Introduction
Marijuana is a drug with a controversial history; it sometimes provokes positive reactions, some other times, negative. Medical marijuana is one of those issues that have brought up controversy since the drug was categorized illegal by the U.S government.
The simple mention of the phrase Medical marijuana is enough to get at least two groups of people disturbed. There are those who believe marijuana should be accessible to patients whose doctors have recommended marijuana to improve their medical condition. These people are angry that the federal government and many states continue to insist that marijuana does not have legitimate medical value.
Marijuana is also known by the experts by its scientific name Cannabis sativa or by the common public as hemp, hashish, pot, weed, skunk and grass; it is one of the oldest psychoactive plants known to humankind and has become one of the most prevalent and diversified of plant species (Nicoll & Alger, 2004)
On the other hand, opponents of medical marijuana believe that agreeing to this matter is nearly the first step in legalizing cannabis and maybe later even some other outlawed drugs such as cocaine and ecstasy. Marijuana plants have been used since antiquity for both herbal medication and intoxication. The current debate over the medical use of marijuana is essentially a debate over the value of its medicinal properties in relation to the risk posed by its misuse (Goldberg, 2003).
The History of Marijuana
Marijuana is one of the drugs that have brought lots of debate during the last 65 years, not only in the United States, but around the world.
Cannabis preparations have been used as remedies for thousands of years in different cultures; in China it was cultivated as hemp and used for rope and fabrics; the ancient Greeks and Romans used the hemp for rope and sails. Marijuana was introduced in the ceremonies and religious rituals in India, and in Egypt it was consumed as an inebriant; when the Europeans became familiar with it, they started using it as an intoxicant (Nicoll and Alger, 2004).
Marijuana cultivation began in the United States around 1600 with the Jamestown settlers who began growing the Cannabis sativa, or hemp plant, for its usually strong fibers which could be used, as in the past with the Greeks and Romans, to make rope, sails and clothing. These were the primary uses of Marijuana in its beginnings until the Civil War when it became a source of major profit for the United States.
During the 19th century, marijuana plantations thrived in Mississippi, Georgia, California, South Carolina, Nebraska, New York and Kentucky (Gostin, 2006). Between 1850 and 1937, marijuana was widely used throughout the United States as a medicinal drug and could be purchased in any pharmacy as easily as if it were any other drug, for example, a drug as strong as morphine or as common as acetaminophen . The recreational use of Cannabis started after the Mexican Revolution in 1910, when an incursion of Mexican immigrants introduced the habit of “smoking pot” (Gostin, 2006).
The United States banned Cannabis (being the third country to do so) with the famous 1937 Marijuana Tax Act. This Act required anyone producing, distributing, or using marijuana for medical purposes to register and pay a tax. These new reforms effectively established non-medical use of marijuana illegal and therefore made it an expensive and inconvenient proposition.
Ironically, the only group opposed at that time to this particular law was the representative of the American Medical Association (Goldberg, 2003).
According to the National Institute on Drug Abuse (2006), due to the prevalent illegal use of Cannabis as a recreational drug, its legal or licensed use in medicine is now a controversial issue in most countries.
Cannabinoids
Marijuana and its various alter egos, such as grass or hashish, are amongst the most widely used psychoactive drugs in the world characterized by a specific group of chemicals known as Cannabinoid. These chemicals activate the body’s own Cannabinoid receptors, as explained by Kassirer in his review about Medical Marijuana. There are three types of Cannabinoids: herbal cannabinoids occur exclusively in the cannabis plants, the endogenous cannabinoids which are fashioned in the bodies of humans and animals, and the synthetic cannabinoids which are then similar compounds but produced in the laboratory (Kassirer, 1997).
Natural cannabinoids (herbal cannabinoids) are nearly insoluble in water but soluble in lipids, alcohols and other organic solvents. They are known to occur naturally in the cannabis plant and the most prevalent are Tetrahydrocannabinol (THC), cannabidiol (CBD) and cannabinol (CBN) (Kassirer, 1997).
On the other hand, Cannabinoids produced naturally in the body of animals, are recognized as endogenous and they participate in the regulation of pain, anxiety, hunger nausea and vomiting, among other processes. They serve as intercellular “messengers,” signaling molecules that are released from one cell to another to activate the Cannabinoid receptor present on the nearby cell (Nicoll & Alger, 2004).
According to an article in the Scientific American, researchers have found that endogenous cannabinoids participate in a process called ‘retrograded signaling,’ a formerly unknown form of communication in the brain. Rather than flowing forward in the standard way from a presynaptic (neuro-transmitter emitting) neuron to a postsynaptic (recipient) one, endocannabinoids work backward, traveling from a postsynaptic cell to a presynaptic one (Nicoll and Alger, 2004). In addition, the receptors that are implicated in the success of this process are CB1 and CB2 (Cannabinoid receptors). The CB1 receptor is found primarily in the brain and mediates the psychological effects of THC. The CB2 receptor is associated with the immune system and its role still remains unclear (Nicoll & Alger, 2004).
According to an investigation pursued by researchers of the National Institute of Health, the University of Brussels and the Laboratory of Molecular Neurobiology at the University of Bonn the cannabinoids biology revealed a variety of cellular pathways through which potentially therapeutic drugs could act on the Cannabinoid system (Nicoll and Alger, 2004). In addition to the known cannabinoids, such drugs might include chemical derivates of plant-derived cannabinoids or of endogenous cannabinoids such as anandamine, but would also include noncannabinoids drugs that act on the Cannabinoid system (McCaffery & Vourakis, 1992).
Meanwhile, the most common and studied compound that accounts for virtually all the pharmacological activity of marijuana is known as THC (delta -9-tetrahydrocannabinol) which displays its pharmacological actions as the product of its binding to the Cannabinoid receptor 1 (CB1), located in the brain. This compound has an analgesic effect even at low doses that do not cause a “high.” Other effects listed included euphoria, altered space-time perception, alteration of visual, auditory and olfactory senses, disorientation; fatigue and appetite stimulation (Nicoll and Alger, 2004). For that reason, the most controversial aspect of the medical marijuana debate is not whether marijuana can lessen a particular symptom, but rather the extent of harm associated with its use (Joy, 1999).
The contemporary understanding recognizes that endocannabinoids take part in almost every major life function in the human body. Cannabinoids operate as a bio-regulatory mechanism for nearly all life processes, which in part explains why medical Cannabis or marijuana has been mentioned as adjuvant treatment for many diseases and illnesses such as: chronic pain, arthritic conditions, migraine headaches, anxiety, epileptic seizures, insomnia, loss of appetite, GERD (chronic heartburn), nausea, glaucoma, AIDS wasting syndrome, cancer, depression, bipolar disorder (particularly depression-manic-normal), multiple sclerosis, menstrual cramps, Parkinson's, high blood pressure, irritable bowel syndrome, and bladder incontinence (Nicoll & Alger, 2004).
Medical Value of Marijuana
Public opinion on the medical value of marijuana has been sharply divided. Some individuals and institutions dismiss medical marijuana as “a hoax that exploits our natural compassion for the sick” as explained in the book Marijuana and Medicine: Assessing the Science Base (Joy, 87).
There are many opposing arguments regarding the use of Cannabis in a medical framework. Some declare that is effective for a wide range of medical problems, while others limit its effectiveness to a small number of specific circumstances. On the other side of the debate, there are those who feel that Cannabis simply has no justifiable or valid medical value. Representatives of both views cite “scientific evidence” to support their views and have been expressing those views for the last 65 years the debate has gone on (Goldberg, 2003).
Meanwhile, much research and study has gone into substantiating the value of marijuana to patients with chronic pain, cancer or AIDS. Investigators have discovered pharmaceuticals that enhance or block selected chemical receptors of the brain’s own cannabinoids, and which should help to treat various conditions such as anxiety. Experiments suggest that too few endocannabinoids receptors, or insufficient release of endocannabinoids themselves, are part of the underlying cause of chronic anxiety and post-traumatic stress disorder. In order to alleviate anxiety, researchers are working to prevent the breakdown of anandamine, thereby increasing the amount readily available to act on the Cannabinoid receptors (Abrams et al., 2003).
In the case of cancer patients, Cannabis is used to combat pain caused by various cancer processes, as well as to help treat chemotherapy induced nausea and vomiting (Kogan, 2005).
A 2003 report showed that “Cannabinoids,” the active component of Cannabis sativa, and their derivates exert palliative effects in cancer patients by preventing nausea, vomiting and pain and by stimulating an increase in appetite (Guzman, 2003). In addition, these compounds have also been shown to inhibit the growth of tumor cells in culture and animal models by modulating key cell-signaling pathways (p. 747).
Researchers at Stanford University's School of Medicine determined that among AIDS’ patients suffering from nausea associated with anti-retroviral therapy; those who used medical marijuana were 3.3 times more likely to adhere to their medication regimens than non-users (Abrams et al., 2003).
In regard to physical dependence from chronic use, marijuana has relatively minor, if any, withdrawal symptoms. Tolerance to natural marijuana develops slowly, if at all. The effects of marijuana are generally more subtle than those of other substances of abuse, such as crack cocaine; it is often considered not strong enough by many addicts and it is rarely their drug of choice (Kassirer, 1997).
Knowledge of addiction offers the understanding that it is not the drug that makes the addict, but rather the negative relationship a person has with a particular drug or drugs. People can become addicted to marijuana just as they can to any other psychoactive drug. Treatment for their addiction should be available to these people. Nonetheless, the fact remains that marijuana, like several other psychoactive drugs, does have medical value: the reality that some people may have an addiction problem should not avert others from benefiting from its therapeutic potential (McCaffery & Vourakis, 1992).
Technical, Legal and Ethical Issues
Marijuana is classified as a Schedule I substance, defined as having a high potential for abuse and no medicinal value (NIDA, 2006). Multiple petitions for rescheduling marijuana have been proposed by reform advocates over the last 30 years. The most recent proposal was submitted in 2002 by the Coalition for Rescheduling Cannabis, and it calls for a full assessment of the scientific research and medical practice concerning marijuana. The FDA (Food and Drug Administration) has yet to respond to this formal request (Gostin, 2006).
Medical marijuana is one of the most broadly supported issues in drug policy reform. Numerous published studies suggest that marijuana has medical value in treating patients with serious illnesses such as AIDS, glaucoma, cancer, multiple sclerosis, epilepsy, and chronic pain (Kogan, 2005).
In 1999, the Institute of Medicine in the most comprehensive study of medical marijuana's efficacy to date: Marijuana and Medicine: Assessing the Scientific Base concluded, "Nausea, appetite loss, pain and anxiety . . . all can be mitigated by marijuana" (p. 159). Allowing patients legal access to medical marijuana has been discussed by numerous organizations, including the AIDS Action Council, American Bar Association, American Public Health Association, California Medical Association, National Association of Attorneys General, and several state nurses associations (Gostin, 2006).
Public opinion also seems to be in favor of ending the prohibition of medical marijuana. According to a 1999 Gallup poll, 73% of Americans are in favor of "making marijuana legally available for doctors to prescribe in order to reduce pain and suffer (Gostin, 2006).
In a 2004 poll commissioned by AARP, 72% of Americans ages 45 and older thought marijuana should be legal for medicinal purposes if recommended by a doctor. Also, since 1996, voters in eight states plus the District of Columbia have passed favorable medical marijuana ballot initiatives (p. 844).
It would seem then as if the only source providing entirely negative information on the use of marijuana is the federal government, who consider that if the drug is used as medicine it will become of a source of ‘potential abuse’ for teenagers. One might dare rate such an argument that marijuana would become increasingly available for recreational use as weak. State laws require a doctor's note authorizing the use of marijuana for medical purposes. As with opioids and other narcotics, production can and must be regulated and controlled. Allowing only licensed pharmaceutical companies, for example, to cultivate marijuana and distribute it to doctors might solve (at least in part) that problem.
Conclusion
Franklin Delano Roosevelt the 32nd president of the United Sates said one time: “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel in order to be tough” (Thinkexist, 2006).
It is that compassion and empathy that moves many followers of medical marijuana to fight for its legalization and regular use on patients with terminal illnesses. The United States has proven to be a country that values and honors the issue of quality of life of the individual, and seeks to find means of improving that quality of life until the very end.
As a result, the issue of considering use of medical marijuana as a treatment option, as an adjuvant therapy, and/or as part of palliative care is very valid.
The studies have shown that not only for patients with chronic cancer pain, but also for people with HIV/AIDS, the adjuvant use of marijuana has significantly contributed to take away the pain and help them to cope with their distress.
This drug should be allowed and available for those who really need it. Since marijuana seems to help people who are fighting terminal illnesses, there does not seem to be a reason why we should refuse a dying person a substance that brings them comfort and relief. For many affected with HIV and AIDS, cancer and other serious chronic illnesses, marijuana can, in a manner of speaking, mark the difference between living and dying, coping and suffering. |
Bibliography
Abrams, D. et al. (2003). "Short-Term Effects of Cannabinoids in Patients with HIV-1 Infection," Annals of Internal Medicine.
Goldberg, Robert. (2003). “Clashing views on controversial issues in drugs and society.”
New York: McGraw Hill Education.
Gostin, Lawrence O. (August, 2006). “Medical Marijuana, American Federalism, and the Supreme Court.” JAMA: Journal of American Medical Association, Vol. 294 Issue 7, p842-844.
Guzman, M (2003). “Cannabinoids: potential anticancer agents.” Nat Rev Cancer. 3(10):
745-55.
Joy, Janet. E. (1999). “Marijuana and Medicine: Assessing the Scientific base”
Washington, D.C.: National Academy Press.
Kassirer, Jerome P. MD (1997). “Medicinal Marijuana.” The New England Journal of
Medicine. 336:1184-7.
Kogan, Natalya M. (October 2005). “Cannabinoids and Cancer.” Mini Reviews in
Medical Chemistry, Vol. 5 Issue 10, p941-952.
Nicoll, Roger. E and Alger, Bradley E. (2004) “The Brain’s own marijuana” Scientific
American, 1122: 70-75.
McCaffery, M., and Vourakis, C. (1992). “Assessment and pain relief in chemically
dependent Patients.” Orthopedic Nursing, 11(12), 12-27
NIDA InfoFacts: Marijuana. (2006) Retrieved September 30, 2006, from National
Institute of Drug Abuse.
http://www.nida.nih.gov/Infofacts/marijuana.html
Thinkexist user. Retrieved November 02, 2006 from
http://thinkexist.com/quotes/franklin_d._roosevelt/4.htm
Wikipedia (2006). Recreational Drug Abuse. Retrieved November, 2006
http://en.wikipedia.org/wiki/Recreational_drug_use
|