Marijuana Update.

In January 1998, the White House Office of National Drug Control Policy reversed its ironclad opposition to the medical use of marijuana and funded a thorough independent scientific review of the topic. On March 17, 1999, the Institute of Medicine, a branch of the National Academy of Sciences (which is not a government agency), released its report. Extremists on both sides of the controversy were probably disappointed. The report contained the following findings and recommendations:

Findings

Marijuana is not completely benign--but the harmful effects of medical use aren't necessarily the same as those of drug abuse.

Marijuana smoke delivers most of the same hazardous toxins as tobacco smoke. Moreover, the smoke contains so many active ingredients in such varying mixtures--like other herbal products--that its medical future is almost certain to be in synthetic cannabinoid drugs.

Data suggest that cannabinoid drugs may offer relief of the pain, loss of appetite, nausea, and vomiting caused by AIDS or cancer.

A smoked drug acts quickly, which is an advantage for control of these symptoms.

Cannabinoids may have potential for treating muscle spasms in multiple sclerosis.

The effects of cannabinoids on many other symptoms are generally modest--and, in most cases, there are other effective drugs available.

Cannabinoids reduce anxiety and bring on euphoria, sedation, and disorientation, which is most disturbing to people with no previous marijuana experience.

Recommendations

Research should continue into the effects and functions of the cannabinoids. This research shouldn't be restricted to THC. While THC is the primary active ingredient, there are several others that may contribute to the effects of THC or have effects of their own.

Reliable, safe delivery systems that retain the fast-acting qualities of smoking without its hazards should be developed quickly and tested in clinical trials.

Evaluations of the ability of cannabinoids to reduce anxiety should be included in any clinical trial, as it is important to understand the role of relief from fear in managing symptoms that are influenced by stress.

What does this mean to people with MS?

People with MS have reported that marijuana relaxes spasticity and relieves tremor and painful muscle spasms. An Iowa woman with MS is one of the 8 people who still receive legal marijuana cigarettes through a compassionate use program sanctioned by the FDA and the National Institute on Drug Abuse. This program closed in 1992. No new patients can be admitted.

Dr. Timothy Vollmer of the Yale University MS Research Center was a member of the Institute of Medicine's advisory committee. He believes that there are sufficient reasons for well-designed studies of synthetic cannabinoids for MS spasticity. While baclofen and tizanidine can reduce spasticity with fewer side effects than smoked marijuana, development of synthetic cannabinoids delivered via inhalers or skin patches might offer an important addition to management.

Previous studies of marijuana or THC in pill form--available as the prescription drug Marinol--for spasticity, tremor, and balance problems in people with MS produced mixed results. There were many side effects, including short-term memory impairment, mental clouding, loss of coordination, and weakness. These trials involved 8 to 10 people each and, except in the trial that looked at balance problems, where no positive results were seen, the researchers concluded that larger, more carefully designed and controlled studies were needed.

A collision course?

Marijuana remains a controlled substance under current federal law, and this Institute of Medicine report was not intended to speak to legal questions. Voters in Alaska, Arizona, Colorado, Nevada, Oregon, and Washington have passed measures to allow medical use. The state/federal conflict is not settled.

Arizona's referendum was invalidated. In Colorado, a court ruled that the petition to put the question on the ballot had too few signatures. Congress barred the District of Columbia from even counting the votes in its ballot initiative.

"We hope this question will be settled by medical science, not by court cases or politics," said Dr. Nancy Holland, vice president of Clinical Programs at the Society. "Since multiple sclerosis is a lifelong chronic illness, not a terminal disease like AIDS, or a short-term crisis like severe nausea from cancer chemotherapy, the health dangers of smoked marijuana are significant for people with MS. We urge people to explore other options for managing spasticity while research pushes forward for answers about the potential of the cannabinoids."

Martha King is editor of this magazine.