From The Globe & Mail
When it comes to cannabinoids, we already grow our own - inside the body.
How ironic. The same day that Health Minister Ann McLellan suggested shelving medical marijuana, I was down at the World pain Congress in San Diego, listening to the first plenary session on pain and cannabinoids (the molecules that count in cannabis). There were about 5,000 pain scientists in one very large room, most of whom were familiar with the evidence that cannabis can relieve pain. Old news. But what I also learned would have come as a shock to our squabbling politicians. When it comes to cannabinoids, we are already growing our own. How are we going to regulate that (q.mark)
The same substance in cannabis that can help people with multiple sclerosis deal with musle spasms, or cancer patients cope with nausea, is present in human breast milk too. Endogeneous cannabinoids, as they're known, are part of the body's own painkilling resources -cousins to more familiar ones like endorphins. Receptors for cannabinoids, located in the brain, spine and peripheral nerves, have just been discovered in the past decade.
This is the science end of things. But we have a tendency to think about drugs superstitiously, dividing them into "natural" vs. "synthetic", or heroic (anti-cancer drugs) vs. sinister (narcotics and cannabis). The fact is that most drugs, regardless of the reassuring bubble packs we buy them in, are synthesized from plants or pods or pretty flowers. Drugs are not alien invaders -they often mimic or amplify perfectly natural mechanisms in the body. And the reason that heroin and marijuana work against pain (in quite distinct ways) is that they match substances that the body is designed for, and creates. Strictly speaking, we all use dope.
Some scientists even believe that cannabis could be more useful for certain difficult kinds of neurological pain than opiates. This was the opinion of Dr. Andrew Rice, Senior Lecturer in pain Research from Imperial College in London England, when he gave his plenary address.
Dr. Rice first pointed out that cannabis has been used for pain relief for centuries. Evidence of smoked marijuana was found beside the body of a woman who died in childbirth more than two centuries ago, and Queen Victoria used cannabis for her menstrual cramps (she was a big fan of ether for childbirth too). In studies that use synthetic cannabinoids, Dr. Rice reported, very small doses have been shown to offer pain relief, and "we are just beginning to discover the importance of the endocannabinoids" - the home-grown stuff. The aim now is to develop a synthetic cannabinoid that would "divorce the analgesia from the high", since not everybody in pain wants all 61 of the cannabinoids in marijuana. It tends to increase Dorito intake, for one thing, and inhaling smoke has its health risks too. Rice concluded that although there was lots of laboratory data to support the use of cannabis for pain relief, its clinical use was premature. Why (q. mark) "This is probably much more of a political question than a medical matter," he said. Access, in other words.
When Health Minister McLellan says let's shelve the use of medical marijuana until further studies, she is depriving science of one very good avenue of research - the experience of people in pain who are already using marijuana, and benefitting from it.
Mark Ware, associate professor of anesthesia at McGill and a pain physician, has done work on the therapeutic potential of cannabis. In a study presented at the Congress (one of sixteen papers on the subject) Ware followed a group of chronic pain patients who used marijuana. They all reported less pain, and most found it helped them relax and get to sleep. "What was interesting was how effective a small amount of marijuana could be," he pointed out. "The doses were variable but some got relief from as little as two or three puffs a day." The amount of cannabis useful for pain relief, in other words, doesn't resemble the Cheech and Chong quantities that its opponents imagine. Nor does everyone want the high. Their aim is normalcy, less suffering, and getting on with life.
Dr. Jim Henry is director of the Canadian Pain Consortium and another researcher in this area. "It's very important that we continue research, because there is tremendous promise, in terms of health care and economic benefits, for these drugs." And cannabis, he points out, can even lead to decreased drug use in patients. "One great advantage of using cannabinoids for pain relief is that when you combine them with opiates, patients find they need less."
Dr. Harold Merskey, an internationally recognized pain researcher in London, Ontario, was happy to offer a few ruminations about why Ann McLellan has chickened out on the marijuana front. "I suspect our politicians don't want to be ahead of America in this matter, because it raises a sensitive border issue." Namely, the fear of people flocking across the border to avail themselve of high-grade, government-issue cannabis. But if Canada puts this sort of fear ahead of the therapeutic potential, we will be headed towards a mini version of America's War on Drugs - a campaign that has been a ruinois and costly failure in addressing addiction and drug abuse.
So it's ironic. We have the legal framework in place, lots of impressive reseach on hand, but we're going to sit on it. Meanwhile, people with cancer, AIDS, MS, or severe arthritis, who could benefit from a puff or two a day, and who may not have the luxury of worrying about long-term effects, have been deprived of a cheap painkiller that has not caused a single fatality (unlike anti-inflammatories, which were linked with 20,000 deaths in the United States last year). It also looks quite nice growing in a windowbox. Cannabis has risks, as all drugs do. We don't know yet what its effects are on memory or the immune system, over time. But as one reader pointed out in a letter to the Globe last week, hormone replacement therapy has its proven dangers too,and the government hasn't bestirred itself to shelf premarin.
So let's do the clinicals trials to measure long term consequences, and by all means let's develop a cannabinoid that cleanly targets pain. (How Canadian - a drug that makes you feel normal.) Canadian cannabis has a nice brand-ish ring to it. If the maple leaf went on a diet, it might even resemble the leaf in question. But in the meantime, let's not deprive ourselves of the one population that could offer us crucial evidence about its pros and cons - the roughly 400,000 Canadians who already use marijuana for pain relief. For them, the main pain now is access.
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