APPENDIX 1.

THE MEDICINAL USE OF CANNABIS

(19)

The medicinal use of cannabis in the ancient world has been well documented (Abel 1980). In the United States, cannabis was first mentioned as a medicinal drug in 1843 and by 1852 it was included in the US dispensatory list of medicines. It was thought to be beneficial in the treatment of 'neuralgia, gout, tetanus, hydrophobia, cholera, convulsions, chorea, hysteria, depression and insanity' (Wood & Bache 1854, cited in [1]Abel 1980, p182). In Australia, tincture of cannabis was used in medicine until the 1960s, when it was declared a prohibited drug ([2]Cartwright 1983).

Since the introduction of legislation prohibiting the recreational use of cannabis, its use for medicinal purposes has, in most Western countries, not been popular. However, recently the therapeutic benefits of cannabis have received close attention in the United States. In 1991, Doblin and Kleiman conducted an anonymous survey of the members of the American Society of Clinical Oncology measuring the attitudes and experiences of American oncologists concerning the use of cannabis to treat nausea in cancer chemotherapy patients. They found that, of those oncologists who replied to the survey (43 per cent), more than 44 per cent of them reported recommending the illegal use of cannabis for the control of nausea to at least one cancer patient. Some 48 per cent said that they would prescribe cannabis to some of their patients if it were legal ([3]Doblin & Kleiman 1991).

Cannabis has been used as an anti-emetic in the treatment of AIDS patients and as a painkiller for those suffering from chronic pain ([4]Grinspoon 1991). It has also been regarded by some medical practitioners as being effective in reducing intra-ocular pressure in glaucoma patients ([5]Caswell 1992) and in treating epilepsy ([6]Cartwright 1983), Huntington's chorea ([7]Moss et al. 1989) and Parkinsonian tremor ([8]Frankel et al. 1990).

Despite the attention that the medical use of cannabis has received in recent times, legislation in the United States does not permit the medical use of marijuana. In the Federal Controlled Substances Act, cannabis is categorised as a Schedule 1 drug, and as such is described as having a high potential for abuse, no currently accepted medical use and no acceptable safe level of use under medical supervision.

In 1989, organisations such as the (US) National Organization for Reform of Marijuana Laws (NORML), the Alliance for Cannabis Therapeutics (ACT) as well as various individuals,20 applied to have cannabis rescheduled so that it could be used for medical purposes. The Administrator of the Drug Enforcement Administration rejected these claims and stated that:

It is clear that cannabis cannot meet the criteria ... for safety under medical supervision. The chemistry of cannabis is not known and reproducible. The record supports a finding that marijuana plant material is variable from plant to plant. The quantities of the active constituents, the cannabinoids, vary considerably. In addition, the actions and potential risks of several of the cannabinoids have not been studied ... (US Government, Federal Register, vol. 54, no. 249, 29 December 1989, p53,734).

This position has recently been restated by Robert C. Bonner, a later Administrator of the US Drug Enforcement Agency, when he responded to a subsequent petition lodged by NORML (US Government, Federal Register, vol. 57, no. 59, 26 March 1992, pp10,499-10,508).

Those in favour of rescheduling the drug argue that, for some, the denial of cannabis as a medicine is particularly cruel. Grinspoon argues that 'sick people are forced to suffer anxiety about prosecution in addition to their anxiety about the illness ... Doctors are afraid to recommend what they know to be the best treatment because they might lose their reputation or even their licence' ([9]Grinspoon 1991).

The Australian medical community has not been as enthusiastic about the therapeutic benefits of cannabis although many argue that where the drug has been demonstrated to be effective its use should be permitted. A study done at the Royal Children's Hospital in Melbourne found that THC (the psychoactive ingredient in cannabis) was an effective anti-emetic for some children undergoing chemotherapy ([10]Cartwright 1983). Dr Lorna Cartwright, a lecturer in Pharmacology at Sydney University stated:

I think there are probably better drugs for medical uses. The point is, though, I think it should be allowed to be used for conditions in which it has been shown to have effect, such as for glaucoma, for children having chemotherapy and for epilepsy. I always feel that if something is good even for a small percentage of patients, it should be allowed to be used (cited in [11]Caswell 1992, p498).

Another pharmacologist, Dr Greg Chesher, argues that cannabis clearly has therapeutic benefits but that research into the possible uses of the drug is being hampered by the fact that cannabis is a prohibited drug (cited in [12]Caswell 1992). The position in Australia is different from that in the USA in that in this country there is no legislation or binding administrative ruling specifically stating that no medical use exists for cannabis.21 Neither does the United Nations Single Convention on Narcotic Drugs, to which Australia is a party, specifically forbid the medical use of cannabis. In fact the Convention recognises that some otherwise illicit drugs may have medical purposes and states that cannabis use should be 'subject to the provisions of this Convention, to limit exclusively to medical and scientific purposes the...use and possession of drugs' (Article 4(1) (c)). Given that the United Nations Conventions do not specifically proscribe the medical uses of cannabis, introducing legislation that allowed the use of the drug for medical purposes in Australia would be relatively simple. Clauses authorising the therapeutic use of the drug could simply be inserted into relevant drug legislation and therapeutic products scheduling. Politically, however, such a change in policy could be difficult.

As an illicit drug, cannabis has a negative image and is seen as an being an inherently dependence producing, damaging drug that has no possible benefits. Recognition of the medical benefits of the drug may challenge this dominant view of cannabis.

References

Abel, E. 1980, Marihuana: The First Twelve Thousand Years, Plenum Press, New York.

Cartwright, L. 1983, 'Marihuana', Current Affairs Bulletin, vol. 59, no. 10, pp19-31.

Caswell, A. 1992, 'Marijuana as medicine', The Medical Journal of Australia, vol. 156, pp497-498.

Doblin, R. E. & Kleiman, M. 1991, 'Marijuana as anti-emetic dedicine: A survey of oncologists experiences and attitudes, Journal of Clinical Oncology, vol. 9, pp1314-1319.

Frankel, J.P., Hughes, A., Lees, A.J. & Stern, G.M. 1990, 'Marijuana for Parkinsonian Tremor', Journal of Neurological Neurosurgical Psychiatry, vol. 53, pp436-442.

Grinspoon, L. 1991, 'Marijuana in a time of psychopharmalogical McCarthyism' in Searching for Alternatives: Drug Control Policy in The United States, eds

M.B. Krauss & E.PLazear, pp379-389, Hoover Institution Press, Stanford, California.

Moss, D.E., Manderscheid, P.Z. & Montgomery, S.P. 1992, 'Nicotine and cannabinoids as adjuncts to neuroleptics in the treatment of Tourettes Syndrome and other motor disorders', Life Science, 1989, vol. 44, pp1521-1525.