Benefits of licensed marijuana up in the air

Chicago TribuneNovember 3, 2013 

CHICAGO -- Even though 20 states have passed laws legalizing medical marijuana, swayed in part by thousands of personal testimonies, current research hasn't nailed down exactly if, and how, marijuana alleviates all the specific diseases the drug is being legalized to treat, experts say.

A number of proponents believe marijuana could benefit people with everything from glaucoma to cancer, and it's been legalized in Illinois to aid patients with some 40 medical conditions. But opponents of its medicinal use believe the risks of smoking medical marijuana outweigh the benefits, while others question whether pa

tients really improve or only feel like they improve.


Some scientists believe the plant's other compounds -- called cannabinoids -- could have equal promise. Although research has increased in recent years as more states legalize medical marijuana, solid evidence of how individual cannabinoids could help people with specific diseases has been significantly lacking, a review of medical literature and interviews with experts shows.

Researching the potential effects of marijuana's various components on conditions such as multiple sclerosis, fibromyalgia or lupus could have serious implications for doctors who want to prescribe medical marijuana to patients.

If the specific benefits could be proved, experts say, doctors ultimately would be able to assign particular strains -- with varying chemical mixes -- to people, depending on their condition.



The only study specifically cited in Illinois' law, signed by Gov. Pat Quinn in August and set to go into effect next year, is a 1999 Institute of Medicine report. But Dr. John Benson, a lead editor of the report, said legislators stretched the conclusion of the book-length study when it said modern medical research "has confirmed the beneficial uses of cannabis."


"Smoking marijuana is not recommended," the report states. "The long-term harm caused by smoking marijuana makes it a poor delivery system."

The 14-year-old article has become a primary source for both critics and supporters of medical marijuana -- the Drug Enforcement Administration and advocacy groups have cited it to prove opposite points.

"I don't think whatever the legislature is saying (in the law) is in effect untrue," Benson, now retired, said from his California home, "but it needs to be qualified."

Illinois legislators knew they had an uphill battle getting the medical marijuana bill passed last summer, Rep. Lou Lang said. Lang worked at swaying his colleagues for five years and said he compromised on the list of about 40 conditions -- some of which are closely related -- that will qualify people for medical marijuana once it becomes available sometime next year.

Illinois legislators, he said, did "a substantial amount of reading," but they did not evaluate each condition on the list with any scientific methodology.

"I can't point to specific studies that we used," Lang said. "Much of it was done by patients telling us what worked and what didn't. ... It became crystal clear some of these things that ought to be in the bill."


"When thousands of people come to me and say they're using this drug illegally because it's the only thing that works," Lang said, "that's good enough for me."


"I didn't even know my name," Graham said. "It was horrid."


"I almost fell out of bed laughing," Graham, 51, said. "I come from a law enforcement family."


"What it comes down to here (is) I wouldn't be here if I hadn't made that decision," Graham said.

While stories like Graham's are plentiful, doctors and researchers say the nonmedical elements of the plant could have sometimes serious adverse effects.


"It's very hard to differentiate whether somebody feels better because they're stoned or because they're getting a true therapeutic benefit from the drug," Voth said.


"You've still got (hundreds of other) substances in there," Voth said. "It just (shouldn't) be smoked. That is a crazy precedent."

Illinois' law allows dispensaries to sell marijuana-infused baked goods in addition to joints, but advocates say it takes longer to feel the effects of marijuana when it's ingested instead of smoked.

Several papers in scientific journals have found that marijuana use over a long period of time can have negative cognitive effects too. Users can't concentrate or remember as well as before, in some cases years after they have quit.



"When a drug comes on the market, you take the active ingredients, you figure out what these drugs do," said Friedman, who wants to open a dispensary in Illinois. "You want to be able to identify the active ingredients and the concentrations ... and then down the line (after more research is done), you'll be able to say, 'OK this one is good for MS,' " Friedman said.


"Essentially what they are, are toxic chemicals," Voth said. "None of those things would you ever mix with medicine."

In 1937, the U.S. criminalized marijuana, and today it's considered a Schedule I drug, along with heroin and LSD.

The FDA approved a synthetic THC pill called Marinol in 1985, acknowledging the drug's benefits for people with nausea and decreased appetite. In Canada and some parts of Europe, a similar drug called Sativex -- containing synthetic THC and cannabidiol -- has been approved in recent years, offered as an oral spray. In the late 1980s, scientists discovered a previously unknown biological system called the endocannabinoid system, which proponents for marijuana theorize could show how it works.

The National Institutes of Health reported in 2006 that the system holds "therapeutic promise in a wide range of disparate diseases."


Mary Lynn Mathre, a founding partner of Patients Out of Time, a marijuana advocacy group that focuses on health issues, said the leading theory regarding the system is that the human body has cannabinoid receptors -- essentially key holes that cannabis compounds fit into, helping the body regulate.

"You take cannabis, which has similar chemicals that we need, and you put it in the body and they work if we're not making the cannabinoids that we need," explained Mathre, a longtime registered nurse. "You can liken this to a diabetic. Their pancreas isn't making insulin, so we give them insulin. If our body can't make this chemical, there happens to be this plant on earth that is there to supply us."

Many prominent health organizations -- including the American Medical Association, the American Cancer Society and the National Multiple Sclerosis Society -- support researching cannabinoids' potential but don't endorse the legalization of medical marijuana. The American Nurses Association and the American College of Physicians support medical marijuana's legalization, while also calling for more research.

"Science has been doing this kind of thing for years," Voth said. "They find a (naturally) occurring substance and then they try to dissect down to what really works, isolate it and synthesize it. That's what pharmaceutical companies do all the time."

While THC has a few proven medical benefits, it's possible that other compounds that don't have the same euphoric effect could relieve symptoms just as well or better than THC, researchers and pharmacists say.



Friedman, the Deerfield pharmacist, said he's hopeful that with medical marijuana legalization on a faster track than ever, disease-specific research in the U.S. will pick up.

"As marijuana gains popularity and (if it) moves from Schedule I to Schedule II, research will really kick in," Friedman said. "This is a whole new industry, and this is going to get bigger and stronger as time goes on."


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