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World: Legalization Permitting Medical Marijuana Reopens Debate

Canada this week became the first country in the world to allow people suffering from chronic or terminal illnesses to legally grow and use marijuana. Will more countries follow Canada's lead? RFE/RL correspondent Jeremy Bransten speaks to a doctor conducting clinical trials in Britain on the therapeutic uses of marijuana.

Prague, 3 August 2001 (RFE/RL) -- Anecdotal evidence about the therapeutic benefits of marijuana has existed for a long time. In recent years, more serious medical research has begun to support some of these claims, although no consensus has been reached.

As doctors come to the realization that cures for many illnesses -- especially chronic ailments like multiple sclerosis, cancer, AIDS, and severe arthritis -- are unlikely to be developed soon, they are increasingly focusing their attention on what is termed "pain management." But many pain suppressants currently in use, such as morphine and codeine, can be highly addictive and do not always work. In many cases, cannabis may prove a more effective alternative.

Dr. William Notcutt is a pain clinician at Great Yarmouth Hospital in Norfolk, England. Since May 2000, he has been conducting clinical trials on the therapeutic uses of marijuana and its derivatives. The trials follow a 1997 recommendation by the British Medical Association to undertake research on the topic. Subsequently, a British company, GW Pharmaceuticals, developed an oral spray to allow doctors to administer cannabis to patients in precisely controlled doses. Notcutt tells RFE/RL the clinical trials using the spray are especially important, as they will allow doctors to evaluate patient response to cannabis in a scientifically measurable way.

"One of the big problems, if you just use straight plant material -- smoking is the common way of doing it -- is that while it may be an effective way of delivering the drug, it's almost impossible to study it clinically in that way, and it's very difficult to get any realistic clinical information out of that sort of situation. Here in the U.K., we realized that a long time ago and have moved forward now and have available to us for clinical research a spray that one sprays under the tongue, and this is an extract of plant cannabis of different compositions. We can actually -- or the company that makes it -- can actually formulate it in various different ways so that we can look at very precise dosing."

Notcutt says patients tend to have highly individual responses to various drugs and treatments. While morphine may help alleviate pain in one cancer sufferer, for example, another patient with similar symptoms may get no relief from the drug. Therefore doctors put more emphasis on designing treatment programs suited to each individual. Notcutt says so far the evidence is that cannabis can have beneficial effects for the chronically or terminally ill in a variety of ways.

"Nowadays in managing chronic pain we look at a drug individually and say: how is it for the patient? If you say: how is it compared to morphine? -- it's like comparing apples with lemons. It's very difficult to draw a comparison between the two. But undoubtedly, a lot of patients do get benefits from this agent in a variety of different ways. We find some patients don't get much benefit on their pain, but what they do get is a tremendous improvement in sleep. And if you know you can reliably rest at night and get a good night's sleep, it makes a very great difference for the next day."

One aspect in which cannabinoids -- that is to say the active chemical elements of cannabis -- can be favorably compared to morphine and other drugs is their relatively low addictiveness. In this respect, says Notcutt, marijuana could be a welcome option for treatment:

"As a pain clinician, I'm quite happy prescribing morphine for patients and we know that in the scale of addiction, cannabis comes much lower than morphine and drugs like valium, which themselves come lower than alcohol and nicotine."

Notcutt says it will take several years of clinical trials for more conclusive results to be tabulated. It will then be up to the British regulatory authorities to consider whether to allow widespread trials or even move to legalizing medical marijuana, like the Canadians.

One thing is clear, however. The issue has raised serious debate in British society and the medical community worldwide. Notcutt says he senses a growing willingness to examine the benefits of marijuana for medical use:

"The attitudes of the medical world have changed radically. I mean, when I first gave a talk at a major meeting in 1997 or 1998, you know, there were sort of giggles behind hands and everyone thought this was a jolly, funny and slightly sexy subject -- how interesting. I go to the same meeting this year and everyone's very seriously talking about this. They're now really getting into this and saying: hey, we need the research! So within the medical framework, within three years, we've seen a very substantial change and society is continuously changing on this issue -- so much so that it's quite openly talked about now."

Indeed, the conservative British weekly "The Economist" last week went even further, devoting a cover story to the broader issue of drug legalization, urging a re-think on the topic. The magazine noted the failure of prohibition and temperance movements in the 19th and early 20th centuries -- a time when alcohol was seen by many as the demon and drugs such as marijuana and cocaine were freely available, even as medicinal drinks for children.

The highly charged nature of the debate on marijuana -- and especially its therapeutic use with those in immediate pain -- has produced other interesting ironies. The Canadian government made its decision for limited legalization despite opposition from the Canadian Medical Association, which had urged more research.

In the United States, by contrast, some doctors have expressed the desire to conduct clinical trials using medical marijuana, but the Justice Department and the Supreme Court have both ruled that any use of marijuana is illegal. Eight U.S. states have passed provisions allowing for the therapeutic use of marijuana and now find themselves in contravention of federal law. The controversy is sure to continue.