Indications for Use
Indications for Use
Healthcare professionals and patients are caught in a legal and ethical dilemma as long as cannabis remains in Schedule I of the Controlled Substances Act of 1970. Placement in this most restrictive category is supposed to be reserved for drugs that:
1) are highly addictive;
2) have no therapeutic value, and;
3) are not safe for medical use.
This is the "forbidden drug" category. 
In 1985, a synthetic THC pill (dronabinol or Marinol), was approved as a Schedule II medication for the limited indications of nausea and vomiting from chemotherapy. By 1991 the FDA also approved the use of Marinol as an appetite stimulant for AIDS patients. So at that time physicians could ONLY prescribe Marinol for those indications. In 1998, due to the lack of diversion problems with Marinol, the DEA down-regulated it to Schedule III, meaning it has a lower abuse potential than those under Schedule II. This less restrictive scheduling also allowed physicians to prescribe the medicine for "off label" indications.
Meanwhile, anecdotal reports from patients as well as research studies pointed to a large number of indications for natural cannabis. Why did the federal government approve the use of a synthetic chemical similar to natural delta-9-tetrahydrocannabinol or THC, which is the primary psychoactive cannabinoid found in cannabis? It is clear that the federal government hoped and believed that allowing the use of this "pot pill" would end the efforts to make the natural plant with more than 400 components available as medicine. But patients knew better and the growing body of science confirmed that the other components of cannabis also had therapeutic value. In fact, Cannabidiol or CBD has the ability to lessen the psychoactive effects of THC. Some strains have high CBD and practically no THC and are minimally psychoactive. So again it causes one to question, why allow the use of the primary chemical that causes the "high" to be used as medicine, but not the natural herbal form that is LESS psychoactive, but offers more therapeutic value?
The late Dr. Tod Mikuriya (1933-2007) from California, who was a noted medical cannbis historian, recommended cannabis for thousands of patients once California passed its medical marijuana initiative in 1996. He developed a long list of indications for use (identified under the International Classification of Diseases 9 or ICD-9 listing) based on his patient encounters and published them on his website ( "Dr. Tod's List" ). The list continues to grow as we learn more.
Based on its safety and efficacy, Patients Out of Time believes that health care professionals should be able to recommend (we cannot use the word "prescribe" as long as cannabis remains in Schedule I) cannabis for any condition in which the benefits of cannabis outweigh its risks. This is standard practice for any medicine. In this section we will present several indications for use. Some are listed according to symptom management and others are listed according to specific diseases or medical conditions.
Chronic Pain - Migraine
Pain is the number one reason people seek medical treatment and patients seeking pain relief are the most prevalent group employing cannabis medicines. Chronic pain seriously interferes with the quality of life for many patients and ushers in depression or substance misuse problems. A typical observation by patients is that their use of cannabis doesn't necessarily take away the pain, but that they are no longer preoccupied with the pain; they are able to ignore it. In cases of inflammatory pain, cannabis decreases the inflammation that causes the pain. Many chronic pain patients have been prescribed strong opioids such as oxycontin, morphine, or hydrocodone to manage their pain. However, with the use of cannabis, most patients significantly decrease or eliminate their use of these opioids.
Neurodegenerative Conditions - MS - ALS - Brain Trauma
The endocannabinoid system is responsible for maintaining homeostasis and thus probably plays a key role in protecting the human body from toxins or stressors found in our environment or through personal lifestyle choices such as a poor diet. Research on the endocanabinoid system has shown that cannabinoids have neuroprotective and anti-inflammatory activity, which suggests that cannabis may be useful in the treatment of neurodegerative diseases such as multiple sclerosis, amyotropic lateral sclerosis, Alzheimers disease or Parkinson's disease .
MS patient, Barbara Douglass, has actually improved her sight, mobility, and bladder control with her use of cannabis. ALS patient, Cathy Jordan, continues to survive against all odds with her deadly disease and she attributes it all to cannabis. For those patients suffering from neurodegenerative diseases, does cannabis boost the endogenous cannabinoid system (ECS) to help it slow or halt the progression of these diseases? Can the use of cannabis or specific cannabinoids help maintain the integrity of our ECS and actually prevent some neurodegenerative diseases from developing? Can cannabis or specific cannabinoids help prevent the damage that often occurs following traumatic injuries that result from the body's initial response to injuries such as traumatic head injuries or spinal cord injuries through its neuroprotective or anti-inflammatory action? We may find the answers to these questions and more as scientists continue to study the ECS and cannabis preparations. Learn more about the science and view the various patient testimonials...
Mental Health - Addiction Treatment - PTS(D)
The pharmaceutical industry is alive and wealthy as a result of the tremendous use of psychotropic medications prescribed to patients for the management of various mental health problems. Americans have grown up with television ads suggesting that they can fix just about any problem with a pill. Although some mental health problems may only require counseling or psychotherapy, others may call for medication on a short or long term basis. Science shows a strong mind-body connection and we have learned that a chemical imbalance in the brain can result in various problems such as severe depression, anxiety, or bipolar disorder that can be managed with medications. However, many of these medications come with significant side effects and may cause adverse effects, including suicidal ideation. Additionally, the financial strains of these medications create compliance issues with many patients.
Anecdotal reports suggest that cannabis could be an effective medication without many of the side effects. Studies on the non-psychoactive cannabinoid, cannabidiol or CBD, indicate that it may be effective in the treatment of anxiety disorders, depression, agitation and bipolar disorder. This is a clear example of why dronabinol (Marinol or synthetic THC) is not a replacement for cannabis. Also, the psychoactive effects of THC is probably the primary reason psychiatrists, addiction specialists and other healthcare providers shy away from cannabis as medicine. It is ironic that the "high" that is so despised by the medical system is prized by many patients suffering from depression.
Post traumatic stress disorder or PTSD may more appropriately be referred to as post traumatic stress syndrome because it is the normal response to an abnormal stress. This condition includes an assortment of symptomology including depression, anxiety, rage, insomnia, flashbacks of the event(s), and isolation. Many PTS victims (especially combat veterans or incest victims with a history of repeated traumatic incidents) have found that cannabis provides more relief than the commonly prescribed medications. The discovery that the ECS is involved in the healing process of the mind to "forget" aversive memories seems to offer an explanation as to why it is helpful for this indication.
Marijuana/Cannabis has been portrayed as a gateway drug of abuse that leads to the use of and addiction to stronger drugs of abuse. The psychoactive effects of cannabis have been cited as a reason it cannot be used as a legitimate medicine. When compared to other drugs of abuse, cannabis does not measure up to the addictive potential of tobacco, alcohol, other illicit drugs or prescribed medications such as opioids, benzodiazepines, stimulants or barbiturates. Historic medical use of cannabis preparations, anecdotal reports and new research indicate that rather than a gateway drug to addiction, cannabis holds promise as an exit drug from other drug addictions. Cannabis is a drug, though, and as a drug it has indications and contraindications. People with psychotic disorders probably should not use cannabis. As with any drug, it should be used in the smallest effective dose.
Glaucoma is the leading cause of preventable blindness in the U.S. and its prevalence increases with age. Glaucoma begins earlier and progresses faster among the black population. Glaucoma occurs when the pressure within the eye (intraocular) becomes elevated and damages the optic nerve. Cannabis acts directly on receptors in the eye to decrease the intraocular pressure and prevents the damage that leads to blindlness. Research on the use of cannabis for the treatment of glaucoma began in the 1970s.
Robert Randall became the first patient to be allowed access to medical marijuana through the Compassionate Investigational New Drug (IND) program under the Food and Drug Administration (FDA) in 1976. As a glaucoma patient, he had found by accident that smoking cannabis decreased his intraocular pressure and thus could prevent him from going blind. Following his initial arrest for growing cannabis he had to prove it controlled his glaucoma to win a medical necessity defense. He was able to do so and in later years two other patients, Elvy Musikka and Corinne Millet, were able to gain access to medical marijuana through the IND access. Learn about their stories and the science that supports the ability to reduce intraocular pressure for glaucoma patients in this section.
The Centers for Disease Control (CDC) first described the disease known as acquired immune deficiency syndrome (AIDS) in July of 1981. As this epidemic spread worldwide patients found that cannabis helped prevent the "wasting syndrome," common among AIDS patients, by stimulating their appetite. As new medications were developed to fight the HIV infection patients also learned that cannabis could control the nausea and vomiting caused by those medications. Kenny Jenks, a hemophiliac patient became HIV positive from contaminated blood supplies that he received to provide him the clotting factors he needed for survival. Unaware that he was infected, he transmitted the virus to his wife Barbra. These 2 Florida residents learned about cannabis and following their arrest for using the medication they were eventually able to gain access through the IND program. It was because of the high number of applications into the IND program for legal access to medical marijuana by HIV/AIDS patients that the federal government made the decision to close the program to new patients in 1992.
Cannabis may also be helpful for AIDS-related neuropathic pain and AIDS-associated dementia.
It is common knowledge that cannabis is helpful in controlling the extreme nausea and vomiting that often accompanies cancer chemotherapy. Cannabis is also helpful for cachexia (extreme weight loss) and pain that is often associated with cancer.
The real excitement comes with the growing evidence that cannabis may actually treat cancer by acting as a perfect chemotherapy medication which kills the cancer cells but not the healthy ones. In addition to reducing tumor size, cannabis also helps cancer from spreading to other areas of the body. Back in 1974, researchers at the Medical College of Virginia in Richmond inadvertently found the THC slowed the growth of cancer cells in mice with cancer of the lung, breast and a virus-induced leukemia. Their funding ended since the original goal was to determine its harmful effects to the immune system. In 2000 Guzman and his research team in Madrid, Spain demonstrated that injected THC could shrink or destroy brain cell tumors (Glioma) in rats. The 1974 studies were never published and in recent years there has been little coverage in the U.S. about Guzman's work.
Gastrointestinal - Nausea/Vomiting - Appetite Stimulation
Gastrointestinal (or GI) problems can include difficulty taking in food/nourishment (appetite or nausea and vomiting problems), inadequate absorption of nutrients, elimination problems (constipation, diarrhea, irritable bowel) and/or cancer developing anywhere along the GI tract from mouth to esophagus to stomach to the small and large intestines, ending at the anus. Anecdotal experiences are numerous among patients suffering from Crohn's disease, Ulcerative Colitis, Irritable Bowel Syndrome in their use of medicinal cannabis. The anti-inflammatory and relaxant effects of cannabis may be responsible for some of their relief.
Nausea and vomiting can occur as a result of a variety of conditions such as acute viral illness (the flu), cancer, cancer chemotherapy or side effects from other medications, radiation treatment, post-operative recovery, pregnancy, motion sickness and poisoning. There is clear evidence-based research that supports the anti-emetic effects of cannabis for persons suffering from nausea and vomiting. The 1999 IOM report, Marijuana and Medicine: Assessing the Science Base, agreed that the evidence supported the anti-emetic effects of cannabis, but expressed concern related to smoking the plant material. While inhalation allows for fairly immediate relief, clinicians should be recommending vaporization rather than smoking to eliminate this concern.
Having "the munchies" is a common phrase among cannabis users and this side effect of gaining an increased appetite can be a strong indication for use with persons suffering from cachexia or wasting syndrome. In fact, Jamaican women have long known that a ganja (cannabis) tea would settle the stomach and often gave some to newborn babies. There is new evidence that the ECS is involved in appetite stimulation. It is now known that all female mammals have anandamide in their breast milk and early research shows that newborn mice will die if the anandamide in the mother's milk is blocked at birth.
Congenital disorders are defined as physical or mental traits, anomolies, malformations or diseases existing at birth that are either hereditary or due to some influence occurring during gestation. George McMahon was born with a rare hereditary disorder called Nail Patella syndrome and he legally uses cannabis for the management of his symptoms. Jacki Rickert from Wisconsin suffers from Ehlers-Danlos Syndrome and she also found cannabis essential to her survival. This page will highlight a variety of congenital disorders in which cannabis has been found to have therapeutic benefit.