Medical marijuana studies.

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Postby budman » Thu Jul 27, 2006 3:35 pm

The BBC wrote:Body's own pain relief 'is best'

July 27, 2006

<table class=posttable align=right width=203><tr><td class=postcell><img class=postimg src=bin/cannabis_growing.jpg title="Cannabis Plants"></td></tr><tr><td class=postcap>Cannabis extracts are hard to target</td></tr></table>Doctors looking to harness the benefits of cannabis may do better to focus on boosting the body's own pain relief system, scientists suggest.

The human body has its own endocannabinoid system which helps regulate pain, hunger and anxiety.

Experts at the Federation of European Neuroscience Societies meeting in Vienna said using plant cannabinoids would mean less targeted therapies.

They said this meant it was harder to avoid unwanted side-effects.

Experts said this was because it was the drug affected many different areas in the brain, nerves and immune system.

Research was presented to the conference which showed a plant-based cannabinoid, anandamide, could worsen symptoms in rats with an epilepsy-like condition.

However, doctors stress previous studies in animals and humans have shown that multiple sclerosis patients can benefit from cannabinoid medicines.

Professor David Baker, of the Institute of Neurology at University College London, who attended the meeting, said: "There is a benefit of moving from agents from illegal plant based medicines to looking at how we use pharmaceutical medications to target the benefits of cannabinoids, but reduce the well known adverse effects."

The only cannabis-based drug which can be currently be used in the UK is a treatment for MS called Sativex.

It has been granted a special licence meaning it can only be used if the doctor takes responsibility for prescribing it.

The drug, produced by GW Pharmaceuticals, is a mouth spray containing two chemicals found in cannabis, THC and cannabidiol.

It is made using plant cannabinoids.

<span class=postbold>See Also</span>: Marijuana-derived drug suppresses bladder pain

<span class=postbold>See Also</span>: Neuropathic Pain

<span class=postbold>See Also</span>: Science | Prescription Drug Abuse Epidemic
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Grant funds research on new pain reliever

Postby palmspringsbum » Thu Aug 31, 2006 2:53 pm

The Albany Times-Union wrote:Grant funds research on new pain reliever

First published: Thursday, August 31, 2006
The Albany Times-Union

Hey man, pass the chips. Wait, maybe not...

Lindsay Hough, a professor at the Albany Medical College's Center for Neuropharmacology and Neuroscience, has received a $1.053 million, four-year research grant from the National Institute on Drug Abuse to continue developing improgan, a marijuana-like pain relieving drug discovered in the college lab in the 1990s.

Improgan has shown promise as a pain reliever that mimics marijuana but does not have the undesirable side effects such as addiction or increased appetite.

But there's one big problem: improgan must be injected directly into the brain. This obviously makes it unsuitable for use on humans. So far, it has only been tested on rats and mice in a laboratory setting.

"The brain has its own marijuana-like chemicals called endocannabinoids that it uses to relieve pain," explained Dr. Hough. "In our animal studies, we have continued to find that improgan's pain-relieving properties overlap with that of the brain's own marijuana-like system."

So the drug study now takes on a twofold task: how to get the drug in a form where it can be swallowed and make it to the brain and how to make sure that form retains the same pain-relieving properties it has now.

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Cannabis-based drug may ease pain

Postby palmspringsbum » Sun Nov 05, 2006 10:33 am

OneNews wrote:Cannabis-based drug may ease pain

<table class=posttable align=right width=232><tr><td class=postcell><img class=postimg src=bin/marijuana_leaf.jpg></td></tr></table><img src=/bin/icon_video.gif> Cannabis Based Drug May Ease Pain (01:47)

News One TV New Zealand
Oct 28, 2006

A drug sourced from the cannabis plant could provide new relief for patients in chronic pain.

Sativex is not available in New Zealand but doctors at a medical conference in Dunedin say evidence is mounting to back its use as a safe alternative to morphine.

Cannabis has been used medicinally for 3,000 years although few countries allow it, but the new cannabis-based drug may one day take marijuana mainstream.

"If the scientific evidence supports the fact that it will help people then I feel that it should be made available," says pharmacology researcher Paul Smith.

The nasal spray contains two cannabis ingredients - THC and cannabidiol.

"It does produce in some people some intoxication, some low level of intoxication, but the actual levels of THC in Sativex are quite a bit lower than the THC you'd get in a cannabis cigarette," says Professor Smith.

There have been 12 international clinical trials on the use of Sativex in the past three years alone - for pain relief, nausea, as an appetite stimulant for cancer and Aids patients and even glaucoma.

Trials show the product does not work for every patient and does have side effects, as opiods do.

"The fact that cannabinoid happens to be related to cannabis happens to be no different to the fact that morphine is related to heroin," says Smith.

The drug was approved in Canada last year for multiple sclerosis and Britain may also licence it for MS. But such a move is some way off in New Zealand.

Doctors and health officials agree it is still early days and more research is needed on the long-term effects of Sativex before it is approved for use in NZ.

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Medicinal 'weed' helps the ill: doctor

Postby palmspringsbum » Thu Dec 28, 2006 1:27 pm

The Suburban wrote:Medicinal 'weed' helps the ill: doctor

By Lucille Hagège, The Suburban
December 13, 2006

<table class=posttable align=right width=250><tr><td class=postcell><img class=postimg src=bin/ware_mark.jpg></td></tr><tr><td class=postcap>Mark Ware: Stop confusing the therapeutic use of cannabis with recreational use.</td></tr></table>One day, when he was in a Jamaican hospital doing graduate research on chronic pain, Dr. Mark Ware noticed that some of his patients were coping with their pain much more easily than others.
Intrigued, he asked an old Rastafarian his secret.

“It’s the herb, Doc,” replied the man.

That’s when the doctor found his vocation.

Ware is now a leading authority on the medical uses of cannabis and works at the McGill University Health Centre Pain Clinic.

But in order for his medical research to continue, he says the public and the media need to stop confusing the therapeutic use of cannabis with recreational use.

During a public lecture at the Montreal General Hospital last Wednesday, Ware pointed to a photograph that recently accompanied an article in the press about medicinal cannabis. The picture showed an elderly man wearing sunglasses emblazoned with bright green marihuana leaves.

“The patients who come to my office don’t look like this,” said Ware. “They’re ill people who are trying to live happier lives.”

“Marijuana engenders powerful emotions in people, but I urge them to take a step back and consider what the possibilities are for pain treatment”

Cannabis shows promise as a medication for a range of symptoms associated with chronic diseases such as HIV/AIDS, multiple sclerosis, and chronic nerve injury pain, he said.

“Every month, new research is published from around the world suggesting that cannabinoids [chemical compounds, such as THC, found in marijuana] play a role in physiological processes like pain, appetite, inflammation and movement,” Ware said.

“We now know there is a system of cannabinoids in our bodies working all the time to control these processes, and this system may be an appropriate target for new therapies," he continued.

While cannabis is by no means a full-proof cure for pain, Ware says it can make small improvements on a patients’ condition.

“Pain is hard to live with and hard to treat, and studies show cannabinoids have some effect,” he said. “It’s just another option we have, it’s just another piece of equipment in our toolbox.”

As with most drugs, however, cannabis will not work in the same way for everyone and the careful monitoring by a physician is required.

Cannabis is also not without danger. While it does not cause madness, as popular lore once claimed, it is linked to higher incidence of psychosis and schizophrenia in early users and individuals with a prior history of psychotic disorders. More research is still needed to determine whether there is truly a cause and effect relationship.

A recent study on patients who had never smoked cigarettes has also proved that there is no link between cannabis and cancer, said Ware. In fact, a study on animals has showed that there might even be anti-cancer agents in THC.

After the talk, a long line of people who either live with severe pain, or have relatives who do, shared their stories with Ware and showed visible interest in his research, giving evidence that pain treatment is a daily concern for many Quebecers.

As of September 2006, 1,492 Canadians were authorized to possess dried marihuana, including 154 Quebecers, while as of last year, 4,500 Quebecers were listed for treatment at pain centres.

On July 30, 2001, Health Canada granted access to marijuana for medical use to those who are suffering from grave and debilitating illnesses, although unlawful possession is still a criminal offence. Holders of an authorization to possess can obtain marihuana from three possible sources: they can apply for access to purchase dried marijuana from Health Canada; they can grow their own supply; or they can designate someone else to grow it for them.

Ware’s research program on cannabis is supported by Canadian and Quebec funding agencies, such as the CIHR and FRSQ. He has advised the Canadian Government on medical marijuana access regulations, and has consulted for pharmaceutical companies on clinical development of new cannabinoid therapies.

Ware’s lecture was the third and final segment of a series that took place at the Montreal General. Entitled “From microscope to stethoscope,” the free public lecture series invited MUHC scientists to share their research with the public and debunk some of the myths that surround it.

In the first two lectures, Dr. David Colman explored the role of serendipity in medical research while Dr. Brian Ward looked at how new immunologic ideas can help fight pandemics diseases like HIV or the avian bird flu.

To apply for the authorization to possess marijuana, an application must be submitted in writing to Health Canada along with a declaration of support from a medical practitioner. Application forms and guidelines are available online or by calling Health Canada at 1-866-337-7705.

2006-12-13 10:23:43

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Opioid and Nonopioid Therapies for the Management of Pain

Postby palmspringsbum » Sat Dec 22, 2007 12:36 am

Abkhazia Institute for Social and Economic Research wrote:Opioid and Nonopioid Therapies for the Management of Pain

The Abkhazia Institute for Social and Economic Research
Written by Ramaz Mitaishvili
Sunday, 16 December 2007
Lynn R. Webster, MD, FACPM, FASAM

<span class=postbigbold>Introduction</span>

The evolving need of pain patients for safe, effective analgesia is driving research into new therapeutic modalities and fresh approaches to familiar treatments. Innovation, involving both opioid and nonopioid pain therapies, dominated discussion at the 23rd Annual Meeting of the American Academy of Pain Medicine held February 7-10 in New Orleans, Louisiana. Because some patients fail to achieve a good outcome with opioid therapy, nonopioid medications and interventions are receiving greater research attention. Opioids are also the subject of new exploration, most of this directed toward separating desired analgesia from unwanted side effects such as euphoria, tolerance, abuse risk, and constipation.

<span class=postbigbold>Pros and Cons of Systemic Opioids</span>

A debate titled "Opioids: Good or Bad?" posed a seemingly simple question, then proceeded to prove the answer is most complex.[1] It was suggested that the downside of opioids -- including opioid-induced hyperalgesia,[2,3] hormonal suppression, and problems with self-administration -- could be attenuated by switching to interventional therapies such as implantable pumps to administer analgesia.

A contrasting view presented during the debate is that systemically-delivered opioids provide safe, effective analgesia with a far lower risk for adverse events than many other medications, including nonsteroidal anti-inflammatory drugs.[1] However, it was emphasized that effective opioid therapy requires careful patient selection, assessment, and monitoring, including a willingness to change course when multiple titrations and rotations achieve no clear benefit.[1]

<span class=postbigbold>Nonopioid Alternatives</span>

<span class=postbold>Cannabinoids</span>

Cannabinoids have demonstrated significant analgesic properties, but problems with side effects remain. Newer compounds show promise for analgesic efficacy while reducing common side effects of dizziness, euphoria, fatigue, and nausea.[4]

An oral mucosal spray (Sativex, GW Pharmaceuticals) that contains 2.7 mg of delta-9-tetrahydrocannabinol (THC) and 2.5 mg of cannabidiol (CBD) has been well tolerated in clinical studies. The co-administration of CBD appears to reduce the psychoactive effects of THC, and intoxication is less than with oral THC, according to presenters at AAPM.[4] Patients are allowed to self-titrate, resulting in an average dose of approximately 20-30 mg/day of both THC and CBD.[5] A double-blind, randomized, placebo-controlled study of 160 outpatients with multiple sclerosis (MS) reported significant reduction of spasticity with the cannabis-based medicinal extract (CBME) (Sativex) compared to placebo (P = .001).[6] A pooled analysis across 3 phase 3 MS spasticity studies, incorporating 666 patients, showed that CBME oral mucosal spray was significantly superior to placebo (P < .05).

The CBME compound has been approved in Canada to treat neuropathic pain generated by MS. Several US clinical trials have been performed, and the US Food and Drug Administration has approved phase 3 studies to evaluate CBME oral mucosal spray in patients with cancer. Obstacles remain to achieving full regulatory and legal approval for cannabis-based medicine in the United States. Eleven states have medical marijuana laws providing patients and caregivers a defense against prosecution; however, federal rulings have created gray areas in how far a practitioner may go to help a patient obtain cannabis.

<span class=postbold>Spinal Cord Stimulation</span>

Two abstracts emphasized the selective targeting of stimulation sites in therapies utilizing spinal cord stimulation (SCS).

The findings of a prospective, multicenter study support SCS as effective for axial low back pain. Outcome data for 159 subjects who received permanent implants showed significant pain improvement at 3.5 months and at 6- and 12-month evaluation time points (P < .001).[7]

The selective stimulation of sacral nerves proved effective in relieving the pain of 2 women, both of whom had suffered long-time pudendal neuropathy and whose treatment options had been exhausted.[8] The 2 subjects underwent bilateral S3 lead implantation. Both patients achieved excellent relief thereby suggesting that SCS may be an effective option for some patients with pudendal neuropathy.

<span class=postbold>Targeting Transient Receptor Potential Vanilloid Receptor (TRPV)1 Receptors</span>

Transient receptor potential vanilloid-1 (TRPV1) receptors act as a transducer for heat and low pH (protons).[9] These receptors are plentiful in the skin where they can be activated by trauma and contribute to postoperative pain. Investigational drug 4975 is a long-acting nonopioid analgesic that targets TRPV1 receptors. The drug was shown to be effective for postoperative pain when administered in a single intra-operative dose as part of a multimodal analgesic protocol. Fifty patients who underwent total knee arthroplasty were randomized to receive a single administration of 60 mL of 4975 or placebo along with concomitant preoperative, intraoperative, and postoperative analgesics.[10] The 4975 group reported significantly less pain on first ambulation at day 1 (5.4 vs 7.1 Brief Pain Inventory score) (P = .027) with analgesic benefits at 2 weeks after surgery.

<span class=postbigbold>Innovations in Opioid Therapy</span>

<span class=postbold>Nonselective Opioid Antagonists/Partial Agonists</span>

Fakata and colleagues[11] presented a class review of peripherally acting opioid antagonists. Administered in combination with mu-receptor agonists, opioid antagonists appear to confer benefits for abuse deterrence and analgesia. Some evidence indicates that opioid-induced tolerance and hyperalgesia could be at least partially blocked by the administration of an ultra-low-dose antagonist in combination with mu-receptor agonist therapy.[12] Other agonist/antagonist combinations contain a sustained-release opioid with a sequestered antagonist, such as naltrexone. The antagonist is only released when the product is crushed, damaged, dissolved, mixed with alcohol or water, or otherwise manipulated in an attempt to extract an abusable portion of active ingredient.[13] Taken as directed, the sustained-release action of the opioid remains intact. Although addicted people may still find clever ways to release an abusable portion of opioid, abuse-deterrent formulations may stop some abuse, prevent some overdose deaths, and increase primary-care confidence in opioid prescribing.

Another formulation discussed in the review addresses lack of analgesic efficacy.[11] Patients who fail to achieve lasting analgesia with long-term opioid therapy have achieved benefit using sublingual buprenorphine, a partial mu agonist. The drug was investigated in an open-label study with 95 consecutive patients who were referred by local pain clinics for detoxification from long-term opiate analgesic therapy (mean 8.8 years) due to increasing pain levels, worsening function and -- in 8% -- opiate addiction.[14] After abstaining from all opiate analgesics for a minimum of 12 hours, patients received low doses of sublingual buprenorphine or buprenorphine/naloxone. The daily sublingual buprenorphine dose ranged from 4 to 16 mg (mean, 8 mg) for an average duration of 8.8 months. Eighty-six percent of patients experienced moderate-to-substantial pain relief, improved mood, and functioning.

Sublingual buprenorphine is approved for opioid detoxification in patients with a primary opioid addiction. Physicians who use buprenorphine for opioid detoxification must be awarded a special license from the US Drug Enforcement Agency.

<span class=postbold>Peripheral Opioid Antagonists to Reduce Side Effects</span>

Fakata and colleagues[11] also discussed peripheral opioid antagonists designed to reduce side effects. Peripheral effects of opioids include inhibition of small intestine motility, the inhibition of normal colonic movements, and delayed transit, resulting in opioid-induced constipation. Opioid-induced constipation reduces quality of life, increases pain severity, and impairs activities, including work. Two new medications utilize a peripherally acting opioid receptor antagonist that does not cross the blood-brain barrier but directly targets the mechanism of bowel dysfunction to reverse an opioid's effects.

Two phase 3, randomized, double-blind, placebo-controlled trials that enrolled 154 and 133 patients, respectively, showed that subcutaneous methylnaltrexone improved laxation (62% in the first study; 48.4% in the second study) within the first 4 hours of drug administration with no significant changes in pain scores.[15] Median time to laxation was significantly greater (P < .0001) at 0.15 mg/kg (70 minutes in the first study) and 0.30 mg/kg (45 minutes in the second study) compared with placebo (less than 24 hours).

Alvimopan is another peripheral mu antagonist shown to increase gastrointestinal motility and to reduce opioid effects on the gut while demonstrating low systemic absorption. A meta-analysis of 5 randomized-controlled trials compared alvimopan with placebo following bowel resection or hysterectomy.[16] Data were reported on 2195 patients: a total of 1521 (69.3%) received alvimopan and 674 (30.7%) received placebo. The primary efficacy endpoint measures -- passage of flatus, stool, and tolerance of solid food -- significantly improved with alvimopan as did time to discharge after major surgery.

Side effects of both medications are similar to those of common laxatives and include abdominal cramping, diarrhea, nausea, and flatulence.

<span class=postbold>Metabolism of Opioids</span>

Metabolism of opioids is influenced by individual genetic variability, a reality that could have implications for the selection and monitoring of pain therapies. Because opioids are metabolized by polymorphic enzymes, including CYP2D6, researchers from the Medical College of Wisconsin undertook a study to evaluate the clinical efficacy of CYP2D6 genotyping for chronic pain patients on analgesic therapy.[17]

Patients were classified as extensive metabolizers, intermediate metabolizers, and poor metabolizers by measuring steady-state opioid concentrations using liquid chromatography/mass spectrometry/mass spectrometry. The higher the steady-state concentrations, the greater the opportunity for adverse drug reactions, according to study investigators. As hypothesized, patients classed as poor metabolizers (5% of the sample) had the highest steady-state opioid concentrations. Of the patients who reported adverse drug reactions, 80% also had impaired CYP2D6 metabolism.

Pharmacogenetic analysis may become more routine to facilitate the selection of treatments and to predict and monitor disease. Genetic profiling also may present ethical issues for purposes of insuring or hiring the individual. These issues have yet to be fully defined and addressed.

<span class=postbigbold>Conclusion</span>

Pain medicine will continue to evolve as time and research clarify the risks and benefits of long-term opioid therapy for chronic nonmalignant pain. Heightened patient selection, monitoring measures, and treatment adjustments may increase chances for beneficial outcomes with opioid therapy. Novel opioid formulations, including some that utilize opioid antagonists, may prove valuable for mitigating some opioid-induced side effects. Some patients with pain resistant to systemic opioids or with dose-limiting side effects may require a different route of administration or a nonopioid alternative. Research into cannabinoids as a nonopioid class of analgesia appears promising, but legal and regulatory hurdles remain to the approval of cannabis-derived medicines for pain treatment. Pain treatments and clinical investigations are likely to continue in the direction of nontraditional opioid and nonopioid therapies.

Supported by an independent educational grant from Cephalon
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Medical Marijuana Policy Catches Up With Science

Postby palmspringsbum » Fri Jan 15, 2010 12:34 pm

Genetic Engineering & Biotechnology News wrote:Genetic Engineering & Biotechnology News
Jan 15 2010 (Vol. 30, No. 2)

<span class="postbold">Point of View</span>

Medical Marijuana Policy Catches Up with Science
<span class="postbigbold">Shifting Stance on Herbal Medicine by Government and Physicians Benefits Patients</span>

Bruce Mirken

Marijuana’s recorded use as a medicine goes back nearly 5,000 years. The ban on such use is a much newer phenomenon—72 years in the U.S., a bit more or less in other nations and in specific U.S. states—and one whose unhappy tenure is now apparently near an end. Simply put, research has made that ban increasingly untenable.

The two clearest signals of the sea change that is occurring came this past fall. In October, the Obama administration signaled a careful but hugely significant softening of the federal government’s dogmatic hostility toward medical marijuana. Instead of treating state medical marijuana laws either as nullities or as affronts to be attacked any way possible, a memo from the Department of Justice signaled a hands-off policy toward medical marijuana activities when such activities are clearly permitted by state law.

Less than a month later, the American Medical Association (AMA)—the largest and most institutionally conservative U.S. physicians’ group—announced a major reversal of its policy on the issue. The AMA’s old language had urged that marijuana “be retained in Schedule I” of the federal Controlled Substances Act. That classification deemed marijuana as having a high potential for abuse, lacking accepted medical uses in the U.S., and as unsafe for use even under medical supervision.

In contrast, Schedule II—still considered to have high abuse potential but declared to have accepted medical uses and to be safe for use under physician supervision—includes cocaine, morphine, and even methamphetamine. Stranger still is the fact that in pill form, THC—the component responsible for marijuana’s “high,” though not all of its therapeutic effects—is in Schedule III, with controls so mild that phoned-in prescriptions are allowed.

Some of us thought this classification of marijuana was ludicrous from the get-go, but a recent succession of controlled clinical trials has made the case irrefutable. And the AMA has noticed, replacing its old position with this: “Our AMA urges 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 and alternate delivery methods.” While carefully avoiding an endorsement of existing state medical marijuana laws, the new AMA stand represents a major shift.

The report accompanying the new policy makes clear that this shift was driven by research into medical marijuana, some of the most interesting of which has looked at marijuana for neuropathic pain. This type of pain, stemming from nerve damage that can be caused by a wide variety of illnesses (including HIV/AIDS, multiple sclerosis, and diabetes) and injuries, is notoriously hard to treat. Standard pain drugs, even opioid narcotics, often provide incomplete relief at best. Sometimes anticonvulsant drugs such as gabapentin can be helpful, but some patients do not respond or cannot tolerate these medications. The need for better treatments is universally recognized.

<span class="postbold">Trial Results</span>

The first human trial of marijuana for HIV-associated neuropathy, conducted by Donald Abrams and colleagues at the University of California, San Francisco, was published in Neurology in February 2007. Abrams compared smoked marijuana to placebo (marijuana with the cannabinoids removed) in patients who had a chronic pain score of at least 30 on a 100-point scale. The first marijuana cigarette reduced pain 72%, compared to just 15% with placebo. No serious adverse events were reported, and while some experienced the side effects one would expect (like dizziness or disorientation), these were mild enough that the researchers concluded that they “do not represent any serious safety concerns in this short-term study.”

A second HIV neuropathy study, out of UC San Diego and published in 2008 by Neuropsychopharmacology, focused on patients for whom at least two classes of analgesic drugs had failed. Again, smoked marijuana was, as the study concluded, “generally well-tolerated and effective... cannabis was associated with a sizeable (46%) and significantly greater (vs. 18% for placebo) proportion of patients who achieved what is generally considered clinically meaningful pain relief.”

A third University of California study, also published in 2008, found smoked marijuana effective for relief of neuropathic pain from a variety of non-HIV causes, including multiple sclerosis and spinal cord injury. Notably, the researchers explained, “cannabis does not rely on a relaxing or tranquilizing effect (e.g., anxiolysis), but rather reduces both the core component of nociception and the emotional aspect of the pain experience to an equal degree.”

Meanwhile, a 2007 Columbia University study, published in the Journal of Acquired Immune Deficiency Syndromes in August 2007, compared relatively weak marijuana (2.0 or 3.9% THC) with relatively high doses of Marinol (dronabinol), the prescription THC pill. Margaret Haney and colleagues compared the drugs’ effects on a variety of parameters, including caloric intake, weight, mood, sleep, and cognitive performance.

The pill was administered at five or 10 mg four times a day, four or eight times the standard dose for appetite stimulation.

Both treatments were rated as effective, but the 3.9% THC marijuana outperformed even the highest dose of dronabinol at stimulating hunger/desire to eat, increase in daily caloric intake, sleep duration, and in patients’ self-rated quality of sleep. The researchers also tracked patient requests for over-the-counter medications to treat nausea, diarrhea, and upset stomach, and both marijuana and dronabinol reduced these to almost zero. Strikingly, the article notes no effect on patient performance on a series of tests used to measure psychomotor or cognitive functioning: “Compared with placebo, neither marijuana nor dronabinol significantly altered performance on any of the tasks.”

As Dr. Abrams has been known to observe, it’s not surprising that an herbal medicine that’s been safe and effective for 5,000 years is still safe and effective today. But as the evidence piles up in favor of this natural plant product, the pharmaceutical industry is energetically pursuing its own versions of cannabinoid medicines.

Some, such as GW Pharmaceuticals’ Sativex, are made from the plant, while others are synthetic single cannabinoids. No doubt Western medicine’s preference for single chemical entities—along with politicians’ continuing desire not to recognize anything good about marijuana—will exert a powerful pull in favor of prioritizing these new pharmaceutical products over the plant.

And maybe, someday, Big Pharma will produce a synthetic cannabinoid medicine that works better than Marinol, which is unloved by patients. At that point, the policy question will be this: Is it appropriate for government to push customers toward expensive pharmaceutical products, when many can get adequate and safe relief from a plant they can grow in their own backyard?

The right answer is obvious. What will happen in the real world is less so.

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