Streams

Does Medical Marijuana Work? The Experts Are Divided

The Weed Next Door

Tuesday, May 07, 2013

Test subjects at Columbia University's Substance Use Research Center gauge pain relief, after they swallow an FDA-approved 'pot pill' and smoke a marijuana cigarette -- but one or both is a placebo. (Dr. Ziva Cooper/WNYC)

The phrase “medical marijuana” has a nice clinical ring to it, but doctors and researchers are divided on the data: some are confident that smoking pot can help a wide range of pains and other symptoms. Others remain skeptical and say patients can get similar relief from a prescription pill that mimics marijuana.

Meanwhile, regardless of what scientists say, 18 states -- including New Jersey – have decided to let patients legally puff the narcotic smoke. 

Each of those states has its own list of conditions for which patients are eligible for “medicinal cannabis.” California, for instance, has a dozen syndromes on the list, many of them very broad – including cancer, arthritis and chronic pain. New Jersey, coincidentally, has the exact same number of bullet points, but most of them are narrowly defined – including terminal cancer, multiple sclerosis and muscular dystrophy – and there are no large catch-all categories.

To Dr. Margaret Haney, from Columbia University’s Substance Use Research Center, these disparate state lists are evidence that there’s a lack of evidence, when it comes to widely using marijuana for palliative care.

“There are some things we know it works well on, like relieving certain kinds of pain or increasing appetite,” Haney said, citing cancer and HIV treatment as areas that clearly benefit from either smoking marijuana or taking a prescription pill called Marinol, that uses a synthetic version of THC, a key compound found in cannabis. “But the data is much weaker for many of the other indications.”

Others are more upbeat.

A recent meta-analysis in the peer-reviewed journal reviewed Clinical Journal of Pain looked at published research on the efficacy of treating different types of pain, and found that in 27 out of 38 randomized controlled trials, “cannabinoids had empirically demonstrable and statistically significant pain-relieving effect.” (“Cannabinoids” encompasses both herbal, smoked marijuana and other cannabis-related derivatives and synthetics.)

“It could be chronic pain secondary to cancer, chronic pain in multiple sclerosis, arthritic pain, especially rheumatoid arthritic pain, or if you have an injury to a nerve through trauma,” said study author Dr. Sunil Aggarwal, a medical resident at NYU studying physical medicine and rehabilitation, who has a doctorate in medical geography and an upcoming clinical fellowship at the National Institutes for Health.

Aggarwal’s article is intended to be “A Concise Clinical Primer,” as his subtitle puts it, for doctors. Aggarwal is untroubled by the disparate state lists of eligible medical conditions and the mixed evidence for pain relief potency. His reading of the research is that marijuana provides sufficiently potent pain relief with few enough side effects that doctors should be allowed to work with patients and develop their own protocols. He likens these prescriptions to the gray area that surrounds off-label use of FDA-approved pharmaceuticals.

“Many different drugs are approved for one indication but more often are used for something else,” he said. “In the hospital here, we have patients that we treat for pain using Gabapentin. It’s really a seizure medicine, but hardly anyone uses it for anti-seizure medicine, even though that’s what the label says.”

The FDA, of course, doesn’t classify marijuana as a pharmaceutical. It’s technically a Schedule I controlled substance – in other words, an illegal narcotic. But the FDA and the federal government essentially look the other way at the state programs.

One substance the FDA does approve is Marinol, the “synthetic pot,” based on THC and manufactured by a Belgian drug company (but also available generically as Dronabinol).

Pro-cannabis advocates believe Marinol isn’t as effective as smoked marijuana, because the pill only contains THC and doesn’t replicate the other more subtle substances in the plant. Dr. Aggarwal and others say it’s like taking vitamins – there’s some benefit from the pills, but they’re no substitute for getting nutrients via real food. (Marinol's manufacturers, for their part, currently market the drug almost exclusively to increase appetite for people suffering severe nausea as a side effect from cancer and HIV medications.)

Haney and her colleague, Dr. Ziva Cooper, have rigorously compared the pain-relieving effects of Marinol and herbal marijuana in a Columbia University laboratory in Washington Heights, overlooking the Hudson River. They give experiment volunteers real and placebo marijuana cigarettes and Marinol pills and then subject them to various stimuli, including cognitive tests on a computer and mild pain, from immersing their hands in ice-cold 39-degree water.

In a recent study in the Neuropsychopharmacology, an imprint of the prestigious journal Nature, Cooper found that “change in pain sensitivity and tolerance did not differ between marijuana and dronabinol.”

“Oral THC was slower to peak, but it was more sustained than smoked marijuana,” Cooper said, in an interview. “[With smoked marijuana] we saw a much faster peak to that pain relieving effect, but we also a fast decrease back to baseline.”

Drs. Cooper and Haney are among a very small group of researchers licensed by federal authorities to use herbal marijuana in laboratory studies.

I asked them what they made of both the research and the anecdotes suggesting smoked marijuana provides pain relief for a wide range of symptoms that other substances, including Marinol, don’t help. They said they understand why people might feel better while smoking marijuana than taking other painkillers. But they said there is often a strong placebo effect among patients hoping and expecting drugs to work, and many pro-marijuana researchers don’t take those forces into account.

Haney said relatively few other studies use placebo controls as rigorously as she and Cooper do – so the other researchers’ data is much less reliable.

“You can’t just give someone a pill and say, ‘What does that do?’ and give them a joint, and say, ‘What does that do?’” Haney said, “because guess what’s going to win? The joints are gonna win every single time.”

Hundreds of doctors have registered to prescribe medical marijuana in New Jersey – and many thousand have in the other 17 states that allow it. The federal Food and Drug Administration, which typically exercises an iron grip over prescription drugs, has basically agreed to look the other way.

In New York, medical marijuana bills have passed in the state Assembly before. Staten Island State Senator Diane Savino believes a bill could get through her chamber, this year, too. Gov. Andrew Cuomo has said he’s mostly opposed to it, but “has an open mind” and would take a closer look, now that the annual budget has passed.

Editors:

Karen Frillmann

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Comments [41]

keyshia from us

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Jul. 10 2014 05:07 PM
kelly word

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Jun. 14 2014 05:24 AM
kelly word

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Jun. 10 2014 04:00 AM
Harriet Beecher from USA

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My son Ben was diagnosed of brain tumor last year October 5th 2013, the doctor told me there was nothing that could be done for my son and I was so scared to lose him because he is the only one I got, I lost his dad May 2011 and I was not ready to lose my only son. My co-worker told me about Dr. Rick Simpson cannabis oil and how it helped her dad so I collected his contact ricksimpsoncannabisoil_phoenix@outlook.com and wrote him, purchase the oil and used it on my son, last week we went for checkup and the doctor who told me that my son had few months to live confirmed that my son no longer has brain tumor.
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Feb. 05 2014 09:05 PM
ANDREW PANA from USA

My name is Andrew Pana of California. In May. of 2012 my wife was diagnosed with terminal cancer at the age of 38. The doctors could give her no hope. She did have chemo and radiation, the doctors thought that could prolong her life for a little while. In September of 2013 she done surgery, that's when they found out that the cancer had spread to her lymp nodes in her left hip area and couldn't get it all with the surgery. Now it looked like 2-4 months is all she would live. It was a very aggressive form of colorectal cancer.

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Jan. 05 2014 06:19 PM
marian smith from usa

Hello my name is Marian Smith I want to give a testimony about my HIV virus that was cured by a great spell caster. Since last 4years I have being a HIV AID patient. I never think I live long again and am so grateful about him PROPHET MEZE who help me cured my HIV AIDS last 3 weeks. I was in a great pain so I told one of my best friend; he told me that there is a great spell caster that can cure my VIRUS. I asked her if she had his email, she gave me his email, I emailed him he talked to me and he perform the necessary rituals and he told me that after two weeks I should go for a test. Which I did, when the doctor told me that am now a HIV negative I couldn’t believe myself I went to see another doctor the result was still the same, I was human on planet earth, so I emailed him and thanked him. Please if you are having a similar autism problem please visit him/contact him at; prophetmezetemple@outlook.com; ALL THANKS TO PROPHET MEZE.

Nov. 25 2013 12:35 PM
Joe from New York

I am dealing with PHN from Shingles 120 days ago and I can honestly tell you marihuana works better than any medicine / anti convulsant out there today .

Nov. 03 2013 10:07 AM
sandra from usa


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Oct. 23 2013 06:59 PM

My Daughter was diagnosed with the Small cell bladder cancer, the i wasted a lot of money for years for treatment,until i saw in the phoenixtear.ca in the internet that cannabis oil can cure all cancer,i tried to look for a way to contact Rick Simpson and
finally a friend of mine who he helped via email: ricksimpsoncannabisoil@hotmail.ca told me how to reach him,i was able to email him and bought his oil,my daughter started taking it on 12th March and glory be to God she was healed in June after her last scan,i would want to thank Rick Simpson for the time he spent in getting this oil to save lives his email is ricksimpsoncannabisoil@hotmail.ca,the oil works for all type of cancer and it is worth it.
William Dickerson

Sep. 23 2013 10:22 PM

My Daughter was diagnosed with the Breast cancer, the i wasted a lot of money for years for treatment,until i saw in the phoenixtear.ca in the internet that cannabis oil can cure all cancer,i tried to look for a way to contact Rick Simpson and finally a friend of mine who he helped via email: ricksimpsoncannabisoil@hotmail.ca told me how to reach him,i was able to email him and bought his oil,my daughter started taking it on 12th March and glory be to God she was healed in June after her last scan,i would want to thank Rick Simpson for the time he spent in getting this oil to save lives his email is ricksimpsoncannabisoil@hotmail.ca,the oil works for all type of cancer and it is worth it.
William Dickerson

Sep. 23 2013 10:19 PM
James Walker from USA

My Wife was diagnosed with Breast cancer with metastases with bone/liver/ovary involvement, after so many Chemo and Radiation. I came across Dr Thomas through several testimonies of his Cannabis oil and I was able to contact him at: thomasmedicalservice@gmail.com, I but the cannabis oil from the Dr Thomas and I have been using Cannabis Oil to treat my wife cancerous diseases for the past 5 months. It’s been about 4 months since I stopped using it. All of the positive effects are still there.
My wife is now healthy with no cancer in her body system anymore. Essentially her body feels like a 20 years old girl, while in reality she is 41 years old. Within 5 months of being on the oil I started to loose pounds, my metabolism is super fast. I can eat burgers at fast food joints and still loose weight. I sleep through the night, my digestive system works better than it ever has. I have NO back pain whatsoever. Even after being off the meds this long. This stuff is simply amazing. For help email: thomasmedicalservice@gmail.com I am no longer a victim of cancer and I would love every other cancer patient at there to contact Dr Thomas for help via: thomasmedicalservice@gmail.com I do not have cancer anymore, but I still use my follow up medication for other cleansing of the body system. I started to use the oil to find its other benefits. Dr. Thomas told me about how he believes the oil can reverse aging. I'm hoping it will slow it down or stop it completely. Not sure what to expect after prolonged use. I will update you guys to my findings of Dr Thomas HEMP OIL. Am using this medium to let you know that Dr Thomas Kelvin HEMP OIL Oil will guarantee the total eradication of all types of cancers and other diseases as well. for help email: thomasmedicalservice@gmail.com James Walker

Jul. 25 2013 08:26 AM
Robert from Amsterdam

Severe chronic pain is most commonly treated with opioid narcotics like codeine, morphine, oxycodone (in Percocet decoding and OxyContin), and methadone (among other synthetic analgesics). These opiates are notoriously addictive and patients can build up a tolerance to the effects. A growing faction of patients finds that smoking marijuana can completely eliminate the need for potent drugs like opiate narcotics. So if it workds for you, just keep smoking…. More about medical marijuana on http://www.ilovegrowingmarijuana.com/guides/medical-marijuana
Peace,

Robert

Jun. 28 2013 10:48 AM
Needadvice from scotland

Hi,
I would appreciate it if any doctor could let me know why my cervical lymph nodes and epigastric lymph nodes had completly regressed before chemo.

(dx with secondary her2-ve brest cancer with tumor mass in liver that had regressed by 35% after 3 rounds of chemo).

Could it be that the dx is inaccurate ? (a core biopsy was done of the cervical lymph node was done before it had regressed)

many thanks

May. 30 2013 03:10 PM

Have you seen the newest research that opioids my speed up the destruction of bone, not something you want to happen when you are battling metastatic bone cancer. As for the pain, cancer patients are having to use their life savings to relocate to a state where they are able to get human treatment for bone pain. Opioids do help, but the side effects can be awful. It is hard to tell if your back is hurting from cancer or constipation. With orally ingested cannabis the side effects aren't there and yes, it does control the pain better, allowing for more mobility and exercise. Patient's are living this, pain is what they say it is, and quality of life and quantity of life are being improved. I am a nurse, my husband has stage 4 metastatic bone cancer, how sad is it that this human treatment is illegal in the state of Texas. What are we doing? Call your legislatures, Perry has called a special session, appeal for these bills to be readdressed... the bills that have died in committee will not be reintroduced till 2015, many cancer patients will be dead by then....time isn't on our side and unless you have experienced excruciating bone pain 24 hours a day, don't judge desperate patients that are seeking compassionate care wherever they can get it!

May. 29 2013 09:35 PM
jf from REALITY

Ask the children with leukemia whose parents were told they would die in a matter of months, secretly gave their children cannabis oil and they miraculously recovered completely. The doctors are always so surprised. CANNABIS CURES CANCER LOOK IT UP.

May. 15 2013 09:53 AM
Sunil Aggarwal, M.D., Ph.D. from New York, NY

Dear Joseph Moore, thank you so much for sharing your perspective as a study subject in the research lab that Fred Mogul visited. It is so fantastic to have an actual subject's perspective on what is happening to them and how they experience it.

May. 11 2013 10:49 AM
joseph moore from nyc

i participated in this study over the winter. here is an article i wrote from my perspective:
http://thoughtcatalog.com/2013/how-i-paid-my-rent-by-smoking-weed-in-harlem/

May. 10 2013 01:47 PM
shane watson

Marijuana is really effective in various diseases.I have also used this drug. I really got benefit after using this drug.

May. 10 2013 01:01 PM
Sunil Aggarwal, M.D., Ph.D. from New York, NY

Response II to Dr. King:
"those patients in the studies he reported still did not receive many available treatments"
While their are many, take for example Citation #93 in my report: Wilsey B al. A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. J Pain. 2008;9:506–521. Those 38 patients had spinal cord injuries, complex regional pain syndromes, diabetic neuropathy, and other conditions and suffered from pain for an average of 6 years. According to Table 1, they used the following Concomitant medications (No.), Opioids (31), Antidepressants (19), NSAIDS (9), Anticonvulsants (22). Despite using all available treatments, subjects using cannabis still demonstrated significantly superior analgesia compared to placebo.

>"Yes Tylenol has many different uses but we don't know how it works"
the analgesic and anti-pyretic activities of acetaminophen are proposed to be through its activity on the endocannabinoid, COX, and TRPV systems, proposed first in 2005. see: http://www.nature.com/drugdisc/res_high/articles/nrd1887.html
http://en.wikipedia.org/wiki/AM404

>re: HIV neuropathy: "It's possible but I don't believe it's been anywhere close to proven" This belief should be based on evidence. According to a 2011 meta-analysis and systematic review (Phillips et al. PLOSOne 5:e14433)cannabis has a lower number-needed-to-treat (3.38) compared to topical capsaicin (6.46), and there are no positive outcome RCTs in this condition for commonly used tricyclic antidepressants and anticonvulsant agents such as amitriptyline, gabapentin, pregabalin, or lamotrigine.

>"would Dr. Aggarwal argue that only patients with this condition be eligible for receiving medical marijuana"

No. Plenty of evidence for other conditions. AMA report highlights neuropathic pain, spasticity in MS, and wasting syndromes. No reason to be so restrictive with a medicine with an extremely safe track record.

May. 08 2013 10:36 PM
Steven A. King,M.D. from New York

Response to Dr. Aggarwal:

Despite what he says, those patients in the studies he reported still did not receive many available treatments that have been demonstrated by far more studies to have efficacy in the management of pain. And remember, I said that many of the patients who are supporting medical marijuana say "nothing else works." If Dr. Aggarwal gives one of his patients ibuprofen, is he willing then to say that this demonstrates that no NSAID would work for that patient?

I am not sure what point he was making with regard to Tylenol. Yes Tylenol has many different uses but we don't know how it works so no one can say with any certainty whether these are the result of one or multiple actions. Again, generally in developing new drugs the idea is to pare down the number of actions to reduce the risk of adverse events.

Finally, he cites HIV neuropathy as one condition for which marijuana may be more beneficial than currently available treatments. It's possible but I don't believe it's been anywhere close to proven but if I was willing to concede this point then would Dr. Aggarwal argue that only patients with this condition be eligible for receiving medical marijuana until we have further studies on the other conditions for which, in the states where medical marijuana has already been legalized, are much more commonly prescribed.

May. 08 2013 07:22 PM
Sunil Aggarwal, M.D., Ph.D. from New York, NY

Responses to Dr. Snyder from ?:

That's a ad hominem attack. Shyster? Funding from pro-marijuana groups? Conning the AMA? C'mon, doctor. AMA house of delegates takes their own decisions -- they are composed of hundreds of delegates. Their decision was based on an INTERNALLY written report by their most prestigious council (Council on Science and Public Health). You can read their report here: http://www.ama-assn.org/resources/doc/csaph/i09csaph3ft.pdf
Yes, marijuana policy project covered some expenses to get me to a meeting, but never did I receive funds for research or personal gain. I sit on the board of the Americans for Safe Access foundation and Patients out of Time, but these are all-volunteer gigs. Shyster--I don't know what that even means. My credentials speak for themselves. Funny why you left off your location which, granted is not a required field, but interesting how you don't bother to disclose. Please stick to science, reason, and compassion, not libel and baseless accusation, Dr. Synder. See the rules below, which include the stipulation to "be civil".

May. 08 2013 06:02 PM
Sunil Aggarwal, M.D., Ph.D. from New York, NY

Great to have physicians commenting.Re: Dr. King of NY:
1.Yes, most did only look at pain responses, though more recent placebo-controlled large studies of oral cannabis extracts in MS have shown improvements in mobility (using Rivermead Mobility Index) and reduction in frequency of hospitalizations (see HuffPo piece cited in my prior comment for link to abstract for this study).Additionally, in the lit >30% pain reduction has been correlated w/ improved function, achieved in numerous studies.More study is needed. If you see my review article, I call for such studies focusing on functionality, given that I’m in physiatry after all!
2." no one has shown that marijuana works as well as the currently available analgesic medications much less better than them."
This is not supported by the literature. Please see my review article for citations. Note that in the case of HIV neuropathy, no other treatment has as strong a level of evidence to treat this compared to inhaled cannabis (better than capsaicin, anticonvulsants, etc).
"for the people who say that they have "tried everything" before turning to marijuana, I am willing to bet that… this is far from accurate."
I would recommend reviewing the 138 patient case series we published in the Journal of Opioid management which included over 200 pt-yrs of med cannabis exposure. The appendix summarizes chart notes showing variety of modalities tried for pain. Also, as it is, other classes of pain meds such as opioids are causes of an overdose death epidemic,so perhaps it is not such a great idea to have cannabis, that cannot cause overdose death, as a "last resort", esp. if it is superior for certain types of pain. But yes, knowledge is limited, and we must educate physicians. CME courses are now available for physicians on medical cannabis (eg, www.theanswerpage.com)
3."To suggest that the more actions any drug has, the better is foolish. In fact, the more actions a drug has, the more likely the number of adverse events associated with its use. "
Not sure what is meant by this. Tylenol is useful for many things, as is exercise. Cannabis is a cannabinoid botanical medicine that has multiple uses precisely because the endocananbinoid system is involved in regulating many physiologically important functions such as pain perception, mood, appetite, memory, neuroprotection, inflammation, etc. For citations, see Endocannabinoid system as an emerging target of pharmacotherapy, by NIH researchers (cited in my review)
4.Thanks for the reminder on the add’l labeled use of gabapentin for post-herpetic neuralgia (PHN). FDA approved it in 1994 for epilepsy and then 8 yr later added PHN indication. Only because of off-label use was pain relief discovered and an enterprising company won an indication (Pfizer). But the cases I was referring to were not PHN, and the vast majority of gabapentin prescribing remains off-label. In fact, Between 40-60% of all drug prescriptions in this country are "off-label".

May. 08 2013 05:59 PM
John Snyder MD

Sunil Aggarwal is a Shyster who conned the AMA into believing his BS. He's funded by the pro marijuana groups. He reminds me of the tobacco docs of the early 20th century.

The article never mentions that every major medical group opposes MMJ.

May. 08 2013 01:02 PM
Jamin

Listen to the pain docs, not the addiction medicine docs who have a vested interest in keeping cannabis a Schedule 1 drug.

May. 08 2013 10:23 AM
Steven A. King, M.D. from New York

As a physician specializing in pain management, I have several comments on this story:
1. For the most part, the studies that Dr. Aggarwal cited in his article were on chronic pain conditions. Generally, they only measured response with regard to self-reported pain level. I hope that Dr. Aggarwal knows that for patients with chronic pain, improvement in level of functioning is considered a far more valid way of gauging the effectiveness of treatment than is the pain level.
2. The story indicates that the debate is simply between the efficacy of marijuana and marinol. It should be noted that no one has shown that marijuana works as well as the currently available analgesic medications much less better than them. And for the people who say that they have "tried everything" before turning to marijuana, I am willing to bet that, based on my experience and studies demonstrating the limited knowledge most physicians have about pain management,this is far from accurate.
3. To suggest that the more actions any drug has, the better is foolish. In fact, the more actions a drug has, the more likely the number of adverse events associated with its use.
4.Dr.Aggarwal might want to re-read the label of gabapentin which he indicates only says it's a seizure medication. In fact, its label also says it's for treatment of postherpetic neuralgia, a very painful condition.

May. 08 2013 09:51 AM
claygooding from Seymour,Tx

Because cannabis has so many medical attributes the pharmaceutical companies will keep it prohibited with a machine they have built within the federl government to assure it is prohibited.
It is a machine built from bureaucracies and legislation that protects the prohibition of marijuana from ant attacks in congress and the courts.
The ONDCP is the head of the snake and through their offices the bureaucratic funding of the individual agencies fulfill their role in keeping prohibition in place,regardless of scientific findings,historical evidence and practical experience.
The DEA is the enforcement arm of the machine and is made up of contract agents and they are charged with the last decision on any medical studies allowed on cannabis,the main source of their funding justification.
The NIDA is the scientific arm of the machine which is charged with oversight of any medical studies allowed on cannabis and they have alredy stated they do not do medical studies on cannabis,only harm studies,,one sided science at it's best.
The Rand Corporation is the goto statistics research group that provides the government with all the statistics on the success of prohibition,which is sorely blank. Rand is a non-profit org chaired by a board member of a pharmaceutical company.
If you goto the ONDCP budget report you can see how these agencies are relying on funding from the ONDCP and over 60% of all funding relies on marijuana laws enforcement.

Wake up America,you are being played!

May. 08 2013 09:23 AM
doxie from manhattan

How can a plant be illegal? What if flowers made you "high" or whatever, would those be considered "illegal" substances?

May. 08 2013 08:39 AM
Brian

Israel has been researching medicinal marijuana since the 1960s. Watch this:

http://www.youtube.com/watch?v=H8eybPn6cLU

May. 08 2013 07:57 AM
Malcolm Kyle from Texas

More Smoke & Mirrors from NIDA

Health concerns regarding marijuana tend to come from a self-fueling group of discredited scientists funded by the pharmaceutical, prison, tobacco, and alcohol industries, pushing non-peer-reviewed papers while relying upon reports issued by others in their own group to further support their own grossly misleading research and clearly biased agendas—this one, which was funded by NIDA (the U.S. National Institute on Drug Abuse), is no different!

Reducing cannabis to just THC (Marinol), minimizes efficacy and greatly increases side effects.

Many scientists believe—and patients agree with them—that Marinol/dronabinol lacks the beneficial properties of marijuana/cannabis, which contains more than 60 cannabinoids, including cannabidiol (CBD), which is thought to be the major anticonvulsant that helps multiple sclerosis patients, and cannabichromene (CBC), an anti-inflammatory which is believed to contribute to the pain-killing effect of cannabis.

It takes two to four hours for Marinol to reach full effect, compared to minutes for smoked or vaporized cannabis. Patients accustomed to inhaling just enough cannabis smoke to manage symptoms have complained of too-intense intoxication from Marinol's predetermined dosages. Further, If a patient is suffering from nausea it makes it near impossible to keep a pill down. Many have also said that Marinol even produces a far more acute psychedelic effect than cannabis.

The following two paragraphs come from "Marijuana and Medicine", a report published by the Institute of Medicine, March 1999:

"Marinol is synthesized in the laboratory rather than extracted from the plant. Its manufacture is complex and expensive because of the numerous steps needed for purification. The poor solubility of Marinol in aqueous solutions, and its high first-pass metabolism in the liver, account for its poor bioavailability; only 10-20% of an oral dose reaches the systemic circulation.
The onset of action is slow; peak plasma concentrations are not attained until two to four hours after dosing. In contrast, inhaled marijuana is rapidly absorbed..."

"Marinol's most common adverse events are associated with the central nervous system (CNS); anxiety, confusion, depersonalization, dizziness, euphoria, dysphoria, somnolence, and thinking abnormality."

Marinol (Dronabinol) = 1344 USD per month

Marijuana = practically free if you grow your own outdoors.

Cannabis is safe. The Queen of all herbs, with euphoria-inducing and life-preserving qualities . . . and need euphoria be a bad thing?

Cannabis vs Marinol http://tiny.cc/alxy0

May. 08 2013 04:52 AM
Malcolm Kyle from Texas

CONT.

The following text is taken directly from the US government's National Cancer Institute website: http://www.cancer.gov/cancertopics/pdq/cam/cannabis/healthprofessional/page4

* APPETITE STIMULATOR

Many animal studies have previously demonstrated that delta-9-THC and other cannabinoids have a stimulatory effect on appetite and increase food intake. It is believed that the endogenous cannabinoid system may serve as a regulator of feeding behavior. The endogenous cannabinoid anandamide potently enhances appetite in mice. Moreover, CB1 receptors in the hypothalamus may be involved in the motivational or reward aspects of eating.

* AS A PAIN KILLER

The understanding of the mechanism of cannabinoid-induced analgesia has been increased through the study of cannabinoid receptors (endocannabinoids), and synthetic agonists and antagonists. The CB1 receptor is found in both the central nervous system (CNS) and in peripheral nerve terminals. Similar to opioid receptors, increased levels of the CB1 receptor are found in sections of the brain that regulate nociceptive processing. CB2 receptors, located predominantly in peripheral tissue, exist at very low levels in the CNS. With the development of receptor-specific antagonists, much additional information about the roles of the receptors and the endogenous cannabinoids in the modulation of pain has also been obtained.

Cannabinoids may also contribute to pain modulation through an anti-inflammatory mechanism; a CB2 effect with cannabinoids acting on mast cell receptors to attenuate the release of inflammatory agents, such as histamine and serotonin, and on keratinocytes to enhance the release of analgesic opioids.

May. 08 2013 04:51 AM
Malcolm Kyle from Texas

The following text is taken directly from the US government's National Cancer Institute website: http://www.cancer.gov/cancertopics/pdq/cam/cannabis/healthprofessional/page4

* ANTI-TUMOR EFFECTS

One study in mice and rats suggested that cannabinoids may have a protective effect against the development of certain types of tumors. During this 2-year study, groups of mice and rats were given various doses of THC by gavage. A dose-related decrease in the incidence of hepatic adenoma tumors and hepatocellular carcinoma was observed in the mice. Decreased incidences of benign tumors (polyps and adenomas) in other organs (mammary gland, uterus, pituitary, testis, and pancreas) were also noted in the rats. In another study, delta-9-THC, delta-8-THC, and cannabinol were found to inhibit the growth of Lewis lung adenocarcinoma cells in vitro and in vivo. In addition, other tumors have been shown to be sensitive to cannabinoid-induced growth inhibition.

Cannabinoids may cause antitumor effects by various mechanisms, including induction of cell death, inhibition of cell growth, and inhibition of tumor angiogenesis and metastasis. Cannabinoids appear to kill tumor cells but do not affect their nontransformed counterparts and may even protect them from cell death. These compounds have been shown to induce apoptosis in glioma cells in culture and induce regression of glioma tumors in mice and rats. Cannabinoids protect normal glial cells of astroglial and oligodendroglial lineages from apoptosis mediated by the CB1 receptor.

In an in vivo model using severe combined immunodeficient mice, subcutaneous tumors were generated by inoculating the animals with cells from human non-small cell lung carcinoma cell lines. Tumor growth was inhibited by 60% in THC-treated mice compared with vehicle-treated control mice. Tumor specimens revealed that THC had antiangiogenic and antiproliferative effects.

* ANTI-INFLAMMATORY EFFECTS

In addition, both plant-derived and endogenous cannabinoids have been studied for anti- inflammatory effects. A mouse study demonstrated that endogenous cannabinoid system signaling is likely to provide intrinsic protection against colonic inflammation. As a result, a hypothesis that phytocannabinoids and endocannabinoids may be useful in the prevention and treatment of colorectal cancer has been developed.

* ANTIVIRAL PROPERTIES

Another study has shown delta-9-THC is a potent and selective antiviral agent against Kaposi sarcoma-associated herpesvirus (KSHV), also known as human herpesvirus 8. The researchers concluded that additional studies on cannabinoids and herpesviruses are warranted, as they may lead to the development of drugs that inhibit the reactivation of these oncogenic viruses. Subsequently, another group of investigators reported increased efficiency of KSHV infection of human dermal microvascular epithelial cells in the presence of low doses of delta-9-THC.

May. 08 2013 04:49 AM
gary

Off-label perscribing...doesn't that make the authors subject of there being different indications between states nonsense

May. 08 2013 01:55 AM
Sunil Aggarwal from New York, NY

Readers, just some clarifications I thought I'd share:
1. The 27 out of 38 randomized controlled trials that are mentioned -- all were double-blind, placebo-controlled. Many of these studies tested to see if the blinding was effective and in all cases, it was found to be so. These were not necessarily tests that were looking at the consumption of "joints" vs. pills, as Clinical Psychologist Margaret Haney has characterized it. In many cases, they looked at an orally administered form of herbal marijuana versus a placebo version of that. So it is incorrect to say that these studies were not rigorously controlled.
2. One thing this article did not address is the fact that oral THC is poorly tolerated by many patients, especially at the higher doses that are required to achieve comparable effects to inhaled cannabis. In fact, in an earlier study published by the Columbia research group looking at appetite stimulation in HIV patients, eight times the daily recommended dose of Marinol (R) was required to achieve the same therapeutic benefits provided by just a few inhalations of herbal cannabis. Other components in herbal cannabis make THC more tolerable, and when it comes to appetite stimulation more effective.
3. To really understand how the evidence is misconstrued, I recommend reading this op-ed: huffingtonpost.com/sunil-kumar-aggarwal/marijuana-schedule-1_b_3071725.html

Thank you, Sunil Aggarwal, M.D., Ph.D.

May. 07 2013 11:19 PM
Andrew Swanteni

I love how all the scientists are saying "The pills effects last longer than smoking". This really isn't anything we havn't known for decades. It's not Marinol that is better than smoking, so they need to stop with that. Eating marijuana in a brownie will of course have longer and slightly more intense effects because it's being eaten rather than smoked. They're trying to say Marinol works better to detract from legalizing the real thing.

May. 07 2013 10:21 PM
Miles Monroe

"… the federal government essentially look(s) the other way at the state programs."

If by "look the other way', you mean criminal prosecutions and other zero-tolerance enforcement actions (asset seizure, etc) against medical cannabis providers, caregivers, and even patients(!) who are in full compliance with state laws … !

On the contrary, the author, along with the rest of the mainstream media, is who's looking the other (wrong) way.

JOURNALISM: YOU'RE DOING IT WRONG

May. 07 2013 09:06 PM
Kyle Shoemer from Atlanta, GA

Yet another Big Pharma shill trotting out lies and misinformation. Shame on you!

May. 07 2013 08:41 PM
JustinHale from here

Narcotic substance?

May. 07 2013 07:48 PM
Haille Selasie from Manhattan

Ha H Ha You gotta be kidding me ! I smoked as much weed in my teens, 20's and 30 's as Bob Marley and Peter Tosh combined. I haven't toked in 14 years and thank God I don't anymore. That Sh!!t kept me in a spaced out haze. I couldn't advance in my career or my relationships. I was wasted and I wasted a lot of my life spaced out on skunk from uptown. Don't let "Corporate Marijuana" fool ya. Weed crimps your personality, hold you back in life and it can be addictive to some people. Get high on life.

May. 07 2013 07:48 PM
mark from Rochester NY/San Diego CA

Yeah I agree, furthermore, as a medically retired veteran with two tours in iraq, getting hurt, and getting treated with RX drugs that almost cost me mu life. but if it were not for cannabis, I would be DEAD already.... Cannabis is the safest, no-toxic plant with many health benefits. I went from 15 medications not including OTC meds to using just cannabis. It will always be my medicine for the rest of my life, and as combat veterans like myself, we need Cannabis, it helps, and I will do everything I can due to educate our vets about this medicinal plant.

Ssgt Mark DiPasquale USMC Medically Retired
Veterans for Alternative Care
Co-founder

May. 07 2013 07:48 PM
Bill Williams from Panama City, FL

GET YOUR FACTS STRAIGHT, FRED.

Marijuana may be on Schedule I, but it is NOT a narcotic. It is non-addictive and you cannot be poisoned by it.

Requesting a correction to your article, please.

May. 07 2013 06:49 PM
John Smith

Author is clearly biased. Why didn't you write about cannabis oils, salves, tinctures, and edibles all helping patients everyday? That is true medical marijuana in its most potent medical form. The plant extract is MUCH safer than RX drugs.

May. 07 2013 06:42 PM

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