Marihemp: Medical: The Drug of Choice (Part 1 of 4)

The Drug of Choice

Cannabis as Medicine

(Part 2 of 4) by Gary Stimeling

It would be unreasonable, arbitrary, and capricious for DEA to continue

to stand between those sufferers and the benefits of this substance.

— DEA Administrative Law Judge Francis Young, 1988,

ruling in favor of legalizing marijuana for medical use

Whenever folks over at the U.S. Justice Department were feeling blue about anti-American terrorists, uppity librarians or naked statues standing behind the attorney general, they could always take a deep drag on the anti-drug drug by busting a few terminal cancer patients in California. But now some derned activist federal judge has taken that simple pleasure away from them.

Some days it just doesn’t pay to be a jack-booted thug.

— Salt Lake City Tribune editorial, April 25, 2004

The stripper promised to make love to quadriplegic Wayne Hobbs of Hisperia, California, if he’d just help her score some meth. He didn’t want to, but she pleaded and tempted. His hormones hadn’t been paralyzed, so he gave in and called a friend. Turned out the ecdysiast had a day job as a narc. Agents of the Drug Enforcement Administration burst in to bust Hobbs’s friend as soon as he arrived with the crystal. While they were there, they took Hobbs’s 235 marijuana plants and seedlings, and destroyed two doors custom-made to accommodate his disability. Hobbs uses cannabis for the intense pain of paraplegia. No charges ultimately were filed against him, but no apology or restitution was made.

Brooklyn rabbi Yitzchak Fried had been providing marijuana at cost to severely ill AIDS, cancer, and multiple sclerosis patients since 1993. He also worked with heroin addicts who use pot to help them kick the habit. In March 2001, a professional trapper of humans who was working for the New York Police Department pretended to need it as medicine. Saying he was a junkie with AIDS, he bought a total of seven ounces from Fried on five occasions, then took him prisoner. Because of his impeccable humanitarian and religious credentials, Fried was able to plead guilty, express remorse, and get off with five years probation and a $5,000 fine, instead of the usual three years in jail for a guilty plea, or fifteen-to-twenty if he’d gone to trial and lost.

In January 1998, six armed robbers in camouflage burst into the North County Cannabis Cooperative in Valley Center, near San Diego, with guns drawn. They stole all 400 plants and all of the growing equipment. The thieves were DEA agents without warrants. Co-op founder Steve McWilliams, wheelchair-bound after two auto accidents, was in county jail at the time for transporting nine plants in his van in accordance with the California Compassionate Use Act. In a plea deal to avoid bad publicity from hounding paraplegics, federal prosecutors allowed McWilliams and co-founder Dion Markgraaf to supply themselves but no one else. So the two founded Shelter from the Storm, a grow-space for people to use on their own, supplying their own seeds and equipment along with a contribution toward expenses. Armed robbers from the same gang broke into the new haven on July 6, 1999 and took all 300 plants, just to harass, filing no charges. On September 17, 2002, simultaneously with the Wo/Man’s Alliance for Medical Marijuana (WAMM) in Santa Cruz, McWilliams and others handed out free samples of marijuana to patients showing a doctor’s written recommendation on the requisite state form. In retaliation eight days later, DEA agents raided Shelter from the Storm again, even though the group had complied with city and state regulations, cooperated with local police, and stayed well under the 100-plant limit sometimes observed by the feds for felony intent-to-distribute charges.

Joe Tacl of Bronson, Florida, began growing marijuana after he found that it relieved the intractable pain he’s suffered ever since his spine was crushed when he was struck by a van in 1993. Fentanyl and other painkillers caused vomiting and diarrhea. Opiates caused constipation, which had progressed to malnutrition and intestinal bacterial sepsis. Cannabis relieved the pain without side effects. In May 1998, he was arrested by chopper-guided cops after someone reported 9 two-foot plants in his backyard. His lawyers argued medical necessity based on a 1991 Florida Supreme Court ruling that allowed marijuana use by AIDS patient Kenny Jenks, but in this case judge Frederick D. Smith prevented any mention of Tacl’s Dutch prescription or his certification of need by psychiatrist Tod Mikuriya. Prosecutors even fought the admissibility of Tacl’s x-rays and wheelchair use, and won with the rhetoric of small-town intolerance.

Government contempt for medical needs was already evident in the closed-door hearings at which the House Ways and Means Committee pretended to accept debate on the Marijuana Tax Act of 1937. AMA representative Dr. William C. Woodward strenuously opposed prohibition, citing hardships to doctors, patients, and farmers, as well as the complete lack of any evidence of problems caused by the drug, other than some very dubious newspaper scare stories. He also condemned the way the bill had been crafted in secret for two years, using the then-unfamiliar Mexican slang term marijuana instead of the botanical name cannabis to conceal the law’s intent, since most people, including doctors, would not connect the two words. The Committee cut his testimony short, and Chairman John Dingell bluntly told him to shut up, “rather than trying to throw obstacles in the way of something the federal government is trying to do.”

Attacks on patients have been a major part of the drug war since about 1990, particularly to suppress nonprofit grow-and-supply co-ops that sprang up along the West coast from Vancouver to San Diego. Since 1996, many of these have been legal under laws passed by public referendum in California, Oregon, Washington, Alaska, Arizona, Nevada, Colorado, Hawaii, and Maine. Despite intense and deceitful propaganda campaigns by the White House Office of National Drug Control Policy (ONDCP), medical marijuana initiatives have passed overwhelmingly in all states where they’ve made the ballot, as well as in the District of Columbia. In DC, Congress nullified the election and kept the votes from being counted, but exit polls showed that the measure carried with 69 percent in favor.

Various polls have measured support for medical marijuana at from 65 to 96 percent, and 35 states have passed some sort of law toward that goal. Nevertheless, in yearly spring and fall campaigns, federal drug agents have conducted hundreds of raids on medical cannabis support groups, especially in California. They’ve often broken down the doors with battering rams, entered without ID or warrants, ordered patients to the floor at gunpoint, jailed them, trashed the rooms, and stolen all computers, supplies, and equipment. Most states have not tried to implement their own laws on this matter, knowing they’ll only be strong-armed by the feds.

In a world run according to the actual meaning of the words in treaties, those who order such raids on patients would be tried before an international tribunal for violating the Geneva Convention’s provisions against abusing the sick or injured among civilians and prisoners of war. In our world, however, the crass illogic of the drug war catches millions of the severely ill in its dragnet—by arresting them, by subjecting them to constant fear of arrest, and by depriving them of an essential and otherwise very affordable medicine. This is a symptom of mental illness in our society, which the very tolerance of cannabis could mightily help heal.

Abstract

Marijuana has at least 18 well documented medical uses: glaucoma reliever, antinausea agent, appetite stimulus and digestive normalizer, bronchodilator, antihypertensive, antiepileptic, treatment for degenerative nerve diseases, treatment for muscle spasms, pain reliever, antibiotic, treatment for autoimmune and inflammatory conditions, anticancer agent, antidepressant, a cure for migraines, enhancer of empathy and sexual desire, an aid in menstruation, pregnancy, and childbirth, a hypnotic relaxant and sleep inducer, and an aid to withdrawal from more debilitating drugs. It may also be an antiviral, an antidiabetic, a help with hepatitis C, and the best treatment of all for genuine cases of attention deficit disorder. Its usefulness, low cost (if legal), and complete safety threaten pharmaceutical empires.

A Molecular Cornucopia

Hemp drugs have played prominent roles in traditional medical systems. They were perhaps most fully explored in China and India, although much knowledge about their use in the Middle East and around the Mediterranean was lost by destruction of ancient literature from those regions. The ancient Chinese classic Pen Cao [Medical Materials] is ascribed to Shen Nong [Divine Farmer], the legendary emperor and sage who invented agriculture and discovered tea. His rule is traditionally dated 2737–2697 B.C. As an herbal physician, he was said to have tried all of his hundreds of medicines on himself to study their properties before using them on patients. In this book, ma-fen—“mother flowers,” or female hemp tops—are rated the best of all yin [female] medicines, beneficial in many illnesses.

For thousands of years, people of India have considered cannabis a tonic of daily magic, one of life’s necessities, sacred to Shiva and like him called “the preserver.” Beginning with the Atharvaveda [Corrective Magic Lore], compiled 1400–500 B.C., Indian medical writers have agreed enthusiastically. Charaka, who lived between 200 B.C. and A.D. 200, and Susruta, who lived about 380–450, developed Vedic teachings into the Ayurvedic system of practice. They both considered cannabis a prized euphoriant and versatile medicine. They especially valued its hypothermic (temperature lowering) property against fevers and sunstroke.

William B. O’Shaughnessy, a British East India Company physician, was the first to introduce hemp medicine to the West in a systematic way. His 1839 essay “On the Preparation of the Indian Hemp or Gunja” was followed in 1840 by a book on the herb by French doctor Louis Aubert-Roche. By the end of the century, hundreds of medical reports had been written, nearly all extolling dramatic benefits of cannabis in tests on various groups of patients.

Before surveying medical uses, it will be helpful to know a little about the botany and chemistry. Cannabis is one of the most widespread and varied plants on earth. Most taxonomists now agree that it comes in three species, the second two descended from the first:

$ Cannabis sativa, literally “common aromatic cane,” is tall (5N–15N), long-stemmed, native to grasslands and mixed forest-and-grassland areas throughout the tropics and subtropics of Africa and Asia. It yields fiber, seed, and—in many but not all strains—drug resin. C. sativa resin generally has a high ratio of delta-9-THC to other cannabinoids and is known for a stimulating cerebral high that is good for creative insight.

$ Cannabis indica is shorter and bushier (3N–6N), native to the mountains and high plains of Central Asia, the Hindu Kush, the upper Indus valley, and the upper Ganges (Ganja River) valley. C. indica is rich in other cannabinoids as well as THC, and is known for a more sedative, grounding effect, a sensual body high.

$ Cannabis ruderalis, growing as unbranched stalks 2N tall or shorter, native to central and eastern Europe, is nonpsychoactive, used for seed and fiber.

At least 483 chemical compounds have been identified in resin-producing varieties of the female cannabis plant. Most of them are ordinary biochemicals known from many plants. Interest centers on the 66 compounds found only in psychoactive hemp. These are called cannabinoids. Most of them come in several slightly different forms, which vary by a slight rearrangement of the atoms that make up the basic molecule. Therefore they are sometimes referred to in the plural, as groups, and sometimes in the singular, as single molecules. The abundance of the various cannabinoids varies widely by genetics, geography, and cultivation methods. The mature female flowers contain:

$ 6 cannabigerols (CBG), the first cannabinoids formed as the plant matures. They have anti-inflammatory, antibiotic, and sedative properties.

$ 5 cannabichromenes (CBC), most abundant in crops from parts of Africa. CBC is also anti-inflammatory and sedative.

$ 7 cannabidiols (CBD), most abundant in the indica species (hash plant). Often called nonpsychoactive, CBD actually balances THC’s mental stimulation with its mild sedative-hypnotic effect. It also has antiepileptic, anti-inflammatory, muscle relaxant, antianxiety, immune-balancing, and pain-relieving properties. Its acid form, cannabidiolic acid (CBA), is a potent antibiotic and possibly an antiviral agent. The 7 cannabidiols are accompanied by their oxidized and depotentized (“burnt-out”) forms, called the cannabinodiols.

$ 9 tetrahydrocannabinols (THC), of which the ninth, delta-9-THC, is the chief psychoactive component and by far the most abundant one in the ripe female’s resin capsules. It has pain-relieving, appetite-stimulating, antinausea, neuroregulatory, bronchodilating, antiepileptic, anticancer, antidepressive, mildly stimulant, mind-focusing, sense-enhancing, and sense-of-time dilating effects. Delta-8-THC is less psychoactive, but with antiglaucoma properties. Because it is easier to make in the laboratory, it is the form most often used as the starting point for synthetic native cannabinoids, as well as chemically invented ones not found in the plant.

$ THC is accompanied by its own oxidized (burnt-out) forms, called the cannabinols (CBN). They gradually replace THC in stored cannabis, deactivating it. They have sedative, antinausea, and antiglaucoma activity.

$ Traces of cannabicyclols, cannabielsoins, cannabitriols, and probably other native cannabinoids yet to be discovered and studied.

$ 2 alkaloids, which, unlike the other cannabinoids, contain nitrogen and are soluble in water: cannabisativine and anhydrocannabisativine. Their medical properties have not been studied.

$ 100 terpenes and 20 flavonoids. These compounds are found in many plants. Their unique profile in cannabis gives it its signature aroma. Many terpenes and flavonoids cross the blood-brain barrier. The BBB consists of capillaries surrounding the brain, which act as a filter to keep undesirable molecules in the bloodstream from entering it. The ability of terpenes to enter the brain through the nose is the physical basis of aromatherapy and use of incense. In the ancient Near East, the resin’s complex heady aroma was so valued that some languages used the word for cannabis to mean “incense.” The herb’s medical effects as an aromatic may be rediscovered after relegalization. Most of these compounds evaporate in days or weeks from freshly cured cannabis, taking the edge off its bouquet and potency. For this reason, cannabis is best stored in glass—dark glass jars kept in a dark closet, because light rapidly destroys THC in the harvested plant.

All of the subsidiary ingredients interact with THC in the body, enhancing or muting various medical virtues, as well as aspects of the high. Thus the effect of the whole herb can be changed by selectively breeding for different balances of these components. Growers on the West Coast and in Europe are learning how to do so, supported in some cases by groups like the Stichting Institute of Medical Marijuana, www.medicalmarijuana.org, in Holland.

There are two more chemical names we need for the discussion that follows:

Marinol is Unimed Pharmaceuticals’ brand name for the generic drug dronabinol, which is synthetic delta-9-THC dissolved in sesame oil. Unimed makes Marinol in 2.5, 5, and 10 mg strengths. It is the only form of any cannabinoid that has any tinge of legality in the United States. It has been approved as an adjunct to cancer chemotherapy when other drugs fail to control nausea, and as an appetite stimulant in AIDS wasting syndrome. Only these uses are approved, and the DEA once threatened to prosecute doctors who prescribe it for anything else, the only drug whose use “off label” was forbidden. After more than a decade of very limited use, the federal drug agencies moved Marinol from Schedule II to the less strictly regulated Schedule III due to evidence from the Haight Ashbury Free Clinics that it does not lead people to use it recreationally or “divert” (pilfer) it for resale: Because no one likes it as well as real marijuana. The DEA will still prosecute doctors who prescribe marijuana, and state drug cops routinely attack pot-recommending doctors by forcing state medical boards to investigate them, in California so much so that police complaints have put cases of real malpractice on the back burner.

Anandamide, aka arachidonylethanolamide (AEA) and related hormones. THC binds to two types of cannabinoid receptors on cell membranes. CB₁ receptors exist throughout the brain and spinal cord but are concentrated in the frontal cortex, where the highest-level integrative thinking takes place, and especially in the right frontal cortex (left frontal in some left-handers), where we interpret pictures, visualize in 3D, and have intuitions. CB₂ receptors are found throughout the body but are most numerous in the spleen, where they probably play as yet unknown roles in balancing the immune and circulatory systems. Anandamide (from Sanskrit ananda, bliss) is the hormone that binds to both CB receptors. These receptors apparently exist in all multicellular animals. They’ve even been found in the Hydra, one of the simplest.

Anandamide modulates responses along nerve pathways that control movement, appetite, pain, learning, memory, and mood. The delta-9-THC molecule’s key seems to fit perfectly into the receptor’s lock even though THC has a chemical structure very different from anandamide, apparently because the THC molecule has a similar pattern of electrical charges on its surface. Chocolate also contains at least three cannabinoid-like compounds that bind to CB receptors.

Hemp may have been co-evolving with animals since the early Miocene Period, 25–17 million years ago, when a drier climate reduced forests throughout the world, and grasses rapidly evolved to fill the ecological gap. By 20 million years ago, several species of forest-dwelling apes called Dryopithecus were adapting from life in the trees to the new prairie lands. They spread from Africa throughout Eurasia, losing their tails and evolving into Ramapithecus and other species. From 15–8 million years ago, as grasslands developed further, ramapithecine apes developed bipedal walking and running so as to carry food from open areas to refuges. They gained color vision as they adapted from arboreal night life to daytime ground-living, on a diet of bugs, roots, seeds, and greens. Cannabis seeds contain the best balance of essential fatty acids, including omega-6 and omega-3 fatty acids in the 3:1 ratio humans need. They are one-third protein, and of all plant foods, their protein is the most fully assimilated. The greens supply fiber, enzymes, vitamin K, and B vitamins.

Sooner or later, our earliest ancestors became familiar with the evolving mental effect of cannabis resin while eating the seeded tops. Some resin capsules would also be ingested during grooming, because they grow on tiny stalks, from which they easily break off and stick to a passing animal’s fur or skin. Perhaps the resin evolved as a way to disperse seeds by sticking them to passing beasts, then became psychoactive by mimicking internal receptors as a way to get beasts to browse in hemp fields. At any rate, because of their affinity for chemical receptors in the human body, cannabinoids help it in wondrous ways.