THC (Cannabis) Between 1840 and
1900, European and American medical journals
published more than 100 articles on the
therapeutic use of the drug known then as
Cannabis indica (or Indian hemp) and now as
marijuana. It was recommended as an appetite
stimulant, muscle relaxant, analgesic, hypnotic, and
anticonvulsant. As late as 1913 Sir William Osler
recommended it as the most satisfactory remedy
for migraine headaches . Today the 5000-year
medical history of cannabis has been almost
forgotten. Its use declined in the early 20th century
because the potency of oral ingestion was high,
and alternatives became available -- injectable
opiates and, synthetic drugs such as aspirin and
barbiturates. In the United States the Marijuana
Tax Act of 1937 was passed. It was designed to
prevent non medical use. This law made cannabis
so difficult to obtain for medical purposes that it
was removed from the pharmacopoeia. It is now
confined to Schedule I under the Controlled
Substances Act as a drug that has a high potential
for abuse, lacks an accepted medical use, and is
unsafe for use under medical supervision. In 1972
the National Organization for the Reform of
Marijuana Laws petitioned the Bureau of
Narcotics and Dangerous Drugs, later renamed
the Drug Enforcement Administration (DEA), to
transfer marijuana to Schedule II so that it could
be legally prescribed. As the proceedings
continued, other parties joined, including the
Physicians Association for AIDS Care. It was in
1986, after many years of legal maneuvering, that
the DEA acceded to the demand for the public
hearings required by law. During the hearings,
which lasted 2 years, many patients and physicians
testified, and thousands of pages of documentation
were introduced. In 1988 the DEA's own
administrative law judge, Francis L. Young,
declared that marijuana in its natural form fulfilled
the legal requirement of currently accepted
medical use in treatment in the United States. He
added that it was "one of the safest therapeutically
active substances known to man." His order that
the marijuana plant be transferred to Schedule II
was overruled, not by any medical authority, but
by the DEA itself, which issued a final rejection of
all pleas for reclassification in March 1992.
Meanwhile, a few patients have been able to
obtain marijuana legally for therapeutic purposes.
Since 1978, legislation permitting patients with
certain disorders to use marijuana with a
physician's approval has been enacted in 36
states. Although federal regulations and
procedures made the laws difficult to enact, 10
states eventually established formal marijuana
research programs to seek FDA approval for
Investigational New Drug (IND) applications.
These programs were later abandoned, mainly
because the bureaucratic burden on physicians
and patients became intolerable. Growing demand
also forced the FDA to Institute an Individual
Treatment IND for the use of physicians whose
patients needed marijuana because no other drug
would produce the same therapeutic effect. The
application process was made complicated, and
most physicians did not want to become involved,
especially since many believed there was some
disgrace on prescribing cannabis. Between 1976
and 1988 the government reluctantly awarded
about a half dozen Compassionate INDs for the
use of marijuana. In 1989 the FDA was
overwhelmed with new applications from people
with AIDS, and the number granted rose to 34
within a year. In June 1991, the Public Health
Service announced that the program would be
suspended because it undercut the administration's
opposition to the use of illegal drugs. After that no
new Compassionate INDs were granted, and the
program was discontinued in March 1992. Eight
patients are still receiving marijuana under the
original program; for everyone else it is officially a
forbidden medicine. Many people know that
marijuana is now being used illegally for the nausea
and vomiting induced by chemotherapy. Some
know that it lowers intraocular pressure in
glaucoma. Patients have found it useful as a muscle
relaxant in spastic disorders, and as an appetite
stimulant in the wasting syndrome of HIV
infection. It is also being used to relieve phantom
limb pain, menstrual cramps, and other types of
chronic pain, including (as Osler might have
predicted) migraine. Polls and voter referenda
have repeatedly indicated that the vast majority of
Americans think marijuana should be medically
available. One of marijuana's greatest advantages
as a medicine is its safety. It has little effect on
major physiological functions. There is no known
case of a lethal overdose; on the basis of animal
models, the ratio of lethal to effective dose is
estimated as 40,000 to 1. By comparison, the
ratio is between 3 and 50 to 1 for barbiturates and
between 4 and 10 to 1 for ethanol. Marijuana is
also far less addictive and far less subject to abuse
than many drugs now used as muscle relaxants,
hypnotics, and chronic pain relievers. The chief
legitimate concern is the effect of smoking on the
lungs. Cannabis smoke carries even more tars and
other particulate matter than tobacco smoke. But
the amount smoked is