Marihemp: The Drug of Choice: Cannabis as Medicine

The Drug of Choice

Cannabis as Medicine

(Part 2 of 4) by Gary Stimeling

Copyright 2005 Psychotropics Cornucopia, Inc. All Rights Reserved.

Glaucoma Reliever

Rising intraocular pressure (IOP) is the distinctive sign of glaucoma. R. S. Hepler and I. M. Frank at UCLA showed the IOP lowering effect of cannabis in 1971 by accident as they were trying to document the dilated-pupil myth as a stop-and-search cause for the Los Angeles Police Department. And the two scientists had only rediscovered the IOP effect, as cannabis had been the standard remedy for glaucoma in the 19th century.

In 1973, Robert C. Randall found the effect independently when he smoked grass and noticed that the visual halo—his own personal marker for progress of the disease—had diminished. Randall had been diagnosed with end-stage glaucoma unresponsive to standard treatment and ineligible for surgery. His doctor forecast another three to five years of eyesight. Marijuana halted the progress of the disease and enabled him to keep his sight for 28 years, until his death in 2001. With his continued gift of vision, Randall pioneered the medical necessity defense in Florida and in 1976 became the first American to use pot legally in almost 40 years. Later, he compiled standard medicolegal references on marijuana, and, in Marijuana Rx, documented the decades-long quest of federal pot patients for their oft-withheld supplies.

Improvements in pharmaceuticals since the 1970s make marijuana an absolute necessity for fewer glaucoma patients, but there are still a substantial minority, almost half in some studies, for whom standard drugs (beta blockers, epinephrine, prostaglandins, and a few others) are ineffective or have severe side effects, such as depression or heart problems.

How marijuana lowers IOP is not known for certain, but recent work indicates there may be anandamide receptors in the microscopic outflow duct, called Schlemm’s canal, that allows intraocular fluid to exit the chamber behind the cornea, thus preventing pressure from building up. Blockage of Schlemm’s canal raises IOP, damaging the optic nerve. THC or anandamide may relax and dilate this crucial drain. In addition, there are probably contributions by THC’s ability to lower high blood pressure, its antioxidant virtues, and its relaxation and stress-relief in general.

The antiglaucoma effect may not be closely related to the high, however. Cannabinol, the inactive degraded form of delta-9-THC, and delta-8, number 9's less stony precursor form, both lower IOP, while cannabidiol and delta-9 do so much less. This explains why high-test pot works no better than stale government 2-percent low-grade. Randall once said, “The U.S. government makes marijuana the way the East German government made cars.”

The effectiveness of low-test can be good for glaucoma patients, since their need to renew the dose every few hours can otherwise make it a burden to be high all the time. However, this need also exposes patients to the most risk from smoking, so they may be better off extracting cannabinoids from cheap, low-THC bud and leaf, then smoking the extract, or adding it to food, or making a tincture. Research abroad moves toward the goal of delivering the glaucoma-active ingredients in eyedrops, perhaps eventually using the body’s own anandamide.

Antinausea Agent

Numerous controlled studies have shown synthetic THC to be better than most other antinausea medicines, although a new group of drugs, the 5-HT₃ antagonists, are now considered somewhat more powerful. Synthetic THC is not as effective as inhaled natural cannabis, however. First of all, nausea often makes a person vomit the pill right back up. At $12 each, that’s hard to swallow. Even a patient does keep it down, absorption varies in a subpar digestive system, so it may not work anyway. If it does, the dose takes an hour and then comes on like a kick in the head, often relieving nausea at the price of headache, sleepiness, anxiety, or a long rough high that makes it hard to function at everyday activities. By contrast, smoked or vaporized cannabis takes effect at once, and the dose is easily controlled and easily renewed when necessary.

Retching from radiation and chemotherapy nausea often lasts for days and can be so violent as to break ribs or rupture the esophagus. Physicians have recognized cannabis as an excellent treatment for it since the pioneer work of Dr. Norman Zinberg and colleagues in 1975. They followed up on a lead from Dr. Lester Grinspoon, whose teenage son Danny successfully used marijuana to control nausea in a life cut short by leukemia. Scores of research papers and clinical reports have confirmed the effect since then. Because of its lack of side effects of its own, cannabis is ideal for this use in children. A 1995 article in Life Sciences reviewed studies in which the herb or cannabinoids had been given to a total of 480 children, aged 3 to 13, who were suffering extreme nausea from cancer treatment. The review found that all of them responded. In most cases, the vomiting stopped entirely.

Appetite Stimulus

Restoration of appetite by cannabis goes hand in hand with its antinausea effect, but that’s not the whole story. Due to metabolic problems, people with advanced AIDS, cancer, or congestive heart disease routinely lose weight despite constant feeding through a stomach tube or other means. By using marijuana, some of these patients have been able to regain weight even in the late stages of disease.

By 1992, AIDS sufferers had found that marijuana helps them keep their weight up. More than 200 of them had applied for legal access to pot via the Compassionate Investigational New Drug Protocol. That’s the program established in response to Robert Randall’s lawsuit under which the federal government fitfully gave poorly manicured grass in tins of Pall Mall-style joints to a total of 13 severely ill patients like a stingy rich uncle into power trips. Thousands more AIDS sufferers were expected to apply that year. Denying them would have made the government appear callous, but supplying them would have made the law’s absurdity more obvious than it already was, so President Bush (Aitch Dubya) simply closed the program.

In less dire situations, cannabis is well known to increase appetite. It gives people the munchies, which were well known to traditional medicine and 19th-century Western practice. It does so by a direct effect on the appetite pathways of the brain, plus enhancement of food’s sensual appeal. Today, despite the abundantly proven benefits of marijuana for cachexia (wasting) from AIDS and for weight-loss from chemotherapy and radiation, American doctors fear to use even Marinol “off-label” for anorexia from tuberculosis, kidney disease, extreme morning sickness, and other health problems.

Traditional medicine considers cannabis a digestive normalizer. Due to prohibition, there’s been little research on this broader aspect, but there are many reports by individuals of benefit in a variety of digestive disorders, including irritable bowel syndrome, ileitis, and colitis. The Pen Cao recommends it for constipation. That opinion was seconded in 2002, when North Korea honored researchers at Pyongyang Hospital with the state’s highest award in medical science. The doctors had developed an herbal remedy for constipation that completely cured 97 percent of the patients it was tested on. The medicine consists of rhubarb, elecampine, and cannabis.

Ganja is an Ayurvedic remedy for dysentery and diarrhea. For this use the customary dose is about 2 grams of dried leaves with sugar and black pepper. Indians also use tea from the leaves as a digestive tonic, even for infant colic.

Bronchodilator

Clinical research and a large number of case reports attest that THC dilates the bronchioles, providing several hours of freer breathing for asthmatics. Over the long term, it can effect a complete or nearly complete cure, using only small amounts of smoke. Ayurvedic scholar Joan Bello gives her own testimony of such a cure in one of her sons. Asthma was one of the chief medical indications for cannabis in the 19th century, and Asthmador cigarettes were among the most often used cannabis medicines of the time. Marijuana tends to quell over-reactivity caused by stress, which aggravates asthma. Marinol works, but not as well, and it also yields a long high that users describe as brutal. There’s been no success yet toward a THC inhaler, but bubble hash and vaporizers (see below) give optimal effect with least smoke.

Antihypertensive

There is usually a 20–50 percent increase in pulse rate plus a slight decrease in blood pressure for half an hour after smoking, or for 2–4 hours after eating, cannabis. These changes are about the same as those caused by moderate exercise, and they diminish with habitual use. Those new to the herb may experience a slight increase in blood pressure, perhaps due to anxiety. For most, the heart pumps more blood with less resistance. Coupled with deeper, more regular breathing, this results in better oxygenation of the tissues. Augmented blood flow to the brain is outwardly signaled by a slight reddening of the whites of the eyes. Cannabis increases the effect of exercise on heart rate without other effects. Reviews of the medical literature by the U.S. Institute of Medicine in 1982 and by the UN World Health Organization in 1997 found no adverse effects on the circulatory system, either short-term or long-term. Regular use sometimes lowers high blood pressure to normal and keeps it there, probably in part due to the drug’s calming effect on stress and Type A behavior, as well as by direct physiological action via anandamide receptors in the circulatory system. Due to prohibition, this is one of the least studied of marijuana’s medical effects.

Antiepileptic

Epilepsy is usually treated with barbiturates, benzodiazepines (Valium and Librium), or diphenylhydantoin (Dilantin). These drugs don’t work in 20–30 percent of cases, and often produce addiction, lethargy, or depression. Many epileptics who’ve tried it find that marijuana works better without side effects. Seizures are prevented primarily by cannabidiol (CBD) and possibly other cannabinoids, not THC.

Valerie Corral, cofounder of the Wo/Men’s Association for Medical Marijuana (WAMM), in Santa Cruz, California, suffered numerous daily grand mal seizures resulting from head injury in an auto accident in 1973. Conventional medicines were ineffective and debilitating. Cannabis completely prevents her seizures, so she has grown it since 1978. With her husband Mike, she has been arrested many times between August 1992 and October 2002. In April 2004, in a lawsuit by Santa Cruz County against Attorney General John Ashcroft, Judge Jeremy Fogel of the Northern District of California granted a temporary injunction against further government raids until the suit is decided, marking the first time that a federal court has recognized the right of groups of patients to grow and use marijuana. This is fifty-five years after two researchers had found that THC controls children’s epileptic seizures better than Dilantin [Federation Proceedings 8: 284–285, March 1949], which is still the most often prescribed antiepileptic.

From 1954 to 1959, the Department of Defense sponsored secret research in the chemical weapons research center at Edgewood Arsenal in Maryland on marijuana’s military potential. No such potential was found. But project director Van M. Sim later called marijuana “probably the most potent antiepileptic known to medicine today” [Medical World News, July 16, 1971, pp. 37–43]. In the 1990s, tests on rats given synthetic cannabinoids showed 70 percent less brain damage and fewer seizures after a dose of nerve gas.

Treatment for Degenerative Nerve Diseases

The usual drugs given for multiple sclerosis and other degenerative nerve diseases include steroids, major tranquilizers, barbiturates, and opiates, all of which have their bad sides. Animal and human studies, including clinical studies on “treatment failures,” show that marijuana quells the palsy of these diseases better. MS is also characterized by discoordinated voluntary muscle movements distinct from the involuntary tremors or muscle spasms. Standard drugs don’t help here, but in many patients cannabis does. Scientists suspect a direct action of cannabinoids on the brain, because areas that control movement and muscle function have high concentrations of cannabinoid receptors.

Cannabis also reduces nerve inflammation in lab animals with induced symptoms of MS. Many MS patients report that cannabis not only provides symptomatic relief but has slowed, halted, or even reversed the progress of their disease. Few studies have been done in the modern medical era. In one of them, in just two weeks of treatment with cannabidiol, one group of researchers achieved a 40-percent reduction in uncontrolled movements among a group of patients with Huntington’s chorea, an inherited, untreatable, and fatal disease of nerve degeneration. Several patients suddenly could sign their names legibly. Part of the benefit may be a result of the drug’s ability to control muscle spasms in general (see below), but there may also be some restorative effect on nerve pathways, since scientists have learned that many cannabinoid receptors in the brain are lost during the onset of Huntington’s chorea.

General Treatment for Muscle Spasms

In herbal medicine, cannabis has been known for thousands of years as the most dependable antispasmodic, no matter what underlying problem is the cause of the muscle over-reactivity. When William O’Shaughnessy introduced ganja to Western medicine in 1839, he highlighted his excellent results in tetanus and rabies. Other doctors soon confirmed his work and extended it to other conditions involving dystonia, prolonged involuntary twitching or painful contraction of muscles anywhere in the body. Even in prohibition’s research desert, dozens of preliminary reports and hundreds of patient testimonials show that cannabis can relieve muscle spasms in a wide variety of diseases, including the involuntary exclamations of Tourette’s syndrome. It also subdues menstrual cramps, as well as the tremors caused by Thorazine and similar antipsychotic drugs. It’s especially good for intestinal cramps and other spasms of muscles in the digestive tract, including long bouts of hiccups, which often plague AIDS patients who have yeast infections of the esophagus. In Britain, research on cannabinoids for all conditions involving spasticity has been given the highest priority in response to a petition from doctors.

Treatment for Autoimmune and Inflammatory Conditions

In the 1970s, several scientists bent on finding health hazards from marijuana showed that enormous concentrations of THC, far beyond those achievable by human use, can suppress the activity of some immune-system cells in test tubes. Such research has been outweighed by numerous studies of long-term heavy marijuana users, all of which have found no increase in disease compared with the rest of the population. The UN World Health Organization’s Project on Health Implications of Cannabis Use reported in 1997, “Given the duration of large scale cannabis use by young adults in Western societies, the absence of any epidemics of infectious disease makes it unlikely that cannabis smoking produces major impairments in the immune system.” The fact that marijuana benefits AIDS patients, even with their decimated immune systems, drives home the point.

On the contrary, tradition and clinical observations suggest that the herb can help, at least symptomatically, in several immune disorders. Asthma, thought to be caused in part by immune-system malfunction, is one such condition. Cannabis has also been shown to relieve the intense itching of neurodermatitis, also called atopic dermatitis, a debilitating and incurable condition in which the skin turns scaly and flakes off. Itching from other causes often responds to the drug, too.

It is not yet known how much of the itch relief from whole herb is due to the euphoric relaxation and how much to a direct effect on the nerves, skin, or immune system. A direct effect is argued by time-tested Ayurvedic treatment of eye and skin inflammation with a poultice of the fresh leaves, which produces no mental stimulation. Several experimenters have found that cannabidiol reduces inflammation and associated pain better than aspirin. New research suggests that a derivative of delta-8-THC called ajulemic acid may reduce inflammation much the same way as prostaglandin inhibitors (non-steroidal anti-inflammatory drugs, or NSAIDs), but without the severe side-effects of long-term NSAID use, and also without the THC high.

Cannabis shows great promise as a source of treatments for arthritis, another autoimmune inflammatory disease. Marinol and natural herb both give some relief from the pain, but certain constituents may have a more direct effect on the disease process itself. Pharmacologist Leo Hollister has shown that three compounds that don’t contribute to the high—cannabichromene, cannoflavin, and olivetol—are very good at reducing inflammation. So are cannabidiol and cannabigerol, according to other researchers. Animal tests of a THC derivative called CT-3 by Atlantic Pharmaceuticals indicate that it reduces inflammation and prevents destruction of cartilage in arthritic joints.

Pain Reliever

Cannabis is the only effective pain medication that is nonaddictive and without side effects. Its analgesia is not as powerful as morphine or heroin—it’s about as strong as codeine—but unlike the opiates it does not cause somnolence, mental depression, constipation, loss of appetite, or respiratory depression. Rather than numbing all feeling, cannabis seems to change people’s perception of pain, making it less intrusive or “further away.”

The body’s internal cannabinoids play a major role in regulating the sensitivity of pain pathways. That’s probably why marijuana is especially good at relieving pain caused by nerve damage, as thousands of accident victims have learned. President Kennedy occasionally smoked it in the White House, no doubt at least in part to ease his back pain caused by wartime spinal injury and later surgery.

Martin Martinez was in a coma for a month, and was expected to be crippled for life after being hit by a car while riding his motorcycle. He was on 24-hour morphine until it became as detrimental to him as his injuries. By using marijuana daily over the course of ten years, Martinez weaned himself from other drugs yet controlled the pain well enough to undergo intensive physical therapy. With it he gradually resumed an active life of carpentry and real estate management—not to mention writing The New Prescription and contributing mightily to the campaign for legal medical marijuana in Washington state.

The ability of hemp resin to alleviate pain was well known in traditional lore. Hua To, the 2nd-century Chinese “god of surgery,” pioneered its use with alcohol (ma-yo, hemp wine) as an anesthetic. Throughout 19th-century Western medical literature, pain relief was the most important virtue ascribed to cannabis. Over and over it was found to be not as powerful as opiates in emergencies, yet gentle, trouble-free, and remarkably effective in the long run. Among users today, the common theme is their joy at being able to replace Ativan, Dilaudid, Oxycontin, and other pain meds with one that doesn’t ruin their quality of life.

Today the Drug Enforcement Administration endorses more use of pharmaceutical opiate derivatives in medicine’s ongoing “war on pain,” while still forbidding medical use of heroin, the strongest painkiller of all, even in extreme cases. With the same stubborn bureaucratic turf-guarding, the DEA refuses to allow medical use of cannabis, despite overwhelming ancient and modern evidence and a strongly worded ruling in favor or reclassification by the agency’s own administrative judge back in 1988. The 1999 Institute of Medicine report called pain relief the most important and best proven of all marijuana’s medical benefits.

Now, a century after aspirin and morphine replaced cannabis as pain medicine because of their convenience and shelf life, many investigators believe that cannabinoids may be better than either one of them or any of the newer drugs. It appears that the endorphin (internal opiate) system is subsidiary to the anandamide system. Thus cannabis activates internal opiates without causing addiction, but external opiates don’t activate the body’s internal cannabinoids. This explains why 19th-century doctors found that cannabis magnifies the pain relief from opiates, so that when they are necessary they can be used in smaller doses less often. Moreover, there are ten to fifty times more cannabinoid receptors than endorphin receptors in the spinal nerves. Other research shows that anandamide probably regulates the body’s pain threshold in the brain. In addition, cannabinoids have been shown to prevent hyperalgesia, the regrowth within injured tissue of new nerve fibers that are more sensitive to pain than normal fibers in uninjured tissue.

Marijuana is especially good at subduing the pain of migraine headaches, apparently by preventing or stopping the migraine process itself. In his 1915 textbook of medical practice, Sir William Osler, the greatest doctor of the 19th century and the founder of modern medicine, summed up 75 years of experience by calling cannabis the only truly effective remedy for migraines. Even today about 20 percent of migraine sufferers find that standard medications don’t relieve their headaches, while many people have found that regular use of marijuana prevents them altogether. Migraine headaches start with a large inappropriate release of serotonin from blood platelets in the brainstem. Cannabis inhibits this release, preventing onset of the pain, but it does not interfere with normal serotonin levels elsewhere.

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