The New South Wales Police have hit a new low by descending in an expensive taxpayer-funded operation with a police helicopter and confiscating a medical cannabis crop intended for patients. The crop was a strain of cannabis bred specifically to be extracted into a medical tincture.
Each of the plants had been labelled for specific patients, according to Mullaways Medical Cannabis Pty Ltd. "Through the confiscation of this medical cannabis crop, the NSW Police have deprived many Australians of their medicine," Mullaways said. "It is a form of discrimination against sufferers of chronic illness and pain who need this medicine - medical cannabis."
More than 300 chronically ill and dying patients will now be deprived of this indispensable medicine used for the relief of pain and suffering.
Many of the patients have been using Mullaways Medical Cannabis Tincture for years and have letters of support from their doctors to use it. According to Mullaways, it is the only company in Australia providing medical cannabis.
The only other avenue for Australian patients to access medical cannabis is through the Commonwealth Government's Special Access Scheme. This is a long, expensive process, as the product is required to be imported from an overseas medical cannabis company and many patients are unable to afford it as it is unavailable on the Pharmaceutical Benefits Scheme (PBS).
Tony Bower, managing director of Mullaways Medical Cannabis Pty Ltd, said he has maintained clear accountability and transparency in his business. Both state and federal governments have been fully aware of Mullaways' operations for years.
According to Bower, Mullaways has been open and forthright with all parties, especially the government. Tony complied with all government requirements for the past three years to get his company up and running and to get this medicine to the dying and chronically ill people who need it free of charge.
"My culture does not allow me to refuse help to people who ask for it and where I know I can help, as it is, and surely should be, in any civilized culture," Bower said. "I could not have been any more honest and open about what I am doing.
"I know that I can help and even heal people with my medicine, a medicine that doesn't get people stoned," Bower said. "Almost half of Americans now have access to legal medical cannabis. We need to urgently address the issue here in Australia."
"I have worked tirelessly to try to please people in government, but continue to be treated with disrespect," Bower said. "The patients need their medicine daily. Does the NSW Department of Health have a plan for the dying and chronically ill medical cannabis patients in this part of 'country'?"
16 March, 2012
Steve Elliott
TOKE OF THE TOWN
Something incredible is happening right now in Latin America.
After decades of being brutalized by the U.S. government's failed prohibitionist drug policies, Latin American leaders, including not just distinguished former presidents but also current presidents, are saying "enough is enough." They're demanding that the range of policy options be expanded to include alternatives that help reduce the crime, violence and corruption in their own countries - and insisting that decriminalization and legal regulation of currently illicit drug markets be considered.
Guatemala's new president, Otto Perez Molina, is providing important leadership. As a political conservative and former general, he has credibility that others lack. When he started speaking out publicly last month about the need to consider new drug policy options including legalization, many observers thought it was just a ploy to secure greater economic and military aid from the United States. But he's demonstrated a commitment and engagement over the past month that have persuaded fellow presidents that he's serious about this. Within Guatemala, his initiative has been praised by diverse voices including prominent business leaders, Archbishop Oscar Julio Vian and the head of the International Commission against Impunity in Guatemala (CICIG), Francisco Dall'Anese.
President Perez Molina sent his vice president, Roxana Baldetti, on a tour of neighboring countries two weeks ago to seek the support of other Central American presidents for opening up a new discussion on drug policy alternatives for the region. Most said they were willing to join the discussion. (It probably helped that U.S. Homeland Security Secretary Janet Napolitano was also touring the region that week, and alienating regional leaders with unsubstantiated claims that the drug war was working). Now the presidents have agreed to come to Guatemala on March 24 for a wide-ranging debate on the subject.
Meanwhile, Colombia's President Juan Manuel Santos, who had been eager to open the debate but reportedly frustrated by the failure of other regional leaders to join him, appears to have been galvanized by the Guatemalan president's initiative. He met yesterday with former presidents Fernando Henrique Cardoso (Brazil), Ricardo Lagos (Chile) and Felipe González (Spain) to talk about the best way to raise this issue at the Summit of the Americas meeting in Cartagena in April. He also said that he would attend the presidents' meeting in Guatemala on March 24.
Mexican President Calderon also seems increasingly willing to engage. Having waged a multi-year battle with criminal organizations whose principal source of revenue is the illicit drug traffic to the United States, no one has greater moral authority to call for alternatives to failed prohibitionist policies. And no one knows better that one cannot win a war against what is essentially a dynamic global commodities market, especially when one's country abuts the largest consumer market in the world. He put his toes in the water last year when he started saying that the United States should consider "market alternatives" if it were unable to reduce its demand for illegal drugs. And he followed up by joining with regional leaders in late 2011 in the "Tuxtla Declaration," which stated that if the demand for illegal drugs could not be reduced, "authorities in the consuming countries ought then to explore possible alternatives to eliminate the exorbitant profits of the criminals, including regulatory or market oriented options to this end. Thus, the transit of substances that continue provoking high levels of crime and violence in Latin American and Caribbean nations will be avoided."
Calls for drug policy reform are proliferating rapidly in Mexico. Calderon's predecessor, Vicente Fox, pulls no punches in saying that legalization is the best approach. Fox's predecessor, Ernesto Zedillo, joined with former Brazilian president Cardoso and former Colombian president Cesar Gaviria in organizing first a Latin American and then a Global Commission on Drug Policy, both of which called for major reform of drug policies, including legal regulation of marijuana, and also for "breaking the taboo" on considering all drug policy options, including legal regulation.
Now business leaders in Monterrey and Mexico City, wary of the growing power of criminal organizations, are joining the debate with sophistication, resources and support for legalization in one form or another. And, from the left, Javier Sicilia, the influential poet turned social justice movement leader, is saying much the same.
It's thus no surprise that Mexican foreign secretary Patricia Espinosa announced at a meeting of the Euro-Latin American Parliamentary Assembly in late February that her government now supported a debate on legalization. And just a little less surprising that yesterday President Calderon said that he too would attend the presidents' gathering in Guatemala on March 24.
All this presents a dilemma for the U.S. government. When Vice President Biden visited the region last week, he made clear that the Obama administration firmly opposes legalization - but also acknowledged, as President Obama had in early 2011, that the topic was a legitimate subject for discussion. That modest concession was important, not least in sending a clear message to other federal officials, including the drug czar, senior diplomats and Pentagon officials, that outright rejection of any discussion was no longer required. It manifested yesterday when the State Department's (Acting) Assistant Secretary for Public Affairs, Mike Hammer, stated that "We are, of course, willing to discuss the issue to express our opinion as far as why we do not see it as the best way in which to address the problem." "It is, he continued, "a serious subject and we are not in any way opposed to discussing it. Our position, though, is very clear." Latin American media quickly picked up on the slight change of tone from Washington.
This all represents a dramatic turn of events in the regional, and potentially, global debate about drug policy. In Latin America, current presidents are now taking the baton from ex-presidents in calling for a new drug policy debate with all options on the table. Respected intellectuals like Carlos Fuentes and Enrique Krauze in Mexico, Sergio Ramirez in Nicaragua and Mario Vargas Llosa in Peru are speaking out. So are distinguished former cabinet ministers as well as leaders in business, media and the arts.
The immediate political challenge will be to sustain this momentum in the face of vigorous behind-the-scenes efforts by the U.S. government to suppress the debate, notwithstanding public statements that they're open to it. The more substantive challenge will be to flesh out proposals for alternative strategies. Presidents Santos, Otto Perez Molina and others know full well that no nation can unilaterally legalize drugs, that any significant changes in direction must be pursued multilaterally, and that major reform of the failed global drug prohibition regime of the 20th century will take years and likely decades. Governments as well as non-governmental organizations in the region are just beginning to look seriously at alternative drug policy options, enlisting scholars and other policy experts.
Fortunately the drug war consensus within the United States is also dissolving. George Shultz, the former Secretary of State (and Treasury) and Paul Volcker are among the members of the Global Commission on Drug Policy, whose bold recommendations last June stirred debate worldwide. Former President Jimmy Carter has endorsed the Global Commission's recommendations and former President Bill Clinton has repeatedly expressed regrets for the drug war excesses he condoned when he was in the White House. African-American leaders who previously supported the drug war are coming to the conclusion that it did nothing to lessen drug addiction on their communities but much to incarcerate an extraordinary number of young men and women.
Public support for legalizing marijuana is rising rapidly -- from 36 percent in favor in 2006 to 50 percent in 2011, according to Gallup's polling. And this past week, the conservative Evangelical Christian leader, Pat Robertson, surprised lots of people by saying marijuana should be legally regulated like alcohol, and by endorsing ballot initiatives in Colorado and Washington State that would do just that if they prevail this November.
The biggest obstacle right now is the head-in-the-sand resistance within the Obama administration and Congress to any real discussion of alternative drug policy options. Censorship and self-censorship in this area within the federal government is endemic, driven by fears that any internal policy memos, or even oral discussions, that conclude with politically inconvenient recommendations, are not just unwelcome but dangerous to one's standing and career. One result is that U.S. government officials will be increasingly handicapped in the international drug policy discussions at Cartagena and elsewhere, armed only with defenses of failed U.S. policies but bereft of any in-depth analysis of the options that other governments are putting on the table.
The worst prohibition, it must be said, is a prohibition on thinking -- and that, sadly, is what the U.S. government is guilty of today.
10 March, 2012
Ethan Nadelmann,
Executive Director, Drug Policy Alliance
Marinol Versus Marijuana
Last week I received a call from an attorney in Eugene that is representing a medical marijuana patient that is on probation. The judge is willing to allow the medical marijuana patient to use Marinol while he serves his probation, but not raw medical marijuana. The attorney admitted that he knows nothing about medical marijuana, but felt that the judge is willing to listen to an argument that would support the medical marijuana patient being allowed to consume raw marijuana. Rather than just send over what I dug up for the attorney, I figured I would post it here so everyone could benefit from it. Who knows, it just might come in handy if you or someone you know is in a similar position. Below is an article that was written by Paul Armentano for NORML :
Introduction
Marinol[1] (dronabinol) is the only US FDA-approved synthetic cannabinoid. It is often marketed as a legal pharmaceutical alternative to natural cannabis.
Marinol is manufactured as a gelatin capsule containing synthetic delta-9-tetrahydrocannabinol (THC) in sesame oil. It is taken orally and is available in 2.5mg, 5mg and/or 10mg dosages. Marinol may be prescribed for the treatment of cachexia (weight loss) in patients with AIDS and for the treatment of nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments.
Despite FDA approval[2] , Marinol typically provides only limited relief to select patients, particularly when compared to natural cannabis and its cannabinoids. Marinol should remain a legal option for patients and physicians; however, federal and state laws should be amended to allow for those patients who are unresponsive to synthetic THC the ability to use natural cannabis and its cannabinoids as a medical therapy without fear of arrest and/or criminal prosecution. By prohibiting the possession and use of natural cannabis and its cannabinoids, patients are unnecessarily restricted to use a synthetic substitute that lacks much of the therapeutic efficacy of natural cannabis.
Marinol Lacks Several of the Therapeutic Compounds Available in Natural Cannabis
Chemical compounds in cannabis, known as cannabinoids, are responsible for its numerous therapeutic benefits. Scientists have identified 66 naturally occurring cannabinoids.[3]
The active ingredient in Marinol, synthetic delta-9-tetrahyrdocannabinol (THC), is an analogue of one such compound, THC. However, several other cannabinoids available in cannabis — in addition to naturally occurring terpenoids (oils) and flavonoids (phenols) — have also been clinically demonstrated to possess therapeutic utility. Many patients favor natural cannabis to Marinol because it includes these other therapeutically active cannabinoids.
For example, cannabidol (CBD) is a non-psychoactive cannabinoid that has been clinically demonstrated to have analgesic, antispasmodic, anxiolytic, antipsychotic, antinausea, and anti-rheumatoid arthritic properties.[4]
Animal and human studies have shown CBD to possess anti-convulsant properties, particularly in the treatment of epilepsy.[5] Natural extracts of CBD, when administered in combination with THC, significantly reduce pain, spasticity and other symptoms in multiple sclerosis (MS) patients unresponsive to standard treatment medications.[6]
Clinical studies also demonstrate CBD to be neuroprotective against glutamate neurotoxicity[7] (i.e. stroke), cerebral infarction[8] (localized cell death in the brain), and ethanol-induced neurotoxicity,[9] with CBD being more protective against glutamate neurotoxicity than either ascorbate (vitamin C) or alpha-tocopherol (vitamin E).[10] Clinical trials have also shown CBD to possess anti-tumoral properties,[11] inhibiting the growth of glioma (brain tumor) cells in a dose dependent manner and selectively inducing apoptosis (programmed cell death) in malignant cells.[12]
Additional cannabinoids possessing clinically demonstrated therapeutic properties include: cannabinol (anticonvulsant[13] and anti-inflammatory[14] activity); cannabichromine (anti-inflammatory[15] and antidepressant[16] activity); and cannabigerol (anti-tumoral[17] and analgesic[18] activity). Natural cannabis’ essential oil components (terpenoids) exhibit anti-inflammatory properties[19] and its flavonoids possess antioxidant activity.[20] Emerging clinical evidence indicates that cannabinoids may slow disease progression[21] in certain autoimmune and neurologic diseases, including multiple sclerosis[22] (MS), Amyotrophic Lateral Sclerosis[23] (Lou Gehrig’s disease) and Huntington’s Disease.[24]
Clinical data indicate that the synergism of these compounds is likely more efficacious[25] than the administration of synthetic THC alone.[26] For example, McPartland and Russo write: “Good evidence shows that secondary compounds in cannabis may enhance beneficial effects of THC. Other cannabinoid and non-cannabinoid compounds in herbal cannabis … may reduce THC-induced anxiety, cholinergic deficits, and immunosuppression. Cannabis terpenoids and flavonoids may also increase cerebral blood flow, enhance cortical activity, kill respiratory pathogens, and provide anti-inflammatory activity.”[27] In an in vitro model of epilepsy, natural cannabis extracts performed better than THC alone.[28] In human trials, patients suffering from multiple sclerosis experienced greater symptomatic relief from sublingual natural cannabis extracts than from the administration of oral THC.[29] In 2005, Health Canada approved the oral spray Sativex[30] – which contains precise ratios of the natural cannabinoid extracts THC and CBD, among other compounds — for prescription use for MS-related symptoms.[31]
Marinol is More Psychoactive Than Natural Cannabis
Patients prescribed Marinol frequently report that its psychoactive effects are far greater than those of natural cannabis. Marinol’s adverse effects include: feeling “high,” drowsiness, dizziness, confusion, anxiety, changes in mood, muddled thinking, perceptual difficulties, coordination impairment, irritability, and depression.[32] These psychoactive effects may last four to six hours.[33] About one-third of patients prescribed Marinol report experiencing one or some of these adverse effects.[34]
Marinol’s oral route of administration is responsible, in part, for its heightened psychoactivity compared to inhaled cannabis. Once swallowed, Marinol passes from the stomach to the small intestine before being absorbed into the bloodstream. Following absorption, Marinol passes through the liver where a significant proportion of the drug is metabolized into other chemicals.[35] One of these chemicals, 11-hydroxy-THC, may be four to five times more potent than natural THC,[36] and is produced in greater quantities.[37] Thus, patients administered Marinol experience the psychoactive effects of both THC and 11-hydroxy-THC, greatly increasing the likelihood that they will suffer from an adverse psychological reaction. By comparison, only minute quantities of 11-hydroxy-THC are produced when cannabis is inhaled.[38] Moreover, Marinol lacks the compound cannabidiol, which possesses anxiolytic activity and likely modifies and/or diminishes much of THC’s psychoactivity in natural cannabis.[39]
Cannabis Vaporization Offers Advantages Over Orally Administered THC
Vaporization is an alternative method of cannabis administration that holds distinct advantages over both smoking and oral administration. Cannabis vaporization suppresses respiratory toxins by heating cannabis to a temperature where cannabinoid vapors form (typically around 180-190 degrees Celsius), but below the point of combustion where noxious smoke and associated toxins (i.e., carcinogenic hydrocarbons) are produced (near 230 degrees Celsius).[40] Although a comprehensive review of cannabis and health conducted by the National Academy of Sciences Institute of Medicine found “no conclusive evidence that marijuana causes cancer in humans, including cancers usually related to tobacco use,”[41] studies have found that heavy cannabis smokers face a higher risk of contracting bronchitis and respiratory illnesses.[42] This risk is likely not due to the inhalation of cannabinoids, but rather to the exposure of noxious smoke. Because vaporization can deliver therapeutic doses of cannabinoids while reducing the users intake of pyrolytic smoke compounds, it is considered to be a preferred and likely safer method of cannabis administration than smoking.[43]
In practice, cannabis vaporization offers considerable advantages over oral THC consumption. While the oral ingestion of Marinol avoids the potential risks of smoking, it has significant drawbacks. Because of synthetic THC’s poor bioavailability, only 5-20 percent of an oral dose ever reaches the bloodstream[44] and the drug may not achieve peak effect until four hours after dosing.[45] Moreover, because Marinol is metabolized slowly, its therapeutic and psychoactive effects may be unpredictable and vary considerably, both from one person to another, and in the same person from one episode of use to another.[46] By contrast, cannabis vaporization delivers cannabinoids to the bloodstream almost instantaneously.[47] Vaporization’s rapid onset also allows patients to self regulate their dosage of cannabinoids by immediately ceasing inhalation when/if their psychoactive effects become unpleasant.[48] After oral administration of Marinol, patients have no choice but to experience the full psychoactive effects of the dose consumed. These dysphoric effects may last several hours.
Because of its rapid onset, vaporized cannabis is more desirable than Marinol for patients requiring a fast-acting therapeutic agent, such as those combating oncoming attacks of nausea, seizures or muscle spasms. Cannabis vaporization also offers a unique advantage to patients suffering from nausea and vomiting because it allows them an alternative delivery route to swallowing. Cancer and HIV/AIDS patients often report that their stomachs cannot hold down Marinol capsules during bouts of severe nausea[49] and many rely on natural cannabis and cannabinoids for symptom control.[50] In a 1994 survey of oncologists, respondents ranked synthetic THC ninth on a list of available antiemetic medications.[51] In another survey of oncologists, 44 percent of respondents said that they believed natural cannabis to be more efficacious than oral synthetic THC; only 13 percent of respondents rated Marinol more effective.[52] A 1997 survey of physicians found that a majority preferred megestrol acetate over Marinol as an appetite stimulant in patients with HIV/AIDS.[53]
As a result of Marinol’s slow onset and poor bioavailablity, scientists are now in the process of developing a new formulation of pulmonary dronabinol, delivered with a pressurized metered dose inhaler.[54] In a Phase I study, pulmonary Marinol delivered via an inhaler provided rapid systemic absorption. Unlike oral synthetic THC, it’s possible that pulmonary Marinol “could offer an alternative for patients when a fast onset of action is desirable.”[55] However, FDA approval of pulmonary Marinol and/or its inhaler remains years away. Sativex, an oral cannabis spray consisting of natural cannabinoid extracts, has greater bioavailability and is faster acting than oral synthetic THC. Clinical trials comparing its bioavailability and time of peak onset compared to vaporized cannabis have not been performed, though anecdotal reports indicate that vaporized cannabis and its cannabinoids likely possess greater bioavailability and are faster acting than the Sativex spray.
Marinol is More Expensive Than Natural Cannabis
Synthetic THC is a costly and difficult compound to manufacture.[56] Much of this cost is passed on to the patient consumer, particularly if the full cost of Marinol (approximately $200 to $800 per month,[57] depending on the dosage) is borne out of pocket. Patients, particularly those with chronic conditions, often report that Marinol’s market cost limits their use of the drug.[58] Doctors also report that Marinol’s high cost dissuades them from prescribing it to patients. In one survey of HIV/AIDS specialists, among respondents who had never prescribed Marinol to their patients, 33 percent cited the high cost of the drug as the reason.[59] Natural cannabis, even at its inflated black market value, often remains far less costly for patients than oral synthetic THC.[60]
Patients Ultimately Prefer Natural Cannabis to Marinol
In the 1970s and 1980s, several states conducted patient trials[61] of natural cannabis’ effectiveness as an anti-emetic in cancer patients unresponsive to conventional therapies. Some state protocols allowed patients to choose between inhaled cannabis[62] and synthetic THC. In those studies which compared natural cannabis to dronabinol, inhaled cannabis was equal to or better than the oral administration of synthetic THC.[63]
For example, researchers at the Tennessee Board of Pharmacy found a “23 percent higher success rate among those patients smoking than among those patients administered THC capsules” in the treatment of nausea and/or vomiting associated with cancer chemotherapy.[64]
Researchers in New Mexico observed similar findings. “When the routes of [drug] administration were analyzed separately, it was found that inhalation was far superior to ingestion: 90.39 percent of the patients in the group that inhaled the marijuana showed improvement while only 59.65 percent of the patients in the group that orally ingested the delta-9-THC showed improvement,” they concluded.[65]
Researchers at the California Board of Pharmacy found that inhaled cannabis and oral THC produced similar results in patients. However, physicians still rated natural cannabis as slightly more effective than oral THC as an anti-emetic.[66]
A 1988 New York State pilot study comparing inhaled cannabis to oral THC in cancer chemotherapy patients who were unresponsive to standard antiemetic agents found: “Twenty-nine percent of patients who failed oral THC responded to the cigarette form. … Our results demonstrate that inhalation marijuana is an effective therapy for the treatment of nausea and vomiting due to cancer chemotherapy.”[67]
Today, several patient populations continue to use natural cannabis and its cannabinoids in large numbers despite its illegality and the availability of Marinol. A 2005 British survey of more than 500 HIV/AIDS patients found that one-third of respondents use natural cannabis for symptomatic relief, with more than 90 percent of them reporting that it improves their appetite, muscle pain and other symptoms.[68] A previous US survey found that approximately one out of four patients with HIV had used natural cannabis medicinally in the past month.[69]
Cannabis use is also prevalent among patients with neurologic disorders. Nearly four out of ten Dutch patients with prescriptions for “medical grade cannabis” (cannabis provided by Dutch pharmacies with a standardized THC content of 10.2 percent) use it to treat MS or spinal cord injuries, according to survey data published in 2005 in the journal Neurology.[70] Perceived efficacy is greater among respondents who inhale cannabis versus those who ingest it orally, the study found.[71]
A 2002 British survey of MS patients found that 43 percent of respondents used natural cannabis therapeutically, with about half admitting they used it regularly.[72] Seventy-six percent said they would do so if cannabis were legal.[73] A Canadian survey of MS patients found that 96 percent of respondents were “aware cannabis was potentially therapeutically useful for MS and most (72 percent) supported [its] legalization for medicinal purposes.”[74] Sixteen percent of respondents answered that they use natural cannabis for medical purposes to treat symptoms of anxiety/depression, spasticity and chronic pain.[75]
A more recent Canadian survey published in Neurology reported that 14 percent of MS[76] patients and 21 percent of respondents with epilepsy had used medical cannabis in the past year.[77] Among epileptics, twenty-four percent of respondents said that they believed that cannabis was an effective therapy for the disease.[78] A 2002 survey of patients with Parkinson’s Disease (PD) found that 25 percent of respondents had tried cannabis, with nearly half of those saying that it provided them symptomatic relief.[79]
Conclusion
Oral synthetic THC, legally available by prescription as Marinol, often provides only limited relief to a select group of patients, particularly when compared to natural cannabis and its cannabinoids. Patients often experience minimal relief from Marinol and many experience unwanted side effects. In addition, many physicians are hesitant to prescribe the drug, and some patients are unable to afford it. Despite Marinol’s legality, many patient populations continue to risk arrest and criminal prosecution to use natural cannabis medically, and most report experiencing greater therapeutic relief from it.
The active ingredient in Marinol is a synthetic analogue of only one of the compounds in cannabis that is therapeutically beneficial to patients. By prohibiting the possession and use of natural cannabis and its cannabinoids, patients are unnecessarily burdened to use a synthetic substitute that lacks much of the therapeutic efficacy of natural cannabis and its cannabinoids.
Marinol should remain a legal option for patients and physicians and the development of additional cannabis-based pharmaceuticals should be encouraged. However, federal and state laws should be amended to allow for those patients who are unresponsive to synthetic THC, or simply desire an alternative to oral dronabinol, the ability to use natural cannabis and its cannabinoids as a legal medical therapy without fear of arrest and/or criminal prosecution.
March 5, 2012
Johnny Green
THE Weed Blog
End notes
1 Marinol is produced and marketed by Unimed Pharmaceuticals, a subsidiary of Solvay Pharmaceuticals.
2 The FDA approved Marinol in 1985 as a Schedule II controlled substance. By definition, Schedule II drugs adhere to the following criteria: (A) The drug has a high potential for abuse; (B) The drug has a currently accepted medical use in treatment in the United States; (C) Abuse of the drug may lead to severe psychological or physical dependence. In 1999, Marinol was downgraded to a Schedule III controlled substance. By definition, Schedule III drugs adhere to the following criteria: (A) The drug has a potential for abuse less than Schedule I and Schedule II drugs; (B) The drug has a currently accepted medical use in treatment in the United States; (C) Abuse of the drug may lead to moderate or low physical dependence or high psychological dependence.
3 National Academy of Sciences, Institute of Medicine. 1999. Marijuana and Medicine: Assessing the Science Base. National Academy Press: Washington, DC. p. 25: Table 1.5: Cannabinoids Identified in Marijuana.
4 R. Mechoulam et al. 2003. Cannabidiol: an overview of some pharmacological aspects. Neuroscience Letters 346: 61-64; J. McPartland and E. Russo. 2002. Cannabis and cannabis extracts: greater than the sum of their parts. Journal of Cannabis Therapeutics 1: 103-132; A. Zuardi and F Guimaraes. Cannabidiol as an anxiolytic and antipsychotic. In: M. Mathre (Ed): Cannabis in medical practice: a legal, historical and pharmacological overview of therapeutic use of marijuana. McFarland Press: 1997: 133-141.
5 P. Consroe and S. Snider. Therapeutic Potential of Cannabinoids in Neurological Disorders. In: R. Mechoulam (Ed): Cannabinoids as Therapeutic Agents. CRC Press: 1986 21-51; E. Carlini and J. Cunha. 1981. Hypnotic and antiepileptic effects of cannabidiol. Journal of Clinical Pharmacology. 21: 417S-427S; J. Cunha et al. 1980. Chronic administration of cannabidiol to healthy volunteers and epileptic patients. Pharmacology 21: 175-185.
6 D. Wade et al. 2004. Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients.Multiple Sclerosis 10: 339-340; D. Wade et al. 2003. A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Journal of Clinical Rehabilitation 17: 21-29.
7 A. Hampson et al. 1998. Cannabidiol and THC are neuroprotective antioxidants. Proceedings of the National Academy of Sciences 95: 8268-8273.
8 K. Mishima et al. 2005. Cannabidiol Prevents Cerebral Infarction. Stroke 36: 1077-1082.
9 C. Hamelink et al. 2005. Comparison of cannabidiol, antioxidants, and diuretics in reversing binge ethanol-induced neurotoxicity. Journal of Pharmacology and Experimental Therapeutics (electronically published May 5, 2005, ahead of printing).
10 A. Hampson, et al. 1998. Cannabidiol and THC are neuroprotective antioxidants. Proceedings of the National Academy of Sciences.
11 H. Patsos et al. 2005. Cannabinoids and cancer: potential for colorectal cancer therapy. Biochemical Society Transactions. 33: 712-714; M. Guzman. 2003. Cannabinoids: potential anticancer agents.Nature Reviews Cancer 3: 745-755.
12 P. Massi et al. 2004. Antitumor effects of cannabidiol, a nonpsychoactive cannabinoid, on human glioma cell lines. Journal of Pharmacology and Experimental Therapeutics 308: 838-845; G. Carter et al. 2004. Medical marijuana: emerging applications for the management of neurologic disorders.Physical Medicine and Rehabilitation Clinics of North America 15: 943-954.
13 C. Turner et al. 1980. Constituents of Cannabis sativa L.: A review of the natural constituents.Journal of Natural Products 43: 169-304.
14 F. Evans. 1991. Cannabinoids; the separation of central from peripheral effects on a structural basis.Planta Medica 57: S60-S67.
15 P. Wirth et al. 1980. Anti-inflammatory properties of cannabichromene. Life Science 26: 1991-1995.
16 R. Deyo and R. Musty. A cannabichromene (CBC) extract alters behavioral despair on the mouse tail suspension test of depression. In: International Cannabinoid Research Society (Ed.) 2003 Symposium on the Cannabinoids. ICRS: 2003.
17 S. Baek et al. 1998. Antitumor activity of cannabigerol against human oral epitheloid carcinoma cells.Archives of Pharmacal Research 21: 353-356.
18 J. McPartland and E. Russo. 2002. Cannabis and cannabis extracts: greater than the sum of their parts. Journal of Cannabis Therapeutics.
19 Ibid.
20 Ibid.
21 Society for Neuroscience. “Marijuana-like compound may aid array of debilitating conditions ranging from Parkinson’s Disease to pain.” October 26, 2004.
22 G. Pryce et al. 2003. Cannabinoids inhibit neurodegeneration in models of multiple sclerosis. Brain. 126: 2191-2202.
23 C. Raman et al. 2004. Amyotrophic lateral sclerosis: delayed disease progression in mice by treatment with a cannabinoid. Amyotrophic Lateral Sclerosis & Other Motor Neuron Disorders 5: 33-39.
24 I. Lastres-Becker et al. 2003. Effects of cannabinoids in the rat model of Huntington’s disease generated by an intrastraital injection of malonate. Neuroreport 14: 813-816.
25 E. Williamson. 2001. Synergy and other interactions in phytomedicines. Phytomedicine: International Journal of Phytotherapy and Phytopharmacology 8: 401-409.
26 A. Holdcroft. 2001. Cannabinoids: from plant to patient. Investigative Drugs Journal. 4: 773-775. (See specifically: Abstract: “The active constituents of cannabis, predominantly cannabinoids and possibly flavonoids, are more effective than a single cannabinoid. … Government … clinical trials of cannabis … should enable evidence to be presented to regulatory bodies documenting the medicinal uses of standardized cannabis plant material.”)
27 J. McPartland and E. Russo. 2002. Cannabis and cannabis extracts: greater than the sum of their parts. Journal of Cannabis Therapeutics. p. 103.
28 The Pharmaceutical Journal. “Cannabis herb may have advantages over THC in epilepsy.” July 19, 2003.
29 Comparison of results from: D. Wade et al. 2004. Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Multiple Sclerosis (See specifically: Abstract: Spasticity VAS scores were significantly reduced by cannabis-based medicinal extracts in comparison with placebo.) and J. Zajicek et al. 2003. Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis. Lancet. 362: 1517-26 (See specifically: Abstract: Treatment with [oral cannabis extract or THC] did not have a beneficial effect on spasticity.)
30 http://www.drugdevelopment-technology.com/projects/sativex/
31 Canada News Wire. “Sativex: Novel cannabis derived treatment for MS pain now available in Canada by prescription.” June 20, 2005.
32 Physician’s Desk Reference: 43rd edition. Medical Economics Company. 1989: 1859-1860.
33 Physician’s Desk Reference: 52nd edition. Medical Economics Company. 1998: 2353-2355.
34 National Academy of Sciences, Institute of Medicine. 1999. Marijuana and medicine: Assessing the Science Base. p. 203.
35 J. Morgan and L. Zimmer, Marijuana Myths, Marijuana Facts: A Review of the Scientific Evidence. The Lindesmith Center. 1997: 18-19.
36 L. Lemberger et al. 1973. Comparative pharmacology of delta-9-THC and its metabolite 11-0H-Delta-9-THC. Journal of Clinical Investigation 54: 2411-2417 and M. Perez-Reyes et al. 1972. Intravenous injection in man of delta-9-tetrahydrocannabinol and 11-hydroxy-delta-9-tetrahydrocannabinol. Science177: 633-635 as cited by J. Morgan and L. Zimmer, Marijuana Myths, Marijuana Facts: A Review of the Scientific Evidence.
37 L. Growing et al. 1998. Therapeutic use of cannabis: clarifying the debate. Drug and Alcohol Review.17: 445-452.
38 Ibid; J. Morgan and L. Zimmer, Marijuana Myths, Marijuana Facts: A Review of the Scientific Evidence,19.
39 G. Carter et al. 2004. Medical marijuana: emerging applications for the management of neurologic disorders. Physical Medicine and Rehabilitation Clinics of North America; L. Growing et al. 1998. Therapeutic use of cannabis: clarifying the debate. Drug and Alcohol Review; A. Zuardi et al. 1982. Action of cannabidiol on the anxiety and other effects produced by delta-9-THC in normal subjects.Psychopharmacology 76: 245-250; G. Karinol et al. 1974. Cannabidiol interferes with the effects of delta-9-tetrahydrocannabinol in man. European Journal of Pharmacology 28: 172-177.
40 D. Gieringer et al. 2004. Cannabis vaporizer combines efficient delivery of THC with effective suppression of pyrolytic compounds. Journal of Cannabis Therapeutics 4: 7-27.
41 National Academy of Sciences, Institute of Medicine. 1999. Marijuana and Medicine: Assessing the Science Base. p. 199; See also: M. Hashibe et al. 2005. Epidemiologic review of marijuana use and cancer risk. Alcohol 35: 265-275; K. Rosenblat et al. 2004. Marijuana use and risk of oral squamous cell carcinoma. Cancer Research 64: 4049-4054; D. Ford et al. 2001. Marijuana use is not associated with head, neck or lung cancer in adults younger than 55 years: Results of a case cohort study. In: National Institute on Drug Abuse (Eds) Workshop on Clinical Consequences of Marijuana: Program Book.National Institutes of Health: Rockville, MD: p. 10.
42 M. Polen et al. 1993. Health care use by frequent marijuana smokers who do not smoke tobacco.Western Journal of Medicine 158: 596-601; D. Tashkin. 1993. Is frequent marijuana smoking hazardous to health? Western Journal of Medicine 158: 635-637.
43 D. Gieringer et al. 2004. Cannabis vaporizer combines efficient delivery of THC with effective suppression of pyrolytic compounds. Journal of Cannabis Therapeutics.
44 National Academy of Sciences, Institute of Medicine. 1999. Marijuana and Medicine: Assessing the Science Base. p. 203; L. Growing et al. 1998. Therapeutic use of cannabis: clarifying the debate. Drug and Alcohol Review.
45 National Academy of Sciences, Institute of Medicine. 1999. Marijuana and Medicine: Assessing the Science Base. p. 203.
46 S. Calhoun et al. 1998. Abuse potential of dronabinol. Journal of Psychoactive Drugs. 30: 187-196; J. Morgan and L. Zimmer, Marijuana Myths, Marijuana Facts: A Review of the Scientific Evidence, p. 19.
47 Ibid; National Academy of Sciences, Institute of Medicine. 1999. Marijuana and Medicine: Assessing the Science Base. ”The poor solubility of Marinol in aqueous solutions and its high first-pass metabolism in the liver account for its poor bioavailability; only 10-20% of an oral dose reaches the systemic circulation. The onset of action is slow; peak concentrations are not attained until two to four hours after dosing. In contrast, inhaled marijuana is rapidly absorbed. … Variations in individual responses is highest for oral THC and bioavailability is lowest.”
48 L. Growing et al. 1998. Therapeutic use of cannabis: clarifying the debate. Drug and Alcohol Review.
49 Of Marinol’s patient population, only about 10 percent use it to combat cancer-related nausea. National Academy of Sciences, Institute of Medicine. 1999. Marijuana and Medicine: Assessing the Science Base. p. 204.
50 E. Woolridge et al. 2005. Cannabis use in HIV for pain and other medical symptoms. Journal of Pain and Symptom Management 29: 358-67.
51 R. Schwartz and R. Beveridge. 1994. Marijuana as an antiemetic drug: how useful today. Opinions from clinical oncologists. Journal of Addictive Diseases 13: 53-65.
52 R. Doblin and M. Kleiman. 1991. Marijuana as an anti-emetic medicine: a survey of oncologists’ attitudes and experiences. Journal of Clinical Oncology 19: 1275-1290.
53 National Institutes of Health. 1997. Report of the Workshop on the Medical Utility of Marijuana.Washington, DC as cited by L. Growing et al. 1998. Therapeutic use of cannabis: clarifying the debate.Drug and Alcohol Review.
54 Medical News Today. “New synthetic delta-9-THC Inhaler offers safe, rapid delivery, Phase I study.” April 17, 2005.
55 Ibid.
56 Presentation of Unimed Pharmaceuticals Senior Vice President Robert Dudley before the National Academy of Sciences, Institute of Medicine. Washington, DC: February 24, 1998.
57 National Academy of Sciences, Institute of Medicine. 1999. Marijuana and Medicine: Assessing the Science Base. p. 207; Morgan and L. Zimmer, Marijuana Myths, Marijuana Facts: A Review of the Scientific Evidence, p. 21; Medical Marijuana ProCon.org
58 National Academy of Sciences, Institute of Medicine. 1999. Marijuana and Medicine: Assessing the Science Base. p. 206.
59 L. Growing et al. 1998. Therapeutic Uses of Cannabis. Drug and Alcohol Services Council: South Australia.
60 National Academy of Sciences, Institute of Medicine. 1999. Marijuana and Medicine: Assessing the Science Base. p. 207; Medical Marijuana ProCon.org
61 State research trials regarding natural cannabis were discontinued by 1985, after the FDA approved Marinol.
62 The cannabis distributed in these trails was manufactured and provided by the US National Institute on Drug Abuse (NIDA). Cannabis was provided to patients in the form of a cigarette.
63 R. Musty and R. Rossi. 2001. Effects of smoked cannabis and oral delta-9-tetrahydrocannabinol on nausea and emesis after cancer chemotherapy: a review of state clinical trials. Journal of Cannabis Therapeutics. 1: 29-56. “The data reviewed here suggested that the inhalation of THC appears to be more effective than the oral route. … Patients who smoked marijuana experienced 70-100% relief from nausea and vomiting, while those who used THC capsules experienced 76-88% relief.”
64 Board of Pharmacy, State of Tennessee. 1983. Annual Report: Evaluation of Marijuana and Tetrahydrocannabinol in Treatment of Nausea and/or Vomiting Associated with Cancer Therapy Unresponsive to Conventional Anti-Emetic Therapy: Efficacy and Toxicity. p. 5.
65 Behavioral Health Services Division. 1983. The Lynn Pierson Therapeutic Research Program: A Report on Progress to Date. Health and Environment Department: New Mexico. p. 4.
66 Research Advisory Panel. 1986. Seventeenth Annual Report of the Research Advisory Panel, p. 9-10.
67 V. Vinciguerra et al. 1988. Inhalation marijuana as an antiemetic for cancer chemotherapy. New York State Journal of Medicine 88: 525-527.
68 E. Woolridge et al. 2005. Cannabis use in HIV for pain and other medical symptoms. Journal of Pain and Symptom Management.
69 D. Prentiss et al. 2004. Patterns of marijuana use among patients with HIV/AIDS followed in a public health care setting. Journal of Acquired Immune Definiciency Syndromes 35: 38-45
70 R. Gorter et al. 2005. Medical use of cannabis in the Netherlands. Neurology 64: 917-919.
71 Ibid.
72 Reuters News Wire. “Marijuana helps MS patients alleviate pain, spasms.” August 19, 2002.
73 Ibid.
74 S. Page et al. 2003. Cannabis use as described by people with multiple sclerosis. Canadian Journal of Neurological Sciences 30: 201-205.
75 Ibid.
76 A. Clark et al. 2004. Patterns of cannabis use among patients with multiple sclerosis. Neurology 62: 2098-2100.
77 D. Gross et al. 2004. Marijuana use and epilepsy. Neurology 62: 2095-2097.
78 Ibid.
79 News Wire. “Pot may ease Parkinson’s symptoms — Czech study.” November 13, 2002.
"My culture does not allow me to refuse help to people who ask for it and where I know I can help, as it is, and surely should be, in any civilized culture," Bower said. "I could not have been any more honest and open about what I am doing.
