Patients’ Experiences and Their
Following state laws that allow for the medical
use of cannabis, an increasing number of patients have collected
experience with cannabis. Many reported benefits from its
use. Some of this experience has been confirmed in reports
and clinical investigations or stimulated clinical research
that confirmed these patients' experience on other patients
suffering from the same disease
Several examples show that the attitude of people
towards the medical use of cannabis is based on such personal
experience. Lynn Nofziger, the former White House director
of communication and chief speech writer of President Ronald
Reagan, stated in a foreword to a book on the medical use
"Strange as it may seem, here is one right-wing
Republican who supports carefully controlled, medical access
to marijuana. When our grown daughter was undergoing chemotherapy
for lymph cancer, she was sick and vomiting constantly as
a result of her treatments. No legal drugs, including the
synthetic "marijuana" pill Marinol™, helped
her situation. As a result we finally turned to marijuana
which, of course, we were forced to obtain illegally. With
it, she kept her food down, was comfortable, and even gained
weight. (...) A doctor should have every possible medication
-- including marijuana -- in his armentarium. (...)"
In several investigations, patients’ experiences
were collected by health care professionals and scientists.
Among these investigations is the report "Cannabis. The
scientific and medical evidence" by the British House
of Lords Select Committee on Science and Technology (1998)
and " Marijuana and medicine: Assessing the science base"
by the U.S. Institute of Medicine (Joy et al. 1999)
The IOM report, "Marijuana and Medicine:
Assessing the Science Base," was ordered by the White
House Office of National Drug Control Policy in January 1997
(Joy et al. 1999). Review of available information began in
August 1997, including several public hearings, site visits
to cannabis buyers' clubs and HIV/AIDS clinics, and months
of examining the existing scientific database. The report
urges politicians to soften their hard line against the therapeutic
use of cannabis and states that marijuana is potentially effective
for some symptoms. It recommends rigorous clinical trials
and development of a delivery system that eliminates the harmful
effects of smoking. Beyond the harms of smoking, the range
of problems associated with medical marijuana were within
the acceptable range of problems associated with other medications.
Under the headline "Who Uses Medical Marijuana?"
the IOM Report of 1999 says:
"There have been no comprehensive surveys
of the demographics and medical conditions of medical marijuana
users, but a few reports provide some indication. In each
case, survey results should be understood to reflect the situation
in which they were conducted and are not necessarily characteristic
of medical marijuana users as a whole. ... The membership
profile of the San Francisco club was similar to that of the
Los Angeles Cannabis Resource Center (LACRC), where 83% of
the 739 patients were men, 45% were 36-45 years old, and 71%
were HIV-positive.... Among the 42 people who spoke at the
public workshops or wrote to the study team, only six identified
themselves as members of marijuana buyers' clubs. Nonetheless,
they presented a similar profile: HIV - AIDS was the predominant
disorder, followed by chronic pain (table 1.3) [not included
here]. All HIV-AIDS patients reported that marijuana relieved
nausea and vomiting and improved their appetite. About half
the patients who reported using marijuana for chronic pain
also reported that it reduced nausea and vomiting" (Joy
et al. 1999).
With regard to the therapeutic potential the
"The accumulated data indicate a potential
therapeutic value for cannabinoid drugs, particularly for
symptoms such as pain relief, control of nausea and vomiting,
and appetite stimulation. (…)
The effects of cannabinoids on the symptoms
studied are generally modest, and in most cases, there are
more effective medications. However, people vary in their
responses to medications and there will likely always be a
subpopulation of patients who do not respond well to other
medications" (Joy et al. 1999).
Gieringer (2002) noted that the indications
for the medcial use of cannabis in medical cannabis clubs
changed in recent years, shifting from predominantly HIV/AIDS
to chronic pain, due to three reasons, (1) a heightened appreciation
among physicians of cannabis’s utility for other conditions;
(2) an exodus of former cannabis clubs members to new clubs,
and (3) a decline in the number of HIV/AIDS patients with
wasting syndrome due to the advent of protease inhibitors.
"Surveys of C.B.C. members show that cannabis
is used for a wide variety of indications. Initial reports
from the S.F. C.B.C. showed a high concentration of people
with AIDS. A 1993-5 survey of 351 randomly-selected members
of the S.F.C.B.C found that 87% (N=305) had a medically verified
illness, of whom fully 84.5% (N=258) were HIV positive, a
majority being diagnosed with AIDS.1 Approximately 2% each
were diagnosed with multiple sclerosis (N=6) or severe musculoskeletal
disorders (N=7); another 11% (N=34) were diagnosed with conditions
such as cancer, glaucoma or other diseases. The sample closely
reflected the gender and age distribution of San Francisco’s
AIDS population (90% male and a median age of 36).
More recent surveys from other clubs reveal
a far more diverse population. Table 12.1 [not included here]
summarizes two surveys by Mandel of members of the Oakland
Cannabis Buyers’ Cooperative (J. Mandel, 1997 and 1998,
unpublished). Mandel’s first survey, in 1997, found
a preponderance of AIDS patients. This is not surprising,
since the O.C.B.C. absorbed a heavy influx of patients from
San Francisco when the S.F. C.B.C. was first (temporarily)
closed in 1996-7. More recently, Mandel’s data show
that the population of people with AIDS has declined to 29%
and is now smaller than those with chronic pain and related
disorders (40%, by Mikuriya’s classification . . .)"
In several surveys conducted with patients with
several diseases, cannabis preparations have been reported
to be helpful.
471 persons with spinal cord injuries were asked
about their experience with different pain treatments. The
treatments rated as most helpful were opioid medications,
physical therapy, and diazepam therapy (Warms et al 2002).
Those rated as least helpful were spinal cord stimulation,
counseling or psychotherapy, administration of acetaminophen,
and administration of amitriptyline. Alternative treatments
reported as most helpful were massage therapy and use of cannabis.
In a survey by Consroe et al. (1997), 53 UK
and 59 U.S.A people with multiple sclerosis (MS) answered
anonymously the first questionnaire on cannabis use and MS:
"From 9 to 30% of the subjects reported
cannabis improved (in descending rank order): spasticity,
chronic pain of extremities, acute paroxysmal phenomenon,
tremor, emotional dysfunction, anorexia/weight loss, fatigue
states, double vision, sexual dysfunction, bowel and bladder
dysfunctions, vision dimness, dysfunctions of walking and
balance, and memory loss. The MS subjects surveyed have specific
therapeutic reasons for smoking cannabis. The survey findings
will aid in the design of a clinical trial of cannabis or
cannabinoid administration to MS patients or to other patients
with similar signs or symptoms" (Consroe et al. 1997).
A similar investigation was conducted with patients
suffering from spinal cord injury and presented at the 1998
Symposium of the International Cannabinoid Research Society
(Consroe et al. 1998). A questionnaire was mailed out via
an intermediate bulk mailing to the Alliance for Cannabis
Therapeutics (ACT) of the U.S. Of the 190 mailed questionnaires
106 were returned as valid. 87% of the respondents were male
and 13% were female with a mean age of 40 years (range: 18
to 61 years). Patients smoked marijuana for an average of
12 years, a mean of 4 marijuana cigarettes per day, mostly
to relieve symptoms. Over 70% of patients took marijuana together
with their other spasmolytic and analgesic medications. 82%
reported that symptoms worsened when stopping their use of
cannabis. Improvement with marijuana was reported from 99%
to 70% of patients (in descending order) for spasms of legs,
arms and bladder, muscle and phantom pains, headache, urinary
urgency, and paralysis. In less than 70%, improvement was
noticed for other bladder dysfunctions, bowel dysfunctions,
weakness, and paresthesias. "The results indicate that
SCI patients have specific therapeutic reasons for smoking
marijuana," the meeting abstract says.
There are several surveys conducted in other
countries, among them Australia, The Netherlands and Germany,
describing medicinal benefits from cannabis use in several
diseases (Barsch 1996, Schnelle et al. 1999, Helliwell 1999,
Mueller-Vahl et al. 1997, TNO Preventie en Gezondheid 1998)
The medical use of cannabis not only increased
in the U.S., but also in other countries. 1.9 percent of Canadians
reported using marijuana for a medical reason in the year
preceding a survey of the Centre for Addiction and Mental
Health. Interviews were completed with 2508 Ontario adults
aged 18 years or more. 49 respondents (1.9%) reported using
marijuana for a medical reason in the year preceding the survey.
Eighty-five percent of the surveyed medical marijuana users
reported using it to help relieve pain or nausea (Ogborne
et al. 2000).
Cannabis preparations are used in the treatment
of numerous diseases, with marked differences in the available
supporting data. For applications such as nausea and vomiting
associated with cancer chemotherapy; anorexia and cachexia
in HIV/AIDS, and spasticity in multiple sclerosis and spinal
cord injury, there is strong evidence for medical benefits.
For indications such as epilepsy, movement disorders and depression
there is much less available data. However, the history of
clinical use of cannabis and cannabinoids has demonstrated
that the scientific evidence for a specific indication does
not implicitly reflect the actual therapeutic potential for
a given disease.
Clinical studies with single cannabinoids or,
less often, with whole plant preparations (smoked marijuana,
encapsulated cannabis extract) have often been inspired by
positive anecdotal experiences of patients employing crude
cannabis products (usually without legal sanction). The most
often mentioned benefits are the anti-emetic (Dansak 1997),
the appetite enhancing (Plasse et al. 1991), the relaxing
(Clifford 1983), and the analgesic effects (Noyes & Baram
Research in recent years added to this pattern.
Mueller-Vahl et al. (1997) noted that several patients reported
therapeutic benefits from cannabis in Tourette syndrome (Gilles
de la Tourette syndrome). This observation resulted in a structured
interview which questioned 47 patients with Tourette syndrome
at the Medical School of Hannover/Germany on their use of
alcohol, nicotine and marijuana and the effects of these substances
on their symptoms. Cannabis was reported to have a positive
influence on the symptomatology.
"Using a structured interview, we questioned
a larger group of patients with Tourette syndrome (n=47) about
the use of nicotine, alcohol, and marijuana and their subjective
experiences. Of 28 smoking patients only 2 (7%) reported a
tic reduction when smoking [cigarettes]. Of 35 patients drinking
alcohol 24 (69%) noted an improvement. Thirteen patients reported
the use of marijuana, of whom 11 (85%) noted a marked improvement.
Our results provided strong evidence that alcohol and, even
more than that, marijuana cause much more improvement in TS
than nicotine smoking". (...)
With respect to the considerable side effects
of those therapy forms presently in use that apply neuroleptics,
and considering the limited alternatives, cannabinoids could
be used for therapy in the future, when further clinical research
by way of controlled studies will have been conducted"
(Mueller-Vahl et al. 1997).
These results stimulated research on the efficacy
of dronabinol in Tourette syndrome, a study with one patient
(Mueller-Vahl et al. 1999a), followed by a randomized double-blind
placebo-controlled crossover trial of delta-9-THC in 12 adults
(Mueller-Vahl et al. 1999b). Both confirmed the patients'
experience described in the interviews.
In several studies, patients’ experiences
have been further investigated usually leading to a confirmation
of their subjective experience. A patient with multiple sclerosis
reported a reduction of spasticity and tremor with smoking
a cannabis cigarette. This was confirmed in a single case
study with smoked cannabis (Meinck et al. 1989). A patient
with spinal cord injury reported a reduction of spasticity
and pain with smoking cannabis. This experience was confirmed
in an extended double-blind controlled study of several weeks
with dronabinol (Maurer et al. 1990). A patient with multiple
sclerosis who had experienced relief from cannabis smoking
received the synthetic THC derivative nabilone in a double
blind manner (Martyn et al. 1995). Spasticity was reduced
and bladder function was improved with the verum. A patient
with a ten-year history of acute and chronic abdominal pain
from Familial Mediterranean Fever who required daily morphine
(30mg) for analgesia had experienced relief from smoked cannabis
(Holdcroft et al. 1997). This subjective experience was confirmed
in a double-blind study with a capsulated cannabis extract.
The authors stated:
"This is the first United Kingdom report
of the controlled use of a standardised pharmaceutical preparation
of cannabinoids in capsular form. The therapy was assessed
in a patient with familial Mediterranean fever, who presented
with chronic relapsing pain and inflammation of gastrointestinal
origin. After determining a suitable analgesic dosage, a double-blind
placebo-controlled cross-over trial was conducted using 50
mg tetrahydrocannabinol daily in five doses in the active
weeks and measuring effects on parameters of inflammation
and pain. Although no anti-inflammatory effects of tetrahydrocannabinol
were detected during the trial, a highly significant reduction
(p < 0.001) in additional analgesic requirements was achieved"
(Holdcroft et al. 1997).
In an extended study, patients who receive cannabis
through a Compassionate Investigational New Drug Program (IND)
of the Food and Drug Administration (FDA) and obtain it from
the National Institute on Drug Abuse (NIDA) were examined
with regard to medicinal benefits from smoked cannabis and
long-term side effects. Therapeutic effects on several conditions
could be confirmed (Russo et al. 2002).
These patients’ reports and supporting
clinical research confirm that the subjective benefits from
cannabis experienced by many patients, suffering from a range
of illnesses and symptoms, have a rational basis.
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Clifford DB. Tetrahydrocannabinol for tremor in multiple sclerosis.
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Consroe P, et al: Reported marijuana effects in patients with
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