Health Canada info on medical marijuana

Information for Health Care Professionals
(Revised)
Marihuana (marijuana, cannabis)
dried plant for administration by ingestion or other means
Psychoactive agent
Prepared by Health Canada, July 2003
Presented in present format by CPhA, June 2004
This document has been prepared for the Drug Strategy and Controlled
Substances Programme to provide information on the use of marihuana for
medical purposes. Marihuana is not an approved therapeutic product and
the provision of this information should not be interpreted as an
endorsement of the use of this product, or marihuana generally, by Health
Canada.
Despite the similarity of format, it is not a Drug Product Monograph, which is
a document which would be required if the product were to receive a Notice of
Compliance authorizing its sale in Canada. This document is a summary of
peer reviewed literature and international reviews concerning potential
therapeutic uses and harmful effects of marihuana. It is not meant to be
comprehensive and should be used as a complement to other reliable sources
of information.
This document should not be construed as expressing conclusions from
Health Canada about the appropriate use of marihuana for medical
purposes.
Marihuana (marijuana, cannabis) is not an approved therapeutic
substance in Canada and no marihuana product has been issued a
notice of compliance by Health Canada authorizing sale in
Canada.
Health
Canada
Santé
Canada
TABLE OF CONTENTS
Page
1.0 Chemistry.................................................................................................................................1
1.1 Composition..............................................................................................................................1
1.2 Other ingredients.......................................................................................................................1
1.3 Stability and storage...................................................................................................................1
2.0 Clinical Pharmacology.............................................................................................................2
2.1 Pharmacodynamics ....................................................................................................................2
2.2 Pharmacokinetics .......................................................................................................................5
2.2.1 Absorption...................................................................................................... 5
2.2.1.1 Smoked cannabis ............................................................................ 5
2.2.1.2 Oral THC .........................................................................................6
2.2.1.3 Rectal THC ......................................................................................7
2.2.2 Distribution .....................................................................................................7
2.2.3 Metabolism .................................................................................................... 8
2.2.3.1 Inhalation ..........................................................................................8
2.2.3.2 Oral ...................................................................................................9
2.2.4 Excretion .......................................................................................................10
2.3 Pharmacokinetic-pharmacodynamic relationships ................................................................. 10
3.0 Dosing.................................................................................................................................... 11
3.1 Smoking ................................................................................................................................. 11
3.2 Oral .........................................................................................................................................12
4.0 Purported Indications and Clinical Use.............................................................................. 12
4.1 Nausea and vomiting................................................................................................................13
4.2 Wasting syndrome and loss of appetite in AIDS and cancer patients .....................................13
4.2.1 To stimulate appetite and produce weight gain in AIDS patients ................13
4.2.2 To stimulate appetite and produce weight gain in cancer patients ...............14
4.2.3 Anorexia nervosa ..........................................................................................15
4.3 Multiple sclerosis, spinal cord injury or disease......................................................................15
4.3.1 Multiple sclerosis .........................................................................................15
4.3.2 Spinal cord injury..........................................................................................15
4.4 Epilepsy...................................................................................................................................16
4.5 Pain .........................................................................................................................................16
4.5.1 Cancer pain ...................................................................................................16
4.5.2 Other pain categories ....................................................................................17
4.6 Other diseases and symptoms..................................................................................................18
4.6.1 Movement disorders......................................................................................18
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4.6.1.1 Dystonia .........................................................................................18
4.6.1.2 Huntington’s disease......................................................................18
4.6.1.3 Parkinson’s disease ........................................................................18
4.6.1.4 Tourette’s syndrome ......................................................................19
4.6.2 Glaucoma ......................................................................................................19
4.6.3 Bronchial asthma ..........................................................................................19
4.6.4 Hypertension .................................................................................................20
4.6.5 Psychiatric disorders .....................................................................................20
4.6.6 Alzheimer’s disease ..................................................................................... 21
5.0 Contraindications................................................................................................................. 21
6.0 Warnings................................................................................................................................21
7.0 Precautions ............................................................................................................................ 22
7.1 General....................................................................................................................................22
7.2 Dependence and withdrawal ....................................................................................................22
7.3 Special populations ..................................................................................................................22
7.4 Drug interactions.....................................................................................................................22
7.5 Drug screening tests.................................................................................................................23
8.0 Adverse Effects...................................................................................................................... 23
8.1 Carcinogenesis, mutagenesis and respiratory tract ..................................................................23
8.2 Immune system ........................................................................................................................24
8.3 Reproductive and endocrine systems.......................................................................................24
8.4 Cardiovascular effects..............................................................................................................25
8.5 Central nervous system............................................................................................................27
8.5.1 Cognition......................................................................................................27
8.5.2 Psychomotor performance ...........................................................................27
8.5.3 Behavioural effects ......................................................................................28
8.5.3.1 Psychiatric disorders ............................................................................28
8.5.3.2 Schizophrenia.......................................................................................29
8.5.3.3 Amotivational syndrome......................................................................29
8.5.3.4 Dependence and tolerance ...................................................................30
9.0 Overdose and toxicity ........................................................................................................... 31
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1.0 Chemistry
1.1 Composition
Marihuana (Marijuana) is the common name for Cannabis, a hemp plant that grows
throughout temperate and tropical climates in almost any soil condition. Delta-9-
tetrahydrocannabinol ( Δ9-THC, THC) is the main psychoactive ingredient of cannabis.
The flowering tops and leaves are used to produce cannabis for smoking. Marihuana is
most commonly smoked in hand-rolled cigarettes (“joints”) containing marihuana plant
material.
Although the leaves and flowering tops of Cannabis plants yield more than 60
cannabinoids, the major active components are Δ9-THC, cannabinol (CBN) and
cannabidiol (CBD) (British Medical Association, 1997, p 7).
1.2 Other ingredients
There are other components in marihuana joints which are common to tobacco and the
smoke from them is considered chemically similar to that from tobacco cigarettes
(Iverson, 2000, p 191; British Medical Association, 1997, p 14). However, some
investigators report that two potent carcinogens in tobacco smoke, benzanthracene and
benzpyrene, are present in higher amounts in marihuana smoke (Novotny, et al., 1976).
Differences in the smoking techniques used by marihuana and tobacco smokers are
reported to result in three-fold higher levels of tar and five-fold higher levels of carbon
monoxide being retained in the lungs during cannabis than during tobacco smoking (Wu,
et al., 1988). This greater retention of tar and carbon monoxide from cannabis smoke
may offset the fact that a marihuana smoker typically smokes fewer cigarettes per day
than a tobacco smoker (i.e., the exposure to tar and carbon monoxide could be similar for
both groups of smokers) (Peterson, 1979; Tashkin, et al, 1987).
1.3 Stability and storage
Most of the information on stability of marihuana does not distinguish between THC and
its carboxylic acid analogue (THCA). The latter is degraded to THC by pyrolysis during
smoking or in the inlet of gas chromatographs used in forensic analysis (Baker, et al.,
1981). Heat, light, humidity, acidity and oxidation all affect the stability of cannabis
(Garrett, et al., 1974; Mechoulam, et al., 1981). Available information suggests that THC
in recently harvested plant material stored in dry, tightly- closed, refrigerated containers
would be stable for several months. The National Institute of Drug Abuse (NIDA) reports
(Thomas, et al., 1999) that retention samples of their carefully prepared and standardized
cigarettes are stable for months, particularly when stored below 0oC. However, even at
18oC, there is a loss of only a third of the THC potency (from 2.87 to 1.8% THC) over 5
years, with some increase in the concentration of CBN.
2.0 Clinical Pharmacology
2.1 Pharmacodynamics
Most of the pharmacodynamic information on marihuana in humans refers to the effects
of the major constituent THC. CBD does not appear to be psychoactive; its principle
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action is inhibition of cytochrome P450 enzymes, which decreases the metabolism of
TCH and other drugs. CBN, while only weakly active compared to THC in the brain,
appears to have activity in isolated immune cells (National Academy of Sciences, 1999, p
2.5).
Cannabinoid receptors have been discovered in neural tissue. Two types of cannabinoid
receptors, CB1 and CB2, have been identified. Table 1, adapted from the British Medical
Association Report (British Medical Association, 1997, p 19), notes some of the effects
of cannabis. Many of the effects are biphasic, e.g., increased activity with acute or
smaller doses, decreased activity with larger doses or chronic use. Effects differ greatly
among individuals and may be greater in severely ill and elderly patients.
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Table 1: Pharmacologic actions of cannabis in man
Body System/Effect Detail of Effects
CNS
Psychological Euphoria (“high”), dysphoria, anxiety, depersonalization,
precipitation or aggravation of psychosis.
Perception Heightened sensory perception, distortion of space and time, sense,
hallucinations, misperceptions.
Sedative Generalised CNS depression, drowsiness, somnolence; additive
with other CNS depressants.
Cognition, psychomotor
performance
Fragmentation of thoughts, mental clouding, memory impairment,
global impairment of performance especially in complex
demanding tasks.
Motor function Increased motor activity followed by inertia and in coordination,
ataxia, dysarthria, tremulousness, weakness, muscle twitching.
Analgesic Currently available oral cannabinoids are similar in potency to
codeine (but from a different mechanism).
Anti-emetic, increased
appetite
With acute doses; effect reversed with larger doses or chronic use
(tolerance).
Tolerance To most behavioural and somatic effects, including the “high”.
Dependence, abstinence
syndrome
Has been produced experimentally following prolonged
intoxication: symptoms include disturbed sleep, decreased appetite,
restlessness, irritability and sweating. Information from therapeutic
use lacking.
Cardiovascular System
Heart rate Tachycardia with acute dosage, bradycardia with chronic use.
Peripheral circulation Vasodilation, conjunctival redness, postural hypotension.
Cardiac output Increased output and myocardial oxygen demand.
Cerebral blood flow Increased with acute dose, decreased with chronic use.
Respiratory system
Ventilation Small doses stimulate; larger doses depress.
Bronchodilation Coughing, but tolerance develops.
Airways obstruction From chronic smoking.
Eye Decreased intraocular pressure.
Immune system Chronic use: impaired bactericidal activity of macrophages in lung
and spleen.
Reproductive System
Males Antiandrogenic, decreased sperm count and sperm motility (chronic
use, but tolerance may develop).
Females Suppression of ovulation, complex effects on prolactin secretion;
chronic use: increased obstetric risk.
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The acute effects of smoking marihuana include almost immediate euphoria (the
marihuana “high”) as well as cardiovascular, bronchopulmonary, ocular, psychological
and psychomotor effects. Maximum euphoria occurs within 15 minutes after smoking;
the psychological effects (see Table 1) reach a plateau which can last for several hours.
However, on first dosing, some people experience dysphoria and anxiety. The effects on
the cardiovascular system (tachycardia, etc.) decline much faster as THC is distributed
out of the circulatory system. Tachycardia is the most consistent of the physiological
effects of marihuana (Beaconsfield, et al., 1972; Perez-Reyes, 1990).
The short-term psychoactive effects of marihuana smoking include euphoria, relaxation,
time-distortion, perception of enhanced sensory experiences (such as music) and loss of
inhibitions that may result in laughter (Hall, et al., 1998). This is followed by a
depressant period (Ameri, 1999). While there is some inconsistency in reports of the
acute effects on memory and motor skills (Fant, et al., 1998; Kelly, et al., 1993; Barnett,
et al., 1985), most reviews note that marihuana use is associated with impaired function
of a variety of cognitive tasks and short-term memory (Ameri, 1999; National Academy
of Sciences, 1999, p 2.27; Hollister, 1998; Miller, Ch. 15 p 227-231).
A major concern
from such an acute effect is impairment affecting driving or operation of intricate
machinery (Hansteen, et al., 1976; Smiley, et al., 1999; O’Kane, et al., 2002). There are
reports of reduced skills on flight simulators by experienced pilots 24 h after smoking one
marihuana cigarette (Leirer, et al., 1991). Plasma THC levels attained after smoking seem
to have a dose and concentration dependent effect on cognitive function (Heishman, et
al., 1990).
2.2 Pharmacokinetics
This section will be restricted to human pharmacokinetics, mainly of smoked cannabis,
but with some comparisons to oral THC, including dronabinol (Marinol®).
2.2.1 Absorption
2.2.1.1 Smoked cannabis
The estimation of dose administered by the smoking route is a major variable in
the assessment of absorption of cannabinoids (mainly THC) in humans. The
source of the plant material and the composition of the cigarette, together with the
efficiency of smoking by the subject, are additional uncontrolled factors. It might
be reasonable to consider about 10% (range 3-30%) as an average for THC
content in Canadian marihuana. It appears that habitual (heavy) marihuana
smokers can increase the amount absorbed, which is attributed to more efficient
smoking techniques (Agurell, et al., 1986).
THC absorption by inhalation is extremely rapid, with a bioavailability of 18 to
50% from the cigarette (Huestis, 1999), and is the main reason this route is
preferred by many people (Iverson, 2000, p 46-47).
Standardised cigarettes have been developed by NIDA, and the relationships
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among cannabis (THC) content, dose administered and resultant plasma levels
have been investigated. Smoking cannabis containing 1.64% THC (mean dose
13.0 mg THC) resulted in mean peak THC plasma levels of 77 ng/mL (Ohlsson,
et al., 1980).
THC levels in plasma decreased rapidly after cessation of smoking and were
below 5 ng/mL, 2 hours after smoking; mean concentrations declined by about
50%, 15 minutes after (Huestis, et al., 1992) reaching the maximum (Huestis,
1999). However, THC from a single dose can be detected in plasma for at least a
day using modern sensitive analytical techniques and for 13 days in chronic users
(Johansson, et al., 1988). The decline of THC in plasma is multiphasic and as
Harvey (Harvey, 1999) notes, the estimates of the terminal half-life of THC in
humans have increased as analytical methods have become more sensitive. There
is still no consensus. It is probably safe to say that the terminal half-life of THC
averages at least a week and could be considerably longer. The half-life in plasma
does not appear to be different between heavy and light users (Agurell, et al.,
1971).
2.2.1.2 Oral THC
Absorption from an oral dose of 20 mg THC in a chocolate cookie was described
as slow and unreliable (Agurell, et al., 1986), with a systemic availability of only
4 to 12% (Ohlsson, et al., 1980). While most subjects had peak plasma THC
concentrations between 1 to 2 hours, some of the 11 subjects only peaked at 6
hours and many had more than one peak.
Only 10-20% of synthetic THC (dronabinol, Marinol®) administered in capsules
with sesame oil enters the systemic circulation indicating extensive first-pass
metabolism (Compendium of Pharmaceuticals and Specialties, 2003). The
psychotropic effect or “high" is observed to occur more quickly by the smoking
than the oral route, which has been characterized by Iversen (Iverson, 2000, p 46-
47) as the reason “smoking is the preferred route of cannabis for many people”.
2.2.1.3 Rectal THC
Limited evidence suggests a higher bioavailability of THC by the rectal route than
by the oral route (Mattes, et al., 1993 p 745-747; Brenneisen, et al., 1996).
2.2.2 Distribution
Distribution of THC begins immediately after absorption. The plasma protein binding
of THC and its metabolites is approximately 97% (Garrett, et al., 1977; Widman, et
al., 1974). THC is mainly bound to low-density lipoproteins, with up to 10% present
in red blood cells (Walqvist, et al., 1970), while the metabolite, 11-hydroxy THC, is
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even more strongly bound with only 1% found in the free-fraction (Widman, et al.,
1973).
THC has a large apparent volume of distribution, approximately 10 L/kg, because of
its high lipid solubility. Animal studies show that it is sequestered to fatty tissues
including brain (Harvey, 1999). The highest concentrations are found in the heart and
in adipose tissue, with levels reaching 10 and 1000 times that of plasma, respectively
(Truitt Jr., 1971). THC readily crosses the blood brain barrier and the slight delay in
correlating peak plasma concentration to effects is assumed to reflect this distribution
(Agurell, et al., 1986). While immediate distribution is high in liver, spleen and body
fat are the major sites of distribution after 72 h. Spleen and body fat are the long-term
storage sites (Harvey, 1999).
There has been concern about the possible consequences of the long persistence of
THC in fatty tissues. There is no evidence that the THC residues persist in the brain.
Release from the fatty storage sites into blood is slow; levels attained are not high
enough to cause psychological effects.
2.2.3 Metabolism
Most metabolism of cannabinoids occurs in the liver and different metabolites
predominate when different routes of administration are used. The complex
metabolism of THC involves allylic oxidation, epoxidation, decarboxylation and
conjugation (Agurell, et al., 1986). Cannabinoids are good substrates for cytochrome
P450 mixed-function oxidases, mainly CYP 2C9. The major initial metabolites of
THC are 11-hydroxy THC and 11-nor-9-carboxy THC. 11-hydroxy THC is rapidly
formed by action of hepatic microsomal oxidases, and plasma levels parallel the
duration of observable drug action. 11-hydroxy THC has been found to have
psychotomimetic properties equal to THC (Christensen, et al., 1971; Perez-Reyes, et
al., 1972).
2.2.3.1 Inhalation
After smoking (1.75 and 3.55% THC cigarettes) 11-hydroxy THC (Huestis, et al.,
1992) appears rapidly and peaks shortly after THC, at about 15 minutes after the
start of smoking. It exhibited peak plasma concentrations of about 7.5 ng/mL
(about 5% of parent THC) and the AUC profile of this metabolite averaged 20%
of the parent. Similar results were obtained with intravenous administration
(Agurell, et al., 1971).
The psycho-inactive 11-nor-9-carboxy THC is the primary acid metabolite of
THC excreted in urine (Huestis, et al., 1996) and it is the cannabinoid often
screened for in forensic analysis of body fluids (Martin, et al., 1999). Peak
plasma values of this metabolite occur 1.5 to 2.5 h after smoking and are about
one third the concentration of parent THC. Following oxidation, the phase II
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metabolites of the free drug or hydroxy-THC appear to be glucuronide conjugates
(Agurell, et al., 1986).
It is known that polyaromatic hydrocarbons found in tobacco and cannabis smoke
induce the action of CYP1A2. If it is shown that the metabolism of THC also
involves this cytochrome P450 isoenzyme, then repeated exposure to cannabis
could cause the more rapid disappearance of THC via this specific enzyme
(Valjent, et al., 2002). Various other cytochrome P450, enzymes are of interest for
potential drug interactions. In human liver microsome preparations, CBD has been
shown to inhibit formation of THC metabolites catalyzed by CYP 3A, with less
effect on CYP 2C9 (Harvey, 1999). However, others suggest that CBD decreases
formation of 11-hydroxy THC by inhibition of CYP 2C9 (Bornheim, et al., 1993).
Observed and potential interactions of cannabis with other drugs are discussed
later.
2.2.3.2 Oral
After oral doses of THC, parent THC and its active metabolite, 11-OH-THC, are
present in approximately equal concentrations in plasma (Wall, et al., 1981; Cone,
et al., 1988). Concentrations of both parent drug and metabolite peak at
approximately 2 to 4 hours after oral dosing and decline over several days.
Clearance averages about 0.2 L/kg-h, but is highly variable, due to the complexity
of cannabinoid distribution (Marinol US monograph). The larger amount of 11-
hydroxy THC metabolite, from first pass metabolism by this route, which is
similar in potency to THC, complicates interpretation of potential effects. With
oral THC dosing, the absorption is slow and variable, and peak concentrations of
THC may be considered one tenth those from efficiently smoked administration
but the plasma levels of active 11-hydroxy metabolite are about 3 times higher
than observed in the plasma from smoking (Wall, et al., 1983).
2.2.4 Excretion
Following inhalation, elimination of THC and its metabolites occurs via the faeces
(65%) and the urine (20%). After five days, 80% to 90% of the total dose is excreted.
Similarly, following oral doses, THC and its biotransformation products are excreted
in both faeces and urine. Biliary excretion is the major route of elimination with
about half of a radiolabelled oral dose being recovered from the faeces within 72
hours as contrasted with 10 to 15% recovered from urine. Less than 5% of an oral
dose is recovered unchanged in the faeces. Following administration of a single oral
dose, low levels of THC metabolites have been detected for more than 5 weeks in the
urine and faeces (Harvey, 1999, p 91-103; Compendium of Pharmaceuticals and
Specialties,2003).
Traces of marihuana can be detected in urine even for weeks (Ohlsson, et al., 1980)
after dosing in forensic or employment situations when such testing may be applied.
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2.3 Pharmacokinetic-pharmacodynamic relationships
Though it is of major forensic interest, the temporal relationship between plasma
concentrations of TCH and its psychotropic, cognitive and motor effects is unclear
(Harder, et al., 1997; Cone, et al., 1993). Dose and plasma concentration vs. response for
possible therapeutic applications are ill-defined, except for some information obtained for
oral dosing with dronabinol (synthetic THC) for its limited indications (Compedium of
Pharmaceuticals and specialties, 2003). Interpretations of THC pharmacokinetics is also
complicated by the emergence of active metabolites, particularly 11-hydroxy THC (Wall,
et al., 1981; Cone, et al., 1988), which attains higher concentrations after oral than
inhalation doses. Pharmacodynamic modelling (Barnett, et al., 1982) supports a 10
ng/mL cutoff as evidence of functional impairment (McBay, 1985) which is in agreement
with the estimate of 25 – 29 ng/mL for the steady state plasma concentration at 50% of
the maximum “high” effect, or Css(50). The model was also used to simulate multiple
dosing with a 1% cigarette containing 9 mg THC (Harder, et al., 1997). The duration of
maximal “high” for this dose was estimated at about 45 minutes after dosing and declined
to 50% of this peak effect at about 100 minutes following smoking. A dosing interval of
1h with this dose would give a “continuous high” and the recovery after the last dose
would be 150 minutes. The peak plasma concentration during this dosage is estimated at
about 70 ng/mL and the Css(50) at about 30 ng/mL THC.
Target THC plasma concentrations have been derived based on the subjective “high”
response that may or may not be related to the potential therapeutic applications.
However, it is likely that the psychoactivity that elicits this response from the central
nervous system is receptor derived and the concentrations are useful for suggesting doses
from smoking.
3.0 Dosing
3.1 Smoking
The actual dose of THC absorbed when smoked is not easily quantified (see section
2.2.1). According to the World Health Organization (World Health Organization, 1997),
a typical joint contains between 0.5 and 1.0 g of cannabis plant matter (average 750 mg)
which may vary in THC content between 7.5 and 225 mg (i.e., typically between 1 and
30%; see Table 2. The actual amount of THC delivered in the smoke has been estimated
at 20 to 70%, the remainder being lost through combustion or side stream smoke. The
bioavailability of THC (the fraction of THC in the cigarette which reaches the
bloodstream) from marihuana cigarettes in human subjects has been reported from 5 to
24%. The amount of other cannabinoids present, mainly CBN and CBD, is usually much
lower, but the amount delivered and absorbed parallels that of THC.
Table 2 shows some relationships between percentage of THC in cannabis plant material
and the amount in average joints. Bioavailability of cannabinoid depends greatly on
smoking technique (likely maximum approximately 50%).
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Table 2: Relationship of THC percent in plant material to
available dose in a joint
%THC (mg per 100 mg cannabis) mg THC per 750 mg*
(“ average joint”)
1 7.5
2.5 18.75
5 37.5
10 75
15 112.5
20 150
30 225
* WHO average weight
Assuming the desired peak plasma concentration of smoked THC is in the 50-100 ng/mL
range, (see Section 2.3) it has been shown (Huestis, et al., 1992) that this can be readily
achieved with smoke from a single 3.55 % marihuana cigarette with about 900 mg plant
material (approximately 32 mg THC).
A 750 mg joint of 5% strength (i.e., 37.5 mg THC) would yield slightly higher plasma
levels. If the current average “street” marihuana contains 10% THC, then plants yielding
joints from such a source might have an available 75 mg dose and could result in rapid
attainment of plasma concentrations above 300 ng/mL. Clearly even more potent strains
of cannabis have been reported. Patients initiating smoked marihuana therapy should
be cautioned to begin slowly and to stop smoking if tachycardia occurs.
3.2 Oral
The pharmacokinetic information described in section 2.2 reports the erratic and slow
absorption from the oral route and doses are estimated from the information for Marinol®.
4.0 Purported Indications and Clinical Use
The oral form of synthetic THC, dronabinol (2.5, 5 or 10 mg, dissolved in sesame oil) in
capsules is marketed in the US and Canada as Marinol®. It is indicated for treatment of
chemotherapy-induced emesis and for appetite stimulation in AIDS- related anorexia associated
with weight loss (Compendium of Pharmaceuticals and Specialties, 2003; Marinol US
monograph).
While there are many anecdotal reports of the therapeutic value of smoked marihuana, scientific
studies supporting the safety and efficacy of marihuana for therapeutic claims are inconclusive.
The existing scientific evidence for various symptoms is summarized in the following sections.
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4.1 Nausea and vomiting
The IOM (National Academy of Sciences, 1999, p 4.17) and other committees (Health
Department, NSW, Australia, 2000, p 41) consider that the place (if any) for smoked
marihuana would be as an adjunct to other antiemetics, when they are not fully successful
in treatment. However, there are no trials available for guidance. The BMA report
(British Medical Association, 1997, p 27) indicates the research needed to evaluate
marihuana in chemotherapy-induced emesis. This includes establishing dose ranges for
cannabinoids and clinical trials to differentiate optimum cannabinoid treatment for
specific anticancer agents and patient groups.
The IOM report suggests that, since there are now more effective antiemetic agents
available than were available in the 1980s (especially the 5-HT3 receptor antagonists),
patients are less in need of THC.
4.2 Wasting syndrome (cachexia, e.g., from tissue injury by infection or tumor) and
loss of appetite (anorexia) in AIDS and cancer patients
4.2.1 To stimulate appetite and produce weight gain in AIDS patients
The reports that marihuana is beneficial for patients with AIDS wasting syndrome
are anecdotal, although it appears to be very popular with AIDS patients
(Grinspoon et al., 1993). Studies with healthy subjects confirm an appetite
stimulating effect of smoked marihuana together with increases of food
consumption and body weight (Mattes, et al., 1994; Foltin, et al., 1988). In a
controlled, residential laboratory study in which food consumption was carefully
monitored and cannabis cigarettes were smoked with a standardized procedure,
subjects consumed significantly more calories daily compared to placebo (Foltin,
et al., 1988). There are, however no clinical trials of the smoked drug for this
indication (National Academy of Sciences, 1999, p 4.19).
Oral synthetic THC, dronabinol, administered as capsules (Marinol®) has been
approved for this indication. The Marinol product monograph summarizes a
randomized double-blind, placebo controlled-trial in 139 patients (Beal, et al.,
1995) with the 72 patients in the treatment group initially receiving 2.5 mg
dronabinol twice a day, but then having the dose reduced to 2.5 mg at bedtime
due to side effects (feeling high, dizziness, confusion and somnolence). Over the
six week treatment period dronabinol significantly increased appetite, with a trend
towards improved body-weight, and mood, and a decrease in nausea. After the six
weeks, patients were allowed to continue receiving dronabinol, during which the
appetite improvement continued.
A major concern with marihuana smoking in HIV-infected patients is that they
might be more vulnerable than other marihuana users to immunosuppressive
effects of marihuana or to the exposure of infectious organisms associated with
marihuana plant material (National Academy of Sciences, 1999, p 4.19). There
are also drug interaction concerns that are reviewed later.
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4.2.2 To stimulate appetite and produce weight gain in cancer patients
Smoked marihuana has not been studied in patients with cancer cachexia. Oral
THC (dronabinol) has been shown to improve appetite and food intake from
observations during the investigations of the anti-nausea effect (Ekert, et al., 1979;
Sallan, et al., 1980). Improved appetite and increased food intake was reported in
patients with unresectable or advanced cancer treated with open-label dronabinol
2.5 mg 2 to 3 times daily for 4 to 6 weeks, but weight gain was achieved in only a
few patients (Plasse, et al., 1991; Wadleigh, et al.,1990, p 331; Nelson, et al.,
1994). Modest weight gain was obtained with a larger dose regimen of dronabinol
(5 mg, 3 times daily), but the CNS side effects including dizziness and
somnolence were limiting (Regelson, et al., 1976). Cancer cachexia is not an
approved indication for dronabinol either in Canada or the U.S.
The immunomodulating effects of some cannabinoids could be contraindicated in
some cancer patients (both the chemotherapy and the cancer can be
immunosuppressive) (National Academy of Sciences, 1999, p 4.21).
4.2.3 Anorexia nervosa
A randomized trial of oral THC (Gross, et al., 1983) was unsuccessful for weight
gain and three of the eleven patients administered THC reported severe dysphoric
reactions. Both the British Medical Association (British Medical Association,
1997, p 46) and IOM (National Academy of Sciences, 1999, p 4.21) conclude that
marihuana is unlikely to be effective in this group of patients.
4.3 Multiple sclerosis, spinal cord injury or disease
The common symptom of these diseases is muscle spasticity. There are many anecdotal
reports that marihuana can ameliorate spasticity associated with multiple sclerosis or
spinal cord injury when other drugs fail or produce unacceptable side effects (American
Medical Association, 1997, p 10; British Medical Association, 1997, p 30; National
Academy of Sciences, 1999, p 4.23).
4.3.1 Multiple sclerosis (MS)
Published reports spanning one hundred years suggest that people with spasticity may
experience relief with cannabis (Consroe, et al., 1986). As many as 4% of MS
patients in the UK already smoke cannabis to relieve symptoms (Iverson, 2000, p
157) and in a mail survey of 233 MS patients in the UK and US, 112 (48%) reported
(Consroe, 1997) that cannabis was used to ameliorate symptoms.
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4.3.2 Spinal cord injury
Patients surviving spinal cord injuries are usually young (60% are less than 35 years
old (National Academy of Sciences, 1999, p 4.28)), and require long-term or even
life-long care. While there are no clinical trials of smoked marihuana for treatment of
muscle spasms, spinal patients reported to the IOM workshops that muscle spasms,
nausea and sleeplessness were alleviated by smoking marihuana.
4.4 Epilepsy
While some work in animals suggests that cannabinoids could have a role in treatment of
some types of epileptic seizures (Consroe, et al., 1992), (in particular CBD appeared to
have anticonvulsant without psychoactive properties (Hollister, 1986)), there are only
anecdotal and individual case reports that marihuana controls seizures in epileptics.
The potential antiepileptic activity of cannabidiol (CBD) in epileptic patients who were
poorly controlled with conventional anticonvulsants, has been investigated but is not
promising (Ames, et al., 1986, p 14; Trembly, et al., 1997, p 51; Cunha, et al., 1980).
4.5 Pain
4.5.1 Cancer pain
There are no controlled clinical trials of smoked marihuana in treatment of pain.
There are two double-blind, controlled studies of oral THC (dronabinol,
Marinol®) in cancer pain. The first (Noyes Jr., et al., 1975) was a dose ranging
study of 5, 10, 15 and 20 mg THC, given in successive days, to ten cancer
patients. Significant pain relief was found at the 15 and 20 mg dose levels, but at
these higher doses patients were heavily sedated with mental clouding common. A
second, placebo-controlled, study (Noyes, et al., 1975) compared oral 10 and 20
mg THC with 60 and 120 mg codeine in 36 patients with cancer pain. The 10 and
20 mg THC were equivalent in analgesic potency with 60 and 120 mg codeine
respectively. The 10 mg THC dose was well tolerated and, despite its sedative
effect, may have analgesic potential, but the 20 mg THC dose induced side effects
including somnolence, dizziness, ataxia, and blurred vision. Alarming extreme
anxiety was also observed at this dose. This side effect profile is supported by a
report concerning a synthetic analogue of THC also tested in controlled trials
(Staquet, et al., 1978). While it was equivalent in efficacy to codeine, it was not
considered clinically useful because of the frequency of side effects.
4.5.2 Other pain categories
Intravenous THC (0.22 mg/kg and 0.44 mg/kg) administered to patients
undergoing tooth extraction (Raft, et al., 1977) was compared to diazepam (0.157
mg/kg). High dose THC was least effective and diazepam most effective. Four
patients preferred placebo to low dose THC. A study of oral CBD, 450 mg/day in
divided doses, in 10 patients with chronic neuropathic pain (neuralgia, etc.) also
found no significant pain relief (Lindstrom, et al., 1997, p 43). Receptor studies
indicate that cannabinoids might be useful adjuncts to opioid analgesia (National
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Academy of Sciences, 1999, p 4.8). Improvement in phantom limb pain has been
documented (British Medical Association, 1997, p 43).
A meta-analysis of all cannabinoid trials for analgesia concluded that as well as
having effects on the CNS that limit their use, cannabinoids are no more effective
than codeine as analgesics (Campbell, et al., 2001).
4.6 Other diseases and symptoms
4.6.1 Movement disorders
The endogenous cannabinoid system appears to be intricately involved in normal
physiology, specifically in the control of movement, formation of memories and
appetite control and may be involved in the pathology of several neurological
diseases. The contribution of cannabinoids to Huntington’s disease, Parkinson’s
disease and tremor has been reviewed (Glass, 2001).
4.6.1.1 Dystonia
No controlled study of smoked marihuana in dystonic patients has been
published. However, there was a preliminary open trial (Consroe, et al., 1986,
30: 277-282) of an oral cannabinoid. CBD, administered in five dystonic
patients (100 mg/day rising to 600 mg/day over 6 weeks), showed modest
dose-related improvements in all five, but worsening of tremor and hypokinesia
in 2 patients with co-existing Parkinson’s disease. Results of a double-blind
randomized, placebo- controlled study of a synthetic cannabinoid (nabilone)
showed no significant reduction in dystonia (Fox, et al., 2002).
4.6.1.2 Huntington’s disease
A double-blind, placebo-controlled trial (Consroe, et al., 1991) of oral CBD, 10
mg/kg/day in 15 patients with Huntington’s disease found no beneficial effects of
treatment .
4.6.1.3 Parkinson's disease
There are theoretical reasons from research on brain transmission pathways that
support a role for cannabinoids in the treatment of Parkinsonism. However, the
one published clinical trial of smoked marihuana (1 g cigarettes containing 2.9%
THC) involving five cases of idiopathic Parkinson’s disease (Frankel, et al., 1990,
53: 436) found no improvement in tremor after the patients smoked marihuana,
whereas all subjects benefited from the administration of levodopa and
apomorphine. A small randomized clinical trial of the synthetic cannabinoid,
nabilone, in seven patients with Parkinson’s disease found that the treatment
reduced levodopa-induced dyskinesia (Sieradzan, et al., 2001).
4.6.1.4 Tourette's syndrome
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Four case histories suggest that smoked marihuana use can reduce tics in
Tourette’s patients (National Academy of Sciences, 1999, p 4.32). In one report of
3 patients, it is hypothesized that beneficial effects of marihuana might have been
due to anxiety-reducing properties of marihuana rather than to a specific anti-tic
effect (Sandyk, et al., 1988, p 444-445). A randomized, double-blind, placebo
controlled trial of single oral doses of THC (5, 7.5 or 10 mg) in 12 patients with
Tourette’s syndrome showed plasma concentration-related improvements in
control of tics and obsessive-compulsive behaviour, with no serious side effects;
although transient, mild side effects were noted in five patients (Muller-Vahl, et
al., 2002). A related study showed that in contrast to healthy marihuana users,
single does of THC (5-10 mg) caused no cognitive impairment measured by
objective tests in 12 patients with Tourette’s syndrome (Muller-Vahl, et al.,
2001).
4.6.2 Glaucoma
The high intraocular pressure (IOP) of glaucoma can be reduced by marihuana (oral
or smoked) and there are a few reports from treatment of glaucoma patients (British
Medical Association, 1997, p 55). One reviewer remarks (Green, 1998) that
“smoking of marijuana plant material for the reduction of elevated IOP in glaucoma
is ill-advised, given its toxicological profile.” Research with cannabinoids, including
the discovery of ocular cannabinoid receptors, could lead to improved agents for
glaucoma treatment (Jarvinen, et al., 2002).
4.6.3 Bronchial asthma
While cannabinoids are bronchodilators, there have been very few studies of the
bronchodilator effect in asthmatic patients. A double-blind, placebo-controlled study
of smoked marihuana (2% THC), oral THC (15 mg) and isoprenaline (0.5%) in 14
asthmatic subjects showed reversal of experimental bronchospasm by
bronchodilation which was almost equivalent (Tashkin, et al., 1976). However,
tolerance to this effect developed after several weeks (Tashkin, et al., 1976).
Another single-blind investigation of smoked marihuana (0.9 and 1.9% THC) found
that it caused significant and prolonged bronchodilation, but tachycardia occurred
with the higher dose (Vachon, et al., 1976). It is clear that smoked marihuana is not
suitable for chronic use in asthma because of bronchial irritation from various
components of smoke (British Medical Association, 1997, p 60).
4.6.4 Hypertension
Cannabinoids cause postural hypotension, but tolerance to the cardiovascular effects
develops rapidly and together with adverse effects would preclude their consideration
as a treatment for long-term use in hypertension (British Medical Association, 1997,
p 64).
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4.6.5 Psychiatric disorders
Cannabis has been advocated as a treatment for anxiety, depression, sleep disorders
and alcohol and opiate withdrawal symptoms (Iverson, 2000, p 172). Use is
anecdotal and occurred before modern psychotherapeutic agents became available.
One anecdote concerns relief of depression by smoking marihuana, with much faster
mood alteration than from amitriptyline, a conventional antidepressant that usually
takes some weeks to take effect (Grinspoon, et al., 1993). Trials for treatment of
chemotherapy-induced nausea with cannabinoids have mentioned some
antidepressant effect (Regelson, et al., 1976). However, these are offset by the
potential for severe psychological side effects.
Anecdotal information and some animal studies suggest that cannabinoids may be
useful in treatment of opiate withdrawal, but there are no clinical studies to support
this indication (British Medical Association, 1997, p 64).
4.6.6 Alzheimer’s disease
Two possible indications for cannabinoid treatment in Alzheimer’s are to stimulate
appetite (i.e., to combat food refusal) and improve behaviour. Although oral THC
(dronabinol, Marinol®) has been investigated in 11 patients and showed efficacy
(Volicer, et al., 1997), there are concerns about the known THC effects on memory
of healthy adults in this condition in which memory is already diminishing. There
are also obvious concerns about the fire hazards of smoking marihuana in cognitively
impaired patients.
5.0 Contraindications
Marihuana is contraindicated in any patient who has a history of hypersensitivity to any
cannabinoid or to smoking. Marihuana should not be used in patients with a history of psychotic
disorders, particularly schizophrenia.
6.0 Warnings
The dose of marihuana is difficult to estimate and is affected by source of plant material, its
processing and by different smoking techniques. These include depth of inhalation and breathholding
and the number and frequency of puffs as well as how much of the cigarette is smoked.
Smoking should be gradual and should cease if the patient begins to feel disoriented or agitated.
Experienced smokers are able to “titrate” their dose, but naïve smokers should take great care
and be supervised.
Marihuana can produce physical and psychological dependence and has the potential for abuse.
The drug has complex effects in the CNS. These can result in cognitive and memory impairment,
mood changes, altered perception and decreased impulse control. Patients should be supervised
when administration s initiated.
Any patient experiencing a psychotic reaction to marihuana should stop taking the drug
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immediately and be kept under observation until the normal mental state is regained.
Occupational hazards: Patients using marihuana should be warned not to drive or perform
hazardous tasks such as operating heavy machinery because impairment of mental alertness and
physical coordination may decrease their ability to perform such tasks. Such impairment can last
for over 24 hours after using due to the long half-life of THC.
Pregnancy: Use of marihuana during pregnancy should be avoided as there is evidence of long
term development problems in children exposed to marihuana in utero.
Lactation: Cannabinoids are excreted in human milk and may be absorbed by the nursing baby.
Because of potential risks to the child, nursing mothers should not use marihuana.
7.0 Precautions
7.1 General
The risk/benefit ratio of marihuana should be carefully evaluated in patients with the
following medical conditions, because of individual variation in response and tolerance to
its effects as well as the difficulty in dosing noted in section 3.0:
• Marihuana should be used with caution in patients with cardiac disorders because
of occasional hypotension, possible hypertension, syncope, or tachycardia.
• Smoked marihuana is not recommended in patients with respiratory insufficiency
such as asthma or chronic obstructive pulmonary disease.
• Marihuana should be used with caution in patients with a history of substance
abuse, including alcohol abuse or dependence, because they may be more prone to
abuse marihuana, which itself, is a frequently abused substance.
• Patients with mania, depression, or schizophrenia should be under careful
psychiatric monitoring if marihuana is taken, because it may exacerbate these
illnesses.
• Marihuana should be used with caution in patients receiving concomitant therapy
with sedatives, hypnotics or other psychoactive drugs because of the potential for
additive or synergistic CNS effects.
• Patients should be advised of the negative effects on memory and to report any
mental or behavioural changes that occur after using marihuana.
7.2 Dependence and withdrawal
Tolerance, psychological and physical dependence may occur with prolonged use of
marihuana. Tolerance to cardiovascular effects occurs quickly, but the dependence is
slower to develop and appears more likely with higher, more frequent dosing.
7.3 Special populations
Marihuana should be used with caution in pregnant, pediatric and elderly patients,
because there is insufficient knowledge about its use in these patient populations and the
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potential for harm is likely to outweigh benefits (see Warnings, Pregnancy and
Lactation).
7.4 Drug interactions
THC and CBD are metabolized by the cytochrome P450 system and in vitro human
microsomal studies have suggested a potential for interaction with other drugs. CBD has
been shown to inhibit formation of THC metabolites catalyzed by CYP 3A with less
effect on CYP 2C9. For this reason there is concern that in patients undergoing multiple
drug therapy, such as treatment of AIDS or cancer, clinically significant drug interactions
might occur. However, both with dronabinol and smoked marihuana clinically
significant interactions have not been detected. Protein binding is another possible source
of interaction and patients exposed to marihuana should be monitored for a change in
dosing requirements if they are taking other drugs that are highly protein-bound.
7.5 Drug screening tests
Because of the long half-life of elimination of cannabinoids and their metabolites, drug
screening tests can be positive long after using marihuana (weeks with some tests).
8.0 Adverse Effects
This section includes known cannabis-related effects (e.g., cardiac) as well as effects related to
smoking (e.g., respiratory).
8.1 Carcinogenesis, mutagenesis and respiratory tract
The only epidemiological study in relatively young health maintenance organization
(HMO) clients found an increased number of men with prostate cancer in smokers of
cannabis and other non-tobacco materials. In this study, limited by the demographics of
the HMO clientele and the low marihuana exposures, there were no other associations
found between marihuana use and other cancers (Sidney, et al., 1997). A case control
study (Zhang, et al., 1999) suggested that marihuana use may increase the risk of head
and neck cancer with a strong dose-response pattern. The risk was increased 36-fold in
those using both marihuana and tobacco compared to non-smoking controls. There has
also been a rise in the number of cancers of the respiratory and digestive systems that are
rare in young patients and are attributed to marihuana smoking (Hyman, 1999; Hall, et
al., 1998). In addition there are many cellular and molecular studies that provide strong
evidence that smoked marihuana is carcinogenic (National Academy of Sciences, 1999, p
3.41).
Epidemiological studies have found mild pulmonary function changes in heavy cannabis
smokers, including reduction of forced expiratory volume in 1 second (FEV1), increase in
airway resistance and decrease in airway conductance (Bloom, et al., 1987; Roth et al.,
1998; Tashkin, et al., 1987). Heavy chronic smokers presented with symptoms of
bronchitis, including wheezing, production of phlegm and chronic cough and it may be a
risk factor for chronic obstructive pulmonary disease in later life (Hall, et al., 1998;
Taylor, et al., 2002). All changes were most evident in heavy chronic users, defined as
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those who smoked more than 3 joints per day for 25 years (Sidney et al., 1997; Tashkin,
1999). The effects on the respiratory tract defence system may increase the risk of
infection in chronic users (Denning, 1991). Thus although additional epidemiological
studies are required to determine the potential causal relationship between marihuana use
and the development of respiratory infection and/or cancer, evidence is mounting that
habitual smoking of marihuana has a number of adverse effects on the respiratory and
immune systems (see below) that may be clinically relevant (Tashkin, et al., 2002).
8.2 Immune system
The effects of marihuana smoking on the immune system are inconclusive. Among
patients suffering from AIDS, the increased mortality and reports of opportunistic
bacterial and fungal infections associated with marihuana use cause concern. Reviews
suggest (Cabral, 2001; Klein, 2001) that such patients may be exposed to more pathogens
or that the immune system is suppressed by marihuana (National Academy of Sciences,
1999, p 3.39).
8.3 Reproductive and endocrine systems
Results of human epidemiological studies have been conflicting; some report reduced
birth weight (Zuckerman, et al., 1989) and others no effect on birth weight (Shiono, et al.,
1995) among women who smoked cannabis during pregnancy. There appears to be some
long-term effects on development of children born to mothers who used marihuana
during pregnancy. Two longitudinal investigations over 20 years (Fried, 2002),
confirmed by a third (Richardson, et al., 2002), suggest that such in utero exposure
impacts negatively on attentional behaviour and visual analysis/hypothesis testing but not
on standardized derived IQ scores. In later years these behavioural effects have a negative
influence on aspects of executive function. Also, frequent maternal cannabis use may be
a weak risk factor for sudden infant death syndrome (SIDS) (Scragg, et al., 2001).
There is little information concerning transfer of cannabinoids and their metabolites in
human milk (Chao, et al., 1976; Perez-Reyes, et al., 1982). However, in habitual maternal
users of marihuana the above influences in development and behaviour would also be
relevant. In a case-control study (Astley, et al., 1990), exposure to marihuana from the
mother’s milk, during the first month postpartum, appeared to be associated with a
decrease in infant motor development at one year of age.
8.4 Cardiovascular effects
The most consistent acute physiological effect of smoking marihuana is dose-related
tachycardia (Trouve, et al., 1999). While cardiovascular changes have not usually been a
problem for healthy young users, the tachycardia induced by cannabis smoking may be
problematic to those already suffering from cardiac disorders or angina (National
Academy of Sciences 1999 p 3.44). It was found that inhalation of cannabis smoke
reduces the amount of exercise required to cause an attack by 50% (Aronow, et al.,
1974). Recently, marihuana has been associated with an increased relative risk of
nonfatal myocardial infarction in the first hour following smoking (Mittleman, et al.,
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2001). This may be due to increasing myocardial oxygen demand from the increase in
heart rate following cannabis use. However, other drug use could confound reports
(Hollister, 1998).
Cannabis is known to cause postural hypotension immediately after smoking (Merritt, et
al., 1982). It also causes peripheral vasodilatation, which can impact on body
temperature perception and is involved in characteristic conjunctival reddening. The
mechanisms for those effects on the autonomic nervous system are not understood
(National Academy of Sciences, 1999p 3.44).
Chronic marihuana smoking appears to induce tolerance to the cardiac accelerating
effect. In fact, after about 8 days of constant dosing with equivalent of 10 mg of THC per
day (equivalent to 100 mg of marihuana containing 10% THC), bradycardia with
hypotension (decrease in supine blood pressure) was observed (Chesher, et al., 1999).
THC and smoked marihuana poses health risks to people with cardiovascular disease
because of the resulting increased cardiac work, increased catecholamine levels,
carboxyhemoglobin and postural hypotension (Trouve, et al., 1999; Jones, 2002; Sidney,
2002).
AIDS patients may be at risk of cardiovascular effects from interactions of their antiviral
drugs, such as ritonavir, which has been shown to cause plasma lipid abnormalities that
increase risk of cardiovascular events (Purnell, et al., 2000). As this patient population
may use cannabis for weight gain or other amelioration of symptoms, the additional
cardiovascular effects from the marihuana should be considered in risk assessment.
8.5 Central nervous system
According to the Marinol® (oral THC) product monograph, the most commonly
encountered CNS events in controlled clinical trials were drowsiness, dizziness and
transient impairment of sensory and perceptual functions (Compendium of
Pharmaceuticals and Specialties, 2003). Psychotropic effects were observed in most
patients; these included the “high” (easy laughing, elation, heightened awareness) in 24%
of the THC group. Five percent of patients in the THC group and none in the placebo
group experienced weakness or sluggishness, hallucinations, memory lapse and ataxia.
Other events reported were dry mouth, paresthesias, visual distortions (all at 3%),
paranoia, depersonalization (each 2%) and disorientation with confusion (1%).
8.5.1 Cognition
Marihuana impairs cognition involving short-term memory, attention and
concentration. The digit span task has been used to estimate the effects of
cannabis on recent memory, but results have been inconsistent. Differences may
be due to the dosage used (% THC), the smoking procedure or whether the digit
span task assesses forward or backward recall (Heishman, et al., 1989).
Methodological issues have contributed to difficulties in assessing the effects of
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chronic use (Pope Jr, et al., 1995). However, overall, studies suggest that chronic
users of marihuana suffer varying degrees of cognitive impairment that can be
long lasting (Hollister, 1998). Cannabis intoxication significantly impairs the
ability to learn and recall word lists or short stories. Recent studies comparing 51
long-term marihuana smokers (mean age 24 years) with nonsmoking and shortterm
user controls have confirmed that deficits in attention and memory occur
with heavy cannabis use, and that these continue beyond the period of intoxication
and are cumulative with longer periods of use (Solowij, et al., 2002).
8.5.2 Psychomotor performance
Cannabis exposure impairs psychomotor performance and patients must be
warned not to drive after smoking marihuana. The period of time to abstain from
operating complex machinery depends on the dose, the disease being treated and
the patient’s age and gender. Individuals are affected differently by prolonged
exposure to marihuana and there is some evidence of greater effects on
adolescents. Discrimination of marihuana’s effects from the normal effects of
aging on cognition and performance has not been fully researched (Solowij, et al.,
1999). Performance impairment appears to be less among people who are heavy
users of cannabis compared to occasional users (National Academy of Sciences,
1999, p 3.8). It has been suggested that, unlike alcohol, cannabis users are aware
of their level of intoxication and compensate to become hyper-cautious, resulting
in decrease of speed, decreased frequency of overtaking as well as an increase in
following distance (Gieringer, 1988). Others disagree with this assertion
(Moskowitz, 1985).
8.5.3 Behavioural effects
8.5.3.1 Psychiatric disorders
It is noted in the Marinol® (dronabinol, oral THC) product monograph
(Compendium of Pharmaceutical and Specialties, 2003) that this drug should
be used with caution and careful psychiatric monitoring in patients with mania,
depression or schizophrenia because Marinol® may exacerbate these illnesses.
This reflects the IOM report (National Academy of Sciences, 1999, p 3.23,
3.29) and also the knowledge that psychiatric disorders are associated with
substance dependence and are risk factors for drug abuse.
Acute toxic reactions such as nausea, anxiety, paranoia and disorientation often
occur in naïve marihuana smokers but are uncommon in regular users (Noyes
Jr, et al., 1975). The triggering of psychosis by marihuana has not been
definitively established, but it appears that cannabis is frequently used by
psychotic patients (Hollister, 1998). Heavy cannabis smoking, and even lighter
use in susceptible individuals, can produce an acute psychosis including
anxiety, agitation, amnesia, delusions, hallucinations and hypomanic symptoms
(Australian Commonwealth Government, Department of Health and Ageing,
1994).
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8.5.3.2 Schizophrenia
Self-reported use of cannabis in childhood has been associated with an
increased risk of developing schizophrenia and this risk was related to
frequency of marihuana exposure (Zammit, et al, 2002). A cohort study of
over 1000 children, followed to age 26 from birth, showed a three-fold
increased risk of psychotic disorders in cannabis users and suggested that
cannabis exposure among psychologically vulnerable adolescents should be
strongly discouraged (Arseneault, 2002, p 1212-1213). Heavy marihuana use
can aggravate symptoms and cause more relapses (Alleback, 1999; National
Academy of Sciences, 1999, p 3.29). Follow-up studies confirm the increased
risk of poor prognosis in psychosis for those using marihuana (Caspari, 1999;
van Os, et al., 2002). Individuals with schizophrenia or with a family history of
this disorder are likely to be at greater risk of suffering adverse psychiatric
effects from marihuana (Johns, 2001).
8.5.3.3 Amotivational syndrome
This syndrome is used to describe young people who show little interest in
school, work or other goal-oriented activity as well as withdrawing from social
activities. While it is an ill-defined condition, this is a common feature of
chronic intoxication with many different psychoactive drugs and when the
chronic intoxication is treated or “cured” the behaviour improves. There is no
convincing evidence to show a casual relationship between marihuana smoking
and such behavioural characteristics (National Academy of Sciences, 1999, p
3.31).
8.5.3.4 Dependence and tolerance
Tolerance to most of the effects of marihuana can develop after a few doses
and it also disappears rapidly (National Academy of Sciences, 1999, p 3.8). In
normal subjects tolerance develops to mood, intraocular pressure, EEG
changes, psychomotor performance, antiemetic effects (Jones, et al., 1976) as
well as to cardiovascular effects (Compton, et al., 1990). The dynamics of
tolerance differs for different effects (Pertwee, 1991). Tolerance to some of the
cannabis effects develops both when THC is administered orally (30 mg four
times a day) and when a roughly equivalent dose was given by smoking
(Haney, et al., 1999) (3.1% cigarette, 5 x 10 second puffs). Both groups
became tolerant to the “high”, but there was no diminution of the appetite
stimulating effect from either route of administration.
There is evidence that cannabis dependence occurs with chronic heavy
recreational use. Some individuals report problems in controlling such use
despite resulting personal difficulties (Australian Commonwealth Government,
Department of Health and Ageing, 1994; Stephens, et al., 1993). Dependence is
unlikely to be problematic when cannabis is used therapeutically although
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withdrawal effects may be uncomfortable (British Medical Association, 1997,
p 67). These include restlessness, anxiety, mild agitation, irritability, tremor,
insomnia and EEG/ sleep disturbance, nausea, diarrhea and cramping.
Withdrawal has been studied in subjects, including adolescents who smoked
marihuana recreationally (Crowley, et al., 1998). These effects are considered
mild compared to the physical “syndromes” experienced with alcohol or opiate
withdrawal (Jones, et al., 1976) and the pattern of withdrawal is less clear than
for these drugs (Smith, 2002).
9.0 Overdose/Toxicity
The LD50 is estimated to be 20,000 to 40,000 times the amount in one marihuana cigarette
(approximately 1500 lb) smoked in a period of 15 minutes (Annas, 1997). Marihuana is not a
completely benign agent and it has a variety of physiological effects, but aside from the hazards
consequent to smoking, the adverse effects are within the range tolerated for other medications
(National Academy of Sciences, 1999, p3.49). Cannabis often produces unwanted effects,
typically dizziness, sedation, intoxication, clumsiness, dry mouth, lowered blood pressure or
increased heart rate (Robson, 2001). The rare acute complications (such as panic attacks,
psychosis, convulsions, etc.) that present to the Emergency Department can be managed with
conservative measures (Seldon, et al., 1990). As is stated for overdose with Marinol®
(Compendium of Pharmaceuticals and Specialties, 2003), signs and symptoms with smoked
marihuana are an extension of the psychotomimetic and physiologic effects of THC. If disturbing
psychiatric symptoms occur at the prescribed dosage, the patient should be closely observed in a
quiet environment and supportive measures, including reassurance, should be used.
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marihuana as compared to tobacco. New England Journal of Medicine, 1988; 318
145. Zammit, S., Allebeck, P., Andreasson, S., Lundberg, I., Lewis, G. Self reported cannabis
use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort
study. BMJ 2002; 325: 1199-1201
146. Zhang, Z.F., Morgenstern, H., Spitz, M.R., Tashkin, D.P., Yu, G.P., Marshall, J.R., Hsu,
T.C., Schantz, S.P. Marijuana use and increased risk of squamous cell carcinoma of the
head and neck. Cancer Epidemiol Biomarkers Prev 1999; 8: 1071-1078
147. Zuckerman, B., Frank, D.A., Hingson, R., Amaro, H., Levenson, S.M., Kayne, H.,
Parker, S., Vinci, R., Aboagye, K., Fried, L.E. Effects of maternal marijuana and cocaine
use on fetal growth. N Engl J Med. 1989; 320: 762-768

Medicinal marijuana for ADHD and Tourettes

Source: http://www.brendastardom.com/arch.asp?ArchID=391



A woman doctor in Ventura County believes it is. Of course there's intense opposition to her findings. Ever since Reefer Madness, the world has viewed marijuana as a dangerous drug. Nothing could be further from the truth.

I'm so glad I received an email from a friend in California this morning about her daughter who has always been thought of as having ADHD (attention deficit hyper disorder). Rachel fought the school over giving Cindy the standard dangerous drugs to control her, but was dismayed at her grades and the trouble she was always in. To her shock, Cindy, now in Junior High, just got an excellent report card.

Weeks before grades came out, Rachel had written that she'd discovered Cindy smoked pot and she was beyond distraught, buying into the tried and tired bit that it's a gateway drug, leading to the hard stuff. I wrote back and told her that was total nonsense, that kids experiment at Cindy's age and not to come down hard on her, as it could make things worse. She was worried about her education and that she was headed down the wrong path and revealed that well-meaning friends and family were giving her too much advice, but it all boiled down to putting Cindy on a very short leash.

The good grades turned Rachel's head around from thinking that pot had probably turned Cindy's brain into mush and she'd flunk. What bunk! She gave me a URL to an article she'd discovered in the local paper and asked me to read it and tell her what I thought. I actually cheered upon reading it. Well, there were some boo's, too, aimed at the pathetically ill-informed debunkers.

Put that pre-judgement away and read this, please. Headlined: "Ventura physician promotes marijuana to treat attention disorders." from the Ventura County Star. I'm surprised they printed it and happy they did.

"Dr. Claudia Jensen has seen marijuana help lawyers focus in court, executives excel and adolescents get good grades.

The drug often associated with slackers can do more than Ritalin and other stimulants to motivate millions of Americans with attention disorders, says Jensen, a physician at the Center for Integrated Health in Ventura.

"It can calm you down; Ritalin amps you up," Jensen said. "Cannabis can help you sleep; Ritalin gives you insomnia. Cannabis gives you an appetite; Ritalin makes you anorexic."

Jensen is one of a handful of California doctors invoking state law to approve marijuana, medically known as cannabis sativa, for adults and adolescents who have difficulty with routine daily tasks because they have attention-deficit disorder or attention-deficit hyperactivity disorder. On Thursday, Jensen will have five minutes to convince a congressional subcommittee in Washington, D.C., that the drug works."

I have to say this article has me pumped. There's been huge focus on medicinal marijuana for everything from AIDS,chronic pain to glaucoma and particularly as the substance of choice to control nausea and vomiting in chemotherapy patients. Look at San Francisco and Northern California and the strides made there to make it legal for those in need of non-chemical relief. I've never read of it being used on kids with these disorders, but it sure makes sense to me.

Back to the article, check out what one of Jensen's fellow doctors has to say. What century or better, what planet is this guy on? It's this kind of thinking that stunts progress and in turn, messes up a lot of kids whose parents take his advice.

"When someone is high on marijuana, they are not able to process properly, they have more problems with their focus and attention, and it is well known that marijuana causes short-term memory problems," said Dr. Loren Label, head of the ADD Clinic in Thousand Oaks.

Is that why Cindy got a 3.0 grade average? She's not hyped up on behaviour-controlling drugs, she smokes pot and is a top student. Doesn't that say something? Her mom didn't know she was smoking before school because Cindy knew she'd wig big time and would never understand how it helps her focus. It's a sad fact that most parents are of the belief that their pot-smoking kid is going to wind up dead in an alley with a needle that contained heroin in their arm. Wake up! That's not the case, dammit, and of course, there are kids as well as adults who shouldn't smoke the wild weed, as not all chemical make-up's are the same, but for those that it helps, where's the fucking problem?

I point a finger at the haha War On Drugs and it's complete failure. I shake one at educators who order their students to take dangerous chemicals just so they won't have to be dealt with and of course the money they receive. Pot could be a life-saver for overly hyper kids who won't take the pills. Finally, an alternative, but a very unpopular one it is, in spite of testimony from so many as to how it's benefited their lives, and the cry is always, "they're kids!!" I agree, this is a radical departure from standard treatment, but a good radical approach to organic vs chemical. Mydog, they give them something similiar to cocaine and balk at the benign marijuana?

Jensen and the others aren't alone -- they have back-up in Oregon. From hevanet, no date but it must be fairly recent. Give this puppy a read, but I must warn that it's highly technical and easy to scan through, but it gets into the different kinds of ADD and how little is known about the variants. Headline:

"Marijuana and ADD
Therapeutic uses of Medical Marijuana in the treatment of Attention Deficit Disorder"

"It was mentioned in the Portland newspaper that the Oregon Health Division is considering allowing medical marijuana to be used to treat Attention Deficit Disorder (ADD) under the Oregon Medical Marijuana Act. At first glance it might seem counter-intuitive to use a medication that has a public perception of decreasing attention to treat a condition whose primary symptom is a deficit of attention. But just as taking stimulants often calms those with hyperactivity, medical marijuana improves the ability to concentrate in some types of ADD." Oh yeah, this is bigger than first thought. Wow, this next part hits home!

The particular type of ADD under consideration for treatment with medical marijuana might better be termed "Racing Brain Syndrome" (RBS). A useful analogy for this mental condition is that of a centrifugal pump that is being over-driven. As the pump speed increases, cavitation sets in and the pump's output decreases. The faster the pump is driven the greater the cavitation until a point is reached where large amounts of energy are being input but nothing is being output. Without medication there is a sensation that thoughts flash through the brain too fast to "think" them. Medical marijuana slows the brain down sufficiently to achieve impressive improvements in functionality."

Listen to what a retired Harvard Medical School psychiatrist and author of 2 books on medicinal marijuana has to say about ADHD and marijuana in the question and answer section of his site, rxmarihuana.

"Dear Dr, Grinspoon:

Hilary Black at the Compassion Club in Vancouver B.C. Canada gave me your name. I am a Master's student who is conducting a qualitative inquiry on the relationship between ADHD and the use of marijuana. I have had a very difficult time finding any literature on this specific topic. It would appear that there is very little evidence on what marijuana does for these folks. My research is almost completed and the stories from the five participants are great. It is clear that cannabis offers a sense of calm and "normalcy". But my lit review is still lacking and I was hoping that you could offer me some suggestions. Has no one else ever published an inquiry on the effects of marijuana on ADHD? Has no one else ever listened to their stories?

I look forward to your response.

Thank you very much.

Cheers,
Debbie Verkerk

Dear Ms. Verkerk,

It was more than a decade ago that I first had the experience of observing a high school student with ADHD treat this disorder much more successfully with cannabis than with his doctor-prescribed Ritalin. His mother (now deceased), a vice president of the Massachusetts Institute of Technology, who had asked me to see him for evaluation, was also persuaded that he did much better while using cannabis than he ever did with Ritalin. Since that time I have seen a number of patients, both young people and adults, who have had similar experiences. I have also heard from many others; still I have seen no reference to this possibility in the scientific or medical literature. I think that we are now in the same situation we were with Tourette's syndrome about a decade ago; a number of anecdotal reports but nothing in the medical literature. Today you can find citations in the literature on cannabis as a treatment for Tourette's. The bottom line is that this use of cannabis for the treatment of ADHD is still in the clinical observation or anecdotal stage, and it may be impossible to find the citations you seek.

With best wishes for success with your paper,

Lester Grinspoon MD"

There you have it, it's still being studied, not much information is available, but I can't help but think if a wise parent had to choose between legal speed (which is what Ritalin and the others are) and marijuana, they'd choose the latter. I know I would. I wish Dr. Claudia Jensen the best of luck when she visits DC. I realize this is most controversial and is liable to evoke some pretty strong criticism, but all I want is for people to think about it and the lesser of evils. I thank Rachel for bringing this to my attention. I wrote, "Legally Drugging the Kids" eight months ago and it's accessed daily. What does that tell you?

"Marijuana is the safest therapeutically active substance known to man... safer than many foods we commonly consume."
-- DEA Judge Francis L. Young


Brenda Stardom
Portugal


2002-2008 © Brenda Stardom

Burnt marijuana smell not proof of drug: Canadian court

OTTAWA (AFP) - A Saskatchewan appeal's court upheld a decision that
the smell of burnt marijuana is not evidence of illegal drug
possession since by definition the proof has gone up in smoke, it said
Wednesday.
(Advertisement)

"The smell of burnt marijuana does not reasonably support the
inference that additional marijuana is present," the three-judge panel
said in newly-released court filings.

Thus, police "did not have reasonable grounds to search" the truck of
Archibald Janvier after his roadside arrest in 2004 for narcotics
possession, the judges said in maintaining his acquittal.

Police had originally stopped Janvier's truck in La Loche,
Saskatchewan, in western Canada, to ticket him for a busted tail
light.

At trial, the arresting officer testified he had smelled the "pungent
odor of burnt marijuana" coming from inside Janvier's truck, charged
him with illegal drug possession, and then searched his vehicle.

The Royal Canadian Mounted Police constable found eight grams of
marijuana in Janvier's coat pocket, boot and truck console, but that
evidence was thrown out.

Archibald's lawyer Ronald Piche successfully argued the warrantless
search and seizure were "unreasonable" because the aroma of burnt
marijuana -- as opposed to raw marijuana -- infers that the drug has
dissipated.

"How can you say you're in possession of something that doesn't
exist," Piche told the daily Saskatoon Star Phoenix.

Senate health committee to discuss medical conditions as possession defense

Marijuana on panel agenda
Senate health committee to discuss medical conditions as defense
By James Carlson
The Capital-Journal
Published Monday, February 11, 2008

A Senate health committee will hear testimony today on a bill that
would allow certain medical conditions as a defense against
prosecution for marijuana possession.

Under the Kansas Medical Marijuana Act, people with a debilitating
disease could present to the judge a "written certification" from
their doctor attesting to the relief marijuana provides.
Print E-mail Comment

"(This bill) doesn't legalize marijuana, it doesn't decriminalize it,"
said Laura Green, director of Kansas Compassionate Care Coalition. "It
just allows a person who has a serious debilitating medical condition
who gets arrested for marijuana to bring it up to a court."

Jon Hauxwell, a physician from Hays, will testify in favor of the
bill. He used to work on a reservation in Montana where he dealt with
substance abuse issues. He said he understands the opposition to this
bill, but he added that the medical community has never allowed those
who abuse a drug to deter doctors from prescribing it to patients in
need. He listed morphine and Ritalin as other legally prescribed drugs
to which patients can get addicted.

"We shouldn't throw the baby out with the bathwater," Hauxwell said.

Former Attorney General Robert Stephan, a cancer survivor himself,
also will testify in favor of the bill. In August, he came out in
favor of legalizing the drug for medical use.

He said at the time he believes "the state should not pre-empt the
role of the physician when it comes to deciding what is best for ill
Kansans."

The legislation defines a debilitating condition as "cancer, glaucoma,
positive status for human immunodeficiency virus, acquired immune
deficiency syndrome, hepatitis C, amyotrophic" or any other condition
that causes a host of debilitating symptoms.

Current law doesn't allow judges or juries to consider a medical
condition when prescribing punishment for possession of the drug.

"You can't even mention it," Hauxwell said.

The bill faces an uphill battle in a state wary of legislation that
even smells like marijuana legalization. Senate Health Care Strategies
Committee member Sen. Vicki Schmidt, R-Topeka, opposed the
introduction of the bill. She said there was no way of standardizing
dosages of marijuana.

And committee chairwoman Sen. Susan Wagle, R-Wichita, who is in
remission from stage four non-Hodgkin's lymphoma and whose son
survived leukemia, said in a recent article about medical marijuana
that there are other drugs on the market that work.

Ottawa seeks appeal on medical marijuana ruling

Feb 07, 2008 07:32 PM
Maria Babbage
THE CANADIAN PRESS

Ottawa is asking for an appeal of a Federal Court decision that struck
down a key restriction in the government's controversial medical
marijuana program.

The Jan. 10 decision allowed growers to supply medical marijuana to
more than one patient, effectively loosening the government's tight
grip on accessing the drug.

The court erred in concluding that a restriction preventing growers
from supplying the drug to one person is unconstitutional, the
Department of Justice said in court documents filed Jan. 31.

Justice Barry Strayer also erred in concluding that the provision was
forcing medical users to obtain the drug on the black market, the
documents state.

Prior to the January ruling, medical users could grow their own pot,
but growers like Carasel Harvest Supply Corp. couldn't supply the drug
to more than one user at a time.

The federal government is seeking that the Jan. 10 judgment be set
aside and that it be awarded legal costs.

Lawyers representing medical users, who considered the Jan. 10
decision a victory, also filed for a cross-appeal of the ruling.

They say the court should be monitoring the federal government to
ensure it's not unfairly restricting access to the drug by denying
licences to growers who want to produce medical pot for a number of
users.

Strayer erred in not requiring the court to "retain ongoing
supervisory jurisdiction" over Health Canada or order the government
to periodically report back to the court on its progress, according to
a court document filed Tuesday by Toronto lawyer Ron Marzel.

"The record before the court contained ample evidence that the
government of Canada, the minister of health and Health Canada have,
since 1999, delayed and frustrated reasonable access to medical
cannabis," the document states.

Lawyers for medical users had argued that the restriction preventing
growers from producing medical pot for more than one person at a time
effectively established Health Canada as the country's sole legal
provider.

They said the restriction was unfair and prevented seriously ill
Canadians from obtaining the drug they need to treat their
debilitating illnesses.

The provision had been struck down by the courts before, but was
reinstated by the government which contracted Prairie Plant Systems
Inc. in Flin Flon, Man., to grow the drug for patients.

Previous governments have been uncomfortable with their role as a
cannabis supplier. Former Liberal health minister Anne McLellan, an
unabashed opponent of the program, was reluctant to provide the drug
to patients.

Lawyers representing medical users have accused Ottawa of trying to
buy time until pharmaceutical companies come up with marijuana
products, so it can wash its hands of the program.

The case challenging the restriction began in 2004 and was heard
before the Federal Court in December.

No date has been set for the court to hear the appeal and cross-appeal.

Canadian say yes to legalizing marijuana

according to the Angus Reid poll I just took. a majority of Canadians think Marijuana should be legal in Canada

growing resources

check out these neat compact garden tool sheds fitted for growing your
own medicine.

recourse website on medicinal marijuana

http://www.medicalmarijuanainformation.com/home/

We ( Canada) aren't smart enough to legalize marijuana ( letter to the editor )

NP Network Blogs

THE EDITOR:

Re: 'Medicinal marijuana has many challenges' (Our View, Daily News, Jan. 29).

You are quite right in stating that medical marijuana has many
challenges. Unfortunately, the major one will be overcoming the lies
and propaganda perpetuated by the drug war.

Your statement that the "idea that recreational drug use is in any way
socially acceptable has to be fought" made me wonder where you have
lived all of your life. Alcohol is a drug that is used recreationally
by millions of Canadians every year. Our governments make millions of
dollars off it and you advertise and promote it in your newspaper.
While it is also true that some Canadians are irresponsible with
alcohol, most are not. The same can be said for marijuana users.

The report of the Senate Special Committee on Illegal Drugs was a joy
to read. The nine senators stated very plainly that the war on
marijuana was a failure. Canadian citizens have been harmed far more
from marijuana prohibition than from the plant itself. The Senate
committee recommended outright legalization with people being able to
grow a reasonable number of plants for personal use. While they
realized that it was a bold step, they believed that Canadians had the
intelligence and maturity to welcome such a debate. Unfortunately, the
Senate committee grossly over-estimated the intelligence of our
government in Ottawa.

The only reason marijuana is still illegal today is because too many
people make too much money from the drug war. It is perverse to think
of how much money is wasted in the United States on the drug war,
which is partially funded by a beer company. I'm sure you cannot help
but notice the hypocrisy. The cops, the crooks, and the workers in the
court and prison system all have guaranteed employment. Now the
government wants to build more jails to lock up people who grow even
one plant. It is not hard to see whose buddies will benefit from that
decision. With all of the corruption because of the illegality of
drugs, it is hard most days to tell who the crooks are.

Growing pot poses no security threat at all, but marijuana
prohibition, and the violence that has resulted from it, certainly
does. I find it almost humourous that the public gets so concerned
about children found in homes with grow-ops, that when installed
properly would not pose a threat, but we ignore children living in
mouldy basements or worse due to poverty.

Where is that intelligence and maturity that the Senate committee was
so sure Canadians had?

Lynne Williams

Nanaimo

Source:National Post

Medical marijuana advocates cry foul

Medical marijuana advocates cry foul

By Shannon Kari, National Post Published: Sunday, February 10, 2008

Companies can fire employees who use marijuana for medical reasons
even if California law allows such use because federal law prohibits
it, the state's Supreme Court ruled on Thursday.

It was more than 35 years ago that the LeDain Commission recommended
marijuana be decriminalized in Canada.

Attempts to suppress or even control its use were failing, possession
laws were enforced on a "selective and discriminatory" basis and its
prohibited status invited "exploitation" by criminal elements,
concluded the Royal Commission in 1972.

It suggested the government regulate cannabis in the same way as
alcohol, which resulted in proposed legislation to decriminalize
possession. The bill died on the order paper when a federal election
was called in 1974, in the same way that a similar bill died 30 years
later.

Today, discussion about reforming the country's marijuana laws is not
on the political landscape. If anything, the country is moving in the
opposite direction.

The government of Stephen Harper has ruled out any changes to the law,
and during a visit to marijuana-friendly Vancouver last week, Liberal
leader Stéphane Dion said his party is not going to advocate for the
end of criminal sanctions for possession.

Another sign that the marijuana lobby has lost political momentum is
the recent announcement by Marc Emery that he is giving up his
extradition fight. The self-professed "Prince of Pot" is negotiating a
plea bargain with U.S. authorities to try to reduce a prison sentence
for selling marijuana seeds over the Internet.

As well, almost 45,000 criminal charges for simple possession continue
to be laid each year, up nearly 20% from a decade ago.

Even the 2,200 people in Canada authorized to possess marijuana for
medical reasons have not been able to convince Health Canada to ease
restrictions to make it easier to access a legal supply of what they
consider to be their medicine.

Late last month, the federal government appealed a Federal Court of
Canada ruling that found medical marijuana regulations to be
unconstitutional for the third time in eight years.

"There is a cycle of ignorance that seems impossible to transcend" in
any discussion about marijuana, suggested Alan Young, a professor at
Osgoode Hall law school in Toronto, who has represented chronically
ill people in a number of medical-marijuana court challenges. "We are
either running on the spot or moving backwards," he said.

Medical-marijuana users have long complained about the bureaucratic
obstacles in dealing with Health Canada, when it involves licences for
legal possession or production of the drug.

Its actions have also repeatedly been criticized by the courts. Part
of the medical-marijuana regulations were struck down in 2003 by the
Ontario Court of Appeal because there was not a sufficient legal
supply of the drug and designated producers were permitted to grow for
only one person with a licence to possess.

In response, Health Canada re-enacted virtually the same restrictions.

As a result, Federal Court Justice Barry Strayer ruled last month that
the new regulations were also unconstitutional.

He noted that fewer than 20% the people with licences to possess
marijuana, acquire it from Prairie Plant Systems Inc., the company
licensed to produce for Health Canada.

Requiring citizens to break the law and access the black market to
acquire their medicine is "contrary to the rule of law," said the
75-year-old judge, who was a senior official in the federal Justice
Department in the late 1970s.

The government's appeal of the decision is part of an ongoing strategy
to marginalize the medical-marijuana program, suggested Mr. Young.
"This is a program the government never wanted to undertake," he said.

For medical users who have licences to produce their own marijuana,
there is also the constant threat of criminal prosecution.

Derek Pedro, a 35-year-old former construction industry employee who
suffers from a connective tissue disorder, said he is still trying to
rebuild his life after five police officers in Hamilton, Ont., raided
his home in January, 2007. Police seized 15 seedlings and charged Mr.
Pedro with production offences, even though he has licences to possess
and to grow marijuana. Eight months later, all charges were withdrawn.
"I am stressed all the time. I start shaking when I see police," Mr.
Pedro said. "I thought I had rights."

Using marijuana has been effective in dealing with his chronic pain
and it has also enabled him to dramatically reduce his intake of such
pharmaceutical drugs as OxyContin, Mr. Pedro said. The marijuana he
produces costs him less than one-sixth the price that Health Canada
charges for the product from Prairie Plant Systems, he noted.

Even the Canadian Association of Chiefs of Police agrees there is need
for improvement in access for approved medical-marijuana users.

"We need to find a better way to get that drug to them in a safe and
reliable way," said Fredericton police Chief Barry MacKnight, who
heads the organization's drug-abuse committee.

As well, the association has supported changes to the marijuana
possession laws so that police could impose fines if appropriate.
"Police officers must have the discretion to decide whether to issue a
ticket or to send it to court," stressed Chief MacKnight, who does not
support outright legalization of what he described as a harmful drug.

The tens of thousands of possession charges laid each year are likely
a result of cases where individuals face a number of other charges as
well and not someone "standing on the corner smoking a joint," Chief
MacKnight said.

The ongoing criminal prohibition against marijuana is a useful tool
for police, because it can be used as a pretext to search cars and
homes for evidence of more serious crimes, said Vancouver defence
lawyer Simon Buck.

While the public may approve of these tactics when police find weapons
or other illegal items, it is impossible to know how many times these
searches come up empty-handed, Mr. Buck said. "You never hear about
those cases," he noted.

Source: Today's National Post

In Cannabis he trusts

Source:http://www.themonitor.com/news/marijuana_8702___article.html/zuniga_use.html

Jackie Leatherman
February 3, 2008 - 2:51PM

EDINBURG — He calls himself the Rev. Adam E. Zuniga.

His religion is illegal.

According to his business card, he is ordained by the Shemshemet Ministry, which teaches the Cannabis Sacrament.

“It’s a means to my survival, spiritually,” he says.

For Zuniga, his Eucharist is pot. But he doesn’t call it that.

“Please refer to it as cannabis. I don’t refer to propaganda names. It’s sacrament. It’s herb. It is a plant.”

In July 2003, the 27-year-old had just wrapped up working security in the U.S. Air Force, and was awaiting an instructor position at Lackland Air Force Base in San Antonio.

That’s when a car accident changed his life. He hydroplaned while driving in the rain and collided with several trees.

Prior to the accident, Zuniga says he dabbled in marijuana use in high school, but switched to cigarettes when he joined the Air Force.

After shattering several bones in his left arm and tearing ligaments in his right leg during the car accident, he found himself chasing the strong pain medicine he was prescribed with beer, and still feeling the pain.

It took one year before a friend finally convinced him that he had become addicted to prescription medicine.

Right about that time, his girlfriend, a nursing major, turned in a research paper at the University of Texas-Pan American on cannabis and its medical affects.

Through his own research, Zuniga discovered the drug could help him.

What he didn’t expect was that it would also help him spiritually, too.

“I don’t just want to smoke cannabis. I want to live my life comfortably,” he said. “It’s not just ‘quote unquote’ pot.”

Shemshemet Ministry
Today, Zuniga uses a cane. Doctors tell him it’s just a matter of time before he’ll need a full knee replacement.

An anthropology student at UTPA, he lists “The Allegory of the Cave” by Plato and “Constantine’s Sword: the Church and the Jews” by James Carroll — a controversial book that argues the historical fight of the church’s battle against Jews — as some of his favorite reads on his Facebook page.

It doesn’t take long to tell Zuniga has emphatically researched the history of all religions and the role that natural, now-prohibited drugs have played in them. He knows his stuff.

Though his studies, he stumbled upon the Shemshemet Ministry.

The organization’s Web site states: “Celebrating our constitutional right to practice religion in the USA.”

It further states that the ministry provides education in spirituality that will “help to protect you from arrest, prosecution and/or conviction of ‘marijuana’ charges — wherever you live — starting as soon as you sign-up, become ordained and receive your ministry documents.”

Zuniga says God made the marijuana plant and his body, which allows for the two to combine.
He advocates that natural drugs currently prohibited by law — including hallucinogenic mushrooms — should be legalized. He says his practice is a basic human rights issue. What he does with his own body, and in his own home, is his business, he says; he isn’t hurting anyone else.

“It is about the greater whole,” he said. “I’m fighting for everyone, just like the military. I want people to realize that they have a right to question.”

Hidalgo County Sheriff Lupe Treviño, who’s taught criminal justice courses at UTPA, says Zuniga’s assertions aren’t based on any legal fact or right. It is illegal to possess marijuana in Texas, and like in every other state but 10, its use for medicinal purposes is prohibited. The severity of the charges someone like Zuniga could face depends on the amount in possession, Treviño said.

“Obviously, he is very well misinformed,” the sheriff said. “He is putting himself in peril of being arrested for possession of marijuana.”

“Nirvana”
In 2005, the U.S. Supreme Court declared medical marijuana patients are subject to federal prosecution even if they live in a state that allows medicinal use of marijuana. There are several grassroots groups like the Shemshemet Ministry that uphold the use of medicinal marijuana, including the credible national organization Americans for Safe Access, but their cause has struggled.

Douglas Laycock, a professor emeritus at the The University of Texas at Austin, said there is no definition of when a religion becomes a religion: “it is a question of sincerity.”

“There is a very long history of religious use of hallucinogens,” he said.

But Laycock seem skeptical that the government would ever recognize marijuana use as a religious practice.

He said in the late 1960s Congress passed the Controlled Substance Act, which allowed Native Americans to use peyote — a small cactus that when eaten has powerful hallucinogenic affects.

And Ras Tafarians, a black Zionist movement that emerged in Jamaica in the 1930s, is known for using marijuana for spiritual purposes, according to the United Nations Office on Drugs and Crime.

They have been on court for years advocating their rights to use pot to practice their religion and have lost, Laycock said.

“If (marijuana) were exempt (from law for religious practice), how would the government ever enforce the marijuana laws?” Laycock said. “Every one would say they are a Ras Tafarian.”

Zuniga said when he “practices,” he uses the time for meditation and insight on historical and current global issues, as well as his own life. It allows him to reach deeper questioning, he said.

He said his first religious experience with cannabis came to him in winter 2005. He realized “the creation” says humans came from dirt, which is from where cannabis comes. So, when he puts the herb into his body and exhales the smoke, he is merely furthering the circle of life and releasing the organism back into Earth, a part of which he will be again when he is dead and buried.

“For me, it is a living organism that has the ability to show me that there is something that transcends me,” he said.

“It helps me to become a better human being. … I am reaching what Buddha called Nirvana.”

Community gardens for medical marijuana users? NEAT Idea.

Source:http://starbulletin.com/2008/02/04/editorial/editorial02.html

A state legislator from Maui has proposed a facility where patients using marijuana for medical purposes could grow their own under state protection. While well-intended, such a facility would invite a raid by the Bush administration's Department of Justice and probably would be unnecessary under a more compassionate federal government.

Rep. Joe Bertram would authorize the state Department of Health to create a facility on his island where a patient or caregiver would be given space to grow as many as 98 plants at a time. Such a facility would wave a red flag to federal zealots who stubbornly regard marijuana as a dangerous drug with no medical value.

The U.S. Supreme Court ruled in 2005 that the federal government may prosecute medical users of marijuana, even in the 12 states, including Hawaii, where marijuana is permitted for medical use. The Justice Department has been raiding California medical dispensary facilities since then, while Hawaii, which has no marijuana facilities, has kept a relatively low profile.

The state Narcotics Enforcement Division administers the medical marijuana law, and its chief, Keith Kamata, says the growing facility would violate federal law. More than 4,000 Hawaii patients have medical marijuana cards and such a facility would give them false assurance that their therapy with marijuana would be protected.

A better approach would be to improve protection to doctors recommending marijuana treatment for such ailments as nausea, vomiting and AIDS. Existing state law also could be revised to expand the "adequate supply" of marijuana, now limited to three mature plants, four immature plants and one ounce of usable marijuana.

USA Federal government stands in the way of a state-run medical marijuana distribution

SOURCE:http://www.nevadaappeal.com/article/20080204/NEWS/440177627
By Dave Frank
February 4, 2008, 4:01 AM


The water, the lights, the seeds, the soil. The problem could be several things.

Some patients will learn how to grow, said Claude Miller, a Nevada medical marijuana consultant. Some won't.

"There's patients who can't grow a flower," he said. "Much less medical marijuana."

That's part of the reason he started his business. Many of the 900 patients in Nevada's program know little about the plant when they register.

But those patients, despite a provision in state law, must grow their marijuana themselves or find a state-approved "caregiver" who will grow it for them.

"(Marijuana) is a godsend and it really helps people," said Miller, who supports medical marijuana only under a tightly regulated system.

Patients, however, will not be able to get the drug like other prescriptions the state recognizes unless the federal government changes its stance.

Following a 2000 ballot initiative, the state Legislature wrote the constitutional amendment into law including a section that ordered the University of Nevada School of Medicine to research marijuana and develop a program to distribute it to patients.

The 2001 law says the Legislature understands the state's "obligation" to research a distribution program, but also says it must do it with the permission from the federal government.

The ballot initiative, approved by 65 percent of voters, called for "appropriate methods for supply of the plant to patients authorized to use it." These patients include residents diagnosed with illnesses such as cancer, glaucoma and AIDS.

The federal government, however, rejects the opinion of the 12 states with medical marijuana programs.

"Smoked marijuana has not withstood the rigors of science," according to the Web site of the U.S. Drug Enforcement Administration. "(It) is not medicine, and it is not safe."

Federal authority

Federal policy, supported by the past three presidents, has stalled research and development of a state distribution program.

Dr. Dave Lupan, an associate dean at the state school of medicine, said the university has made "no progress whatsoever" on the legislature's mandate. It will stay that way at least until there is a new president, he said.

It is unlikely the policy will change under the next administration, though. Republican presidential candidates John McCain and Mitt Romney do not support legalizing medical marijuana. Democratic presidential candidates Hillary Clinton and Barack Obama are undecided.

But the university would have more problems than policy if it tried to start a program. Not only does the federal government have no interest in the school's research, Lupan said, the state has given no money for it.

"It's not only a matter of bucking federal government authority," he said, but of finding doctors to work for free.

The federal government itself has had medical marijuana evaluated several times. A 1999 federally-commissioned study by the Institute of Medicine reported, "the accumulated data indicates a potential therapeutic value for cannabinoid drugs, particularly for symptoms such as pain relief, control of nausea and vomiting and appetite stimulation."

The Federal Drug Administration, however, said in 2006 the medical use of the drug is not supported by science.

Green and black thumbs

A change in federal policy that led to state distribution could, according to supporters, help many patients.

Jennifer Bartlett, who manages the current state program through the Nevada Department of Agriculture, said "there are some who can't grow it, and it's a struggle."

She has not endorsed state distribution, however, and said many patients have no problems growing their own marijuana or finding a caregiver.

A state program would help all patients, though, not just those who have difficulty growing it, said Dan Hart, who managed the group that led the medical marijuana ballot initiative.

The state could make sure the medicine was good quality, he said, and this also would particularly help patients with a debilitating disease.

But some medical marijuana advocates, such as Chandler Laughlin, said the state should not be involved with marijuana and that a state-run program is a bad idea.

The Silver City resident and radio host did say many patients like him can't grow high quality marijuana.

"I have a black thumb," he said.

Bruce Mirken, who supports marijuana legalization, said a state-run program could make it easier for the state to both guarantee effective use for patients and track illegal use by others.

It can't be difficult for patients to get the medicine they need under the current program, he said.

"You could grow your own tomatoes, but if all your plants die, you don't have a salad that day," said Mirken, a representative for the Marijuana Policy Project, which has unsuccessfully pushed ballot initiatives in Nevada to partially legalize marijuana.

A model program

If Nevada eventually does set up a distribution program, it probably won't be the first state to do it.

New Mexico, which legalized medical marijuana in April, is working on the rules its department of health would need to run a distribution program.

This will allow patients to get the drug the way other patients get their medicine, said Reena Szczepanski, director of the anti-drug prohibition New Mexico Drug Policy Alliance. It would help prevent patients from going to the black market, she said.

But New Mexico's system might not work for Nevada, because of the state's sparsely populated areas. She said a state-run system where the drug is distributed through pharmacies might be better for Nevada.

The federal government itself has the only active government-run distribution program in the country. The Compassionate Investigational New Drug program was started in 1978 and closed to new patients by President George H.W. Bush in 1991. A few people are still in the program, though, and they get monthly supplies of marijuana grown at the University of Mississippi.

Miller, head of Nevada Medical Marijuana Consultants, said a state-run distribution program could be good for Nevada, but the state should be careful not to legalize it or regulate it the way California does, with marijuana available at licensed clubs.

"We don't want a bunch of drug-dealing thugs in this," he said.

But Miller, who became a patient after a spine surgery, said the drug is more safe and effective for many people who would otherwise be prescribed pain killers. Those people, he said, deserve to have their medicine.

Opponents, he said, don't understand the research or the state's program.

"We're not just a bunch of yahoos smoking reefer," he said.

Check out this Link: CAMP- Christians Against Marijuana Prohibition

Christians Against Marijuana Prohibition

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This page was blessed with the task of informing the people of the outright lies being propagandized by the Federal Government. The prohibition of marijuana is an affront to the Bible and all who worship the one true God. As an example in Genesis 1:29 the bible clearly states "...I give every green plant for food. And it was so."

Until the U.S. government decided God was wrong.

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