Flare-ups of pre-existing
>auto-immune diseases such as rheumatoid arthritis, ulcerative colitis
>and Crohn's Disease are common. Marijuana can mitigate the majority
>of these side effects as well as offering effective help to those
>patients where alpha-interferon treatment is not indicated.
>Marijuana (Cannabis) is a powerful antiemetic2, 15, 18 that has been
>shown to be particularly effective controlling nausea and stimulating
>the appetites of immune surpressed patients such as those with HIV or
>undergoing chemotherapy. Cannabis has anti-depressant and
>anti-anxiety properties. It is an anti-inflammatory 3, 4, 6, 9, 10,
>14, 18, 19 and immuno-modulating, 7, 8, 11, 12, agent that can help
>minimize portal inflammation and slow the progression of both
>cirrhosis and Hepatocellular carcinoma. The cannabinoids have been
>shown to be powerful anti-inflammatories and anti-oxidants. They have
>also been shown to have anti-neoplastic activity, at least in gliomas
>(a form of brain cancer). Cannabinoids both slow programmed cell
>death (apoptosis) in normal cells while accelerating apoptosis in
>cancer cells. Cannabis has the added advantage of easing, or even
>completely eliminating, the muscle pains and cramping 1, 2, 5, 17,
>18, 21 that patients often experience. Marijuana is an effective
>analgesic.2, 3, 9, 14,15, 16, 20, 21 Cannabis has also been
>demonstrated as effective with rheumatoid arthritis, MS, and Crohn's.
>4, 7, 8, 20, it can aid in the prevention of inflammation associated
>with flare-ups of these conditions should they be present in your
>patient. Recent studies published this year (2002) have shown that
>cannabinoid receptors throughout the digestive tract act to reduce
>immune-reactivity and to surpress the vagal drive of the digestive
>system, slowing the digestive process, allowing more nutrients to be
>absorbed at a slower rate, thus putting less stress on the liver 1
>The Washington State Medical Quality Assurance Board has included
>Hepatitis C as a debilitating medical condition that could
>potentially benefit from the use of medical marijuana. Please review
>the following reference data. The minimal side effects of cannabis
>will be discussed following the data.
>Published Reference Data (Studies relevant to Hepatitis C, short
>synopsis - complete articles are available. Other references are
>located following the conclusion of this report.)
>1. Adami, Frati, Bertini, Kulkarni-Narla, Brown, de Caro, Coruzzi,
>and Soldani, "Gastric antisecretory role and immunohistochemical
>localization of cannabinoid receptors in the rat stomach" British
>Journal of Pharmacology Vol. 135, 2002, The study found cannabinoid
>receptors throughout the gastrointestinal organs of rats.
>"Immunoreactivity to the CB1 receptor was co-localized with that of
>the cholinergic marker choline acetyltransferase in neural elements
>innervating smooth muscle, mucosa and submucosal blood vessels of rat
>stomach fundus, corpus and antrum. These results indicate that
>gastric antisecretory effects of cannabinoids in the rat are mediated
>by suppression of vagal drive to the stomach through activation of
>CB1 receptors, located on pre- and postganglionic cholinergic
>2. Baron and Folan, "Ulcerative Colitis and Marijuana", Annals of
>Internal Medicine, Vol. 112, No.6, p 47, 1990, "The symptoms of
>ulcerative colitis were repeatedly relieved by smoked cannabis."
>3. Beltramo and Piomelli, "Functional role of high-affinity
>anandamide transport as revealed by selective inhibition." Science,
>Vol.277, No. 5329, pp1094, 1997, "Cannabinoid and non-cannabinoid
>compounds in marijuana reduce pain and inflammation."
>4. BW Healthwire, January 1998, "Pre-clinical studies show CT-3
>reduces chronic and acute inflammation and reduces destruction of
>joints." Atlantic Pharmaceuticals was evaluating CT-3, a cannabinoid
>derivative. The company reported "In recent studies, the agent was
>found to reduce inflammation and prevent the destruction of joint
>5. Egli, Elsohly, Henn and Spiess. International Journal of Clinical
>Pharmacology, Vol. 34, No. 10, pp46-452, 1988, "The effect of orally
>and rectally administered delta-9-tetrahydrocannabinol on spasticity"
>"THC was shown to relieve muscle spasms in human patients."
>6. Formukong, Evans, and Evans "Analgesic and anti-inflammatory
>activity of constituents of cannabis sativa l" Inflammation, Vol. 12
>No. 4, pp361-371, 1988, "Cannabidol is more effective than aspirin in
>reducing inflammation" (Cannabidol or CBD, is one of the scores of
>cannibinoids found in marijuana other than THC)
>7. Friedman, H.; Klein, T.W.; Newton, C.; and Daaka, Y., "Marijuana
>receptors and immunomodulation." Advances in Experimental Medicine
>and Biology 373: pp103-113, 1995, "The study suggested that the
>immunosuppressive effects of cannabinoids might be useful clinically;
>for example, in treating multiple sclerosis.
>8. Grotenhermen Dr. Franjo, IACM-Bulletin of 25 June 2000, (IACM):
>"We know from animal studies that THC inhibits the production of Th-1
>cytokines such as IL-1, IL-2, and IFN-gamma and stimulates the
>production of Th-2 cytokines such as IL-4, IL-10, and TGF-beta. This
>would give reason for a causal therapeutic use of THC in certain
>autoimmune diseases that appear to be Th-1 mediated such as Crohn's
>disease, a form of chronic intestinal inflammation, and rheumatoid
>9. Holdcroft, et al., "Pain relief with oral cannabinoids in familial
>Mediterranean fever" Anesthesia, Vol. 52, No. 5, May 1997. This
>research paper done at Hammersmith Hospital in London confirmed
>cannabis' analgesic effects in the first UK clinical trial. The paper
>states "Cannabinoids have analgesic and possibly anti-inflammatory
>properties but their clinical use has been restricted by legislation"
>10. Hollister L.E, "Health Aspects of Marijuana" Pharmacological
>Review, Vol. 38, No. 1, 1986, "Constituents of marijuana; CBC,
>olivitol, and cannoflavin all have marked anti-inflammatory
>11. Hollister L.E, "Marijuana and immunity" Journal of Psychoactive
>Drugs Vol.20 (1: 3-8, January-March, 1988, Cannabinoids found in
>marijuana are effective immunomodulators.
>12. Kaminsky N. E., "Evidence for a cannabinoid receptor in
>immunomodulation by cannabinoid compounds" Advances in Experimental
>Medicine and Biology, Vol. 335, 115-120, 1993, Identifies the
>receptors and process that allows marijuana to be an effective
>13. Kaminsky N. E. Journal of Neuroimmunology, 1998, "These
>[cannabinoids] might be useful as immune modulators, perhaps to be
>used as anti-inflammatory agents"
>14. Maurer, Henn, Dietrich and Hoffmann "Delta-9-tetrahydrocannibinol
>shows anti-spastic and analgesic effects in a single case
>double-blind trial" European Archive of Psychiatry and Neurological
>Science, Vol. 240 No. 1 pp1-4 1990, The trial compared Codeine, THC,
>and a placebo. The study found codeine and THC had comparable
>analgesic effects but only THC had a significant beneficial effect on
>spasticity and inflammation."
>15. National Academy of Science, Institute of Medicine, "Marijuana
>and Medicine; Assessing the Science Base " Executive Summary, 1999,
>"Conclusion: Scientific data indicate the potential therapeutic value
>of cannabinoid drugs, primarily THC, for pain relief, control of
>nausea and vomiting, and appetite stimulation;"
>16. Noyes and Barnes, Comprehensive Psychiatry, Vol. 15, No. 6, pp
>413s-416s, 1974, "There are indications that the active ingredients
>in marijuana may be an effective analgesic that is efficacious in
>17. Petro and Ellenberger, "Treatment of human spasticity with
>delta-9-tetrahrdrocannibinol" Journal of Clinical Pharmacology, Vol.
>21, 1981, "THC can relieve a broad range of muscle spasms in humans
>18. Pharmos Corporation Press Release, May 21 1998, Researchers
>reported that experimental treatment of rats suffering from
>ulcerative colitis with Dexanabinol (synthetic cannabidiol-CBD)
>"significantly reduced the anorexia and the colonic inflammation
>associated with this condition compared with untreated rats."
>19. Richardson, Kilo, & Hargreaves, "Cannabinoids Reduce Hyperalgesia
>and Inflammation via Interaction with Peripheral CB1 Receptors". Pain
>Vol. 75, 1 pp. 111-119, 1998, Conclusion is in title.
>20. Society for Neuroscience Conference, symposium syllabus,
>Functional Role of Cannabinoid Receptors, Aug. '98, "Cannabinoids
>were shown to have a direct effect on the biochemical pain signals in
>the central nervous system, and to exhibit superior pain control to
>addictive opiate based narcotics. Cannabinoids prevented hyperalgia
>and were shown to be particularly effective in the treatment of
>arthritis and other inflammation induced pain.
>21. Zeltser, R.; Seltzer, Z.; Eisen, A.; Feigenbaum, J.J.; and
>Mechoulam, R "Suppression of neuropathic pain behavior in rats by a
>non-psychotropic synthetic cannabinoid with NMDA receptor-blocking
>properties" Pain Vol. 47(1): 95-103, October. 1991, The study found
>cannabis surpressed neuropathic pain which complicates many CNS
>diseases. Cannabis was effective when few available therapies
>provided even partial relief.
>*The oldest medical text known to man was written over 5,000 years
>ago. The Chinese Pen Ts'ao, prescribed cannabis for rheumatism and
>digestive disorders among other illnesses.
>*The New English Dispensary of 1764 recommended hemp to reduce
>*In 1814, Nicholas Culpepper published his Complete Herbal, which
>included "allaying humors of the bowels" and "reducing inflammation"
>among the applications of cannabis.
>*Surgeon William O'Shoughnessy in his 1839 paper titled On the
>preparation of the Indian Hemp found that cannabis relieved
>rheumatism, convulsions and muscle spasms.
>*The 1854 United States Dispensatory listed many uses for cannabis
>including "reduction of inflammation", "relax muscle contractions",
>"treatment of digestive disorders" and as "an analgesic and sedative"
>*Between 1840 and 1890 over 100 papers were published on the medical
>uses of cannabis.
>*Sir William Osler, known as the "father of modern medicine",
>proclaimed cannabis the best treatment for migraine pain in his
>authoritative 1915 textbook.
>*In 1937, when the Marijuana Tax Act was before Congress The American
>Medical Association protested vehemently, Dr William C. Woodward, the
>AMA's counsel, testified that the bill would deprive Americans of one
>of the most useful drugs known to medicine. He also complained that
>the only reason there hadn't been a larger public outcry was because
>the Act referred to the Mexican slang "marijuana" and not to
>cannabis, which everyone understood was a medicine
>There has never been a reported death from overdose of marijuana 10,
>15, 22, 23, 26 27. There has never been a death or permanent health
>effect reported from long-term heavy use of marijuana 10, 22, 23, 27.
>Side effects include; a slight increase in heart rate24, 25, slight
>hypotension24, 25, increased appetite 15, 24, and of course, a mild
>euphoric effect. There are "no deleterious effects on the normal
>cardiovascular system" as a result of these side effects according to
>a 1997 WHO report27,. An Australian National Drug Strategy report
>states "Tolerance to the cardiovascular effects develop within 7-10
>days in persons receiving daily doses of THC" 24,.
>The euphoria also is subject to the effects of tolerance. Any effects
>on coordination and cognition dissipate within 7-10 days of daily
>use15, 24. However marijuana's effects continue to aid with the
>patient's stress reduction and to alleviate the depression and other
>emotional problems that Hepatitis C patients often suffer from 10,
>15, 28, 29, 30. Many patients find cannabis far superior to Valium,
>Serax, Elavil, or Sinequan; all are commonly prescribed to Hepatitis
>C sufferers. Please contact the Lifevine Foundation for published
>data regarding the anti-anxiety and anti-depressant properties of
>cannabis. Hepatitis C patients find the appetite stimulation10, 15,
>31, an added benefit. It is likely that your patient has already
>tried marijuana for their symptoms and feels the perceived benefits
>outweigh any side effects they have experienced.
>The most obvious risk of smoking marijuana, is, of course, the risk
>incurred smoking any vegetable material. There are several factors to
>consider when determining this risk. If your patient is not suffering
>from malabsorbtion due to their Hepatitis C and they are able to keep
>food digesting for two hours, the patient may choose to eat their
>cannabis and avoid all smoking risks. Other smoking methods such as
>vaporizers (which heat the cannabis to a temperature high enough to
>"vaporize" the cannabinoids on the surface of the marijuana without
>igniting the vegetable matter) may minimize the smoking risks.
>The carcinogenic ingredients in both tobacco and cannabis are
>primarily the tars that reside in both plants - not the THC or other
>cannabinoids of cannabis. The main difference in the incidence of
>development of lung cancer is a matter of exposure to these tars,
>which is overwhelmingly greater with tobacco than with cannabis.
>It takes 20 - 25 pack/years or more (1 pack/year == smoking 1 pack of
>cigarettes/day for 1 year.) for most tobacco-induced lung cancers to
>develop. 20 - 25 pack/years worth of cigarettes == 150,000 to 200,000
>cigarettes. Of all those people who smoke 1 pack/day or more of
>tobacco cigarettes for all of their adult lives, only 1 in 5 (20%)
>will actually develop tobacco-induced lung cancer.
>Most patients who use marijuana medicinally develop their illness in
>mid to late life, and start smoking marijuana medicinally only when
>their projected remaining life span is already relatively short.
>Light medical marijuana users - (1-2 joints/day) in one year would
>smoke 365 - 730 joints; In ten years - 3650 - 7300 joints. In order
>to reach the equivalent of 200,000 cigarettes it would take them 270
>years, at which time 1/5 of them might develop a cancer.
>Very heavy use of medicinal marijuana may amount to 10 joints/day. In
>one year they would smoke roughly 3,650 joints; in ten years- 36,500
>joints It would take them 54 years to smoke the equivalent of 200,000
>tobacco cigarettes, at which time 1/5 of them might develop a cancer.
>These figures assume large (1 gm) joints are being smoked - similar
>in size to a tobacco cigarette
>Tobacco smoke is a bronchial constrictor known to penetrate the
>lung's smaller peripheral air passages and causes inflammation of the
>lung's absorbent microphages. Tobacco causes blockages which leads to
>emphysema. Dr. Donald Tashkin, a federally sponsored pulmonologist
>and professor of medicine at UCLA Medical School has determined that
>marijuana smoke acts as a bronchial dilator and surpresses
>inflammation of the lung's macrophages. In a 1997 UCLA study
>involving 394 participants32 Tashkin noted "Neither habitual
>long-term marijuana smokers nor intermittent marijuana smokers
>exhibited any significantly different rates of decline in lung
>function. No differences were noted between even quite heavy smoking
>and non-smoking of marijuana." In contrast, the tobacco-only smokers
>in the study experienced a rapid decline in lung function during the
>eight years this study ran. The study also found no connection
>between marijuana and tobacco smoking in those s ubjects who smoked
>both. The evidence from this exhaustive real-world study indicates
>that the pulmonary health of marijuana smokers is no different from
>that of the general population.
>In an article in American Journal of Respiratory Cellular and
>Molecular Biology 2001 Mar; 24(3): 339-44 titled "Induction and
>regulation of the carcinogen-metabolizing enzyme CYP1A1 by marijuana
>smoke and delta (9) tetrahydrocannabinol" by the Roth et al, Division
>of Pulmonary and Critical Care Medicine, Department of Pathology and
>Laboratory Medicine, UCLA School of Medicine, "Induction of the
>carcinogen-metabolizing enzyme cytochrome P4501A1 (CYP1A1) is a key
>step in the development of tobacco-related cancers." They determined
>THC had a significant inhibitory effect on the cancer-causing
>enzyme's induction into the body.
>Other tests conducted by Dr. Tashkin at UCLA have found a slightly
>higher risk of bronchitis and other upper respiratory infections in
>marijuana smokers33. This risk may be mitigated by the use of
>vaporizers or by the use of ice or water-cooled pipes
>Other risks include physical or psychological dependence. These risks
>are far lower than with any other psychotropic drug15. The addictive
>properties of marijuana are less than caffeine, ephedrine, or
>benzodiazepines (like Valium).15 Marijuana is similar to chocolate in
>it's potential for dependency34. Unlike alcohol, nicotine, opiates,
>barbiturates, amphetamines, cocaine or chocolate, marijuana does not
>effect the dopamine receptors of the brain35, 36. There is no
>physical withdrawal10, 15, 26, 27,36. Unlike steroids and other
>pharmaceuticals, one can cease use immediately; there is no need to
>"taper down" dosages.
>There is compelling evidence that cannabis is an effective
>antiemetic, anti-inflammatory, immune modulating, analgesic and anti
>spasmodic agent. These properties are indicated for patients
>suffering from Hepatitis C. Five thousand years of recorded medical
>of use, has shown no long-term consequences. Side effects from the
>use of medical marijuana are much milder than the side effects of the
>traditional drugs used to treat Hepatitis C. Many patients who use
>cannabis report they are able to continue the use of their
>prescription medications only when the side effect can be mitigated
>with cannabis. Marijuana also has recognized anti-anxiety,
>anti-depressant and stress reducing qualities which ease
>psychological symptoms and side effects as well as helping to prevent
>substance abuse relapse. Cannabis has the ability to stimulate
>appetite, which many Hepatitis C patients find beneficial. Patients
>without prescription insurance find the ability to grow their own
>medicine at li ttle or no cost to be an additional benefit.s
>RCW 69.51A states that for a patient to qualify for use of medical
>marijuana, their physician must find that "It is their medical
>opinion that the potential benefits of the medical use of marijuana
>would likely outweigh the health risks for this patient." We urge you
>to sign the enclosed "Documentation of Medical Authorization to
>Possess Marijuana for Medical Purposes in Washington State." The
>Washington State Medical Association has prepared this document for
>use by our state's physicians. The link between stress and Hepatitis
>C is well established. Eliminating the stress induced by the fear of
>arrest by patients who currently use marijuana for their symptoms is
>yet one more benefit of the medical marijuana act.
>Other Published reference data
>22. Mechoulam R. 1986. The pharmacology of cannabis sativa. In
>Cannabinoids as Therapeutic Agents, ed. R Mechoulam, pp. 1