Integrative Medicine: Legalization and regulation of cannabis

This month, the California Medical Association made news when it became the first state medical association to recommend the legalization and regulation of cannabis, better known as marijuana.  The CMA’s Council on Scientific and Clinical Affairs noted in its recommendations that there is an increasing body of evidence that marijuana may be useful in the treatment of a number of medical conditions, but research to determine both risks and benefits is hampered in the United States because marijuana still is classified as an illegal drug.  The CMA council believes that the legalization and regulation of marijuana will allow for broader research and objective data on the potential benefits and risks of marijuana. It also will help to regulate dispensaries of marijuana, regulate the physicians who prescribe marijuana, ensure that safe and consistent products are available to patients, reduce diversion and improper use of medical cannabis, and support the physicians who wish to appropriately prescribe medical marijuana to patients who are most likely to benefit from its use.  To give you some perspective on the current controversy around marijuana, here’s a little background.  Marijuana is classified under the Controlled Substances Act of 1970 as a Schedule 1 drug, meaning that it has a high potential for abuse and has no accepted medical benefit. However, marijuana, like other herbal remedies, has been used as a medicinal agent for thousands of years in many parts of the world. The Irish physician and pharmacologist Dr. William O’Shaughnessy, who had spent years studying its medical benefits in India, first introduced marijuana into Western medicine in 1841; it was used to relieve pain, muscle spasm and convulsions.

In the 1930s, marijuana came under fire in the United States as a harmful drug, and in spite of a lack of good data about its potential risk, it was removed from the U.S. Pharmacopeia in 1942.  In 1970, Congress initiated the Controlled Substances Act, which then awarded marijuana its Schedule 1 status, effectively shutting the door on further research. Shortly thereafter, Congress authorized the creation of the National Commission on Marijuana and Drug Abuse to study the risk of marijuana use. The commission’s report to Congress in 1972 was titled “Marijuana, A Signal of Misunderstanding.”  The physicians and other members of the commission concluded that there was “little proven danger of physical or psychological harm from the experimental or intermittent use of the natural preparations of cannabis,” and that “the actual and potential harm of use of the drug is not great enough to justify intrusion by the criminal law into private behavior.”  They also recommended the decriminalization of simple possession of marijuana. That recommendation was ignored by the Nixon administration, and marijuana remained classified as a Schedule 1 dangerous drug, unsuitable for any medical use (and this remains puzzling to many health care providers who work in the field of substance abuse, considering that alcohol and nicotine are both considered significantly more addictive and physically harmful than marijuana).  The controversy continued, and in 1996, 14 states including California legalized the use of marijuana for medical purposes.  In 1999, the California Legislature approved funding for cannabis research, leading to the formation of the University of California Center for Medicinal Cannabis Research, based at the University of California-San Diego.

The beginning results of that research were published last year and were promising: Cannabis was found to significantly reduce neuropathic pain as well as muscle spasm and muscle spasticity, particularly in patients with multiple sclerosis.  One of the studies showed that marijuana significantly reduced HIV-related pain in more than more than 50 percent of patients. In other research endeavors, cannabis also has been shown to reduce pain and neuropathy in cancer patients and in patients with neurologic diseases. It also helps to reduce nausea and vomiting from chemotherapy, and it may help reduce the loss of appetite that can accompany cancer and HIV disease. Cannabis may also help augment the pain-relieving properties of narcotic drugs.  Even more intriguing, some data also suggest that cannabis may play a role in cancer risk reduction.  Rodent studies have shown that THC, one of the active ingredients in marijuana, not only reduces the risk of cancer in animals but also increases survival.  In a study of more than 64,000 Kaiser patients who were followed for about nine years, men who smoked marijuana had the lowest rates of lung cancer, even lower than the nonsmokers. A large case-control study done in Los Angeles also suggested a reduced risk of all cancers studied except for oral cancer in users of marijuana. There is biological plausibility for this: studies show that THC and other phytochemicals in marijuana inhibit the growth and spread of cancer cells in cell cultures and in rodents.  The public opinion on the legalization of marijuana has been heated and divided for many years; perhaps it’s time for more objective data on the potential risks and benefits of marijuana so that we can make informed decisions about its use.  The changes advocated by the California Medical Association can help pave the way for this.

via : sunherald

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