MEDICAL MARIJUANA USE SHOULD BE APPROVED

Since 1972 when marijuana was placed as a Schedule I drug in the
Federal Controlled Substance Act, there have been many questions about
the safety and effectiveness of this drug in combating a variety of
medical ailments.

Arguments against the medical use of marijuana often focus on issues
that have less to do with its therapeutic value and more to do with
broader policy implications. Opponents frequently claim that the
medical use of marijuana would set a bad example for youth, encourage
more wide-spread use of the substance and generate other social problems.

As a pharmacist with years of experience with pain and symptom
management, the available research on the medical use of marijuana
supports its approval as a drug for palliative care. I am convinced
our legislature should approve legislation to legalize the use of
medical marijuana in Connecticut.

Oral preparations of cannabis can be found throughout history for a
multitude of therapeutic uses. In many countries, oral cannabinoids
are used to relieve nausea and vomiting, stimulate appetite, and help
treat chronic pain.

One question that consistently emerges from discussions about
marijuana as medicine is whether smoked marijuana is more effective
than oral preparations of THC - and clinical evidence makes a strong
case that smoked marijuana is indeed superior for palliative purposes.

A study at McGill University Health Centre found that a single
inhalation of herbal cannabis, three times daily for five days,
reduced the intensity of pain, improved sleep and mood, and was well
tolerated in patients with neuropathic pain.

Another study found that smoking cannabis three times daily reduced
HIV associated sensory neuropathy pain by 34 percent - a reduction in
pain twice as effective as the 17 percent reduction with placebo
cigarettes. During this study, smoked cannabis was well tolerated and
effective in relieving chronic neuropathic pain. Oral THC was compared
with smoked cannabis in over 1,000 patients to treat
chemotherapy-induced nausea and vomiting. Researchers found that
patients who smoked cannabis had a 70-100 percent relief from their
nausea and vomiting compared with only a 76-88 percent relief in those
who took oral THC.

The reason that inhaled cannabis is more favorable than oral
cannabinoids may be due to how the human body reacts to the
substances. Inhaled marijuana has a more predictable effect, which is
both more rapid and potent.

Smoking cannabis causes a rapid rise in plasma levels of THC. A peak
THC concentration is reached within nine minutes of smoking a single
cannabis cigarette and quickly decreases due to rapid distribution
into the tissues. This rapid onset of action is desirable in patients
with breakthrough pain or nausea who need immediate relief.

When cannabinoids enter the body, they begin to work on the body's
receptors. The principal actions at the receptor cause a stabilizing
effect of the neuron, depressing neuronal excitability and reducing
the release of transmitters.

By stabilizing the neuron in this fashion, there is a reduction of
pain transmission to the brain.

Overall, cannabis has been found to have minimal toxicity and a good
safety profile. When delivered via inhalation, cannabis does not have
similar health hazards to nicotine-rich tobacco smoking, except for a
potential increased risk for bronchial irritation or bronchitis.

When considering the relative safety of cannabis, it is important to
remember that FDA indicated medications currently used to treat
neuropathic pain have a variety of pitfalls. Medications typically
used to treat neuropathic pain can include anticonvulsants,
antidepressants, opioids, and local anesthetics, which have varied
results and adverse side effects that can limit medication adherence.
These side effects can include constipation, paresthesias, sexual
dysfunction, weight gain, appetite loss and arrhythmias.

Simply put, cannabis is a substance that can deliver significant pain
relief. With its quick onset of action and high profile for relief of
pain, it is clear that there is a potential place for cannabis in
palliative care.

Medical teams at Connecticut Hospice currently employ a variety of
medications, including an oral derivative of cannabis, to relieve the
pain experienced by the terminally-ill patients and manage their
medical conditions such as nausea, vomiting and anorexia.

Working with University of Connecticut pharmacy students who come to
Connecticut Hospice to complete their clinical requirements, we would
be able to conduct trials of newly approved cannabis forms
specifically for pain and suffering related to serious medical conditions.

I fully support adding medical marijuana to the tools we use to
support our patients' well-being at the end of life and I believe "An
Act Concerning the Palliative Use of Marijuana" should be approved and
signed into law.