Pubdate: Thu, 12 Jul 2012
Source: Sacramento Bee (CA)
Copyright: 2012 The Sacramento Bee
Author: Peter Hecht


University of California medical researchers slipped an ingredient in 
chili peppers beneath the skin of marijuana smokers to see if pot 
could relieve acute pain. It could  at certain doses.

They monitored patients with AIDS and HIV as they toked on joints or 
placebos to determine whether marijuana could quell agonizing pain 
from nerve damage. It provided relief.

They tested a "Volcano Vaporizer" to see whether inhaling smokeless 
pot delivered healthier, low-tar cannabis. It did.

Over a dozen years, California's historic experiment in medical 
marijuana research brought new science to the debate on marijuana's 
place in medicine. State-funded studies  costing $8.7 million  found 
pot may offer broad benefits for pain from nerve damage from 
injuries, HIV, strokes and other conditions.

California's famed Center for Medicinal Cannabis 
Research  established by the Legislature to answer the question, 
"Does marijuana have therapeutic value?"  has now all but completed 
America's most comprehensive studies into the efficacy of pot.

The money is gone. State-commissioned clinical trials totaling more 
than 300 research subjects are over. The last data are being crunched 
for medical journals. And it is unlikely that medicinal pot research 
on such a scale is going to be repeated any time soon.

Headquartered at UC San Diego with work also conducted in Sacramento 
County and San Francisco, the Center for Medical Cannabis Research 
challenged medical orthodoxy by undertaking the first clinical trials 
in decades looking at pot as medicine.

Now it survives in name only  as an informational center and 
potential clearinghouse for grant applications for future cannabis studies.

Political frictions over pot remain volatile, and researchers say 
getting additional studies approved by federal agencies is as hard as 
ever. Despite findings of potential health benefits by California 
researchers, cannabis is no closer to winning federal acceptance as medicine.

Three years after California voters passed the nation's first medical 
marijuana law in 1996, the Legislature in 1999 approved funding for 
the nation's first sustained modern medical research for pot.

After seven completed trials between 2002 and 2012, with five studies 
published and two pending, California researchers say the research 
shows pot does, in fact, have therapeutic value.

"Every one of the studies showed a benefit," said Dr. Igor Grant, a 
neuropsychiatrist who served as director of the Center for Medicinal 
Cannabis Research. "The convergence of evidence makes me convinced 
there is a medical benefit here, and there may be a niche for cannabis."

The California researchers sought to avoid the politics of pot or 
advocacy of its use. But Grant said the research results suggest the 
U.S. government's listing of marijuana as a Schedule I drug with no 
medical use  on par with heroin and LSD  "is completely at odds with 
the existing science."

"It is intellectually dishonest to say it has no value whatsoever, 
because it's just not true," he said.

Trials with HIV patients

While doctors can recommend marijuana, and people buy it at 
California dispensaries, it is not available as a legal prescription drug.

So the challenge for California researchers was to try to determine 
if a plant with no uniform medical dose could be shown as effective.

In many cases, researchers took their cues from people already using marijuana.

Dr. Donald Abrams at UC San Francisco and Dr. Ronald Ellis at UC San 
Diego knew AIDS and HIV patients with nerve damage were treating 
themselves with cannabis to quell shooting pains from stimuli as 
benign as pulling a bed sheet over their toes.

In separate clinical trials between 2002 and 2006, Abrams and Ellis 
found that patients infected with HIV got marked pain relief from pot 
even on top of prescription pain medications.

In May, a published study by Jody Corey-Bloom, director of the 
Multiple Sclerosis Center at UC San Diego, reported that 30 patients 
smoking marijuana got noticeable relief from painful spasticity.

Through May, another research team led by UC Davis pain management 
physician Dr. Barth Wilsey worked to determine whether cannabis could 
relieve pain without getting people stoned.

Wilsey was surprised when research subjects with discomfort from 
nervous system damage found the same relief from marijuana cigarettes 
with 3.5 percent tetrahydrocannabinol  the psychoactive ingredient in 
pot  as from cigarettes with 7 percent THC. He commissioned a 
follow-up, in which patients breathed in vaporized pot with even 
smaller amounts of THC or with psychoactive elements extracted.

"I think we're traveling together," Wilsey said of the synergy 
between researchers and subjects using cannabis. "I want to be able 
to provide a suitable dose that doesn't impair people or impairs them 

It was as part of that study that Sacramento County resident Gene 
Murphy, a multiple sclerosis patient, was driven to a UC Davis 
research center in Rancho Cordova over a three-week period so 
scientists could watch him inhale different potencies of cannabis 
from a vaporizer, check his pain and see if he was getting high.

Murphy found himself taking tokes of government pot, grown for 
research at the University of Mississippi, and complaining about the 
taste as the UC Davis team tried to find out if a minuscule dose of 
marijuana could help with his shooting pains.

"It was harsh on your throat and you didn't get high or nothing," 
Murphy said. "I asked them, 'Can't you get something better out of 
Humboldt County?' "

But Murphy also found his discomfort seemed to decrease with cannabis 
use in a way it didn't with his prescription of Vicodin alone. His 
impressions will be included in an upcoming study.

This month, Wilsey is enrolling research subjects for another study, 
funded under a $910,000 grant from the National Institutes of Health, 
on cannabis's effectiveness with spinal cord injury pain.

Conflicts over testing

Before the California research  and still today  federal agencies 
have preferred to support studies of marijuana as a drug of abuse, 
not as a potential medical benefit.

As U.S. authorities crack down on California marijuana dispensaries, 
some UC researchers question if medical cannabis research is any more 
acceptable today. "I don't think science drives the train here," 
Abrams said, adding. "It's a difficult environment at the current 
time to obtain funding."

Rick Doblin, director of the Multidisciplinary Association for 
Psychedelic Studies, a nonprofit group advocating alternative medical 
research, said he hoped the California studies would have kicked open 
the door to large, multistate trials that could evaluate marijuana as 
a prescription drug.

That didn't happen. Neither did a much-publicized study MAPS hoped to 
undertake in Arizona this year on whether pot could help Iraq and 
Afghanistan combat veterans with symptoms of post-traumatic stress disorder.

Doblin said the Food and Drug Administration supported the veterans 
study. But the National Institute on Drug Abuse, which controls 
access to the government's supply of marijuana for research, did not.

"With the fact that the Center for Medicinal Cannabis Research had 
all of these promising leads, you would think in a rational world 
that people would be studying marijuana to make it a (prescription) 
medicine," Doblin said.

In response to written questions from The Bee, Stephanie Older, a 
public affairs officer with the National Institutes of Health and the 
National Institute on Drug Abuse, wrote that the agencies "will 
continue to support research on the potential benefits of cannabis."

However, she added: "While there have been some small studies on the 
potential therapeutic benefits of smoked cannabis, the literature on 
its harms is much more well-established."

For now, Grant said, the Center for Medicinal Cannabis research 
suggests that pot is a promising secondary therapy for people for 
whom other treatments fail.

But Grant said he worries about a lack of standardization for medical 
marijuana. He suggests people buying pot at dispensaries  offering 
products far more potent than used in state research  is akin "to 
going to a flea market for an antibiotic."

And UC San Diego researcher Dr. Mark Wallace said finding proper 
dosing for marijuana is a challenge.

In a novel study, Wallace, an anesthesiologist and pain specialist, 
injected capsaicin, the hot ingredient in chili pepper, beneath the 
skin of healthy research subjects who smoked pot with different THC levels.

Five minutes after inhaling marijuana, none reported pain relief. 
After 45 minutes, those who smoked marijuana with 2 percent THC said 
they still hurt. But those who smoked pot with 4 percent THC said 
their pain was all but gone. And those who smoked marijuana with 8 
percent THC reported their pain actually increased.

Wallace said the findings are significant because they showed "that 
cannabis has a therapeutic window."

But exactly what the proper marijuana dose is  and how it may vary 
for different conditions  will require much more research, Wallace 
said. He doesn't know when that may happen.
- ---
MAP posted-by: Jay Bergstrom