||This article needs more medical references for verification or relies too heavily on primary sources. (November 2013)|
Medical cannabis (or medical marijuana) refers to the use of cannabis and its constituent cannabinoids, such as THC, as medical therapy to treat disease or alleviate symptoms. The Cannabis plant has a history of medicinal use dating back thousands of years across many cultures.
Cannabis has been used to reduce nausea and vomiting in chemotherapy and people with AIDS, and to treat pain and muscle spasticity. Its short term use while increasing minor adverse effects, does not appear to increase major adverse effects. Long term effects are not clear. Other concerns include a greater risk of schizophrenia when used by the young, memory and cognition problems, and the risk of children taking it by accident.
Medical cannabis is administered by a variety of routes, including vaporizing or smoking dried buds, eating extracts, and taking capsules. Synthetic cannabinoids are available as prescription drugs in some countries. Examples include dronabinol, available in the United States and Canada, and nabilone, available in Canada, Mexico, the United Kingdom, and the US. Recreational use of cannabis is illegal in most parts of the world, but the medical use of cannabis is legal in some countries, including Canada, Austria, Germany, the Netherlands, Spain, Israel, Italy, Finland, and Portugal. In the US, federal law outlaws all cannabis use, while 20 states and the District of Columbia have legalized its use.
- 1 Medical uses
- 2 Adverse effects
- 3 Pharmacology
- 4 Methods of consumption
- 5 History
- 6 Society and culture
- 7 Research
- 8 See also
- 9 References
- 10 Further reading
- 11 External links
Medical cannabis has several potential beneficial effects. The U.S. Food and Drug Administration (FDA) has not approved smoked cannabis for any condition or disease as it considers evidence to be lacking for the safety or efficacy of cannabis for medical use.
Medical marijuana is helpful to people who experience chronic non-cancer pain, vomiting and nausea caused by chemotherapy. The drug can also help with treating symptoms of AIDS patients. As of 2011, the use of medical marijuana is legalized in 16 U.S. states but illegal by federal law.
Cannabinoids found in marijuana may have analgesic and anti-inflammatory effects, antitumor effects, and anticancer effects, including the treatment of breast and lung cancer.
The United States Food and Drug Administration (FDA) issued an advisory against smoked medical cannabis stating that, "marijuana has a high potential for abuse, has no currently accepted medical use in treatment in the United States, and has a lack of accepted safety for use under medical supervision." The National Institute on Drug Abuse NIDA state that "Marijuana itself is an unlikely medication candidate for several reasons: (1) it is an unpurified plant containing numerous chemicals with unknown health effects; (2) it is typically consumed by smoking further contributing to potential adverse effects; and (3) its cognitive impairing effects may limit its utility".
The Institute of Medicine, run by the United States National Academy of Sciences, conducted a comprehensive study in 1999 to assess the potential health benefits of cannabis and its constituent cannabinoids. The study concluded that smoking cannabis is not recommended for the treatment of any disease condition, but did conclude that nausea, appetite loss, pain and anxiety can all be mitigated by marijuana. While the study expressed reservations about smoked cannabis due to the health risks associated with smoking, the study team concluded that until another mode of ingestion was perfected that could provide the same relief as smoked cannabis, there was no alternative. In addition, the study pointed out the inherent difficulty in marketing a non-patentable herb. Pharmaceutical companies will probably make less investments in product development if the result is not possible to patent. The Institute of Medicine stated that there is little future in smoked cannabis as a medically approved medication. The report also concluded that for certain patients, such as the terminally ill or those with debilitating symptoms, the long-term risks are not of great concern.
"Citing the dangers of cannabis and the lack of clinical research supporting its medicinal value" the American Society of Addiction Medicine in March 2011 issued a white paper recommending a halt to using marijuana as a medicine in U.S. states where it has been declared legal.
Nausea and vomiting
Medical cannabis is somewhat effective in chemotherapy induced nausea and vomiting (CINV) and it may be a reasonable option in those who do not improve with other treatments. Comparative studies have found cannabinoids to be more effective than some conventional antiemetics such as prochlorperazine, promethazine, and metoclopramide in controlling CINV, but there are used less frequently because of side effects including dizziness, dysphoria, and hallucinations. Long term cannabis use may cause nausea and vomiting, a condition known as cannabinoid hyperemesis syndrome.
A 2010 Cochrane review said that cannabinoids were "probably effective" in treating chemotherapy-induced nausea in children, but with a high side effect profile (mainly drowsiness, dizziness, altered moods, and increased appetite). Less common side effects were "occular problems, orthostatic hypotension, muscle twitching, pruritis, vagueness, hallucinations, lightheadedness and dry mouth".
A 2013 Cochrane review found evidence lacking for both efficacy and safety of cannabis and cannabinoids in treating patients with HIV/AIDS or for anorexia associated with AIDS; studies as of 2013 suffered from effects of bias, small sample size, and lack of long-term data.
Cannabis appears to be somewhat effective in chronic pain, including that due to neuropathy and possibly that due to fibromyalgia and rheumatoid arthritis. A 2009 review said it was unclear if the benefits were greater than the risks, while a 2011 review considered it generally safe for this use. In palliative care its use appears safer than opioids.
In multiple sclerosis (MS) cannabis does not appear to improve measured spasticity but may improve the persons feelings of spasticity.[unreliable medical source?] Use of the drug for MS is approved in Germany and Spain. A 2012 review found no problems with tolerance, abuse or addiction.
A 2013 literature review said that exposure to marijuana had biologically-based physical, mental, behavioral and social health consequences and was "associated with diseases of the liver (particularly with co-existing hepatitis C), lungs, heart, and vasculature". There are insufficient data to draw strong conclusions about the safety of medical cannabis, although short-term use is associated with minor adverse effects such as dizziness. While a number of preclinical and in vitro studies suggest that cannabis is carcinogenic, data on cancer risk in humans are limited and inconclusive. Further research is required to assess the long term safety of its use.
Cannabis contains 483 compounds. At least 80 of these are cannabinoids, which are the basis for medical and scientific use of cannabis. This presents the research problem of isolating the effect of specific compounds and taking account of the interaction of these compounds. Cannabinoids can serve as appetite stimulants, antiemetics, antispasmodics, and have some analgesic effects. Six important cannabinoids found in the cannabis plant are tetrahydrocannabinol, tetrahydrocannabinolic acid, cannabidiol, cannabinol, β-caryophyllene, and cannabigerol.
Tetrahydrocannabinol (THC) is the primary compound responsible for the psychoactive effects of cannabis. The compound is a mild analgesic, and cellular research has shown the compound has antioxidant activity. THC is believed to interact with parts of the brain normally controlled by the endogenous cannabinoid neurotransmitter, anandamide. Anandamide is believed to play a role in pain sensation, memory, and sleep.
Cannabidiol (CBD) is a major constituent of medical cannabis. CBD represents up to 40% of extracts of medical cannabis. Cannabidiol has been shown to relieve convulsion, inflammation, anxiety, cough, congestion and nausea, and it inhibits cancer cell growth.[dubious ] Recent studies say cannabidiol is as effective as atypical antipsychotics in treating schizophrenia[dubious ] and psychosis. Because cannabidiol relieves the aforementioned symptoms, cannabis strains with a high amount of CBD may benefit people with multiple sclerosis or frequent anxiety attacks.
Cannabinol (CBN) is a therapeutic cannabinoid found only in trace amounts in Cannabis sativa and Cannabis indica. It is mostly produced as a metabolite, or a breakdown product, of tetrahydrocannabinol (THC). CBN acts as a weak agonist of the CB1 and CB2 receptors, with lower affinity in comparison to THC.
Part of the mechanism by which medical cannabis has been shown to reduce tissue inflammation is via the compound β-caryophyllene. A cannabinoid receptor called CB2 plays a vital part in reducing inflammation in humans and other animals. β-Caryophyllene has been shown to be a selective activator of the CB2 receptor. β-Caryophyllene is especially concentrated in cannabis essential oil, which contains about 12–35% β-caryophyllene.
Pharmacologic THC and THC derivatives
These medications are usually used when first line treatments for nausea and vomiting associated with cancer chemotherapy fail to work. In extremely high doses and in rare cases "psychotomimetic" side effects are possible. The other commonly used antiemetic drugs are not associated with these side effects.[medical citation needed]
Marinol's manufacturer stated on their website: "The most frequently reported side effects in patients with AIDS during clinical studies involved the central nervous system (CNS). These CNS effects (euphoria, dizziness, or thinking abnormalities, for example) were reported by 33% of patients taking MARINOL". Four documented fatalities resulting from Marinol have been reported.
Nabiximols (USAN, trade name Sativex) is an aerosolized mist for oral administration intended for the treatment of pain. The prescription drug Sativex, an extract of cannabis administered as a sublingual spray, has been approved in Canada for the adjunctive treatment (use alongside other medicines) of both multiple sclerosis and cancer related pain. Sativex has also been approved in the United Kingdom, New Zealand, and the Czech Republic, and is expected to gain approval in other European countries. William Notcutt is one of the chief researchers that has developed Sativex, and he has been working with GW and founder Geoffrey Guy since the company's inception in 1998. Notcutt states that the use of MS as the disease to study "had everything to do with politics."
|Nabilone||1985||U.S., Canada||Nausea of cancer chemotherapy that has failed to respond adequately to other antiemetics||US$4000.00 for a year's supply (in Canada)|
|Canasol||1987||U.S., Canada, several Caribbean nations||Introcular pressure associated with late-stage Glaucoma|
|Nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional treatments||
US$652 for 30 doses @ 10 mg online
|1992||U.S.||Anorexia associated with AIDS–related weight loss|
|Sativex||1995||Canada||Adjunctive treatment for the symptomatic relief of neuropathic pain in multiple sclerosis in adults|
|1997||Canada||Pain due to cancer|
The genus Cannabis contains two species which produce useful amounts of psychoactive cannabinoids. Cannabis indica produces a higher level of cannabidiol (abbreviated CBD) relative to THC (the primary psychoactive component in medical and recreational cannabis). Cannabis sativa, on the other hand, produces a higher level of THC relative to CBD.[unreliable medical source?]
Medical use of sativa is associated with a cerebral high, and many patients experience stimulating effects. For this reason, sativa is often used for daytime treatment. It may cause more of a euphoric, "high" sensation, and tends to stimulate hunger, making it potentially useful to patients with eating disorders or anorexia.Sativa also exhibits a higher tendency to induce anxiety and paranoia, so patients prone to these effects may limit treatment with pure sativa, or choose hybrid strains.[not in citation given]
Cannabis indica is associated with sedative effects and is often preferred for night time use, including for treatment of insomnia.[page needed] Indica is also associated with a more "stoned" or meditative sensation than the euphoric, stimulating effects of sativa, possibly because of a higher CBD-to-THC ratio.
Many strains of cannabis are currently cultivated for medical use, including strains of both species in varying potencies, as well as hybrid strains designed to incorporate the benefits of both species. Hybrids commonly available can be heavily dominated by either Cannabis sativa or Cannabis indica, or relatively balanced, such as so-called "50/50" strains.
Cannabis strains with relatively high CBD-to-THC ratios, usually indica-dominant strains, are less likely to induce anxiety. This may be due to CBD's receptor antagonistic effects at the cannabinoid receptor, compared to THC's partial agonist effect. CBD is also a 5-HT1A receptor agonist, which may also contribute to an anxiolytic effect.[page needed] This likely means the high concentrations of CBD found in Cannabis indica mitigate the anxiogenic effect of THC significantly.[page needed]
Methods of consumption
One of the major criticisms of cannabis as medicine is opposition to smoking as a method of consumption.[unreliable medical source?] However, smoking is not necessary due to alternative methods of ingestion. Medicinal cannabis patients can use vaporizers, where the essential cannabis compounds are extracted and inhaled. In addition, edible cannabis, which is produced in various baked goods, is also available, and has demonstrated longer lasting effects.[unreliable medical source?]
Any possible harm caused by smoking cannabis can be minimized by the use of a vaporizer[unreliable medical source?] or ingesting the drug in an edible form. Vaporizers are devices that heat the active constituents to a temperature below the ignition point of the cannabis, so that the resultant vapors can be inhaled. Combustion of plant material is avoided, thus preventing the formation of carbon monoxide and carcinogens, such as polyaromatic hydrocarbons and benzene. There are pocket-sized forms of vaporizer which use rechargeable batteries, are constructed from wood, and feature removable covers.[unreliable medical source?]
Cannabis, called má 麻 (meaning "hemp; cannabis; numbness") or dàmá 大麻 (with "big; great") in Chinese, was used in Taiwan for fiber starting about 10,000 years ago. The botanist Li Hui-Lin wrote that in China, "The use of Cannabis in medicine was probably a very early development. Since ancient humans used hemp seed as food, it was quite natural for them to also discover the medicinal properties of the plant." Emperor Shen-Nung, who was also a pharmacologist, wrote a book on treatment methods in 2737 that included the medical benefits of cannabis. He recommended the substance for many ailments, including constipation, gout, rheumatism, and absent-mindedness. Cannabis is one of the 50 "fundamental" herbs in traditional Chinese medicine.
Surviving texts from ancient India confirm that cannabis' psychoactive properties were recognized, and doctors used it for treating a variety of illnesses and ailments, including insomnia, headaches, gastrointestinal disorders, and pain, including during childbirth.
The Ancient Greeks used cannabis to dress wounds and sores on their horses, and in humans, dried leaves of cannabis were used to treat nose bleeds, and cannabis seeds were used to expel tapeworms.
In the medieval Islamic world, Arabic physicians made use of the diuretic, antiemetic, antiepileptic, anti-inflammatory, analgesic and antipyretic properties of Cannabis sativa, and used it extensively as medication from the 8th to 18th centuries.
Albert Lockhart and Manley West began studying in 1964 the health effects of traditional cannabis use in Jamaican communities. They developed, and in 1987 gained permission to market, the pharmaceutical Canasol: one of the first cannabis extracts.
Voters in eight US states showed their support for cannabis prescriptions or recommendations given by physicians between 1996 and 1999,[dated info] including Alaska, Arizona, California, Colorado, Maine, Michigan, Nevada, Oregon, and Washington, going against policies of the federal government.
Society and culture
Methods of acquisition
The method of obtaining medical cannabis varies by region and by legislation. Currently some of the permitted methods are through regulated marijuana dispensaries (or marijuana clubs) or by self-propagation. In some areas it is legal for a person to grow their own marijuana for personal use.
The authors of report on a 2011 survey of medical cannabis users say that critics have suggested that some users "game the system" to obtain medical cannabis ostensibly for treatment of a condition, but then use it for nonmedical purposes – though the truth of this claim is hard to measure. The report authors suggested rather that medical cannabis users occupied a "continuum" between medical and nonmedical use.
A marijuana vending machine is a vending machine for selling or dispensing marijuana. They are currently in use in the United States and may be located in secure rooms in medical marijuana dispensaries. Some may be operated by employees after a fingerprint scan is obtained from the patient. In Canada, marijuana vending machines are planned to be used in centres that cultivate the drug.
At least three companies are developing the vending machines. Endexx Corp. (ticker symbol: EDXC) has recently acquired two smaller companies to merge their respective technologies into a marijuana vending machine. The first acquisition, called Cann-Can LLC, was announced by Endexx in April 2013. The second acquisition, known as Dispense Labs LLC, was finalized and announced by Endexx in October 2013. Dispense Labs has developed an advanced vending machine, known as Autospense, through its partnership with the leader in industrial vending inventory solutions, Autocrib, Inc. The Autospense machines have many built-in benefits and features to improve security, inventory management, profitability, efficiency, accountability and to mitigate risk. Endexx, through its wholly owned subsidiary, Dispense Labs, has secured exclusive worldwide rights for medical marijuana dispensing technology with Autocrib. Together, with M3Hub and the recent acquisition of THCFinder.com, these vending machine acquisitions will enable Endexx to provide a complete seed-to-sale solution to assist dispensaries, and other cannabis-related businesses, to work within the confines of the law. The THC Finder website will enable marijuana patients to locate the nearest dispensary with an Autospense marijuana vending machine.
Medbox Inc. is the industry leader in medical marijuana dispensing machines. They sell two machines for $50,000, one foredible marijuana products like brownies, and the other for portions of marijuana itself. As of October 2013, Medbox has sold approximately 160 marijuana vending machines to US medical marijuana dispensaries.
National and international regulations, classification and patent
Medical use of cannabis or preparation containing THC as the active substance is legalized in Austria, Belgium, Canada, Belgium, Finland, Israel, Netherlands, Spain, the UK and some states in the US, although it is illegal under US federal law.
Cannabis is in Schedule IV of the United Nations' Single Convention on Narcotic Drugs, making it subject to special restrictions. Article 2 provides for the following, in reference to Schedule IV drugs:
A Party shall, if in its opinion the prevailing conditions in its country render it the most appropriate means of protecting the public health and welfare, prohibit the production, manufacture, export and import of, trade in, possession or use of any such drug except for amounts which may be necessary for medical and scientific research only, including clinical trials therewith to be conducted under or subject to the direct supervision and control of the Party.
The convention thus allows countries to outlaw cannabis for all non-research purposes but lets nations choose to allow medical and scientific purposes if they believe total prohibition is not the most appropriate means of protecting health and welfare. The convention requires that states that permit the production or use of medical cannabis must operate a licensing system for all cultivators, manufacturers and distributors and ensure that the total cannabis market of the state shall not exceed that required "for medical and scientific purposes."
A number of medical organizations have endorsed reclassification of marijuana to allow for further study. These include, but are not limited to:
- The American Medical Association
- The American College of Physicians – America's second largest physicians group
- Leukemia & Lymphoma Society – America's second largest cancer charity
- American Academy of Family Physicians opposes the use of marijuana except under medical supervision
Other medical organizations recommend a halt to using marijuana as a medicine in U.S.
|“||Cannabinoids have been found to have antioxidantproperties, unrelated to NMDA receptor antagonism. This new found property makes cannabinoids useful in the treatment and prophylaxis of wide variety of oxidation associated diseases, such as ischemic, age-related,inflammatory and autoimmune diseases. The cannabinoids are found to have particular application as neuroprotectants, for example in limiting neurological damage following ischemic insults, such as stroke and trauma, or in the treatment of neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease and HIV dementia... .||”|
Anecdotal evidence and pre-clinical research has suggested that cannabis or cannabinoids may be beneficial for treating Huntington's disease or Parkinson's disease, but follow-up studies of people with these conditions has not produced good evidence of therapeutic potential. A 2001 paper argued that cannabis had properties that made it potentially applicable to the treatment of amyotrophic lateral sclerosis, and on that basis research on this topic should be permitted, despite the legal difficulties of the time.
A 2005 review and meta-analysis said that bipolar disorder was not well-controlled by existing medications and that there were "good pharmacological reasons" for thinking cannabis had therapeutic potential, making it a good candidate for further study.
Cannabinoids have been proposed for the treatment of primary anorexia nervosa, but have no measurable beneficial effect. The authors of a 2003 paper argued that cannabinoids might have useful future clinical applications in treating digestive diseases.
Cannabinoids have been proposed as having the potential for lessening the effects of Alzheimer's disease. A 2012 review of the effect of cannabinoids on brain ageing found that "clinical evidence regarding their efficacy as therapeutic tools is either inconclusive or still missing". A 2009 Cochrane review said that the "one small randomized controlled trial [that] assessed the efficacy of cannabinoids in the treatment of dementia ... [had] ... poorly presented results and did not provide sufficient data to draw any useful conclusions".
According to a 2011 review by Di Marzo et al, there is emerging evidence that cannabidiol may help slow cell damage in diabetes mellitus type 1. There is a lack of meaningful evidence of the effects of medical cannabis use on people with diabetes; a 2010 review concluded that "the potential risks and benefits for diabetic patients remain unquantified at the present time".
There is not enough evidence to draw conclusions about the safety or efficacy of cannabinoids in the treatment of epilepsy. There have been few studies of the anticonvulsive properties of CBD and epileptic disorders. The major reasons for the lack of clinical research have been the introduction of new synthetic and more stable pharmaceutical anticonvulsants, the recognition of important adverse effects and the legal restriction to the use of cannabis-derived medicines.
The American Glaucoma Society noted that while cannabis can help lower intraocular pressure, it recommended against its use because of "its side effects and short duration of action, coupled with a lack of evidence that it use alters the course of glaucoma." As of 2008 relatively little research had been done concerning effects of cannabinoids on the eye.
Controlled research on treating Tourette syndrome with a synthetic version of THC called (Marinol), showed the patients taking the pill had a beneficial response without serious adverse effects; other studies have shown that cannabis "has no effects on tics and increases the individuals inner tension". A 2009 Cochrane Review found that the few relevant studies of cannibinoids in treating tics had attrition bias, and that there was "not enough evidence to support the use of cannabinoids in treating tics and obsessive compulsive behaviour in people with Tourette's syndrome".
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|Wikimedia Commons has media related to Medical cannabis.|
- Medical cannabis at the Open Directory Project, links to websites about medical cannabis.
- Information on Cannabis and Cannabinoids from the U.S. National Cancer Institute
- Information on cannabis (marihuana, marijuana) and the cannabinoids from Health Canada
- The Center for Medicinal Cannabis Research of the University of California.