Thesis: As a medical drug, marijuana should be available to patients who do not adequately respond to currently available therapies.

Outline:
I. Introduction
a. Beginning Quote
b. State Thesis

II. History
a. Ancient China
b. Early 1900's
c. Today's Laws

III. Synthetic THC
a. What it is
b. As an alternative
c. Effects

VI. Other Drugs
a. Epidemics
b. Reverse Angle

V. Research
a. Lungs
i. Aspergillus Fungi
ii. Ways to avoid
a. Alternatives to Smoking Marijuana
b. Record of past use as a medicine
c. AIDS

VI. Patients
a. Statistics
b. Benefits

VII. Christianity and Marijuana
a. No use of word in bible
b. Genesis 1:12
c. Paul's' Prediction (Timothy 4:1)

VIII. Conclusion

Medicinal Marijuana: A Compassionate Therapeutic Drug
Joycelyn Elders, former Surgeon General, once spoke about the legalization of marijuana for medical use in a press conference. "It's criminal to keep this medicine from patients," she said (Silverman, 1995, pg. 2). She received criticism not only from many citizens of the United States, but also strong criticism from the President who appointed her. The legalization of marijuana for medical use has always been a sharply debated subject, and many of the debaters are uneducated about the effects of using this illegal drug for therapeutic use. Many studies have been done and the results are clear. As a medical drug, marijuana should be available to patients who do not adequately respond to currently available therapies.

Marijuana is commonly called by its scientific name, Cannabis or its chemical name THC, tetrahydrocannibinol (tetrahydro-6,6,9-trimethyl-3-pentyl-6H-dibenzo[b,d]pyran-1-ol). Its chemical formula is C21 H30 O2. It has a molecular weight of 314.47 and its boiling point is 200 (Erowid website, 2000).

The first recorded use of marijuana was in 2727 BC, and it was used as a medicine in Chinese pharmacopoeia (Silverman, 1995, pg.1). In 1870, Giovanni Polli, the father of laboratory medicine in Italy, had much to say about this pain-relieving drug. "It is obvious that hashish (marijuana), which we tried, can always be called on for help as the most benign and sure sedative when there is no hope of a definite cure" (Kassirer, 1997, pg.1185). In fact, marijuana was legal until 1937 when Cannabis, the scientific name for marijuana, was withdrawn from the United States public and made federally illegal with the passage of the Marijuana Tax Act against the advice of the medical community (Silverman, 1995). At that time the law was made that still is readily enforced today in the United States. Marijuana, in the USA, is illegal and there are strict punishments against its use or possession (Gordon, 1997). "It is very disturbing to realize that Giovanni Polli (1812-1880), was more compassionate 130 years ago than many government authorities today" (Kassirer, 1997, pg. 1185). The debates began and in 1975, the FDA established the Compassionate Use program for medical marijuana (Silverman, 1995). Marijuana is a DEA Schedule I in all forms (hash, hash oil, and cannabis) except for synthetic THC, which is schedule III. Schedule I is federally defined as drugs which have a high potential for abuse, have no currently accepted medical use in treatment, and have a lack of accepted safety for use of the drug under medical supervision. This federal law was disputed in 1988 by Judge Francis Young, an administrative law judge for the DEA, who recommended that marijuana be reclassified as schedule II on the grounds that if a respectable minority of doctors indorse it, then it has a "currently accepted medical use" (Erowid website, 2000). In 1990, the states of California and Arizona came to their senses and allowed marijuana to be legalized just for medical purposes (Silverman, 1995). A few years later, Missouri and Michigan also legalized medicinal marijuana. As of today, no additional states have decided to follow their lead.

Since many uneducated authorities did not want to legalize marijuana, they spent money on developing Dronabial or Marinol, a synthetic version of THC, the primary psychoactive constituent of marijuana (Gordon, 1997). This drug is approved by the FDA and is helpful in relieving nausea and vomiting. However, even though Dronabinal is a legal alternative, patients do not report the same degree of relief as they get from marijuana. Researchers say this is because the other ingredients in marijuana called canabinoids, combine with the THC. These components combined are what give marijuana its therapeutic value, not just the THC (Gordon, 1997). Research is extremely difficult because the outcomes that are evaluated are entirely subjective (Kassirer, 1997). In addition, the government, despite a century of mechanisms for assessing safety and effectiveness, almost never permits clinical research on marijuana (Kassirer, 1997).

As an appetite stimulant, usually about 2.5 mg of Marinol is given to the patient. This is about equivalent to a medium dose of real marijuana (about 2/30th of a gram). A sample chemotherapy dose is 5 mg 3 times a day. This requires greater dosage because here nausea and vomiting must be relieved (Erowid website, 2000).

The compassionate use of medical marijuana does not lead to widespread abuse of marijuana; "Such abuse is a function of the availability of street drugs, not prescription drugs" (Kassirer, 1997). There has been no abuse epidemic for morphine and codeine use, even though these drugs are more dangerous and more addicting than marijuana. Of course, there is always the individual exception. Anti-marijuana advocates are worried that by legalizing marijuana malpractice claims and costs would increase. However, there would be no reason for malpractice claims and costs to increase if physicians were responsible, which most of them are, for prescribing just one more controlled substance (Kassirer,1997).

There are some negative effects of marijuana which as one can see are virtually harmless or can be avoided by taking the marijuana some other way than smoking. Some of these include coughing, upper respiratory problems, difficulty with short term memory, racing heart, agitation, tenseness, mild to severe anxiety, panic attacks at very high doses, headaches, dizziness, confusion, paranoia, possible psychological dependence, and mild withdrawal symptoms in some users. This withdrawal may last for 1-6 weeks after cessation of use and can include anxiety, anhedonia (reduces experience of pleasure), headaches, general discomfort, difficulty sleeping, and a desire to smoke (Erowid website, 2000).

It has been found in numerous studies that marijuana itself is virtually harmless (Kassirer, 1997). Some researchers say that smoking marijuana promotes aspergillus fungi in the lungs. However, as most Americans know, "...an association alone does not prove causality" (Kassirer, 1997). In fact, aspergillus fungi are also found in the air, soil, and in all plant matter (Kassirer, 1997). If a patient is worried about this mold that can cause lung infections, educated physicians say to bake the marijuana at 300 degrees for 15 minutes to avoid the risk for aspergillus fungi (Gordon, 1997).

There are many neutral effects of smoking marijuana. Some of these include general change in consciousness, increased appetite, slowness, tiredness, blood shot eyes, mouth dryness and interruption in linear memory (Erowid website, 2000).

Researchers have noted that the effects of smoking cannabis are usually lighter than those of many other recreational psychoactive substances. Many people are generally capable of carrying out normal actions and activities while "high." Many of the positive effects of marijuana include mood life, relaxation, creative, philosophical or deep thinking, increased appreciation of music, increased awareness of senses, change in experience of muscle fatigue, pleasant boy feel, pain relief, and reduced nausea (Erowid website, 2000).

Many anti-marijuana activists say that smoking marijuana is dangerous enough in itself, and they wonder why a sickly person would want to make their situation any worse. Eric Voth, a renowned physician, states his opinion on the subject. "We're currently in a huge anti-tobacco thrust in this country which is appropriate. So why should we waste money on drug delivery that is based on smoking?" (Voelker, 1994, pg. 802). What Dr. Voth does not realize is that normal risks of smoking can be avoided by steeping tea with marijuana or baking it into brownies (Gordon, 1997). This oral route is very effective in most treatments. However, it may not help those patients with nausea and vomiting. In this case inhalation is better. Also, since Dronabinol cannot be inhaled, smoking marijuana is cited as an advantage (Gordon, 1997). Also, the amount smoked is much less then that of a tobacco cigarette (Grinspoon, 1995). If legalized, physicians and the FDA would be able to control the dosage and duration of action in the marijuana. Dosage is easy to control and other cannabinoids in the plant help modify the action of THC (Grinspoon, 1995).

Many other therapeutic agents are toxic. However, marijuana has a wide margin of safety and has been used for over 5,000 years without a single record of lethal overdose. Marijuana is also far less addictive and far less subject to abuse than many drugs used as muscle relaxants, hypnotics, and analgesics (Grinspoon, 1995).

Richard Mays, M.A., brother of a deceased AIDS patient, declares, "The war on drugs has become the war on patients" (Kassirer, 1997). Marijuana can be used for the therapeutic treatment of asthma, glaucoma, tumors, nausea relief, epilepsy, back pain, muscle spasms, antibiotics, disinfectants, arthritis, herpes, cystic fibrosis, rheumatism, lung cleaner and expectorant, sleep and relaxation, migraines, increasing appetite, reducing saliva, AIDS, and depression (Conrad, 1997). With so many benefits on a wide range of health problems, how can one object to legal use of marijuana as a therapeutic medical treatment?

There have been many studies done about how marijuana can help suffering patients . In fact, in all of the research numbers prove how effective marijuana can be. More than 15 million Americans are affected by asthma, and 80% of them would find smoking cannabis beneficial (Conrad, 1994). "Taking a hit" of marijuana has been known to stop a full-blown asthma attack (Conrad, 1994 ). Fourteen percent of all blindness in America is from glaucoma, a progressive loss of vision. Smoking marijuana would benefit 90% of the United States' 2,500,000 victims and it is 2 to 3 times as effective as any current medicines for reducing ocular pressure (Conrad, 1994). Marijuana smoke is the best natural expectorant to clear human lungs. It effectively dilates the airways of the lungs, opening them to allow more oxygen into the lungs. This makes cannabis the best overall bronchial dilator for 80% of the population (Conrad,1994). Marijuana lowers blood pressure, dilates the arteries, and reduces body temperature an average of one-half degree, thereby allowing patients more restful sleep. This sleep enhancing effect is important because many patients are in pain and have trouble sleeping (Conrad, 1994).
Personal reports from suffering patients constitute the most notable reason why marijuana should be legalized for medical use. AIDS patients report increased appetite and greater ability to cope emotionally (Gordon, 1997). Cancer patients report immediate relief from chemotherapy-induced nausea and vomiting (Gordon, 1997 ). Gary Allen Johnson, an AIDS patient reports, "The medicinal use of marijuana is one of the only things that makes me feel generally better, and it helps me eat" (Kassirer, 1997). There are thousands more suffering patients with testimonies like these. Marijuana takes their pain away and allows them to live the life they have left to the fullest.

Many physicians pretend to ignore the fact that their patients with cancer, AIDS, or multiple sclerosis are smoking marijuana for relief, but some quietly encourage it. In a 1990 survey, 44% of oncologists said they had quietly suggested that a patient smoke marijuana for relief of the nausea induced by chemotherapy (Grinspoon, 1995). Physicians "...will not admit that it can be a safe and effective medicine largely because they are stubbornly committed to exaggerating its dangers when used for nonmedical purposes" (Grinspoon, 1995, pg.1876).

Many Christians are opposed to the legalization of marijuana, even though it helps many patients feel better. They claim that the body is a temple and should be treated so. However, in the Bible we find that Cannabis is never forbidden or even discouraged. In fact, some passages directly refer to the goodness of using herbs, like Cannabis. (Conrad, 1994). "And the Earth brought forth grass and herb yielding seed after its kind and the tree yielding fruit, whose seed was in itself after its kind: And God saw that is was good" (Genesis 1:12). Also, Paul predicted marijuana's prohibition. "In later times, some shall...speak lies in hypocrisy...commanding to abstain from that which God hath created to be received with thanksgiving of them which believe and know the truth" (1 Timothy 4:1).

"To seek to tell the virtues and greatness of this holy herb, the ailments which can be cured by it, and have been, the evils from which it has saved thousands would be to go on to infinity" (Kassirer, 1997, pg.1185). Juan de Cardenus, a 16th century Spanish physician, knew of the healing ailments of marijuana many years ago. However, because society has placed a negative attitude on marijuana, legalization has been delayed. Many patients deserve the right to have the most effective drug legal and available on the market. Marijuana, as a medical drug, should be legalized for patients who do not adequately respond to currently available therapies.

Bibliography

Conrad, Chris, et al (1994). Hemp and the Marijuana Conspiracy: The Emperor Wears no Clothes. Van Nuys: Access Unlimited.

Erowid, (2000, Oct. 29). The Vaults of Erowid. [Online]. Available: http://www.erowid.org/plants/cannabis [2000, Sept. 12].

Gordon, Mary (1997). Medicinal Use of Marijuana. American Journal of Nursing pg. 23.

Grinspoon, Lester, MD and James B. Bakalar, MD (1995). "Marijuana as Medicine." Journal of the American Medical Association. 273:1875-6..

Kassirer, Jerome P. MD (1997). "Medicinal Marijuana?" The New England Journal of Medicine. 336:1184-7.

Silverman, Alan (1995, March 22). The History of Medicinal Marijuana. [Online]. Available: http://www.hyperreal.org/drugs/marijuana/medical/timeline [2000, Sept. 12]

Voelker, Rebecca (1994). "Medical Marijuana: A Trial of Science and Politics." Journal of the American Medical Association. 271:1647-8.