1807. Marijuana Liquid Extract May Bring Hope for Children With Severe Epilepsy

By Science Daily, April 13, 2015

A medicinal liquid form of marijuana may show promise as a treatment for children with severe epilepsy that is not responding to other treatments, according to a study released today that will be presented at the American Academy of Neurology's 67th Annual Meeting in Washington, DC, April 18 to 25, 2015.

The study involved 213 people, ranging from toddlers to adults, with a median age of 11 who had severe epilepsy that did not respond to other treatments. Participants had Dravet syndrome and Lennox-Gastaut syndrome, epilepsy types that can lead to intellectual disability and lifelong seizures, as well as 10 other types of severe epilepsy.

The participants were given the drug cannabidiol, a component of marijuana that does not include the psychoactive part of the plant that creates a "high." The drug is a liquid taken daily by mouth. Participants all knew they were receiving the drug in the open-label study, which was designed to determine whether the drug was safe and tolerated well.

Researchers also measured the number of seizures participants had while taking the drug. For the 137 people who completed the 12-week study, the number of seizures decreased by an average of 54 percent from the beginning of the study to the end. Among the 23 people with Dravet syndrome who finished the study, the number of convulsive seizures had gone down by 53 percent by the end of the study. For the 11 people with Lennox-Gastaut syndrome who finished the study, there was a 55 percent reduction in the number of atonic seizures, which cause a sudden loss of muscle tone.

A total of 12 people, or 6 percent, stopped taking the drug due to side effects. Side effects that occurred in more than 10 percent of participants included drowsiness (21 percent), diarrhea (17 percent), tiredness (17 percent) and decreased appetite (16 percent).

Study author Orrin Devinsky, MD, of New York University Langone Comprehensive Epilepsy Center and a Fellow of the American Academy of Neurology, said that these are early findings and larger, placebo-controlled, double-blind trials are needed to measure the effectiveness of the drug.

"So far there have been few formal studies on this marijuana extract," Devinsky said. "These results are of great interest, especially for the children and their parents who have been searching for an answer for these debilitating seizures."

The study was supported by GW Pharmaceuticals.

1780. Seeking the Facts on Medical Marijuana

By Claudia Dreifus, The New York times, March 23, 2015

Twenty-three states and the District of Columbia have legalized medical marijuana, but scientific research into its appropriate uses has lagged. Dr. Mark Ware would like to change that.

Dr. Ware, 50, is the director of the Canadian Consortium for the Investigation of Cannabinoids and the director of clinical research of the Alan Edwards Pain Management Unit of McGill University Health Center. Medical marijuana has been legal in Canada for 16 years, and Dr. Ware, a practicing physician, studies how his patients take the drug and under what conditions it is effective.

We spoke for two hours at the recent meeting of the American Association for the Advancement of Science and later by telephone. Our interviews have been condensed and edited for space.

Q. How did you become interested in the medical possibilities of cannabis?

A. In the late 1990s, I was working in Kingston, Jamaica, at a clinic treating people with sickle cell anemia. My British father and Guyanese mother had raised me in Jamaica, and I’d attended medical school there.

One day, an elderly Rastafarian came for his annual checkup. I asked him, “What are your choices of medicines?” He leaned over the table and said, “You must study the herb.”

That night, I went back to my office and looked up “cannabis and pain.” What I found were countless anecdotes from patients who’d obtained marijuana either legally or not and who claimed good effect with a variety of pain-related conditions.

There were also the eye-opening studies showing that the nervous system had specific receptors for cannabinoids and that these receptors were located in areas related to pain. Everything ended with, “More studies are needed.”

So I thought, “This is what I should be doing; let’s go!”

Was getting started that easy?

Actually, not.

That summer, I went to England and considered working with a British pharmaceutical concern researching cannabinoids. But just then, a Canadian court took up the case of an epileptic who’d been arrested when he used cannabis for his seizures. The court essentially legalized medical marijuana throughout Canada.

When I heard that, it seemed like Canada was the place I should be going to. I packed up my young family and moved to Montreal. What I proposed to McGill was a clinic where we might evaluate the claims of patients about medical marijuana.

So much of what we knew about the drug was anecdotal. Some of it was folkloric. My idea was to listen to the patients’ stories and put them to a clinical evaluation.

When you first moved to Canada in 1999, what was known about medical marijuana?

We certainly knew that cannabinoids were analgesic in animal models. There were case reports floating around of people with multiple sclerosis who’d been helped.

In California, people with H.I.V. were using it for appetite stimulation, nausea and pain. Cancer patients sometimes used it to curb nausea from chemotherapy.

Since then, there have been at least 15 good-quality trials around the world. Cannabinoids are reported to help with H.I.V.-associated neuropathy, traumatic neuropathy, multiple sclerosis, pain from diabetes. There have also been a few small studies on fibromyalgia and PTSD.

When you talk about translational medicine, a drug usually moves from “bench to clinic.” But cannabis has had this unique trajectory: The patients were using it on their own, and then you had these papers, often based on a few case studies. And sometimes, you had later trials which led to drugs — like with H.I.V. patients’ using cannabis, which led to Marinol.

Tell us about some of your own research.

One investigation we published in the Canadian Medical Association Journal in 2010 studied 23 patients who used three slightly different levels of cannabis preparations and one placebo for two months. They had one puff three times a day. We found that the 9.4 percent THC level was superior to the placebo in terms of its effect on pain.

We also found that it helped with anxiety and sleep. Interestingly, our patients appeared to actually use very small quantities of the drug to control their symptoms, a lot less than recreational users.

Later this spring, we hope to take this research further by launching what we think will be the first ever longitudinal study of medical marijuana patients. We’ll follow the long-term effects of those of our regular patients who’ve been using it for chronic conditions. We’ll look at safety over the years.

Why do you think cannabis use has been generally so under-researched?

The fundamental answer is that the illegality of the drug has stigmatized most research. In Canada, people are sometimes afraid because of the perception that they are working with illegal substances, even when that’s no longer the case.

In the United States, it’s a different matter, because on the federal level, cannabis is listed as a Schedule I drug, like heroin. That means that the medical community is quite restricted in gaining access to research materials.

At the same time, there are more than 20 states where medical marijuana, to differing degrees, is legal. However, the plants grown in Colorado may be quite different from those grown elsewhere. Moreover, the medically eligible conditions vary from state to state.

This lack of standardization has been another factor making research difficult, because when you’re talking about cannabis in one state and cannabis in another, you may not be talking about the same thing.

You’ve said that physicians call you frequently for practical advice about the drug. What do they ask?

The most common question is, “How do I make the distinction between patients who want it for medical or recreational use?” The other call I get is from a clinician who wants me to take his patient and explain whatever I can.

Actually, I wish those doctors would inform themselves better; a lot of information does exist, though we need more. I believe that by not informing themselves, physicians aren’t fully serving their patients.

In Canada, for instance, we’ve noticed that our oncologists generally don’t tell their patients about medical marijuana. It’s the nurses who’ll go, “Dear, why don’t you go outside and have a puff.”

Your own Canadian Medical Association reminds its members that they are not obligated to write marijuana prescriptions because there is “insufficient evidence on clinical risks and benefits.” What is your take on their stance?

Well, I agree with them, at least on this: We need more research.

I think the time has come for us as a global community to agree on what we want to know and then go get it. And our patients need to move away from self-experimenting with substances and derivatives we don’t know about, and move to a situation where we know what they are using and where we can better help them. This isn’t going away.

1779. Marijuana: U.S. Ban Is Rooted in Myth and Xenophobia

By The Editorial Board, The New York Times, July 29, 2014

The federal law that makes possession of marijuana a crime has its origins in legislation that was passed in an atmosphere of hysteria during the 1930s and that was firmly rooted in prejudices against Mexican immigrants and African-Americans, who were associated with marijuana use at the time. This racially freighted history lives on in current federal policy, which is so driven by myth and propaganda that it is almost impervious to reason.

The cannabis plant, also known as hemp, was widely grown in the United States for use in fabric during the mid-19th century. The practice of smoking it appeared in Texas border towns around 1900, brought by Mexican immigrants who cultivated cannabis as an intoxicant and for medicinal purposes as they had done at home.

Within 15 years or so, it was plentiful along the Texas border and was advertised openly at grocery markets and drugstores, some of which shipped small packets by mail to customers in other states.

The law enforcement view of marijuana was indelibly shaped by the fact that it was initially connected to brown people from Mexico and subsequently with black and poor communities in this country. Police in Texas border towns demonized the plant in racial terms as the drug of “immoral” populations who were promptly labeled “fiends.”

As the legal scholars Richard Bonnie and Charles Whitebread explain in their authoritative history, “The Marihuana Conviction,” the drug’s popularity among minorities and other groups practically ensured that it would be classified as a “narcotic,” attributed with addictive qualities it did not have, and set alongside far more dangerous drugs like heroin and morphine.

By the early 1930s, more than 30 states had prohibited the use of marijuana for nonmedical purposes. The federal push was yet to come.

The stage for federal suppression of marijuana was set in New Orleans, where a prominent doctor blamed “muggle-heads” — as pot smokers were called — for an outbreak of robberies. The city was awash in sensationalistic newspaper articles that depicted pushers hovering by the schoolhouse door turning children into “addicts.” These stories popularized spurious notions about the drug that lingered for decades. Law enforcement officials, too, trafficked in the “assassin” theory, under in which killers were said to have smoked cannabis to ready themselves for murder and mayhem.

1778. Marijuana: Repeal, Prohibition, Again

By The Editorial Board, The New York Times, July 27, 2014

It took 13 years for the United States to come to its senses and end Prohibition, 13 years in which people kept drinking, otherwise law-abiding citizens became criminals and crime syndicates arose and flourished. It has been more than 40 years since Congress passed the current ban on marijuana, inflicting great harm on society just to prohibit a substance far less dangerous than alcohol.

The federal government should repeal the ban on marijuana.

We reached that conclusion after a great deal of discussion among the members of The Times’s Editorial Board, inspired by a rapidly growing movement among the states to reform marijuana laws.

There are no perfect answers to people’s legitimate concerns about marijuana use. But neither are there such answers about tobacco or alcohol, and we believe that on every level — health effects, the impact on society and law-and-order issues — the balance falls squarely on the side of national legalization. That will put decisions on whether to allow recreational or medicinal production and use where it belongs — at the state level.

We considered whether it would be best for Washington to hold back while the states continued experimenting with legalizing medicinal uses of marijuana, reducing penalties, or even simply legalizing all use. Nearly three-quarters of the states have done one of these.

But that would leave their citizens vulnerable to the whims of whoever happens to be in the White House and chooses to enforce or not enforce the federal law.

The social costs of the marijuana laws are vast. There were 658,000 arrests for marijuana possession in 2012, according to F.B.I. figures, compared with 256,000 for cocaine, heroin and their derivatives. Even worse, the result is racist, falling disproportionately on young black men, ruining their lives and creating new generations of career criminals.

There is honest debate among scientists about the health effects of marijuana, but we believe that the evidence is overwhelming that addiction and dependence are relatively minor problems, especially compared with alcohol and tobacco. Moderate use of marijuana does not appear to pose a risk for otherwise healthy adults. Claims that marijuana is a gateway to more dangerous drugs are as fanciful as the “Reefer Madness” images of murder, rape and suicide.

There are legitimate concerns about marijuana on the development of adolescent brains. For that reason, we advocate the prohibition of sales to people under 21.

Creating systems for regulating manufacture, sale and marketing will be complex. But those problems are solvable, and would have long been dealt with had we as a nation not clung to the decision to make marijuana production and use a federal crime.

In coming days, we will publish articles by members of the Editorial Board and supplementary material that will examine these questions. We invite readers to offer their ideas, and we will report back on their responses, pro and con.

We recognize that this Congress is as unlikely to take action on marijuana as it has been on other big issues. But it is long past time to repeal this version of Prohibition.