Marijuana (an introduction)  

Drugs can be applied for recreation or as medication. A continuously growing group of doctors and associations of patients acclaim that it can be both. Already since the start of the Seventies there is a group of medics in the United States who advocate the medical application of Marijuana for the treatment of the sickness that occurs with Chemotherapy and radiation therapy (Cancer and Aids), for the treatment of glaucoma (Marijuana reduces the pressure of the eyeball), as a means against spasms (M.S) and chronic pain (Marijuana does not fight the pain itself, but can support the effect of other anodynes (pain assuaging medicines). The medicinal effect of Marijuana is actually known for thousands of years and already occurred in a list of medicines described by the Chinese emperor Shen-Nung. At the start of this century as the pharmaceutical industry emerged there was no place anymore for a medicinal herb. Marijuana could not be injected and nobody wanted to register or patent the medicinal herb. (for the simple reason that it was hardly profitable). Due to political pressures the herb was included in the Narcotics legislation among other dangerous substances to the effect that research, possession and usage was liable. As the recreational use of Marijuana became fashionable in the Sixties once more attention was also drawn to the medicinal effects. Sometimes by chance, as in the case of glaucoma, but often by patients using Marijuana for recreation themselves the medicinal effects were discovered and reported to the treating doctor. Also the mind broadening effect of Marijuana was a source of scientific research in which the many medicinal qualities of Marijuana were discovered. Still the return of Marijuana is threatened because of the recreational use of it outside the field of medical care. Advocates and adversaries of the use of soft drugs focus on the medicinal effects in their battle against or in favor of usage so that scientists and doctors become afraid to be regarded as advocates or adversaries of the recreational use of Marijuana. It must be clear that the legislation of Marijuana as a drug, or the possibility to prescribe a medicine are two totally different issues.  

Marijuana (the plant)    

  Of the Marijuana plant -primarily known by the Cannabis Sativa- only the female plant contains considerable amounts of the working substances. The plant contains more working substances if the plant did not lose strength by the production of seeds. One element the THC (Delta-9-Tetrahydrocannabinol) has a particular psychic effect and acts differently from the other ingredients in the Marijuana. This ingredient can be found in large quantities in the dried plant. There are also other components in the plant that are just as potent as THC, but these mostly occur in minor quantities and not in all plant species. The medicinal use of Marijuana dates back to 4000 BC. and can be found again and again throughout the centuries, mostly in the form of a tincture or ointment or in the form of tea. Today the herbs are mostly smoked, but recreational use in the form of bakery and tea does also frequently occur. Also here the remark should be made that again the recreational use and medical use must be separated, because one wants to become "high" (side-effect of Marijuana) when it is taken for recreational purpose. In the case of medicinal application of Marijuana one wants to benefit from the medicinal effect of the herb without being troubled by this side-effect. The toxicity of Marijuana is extremely low: The therapeutic index for mice is 40.000!. Because of this quality Marijuana is the safest therapeutic substance existing. Marijuana is not registered as a medicine; the quality (for instance a constant composition) and the (long-term) safety have not been established. The VMS ministry (Ministry of health, public safety and environmental affairs) emphasizes that patients use Marijuana on their own responsibility.

Sickness and depressions during chemotherapy and radiotherapy.    

  This topic concerns the most promising application of Marijuana in the field of medical care. The use of Marijuana for this indication can be called absolutely positive, except for a single case. Clinical research after this application has also in the Netherlands been extensively performed. Already in 1976 research was done by the department of oncology of the University Hospital of Leiden to examine the effect of smoking Marijuana on chemotherapy. For several reasons the result of the research was considered negative and the method was rejected. Looking back the failure of this research could have been the result of relative overdosing (patients became too 'high'). It was generally confirmed that Marijuana had strongly reduced the actual perception of the sickness. It is essential that the dosing is not too high. During a pilot-study in the University Hospital "Dijkzigt" in Rotterdam it was discovered that the effects of a chemotherapy could be best dealt with by a tea of Marijuana consisting of a ratio of 1 gram tea to 1 liter of water and boiled for 15 minutes. Because of the fact that the active ingredients dilute poorly in water only a slight quantity of the active ingredients gets into the tea, as such eliminating the possibility of overdosing. Given the period of 36 hours in which the effectiveness of the active ingredients is reduced by 50% a cup of this day per day throughout the duration of the chemotherapy is sufficient. One does not become "high" of this tea, the only thing that can be experienced is a increased ability to put things into perspective as well as an increased ability to live in the 'here and now'. Still most patients prefer smoking or vaporizing Marijuana as the effects can be felt immediately. This is contrary to oral application when it certainly takes up to 2 hours before something is noticed. Smoking or vaporizing also seems a solution when the patient is too sick for oral application. During smoking or vaporizing another component called CBD with anxiety suppressing qualities is released. Altogether the results of the application of Marijuana as a therapy for sickness and depression seems hopeful with focus on improvement of the quality of life, for instance, increased appetite and an improved sense of wellbeing.

Glaucoma    

  The effect of Marijuana on the pressure of the eyeball was coincidentally discovered when the Los Angeles Police Department together with the University of Los Angeles did a research after the size of the pupil after the use of Marijuana hoping to be able to arrest people suspected of the use of Marijuana. The difference in size of pupil (a minor contraction) appeared to be irrelevant, however, a remarkable reduction of the eyeball pressure was established. In relation to the therapeutic value of Marijuana the case of glaucoma is clear in all reports and examination results: Marijuana proved both in animal experiments and human research a effective substance for the reduction of the eyeball pressure as compared to the conventional anti-glaucoma medication with minor side-effects. From research with animals it appears that it is also locally effective with the application of a tincture. (for example, eye-drops). This has as yet not led to the production of Ophthalmologic drops for human application. The method of application and dosing is unfortunately less clear: some claim an effect using 2 times 20 mg. pure THC per day, others regard the pure THC as less effective and recommend smoking of 2 times 0,5 grams of Marijuana per day. This indicates that there is agreement about the effect, but also that research after the relation between dosing and response is still desirable. It is remarkable that many publications concerning the medicinal effects of Marijuana reveal the same defect. Only research with pure THC meets this aspect, however, the majority of the researchers assume that the pharmacological effect of THC just partially explains the favorable medicinal effect of Marijuana.

Spasms (M.S.)  

  Probably a Dutch example is tale-telling regarding the effect of Marijuana on spasms: A young M.S. patient suffered in spite of almost the heaviest of Baclofen and Dantrolene po medication from spasms to such a degree that he was totally dependent of the support of others. An anaesthetic tried a test treatment with baclofen intrathecale (in the spinal marrow) and this proved so successful that the anaesthetic was permitted implant a Synchromed pump (a pump that is implanted and provides continuously an a certain amount of medicine) for the continuous application of baclofen without too many problems with the health insurance. The recovery of the patient was beyond expectation. He became completely self-sustaining and resumed his education at the Academy of Arts. After the anaesthetic had filled the pump for the second time the patient had started to smoke Marijuana advised by a friend. The patient did not turn up for the appointment at which the pump was to be filled for the third time and never got in contact anymore. Two years (!) later he reported back with the request to refill the pump. He told that he has lived for 2 years on Ibiza, had used quite a lot of Marijuana and almost fully mobile up to that moment. Things became less good and that was why he had returned. Many researchers mention the positive effect of Marijuana on spasms as well as tremors, in particular on M.S. In almost all the mentioned cases it appeared that Marijuana was the most effective in those instances that all other medication had failed. The beneficial effects are noted from a daily doses of 5 mg. THC. The concurring mild 'high' sensation is said not to affect the ability coordination and judgement.. There is at this moment no pure THC available in the Netherlands for patients and they have to rely on Marijuana itself. At the beginning is it worthwhile to make tea of Marijuana at a ratio of 1 gram to 1 litre of water and to boil it for 15 minutes for the consumption of 1 cup (200 ml) in the morning and the evening. Experiences show that this is insufficient for most M.S. patients. An increase of the dose is not effective. It is to no avail to make the tea stronger, because the active ingredients do not dissolve well in water. It is possible to make the tea stronger by the addition of a small amount of butter as this allows the ingredient to dissolve more easily. One should be cautious concerning the oral application of Marijuana in (too) large quantities. In the case of oral application THC produces a by-product in the liver. It is preferable to smoke or vaporize Marijuana when it desirable to apply more Marijuana, because subjective dosing is done more accurately as the effect is immediately experienced. It is recommended to smoke the Marijuana pure (without tobacco), preferably by means of a water pipe or vaporizer. It is best to smoke or vaporize a small quantity at the time. One should understand that it is necessary to get accustomed to the mind broadening psycho- active effect that accompanies the use of Marijuana. One should experience how it feels and works. The experience teaches that one knows how to apply the right dose quite quickly, whereas the concurring sensation of feeling 'high' is perceived as pleasant during the course of the illness. The patient becomes more active and feels betters, etc. Altogether the application of Marijuana in the case of M.S. is considered to be definitively positive.

Aids Wasting Syndrome  

  The Aids Wasting Syndrome is the syndrome that occurs when the intake of food comes almost to a halt in an advanced stage of aids due to a combination of the complete absence of appetite and painful swallowing. This results in a sharply reduction of the body weight. The effect of Marijuana on this syndrome has currently drawn wide attention. Unfortunately there are quite some expectations concerning the beneficial effect on the progress of Aids: expectations for which the scientific foundation is not present. It is certain that the appetite and hence the weight of the patient increases spectacularly due to the influence of Marijuana and that the mind broadening effect of Marijuana brings about a positive state of mind. The patient is less occupied with his illness and subsequently an improvement of the quality of life takes place. This fact alone is strong argument to contemplate the prescription of Marijuana in the case of Aids. Some scientists warn for traces of moulds when smoking Marijuana that could pose a danger for patients with a weak immunity system or a poor condition and recommend therefore an accurate quality check. We therefore recommend patients with a weak immunity system always to consult the treating doctor first when they think that Marijuana could serve them as a medicine. The experiences show that many Aids patients benefit by Marijuana and that dosing (many patients smoke the Marijuana) gives hardly any problems.

Chronic pain  

  The majority of the scientific publications concerning the pain suppressing qualities of Marijuana are quite old. Given the fact that the attention for chronic pain has increased enormously over the last decade the small interest in Marijuana in this respect is a negative indication for the effect of Marijuana on chronic pain. (Marijuana does not work like a 'pain- killer' like most conventional anodynes) The most recent serious publications date back to 1975. The author of an article shows that 20 mg THC is just as effective as 120 mg codeine in the case of chronic pain. The remark must be made that the patient is so 'high' after application of 20 mg THC that one must wonder if the patient could still effectively communicate. As such the result does not provide scientific support. It becomes clear though that Marijuana is a welcome additive in case of chronic pain, whereas the psycho active and mind broadening effects form the most important aspects. Many scientists report a significant reduction of anodynes when Marijuana is smoked at the same time. From my own experience I have found that the application of Marijuana has a positive effect on illness treatment, in my case a chronic inflammation of the pancreas. In 4 years time I was hospitalized with severe pains 5 times, each time for 6 weeks of which the first two times in an intensive care ward. Also when I was not hospitalized I suffered a great deal of pain and subsequently I was tested for the right suppression of pain in order to try to life on with as little pain as possible. Many anodynes were tried and eventually it appeared that the pain was reasonably suppressed by para-codeine 500/20 at 4 to 6 times a day. Because of the tension that accompanied my illness I also took tranquilizers (10 gm. Valium at 4 to 6 times a day) and sleeping tablets. All the medicines caused in turn problems with stomach and bowels for which I got in turn other medicines. At a given moment I took tablets all day long and became less active and fatter. As a result my state of mind grew worse by the day and hampered my recovery. My situation became critical the last time I was hospitalized in 1993 and I was actually fighting for my life. An assistant working in the intensive care ward cared about me and told me about scientific articles concerning Marijuana that he had read and advised me to experiment with it at home in case my situation would not improve. I had smoked 'Hashish' in the Seventies, but did not know anything of the medicinal effect of it for the simple reason that I was not sick back then. The strength of the product also mattered, the hashish of the time was not as strong of the Dutch Marijuana of present day that contains much THC. As I recovered slowly, I decided to make good use of it. After I departed the hospital I went to a coffee shop on my way back home, bought Marijuana for Dfl 25,- and started experimenting. Initially the pain did not become less and I remained to use painkillers. My mood became brighter and joyful though, I looked at life more positively and was less involved with my illness. I noticed soon that when you are less occupied by the pain or the illness the need for pain suppressing medicines and tranquilizers becomes less as a result of which one becomes less drowsy. In 1994 I read an article of a doctor using natural healing methods that prescribed Marijuana to his patients and met him through mediation of my doctor. With his support I was able to get rid of all the medicines using Marijuana although I suffered quite a lot from detoxification effects that accompanied the reduction of valium. Also in this respect Marijuana can be of use thanks to its muscle relaxing and calming effects. I am reasonably healthy now and using Marijuana I can function normally, it is not difficult to get accustomed to the sensation of feeling 'high' and it is not an irritating side-effect. I am by far more active and perceive the concurring mind broadening effect as a plus.

General information  

  Apart from the indications for which there is wide support in the literature, such as depression an nausea in the case of chemotherapy and radiotherapy, glaucoma, spasms, aids wasting syndrome and chronic pains there is much more written about the medicinal effects of Marijuana. There is not much hard evidence in this respect as it often deals with the experiences of the patients themselves. Dr. Lester Grinspoon, Professor at the Boston Medial School has taken a stand in the United States as an advocate for the medical application of Marijuana in two of his books called 'Marijuana reconsidered' and 'Marijuana the forbidden medicine', of which the latter has been translated into Dutch and available in book stores. Dr. Grinspoon mentions various examples of illnesses for which Marijuana can be beneficial. Apart from the indications mentioned before dr. Grinspoon also mentions experiences of patients suffering from the consequences of chemotherapy, glaucoma, epilepsy, M.S., paraplegia, aids, chronic pain, migraine, itches, menstruation, cramps and pains during labor (child birth), depressions and other mood disorders. He also mentions other examples for which Marijuana could be effective, i.e. asthma, insomnia, other causes of severe sickness, anti-bacterial qualities, and the effectiveness against tumors. As it concerns mainly testimonies of patients rather than scientific literature it does implicate that these stories are fairy tales. Sometimes it concerns studies that lasted many years, but which have been performed with a inaccurate methodology rendering its scientific value useless. Moreover, the structure of Marijuana is so complex that that research often got stuck over the issue of the psycho-active effect, i.e. the 'high'-feeling. It can be understood that the pharmacological industries are not really eager to market a product like Marijuana in spite of the diversity of medicinal effects. Once more we would like to advise you to discuss the application of Marijuana with your doctor when you think it could be beneficial in your case.

 

 Ger de Zwaan, Chairman

 Association for Patient Interests Medicinal Marijuana  

 bron:   

  • M.P. Neeleman, anaesthesioloog, Hoofd pijncentrum AZR DijkzigtRotterdam. 
  • Marihuana soft drug of medicijn, een literatuuroverzicht.augustus 1996 Lester Grinspoon M.D. and James B. Bakalar 
  • Marihuana de verboden medicijn 1993, vertaald in het Nederlandsin 1996, uitgeverij het Spectrum ISBN 90 274 3329 Bijgewerkt met ervaringen van de Stichting patiŽntenbelangen Medicinale Marihuana op gedaan met patiŽnten die medicinaal marihuana gebruiken