History Of The Medical Marijuana Industry

During 2008-10, many western and central states witnessed an exponential surge in the number of medical marijuana dispensaries that sold marijuana for medicinal purposes. California, the first state in the United States to legalize marijuana, has been the biggest beneficiary and supplier of marijuana in the country.

In recent times, the business of medical marijuana is growing with every passing day despite the stigma often linked with drugs. Medical marijuana has been used for alleviating symptoms of physical conditions, including chronic pain, gout, vision problems and nausea associated with chemotherapy treatment.

The consumption of marijuana is no longer restricted to hippies at concerts and its sale is no longer limited to shady people in alleys.

Erik Santus, the owner of Lotus Medical, a medical marijuana dispensary in Colorado, said he opened a dispensary for medical marijuana to create a favorable environment for people to learn about the benefits of marijuana. Santus further remarked that bringing a dispensary involves several initial hurdles and a burden of $200,000 to set up and another $15,000-$20,000 every month for maintenance.

The list of clients is long but legitimate. While some have fought in Iraq and struggling with post-traumatic stress disorder, a few elderly take it for getting relief from chronic pain and have a sound sleep, and some take medical marijuana for finding comfort from health conditions such as gout.

Marijuana And Gastrointestinal Disorders

Gastrointestinal (GI) disorders, including functional bowel diseases like irritable bowel syndrome (IBS) and inflammatory bowel diseases afflict more than one in five Americans, particularly women. While some of these disorders could be controlled by diet and pharmaceutical medications, others are poorly moderated by conventional treatments. GI disorder symptoms include cramping, abdominal pain, inflammation of the lining of the large and/or small intestine, chronic diarrhea, rectal bleeding, and weight loss.

Virtually no clinical trial work has been performed in this area although several anecdotal reports and a handful of case reports exist in the scientific literature supporting the use of cannabinoids to treat symptoms of GI disorders, aside from a 2007 clinical study assessing the impact of oral THC on colonic motility.

However, many preclinical studies have demonstrated that activation of the CB1 and CB2 cannabinoid receptors exert biological functions on the gastrointestinal tract. Many experts now believe that cannabinoids and/or modulation of the endogenous cannabinoid system represent a novel therapeutic approach for the treatment of numerous GI disorders — including inflammatory bowel diseases, functional bowel diseases, gastro-oesophagael reflux conditions, secretory diarrhea, gastric ulcers, and colon cancer.

References:
[1] Gahlinger, Paul M. 1984. Gastrointestinal illness and cannabis use in a rural Canadian community. Journal of Psychoactive Drugs 16: 263-265.
[2] Swift et al. 2005. Survey of Australians using cannabis for medical purposes. Harm Reduction Journal 4: 2-18.
[3] Baron et al. 1990. Ulcerative colitis and marijuana. Annals of Internal Medicine 112: 471.
[4] Jeff Hergenrather. 2005. Cannabis alleviates symptoms of Crohn’s Disease. O’Shaughnessy’s 2: 3.
[5] Esfandyari et al. 2007. Effects of a cannabinoid receptor agonist on colonic motor and sensory functions in humans: a randomized, placebo-controlled study. American Journal of Physiology, Gastrointestinal and Liver Physiology 293: 137-145.
[6] Massa and Monory. 2006. Endocannabinoids and the gastrointestinal tract. Journal of Endocrinological Investigation 29 (Suppl): 47-57.
[7] Roger Pertwee. 2001. Cannabinoids and the gastrointestinal tract. Gut 48: 859-867.
[8] DiCarlo and Izzo. 2003. Cannabinoids for gastrointestinal diseases: potential therapeutic applications. Expert Opinion on Investigational Drugs 12: 39-49.
[9] Lehmann et al. 2002. Cannabinoid receptor agonism inhibits transient lower esophageal sphincter relaxations and reflux in dogs. Gastroenterology 123: 1129-1134.
[10] Massa et al. 2005. The endocannabinoid system in the physiology and pathophysiology of the gastrointestinal tract. Journal of Molecular Medicine 12: 944-954.
[11] Wright et al. 2005. Differential expression of cannabinoid receptors in the human colon: cannabinoids promote epithelial wound healing. Gastroenterology 129: 437-453.
[12] Massa and Monory. 2006. op. cit.
[13] Izzo and Coutts. 2005. Cannabinoids and the digestive tract. Handbook of Experimental Pharmacology 168: 573-598.
[14] Izzo et al. 2009. Non-psychotropic plant cannabinoids: new therapeutic opportunities from an ancient herb. Trends in Pharmacological Sciences 30: 515-527.

Agitation In Alzheimer’s Patients Reduced By Synthetic Marijuana

A synthetic version of the active ingredient in marijuana, dronabinol, minimizes agitation in patients with Alzheimer’s disease according to results from a Phase II, multi-center study. It was also concluded by the researchers that minimized agitation could contribute to the relief of caregiver burden linked with the condition.

The findings were presented at the American Society of Consultant Pharmacists’ 34th annual meeting.

‘Our results show dronabinol is an effective treatment for behavioral agitation in patients with Alzheimer’s and may ultimately help reduce the stress often experienced by caregivers,’ said geriatrician Joel S. Ross, M.D. a member of the teaching faculty at Monmouth Medical Center and the lead investigator in the study.

‘While difficult for the patient, the effects of agitation can greatly impact the emotional and physical health of family members and caregivers. By reducing patients’ agitation, caregivers are able to focus more time and energy on their patients’ overall wellbeing.’

Agitation is the most common behavioral management problem in Alzheimer’s patients and could lead to a variety of symptoms ranging from physical and/or verbal abusive postures, physically non-aggressive conduct including pacing and restlessness.

Marketed as Marinol, Dronabinol is synthetic delta-9-tetrahydrocannabinol (delta-9-THC). Delta-9-THC also is a naturally occurring component of Cannabis sativa L (marijuana). The U.S. Food and Drug Administration (FDA) have approved Dronabinol for the treatment of anorexia in patients with HIV/AIDS and for the treatment of nausea and vomiting associated with cancer chemotherapy.

Reference:
1Zajicek, J. The Lancet, Nov. 8, 2003: vol 263;pp 1517-1526

Prescription Pain Drug Deaths Could Be Reduced With Cannabis

According to a peer-reviewed paper published online this week in the Harm Reduction Journal, physicians who prescribe opioid drugs to patients with neuropathy (nerve pain) ought to consider recommending cannabis as an alternative therapy.

“There is sufficient evidence of safety and efficacy for the use of (cannabis/cannabinoids) in the treatment of nerve pain relative to opioids,” the commentary states. “In states where medicinal cannabis is legal, physicians who treat neuropathic pain with opioids should evaluate their patients for a trial of cannabis and prescribe it when appropriate prior to using opioids. … Prescribing cannabis in place of opioids for neuropathic pain may reduce the morbidity and mortality rates associated with prescription pain medications and may be an effective harm reduction strategy.”

The author notes that between the years 1999 and 2006, “approximately 65,000 people died from opioid analgesic overdose.” By contrast, he writes “[N]o one has ever died from an overdose of cannabis.”

In clinical trials, inhaled cannabis has consistently been demonstrated to minimize neuropathic pain of diverse causes in subjects unresponsive to standard pain therapies.

Reference:
Prescribing cannabis for harm reduction

Life Expectancy Of Lou Gehrig’s Disease Patients May Extend With Marijuana

According to a scientific review published online last week by the American Journal of Hospice & Palliative Medicine, cannabis therapy may reduce symptoms and prolong survival in patients diagnosed with amyotrophic lateral sclerosis (ALS aka Lou Gehrig’s disease).

Preclinical and anecdotal data was reviewed by investigators at the University of Washington Medical Center in Seattle and Temple University in Pennsylvania indicating that marijuana appears to treat symptoms of ALS as well as moderate the course of the disease.

Authors wrote: “Preclinical data indicate that cannabis has powerful antioxidative, anti-inflammatory, and neuroprotective effects. … Cannabis also has properties applicable to symptom management of ALS, including analgesia, muscle relaxation, bronchodilation, saliva reduction, appetite stimulation, and sleep induction. … From a pharmacological perspective, cannabis is remarkably safe with realistically no possibility of overdose or frank physical addiction. There is a valid, logical, scientifically grounded rationale to support the use of cannabis in the pharmacological management of ALS.”

They added, “Based on the currently available scientific data, it is reasonable to think that cannabis might significantly slow the progression of ALS, potentially extending life expectancy and substantially reducing the overall burden of the disease.”

Investigators concluded, “There is an overwhelming amount of preclinical and clinical evidence to warrant initiating a multicenter randomized, double-blind, placebo-controlled trial of cannabis as a disease-modifying compound in ALS.”

Reference:
Cannabis and amyotrophic lateral sclerosis: hypothetical and practical applications, and a call for clinical trials-American Journal of Hospice & Palliative Medicine.

Health Professionals Support Cannabis Legalization For Therapeutic Use

According to survey data published online in the Journal of Palliative Medicine, a majority of hospice health professionals favor allowing the legally regulated use of cannabis for terminally ill patients.

A 16-item questionnaire was utilized by investigators at the University of Pennsylvania for assessing the knowledge, experience, and views of hospice professionals regarding the use of marijuana in terminally ill patients.

Authors concluded, “The study results revealed that, like the general public, hospice health care providers are generally in favor of legalization of marijuana and, if legalized, would support its use in symptom management for their terminally ill patients.”

Many health professional organizations, including the American Nurses Association, and the American Public Health Association, have enacted resolutions in support of allowing patients the legal alternative to use cannabis therapy.

Colorado State Approval For Greenway University To Teach Medical Marijuana

The industry’s leading medical marijuana educational provider, Greenway University, has received full format state approval from the Colorado Department of Higher Education.

This marks yet another industry milestone by moving from probationary status to full status as a recognized Colorado vocational school and the University has also received authorization for teaching medical marijuana state approved courses. The authorization makes it the first and only such state approved and regulated medical marijuana courses in the United States.

“We are extremely thankful to the state of Colorado for allowing us to become a part of history for the entire medical marijuana industry. This monumental decision further validates our forward thinking messages of education, professionalism and industry leading programs,” Greenway University founder and CEO Gus Escamilla, said. “We feel incredibly blessed and thankful to the state of Colorado for providing us with this monumental decision and approving us for an additional 10 state approved and regulated medical marijuana education courses that range from Budtender™, medicine making, tinctures, concentrates, continuing legal education to advanced cultivation courses that set the standard for a higher level of professional education for the entire medical marijuana industry.”

Escamilla added, “This marks yet another historic milestone for our industry. We recently announced our second campus development plans into the Arizona marketplace with passing of Proposition 203 with further expansion plans across the US with the continued legalization of the medical marijuana industry. We are exceptionally excited about the Arizona marketplace. Our first weekend course was such an incredible success with over 300 students in attendance that we immediately scheduled a second seminar for February 26th and 27th, 2011 in Scottsdale, Arizona to meet the growing demand.”

Reference:
Greenway University

CMA Wants To Legalize And Regulate Marijuana

The California Medical Association (CMA) that includes 35,000 doctors has adopted an official policy that recommends the legalization and regulation of cannabis. The CMA adopted the new stance at its annual meeting recently in Anaheim.

The board of trustees of the largest physician group in California adopted the policy unanimously at its meeting in Sacramento, according to a statement on the CMA website.
California is one of the sixteen states where medical marijuana is legal, making it possible for doctors to recommend the drug to their patients.

Dr. James Hay, the president-elect of CMA, said that present-day laws put doctors in an uncomfortable position. “California decriminalized its medical use, yet if a physician recommends it to a patient we are violating federal law.” Hay said.

According to a statement put out by CMA, marijuana is a Schedule 1 drug that means that study and research of the drug is limited. “Think it ought to be regulated, better controlled, no control over what’s in marijuana. If we don’t know what’s in it, we can’t do any kind of scientific evaluation,” Hay said.

Dr. Donald Lyman, the Sacramento physician who wrote new policy of the group, attributed the shift to growing frustration over California’s medical marijuana law, which permits cannabis use with a doctor’s recommendation.

“It’s an uncomfortable position for doctors,” he said. “It is an open question whether cannabis is useful or not. That question can only be answered once it is legalized and more research is done. Then, and only then, can we know what it is useful for.”
The California Police Chiefs Association opposes the new policy of the CMA. “Drug use is a health issue and for too long we have let law enforcement and federal bureaucrats decide policy. CMA is saying let’s treat medical marijuana as a health issue,” Bill Piper, the director of national affairs for the Drug Policy Alliance said.

Dr. Igor Grant, head of the Center for Medicinal Cannabis at UC San Diego, defended therapeutic use of the drug. “There’s good evidence that it has medicinal value,” he said. “Can you say it’s 100% bulletproof? No. But the research we’ve done at the center shows it’s helpful with certain types of pain.”

Reference:
California Medical Association

Cannabinoids Treat Lung Cancer

According to a study, Δ9-Tetrahydrocannabinol inhibits epithelial growth factor-induced lung cancer cell migration in vitro as well as its growth and metastasis in vivo.

The primary cannabinoid of marijuana, Δ9-Tetrahydrocannabinol (THC), has been shown to either inhibit or potentiate tumor growth, depending on the cancer type and its pathogenesis. Little is known about activity of cannabinoids such as THC on epidermal growth factor receptor-over expressing lung cancers that are often highly aggressive and resistant to chemotherapy.

In the study, the researchers characterized the effects of THC on the EGF-induced growth and metastasis of human non-small cell lung cancer using the cell lines A549 and SW-1573 as in vitro models. It was found that these cells express cannabinoid receptors CB1 and CB2, known targets for THC action. It was also found that THC inhibited EGF-induced growth, chemotaxis, and chemoinvasion. The signaling studies indicated that THC could act by inhibiting the EGF-induced phosphorylation of ERK1/2, JNK1/2 and AKT. The primary cannabinoid of marijuana was also responsible for inducing phosphorylation of focal adhesion kinase at tyrosine 397.

Additionally, there was significant inhibition of the subcutaneous tumor growth and lung metastasis of A549 cells in THC-treated animals as compared to vehicle-treated controls in vivo studies. Tumor samples from animals treated with THC revealed anti-proliferative and anti-angiogenic effects of THC.

The study suggested that cannabinoids such as THC must be explored as novel therapeutic molecules to control the growth and metastasis of certain lung cancers.

Reference:
Oncogene 10: 339-346

Cannabidiol Reduces Anxiety In Social Phobia Patients

Cannabidiol has the ability to minimize anxiety induced by simulated public speaking in treatment-naïve social phobia patients, according to a study.

Generalized Social Anxiety Disorder (SAD) is one of the most common anxiety conditions with social life impairment. CBD (cannabidiol), a major non-psychotomimetic compound of the cannabis sativa plant, has demonstrated anxiolytic effects both in humans and in animals.

Preliminary results of the study aimed for comparing the effects of a simulation public speaking test (SPST) on healthy control (HC) patients and treatment-naïve SAD patients who received a single dose of CBD or placebo. In a double-blind randomized design 1 h and a half before the test, a total of 24 never-treated patients with SAD were allocated to receive either CBD (600 mg; n=12) or placebo (placebo; n=12). The same number of HC (n=12) performed the SPST without any medication.

Each of the volunteers participated in only one experimental session in a double-blind procedure and subjective ratings on the Visual Analogue Mood Scale (VAMS) and Negative Self-Statement scale (SSPS-N) and physiological measures (blood pressure, heart rate, and skin conductance) were measured at six different time points during the SPST.

The obtained results were submitted to a repeated-measures analysis of variance. Pre-treatment with cannabidiol significantly minimized anxiety, cognitive impairment and discomfort in their speech performance, and significantly reduced alert in their anticipatory speech. The placebo group presented higher anxiety, cognitive impairment, discomfort, and alert levels when compared with the control group as assessed with the VAMS.

However, no significant differences were observed between CBD and HC in SSPS-N scores or in the cognitive impairment, discomfort, and alert factors of VAMS while the increase in anxiety induced by the SPST on subjects with SAD was reduced with the use of CBD, resulting in a similar response as the HC.

Co-authors of the study were Bergamaschi MM, Queiroz RH, Chagas MH, de Oliveira DC, De Martinis BS, Kapczinski F, Quevedo J, Roesler R, Schröder N, Nardi AE, Martín-Santos R, Hallak JE, Zuardi AW, and Crippa JA.

Reference:
Neuropsychopharmacology 2011 May; 36(6):1219-26