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Medical Marijuana on Trial As Supreme Court Nears Decision,
Benefits of Drug Remain in Question
NY, New York- April 21, 2005 -Medical marijuana is now legal in Washington and 10 other states, and bills to legalize it are pending in at least seven more. The drug is also at the heart of a case being considered by the U.S. Supreme Court.
Yet there remains much confusion over whether marijuana has any significant medical effect.
"People subjectively report benefits," said Dr. Joseph 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."
Diane Ballard is one of those subjective cases. Ballard has been smoking marijuana since 1999 to help control the pain and nausea caused by treatments she received for a rare form of cancer.
"When I don't take marijuana I'm nauseous all the time and I can't hold down any food," said Ballard, who smokes up to two marijuana cigarettes a day at her home in West Seattle.
Multiple rounds of chemotherapy and radiation left their mark on Ballard's body. She's been diagnosed with fibromyalgia and severe acid reflux.
Washington voters approved a law in 1998 that allows people with a terminal or debilitating illness to grow, smoke or obtain marijuana for medical needs with a doctor's recommendation.
Ballard's doctors -- she sees someone for pain, an oncologist and an arthritis specialist -- have all provided her with notes suggesting marijuana will do her more good than harm.
"I'm positive it helps me," said Ballard. "For somebody to say it doesn't help, they haven't a clue."
Dr. David Baker, a professor at the Institute of Neurology in London, has found beneficial effects of cannabinoids in mice that 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. What is clear is that there have been no dramatic improvements overall."
Dr. Kenneth 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," Mackie said. "But the clinical studies just aren't there."
In an editorial last year in the journal Neurology, Sirven said the best studies of marijuana's effects on humans so far have shown little objective evidence of benefit in certain patients -- those 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.
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-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," Abrams said.
He said he had completed three studies in patients with HIV 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.
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 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.
Raich's physician, Dr. Frank Henry Lucido of Berkeley, Calif., asserted in an affidavit that 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, 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 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, 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 Gross, director of the University of Alberta's adult epilepsy program.
A large body of research in test tubes and animals supports the view that cannabinoids have anti-convulsive properties. But while a 2003 study of 657 patients with MS 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 the results should be interpreted cautiously because the study had been intended to test only short-term benefits.
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 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, 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.
"You have to take a lot to go psychotic," 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."
But he added, 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.
Source: New York Times
Copyright: © 1998-2005 Seattle Post-Intelligencer
Contact: DAN HURLEY, THE NY TIMES, P-I reporter Julie Davidow contributed
Website: https://seattlepi.nwsource.com/local/220955_hcenter21.html
Benefits of Drug Remain in Question
NY, New York- April 21, 2005 -Medical marijuana is now legal in Washington and 10 other states, and bills to legalize it are pending in at least seven more. The drug is also at the heart of a case being considered by the U.S. Supreme Court.
Yet there remains much confusion over whether marijuana has any significant medical effect.
"People subjectively report benefits," said Dr. Joseph 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."
Diane Ballard is one of those subjective cases. Ballard has been smoking marijuana since 1999 to help control the pain and nausea caused by treatments she received for a rare form of cancer.
"When I don't take marijuana I'm nauseous all the time and I can't hold down any food," said Ballard, who smokes up to two marijuana cigarettes a day at her home in West Seattle.
Multiple rounds of chemotherapy and radiation left their mark on Ballard's body. She's been diagnosed with fibromyalgia and severe acid reflux.
Washington voters approved a law in 1998 that allows people with a terminal or debilitating illness to grow, smoke or obtain marijuana for medical needs with a doctor's recommendation.
Ballard's doctors -- she sees someone for pain, an oncologist and an arthritis specialist -- have all provided her with notes suggesting marijuana will do her more good than harm.
"I'm positive it helps me," said Ballard. "For somebody to say it doesn't help, they haven't a clue."
Dr. David Baker, a professor at the Institute of Neurology in London, has found beneficial effects of cannabinoids in mice that 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. What is clear is that there have been no dramatic improvements overall."
Dr. Kenneth 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," Mackie said. "But the clinical studies just aren't there."
In an editorial last year in the journal Neurology, Sirven said the best studies of marijuana's effects on humans so far have shown little objective evidence of benefit in certain patients -- those 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.
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-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," Abrams said.
He said he had completed three studies in patients with HIV 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.
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 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.
Raich's physician, Dr. Frank Henry Lucido of Berkeley, Calif., asserted in an affidavit that 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, 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 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, 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 Gross, director of the University of Alberta's adult epilepsy program.
A large body of research in test tubes and animals supports the view that cannabinoids have anti-convulsive properties. But while a 2003 study of 657 patients with MS 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 the results should be interpreted cautiously because the study had been intended to test only short-term benefits.
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 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, 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.
"You have to take a lot to go psychotic," 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."
But he added, 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.
Source: New York Times
Copyright: © 1998-2005 Seattle Post-Intelligencer
Contact: DAN HURLEY, THE NY TIMES, P-I reporter Julie Davidow contributed
Website: https://seattlepi.nwsource.com/local/220955_hcenter21.html
