There
are marked differences in the knowledge on the medical uses of
cannabis and cannabinoids in different diseases. For nausea and
vomiting associated with cancer chemotherapy, anorexia and cachexia
(weight-loss) in HIV/AIDS, chronic, especially neuropathic pain,
spasticity in Multiple Sclerosis (MS) and spinal cord injury there is
strong evidence for medical benefits. For many other indications,
such as epilepsy, pruritus and depression there is much less
available data. However, the scientific evidence for a specific
indication does not necessarily reflect the actual therapeutic
potential for a given disease.
Clinical
studies with single cannabinoids or whole plant preparations have
often been inspired by positive anecdotal experiences of patients
employing crude cannabis products. The anti-emetic, the appetite
enhancing, relaxing effects, analgesia and therapeutic use in
Tourette syndrome (aka Tourette's syndrome) were discovered in this
manner.
Incidental observations have also revealed therapeutically useful effects. This occurred in a study of patients with Alzheimer's disease wherein the primary issue was an examination of the appetite-stimulating effects of Δ-9-Tetrahydrocannabinol (THC). Not only appetite and body weight increased, but disturbed behaviour among the patients decreased. The discovery of decreased intra-ocular pressure with THC administration in the beginning of the 1970's was also serendipitous. Additional interesting indications that have not been scientifically investigated, but remain common problems in modern medicine may benefit from treatment with cannabis or cannabinoids. For this reason, surveys have been conducted questioning individuals that use cannabis therapeutically. They were conducted either as oral non-standardised interviews in the course of investigations of state or scientific institutions (House of Lords Select Committee on Science and Technology in the UK, Institute of Medicine in the USA) on the therapeutic potential of cannabis or as anonymous surveys using standardised questionnaires. In Australia, such information is garnered from the likes of the University of New South Wales, Australia (UNSW Australia) which is involved in cannabis related research in association with the National Drug and Alcohol Research Centre (NDARC). A survey involving 1,500 chronic pain sufferers showed there was a high rate of medicinal cannabis use in Australia. Australians suffering from chronic pain may get more relief from their symptoms using cannabis than they do from conventional medications, researchers found.
A
positive influence on body weight was reported in patients with
Alzheimer's disease who were previously refusing food. Clinical
studies have shown that cannabis may not only increase appetite in
patients with Alzheimer's disease but also reduce disturbed behaviour
and agitation.
An
appetite enhancing effect of THC is observed with daily divided doses
totalling 5 mg. When required, the daily dose may be increased to 20
mg. In longer-term studies (for
example) of AIDS patients,
the appetite-stimulating effect of THC continued for months,
confirming the appetite enhancement noted in a shorter 6 week study.
THC doubled appetite on a visual analogue scale in comparison to
placebo. Patients tended to retain a stable body weight. In addition,
cannabis products can improve appetite in cancer patients and
in Chronic
Obstructive Pulmonary Disease (COPD).
Experiments
examining the anti-asthmatic effect of THC or cannabis date mainly
from the 1970's, and are all acute studies. The effects of a cannabis
cigarette (2% THC) or oral THC (15 mg), respectively, approximately
correspond to those obtained with therapeutic doses of common
bronchodilator drugs (for example, salbutamol). Since inhalation of
cannabis products may irritate the mucous membranes, oral
administration or another alternative delivery system would be
preferable. Very few patients developed bronchoconstriction after
inhalation of THC.
Autoimmune
Diseases, Inflammation and Allergies
In
a number of painful syndromes secondary to inflammatory processes
(e.g. ulcerative colitis, arthritis), cannabis products may act not
only as analgesics but also demonstrate anti-inflammatory potential.
For example, some patients employing cannabis report a decrease in
their need for steroidal and non-steroidal anti-inflammatory drugs.
Moreover there are some reports of positive effects of cannabis
self-medication in allergic conditions. It is as yet unclear whether
cannabis products may have a relevant effect on causative processes
of autoimmune diseases.
Dependency
and Withdrawal
According
to historical and modern case reports, cannabis is a good remedy to
combat withdrawal in dependency on benzodiazepines, opiates and
alcohol. For this reason, some have referred to it as a gateway drug
back. In this context, both the reduction of physical withdrawal
symptoms and stress connected with discontinuance of drug abuse may
play a role in its observed benefits.
Use
in Epilepsy is among the historically oldest indications of cannabis.
Animal experiments provide evidence of the anti-epileptic effects of
some cannabinoids. The anti-convulsant activity of some epilepsy
medications have been potentiated by THC. According to case reports,
many epileptic patients utilise cannabis to control otherwise
unmanageable seizure disorders.
A review published
in Current
Gastroenterology Reports in
February 2015 examined the role of cannabinoids in the treatment
of gastrointestinal symptoms like nausea, vomiting,
and visceral pain (pain that originates from in/around
organs) and found that certain targeted cannabinoid therapies may be
useful in GI disorder/disease management. Read details of a clinical
trial from Israel on Cannabidiol (CBD) for
Inflammatory Bowel Disease.
In
1971, during a systematic investigation of its effects in healthy
cannabis users, it was observed that cannabis reduces intra-ocular
pressure. In the following 12 years a number of studies in healthy
individuals and glaucoma patients with cannabis and several natural
and synthetic cannabinoids were conducted. Cannabis decreases
intra-ocular pressure by an average 25-30%, occasionally up to 50%.
Some non-psychotropic cannabinoids and to a lesser extent, some
non-cannabinoid constituents of the hemp plant also decrease
intra-ocular pressure.
Hyperactivity/ADHD
Cannabis
may be beneficial in patients suffering from ADHD (attention deficit
hyperactivity disorder).
Miscellaneous,
Mixed Syndromes
There
are a number of positive patient reports on medical conditions that
cannot be easily assigned to the above categories, such as hiccup,
high blood pressure, tinnitus, chronic
fatigue syndrome, restless leg syndrome and others. Several
hundred possible indications for cannabis and THC have been described
by different authors. One example is the successful treatment of a
chronic hiccup that developed after a surgery. No medication was
effective, but smoking of a cannabis cigarette completely abolished
the symptoms. Cannabis products often show very good effects in
diseases with multiple symptoms that encompassed within the spectrum
of THC effects, for example, in painful conditions that have an
inflammatory origin (e.g. arthritis), or are accompanied by increased
muscle tone (e.g. menstrual cramps, spinal cord injury), or in
diseases with nausea and anorexia accompanied by pain, anxiety and
depression, respectively (e.g. AIDS, cancer,
hepatitis C).
Large
clinical studies have proven analgesic properties of cannabis. Among
possible indications are neuropathic
pain due to MS, damage of the brachial plexus and HIV
infection, pain in Rheumatoid Arthritis,
cancer pain, headache, menstrual pain, chronic bowel inflammation and
neuralgias. Combination with opioids is possible.
According
to small clinical studies cannabinoids taken internally or externally
as ointment ameliorate pruritus by different causes, for example
severe pruritus in the course of liver
diseases.
Psychiatric
Symptoms
An
improvement of mood in reactive depression has
been observed in several clinical studies with THC. There are
additional case reports claiming benefit of cannabinoids in other
psychiatric symptoms and diseases, such as sleep
disorders, anxiety and bipolar disorders, schizophrenic psychosis
and dysthymia. According to some case reports THC was effective in
otherwise treatment refractory heavy compulsive disorders.
Cannabinoids may also reduce symptoms of post-traumatic stress
disorders. Various authors have expressed different viewpoints
concerning psychiatric syndromes and cannabis. While some emphasise
the problems caused by cannabis, others promote the therapeutic
possibilities. Quite possibly cannabis products may be either
beneficial or harmful, depending on the particular case.
Treatment
of side effects associated with anti-neoplastic (anti-tumour) therapy
is the indication for cannabinoids which has been most documented,
with about 40 cannabis studies. Most trials were conducted in the
1980's. THC has to be dosed relatively highly, so that resultant side
effects may occur comparatively frequently. Some recent
investigations have shown that THC in low doses improves the efficacy
of other anti-emetic drugs if given together. There is evidence from
clinical studies that cannabinoids are also effective in nausea and
vomiting due to radiotherapy and after surgery. In folk or
'alternative' medicine, cannabinoids are popular and are often used
in other causes of nausea including AIDS, hepatitis and nausea
in pregnancy.
 |
United
Kingdom Medical Cannabis Activist Clark French
|
In
many clinical trials of cannabis, a beneficial effect on spasticity
caused by MS or spinal
cord injury has been observed. Among other positively
influenced symptoms were pain,
paraesthesia, tremor and ataxia. In some studies improved bladder
control was observed. There is also anecdotal evidence of a benefit
of cannabis in spasticity due to lesions on the brain.
Tourette
syndrome and other Movement Disorders
There
are some positive anecdotal reports of therapeutic response to
cannabis in Tourette syndrome, dystonia and
tardive dyskinesia. The use in Tourette syndrome is being
investigated in clinical studies. Many patients achieve a modest
improvement, however some show a considerable response or even
complete symptom control. In some MS patients, benefits on ataxia and
reduction of tremor have been observed following the administration
of THC. Authors
of a controlled animal study published
in the journal Neuropharmacology have
found that long-term stimulation of cannabinoid receptors may prevent
onset of movement/motor dysfunction symptoms that result
from Huntington’s
disease. Cannabis products may prove useful in Parkinson's
disease without worsening the primary symptoms. In
a study published
in the Journal of Psychopharmacology in 2014, patients
treated with 300 mg/day of cannabidiol (CBD) with Parkinson’s
Disease, without dementia or co-morbid psychiatric conditions,
experienced increased well-being and quality of life compared to
patients who had received a placebo.
Prescribing
Patients Medical Cannabis for Pain
In
December 2014, the College of Family Physicians of Canada published
its preliminary
recommendations for physicians recommending/prescribing
smoked cannabis for chronic
non-cancer pain in the organisation’s journal, Canadian
Family Physician. The authors reviewed the information available on
cannabis for medical use, utilising mainly level II (“well
conducted observational studies”) and level III (“expert
opinion”) evidence to create guidelines on the following aspects of
medical cannabis use for chronic non-cancer pain: conditions
recommended for use; circumstances under which medical cannabis
should not be recommended; circumstances under which caution should
be taken when recommending medical cannabis use; and, dosing. The
number of Canadians authorised to use 'medical marijuana' has been
sky-rocketing. In 2002 – a year after the government first
permitted access through Health Canada regulations – 500 patients
had registered. Today, there are more
than 50,000. This has happened despite the official position of
the Canadian Medical Association (CMA) that “there is insufficient
scientific evidence available to support the use of marijuana for
clinical purposes.” The CMA also believes we don’t know enough
about its risks and benefits, about the interactions between
marijuana and other medications or how to prescribe an appropriate
dosage. It advises doctors they are not obligated to write cannabis
prescriptions for patients.
Meanwhile the Australian Medical Association (AMA) are not interested in anything but pharmaceutical cannabis which has limited applications. Quoted in the Australian mainstream media, "Medicinal cannabis should be subject to the same safety and efficacy tests as any other 'drug' before being made available on the Australian market", said the AMA. They also warned against the legalisation of the raw 'dope plant', or any oils and tinctures made from it and urged that only fully-tested cannabis-based medicines should be considered for use.
In a significant development for those who argue cannabis is effective in alleviating chronic pain and providing relief from symptoms including nausea and muscle spasms and should be legalised, the NSW government has secured the support of the Commonwealth and its state and territory counterparts to 'trial' the use of cannabis for medicinal purposes. In March 2015 the Australian Broadcasting Commission (ABC) reported that NSW was running three medical trials to allow children with severe epilepsy, adults with a terminal illness and people with nausea and vomiting caused by chemotherapy to use medical cannabis. The Terminal Illness Cannabis Scheme (TICS) was launched with patients and carers allowed to 'register' with the government (NSW) as using medical cannabis but with no support whatsoever from the government; even when law enforcement arrested a 'carer' and confiscated the medicine/s (the scheme notates that law enforcement may use their discretion not to charge).
 |
Australian
Epilepsy sufferer Deisha takes cannabis oil which
allows her to live seizure free (seen here with Dad, David).
Deisha
was having seizures every five to eight seconds, cannabis stopped
them completely.
|
Big
and Not-so-Big 'Pharma' are targeting a very small number of patients
to get their pharmaceuticals into as many countries as possible to
make their drugs the only preparations available at exorbitant
prices, it would seem (pharmaceutical companies care about profits
not patients). The Victorian (Australia) government quoted the cost
of Sativex, a cannabis-derived pharmaceutical mouth spray, to be $500
per month in New Zealand (NZ), but Fairfax media (NZ) reported that
Sativex, classed as a Schedule B drug like cannabis, would cost for a
typical yearly prescription, about NZ$20,200.
Somewhere in between lies the true cost but the latest research
reiterates that the whole, organic cannabis plant is needed for the
best medicinal applications (the Entourage Effect).
A
San Diego, California Scientist, Igor Grant, said recently
"It's now well-established that 'marijuana' can soothe
neuropathic pain in patients with diseases like HIV/AIDS. It can
reduce spasticity in MS and, perhaps obviously, it can stimulate
appetite in underweight patients. More research is needed before
reaching conclusions about marijuana's usefulness with other
diseases, like epilepsy and schizophrenia." Grant says there's
now more than enough evidence to justify rescheduling 'marijuana' in
the US. Other scientists agree. The American Academy of
Paediatrics recently called
for rescheduling. Even US Surgeon General Vivek Murthy has
acknowledged 'marijuana' can be helpful in treating certain
conditions.
expanded
from International
Association of Cannabinoid Medicines
additional
medical and scientific references compliments of Granny
Storm Crow's List 2015
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