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Medical marijuana - Here to stay but never really went away - (12/1/2017)

By Dr. Ron Gasbarro

A short history of medical marijuana

Jesus Christ anointed his disciples with it. William Shakespeare was inspired by it. George Washington had a field of it. Thomas Jefferson may have smoked it. Bill Clinton did too but did not inhale. 

A longer history of medical marijuana

The use of marijuana as a medicine goes back many millennia. Cannabis, called má (meaning "hemp; cannabis; numbness") or dàmá (with "big; great") in Chinese, was used in Taiwan for fiber starting about 10,000 years ago [Abel, 1980]. The Chinese Emperor Fu Hsi (c. 2900 BC), whom the Chinese credit with bringing civilization to China, made reference to , noting that cannabis was a very popular medicine that possessed both yin and yang, that is, a perfect balance within the body [Deitch, 2003]. 

The 20th-century botanist Hui-lin Li wrote that in China, "The use of cannabis in medicine was probably a very early development. Since ancient humans used hemp seed as food, it was quite natural for them to also discover the medicinal properties of the plant" [Li, 1974]. Emperor Shen-Nung, who was also a pharmacologist, wrote a book on treatment methods in 2737 BC that included the medical benefits of cannabis. He recommended the substance for many ailments, including constipation, gout, rheumatism, and absent-mindedness [Bloomquist, 1972]. 

The Ebers Papyrus from Ancient Egypt (c. 1550 BC) describes medical cannabis, and, ostensibly used it in suppositories for relieving the pain of hemorrhoids [Pain, 2007]. Surviving texts from ancient India confirm that cannabis' psychoactive properties were recognized, and doctors used it for treating a variety of illnesses and ailments, including insomnia, headaches, gastrointestinal disorders, and pain, including during childbirth [Touw, 1981].

There is some speculation that Jesus Christ used marijuana oil as an ingredient in his anointing rituals. In the Bible’s New Testament, Jesus... anointed [his disciples] with [a] potent entheogenic [psychoactive substance] oil, sending out the 12 apostles to do the same (c. 30 AD) [Bennett,2003]. Greek scholar Carl Ruck, PhD wrote “The word Christ does mean 'the anointed one' and researchers contend that Christ was anointed with chrism, a cannabis-based oil, that caused his spiritual visions. The ancient recipe for this oil, recorded in Exodus, included over 9 pounds of flowering cannabis tops (known as kaneh-bosem in Hebrew), extracted into a hin (about 11 pints) of olive oil, with a variety of other herbs and spices. The mixture was used in anointing and fumigations that, significantly, allowed the priests and prophets to see and speak with Yahweh (God). Moreover, residues of cannabis have been detected in vessels from Judea and Egypt indicating its medicinal, as well as visionary, use. Jesus is described by the apostle Mark as casting out demons and healing by the use of this holy chrism. Earlier, from the time of Moses until the later prophet Samuel, holy anointing oil was used by the shamanic Levite priesthood to receive the 'revelations of the Lord'. The chosen ones were drenched in this potent cannabis oil" [Ruck, 2003]. 

William Shakespeare may have written some of his plays while stoned, says one study [Thackeray, 2015]. The results of chemical analyses of plant residues in 'tobacco pipes' from Stratford-upon-Avon and environs, dating to the early 17th century showed that marijuana residue was found in some of the pipes. Several of these pipes had been excavated from the garden of William Shakespeare. Results of this study (including 24 pipe fragments) indicated cannabis in 8 samples, nicotine (from tobacco leaves)  in at least one sample, and definite evidence of Peruvian cocaine in 2 samples. The study author suggested that Shakespeare preferred cannabis as a stimulant which had mind-blowing properties. 

“[George] Washington's diary entries indicate that he grew hemp at Mount Vernon, his plantation, for about 30 years [approximately 1745-1775]. According to his agricultural ledgers, he had a particular interest in the medicinal use of cannabis, and several of his diary entries indicate that he indeed was growing cannabis with a high tetrahydrocannabinol (THC) content - marijuana" [Deitch, 2003]. 

The good, the bad, and the ugly 

The pharmacology of marijuana
Marijuana is the dried leaves and flowers of the Cannabis sativa or Cannabis indica plant. Stronger forms of the drug include high potency strains - known as sinsemilla (sin-seh-me-yah), hashish (hash for short), and extracts including hash oil, shatter, wax, and budder. Of the more than 500 chemicals in marijuana, delta-9-tetrahydrocannabinol (Δ9-THC), known as THC, is responsible for many of the drug’s psychotropic (mind-altering) effects. It’s this chemical that distorts how the mind perceives the world.

According to the National Institute on Drug Abuse (NIDA), the marijuana plant itself has not been approved as a medicine by the US federal government. However, the plant contains chemicals—called cannabinoids—that may be useful for treating a range of illnesses or symptoms. Here are some samples of cannabinoids that have been approved or are being tested as medicines:
THC:  The cannabinoid that can make you “high”—THC—has some medicinal properties. A synthetic formulation of THC, dronabinol (Marinol®), has been approved by the FDA to treat nausea, prevent sickness and vomiting from chemotherapy in cancer patients, and to increase appetite in some patients with AIDS.
CBD: Another chemical in marijuana with potential therapeutic effects is called cannabidiol (CBD). CBD does not have mind-altering effects and is being studied for its possible uses as medicine. For example, CBD oil is being studied as a possible treatment for seizures in children with severe epilepsy.
THC and CBD:  A medication with a combination of THC and CBD is available in several countries outside the US as a mouth spray for treating pain or the symptoms of multiple sclerosis.

Strength and potency
Says NIDA, the amount of THC in marijuana has increased over the past few decades. In the early 1990s, the average THC content in marijuana was about 3.74%. In 2013, it was almost 10 percent, and much higher in some products such as oils and other extracts [ElSohly, 2014].1 Scientists do not yet know what this increase in potency means for a person’s health. It may cause users to take in higher amounts of THC – which could lead to greater health risks including increased risk of addiction, or they may adjust how they consume marijuana (by smoking or eating less) to compensate for the greater potency. There have been reports of people seeking help in emergency rooms with symptoms, including psychosis (having false thoughts or seeing or hearing things that aren't there), after consuming high concentrations of THC. 

Legal issues
Note that a growing number of states have legalized the marijuana plant’s use for certain medical conditions, and a smaller number have voted to legalize it for recreational use. So, in some cases, federal and state marijuana laws conflict. It is illegal to grow, buy, sell, or carry marijuana under federal law. The US federal government considers marijuana a Schedule I substance—having no medicinal uses and high risk for misuse. Some states do allow doctors to recommend CBD in oil form to children with severe seizures. But because of concerns over the possible harm to the developing teen brain, recreational marijuana use by people under age 21 is against the law in all states.

Safety issues 

Smoking marijuana can have side effects, making it difficult to develop as a medicine. For example, it can harm lung health, impair judgment, and affect memory. Side effects like this might outweigh its value as a medical treatment, especially for people who are not very sick. Another problem with smoking or eating marijuana plant material is that the ingredients can vary a lot from plant to plant, so it is difficult to get an exact dose. Until a medicine can be proven safe and effective, it will not be approved by the FDA. But researchers continue to extract and test the chemicals in marijuana to create safe medicines.

Where the drug is today

Current medical research
Epilepsy – A multicenter interventional trial was aimed at establishing the safety, tolerability, and efficacy of CBD in patients with severe, intractable childhood-onset treatment-resistant epilepsy [Devinsky, 2016]. The authors recruited 214 patients. Only 3% of patients in the safety assessment group discontinued treatment because of an adverse event. A 37% median reduction in monthly motor seizures was reported.

Other clinical conditions
- A number of clinical trials are currently underway around the world with CBD, alone or in combination with Δ9-THC [Fasinu, 2016]. These trials are generally small – approximately 100 patients or less – and will assess the drug’s effect on a variety of conditions:
o Anxiety
o Bipolar disorder
o Bowel disease
o Diabetes
o Fatty liver
o Infantile spasms
o Pain 
o Schizophrenia
o Solid tumors

A calmer world? 
The legalization of medical marijuana has produced some interesting statistics. A 2016 study found significant declines in violent crime in states that have legalized medical cannabis [Shepard, 2016]. A 2014 study similarly found that introduction of medical cannabis laws caused a reduction in violent crime in American states that border Mexico [Gavrilova, 2014]. Other studies have found decreased rates of opioid use and abuse in states that have legalized medical cannabis [Shi, 2017; Bachhuber, 2014].

In the United States, the use of cannabis for medical purposes is legal in 29 states, plus the territories of Guam and Puerto Rico, and the District of Columbia, as of April 2017. There is significant variation in medical cannabis laws from state to state, including how it is produced and distributed, how it can be consumed, and for what medical conditions it can be used. 

Recent legalizations have occurred in the following states:  
o Pennsylvania became the 24th state to legalize medical marijuana on Apr. 18, 2016. The bill prohibits smoked marijuana. Conditions approved for use in PA include cancer, HIV/AIDS, amyotrophic lateral sclerosis (ALS; Lou Gehrig’s disease), Parkinson's, multiple sclerosis, epilepsy, Huntington's disease, Crohn's disease, post-traumatic stress syndrome (PTSD), intractable seizures, glaucoma, autism, and more. 
o Ohio became the 25th state to legalize medical marijuana on June 8, 2016. The bill prohibits smoked marijuana. Conditions approved for use include AIDS/HIV, Alzheimer's disease, ALS, cancer, chronic traumatic encephalopathy, Crohn's disease, epilepsy, fibromyalgia, glaucoma, hepatitis C, inflammatory bowel disease, multiple sclerosis, chronic, severe, or intractable pain, Parkinson's disease, PTSD, sickle cell anemia, spinal cord disease or injury, Tourette's syndrome, traumatic brain injury, and ulcerative colitis. 
o Arkansas, Florida, North Dakota voted to legalize medical marijuana on Election Day, Nov. 8, 2016, making them the 26th, 27th, and 28th legal medical marijuana states. 
o 53.2% of Arkansas voters approved the constitutional amendment that allows medical marijuana use for conditions including cancer, glaucoma, HIV/AIDS, hepatitis C, ALS, Tourette's syndrome, Crohn's disease, ulcerative colitis, PTSD, severe arthritis, fibromyalgia, Alzheimer's disease, and more.
o 71.3% of Florida voters approved amending the state constitution to allow medical marijuana for conditions including Cancer, epilepsy, glaucoma, HIV/AIDS, PTSD, ALS, Crohn's disease, Parkinson's disease, and multiple sclerosis.
o 63.7% of North Dakota voters approved the measure that allows medical marijuana use for conditions including cancer, HIV/AIDS, hepatitis C, ALS, PTSD, Alzheimer's disease, dementia, Crohn’s disease, fibromyalgia, and more.
o West Virginia became the 29th state to legalize medical marijuana on Apr. 19, 2017. The bill prohibits smoked marijuana. Conditions approved for use include anorexia, severe or chronic pain that does not find effective relief through standard pain medication, severe nausea; seizures, PTSD, and more.

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.com. Read more at www.rx-press.com 

References

Abel EL. Marihuana: the first twelve thousand years. New York, NY: Plenum Publishers; 1980.

Bachhuber MA, Saloner B, Cunningham CO, Barry CL. Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010. JAMA Intern Med. 2014;174:1668-73.

Bennett C. "Was Jesus a stoner?" High Times Magazine, Feb. 10, 2003. 

Bloomquist E. Marijuana: The Second Trip. Beverly Hills, CA: Glencoe Press; 1972.

Deitch R. Hemp: American History Revisited: The Plant with a Divided History. Baltimore, Maryland: Algora Publishing; 2003.

Devinsky O, Marsh E, Friedman D, et al. Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial. Lancet Neurol. 2016;15:270–8.

ElSohly MA. Potency Monitoring Program quarterly report number 124. Reporting period: 12/16/2013 -03/15/2014. Bethesda, MD: National Institute on Drug Abuse; 2014.

Fasinu PS, Phillips S, ElSohly MA, Walker LA. Current status and prospects for cannabidiol preparations as new therapeutic agents. Pharmacotherapy. 2016;36:781-96.

Gavrilova E, Kamada T, Zoutman FT. Is legal pot crippling Mexican drug trafficking organizations? The effect of medical marijuana laws on US crime. SSRN. 2014:1-42. 

Li, Hui-Lin. An archaeological and historical account of cannabis in China. Economic Botany. 1974;28:437–448.

Pain S. The pharaoh’s pharmacists. New Scientist; 2007. 

Ruck C. "Did Jesus use cannabis?" The Sunday Times; Jan. 12, 2003.

Shepard EM, Blackley PR. Medical marijuana and crime; Further evidence from the Western states. J Drug Issues. 2016;46:122-34. 

Shi Y. Medical marijuana policies and hospitalizations related to marijuana and opioid pain reliever. Drug Alcohol Depend. 2017;173:144-50.

Thackeray F. Shakespeare, plants, and chemical analysis of early 17th-century clay ‘tobacco’ pipes from Europe. S Afr J Sci. 2015;111:7-8.

Touw M. The religious and medicinal uses of cannabis in China, India, and Tibet. J Psychoact Drugs. 1981;13:23-34. 


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