The journal Neurology on Feb. 13 published an article by UCSF’s Donald I. Abrams, MD, and colleagues establishing that smoked cannabis relieves neuropathic pain (an intense tingling or burning sensation usually occurring in the feet). Abrams et al conducted a study at San Francisco General Hospital with 50 patients whose neuropathy was HIV-related. (Neuropathic pain can also result from diabetes, trauma, and other causes.) Another type of pain was induced by applying capsaicin to a patch of each patient’s skin.
The study participants were randomly divided into two groups -one that smoked cannabis (3.5% THC, provided by the National Institute on Drub Abuse), and one that smoked placebo joints from which the cannabinoids had been extracted (also from NIDA). Patients smoked three times a day for five days. Those getting the real thing reported a 34 percent reduction in pain whereas the placebo smokers reported a 17 percent reduction. Capsaicin-induced inflammation was reduced, too. “These results provide evidence that there is a measurable medical benefit to smoking cannabis for these patients,” says Abrams.
Prospective randomized placebo-controlled trials are considered the “gold standard” in clinical research, and Neurology is a prestigious journal. You may be wondering, given this study, how the Prohibitionists can deny that marijuana has a recognized medical use. Here’s how: “Very promising result but it’s just one study… More research is needed.” And more research is on the way.
It didn’t take long for Abrams et al’s study to get cited. On Feb. 18 Philip A. Denney, MD, wrote the following in support of a Workers’ Comp claim by a retired law enforcement officer:
“I am writing at Patient A.’s request regarding payment for the use of medicinal cannabis to treat his occupational injuries… Patient A. is a 55-year-old retired/disabled peace officer who sustained serious injuries in a work-related motor-vehicle accident in 1998. As a result he suffers chronic pain in the neck and lower back with radiation into the left upper and right lower extremities. The pain, particularly in the right lower extremity, is reported to be sharp and ‘electrical’ in nature, consistent with neuropathic pain. My physical findings are consistent with those reported by Dr. P. in his supplemental Qualified Medical Examiner evaluation.
“Patient A. has found the modest use of inhaled cannabis to be very effective for pain control and much preferred to previously prescribed medications, particularly opiates. Patient A. reports that 14 grams per week moots his need and denied any adverse effects. He does not use tobacco, alcohol, or any illicit drugs. This history is very consistent with that obtained from many patients in our practice with neuropathic pain syndromes, and a recent study has clearly confirmed the efficacy of cannabis for the treatment of neuropathic pain. (D. I. Abrams, et al. “Cannabis in Painful HIV-associated Sensory Neuropathy: A randomized placebo-controlled trial, Neurology 2007 68 515-521.) “In summary… medicinal cannabis is an appropriate treatment in this case and is preferred to Marinol, opiate or other standard drugs. Whole plant cannabis is more effective, better tolerated, and less expensive in my experience.
“The California Supreme court has addressed this issue in People v. Mower (2005) and stated that as long as the statutory conditions are met, cannabis must be treated as ‘… any other prescription drug.'”
Dr. Denney says that Patient A, like most other patients with severe chronic pain, was extremely glad to be able to reduce his intake of opiates, which cause grogginess and constipation, among other adverse effects. The remarkable ability of cannabis to substitute for or potentiate the effect of other drugs has been noted by every doctor who employs it in his or her practice. As Denney put it in the current O’Shaughnessy’s, “Cannabis allows significant decreased use or elimination of many prescription medications, particularly narcotics. Patients usually report decreases of 50% or better.”
By coincidence “Genentech Sales Could Take Hit on Lower Dosing,” read a Wall St. Journal headline 2/23. A clinical trial has shown that a half dose of Avastin, a costly drug given to advanced lung-cancer patients, is just as effective as a whole dose (15 milligrams per kilogram of body weight). If doctors prescribe the lower dose, Genentech and its parent company, Roche, lose $4,400 per patient per month. Genentech’s stock fell 2.5% on news of the study results. Capitalism can be so crass. For all its pretensions, the class system is a crass system.
FRED GARDNER is a former Public Information Officer for the District Attorney of San Francisco. He can be reached at email@example.com