SirBlazinBowl
New Member
The Food and Drug Administration, which recently quixotically asserted that cannabis has no medical utility, has at the same time approved advanced clinical trials for a marijuana-derived drug called Sativex, a liquid preparation of two of the most therapeutically useful components of cannabis. Clinicians who are familiar with the medicinal uses of marijuana know that the herb, because it can be smoked or vaporized, is much more reliable than this liquid preparation.
A few years ago GW Pharmaceuticals persuaded the UK Home Office that it should be allowed to develop this product on the assertion that it will provide all of the medical benefits of cannabis without burdening patients with two common wisdom "dangerous" effects those of smoking and getting high. There is very little to support the belief that smoking marijuana represents a significant risk to the pulmonary system. Although cannabis has been smoked widely in Western countries for more than four decades, there are no reported cases of lung cancer or emphysema which can be attributed to marijuana. I suspect that a day's breathing in any city with poor air quality poses more of a threat than inhaling a day's dose of smoked marijuana. Furthermore, those who are, in today's antismoking climate, concerned about any toxic effects on the pulmonary system can now use a vaporizer, a device which frees the cannabinoid molecules from the plant material without the necessity of producing smoke by burning it. As for the psychoactive effects, I am not persuaded that the therapeutic benefits of cannabis can always be separated from the psychoactive effects nor am I convinced that attempting to do so is always a desirable goal. For example, many patients with multiple sclerosis who use marijuana speak of "feeling better" as well as the relief from muscle spasm and other symptoms. If cannabis contributes to this mood elevation, should patients be deprived of this effect? The statement that, "The company maintains that Sativex, when taken properly, does not cause the kind of intoxication that people routinely experience from smoking marijuana" hinges on the phrase, "when taken properly". Properly here means taking a dose which is under the level required for the psychoactive effect.
One has to question whether that dose is always therapeutic and whether cannabis taken under the tongue can be so carefully titrated to readily determine that precise dose. It is also true that people who want to use Sativex to get high will certainly be able to do so. One of the most important characteristics of cannabis as a medicine is its capacity for self-titration when taken through the pulmonary system. Because the effects are achieved so rapidly through this means of administration, the patient can determine precisely the amount needed for symptom relief; the risk of underdosing or overdosing is minimized. While sublingual absorption of cannabis leads to faster relief than oral administration (which may take one and a half to two hours), it is not nearly as fast as pulmonary administration and therefore makes self-titration much more difficult if not impossible. Furthermore, many patients cannot hold Sativex, which has a most unpleasant taste, under the tongue long enough for it to be absorbed; as a consequence varying amounts trickle down the esophagus. It then behaves like orally administered cannabis with the consequent delay in the therapeutic effect. Cannabis will one day be seen as a wonder drug as was penicillin in the 1940s. herbal marijuana is remarkably nontoxic, has a wide range of therapeutic applications, and will be quite inexpensive when it is freed of the prohibition tariff. Even now good quality illicit or homegrown marijuana, which is, at the very least, no less useful than Sativex, is less expensive than Sativex will be. While the pharmaceutical industry will undoubtedly produce new strains of herbal marihuana and unique analogs of cannabis which will be useful in ways that whole smoked cannabis is not, Sativex provides only one advantage over whole smoked (or vaporized) marijuana: its use will be legal. I have yet to see a patient who has used both dronabinol (Marinol, a prescription-available synthetic form of the most active cannabinoid) and smoked marijuana who has not found the latter more useful and manageable. The primary reason patients use dronabinol rather than herbal marihuana is a function of the law. Without the prohibition, few would use dronabinol. Similarly, the commercial success of Sativex will largely depend on the vigor with which the prohibition is enforced. It is not unreasonable to believe that as the pharmaceutical armamentarium of cannabinoids increases, so will the pharmaceutical industry's interest in sustaining the prohibition. Dr. Geoffrey Guy claims that he founded GW Pharmaceuticals to keep people who find marijuana useful as a medicine out-of-court; there is, of course, a way to do this which would be much less expensive both economically and in terms of human suffering.
Newshawk: SirBlazinBowl - 420 Magazine
Source: Lester Grinspoon MD
Copyright: N/A
Contact: N/A
Website:N/A
Author: Lester Grinspoon MD
A few years ago GW Pharmaceuticals persuaded the UK Home Office that it should be allowed to develop this product on the assertion that it will provide all of the medical benefits of cannabis without burdening patients with two common wisdom "dangerous" effects those of smoking and getting high. There is very little to support the belief that smoking marijuana represents a significant risk to the pulmonary system. Although cannabis has been smoked widely in Western countries for more than four decades, there are no reported cases of lung cancer or emphysema which can be attributed to marijuana. I suspect that a day's breathing in any city with poor air quality poses more of a threat than inhaling a day's dose of smoked marijuana. Furthermore, those who are, in today's antismoking climate, concerned about any toxic effects on the pulmonary system can now use a vaporizer, a device which frees the cannabinoid molecules from the plant material without the necessity of producing smoke by burning it. As for the psychoactive effects, I am not persuaded that the therapeutic benefits of cannabis can always be separated from the psychoactive effects nor am I convinced that attempting to do so is always a desirable goal. For example, many patients with multiple sclerosis who use marijuana speak of "feeling better" as well as the relief from muscle spasm and other symptoms. If cannabis contributes to this mood elevation, should patients be deprived of this effect? The statement that, "The company maintains that Sativex, when taken properly, does not cause the kind of intoxication that people routinely experience from smoking marijuana" hinges on the phrase, "when taken properly". Properly here means taking a dose which is under the level required for the psychoactive effect.
One has to question whether that dose is always therapeutic and whether cannabis taken under the tongue can be so carefully titrated to readily determine that precise dose. It is also true that people who want to use Sativex to get high will certainly be able to do so. One of the most important characteristics of cannabis as a medicine is its capacity for self-titration when taken through the pulmonary system. Because the effects are achieved so rapidly through this means of administration, the patient can determine precisely the amount needed for symptom relief; the risk of underdosing or overdosing is minimized. While sublingual absorption of cannabis leads to faster relief than oral administration (which may take one and a half to two hours), it is not nearly as fast as pulmonary administration and therefore makes self-titration much more difficult if not impossible. Furthermore, many patients cannot hold Sativex, which has a most unpleasant taste, under the tongue long enough for it to be absorbed; as a consequence varying amounts trickle down the esophagus. It then behaves like orally administered cannabis with the consequent delay in the therapeutic effect. Cannabis will one day be seen as a wonder drug as was penicillin in the 1940s. herbal marijuana is remarkably nontoxic, has a wide range of therapeutic applications, and will be quite inexpensive when it is freed of the prohibition tariff. Even now good quality illicit or homegrown marijuana, which is, at the very least, no less useful than Sativex, is less expensive than Sativex will be. While the pharmaceutical industry will undoubtedly produce new strains of herbal marihuana and unique analogs of cannabis which will be useful in ways that whole smoked cannabis is not, Sativex provides only one advantage over whole smoked (or vaporized) marijuana: its use will be legal. I have yet to see a patient who has used both dronabinol (Marinol, a prescription-available synthetic form of the most active cannabinoid) and smoked marijuana who has not found the latter more useful and manageable. The primary reason patients use dronabinol rather than herbal marihuana is a function of the law. Without the prohibition, few would use dronabinol. Similarly, the commercial success of Sativex will largely depend on the vigor with which the prohibition is enforced. It is not unreasonable to believe that as the pharmaceutical armamentarium of cannabinoids increases, so will the pharmaceutical industry's interest in sustaining the prohibition. Dr. Geoffrey Guy claims that he founded GW Pharmaceuticals to keep people who find marijuana useful as a medicine out-of-court; there is, of course, a way to do this which would be much less expensive both economically and in terms of human suffering.
Newshawk: SirBlazinBowl - 420 Magazine
Source: Lester Grinspoon MD
Copyright: N/A
Contact: N/A
Website:N/A
Author: Lester Grinspoon MD
