Inhaled cannabis reduces pain and improves sleep compared to placebo, and is well tolerated by patients with chronic neuropathy, according to clinical trial data published this week in the Journal of the Canadian Medical Association (CMAJ).

Investigators at McGill University in Montreal assessed the efficacy of inhaled cannabis on pain intensity in 23 subjects with chronic post-traumatic or post-surgical neuropathic pain in a randomized, double-blind, placebo-controlled crossover trial. Participants in the study received a single inhalation of 25 mg of 9.4 percent herbal cannabis or placebo three times daily. All of the volunteers in the study suffered from refractory pain for which conventional therapies had proven ineffective.

Researchers reported: “[H]erbal cannabis … significantly reduced average pain scores compared with … cannabis placebo in adult participants. … We found significant improvement in measures of sleep quality and anxiety. … Our results support the claim that smoked cannabis reduces pain, improves mood, and helps sleep.”

Speaking to Web MD online, the study’s lead researcher Mark Ware said: “We’ve shown again that cannabis is an analgesic. Clearly it has medical value.”

In February, investigators from the California Center for Medicinal Cannabis Research summarized the results of four separate FDA ‘gold standard’ designed clinical trials demonstrating that inhaled marijuana was safe and effective for the treatment of neuropathy.

An estimated one to two percent of the population suffers from some form of neuropathic pain, which typically goes untreated by standard analgesics.

Listen to NORML Executive Director Allen St. Pierre and NORML Advisory Board member Lester Grinspoon discuss this trial, and other subjects related to the medical use of cannabis, on NPR’s The Diane Rehm show here.

Marijuana Law Reform in 2010 (March Update)

With New Jersey recently becoming the 14th medical marijuana state, activists in marijuana law reform have been celebrating. After all, over 82 million Americans now live in states where medical use of marijuana is legal – that’s 27% of the US population! Last election, Massachusetts became the 13th decriminalization state, which means over 107 million Americans live in a state where possession of small personal amounts of marijuana no longer merit an arrest – that’s 35% of the US population.

Population of States with Medical Marijuana Laws

Population of States that have Decriminalized Marijuana

However, after watching fourteen years of marijuana activism focused solely on those who use cannabis for medicine, I must warn activists that medical marijuana is not getting any better and the time for re-legalization of cannabis for all adults – even the healthy ones – is now.

Comparison of five core rights found in existing medical marijuana law

California legalized medical marijuana in 1996. That initiative, Prop-215, established what is clearly the most liberal medical marijuana statute to date:

• A doctor can recommend for any condition;
• You needn’t have a “bona fide” doctor/patient relationship;
• Dispensaries are allowed;
• Self cultivation is allowed;
• Patients are protected from arrest.

Comparison of plant and possession limits and qualifying conditions in medical marijuana law

If we consider these five attributes of the law the baseline, then in the past fourteen years, all thirteen medical marijuana states that have followed have failed to achieve all five. Eight states only offer three or four of those liberties and the rest offer two or only one. Most disturbingly, the right of patients to grow their own medicine (or have a caregiver do it for them), which has been a bedrock principle in medical marijuana law, was taken away from patients in the most recent medical marijuana state, New Jersey. Bills that were considered but vetoed in 2009 in Minnesota and New Hampshire, and those moving forward in New York, Pennsylvania, as well as an initiative in Arizona, all sacrifice this core right.

New Jersey - The (No Medical Marijuana) Garden State

A comparison of plant and possession limits also shows the decline from the original starting point in California, where 12 plants and 8 ounces are allowed. Oregon and Washington passed their laws next and have the highest statutory limits: 24 plants and 24 ounces in Oregon and 15 plants and 24 ounces in Washington. (To be fair, all the West Coast states started with lower limits or more vague limits that were modified by the legislature.) But since then, only one state has allowed more than 3 ounces (New Mexico with 6 ounces) and average number of plants allowed is a little less than ten.

The "Big 8" Conditions for which marijuana is recommended in the states

Another decline in medical marijuana freedom appears when we look at the conditions for which medical marijuana protection is afforded in the various states. There are eight conditions which could be considered the “standard” ones: cancer; HIV/AIDS; seizure disorders, like epilepsy; spastic disorders, like multiple sclerosis; glaucoma; chronic nausea; cachexia; and chronic pain. Most medical marijuana states recognize all eight conditions; a couple (Vermont and Rhode Island) recognize seven of eight.

Other conditions recognized in state medical marijuana laws (not a complete list)

The latest law in New Jersey, however, eliminated chronic pain, chronic nausea, and cachexia, making it the most restrictive list in the nation. The bill proposed but vetoed in New Hampshire required one to try all other remedies for chronic pain before trying medical marijuana. The vetoed Minnesota bill wouldn’t even allow cancer and HIV/AIDS patients to use medical marijuana unless they could show they were terminal (about to die). The lists in the latest proposed bills continue to become more restricted.

Until we do have legalization for all, every medical marijuana law is going to fail to adequately serve all medical users and subject them to increasing restriction and scrutiny. Additionally, medical marijuana laws make patients an attractive target for criminals because prohibition maintains huge profits for stolen medical cannabis, as well as becoming targets for overzealous anti-marijuana cops and prosecutors.

The reason the recent medical marijuana laws are losing ground is not a failure of the medical marijuana strategy, but rather due to its success. Medical marijuana has portrayed the herb as “powerful and effective medicine”. Well, what do we do with powerful and effective medicines? We keep them under lock and key. We require people to visit doctors. We strictly monitor prescription pads. We bust people who have them without proper papers.

Rather than justifying the prohibitionists’ shibboleth of medical marijuana as “the camel’s nose under the tent” for legalization, I’m arguing it’s the opposite: that continuing the medical marijuana strategy further cements the “powerful and effective medicine” frame and takes us farther away from treating cannabis as a personal choice of relaxant. We’ll get to a point where the public accepts “powerful and effective cannabis medicine” and looks upon personal use like we look at someone getting fraudulent scrips for painkillers.

If one of the West Coast states doesn’t pull off legalization soon, the pendulum is going to swing back the other way on marijuana. The economic incentives may fade if the economy recovers and then the tax & regulate argument fizzles. And if we are going to continue working on medical marijuana, the bills and initiatives need to get better, not worse. The way it’s looking now is that the Northeast and upper Midwest are going to institute chronic conditions-only, 2 oz limit, strict registry, only personal doctor, no home grow, state-run dispensary medical marijuana for $15/gram in the next six years. How then do we approach those people and say, “Hey, you know that powerful and effective medical marijuana that you only let a few hundred really sick people use after jumping though a mile of hoops? We think everybody should have it and jump through no hoops!”

Medical marijuana would never have passed in any state if it were not for the votes of non-medical users of marijuana. I do believe it is time for medical marijuana patients in the states that have programs to “repay the favor” and fight as hard for legalization as social tokers fought for medical. Only patients can best make the argument that while prohibition exists, they will always face job discrimination, loss of child custody, high black market prices, housing discrimination, and the sneers of the Bill O’Reillys who think 99% of medical marijuana patients are faking. So long as the prohibition profit exists, there will always be these CBS Undercover investigations casting a pall on all legitimate medical marijuana because of the irresponsible acts of a few.

Maybe I’m just too much of a dreamer. I imagine acres and acres of hemp fields, huge indoor hydroponic cannabis warehouses, thriving cafes and coffeehouses, some folks growing their own in a garage or closet, regular outdoor festivals and special indoor events where cannabis smoking is permitted, buying and selling all varieties of cannabis from ounces at a farmer’s market to bulk bales at CostCo… and none of that is done with “powerful and effective medicines”.

I don’t think that it is reformer’s job to pass medical marijuana in all fifty states first and then worry about legalization in one. I think states that have medical should be moving forward on legalization, states without should focus on better medical laws by calling prohibitionists’ bluff on “marijuana outta control!” in the Western states with liberal medical laws.

NORML’s Cannabis Café

By George Rohrbacher, NORML board of directors, medical marijuana patient

The first time I met Madeline Martinez, the executive director of Oregon NORML, she told me about her dream…a meeting place for medical marijuana patients, some space to hold classes, a very different vision of healthcare. I took a drive to Portland last week to see this dream come true; to Oregon NORML’s World Famous-Cannabis Café, a trip to a Future of our own making.

Set in an older blue-collar neighborhood in North East Portland, NORML’s Cannabis Café, occupies a building that was reputed to be a ‘speakeasy’ during Prohibition, alcohol Prohibition, that is. It includes a meeting/concert space upstairs for about 200+ people, in addition to the Café downstairs. Oregon NORML signed a lease this fall with the onsite restaurant operator and took over the business in November. NORML volunteers have been working there non-stop ever since, turning the building into the Cannabis Café. Its opening last month became a world-wide press event…apparently a lot more people than Madeline thought the NORML’s Cannabis Café was an idea whose time had come.

America is currently a crazy-quilt of regulation with the 13 states and counting that have legal medical marijuana. Think what it will look like when all 50 states finally have it! In July, a front page article in the Wall Street Journal announced to the world that the Feds were standing down from enforcement in states with medical marijuana laws, and that MEDICAL MARIJUANA IS NOW OPEN FOR BUSINESS. As I read this, I could imagine entrepreneurs from coast to coast starting to draft their own plans for the medical marijuana businesses, the Next New Thing.

Stephen DeAngelo, the founder of Oakland’s Harborside Health Center, the Bay Area’s largest medical marijuana dispensary, gave one of the most thought provoking speeches at NORML’s 2009 Annual Conference on this very important topic: When marijuana is finally legalized (and new polls indicate America has finally reached the tipping point on this political issue) and the dust has settled, what will the business end of marijuana eventually come to look like? Remember, we are talking about taking an underground multi-billion dollar business and bringing it above ground. This is BIG. There will be huge long-term societal consequences of legalization far beyond the river of tax revenues it will create, many of which will be determined by what physical form legalization takes. So, what will the legal marijuana business in America come to look like? Something big and corporate? Something along the lines of Pepsi, RJ Reynolds, Starbucks, Pfizer, or Budweiser companies that market similar kinds of products??? Big profits, huge advertising budgets and lots of political cash….OR…should legal marijuana be something very different?

Stephen challenged his listeners to see that right now we have the opportunity to shape that marijuana business future, to get something different than the standard corporate outcome …right now, we have the opportunity to create a different cannabis delivery system that isn’t just about the performance on the quarterly bottom line, like it is in the ‘Pepsi’ paradigm, we can create a system that serves the public while at the same time it provides community service…something more along the business lines of Newman’s Own Salad Dressings from whose revenues have come donations of  almost $300 million to charities… Just think of that! The outcome for legal cannabis America could be vastly different, if we choose it…

Pain management is one of the places where the rubber truly meets the road in healthcare, a multi-billion dollar business. Non-toxic cannabinoid therapy has a very real place there. And non-toxic is good, as the very first rule of medicine should always be ‘to do no harm’. So, shouldn’t cannabis, from the get-go, do it differently than the Vicodin/Oxycodone ‘take these pills by yourself’ delivery model? After all, cannabis and all its users, medicinal or not, have been long defined by society as ‘counterculture’, so shouldn’t we be expected to do it differently, when we got our turn to create legal marijuana??? How about creating a non-profit medical cannabis delivery system whose central focus was on the patients, not profits for starters? Patients will have better results in chronic pain relief in the social setting of a Cannabis Café, where having people to talk to makes one’s problems feel lighter and one’s pain (medicated or not) easier to bear. Classes will be starting soon at the Cannabis Café on everything from aerobics, yoga, and weight management to plant propagation. Figuring out ways to provide free medicine to the indigent has been part of the design of the Oregon NORML’s Cannabis Café since its very inception. (Imagine that, the poor thought of first in the NORML model, not dead-last like in the standard corporate model.)  Perhaps a “Buds on Wheels” program for shut-in medical marijuana patients, too…A hemp products emporium, you get it, a place for everything cannabis, and you, too.

At NORML’s Cannabis Café, feel better…get better And then…What if… patients could meet at NORML Cannabis Cafés all over the country and the revenues generated driving a host of programs, in the area of healthcare and post drug war reparations, like freeing the thousands in jail today on pot charges? Think about it. Is that the kind of future you want? We can have it.

About two years ago, to better understand medical marijuana from the patient’s viewpoint, I interviewed the first 45 people waiting to get into one of the bi-monthly Oregon NORML Medical Marijuana meetings. Virtually everyone I asked that morning willingly volunteered his or her medical history. I heard a long litany of construction, car, and motorcycle accidents, of broken bones, dislocated joints, failed surgeries, and cancer… people who made me wonder, “How in the world does this guy/gal sleep at night?” Then it would occur to me, “Oh yes, of course, the cannabis.” For them NORML’s Cannabis Café puts dealing with serious medical issues in social setting…and shows it can be fun, as well. No wonder it’s a raging success.

NORML’s Cannabis Café is getting better by the day, as this new evolving healthcare paradigm kicks in. America can definitely learn something from the good folks who are blazing the Oregon Trail with medical marijuana; the future IS ours for the molding.

I’ve seen it.

A funny thing happens when the US government begrudgingly allows for double-blind, placebo-controlled clinical trials evaluating the therapeutic efficacy of inhaled cannabis.  

Investigators discover time after time that it works! 

Here are the results from the latest study, conducted at California’s Center for Medical Cannabis Research.   

Low-dose pot eases pain while keeping mind clear
via Reuters News Wire

NEW YORK (Reuters Health) — Giving carefully calibrated doses of smoked marijuana to people with neuropathic pain, which can be difficult-to-treat and extremely painful, can ease their pain without clouding their minds, California researchers report.

Read the full story here. 

Unfortunately, according to recently released legal filings, fewer than 20 investigators in the United States currently possess federal approval to conduct legal clinical research on whole smoked cannabis. (Not surprisingly, most of these researchers are conducting trials that seek to assess the potential physical and mental harms allegedly associated with the drug.) In addition, state funding for the CMCR — which has backed virtually all of the medical cannabis research conducted over the past several years — has dried up and no new appropriations are likely.

Of course, federal officials could readily step in with grant money to keep this important clinical research going — after all, just last month the US National Institute on Drug Abuse announced that it would be spending millions to establish the first-ever ‘Center on Cannabis Addiction‘ — but, needless to say, I’m not holding my breath.