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Resolution of the American Public Health Association
Access to Therapeutic Marijuana/Cannabis
The American Public Health Association,
Being aware that cannabis/marijuana has been used medicinally for centuries and that cannabis products were widely prescribed by physicians in the United States until 19371'2; and
Being aware that "marijuana" prohibition began with the Marihuana Tax Act of 1937 under false claims despite disagreeing testimony from the AMA's representative3' 4; and
Being further aware that the Controlled Substances Act of 1970 completely prohibited all medicinal use of marijuana by placing it in the most restrictive category of Schedule I, whereby drugs must meet three criteria for placement in this category: 1) have no therapeutic value, 2) are not safe for medical use, and 3) have a high abuse potentials; and
Being cognizant that the Drug Enforcement Administration's own administrative law judge ruled in 1988 that marijuana must be removed from Schedule I and made available for physicians to prescribe' 7'8; and
Knowing that 36 states have passed legislation recognizing marijuana's therapeutic value9,10; and
Also knowing that the only available access to legal marijuana which was through the Food and Drug Administration's Investigational New Drug Program has been closed by the Secretary of Health and Human Resources since 1992"; and
Understanding that while synthetic tetrahydrocannabinol (THc) is available in pill form, it is only one of approximately 60 cannabinoids which may have medicinal value individually or in some combination; and
Understanding that marijuana has an extremely wide margin of safety for use under medical supervision and cannot cause lethal reactions6'32'32,34; and
Understanding that marijuana has been found to be effective in a) reducing intraocular pressure in glaucoma,"' 13 b) reducing nausea and vomiting associated with chemotherapy,14, 15, 16 c) stimulating the appetite for patients living with AIDS and suffering from the wasting syndrome,", ",19 d) controlling spasticity associated with spinal cord injury and multiple sclerosis,20, 21, 22,23,24,25 e) decreasing the suffering from chronic pain,26,27,28 and f) controlling seizures associated with seizures disorders29, 30, 31; and
Understanding that marijuana seems to work differently than many conventional medications for the above problems, making it a possible option for persons resistant to the conventional medications32,33; and
Being concerned that desperate patients and their families are choosing to break the law to obtain this medicine when conventional medicines or treatments have not been effective for them or are too toxic34, and
Realizing that this places ill persons at risk for criminal charges and at risk for obtaining contaminated medicine because of the lack of quality control; and
Realizing that thousands of patients not helped by conventional medications and treatments, may find relief from their suffering with the use of marijuana if their primary care providers were able to prescribe this medicine; and
Concluding that cannabis/marijuana was wrongfully placed in Schedule I of the Controlled Substances depriving patients of its therapeutic potential; and
Recognizing that APHA adopted a resolution (7014) on Marijuana and the Law which urged federal and state drug laws to exclude marijuana from classification as a narcotic drug,36 and
Concluding that greater harm is caused by the legal consequences of its prohibition than possible risks of medicinal use; therefore
1. Encourages research of the therapeutic properties of various cannabinoids and combinations of cannabinoids; and
2. Encourages research on alternative methods of administration to decrease the harmful effects related to smoking; and
3. Urges the Administration and Congress to move expeditiously to make cannabis available as a legal medicine where shown to be safe and effective and to immediately allow access to therapeutic cannabis through the Investigational New Drug Program.
References
1. Abel EA: Marihuana: The First Twelve Thousand Years. New York: McGraw-Hill Book Company, 1982.
2. Mikuriya TH, Ed: Marijuana: Medical Papers 1839-1972. Oakland, CA: Medi-Comp Press, 1973.
3. Bonnie RJ and Whitebread II, CH: The Marihuana Conviction: A History of Marihuana Prohibition in the United States. Charlottesville, VA: University Press of Virginia, 1974.
4. National Commission on Marihuana and Drug Abuse (RP Shafer, Chairman): Marihuana: a Signal of Misunderstanding. New York: the New American Library, Inc., 1972.
5. Controlled Substances Act of 1970 (Pub.L. 91-513, October 27, 1970, 21USC801 et seq.)
6. In the Matter of Marihuana Rescheduling Petition, Docket 86-22, Opinion, Recommended Ruling, Findings of Fact, Conclusions of Law, and Decision of Administrative Law Judge, September 6, 1988. Washington, D.C.: Drug Enforcement Agency, 1988.
7. Randall RC: Marijuana, Medicine and the Law. Washington, D.C.: Galen Press, 1988.
8. Randall RC: Marijuana, Medicine and the Law. (Volume II) Washington, D.C.: Galen Press, 1989.
9. Alliance for Cannabis Therapeutics: No accepted medical value?? ACT News Spring, 1995; p. 4.
10. Grinspoon L and Bakalar JB: Marihuana as medicine: a plea for consideration. JAMA 1995; 273(23):1875-1876.
11. Government extinguishes marijuana access, advocates smell politics. JAMA May 20,1992; 267(19):2673-2674.
12. Colasanti BK: Review: Ocular hypotensive effect of marihuana cannabinoids: correlate of central action or separate phenomenon. J Ocular Pharmacol 1986; 2(3):295-304.
13. Hepler RS and Frank IM: Marihuana smoking and intraocular pressure. J Am Med Ass 1971 217:1392.
14. Sallan SE, Zinberg NE and Frei, III E: Antiemetic effect of delta-9-tetrahydrocannabinol in patients receiving cancer chemotherapy. New Engl J Med 1975; 293(16):795-797.
15. Sallan SE, Cronin C, Zelen M, and Zinberg NE: Antiemetics in patients receiving chemotherapy for cancer. New Engl J Med 1980; 302:135-138.
16. Vinciguerra V, Moore T, and Brennan, E: Inhalation marijuana as an antiemetic for cancer chemotherapy. N Y State J Med 1988; 88:525-527.
17. Nelson K, Walsh D, Deeter P, et al: A phase II study of delta-9-tetrahydrocannabinol for appetite stimulation in cancer-associated anorexia. J Palliative Care 1994; 10(1):14-18.
18. Regelson W, Butler JR, Schultz J et al: Delta-9-THC as an effective antidepressant and appetite stimulating agent in advanced cancer patients. In Int Conf Pharmacol Cannabis, Ed S Szara, MC Bruade. Savannah: Raven, 1975.
19. Foltin RW, Fischman MW, and Byrne MF: Effects of smoked marijuana on food intake and body weight of humans living in a residential laboratory. Appetite 1988; 11:1-14.
20. Clifford DB: Tetrahydrocannabinol for tremor in multiple sclerosis. Ann Neurol, 1983; 13:669-671.
21. Malec J, Harvey RF, and Cayner JJ: Cannabis effect on spasticity in spinal cord injury. Arch yhys Med Rehab 1982; 35:198.
22. Meinck H, Schonle PW, and Conrad B: Effect of cannabinoids on spasticity and ataxis in multiple sclerosis. J Neurol 1989; 236:120-122.
23. Petro D: Marihuana as a therapeutic agent for muscle spasm or spasticity. Psychosomatics 1980; 21:81-85.
24. Petro D and Ellenberger C: Treatment of human spasticity with delta-9-tetrahydrocannabinol. J Clin Pharmacol 1981:21:413S-416S.
25. Ungerleider JT, Andyrsiak T, Fairbanks L., et al: Delta-9-THC in the treatment of spasticity associated with multiple sclerosis. Pharmacological Issues in Alcohol and Substance Abuse 7(1):39-50.
26. Johnson MR, Melvin LS, Althius, TH et al: Selective and potent analgesics derived from cannabinoids. J Clin Pharmacol 1981; 21:271S-282S.
27. Maurer M, Henn V, Dittrich A, et al: Delta-9-tetrahydrocannabinol shows antispastic and analgesic effects in a single case double-blind trial. Eur Arch Psychiatry Clin Neurosci 1990; 240:1-4.
28. Noyes, R, Jr., Brunk SF, Avery DH, et al: The analgesic properties of delta-9-tetrahydrocannabinol and codeine. Clin Pharmacol Ther 1975; 18(1):84-89.
29. Cunha JM, Carlini EA, Pereira AE, et al: Chronic administration of cannabidiol to healthy volunteers and epileptic patients. Pharmacology 1980; 21:175-185.
30. Feeney D: Marihuana use among epileptics. JAMA 1976; 235:1105.
31. Karler R and Turkanis SA: The cannabinoids as potential antiepileptics. J Clin Pharmacol 1981; 21:437S-448S.
32. Institute of Medicine: Marijuana and Health. Washington, D.C.: National Academy Press, 1982.
33. Mechoulam R, Ed: Cannabinoids as Therapeutic Agents. Boca Raton, FL: CRC Press, 1986.
34. Cannabis clubs open for medicinal business. USA Today October 1, 1993: B1 and B5.
35. Berger J: Mother's homemade marijuana: a plan to aid her son leads to arrest and push for change. The New York Times October 11, 1993.
36. American Public Health Association Resolution No. 7014: Marijuana and the Law. APHA Public Policy Statements, 1948—present, cumulative. Washington, DC: APHA, current volume.
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