Pubdate: Tue, 29 Mar 2005
Source: Star-News ( NC )
Copyright: 2005 The New York Times Company
Contact:  http://www.wilmingtonstar.com
Details: http://www.mapinc.org/media/500
Author: Dan Hurley
Bookmark: http://www.mapinc.org/people/Angel+Raich (Angel Raich)
Bookmark: http://www.mapinc.org/mmj.htm (Cannabis - Medicinal)
Bookmark: http://www.mapinc.org/find?232 (Chronic Pain)
Bookmark: http://www.mapinc.org/decrim.htm (Decrim/Legalization)

MEDICINAL MARIJUANA ON TRIAL

Medical marijuana is now legal in 11 states, and bills to legalize it are 
pending in at least 7 more.  The drug is also at the heart of a case being 
considered by the United States Supreme Court.

Yet there remains much confusion over whether marijuana in fact has any 
significant medical effect.

"People subjectively report benefits," said Dr.  Joseph I.  Sirven, an 
epilepsy specialist and associate professor of neurology at the Mayo Clinic 
College of Medicine in Scottsdale, Ariz.  "There's a whole Internet 
literature suggesting what a wonderful thing it is.  But the reality is, we 
don't know."

In an editorial last year in the journal Neurology, Dr.  Sirven pointed out 
that the best studies of marijuana's effects on humans have so far shown 
little objective evidence of benefit in patients with epilepsy or multiple 
sclerosis.  And a growing body of research indicates that, at least in 
teenagers, heavy marijuana use over a period of years significantly 
increases the risk of developing psychosis and schizophrenia.

In the Supreme Court case, two California residents, Angel McClary Raich 
and Diane Monson, brought a suit against federal officials in October 2002 
to defend their use of marijuana after six of Ms.  Monson's marijuana 
plants were seized and destroyed by the Drug Enforcement Administration.

The federal government, which considers marijuana illegal under the 
Controlled Substances Act, asked the Supreme Court to overturn a Court of 
Appeals ruling that supported the two women.  Oral arguments were heard 
just after Thanksgiving, and a ruling could come any day.

Ms.  Raich's physician, Dr.  Frank Henry Lucido of Berkeley, Calif., 
asserted in an affidavit that Ms.  Raich risked death if she was denied the 
marijuana to treat nausea, anorexia, severe chronic pain and other 
disorders brought on by a variety of illnesses, including post-traumatic 
stress disorder, asthma and an inoperable brain tumor.  On a Web site 
created on her behalf, www.angeljustice.org, Ms.  Raich says she joined the 
lawsuit "in order to save my life."

While little scientific evidence supports such a lifesaving role for 
marijuana, many studies have found modest benefits in patients' subjective 
measures of pain, sleep, nausea, appetite, tremors and muscle spasms.

"There's nothing better for nerve pain than marijuana," said Phillip Alden, 
41, a writer in Redwood City, Calif.

Twice a month, he spends about $200 to buy a half ounce of high-potency 
marijuana from one of San Francisco's medical marijuana buyers' clubs.

He smokes it three or more times a day to treat pain from a back injury, 
and to improve his appetite and reduce nausea associated with AIDS and the 
antiviral drugs he takes for it.  It has even checked the progression of 
his peripheral neuropathy, he said.

Two recent surveys, also published in Neurology, have documented widespread 
use of marijuana among Canadian patients and a widespread belief in its 
benefits.

The first survey, of 220 patients with multiple sclerosis, found that 36 
percent had used marijuana to treat their symptoms, and that 14 percent 
were using it at the time of the survey.

The second survey, of 136 patients attending the University of Alberta 
Epilepsy Clinic, found that 21 percent had used marijuana in the previous 
year.  Just over two-thirds of the active users said it decreased the 
severity of their seizures and slightly more than half reported a decreased 
frequency of seizures.

But the lead author of the epilepsy study said it proved only that some 
patients believed in marijuana, not that it or its active ingredients, 
called cannabinoids, actually worked.

"There's not been a randomized, controlled trial demonstrating that 
marijuana or any cannabinoid is any more effective in controlled seizures 
than a placebo," said Dr.  Donald W.  Gross, director of the University of 
Alberta's adult epilepsy program.

Although doctors may now prescribe marijuana in Canada for certain 
disorders, including epilepsy, Dr.  Gross said he had never done so.  "It's 
terribly complicated from a physician's standpoint, and somewhat 
frustrating," he said.  "We have a product that has been legitimized 
without any evidence of efficacy."

A large body of research in test tubes and animals supports the view that 
cannabinoids have anticonvulsive properties.  But while a 2003 study of 657 
patients with M.S.  published in the journal Lancet found significant 
improvements in subjective reports of muscle spasms and pain, it found no 
improvement by objective measures after 15 weeks.

A follow-up report on the same group of patients did show modest benefit 
after 12 months, but the researchers said that the results should be 
interpreted cautiously, because the study had been intended to test only 
short-term benefits.

Dr.  David Baker, a professor at the Institute of Neurology in London, has 
found beneficial effects of cannabinoids in mice who have an artificially 
induced type of multiple sclerosis.  But, he said, "Showing clinical 
benefit in humans has been an elusive beast."

"At best there is a narrow therapeutic effect before the side effects 
become unacceptable for many people," he said.  " What is clear is that 
there have been no dramatic improvements overall."

Dr.  Kenneth P.  Mackie, a professor of anesthesiology at the University of 
Washington, has devoted 15 years to studying the brain's response to 
cannabinoids through specialized brain receptors called CB1 and CB2.

"There's a whole bunch of theoretical reasons suggesting there would be a 
benefit for marijuana on a variety of conditions relating to pain and 
neuroinflammation," Dr.  Mackie said.  "But the clinical studies just 
aren't there."

Far stronger evidence exists for a harmful effect of marijuana in teenagers 
who use it early and often.  "We know that cannabis is a contributory cause 
of schizophrenia," said Dr.  Robin M.  Murray, a professor at the Institute 
of Psychiatry in London and the co-editor of a new book, "Marijuana and 
Madness: Psychiatry and Neurobiology."

In a 2002 study published in the British medical journal BMJ, Dr.  Murray 
reported that New Zealand teenagers who started smoking marijuana before 
age 15 and continued doing so on a daily basis raised their risk of 
developing psychosis and schizophrenia from about 2 percent to as much as 
10 percent.

The study, he said, ruled out the possibility that the teenagers who used 
marijuana were also those who were more likely to develop schizophrenia, 
whether or not they used the drug.

Still, "You have to take a lot to go psychotic," Dr.  Murray said.  "But 
with five joints a day for five years, an amount that is increasingly 
common in Europe, you're seriously increasing your risk of schizophrenia."

He added that even so, the risk dropped sharply as people aged, so that 
most chronically ill people who used marijuana for medical purposes were 
unlikely to experience psychosis as a result.

Research in the United States has been greatly hampered by legal restrictions.

In 1997, Dr.  Donald Abrams, an oncologist and assistant director of the 
Positive Health Program at the University of California at San Francisco, 
became the first doctor authorized by the National Institute of Drug Abuse 
to receive marijuana to conduct research to determine if it provided 
medical benefits.

Now more than a dozen California researchers are studying it under the 
auspices of the University of California's Center for Medicinal Cannabis 
Research.

"Cannabis has a 5,000-year history of medical use," Dr.  Abrams said.  He 
said he had completed three studies in patients with H.I.V.  that showed no 
negative effects on their immune systems or on the functioning of the 
protease inhibitor drugs they were taking.

He is now trying to show that marijuana has a beneficial effect on immune 
functioning, he said.

The patients were brought into the hospital to smoke marijuana under 
medical supervision.
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MAP posted-by: Jay Bergstrom