"The National Academy of Science Report: Looking Good!" by Peter McWilliams Here are the official summaries of the three hearings held by the National Academy of Sciences, Institute of Medicine. The report, due in December 1998, is the one General Czar McCaffrey paid $1 million of our tax dollars for. That fifty cents per taxpayer, but, buy will it be worth it. Note the magnificently flat tone--irrefutable and scientific, but deadly. My favorite: "Psychopharmacologist and other individuals testified that the only serious health risk with marijuana use, is that associated with being caught in the criminal justice system." While my reading of these summaries indicates an accurate (that is, favorable) determination that marijuana is a safe and effective medicine. I caution you, however, with the words of the National Academy of Sciences, Institute of Medicine itself: "Although opinions may be stated and lively discussion may ensue, no conclusions are being drawn at this time; no recommendations will be made. In fact, the IOM study investigators will deliberate thoroughly before writing its draft report. Once the draft report is written, it will through a rigorous review by experts who are anonymous to the IOM study investigators, and the IOM study investigators then must respond to this review with appropriate revisions that adequately satisfy the Academy's Report Review IOM study investigators and the chair of the National Research Council (NRC) before it is considered an NRC report. (The NRC is the operating arm of the National Academy of Sciences). Therefore, observers who draw conclusions about the IOM study investigator’s work based on discussions in any of the workshop sessions will be doing so prematurely." Well, I've always been the impetuous type. I bet on science, not politics, writing the final report. Perspectives On The Medical Use Of Marijuana: Basic And
Clinical Science
Meeting Summary This was the first in a series of three sessions held to gather information for the Institute of Medicine’s study on the Medical Use of Marijuana: Assessment of the Science Base. The session consisted of four site visits by the IOM investigators and staff and a three-day meeting that was open to the public. Three of the site visits took place at Cannabis Buyer’s Clubs in San Francisco, Oakland and West Hollywood. Individuals presented personal observations and experience with marijuana either as a substitute or complement to standard medications for a variety of symptoms and diseases. Conditions related to HIV/AIDS (e.g., side effects to protease inhibitors) were reported as the predominate problems for which marijuana was used as a treatment. There were also accounts of relief from nausea and vomiting due to the effect of chemotherapy; physical pain due to arthritis, central nervous system (CNS) inflammatory diseases or trauma; congestion due to chronic asthma; and muscle tremors due to multiple sclerosis or injury. Additional conditions that people sought help for included, glaucoma, digestive problems (e.g., enteritis and colitis), and dependence on “harder” drugs (e.g., heroin and cocaine). Beyond the reported benefits of marijuana as a treatment for the conditions listed above, there were accounts of the benefits provided by other services offered by the clubs, including shut-in visitation program, and social support from the members of the clubs. The fourth site visit was held at an AIDS clinic in Los Angeles, where professionals reported on their experiences with patients’ requests for marijuana. The three-day public meeting began with a public hearing, in which individuals gave testimony on their experience with marijuana in helping with seizures, migraines, nausea associated with chemotherapy, sleeplessness, stress, depression, high blood pressure and spasticity. Advocates for the therapeutic use of marijuana also pointed out that patients profit from marijuana use in ways other than symptom alleviation, namely reduced cost and better dosage control than conventional medications. One speaker criticized what she viewed as the misinformation spread by advocates of the medical use of marijuana; other speakers complained that research supporting the medical use of marijuana has been ignored or suppressed. The last two days of the meeting were devoted to presentations of scientific studies relevant to the scientific information surrounding marijuana. This scientific session was divided into three areas, Cannabinoid Neuroscience, Medical Uses of Marijuana: Clinical Data and Basic Biology, and Summary Views. The following is a brief description of each speakers’ presentation:
Cannabinoid Neuroscience Steven Childers reported on the presence of cannabinoid receptors in the central nervous system and peripheral tissue, general function of the lipid-like endogenous ligands and basic brain anatomy. Michael Walker described a mild THC-withdrawal syndrome that can be induced in rats and reported on cannabinoid agonists that inhibit pain at the level of the spinal cord and thalamus in rats. Clara Sanudo reported on the interaction between the cannabinoids and the control of movement. Sandra Welch presented information on an interaction between endogenous opioids and cannabinoids suggesting synergistic with respect to pain relief. She also reported on the receptor and second messenger tolerance to cannabinoids.
Medical Uses of Marijuana: Clinical Data and Basic Biology John Mendelson presented data from a survey profiling the health status and drug use among the members of the Cannabis Cultivator’s Club of San Francisco. Norbert Kaminski described the cannabinoid receptor subtypes found in lymphoid cells and how the cannabinoid agonists and antagonists act on the immune system. Charles Schuster presented data on the psychological side-effects of any use, noting that the short-term effects are stronger than the long-term effects, such as motor performance, memory and tolerance, of marijuana use. Paul Kaufman described cannabinoid effects on interocular pressure, which are significant but short term only (3-4 hours) including duration of action and comparison to current agents. Paul Consroe summarized the literature on the effects of cannabinoids and cannabis on motor and spastic disorders, including muscle sclerosis and spinal cord injury. Howard Fields contrasted the analgesic effects of cannabinoids and opiates, which act via different biochemical & anatomical systems. Michael Rowbotham discussed the prevalence, which is 10 - 40%, of marijuana use for the management of pain among patients at the UCSF Pain Management Center. Donald Kotler discussed the different biological mechanisms behind malnutrition in terms of starvation verses cachexia, and discussed potential therapeutic approaches, include marinol. Stephen O’Brien gave an account of HIV/AIDS patients’ use of marijuana for nausea, anorexia, pain and detoxification form other drug use. Donald Abrams presented information on patients’ reports of the use of marijuana and THC. He also talked about his plan to study the effects of inhaled marijuana versus dronabinol. Allen Miller discussed data on the complex biology of nausea and vomiting, and how cannabinoids might act on this system. Richard Gralla compared the effectiveness of marijuana and anti-emetic medications for controlling nausea and vomiting due to chemotherapy.
Summary Views Richard Musty summarized the results of a series of studies done by state health departments on the psychobiology and effect of combinations of several cannabinoids. Eric Voth summarized information on the use of marijuana for various conditions, efficacy and safety of marijuana to date, and alternative methods of delivery.
My testimony before this august committee at http://www.marijuanamagazine.com/toc/naosim.htm
Acute and
Chronic Effects of Marijuana Use
Meeting Summary This was the second in a series of three sessions held to gather information for the Institute of Medicine’s study on the Medical Use of Marijuana: Assessment of the Science Base. The session consisted of one site visit by the IOM investigators and staff and a two-day meeting that was open to the public. The site visit was held at an AIDS clinic in New Orleans, where physicians, nurse practitioners and researchers reported on their experiences treating patients for nausea, anorexia and depression with marinol. The two-day public meeting began with a public hearing, in which individuals gave testimony on their experience with marijuana in helping with muscle spasticity, side-effects associated with conventional therapies for AIDS and pain associated with bone tumors. Two legal medical marijuana users reported that long term marijuana use has not caused them any health problems, and a pathologist reported that he never came across a death due to the effect of cannabis. A Psychopharmacologist and other individuals testified that the only serious health risk with marijuana use, is that associated with being caught in the criminal justice system. Advocates for the therapeutic use of marijuana suggested the need for studies on smokable marijuana and rescheduling of marijuana so that it can be used medically. Lastly, a representative from the American Society of Addiction Medicine reported on his experience with patients addicted to marijuana and encouraged research on marijuana, including the basic science, applied clinical studies and the potential effects related to public policy. The second day of the meeting was devoted to presentations of scientific studies relevant to the acute and chronic effects of marijuana use. This scientific session was divided into two areas, Health Consequences of Marijuana Use, and Effects of Marijuana on Behavior. The following is a brief description of each speaker's presentation:
Health Consequences of Marijuana Use Steven Sidney presented data collected through a research questionnaire about tobacco, alcohol and marijuana use from the Kaiser Permanete Medical Care Program. These studies provided a comparison between mortality and the use of marijuana with and without tobacco and alcohol use. Thomas Klein reported on cannabinoid modulation of the immune system such as, antibody production, serum immunoglobin concentrations, natural killer cell activity and T cell proliferation. He also reported on the effects of infectious agents in the presence of marijuana and cannabinoids in animal models and the presence of cannabinoid receptors on immune cells. Donald Tashkin addressed the effects of marijuana smoke on the lung namely, incidence of bronchitis and emphysema (chronic obstructive pulmonary disease), the changes in bronchial epithelial histology and alveolar macrophage concentrations. Donald Tashkin and Steven Sidney reported on the relationship between marijuana use and the development of cancer. The tar and carcinogen (benzyrene) content of marijuana compared to tobacco were discussed, along with the activation of a cytochrome enzyme responsible for converting compounds into carcinogens with in the lung tissue. Epidemiological data evaluating marijuana use and the incidence of certain cancers was also presented.
Effects of Marijuana on Behavior John Morgan discussed human and animal marijuana studies in relation to an amotivational syndrome, addictive behavior, withdrawal effects and discontinuation rate. Richard Foltin presented data on the acute effects of smoked marijuana on food intake, social behavior and work performance in humans. Margaret Haney presented data on the chronic effects of smoked marijuana and oral THC in the development of tolerance, dependence and withdrawal symptoms. Parameters looked at included food intake, anxiety, depression, social behavior and sleep patterns. Robert Pandina discussed the data surrounding a gateway hypothesis for marijuana. He addressed the use of marijuana, tobacco and alcohol in relation to harder drug (cocaine, heroine) use and how they may fit into the steps leading to harder drug use. Prospects
for Cannabinoid Drug Development
Meeting Summary This was the third in a series of three sessions held to gather information for the Institute of Medicine’s study on the Medical Use of Marijuana: Assessment of the Science Base. The session consisted of a two-day meeting that was open to the public. The meeting began with a public hearing, in which individuals gave testimony on their experience with marijuana to relieve nausea and/or anorexia associated with AIDS and chemotherapy; pain, muscle spasticity and/or swelling associated with arthritis, reflex sympathetic dystrophy and nail patella syndrome; and interocular pressure associated with glaucoma. Two participants presented their experiences with melatonin to relieve some of the side effects associated with cannabis, advocates voiced their concern for the medical needs of patients who cannot wait for the development of new cannabinoid drugs, and others presented the history of cannabis use. Lastly, a participant discussed her concerns toward legalizing marijuana and the use of a plant for medicine instead of the isolated active components of the plant. The second day of the meeting was devoted to presentations of scientific studies relevant to the development of Cannabinoid drugs. This scientific session was divided into three areas, Overviews of Previous Workshops, Drug Development, and Drug Delivery. The following is a brief description of each speaker’s presentation.
Overviews of Previous Workshops Billy Martin summarized basic cannabinoid biology presented at the first and second meetings, which included brain and peripheral receptors, endogenous ligands, agonists and antagonists, signaling biochemistry, and pharmacology. Eric Larson summarized the clinical evidence for cannabinoids in the treatment of anorexia and weight loss seen in AIDS patients, nausea and vomiting associated with chemotherapy, spasticity, chronic pain and glaucoma. He also reviewed the effect of smoking marijuana with respect to lung disease and cancer development. George Koob discussed neurobiology of cannabis dependence, including positive and negative reinforcing properties, dopamine systems in the brain, and corticotrophin releasing factor in withdraw responses.
Drug Development J. Richard Crout presented an overview of the Food and Drug Administration’s requirements, principals, and polices for drug development. This included approaches under the Food, Drug and Cosmetic Act; for cigarettes; for botanical and herbal remedies; and the possibility for legitimizing substances, like marijuana, for medical use. Robert Dudley discussed the commercial side of drug development, including the regulatory history of Marinol in the United States, the value of researching and developing new drugs and the marketing involved in distributing new drugs. David Pate of HortaPharm, a private firm in the Netherlands, discussed the company’s plans to grow cannabis as a potential raw material for the manufacture of pharmaceuticals. This included studying the effects of environmental conditions on the content of different cannabinoids in the cannabis plant, and creating technical solutions for medical objections to using the herbal form of cannabis as a therapeutic agent.
Drug Delivery Phyllis Gardner reviewed five routes of drug delivery: oral, transdermal, transmucosal, inhalation and parenteral. She discussed route-dependent pharmacokinetics and pharmacodynamic profiles, along with potential delivery routes for cannabinoids. Reid Rubsamen presented information on the history, state of the art and future trends for drug delivery through the respiratory tract. He discussed the potential role of inhalation delivery for cannabinoids and a new system for intrapulmonary delivery of morphine. Mahendra Dedhiya reviewed the literature on cannabinoid drug delivery, challenges presented by -9-THC and designing delivery systems from a formulation science perspective. Mahmoud ElSohly presented information on the development of a suppository formulation of -9-THC. He also presented data on the absorption and bioavailability of THC hemisuccinate.
The National Academy of Sciences, Institute of Medicine, Marijuana as Medicine home page is: http://www2.nas.edu/medical-mj/
Here is a letter I wrote the IOM about its LINKS selection, that had only three links then: May 22, 1998 Dear National Institute of Medicine, Academy of Science, Medical Use of Marijuana Page (http://www2.nas.edu/medical-mj/), Could you please link to our page: The Medical
Marijuana Magazine Online It is sponsored by the Medical Botanical Foundation, a 501c3 nonprofit organization. I am its publisher. You can also see the first one-third of my book about medical marijuana, A Question of Compassion: A Cancer Survivor Living with AIDS Explores Medical Marijuana at: http://www.mcwilliams.com/compassion.html Might
I also recommend linking to Norml The Marijuana Policy Project The Drug
Policy Foundation and the
Schaffer Library of Drug Policy All are sources of accurate information on medical marijuana. Might I congratulate you on linking to the International Cannabinoid Research Society. http://129.49.19.42/ICRS/ICRS_main.html This is a stellar collection of scientists from all branches of learning, expanding our ever-increasing knowledge about the human interaction with one remarkable plant. An excellent choice. Thank you, too, for linking to the Marijuana Policy Project. www.mpp.org This organization views marijuana from a medical, harm-reduction model. From its Mission Statement: "The Marijuana Policy Project (MPP) understands that no one policy will solve all problems. Each potentially harmful effect of marijuana consumption and the myriad public and private marijuana control efforts must be thoroughly evaluated. Each policy option should be judged according to whether the overall harm is reduced or increased." Good approach, that. Scientific. My favorite. On the other hand, might I object to your linking to the International Drug Strategy Institute http://www2.druginfo.org/orgs/dsi/ and its "sister" organization, Drug Watch International. The information presented by these organization is unscientific, slanted, biased, deceptive, and sometimes dishonest.. Consider
this from Dr. Voth, who used his International Drug Strategy Institute
(a phone in his medical office answered by his nurse--call it and see),
to get a speaker's slot at the IOM Irvine meeting: "Groups like
the National Organization for the Reform of Marijuana Laws, Marijuana
Policy Project, and Drug Policy Foundation have systematically tried
to convince the public that marijuana is an inconsequential recreational
drug despite mountains of evidence to the contrary. Sound familiar?
This is the same technique that tobacco companies have used for years
denying Can you imagine, comparing the addictiveness of nicotine with that of marijuana, and in such an accusatory tone? And the "mountains of evidence"? Where? The mountain of evidence indicates that marijuana is one the the safest medicines used by humans.The mound of evidence Dr. Voth defends has been disputed medically time and time again, and the harsh predictions of "long term use" have failed to materialize. At the very least, you can see by this attack by Dr. Voth that DWI and the IDSI do not approve of Groups like the National Organization for the Reform of Marijuana Laws, Marijuana Policy Project, and Drug Policy Foundation, so these groups should, at the very least, get equal linkage on your page (which one already has). I don't think you'll find scientific inaccuracy on these sites--when the science on your side, why lie? And finally, as a writer, I object to this use of the word "years" twice. Or, consider this from Dr. Voth, accusing fellow physicians of criminal conduct in an effort to smear medical marijuana: "Many of the physicians leading the central push for medical marijuana have no direct medical patient contact, maintain leadership roles in pro-marijuana organizations, and smoke marijuana themselves." When that statement was read to Dr. Voth at the IOM meeting in Irvine, Dr. Voth first questioned its authenticity. When told it was copied from his IDSI website that morning, and he had written it, Dr. Voth blushed before his peers and said there must have been some mistake, that of curse he couldn't name any physicians who "smoked marijuana themselves," and implied the offending (and inflammatory) statement would be removed at once. Five months later, it has not been, as you can see for yourself by going to: http://www2.druginfo.org/orgs/dsi/Crude/ArgumentsAgainstMarijuanaasMed This accusation of criminal activity by physicians is on a site linked to your site, containing serious misinformation that the original accuser (Dr. Voth) said was not true at the IOM Irvine conference. (I invite you to look at the transcript. In fact, may I please have a copy of Dr. Voth's entire talk? I will be happy to pay whatever the transcription or copying costs might be.) The "sister" organization, Drug Watch International http://www.drugwatch.org/ , flatly states: "The purpose of Drug Watch is to provide the public, policymakers, and the media with current drug information, factual research and expert resources, and to counter measures aimed at drug legalization." How can an organization that adheres "to the scientific research standards and ethics that are prescribed by the world scientific community and professional associations" proclaim such a potentially contradictory purpose? What if "current drug information", "factual research", and "expert resources" all point, for example, to the legalization of marijuana for the sick? How can DWI "counter measures aimed at drug legalization" then? The answer is presented, page after page, on the DWI site, for science has been against medical marijuana prohibition for some time now. DWI's purpose is the very opposite of science: the conclusion is reached, and then the facts are gathered to support that conclusion. This is the definition of faith, or propaganda, not science. The DWI and IDSI take the most extreme Drug-War hawk position ("The idea of smoking medicine is a hoax and a manipulation of the public to further the agenda of the marijuana lobby."--Dr. Voth 3-23-98) and then backs it up with junk science, all in the name of medicine. That this all comes from doctors makes me sick. Both organizations exist only to get their pathetic handful of "experts" fat speaking fees from extreme Drug-War groups who want to have their prejudices massaged. Test the authenticity of these two organizations. Ask for the budgets and reports for the past five years, as required by federal law. Ask them to fax the reports to you. Today. Neither can, because neither has any. At least none they have sent to me, and I have made four requests of each organization in the past twelve months. (Federal law requires nonprofits to respond to such requests within 30 days.) I am an investigate reporter and cancer survivor with AIDS, and medical marijuana has been the focus of my research for the past two years. I also worship science with a religious passion, for only through science comes truth. I implore you to objectively examine even a random sampling of the DWI and IDSI pages before continuing to link to them to your own highly reputable site. Thank you. Sincerely, Peter
McWilliams
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