Hope is faith holding out its hand in the dark.  -George Iles

Saturday, July 18, 2009

Fibromyalgia and Medical Marijuana

Fibromyalgia, a chronic pain syndrome, is hard to treat and impossible to cure. With pain so debilitating, patients may wonder about trying medical marijuana to ease their discomfort.

Still widely controversial, "medical marijuana" refers to the smoked form of the drug. It does not refer to the synthesized version of THC, one of the active chemicals in marijuana, that's available in a medication called Marinol. The FDA first approved Marinol (dronabinol) in 1986 for nausea and vomiting from chemotherapy. It later approved its use for nausea and weight loss from AIDS.

The history of medical marijuana

Medical marijuana was prescribed by doctors until 1942. That's when it was taken off the U.S. pharmacopoeia, the list of commonly available drugs.

"Marijuana has been a medicine for 5,000 years," says Donald I. Abrams, MD. "That's a lot longer than it hasn't been a medicine." Abrams, who is an oncologist and director of clinical research programs at the Osher Center for Integrative Medicine at the UCSF School of Medicine in San Francisco, is one of a handful of top-flight doctors in the country researching medical marijuana. "The war on drugs is really a war on patients," he says.

So why research medical marijuana when a pill, Marinol, is now available?

Marijuana -- the plant's Latin name is cannabis -- has a host of components called cannabinoids. These components may have medicinal properties.

"There are 60 or 70 different cannabinoids in marijuana," says Abrams. Marinol contains only one cannabinoid -- delta-9 THC. When THC is isolated from the plant, other ingredients are lost, including those that might be buffering any adverse effects of taking "straight" THC. "In Chinese medicine," Abrams says, "they prescribe whole herbs and usually combinations of herbs."

Abrams goes on to point out that, "In 1999 the Institute of Medicine did a report --Marijuana and Medicine. And they said, in fact, that cannabinoids have benefit in relief of pain, increase in appetite, and relief of nausea and vomiting."

Is medical marijuana legal?

The federal government, in the Controlled Substances Act of 1970, placed drugs into five groups called "schedules," driven by three criteria:

  • potential for abuse or addiction
  • medical usefulness
  • dangers of abuse or addiction, both physically and psychologically

Marijuana, LSD, and heroin were all initially placed in Schedule I -- the most addictive, and least medically useful, category.

To further entangle the legal issues, several states have passed their own controlled substance laws that conflict with federal laws. That includes drug policy reforms and "compassionate use" laws that allow patients with terminal and debilitating diseases to use medical marijuana. In order to be able to use it, a patient needs to have documentation from a doctor.

The American Chronic Pain Society says in ACPA Medications & Chronic Pain, Supplement 2007: "Some states allow the legal use of marijuana for health purposes including pain, while the federal government continues to threaten physicians with prosecution for prescribing it."

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