The Medicinal Use of Marijuana
Mary Lynn Mathre, MSN RN CARN
Some addictions nurses have thought of marijuana only
as a drug associated with abuse and/or addiction. However,
the drug has been documented as having medicinal value.
This article examines the medicinal value of marijuana
and the history of efforts to prohibit marijuana's
use.
The therapeutic
value of marijuana | top
The therapeutic properties of marijuana come from
the numerous chemicals found in the leaves, buds, and
resin of the cannabis plant. The cannabis plant, commonly
called hemp, is also well known for the value of its
fiber and pulp from the stalk as well as the highly
nutritional seed oil.
The history of marijuana's medicinal use was traced
by Mikuriya (1973). The earliest records of medicinal
marijuana use have been traced back to China in 2737
BC, and evidence of its therapeutic use can be found
throughout world cultures. It was used in colonial
America and listed in the U.S. Pharmacopoeia, as tincture
of cannabis, until 1941. In the 19th century, William
B. O'Shaughnessy, MD, studied marijuana and concluded
that it was safe and effective in the treatment of
various maladies. The first extensive U.S. study, conducted
by the Ohio State Medical Society in 1860, had similar
conclusions.
More recently, in 1980, the Institute of Medicine
(IOM) of the National Academy of Sciences, at the request
of the U.S. Secretary of Health and Human Services
and the director of the National Institutes of Health,
agreed to conduct a review and analysis of health-related
effects of marijuana. IOM's findings recognized marijuana's
therapeutic potential in decreasing the intraocular
pressure for glaucoma patients, controlling the severe
nausea and vomiting associated with chemotherapy, acting
as an anticonvulsant, relaxing muscles and thus counteracting
spasticity problems, and other uses. The IOM investigators
highly recommended further research to determine the
full therapeutic potential of this drug. This study
also noted that marijuana seems to work differently
than other conventional medicines (Institute of Medicine,
1982). The government's response was to print only
300 copies of this study -- not even enough for each
member of Congress.
Safety: Numerous studies have been conducted to determine
marijuana's toxic level: they have concluded that it
would take 20,000 to 40,000 times the normal dose to
induce death (Institute of Medicine, 1982: Randall,
1988). Another way of stating this would be that a
person would have to ingest (or inhale) 1,500 pounds
in 15 minutes. After studying all the evidence, the
judge in DPF v. DEA #92-1179 and ACT v. DEA #92-1168
found marijuana to be "one of the safest therapeutically
active substances known to man" (Randall, 1989,
p. 440). He continued. "One must reasonably conclude
that there is accepted safety for use of marijuana
under medical supervision. To conclude otherwise, on
the record, would be unreasonable, arbitrary and capricious" (Randall,
1989, p. 444).
Addictive potential: In regard to physical dependence
from chronic use, marijuana has relatively minor, if
any, withdrawal symptoms. Tolerance to natural marijuana
develops slowly, if at all. The effects of marijuana
are generally more subtle than those of other substances
of abuse, such as crack cocaine: often it is considered
not strong enough by many addicts and rarely is their
drug of choice.
A knowledge of addiction provides the nurse with the
understanding that it is not the drug that makes the
addict, but rather the negative relationship a person
has with a particular drug or drugs. People can become
addicted to marijuana just as they can to any other
psychoactive drug. Treatment for their addiction should
be available to these people. However, the fact remains
that marijuana, like many other psychoactive drugs,
does have medical value: the fact that some people
may have an addiction problem should not prevent others
from benefiting from its therapeutic potential. Studies
have found opioids to be effective pain management
agents, with an addiction rate of less that 1% in hospitalized
patients treated for their pain, (McCaffery & Vourakis,
1992).
The prohibition
efforts | top
Under the Controlled Substances Act of 1970, marijuana
is a Schedule I controlled drug. This status prohibits
its use by anyone and prohibits physicians from prescribing
it for patients. Until February 1992, there was a little-known
loophole that allowed a handful of patients legal access
to this medicine: the Investigational New Drug (IND)
Program administered by the Food and Drug Administration.
Unfortunately, in February 1992, U.S. Secretary of
Health & Human Services Louis Sullivan, MD, closed
this access to all new applicants, as well as to more
than 30 patients who had been approved for having access
to this medicine but had not yet received their supply.
Only 10 patients who had been approved and already
were receiving their medicine have been allowed continued
legal access to this drug.
Various theories attempt to rationalize the government's
prohibition of this drug/plant: As an efficient fuel,
it presented competition to the oil industry. As a
durable natural fiber, it presented competition to
the synthetic fiber industry; in fact, Levi's jeans
originally were made of hemp. "Reefer madness" hysteria
was created in the 1930s by Harry Anslinger of the
Bureau of Narcotics and Dangerous Drugs, which eventually
evolved into the Drug Enforcement Agency (DEA). Use
of the Mexican name of the cannabis plant, marijuana,
was popularized by the Hearst newspaper chain to scare
the public into believing that there was a new and
dangerous drug being introduced to American youth by
black musicians and Mexicans. The act of bigotry insinuated
that the use of this drug would lead to insanity or
acts of violence such as rape or murder. The result
of this media blitz was the passage of the Marijuana
Tax Act of 1937, which marked the beginning of marijuana's
prohibition (Herer, 1991).
The Controlled Substances Act of 1970 completed the
prohibition efforts. This act provided five levels
of control for psychoactive drugs, with Schedule I
drugs under the most restrictions and Schedule V drugs
under the fewest restrictions. To be placed in Schedule
I, a drug had to meet three criteria: (a) it had to
have no therapeutic value, (b) it had to be deemed
unsafe for use under a physician's care, and (c) it
had to be highly addictive. The DEA was given authority
to place drugs in the "appropriate" schedules.
the DEA placed marijuana in the Schedule I category,
which resulted in the complete prohibition of the growth
and use of this plant -- an act that could be seen
as politically and medically generated. Marijuana does
not appear to meet the criteria for Schedule I.
Responding to prohibition: The National Organization
for the Reform of Marijuana Laws (NORML) was founded
in 1970 in response to the harsh penalties, including
lifetime prison sentences, instituted by a variety
of state and federal laws for the possession of marijuana.
While NORML's primary focus was to change the legal
status of marijuana for all users, the organization
also began legal action to allow patients access to
its medical use. This legal action has continued for
more than 20 years with the assistance of the Alliance
for Cannabis Therapeutics (ACT) and the Drug Policy
Foundation (DPF). Finally, the lawsuit was brought
before the DEA's own chief administrative law judge,
Francis Young, with the motion to remove marijuana
from the Schedule I category and make it available
by prescription. Only two criteria needed to be challenged:
(a) that marijuana had medicinal value and (b) that
marijuana was safe for therapeutic use. In 1988, after
reviewing more than 5,000 pages of evidence, Young
ruled that marijuana did meet both criteria, and therefore
it must be removed from Schedule I (Randall, 1988,
1989). However, in 1989, DEA Director John Lawn refused
to abide by Young's decision and marijuana was kept
in Schedule I. More recently, the Physicians' Association
for AIDS Care and National Lymphoma Foundation have
joined this lawsuit to continue the fight (DPF v. DEA
#92-1179 and ACT v. DEA #92-1168).
A political
and legal issue or a health issue? | top
Since the passage of the Controlled Substances Act,
35 states have fought the prohibition of marijuana
and have passed legislation recognizing marijuana's
therapeutic value (Randall & O'Leary, 1993). In
1991, the city of San Francisco, ravaged by the AIDS
epidemic, passed a resolution recognizing marijuana's
medicinal value; by 1992, the California Medical Association
recognized marijuana's medicinal value and made plans
to take its resolution to the American Medical Association
to press for a similar national policy. These state
and local acts, although will intended, are useless,
as the federal prohibition overrides them.
Despite the prohibition of the natural marijuana plant,
pharmaceutical companies were allowed to develop a
marijuana pill that is composed of delta-9-tetrahydrocannabinol
(THC), the main psychoactive chemical in the plant.
There are other cannabinoids in this plant that have
their own therapeutic action and/or influence the action
of others. A plant that can be easily grown and consumed
as medicine is Schedule I, while a pill of the main
psychoactive chemical contained in that plant can be
developed by a pharmaceutical company and sold for
profit as a Schedule I drug. Also important to note
is that it appears the pharmaceutical industry pressured
the government to prohibit university research of marijuana.
The role
of addictions nurses in the medicinal use of marijuana
| top
Addictions nurses understand that no drug is completely
safe and that any drug can be abused. Prior to using
any medication or drug, the patient should have an
understanding of its expected benefits and associated
risks so that he or she can make a responsible decision
regarding its use.
Nurses are patient advocates. Addictions nurses advocate
treatment for addicted people. Addictions nurses also
advocate medicinal treatment of life- and sense-threatening
illnesses if the medicine improves the quality of life
for a patient. Nurses, as healthcare professionals,
must honestly and rationally examine this issue, rather
than respond to scare tactics and moral judgments about "illegal
drug users."
As addictions nurses, we are expected to base our
knowledge of drugs of abuse and the disease of addiction
on scientific evidence and clinical experience. Advocating
legal access to marijuana for patients whose quality
of life can be improved through the use of this drug
is a moral and ethical obligation we owe the general
public, if we are truly serving as patient advocates.
top
Mary Lynn Mathre, MSN RN
CARN
References
Herer, J. (1991). Hemp and the marijuana conspiracy:
The emperor wears
no clothes. Van Nuys, CA: Hemp Publishing.
Institute of Medicine. (1982). Marijuana and health.
Washington, DC:
National Academy Press.
McCaffery, M., & Vourakis, C. (1992). Assessment
and pain relief in
chemically dependent patients. Orthopedic Nursing, 11(12), 12-27.
Mikuriya, T.H. (Ed.). (1973). Marijuana: Medical Papers
1839-1972.
Oakland, CA: Medi-Comp Press.
Randall, R.C. (1988). Marijuana, medicine, and the
law. Washington,
DC: Galen Press.
Randall, R.C. (1989). Marijuana as medicine: Initial
steps.
Washington, DC: Galen Press.
Perspectives on Addictions Nursing / Vol. 4, No. 2
/ June 1993
pages 8-9
