INTEGRATIVE MEDICINE: POT BENEFITS, RISKS DESERVE STUDY

This month, the California Medical Association made news when it
became the first state medical association to recommend the
legalization and regulation of cannabis, better known as marijuana.

The CMA's Council on Scientific and Clinical Affairs noted in its
recommendations that there is an increasing body of evidence that
marijuana may be useful in the treatment of a number of medical
conditions, but research to determine both risks and benefits is
hampered in the United States because marijuana still is classified as
an illegal drug.

The CMA council believes that the legalization and regulation of
marijuana will allow for broader research and objective data on the
potential benefits and risks of marijuana. It also will help to
regulate dispensaries of marijuana, regulate the physicians who
prescribe marijuana, ensure that safe and consistent products are
available to patients, reduce diversion and improper use of medical
cannabis, and support the physicians who wish to appropriately
prescribe medical marijuana to patients who are most likely to benefit
from its use.

To give you some perspective on the current controversy around
marijuana, here's a little background.

Marijuana is classified under the Controlled Substances Act of 1970 as
a Schedule 1 drug, meaning that it has a high potential for abuse and
has no accepted medical benefit. However, marijuana, like other herbal
remedies, has been used as a medicinal agent for thousands of years in
many parts of the world. The Irish physician and pharmacologist Dr.
William O'Shaughnessy, who had spent years studying its medical
benefits in India, first introduced marijuana into Western medicine in
1841; it was used to relieve pain, muscle spasm and
convulsions.

In the 1930s, marijuana came under fire in the United States as a
harmful drug, and in spite of a lack of good data about its potential
risk, it was removed from the U.S. Pharmacopeia in 1942.

In 1970, Congress initiated the Controlled Substances Act, which then
awarded marijuana its Schedule 1 status, effectively shutting the door
on further research. Shortly thereafter, Congress authorized the
creation of the National Commission on Marijuana and Drug Abuse to
study the risk of marijuana use. The commission's report to Congress
in 1972 was titled "Marijuana, A Signal of Misunderstanding."

The physicians and other members of the commission concluded that
there was "little proven danger of physical or psychological harm from
the experimental or intermittent use of the natural preparations of
cannabis," and that "the actual and potential harm of use of the drug
is not great enough to justify intrusion by the criminal law into
private behavior."

They also recommended the decriminalization of simple possession of
marijuana. That recommendation was ignored by the Nixon
administration, and marijuana remained classified as a Schedule 1
dangerous drug, unsuitable for any medical use (and this remains
puzzling to many health care providers who work in the field of
substance abuse, considering that alcohol and nicotine are both
considered significantly more addictive and physically harmful than
marijuana).

The controversy continued, and in 1996, 14 states including California
legalized the use of marijuana for medical purposes.

In 1999, the California Legislature approved funding for cannabis
research, leading to the formation of the University of California
Center for Medicinal Cannabis Research, based at UC San Diego.

The beginning results of that research were published last year and
were promising: Cannabis was found to significantly reduce neuropathic
pain as well as muscle spasm and muscle spasticity, particularly in
patients with multiple sclerosis.

One of the studies showed that marijuana significantly reduced
HIV-related pain in more than more than 50 percent of patients. In
other research endeavors, cannabis also has been shown to reduce pain
and neuropathy in cancer patients and in patients with neurologic
diseases. It also helps to reduce nausea and vomiting from
chemotherapy, and it may help reduce the loss of appetite that can
accompany cancer and HIV disease. Cannabis may also help augment the
pain-relieving properties of narcotic drugs.

Even more intriguing, some data also suggest that cannabis may play a
role in cancer risk reduction.

Rodent studies have shown that THC, one of the active ingredients in
marijuana, not only reduces the risk of cancer in animals but also
increases survival.

In a study of more than 64,000 Kaiser patients who were followed for
about nine years, men who smoked marijuana had the lowest rates of
lung cancer, even lower than the nonsmokers. A large case-control
study done in Los Angeles also suggested a reduced risk of all cancers
studied except for oral cancer in users of marijuana. There is
biological plausibility for this: studies show that THC and other
phytochemicals in marijuana inhibit the growth and spread of cancer
cells in cell cultures and in rodents.

The public opinion on the legalization of marijuana has been heated
and divided for many years; perhaps it's time for more objective data
on the potential risks and benefits of marijuana so that we can make
informed decisions about its use.

The changes advocated by the California Medical Association can help
pave the way for this.