Medical Marihuana A paradigm delayed? Have you been run over by the Kuhn cycle? How did cannabis disappear from medicine in the first place? An overview of what we know about the medical potential of cannabis Gaylord Wardell MD (U of S,1978); FRCP(C) (U of S, 1988) FRCP Pain Medicine, 2016 Self-portrait Conflict of Interest Disclosure: Company-Supported Lectures FINANCIAL DISCLOSURE: Grants/Research Support:AHS,Purdue Pharma, Pfizer, Janssen Speakers Bureau/Honoraria:Valeant, Biovail, Lilly, Cannimed, Tweed Consulting Fees:none Other: None The impression that marihuana is a dangerous drug which must be carefully regulated is widespread, particularly in medical circles and governments.1 The vast majority of the public feel marihuana should be legalised for medicinal use.3 The majority of doctors in Canada do not prescribe medical marihuana despite it having been legal since 2001.1 As far back as 1969, the Le Dain Commission on the Non Medical Use of Drugs decries the number of Canadians incarcerated for drug related crimes and called for decriminalisation of possession of marihuana for personal use.2 Considering that, when taken as prescribed, there has never been a death from medical marihuana yet there are thousand of deaths annually in North America from NSAIDs, opioids, acetaminophen, antidepressants, anticonvulsants, tobacco and alcohol which are all widely used legally and illegally.4 Is the barrier erected against marihuana based on a possibly mistaken negative perception of cannabis in the medical community that is impeding a more useful paradigm? The body of historical literature supports a conclusion that cannabis, if not actually valuable, is not sufficiently harmful to be vilified as it has, and yet this conclusion has been only slowly accepted in the medical and policing community Max Planck: A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grow up that is familiar with it. 1.By Jennifer Lee, CBNC News poll Posted: Jul 31, 2017 5:00 AM MT Last Updated: Jul 31, 2017 5:00 AM MT 2.Canadian Government Commission of Inquiry into the Non-Medical Use of Drugs. Information Canada. Gerald Ledain, 1969 3.Jun 30, 2016 - 7 in 10 Canadians support marihuana legalization: Nanos poll 4.Drug Overdose Deaths in the United States, 1999–2016 Holly Hedegaard, M.D., Margaret Warner, Ph.D., and Arialdi M. Miniño, M.P.H.CDC data 5. Cloning of type 1 cannabinoid receptor in Rana esculenta reveals differences between genomic sequence and cDNA Rosaria Meccariello1 , Rosanna Chianese2 , Gilda Cobellis2 , Riccardo Pierantoni2 and Silvia Fasano 6. The active chemical of cannabis is identified J Amer Chem Soc 86; 1646-7, 1964 7. National Academies of Sciences, Engineering, and Medicine. 2017. The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. Washington, DC: The National Academies Press. doi: 10.17226/24625. .8.The endocannabinoid signaling system: a potential target for next-generation therapeutics for alcoholism Balapal S. Basavarajappa Mini Rev Med Chem. 2007 Aug; 7(8): 769–779 The existence of a major signalling system, the endocannabinoids and its receptors, with major implications for medical therapeutics, has been known for over forty years.8 “Men occasionally stumble over the truth, but most of them pick them- The ligands have been identified.6 selves up and hurry off as if nothing The receptors have been cloned and mapped.5 ever happened!” The potential for many medical benefits have been clearly delineated and much research has already been done.7 These are facts, yet in North America the research and potential medical application of cannabis and its elements has lagged far behind its potential. WHY? Sir Winston Churchill LaGuardia Committee Report on Marijuana 1944 CONCLUSIONS 1. Under the influence of marihuana the basic personality structure of the individual does not change but some of the more superficial aspects of his behavior show alteration. 2. With the use of marihuana the individual experiences increased feelings of relaxation, disinhibition and self-confidence. 3. The new feeling of self-confidence induced by the drug expresses itself primarily through oral rather than through physical activity. There is some indication of a diminution in physical activity. LaGuardia Committee Report on Marijuana 1944 4. The disinhibition which results from the use of marihuana releases what is latent in the individual's thoughts and emotions but does not evoke responses which would be totally alien to him in his undrugged state. 5. Marihuana not only releases pleasant reactions but also feelings of anxiety. 6. Individuals with a limited capacity for effective experience and who have difficulty in making social contacts are more likely to resort to marihuana than those more capable of outgoing responses. Cannabis was legal medicine from the initial colonization until 1937 only being removed from the US Pharmacopeia in 1941 HOW DID IT BECOME ILLEGAL?? How did we go from this: To this? SCHEDULE 1 (CLASS I) DRUGS are illegal because they have high abuse potential, no medical use, and severe safety concerns; for example, narcotics such as Heroin, LSD, and cocaine. Marijuana is also included as a Class 1 drug* • *These are American FDA classes, although they are different in Canada, where medical cannabis is legal, for most of the 20th Century Canada followed the American lead on illegality. Cannabis cannot legally cross the border to the USA - Attorney General John Mitchell of the Nixon administration placed marijuana in this category in 1972 The Indian Hemp Drugs Commission 1893-1894 • The house of commons of the United Kingdom was concerned with the effects of hemp drugs in the province of Bengal, India • 490 pages report • 2000 witnesses from military officers to missionaries in 30 cities across India • The commission has come to the conclusion that the moderate use of hemp drugs is practically attended by no evil results at all Marijuana on Trial: The Panama Canal Zone Report 1925 Concern among army officers about marijuana’s effects on discipline and morale led to the issuing of Army circular No. 5 on January 20, 1923. The circular banned the possession and use of marijuana by army soldiers in the Canal Zone and subjected violators to a court-martial and dishonorable discharge. By April of 1925, a joint civilian and military committee was formed to study the effects of marijuana on users and to re-evaluate the logic of Circular No. 5. The conclusions of the report were that the deleterious effects of marijuana had been exaggerated, and it recommended that no restrictions be placed on the use of the drug. 1. 1894 Indian Hemp Drugs Commission, "Report of the Indian Hemp Drugs Commission", Simla, India: Government Central Printing Office "The commission has come to the conclusion that the moderate use of hemp drugs is practically attended by no evil results at all." 2. 1925 Canal Zone Committee, "The Panama Canal Zone Military Investigations" "The influence of [marijuana]... has apparently been greatly exaggerated... There is no evidence... that it has any appreciably deleterious influence on the individual using it.“ 3. 1944 Mayor's Committee on Marihuana, "The La Guardia Commission Report“ 4. 1969 Advisory Committee on Drug Dependence, "Cannabis", London: Her Majesty's Stationery Office. 5. 1970 Canadian Government Commission of Inquiry, "The Non-Medical Use of Drugs", Ottawa, Canada: Information Canada. (a.k.a "Le Dain Commission") "Since cannabis is clearly not a narcotic we recommend that the control of cannabis be removed from the Narcotic Control Act... The Commission is of the opinion that no one should be liable to imprisonment for simple possession." 6. 1972 National Commission of Marihuana and Drug Abuse, "Marijuana: A Signal of Misunderstanding, Washington, D.C.: U.S. Government Printing Office. "Marihuana's relative potential for harm to the vast majority of individual users and its actual impact on society does not justify a social policy designed to seek out and firmly punish those who use it... Existing social and legal policy is out of proportion to the individual and social harm engendered by the drug." 7. 1972 Werkgroep Verdovende Middelen, "Background and Risks of Drug Use", The Hague: Staatsuitgeverij. 8. 1977 Senate Standing Committee on Social Welfare, "Drug Problems in Austrailia- An Intoxicated Society?", Canberra: Austrailian Commonwealth Government Printing Office. "Legal controls [should] not [be] of such a nature as to... cause more social damage than use of the drug... Cannabis legislation should be enacted that recognizes the significant differences between... narcotics and cannabis in their health effects... Possession of marijuana for personal use should no longer be a criminal offence." 9. 1982 National Research Council, "An Analysis of Marijuana Policy", Washington D.C.: National Academy Press. "The advantages of a policy of regulation include... the savings in economic and social costs of law enforcement... better controls over the quality and safety of the product, and, possibly, increased credibility of warnings about risks." 10. 1994 McDonald D., et al., "Legislative Options for Cannabis in Australia", Report on the National Task Force on Cannabis", Canberra: Australian Government Publishing Service. "Australian experiences more harm... from maintaining cannabis prohibition policy than it experiences from the use of the drug... We conclude that cannabis law reform is required in this country." 11. 1995 Ministry of Health, Welfare, and Sport, "Drug Policy in the Netherlands: Continuity and Change", The Netherlands. "It has been demonstrated the more or less free sale of... [marijuana] for personal use in the Netherlands has not given rise to levels of use significantly higher than in countries which pursue a highly repressive policy... Dutch policy on drugs over the last twenty years... can be considered to have been successful." 12.