Vice-President: Al Arsenault

"... we should not decriminalize pot until we get more facts."

Cannabis is a strikingly safe, versatile, and potentially inexpensive medicine. When we reviewed its medical uses in 1993 after examining many patients and case histories, we were able to list the following: nausea and vomiting in cancer chemotherapy, the weight loss syndrome of AIDS, glaucoma, epilepsy, muscle spasms and chronic pain in multiple sclerosis, quadriplegia and other spastic disorders, migraine, severe pruritus, depression, and other mood disorders. Since then we have identified more than a dozen others, including asthma, insomnia, dystonia, scleroderma, Crohn’s disease, diabetic gastroparesis, and terminal illness. The list is not exhaustive.

For example, cannabis has also been found useful in the treatment of osteoarthritis. Aspirin is believed to cause more than 1,000 deaths annually in the United States. More than 7,600 annual deaths and 70,000 hospitalizations caused by non-steroidal antiinflammatory drugs (NSAIDs) are reported. Gastrointestinal complications of NSAIDs are the most commonly reported serious adverse drug reaction. Long-term acetaminophen use is thought to be one of the most common causes of end-stage renal disease. Cannabis smoked several times a day is often as effective as NSAIDs or acetaminophen in osteoarthritis, and there have been no reports of death from cannabis.

It is often objected that the evidence of marihuana’s medical usefulness, although powerful, is merely anecdotal. It is true that there are no studies meeting the standards of the Food and Drug Administration, chiefly because legal, bureaucratic, and financial obstacles are constantly put in the way. The situation is ironical, since so much research has been done on marihuana, often in unsuccessful efforts to show health hazards and addictive potential, that we know more about it than about most prescription drugs. In any case, controlled studies can be misleading if the wrong patients are studied or the wrong doses are used, and idiosyncratic therapeutic responses can be obscured in group experiments.

Anecdotal evidence is the source of much of our knowledge of drugs. As Louis Lasagna has pointed out, controlled experiments were not needed to recognize the therapeutic potential of chloral hydrate, barbiturates, aspirin, insulin, or penicillin. Anecdotal evidence also revealed the usefulness of propranolol and chlorothiazide for hypertension, diazepam for status epilepticus, and imipramine for enuresis. All these drugs had originally been approved for other purposes.

Some physicians may regard it as irresponsible to support, let alone advocate the medical use of cannabis on the basis of anecdotal evidence, which seems to count successes and ignore failures. That would be a serious problem only if cannabis were a dangerous drug. The years of effort devoted to showing that marihuana is exceedingly dangerous have proved the opposite. It is safer, with fewer serious side effects, than most prescription medicines, and far less addictive or subject to abuse than many drugs now used as muscle relaxants, hypnotics, and analgesics.

-- Marihuana: An Old Medicine Of The Future, By Lester Grinspoon, M.D. and James B. Bakalar

Since 1987 in South Australia and 1992 in the Australian Capital Territory, an "expiation" scheme has been in place in cases of simple possession of small amounts of cannabis. Under these schemes, the offender may pay a small fine, thereby avoiding criminal conviction and record. Studies by [the] South Australian Office of Crime Statistics found that these schemes did not result in any significant increase in the number or type of persons caught using marihuana.

Again, in those American states (eleven) which have reduced the possession of marihuana from a criminal offence to a regulatory offence (enforced by way of a ticket or fine), consumption rates do not appear to have been significantly affected. These rates are not out of line with the rates of use in comparable states where possession of marihuana is punishable by imprisonment. At times they are actually lower, suggesting that marihuana consumption rates tend to rise and fall independent of the law."

-- R. v. Caine, (April 20, 1998)

"Many dopers claim to have smoked pot for decades and insist they are still not addicted. Denial and self-centeredness are two of the great hallmarks of the addict."

Cannabis is not an addictive substance;

Less than 1% of marijuana consumers are daily users;

-- R. v. Clay, (August 14, 1997)

In summary, although few marijuana users develop dependence, some do. But they appear to be less likely to do so than users of other drugs (including alcohol and nicotine), and marijuana dependence appears to be less severe than dependence on other drugs. Drug dependence is more prevalent in some sectors of the population than others, but no group has been identified as particularly vulnerable to the drug-specific effects of marijuana. Adolescents, especially troubled ones, and people with psychiatric disorders (including substance abuse) appear to be more likely than the general population to become dependent on marijuana.

If marijuana or cannabinoid drugs were approved for therapeutic uses, it would be important to consider the possibility of dependence, particularly for patients at high risk for substance dependence. Some controlled substances that are approved medications produce dependence after long-term use; this, however, is a normal part of patient management and does not generally present undue risk to the patient.

-- Marijuana and Medicine: Assessing the Science Base, National Academy of Sciences, Institutute of Medicine, 1999.

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