit from communitatis must be separated from the pharmacologic benefits by future clinical research.
Psychological aspects of cannabis criminalization. The stigma of criminality- a significant stressor and the salutory effect of medicalization. In the interviews at the end of which I present my California physicians statement that recommends and approves the use of cannabis for officially diagnosed serious illness there is frequently a genuine expression of gratitude and relief. The sense of freedom from the burden of criminal status and all that portends is one of my most satisfying experiences as a physician since medical school.
Criminal status is an alienating experience which is connected with ones self esteem. But Im really not a criminal! complained a businesswoman in her forties. And the question Who do you think you are? takes on a new meaning. What are your rights and expectations as an individual and who are you with regard to society? With official physicians statement definition as a non criminal, there is a palpable sense of conciliation and feeling a reduced fear of harmful intervention by sanction. For others it provides a support and shield to fight for the right to work, freedom from losing ones home to civil forfeiture, or custody of children.
5. Increased Appetite
Cannabis has been recognized as an appetite stimulant for hundreds of years in non-western medicine. Mirza Abdool Rhazes, a most intelligent Persian physician...considers Hemp to be a powerful exciter of the flow of bile, and relates cases of its efficacy in restoring appetite.. produces a healthy appetite, ..digestive, easy of digestion,.. and the digestive faculty . During its century long prescriptive availability before being taken off the market, stimulation of appetite was frequently described, as a secondary effect during its use as an analgesic or sedative in comparison with the opiates. McConnell in 1888 specifically described success in treating anorexia One of the conditions in which the drug has proved useful in his hands is anorexia- loss of appetite consequent upon exhausting diseases such as prolonged fevers, diarrhoea, dysentery, phthisis, etc.
Lees described the drug as a mild stimulant to overcome constipation and gastritis that is nervous in origin
Marinol and cannabis are both useful in the treatment of anorexia, nausea, and vomiting from both disease processes and the iatrogenic symptoms caused by other drugs like cancer chemotherapeutic or antibiotics. Marinol which is supplied only as an oral preparation frequently is less effective than the smoked route because of the long time between ingestion and onset of effects. Additionally, the status of the gastrointestinal tract motility, and contents, affect the absorbtion rates of the drug.
6. Hypothermogenic
As part of the comprehensive evaluation of cannabinoids impact on human physiology as part of the intelligence communitys assessment of the drug as an incapacitation agent noted that body temperature was significantly lowered at higher doses. The potential for use for preoperative hypothermia in trauma was suggested by Hardman in 1970 reporting on classified research funded by the covert community.
Tod H. Mikuriya, M.D.
( Medical Coordinator, California Cannabis Buyers Clubs Former Director of Marijuana Research National Institute of Mental Health
notes:
OShaughnessy, W.B. On the Preparations of the Indian Hemp, or Gunjah (Cannabis Indica); Their Effects on the Animal System in Health, and Their Utility in the Treatment of Tetanus and Other Convulsive Diseases. Trans Med and Phys Soc Bengal 1838-40, pp. 421-461. Reprinted in Marijuana Medical Papers 1839-1972 Ed. Mikuriya, TH, MediComp Press, Oakland 1973, 465 pp, p 3-30.
California Health and Safety Code section 11260 President Clinton, Director of the White House Office of Drug Control Strategy, General Barry McCaffery, Republican Presidential Candidate, Bob Dole, Former U.S. Surgeon General, Everett Koop, M.D., California Governor, Pete Wilson, Senators Diane Feinstein and Barbara Boxer, State Attorney General Dan Lungren, California Medical Association, and the California
Narcotic Officers Association..
Lungren, D.E. California Attorney General Memorandum to District Attorneys, Sheriffs, and Chiefs of Police, 11 6/96 page 2.
Stanton, S. Medical-pot law a blur to police Sacramento Bee 11/13/96 page 1.
Marshall, J. Prop. 215 May Allow Pot Use at Work San Francisco Chronicle 11/16/99 A1
Richtel, M Medical marijuana at new Web site Oakland Tribune 11/22/96 C1
Mikuriya, T.H. Marijuana Medical Papers 1839-1972 MediComp Press, Oakland 1973 465pp P. xxiv
Mikuriya, T.H. Marijuana Medical Papers 1839-1972 MediComp Press, Oakland 1973 465pp P. xxiv.
Homer Odyssey 4:219-23 (as quoted in Abel EL,
Marihuana The First Thousand Years Plenum Press, New York 1980 289 pp page 28-29
Grierson, GA On References to the Hemp Plant Occurring in Sanskrit and Hindi Literature IHDRC 1894 p 32-34
O'Shaughnessy in Marijuana Medical Papers p. 10 - 11
Moreau JJ Hashish and Mental Illness Ed Peters, H & Nahas GG Translated by Barnett, GJ Raven Press New York 1973 245 pp p 28
Wood GB, Bache F Dispensatory of the United States of America 12th Ed Lippincott Philadelphia 1866 page 282
Remington JP, Wood HC, Sadtler SP, LaWall CH, Kraemer H, and Anderson JF The Dispensatory of the United States of America 20th Ed
Lippincott Philadelphia 1918 p 280
Hare HA Practical Therapeutics Blakiston Philadelphia 1922 p 181
Clouston TS On the Use of Opium, Potassium Bromide and Cannabis Indica in Cases of Mental Illness Brit. Rev. XLVII Page 203 Jan 1871
Villard F Du Hachisch Etude Clinique, Physiologique, Et Therapeutique Adrien Delahaye, Paris 1872 67 pp. page 58
O'Shaughnessey, W.B. On the Preparations of the Indian Hemp, or Gunjah: Their effects on the animal system in health, and their utility in the treatment of tetanus and other convulsive diseases. Trans. Proc. Med. Soc. of Bengal
Clendinning, JJ. Observations on the Medicinal Properties of the Cannabis Sativa of India Med. Chirg. Trans. 26:188-210 1843.
Christison, A.On the Natural History, Action, and Uses of Indian Hemp Monthly J. Med.Sci. 1851 Sutherland & Knox Edinburgh pp 1-26
Willis, I P, Cannabis Indica Boston Med & Surg J. 173-178 1859.
Report of the Ohio State Medical Society Committee on Cannabis Indica. Trans 15th Ann Mtg. Ohio State Med Soc White Sulfur Spgs Jun 12-14, 1860 pp 75-100.
Waring, EJ Practical Therapeutics Lindsay & Blakiston, Philadelphia 1874 p 157-161
Lilly's Handbook of Pharmacy and Therapeutics, 5th Revision 1897 p 257.
Squibb's Materia Medica Date Unknown P.396
Shoemaker, J.V. Materia Medica and Therapeutics 6th Ed. 1906 p307
Solis-Cohen, S. & Githens, T.S. Pharmacotherapeutics Materia Medica, and Drug Action Appleton & Co. NY 1928 p 1705
Indian Hemp Drugs Commission Report Simla India 1894 3,281 pp Vol. 1 Ch X, 461.
Treatment of Disease p 176.
Wood, GB and Bache, F The Dispensatory of the United States of America 17th Edition J B Lippincott Co. Phila 1894 p 308-311
Loewe, S and Goodman, L.S. Anticonvulsant action of marihuana-active substances. Fed Proc. Vol. 6 1947 p. 352
Davis, J P and Ramsey, H H Anti epileptic action of Marihuana-active substances. Fed Proc Vol. 8, No. 1 1949 p 284.
Cosroe, PF, Wood, GC, and Buchsbaum, H Anticonvulsant Nature of Marijuana Smoking JAMA, 234:3:307-307 October 20, 1975
Cosroe, P and Wolkin, A. Cannabidiol- Anti epileptic drug comparisons and interactions in experimentally induced seizures in rats. J. Pharmacol
Exp. Ther. 201:26-32, 1976
Karler, R, Cely, W and Turkanis S A The anticonvulsant activity of cannabidiol and cannabinol Life Sci 13: pp 1527-1531 1973
Carlini EA, Mechoulem R, and Lander, N. Anticonvulsant activity of four oxygenated cannabidiol derivatives. Res Comm Chem Path & Pharm 12:1: Sept 1975 1-15
Wada JA, Sato M, and Corcoran ME Anti epileptic Properties of Delta 9 Tetrahydrocannabinol Exp. Neuro 39, 157-165 1973
Sim, V M quoted in Marijuana Medical World News Vol 12:27 July 16, 1971 pp 37-44
Morishima, Nahas Burstine S, Eicosanoids as Mediators of Cannabinoid Action Marijuana/Cannabinoids Ch 3 P73 -92
Pertwee RG In Vivo Interactions between Psychotropic Cannabinoids and Other Drugs Involving Central and Peripheral Neurochemical Mediators Marijuana/Cannabinoids Ch 6 P 165-218
Perez-Reyes, M, Burstine SH, White WR, McDonald SA, and Hicks RE, Antagonism of marihuana effects by indomethacin in humans. Life Sci 48, 507, 1991.
Huestis M and Cone E Elevated Cortisol Levels in Marijuana Smokers Forensic Drug Abuse Advisor Vol 7(3) March 1995 p 20.
Gross G, Roussaki A, Ikenberg H, Drees N Genital Warts Do Not Respond to Systemic Recombinant Interferon Alfa-2a Treatment during Cannabis Consumption Dermatologica 1991:183:203-207
O'Shaughnessy MMP pages 17 -19
Clendinning Cases 4, 6, 8 and 14
Buckingham, CE Use of Cannabis in Acute Rheumatism
Boston Med and Surg J. Vol lviii March 1858 (Cited in McMeens Report of the Ohio
State Medical Committee on Cannabis Indica Trans of the Fifteenth Annual Meeting of the Ohio State Medical Society June 12-14 1860 pp 75-100 (Reprinted in Marijuana Medical Papers p 117-140)
Clendinning, J. Observations on the Medicinal Properties of the CANNABIS SATIVA OF INDIA.,Med. Chirug. Trans. London 26:188-210. 1843
O'Shaughnessy in Marijuana Medical Papers P13
Grierson, GA On References to the Hemp Plant Occurring in the Sanskrit and Hindi Literature Indian Hemp Drugs Commission Report 1893-1894 Appendix A. Reprinted in Excerpts from the Indian Hemp Drugs Commission Report compiled by Mikuriya, TH Last Gasp San Francisco 1994 40 Pages P. 32.
McConnell FP Uses of Cannabis Indica JAMA v10 Feb. 25, 1888 p 234
Lees RC Cannabis Sativa, Indica: Indian Hemp Brit Med J Feb. 8, 1895 p 300-301
www.mikuriya.com/althealt...a.html#Can RX
Cannabis, ingested safely, is one of the most useful of medicines for a variety of conditions. These include: pain, spasticity, anxiety, depression, headache, nausea, anorexia, epilepsy, asthma, dysmenorrhea, premenstrual tension, withdrawal from other drugs, and glaucoma.
Ignorantly or imprudently used, cannabis can be harmful.
From "Safe Use of Cannabis" by Tod H. Mikuriya, M.D.
NEW: Added 04/23/00 Marijuana Medical Papers, originally published in 1972, long out of print...available now on line.
MedicoLegal The link to follow if you are looking for an expert witness/consultant on issues relating to the medical use of cannabis.
Dependency and Cannabis Submitted for publication 10 99. A nice summary of the historical overview combined with recent clinical experience. A decent retort to those who view cannabis as a "gateway drug". In many cases cannabis is a "gateway" back.
Medicinal Uses of Cannabis Written in 1998, this piece ties together historical medical texts concerning cannabis with Dr. Tod's own clinical findings since the passage of the California Compassionate Use Act of 1996 for a new look at the medicinal uses of cannabis.
Click here to browse Dr. Tod's writings that have been published elsewhere on the WWW. If you know of other web published writings that could be linked here, e mail Dr. Tod.
Visit Dr. Tod's links page, a few of the people and organizations that are making things better for the rest of us.
Clinical Review: 3000 Cases, presented at The First National Clinical Conference On Cannabis Therapeutics, Iowa City, Iowa April 7, 2000, this file is an updated synopsis of the following paper. This is a small html file.
Medical Uses of Cannabis in California ; presented at the 1999 Symposium on the Cannabinoids, International Cannabinoid Society. A 10 page pdf file. Must have acrobat reader to access.
A Proposal for Comprehensive Rational Drug Abuse Control Originally published in three consecutive issues of Sinsemilla Tips beginning with Vol 8 #4, Summer 1989. PDF format, must have Acrobat Reader to access.
More will be added periodically, come back and visit. Also visit the California Compassionate Use Act of 1996 web site at www.drugsense.org/CCUA/.
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Dependency and Cannabis
Tod H. Mikuriya, M.D.
Pre Prohibition
OShaughnessy in 1839 visited cannabis buyers centers in India and mingled with the dissolute and depraved to learn about the preparations of this social drug for clinical medical trials finding it to be useful in the treatment of tetanus and seizures.
Cannabis substitution for more harmful medicines In 1843 Clendinning utilized cannabis substitution for the treatment of alcoholism and opium addiction. Potter recommended full dose Squibb cannabis extract for withdrawal from opium addiction .
The Indian Hemp Drugs Commission Report in 1894 recognized the comparative safety of cannabis. Its unsurpassed ethnographic studies within different cultures, voiced a concern that if prohibited would cause the use of more dangerous drugs.
Cannabis combination with other medicines: decrease of dose, suppression of side effects Mc Meens citing Fronmueller in 1860 described the use of cannabis either alternating or combined with opiates reduced harm from increased dose, tolerance, dependence, and side effects. Cannabis was confirmed as useful in the treatment of delirium tremens and alternative to opium for analgesia . Dutt independently described the comparative safety in Materia Medica of the Hindus . Yeo warned about addiction to morphine in the treatment of neuralgia and suggested cannabis as an alternative.
Cannabis and mood disorders
The connection between dependency on drugs and mood disorders may represent unsuccessful attempts to self medicate uncomfortable feelings with the cure causing more harm and aggravation of the underlying condition.
Moreau described cannabis as being useful in the treatment of depression in 1845. The drug is listed in medical texts and pharmaceutical catalogs for treatment of melancholia or mania.
Patients report that cannabis facilitates both anti mania and antidepressant medications. Cannabis used in combination with antidepressants appears to decrease the side effects of nervousness, muscle tension, and nausea for SSRI type antidepressants. Other patients report that cannabis is complementary. A typical report is that the SSRI elevates mood overall and cannabis improves affectual responsivity. Cannabis can either diminish the dosage needs for sufferers of bipolar disorders or substitute altogether for anti-mania medications. With symptoms of mania or agitation cannabis appears to decrease affectual lability.
Cannabis substitution for more harmful non-medical drugs Notwithstanding some polysubstance abusers who maladaptively combine cannabis with other psychoactives, there appears to be a significant number of persons who have learned that cannabis can be totally substituted for other, more harmful, substances..
Following the therapeutic path of Clendinning, throughout the 19th and early 20th century, cannabis was found useful in the treatment of opiate and sedative abuse. Brunton describes use of cannabis for the treatment of opiate dependence or as a substitute when opiates were not tolerated. Shoemaker finds in some instances cannabis to be useful for the cure of opium or chloral habit. Birch advocated for the use of Indian Hemp in the treatment of chronic chloral and opium poisoning. Mattison, an early addiction specialist, recommended cannabis as a substitute of morphine and cautioned his fellow physicians about hypodermic use of the drug.
Alcohol abuse, stimulant, sedative, and opiod abuse and dependence are conditions potentially treatable with cannabis substitution. All of these conditions involve management of mood and emotional reactivity. While there have been numerous synthetic homologs developed, short acting psychotropics continue to have high potential for dependency and abuse. The quality of immediacy for mood management would appear to be inseparable from abuse potential, however cannabis appears to be the exception because of lesser or milder withdrawal symptoms.
Pharmacologic mechanisms
This may be accounted for by the lipophillic water insolubility of the tetrahydrocannabinols that appears to act through the prostaglandins as eicosanoids, precursors, whose structures are similar. While largely unknown in specific details, tetrahydrocannabinols appear to modulate the behavior of the CNS either directly, or through the adrenopituitary axis. Additionally, eicosanoid peripheral physical activity in specific organ systems like lung tissue has been demonstrated in animals.
California cannabis center members and patients in my private practice independently rediscovered and confirmed cannabis as a safer substitute for prescribed and non medical psychoactive drugs in the control of depression, anger, and anxiety. Cannabis substitution may be a gateway drug back to sobriety and dealing with the underlying psychopathologic etiologies.
Gieringer summarized 2479 California cannabis users interviewed by the author noted 5.5% (136) described that the use of cannabis to be less harmful than alcohol, opiate, and other drug dependencies as primary presenting illness. For this group of self medicators cannabis has found to have far fewer adverse effects than opioids, sedatives, and stimulants. This small percentage represents only dependencies as primary conditions, and, as such, grossly underreports dependencies in chronic pain conditions.
Antabuse (disulfiram) and alcoholism
I have personally successfully treated two patients suffering severe alcoholism with a combination of disulfiram and cannabis substitution. This carrot and stick approach appears to address the needs of pharmacologic management of mood and avoids relapse with emotionally stressful events.
Posttraumatic Stress Disorders- A specialized category of dependencies Adult children of alcoholic families are doubly harmed by abuse and functional ignorance. Violence, sexual abuse or emotional absence by one or both parents is compounded by failure to provide coping skills to deal with normal feelings and pathologic role models. Alcoholism and polysubstance dependence is significant with destructive and symbiotic family involvements.
Vietnam veterans and other survivors of horrific experiences of adulthood suffer from living nightmares and flashbacks triggered by certain specific stimuli that cause overwhelming fight-flight reactions. Chronic depression with insomnia and fearfulness frequently incapacitate and isolate.
Many of each group have come to realize that cannabis is less toxic or harmful than alcohol, opiods, and other psychotropics in their continuing struggles with indelible memories and their physiologic concomitants. Cannabis is used to relieve depression, decrease emotional overreactivity, and sleep deficit.
The alternative medical movement represents a populist rebellion against conventional medicine for treating chronic relapsing illness that include alcohol and other drug dependencies. Cannabis self-medication has been discovered to be a viable alternative to treat these conditions and may enhance or substitute forconventional pharmacotherapy.
American Drug Policy, Dependencies, and Cannabis
The complex interplay of cannabis use with physiology and psychology challenges research. Outcomes are combinations of pharmacology, expectations, setting, personal and social forces. The contemporary ambiguity, a product of ignorance from deprivation of contemporary clinical experience, may be somewhat assuaged by two facts: Firstly, cannabis has been used for millennia by numerous cultures without serious adverse consequences. Secondly, neither the composition of cannabis nor the physiology of humans have changed since the drug was taken from the armementarium of medicine.
Perceptions of cannabis and its effects--distorted by sixty years of prohibition--are embedded in official policy . The Controlled Substances Act of 1970 classifies cannabis as Schedule I: high potential for abuse, no currently accepted medical use, and lack of accepted safety. A 1999 Institute of Medicine report favorably compares the psychophysical profile of cannabis to other conventional medication in chronic pain and spastic conditions but avoids any recommendation of using cannabis for the treatment of alcohol and drug dependencies.
To circumvent prohibition censorship and dissimulation of contemporary official propaganda a review of medical and pharmaceutical literature prior to the passage of the Marihuana Tax Act in 1937 is mandatory. Cannabis was available and utilized extensively in medical practice until its removal from availability. There was an overall decline in its use with the development of newer synthetic sedative, stimulant, and analgesic drugs.
Criminalization of dependencies in the United States began in 1869 when the Temperance party became the Prohibition party. The ensuing state by state war of the drys against the wets culminated 1919 with the passage of the Vollstedt Act and the Prohibition of alcohol.
The Harrison Narcotics Act of 1914 criminalized non medical use of opiates and cocaine. In 1921 the Federal Prohibition Commissioner criminalized the maintenance of unconfined narcotic addicts. The subsequent demonization and persecution of narcotic addicts, and physicians that sought to treat them, significantly limited treatment . Methadone maintenance programs, available since the 1970s, remain heavily bureaucratized and functionally rationed. Alcohol and drug dependency treatment remain frequently unavailable. The last to be funded, first to be cut from public budgets and often not covered by private insurance. In America drug policy is controlled by the Attorney General- not the Surgeon General. Drug dependencies are defined as moral defects and not medical problems. Police become the armed pharmacologists. Drug Awareness and Resistance Education celebrated its 17th birthday with uniformed police in the class rooms.
Meanwhile, television and print media tell us to ask your physician about Paxil (paroxetine), a SSRI antidepressant.
THM Berkeley, CA 10/6/99
Medicinal Uses of Cannabis
Tod H. Mikuriya, M.D.
(c)1998
Hemp is used in various forms, by the dissipated and depraved, as the ready agent of a pleasing intoxication. In the popular medicine of these nations, we find it extensively employed for a multitude of affections. But in Western Europe, its use either as a stimulant or as a remedy, is equally unknown. wrote W.B. OShaughnessy in 1838. Over 150 years later cannabis prohibition causes the drug to be largely unknown as a remedy. In certain segments of contemporary California cultures its therapeutic properties are being independently reaffirmed and elaborated.
Until the initiation of the cannabis buyers clubs in 1992 there has been minimal opportunity for clinical research. Since removal from prescriptive availability in 1937 therapeutic experience with the drug has been minimal. Removal of cannabis from prescriptive availability in 1937 plunged the medical and scientific community into a dark world of clinical ignorance; with prevailing realities and definitions hostage to police, prosecutors, and (unbeknownst to the public) the covert agencies. Despite continuing official stories to the contrary, anecdotal accounts of therapeutic efficacy could not be entirely suppressed. Under covert community contracts a synthetic d 1-9 tetrahydrocannabinol was synthesized in quantity by a federal contractor to the CIA and made available under the trade name, dronabinol (Marinol) in 1986. Additionally, there was legislative recognition that cannabis drugs had therapeutic potential and the California Research Advisory Panel (CRAP) was set up in 1969 . The agency was installed in the Attorney Generals office. The secretary, Edward P. OBrien, Assistant Attorney General strictly interpreted the law and inhibited the panel from carrying out its legislative mandate of affording compassionate access. The 22 year old autocracy was unsuccessfully challenged in August 1990.
The panel, exclusive of OBrien, attempted to publish an executive summary which, among other things, recommended the decriminalization of marijuana. The executive summary was expurgated from the annual report. UCSF professor of pharmacology, Frederick Meyers, M.D., was obliged to publish it privately. Significant research did take place with Reese Jones, MD at UCSF proved the safety of high dose THC and marijuana which contributed to the release of Marinol as a schedule II controlled substance. The National Organization for the Reform of Marijuana Laws (NORML) brought suit against the Drug Enforcement Administration (DEA) in 1972 to reclassify marijuana to make it available for prescription After two years of hearings and testimony down scheduling of crude cannabis from schedule I to schedule II was recommended by administrative judge Francis L. Young on September 6, 1988. The DEA appealed this and in October 1991 was told to facilitate the decision making process or better justify retention in schedule I. James O. Mason, M.D. Assistant Secretary for Health in May, 1991 terminated the compassionate Investigative New Drug (IND) for cannabis. AIDS activist protesters led opposition to this which resulted in the INDs continuing until November 18, 1991 when he again announced suspension.
Mason stated that cannabis has no legitimate medicinal use an that use of marijuana promoted disinhibition leading to unsafe sex. Another claim of was that natural cannabinoids may expose immunocompromised individuals to harmful contaminants like fungi, molds, and bacteria. While there are no cases reported as yet, these were the rationalizations for his decision. Dr Donald Abrams and a respected team at University of California, San Francisco at the San Francisco General Hospital have been finally successful in obtaining approval after 5 years delay to research the comparative utility of Marinol and cannabis in AIDS patients.
In 1992 the first Cannabis Buyers Clubs were started in San Francisco, New York, and Washington, DC with originated by gay community activists after informal meetings in Washington, DC at the 1991 annual Drug Policy Foundation conference. Of the buyers clubs, the San Francisco CBC was the largest. It grew from a few hundred to twelve thousand before it was raided and closed in August, 1996 by the California State Bureau of Narcotics. Currently, known CBCs are throughout the greater San Francisco Bay area operating autonomously with varying admission requirements and protocol. Since the closing of the San Francisco CBC, the procedures, for the most part, tended to be cautious and exclusive until the passage of Proposition 215. Notwithstanding official statements that the medicinal usefulness were yet to demonstrated in opposing Proposition 215 , the Compassionate Use Act of 1996, the initiative passed 55% to 44% and became California Health and Safety Code section 11362.5. Because little preparation for the eventuality of its passage, enforcement of California marijuana laws has become problematic.
While cannabis law reform activists celebrated by conspicuously self-medicating, institutional response was anxious perplexity. From the White Office of National Drug Control Policy, and Drug Enforcement Administration to the California Attorney Generals Office, and the California Medical Association, all trying to determine responses to the legalization of medical marijuana. Meanwhile, California marijuana law anarchy. De facto partial legalization. Cannabis, however, had a ninety year history of clinical use in the U.S. since the mid 1840s until removal from clinical availability by the Marihuana Tax Act. Pre 1937 Cannabis Therapeutic Uses
1. Analgesic-Hypnotic
2. Appetite stimulant
3. Antiepileptic-antispasmodic
4. Prophylactic and treatment of the neuralgias, including migraine and tic doloreux
5. Antitussive
6. Antidepressant-tranquilizer
7. Antiasthmatic
8. Oxytocic
9. Topical anesthetic
10. Withdrawal agent and substitute for opiate, chloral, and alcohol dependence
11. Childbirth analgesic
Unapproved Clinical Research: California Cannabis Center Interviews
Because the use of marijuana is illegal, usual institutional channels of support are blocked and funding unavailable. U.S. Analytical laboratories are forbidden to analyze specimens from extralegal sources. Notwithstanding these impediments the cannabis buyers clubs afford unique clinical research opportunities in therapeutic uses of cannabis. CBCs are communities of persons who seek the drug for self-medication. Gaining entry to a CBC requires proof of illness and a written referral from a physician.
Interviews at the CBCs in San Francisco, Santa Cruz, Oakland and in my office confirm descriptions in the pre prohibition medical, pharmaceutical and scientific literature. Clinical phenomena once known to medicine and treated by the physician are rediscovered by persons self medicating with cannabis. Additional unreported conditions are encountered.. Despite the lack of information of forgotten medical intelligence there appears to be frequent spontaneous discovery of medicinal utility. A typical story goes: A person in their forties Oh yes, I did it a few times in high school but never used it again until recently and to my surprise the symptom improved!
A pilot study of interviews with 57 San Francisco Cannabis Buyers Club members in 1994 was done using an outline derived from pre-prohibition medical literature citations and personal clinical observations Interviews with over 200 CBC members have led me to certain overall clinical findings: Cannabis therapeutic effects appear to be at least six categories.
1. Psychotherapeutic: Antidepressant/Anxiolytic
2. Antispasmodic Anticonvulsant
3. Analgesic immunomodulator
4. Harm reduction substitute
5. Appetite stimulant
6. Hypothermogenic
1. Psychotherapeutic: Antidepressant/Anxiolytic
Before it was taken away from physicians for prescribing in 1937 cannabis had a long history as a drug for the treatment of melancholia or depression with and without agitation. The ancient Greek, Indian, Persian, writings are replete with descriptions of antidepressant properties. Homers Odyssey describes Helen using a potion obtained from Polydamna that lifted the spirits at a morose gathering by slipping Nepenthe in the wine. Nepenthe means against sorrow . Sanskrit and Hindi writings characterize cannabis: Before the 8th century an anti phlegmatic, Circa 1050: victorious (Vijaya), and victorious in three worlds (Trailokyavijaya).
1300 A.D. in The Rajanighantu of Narahari Pandita: the light hearted (Capala), the joyful (Ananda), the rejoicer (Harsini), speech giving (vakpradatva) inspiring of mental power (medhakaritva), and a most excellent excitant (cresthadipanatva). 17th Century Materia Medica The Rajavallabha: It creates vital energy, the mental powers, and internal heat, corrects irregularities of the phlegmatic humour, and is an elixir vitae.
In contemporary terms a case of severe and chronic depression may have been successfully treated through self medication with cannabis.
The Persian physician Mirza Abdool Rhazes wrote: The oldest work in which Hemp is noticed is a treatise by Hasan, who states that in the year 658 (Mahometan era)(1258), the Sheikh Djafar Shirazi, a monk of the order of Haider, learnt from his master the history of the discovery of Hemp. Haider, the chief of ascetics and self-chasteners, lived in rigid privation on a mountain between Nishabor and Romah, where he established a monastery of Fakirs. Ten years he had spent in his retreat, without leaving it for a moment, till one burning summers day, when he departed alone to the fields. On his return an air of joy and gaiety was imprinted on his countenance; he received the visits of his brethren, and encouraged their conversation.
On being questioned, he stated that: struck by the aspect of a plant which danced in the heat as if with joy, while all the rest of the vegetable creation was torpid, he had gathered and eaten of its leaves. He led his companions to the spot, all ate, and all were similarly excited. A tincture of the Hemp leaf in wine or spirit seems to have been the favorite formula in which the Sheikh Haider indulged himself. An Arab poet sings of Haiders emerald cup; an evident allusion to the rich green colour of the tincture of the drug. The Sheikh survived the discovery ten years, subsisting chiefly on this herb, and on his death his disciples by his desire planted it in an arbour about his tomb. From this saintly sepulcher the knowledge of the effects of
Hemp is stated to have spread into Khorasan.
In 1845 J.J. Moreau de Tours, a French psychiatrist utilized cannabis in the treatment of depression described the drugs effects: It seems that nothing can hurt you in this peace of mind, that you are inaccessible to sadness. I doubt that the most unfortunate news could draw you out of that imaginary bliss, which can only be appreciated through experience. I have just attempted to give an idea of the delights that hashish produces. I hasten to add that I have presented them here in no more than raw form, as it were, and at their simplest. It will depend upon external circumstances to confer upon these feelings of happiness still greater intensity by directing them toward a determined goal and by concentrating them on a single point. One imagines what reality can add to this state of bliss and how much the joys of hashish can be enhanced by external impressions, by direct sensory excitations, or by the stirring of passions through natural causes. At that time, the rapture of hashish intoxication, taking shape and form, will assume the dimensions of delirium. This disposition of the mind, linked with another which I will discuss later, was, I feel, the fertile source from which the fanatic inhabitants of Lebanon derived that happiness, those ineffable delights for which they gladly sacrificed their lives.
It is necessary here to clarify what I have just said. It is really happiness that hashish gives, and by that I mean mental joy, not sensual joy as one might be tempted to believe. This is indeed very curious, and one can draw strange conclusions- this one among others, that all joy, all contentment, even though its cause is strictly mental, deeply spiritual, and highly idealistic, could well be in reality a purely physical sensation, developed physiologically, exactly like those caused by hashish. At least, if one relies on inner feelings, there is no distinction to be made between these two orders of sensations, in spite of the diversity of the causes to which they are related for the hashish user is happy, not in the manner of the glutton, of the ravenous man who satisfies his appetite, or even of the hedonist who gratifies his desires, but in the manner, for example, of the man who hears news that compounds his joys, of the miser counting his treasures, of the gambler whom luck favors, or the ambitious man whom success intoxicates.
However, the preceding remarks were not intended to raise a psychological question. I am merely recording observations, and have no other pretension than that of being the faithful and exact historian of my sensations. This characterization of the antidepressant effects of the drug in contemporary contexts would be unthinkable pro drug sedition and would never be found in any advertisement today . Depression as one of the conditions listed for treatment appeared in general Materia Medica, or medical texts , , ,
Subsequent clinical use in depression is described as having variable results. Clouston in 1871 from the Cumberland and Westmoreland asylum reported on five cases of melancholy with some success in four and marked improvement in one. Villard describes similar variable results in melancholia by physicians in France.
The Indian Hemp Drugs Commission in 1894 reviewed medical literature, testimony by both indigenous medical practitioners and Western trained physicians and described cannabis to be used as a tonic to increase stamina.
Cannabis decreases emotional reactivity and intensity of affect while increasing introspection as evidenced by the slowing of the EEG after initial stimulation. The unique anti depressive effects of cannabis are experienced immediately with the alteration in cognition. Obsessive and pressured thinking give way to introspective free associations when in relaxed circumstances. Emotional reactivity is smoothed out, worries are less pressing. Used on a continuing basis, cannabis used to hold the depressive symptoms at bay. Agitated depression appears to respond to the anxiolytic component of the drug . The poorly modulated emotional control seen in bipolar disorder with its overreactive affectual responses are diminished with cannabis.
The treatment of depression with cannabis may be difficult because of differences in individual makeup, need for continuous dose levels, expense, availability, and illegality. Hostile attitudes of clinicians who are ignorant of cannabis therapeutic properties are a significant impediment to its appropriate use in the treatment of depression with and without anxiety. Cannabis appears to be effective both adjunctively and alone in bipolar disorders by decreasing affectual overreactivity., In schizoaffective disorder, dysthymic disorders, and major depressions cannabis appears to lessen feelings of alienation and blocking of ideation. In any disorder cannabis sedative properties help with problems of insomnia.
Posttraumatic stress disorders are particularly helped by cannabis which afford control of symptoms more effectively than other psychotherapeutic agents because of the absence of incapacitating or debilitating side effects. The modulation of mood response prevents or significantly decreases the symptoms of anxiety attacks, mood swings, and insomnia. The short term memory loss effects that may be undesirable in other contexts are therapeutic in controlling obsessive worry ignited by the triggering stimuli.
Cannabis while possibly adversely interacting with tricyclic antidepressants appears to have either no interaction with SSRI antidepressants or possibly act synergistically. A 43 year old female graphics artist reported that while fluoxetine relieved her subjective depression, she needed cannabis to stimulate the flow of ideas. Others find cannabis useful in suppressing side effects of tenseness or anorexia from the SSRIs.
Individual psychotherapy may focus on problems secondary to feelings of marginalization because of criminal status and alienation from judgmental therapists and family.
2. Anticonvulsant-Antispasmodic
Another of the significant contributions to medicine by William Brooke Oshaughnessey, M.D. was the discovery that cannabis was useful in the treatment of seizures and spasticity. So important was this discovery that his nonpareil monograph ON THE PREPARATIONS OF THE INDIAN HEMP, OR GUNJAH presented in 1839 was subtitled: THEIR EFFECTS ON THE ANIMAL SYSTEM IN HEALTH, AND THEIR UTILITY IN THE TREATMENT OF TETANUS AND OTHER CONVULSIVE DISEASES.
These findings were confirmed by Clendinning in 1843 who described efficacy in both tetanic spasticity and irritability of the central nervous system. The latter secondary to alcohol withdrawal symptoms. Christison in 1851 described two cases of tetanic muscle spasms alleviated. Willis in 1859 reported success in the treatment of puerperal convulsions and delirium tremens. The Ohio State Medical Society convened a committee that reported on the medicinal properties of cannabis in 1860. W.P. Kincaid reported: I have treated four cases of epilepsy with the hemp; two were permanently benefited (at least to the present time); one temporarily, and one not at all. Major pharmaceutical firms listed epilepsy as one of the conditions for which cannabis was indicated either alone or as an ingredient in combination preparations.
The Indian Hemp Drugs Commission in 1894 listed brain fever, cramps, convulsions of children,...neuralgia, and tetanus. The U.S. Dispensatory of that year lists convulsions as one of the indicated conditions recommended for treatment. After the onset of marijuana prohibition in 1937, citations in medical literature all but disappeared and only isolated mentions in the scientific literature.
Cosroe both described a case of epilepsy controlled by smoked marijuana and demonstrated the efficacy in blocking experimentally induced seizures in rats. Similarly, anticonvulsant activity was demonstrated in mice using various constituents of cannabis.
Findings from secret research on cannabinoids as an incapacitation agent for chemical warfare produced the useful side effect of reconfirming the use of cannabis as an anti seizure medication. Van M. Sim, M.D. then director of the Edgewood Arsenal Chemical Warfare declared: Marijuana...is probably the most potent anti epileptic known to medicine today. and Harold Hardman described significant hypothermogenic activity.
Despite these disclosures in 1971 to date there has been no efforts to exploit these beneficial medicinal properties.
3. Analgesic Immunomodulator
Gabriel Nahas, M.D. Columbia University Anesthesiology professor long time antimarijuana activist, and others have alleged adverse effects of cannabis on the immune system supposedly decreasing the immune response as represented by numbers of one of the white blood cells, the T lymphocyte. Their discredited thesis of immunocompromise caused by cannabis, nonetheless adversely affected clinical research by turning attention away from possible beneficial effects on the immune system by the drug. More recent studies show much more complex effects.
Lipid metabolic pathway of the Eicosanoids, arachidonic acid compounds, precursors to production of Prostaglandin and decrease of release of PG. Inhibition of healing of viral skin infection may be related to pulsatile elevations in circulating cortisol. Antagonism of marihuana mental effects by indomethacin, an anti inflammatory drug with side effects of suppressing production of leukocytes also indicates the complexity of the effects of cannabis on the immune system..
First described by OShaughnessy in the treatment of acute and chronic arthritis in 1839, Clendinning confirmed the findings in 4 of his 18 patients in 1843. Acute rheumatism was successfully treated by Buckingham in 1858 Clinical interviews of over 150 members at cannabis buyers clubs and patients in my psychiatric practice lead to this generalization: Cannabis appears to be a unique immunomodulator analgesic that is useful in the control of autoimmune inflammatory illnesses that include:
Autoimmune Inflammatory Illnesses
Musculoskeletal
Posttraumatic Arthritis, Rheumatoid, and Osteoarthritis, Fibromyalgia, Nail-patellar-tooth disease, Melorheostosis
Cardiopulmonary
Asthma, chronic cough
Cystic fibrosis
Central and Peripheral Nervous System
Seizure Disorders, Degenerative diseases of the CNS and PNS: Cerebral Palsy, Multiple Sclerosis, Charcot Marie Tooth,
Post viral encehalophathy and neuropathies, Tic doloroux, Diabetic Neuropathy, Post CNS and PNS injury pain.
Glaucoma, Intraocular hypotensive, conjunctivitis, drusen of the optic nerve, Oculomotor post congenital spastic blindness,
Menieres disease, Migraine headache.
Gastrointestinal System
Gastritis, Duodenal Ulcer, Regional Enteritis, Crons Disease, Colitis, Spastic and Ulcerative, Hepatitis, Peutz-Jeghers disease.
Genitourinary
Cystitis, dysmenorrhea, orchitis, epididimitis, prostatitis
Endocrine
Thyroiditis, Amyloidosis, Scleroderma, Lupus, Premenstrual syndrome (PMS)
Skin
Allergic Rashes, Dermatitis, Psoriasis, Intractable Itching
Ear, nose and throat
Menieres Disease, Motion Sickness, Sinusitis, Allergic Rhinitis
Possible Therapeutic Mechanisms of action
Clinical interviews in over 800 cases lead me to certain impressions regarding how cannabis produces therapeutic effects.
Therapeutic mechanism of action appears to be bimodal involving both central nervous system and peripheral sites. There appears to be cognitive change affecting the perception of pain that produces relief or amelioration. The control of emotional reactivity diminishes the cognitive response to the stressor or aggravating stimulus. In persons with spastic conditions, the decrease in muscle tension or sympathetic nervous system activity, the physical effects appears to come before the cognitive or perceptual changes.
The Body- mind Link
There appears to be a distinct physical component of the effect that is different from cognitive changes. While there is contiguity of both, physical sensation appears, at least when cannabis inhaled, to start a minute or less before the onset of cognitive changes. I have a sense of physical release. Something that was getting tighter let go and the migraine attack was avoided. Articulated a lawyer in his late 40s. The decreased emotional reactivity is synergistic with cognitive changes to interdict the obsessive thinking driven by the physical discomfort mediated by emotional reaction. This appears to be the body-mind link.
The initial increase in the flow of ideas appears to be related to increase in cerebral blood flow. Decreased peripheral resistance in the capillary bed of the cerebral cortex and vasodilation of the meninges. The latter may be observed by reddened eyes sclera that are extensions of the meninges.
It would appear that cannabis affects local inflammation by playing some role in the prostaglandin production and release behavior of the immune system. This would also explain relief of spasticity both in skeletal and smooth musculature. The Mind-body link The mind-body link appears to be altered time perception as it impinges on short term memory. This alteration of cognition then modifies the perception of pain. The pain appears to fade into the distance or other description of altered perception of the physical sensation is the other mechanism of cannabis analgesia. Harm Reduction by substitution for more toxic drugs Over half of 57 randomly selected San Francisco Buyers Club members interviewed used cannabis to avoid or diminish the use of alcohol, cocaine, amphetamine, and opiates.
4. Cannabis Substitution- Gateway drug back.
The substitution of cannabis for more harmful drugs- especially alcohol and opiates - is one of the early and important therapeutic applications described in preprohibition literature. In 1843 Clendinning , a clinic physician in Edinburgh, used cannabis for the detoxification of alcoholics and opiate dependent. He also described the drug to be effective in both inflammatory and spasmodic pain. . With the invention and popularization of synthetic and purified drugs such as the barbiturates, heroin, and amphetamine, the use of cannabis drugs declined.
The use of cannabis in acute alcoholic withdrawal has yet to be reevaluated. Doubtless, there are some that have probably used the drug in this application but reports are unlikely from any institution at this time.
Cannabis as a substitute for alcohol.
A significant number of alcoholics have discovered mood management with cannabis to be significantly less toxic than alcohol. They have been able to avoid being caught up in the enabling of a dysfunctional group to aggravate this chronic progressive serious illness. Certain alcoholics may need the additional pharmacological support to resist impulse to relapse through the use of Antabuse (disulfiram).
Carrot and Stick Intervention
In the county alcoholism clinic some years ago I met a terminal chronic alcoholic woman with a lengthy history of treatment failures and non compliance. She confide to me that she was able to avoid drinking if she could smoke marijuana. I encouraged this substitution but added the use of disulfiram which prevented her drinking through threat of a severe histamine reaction if she drank. This carrot and stick pharmacologic intervention helped her to be clean and sober for seven years before her death from breast cancer. During this period of recovery she was able to heal the painful alienated relationship with her son caused by her alcoholism.
At the Santa Cruz Cannabis Buyers club a 40 year old musician with a degree in engineering has been functionally disabled since his mid 20s by a gradually encroaching chronic alcoholism. He exhibited serious medical problems including cirrhosis and peripheral neuropathy. His personality deterioration and organic mental symptoms produced continuing conflict with his girl friend (now fiancee) was on the verge of making him homeless again.
Carrot and stick therapy was implemented with an ongoing arrangement where he receives three days worth of cannabis in exchange for taking his disulfiram tablet under direct observation by the CBC staff. Over one year has passed and not without incident. There have been incidents involving conflicts with the couple and the CBC staff that have diminished in frequency and intensity as recovery has progressed.
Clinical medical reality is represented by a bell shaped distribution of drug interactions, covering the entire spectrum from those who should avoid the use of cannabis altogether to those who should never be without the drug. Misuse of cannabis is also a real and legitimate concern, and must be recognized as a symptom of emotional discomfort that must be treated. Cannabis itself is a tool without intrinsic moral properties. Development of Harm Reduction Support Groups The milieu at the CBCs itself appears to have a salutary effect upon the healing process. Informal and videotaped clinical interviews repeatedly make reference to the CBC as a sanctuary. The cohesiveness from the illicit nature of the activity is, no doubt, a significant factor. An extension of that is the opportunity for social contact with others. The non judgmental inclusive egalitarian style of interactions are sufficiently desirable to members to linger rather than just make their purchase and leave. A familiar theme in the interviews is the feeling of sanctuary and acceptance. The therapeutic benefit from communitatis must be separated from the pharmacologic benefits by future clinical research.
Psychological aspects of cannabis criminalization. The stigma of criminality- a significant stressor and the salutory effect of medicalization. In the interviews at the end of which I present my California physicians statement that recommends and approves the use of cannabis for officially diagnosed serious illness there is frequently a genuine expression of gratitude and relief. The sense of freedom from the burden of criminal status and all that portends is one of my most satisfying experiences as a physician since medical school.
Criminal status is an alienating experience which is connected with ones self esteem. But Im really not a criminal! complained a businesswoman in her forties. And the question Who do you think you are? takes on a new meaning. What are your rights and expectations as an individual and who are you with regard to society? With official physicians statement definition as a non criminal, there is a palpable sense of conciliation and feeling a reduced fear of harmful intervention by sanction. For others it provides a support and shield to fight for the right to work, freedom from losing ones home to civil forfeiture, or custody of children.
5. Increased Appetite
Cannabis has been recognized as an appetite stimulant for hundreds of years in non-western medicine. Mirza Abdool Rhazes, a most intelligent Persian physician...considers Hemp to be a powerful exciter of the flow of bile, and relates cases of its efficacy in restoring appetite.. produces a healthy appetite, ..digestive, easy of digestion,.. and the digestive faculty . During its century long prescriptive availability before being taken off the market, stimulation of appetite was frequently described, as a secondary effect during its use as an analgesic or sedative in comparison with the opiates. McConnell in 1888 specifically described success in treating anorexia One of the conditions in which the drug has proved useful in his hands is anorexia- loss of appetite consequent upon exhausting diseases such as prolonged fevers, diarrhoea, dysentery, phthisis, etc.
Lees described the drug as a mild stimulant to overcome constipation and gastritis that is nervous in origin
Marinol and cannabis are both useful in the treatment of anorexia, nausea, and vomiting from both disease processes and the iatrogenic symptoms caused by other drugs like cancer chemotherapeutic or antibiotics. Marinol which is supplied only as an oral preparation frequently is less effective than the smoked route because of the long time between ingestion and onset of effects. Additionally, the status of the gastrointestinal tract motility, and contents, affect the absorbtion rates of the drug.
6. Hypothermogenic
As part of the comprehensive evaluation of cannabinoids impact on human physiology as part of the intelligence communitys assessment of the drug as an incapacitation agent noted that body temperature was significantly lowered at higher doses. The potential for use for preoperative hypothermia in trauma was suggested by Hardman in 1970 reporting on classified research funded by the covert community.
Tod H. Mikuriya, M.D.
( Medical Coordinator, California Cannabis Buyers Clubs Former Director of Marijuana Research National Institute of Mental Health
notes:
OShaughnessy, W.B. On the Preparations of the Indian Hemp, or Gunjah (Cannabis Indica); Their Effects on the Animal System in Health, and Their Utility in the Treatment of Tetanus and Other Convulsive Diseases. Trans Med and Phys Soc Bengal 1838-40, pp. 421-461. Reprinted in Marijuana Medical Papers 1839-1972 Ed. Mikuriya, TH, MediComp Press, Oakland 1973, 465 pp, p 3-30.
California Health and Safety Code section 11260 President Clinton, Director of the White House Office of Drug Control Strategy, General Barry McCaffery, Republican Presidential Candidate, Bob Dole, Former U.S. Surgeon General, Everett Koop, M.D., California Governor, Pete Wilson, Senators Diane Feinstein and Barbara Boxer, State Attorney General Dan Lungren, California Medical Association, and the California
Narcotic Officers Association..
Lungren, D.E. California Attorney General Memorandum to District Attorneys, Sheriffs, and Chiefs of Police, 11 6/96 page 2.
Stanton, S. Medical-pot law a blur to police Sacramento Bee 11/13/96 page 1.
Marshall, J. Prop. 215 May Allow Pot Use at Work San Francisco Chronicle 11/16/99 A1
Richtel, M Medical marijuana at new Web site Oakland Tribune 11/22/96 C1
Mikuriya, T.H. Marijuana Medical Papers 1839-1972 MediComp Press, Oakland 1973 465pp P. xxiv
Mikuriya, T.H. Marijuana Medical Papers 1839-1972 MediComp Press, Oakland 1973 465pp P. xxiv.
Homer Odyssey 4:219-23 (as quoted in Abel EL,
Marihuana The First Thousand Years Plenum Press, New York 1980 289 pp page 28-29
Grierson, GA On References to the Hemp Plant Occurring in Sanskrit and Hindi Literature IHDRC 1894 p 32-34
O'Shaughnessy in Marijuana Medical Papers p. 10 - 11
Moreau JJ Hashish and Mental Illness Ed Peters, H & Nahas GG Translated by Barnett, GJ Raven Press New York 1973 245 pp p 28
Wood GB, Bache F Dispensatory of the United States of America 12th Ed Lippincott Philadelphia 1866 page 282
Remington JP, Wood HC, Sadtler SP, LaWall CH, Kraemer H, and Anderson JF The Dispensatory of the United States of America 20th Ed
Lippincott Philadelphia 1918 p 280
Hare HA Practical Therapeutics Blakiston Philadelphia 1922 p 181
Clouston TS On the Use of Opium, Potassium Bromide and Cannabis Indica in Cases of Mental Illness Brit. Rev. XLVII Page 203 Jan 1871
Villard F Du Hachisch Etude Clinique, Physiologique, Et Therapeutique Adrien Delahaye, Paris 1872 67 pp. page 58
O'Shaughnessey, W.B. On the Preparations of the Indian Hemp, or Gunjah: Their effects on the animal system in health, and their utility in the treatment of tetanus and other convulsive diseases. Trans. Proc. Med. Soc. of Bengal
Clendinning, JJ. Observations on the Medicinal Properties of the Cannabis Sativa of India Med. Chirg. Trans. 26:188-210 1843.
Christison, A.On the Natural History, Action, and Uses of Indian Hemp Monthly J. Med.Sci. 1851 Sutherland & Knox Edinburgh pp 1-26
Willis, I P, Cannabis Indica Boston Med & Surg J. 173-178 1859.
Report of the Ohio State Medical Society Committee on Cannabis Indica. Trans 15th Ann Mtg. Ohio State Med Soc White Sulfur Spgs Jun 12-14, 1860 pp 75-100.
Waring, EJ Practical Therapeutics Lindsay & Blakiston, Philadelphia 1874 p 157-161
Lilly's Handbook of Pharmacy and Therapeutics, 5th Revision 1897 p 257.
Squibb's Materia Medica Date Unknown P.396
Shoemaker, J.V. Materia Medica and Therapeutics 6th Ed. 1906 p307
Solis-Cohen, S. & Githens, T.S. Pharmacotherapeutics Materia Medica, and Drug Action Appleton & Co. NY 1928 p 1705
Indian Hemp Drugs Commission Report Simla India 1894 3,281 pp Vol. 1 Ch X, 461.
Treatment of Disease p 176.
Wood, GB and Bache, F The Dispensatory of the United States of America 17th Edition J B Lippincott Co. Phila 1894 p 308-311
Loewe, S and Goodman, L.S. Anticonvulsant action of marihuana-active substances. Fed Proc. Vol. 6 1947 p. 352
Davis, J P and Ramsey, H H Anti epileptic action of Marihuana-active substances. Fed Proc Vol. 8, No. 1 1949 p 284.
Cosroe, PF, Wood, GC, and Buchsbaum, H Anticonvulsant Nature of Marijuana Smoking JAMA, 234:3:307-307 October 20, 1975
Cosroe, P and Wolkin, A. Cannabidiol- Anti epileptic drug comparisons and interactions in experimentally induced seizures in rats. J. Pharmacol
Exp. Ther. 201:26-32, 1976
Karler, R, Cely, W and Turkanis S A The anticonvulsant activity of cannabidiol and cannabinol Life Sci 13: pp 1527-1531 1973
Carlini EA, Mechoulem R, and Lander, N. Anticonvulsant activity of four oxygenated cannabidiol derivatives. Res Comm Chem Path & Pharm 12:1: Sept 1975 1-15
Wada JA, Sato M, and Corcoran ME Anti epileptic Properties of Delta 9 Tetrahydrocannabinol Exp. Neuro 39, 157-165 1973
Sim, V M quoted in Marijuana Medical World News Vol 12:27 July 16, 1971 pp 37-44
Morishima, Nahas Burstine S, Eicosanoids as Mediators of Cannabinoid Action Marijuana/Cannabinoids Ch 3 P73 -92
Pertwee RG In Vivo Interactions between Psychotropic Cannabinoids and Other Drugs Involving Central and Peripheral Neurochemical Mediators Marijuana/Cannabinoids Ch 6 P 165-218
Perez-Reyes, M, Burstine SH, White WR, McDonald SA, and Hicks RE, Antagonism of marihuana effects by indomethacin in humans. Life Sci 48, 507, 1991.
Huestis M and Cone E Elevated Cortisol Levels in Marijuana Smokers Forensic Drug Abuse Advisor Vol 7(3) March 1995 p 20.
Gross G, Roussaki A, Ikenberg H, Drees N Genital Warts Do Not Respond to Systemic Recombinant Interferon Alfa-2a Treatment during Cannabis Consumption Dermatologica 1991:183:203-207
O'Shaughnessy MMP pages 17 -19
Clendinning Cases 4, 6, 8 and 14
Buckingham, CE Use of Cannabis in Acute Rheumatism
Boston Med and Surg J. Vol lviii March 1858 (Cited in McMeens Report of the Ohio
State Medical Committee on Cannabis Indica Trans of the Fifteenth Annual Meeting of the Ohio State Medical Society June 12-14 1860 pp 75-100 (Reprinted in Marijuana Medical Papers p 117-140)
Clendinning, J. Observations on the Medicinal Properties of the CANNABIS SATIVA OF INDIA.,Med. Chirug. Trans. London 26:188-210. 1843
O'Shaughnessy in Marijuana Medical Papers P13
Grierson, GA On References to the Hemp Plant Occurring in the Sanskrit and Hindi Literature Indian Hemp Drugs Commission Report 1893-1894 Appendix A. Reprinted in Excerpts from the Indian Hemp Drugs Commission Report compiled by Mikuriya, TH Last Gasp San Francisco 1994 40 Pages P. 32.
McConnell FP Uses of Cannabis Indica JAMA v10 Feb. 25, 1888 p 234
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