WHAT IS CANNABIS?

Modern research suggests that cannabis is a valuable aid in the treatment of a wide range of clinical applications. These include pain relief -- particularly of neuropathic pain (pain from nerve damage) -- nausea, spasticity, glaucoma, and movement disorders and a full spectrum conditions including: cancer, glaucoma, arthritis, headache, asthma, premenstrual tension amongst many other conditions. Cannabis is also known as powerful appetite stimulant, specifically for patients suffering from HIV, the AIDS wasting syndrome, anorexia or dementia. Emerging research suggests that marijuana's medicinal properties may protect the body against some types of malignant tumors and are neuroprotective.

Currently, more than 60 U.S. and international health organizations all over the country support granting patients immediate legal access to medicinal marijuana under a physician's supervision. For more information about Cannabis laws in your state, click here.


HISTORY

Humans have cultivated and consumed the flowering tops of the female Cannabis plant, colloquially known as Marijuana, since virtually the beginning of recorded history. Cannabis-based textiles dating to 7,000 B.C.E have been recovered in Northern China, and the plant's use as a medicinal and mood altering agent date back nearly as far. In 2008, archeologists in Central Asia discovered over two-pounds of cannabis in the 2,700-year-old grave of an ancient shaman. After scientists conducted extensive testing on the material's potency, they affirmed, "[T]he most probable conclusion ... is that [ancient] culture[s] cultivated Cannabis for pharmaceutical, psychoactive, and divinatory purposes." Modern cultures continue to indulge in the consumption of Cannabis for these same purposes.


SCIENTIFIC CANNABIS STUDIES

To date, there are over 20,000 published studies or reviews in the scientific literature referencing the cannabis plant. Several of studies conducted assessed smoked marijuana's ability to alleviate neuropathic pain, a notoriously difficult to treat type of nerve pain associated with cancer, diabetes, HIV/AIDS, spinal cord injury and many other debilitating conditions. Each of the trials found that Cannabis consistently reduced patients' pain levels to a degree that was as good or better than currently available medications.

Another study assessed the use of marijuana as a treatment for patients suffering from multiple sclerosis. That study determined that "smoked Cannabis was superior to placebo in reducing spasticity and pain in patients with MS, and provided some benefit beyond currently prescribed treatments."

Around the globe, similarly controlled trials are also taking place. A 2010 review by researchers in Germany reports that since 2005 there have been 37 controlled studies assessing the safety and efficacy of Marijuana and its naturally occurring compounds in a total of 2,563 subjects.

Of particular interest, scientists are investigating cannabinoids' capacity to moderate autoimmune disorders such as multiple sclerosis, rheumatoid arthritis, and inflammatory bowel disease, as well as their role in the treatment of neurological disorders such as Alzheimer's disease and amyotrophic lateral sclerosis (a.k.a. Lou Gehrig's disease.) In 2009, the American Medical Association (AMA) resolved for the first time in the organization's history "that marijuana's status as a federal Schedule I controlled substance be reviewed with the goal of facilitating the conduct of clinical research and development of cannabinoid-based medicines."

Investigators are also studying the anti-cancer activities of cannabis, as a growing body of preclinical and clinical data concludes that cannabinoids can reduce the spread of specific cancer cells via apoptosis (programmed cell death) and by the inhibition of angiogenesis (the formation of new blood vessels). Arguably, these latter findings represent far broader and more significant applications for cannabinoid therapeutics than researchers could have imagined some thirty or even twenty years ago.


THE SAFETY PROFILE OF MEDICAL CANNABIS

Cannabinoids have a remarkable safety record, particularly when compared to other therapeutically active substances. Most significantly, the consumption of marijuana — regardless of quantity or potency — cannot induce a fatal overdose. According to a 1995 review prepared for the World Health Organization, "There are no recorded cases of overdose fatalities attributed to Cannabis, and the estimated lethal dose for humans extrapolated from animal studies is so high that it cannot be achieved by ... users."

In 2008, investigators at McGill University Health Centre and McGill University in Montreal and the University of British Columbia in Vancouver reviewed 23 clinical investigations of medical cannabinoid drugs (typically oral THC or liquid Cannabis extracts) and eight observational studies conducted between 1966 and 2007. Investigators "did not find a higher incidence rate of serious adverse events associated with medical Cannabinoid use" compared to non-using controls over these four decades.

That said, Cannabis should not necessarily be viewed as a 'harmless' substance. Its active constituents may produce a variety of physiological and euphoric effects. As a result, there may be some populations that are susceptible to increased risks from the use of Cannabis, such as adolescents, pregnant or nursing mothers, and patients who have a family history of mental illness. Patients with decreased lung function (such as chronic obstructive pulmonary disease) or those who have a history of heart disease or stroke may also be at a greater risk of experiencing adverse side effects from marijuana. As with any medication, patients should consult thoroughly with their physician before deciding whether the medical use of Cannabis is safe and appropriate.

HOW TO USE THIS REPORT

As states continue to approve legislation enabling the physician-supervised use of medical marijuana, more patients with varying disease types are exploring the use of therapeutic cannabis. Many of these patients and their physicians are now discussing this issue for the first time and are seeking guidance on whether the therapeutic use of cannabis may or may not be advisable. This report seeks to provide this guidance by summarizing the most recently published scientific research (2000-2013) on the therapeutic use of cannabis and cannabinoids for 20 clinical indications.

In some of these cases, modern science is now affirming longtime anecdotal reports of medical Cannabis users. In other cases, this research is highlighting entirely new potential clinical utilities for cannabinoids.

The conditions profiled in this report were chosen because patients frequently inquire about the therapeutic use of cannabis to treat these disorders. In addition, many of the indications included in this report may be moderated by cannabis therapy. In several cases, preclinical data and clinical data indicate that cannabinoids may halt the advancement of these diseases in a more efficacious manner than available pharmaceuticals.

For patients and their physicians, this report can serve as a primer for those who are considering using or recommending medical cannabis. For others, this report can serve as an introduction to the broad range of emerging clinical applications for cannabis and its various compounds.

Paul Armentano
Deputy Director
NORML | NORML Foundation
Washington, DC
January 7, 2014

* The author would like to acknowledge Drs. Dale Gieringer, Estelle Goldstein, Dustin Sulak, Gregory Carter, Steven Karch, and Mitch Earleywine, as well as Bernard Ellis, MPH, former NORML interns John Lucy, Christopher Rasmussen, and Rita Bowles, for providing research assistance for this report. The NORML Foundation would also like to acknowledge Dale Gieringer, Paul Kuhn, and Richard Wolfe for their financial contributions toward the publication of this report.