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Hisotry of Medical Marijuana
The Cannabis plant has a history of medicinal use dating back thousands of years across many cultures. Its current use is controversial.
The American Medical Association, the Minnesota Medical Association, the American Society of Addiction Medicine, and other medical organizations have issued statements opposing its use for medicinal purposes.
The American Academy of Pediatrics states that while cannabinoids may have potential as therapy for a number of medical conditions, they do not recommend it until more research is done. They, along with the American Medical Association and the Minnesota Medical Association, call for moving cannabis out of DEA Schedule I to facilitate this research.
Medical cannabis can be administered using a variety of methods, including vaporizing or smoking dried buds, eating extracts, taking capsules or using oral sprays. Synthetic cannabinoids are available as prescription drugs in some countries; examples include: dronabinol and nabilone. Recreational use of cannabis is illegal in most parts of the world, but the medical use of cannabis is legal in certain countries, including Austria, Canada, Czech Republic, Finland, Germany, Israel, Italy, the Netherlands, Portugal and Spain. Australia is currently in the process of passing a law which would allow the use of marijuana for medical and scientific purposes.
In the United States, federal law outlaws all cannabis use, while 20 states and the District of Columbia no longer prosecute individuals for the possession or sale of marijuana, as long as the individuals are in compliance with the state's marijuana sale regulations. However, an appeals court ruled in January 2014 that a 2007 Ninth Circuit ruling remains binding in relation to the ongoing illegality, in federal legislative terms, of Californian cannabis dispensaries, reaffirming the impact of the federal Controlled Substances Act.
Medical cannabis has several potential beneficial effects. Evidence is moderate that it helps in chronic pain and muscle spasms. Lesser evidence supports its use for reducing nausea during chemotherapy, improving appetite in HIV/AIDS, improving sleep, and improving tics in Tourettes syndrome.
Nausea and vomiting
Medical cannabis is somewhat effective in chemotherapy-induced nausea and vomiting (CINV) and may be a reasonable option in those who do not improve following preferential treatment. Comparative studies have found cannabinoids to be more effective than some conventional antiemetics such as prochlorperazine, promethazine, and metoclopramide in controlling CINV, but these are used less frequently because of side effects including dizziness, dysphoria, and hallucinations. Long-term cannabis use may cause nausea and vomiting, a condition known as cannabinoid hyperemesis syndrome. A 2010 Cochrane review said that cannabinoids were "probably effective" in treating chemotherapy-induced nausea in children, but with a high side effect profile (mainly drowsiness, dizziness, altered moods, and increased appetite). Less common side effects were "occular problems, orthostatic hypotension, muscle twitching, pruritis, vagueness, hallucinations, lightheadedness and dry mouth".
Evidence is lacking for both efficacy and safety of cannabis and cannabinoids in treating patients with HIV/AIDS or for anorexia associated with AIDS. As of 2013, current studies suffer from effects of bias, small sample size, and lack of long-term data.
Cannabis appears to be somewhat effective for the treatment of chronic pain, including pain caused by neuropathy and possibly that due to fibromyalgia and rheumatoid arthritis. A 2009 review states it was unclear if the benefits were greater than the risks, while a 2011 review considered it generally safe for this use. In palliative care the use appears safer than that of opioids. A 2014 review found limited and weak evidence that smoked cannabis was effective for chronic non-cancer pain. The review recommended that it be used for people for whom cannabinoids and other analgesics were not effective. A 2015 review found moderate quality evidence that cannabinoids were effective for chronic pain. A 2015 meta-analysis found that inhaled medical cannabis was effective in reducing neuropathic pain in the short term for one in five to six patients. Another 2015 systematic review and meta-analysis found limited evidence that medical cannabis was effective for neuropathic pain when combined with traditional analgesics.
The efficacy of cannabis in treating neurological problems, including multiple sclerosis, epilepsy, and movement problems, is not clear. Studies of the efficacy of cannabis for treating multiple sclerosis have produced varying results. The combination of Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) extracts give subjective relief of spasticity, though objective post-treatment assessments do not reveal significant changes. Evidence also suggests that oral cannabis extract is effective for reducing patient-centered measures of spasticity. A trial of cannabis is deemed to be a reasonable option if other treatments have not been effective. Its use for MS is approved in ten countries. A 2012 review found no problems with tolerance, abuse or addiction.
Smoking is the means of administration of cannabis for many consumers, and the most common method of medical cannabis consumption in the US as of 2013. It is difficult to predict the pharmacological response to cannabis because concentration of cannabinoids varies widely as there are different ways of preparing cannabis for consumption (smoked, applied as oils, eaten, infused into other foods, or drunk) and a lack of production controls.The potential for adverse effects from smoke inhalation makes smoking a less viable option than oral preparations.
Cannabis vaporizers have gained popularity because of the perception among users that less harmful chemicals are ingested when components are inhaled via aerosol rather than smoke.
Cannabinoid medicines are available in pill form (dronabinol and nabilone) and liquid extracts formulated into an oromucosal spray (nabiximols). Oral preparations are "problematic due to the uptake of cannabinoids into fatty tissue, from which they are released slowly, and the significant first-pass liver metabolism, which breaks down Δ9THC and contributes further to the variability of plasma concentrations".
The U.S. Food and Drug Administration (FDA) has not approved smoked cannabis for any condition or disease as it deems evidence is lacking concerning safety and efficacy of cannabis for medical use. The FDA issued a 2006 advisory against smoked medical cannabis stating: "marijuana has a high potential for abuse, has no currently accepted medical use in treatment in the United States, and has a lack of accepted safety for use under medical supervision.