The scuttlebutt on the drug-culture grass line always did hold that marijuana was good medicine.
As it turns out, Queen Victoria reportedly used it for menstrual cramps (with what success we are not told). Her physician, Dr. J. Russell Reynolds, thought it (he called it India hemp) would be useful in "cases of so-called epilepsy in adults, but which, in my opinion, (are) the result of organic disease of a gross character in the neverous centers . . . (for which) India hemp is the most useful agent with which I am acquainted."
So he wrote in the March 22, 1890, issue of the venerable and highly respected British medical journal, The Lancet.
The folks who dug up this and other actual historical tidbits about the therapeutic value of Delta-9-tetrahydrocannabinol (THC), the thing in marijuana that gives it its zing, are unsurprisingly the people at the Medical Reclassification Project at NORML (National Organization for the Reform of Marijuana Laws).
Their natural bias notwithstanding, some studies in the late 1970s are beginning to lead doctors to the conclusion that given receptive patients and the right conditions, THC can be medically useful, and, on occasion, quite possibly more useful than anything else currently available.
Its success (not a universal one, however) in treating glaucoma, the progressive illness affecting the eyes, has been widely publicized, but marijuana is coming under clinical scrutiny for a number of other clinical uses as well.
The latest studies pick up where Dr. Reynolds left off 90 years ago, and are checking out THC for its relief of the kind of spasticity that comes with diseases like multiple sclerosis or after strokes. A different cannabinol is being tested for use in epilepsy.
At the Hershey Medical Center of Pennsylvania State University, Drs. Carl Ellenberger and Denis Petro, then with the Food and Drug Administration, conducted a pilot study with about a dozen multiple-sclerosis patients, using low doses of THC in capsules and a placebo in an identical capsule. Spasticity declined significantly more (for short periods of time) when THC was taken than when the patient received the placebo. The patients, of course, never knew which they were getting or when. In four patients there was, Ellenberger subsequently reported, "substantial benefit" from THC.
A broader study is about to get underway. Although "there are some other drugs for spasticity, they are not terribly satisfactory," Ellenberger says. "Though heavily promoted by drug companies they have major disadvantages," including liver toxicity and other dangers. He warns that while THC may be helpful for MS victims, it does not mean a cure.
Most of the current studies of the medical uses for THC involve its potential in controlling the nausea and vomiting that too often accompanies chemotherapy for cancer victims. One such study now underway at Georgetown University here is showing positive early results.
Studies elsewhere already had established that THC was better than a sugar pill; the newer programs like Georgetown's are attempting to compare THC with some of the other available anti-emetic drugs such as Compozine.
The medical community finds it tricky to deal with marijuana because it is classified as a schedule I drug -- defined as one with a high-abuse potential and no currently accepted medical value. To use it legally a researcher must obtain a narcotics registration, take security precautions and bow to the circuitous and often agonizingly slow way the government churns out its business -- or delivers THC. As a result, doctors often are frustrated and impatient.
It is, says Dr. Ellenberger, "a hot issue."
It is, says Dr. Deborah Goldberg, a medical oncologist who helped initiate the Georgetown program, "a bureaucratic nightmare . . . cancer patients don't have time to wait . . . "
Dr. Robert Willette of the National Institute on Drug Abuse (NIDA) has little sympathy: "The frustration comes with individual doctors who really want to treat patients, not do research . . . but this drug has not yet been adequately studied. The evidence is encouraging, but we don't know."
Nevertheless, in the past 18 months 14 states (including Virginia, but not Maryland) have passed laws officially recognizing the medical value of marijuana and easing restrictions on physicans under certain medical circumstances.
Then there is the problem of the high.
Dr. Goldberg puts it this way: "You can say there are two kinds of people in the universe -- people who like to have their consciousness altered and people who don't."
By and large, where successes have been reported in the anti-emetic studies (which account for 22 of the 34 THC studies underway now with NIDA support), they have been with younger patients, most of whom had been at least occasional users, as at Georgetown.
In a study conducted at the Mayo Clinic by Dr. Charles G. Moertel and Dr. Stephen Frytak, where the average age was 60 years, "a more typical cancer population," according to Dr. Moertel, "we found that THC produced side effects -- sedation, incoordination and even a couple of hallucinations.
"For our group of adults -- not marijuana users -- it was not a pleasant experience and a substantial portion treated with marijuana dropped out, seriously distressed by the side effects."
(In Dr. Ellenberger's study, two patients complained of "highs" from the dose which is lower for spasticity, but, noted Ellenberger, one of those had been given only a placebo. The low does appears to be under the "high" threshold.)
In the research studies, THC is mostly being administered orally, not always the most effective method, especially when you are dealing with nausea, but, as Dr. Willette puts it, "cigarettes are just not an acceptable way for the members of the medical profession to administer drugs. It may be effective, but you're administering a whole bunch of carcinogens at the same time . . . "
NIDA is the "drug store," for the THC studies and gets its supply from the University of Mississippi on a contract basis. Some cigarettes also are supplied "as a backup," and THC also can be administered by injection, although a satisfactory injectable still eludes the pharmacology researchers.
Despite the continuing problems and controversy, more and more doctors are turning to marijuana -- mostly on a clinical, experimental basis -- in hopes that it will, as the folklore has had it for a millenium or so, offer help in areas where traditional pharmacology has not succeeded, or at least has not succeeded well enough.