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THE SIGNIFICANCE OF CANNABIS IN THE HISTORY OF MEDICINE

By Tod H. Mikuriya M.D

 

(It is thought this was published in the 1970's)

            Cannabis indica, cannabis sativa, cannabis americanus, Indian hemp and marijuana (or marihuana) all refer to the same plant.  Cannabis is used throughout the world for diverse purposes and has a long history characterized by usefulness, euphoria or evil depending on one’s point of view.  To the agriculturist cannabis is a fiber crop (first recorded for this use in the twenty-eighth century BC); to the physician of the past it was a valuable medicine (it was described as a remedy as long ago as 1000 BC); to the physician of today it is an enigma; to the user, a euphoriant; to the police, a menace; to the traffickers, a source of dangerous profit; to the convict or parolee and his family, a source of sorrow.  This paper is concerned primarily with the medicinal aspects of cannabis.

            Medical professional in the western world have forgotten almost all they once knew about therapeutic properties of marijuana, or cannabis.  Analgesia, anticonvulsant action, appetite stimulation, ataraxia, antibiotic properties and low toxicity were described throughout medical literature, beginning in 1839, when W.B. O’Shaughnessy introduced cannabis into the western pharmacopoeia. (1)

THE CURRENT STATUS OF CANNABIS RESEARCH

The restrictive federal legislation on “recreational” smoking of cannabis in the twentieth century has functionally ended all medical uses of marijuana.  Despite the current hostile climate, a few medical researchers have continued the investigation of the therapeutic applications of cannabis in recent years.  In his study of the medical applications of cannabis for Mayor LaGuardia’s committee, Samuel Allentuck reported, among other findings, favorable results in treating withdrawal of opiate addicts with tetrahydrocannabinol (THC), a powerful purified product of the hemp plant (2,3).  This finding was reconfirmed three decades later (4,5).

            An article in 1949, buried in a journal of chemical abstracts, reported that a substance related to THC controlled epileptic seizures in a group of children more effectively than diphenylhydantoin (Dilantin), a most commonly prescribed ant-convulsant (6).

            A number of experimenters, believing that cannabis products might be of value in psychiatry, have investigated the applications of various forms of them in the treatment of mental disorders.  (Cannabis had been used in the nineteenth century to treat mental illness 7, 8, 9, 10).  However, aside from some rather equivocal clinical studies, primarily in the treatment of depression (11, 12, 13, 14), and another report of success in treating withdrawal from alcohol and opiate addiction (15), no significant contemporary psychiatric studies involving cannabis therapy have been reported to date.

            In 1950, W. S. Loewe, from the University of Utah, published in Archiv fur Experimen.  Pathologie und Pharmakologie a brilliant study of 11 different THC homologs structure-activity relationships for potency, analgesia, anticonvulsant activity and hypnotic qualities (16).

            As compared with the 1800s, this century has seen very little medical research on the array of some 20 chemicals that are found in the hemp plant (17).

            Today’s readers may tend to be skeptical about a report of a cure for gonorrhea published over a century ago (7,8).  Such findings may bear reinvestigation, however, in the light of a report from Czechoslovakia in 1960 that cannabidiolic acid, a product of the unripe hemp plant, has bacteriocidal properties (5).  Later investigators have corroborated some of the therapeutic applications reported in the early medical papers.  But for the most part the therapeutic aspects of cannabis remain to be re-explored under modern clinical conditions.

THE FUTURE OF CANNABIS AND MEDICINE

            From 1839 to its removal from availability to physicians in 1937 at least 12 separate therapeutic uses for cannabis were described: analgesic-hypnotic; appetite stimulant/gastrointestinal sedative; anteipileptic-antispasmodic; prophylactic and treatment of the neuralgias, including migraine and tic douloreuz; antidepressant-tranquilizer; antiasthmatic; oxytocic; antitussive; topical anesthetic; withdrawal agent for opiate and alcohol addiction; childbirth analgesic; antibiotic.

            After its removal:

1.      Intraocular hypotensive (18)

2.      Hypotherogenic (19, 20)

3.      Antemetic (21, 22):  A growing number of state legislatures and courts have

responded sympathetically to cancer victims who have discovered that cannabis is useful as an antiemetic in relieving a most painful and debilitating side effect of chemotherapy.  The initiative for this has come not from the federal or state governments but form the private citizen obtaining the drug form illicit sources.

4.      Alcoholism treatment:  I must admit to occasional encouragement of alcoholic

patients to attempt cannabis substitution.  Updating: One case I described as making the switch in 1968 has continued the treatment successfully to date using less than three marijuana cigarettes per week.  Generalizing on my experience with less than a dozen cases, it is my observation that the substitution can be successful if there is immediate social support but fails if this is not available (19).

5.      Glaucoma treatment:  Soon after Hepler and Frank (18) reported lowering of

intraocular pressure in a fortuitous discovery, William Blanton, a Florida ophthalmologist in private practice, in 1973 successfully treated glaucoma in his patients using illicitly obtained marijuana after he was turned down by a federal interagency “joint” committee.  Instead of being lauded by his profession for his clinical discoveries he was dropped from the staffs of two hospitals and put on probation by his county medical society.

            Robert Randall, a glaucoma victim, and activist, finally gained access to a maintenance supply of the crude cannabis cigarettes produced by the federal farm in Mississippi only after repeatedly taking the federal government to court.  He reported to me last year that the quality of the crude cannabis has deteriorated over the last four years and that the strength has dropped from 2.73% THC to 0.88% THC.  He also stated that the federal cannabis cultivation operation had problems with improper storage leading to overgrowth of potentially pathogenic molds, which caused him to suffer increased bronchial irritation.

            Currently, a modestly funded clinical glaucoma study is finally underway.  Meanwhile, cannabis continues to be denied to sufferers by the state despite efficacious preliminary results and entreaties of glaucoma victims to unresponsive government agencies rationalizing their intransigence by a “we can’t be too careful” stance.

PROPOSED FEDERAL POLICY CHANGES

1.      Immediate restoration of cannabis USP preparations for prescription as a class

IV controlled substance.  There is no scientific justification for cannabis products’ current classification as a class I controlled substance.  Adequate medical evidence of efficacy and safety already exists and may be found in medical literature and archival records of pharmaceutical companies to permit resumption of general availability to the physician for indications enumerated in the US Pharmacopeia, with the addition of glaucoma and emesis.

2.      Limited clinical investigative trials should be instituted with the goal of

 widening the number of pathologic conditions for which cannabis products and synthetic cannabinoids maybe beneficial.

3.      Develop chemical and toxicologic assay methods that verify existing bioassay

 methodology standards.

4.      Continue the research studies into the synthetic and derivative cannabis

homologs begun by W. S. Loewe in 1950.

5.      Develop purified natural and synthetic cannabinoid products that are free of

irritating components, standardized in strength and close, and available through aerosol or spray for inhalation, orally and topically.

            The development of safe, non-irritating and pure cannabis products should be high in priority in order to best protect the health and safety of the user.

WHAT YOU CAN DO ABOUT-

1.      Restoring cannabis to the formulary:  Prior to the passage of the 1937

 Marihuana Tax Act the federal proponents promised the retention of cannabis for general prescriptive availability.  However they reneged and in 1941 cannabis was dropped from the National Formulary and Pharmacopoeia.  Cannabis was declared to have no medicinal  redeeming importance by the chief of the Federal Bureau of Narcotics.

The principal rationalization for withholding cannabinoids from general

availability by prescription is that they are allegedly new drugs.  As a “new drug” cannabis needs extensive clinical and pre-clinical testing before it can be made widely available, even though cannabis appeared in medical texts and pharmacopeias some fifty years before aspirin was synthesized.  Cannabis continues to be listed with its actions and properties in authoritative texts and references.

            It is vital that the word restore be used when referring to reclassification, as “restore” directly counteracts “new drug” cannabis arguments and interdicts federal efforts to rewrite history.

2.      The Controlled Substances Act of 1970:  This flawed legislation from the Nixon/Mitchell Department of Justice is the framework for federal and state anti-drug social policy.  The Department’s own handpicked scientific advisory committee quit en masse in outrage over the irrational classification scheme that was set up.

This Act and “uniform” state laws are utterly irrational and devoid of any medical

or scientific legitimacy.  The resultant rapidly growing multi-billion dollar drug abuse industry complex is not just ineffectual in suppressing trafficking and use, but actually creates many of the problems whose genesis may be traced to the laws criminalizing drugs.

            Humanists should press for hearings to investigate the genesis and effects of these laws with an eye to reform.

            3.   Federal cover-up in the scientific establishment:  Private consultants and institutions act in advisory roles to influence public policy; they are paid by tax monies but the knowledge gained from research is withheld from the public.

One of the specific instances is the work at the Edgewood Arsenal Chemical

Biological Warfare Unit in Maryland from 1954 to 1959, where Loewe’s cannabis homologs were studied as a potential incapacitating agent.  The project was finally declassified in 1971 after pressure from some of the scientists working on the project to publicize the possible therapeutic uses of the cannabinoids.

            At the other end of the spectrum we have the National Institute on Drug Abuse’s

Supporting one of the most virulent anti-cannabis proponents, Gabriel Nahas, whose alleged new findings of adverse effects served as the basis for articles in Science, The Readers Digest and other outlets.

            Humanists should press for an investigation into the relationships between government agencies and anti-cannabis law reform activists like Nahas.

4.       Confronting the judiciary on “wrong drug” laws:  With a few notable

exceptions the judiciary has consistently refused to hear any cases that attempted to raise constitutional issues other than illegal search and seizure.  Freedom of Speech, equal protection or other personal rights allegedly protected by the US Constitution fall by the wayside.

            Humanists must repeatedly confront representatives of the judiciary on the refusal of the courts to hear constitutional arguments concerning the legitimacy of the “wrong drug” laws.

            Also: so far nobody ahs raised the question of the ethics or legality of withholding cannabis treatment in response to the “we can’t be too cautious” evasions.

5.      Intrusion of the police into the medical consultation room:  We now have

 police and lawyers writing the drug laws as well as dictating their implementation.

            A contemporary example is the California research Advisory Panel’s (CRAP) attempt to dispense cannabinoids for the treatment of side effects of nausea from cancer chemotherapy.  Edward P. O’Brien, assistant attorney general for the State Attorney General’s office, the chairman of CRAP, has successfully exerted his influence to be the most restrictive in making cannabis available to cancer victims.  Despite his valiant efforts the federal bureaucratic obstruction and budget cuts subvert the original intent of the law to permit cancer victims compassionate access to cannabinioids.  There are normal medical channels.  We do no need another state office.

Putting attorneys and police in charge of medical programs is malpractice. 

Humanists should confront the California state administration for not putting this program under the health department where it belongs, if the state should be involved at all.

TO SUM UP

More reasonable laws and regulations controlling psychoactive drug research are required to permit significance medical inquiry to begin so that we can fill the large gaps in our knowledge of cannabis.  Medicine, being an empiric art, has not hesitated in the past to utilize a substance first used for recreational purposes for the pursuit of the more noble purposes of healing, relieving pain and teaching us more of the workings of the human mind and body.

 

Psychiatrist Tod H. Mikuriya was first director of marijuana research at the National Institute of Mental Health, Center for Narcotics and Drug Abuse Studies.