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Gregory L. Gerdeman and Juan Sanchez-Ramos

New futures for cannabis-based medicines

Samuel Bagdorf of San Francisco, who suffers from anxiety disorders, exhales after smoking his marijuana pipe last month at the San Francisco Medical Cannabis Clinic.

Associated Press

Samuel Bagdorf of San Francisco, who suffers from anxiety disorders, exhales after smoking his marijuana pipe last month at the San Francisco Medical Cannabis Clinic.

Medicinal use of cannabis is being discussed more actively than ever. Although prior to its prohibition in 1937 cannabis was used widely in pharmacies, there was little debate about its usefulness to treat various symptoms such as inflammatory pain. Cannabis remedies were well known, publicly advertised and widely prescribed.

"Marijuana," on the other hand, was virtually unknown Mexican jargon before becoming the "assassin of youth" in propaganda films. Such depictions led to an unceremonious vote by Congress to effectively criminalize Cannabis sativa in all of its forms. The strongest opposition came not from the public (which did not equate the new "scourge" with cannabis remedies) but from the American Medical Association, whose congressional liaison decried the legislation as speciously motivated by "indirect hearsay evidence."

Over the next 72 years, the image of the American cannabis user morphed from the immigrant madman and criminal deviant of the '40s, to the counter-culture crowd of the '60s to the unmotivated slacker of the '80s. In the '90s, a "new" image arose: the medical marijuana patient, who is driven not to get high but to get well. It is linguistically ironic that "medical marijuana" may usher in a new chapter in the ancient relationship between human society and the cannabis plant.

Now the American Medical Association has turned heads by again weighing in on cannabis policy. After extensive review of scientific and clinical evidence regarding the harms and benefits of cannabinoids (molecules found in cannabis) as well as recent legal precedence regarding medical marijuana, the AMA announced that the federal Schedule I status of marijuana (most prohibited) should be reconsidered in order to advance clinical research with botanical cannabinoid medicines. The AMA report furthermore expresses that "physicians who comply with their ethical obligations to 'first do no harm' and to 'relieve pain and suffering' should be protected in their endeavors, including advising and counseling their patients on the use of cannabis for therapeutic purposes."

The emphasis on research is important. There is a future for botanical cannabis-based medicines, but patients and physicians should be empowered to base health care decisions on real evidence rather than hyperbolic claims of marijuana's dangers or virtues. Not surprisingly, the AMA does not support legalizing medical marijuana through state ballot initiatives, such as the one Floridians could vote on next year if a petition by the group People United for Medical Marijuana gains traction. Cannabis is a plant and modern standards for purity, packaging and delivery of drugs play an important part in assuring reliable predictability. Also at play is the arena of pharmaceutical development — new drugs are being pioneered to enhance the body's THC-like "endocannabinoid system," intended to achieve therapeutic effect with improved specificity and minimal psychoactivity. Research is clearly needed to ensure efficacy and safety of these new drugs.

Nonetheless, the perceived promise of such drugs highlights a need for greater maturity in social discussion of medical use for cannabis and/or its constituent molecules. Whatever else might be said about the apparent sea change of public opinion about cannabis, the oft-repeated claims by federal drug czars that medical marijuana is a "smoke screen" or lacks even a "shred of evidence" must be laid to rest as a relic of socially juvenile, 20th century reefer madness. Public policy should be based on sound scientific evidence — not a roadblock to it. Cannabis has been used safely as a folkloric remedy for thousands of years, but in modern America inappropriate Schedule I listing of marijuana has obstructed research to find promising therapies for debilitating human conditions. This is a paramount reason why the scheduling should be changed.

Gregory L. Gerdeman, Ph.D., is an assistant professor of biology at Eckerd College in St. Petersburg. Juan Sanchez-Ramos, Ph.D./M.D., is the Helen Ellis Professor of Neurology and chair for Parkinson's Disease Research at the University of South Florida College of Medicine in Tampa.

Sanchez-Ramos was a physician involved in the "Compassionate Use Protocol for Marijuana" sponsored by the National Institute on Drug Abuse and approved by the Food and Drug Administration and the Drug Enforcement Administration. In this study, marijuana was prepared and shipped by NIDA to patients with various medical conditions. His patient suffered from muscle spasms and pain caused by a rare disease, successfully treated with cannabis.

New futures for cannabis-based medicines

11/15/09 [Last modified: Sunday, November 15, 2009 9:31pm]
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