Pubdate: Thu, 31 Aug 2000 Source: USA Today (US) Copyright: 2000 USA TODAY, a division of Gannett Co. Inc. Contact: Address: 1000 Wilson Blvd., Arlington VA 22229 Fax: (703) 247-3108 Website: Author: A.J.S. Rayl, with medical adviser Stephen A. Shoop, M.D.*


Is Good Medicine A Political Headache?

When Kareem Abdul-Jabbar, the NBA's career leading scorer, was arrested in Los Angeles last month and accused of driving under the influence of marijuana, it was the second time the former Laker has been stopped and detained because of possession of the green weed. But Abdul-Jabbar maintains that his marijuana use is medicinal: to alleviate the migraine headaches from which he has suffered for years.

In California, it's been technically legal to possess marijuana -- provided you have a doctor's recommendation -- since 1996 when Proposition 215, which legalizes the use of medicinal marijuana, was adopted by 56% of the voters. Seven other states have passed similar legislation.

Other details of his arrest notwithstanding, Abdul-Jabbar, according to well-placed sources, does have a doctor's recommendation issued in the state of California.

On Tuesday, however, the Supreme Court issued an emergency order that at least temporarily halts the distribution of medicinal cannabis to Californians who are sick and in pain. The order ignited a firestorm of confusion for everyone who is finding relief with medicinal marijuana -- - - and for the California physicians who are prescribing it.

"The Supreme Court's action is not unexpected, and actually, I don't think it affects Prop. 215," says David Bearman, former director of the Drug Treatment Program at the Haight Asbury Freee Clinic. Now in private practice in southern California, Bearman prescribes cannabis for indicated ailments, including migraines.

Bearman maintains that despite the court's edict, physicians can still recommend the drug, and patients can still use and possess medicinal marijuana. Further, Bearman says, patients can still cultivate cannabis in California.

"It's an interim setback for medical marijuana patients," says neurologist Ethan Russo of the Montana Neurobehavioral Specialists group in Missoula.

Medical Efficacy?

But while the actual effects of the ruling will take time to sort out, the question remains: Does marijuana have medicinal value for migraine headaches and other maladies?

"There is no question that cannabis is beneficial medicinally," Bearman says. With migraines, "some people say it makes the pain go completely away or can prevent migraines from coming on. Others say it lessens the pain and allows them to focus on other things to get their work done."

What cannabis does to alleviate migraines is complicated and not completely understood. "But it works on serotonin and dopamine receptors, and has anti-inflammatory activity," says Russo, who is just finishing a paper for the Journal of Cannabis Therapeutics.

"Basically, it is a multi-modality agent that works on various aspects of migraine in a way that's really unique. And it's not just the THC -- tetrahydrocannabinol, the psychoactive chemical -- that does it. It appears now that it's the result of the interaction of a combination of other cannabinoids and also the essential oils in the plant."

Unlike most headache medications, cannabis is unique in that it works as both a preventive agent and an analgesic. "At any point in the migraine, they could use cannabis by smoking, vaporizer, etc., and about 80% of these people get significant or total relief," he says. "And, if someone has a chronic migraine, daily use in whatever form will often lead to a complete remission."

Bureaucratic Impediments:

The cannabis mechanism is not fully understood because there hasn't been enough research. Despite all the claims of its beneficial effect on migraines, there has yet to be a scientific study investigating the therapeutic use of marijuana for migraines.

"In fact, there haven't been any clinical studies investigating cannabis for a therapeutic purpose approved in the USA for some 15 years," Russo says. But that's not because researchers aren't interested. Nobody knows that better than Russo.

Russo first applied to the FDA in 1997 for an Investigational New Drug application to test cannabis on acute migraines. He was put through a classic bureaucratic run-around between the FDA and the National Institutes of Health.

Last year, Russo finally hooked up with FDA ombudsman Jim Morrison. "He led me to understand the FDA had not been following its own procedures, and that things would be different henceforth."

By September, Russo had secured approval from both the FDA and the National Institute on Drug Abuse (NIDA). Then NIDA changed its policy and ultimately rejected his grant application for a variety of reasons, including the requirement that participants be exposed to marijuana only once.

Though Russo hopes at some point to be able to conduct the study, he views the conflicting requests by NIDA officials and the scientific review board as -- at the moment anyway -- "unbridgeable."

"And that's exactly the reason more studies on cannabis have not been done -- the political hassle," Bearman says. "It's just easier to look at other pharmacology questions that don't have the political stigma or pressure associated with cannabis. Generally across the board, what research does get done is often of poorer quality than most medical research because the government sticks its foot in there and interferes with the scientists."

Both Russo and Bearman cite the case Donald Abrams of the University of California at San Francisco and his six-year effort to test the therapeutics of cannabis on AIDS wasting syndrome. Abrams had to shift his focus from efficacy to safety to get the study pushed through.

But despite the drill, Abrams came out a winner. "He showed that cannabis was effective for wasting syndrome and that it does not produce immune problems in people taking protease inhibitor drugs," Russo says.

Historical Perspective:

It may come as a surprise, but marijuana has been used medicinally for more than a century in the USA and was for many decades a mainstream medicine for migraine treatment.

"Cannabis has been used in American medicine since it was introduced in 1839 by British physician W.B. O'Shaugnessey, and one of the primary debilitations it was indicated for were migraines," Bearman says. "O'Shaugnessey was knighted, by the way -- not for introducing cannabis but for helping put the telegraph across India. But he was a very well- respected physician, and not some fly-by-night fellow."

Sir John Russell Reynold -- another knight and personal physician to Queen Victoria -- was also a major proponent for the use of cannabis for migraine. He prescribed the weed to her Majesty for her cramps.

In this century, Sir William Osler, honored as "the father of modern medicine," proclaimed in 1915 that cannabis was the best medicine for migraines. Even more recently, an editorial last year in the New England Journal of Medicine openly supported physicians' rights in prescribing medicinal marijuana.

"The only real news about cannabis for migraine treatment as far as the mainstream population goes is that it's been suppressed information," says Russo, who has spent the last decade of his research focusing on herbal remedies for the excruciatingly painful, debilitating headaches.

Remedy Required:

Time will tell how the law will treat Abdul-Jabbar and other migrainers, as they're known. In the meantime, Bearman says, "There are literally thousands of doctors who are recommending cannabis."

Adds Russo: "Numerous states and thousands of people have found cannabis to be a viable option in medicine to treat migraines and other disorders, and I just don't see the tide changing now."

"A physician's job is supposed to be to alleviate pain, and help people, and get them back to doing the things they need to do or enjoy doing," Bearman says. "I recommend cannabis because it has medicinal value. I recommend it where indicated because it's reasonable, responsible medicine." He has given out dozens of "prescriptions" for marijuana to patients who suffer from migraines, as well as chronic pain, fibromyalgia and a number of other ailments.

"You can't always cure illness, particularly chronic illness, but you can treat people symptomatically," Bearman says. "Cannabis is one more tool. It's not a magic bullet. It's not the answer for everybody who has a condition for which this may be beneficial."

Cannabis is, also, he says, "very affordable, especially when you compare it with a month's supply of Marinol -- the synthetic compound now on the market -- at around $700."

Meanwhile, the cost of policing the situation is enough to give anyone a headache.

"When you look at the expenditure to fight all these law enforcement fights -- $100 billion a year at city, county and federal levels to fight laws where it could be funneled into social security, our school programs and all kinds of other good places -- it's truly amazing," Bearman says.

"The government is taking a moralistic stance," charges Russo. "It's sort of like the little Dutch boy with his thumb in the dike. I really think they are afraid that my study will actually show a therapeutic application for cannabis, and then the whole dike will come tumbling down, and they'll end up with a situation they're not prepared to deal with."

But despite the obstacles, the research community is pushing ahead. As the Supreme Court issued its order Tuesday, the University of California announced the establishment of a new cannabis study center with headquarters at UC San Diego. Its mission is to determine whether marijuana does have medicinal value and to help develop data to help counties implement the new state law.

*A Doctor In Your