Mary Lynn Mathre, R.N., M.S.N., C.A.R.N., is an addictions consultant at the University of Virginia Medical Center in Charlottesville.

 

Corinne Millet, a physician's widow and glaucoma patient from Nebraska, grew up hearing many stories regarding the dangers of marijuana. It was a lucky coincidence that she learned of marijuana's therapeutic potential because her ophthalmologist was certain that she would be blind within three years. None of the accepted medical therapies nor two surgical procedures were effective in decreasing her intraocular pressure. In 1989 she gained legal access to medicinal marijuana with the support of her physician through the Investigational New Drug Program administered by the FDA. Not only does she still have her sight as a result of the therapeutic use of marijuana, but she also has gained an uncomfortable insight regarding the government she had believed for many years. Ms. Millet has the following to say:

 

It's very frustrating for me to know that there are all these people out there that have no idea what they should do. They're going blind, they're losing their sight—they know they are. They don't know what to do. They don't know who to write to. They don't know who to call. They don't know what they have to have. This is very upsetting to me, because these people are desperate as I was desperate. I don't want to be blind. I don't want to be any more handicapped than I already am. And I don't feel that this is justifiably honest for this country to deny these people this information. And who is doing it? Who? Why? I don't know.

 

Why write a book about an illegal plant that contains a legitimate medicine? Because the cannabis plant (marijuana) does have therapeutic benefits and could ease the suffering of millions of persons with various illnesses such as AIDS, cancer, glaucoma, multiple sclerosis, spinal cord injuries, seizure disorders, chronic pain, and other maladies.

 

Marijuana is the most commonly used illicit drug in the United States. Estimates regarding its use in the United States range from 20 million to 80 million regular users, and although many cannabis users do consume this drug for enjoyment and relaxation, others use it for medicinal purposes. If they were aware of its therapeutic value and had the opportunity and guidance to use it effectively, countless others could benefit from its therapeutic properties.

 

Marijuana Prohibition

 

Legal access to therapeutic cannabis is currently unavailable to most people. Marijuana is a Schedule I drug under the Controlled Substances Act and therefore cannot be prescribed. Although difficult to obtain, medicinal marijuana was at one time available through a special federal program (the Investigational New Drug Program). However, access through this program was closed in 1992. Because marijuana is an illegal drug, accurate information about it is difficult to obtain. Mainstream information includes scare tactics, lies, and faulty research findings that have been repeatedly reported as though they were factually correct. The therapeutic benefits of cannabis are no longer mentioned in the formal education of healthcare professionals (i.e., physicians, nurses, pharmacists) nor are they mentioned in the thousands of medical and healthcare textbooks that discuss the various illnesses against which the plant may be helpful. Thus, many healthcare professionals are simply ignorant of the therapeutic uses of cannabis.

 

Those healthcare professionals who do learn of its therapeutic value are quite often intimidated by its illegal status. Any association with this drug could result in the loss of prescription privileges or professional licenses, and could possibly lead to criminal charges for possession of or intent to distribute an illegal drug. Those charges could further result in forfeiture of property and prison time. Thus, because of intimidation and fear of penalties, most healthcare professionals do not even want to discuss any positive uses of cannabis.

 

The contributors to this book are aware of the therapeutic benefits of cannabis and believe this information should be readily available. They recognize that people are currently using this medicine without access to a reliable source of information about it. In fact, they believe that the illegal status of cannabis jeopardizes the health of the American people by denying them access to a remarkably safe and effective medicine.

 

A patient generally learns of the medicinal value of cannabis through personal experience or by word of mouth from another patient, a friend or a healthcare professional, who has learned of its benefits and is willing to share this information. The patient must then commit the illegal acts of procurement and possession to determine if the drug is effective for his or her illness. If cannabis is effective, the patient must then determine how to obtain this illegal substance on a regular basis.

 

Because of its illegality, there is no quality control on the ingredients of this medicine, and this places the patient in further jeopardy. Patients are not taught by a healthcare professional about the safe administration of the medicine, the recommended dosages or the medicine's associated risks and benefits. Because the patient fears admitting to using the drug or the healthcare professional refuses to care for a patient using this illegal substance, there is no follow-up by healthcare professionals. And there is no current research on humans regarding its therapeutic use, because it supposedly has no therapeutic benefits, and therefore, there is no funding available for such research.

 

Government-sponsored (funded) research projects have been aimed at determining the dangers of this drug. However, when these studies have shown minimal risks, they have been buried or the data have been manipulated to indicate a greater risk. For example, in 1980 and 1981, a committee of the Institute of Medicine completed a study, Marijuana and Health, supported by the National Institutes of Health, which was published in 1982. When the study, chaired by A.S. Relman, concluded that cannabis had therapeutic value and should be further evaluated, and that the dangers of cannabis were not great enough to warrant its prohibition, fewer than 300 copies of the study were printed. There were not even enough copies for every member of Congress.

 

Another example can be found with research on the effects of cannabis on the immune system. What the reader will find when reviewing most of the research studies is that extremely high doses are necessary to yield negative effects. In fact, when a study funded by the National Institute on Drug Abuse (NIDA) found little evidence that cannabis was hazardous to the immune system, the researchers had to go outside the United States to find a journal willing to publish their findings. It is a simple case of catch-22 that lack of research is often cited as the reason why marijuana cannot be removed from the Schedule I category; however, one cannot research this drug because it is in Schedule I (forbidden use category).

 

War on Drugs Based on Faulty Premise

 

Our modern-day "war on drugs" has given rise to emotionally charged attitudes and dangerously unsafe misconceptions about both medicines and drugs. Under this model, medicines are represented and viewed as "good chemicals," which can be taken to provide a quick fix for just about any health problem. There are over-the-counter (oTc) medicines, which are considered safe enough for individuals to consume at their own risk. In addition, there are prescription medicines, which are judged to be stronger and therefore require the permission and guidance of a physician in the form of a prescription.

 

The Comprehensive Drug Abuse Prevention and Control Act of 1970 was signed by President Richard M. Nixon on October 27, 1970, and became effective on May 1, 1971. Commonly known as the Controlled Substances Act of 1970, this law specifically states that all drugs controlled by the act are under the jurisdiction of federal law. Under this law, five Schedules were created to categorize drugs according to their potential for abuse.   Schedule I: These drugs are not safe, have no accepted medical use in the United States, and have a high potential for abuse. These drugs cannot be prescribed and are available only for research after special application to federal agencies. Examples: marijuana, natural THC, heroin, LSD, peyote, psilocybin.   Schedule II: These drugs have a currently accepted medicinal use and have a high potential for abuse and dependence liability. A written prescription is required by a physician who is registered with the Drug Enforcement Administration (DEA). Telephoned prescriptions are not allowed and no refills are allowed. Examples: opium derivatives (e.g., morphine, codeine), meperidine (Demerol), methadone, Fentanyl, cocaine, amphetamines (Dexedrine), short-acting barbiturates (e.g., Nembutal, Seconal), and dronabinol (Marinol) (synthetic THC).   Schedule III: Medicinal drugs with potential for abuse and dependence liability less than Schedule II, but greater than Schedule IV. A telephoned prescription is permitted to be converted to written form by the dispensing pharmacist. Prescriptions must be renewed every six months and refills are limited to five. Examples: paregoric, some appetite suppressants (e.g.,' Didrex, Tenuate), some hypnotics (e.g., glutethimide, methyprylon).   Schedule IV: Medicinal drugs with less potential for abuse and dependence liability than Schedule III drugs. Prescription requirements are similar to Schedule III drugs. Examples: pentazocin (Talwin), propoxphene (Darvon), benzodiazepines (e.g., Librium, Valium), meprobamate.   Schedule V: Medicinal drugs with the lowest potential for abuse and dependence liability. Drugs requiring a prescription are handled the same way as any nonscheduled prescription drug. The buyer may be required to sign a log of purchase. Examples: codeine and hydrocodone in combination with other active, non-narcotic drugs usually in cough suppressants and antidiarrheal agents.   Schedules of Controlled Substances

 

Information about specific OTC and prescription medicines is readily available to the healthcare professional as well as to consumers—as it should be. This information generally includes the pharmacology of the drug, indications for use, possible side effects and adverse reactions as well as recommended therapeutic dosage and administration instructions. Advertising for these drugs often stresses the strength and effectiveness of the medicine and minimizes the side effects and risks. And the seller, or prescriber, of medications is a "reputable" pharmacist or physician, who is considered a helpful authority.

 

Drugs, on the other hand, are misrepresented and viewed as "bad chemicals" used only by drug abusers, drug addicts, or criminals. Once a chemical is determined to be an illegal drug (by bureaucrats and law enforcement officials), no one is allowed to consume it. Accurate information about these drugs is more difficult to come by. Information about drugs is skewed to include only the dangers of the drugs, the extreme potential for abuse and addiction, and the negative effects (which are usually based on extremely high doses). The seller of these drugs is a "drug dealer," who is portrayed as a sleazy and dangerous criminal. The seller of drugs is such a menace to society that the death penalty or life imprisonment has been considered as appropriate punishment for this less-than-human scum.

 

Under our current system of drug control, people learn (incorrectly) that there is a quick-fix medicine for just about any ailment and assume they can take these good chemicals without any negative health effects. They often take little responsibility to learn about the medicine(s) they are taking, based on the naive perception that because it is legal, it is without risk. This perception could not be further from the truth. Roughly 70 percent of drug-related emergency room visits are due to prescription medications. On the other hand, there is no tolerance for anyone using an illegal drug. Healthcare professionals often do not even inquire why a person is using an illegal drug. Instead, the person is often reprimanded in some manner and assumed to have a drug problem.

 

The paradigm for the "war on drugs" is based on a belief that there are "bad" drugs and that the solution to our drug problems is to prohibit the use of these drugs. This basic premise is faulty and must be challenged. Clearly, irresponsible use of drugs, legal or illegal, can be dangerous and costly to society. Our government maintains that drug prohibition is the best approach to our drug problem. We would argue that drug prohibition is a costly, intolerant, moralistic, simplistic, irrational, and dishonest approach. The "war on drugs" approach addresses drug use as a criminal issue instead of a healthcare issue and focuses on punishing people rather than treating addiction.

 

In Europe drug problems are addressed with a harm reduction approach, which is based on the understanding that a drug is neither "good" nor "bad." Instead it is the manner in which drugs are used that may be good or bad, healthy or unhealthy, safe or very risky. According to this approach, drug problems are addressed as a health issue, and the focus is on helping people to reduce unsafe or irresponsible drug use through educational and medical intervention.

 

Harm Reduction

 

Individuals must have knowledge in order to make responsible choices. In the context of using the harm reduction approach, the terms drug and medicine will be used interchangeably throughout this book. Webster's dictionary defines a drug as "any substance used as a medicine, or in making medicines, for internal or external use," and it defines a medicine as "any substance or preparation used in treating disease." A druggist is synonymous with a pharmacist and is defined as "one who deals in drugs." Whether a drug is over-the-counter, prescription, legal, or illegal, it has potential risks. No drug is completely safe, and any drug can be abused. A drug or medicine is neither good nor bad, but rather the manner of use may be good or bad for a particular person.

 

In order to decrease any potential harm from a drug, people should obtain some basic information regarding the inherent risks and benefits of the drug. In Teach Your Children Well:• A Rational Guide to Family Drug Education (Mosier OR: Mothers Against Misuse and Abuse, 1995), M. Miller and S. Burbank list the seven basic questions necessary to evaluate a drug for its benefits and risks:

 

1. What is the name of the drug (medicine, chemical)?

2. Where is it working in my body (desired effect, side effects)?

3. What is the correct dosage (amount, route, and frequency)?

4. What drug interactions may occur?

5. What allergic actions can occur?

6. Will it produce tolerance?

7. Will it produce dependence?

 

This book will provide the answers to these questions as they relate to the use of cannabis.

 

Just Say "Know"

 

This book is not about a miracle drug, a perfect drug, or a completely safe drug. Such a drug exists only in fantasy. No drug can be everything for everyone. What works for one person may not work for another. All drugs come with risks, some known and some unknown. Prior to using a drug, medicinally or otherwise, both the potential risks and the likely benefits should be considered. The goal is to maximize the benefits and minimize the risks.

 

This book is not about a drug that causes insanity, leads to heroin addiction, or causes one to commit violent crimes while causing at the same time the amotivational syndrome. That drug, too, exists only in fantasy. That is, however, what was said of marijuana, the new name created for preparations from the cannabis plant in the 1930s. The renaming of cannabis allowed the politically motivated media to create such a nationwide emotional hysteria and fear of this "new" and dangerous drug that the Marihuana Tax Act of 1937 was passed, marking the beginning of the marijuana prohibition. During this time, cannabis was listed in the U.S. Pharmacopoeia and recognized for its therapeutic value in the treatment of numerous ailments.

 

This book is about a plant, the cannabis plant. In colonial times, it was commonly known as the hemp plant, while today in the United States it is commonly known as marijuana (found most often in U.S. government literature misspelled: marihuana). Around the world, it is known by other names: ganja in Jamaica, bhang in India, dagga in South Africa, and kifin Morocco. The leaves and buds of the cannabis plant have natural therapeutic properties, which have been used for centuries in the treatment of numerous life-and sense-threatening illnesses.

 

Today, this plant is illegal in the United States. It is illegal for physicians to prescribe it, illegal for anyone to sell it, illegal to possess it, illegal to consume it, and illegal to grow it. Think about that. The goal of marijuana prohibition is to eradicate this plant. What is the merit of this goal?

 

There is a shrinking population of the elderly in this country who may remember that it was once a patriotic duty for an American farmer to grow marijuana (hemp). In 1942 a film called Hemp for Victory was produced and distributed by the U.S. Department of Agriculture to encourage American farmers to grow cannabis for much-needed hemp products, particularly rope. This film was somehow lost from our National Archives at the Library of Congress, but it has been replaced by a persistent hemp researcher, Jack Herer, who found it listed in a catalog of the Department of Agriculture's films and donated a copy of the film to the library.

 

Many Americans have easily accepted the negative propaganda on cannabis. However, for those millions of Americans who have experiential knowledge of cannabis's properties and potential value, prohibitionist fantasies simply do not measure up to reality.

 

The 80 million users of marijuana in the United States and the 500 million worldwide have the right to obtain honest and unpoliticized information about cannabis. This book was written in an effort to fill the void of accurate information about medicinal cannabis. It is intended for the healthcare professional, the patient, and the general public. This book will provide essential information regarding the historical use of therapeutic cannabis, the pharmacology of the drug, indications for use, dosage and administration, and potential risks and side effects. To fulfill their ethical obligation of using scientific knowledge to provide optimal care to patients, healthcare professionals must have access to this information in order to provide advice based on knowledge, not on the party line. With little or no help from healthcare professionals, thousands of patients have chosen to go outside the law to obtain a medicine that has significantly improved their quality of life. This book is intended to provide patients with the information they will need.

 

The book begins with Norman Kent's report of patients who have become victims of the marijuana prohibition. He has defended many of these patients in court and describes a small sample of the numerous patients who have had to endure additional suffering as a result of the marijuana prohibition. Next Kevin Zeese presents a clear overview of the legal risks involved with the therapeutic use of cannabis and provides legal counsel to guide patients in their decision of whether or not to use this medicine and what to do if they, their family members, or their healthcare provider face legal charges as a result of their use or procurement of cannabis.

 

In chapter 3, Michael Aldrich provides a well-documented historical review of the use of cannabis throughout the world. He begins with the earliest records of cannabis use in China and follows its use throughout the centuries, including its therapeutic use in America prior to the marijuana prohibition. He then describes the progression of the marijuana prohibition despite modern research findings and new indications for use. What was known centuries ago about its various therapeutic applications is being rediscovered and validated with modern research capabilities despite the limiting constraints of the prohibition.

 

Denis Petro reviews the pharmacology of cannabis in chapter 4, relying highly on the more studied synthetic preparation of delta-9-tetrahydrocannabinol (THc), the primary psychoactive cannabinoid in cannabis. He reviews the toxicity of smoked cannabis as well as of the THC and discusses the significance of the newly discovered cannabinoid receptor and how that will influence future research.

 

Part III provides several close looks at specific therapeutic indications for use. Dan Dansak begins with his research on the use of cannabis and oral THC for cancer patients experiencing nausea and vomiting from chemotherapy. The study was initiated as a result of a cancer patient who found cannabis very useful but died before he was ever allowed legal access to this medicine. Walter Krampf cares for AIDS patients in San Francisco and has much experience with its value as an appetite stimulant as well as an effective antiemetic for his patients. His clinical experience and review of the literature indicate beneficial effects for AIDS patients and do not confirm claims that the drug damages the immune system when used in therapeutic dosages. For use in the treatment of glaucoma, Robert Randall, the first legal medical marijuana patient through the IND program, reviews his experience with smoked marijuana and the research in which he was a subject. Manley West offers information about an ophthalmic preparation of cannabis, Canasol, and explains how eye drops can deliver medication directly to the area of need, while eliminating the possible risks associated with smoking. Petro reviews the use of cannabis with spasticity disorders, as seen in patients with multiple sclerosis and spinal cord injuries and its use in alleviating chronic pain. In his review, he notes that research indicates that a cannabinoid other than THC, cannabidiol (cBD), may be the more effective substance. Milton Burgiass takes a cautious view of cannabis's possible use in psychiatry. Although research has not shown efficacy in this area, numerous anecdotal accounts, both current and in historical records, discuss its usefulness for depression, anxiety, insomnia, and stress management. This appears to be an area in need of more rigorous research especially with the natural form of cannabinoids other than THC, the plant's main psychoactive cannabinoid. To that end, Antonio Zuardi and Francisco Gimaraes present their research on the use of cannabidiol (cBD) in the treatment of anxiety and psychotic symptoms.

 

Madelyn Brazis and Mary Lynn Mathre provide an educational overview regarding the safe dosage and administration of therapeutic cannabis in chapter 13. All medications present risks and patients need to understand the potential risks and how to avoid them if possible. Brazis presents an application of this information as she instructed many patients in the proper use of cannabis during a research study.

 

Part IV reviews additional considerations with the use of cannabis. Melanie Dreher reviews the potential risks of women using cannabis during pregnancy. In her review Dreher presents her research of use during pregnancy in Jamaica, a culture in which ganja is viewed more favorably. Her studies and those of a Canadian researcher do not confirm reports of negative effects on the fetus of cannabis-using mothers. Mathre examines the potential of dependence and addiction problems associated with regular use of cannabis. She first clarifies the terms abuse, tolerance, dependence, and addiction and then discusses the relative concerns with the therapeutic use of cannabis.

 

There is more to know about the cannabis plant than its therapeutic value in the treatment of illnesses. In chapter 16 Don Wirtshafter discusses the nutritional value of hemp seed and hemp seed oil, which is important for all people. Cannabis seeds are a nutritious protein source rich in essential fatty acids. He provides an analysis of the contents of the seed and its oil and an explanation of why they are so nourishing.

 

A full discussion of the cannabis plant and possible hemp products is presented in chapter 17, which looks at the ecological (or world health) value of this plant. Robert Clarke and David Pate review the plant structure and clarify the difference between the plants grown for medicine and those cultivated for hemp products. The stalk of the plant is valuable because of its pulp and fiber, for paper products, building materials, rope, and textiles, and it also has potential as a fuel source. Clarke and Pate discuss how this crop is environmentally friendly, requires low maintenance, and helps prevent soil erosion through its root structure.

 

We hope that the reader of this book will learn to question the sources of negative reports about the medical use of marijuana. Are those reports based on scientific research and history? Or do they carry a strong sense of politics, scare tactics, even outright lies? We hope we have provided information that will inspire the reader to ask these questions and more—to ask, above all, why the United States government continues its prohibition of this remarkable plant.