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Medical Marijuana – The Debate Rages On

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 Marijuana  is also known as pot, grass and weed but its formal name is actually cannabis. It comes from the leaves and flowers of the plant Cannabis sativa. It is considered an illegal substance in the US and many countries and possession of  marijuana  is a crime punishable by law. The FDA classifies  marijuana  as Schedule I, substances which have a very high potential for abuse and have no proven  medical  use. Over the years several studies claim that some substances found in  marijuana  have medicinal use, especially in terminal diseases such as cancer and AIDS. This started a fierce debate over the pros and cons of the use of  medical   marijuana . To settle this debate, the Institute of Medicine published the famous 1999 IOM report entitled  Marijuana  and Medicine: Assessing the Science Base. The report was comprehensive but did not give a clear cut yes or no answer. The opposite camps of the  medical   marijuana  issue often cite part of the report in their advocacy arguments. However, although the report clarified many things, it never settled the controversy once and for all.

Let’s look at the issues that support why  medical   marijuana  should be legalized.

(1)  Marijuana  is a naturally occurring herb and has been used from South America to Asia as an herbal medicine for millennia. In this day and age when the all natural and organic are important health buzzwords, a naturally occurring herb like  marijuana  might be more appealing to and safer for consumers than synthetic drugs.

(2)  Marijuana  has strong therapeutic potential. Several studies, as summarized in the IOM report, have observed that cannabis can be used as analgesic, e.g. to treat pain. A few studies showed that THC, a  marijuana  component is effective in treating chronic pain experienced by cancer patients. However, studies on acute pain such as those experienced during surgery and trauma have inconclusive reports. A few studies, also summarized in the IOM report, have demonstrated that some  marijuana  components have antiemetic properties and are, therefore, effective against nausea and vomiting, which are common side effects of cancer chemotherapy and radiation therapy. Some researchers are convinced that cannabis has some therapeutic potential against neurological diseases such as multiple sclerosis. Specific compounds extracted from  marijuana  have strong therapeutic potential. Cannobidiol (CBD), a major component of  marijuana , has been shown to have antipsychotic, anticancer and antioxidant properties. Other cannabinoids have been shown to prevent high intraocular pressure (IOP), a major risk factor for glaucoma. Drugs that contain active ingredients present in  marijuana  but have been synthetically produced in the laboratory have been approved by the US FDA. One example is Marinol, an antiemetic agent indicated for nausea and vomiting associated with cancer chemotherapy. Its active ingredient is dronabinol, a synthetic delta-9- tetrahydrocannabinol (THC).

(3) One of the major proponents of  medical   marijuana  is the  Marijuana  Policy Project (MPP), a US-based organization. Many medical professional societies and organizations have expressed their support. As an example, The American College of Physicians, recommended a re-evaluation of the Schedule I classification of  marijuana  in their 2008 position paper. ACP also expresses its strong support for research into the therapeutic role of  marijuana  as well as exemption from federal criminal prosecution; civil liability; or professional sanctioning for physicians who prescribe or dispense  medical   marijuana  in accordance with state law. Similarly, protection from criminal or civil penalties for patients who use  medical   marijuana  as permitted under state laws.

(4)  Medical   marijuana  is legally used in many developed countries The argument of if they can do it, why not us? is another strong point. Some countries, including Canada, Belgium, Austria, the Netherlands, the United Kingdom, Spain, Israel, and Finland have legalized the therapeutic use of  marijuana  under strict prescription control. Some states in the US are also allowing exemptions.

Now here are the arguments against  medical   marijuana .

(1) Lack of data on safety and efficacy. Drug regulation is based on safety first. The safety of  marijuana  and its components still has to first be established. Efficacy only comes second. Even if  marijuana  has some beneficial health effects, the benefits should outweigh the risks for it to be considered for  medical  use. Unless  marijuana  is proven to be better (safer and more effective) than drugs currently available in the market, its approval for  medical  use may be a long shot. According to the testimony of Robert J. Meyer of the Department of Health and Human Services having access to a drug or medical treatment, without knowing how to use it or even if it is effective, does not benefit anyone. Simply having access, without having safety, efficacy, and adequate use information does not help patients.

(2) Unknown chemical components.  Medical   marijuana  can only be easily accessible and affordable in herbal form. Like other herbs,  marijuana  falls under the category of botanical products. Unpurified botanical products, however, face many problems including lot-to-lot consistency, dosage determination, potency, shelf-life, and toxicity. According to the IOM report if there is any future of  marijuana  as a medicine, it lies in its isolated components, the cannabinoids and their synthetic derivatives. To fully characterize the different components of  marijuana  would cost so much time and money that the costs of the medications that will come out of it would be too high. Currently, no pharmaceutical company seems interested in investing money to isolate more therapeutic components from  marijuana  beyond what is already available in the market.

(3) Potential for abuse.  Marijuana  or cannabis is addictive. It may not be as addictive as hard drugs such as cocaine; nevertheless it cannot be denied that there is a potential for substance abuse associated with  marijuana . This has been demonstrated by a few studies as summarized in the IOM report.

(4) Lack of a safe delivery system. The most common form of delivery of  marijuana  is through smoking. Considering the current trends in anti-smoking legislations, this form of delivery will never be approved by health authorities. Reliable and safe delivery systems in the form of vaporizers, nebulizers, or inhalers are still at the testing stage.

(5) Symptom alleviation, not cure. Even if  marijuana  has therapeutic effects, it is only addressing the symptoms of certain diseases. It does not treat or cure these illnesses. Given that it is effective against these symptoms, there are already medications available which work just as well or even better, without the side effects and risk of abuse associated with  marijuana .

The 1999 IOM report could not settle the debate about  medical   marijuana  with scientific evidence available at that time. The report definitely discouraged the use of smoked  marijuana  but gave a nod towards  marijuana  use through a  medical  inhaler or vaporizer. In addition, the report also recommended the compassionate use of  marijuana  under strict  medical  supervision. Furthermore, it urged more funding in the research of the safety and efficacy of cannabinoids.

So what stands in the way of clarifying the questions brought up by the IOM report? The health authorities do not seem to be interested in having another review. There is limited data available and whatever is available is biased towards safety issues on the adverse effects of smoked  marijuana . Data available on efficacy mainly come from studies on synthetic cannabinoids (e.g. THC). This disparity in data makes an objective risk-benefit assessment difficult.

Clinical studies on  marijuana  are few and difficult to conduct due to limited funding and strict regulations. Because of the complicated legalities involved, very few pharmaceutical companies are investing in cannabinoid research. In many cases, it is not clear how to define  medical   marijuana  as advocated and opposed by many groups. Does it only refer to the use of the botanical product  marijuana  or does it include synthetic cannabinoid components (e.g. THC and derivatives) as well? Synthetic cannabinoids (e.g. Marinol) available in the market are extremely expensive, pushing people towards the more affordable cannabinoid in the form of  marijuana . Of course, the issue is further clouded by conspiracy theories involving the pharmaceutical industry and drug regulators.

In conclusion, the future of  medical   marijuana  and the settlement of the debate would depend on more comprehensive and comparable scientific research. An update of the IOM report anytime soon is well-needed.

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Source by Katt Mollar

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