CANNABIS, WEED OR WONDER DRUG?

Nearly 30 Years After Cannabis Was Banned, A Proposed Change In The Law
Looks Set To Clear It For Medicinal Use. But Just How Useful Is The Drug -
And How Safe?

Historical rumour has it that Queen Victoria was a keen proponent of
cannabis, apparently using it for the relief of period pains. Sir John
Russell Reynolds, for many years her personal physician, wrote extensively
on the benefits of taking cannabis, and in Victorian times the herb was
widely used to treat a variety of ailments and conditions, including muscle
spasms, menstrual cramps and rheumatism.

Now, 150 years later, the situation is very different. Cannabis is illegal.
Not only is it outlawed in Britain as a class-B drug; the herb, which is
referred to in the oldest surviving text on medical drugs - the
5,000-year-old Chinese Shen-Nung Pen-tsao - is banned for all medical purposes.

But the phoenix is rising from the ashes. After a dormancy of almost 30
years since the total ban in 1971, a private member's Bill for the
legalisation of cannabis for medical purposes is currently going through
Parliament; its second reading is scheduled for later this month and has
the signed support of 100 MPs. Should the Bill go through, cannabis may
become immediately available as a treatment for illnesses such as multiple
sclerosis. Research in the UK is abuzz with testing for its therapeutic
gains. For conditions from asthma to migraines, cannabis could be the
treatment of tomorrow.

Lester Grinspoon is associate professor of psychiatry at Harvard Medical
School, in the United States. He is co-author of the book Cannabis the
Forbidden Medicine and is one of many medical professionals across the
world who believe that there is sufficient proof that cannabis is
legitimate for medicinal purposes.

Dr Grinspoon explained: "It has been well known for thousand of years that
cannabis has medical uses. It is far safer than most medicines prescribed
by doctors daily and often works for patients who cannot tolerate the
side-effects of other drugs. In many cases no other drug will do the job as
safely or as well."

The list of illnesses that cannabis has been used to treat, from both
historical and contemporary evidence, is impressive. Dr Grinspoon
continued: "Clinical experience suggests that it is helpful for patients
with severe nausea and vomiting, arthritis, glaucoma, muscle spasms,
pre-menstrual syndrome, seizure disorders, the Aids weight-loss syndrome,
asthma, fibromyalgia, Tourette's syndrome and depression, to name a few."

Doctors have known of the medicinal benefits of cannabis for decades. Two
drugs based on its active ingredient - tetrahydrocannabinol, or THC - have
been used in Britain for over 30 years to treat nausea in cancer patients
who are undergoing chemotherapy, although their use has declined as newer
drugs have taken their place.

Interest in other medicinal uses of cannabis is growing. There are at least
60 psychoactive substances among the 400 chemicals contained in the drug.
The aim of research is to extract the active constituents of cannabis - in
the same way that morphine was extracted from opium - to establish which
are of benefit.

A 1997 report by the British Medical Association's board of science,
"Therapeutic Uses of Cannabis", concluded that there was evidence that the
drug could help muscle spasm in patients with multiple sclerosis. There was
also limited evidence of benefits in epilepsy, glaucoma, asthma, high blood
pressure and the weight-loss associated with Aids.

The BMA stressed it was not advocating use of the whole cannabis plant,
which could be as damaging as tobacco, if not more so, but wanted research
to determine which of the plant's 400 chemical constituents might bring
medical benefits. However, in the meantime, it called on the courts to show
compassion to people using the drug for medicinal reasons.

As you read this, there are about 40,000 cannabis plants being cultivated
at a secret location in the south of England for precisely that purpose. GW
Pharmaceuticals was set up in December 1997, after discussions with UK
government officials, by Geoffrey Guy, who has 18 years' experience in
pharmaceutical development, with the sole purpose of conducting medical
research on cannabis.

Because of the illegality of using cannabis for medical purposes, any
research has to be conducted with the Home Office's permission. To conduct
in-depth research, the company has been granted two licences: a cultivation
licence, which allows it to grow cannabis in a highly secure glasshouse
facility, and a licence for possession and supply for medical research,
which - as the name suggests - allows the company to dispense cannabis
preparations for the purpose of research.

But after 5,000 years of historical accounts and reams of anecdotal
evidence - why all this additional investigation? Why should we not just
light up a spliff at the first inkling of a toothache?

The BMA's findings cite that smoking a cannabis cigarette - containing only
herbal cannabis - leads to three times more tar inhalation than from
smoking a tobacco cigarette. Chronic smoking of cannabis can increase the
risk of smoking-related illnesses - such as cardiovascular disease,
bronchitis and emphysema - threefold. Other potential dangers of long-term
use include the suppression of ovulation in women, a decreased sperm count
in men, sedation and anxiety.

Research into the administration of cannabis via alternative, safer methods
is already under way. GW Pharmaceuticals has developed a number of delivery
methods, including sub-lingual sprays and drops and aerosols and vaporisers
for inhalation. The benefits of such methods are that they avoid smoking
and allow the cannabinoids to be absorbed straight into the bloodstream.

By the time the herb has been fully developed for medicinal use, it is
likely that its psychotropic effects will have been eliminated. In other
words, if you are going to be using it as a medicine in the future, you are
not going to be getting high.

Dr Guy believes that the psychoactive effect is an unwanted effect. He
said: "There is a false assumption that multiple sclerosis sufferers, for
example, who use cannabis get high and don't care about the pain. That is
not what happens.

"People who are taking part in our trials are ordinary people who want
relief from the pain and other symptoms such as spasm. They just want to
get on with their lives. They want to go to the supermarket and do simple
things, and you can't do that if you are suffering from unwanted
psychoactive side-effects."

Roger Pertwee, of Aberdeen University, who has dedicated years of
scientific study to cannabis, seconds his view. He explained: "I've seen
anecdotal claims that you don't need to get high to feel better. Usually
people are not seeking to get high; they are just using it to treat their
symptoms. I would imagine that for some people getting high is a real
nuisance. It might be fun on the odd occasion, but every day it would get
rather boring."

The sub-lingual and inhalation methods developed by GW Pharmaceuticals will
ensure a sufficiently low dosage to eliminate the psychotropic effects but
still provide quick, effective pain relief.

Earlier this month, another breakthrough for administering cannabis was
achieved by a team of scientists at Imperial College, University of London.
They showed that cannabinoids act on the spinal cord as well as the brain.
The finding paves the way for the development of new cannabinoid-based
drugs that target the spinal cord to fight pain but bypass the brain and
so, again, do not cause the high.

So what happens next? GW Pharmaceuticals estimates that a cannabis-based
medicine will be available in 2003. Dr Guy predicts that it will be treated
in the same way as morphine. "Morphine, which is used as a painkiller for
cancer, is a dangerous substance. But under the right conditions, nobody
would suggest that we couldn't prescribe morphine. What we are keen to do
is to see if cannabis should occupy the same shelf in the pharmacist's
cupboard as morphine does."

So, if and when a cannabis-based medicine becomes available, it is unlikely
to bear much similarity to what Queen Victoria would have put in her pipe.