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
patiëntenbelangen Medicinale Marihuana
op gedaan met patiënten die medicinaal
marihuana gebruiken
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