Tetrahydrocannabinol – Cannabis

The pros and cons of using marijuana as medicine can be established from a quote from page 63 of the book Marijuana, Noah Berlatsky, book editor, which has an excerpt from Bill McCarberg’s book “Marijuana and Pain Management” saying “Numerous studies have now established that cannabinoids help lessen pain and affect a wide range of symptoms and bodily functions. ” Bill McCarberg, founder of the Chronic Pain Management Program for Kaiser Permanente, says that cannabinoids found in marijuana have been shown to be effective in reducing pain.

He notes that much more clinical study is required and that it is difficult to balance the intoxicating and pain relieving effects of marijuana. Nonetheless, he concludes that cannabinoid pain relievers are very promising and hopes that they will soon become an important medical therapy for pain. When taken orally, cannabinoids are not very well absorbed and often have unpredictable effects. Patients often become sedated or have intoxication-like symptoms when tetrahydrocannabinol (THC-the primary psychoactive cannabinoid in cannabis) is metabolized by the liver.

A small number of studies with Marinol (synthetic THC analogue) have shown some effectiveness in pain relief, but optimal doses that relieve pain often cannot be achieved because of unpleasant psychological side effects. Inhaling cannabinoids, especially THC, also may cause problems for many patients. Blood levels rise suddenly and then drop off sharply. This rapid on-off effect may produce significant intoxication, particularly in patients who are new to cannabinoids. This may pose the risk of abuse potential. Smoking cannabis produces this effect, which is the very reason that recreational users prefer the inhaled route.

Patients, however, generally wish to avoid psychological effects, and it is unclear how difficult it might be to find a dosing pattern that enables them to have pain control without side effects. A new product, called Sativex, was approved by Health Canada in June 2005 for marketing as an adjunctive medicine for central neuropathic pain in multiple sclerosis. Adjunctive therapy means taking two or more medications to help control pain.

Sativex has a different delivery system-an oromucosal/sublingual spray absorbed by the lining of the mouth-that, according to the manufacturer, generally allows patients to gradually work up to a stable dose at which they obtain therapeutic pain relief without unwanted psychological effects. In the United States, Sativex is being studied in large randomized trials in cancer pain that has not been adequately relieved by opiods. Three early and six pivotal controlled studies in the United Kingdom demonstrated positive results treating chronic pain of various origins including neurological pain, various symptoms of multiple sclerosis, rheumatoid arthritis, and cancer pain.

Initial results show improvement in pain for more than one year despite lack of effectiveness of the opioids. Common adverse effects of Savitex have included complaints of bad taste, stinging, dry mouth, dizziness, nausea or fatigue. Additional research also may uncover other ways of avoiding the problems associated with oral or inhaled delivery. Ajulemic acid, a synthetic cannabinoid, binds to both the CB1 and CB2 receptors, and has shown benefit in a small neuropathic pain trial.

It may have reduced psychological effects and is being studied for the treatment of intestinal cystitis. The pros and cons of marijuana’s medical benefits are further explained by an article entitled “Reefer Madness; Medical Marijuana (The Medical Uses of Cannabis),” The Economist, April 29, 2006, p. 83. , quoted in chapter 5 of the book “Marijuana”; Arthur Gillard, book editor which reads as follows: If marijuana had just been discovered it would be regarded as a medical breakthrough, but because of its history it is considered a dangerous, politically controversial drug. The U. S.

Food and Drug Administration (FDA) denies that smoked marijuana has any accepted medical use in America, contradicting an earlier report by the Institute of Medicine as well as the experience of doctors and patients who find it helpful. The FDA approved Marinol, a synthetic version of one of the many active ingredients(“cannabinoids”) in marijuana, but Marinol does not seem to work as well as marijuana itself, probably because many other cannabinoids interact in complex ways to produce a greater effect. More research would improve our ability to use marijuana medically, but the U.S.

Drug Enforcement Administration’s unwillingness to allow researchers to grow it makes such studies very difficult. Controversy with smoked marijuana may be avoided by other methods of administration, such as vaporization or an extract sprayed under the tongue. However, allowing researchers to breed varieties of marijuana is still necessary to learn more about which cannabinoids are having what effects. Such research is making great strides in other countries, which has resulted in a new marijuana treatment called Sativex being made available in Canada and elsewhere.

Sativex is being studied for possible approval in the United States, but meanwhile the medical need for marijuana could be cheaply and easily met if the government had the will to do so. Marijuana is medically useful, whether politicians like it or not. If cannabis were unknown, and bioprospectors were suddenly to find it in some remote mountain crevice, its discovery would no doubt be hailed as a medical breakthrough. Scientist would praise its potential for treating everything from pain to cancer, and marvel at its rich pharmacopoeia-many of whose chemicals mimic vital molecules in the human body.

In reality cannabis has been with humanity for thousands of years and is considered by many governments (notably America’s) to be a dangerous drug without utility. Any suggestion that the plant might be medically useful is politically controversial, whatever the science says. It is in this context that, on April 20th [2006], America’s Food and Drug Administration (FDA) issued a statement saying that smoked marijuana has no accepted medical use in treatment in the United States. The statement is curious in a number of ways.

For one thing, it overlooks a report made if 1999 by the Institute of Medicine (IOM), part of the National Academy of Sciences, which came to a different conclusion. John Benson, a professor of medicine at the University of Nebraska who co-chaired the committee that drew up the report, found some sound scientific information that supports the medical use of marijuana for certain patients for short periods-even for smoked marijuana. This is important, because one of the objections to marijuana is that, when burned, its smoke contains many of the harmful things found in tobacco smoke, such as carcinogenic tar, cyanide, and carbon monoxide.

Yet the IOM report supports what some patients suffering from multiple sclerosis, AIDS and cancer-and their doctors-have known for a long time. This is that the drug gives them medicinal benefits over and above the medications they are already receiving, and despite the fact that the smoke has risks. That is probably why several studies show that many doctors recommend smoking cannabis to their patients, even though they are unable to prescribe it.

Patients then turn to the black market for their supply. The pros and cons of using marijuana as medicine can be further explained by a viewpoint of William Saletan, quoted from his article entitled “Shredded Weed: Taking the Fun Out of Marijuana,” Slate, May 27,2009. www. slate. com. Copyright 2009 by The Slate Group, excerpted from the book “Marijuana”, Chapter 2-viewpoint 7, pp. 104-108. Mr. Saletan starts off with a paragraph titled “Sativex Isn’t Pot”, the article then goes on to say: GW Pharmaceuticals, a British company, has just requested European approval of Sativex, a “cannabinoid pharmaceutical product. ” What’s that? Do I hear you snickering at your keyboard?

You think this is a backdoor way of legalizing weed? For shame, says the company: Sativex is a cannabinoid pharmaceutical product standardized in composition, formulation, and dose, administered by means of an appropriate delivery system, which has been, and continues to be, tested in properly controlled preclinical and clinical studies. Crude herbal cannabis in any form-including a crude extract or tincture- is none of those things. So there. Sativex isn’t pot. It’s a carefully refined derivative: “Once the plants have matured, they are harvested and dried.

GW then extracts the cannabinoids and other pharmacologically active components . . . [ to ] arrive at a pharmaceutical grade material. ” Patients are further expected to regulate their intake to separate pot’s approved effects- relief of pain and spams- from its unapproved effects: By careful self-titration (dose adjustment), most patients are able to separate the thresholds for symptom relief and intoxication, the “therapeutic window”, so enabling them to obtain symptom relief without experiencing a “high”. Bummer, eh? The company knows exactly what you’re thinking: Why not just let patients smoke cannabis?

In GW’s opinion, smoking is not an acceptable means of delivery of medicine. We believe that patients wish to use a medicine that is legally prescribed, does not require smoking, is of guaranteed quality, has been developed and approved by regulatory authorities for use in their specific medical condition and is dispensed by pharmacists under the supervision of their doctor. Pros and cons of using Sativex versus Marinol are explained from authors Dale Gieringer, Ed Rosenthal, and Gregory T. Carter, Marijuana Medical Handbook: Practical Guide to Therapeutic Uses of Marijuana: Stating that Sativex differs from Marinol in important ways.

First, it incorporates CBD [cannabidoil] and other plant ingredients as well as THC [the active ingredient in marijuana]. GW [the company that produces Sativex] says that its research showed the mixture is more effective, partly because CBD mitigated untoward psychoactive effects of pure THC. Second, Sativex is not a pill, but a spray delivered under the tongue. This delivery method is not as fast as inhalation, as it takes several minutes for the cannabinoids to be absorbed through the membranes of the mouth. However, it is faster than oral ingestion.

It also delivers a far more consistent dosage, since the cannabinoids are absorbed directly into the blood from the oral membranes without having to pass through the digestive system. Third, Sativex is cheaper to manufacture because the cannabinoids are derived from the plant rather than expensive chemical synthesis. Back to William Saletans article from Chapter 2, viewpoint 7, page 108 of the book “Marijuana”. First came Cesamet (a “synthetic cannabinoid”), then Marinol (also Synthetic). Only one pesky side effect has remained: Cesamet produces “euphoria in the recommended dosage range,” and Marinol causes “easy laughing” and “elation”.

So the quest to “separate the thresholds for symptom relief and intoxication” continues. According to GW, delivery of Sativex as a spray “enables patients to titrate (adjust) their dose to achieve symptom relief without incurring an unacceptable degree of side effects. ” So these are some of the pros and cons of using marijuana as medicine. References: Marijuana / Arthur Gillard, book editor. (At Issue), Section 5, pp. 41-43, copyright 2009 Greenhaven Press, a part of Gale, Cengage Learning. Reprint of article “Reefer Madness; Medical Marijuana (The Medical Uses of Cannabis),” The Economist, April 29, 2006, p.83.

Copyright 2006 The Economist Newspaper Group, Inc. Republished with permission of The Economist Newspaper Group, Inc. , conveyed through Copyright Clearance Center, Inc. Marijuana / Noah Berlatsky, book editor. (Opposing Viewpoints),Chapter 2, Viewpoint 1, Bill McCarberg, author, pp. 63-67, copyright 2012 Greenhaven Press, a part of Gale, Cengage Learning. Marijuana / Noah Berlatsky, book editor. (Opposing Viewpoints), Chapter 2, Viewpoint 7, William Saletan, author, pp. 104-108, copyright 2012 Greenhaven Press, a part of Gale, Cengage Learning Word Count: 1887.

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