About Medical Marijuana

About Medical Marijuana.

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Medical cannabis (also referred to as medical marijuana) is the use of cannabis and its constituent cannabinoids such as THC as a physician-recommended form of medicine or herbal therapy. The Cannabis plant from which the cannabis drug is derived has a long history of medicinal use, with evidence dating back to 2,737 BC.[1]

Marijuana Health benefitsAlthough the extent of the medicinal value of cannabis has been disputed, and despite the opposition to research and use put forward by most national governments, it does have several well-documented beneficial effects.[2][3][4][5] Among these are: the amelioration of nausea andvomiting, stimulation of hunger in chemotherapy and AIDS patients, lowered intraocular eye pressure (shown to be effective for treatingglaucoma), as well as gastrointestinal illness. Its effectiveness as an analgesic has been suggested (and disputed), as well.

There are several methods for administration of dosage, including vaporizing or smoking dried buds, smoking, drinking, or eating extracts, and taking capsules. The comparable efficacy of these methods was the subject of an investigative study[5] conducted by the National Institutes of Health.

Synthetic cannabinoids are available as prescription drugs in some countries. Examples include Marinol, available in the United States and Canada, and Cesamet, available in Canada, Mexico, the United Kingdom, and also in the United States.

While cannabis for recreational use is illegal in all parts of the world, though decriminalized in some, its use as a medicine is legal in a number of territories, including Canada, Austria, Germany, the Netherlands, Spain, Israel, Italy, Finland, and Portugal. In the United States, federal law outlaws all cannabis use, while permission for medical cannabis varies among states. Distribution is usually done within a framework defined by local laws. Medical cannabis remains a controversial issue worldwide.

Clinical applications

In a 2002 review of medical literature, medical cannabis was shown to have established effects in the treatment of nausea, vomiting,premenstrual syndrome, unintentional weight lossinsomnia, and lack of appetite. Other “relatively well-confirmed” effects were in the treatment of “spasticity, painful conditions, especially neurogenic painmovement disordersasthma, [and] glaucoma“.[6]

Preliminary findings indicate that cannabis-based drugs could prove useful in treating inflammatory bowel diseasemigrainesfibromyalgia, and related conditions.[7]

Medical cannabis has also been found to relieve certain symptoms of multiple sclerosis[8] and spinal cord injuries[9][10][11] by exhibitingantispasmodic and muscle-relaxant properties as well as stimulating appetite.

Other studies have shown cannabis or cannabinoids may be useful in treating alcohol abuse,[12] amyotrophic lateral sclerosis,[13][14] collagen-induced arthritis,[15] asthma,[16] atherosclerosis,[17] bipolar disorder,[18][19] colorectal cancer,[20] depression,[21][22][23][24] dystonia,[25]epilepsy,[26][27] digestive diseases,[28] gliomas,[29][30] hepatitis C,[31] Huntington’s disease,[32] leukemia,[33] skin tumors,[34] methicillin-resistant Staphylococcus aureus (MRSA),[35] Parkinson’s disease,[36] pruritus,[37][38] posttraumatic stress disorder (PTSD),[39] sickle-cell disease,[40] sleep apnea,[41] and anorexia nervosa.[42] Controlled research on treating Tourette syndrome with a synthetic version oftetrahydrocannabinol (brand name Marinol), the main psychoactive chemical found in cannabis, showed the patients taking Marinol had a beneficial response without serious adverse effects;[43][44] other studies have shown that cannabis “has no effects on tics and increases the individuals inner tension”.[45] Case reports found that marijuana helped reduce tics, but validation of these results requires longer, controlled studies on larger samples.[46][47]

Recent studies

Alzheimer’s disease

Research done by the Scripps Research Institute in California shows that the active ingredient in marijuana, THC, prevents the formation of deposits in the brain associated withAlzheimer’s disease. THC was found to prevent an enzyme called acetylcholinesterase from accelerating the formation of “Alzheimer plaques” in the brain more effectively than commercially marketed drugs. THC is also more effective at blocking clumps of protein that can inhibit memory and cognition in Alzheimer’s patients, as reported in Molecular Pharmaceutics.[48]

Lung cancer and chronic obstructive pulmonary disease

One of the surprising research results from the last decade has been the finding that smoking cannabis does not increase the risk of developing lung cancer or chronic obstructive pulmonary disease (COPD) among people who do not smoke tobacco, and may indeed confer a mildly protective effect. Beginning in 2001, multiple research teams began to report results showing that smoking cannabis does not, by itself, increase the risk of lung cancer, and this result is now well-established. Many studies did report a strongly synergistic effect, however, between tobacco use and smoking cannabis such that tobacco smokers who also smoked cannabis dramatically increased their already very high risk of developing lung cancer or chronic obstructive pulmonary disease by as much as 300%. Some of these research results follow below:

  • In 2006, Hashibe, Morgenstern, Cui, Tashkin, et al. presented the results from a study involving 2,240 subjects that showed non-tobacco users who smoked marijuana did not exhibit an increased incidence of lung cancer or head-and-neck malignancies. These results were supported even among very long-term, very heavy users of marijuana.[49]
Tashkin, a pulmonologist who has studied marijuana for 30 years, said, “It’s possible that tetrahydrocannabinol (THC) in marijuana smoke may encourage apoptosis, or programmed cell death, causing cells to die off before they have a chance to undergo malignant transformation”. He further commented that “We hypothesized that there would be a positive association between marijuana use and lung cancer, and that the association would be more positive with heavier use. What we found instead was no association at all, and even a suggestion of some protective effect.”[unreliable medical source?][50][unreliable medical source?][51]
  • Researchers from the University of British Columbia presented a study at the American Thoracic Society 2007 International Conference showing that smoking marijuana and tobacco together more than tripled the risk of developing COPD over just smoking tobacco alone.[unreliable medical source?][52] Similar findings were released in April 2009 by the Vancouver Burden of Obstructive Lung Disease Research Group. The study reported that smoking both tobacco and marijuana synergistically increased the risk of respiratory symptoms and COPD. Smoking only marijuana, however, was not associated with an increased risk of respiratory symptoms of COPD.[unreliable medical source?][53][54] In a related commentary, pulmonary researcher Donald Tashkin wrote, “…we can be close to concluding that marijuana smoking by itself does not lead to COPD”.[55]
  • One of the principal constituents of cannabis, THC, has been found to reduce tumor growth in common lung cancer by 50 percent and to significantly reduce the ability of the cancer to spread, say researchers at Harvard University, who tested the chemical in both in vitro lab studies and in mouse studies. The researchers suggest that THC might be used in a targeted fashion to treat lung cancer.[unreliable medical source?][56]

Breast cancer

According to a 2007 study at the California Pacific Medical Center Research Institute, cannabidiol (CBD) may stop breast cancer from spreading throughout the body.[57] These researchers believe their discovery may provide a non-toxic alternative to chemotherapy while achieving the same results minus the painful and unpleasant side effects. The research team says that CBD works by blocking the activity of a gene called Id-1, which is believed to be responsible for a process called metastasis, which is the aggressive spread of cancer cells away from the original tumor site.[57]


Investigators at Columbia University published clinical trial data in 2007 showing that HIV/AIDS patients who inhaled cannabis four times daily experienced substantial increases in food intake with little evidence of discomfort and no impairment of cognitive performance. They concluded that smoked marijuana has a clear medical benefit in HIV-positive patients.[58][59] In another study in 2008, researchers at the University of California, San Diego School of Medicine found that marijuana significantly reduces HIV-related neuropathic pain when added to a patient’s already-prescribed pain management regimen and may be an “effective option for pain relief” in those whose pain is not controlled with current medications. Mood disturbance, physical disability, and quality of life all improved significantly during study treatment.[60] Despite management with opioids and other pain modifying therapies, neuropathic pain continues to reduce the quality of life and daily functioning in HIV-infected individuals. Cannabinoid receptors in the central and peripheral nervous systems have been shown to modulate pain perception. No serious adverse effects were reported, according to the study published by the American Academy of Neurology.[61]

Brain cancer

A study by Complutense University of Madrid found the chemicals in marijuana promotes the death of brain cancer cells by essentially helping them feed upon themselves in a process called autophagy. The research team discovered that cannabinoids such as THC had anticancer effects in mice with human brain cancer cells and in people with brain tumors. When mice with the human brain cancer cells received the THC, the tumor shrank. Using electron microscopes to analyze brain tissue taken both before and after a 26- to 30-day THC treatment regimen, the researchers found that THC eliminated cancer cells while leaving healthy cells intact.[62] The patients did not have any toxic effects from the treatment; previous studies of THC for the treatment of cancer have also found the therapy to be well tolerated. However, the mechanisms which promote THC’s tumor cell–killing action are unknown.[62]

Opioid dependence

Injections of THC eliminate dependence on opiates in stressed rats, according to a research team at the Laboratory for Physiopathology of Diseases of the Central Nervous System(France) in the journal Neuropsychopharmacology.[63] Deprived of their mothers at birth, rats become hypersensitive to the rewarding effect of morphine and heroin (substances belonging to the opiate family), and rapidly become dependent. When these rats were administered THC, they no longer developed typical morphine-dependent behavior. In the striatum, a region of the brain involved in drug dependence, the production of endogenous enkephalins was restored under THC, whereas it diminished in rats stressed from birth which had not received THC. Researchers believe the findings could lead to therapeutic alternatives to existing substitution treatments.[63]

In humans, drug treatment subjects who use cannabis intermittently are found to be more likely to adhere to treatment for opioid dependence.[64] Historically, similar findings were reported by Clendinning, who in 1843 utilized cannabis substitution for the treatment of alcoholism and opium addiction[unreliable medical source?][65] and Birch, in 1889, who reported a success in treating opiate and chloral addiction with cannabis.[66]

Spasticity in multiple sclerosis

A review of six randomized controlled trials of a combination of THC and CBD extracts for the treatment of MS related muscle spasticity reported, “Although there was variation in the outcome measures reported in these studies, a trend of reduced spasticity in treated patients was noted.” The authors postulated that “cannabinoids may provide neuroprotective and anti-inflammatory benefits in MS.”[67]

Medicinal compounds

Cannabis contains over 300 compounds. At least 66 of these are cannabinoids,[68][69] which are the basis for medical and scientific use of cannabis. This presents the research problem of isolating the effect of specific compounds and taking account of the interaction of these compounds.[unreliable medical source?][70] Cannabinoids can serve as appetite stimulants,antiemeticsantispasmodics, and have some analgesic effects.[71] Five important cannabinoids found in the cannabis plant are tetrahydrocannabinol, cannabidiol, cannabinol, β-caryophyllene, and cannabigerol.


Main article: Tetrahydrocannabinol

Tetrahydrocannabinol (THC) is the primary compound responsible for the psychoactive effects of cannabis. The compound is a mild analgesic, and cellular research has shown the compound has antioxidant activity.[72] THC is believed to interfere with parts of the brain normally controlled by the endogenous cannabinoid neurotransmitteranandamide.[73][74]Anandamide is believed to play a role in pain sensation, memory, and sleep.


Main article: Cannabidiol

Cannabidiol (CBD), is a major constituent of medical cannabis. CBD represents up to 40% of extracts of the medical cannabis plant.[75] Cannabidiol relieves convulsioninflammation,anxiety, cough and congestion, nausea, and inhibits cancer cell growth.[76] Recent studies have shown cannabidiol to be as effective as atypical antipsychotics in treatingschizophrenia.[77] Because cannabidiol relieves the aforementioned symptoms, cannabis strains with a high amount of CBD would be ideal for people with multiple sclerosis, frequentanxiety attacks and Tourette syndrome.[78][unreliable medical source?][79][unreliable medical source?][80]


Main article: Cannabinol

Cannabinol (CBN) is a therapeutic cannabinoid found in Cannabis sativa and Cannabis indica.[81] It is also produced as a metabolite, or a breakdown product, of tetrahydrocannabinol(THC).[82] CBN acts as a weak agonist of the CB1 and CB2 receptors, with lower affinity in comparison to THC.[83][84]


Main article: Caryophyllene

Part of the mechanism by which medical cannabis has been shown to reduce tissue inflammation is via the compound β-caryophyllene.[85] A cannabinoid receptor called CB2 plays a vital part in reducing inflammation in humans and other animals.[85] β-Caryophyllene has been shown to be a selective activator of the CB2 receptor.[85] β-Caryophyllene is especially concentrated in cannabis essential oil, which contains about 12–35% β-caryophyllene.[85]


Main article: Cannabigerol

Like cannabidiol, cannabigerol is not psychoactive but has been shown to lower blood pressure in rates greater than cannabinol.[unreliable medical source?][86]

  • Tetrahydrocannabinol (THC).

  • Cannabidiol (CBD) is known to relieve convulsion, aiding those with diseases such as multiple sclerosis.

  • Cannabinol (CBN).

  • β-Caryophyllene has important anti-inflammatory properties.

  • Cannabigerol.

Pharmacologic THC and THC derivatives

In the USA, the FDA has approved two cannabinoids for use as medical therapies: dronabinol (Marinol) and nabilone. These medicines are taken orally.

These medications are usually used when first line treatments for nausea and vomiting associated with cancer chemotherapy fail to work. In extremely high doses and in rare cases “psychotomimetic” side effects are possible. The other commonly-used antiemetic drugs are not associated with these side effects.

The prescription drug Sativex, an extract of cannabis administered as a sublingual spray, has been approved in Canada for the adjunctive treatment (use along side other medicines) of both multiple sclerosis and cancer related pain.[87][88] This medication may be legally imported into the United Kingdom and Spain on prescription.[89] William Notcutt is one of the chief researchers that has developed Sativex, and he has been working with GW and founder Geoffrey Guy since the company’s inception in 1998. Notcutt states that the use of MS as the disease to study “had everything to do with politics.”[90]

Medication Approval Country Licensed indications Cost
Nabilone 1985 USA, Canada Nausea of cancer chemotherapy that has failed to respond adequately to other antiemetics $4000.00 U.S. for a year’s supply (in Canada)[91]
Marinol 1985 USA
Canada (1992)
Nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional treatments $652 U.S. for 30 doses @ 10 mg online[92]
1992 USA Anorexia associated with AIDS–related weight loss[93]
Sativex 1995 Canada Adjunctive treatment for the symptomatic relief of neuropathic pain in multiple sclerosis in adults $9,351 Canadian per year[94]
1997 Canada Pain due to cancer


One of the major criticisms of cannabis as medicine is opposition to smoking as a method of consumption. However, smoking is no longer necessary due to the development of safer methods. Today, medicinal marijuana patients can use vaporizers, where the essential marijuana compounds are extracted and inhaled. This is somewhat similar to steaming vegetables to avoid cancerous by-products that are produced at higher temperatures. In addition, edible marijuana, which is produced in various baked goods, is also available, and has demonstrated longer lasting effects.

The United States Food and Drug Administration (FDA) issued an advisory against smoked medical marijuana stating that, “marijuana has a high potential for abuse, has no currently accepted medical use in treatment in the United States, and has a lack of accepted safety for use under medical supervision. Furthermore, there is currently sound evidence that smoked marijuana is harmful.”[95]

The Institute of Medicine, run by the United States National Academy of Sciences, conducted a comprehensive study in 1999 to assess the potential health benefits of cannabis and its constituent cannabinoids. The study concluded that smoking cannabis is not recommended for the treatment of any disease condition, but did conclude that nausea, appetite loss, pain and anxiety can all be mitigated by marijuana. While the study expressed reservations about smoked marijuana due to the health risks associated with smoking, the study team concluded that until another mode of ingestion was perfected that could provide the same relief as smoked marijuana, there was no alternative. In addition, the study pointed out the inherent difficulty in marketing a non-patentable herb. Pharmaceutical companies will not substantially profit unless there is a patent. For those reasons, the Institute of Medicine concluded that there is little future in smoked cannabis as a medically approved medication. The report also concluded for certain patients, such as the terminally ill or those with debilitating symptoms, the long-term risks are not of great concern.[96][97]

Marinol was less effective than the steroid megestrol in helping cancer patients regain lost appetites.[98] A phase III study found no difference in effects of an oral cannabis extract or THC on appetite and quality of life (QOL) in patients with cancer-related anorexiacachexia syndrome (CACS) to placebo.[99]

Harm reduction

The harm caused by smoking can be minimized or eliminated by the use of a vaporizer[100] or ingesting the drug in an edible form. This risk is also thought to be decreased by processing the cannabis leaves into hemp oil.[unreliable medical source?][101]

Vaporizers are devices that heat the active constituents to a temperature below the ignition point of the cannabis, so that their vapors can be inhaled. Combustion of plant material is avoided, thus preventing the formation of carcinogens such as polyaromatic hydrocarbonsbenzeneand carbon monoxide. A pilot study led by Donald Abrams of UC San Francisco showed that vaporizers eliminate the release of irritants and toxic compounds, while delivering equivalent amounts of THC into the bloodstream.[102]

In order to kill microorganisms, especially the molds A. fumigatusA. flavus and A. niger, Levitz and Diamond suggested baking marijuana at 150 °C (302 °F) for five minutes. They also found that tetrahydrocannabinol (THC) was not degraded by this process.[103]

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