MARIJUANA AND MIGRAINES

Is Good Medicine A Political Headache?

When Kareem Abdul-Jabbar, the NBA's career leading scorer, was arrested
in Los Angeles last month and accused of driving under the influence of
marijuana, it was the second time the former Laker has been stopped and
detained because of possession of the green weed. But Abdul-Jabbar
maintains that his marijuana use is medicinal: to alleviate the
migraine headaches from which he has suffered for years.

In California, it's been technically legal to possess marijuana --
provided you have a doctor's recommendation -- since 1996 when
Proposition 215, which legalizes the use of medicinal marijuana, was
adopted by 56% of the voters. Seven other states have passed similar
legislation.

Other details of his arrest notwithstanding, Abdul-Jabbar, according to
well-placed sources, does have a doctor's recommendation issued in the
state of California.

On Tuesday, however, the Supreme Court issued an emergency order that
at least temporarily halts the distribution of medicinal cannabis to
Californians who are sick and in pain. The order ignited a firestorm of
confusion for everyone who is finding relief with medicinal marijuana --
- - and for the California physicians who are prescribing it.

"The Supreme Court's action is not unexpected, and actually, I don't
think it affects Prop. 215," says David Bearman, former director of the
Drug Treatment Program at the Haight Asbury Freee Clinic. Now in
private practice in southern California, Bearman prescribes cannabis
for indicated ailments, including migraines.

Bearman maintains that despite the court's edict, physicians can still
recommend the drug, and patients can still use and possess medicinal
marijuana. Further, Bearman says, patients can still cultivate cannabis
in California.

"It's an interim setback for medical marijuana patients," says
neurologist Ethan Russo of the Montana Neurobehavioral Specialists
group in Missoula.

Medical Efficacy?

But while the actual effects of the ruling will take time to sort out,
the question remains: Does marijuana have medicinal value for migraine
headaches and other maladies?

"There is no question that cannabis is beneficial medicinally," Bearman
says. With migraines, "some people say it makes the pain go completely
away or can prevent migraines from coming on. Others say it lessens the
pain and allows them to focus on other things to get their work done."

What cannabis does to alleviate migraines is complicated and not
completely understood. "But it works on serotonin and dopamine
receptors, and has anti-inflammatory activity," says Russo, who is just
finishing a paper for the Journal of Cannabis Therapeutics.

"Basically, it is a multi-modality agent that works on various aspects
of migraine in a way that's really unique. And it's not just the THC --
tetrahydrocannabinol, the psychoactive chemical -- that does it. It
appears now that it's the result of the interaction of a combination of
other cannabinoids and also the essential oils in the plant."

Unlike most headache medications, cannabis is unique in that it works
as both a preventive agent and an analgesic. "At any point in the
migraine, they could use cannabis by smoking, vaporizer, etc., and
about 80% of these people get significant or total relief," he says.
"And, if someone has a chronic migraine, daily use in whatever form
will often lead to a complete remission."

Bureaucratic Impediments:

The cannabis mechanism is not fully understood because there hasn't
been enough research. Despite all the claims of its beneficial effect
on migraines, there has yet to be a scientific study investigating the
therapeutic use of marijuana for migraines.

"In fact, there haven't been any clinical studies investigating
cannabis for a therapeutic purpose approved in the USA for some 15
years," Russo says. But that's not because researchers aren't
interested. Nobody knows that better than Russo.

Russo first applied to the FDA in 1997 for an Investigational New Drug
application to test cannabis on acute migraines. He was put through a
classic bureaucratic run-around between the FDA and the National
Institutes of Health.

Last year, Russo finally hooked up with FDA ombudsman Jim Morrison. "He
led me to understand the FDA had not been following its own procedures,
and that things would be different henceforth."

By September, Russo had secured approval from both the FDA and the
National Institute on Drug Abuse (NIDA). Then NIDA changed its policy
and ultimately rejected his grant application for a variety of reasons,
including the requirement that participants be exposed to marijuana
only once.

Though Russo hopes at some point to be able to conduct the study, he
views the conflicting requests by NIDA officials and the scientific
review board as -- at the moment anyway -- "unbridgeable."

"And that's exactly the reason more studies on cannabis have not been
done -- the political hassle," Bearman says. "It's just easier to look
at other pharmacology questions that don't have the political stigma or
pressure associated with cannabis. Generally across the board, what
research does get done is often of poorer quality than most medical
research because the government sticks its foot in there and interferes
with the scientists."

Both Russo and Bearman cite the case Donald Abrams of the University of
California at San Francisco and his six-year effort to test the
therapeutics of cannabis on AIDS wasting syndrome. Abrams had to shift
his focus from efficacy to safety to get the study pushed through.

But despite the drill, Abrams came out a winner. "He showed that
cannabis was effective for wasting syndrome and that it does not
produce immune problems in people taking protease inhibitor drugs,"
Russo says.

Historical Perspective:

It may come as a surprise, but marijuana has been used medicinally for
more than a century in the USA and was for many decades a mainstream
medicine for migraine treatment.

"Cannabis has been used in American medicine since it was introduced in
1839 by British physician W.B. O'Shaugnessey, and one of the primary
debilitations it was indicated for were migraines," Bearman says.
"O'Shaugnessey was knighted, by the way -- not for introducing cannabis
but for helping put the telegraph across India. But he was a very well-
respected physician, and not some fly-by-night fellow."

Sir John Russell Reynold -- another knight and personal physician to
Queen Victoria -- was also a major proponent for the use of cannabis
for migraine. He prescribed the weed to her Majesty for her cramps.

In this century, Sir William Osler, honored as "the father of modern
medicine," proclaimed in 1915 that cannabis was the best medicine for
migraines. Even more recently, an editorial last year in the New
England Journal of Medicine openly supported physicians' rights in
prescribing medicinal marijuana.

"The only real news about cannabis for migraine treatment as far as the
mainstream population goes is that it's been suppressed information,"
says Russo, who has spent the last decade of his research focusing on
herbal remedies for the excruciatingly painful, debilitating headaches.

Remedy Required:

Time will tell how the law will treat Abdul-Jabbar and other
migrainers, as they're known. In the meantime, Bearman says, "There are
literally thousands of doctors who are recommending cannabis."

Adds Russo: "Numerous states and thousands of people have found
cannabis to be a viable option in medicine to treat migraines and other
disorders, and I just don't see the tide changing now."

"A physician's job is supposed to be to alleviate pain, and help
people, and get them back to doing the things they need to do or enjoy
doing," Bearman says. "I recommend cannabis because it has medicinal
value. I recommend it where indicated because it's reasonable,
responsible medicine." He has given out dozens of "prescriptions" for
marijuana to patients who suffer from migraines, as well as chronic
pain, fibromyalgia and a number of other ailments.

"You can't always cure illness, particularly chronic illness, but you
can treat people symptomatically," Bearman says. "Cannabis is one more
tool. It's not a magic bullet. It's not the answer for everybody who
has a condition for which this may be beneficial."

Cannabis is, also, he says, "very affordable, especially when you
compare it with a month's supply of Marinol -- the synthetic compound
now on the market -- at around $700."

Meanwhile, the cost of policing the situation is enough to give anyone
a headache.

"When you look at the expenditure to fight all these law enforcement
fights -- $100 billion a year at city, county and federal levels to
fight laws where it could be funneled into social security, our school
programs and all kinds of other good places -- it's truly amazing,"
Bearman says.

"The government is taking a moralistic stance," charges Russo. "It's
sort of like the little Dutch boy with his thumb in the dike. I really
think they are afraid that my study will actually show a therapeutic
application for cannabis, and then the whole dike will come tumbling
down, and they'll end up with a situation they're not prepared to deal
with."

But despite the obstacles, the research community is pushing ahead. As
the Supreme Court issued its order Tuesday, the University of
California announced the establishment of a new cannabis study center
with headquarters at UC San Diego. Its mission is to determine whether
marijuana does have medicinal value and to help develop data to help
counties implement the new state law.

*A Doctor In Your House.com: http://www.adoctorinyourhouse.com/