Cannabis Health - [May/June Edition 2005]

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4 Cannabis Health

Editorial...............................................................................................................6

Letters..................................................................................................................7

Health Canada Interview ...................................................................................8

Dr. Richard V iau

Cana dian Aids Society & Cannabis as a Therapy ......................................12

Lynne Belle-Isle

Sublingual Delivery of Sativex .......................................................................17

Dr. Lester Grinspoon M D

The Bodys own Cannabinoid System...........................................................18

Dr. Franjo Grotenhermen MD

Strain Specific Research with Wo/ Mans Alliance for Medical Marijuana .21

Valerie Corral

Cannabis in Pha rmac ies: The Next S tep ......................................................24

Dr. Glenda MacDonald BScPharm, PharmD, RPh

Dr. Robin OBrien BSc, BScPharm Pharm D, BCOP, RPh

Crazy Cookies - Cannabis edibles and the law circa 2005 .........................27

John Conroy QC

Marijuana Leader J oins Libera l Party o f Canada .........................................29

Marc Boris St Maurice

J effreys J ourney - book review ...................................................................31

Pulmonary Drug Delivery Technologies .......................................................32

InsideCannabis Health

Cannabis Health is published six times a year. Allcontents copyright 2005 by Cannabis Health. CannabisHealth assumes no responsibility for any claims orrepresentations contained in this magazine or in anysubmission or advertisement, nor do they encouragethe illegal use of any of th e products advertised within.No portion of this magazine may be reproduced with-out the written consent of the publisher.

StaffSENIOR EDITOR , BARB ST. JEAN

[email protected]

EDITOR/ACCOUNTING BARB CORNELIUS

PRODUCTION BRIAN McANDREW

production@ cannabishealth.com

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Vo l u m e 3 I s s u e 4 , M a y / J u n e 2 0 0 5

Cannabis HealthCannabis Health Magazine is the voice and the new

image of the responsible cannabis user. Th e publicationtreats cannabis as one plant and offers balanced coverage ofcannabis hemp and cannabis marijuana. Special attention isgiven to the therapeutic health benefits of this plant mademedicine. Regular contributors offer the latest on the evolv-ing Canadian cannabis laws, politics, and regulations. Wealso offer professional advice on cannabis cooking, growingat home, human interest stories and scientific articles from

countries throughout the world, keeping our readers intouch and informed. Cannabis Health is integrated with ourresource website, offering complete downloadable PDF

versions of all archived editions. www.cann abishealth.com

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Cover photo source: Health Canada website and Media PhotoGallery, Health Canada, http://www.hc-sc.gc.ca 8 Adaptedand Reproduced with the permission of the Minister ofPublic Works and Government Services Canada, 2005

Every subscriptionreceived between now andAugust 31/05 will be enteredinto a drawing for this one ofa kind n ecklace created by theArtist of Princeton, Charles

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valued at $500 CDN and holds a secretthat will be revealed to the lucky winner.Winner will be announced in theNov/Dec 2005 issue of Cannabis Healthmagazine.

S U B S C R I B E T O D A Y A N D W I N

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6 Cannabis Health

Let the people know the truth and the countryis safe. - Abraham Lincoln

Imagine this scenario. Fun ding UnitedPolicies (FUP) has an army of DistrictEncroachment Officers called (DEO). Theyare currently infiltrating their way into ourprivate homes, disseminating prohibitionistpropaganda to school-aged children throughtheir drug education programme, and

encouraging them to inform on offendingfamily members and neighbors. Great innumber, they have positioned themselveswith in most global commun ities. Th e FUPsDEO teams are being rewarded with largecash payoffs. Up to 5 million dollars can begranted for each successful infiltration. Fordecades DEO personnel, under direction oftheir United Policy regime, have been crimi-nalizing, marginalizing and destroying therights and freedoms of law abiding citizens.For years this attack on hu manity h as largelygone unchecked. DEOs have powerful leader-ship, relentless determination and vast fund-ing resources. However, to combat the DEO,the Propaganda Opposition Project (POP)has recently expanded its POP Watch

program. Law abiding citizens have beenlocated within each school and neighborhoodbattleground. When the DEO are evident, ifsomeone is being told or given propaganda, isbeing harassed or threaten ed, action is imme-diately taken, documented, and compiled forfutur e public exposure. Th e law abidingmembers of the POP Watch program will dowhat ever it takes to stop this insanity.

Myth or Truth? The above description

sounds like comic bookfiction, an aspect ofOrwells 1984 or anepidemic of psychosis. Yet,

the content is based on thereality of the War onDru gs. Shocked? Dontworry, even the strongestand wisest must occasion-ally take a step back toshake their heads in disbe-lief. Th e freedom to makeour own choice should beone of our fundamentalhuman rights. It isingrained into our souls asCanadians and is thereason why so many of uscontinue to fight forpeace.

The War on Drugs isbuilt on lies. Even ourchildren have been madethe targets of deception,and it must be stopped.But in order for it all toend, t he level of propagan-da awareness must be

improved upon. Th e internet is a wonderfultool for this. People just need to follow thedocumented propaganda back to source, andread.

The demand and retrieval of accurateinformation, what a concept! It is nothowever an easy task, as any researchanalyst will tell you. In th is age of informa-tion overload one must wade through

streams of data to find the elusive accurateinformation stamp. I personally use thewho said what, why and wheremethod in determinin g accuracy. If thewho is known as credible then thewhat can be claimed accurate and inmany cases thats all the criteria used bymany media. However, I find th is only worksif the who is independent - not part of anentity, and is prepared to tell the truth, thewhole truth and nothing but. Otherwise thewhy relates to the credibility of the asso-ciated source entity/s, and then thewhere needs to be deter mined. By follow-ing the information back to the final sourceyou will be amazed at what you can find.

Th e first telltale sign of propaganda is th einaccurate interpretation of scientific state-ments. No references are generally made toany credible independent studies. The focususually consists of scare tactics, like picturesof holey brains, threats of incarceration ororganized crime invasions.

If you want to check it out, start with theprohibition propaganda pamphlet;Marijuana - Whats the Big Deal passed

directly to students (and CH) by a DARE-BC/DAS program officer at the CommunitySymposium on Dru gs and Related YouthIssues, held recently in Castlegar, BC. (Watch

for coverage of this excellent two day discus-sion forum in a future issue of CH). Thepamphlet contains gross untruths about theproperties of marijuana, including a photo,depicting a Marijuana affected Brainwhich appears to be riddled with corrosionand holes.

These information pamphlets or stud-ies are generally funded by enforcement affil-iates, i.e. ADIC/DAS/DAREBC/FVU/DEA(acronyms are very popular). If you trace theassociations and links back, in most cases itwill lead you to an en forcement agency in th eUS or possibly a DEA agency stationed inone of the US Embassies in Canada. Th eWhite House Drug Policy training manual

entitled Marijuana Myths and FACTS(see link below), is a prime example of thehuge US bu dgetary spendin g of affiliates likeNIDA in their battle to maintain the globalstatus quo. This paper was completelydebunked years ago byDr Lester Grin spoon inhis bookMarijuana Reconsidered.

This elementary concept of evaluatingthe credibility of information based on accu-rate source mater ial rarely happens in t odaysinformation society. Who has time? Thestream is huge, and the distorted effects ofthe water drops are in th e eyes of the behold-ers, affiliations, associations and fundingsources. Remember, propaganda is the toolused to build the webs of prohibition.

The majority of Canadian pot smokersand brownie munchers already know thatthey, for th e most part, are n ot psychotic, nordo they have holes in their heads from usingthe herbal form of Cannabis. In fact, mostCanadians know that cannabis cultivationand consumption is not in itself dangerousand poses no threat to individuals or society.Canadians also need not worry about someperceived drug crime syndicate. They do,however, need to start demanding protectionfrom the organized prohibitionist enforce-ment agencies who have orchestrated thispsychotic drug war in the first place.

Barb St.Jean

Working together we can treat Washingtons

40 billion dollar a year addiction to the Waron Drugs. - Polly Wilmoth Waco, TX

Quote source:http://www.druglibrary.org/schaffer/

http://www.whitehousedrugpolicy.gov/publica-tions/marijuana_myths_facts/

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Cannabis Health 7

L e t t e r s

Dear Editor,I would like to respond to the Legal

Dilemma letter, in the January/February 2005 issue of Cannabis Health,(Volume 3, Issue 2).

First, go find a specialist or doctorwho IS willing to sign your forms. Theyare out there somewhere. And there areletters you can download (from MedicalMarihuana sites), that are addressed todoctors, promoting the benefits ofMedical Marihuana use to try to forcetheir hand.

As for your stolen plants, unless youalready hold legal authorization topossess and cultivate your own medi-cine, DO NOT GO TO ANY POLICEAUTHORITIES! They will only targetyou and you open yourself to harassment.

As an MMAR licensed user andgrower, I myself have just been chargedwith impaired driving contrary to crimi-nal code of Canada. The OntarioProvincial Police Officer confiscated myounce of legal Medical Marihuana as

evidence and stated because I had oneounce of my medicine IN my car I mustbe impaired. He char ged me, searched meand confiscated my medicine (even afterI showed him my licenses to possess andgrow) with no roadside test, blood test,breath test. Nothing, just his opinion thatI could smoke a joint 3 weeks ago and gethit with euphoria now, today, anytime. Ifeel my human rights have been violated!!

Im not eligible for Legal Aid so Ivealready paid a lawyer $2000 and still oweanother $2000. Im going bankrupt overthis. Health Canada gives out MMARlicenses, but police refused to acknowl-edge them, causing health and financialproblems for sick Canadians.

So dont go to police at all. And if youdo get a license to possess and grow, be

wary of revealing to any police agencies.GOOD LUCK.......

Steve.P Hamilton, Ontario

FindMighty Mike

NEW CONTEST! FIND MIGHTYMIKE & WIN A PRIZE FROM WONGBONG GLASSWERX!!

In our next two issues we will hideMighty Mike somewhere in t he magazine.Your m ission is to find him. When you doemail distribution@ cannabishealth.comwith the page number you found him on.You can snail mail your entr y to: PO Box

1481, Grand Forks, BC V0H 1H0. Closingdate for entr ies is July 29/05. Two winn ers(one guy and one girl) will be announcedin the Sept/Oct issue of Cannabis Health.One entry per person please.

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8 Cannabis Health

The following interview was conducted by Cannabis Health with Dr. RichardViau, Acting Director General of HealthCanadas Drug Strategy and Controlled

Substances Program me.

In preparation for the interview, we polled various members of the global cannabis community for their questions.This community is highly educated and is made up of many organizations (govern- menta l and N.G.O) . It also includes consumers from every walk of life and culture; ethical/compassionate growersand providers, professionals, a nd scientistsalike. The inform ati on currently a vailable to this community is equally diverse as itcomes from m any sources and takes in a ll aspects of cannabis production - strainselection, growing methods, environmental conditions, curing and storage processes,

secondary processing, product testing, delivery methods and more. Research analysis, comparison studies, and opin-ions circulate at the accelerated speed of todays comm unications media . A s thenumber of cannabis users has risen steadi-ly, so has the demand for accurate information. The cannabis community openlyshares inform ati on and t echniques. A lack

of disclosure from any producer, even though this is largely an unregulatedindustr y, results in avoidance of the prod-uct. The overwhelm ing response to our poll

indicated that concerns about access, production, and safety standards are atthe top of every ones list.

ACCESS:As many as one million patients in

Canada use marijuana to manage conditionssuch as nausea, seizures and chronic pain.Statistics from Health Canadas Office ofMedical Cannabis show that as of March 4,2005, only 813 patients were authorized topossess marijuana for medical purposes, andof those, only 150 were actually accessingHealth Canadas dried marijuan a. We areinformed by the cannabis community thatthe r easons for t he low level of participationare many and varied:

Mistrust of HC/PPS product safety. Perceived inferior quality and poten cy ofHC/PPS product. Lack of support from Canadian (andother) Medical Associations and most physi-cians due to a lack of clinical trial data andpeer reviewed medical research relating tosmoked herbal cannabis. It takes significant time and effort for

physicians andpatients to fill outand submit MMARapplication paper -work especially ascompared to thetraditional prescrip-tion/pharmacy drug

distribution model. The legitimateconcerns manyapplicants/patientsfeel about su bmit-ting personal infor-mation to thegovernment andpolice regardingmedical marijuanause. The fact that HCis only making onestrain of cannabisavailable topatients.

C a n n a b i s

Health: Do youhave informationpertaining to thenumber of appli-cants under theMMAR ascompared to thenumber ofapproved partici-pants? How many

applicants have been turned down?

Richard Viau: Since the MMAR regula-tions came into effect in July 2001, nocompleted applications for authorization topossess have been refused. Zero.

CH: What about the ones that areincomplete? Those w ho cant get adoctor to sign, for example.

RV: Let me explain a little bit about h owthe process work s. The pr ocess is pretty clearand transparent. The regulations themselvesare quite clear. The regulations outline whatis needed to be approved, and if the require-ments are met, then the license will beissued. No problem. If the requirementsarent met, there are no exceptions possible.Typically when people have applied andhavent received, its because their applica-tion wasnt complete. There are myriadpieces of information that people have failedto provide. In those instances the Office ofCannabis Medical Access will work with theapplicant; call them on the phone, send aletter or email explaining very clearly whatpieces of information are missin g and what isneeded to complete the application. In someinstances they have actually phoned thephysician because the applicant wasnt ableto clearly explain to the physician what thephysician needed to do in ord er to fill out th eapplication form. We provide all of thesupport we possibly can to the applicants.The intent is, in fact, to make the process aseasy as possible and as simple as possible, butlike any other regulatory process there aresome requirements that are set out.

CH: How will the next amendmentsto the MMAR streamline the process andthe paperwork for obtaining an authori-zation to possess?

RV: We have been cognizant of the feed-back and advice from applicants and fromour Stakeholders Advisory Committee. Theproposed amendments will streamline theregulatory process, thereby streamlining theapplication process for an authorization topossess marijuana for medical purposes.

The categories of symptoms un der wh icha person may apply will be reduced fromthree to two. The current Categories 1 and 2are merged into one category (Category 1).The need for a specialist to sign the medical

declaration for th is category w ill be eliminat-ed. The old Category 3 will become Category2. While applicants under this category willstill need to be assessed by a specialist, thetreating (family) physician can sign themedical declaration.

CH: What about the liability issuethat the doctors raise?

RV: A revised Medical Declaration forthe physician has been developed and it will

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only include those elements essential toconfirm that t he applicant suffers from a seri-ous medical condition and that conventionaltreatments are inappropriate or ineffective.

CH: So they wont actually beprescribing it, just providing a verifica-tion of illness.

RV: Correct.

CH: Can you address the concernsmany applicants/patients feel aboutsubmitting personal information to thepolice regarding medical marijuana use.

RV: One of the proposed amendments isto provide exclusive authority for HealthCanada to communicate limited informationconcerning the authorization process andlicenses or licensees to police. That really isfor the protection of the applicants. Thepolice get complaints; somebodys going by,sees a marijuana plant in the window and

calls the police. The police dont want to gobarging in, knocking down doors and puttingpeople at risk when theres no need to, sothey would much rather know. At no timewill there ever be any medical informationprovided to the police. Strictly informa-tionthe n ame, how much youre entitled tohave in your possession is essential. Thatssimply to make sure no undue legal action istaken.

CH: What recourse does a licensedmedical user have if they feel they arebeing unduly harassed by police? Canthey call Health Canada for help?

RV: The police do not work for HealthCanada. Every police agency has a recourse

mechanism, an ombudsman or some sort ofinvestigative branch that looks intocomplaints of harassment or use of unduephysical intervention and that sort of thing,and th at is who th ese people should complainto. There will be a follow-up investigationand if the complaint is founded then actionwill be taken. Health Canada really has norole to play in that.

CH: When can we expect to see theseamendments come into effect?

RV: I would think sometime later thisspring. I cant give you an exact datebecause thats something that we dontcontrol. The current set of amendmentswas published in Part 1 of the Canada

Gazette in October 2004. After Part 1 of theCanada Gazette, all of the inputs areanalyzed, and comments responded to. Iftheres need to make changes to theproposed amendments, those are made, andthen the draft regulations go before Cabinetfor final approval. We dont control theagenda at that point. We do not control thetiming of when the regulations will gobefore Cabinet for final approval.

CH: Could patients fill out thecurrent forms and send them in so thatthey can be reviewed as soon as the newprocess is in place?

RV: Once the amendments have beenpublished in Part 2 of the Canada Gazette thenew procedures will take effect and appli-cants will be able to use the new forms andprocesses. Until that happens they still haveto use th e old process.

CH: Will you be collecting data fromthe patients or compiling any usagestats?

RV: Th ats kind of speculative. When theamendments take effect we may find thateverybody is happier t han happy. If thats thecase, there will be no statistics to gather, soId rather not speculate as to whats going tohappen after the new amendments takeeffect. Lets just let them take effect an d th en

well see what happens afterward.CH: But you will be open to feedback

from consumers?

RV: We always have been from the verybeginn ing and will continue to be. People cancontact us by email, regular mail, fax or a tollfree phone n umber, all of which are availableon our website.

CH: The latestamendments to theMMAR suggest thatpersonal productionand designatedgrower productionlicenses are going tobe phased out, leav-

ing HC the only legalsource of cannabis.A lot of people areconcerned aboutthat; they want togrow for themselves.

RV: The designat-ed grower and th e abil-ity to grow foryourself, still anoption. The optionhasnt been removed.Indeed, if there is amove to change that,there will be ampleconsultation, amplediscussion and ampleopportunity foranyone and everyoneaffected to providefeedback. Everythingwill be considered andonce everyone has hada chance to have input,then a final decisionwill be made.

QUALITY:

CH: The first marijuana distributedby HC/PPS for patient consumption wasblended with leaf and stem and had low

levels of THC. Grinding cannabis isknow n to increase oxidation and deterio-ration of THC. Although the THC levelis only one part of the effectiveness ofthe overall product, it is tied to consump-tion levels. The stronger it is , the less isneeded, thereby reducing the riskincurred by smoking. In addition, theanalgesic and anti-spasmodic effectappears to be more significant incannabis with higher levels of THC.Have your requirements and standardsfor the product changed since that time?

RV: Lets look at consistency. Th e grind-ing is to try an d get more consistency becauseevery plant is a little bit different from everyother plant an d it depends if you just take theprimary bud or the secondary buds. It alsodepends on the maturity level and the timeyou harvest. There are a lot of factors thataffect your THC level. We have been doing alot of work to optimize all of those conditionsso we can reduce those inconsistencies. Oneof the things that we do is the grinding sothat, in fact, from batch to batch, even with ina batch, when you take a sample it will be

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10 Cannabis Health

consistent. That is the reason behind that.

CH: I understand you are now takinga lot of the stems and sticks out so thatthe product is almost pure bud, is thatcorrect?

RV: I will say that it is pure bud. To theextent that you can take all of the sticks andstems out, we do.

Lets talk a little bit about what qualitymeans. Quality is not just THC levels.Quality is all about having a very clearlydefined process, so that you k now w hat all ofthe qualities of the product are and so thatyou have consistency in your product on anongoing basis. One of the qualities that youwant to know is the THC content. The THCcontent of the product that we are currentlydistributing is between 11% and 14% andindeed, one of the recipients of our producthas commented to us that they were very,very pleased with it, because un like the prod-uct they were getting from the black market,our product was consistent from batch tobatch and it made it very easy for them toself-medicate. We find that sort of commentvery helpful because it gives us an indicationthat we are on the right track.

CH: The THC level patients seem tobe looking for is between 14 and 18%.

RV: Ill tell you a couple of things aboutthat because I know quite a lot about THClevels in marijuana. There are a lot of miscon-ceptions out there about how mu ch THC thereis in marijuana. Weve analyzed about 16,000black market samples of marijuana so I thinkwe have quite a lot of information about w hat

black market marijuana is. Th e average TH Ccontent is 9.6% in the last two years and inprevious years it was lower than that. Th ere isonly about 7% of marijuana seized by policethat has THC that is over 14%. Theres alsoan interesting experiment that was done inHolland, where scientists went into the cafes.Users couldnt differentiate between 14% and18% THC content.

CH: So this has more to do with thecannabinoid profile, right?

RV: No, theres another piece to it too. Ifsomeone from the black market claims theirmarijuana has X percent THC, how do theyknow that?

CH: There is no way right now,because theres no tes ting available.

RV: Thats right. So how do they knowthat theyve got 14 18% ? They also dontknow what the cannabinoid profile is. Theonly way you can know is by testing and infact, when you go out and test, you some-times find th at this product and that product,that are said to be different, have exactly thesame profile. Its perception.

CH: Is it possible for a licensee tosubmit a sample of their ow n marijuanafor testing?

RV: The short answer is no. If theywanted it to be tested, they would have to goto a private testing laboratory and if a privatetesting laboratory wanted to get into testingmarijuana for consumer use they would haveto apply for a license to do that.

CH: So theres no place right nowpatients can get their supply tested?

RV: No private testing laboratory hasever applied for licensing other than the twothat do testing for Prairie Plant Systems. Noother labs that were aware of have everapplied for a license to test marijuana forconsumer use.

CH: Does HC plan to provide morethan one strain for patient use or for

research?RV: For sure, the possibility of growing

other strains has been considered, but rightnow, we havent made any decision. Rightnow, were working at making sure that weknow anything and everything we need toknow with the one strain. Get all theanswers. Obviously once you have all theanswers, its much easier should you decideto expand to other strains. Trying to do theexperiments on three, four, five strains justexpands your risk t hat man y times. You wan tto work it out with one and then you moveon .

CH: What strain is HC providingcurrently?

RV: What we are growing is Cannabissativa L, subspecies indica, cultivar indica.Thats based on The Key to Subspecies forMarijuana published by E. Small and A.Cronquist in 1976. The reason I say this isthat there is another set of nomenclatures forcannabis that other people use. E. Small is aresearch scientist at Agriculture Canada andhe developed this nomenclature in the mid70s and that is the one we are using.

CH: Many medical users maintainthat different strains are effective inmanaging different sy mptoms and condi-tions. They are particular about howmuch sativa and how much indica theywant in their mix because each oneseems to have its own characteristics.

RV: As you know marijuana is not anapproved drug anywhere in the world andindeed, there really is a lack of soundresearch to demonstr ate the safety and effica-cy of marijuana. Health Canada and theCanadian Institutes of Health Research(CIHR) are wor king as partn ers to facilitate afive year research plan called the MedicalMarijuana Research Programme. One of the

questions that researchers want to look at iswhether or not, in fact, different cannabinoidprofiles do or do not h ave any impact in tr eat-ing different types of conditions. Right now

there exists no scientific evidence in supportof that thesis.

I go back to what I said earlier. Patientsdont know w hat th eyre dealing with so h owcan you conclude that this profile or thatprofile helps you when you dont know whatthe profile is? You can t make that conclusionand thats the problem with research thatsbased on anecdotal information. There areinformation gaps and leaps of logic that arenot supported by fact. When you do acontrolled experiment, you may find that theleap of logic is supported or you may find th atits n ot.

SAFETY:

CH: Test results on an early batch ofHC/PPS product, obtained through theAccess to Information Act, showed unac-ceptable levels of heavy metals, bacteria,moulds, aflatoxins and mycotoxins. Howdo you respond to the concernsexpressed by the Cannabis Communityabout the safety of HC/PPS product?

RV: Lets talk about those test results.Those data refer to product that was grownwh ile we were still in t he development stage.It was never distributed to anyone - notresearchers, not therapeutic users. On thequestion of h eavy metals, we test every batchand I do recall being contacted by th e individ-ual who had requested the information. Im achemist, I have a PhD in chemistry and I

explained to that person that the results hehad in his possession were inconsistent withthe results we had. They were out by ordersof magnitude.

CH: Could it be because the productwas old?

RV: No, its not a question of how old theproduct is. I believe there was an err or in th eanalysis. I asked for information on whichtest lab had done it. Was it a reputable,accredited test lab? This information was notprovided, making it very difficult to assessthe credibility of the results.

CH: What can you tell us about theuse of herbicides and pesticides on PPSproduct?

RV: If you want organic, I can tell you,were as organic as youre going to get. Wedont use any herbicides, pesticides, nothinglike that, absolutely prohibited. We use nat u-ral ways of dealing with grubs.

CH: So you use nematodes?

RV:Yes. I dont wan t to get into revealingour trade secrets. (laughing).

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Cannabis Health 11

CH: Of particular concern to theAIDS Foundation are bacteria and afla-toxins - opportunistic fungi which caninfect via the respiratory tract. Can

people with compromised immunesystems rest assured that PPS productwill be safe for them?

RV: Obviously, that is a concern. In deed,how do you get aflatoxins? You dont get afla-toxins un less you h ave mould. So how do youensur e that you don t get mould? You ensu reyou dont get mould by proper dr ying of yourproduct. We dry the product at 25 degreesCentigrade, which is at the high end of therange of normal room temperature, and weget the moisture below 15% . Then w e freezeand irradiate to ensure there are no viablemould spores on t he produ ct. We also test theproduct before it goes out for an y presence ofmould. Now Ill come back to what I said

earlier. When youre buying from the blackmarket or a designated grower, or whenyoure growing for yourself, how do youknow that there is no mould? Do you test?No, so you dont know. The stuff you getfrom PPS, you know. There is NO mould.

CH: Theres controversy surroundingirradiation.

RV: We dont think theres any contro-versy. We think its the way to go.

CH: Could you explain to me thereasoning behind choosing the gammairradiation as opposed to sterilization byheat?

RV: Something that you really need toknow is that there are no health implications

or impacts with the dose of gamma radiationthat we use to irradiate the product. We usethe lowest dose possible, and gamma irradia-tion is a process that has been used for a longtime on a variety of food products includingherbs and spices so this is nothing new. Ithink there is real misapprehension about theheat process. Heat sterilization involvesputting the product in an autoclave and heat-ing it to above 120 degrees Centigrade. If youdid that to marijuana, I guarantee you wouldfind very little THC left and you in factwould denature the protein of the plant, sothere is no way we would ever consider usingthat as a method of sterilization.

CH: Are the terpinoids and CBDs

affected by th e gamma irradiation?RV: At the level which we irradiate it

doesnt affect them at all. We measure every-thin g, the whole profile, before and after irra-diation, and t here is no significant differencethat we can measure in any of these levels.

CH: Can you claim safety for materialthat is to be smoked or inhaled byextrapolation from standards for oralconsumption?

RV: There are only two common smok-able products: tobacco and marijuana. Thefact of the matter is that marijuana is not anapproved drug and there really is a lack of

scientific data on th e efficacy of marijuana asa drug. Indeed, one of the areas researchershave said they want to look at is administra-tion. Is smoking, in fact, the best form ofadministration? We do know that there is acompany from England that has applied tohave a product that is derived from marijua-na as a sublingual spray. Currently there aretwo products on the market in pill form thatare ingested orally. So theres still a lot ofresearch that needs to be done on the ques-tion of safety and efficacy. We are currentlyengaged in a research project called theMainstream Smoke Study, which uses smokemachines to capture the smoke and analyzeall the constituents in it. I would expectsometime in this calendar year or early in the

next that there should be some resultscoming out from that study.

CH: Some patients are looking now atvaporization as a harm reduction meas-ure. Will you be looking at vaporizationas well?

RV: Right now, were going to finish thesmoking study and well decide wher e we goafter th at.

CH: Healt h Canadas OCMAInformation webpage states that PPSconducts laboratory testing and qualitycontrol of its marijuana throughout theproducts life cycle; records of tests andtheir results are obtained and assessedagainst specifications to ensure compli-ance, and the product is not released forsale or supply prior to approval by thequality control department. Is the test-ing process also applied to packagedproduct and to product that has been instorage for varying lengths of time?

RV: For sure testing is a huge part ofwhat we do. Basically, we test product afterits har vested, we test produ ct after its pack-aged and ready to go out the door to thera-peutic users or to researchers. We test itbefore and after irradiation. Lots of testing,lots of testing. And we dont only test forTHC; we test for a variety of other things.

CH: Youre testing for cannabinoidprofile, contaminants, biological prob-lems, etc., correct?

RV: Youve got it.

CH: Is HC willing to provideconsumers with the data obtained in theongoing testing process?

RV: We are in the process now of translat-ing all of our test results for every batch w evesent out, and they will be posted on ourwebsite within a couple of weeks I would hope.

CH: Many medicinal users, because oftheir health condition, are in the lowestof income brackets. Given that HC cannever hope to recoup the cost of the

MMAR program, why is the price ofyour product so high? Why would apatient choose to buy at HCs currentprice of $150 per 30 gm, when a productthey believe to be superior is available onthe black and grey markets for a compa-rable or better price?

RV: I want to be very clear that theprogram that we have is a compassionateprogram. We are supplying a legal source ofmarijuana and this eliminates legal andsafety risks associated with the black marketpurchase or production of marijuan a. Sotheyre getting all of this testing, this reallycontrolled process. Were moving to theprocess that you would use for the produc-

tion of a biological drug. If youve ever seenthe lengths to which drug companies go,thats where were going. So, yes, there aresome costs. I think that for a product with aquality and consistency that cant be matchedand for which they have no legal or safetyconcerns, the price is extremely reasonable.When you compare our price with the priceof black market, based on information thatweve had from police across the countr y, ourprice is two to three times lower than whatpeople buy on the black market.

CH: Two to three times? No, thepolice typically inflate the value ofseized drugs. Most of our patients arebuying from ethical Mom and Pops atabout $100 per ounce (30 grams).

RV: Let me be very clear ethical Momand Pops, what theyre doing is illegal. Itsblack market. Unless th eyre licensed, th eyreillegal. If the p olice find th ese operations an draid them, these people will be charged withcultivation.

And so we come full circle. Until we can overcome the access hurdles, this is thedilemma faced by the medical users - those at the greatest risk due to their compro-mised health. The vast majorit y of medicalusers dont have a supportive physicianand must either find an ethical ma & p a grower, purchase from a compassion clubif available, buy from the black market or grow it them selves. Those are the choices.

Each one represents a risk, especially if thequality of the product i s in question.

For additional information aboutlegal access in Canada :http://www.hc-sc.gc.ca/hecs-sesc/ocma/

Hea l t h Canada I n te r v i ew

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12 Cannabis Health

C a n a d i a n A I D S S o c i e t y & C a n n a b i s a s T h e r a p y

Background on HIV and AIDS

HIV/AIDS surfaced in Canada in th e early1980s. AIDS has killed more than 13,000people in Canada to date, and there arecurrently about 60,000 Canadians living withHIV/AIDS, with about 3,000 to 5,000 newinfections every year. Despite advancementsin therapy that now keep people with HIValive longer than ever, there is still no cure.

HIV (Human Immunodeficiency Virus)attacks the immune system by destroyingcells that are import ant for immu ne response.People with HIV may have no symptoms fora long time. Over time, the immune systemmay grow weak and the infected person canbecome sick with different illnesses. Oncethe immune system is no longer able todefend the body from infections, diseases orcancers, a person is said to have developedAIDS (Acquired Immune Deficiency

Syndrome). About half of people with HIVdevelop AIDS with in 10 years after in fection.This varies greatly from person to person.

Use of cannabis by people living withHIV/AIDS

One of the first indications of AIDS isoften the onset of wasting syndrome. Thisoccurs when a person involuntarily rapidlyloses more than 10% of their weight. Th is is

often accompanied by fever, diarrhea andfatigue for more than 30 days and for whichthere is no other explanation , such as a flu orother causes. Dur ing this wasting, people not

only lose fat but also lose muscle mass.Wasting is linked to disease progression anddeath. Between 23% and 50% of peopleliving with H IV/AIDS use cann abis as part oftheir therapy. They use it to help stimulatetheir appetite, which helps slow down thewasting and maintain their weight.

People who are on t reatment for H IV takea multitude of medications. In the mid 1990s,a new class of drugs called protease inhibitorswas approved. When used in combinationwith the standard antiretroviral drugs, theymarkedly slow the progression of HIV/AIDSdisease. The side effects of protease inhibitorscan be more severe than the standard drugs,often so severe that the treatment is intolera-

ble and many become reluctant to maintaintheir treatment. Cannabis can provide relieffrom the treatments side effects such asnausea and vomiting, and people are moreable to stick to their treatment .

Nausea and vomiting caused by themedication can also lead to low food intakeand wasting. Appetite stimulants such asMegace and Marinol (synthetic THC) can beused to help. Megace, however, mostly

increases body fat. Marinol does notwork well for everyone and manypeople with HIV/AIDS prefer to usemarijuana to stimulate theirappetite. Ron Reid, long-time HIVsurvivor, reports I started usingmarijuan a on th e advice of my physi-cian a few years ago. As my healthbegan to deteriorate, I agreed to useit. I had used Marinol before but itdid not h ave any therapeut ic effect. Ialso used Cesamet (a syntheticcannabinoid to manage nausea andvomiting) but the results weremarginal at best.

Some people living withHIV/AIDS also report that cannabishelps with pain, sleep and relax-ation, anxiety and depression, andmood, therefore improving theirquality of life.

For many, using cannabis hasmeant that they have been able toreduce the number of pharmaceuti-cal pills needed to control the sideeffects. When I was put on therapyin 1994 with AZT, 3T3, and D4T, Ibecame very sick w ith extreme body

pain, nausea, night/day sweats, headachesand depr ession, says Jason Wilcox, who hasbeen living with HIV for 15 years. Mydoctor has a pill for this and a pill for that.Soon I found myself taking 10 pills a dayinstead of the six I truly needed in the HIVcocktail. I also have hepatitis C so taking allthese pills could do some serious damage tomy liver over time, and to other organs, not tomention possible drug interactions. It wasthen that a friend suggested smoking marijuana to substitute some of the pills.Similarly, Robert Newman states, I am ananti-pill type of person, but living with AIDS,I have grown accustomed to th e fact that pillsare a part of my life, whether I like it or not.I take H IV/AIDS pills and very little else thatis not in some way or another holistic ororganic if it works as well. Many peopleliving with HIV/AIDS use various forms of

complementary therapies.The Canadian AIDS Society getsinvolved

With the increase in combination therapyin the 1990s, cannabis as a complementarytherapy became more popular as a way tomanage the various side effects. In 1998, theCanadian AIDS Societys Board of Directorsadopted a position statement on the use ofcannabis as part of HIV/AIDS therapy. It

Lynne Belle-Isle, Project Consultant, Canadian A IDS Society , meeting with lawyer

A lan Young, the projects legal consultant .

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Cannabis Health 13

became the first patient organization inCanada to be so vocal in calling on compas-sionate access to cannabis for therapeuticpurposes.

The Canadian AIDS Society (CAS) wasalso invited to be on Health CanadasStakeholder Advisory Committee on MedicalMarihu ana an d has been an active member ofthe committee since its onset in 2002, provid-ing a voice for people living with HIV/AIDSand for AIDS service organizations in thedevelopment of the medical marijuanaprogram and the Marihuana Medical AccessRegulations.

Funding comes through for a project oncannabis as therapy

More recently, the Public Health Agencyof Canadas (then Health Canadas)HIV/AIDS Policy, Coordination andPrograms Division, through the CanadianStrategy on HIV/AIDS (CSHA), identifiedbroad priorities and called for proposals toaddress these priorities. They includedspecific issues such as the legal, ethical andhum an r ights issues related to access to treat-ment. Treatment in this case includedcontrolled substances for m edical use, such asmarijuana. CAS submitted a proposal andreceived funding to conduct this workthrough the CHSAs Legal, Ethical andHuman Rights Fund.

The project is called Cannabis asTherapy: Access and Regulation Issues forPeople Living with HIV/AIDS. As of January2005, Lynne Belle-Isle was hired as theProject Consultant to do this work over the

next 18 months. This is a very challengingand exciting project where we will be docu-menting the realities that people living withHIV/AIDS face when they choose to use

cannabis as part of their t herapy, and identify-ing the various barriers they face when theywant to access cannabis due to the currentregulatory environment. says Lynne Belle-Isle. We have brought together an amazingteam of people to be part of the NationalSteering Committee that will guide this proj-ect and develop a plan of action to address th ebarriers. The National Steering Committeeincludes a variety of community membersfrom across Canada. (See sidebar pg 16)

CAS believes that a person has the right

to make decisions of fundamental personalimportance, which includes the right tochoose and access a treatment to alleviate theeffects of an illness with life-threatening

consequences, and to do so without fear ofcriminal prosecution.

By the end of the project, CAS will haveproduced a document to present the legal,ethical and human rights issues related toaccess to and regulation of cannabis as th era-py for people living with HIV/AIDS. Thereport w ill include a list of recommendationsand will be a powerful tool to influence thefuture direction of access to marijuana formedicinal purposes in Canada.


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14 Cannabis Health

The reportwill includean in-depthlegal review

and analysis.CAS has hiredbarrister andsolicitor AlanYoung to dothis work. Inlight of myexperience inworking toconstitutional-

ly enshrine theright to choosecannabis asmedicine, Iwelcome theopportunity toprovide the

Canadian AIDS Society with an exhaustivereport on the evolution of lawful access tomedicinal cannabis and a prognosis for thefutur e. Th e legal review an d an alysis will beconducted with the consideration that lawsand policies also affect the h ealth of individ-uals, communities and populations. The waypolicies and programs are designed or imple-

mented can promote or violate human rights.

Th e Nation al Steering Committee will beproviding input into the legal review andanalysis. The suggestions for future avenuesthat will come out of this analysis will beintegrated into the plan of action that willguide the CAS future work in this area. Adissemination plan will be developed todistribute the document to a targeted audi-ence of community-based organizations,politicians, policy makers, people living withHIV/AIDS, among others.

To document the r ealities of people livingwith HIV/AIDS who use cannabis as thera-py, focus groups will be conducted inVictoria, Vancouver, Toronto and Montreal.In order to get to hear from people all acrossCanada, there w ill also be a focus group at th e2005 People Living with HIV/AIDS Forumwhich will take place in Ottawa from June

15th to June 17th. Key stakeholders such asphysicians, pharmacists, Health CanadasDrug Strategy and Controlled SubstancesProgramme, the Public Health AgencysHIV/A IDS Division, police officers, compas-sion clubs, producers,and others will also beinterviewed to ensure

their perspectives are included in the reportand plan of action.

Th e project will document peoples expe-riences with the governments medical marijuana program. Some people living withHIV/AIDS have managed to apply to theprogram successfully, others have encoun-tered obstacles, and others choose not toapply to the program. Some of the NationalSteering Committee members have sharedtheir stories and provide a glimpse into thekinds of issues that will be captured throughthis project. I found it empowering in thelate 1990s to hear that the federal govern-ment was going to license persons withterminal illnesses to obtain and possessmedicinal cannabis. says Jason Wilcox. Itwas a great step forward in my eyes. Nolonger would the fear of jail be a factor forsomething generally supported as a medical

treatment. I soon learned it was even moredifficult to obtain a license for cann abis thanto get a gun license which we all know isextremely hard to get in Canada.

Finding a doctor t o sign the application


Raymond Berger, member

of the National Steering

Committee, also on the

Canadian A IDS Societys

Board of Directors

Jason W ilcox, m ember of the Nat ional Steering Committee, with h is

5-year old daughter.

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Cannabis Health 15

forms remains an important obstacle forpeople wanting to obtain an Authorizationto Possess from Health Canada. RaymondBerger states: I asked my physician to fill

out and sign the forms to apply for myauthorization. My physician refused forfear of the Collge des Mdecins duQubec. (Quebecs college of physicians,who have been vocal in their opposition tothe program) My doctor told me I stillhave a child to send to university! Itseemed too risky and [no doctor] wantstheir career to end because of marijuana.

Even when they find a doctor to sign theforms, obstacles occur. Once I found adoctor to sign for me, I was turned down byHealth Canada for he was not recognized asan HIV/AIDS specialist. reports JasonWilcox. For clarification, there is no recog-nized HIV/A IDS specialty in Canada, even if

a good proportion of a family physicians or ageneral practitioners patient base consists ofpeople living with HIV/ AIDS. I was angryof course. I had a baby coming and did notwan t to be illegal when possessing cann abis.In order to apply under Category 2 of thecurrent MMAR, people with HIV/AIDS haveto be referred to a specialist such as an infec-

tious disease specialist, an immunologist, orsome other relevant specialist. Once theamended MMAR are implemented, they willbe able to get their family doctor or GP to

sign t heir application.

Other s are more defiant about app lying tothe govern ment pr ogram. I have not appliedfor the federal authorization. says RobertNewman, The information I collected forthe compassion club membership is similarin context to the information required in thefederal application. Since both applicationsboiled down to the doctors letter, and I haveone, I challenge the legality of one and theillegality of the other. The project willreview the governments medical marijuanaprogram and pr ovide suggestions as to h ow itcould better address the needs of peopleliving with HIV/AIDS.

Th e issue of a legal supply of cannabis is

a contentious one. Authorized persons havea choice to grow their own, get a designatedgrower who is on ly allowed to grow for oneperson, or buy the cannabis grown byPrairie Plant Systems under contract withHealth Canada. There have been manyconcerns expressed regarding the cannabis

grown for the government, and some meas-ures have been taken to improve the prod-uct. Public perception of this productremains n egative, and this is reflected in thefew people that are actually ordering theircannabis through PPS.


For many, using

cannabis has meant

that they have been

able to reduce the

number of pharmaceu-

tical pills needed to

control the side effects.

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16 Cannabis Health

CAS would like to work w ith th e govern-ment t o improve access to and distribution oflegal cannabis in Canada. Several options w illbe explored throu gh this project and different

models of distribution will be analyzed. Wemust urgently favour the development andlegalization of licensed growers so that theymay produce for many medical users.suggests Luc Gagnon . Many curren t produc-ers already possess a remarkable expertisethat we must tap into, instead of wastingpublic funds in experiments that leadnowhere he says, referring to the PrairiePlant Systems production.

Some people report that it is importantfor them to know and trust their source of

cannabis. I have much more trust forgrowers that I know who grow a productthat is of organic quality, at a very competi-tive price. I have always been lucky enoughto have some quite reliable contacts tosupply me with mar ijuana, and yet I have tobreak the law to get therapeutic marijuanathat I consider helpful for me. saysRaymond Berger. Many oth er people livingwith HIV/AIDS obtain their marijuanathrough a local compassion club. Clubsreport that people with HIV/AIDS repre-sent about 25-30% of their membership.CAS appreciates the import ance of commu-nity-based models for distr ibution of medic-inal marijuana and will consider this in itsanalysis. Of course, agricultural standards

and quality control are also paramount andwill be factored into th e analysis.

The stigma and discriminat ion associatedwith the use of cannabis will also be exam-ined. When asked how people react to theiruse of cannabis as part of their therapy,Raymond Berger comments Unless theyhave experienced benefits from therapeuticmarijuana themselves, most people areconvinced that the therapeutic part is just an

excuse to smoke pot freely! Even doctorsshare this view, as his physicians reactionwas to say The use of marijuana is more ofa lifestyle than a treatment!

The stigma attached to the euphoria (orhigh) associated with cannabis is still verypresent. However, for some, the moodenhan cing property has a beneficial effect ontheir overall health and quality of life.Smoking marijuana was helpful to keep meawake and to believe that life was still worthliving while I was taking Kaletra and otherantiretroviral medication states Berger.Robert Newman says, I currently use marijuana to combat depression. Smoking marijuana not only gives me the relaxing andcalming effects to my day, the act itself ofstopping my day to partake for 5 minutes issomething that I enjoy. One could argue thathealth is more than the absence of symptoms

or disease but includes quality of life andwell-being.

The stigma of using cannabis as part ofones therapy is of particular concern to aparent. Parents face insurmountable pres-sures to take pills instead of smokin g medica-tion when they have a child said JasonWilcox. I personally came under attack formarijuana use by the Ministry of Childrenand Families here in B.C back in March of2001. The Ministry lawyer explained thatthey were concerned about the medication Iwas taking and whether th at would have animpact on my ability to care for my daugh-ter. After lengthy discussions and debate,the Ministr y backed off, though this situationclearly indicates the need for better public

knowledge surrounding the therapeutic useof cannabis.

An important element of the project willbe to develop resource materials to assist theHIV/AIDS community and build its capacityto provide information about the use ofcannabis as therapy, how to apply to themedical marijuana program, legal considera-tions, how to speak to a doctor aboutcannabis, where an d how to obtain cannabis,and issues of stigma and discrimination . Thiswork will ultimately benefit all medicinalusers of marijuana.

The project began in January 2005 andwill run for 18 months. T he results and mate-rials will be ready to be presented when

Canada hosts the XVI International AIDSConference in Toronto on August 13-19,2006. For more information about the proj-ect, or to participate in one of the focusgroups, please contact Lynne Belle-Isle at theCanadian AIDS Society at 1-800-499-1986,extension 126, or at [email protected]

Members of the N ational SteeringCommittee:

Lynne Belle-Isle, Canadian A IDSSociety (Chair/NSC)

Claire Checkland, Canadian A IDSSociety

Raym ond Berger, CPAVIH inMontreal, Quebec (also on CA SBoard of Directors)

Glenn Betteridge, CanadianHIV/A IDS Legal N etwork

Nathalie Bouchard, Production DouceBohme/Gentle Craft Production

Horace Josephs, Canadian Treatment

Action CouncilLaurie Edmiston, Canadian A IDSTreatment Informat ion Exchange

Luc Gagnon, Montreal, Quebec

Brent Lewandoski, Medicine Hat,A lberta

Philippe Lucas, Vancouver IslandCompassion Society

Dr. Glenda MacDonald,Pharmacotherapy Consulting Group

Eric Nash, Island Harvest

Robert Newman , AIDS Committee of

London, OntarioRon Reid, Toronto, Ontario

Trevor Stratton, CanadianA boriginal AIDS Network

Dr. Mark Ware, Montreal GeneralHospital Pain Centre

Jason W ilcox, Vancouver IslandPersons Living with Infectious V irusesCaucus

Charles Dawson, Charlottetown,Prince Edward Island

Ex-Officio/N on-Voting Members:

Valerie Lasher, Manager of the Officeof Cannabis Medical Access at HealthCanada

Michael McCulloch, Senior PolicyAdvisor, HIV/AIDS Policy,Coordination and Programs Divisionat the Public Health A gency ofCanada


The stigma and

discrimination asso-

ciated with the use

of cannabis will

also be examined.

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Dr. Lester Grinspoon MD, is an emeri- tus professor of psychiatry at HarvardMedical School, and has recently sign ed on as a scientific advisor for Cannasat,Canadas newest cannabis company. He has been studying cannabis since 1967 and has published two books on the subject. Marihuana Reconsidered waspublished by Harvard University Press in1971. Marihuana, the Forbidden Medicine, co-authored with James B.

Bakalar, was published in 1993 by YaleUniversity Press. The revised and expand-ed edition appeared in 1997 and is now translated into 10 languages. (MedicalUses rxmarijuana.com - Uses ofMarijuana - marijuana-uses.com)

I am pleased that Health Canada isconsidering allowing Sativex to be sold as amedicine in Canada if for no other reasonthan it contributes to the growing under-standing that cannabis has some remarkablemedicinal utilities. However, I think it impor -tant that as part of that consideration itaddress some concerns about Sativex andGW Pharmaceuticals.

A few years ago GW Pharmaceuticals

persuaded th e UK Home Office that it shouldbe allowed to develop this product on theassertion that it will provide all of themedical benefits of cannabis without burden-ing patients with two common wisdomdangerous effects those of smoking andgetting high. There is very little to supportthe belief that smoking marijuana representsa significant risk to the pulmonary system.Although cannabis has been smoked widely

in Western countries for more than fourdecades, there are no reported cases ofcancer or emphysema which can be attrib-uted to marijuana. I suspect that a daysbreathing in any city with poor air qu alityposes more of a threat than inhaling adays dose of smoked marijuana.Furthermore, those who are, in todaysantismokin g climate, concerned about an ytoxic effects on the pu lmonary system cannow use a vaporizer, a device which freesthe cannabinoid molecules from the plantmaterial without the necessity of produc-ing smoke by burn ing it. As for thepsychoactive effects, I am not persuadedthat the therapeutic benefits of cannabiscan always be separated from thepsychoactive effects nor am I convincedthat attempting to do so is always a desir-

able goal. For example, many patientswith mu ltiple sclerosis who use marijuan aspeak of feeling better as well as therelief of muscle spasm and other symp-toms. If cann abis contributes to th is moodelevation, should patients be deprived ofthis effect? The statement, The company

maintains that Sativex, when taken properly,does not cause thekind of in toxicationthat people routine-ly experience fromsmoking marijua-na hinges on thephrase, whentaken properly.Properly here

means taking adose which isunder the levelrequired for thepsychoactive effect.One has to questionwhether that doseis always therapeu-tic and whethercannabis takensublingually can beso carefully titratedto readily find thatprecise dose. It isalso true thatpeople who want touse Sativex to get

high will certainlybe able to do so.

One of the mostimportant charac-teristics of cannabisas a medicine is itscapacity for self-titration whentaken through thepulmonary system.

Because the effects are achieved so rapidlythrough this means of administration, thepatient can determine precisely the amountneeded for symptom relief; the risk of u nder-dosing or overdosing is minimized. Whilesublingual absorption of cannabis leads tofaster relief than oral administration (whichmay take one and a half to two hours), it isnot nearly as fast as pulmonary administra-tion and therefore makes self-titration muchmore difficult if not imp ossible. Further more,many patients cannot hold the Sativex,which has a most unpleasant taste, under thetongue long enough for it t o be absorbed; as aconsequence varying amounts trickle downthe esophagus. It then behaves like orallyadministered cannabis with the consequentdelay in the th erapeutic effect.

Cannabis will one day be seen as a

wonder drug as was penicillin in the 1940s.Like penicillin, herbal marihuana is remark-ably nontoxic, has a wide range of therapeu-tic applications, an d will be quite inexpensivewh en it is freed of the prohibition tariff. Evennow good quality illicit or homegrown marijuana, which is, at the very least, no less

Cannabis Health 17

This picture of Dr. Grinspoon was recently

taken by his son David when they were

visiting the San Luis Valley in Colorado.

S u b l i n g u a lD e l i v e r y o f S a t i v e x

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useful than Sativex, is less expensive thanSativex will be.

While the pharmaceutical industry willundoubtedly produce new strains of herbalmarihuana and unique analogs of cannabiswhich will be useful in ways that wholesmoked cannabis is not, Sativex providesonly one advantage over whole smoked (orvaporized) marihuana: its use will be legal. Ihave yet to see a patient who has used bothdronabinol (Marinol, a prescription-avail-able synthetic form of the most activecannabinoid) and smoked marijuana whohas not found the latter more useful andmanageable. The primary reason patientsuse dronabinol rather than herbal marihua-na is a function of the law. Without theprohibition, few would use dronabinol.Similarly, the commercial success of Sativexwill largely depend on the vigor with which

the prohibition is enforced. It is not unrea-sonable to believe that as the pharmaceuticalarmamentarium of cannabinoids increases,so will the pharmaceutical industrys inter-est in sustaining the prohibition. Dr.Geoffrey Guy claims that he founded GWPharmaceuticals to keep people who find

marijuana useful as a medicine out-of-court;there is, of course, a way to do this whichwould be much less expensive both econom-ically and in terms of hu man suffering.

18 Cannabis Health

T h e B o d y s O w nC a n n a b i n o i d S y s t e mFranjo Grotenhermen, M.D.,Chairman o f the IACM

Dr. Franjo Grotenhermen is a medicaldoctor. He is principal of the nova-Institutin Hrth near Cologne, Germany,(w ww.nova-institut.de) and Executive Director of the International Association for Cannabis as Medicine (IACM)(www.cannabis-med.org).

D9-THC (THC), the main active

compound of the cannabis plant, and manyother cannabinoids exert most of theiractions through binding to cannabinoidreceptors in the body, while the mode ofaction of other cannabinoids of therapeuticinterest, among them cannabidiol (CBD), aswell as the carboxy metabolite of THC (11-nor-9-carboxy-D9-THC) and its analogues isless well established.

Th e majority of THC effects are mediatedthrough agonistic actions at cannabinoidreceptors. Agonistic action means th at recep-tors are activated, in contrast to antagonisticaction, i.e. blockade of receptor effects. Theactivation of cann abinoid receptors results indifferent actions depending on t he location ofthe cells with receptors on their surface, e.g.

decrease of pain in pain centers of the brain.Some non-cannabinoid receptor mediat-

ed effects of THC and synthetic derivativeshave also been described, e.g. some effects onthe immune system, some neuroprotectiveeffects, and anti-emetic effects. It is possiblethat several effects previously thought to benon-receptor mediated are mediated bycannabinoid receptor subtypes that have notyet been identified.

Sublingual Delivery of Sativex

Dr Lester Grinspoon has

agreed to be interviewed in

the next issue of Cannabis

Health. If you would like to

submit a question about this

article or any other topic

please send to editor@

cannabishealth.com prior to

May 31st, 2005.

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Cannabis Health 19

Cannabinoid ReceptorsTo date two cannabinoid receptors have

been ident ified, the CB1, and the CB2 recep-tor. They differ in signaling mechanisms,

distribution in organs and tissues, and sensi-tivity to certain agonists and antagonists.

CB1 receptors are mainly foun d on n ervecells in the brain, spinal cord and peripheralnervous system, but are also present incertain peripheral organs and tissues, amongthem endocrine glands, leukocytes, spleen,heart and parts of the reproductive, urinaryand gastrointestinal tracts. One of the func-tions of CB1 receptors is inh ibition of neuro-transmitter release. The cannabinoid systemis one of the most important systems in thebrain that inhibits other neurotransmitters.CB1 receptors are highly expressed in thebasal ganglia, cerebellum, hippocampus andin certain regions of the spinal cord, reflect-

ing the importance of the cannabinoidsystem in motor control (basal ganglia, cere-bellum), memory processing (hippocampus)and pain modulation (spinal cord). Theirconcentration in the brainstem is low, whichmay account for the lack of cannabis-relatedacute fatalities, e.g. due to depression ofrespiration. The brainstem connects thebrain with the spinal cord and is responsiblefor the general fun ctions of life. Its structurescontrol the frequency of the heartbeat, bloodpressure and respiration.

CB2 receptors occur principally inimmun e cells, among th em leukocytes, spleenand tonsils. Immune cells also express CB1receptors in lesser numbers.

Geschlafen Activation of the CB1 recep-tor produces cannabis-like effects on psycheand circulation, while activation of the CB2receptor does not. Hence, selective CB2receptor agonists have become an increasing-ly investigated target for therapeutic uses ofcannabinoids, among them analgesic, anti-inflammatory and anti-cancer actions.

Ther e is increasing evidence for th e exis-tence of additional cannabinoid receptorsubtypes in the brain and periphery. Thesereceptors are more likely to be functionallyrelated to the known cannabinoid receptorsand have a different structure to CB1 andCB2, as there is no evidence for additionalcannabinoid receptors in the human genome.

EndocannabinoidsThe identification of cannabinoid recep-

tors was followed by the detection of mole-cules present in humans and animals thatbind to th ese receptors. T hey are called endo-cannabin oids and are der ivates of fatty acids.To date five endocannabinoids have beenidentified. These are N-arachi-donylethanolamide (anandamide, AEA), 2-arachidonylglycerol (2-AG),2-arachidonylglyceryl ether (noladin ether),

O-arachidonyl-ethanolamine (virodhamine),and N-arachidonyl-dopamine (NADA).

Cannabinoid receptors and endo-cannabinoids together constitute the endo-cannabinoid system which is teleologicallymillions of years old and h as been found inmammals and many other species.Endocannabinoids serve as neurotransmit-ters or neuromodulators.

Anandamide and NADA do not onlybind to cannabinoid receptors but also stimu-late vanilloid receptors (VR1), non-selectiveion channels associated with hyperalgesia(increased pain sensitivity). Capsaicin, acompound of red hot chili peppers also acti-vates vanilloid receptors. Thu s, the histor icaldesignation of anandamide as an endo-cannabinoid seems to be only one part ofthe physiological reality. Cannabinoid recep-tors seem to amount only to some of the

anandamide receptors.The first two discovered endocannabi-

noids, anandamide and 2-AG, are best stud-ied. Anandamide was named after theSanskrit word for bliss (ananda) and thechemical structure, an amide of a fatty acid.Endocannabinoids are produced ondemand by th e body and released from cellsin a stimulus-dependent manner. Amongthese stimuli is pain, which may increase thelevels of endocannabinoids in areas of thebrain responsible for pain control. Anotherstimulus is hunger, which results in anincrease of endocannabinoid concentrationsin the gut and brain centers for appetitecontrol. Endocannabinoids are produced bytissues that express cannabinoid receptors.After r elease, th ey are rapidly deactivated byuptake into cells and metabolized. The dura-tion of action of endocannabinoids is only afew minutes, in contrast to THC whoseeffects last several hou rs.

Affinity to the Cannabinoid ReceptorCannabinoids show different affinity to

CB1 and CB2 receptors. Synthetic cannabi-noids have been developed that act as highlyselective agonists or antagonists at one ofthese receptor types. D9-THC has approxi-mately equal affinity for the CB1 and CB2receptor, while anandamide has marginalselectivity for CB1 receptors. However, theefficacy of THC and anandamide is less atCB2 th an at CB1 receptors.

Tonic Activity of the EndocannabinoidSystem

When administered by themselves antag-onists at the cannabinoid receptor not onlyblock the effects of endocannabinoids, butproduce effects th at are opposite in directionfrom those produ ced by cann abinoid receptoragonists, e.g. cause increased pain. Thiswould suggest that t here is a constant releaseof endocannabinoids, or that there is a

portion of cann abinoid receptors that exist ina constitutively active state, indicating thatthe can nabinoid system is tonically active.

Tonic activity of the cannabinoid systemhas been demonstrated in several conditions.Endocannabinoid levels have been demon-strated to be increased in a pain circuit of thebrain ( periaqueductal gray) following painfulstimuli. Tonic control of spasticity by theendocannabinoid system has been observedin chronic relapsing experimental autoim-

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20 Cannabis Health

T h e B o d y s O w n C a n n a b i n o i d S y s t e m

mune encephalomyelitis (CREAE) in mice,an animal model of multiple sclerosis. Anincrease of cannabinoid receptors followingnerve damage was demonstrated in a ratmodel of chronic neuropathic pain and in amouse model of intestinal inflammation. Anincrease of cannabinoid receptors mayincrease the potency of cannabinoids usedfor the treatment of these conditions. Tonicactivity has also been demonstrated withregard to appetite control and with regard tovomiting in emetic circuits of the br ain.

AntagonistsAntagonists interfere with the physiolog-

ical functions of endocannabinoids. Severalmechanisms have been proposed for the

action of antagonists. They may antagonisethe effects of endocannabinoids, they maymodulate the cannabinoid receptors, chang-ing them from a constitut ively active state toan inactive state, or they may act throughcannabinoid receptor independent mecha-nisms. Antagonists are reported to increasemotor activity, improve memory, increasepain perception, cause vomiting and severalother effects in animals.

Endocannabinoids are important mole-cules for the extin ction of aversive memories.CB receptor antagonists block this ability ofthe cannabinoid system to help the brainforget stressful experiences, e.g. physical orpsychological violence.

Therapeutic Prospects

Mechanisms of action of cannabinoidsare complex, involving activation of andinteraction at the cannabinoid receptor, aswell as activation of vanilloid receptors,influence of endocannabinoid concentration,antioxidant activity, and metabolic interac-tion with other compounds. Cannabinoidsenhance the effects of endocannabinoids,

increase appetite, decrease pain, relaxmuscles, decrease intraocular pressure, andchange our mood. CB receptor antagonists(blockers) are under investigation for the

treatment of obesity and nicotine depend-ence.

Cannabinoid analogues that do not bindto the CB1 receptor are attractive compoundsfor clinical research. Additional ideas for th eseparation of the desired therapeutic effectsfrom the psychotropic action comprise theconcurrent administration of THC and CBD;the design of CB1 receptor agonists that donot cross the blood brain barr ier, so that th eydo not bind to cannabinoid receptors in thebrain; and the development of compoundsthat influence endocannabinoid levels byinhibition of their membrane transport(transport inhibitors) or hydrolysis (FAAHinhibitors). Such compounds increase the

concentration of endocannabinoids, enhanc-ing their action. For example, blockers ofanandamide metabolism were able to reduceanxiety in animal tests.

It is remarkable that FAAH inhibitorsmay already be in clinical use. The non-steroidal anti-inflammatory agent flurbipro-fen inhibits the metabolism of FAAH. Whenadministered into the liquid of the spinalcord, it reduces inflammatory pain byincreasing the level of endocannabinoids.

References

Grotenh ermen F. ClinicalPharmacodynamics of Cannabinoids. JCannabis Ther 2004;4(1):29-78.

Grotenhermen F. Pharmacokinetics andpharmacodynamics of cannabinoids.Clin Ph armacokin 20 03;42(4):327-360.

To date two

cannabinoid receptors

have been identified,the CB1, and the CB2

receptor. They differ

in signaling mecha-

nisms, distribution in

organs and tissues,

and sensitivity to

certain agonists and

antagonists.

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Cannabis Health 21

Header art credit: Jean Ha nam otoPhoto: Valerie & Mike Corral

Valerie Leveroni Corral founded theWo/Mens Alliance for Medical Marijuana,WA MM in 1993. WA MM is a collective of patients and caregivers attempting to create

community, build hope, dissolve barriers, andprovide support and medical marijuana at nocost to patient members who possess a signedand verified recommendation from a physicianlicensed to practice medicine in California. Agenetically monitored, organic, communalgarden is tended by WA MM clients / partici-

pants under the direction of Mike Corral and Valerie A .Leveroni Corral.

WAMM initiated astudy in 1993 designed toaddress the question of

differential clinical effects between Cannabissativa and C. indica strains and hybrids, andalso examining effects of inhaled an d ingest-ed routes of administration. This study isongoing and now includes blind trialswhere the varieties used are not apparent tothe participating patient.

The data collected since 1993 fromWAMM members suggest a trove of possibil-ities. That a single plant comprised of amyriad of components promises such awealth of potential is not a novel considera-tion. It is no surprise to researchers investi-gating the earths flora in the hope of

developing drugs to ease the ills ofhumank ind. Nor to indigenous peoples wh ohave relied on plant medicines to reducesuffering and even lay claim to miraclecures. It may well be that the symbiotic rela-tionship between th e components th at makeup each plant in our world could influencetheir efficacy. A whole plant medicineapproach suggests that these combined prop-erties may add a level of usefulness yetuntapped in synthetically produced singlecompounds.

The most significant limitation to thistype of research is the absence of a legalmechanism in the USA for analyzingcannabis samples for their biological

constituent content. However, the value ofclinical observation when further combinedwith the enduring relationship of observer tosubject provides a depth of understanding

that cannot be obtained in any short-termstudy.

Endocannabinoids (neuroprotectiveagents in our brains) appear to be part of acentral system, interdependent with othersystems of human physiology. (1) Restrictedaccess to the use of whole plants may hindera patients ability to effectively control symp-toms and improve quality of life. Controlledstudies of cannabis have revealed the varyin gtherapeutic effectiveness of cannabinoids intreating illnesses such as cancer, AIDS andLupus chemotherapies, AIDS wasting, MS,asthma, glaucoma, rheumatoid arthritis,epilepsy and other seizure disorders, andaiding in the retardation of tumor growth.

Our present collection of data alsoincludes measures of effectiveness ofcannabis on other autoimmune illnesses suchas systemic lupus erythematosis, as well ason other disorders, including musculardystrophy, epilepsy, quadriplegia, paraplegia,Parkinsons disease, fibromyalgia, depressionand m igraine.

It is reported that THC may reducespasms associated with both n eurological andnon-neurological disorders (Hollister, 1986;British Medical Association Report, 1997).The non-psychoactive cannabinoidcannabidiol has been shown to exhibit anti-convulsant properties in certain animal stud-ies (Iversen 2000)(T he Science of Marijuana,

S t r a i n S p e c i f i c R e s e a r c hWo/ M ans Al l iance for Me dical M ari juana

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22 Cannabis Health

L.L.Iversen, PhD). Inthe case of somepatients it has beennoted to reduce or

prevent the onset ofboth spasm andseizures. It appearsthat there are receptorsites for cannabinoidsthat have beneficialeffects on seizureactivity.

M a r i j u a n aproduces its medicaland other effects byvirtue of the concen-tration and balance ofvarious active ingredi-ents, especially thecannabinoids, which

are unique to marijua-na, but including alsoa wide range ofterpenoids andf l a v o n o i d s(McPartland andMediavilla 2001;McPartland and Pruitt 1999). Th e concen-tration and relative proportions of theseingredients depend on the plants geneticstructure and applied hybridization tech-niques, and as such, allow for a substantiallyvaried ou tcome.

Origin & D evelopment of Strains

In this discussion of marijuana orcannabis we must articulate the origin of theplant. There exists some consensus that thegenus is comprised of a single highly variablespecies, Cannabis sativa, and is easily adap-tive throughout the wor ld. It is considered bysome researchers that the sub-species indicais actually a separate species (e.g., R. Clarke1998). For purposes of discussion here wewill divide the species int o C. sativa, general-ly grown in northern latitudes and C. indicagrown furth er south. It is noted that C. indicais cultivated for its psychoactive resinproduction an d C. sativa, until modern times,mainly for fiber. The differentiation between

the species is oftencharacterized byphysical distinctions;C. sativa exhibits

taller growth,increased distancebetween nodes, long,thin, fingerlike leafstructure and anextended life cycle, 6-9 months. C. indica isshorter in stature,with less distancebetween nodes, awide leaf structure,and less time to matu-ration, 4-6 months.Marijuana producesthree types of resin-( c a n n a b i n o i d ) -producing trichomes;

small bulbous, capi-tate sessile, and capi-tate stalked. Thehighest levels ofcannabinoids occurin th e capitate stalkedtrichomes produced

only by the female flowers. It is logical there-fore, to attempt to breed plants that expressmore flowers and fewer leaves.

We began experimenting with marijuanacultivation in 1974. In the ensuing years wedeveloped 32 strains. Of these we havechosen to focus on the cultivation of fourparticular strain s: C. sativa, C. indica and tw ohybrids. We have traced our C. sativa to

Eastern Malawi. We call her the AfricanQueen (AF). This was initially selected forrapid growth, high yield and aromatic quali-ties. Our C. indica, named Pur ple Indica (PI),originated in Afghanistan. Th e qualities mostnoted include early flowering, significantproduction of resin, and a superior flower toleaf ratio. Utilizing these two distin ct strains,as well as hybrids of both, has resulted insignificant variation. Our method of cultiva-tion was inspired by the wisdom of LutherBurbank, mentor to many a homespungardener. We planted hundreds of seedlings

and selected, from th ose, a few of the highestquality from each variety.

Distinction between strainsObserving the evidence provided by the

test ar ticles, we selected the var ieties accord-ing to reported successful use by our collec-tive. In 1998 a revised protocol wasdeveloped in which patients receive a one-week supply of cannabis without knowledgeof the particular variety provided. Patientscomplete forms on a weekly basis. This blind-ing method confirms distinctions between C.sativa and C. indica. Results have implica-tions for subsequent crossbreeding of strainsto maximize th erapeutic effects.

Each variety exhibited distinct effects onthe symptoms of our mostly terminally illmembership. At the time these instrumentswere analyzed, our patient base (some withmultiple diagnoses) consisted of th e following:

HIV/ AIDS 141 patients(48 HIV / 93 AIDS)

Cancer 57 patients

Neurological Disorders 7 patients

MS 13 patients

Epilepsy/ Seizure Disorder 13 patients

Paraplegia/ Quadriplegia 11 patients -

Spinal Stenosis/ Nerve Injury 13

patients

Cannabis administrationCannabis inhalation methods consisted

mostly of smoking, with some use of vapor-ization, although patient reports of effective-ness appear substantially lessened when thistechnique was employed. Th is could certain-

ly depend on the quality of the vaporizerdesign. In haled marijuan a is un iformly effec-tive in relieving symptoms across a widerange of diagnostic categories. Two symp-toms, spasm and nausea, showed preferentialimprovement with smoking as compared toingestion.

Initially, we observed that C. indicaprovided increased energy and improvedappetite. The hybrid C. indica x C. sativa(PIxAF) shows a similar quality to that of C.indica (PI) in stimulating appetite. C. sativaand its hybrid AFxPI are less effective instimulating appetite. In treating nausea inHIV/A IDS & orth opedic diagnosis groups, C.sativa and C. indica strains p rove equivalent.

C. indica proved to significantly reducediscomfort in patients experiencing pain.Upon analysis of blinded therapeuticcannabis exposures, coupled with long-termobservation, results indicate that thecontributing factor of pain relief itself waslargely responsible for reported increasedenergy.

When patients are exposed to the pure-bred C. sativa (African Queen), or th e hybrid

S t r a i n S p e c i f i c R e s e a r c h

photo courtesy of www.wamm.org

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Cannabis Health 23

S t r a i n S p e c i f i c R e s e a r c h

garden blessing - Valerie & Mike Corral WA MM

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C. sativa x C. indica (AFxPI), a significantincrease in energy, not linked to the relief ofpain, is contrasted to the lethargy andsomnambulance reported by pain-free

patients u sing C. indica.

Interestingly, we have found that theintraocular pressure of glaucoma can best bereduced with continuous use of low qualityC. sativa thr oughout th e day.

For more detail refer to http://www.mari-juana-research.org/

WAMMs ingested forms of cannabisconsist of capsules (two grades), mothersmilk (a soymilk-based liquid), baked goods,and a whole cannabis tincture made frompure grain alcohol with leaf or a homoge-nized blend of leaf and flowers.

C. indica and C. sativa are employed inthe preparation of these products.

Consistency is maintained from year to yearthroughout production. Our blend of leaf andflowers is added to butter and cooked atabout 150 F for four hours. Th e mixture iscooled and put into capsules. Patients reportthat this alternative means of ingestioninduces sleep and interrupts acute pain.Users of our tincture report relief of neuro-pathic pain in extremities, including reduc-tion in joint ache symptom ology.

A topical solution (Rub-a-Dub) isprepared by soaking the unu sable parts of theplant in Isopropyl alcohol for 6-12 monthsand is administered by spraying on the skin.This liniment relieves the pain of arthritis

and non-weeping shingles (Herpes Zoster).

Because the therapeutic effects ofcannabis are sometimes ascribed to its mood-altering properties, we also performed acorrelation analysis of the change in moodscore with other out come variables. Energylevel was the only variable to show a signifi-cant correlation with mood. Mood was notcorrelated with any other outcomes, includ-ing pain relief. It appeared that mood wasoften independent of symptom expression.However written testimony by patients intheir surveys indicated that they believe thatchanges in awareness or consciousness doaffect overall healing.

Of all the symptoms that are touched bymedical marijuana, perhaps the mostprofound effect reported by patients facingdeath has been described as a shift inconsciousness a door openin g to an alter-

native reality. Sitting at the deathbed ofcountless friends, it seems there is no moreimportant side-effect than this ability tochange awareness. On several occasions,terminally ill patients have remarked on thisrecurrent phenomenon w hich allows them toapproach their impending death moreopenly or in a more relaxed manner.This is of particular interest, as each patientalso reported a reduction in anxiety oftenassociated with the dying process.

Patients come to WAMM seeking mari-juana. Th ey soon recognize somethin g in on eanother, something simpatico. This providesinsight for us to both meet our own needs

and to see beyond them, by revealing theimportance in serving others. We worktogether to provide for our whole collective.Patients and our caregivers work in our

garden, our office, making medicines, at ourweekly meetings and at each othersbedsides. These plants have inspired thecreation of a community for people whomight otherwise be disenfranchised byillness. Since our inception in 1993 morethan 150 WAMM members have died. Eachlife touches us in profound ways. We recog-nize that we are assisting each other on ajourne

Cannabis Health - [May/June Edition 2005]

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