Medical cannabis and beyond

On December 7, 2012, in Latest News, by The Somerville Times

Part 1:  Good medicine
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By William C. Shelton

 (The opinions and views expressed in the commentaries of The Somerville News belong solely to the authors of those commentaries and do not reflect the views or opinions of The Somerville News, its staff or publishers.)

Only 20.8% of ‘Villens who voted in last month’s election opposed Question 3, the ballot measure that legalizes and regulates the medical use of cannabis. But officials in nearby Wakefield and Reading have already banned treatment centers. Those in Melrose and Peabody are considering bans. And politicians in Boston, Framingham, and Quincy are discussing narrow restrictions.

Like voters who opposed the measure, their concerns about public health, crime, and young people’s wellbeing are sincere. But attitudes regarding cannabis seem to be much more related to the extent of one’s understanding or ignorance of the evidence than to the righteousness of one’s concerns.

Among the claims regarding cannabis’s medicinal value that most evoke skepticism from doubters is the range of ailments for which it is efficacious—multiple sclerosis, ALS, rheumatoid arthritis, hepatitis C, glaucoma, rheumatoid arthritis, cancer, depression, PTSD, osteoporosis, diabetes, nausea, eczema, Crohn’s disease, and others.

I understand why scoffers would see such claims as a litany of excuses for so called “patients” to legally get high. How could one plant possibly contain so many different compounds that are efficacious in treating so many different conditions?

The answer is one of God’s, or evolution’s—or both, if you believe as I do—awe-inspiring mysteries. It is the endocannabinoid system, which for 600 million years has existed in all animals more advanced than mollusks.

Its purpose appears to be homeostasis—establishing and maintaining health by stabilizing the body’s internal environment in response to fluctuations in the external environment. It helps to regulate immunity, inflammation, neurotoxicity, blood pressure, body temperature, appetite, gastrointestinal functioning, bone formation, analgesia, and physical and psychological responses to stress and trauma.

It operates through the activation of its own receptors, molecules embedded in or on a cell that receive chemical signals that direct the cell to do something. The “signal” is a molecule external to the cell called a ligand that binds to the receptor. Each ligand, like a key, can only fit into specific receptors that unlock specific responses.

The human neurological, circulatory, digestive, endocrine, immune and musculoskeletal systems are strewn with endocannabinoid receptors, and their ligands are cannabinoids.

Researchers have so far identified five cannabinoids that the human body itself produces, and at least 85 that cannabis plants produce. Cannabinoids not only regulate cells, but also facilitate communication among cell types.

For 70 years, federal policies have discouraged cannabis research. Nevertheless, scientists worldwide have published over 20,000 studies of cannabis and its medicinal properties, including 2,700 in 2009, 1,950 in 2010, and over 2,500 last year.

Here are just a few examples of findings that, collectively, tempt one to call cannabis a “miracle drug.”

Neuropathy is nerve damage resulting from a variety of causes, including physical trauma, diabetes, liver failure, cancer, toxins, Lyme disease, HIV, and shingles. The pain caused by neuropathy is notoriously difficult to treat. In 2010, four separate University of California studies using FDA clinical trial designs found that cannabis reduced patients’ pain to an extent as good as, or better than, currently available medications, but with less harmful side effects.

Cannabis is efficacious in treating the cramping, inflammation, pain, diarrhea and weight loss associated with such gastrointestinal diseases as colitis, Crohn’s disease, and irritable bowel syndrome. For example, a Mayo Clinic study involving 52 patients found that a cannabinoid relaxed the colon and reduced stomach cramps after eating.

Cannabis is an effective anti-convulsant and anti-spasmodic. It has been used to treat epilepsy for over a thousand years. Today, numerous epileptics report that cannabis use completely eliminates their grand mal seizures.

Its efficacy in treating Multiple Sclerosis symptoms is well established.  One 434-day study involving 167 patents, for example, found that cannabinoids relieved spasticity, pain, and bladder incontinence, without requiring dosage increases. But recent studies suggest that cannabinoids can inhibit the progression of MS as well. This is because of cannabinoids’ capacity to stabilize the immune system.

A growing body of clinical and preclinical studies is finding that cannabinoids can reduce the spread of specific cancer cells, both by instructing the cells to kill themselves (apoptosis) and by blocking the formation of blood cells that feed tumors (angiogenesis). The most study thus far has focused on brain and breast tumors.

Skeptics might reasonably ask why caregivers can’t just prescribe compounds whose effects mimic those of various cannabinoids. One important reason is that cannabinoids’ effects are synergistic. That is, they interact with each other, with different receptors, and with over 100 terpenoids and 20 flavonoids found in cannabis to create effects that are greater and different than the sum of their parts. Science is still far from fully understanding these interactions.

A second reason is safety. “Marijuana in its natural form is one of the safest therapeutically active substances known to man.I’m quoting the Drug Enforcement Administration’s former Administrative Law Judge, Francis J. Young.

Consider, for example, that at least seven cannabinoids are known to reduce inflammation. But while at least 16,500 Americans die each year from taking anti-inflammatory drugs such as aspirin, Advil, Motrin, and Tylenol, the World Health Organization says that no death has ever resulted from a cannabis overdose.

Physicians have been using cannabis effectively for 5,000 years. Cannabis cultivators like George Washington and Thomas Jefferson extolled the plant’s many virtues.

After extensive study of Indian medical literature and clinical practice, Dr. William B. Shaunessy introduced cannabis to the West’s modern pharmacopeia in 1839. Queen Victoria’s doctor prescribed cannabis to treat her menstrual cramps. He wrote that it was, “by far the most useful of drugs” in treating migraine, neuralgia, convulsions, and insomnia.

When it was made illegal in 1939, cannabis was the active ingredient in dozens of medicines marketed by Merck, Eli Lilly, Parke Davis, and other pharmaceutical companies.

So how did a plant that provides such exceptional benefits to humankind come to be so reviled and illegal? How did those who use, grow, and sell it come to be despised and imprisoned?

That’s the subject of the next column in this series.

 

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