Mr. Paddy Doyle and the Case for Medical Marijuana in Ireland
© Martin Cooke, B.Sc., Dip. Ed. (July 1997)
Introduction
Note: In this paper I hope to show that the current legal ban on the medical use of marijuana (cannabis, or Indian hemp) in Ireland should be withdrawn. The paper is largely a review of the literature concerning the medical status of marijuana.
In June 1997, Mr. Paddy Doyle, well known author of his best-selling autobiography, "The God Squad", created some controversy in the Irish media. This was due to the fact that his consultant had been refused permission by the then Minister for Health, Michael Noonan, T.D. to prescribe marijuana to help Mr. Doyle fight the symptoms of a debilitating disease from which he has suffered since childhood. The immediate controversy was, in a way, fairly short-lived, possibly due to the fact that the media had their attention diverted somewhat, due to the general election which had just taken place.
The issues surrounding the medical use of marijuana, however, are serious ones, and in this paper I intend to look at them in some detail.
Mr. Doyle suffers from Idiopathic Torsion Dystonia - a painful and incurable condition. He is subject to constant muscle spasms. Mr. Doyle says: "It starts first thing in the morning and continues right through the day. As an American consultant put it - it's like doing a work out in a gym for 16 hours a day." Let me use"
There is no known cause for the condition, which, though incurable, may be controlled by a mixture of anti-spasmodic drugs and muscle relaxants. But so far, according to Mr. Doyle, none of these prescribed drugs have worked for him.
Mr. Doyle claims that the only genuine relief he has got from these muscle spasms (apart from that gained by using alcohol which, as he points out, would very likely leave him drunk, and so and incapable of working) has been on two occasions when he had smoked marijuana at parties.
Consequently, Mr. Doyle's consultant had written to the then Minister for Justice, Mrs Owen, seeking permission to prescribe marijuana to his patient. Mrs. Owen passed the letter on to the then Minister for Health, Mr Noonan.
In his response Mr Noonan said marijuana is a Schedule One controlled drug under the Misuse of Drugs Acts 1977 and 1984 and that it has no recognised medical use. He said clinical research did not support medical claims made in favour of marijuana and that its use could lead to experimentation with other drugs. It was not, the letter concluded, the Government's stance to change the legal position on any drug including marijuana.
When interviewed about the reply, Mr. Doyle is quoted as saying:
"I wasn't expecting an overtly compassionate response, but the clinically cold letter I got back surprised
me.."
"The letter from Minister Noonan to the consultant is just so callous and cold. And the Department of
Justice simply said no. It's a controlled substance and that's it."
In the same Irish Times article Mr. Doyle made the point that he knows of a prominent consultant in the US who notes a 'definite improvement' in four dystonia sufferers who were given marijuana, and that the drug has also been licensed for use by people with specified illnesses in some US states.
Several points arise from the Minister's reply to Mr. Doyle's consultant. I intend in this paper take some of the statements made and consider them in turn.
I shall also later in the paper consider the suggestion that marijuana is a harmful drug, and possible moral and legal consequences there may be from disallowing Mr. Doyle's request.
The question of the prohibition of certain drugs for "recreational" use is not really the main purpose of this paper, in which I intend to look just at the current prohibition on the medical prescription of marijuana. Unfortunately, one of the often stated reasons for not removing cannabis from Schedule One is the fact that doing so may "send the wrong signals", so it is inevitable that the topic will be touched upon later in the paper. For a fuller discussion on the whole question of drug prohibition in Ireland, I would refer the reader to "Drugs, drug prohibition and crime: A response to Peter Charlton", by Tim Murphy.
"…marijuana is a Schedule One controlled drug…"
Marijuana has only been a Schedule 1 narcotic in the United States since 1970 (later than this in Ireland). It was classified in that year, along with LSD and heroin, as a Schedule 1 narcotic - a drug with no known medical use.
This change in the status of marijuana came about largely as a result of the use of the drug by members of the "hippy" movement of the late 1960's.
The argument that marijuana should be placed in Schedule 1 because it has no known medical use is dealt with in the next section.
In the U.S. morphine, cocaine and even Marinol - a synthetic derivative of marijuana's Delta-9-Tetrahydrocannabinol (THC) - are Schedule 2, which means doctors can prescribe them. Medical marijuana advocates, in the U.S. and elsewhere, argue that synthetic derivatives of marijuana, like Marinol, often don't work as well as the real thing - especially in a vomiting patient - and suggest that the marijuana itself should be moved to Schedule 2.
As a result of pressure by medical marijuana advocates, in the U.S., as many as 87% of the legislators in thirty-four states have voted to end the medical prohibition of marijuana.
As recently as November 1996, voters in California and Arizona approved ballot initiatives which legalised medical access to marijuana
Proposition 215 in California creates a defence to criminal charges if a doctor recommends medical use of marijuana to a patient . Proposition 200 in Arizona, among other things, allows a doctor to prescribe any Schedule I drug if it is supported by another doctor and the medical literature.
In spite of these votes, the Federal Government of the U.S. still puts obstacles in the way of the states who wish to implement these changes.
In private correspondence I have been informed that Swedish Television News (6 June 1997) reported that hospitals in Denmark have begun treating patients with cannabis. The information I received was: "Swedish Television News reported … that Danish doctors have used both natural and synthetic cannabis in large scale treatment programmes. The hospitals carrying out the programme are Rigshospital in Copenhagen and Centralsjukhuset in Esbjerg. Cannabis in pill form is administered to AIDS and cancer patients and according to Dr. Erik Sandberg, Chief Physician at Esbjerg Central Hospital, results are good, cannabis removes sickness, increases appetite and increases the patients well being and will to live."
Medical use of marijuana is, in fact, legal in the U.S. However, the Federal Drug Agency's "Compassionate IND program for medical marijuana" was withdrawn in March of 1992, largely as a result of lobbying by "War on Drugs" hard-liners. Hundreds of applications for the Compassionate programme were trashed, denying the patients access to the medical care that their physicians considered that they needed. Only the handful of existing patients under the scheme (there was a total of ten in February, 1992) escaped.
"...it [marijuana] has no medical use…"
I do not intend to try to list all the possible medical uses of cannabis, but the following may be of interest:
* The medical use of marijuana probably predates recorded history. The earliest known written reference is to be found in the fifteenth century BC, Chinese Pharmacopoeia, the Ry-Ya.
* The first Western physician to take an interest in cannabis as a medicine was W. B. O'Shaughnessy, a young professor at the Medical College of Calcutta, who had observed its use in India in the first half of the nineteenth century. After studying the literature on cannabis and talking with contemporary Hindu and Mohammedan scholars O'Shaughnessy tested the effects of various hemp preparations on animals, before attempting to use them to treat humans. Satisfied that the drug was reasonably safe, he administered preparations of cannabis extract to patients, and discovered that it had analgesic and sedative properties. O'Shaughnessy successfully relieved the pain of rheumatism and stilled the convulsions of an infant with the drug. His most spectacular success came when he quelled the wrenching muscle spasms of tetanus and rabies with the "new" drug.
* In 1860 Dr. R. R. M'Meens reported the findings of the Committee on Cannabis Indica to the Ohio State Medical Society. After acknowledging a debt to O'Shaughnessey, M'Meens reviewed symptoms and conditions for which Indian hemp had been found useful, including tetanus, neuralgia, dysmenorrhea (painful menstruation), convulsions, rheumatic and childbirth pain, asthma, postpartum psychosis, gonorrhoea, and chronic bronchitis. As a sleep-inducing drug he compared it to opium: "Its effects are less intense, and the secretions are not so much suppressed by it. Digestion is not disturbed; the appetite rather increased; ... The whole effect of hemp being less violent, and producing a more natural sleep, without interfering with the actions of the internal organs, it is certainly often preferable to opium." Like O'Shaughnessey, M'Meens emphasised the remarkable capacity of cannabis to stimulate appetite.
This stimulation of appetite by marijuana has led to recent calls for its use to be permitted by AIDS patients to prevent the weight loss which commonly occurs as the disease progresses, and also by cancer patients who often have no will to eat during the treatment of their disease.
* Between 1840 and 1900, European and American medical journals published more than 100 articles on the therapeutic use of the drug known then as Cannabis indica (or Indian hemp) and now as marijuana.
* Concerning migraine headache, Osler stated in 1916: "Cannabis indica is probably the most satisfactory remedy".
* An article in 1949, reported that a substance related to THC (the active ingredient in cannabis) controlled epileptic seizures in a group of children more effectively than diphenylhydantoin (Dilantin(R)), a most commonly prescribed anticonvulsant.
* In UCLA, in the US, during a course of a study on the effects of marijuana on driving, it was incidentally discovered that cannabis lowers intraocular pressure, thus being possibly useful in the treatment of glaucoma. Glaucoma is the most common cause of blindness in the world.
* Tod H. Mikuriya, M.D., writing in 1973 listed the following "Possible Therapeutic Applications of Tetrahydrocannabinols and Like Products":
Analgesic-hypnotic
Appetite stimulant
Antiepileptic-antispasmodic
Prophylactic and treatment of the neuralgias, including migraine and tic douloureux
Antidepressant-tranquilizer
Antiasthmatic
Oxytocic
Antitussive
Topical anesthetic
Withdrawal agent for opiate and alcohol addiction
Childbirth analgesic
Antibiotic
Intraocular hypotensive
Hypothermogenic
* The main active substance in cannabis, [delta-9]-tetrahydrocannabinol ([delta-9]-THC), has been available for use in the United States for limited purposes as a Schedule II synthetic drug since 1985.
"..clinical research did not support medical claims made in favour of marijuana…"
It is not true to say that clinical research does not support claims that marijuana has any medical use. One great problem here, is that just about every request to perform clinical research on the benefits of marijuana has been met with refusal.
For example, in the US, in response to a lawsuit brought by advocates of the medical use of marijuana, an administrative law judge with the Drug Enforcement Administration (DEA) recommended in 1988 that the federal legal classification of marijuana be changed so that physicians can prescribe it.
The DEA did not implement the recommendation.
In 1992, Richard Bonner, then DEA administrator, offered this suggestion: "Those who insist that marihuana has medical uses would serve society better by promoting or sponsoring more legitimate scientific research, rather than throwing their time, money, and rhetoric into lobbying, public relations campaigns, and perennial litigation."
As a result, Donald Abrams, of the University of California, San Francisco, sought permission to conduct a privately financed pilot study comparing three potencies of inhaled marijuana (high, medium, and low) with oral delta-9-tetrahydrocannabinol (dronabinol) capsules, which are available by prescription in the United States, for the treatment of weight loss associated with the AIDS wasting syndrome. Dr. Abrams's protocol (Investigational New Drug No. 43,542) was designed in consultation with the Food and Drug Administration (FDA) and approved by the FDA, the University of California, San Francisco, institutional review board, the California Research Advisory Panel, and the scientific advisory committee of the San Francisco Community Consortium.
Unfortunately, the U.S. government will not allow Dr. Abrams to obtain a legal supply of marijuana.
The DEA refused to permit him to import marijuana from Hortapharm, a company licensed by the government of the Netherlands to cultivate cannabis for botanical and pharmaceutical research. The National Institute on Drug Abuse (NIDA), which controls the domestic supply of marijuana for clinical research, rejected Dr. Abrams's request in April 1995
The British Medical Association at it's annual meeting in June 1997 called on the UK government to legalise of the use of drugs derived from cannabis for the treatment of seriously ill and dying patients. The association's board of science and education is preparing a report on the medical use of cannabinoids drugs derived from cannabis which is due to be published in September 1997.
"…(marijuana's) use could lead to experimentation with other drugs…"
This is the 'stepping stone' or 'gateway' theory - the idea that the use of marijuana will lead to the use and addiction to other, and possibly more dangerous drugs.
All the serious international research has refuted this suggestion:
* The La Guardia report (1944) states: "The use of marijuana does not lead to morphine or heroin or cocaine addiction". [23]
* The Jamaican Study carried out on behalf of The Center for Studies of Narcotics and Drug Abuse of the National Institute of Mental Health. Directed by Drs. Vera Rubin and Lambros Comitas of the Research Institute for the Study of Man and conducted in Jamaica. Summarising the findings of the study in the July 4, 1975 issue of Science Magazine, Dr. Erich Goode of the State university of New York at Stony Brook wrote:
"One of the more interesting findings to emerge from this study relates to the 'stepping-stone' hypothesis. ...
Nothing like that occurs among heavy, chronic ganja smokers of Jamaica. No other drugs were used, aside
from aspirin, tea, alcohol, and tobacco. The only hard drug use known on the island is indulged by North
American tourists." [24]
* The 15-month study conducted by the Institute of Medicine of the National Academy of Sciences (NAS), and released in 1982, analysed the habits of American marijuana smokers and offered one of the most comprehensive and balanced analyses ever compiled regarding marijuana and its effects. In regards to marijuana's gateway potential, the study concluded that, "There is no evidence to support the belief that the use of one drug will inevitably lead to the use of any other drug." [25]
* From the USA, the 1995 guidebook: Marijuana: Facts for Teens, published by the U.S. Department of Health and Human Services (HHS), states unequivocally that, "Most marijuana users do not go on to use other drugs." [26]
* Finally, a quote from the Irish Government's 1991 Drug Strategy document: "While cannabis use seems to be on the increase among young people, it is usually not an ongoing regular pattern of misuse." [27]
Advantage of marijuana over synthetic derivatives [28]
It is ironic, in a way, that after decades of pretending marijuana is medically useless, U.S. federal drug agencies are now aggressively pushing synthetic Marinol, the so-called "pot pill," by arguing it is as safe and effective as marijuana. [29]
Many patients who used Marinol suggest that it is an inferior substitute. One AIDS patient told a reporter: "I tried [Marinol]. I went through five pills before I was able to keep one down....When I did manage to keep one down it took a long while to take effect, and only worked about half a day. Two or three tokes on a joint helps me immediately." [30]
Cancer patients quickly discovered smoking marijuana to be far more effective than swallowing oral THC pills. [31]
During the DEA hearings before Judge Young, one researcher, Norman Zinberg, M.D., testified that during his 1974 research nearly half the patients quit his legal, THC-based study in order to obtain illegal, but more effective, marijuana. [32]
Zinberg's observations were amplified in an internal National Cancer Institute (NCI) memo in 1978. Synthetic THC is described as "erratic," "unpredictable," and finally dismissed as "unfit" for human use. Marijuana cigarettes, by contrast, are described as "reliable" and "highly predictable." After reviewing the available evidence the cancer specialists at NCI concluded, "All in all the [marijuana] cigarette may be the best means of delivering the drug." [33]
After reviewing the available evidence DEA Judge Francis L. Young concluded Marinol is not an adequate substitute for marijuana. Judge Young wrote: "Marijuana cigarettes in many cases are superior to synthetic THC capsules in reducing chemotherapy-induced nausea and vomiting. Marijuana has an important, clear advantage over synthetic THC capsules in that natural marijuana is inhaled and generally takes effect more quickly than the synthetic capsule which is ingested and must be processed through the digestive system before it takes effect." [34]
In 1992 , Dr. Robert Gorter, a primary researcher of synthetic Marinol's use in AIDS therapy, echoed Zinberg's testimony: "Again and again patients have testified that they preferred marijuana above dronabinol [Marinol] for its appetite stimulating effect. Therefore, it is hoped that marijuana will stay an option for the medical treatment of [wasting syndrome] in AIDS patients." [35]
Possibly one reason why inhaled marijuana is superior to synthetic THC is the speed of delivery: When inhaled, marijuana reduces nausea and vomiting within five to ten minutes. [36]
Marinol, when ingested, takes 1 to 4 hours to start working. This gives patients plenty of time to throw-up the pill. This is of particular relevance to patients undergoing cancer therapy, as the very nature of the therapy often makes these patients nauseous.
Furthermore, marijuana, when inhaled, works so quickly that patients are able to exercise very fine control over their dose. Once relief is achieved they can simply stop smoking. On the other hand, a patient can exercise no control over an oral dose; once the pill is swallowed all further control is lost. Moreover, because oral THC takes so long to work, and usually works erratically and unpredictably, patients may take a second oral dose. For this reason adverse psychological effects are far more common among people employing oral Marinol than among those smoking marijuana.
The difference in chemical composition between marijuana and Marinol must also be taken into account.: Marijuana, like all naturally occurring substances, is chemically complex. It has more than 400 chemical ingredients. Little is known about which chemical ingredients - or what combinations of ingredients - are responsible for the plant's multiple therapeutic actions.
It is a fact that U.S. Federal agencies did not approve Marinol because of evidence indicating delta-9 THC is marijuana's most therapeutically-active ingredient. Delta-9 THC was synthesised to facilitate drug abuse research on marijuana's psychoactive effects. Trapped by their legal fixation on psychoactive effects, federal agencies simply assumed, despite ample evidence to the contrary, that what gets you "high" may also make you well.
The irony, of course, is that to avoid making marijuana medically available, federal agencies are now aggressively promoting a synthetic alternative which contains pure THC which is profoundly more psycho-active than marijuana in its natural form. [37]
The "harmful" effects of cannabis
Although cannabis had been demonised for the past half century or so, it is, in fact, a harmless drug.
* Roger Pertwee (Aberdeen University) says: "It is noteworthy that there have been no reports of any human deaths associated with the consumption of cannabis or cannabinoids. In this regard cannabinoids differ from several drugs that can be prescribed in the UK and that do sometimes kill patients, for example the analgesics, morphine (excessive respiratory depression induced by overdose) and aspirin (gastric bleeding induced by recommended doses). The safety of cannabinoids may stem from the fact that the part of the brain primarily responsible for controlling vital functions such as heart beat, circulation of the blood and respiration (the brain stem) contains relatively few cannabinoid receptors." [38]
* In a landmark case in America, the Drug Enforcement Administration's own Administrative Law Judge, Francis Young, found the following:
"In strict medical terms marijuana is far safer than many foods we commonly consume. For example, eating ten raw potatoes can result in a toxic response. By comparison, it is physically impossible to eat enough marijuana to induce death."
"Marijuana, in its natural form, is one of the safest therapeutically active substances known to man. By any measure of rational analysis marijuana can be safely used within a supervised routine of medical care." [39]
* An Editorial in the Journal 'The Lancet', opened with the words: "The smoking of cannabis, even long term, is not harmful to health." The same article ended with: "Sooner or later politicians will have to stop running scared and address the evidence: cannabis per se is not a hazard to society but driving it further underground may well be". [40]
Legal and Moral Considerations
One of the arguments that is often used for retaining marijuana's status as a Schedule One drug is that to do otherwise would send a signal to the general public that the recreational use of marijuana could be considered harmless. As stated in the introduction, it is not my intention to consider the prohibition on the recreational use of this drug. However, in the U.S., the DEA's chief administrative law Judge Francis L. Young, wrote:-
"There are those who, in all sincerity, argue that the transfer of marijuana to Schedule II will 'send a signal'
that marijuana is 'OK' generally for recreational use. This argument is specious. It presents no valid reason
for refraining from taking an action required by law in light of the evidence. If marijuana should be placed
in Schedule II, in obedience to the law, then that is where marijuana should be placed, regardless of
misinterpretation of the placement by some. The reasons for the placement can, and should, be clearly
explained at the time the action is taken. The fear of sending such a signal cannot be permitted to override
the legitimate need, amply demonstrated in this record, of countless suffers for the relief marijuana can
provide when prescribed by a physician in a legitimate case." [41]
In the case of Mr. Doyle's condition, cognisance must be given to the fact that marijuana has been demonstrated on numerous occasions to relieve muscle spasm. [42]
* Mr Paddy Doyle has a right of access to medication for his illness. This is a basic human right, which could well be tested in the International Court of Human Rights.
I would urge the Irish Departments of Health and Justice to reconsider the request by his consultant for permission to prescribe cannabis for his condition.
Perhaps Ireland could in this case be seen to be leading research into the therapeutic uses of this drug, instead of blindly following the blinkered policies of the United States and other countries.
The Department of Health are already facing huge claims for damages as a result of the Hepatitis C controversy (as it did in the case of HIV and haemophiliacs). There is a danger that it could also face substantial damage claims if Mr. Doyle were to win a human rights case.
As noted above, in the Netherlands it is possible to source legal supplies of this drug. This would enable the Department of Health to obtain a supply of the drug. It would also mean that Mr. Doyle would not have to feel that he should have to associate with criminals if he were to decide to source this drug himself.
References:
1) "Let me use marijuana - I need it to ease pain", Evening Herald (Dublin), June 16 1997.
2) "Friendly Rottweiler who snaps at heels of authority", Irish Times, June 21, 1997
3) ibid.
4) ibid.
5) Evening Herald, June 16 1997 (above)
6) Tim Murphy, "Drugs, drug prohibition and crime: A response to Peter Charlton", (1996) 6 Irish Criminal Law Journal, 1-18
7) "Marijuana as Medicine: A Recent History (1976-1996) with Recommendations", Robert C. Randall & Alice M. O'Leary, 1997, Galen Press
8) ibid.
9) John Yates: Private Correspondence.
10) "Marijuana as Medicine, A Recent History" (above)
11) Therapeutic Aspects. 1975. Marijuana and Health, Fifth Annual Report to the U.S. Congress, Nat'l Institute on Drug Abuse, 118-119.
12) O'Shaughnessy, W. B.: "On the preparations of the Indian hemp, or gunjah," Trans. Med. and Phy. Soc., Bengal, 71-102, 1838-40; 421-61, 1842.
13) R. R. M'Meens, "Report of the Committee on Cannabis Indica," Transactions, Fifteenth Annual Meeting of the Ohio State Medical Society, Columbus, 1860.
14) Quoted in: "Marihuana as Medicine A Plea for Reconsideration", Journal of the American Medical Association (JAMA), June 21, 1995, Vol. 273, No. 23.
15) Osler, W., and McCrae, T.: Principles and Practice of Medicine, 8th Edition, D. Appleton and Co., New York, 1916, p. 1089.
16) Davis, J. P., and Ramsey, H. H.: "Antiepileptic action of marihuana-active substances," Federat. Proc., 8:284-85, Mar. 1949.
17) Hepler, R. S. and Frank, I. R. "Marihuana Smoking and Intraocular Pressure," JAMA, Sept. 6, 1971. Vol. 217, no. 10.
18) "Introduction" from "Marijuana: Medical Papers", Tod H. Mikuriya, M.D., Medi-Comp Press, 1973, pp. xiii-xxvii, describing some of the recent history of western medical explorations into the medicinal benefits of hemp drugs.
19) United States Department of Justice, Drug Enforcement Administration, In The Matter Of Docket No. 86-22 Marijuana Rescheduling Petition, Opinion and Recommended Ruling, Findings of Fact, Conclusions of Law and Decision of Administrative Law Judge. Francis L. Young, Administrative Law Judge, Dated: Sep 6 1988.
20) Marijuana scheduling petition: denial of petition: remand. Fed. Regist. 1992; 57: 10503.
21) "Marijuana, the AIDS Wasting Syndrome, and the U.S. Government". New England Journal of Medicine, Sept. 7, 1995, Vol. 333, No. 10, 670-671.
22) "Doctors back cannabis treatments for the seriously ill", The Times Newspaper (UK), July 3 1997.
23) 'The Marihuana Problem in the City of New York': Sociological, Medical, Psychological, and Pharmacological Studies by the Mayors Committee on Marihuana. The Jaques Cattell Press, Lancaster, Pennsylvania, 1944, p. 25.
24) Goode, Erich. "Effects of Cannabis in Another Culture." Science Magazine: July 1975, 41-42.
25) "Marijuana and Health: Report of a Study by a Committee of the Institute of Medicine." National Academy Press, Washington, D.C., 1982, p. 47.
26) "Marijuana: Facts for Teens." U.S. Department of Health and Human Services. Washington, D.C. 1995, p.10.
27)"Government Strategy to Prevent Drug Misuse", Dublin, Department of Health, 1991, p.8.
28) The majority of this section has been taken from: "Marijuana as Medicine: A Recent History (1976-1996) with Recommendations", Robert C. Randall & Alice M. O'Leary, 1997, Galen Press.
29) "One alternative is the use of the oral dosage form of the major active ingredient in marijuana, delta-9 THC.... Its trade name is Marinol.... Marinol may be as effective and even less likely to cause adverse effects than smoking marijuana cigarettes in controlling your patient's symptoms." Information for the Physician on the Use of Marijuana Cigarettes Provided by the National Institute on Drug Abuse, Fact Sheet prepared by NIDA, August 1991.
30) "They Smoke Pot, But Not to Get High," by Sylvia Rubin, San Francisco Chronicle, March 13, 1992.
31) "Theoretically, smoking might be the preferable route since it results in less variability of absorption through the gastro-intestinal route. Moreover, smoking provides greater opportunity for individual patient control by permitting the patient to regulate….." S. Sallan, M.D., N. Zinberg, M.D., & E.I. Frei III, M.D. "Antiemetic Effect of Delta-9-Tetrahydrocannabinol in Patients Receiving Cancer Chemotherapy," New England Journal of Medicine, Vol. 293, No. 16, (October 15, 1975), 795-797.
32) Direct Testimony of Norman Zinberg, M.D., Marijuana, Medicine & The Law, Vol. I, p. 416
33) National Cancer Institute, internal memo dated May 15, 1978. Minutes of a May 9, 1978 meeting, pages 1 & 4.
34) In The Matter Of Docket No. 86-22 Marijuana Rescheduling Petition (above) Robert Gorter, M.D.
35) "Management of Anorexia-Cachexia in Advanced HIV Disease," PAACNOTES, Vol. 3, No. 5, 1992.
36) "Marijuana cigarettes have been used to treat chemotherapy-induced nausea and vomiting and research has shown that the active ingredient THC is more readily and quickly absorbed from marijuana smoke than from an oral preparation of the substance." From Marijuana For Chemotherapy-Induced Nausea and Vomiting, Fact Sheet Prepared by the (U.S.) National Cancer Institute, February 12, 1992.
37) A Harvard University survey of oncologists found that 44% of cancer specialists believe marijuana is more effective than Marinol and 47% stated Marinol caused negative side effects. "Marijuana as Antiemetic Medicine: A Survey of Oncologists Experiences and Attitudes," Journal of Clinical Oncology, (July 1991), p. 1316.
38) Pertwee, R.G., "The evidence for the existence of cannabinoid receptors", Gen. Pharmacol. 24, 1993, 811-824.).
39) In The Matter Of Docket No. 86-22 Marijuana Rescheduling Petition (above)
40) "Deglamorising cannabis", The Lancet, Volume 346, Number 8985, November 11 1995.
41) In The Matter Of Docket No. 86-22 Marijuana Rescheduling Petition (above)
42) Examples include: Carlini, E., Leite, J., Tannhauser, M. and Berardi, A. (1973). Cannabidiol and cannabis sativa extract protect mice and rats against convulsive agents. J. Pharm. Pharmac., 25, 664-665; Dunn, M. and Davis, R., (1974). The perceived effects of marijuana on spinal cord injured males, Paraplegia, 12, 175; Consroe, P., Wood, G., and Buchsbaum, H. (1975).
Anticonvulsant nature of marijuana smoking. JAMA, 234, 306-307; Feeney, D.M., Marihuana and epilepsy: paradoxical anticonvulsant and convulsant effects, Marijuana Biological Effects: Analysis, Metabolism, Cellular Responses, Reproduction and the Brain, (Nahas, GG., Paxton, M., Bruade, J.C., Hardillier, and Harvey, D.J. eds.) Pergamon Press, Oxford, England, 643-657; Petro, D., (1980), Marihuana as a therapeutic agent for muscle spasm of spasticity, Psychosomatics, 21: 81, 85.; Cannabis, (1986) Therapeutic Claims in Multiple Sclerosis, Int'l Federation of Multiple Sclerosis Societies, 226.
