Marijuana conjures up all kinds of associations, whether it’s a memory of some harmless fun we once had at a party, fears about our children becoming addicted, or any number of things. But to certain physicians, researchers, and people suffering from various illnesses, it is a therapeutic herb that is known to prevent nausea, reduce blood pressure, stimulate appetite, relieve insomnia and suppress convulsions. The sticking point is that the government classifies marijuana, along with heroin and LSD, as a Schedule 1 substance—a category for drugs that are deemed unsafe, highly subject to abuse, and possessing no medicinal value. This draconian stance has led to patient’s rights groups, doctors, and various organizations such as NORML (National Organization for the Reform of Marijuana Laws) to work assiduously for the legalization of marijuana, at least for medical use.
Currently, in most US states including New York, individuals who use marijuana are breaking the law and putting themselves at risk of arrest and prosecution. However, eight states have managed to pass their own laws to protect patients who possess and grow their own marijuana with their doctor’s approval: Alaska, California, Colorado, Hawaii, Maine, Nevada, Oregon, and Washington. The federal government does not officially recognize these laws (although individuals in those states are unlikely to ever face prosecution because it has usually been the states that intervene in such cases). Even though hundreds of thousands of residents in these states are now growing their own herb legally, federal law prevents any states from making supplies legally available, and the government has found ways to close down many of the buyers’/cultivation clubs.

It is still illegal for a doctor to write a formal prescription for marijuana, even in those eight states with protection laws. “Doctors can be, and indeed are, prosecuted (or persecuted, if you prefer) for dispensing marijuana to their patients and even recommending it can elicit close scrutiny of the physician’s prescribing practices by the DEA,” said Nicholas Eyre, executive director of ReconsiDer, a Syracuse forum on drug policy.

Most formal associations of physicians have not taken an official position on medical marijuana. However, numerous organizations have endorsed medical access to marijuana or opposed the federal government’s strict prohibitionist stance, including the American Public Health Association, the Federation of American Scientists, the Physicians Association for AIDS Care, former Surgeon General Jocelyn Elders, the Institute of Medicine, the American Academy of Family Physicians, American Bar Association, American Society of Addiction Medicine, British Medical Association, Multiple Sclerosis California Action Network, New York State Nurses Association, and New England Journal of Medicine.

An Ancient Analgesic
When we look back over the history of medical marijuana, it is interesting, and somewhat surprising, that the issue ever became so controversial. For over 3,000 years until the turn of the 20th century, marijuana was among the most used medicines for two thirds of the world’s people, from the Far and Near East to Africa and Europe. It was used to treat most known illnesses during that time. In the US alone, strong extracts, elixirs, and tinctures of marijuana were frequently the most prescribed medicines in the latter half of the 1800s, for everyone from babies to the elderly.

Marijuana continued to be used legally as a medicine until the 1930s, and was especially prominent in veterinary care throughout the world. Medicines based on cannabis extracts were manufactured by prominent American and European pharmaceutical companies, including Eli Lilly and Squibb. The US Pharmacopoeia (the world’s most extensive and recognized database of medicines) recommended cannabis for more than 100 separate ailments, including rheumatism, asthma, migraine, and the cramps or low moods associated with menstruation. It was America’s number one analgesic for 60 years prior to the rediscovery of aspirin around 1900. During all this time there was not one reported death from cannabis medicine, in contrast to the numerous toxic effects of other pharmaceuticals. Dr. Raphael Mechoulam—one of the scientists who isolated tetrahydrocannabinol (THC, marijuana’s main active ingredient) in 1964—stated in 1997 that he still believed cannabis to be the world’s best overall medicine.
Marijuana’s medical uses have been well documented by modern science. Since 1964, more than 400 separate compounds have been isolated in cannabis, more than 60 of which are known to be therapeutic. In studies, marijuana has been shown to reduce unpleasant symptoms of many diseases, from the tremors associated with multiple sclerosis to the intra-ocular pressure of glaucoma.

For many ailments, we are starting to discover how cannabis actually works. It helps migraine headaches, for example, by affecting the vascular circulation of the covering of the brain (the reddened eyes of marijuana users is evidence of this). But unlike other drugs, it does not affect the rest of the vascular system, other than speeding the heart rate slightly.

In the early 1990s, researchers at the National Institute of Mental Health confirmed the existence of marijuana receptors that sit on the outside of brain cells, which are specifically shaped to grab THC molecules and produce a specific reaction. In 1997, scientists found that marijuana has a direct effect on pain signals. Cannabinoids can “stop pain before it ever reaches the spinal cord,” said J. Michael Walker of Brown University. This research was expected to generate a race to manufacture synthetic pain-killing THC drugs. In the meantime, Walker predicted that “people who have serious illnesses will take the steps they feel they have to take.”
One person who has been taking things into her own hands is Sherrie Wilkie, a 65 year-old grandmother who lives in Elmira, New York. She faces eviction from her apartment and criminal charges after police raided her home and confiscated three pounds of marijuana. Wilkie says she never sold the drug for profit, but reinvested the money to buy more marijuana for her buyer’s club members, some of whom have cancer and AIDS. Some of the money covered her own supply of half an ounce a week, which relieved her chronic pain from arthritis. She also has coronary heart disease (she wears a pacemaker), high blood pressure, thyroid problems, high cholesterol, and allergies. Wilkie says she is now in constant pain because she has no marijuana. Conventional medications didn’t work for her, including morphine, which simply made her ill. She says that a liver condition prevents doctors from prescribing painkillers that work as well as the marijuana.

“Marijuana is a plant that God put on this earth to help people,” she says. “It works best in its natural form. It’s a member of the herb family and it’s the only thing I’ve found that gets rid of my pain. Unfortunately, the government has made it illegal.”

Forbidden Studies & Synthetic Alternatives
If marijuana has such obvious therapeutic benefits and a history of medical use that goes back to the beginning of recorded history, how did it ever come to be illegal?

In the 1930s, there was a rash of sensationalist media reports about marijuana’s link to crime and mental degeneration. (The book The Emperor Wears No Clothes by Jack Herer shows that these reports were generated in part by industries whose products—such as petrochemicals and the new synthetic fibers—were in competition with the products that could be made from the ubiquitous marijuana or “hemp” plant.) Although this did not lead to an outright ban on marijuana, the US government introduced a prohibitive tax on it, which doubled its price. As detailed in Act HR 6906, this was to be paid by “Every person who imports, manufactures, produces, compounds, sells, deals in, dispenses, prescribes, administers,” and even simply “gives away” marijuana.

The American Medical Association came out against this new tax, because marijuana was known to have so much medical potential and had never caused any observable addiction or death. Dr. William C. Woodward wrote in a letter to the Senate: “the prevention of the use of the drug for medicinal purposes can accomplish no good whatsoever [but] it may serve to deprive the public of the benefits of a drug that on further research may prove to be of substantial value.” But to no avail. A transcript of the government meeting shows that his letter was mentioned only as an afterthought, and filed away as the committee adjourned.

The 1938-44 “LaGuardia Marijuana Report,” which was commissioned by Fiorello LaGuardia, then Mayor of New York City, highlighted the favorable effects of marijuana. LaGuardia wrote, “I am glad that the sociological, psychological, and medical ills commonly attributed to marijuana have been found to be exaggerated.” But Harry J. Anslinger, then director of the Federal Bureau of Narcotics, denounced the report, and the New York Academy of Medicine. He vowed that the doctors involved would never again conduct marijuana research without his personal permission, or face jail. Anslinger then used his position to illegally halt all US research into marijuana.

By the mid 1960s, millions of young Americans had started to use marijuana as a recreational drug. Concerned parents and the government, wanting to warn of the dangers, began funding numerous health studies. However, the new studies began to demonstrate not that marijuana caused criminal behavior or mental disorders, but that it contained a hidden chemistry of great therapeutic potential. Reports of positive effects and new medical uses became an almost weekly occurrence in medical journals and the national press. For example, the Medical College of Virginia found that it reduced many types of tumors, and the journal Medical World News reported in 1971 that “Marijuana is probably the most potent anti-epileptic known to medicine today.”

But in 1976, the US government forbade, for the second time, all research into marijuana’s medical uses. In a number of its Marijuana and Health reports to Congress, the National Institute on Drug Abuse (NIDA) recommended that research into marijuana’s medicinal use should be continued, again to no avail. Ronald Reagan’s election as president brought a renewed war on illegal drugs. At the same time, NIDA’s report to Congress changed its original position and warned that the negative effects of marijuana diminished its therapeutic potential, and suggested that synthetic analogs of THC should be pursued instead.

The large American pharmaceutical companies were behind the 1976 ban on natural marijuana studies. They successfully petitioned the government to allow them to be the sole financiers and purveyors of 100 percent of the research. They planned to come up with patentable synthetics of the therapeutic cannabis molecules in order to generate huge profits for themselves. (Note: Hundreds of studies had shown marijuana, in its natural, “crude” form, to be more effective than synthetics.) And so, the pharmaceutical giants made two irresistible offers: to conduct their own research at no cost to the government, and to come up with a cannabis medicine that would produce no “highs”. This assumes that the psychoactive effect of marijuana is itself unhealthy or undesirable, even though a mild high can help patients to generally “feel better.”
Eli Lilly eventually produced Nabilone and later Marinol, synthetic relatives of THC, and promised the government great results. But by the 1980s, Nabilone was considered virtually useless. Most patients do not like these pills because, ironically, they find they have to get much higher on the synthetic THC to get the same therapeutic effects as smoking it. Moreover, cannabinoids work synergistically, as do the active ingredients in most plants, so isolating THC may be missing some vital (including as yet undiscovered) ingredients.

Still, the witch-hunt against independent research continued. The Reagan/Bush Administration even put out a soft “feeler” in 1983 for all American universities and researchers to destroy every previous cannabis study, including compendiums in libraries. However, scientists and doctors so ridiculed this unparalleled censorship that these plans were dropped, at least for the time being.
In 1989, the Drug Enforcement Agency’s (DEA) own administrative law judge, Francis L. Young, recommended that marijuana be reclassified from a banned Schedule 1 to a Schedule 2 drug, which would permit at least limited medical use. As a Schedule 2 substance, it would become a drug like morphine and cocaine, that, while still unavailable to the general public, could be prescribed by doctors for limited purposes. After studying the research from various institutions including Harvard and New York University, Young concluded that marijuana had been shown to be “one of the safest therapeutically active substances known to man.” In his conclusion that marijuana’s medical use was “clear beyond question,” Young cited patients as well as medical experts from hospitals where marijuana was being used widely, though illicitly, especially to alleviate the nausea caused by cancer treatment. He added: “It would be unreasonable, arbitrary, and capricious” for the DEA to continue to stand between very ill people and the benefits of marijuana. He said the dangers of marijuana do not outweigh its benefits and that “in strict medical terms, it is far safer than many foods we commonly consume.” Even so, the US Court of Appeals denied the reclassification.
In 1999, the National Academy of Sciences’ Institute of Medicine acknowledged that although cannabis has some medical utility, smoking it is too dangerous, and that patients would have to await the development of pills. However, the report failed to provide a discussion of vaporization, a technique that allows patients to inhale the active ingredients without inhaling the particulate matter in smoke.

And so the debates rage on, and the DEA continues to oppose further research into natural marijuana. In the meantime, Marinol retails at about $825 for just a 20-day supply.
David (not his real name), an ex-military physician who currently practices as a psychiatrist in New York state, has recommended that trials be conducted into the use of natural marijuana for various conditions. But does he ever recommend it to his patients? “Occasionally, over the years,” he admits. “I wouldn’t be allowed to prescribe it or give dealers’ names even if I knew them, but yes, in some cases I have informed my patients about marijuana.”

While marijuana remains illegal, he has occasionally prescribed the very expensive Marinol, but his patients have observed various problems with it. It produces a high which, for many people, is uncomfortably long; whereas when marijuana is smoked, the dose can be better regulated by the patient. “I’d rather people didn’t smoke anything,” says David. “It can irritate the lungs and respiratory passages. But THC is not yet available in aerosol form, otherwise I might recommend that.”

He emphasizes that marijuana is one of the few substances known to man that will dramatically reduce anger. “There is no anti-anger drug, even though anger and rage can in themselves lead to violence to oneself and others and numerous health problems, as we now know.” For this reason, he sees marijuana as especially useful for trauma victims, and he has witnessed its effect in very disturbed ex-Vietnam soldiers. “It can sure stop them from killing other people.”

David uses a responsible and truly holistic approach. “I encourage mindfulness meditation, breathing awareness, and exercise. I am also studying acupuncture to use as an adjunct. Sometimes pharmaceutical drugs are appropriate too. I basically let patients know that they have a whole toolbox of things to call upon, and some of them might simply keep a joint or two in that box.”

A local herbalist who prefers not to be named admitted that marijuana has a place in modern herbalism. “Because of its ability to create altered states of mind I see it more as adjunct to spiritual healing rather than a physiological remedy, but it can be useful for a patient who is in so much discomfort that its pain-killing properties makes life bearable for them,” she says. However, she neither uses nor prescribes marijuana herself. “You are already on shaky ground as a herbalist; our modality is not even officially recognized in this country. Even so, I’m amazed at how many students ask me after lectures if I recommend marijuana.”

Cautioning against its casual use, she adds, “Some herbs help the liver to detoxify, some help the body to produce a certain hormone, and so on. You can take them for a while and eventually discontinue; but marijuana doesn’t really ‘cure’ anything in that way. It’s only having an effect for the duration of the ‘high’. Moreover, it contains phytoestrogens that have a feminizing ‘yin’ quality which is useful when you want to chill out, but prolonged use in some people can result in a loss of drive—sexually and in day-to-day life. It alters the body’s chemistry in a way that isn’t necessary for healthy people.”

It is important to advise that no drug with strong medicinal powers—natural or synthetic—is likely to be 100 percent free of unwanted side effects. For example, in the vast majority of cases, marijuana relieves stress, dilates the arteries and reduces blood pressure; but cardiovascular patients should proceed with caution as in a few cases it has led to especially high heart rates.
True to popular belief, marijuana can indeed cause temporary lassitude, atypical behavior, prolonged reaction times, and intellectual impairment. Users need to be aware of this so that they can postpone important work or potentially dangerous activities like driving until the high has passed. Yet it is also easily observed that individuals react differently, depending on their existing mood, health, the situation in which the marijuana is smoked, and the type of marijuana. Suffice to say, a small percentage of people have negative psychological reactions to marijuana and if you find that the high consistently makes you feel anxious, you should not use it.
Because it is illegal to supply marijuana, there is no way to regulate the potency or quality. Those with compromised immunity are at risk from fungal spores that are sometimes present on the herb. Cannabis Buyers’ Clubs have formed in some cities, to supply uncontaminated marijuana, but people in most parts of the country rely on illegal markets. Reclassification of marijuana as a legal medicine would help ensure access to a guaranteed pure, standardized product. This would also make it easier for people to regulate their doses, but as with all natural products, some variation is inevitable.

Despite the problems outlined above, marijuana is relatively safe, especially when viewed in the context of synthetic drugs. According to a study published in the American Medical Association’s own journal in 1998, pharmaceuticals kill more than 100,000 people a year even when properly prescribed; and in 1994 alone, in addition to the thousands of deaths, 2.2 million people suffered reactions that were serious enough to require hospitalization.

If you are thinking of using marijuana to cure your illness, bear in mind that PMS, nausea, headaches, depression, and the like are not caused by a lack of marijuana in one’s life, any more than they are caused by a lack of Tylenol or Prozac. Marijuana is not a “cure”. Dietary, attitude, and lifestyle improvements effect much deeper changes in the long run. But it is undeniable that marijuana can ease the burden for the terminally ill or those who are chronically in pain. If, as top pulmonary expert Dr. Donald Tashkin says, “Taking a hit of marijuana has been known to stop a full-blown asthma attack,” and if studies are correct in their conclusion that it is the only known substance to halt a stroke, then its role as a potential lifesaver must be acknowledged. “As people learn that its harmfulness has been greatly exaggerated and its usefulness underestimated, the pressure will increase for drastic change in the way we, as a society, deal with this drug,” said Dr. Lester Grinspoon, a foremost supporter of medical marijuana.

For more detailed information on the legalities of medical marijuana, visit the Web site of the Marijuana Policy Project at www.mpp.org.

The book Marijuana Medicine by Christian Rätsch explores the history and culture of marijuana use, and Jack Herer’s The Emperor Wears No Clothes contains a fascinating chapter that explores the medical literature and suppression of research.