Compassionate Use and SCDs

Now that research has shown its positive effect on neuropathic pain and even spasticity, some people with spinal cord disorders are joining the fight to legalize medical cannabis.

Julie Falco (Photo by Paul Meredith)

By Lori A. Wood

Proponents of medicinal marijuana have credited it with the alleviation of everything from chemotherapy- induced nausea to glaucoma. Could the muscle spasticity and neuropathic pain common to certain spinal cord disorders (SCDs) someday be added to that list? According to researchers, it’s possible.

At the University of California in San Diego, the Center for Medicinal Cannabis Research (www.cmcr.ucsd.edu) is funding studies to examine the safety and efficacy of medicinal cannabis for a variety of illnesses. “The Center came about in 2000, as the result of a bill passed by the California legislature and signed into law by the governor, called the Medical Marijuana Research Act of 2000,” says Dr. Andrew Mattison, co-director of the Center. “It was a follow-up on Proposition 215- compassionate use of medical marijuana for patients. Our program is directed toward safety issues, and whether medicinal cannabis works for selected medical indications.”

“The reason that this research has started seriously in the last ten years is that we know a lot more now about what are called cannabinoid receptor systems than we did before,” explains Heather Bentley, project manager at the Center. “It turns out that the body makes its own cannabinoids, as it does its own opioids. Now that we know more about the systems, we can start to target the receptors to produce analgesia, to help with things like muscle spasticity. Scientifically, that’s how we think that cannabis and its natural materials, like delta-9-tetrahydrocannbinol (THC), cannabidiol and cannabinol, as well as those cannabinoids that are less understood, produce this action.”

Whether cannabinoids stop muscle spasticity completely, Bentley admits, “We just don’t know. Until recently, there haven’t been many good rigorous, controlled studies. There have been a lot of anecdotal reports, in which people say it’s helpful to them, but the earlier studies don’t seem to report unanimous effects.”

The Road to Clinical Use

“There’s a lot of pre-clinical, laboratory, and animal research that is looking at the effects of the application of cannabinoids on the spinal cord,” says Bentley. “It’s going to take a long time to come to clinical use. As we come to understand how cannabis works, I think we’ll be able to isolate the good parts, and get rid of the unnecessary parts, like its harmful chemicals. In this regard, we can expect new drugs based on synthetic molecules that preserve the therapeutic actions of cannabis, without many of the harmful side effects. This field of research into the receptors and their mechanisms is very young, but I think there are some good things to look forward to.”

Dr. Barth Wilsey, director of the University of California at Davis Analgesic Research Center, is currently studying the impact of smoked medicinal cannabis on neuropathic pain. “We’re doing our study at the UC Davis General Clinical Research Center which is located at the Sacramento VA Medical Center.” The study is one of the ongoing research projects sponsored by the Center for Medicinal Cannabis Research. “They’ve been very helpful in lowering the barriers to performing research with medicinal marijuana.”

The UC Davis study started in April 2004, and was initially directed to study patients with reflex sympathetic dystrophy (RSD), which occurs when a microscopic nerve injury causes persistent pain. “Now we’ve opened the study to include people with other nervous system injuries, like those with post-stroke pain and SCI [spinal cord injury]. We’re very interested in enrolling people with SCI, because there have been reports from the United Kingdom that medical marijuana is successful in treating this type of neuropathic pain.”

Dr. Wilsey says that research by GW Pharmaceuticals (www.gwpharm.com/sativex.asp) with Sativex®, an oral cannabis spray, indicates that patients with SCI and those with multiple sclerosis (MS) benefit from this form of therapy. “These two conditions seem to respond better than other types of neuropathic pain,” he says.

Of his own research, Dr. Wilsey says, “Patients come into the research laboratory once a week and spend six or seven hours undergoing testing.” The study is double-blinded; subjects smoke highstrength, medium-strength or placebo marijuana cigarettes on separate occasions. “Neither they nor we know what type of cigarette they’re smoking. Initially, we ask them to smoke two puffs. An hour later, they smoke three puffs. An hour after that, they are asked to take four puffs. After each smoking session, we measure the degree of pain relief to see if there’s a cumulative effect from the additional puffs. We ask subjects to rate their pain on a scale that is numbered from zero to ten, with zero meaning no pain, and ten being the most severe pain imaginable.”

Subjects are also tested for cognitive function, including motor and learning skills. “No matter what the results of our study, we would certainly be cautious about recommending that SCI patients who also have traumatic brain injury and/or balance problems use medicinal marijuana, because of the potential for worsening of preexisting impairments. But, for many people with SCI pain, we are hopeful that medicinal marijuana can eventually be used safely, and have designed our experiments with the objective of finding a minimal effective dose.” Sacramento residents who are interested in participating in Dr. Wilsey’s study can call 916-734- 7085 for further information.

Cannabis versus Marijuana

The debate surrounding the legalization of medical marijuana has, so far, overshadowed its possibly beneficial applications. The following states have medical marijuana or compassionate use laws: Alaska, California, Colorado, Hawaii, Maine, Maryland, Montana, Nevada, Oregon, Vermont and Washington. “By federal law, the use of marijuana is illegal,” says Bentley. “It doesn’t matter whether your state has a compassionate use law or not. Our studies are conducted with full federal approval, so they are not affected by this controversy. States, if they choose, can set up a research program, and work just like you would for any drug testing in humans, and it doesn’t matter whether a state has compassionate use laws or not.”

Julie Falco is a United Spinal member and activist with MS who is trying to get a medical cannabis bill enacted in Illinois. “I have found enormous relief from leg spasticity where it calms down the jumpiness and stiffness of my legs,” she says. “It has helped with insomnia and a continual bladder urgency that made me get up in the middle of the night. It regulated bowel issues. It has been the best anti-depressant I’ve ever taken. I’m no longer depressed and have no side effects like I did with other standard pharmaceutical anti-depressants. I am now off all pharmaceutical medications that I had been taking, except for Tylenol #3s with codeine. Cannabis and T3s are my only medications right now and I feel better than I have in years.”

After reading an article about a woman arrested for marijuana possession who needed it for medicinal purposes, Falco became an activist for the legalization of cannabis for medicinal use. She signed up to receive e-mail newsletters from Illinois National Organization for the Reform of Marijuana Laws (NORML) (www.norml.org), and the Drug Policy Alliance.

Falco is now on the board of directors of both Illinois NORML and Illinois Drug Education and Legalization (IDEAL) Reform, www.idealreform.org. Much of her time is devoted to telling her own experience with medical cannabis to legislators, students, physicians and members of the media. “People are interested in learning more about cannabis,” she says. “At the same time, they are working on releasing the toxic stigma and stereotypes about marijuana that have negatively impacted the forward movement of a medical cannabis bill.”

The Illinois Experience

The Illinois Medical Cannabis Act, also known as SB 2568, would enable people with debilitating medical conditions (as diagnosed by a physician), as well as their primary caregivers, to apply for a registry identification card from the Department of Public Health. This card would permit them to use cannabis medicinally, under no threat of prosecution or other legal penalty.

SB 2568 passed out of the Health and Human Services (HHS) Committee in February 2006. Falco testified at the hearing.

“It was the most significant progress medical cannabis had seen in Illinois since passage of our 1978 law” legalizing medical uses of marijuana, asserts George Pappas, Executive Director of IDEAL Reform. “It is a clear indication that legislators are ready for progress on this issue.”

But the battle is far from over in Illinois. “The bill was not called to the floor of the Senate by the end of the legislative session, which means it must go through the same committee process this coming year as it did last year.” Pappas is confident the bill will pass the committee again in the 2007 session. “We are very optimistic about our ability to work with lawmakers in the 2007 session to pass the bill through the legislature and to develop a medical cannabis program that is in the best interest of all aspects of public health. This includes efforts to educate the public that cannabis is a safe and effective treatment for patients with a wide range of ailments, but that this law is in no way advocating recreational use of cannabis by anyone, especially youth. It is up to the state to put out the right message.”

Nationally, Pappas sees progress as well. “Since 1996, eleven states have created programs that allow patients real access, and many more states, like Illinois, are considering such laws every year. This sends a strong message to the United States Congress that the states have taken the lead, and now it’s time for the federal government to pick up the slack on this issue and finally address it.”

Pappas believes the new Speaker of the House may be a sign of change for federal policy on the issue. “Nancy Pelosi is a strong advocate of medical cannabis, which is very promising,” he says.

Lori A. Wood is a regular contributor to Action.