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By Tod H. Mikuriya, M.D.


            Pharmacological harm reduction using cannabis works in three ways:

                        *Substitute for a more harmful drug altogether or in part.

                        *Decrease the use of another drug to minimize undesirable effects.

                        *Suppress the side effects of another drug to permit its use.

            Interviews with patients in may private psychiatric practice and patrons at the San Francisco and Santa Cruz Cannabis Buyers Clubs reveal these general patterns of self-medication with cannabis.

            Cannabis substitution for more harmful drugs as a therapeutic intervention was recognized in the 1840’s at the University of Edinburgh in Scotland where William Brooke O’Shaughnessy, M.D(1). had sent seeds and specimens of cannabis collected in India.  John Clendinning, M.D. in 1943 described the therapeutic intervention of substituting cannabis for opiates in chronic pain and alcohol withdrawal(2).  Clinical reports from American, British and French medical practitioners independently confirmed these findings.  The Drug was ubiquitously found in pharmaceutical catalogs, medical texts, and medical journal articles.  Cannabis and cannabis containing pharmaceuticals were promoted for their safety compared with opiates(3).

            Cannabis was a standard treatment for both alcohol and opiate addiction until removed from the market in 1937 by the Marihuana Tax Act.

            In the consultation room in the county alcoholism clinic in 1969(4), a desperate middle-aged alcoholic woman confided to me that she could avoid drinking when she smoked marijuana.  In the end stages of the disease, she destroyed her health and alienated herself from her family.  I encouraged her in this practice and added Antabuse to prevent relapse.  The result was successful.  She remained clean and sober for ten years until her death from breast cancer.  During her recovery she reconciled with her estranged son (with whom she would share marijuana) and lived a life free from the sad chaos of alcoholism.

            Over the years in social situations with pro marijuana law reform activists I have met many who have substituted cannabis for more harmful drugs alcohol, heroin, cocaine, and amphetamines.  They continue to be angry with being deceived by official censorship and denial that cannabis is a less harmful drug.

            At the Santa Cruz Cannabis Buyers Club another terminal alcoholic is in the process of reclaiming his life with the above described combination of cannabis substitution and Antabuse.  A 39 year- old chronic alcoholic musician and composer with a college degree in engineering presented with symptoms of impending liver failure and peripheral neuropathy.  He was about to be homeless again.  In exchange for being maintained on a personal supply of cannabis, he agreed to ingest an Antabuse tablet under observation by the buyers club staff.

At day 135 of sobriety, K.R. continues to recover.  He had another argument with his tentative fiancée. “And I didn’t drink!” he said with a twinkle in his eyes of a small victory over a habitual dysfunctional reflex.  “And you couldn’t” said I, referring to the effects of Antabuse.

            L.C, a 70 year- old widow, bright, articulate liberal progressive scourge of the rightist talk show callers, uses cannabis to control the pain and muscle spasms of her osteoarthritis.  She finds that, in addition to decreasing her need for aspirin and non- steroidal anti-inflammatory drugs thus avoiding their side effects, cannabis elevates her mood.  Which comes first? Relief of pain, buy the mental effects are of significance as well.  She takes a few puffs of cannabis first thing in the morning and knows “It will be a nice day.  I’m free from pain and can go about as I want!”

            A 67 year- old female volunteer at the San Francisco General Hospital AIDS ward and political activist controls her pain and muscle stiffness from severe osteoarthritis in her knees by eating a quarter to a third of one of her marijuana brownies with her morning coffee.  In mid- morning she will take another half.  Similarly, she minimizes her use of aspirin or NSAIDS.

            Neither of the women experiences any impairing mental effects.

            Their experiences of using cannabis to help cope with pain from osteoarthritis in the elderly, other types of arthritis are benefited from the concurrent or alternation of cannabis.

            Reiter’s syndrome, a painful viral related arthritis, post injury arthritis and soft tissue calcification responds well to cannabis.

            In addition to decreasing or avoiding use of nonsteroidal anti-inflammation drugs (NSAIDS) of equal or greater importance is less need for steroids like prednisone for acute exacerbations.  The avoidance or minimizing acute exacerbations would also significantly decrease hospitalizations and outpatient visits.

            The implications should be studied further in light of costs of health care delivery systems.  The restoration of pre-prohibition uses of cannabis for the management of a variety of chronic conditions would be both cost-effective and clinically optimal.  Thus economic, as well as medical harm would be reduced.





            1 O’Shaughnessy, William B.  On the Preparations of Indian Hemp or Gunjah Trans Med Soc Bengal 1939.


            2 Clendinning, John, Med. Chirg Trans London 26:188-210 1843 Read May 9, 1843.


            3 Mattison, JB Cannabis Indica as a Anodyne or Hypnotic Lilly’s Bulletin, No. 18. February, 1892 page 1.


            4 Mikuriya, TH Cannabis Substitution:  An Adjunctive Therapeutic Tool in the Treatment of Alcoholism.  Medical Times vol. 98, No.4, April 1970, pp. 187-191. (Reprinted in Marijuana Medical Papers 1839-1972. Medicomp Press Oakland 1973)