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

The Drug of Choice

Cannabis as Medicine

(Part 4 of 4) by Gary Stimeling

Do Not Operate This Medication Near Heavy Judicial Machinery

To try to minimize potential trouble with the law, patients should document their medical use of marijuana. They should keep a journal in which they record the specifics of dose, type of material, method of administration, and effects on the disease. They should seek knowledgeable and sympathetic physicians and confide in them, making sure that information about their cannabis use gets into their medical records.

Even if they live in a state with no medical marijuana law, for possible leniency at trial, patients should try to satisfy the six points of medical necessity as defined under the California Compassionate Use Act:

1. “The act charged as a crime [using marijuana] must have been done to prevent a significant evil [the consequences of the disease].

2. The harm caused by the act must not be disproportionate to the harm avoided. [The medical problem must be serious].

3. The accused must entertain a good faith belief that the act was necessary to prevent greater harm. [Thus documenting effects of the disease and the undesirable effects of other drugs is important.]

4. The belief must be objectively reasonable under all of the circumstances. [The disease must get worse without marijuana, or there must be some medical evidence for its use in the condition.]

5. There is no adequate alternative to the commission of the act. [Legal medical drugs don’t work as well.]

6. The accused must not have contributed to the creation of the emergency. [Patients must try legal alternative treatments and must not malinger in order to score weed.]

Actual Medical Risks and Side Effects

Cannabis has been charged with many offenses during the war against it. Science has patiently refuted each one. Pot does not:

$ Break chromosomes and cause birth defects.

$ Make people go insane.

$ Grow breasts on men (gynecomastia).

$ Lead to heroin addiction.

$ Make people lazy and stupid.

$ Fry brain cells.

$ Suppress the immune system.

$ Play havoc with sperm count or testosterone levels.

$ Make people violent.

$ Produce irrational bursts of uncontrollable manic phony laughter (except when watching Reefer Madness).

Opponents of freedom often cite lung cancer as a risk from smoking pot. Like all burning plant material, marijuana smoke does contain carcinogens, such as tars, carbon monoxide, and polycyclic aromatic hydrocarbons (PAHs). Tobacco addicts smoke more cigarettes than the heaviest pot smokers, but pot smokers inhale more deeply and hold the smoke longer—unnecessarily, as it turns out (see below). In the late 1960s and early 1970s, Gabriel Nahas and other scientists of known bias succeeded in producing precancerous lung damage in animals by bombarding them with tremendous amounts of smoke from poorly manicured low-grade government marijuana in which the level of carcinogens must have been very high. Honest work simulating real-world usage has not found the same results.

If marijuana smoke is as dangerous as tobacco smoke, statistics predict there would be about 30,000–40,000 new lung cancer cases among American pot smokers each year. Epidemiologists have tried to find these cases both at home and among ganja users abroad—without success. Several doctors have independently reviewed the extensive literature on this question and concluded that not one case of lung cancer has ever been persuasively linked to marijuana smoking.

UCLA pulmonologist Donald Tashkin has devoted his career to studying the actual effects of marijuana and tobacco smoke. Early work in which he found a small decrease in breath volume among chronic pot smokers is often quoted by prohibitionists, but extensive later studies have found no significant differences across large groups of people. Summarizing two decades of work by his own research group in 1997, Tashkin wrote, “No differences were noted between even quite heavy marijuana smoking and nonsmoking of marijuana.” Introducing a review of the accumulated evidence in 1995, the editors of the leading British medical journal, The Lancet, bluntly stated, “The smoking of cannabis, even long term, is not harmful to health.”

Over the years, Tashkin and his coworkers have found significant differences between tobacco and marijuana smoke in the lungs. Tobacco constricts the small bronchioles and gradually causes blockages in them that lead to emphysema. Marijuana dilates the bronchioles and helps clear them, an effect that fits with its traditional use for asthma. Most important, Tashkin found that tobacco smoke causes inflammation of macrophages in the lungs, which impairs the ability of these “big eater” cells to ingest toxins and germs. Marijuana smoke, on the other hand, seems to release compounds from lung tissue that protect the macrophages from inflammation and thus actually help them deactivate toxins in the smoke. THC’s anticancer influence (see above) also may help protect the lungs. Any inherent dangers can be further reduced by using best quality material, concentrating the resin into kif or hashish, or by using a vaporizer.

There is a real danger, though it is rare. Aspergillus mold sometimes grows on marijuana that has gotten wet or not been properly dried before shipment. When smoked by AIDS patients or other people whose immune systems are suppressed, it can cause spergillosis, a potentially deadly pneumonia.

Though the THC euphoria is integral to many of the herb’s medical powers, for some patients and in some conditions it is undesirable. People vary a great deal in biochemistry and the mental states they prefer. Some simply do not enjoy the cannabis high. In Jamaica, people just say, “I don’t have the head for it,” and pass the spliff on. The high can also interfere with some kinds of work or other necessities. It can be minimized with the accurate self-dosage possible with smoking. Pharmacologists hope to use anandamide and natural cannabinoids as starting points to develop synthetic drugs having the various medical uses of cannabis without psychoactivity. In the meantime, for conditions treated with cannabinoids other than THC, using less potent herb may retain the benefit while reducing the high.

The actual side effects of cannabis are minor or rare, and easily remedied:

$ Thirst. Drink something.

$ Red-eye. Some cool water splashed on the eyes, or a damp washcloth, or eye drops, or a cup of eyebright tea, or a brief rest with the palms over the eyes.

$ Getting too high, uncomfortably spacy. A multivitamin, some vitamin C or lemonade, sedative herbal teas such as chamomile, skullcap, or valerian, or a lukewarm or cool bath or shower.

$ Panic attack. Reassurance, hugs. Many incipient panic attacks can be nipped in the bud simply by knowing beforehand the facts of age-old experience with cannabis. In 5,000 years of recorded history, there is not one known instance of fatal overdose. To prevent anxiety, it helps to partake of the sacrament only in a secure location, in comfortable surroundings safe from prurient law enforcement personnel.

Taking Your Medicine

Experiments funded by California NORML and the Multidisciplinary Association for Psychedelic Studies (MAPS) found that conventional water pipes actually increase the ratio of tars and carcinogenic gases to THC by as much as 30 percent, but that dual-action hot/cold water pipes remove problematic components better without reducing THC yield as much. Users of small, concealable pipes risk burning the airway’s ciliated mucus-clearing cells with an incautious hit. They’ll grow back, but it may mean a sore throat.

Joints are easier on the lungs than all pipes because they burn cooler, destroying less THC in combustion and producing smaller amounts of by-products. However, because they burn continuously, they waste a lot of smoke and produce more odor, so they are less cost-effective and can be more dangerous under prohibition. On the other hand, joints are less noticeable in public than pipes.

The need to save stash perpetuates the old advice to inhale very deeply and hold the smoke in for as long as possible. This is useless and unhealthy, because fat-soluble cannabinoids are absorbed through the membranes of the alveoli in the lungs almost instantly, whereas water-soluble tars and gases take several seconds. Inhaling to a relaxed degree of lung expansion, pausing for a second or two, and exhaling normally is best.

Perhaps the purest and most powerful way to inhale cannabinoids is to make hash or kif from the best possible material, and then vaporize it. Instead of burning it, vaporizers heat the resin just enough to evaporate it. They entail an initial expense, currently from $70 to $600. Designs are improving year by year. Today’s models can deliver nearly pure cannabinoids from even poor quality weed. Possibly for fear of government reprisals, the writers of the 1999 Institute of Medicine report, who solidly favored rescheduling marijuana for medical use, nevertheless “pointedly chose to omit,” as Tod Mikuriya put it, data on vaporizers that Lester Grinspoon had submitted to the scientific panel.

In traditional techniques, resin is removed from the fresh flowering tops and pressed into blocks (hashish) or sieved from dry tops as a fine powder (kif). Commercial kif screens are available, but a reasonable facsimile can be made without them, as follows. Gently force the dried herb through an ordinary tea strainer. Then stretch a piece of pantyhose material moderately taut over a cup and secure it with a rubber band. Now gently work the strained herb through the nylon. Save the leaf bits on top for tea or tincture, and collect the kif from the cup. A new “bubble hash” method [see www.bubblebag.com] pulverizes dried cannabis in a bucket of ice-water with an electric mixer for 10–20 minutes, then passes it through a series of successively finer screens. It can make hashish that is over 50 percent pure THC, compared with a maximum of about 30 percent for traditional hash.

If your medical needs are for the other cannabinoids, it may be best to buy cheap pot with a lot of shake (leaf), which contains some THC but too little for good smoking. When prepared for ingestion, it can be more economical than premium marijuana.

Tinctures were a favorite mode of administration among 19th-century doctors. The following procedure is based on recipes by herbalist Jeanne Rose and by Joan Bello:

Mash 1 ounce of strong, or 2 ounces of weak, marijuana in 1 to 2 cups of grain neutral spirits (ethyl alcohol of 150 proof or more). The dose is from 10 drops to as much as ½ shot glass, but start small and work up in order to gauge its strength. A bottle of liquor can be used, but must be over 100 proof for good results. Use unflavored vodka if you want the pure taste of the resin. Jamaicans use rum, often overproof. Store the bottle in darkness and let the herb steep for two weeks, shaking daily. Strain. Dose: 1 shot glass or less, depending on potency of raw material and alcoholic proof.

Cannabis can also be prepared as a tea. A simple infusion of the dried leaves and small stems will deliver little or no psychoactive resin, but is soothing to the intestinal tract and relaxing before bed. This version of the Indian drink bhang, based on a recipe from Jeanne Rose’s classic Herbs & Things, makes a good hypnotic tea to treat insomnia or bring on interesting dreams:

Add 1 tablespoon of marijuana, or a small piece of hashish, and 1 teaspoon of meadowsweet, to 2 cups of boiling water. Cover and reduce the heat. Let simmer 5–10 minutes. This is best prepared with milk or cream. Add it after removing the liquid from the heat, then let the tea sit a few minutes to give the fat a chance to absorb the THC. Then strain and serve.

Whose Drug Is It, Anyway?

In the health-care paradigm of the West, a physician dispenses medicine like an all-powerful God handing out rewards and punishments. So Western science treats “anecdotal evidence”—the experiences of individual patients—as a joke. True, untested by controlled experiment, such reports can give rise to the anecdotal fallacy: Only the successes become anecdotes, making a treatment look better than it really is. But then again, one anecdote is one thing; a thousand is quite another. Omitting them discards a prime source of medical knowledge.

This disparaging attitude toward the client’s perceptions is in direct contrast to Indian and Chinese medical tradition, in which subjective experience is highly valued. In the East, the overarching goal of all medical practice is to help the patient understand the illness and lead the effort against it.

Furthermore, doctors of the past eagerly learned from those patients whom many ridicule today—self-medicators. William Morton popularized the use of ether for anesthesia after watching medical students get bombed on the solvent at “ether frolics” in 1846. Sir William Osler wrote, “The study of medicine begins with the patient, continues with the patient, and ends with the patient.” Today, a groundswell of the sick and their doctors is gathering to demand repeal of the antimarijuana laws, largely because of what self-medicators have rediscovered about the drug’s benefits. A true science of the future will learn to integrate anecdotal evidence into the scientific method, especially when it studies processes in which the mind plays a crucial role—such as healing.

In addition, despite tremendous recent advances in herbal medicine, tested in well controlled double-blind clinical studies, many scientists cling to an outdated abhorrence of “crude” drugs that developed during the pioneer days of biochemistry about 1860–1930. They insist that the “active principle” must be isolated and purified. Sometimes this attitude is a smoke screen for those who wish to continue the inquisition against self-medicators. In terms of health, the whole argument is nonsense, a distraction.

In general, whole herbs are much better for routine use as health enhancers and for minor ailments. Their many ingredients tend to counterbalance each other, tuned by millions of years of evolution and thousands of years of human experience, so they are safer. Society wide, they make for health-care efficiency and economy. Even at underground prices, marijuana is much cheaper per milligram of THC than Marinol.

On the other hand, specific isolated components unquestionably are better for some problems in some patients, especially in the acute phase of an illness. Pure chemicals can zero in on a particular need with more precision, and researching them can also reveal curative powers that were only latent in the raw plant. Both types of medicines need to be studied and made available.

Bias toward “pure” pharmaceuticals could lead to pseudo-legalization—cannabinoids allowed as highless synthetics for those with the money and savvy to wring their meds out of the bureaucracy. Such a result might get some patients out of the drug war, but it would leave everyone else in it. And the pharma-only route can only reinforce the control syndrome in health care.

Perhaps the use of cannabis for which patients are most grateful is its ability to replace dangerous pharmaceuticals. Prescription drug side effects kill 100,000–300,000 Americans every year. Hundreds die from nonsuicidal use of aspirin. Acetaminophen (Tylenol and other brands) has a dosage safety factor of only 5. That means if one pill works, five could kill you. Most medical drugs have safety factors of less than 100. Marijuana’s is at least 40,000. No one knows the exact number, because no matter how much THC you pump into the lab rats, they just refuse to die. Legal drugs—used as directed, not abused—are the sixth leading cause of death in the United States, and the number of deaths from them has doubled every ten years since 1983. Compare: There has never been a documented case of fatality from any form of cannabis, even among the deathly ill at high doses.

Side effects from pharmaceuticals are sometimes so demoralizing that patients wish they were dead. Medical drugs routinely cause extreme constipation or diarrhea, nausea, dizziness, muscle spasms, liver damage, nerve damage, chest pains, or depression. Well over 90 percent of today’s medical drugs have been in use for less than half of an average human lifespan. We know nothing about their delayed or long-term effects in humans.

As WAMM’s Valerie Corral understated the issue in an essay for the Medical Marijuana Handbook, “It is curious that the FDA and pharmaceutical companies pursue the development of synthetic marijuana if indeed it has no medicinal use.” Americans fill more than 3 billion drug prescriptions every year, ten for every person in the country. American medicine is the largest industry in the world. It consumes nearly $2 trillion a year, about a sixth of our economy. A widely useful, totally safe, pleasant but unpatentable medicine, which can be grown for free in any garden or sunny window, threatens hundreds of billions of dollars in medical company profits throughout the world. Governments’ stubborn denial of marijuana’s medical usefulness is not too hard to understand. Many drug administrators are former employees of those very companies, and many others will move on to better-paying industry jobs after putting in their time as “public servants.” This is the real reason for prohibition. Growing your own and ending dependence on rich purveyors is the ultimate in patients’ rights. Cannabis may not be the best medicine for all conditions, but in this sense it’s truly the “drug of choice.”

Sources and Resources

The information presented here comes ultimately from five types of evidence:

1. Traditional lore.

2. Early medical papers, up to about 1970.

3. Recent research, including test-tube work, experiments on lab animals, and clinical studies on humans,

4. Doctors’ case reports, and

5. Accounts by self-medicating patients.

My primary source for the medical information has been the volume edited by Franjo Grotenherman and Ethan Russo, Cannabis and Cannabinoids: Pharmacology, Toxicology and Therapeutic Potential (Haworth Press, Binghamton NY, 2002). This is the latest and most detailed summary of medical marijuana science—38 chapters, each written by a top specialist, including many from Europe, where the research climate is more favorable.

In addition, I have relied on the excellent summaries written by Martin Martinez and edited for medical accuracy by Dr. Francis Podrebarac in The New Prescription: Marijuana as Medicine (Quick American Archives, Oakland CA, 2000); and upon chapters by Ed Rosenthal, psychiatrist Tod H. Mikuriya, and Dale H. Gieringer in their Marijuana Medical Handbook: A Guide to Therapeutic Use (Quick American Archives, Oakland CA, 1997). Rosenthal also describes how to prepare it for various uses. Chris Conrad’s Hemp for Health: The Medicinal and Nutritional Uses of Cannabis Sativa (Healing Arts Press, Rochester VT, 1997, http://www.chrisconrad.com) devotes more attention to cannabis in food. These three are the best overviews of marijuana’s proven medical benefits, written for nonscientists.

In addition to an elegant summary of the drug’s virtues, Lester Grinspoon and James B. Bakalar, in Marihuana: The Forbidden Medicine (Yale University Press, New Haven CT, 1993), have collected the richest trove of anecdotal evidence (patients’ personal experiences). Their Web sites, http://www.marijuana-uses.com and http://www.rxmarihuana.com, provide research updates and new patient histories.

For the most cautious viewpoints, I’ve gone to Alison Mack and Janet Joy, Marijuana as Medicine? The Science Beyond the Controversy (National Academy Press, Washington DC, 2001), which is based on and slightly updated from the 1999 Institute of Medicine report. I’ve also consulted the British Medical Association’s Therapeutic Uses of Cannabis (Harwood Academic Publishers, Amsterdam, 1997). Though excellent as far as they go, both are weakened by omission of important material, on lung protection by vaporizers, for example, and on evidence that marijuana helps neutralize toxins in its own smoke.

Tod H. Mikuriya’s anthology, Marijuana: Medical Papers 1839–1972 (Medi-Comp Press, 2633 E. 27th St., Oakland CA, 1973) is the source for its part of the subject, supplemented by Manfred Fankhauser’s essay in the Grotenherman/Russo volume, which concentrates on little known writings about medicinal hemp in 18th- and 19th-century Germany.

Beverly A. Potter’s and Dan Joy’s The Healing Magic of Cannabis (Ronin Pub. Co., Berkeley CA, 1998) delves into the plant’s usefulness in psychotherapy and stress reduction, its ability to evoke healing laughter à la Norman Cousins, and its power to help people enter into visualizations as taught by doctors like O. Carl Simonton and Bernie Siegel. Potter and Joy also offer a superb bibliography, a judicious selection of important medical papers old and new, as well as a harvest of small-publisher books from the West Coast.

For her visionary synthesis of Eastern and Western wisdom about cannabis medicines, Joan Bello’s The Benefits of Marijuana: Physical, Psychological and Spiritual (revised edition, Lifeservices, P.O. Box 4314, Boca Raton FL 33429, 2000, www.benefitsofmarijuana.com) stands alone. Her theory of anandamide and THC as homeostatic (balance-restoring) substances is a persuasive explanation as to how the herb exerts so many diverse effects. She has also collected well over a hundred testimonials from medical users.

In Marijuana Rx: The Patients’ Fight for Medicinal Pot (Thunder’s Mouth Press, New York, 1998), Robert C. Randall and Alice O’Leary recount with wit and scholarly finesse their quest for legal weed. They and their fellow patients wander through the drug bureaus like Ulysses and his shipmates among the ancient sea monsters.

Here is the full citation for the Jamaican childbirth study, by members of the Schools of Nursing, Education, and Public Health of the University of Massachusetts at Amherst: Melanie C. Dreher, Kevin Nugent, and Rebekah Hudgins, “Parental Marihuana Exposure and Neonatal Outcomes in Jamaica: An Ethnographic Study,” Pediatrics, February 1994, vol. 93, no. 2, pp. 254–260.

I’ve also consulted several Web sites, including:

Alliance for Cannabis Therapeutics, http://www.marijuana-as-medicine.org (last updated August 13, 2001 due to founder Robert C. Randall’s death)

American Medical Marijuana Association, www.americanmarijuana.org

Association for Cannabis as Medicine, http://www.acmed.org

Californians for Compassionate Use, http://www.marijuana.org

Coalition for Medical Marijuana, http://www.medicalmj.org

The Compassion Club, http://www.thecompassionclub.org

Cures Not Wars, http://www.cures-not-wars.org

The Lindesmith Center, http://www.lindesmith.org

Oakland Cannabis Buyers' Cooperative, http://www.rxcbc.org

Online Pot, http://www.onlinepot.org

Schaffer Library of Drug Policy, medical marijuana page http://www.druglibrary.org/schaffer/hemp/medical/medical.htm

The Science of Medical Marijuana, http://www.medmjscience.org

Wo/Men’s Alliance for Medical Marijuana, http://www.wamm.org

The Web site of the National Organization for Reform of Marijuana Laws, http://www.norml.org, includes a clickable map for current information on all pot laws state by state. Specifics of all medical marijuana laws can be found at:

Marijuana Policy Project, http://www.mpp.org/statelaw/

RAND Corporation Drug Policy Research Center, http://www.rand.org/publications/RB/RB6012/

State Medical Marijuana Laws (.pdf) from http://www.impacteen.org

Other Sources

G. W. Carver. How to Grow Marijuana Indoors for Medicinal Use. Sun Magic Publishing, Seattle, 1997.

Sidney Cohen and Richard Stillman, eds. The Therapeutic Potential of Marihuana. Plenum Press, New York, 1975.

David R. Ford. Good Medicine, Great Sex: How Marijuana Brought Me Creativity, Passion, and Prosperity. Good Press, Sonoma CA, 2003.

George McMahon and Christopher Largen. Prescription Pot: A Leading Advocate’s Heroic Battle to Legalize Medical Marijuana. New Horizon Press, P.O. Box 669, Far Hills NJ 07931, 2003.

Mary Lynn Mathre, ed. Cannabis in Medical Practice: A Legal, Historical, and Pharmacological Overview of the Therapeutic Uses of Marijuana. McFarland & Co., London, 1997.

Raphael Mechoulam, ed. Cannabinoids As Therapeutic Agents. CRC Press, Boca Raton FL, 1986.

National Cancer Institute. Marijuana Use in Supportive Care for Cancer Patients. Cancer Information Service, 1997. 1-800-4-CANCER, http://cancernet.nci.

Robert C. Randall, ed. Cancer Treatment and Marijuana Therapy. Marijuana, Medicine, and the Law Series, Galen Press, Washington DC, 1990.

Robert C. Randall. Marijuana and AIDS: Pot, Politics, and PWAs in America. Marijuana, Medicine, and the Law Series, Galen Press, Washington DC, 1991.

Robert C. Randall. Marijuana Medicine and the Law, 2nd ed, 2 vols. Marijuana, Medicine, and the Law Series, Galen Press, Washington DC, 1988–1990.

Roger A. Roffman. Marijuana as Medicine. Madrona Publishers, Seattle, 1982.

Ethan Russo, ed. Cannabis Therapeutics in HIV/AIDS. Haworth Press, Binghamton NY, 2002.