Previously I wrote about a small study finding that smoked marijuana helps with HIV-related pain. In the last month, two more clinical trials of medical marijuana - or rather, marijuana-based drugs - for pain have come out.First, the good news. Johnson et al tested a mouth spray containing the two major psychoactive chemicals in marijuana, THC and CBD. Their patients were all suffering from terminal cancer, which believe it or not, is quite painful. Almost all of the subjects were already taking high doses of strong opiate painkillers: a mean of 270 mg morphine or equivalent each day, which is enough to kill someone without a tolerance. (A couple of them were on an eye-watering 6 grams daily). Yet they were still in pain.
Patients were allowed to use the cannabinoid spray as often as they wanted for 2 weeks. Lo and behold, the THC/CBD spray was more effective than an inactive placebo spray at relieving pain. The effect was modest, but statistically significant, and given what these people were going through I'm sure they were glad of even "modest" effects. A third group got a spray containing only THC, and this was less effective than the combined THC/CBD - on most measures, it was no better than placebo. THC is often thought of as the single "active ingredient" in marijuana, but this suggests that there's more to it than that. This was a relatively large study - 177 patients in total - so the results are pretty convincing, although you should know that it was funded and sponsored by GW Pharma, whose "vision is to the global leader in prescription cannabinoid medicines". Hmm.
Overall, this is further evidence that marijuana-based drugs can treat some kinds of pain, although maybe not all of them. I have to say, though, that I'm not sure that we needed a placebo-controlled trial to tell us that terminal cancer patients can benefit from medical marijuana. If someone's dying from cancer, I say let them use whatever the hell they want, if they find it helps them. Dying patients used to be given something called a Brompton cocktail, a mixture of drugs that would make Keith Richards jealous: heroin, cocaine, marijuana, chloroform, and gin, in the most popular variant.
And why not? There were no placebo-controlled trials proving that it worked, but it seemed to help, and even if it was just a placebo (which seems unlikely), placebo pain relief is still pain relief. I'm not saying that these kinds of trials aren't valuable, but I don't think we should demand cast-iron proof that medical marijuana works before making it available to people who are suffering. People are suffering now, and trials take time.
Johnson JR, Burnell-Nugent M, Lossignol D, Ganae-Motan ED, Potts R, & Fallon MT (2009). Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients With Intractable Cancer-Related Pain. Journal of pain and symptom management PMID: 19896326
Selvarajah D, Gandhi R, Emery CJ, & Tesfaye S (2009). A Randomised Placebo Controlled Double Blind Clinical Trial of Cannabis Based Medicinal Product (Sativex) in Painful Diabetic Neuropathy: Depression is a Major Confounding Factor. Diabetes care PMID: 19808912
18 comments:
I was watching "Marijuana Monday" on a webshow with guests from an Orange County California medical marijuana dispensary. Their examples of good indications for medical marijuana included menstrual cramps and surgery that they might be having in the future. It's nice to see articles on decent research and legitimate uses.
I am amazed. The same folks who attack BigPharma for lack of efficacy (not effectiveness mind you) and shameless profit seeking and being poorly regulated are defending the most predatory, dishonest, and unregulated industry - recreational ("natural")drugs.
legalization of marijuana will at least double, more likely quintuple psychopathology in the society (alright with those of us who are in business of treating psychiatric disorders - I am being facetious, just in case someone decides to quote me)
Let's not ignore a flood of psychiatric complications and sequalae accompanying "weed":
*Psychosis and in some rare cases emergene of schizoprenia (first episode)
*memory loss (short term and in heavy cases long term)
*loss of concentration and decrease in learning, slow reaction time (drivers, airline pilots...)
* emergence of depression (occasionally bipolar)
*emergence of anxiety and panic disorder.
*somnolence and disruption of wake-sleep cycle
*apathy, amotivational syndrome,
* not to mention:
* Tremors (shaking)
* Nausea
* Headache
* Decreased coordination
* Breathing problems
* Increased appetite
* Reduced blood flow to the brain
* Changes in the reproductive organs
Now the questions: Is it worth a price to treat mild discomfort and MILD chronic pain with such a powerful drug? Would you like your 13 year old daughter be treated with weed for whatever indications with this drug?
legalization of marijuana will at least double, more likely quintuple psychopathology in the society
That's why the Netherlands where marijuana is legal has 2, more likely 5, times the psychopathology of countries where it's banned right... oh wait, it doesn't? - besides which, we are not talking about legalizing it for everyone, just for medical purposes.
Now the questions: Is it worth a price to treat mild discomfort and MILD chronic pain with such a powerful drug? Would you like your 13 year old daughter be treated with weed for whatever indications with this drug?
No, but I wouldn't want my 13 year old daughter with mild pain taking morphine either and that doesn't mean morphine's not a useful drug. If you stood up and told me that because extremely heavy marijuana use can cause psychosis in 18 year olds, my (hypothetical) 50 year old MS-suffering mother or 70 year old terminal cancer patient aunt shouldn't be allowed to use it if they found it helpful... well, you might need some analgesics yourself.
I was planning to do some research to support my point, but the very first link gave me many answers. Although presented to US Supreme Court, the quoted research was not conducted by American government that might be suspected favoring anti-marijuana laws, but by Europeans, mostly British (your neck of the wood? )
From
http://www.zenit.org/article-17602?l=english
... In England, a conference organized by the Institute of Psychiatry of King's College in London late last year heard evidence that marijuana use roughly doubles the risk of psychiatric illness. According to a Dec. 2 article in London's Telegraph newspaper, Jim van Os, a psychiatrist at Maastricht University in the Netherlands, said that a number of studies show that the drug roughly doubles the risk of psychiatric illness such as schizophrenia among young people.
A study carried out by the Dutch psychiatrist revealed even higher risks for those who are already genetically vulnerable to psychiatric problems. For those who had shown evidence of being predisposed to these conditions, marijuana use increased fourfold the risk of developing problems.
On Jan. 1 the Telegraph reported on comments made by Dr. Clare Gerada, head of the drugs misuse unit of the Royal College of General Practitioners. She said that relaxed attitudes toward marijuana use, combined with the greater availability of stronger varieties of the drug, were leading to rising rates of depression and psychosis among vulnerable young people.
Altering the brain
Heavy use of marijuana has been linked to psychosis by a group of scientists in New Zealand. The National Post newspaper of Canada reported March 10 that the researchers followed a group of 1,200 men and women, all born in 1977, over a 25-year period. Their findings were published in the March edition of the journal Addiction.
"The association between cannabis use and psychotic symptoms is unlikely to be due to confounding factors," wrote researchers David Fergusson and L. John Horwood. "The direction of causality is from cannabis use to psychotic symptoms." The study showed that use of the drug probably alters the brain's chemistry, thus precipitating mental health problems.
According to an April 12 article in the London-based Times newspaper, around a quarter of the population have a genetic vulnerability to psychotic illnesses if they use marijuana during their teen years. The problems did not arise just from marijuana use, or from the genetic problem by itself, but from a combination of the two.
The data came from a study led by Avshalom Caspi and Terrie Moffitt, of the Institute of Psychiatry at King's College London, and published in the journal Biological Psychiatry. Caspi also noted that marijuana has many other adverse effects, for example, on respiratory health and possibly on cognitive function [I knew that. ML]
And a report in the Scotsman newspaper on May 23 raised the alarm that marijuana use may weaken the body's bones. The finding came from researchers at Aberdeen University. Stuart Ralston, who led the study, said: "I wouldn't want to strike fear into everyone who uses the drug, but our tests lead us to the conclusion that it might cause bone loss." [I didn't know that. ML]
Here is a bit more:
Two cases of "cannabis acute psychosis" following the administration of oral cannabis. Bernard Favrat, Annick Ménétrey, Marc Augsburger, Laura E. Rothuizen, Monique Appenzeller, Thierry Buclin, Marie Pin, Patrice Mangin, Christian Giroud. BMC Psychiatry 2005, 5:17
http://www.sciencedaily.com/releases/2005/04/050419105717.htm
ScienceDaily (Apr. 19, 2005) — Volunteers taking cannabis-based therapeutic drugs as part of a controlled trial, which had been approved by an ethics board as safe for the subjects, experienced psychotic effects just as strong as if they had smoked cannabis. These findings, highly unexpected in such a controlled environment, are published today in the peer-reviewed, Open Access journal BMC Psychiatry.... (read on)
Lastly. Yogi Berra, american baseball player and a witty fellow mused: "In theory there is no difference between theory and practice. In practice there is."
Recent history offers us myriad of examples when best scientific intentions paved proverbial road to hell.
Who could have thought that innocent cigarette smoking could be so addictive and lethal?
Did anyone thought that hydrocodone and its time-release cousin (Oxycontin) could be so deadly and addictive - they were meant for teenagers but for "(hypothetical) 50 year old MS-suffering mother or 70 year old terminal cancer patient aunt".
Methadone that killed Ann Nichole Smith and her son was not meant for pain-free individuals and the actor Heath Ledger who died at 28 took legal prescription medication approved for mild pain.
Amphetamines and methamphetamines were not approved to get high and fry one's brain but to treat narcolepsy, a legitimate medical condition.
On the list goes on...
When I suggested to a skeptic (a neuroskeptic) to take critical look at a psychoactive drug, I did not expect sarcasm or medical advice. I won't offer one either.
A qualified doctor should have every conceivable drug known to man at her disposal to administer if necessary. The decision to take a drug should be between the doctor and patient. The doctor is there to make the patient understand the benefits and risks.
I live in New Jersey, and the issue of medical marijuana is a thorny one. With our newly elected republican governor, we may not be the next state to approve it.
To assess the relationship between trends of Marijuana related law enforcement activities and the passage of Medical Marijuana law would require a statistical analysis over time that include measures of law enforcement activities such as arrests,as well as data on other factors that are not easily measured.
"Madical marijuana" (madical? ... very clever) offered another reason why we should not rush into legislating marijuana for any reason, including medical.
"Dr" Michael,
I do not want harsh drugs in my body EVER. I do not want to live a life taking 16 pills a day, half of which would help the side effects of the other half.
I want to be able to decide what's best to put in MY BODY instead of having doctors and medical associations, whose only intentions are to increase their bank accounts and the big legal drug companies bottom line, tell me what's "best" for me.
It sickens me to see "psycho" doctors push anti depressants on their patients instead of promoting a healthy chemical free diet and good old fashioned exercise.
Dr. Michael - Why are you a doctor? Did it guarantee you a certain income level and prestige or do you really truly care about people?
A few points I would like to address. Tobacco in its organic form does not cause the damage that today's cigs cause to the body. So what is causing these tobacco deaths? That would be the many chemicals and pesticides put on the plant in processing that makes them deadly and more addictive. The big fat tobacco companies put all of those chemicals in the tobacco and told everyone they were safe to use in the 60's & 70's when they knew they weren't. The big legal drug companies are doing the same thing with Opiates.
Look, I am sick of "experts" with big fancy educations from universities that are all working to produce drug company prodigy doctors talk about what's good or bad in the World. That is predatory, not the "alternatives" which should never have been alternatives in the first place.
I am tired of being lied to and killed slowly with Genetically Modified Seeds, Trans Fats, High Fructose Corn Syrup, chemicals in the air, in my clothes, in the water I drink. That is predatory!
Now, MJ is smoked daily by more people that you can imagine. Kids find it easier to get pot on the black market than cigs & alcohol. The Mom's & Pop's selling weed to their friends all of these years are criminals because the petro chemical companies and timber companies wanted to stamp out the competition. I feel the only reason it's not legal to grow Industrial Hemp & Marijuana is that using Hemp Oil for plastic would put the petro chemical companies out of business. It would affect the timber industry when Industrial Hemp is used to build houses and paper instead of trees. What would happen to the big fat legal drug companies if all of the patients out there chose Marijuana over opiates and antidepressants?
In the medical field, people have made amazing progress proving that cannabinoids can do miraculous things, including eating away at cancerous tumors or putting cancer into remission. We have cannabinoid receptors in our brains and spleens. I have not been able of find any evidence that I have opiate receptors.
Oh and one last point. If cannabinoids are useless as medicines, why does the US Department of Health have the Patton for using cannabinoids as neuroprotectants and antioxidants?
Please, "Dr" Michael, I feel that each of us earns the title. I do not feel people are worthy of their title unless they make sure the opinions they are pushing are filled with glorious truth.
"The argumentative defense of any proposition is inversely proportional to the truth contained."
I hope you find some truth out there because right now you are more a pawn in the drug game than any of us. Good luck with that.
S
Does it not seem strange that in this, “land of the free” that the government is still monitoring the minor indisgressions and leisure activities of its citizens. People should be able to use a glass smoking pipe in their homes without the threat of harassment by law enforcement.
Sunflowerpipes.com
Dr. Levin:
even if marijuana does lead to psychosis, how relevant is that toward the question of regulation? don't people have the right to make the choice to use or not use a harmful substance? shouldn't we simply be alerting people to the potential consequences, especially as criminalization has not reduced availability of the drug?
the claim can (and has been) made that using harmful substances is not victimless in that it leads to public health liability. but if we want to examine individual behavior in this light, shouldn't we examine social programs in a similar light? the public health costs and general financial and social liability of the criminalization of narcotics etc., as well as prostitution, dwarf the consequences of the behaviors being legislated.
no one is defending the recreational drug industry. in fact, there is no better way to attack this industry than to legalize its products and have them produced and issued through government-controlled channels.
I know a number of people who experienced psychotic episodes that may very well have been induced by the use of marijuana or other recreational drugs. but the policy that the FDA and other governments have followed, that people should be restricted from using anything that might cause "dependence" -- meaning anything that makes someone feel good -- evidences a disturbing, paternalistic willingness to legislate the health choices of individuals. the fact that something is bad for me (or makes me feel good) does not a priori mean that I should be thrown in jail for doing it.
Michael: OK, apologies for the sarcasm, I can see that you're interested in having a serious discussion.
There is indeed good evidence that heavy marijuana use can cause psychosis in young people - and of course in the short term it can cause "Tremors, Nausea, Headache, Increased appetite" etc. It's clearly not 100% safe. Although almost uniquely it is 100% non-lethal - you can't die from overdose which is more than you can say for alcohol. Or aspirin. Or nutmeg.
But I really don't think that allowing medical use of marijuana is going to increase marijuana harms. For one thing, the kind of people who are going to be using it medically are much older than the population in which the risk of psychosis has been detected.
For another thing, illicit marijuana use is already extremely high despite prohibition and in countries with less strict prohibition use is no higher; in the Netherlands it is no higher than in the US or Britain for example.
Your mention of Oxycontin and methadone is interesting though. Would you suggest that we shouldn't use opiates at all? Because opiates are the most addictive of all illegal drugs, but they're also medically invaluable. What about propofol which killed Michael Jackson? Should we stop using that?
Of course, we can't know exactly what would happen if we allowed medical marijuana, but we do know a lot about marijuana - it's not like we're talking about inventing a whole new drug - tens of millions of people use it and they're not all dropping dead or going psychotic. A few million more people, mostly terminally ill, using moderate amounts, doesn't sound like a huge risk, and it could relieve a lot of suffering.
I think there is total agreement that medical marijuana is approved, unfortunately most people in Europe and USA use it unequivocally, and that's what hurts for approval in these countries especially in USA, this is what findrxonline indicating as they try to report the correct medicines that can help people.
Nicky VB:
the libertarian idea of keeping government out of drug approval process is unrealistic, in my opinion. In litigious American society it’s not a practical one either. Americans blame government and businesses for everything – from global warming to high prices. Even alerting people to dangers (example: cigarettes warning) do not stop law suits.
I am all for freedom and choices – great concept when dealing with responsible, rational, and well informed populace. Considering that 50% of population has double-digit IQ and teenagers with any IQ act like morons, is it really a good idea to give out a powerful psychoactive drug?
Neuroskeptic:
You raised good points but I believe there is a common confusion about relationship between FDA approval process and use of meds. FDA guidelines do not limit and direct physicians' judgments about the use of psychotropic drugs in children. Instead, they are regulatory guidelines for advertising by pharmaceutical houses:
"......The FD&C Act does not limit the manner in which a physician may use an approved drug. Once a product has been approved for marketing, a physician may prescribe it for use [indications] or in treatment regiments [doses] or patient population [ages] that are not included in approved labeling... Accepted medical practice often includes drug use that is not reflected in approved drug labeling. "
I was not suggesting stopping arbitrarily approved drugs but wanted to bring to everyone’s attention that a) we are not dealing with “innocent” drug (all the benefits and no risk) and b) once the medication is approved, it is impossible to limit its indications or population. Lastly, marijuana is not one chemical (e.g. THC) but hundreds of alkaloids, most of them neither understood nor studied.
That combination of drugs wouldn't make Keith Richards jealous. To us, it's known as the "Brompton Cocktail." To Keith, it's simply considered "breakfast."
Except that Cannabinoids are the molecules you aren't able to fatally overdose using. You can literally eat them, smoke them and breathe them and they help in some way. You even have a built in receptor system (Endo-cannabinoids). S
Except that Cannabinoids are the molecules you aren't able to fatally overdose using. You can literally eat them, smoke them and breathe them and they help in some way. You even have a built in receptor system (Endo-cannabinoids). S
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