Indications & Clinical Use

Acute or Chronic Pain

Almost all analgesic (pain-relieving) medication has limited efficacy for some types of pain. Medical marihuana is particularly useful because it has a broad spectrum of efficacy and a unique set of side effects. Also, many effects that were once thought of as merely side effects are now considered beneficial for pain management.  Marihuana is particularly useful for patients who have developed tolerance to opiates. Opiates, such as codeine and morphine, are commonly used to treat acute pain, but they are not consistently effective when treating chronic pain. Most opiates can also induce nausea. Marihuana is not only beneficial in treating nausea and pain, but there has also been recent research pointing to how marihuana cannabinoids act on pathways in the brain that overlap with those activated by opiates, but through pharmacologically distinct mechanisms (source: Marihuana and Medicine: Assessing the Science Base; Institute of Medicine, 1999. page 140).

Cannabis has been shown to have powerful immune-modulation and anti-inflammatory properties, indicating it may treat chronic inflammatory diseases directly. In fact, one of the earliest records of medical use of cannabis, a Chinese text dating from 2000 BC, notes that cannabis “undoes rheumatism,” suggesting its anti-inflammatory effects were known even then.

There are also many patients who have found drastic and significant pain relief using marihuana specifically for nerve pain. More than 100 types of peripheral neuropathy have been identified, each with its own set of symptoms, causes, and treatment.

In the National Institute of Health (NIH) Report on Medical Marihuana, it was reported that their only scientific finding (excluding anecdotal reports) was that marihuana was most effective for nerve pain. Around every nerve ending are a number of receptors of one kind or another. At every nerve ending in the human body there are fewer opiate receptors than cannabinoid receptors, which means that marihuana is far more effective for stopping nerve pain than opiate drugs, (which do not work for nerve pain very well at all).

Alzheimer’s

Alzheimer's is a degenerative disease that causes a progressive decline in brain function, and it specifically affects memory.  Many people with Alzheimer's disease develop problems, such as agitation, depression, or aggression. Depending on the specific behaviour or mood problems that a patient experiences medical marihuana can be used to treat many of those symptoms, most especially when it comes to appetite. Food refusal is especially common in patients who suffer from Alzheimer's disease, and marihuana can be helpful with weight gain.

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Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (also known as Lou Gehrig's disease) is a fatal neurodegenerative disease. People living with the disease become progressively paralyzed due to degeneration of the upper and lower motor neurons in the brain and spinal cord. Eighty per cent of people with ALS die within two to five years of diagnosis – unable to breathe or swallow. Ten per cent of those affected may live for 10 years or longer.

Marihuana in the management of amyotrophic lateral sclerosis.
Am J Hosp Palliat Care.  2001; 18(4):264-70 (ISSN: 1049-9091)
Carter GT; Rosen BS

Muscular Dystrophy Association (MDA), Neuromuscular Disease Clinic, Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA.

Marihuana has been proposed as treatment for a widening spectrum of medical conditions. Marihuana is a substance with many properties that may be applicable to the management of amyotrophic lateral sclerosis (ALS). These include analgesia, muscle relaxation, bronchodilation, saliva reduction, appetite stimulation, and sleep induction. In addition, marihuana has now been shown to have strong antioxidative and neuroprotective effects, which may prolong neuronal cell survival. In areas where it is legal to do so, marihuana should be considered in the pharmacological management of ALS. Further investigation into the usefulness of marihuana in this setting is warranted.

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Arthritis

There are two common types of arthritis, rheumatoid arthritis and osteoarthritis, but both affect the joints, causing pain, swelling, and limiting movement.

Recent research is accumulating evidence that cannabis therapies are effective for arthritis and the other rheumatic and degenerative hip, joint and connective tissue disorders. Since these are frequently extremely painful conditions, the ability of cannabis to combat chronic pain makes it useful for that aspect, both on its own and as an adjunct therapy that enhances the efficacy of opiate painkillers. The use of cannabis as a treatment for musculoskeletal pain in western medicine dates to the 1700s.

Human studies have shown cannabis to be an effective treatment for rheumatoid arthritis.. Cannabis has a demonstrated ability to improve mobility and reduce morning stiffness and inflammation. Research has also shown that patients are able to reduce their usage of potentially harmful Non-Steroidal Anti- Inflammatory drugs (NSAIDs) when using cannabis as an adjunct therapy.

Modern research on cannabidiol (CBD), one of the non-psychoactive components of cannabis, has found that it suppresses the immune response in mice and rats that is responsible for a disease resembling arthritis, protecting them from severe damage to their joints and markedly improving their condition.

Medical researchers at Hebrew University in Jerusalem found in the metabolism of Cannabidiol an acid with potent anti-inflammatory action comparable to the drug Indomethacin, but without the considerable gastrointestinal side effects associated with that drug.

When the body metabolizes tetra-hydracannibinol (THC), one of the primary components of cannabis, it produces a number of related chemicals.  At least one of these metabolites has anti-inflammatory and pain relieving effects. By modifying this metabolite, researchers at the University of Massachusetts Medical Center have produced a synthetic carboxylic acid known as CT-3 (also called DMH-11C, chemical name dimethylheptyl-THC-11 acid), which is more powerful than the natural metabolite and can be given in smaller doses. Animal tests found CT-3 effective against both chronic and acute inflammation; it also prevented destruction of joint tissue from chronic inflammation.  The long safety record of marihuana - no one has ever died of an overdose - and the fact that a metabolite with the desired anti-inflammatory effect is produced in the body when marihuana is used, strongly suggest that safe and effective anti-inflammatory drugs in this class are possible.

CT3 has demonstrated analgesic effects in animals. In some cases the dose-dependent effect of THC was equivalent to morphine, but with a much greater duration of action.  In contrast to the NSAIDs commonly prescribed arthritis sufferers, CT3 did not cause ulcers at therapeutically relevant doses. Moreover, it does not depress respiration, exhibit dependence, induce body weight loss or cause mutations. Studies on its mechanism of action are currently underway, with cytokine synthesis one of the pathways being studied.  Cannabis may also help combat rheumatoid arthritis by way of its established immune-modulation properties.  Rheumatoid arthritis is characterized by deregulation of the immune system in response to an initial infection or trauma. Over-activity of the immune system's B-cells causes antibodies to attack and destroy the synovial tissues located in the joint.  The immune modulator properties of a group of fats found in cannabis known as sterols and sterolins have been used as natural alternatives to conventional rheumatoid arthritis treatments, which employ highly toxic drugs to either suppress the entire immune response of the body or to palliate pain and the inflammatory process without correcting the underlying immune dysfunction.  Cytokines play a role in either fuelling or suppressing the inflammation that causes damage in rheumatoid arthritis and some other diseases. The release of selected cytokines is impaired by cannabis, but the findings differ by cell type, experimental conditions, and especially the concentration of the cannabinoids examined.  A sterol/sterolin combination has been experimentally demonstrated to reduce the secretion of the pro-inflammatory cytokines controlled by the TH2 helper cells and to increase the number of TH1 cells that regulate the secretion of antibodies from the B cells. This selective activation and inhibition of the immune system results is an effective control of the dysfunctional auto-immune response.

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Cancer

One of the unavoidable side effects of chemotherapy drugs used to treat cancer is the killing of healthy cells. Hence, following the chemotherapy treatments, the patient may experience various adverse effects like nausea, vomiting, loss of appetite and loss of control over the body. Medical marihuana is an effective natural antiemetic, which helps in overcoming nausea, thus allowing the patient to enjoy meals.

Traditional Cancer Treatments

Lung cancer, prostate cancer, breast cancer – in fact, most types of cancer all start the same basic way. Something causes cancer cells to divide and grow without pause, spreading badly damaged DNA. Those cells invade other tissues and, in most cases, form tumours.

Cancer studies have taken leaps and bounds as far as finding treatments to slow, and sometimes stop, the spread of cancer. However, two of the most important treatments, chemotherapy and radiation therapy, also cause damage and, often, severe side effects.

For instance, some of the most powerful, toxic chemicals are used in chemotherapeutic agents. Both treatments kill cancer cells, but healthy cells as well. Chemotherapeutic agents such as Adriamycin (doxorubicin) and Platinol (cisplatin) can, and have, caused immune suppression and multiple organ damage, but they also cause severe nausea and vomiting.

The vomiting can last over a period of days, to the point that some patients have actually torn their esophagus. Due to the vomiting and lack of appetite, severe dehydration and weigh loss is normal. In fact, many cancer patients begin having a reaction before chemotherapy begins, in “anticipation” of the side effects. Unfortunately, although chemotherapy and/or radiation therapy may be an integral part of their survival, many cancer patients decide not to take the therapies because the side effects are so severe.

Because of this, many are given a mix of anti-nausea drugs. Often, the anti-nausea drugs work. However, the drugs only give partial symptom control, while for others they give no control at all. In addition, those who take traditional medications may also suffer fever, bone pain, fatigue, anxiety, sleep problems and changes in heart activity, among other issues. This leaves cancer patients to suffer from the effects of the cancer itself, the side effects of the treatments, and the side effects of medications used to alleviate the initial side effects of the treatments.

Medical Marihuana for Cancer Patients

It has proven in many studies, performed by prestigious scientific and medical organizations and individuals, that medical marihuana can (and does) relieve pain and nausea. In fact, some of these studies go as far back as the 1970s and older.

For instance, in 1975, the New England Journal of Medicine published the results of a “double-blind” study on the effects of oral (ingested rather than smoked) tetrahydrocannabinol on nausea and vomiting. According to the study, “No patient vomited while experiencing a subjective “high”. Oral tetrahydrocannabinol has antiemetic properties and is significantly better than a placebo in reducing vomiting caused by chemotherapeutic agents.”

A 1999 report by the Institutes of Medicine concluded, “In patients already experiencing severe nausea or vomiting, pills are generally ineffective, because of the difficulty in swallowing or keeping a pill down, and slow onset of the drug effect. Thus an inhalation (but, preferably not smoking) cannabinoid drug delivery system would be advantageous for treating chemotherapy-induced nausea.” A possible option for patients who do not want to smoke marihuana is inhalation using a vaporizer.

Although freedom from nausea and vomiting are two of the most noticed benefits of medical marihuana use, many have reported a reduction in the severity of wasting away. As well, they’ve notice a lessening in depression and other “side effects” brought on by the disease, including an increase in appetite. All of these things together have helped many cancer patients live a better, happier, more comfortable life.

Over twenty major studies in the past nine years have shown that cannabinoids (the chemicals in cannabis) actually fight cancer cells. In fact, it’s been shown that cannabinoids arrest cancer growths of many different forms of cancer, including brain, melanoma and breast cancer. There’s even growing evidence that cannabinoids cause direct anti-tumour activity.

Since the possibility was first realized, many more studies have been conducted, focused on the possibility of cannabinoids have anticarcinogenic effects. A 2007 study by the Institute of Toxicology and Pharmacology in Rostock, Germany focused on human cervical cancer (HeLa) cells. The cells were treated with specific cannabioids and THC. Even at low concentrations, MA and THC “led to a decrease in invasion of 61.5% and 68.1% respectively.”

The benefits of medical marihuana for cancer patients are clear when it comes to increased appetite, reduction of pain, wasting, vomiting and nausea, as well as depression. Although its anticarcinogenic effects aren’t quite as clear, ongoing research further points to the possibility that medical marihuana may actually be what many claim it is – a truly miraculous drug.

Nausea and Vomiting

Some anticancer drugs cause nausea and vomiting because they affect parts of the brain that control vomiting and/or irritate the stomach lining. The severity of these symptoms depends on several factors, including the chemotherapeutic agent(s) used, the dose, the schedule, and the patient's reaction to the drug(s). The management of nausea and vomiting caused by chemotherapy is an important part of care for cancer patients whenever it occurs. Although patients usually receive antiemetic drugs that help control nausea and vomiting, there is no single best approach to reducing these symptoms in all patients. Doctors must tailor antiemetic therapy to meet each individual's needs, taking into account the type of anticancer drugs being administered; the patient's general condition, age, and related factors; and, of course, the extent to which the antiemetic is helpful. There has been much interest in the use of marihuana to treat a number of medical problems, including chemotherapy-induced nausea and vomiting in cancer patients. Two forms of marihuana have been used: compounds related to the active chemical constituent of marihuana taken by mouth and marihuana cigarettes. Dronabinol (Marinol®), a synthetic form of the active marihuana constituent delta-9-tetrahydrocannabinol (THC), is available by prescription for use as an antiemetic. In 1985, the U.S. Food and Drug Administration approved its use for the treatment of nausea and vomiting associated with cancer chemotherapy in patients who had not responded to the standard antiemetic drugs.

National Cancer Institute (NCI) scientists feel that other antiemetic drugs or combinations of antiemetic drugs have been shown to be more effective than synthetic THC as “first-line therapy” for nausea and vomiting caused by anticancer drugs. Examples include drugs called serotonin antagonists, including ondansetron (Zofran®) and granisetron (Kytril®), used alone or combined with dexamethasone (a steroid hormone); metoclopramide (Reglan®) combined with diphenhydramine and dexamethasone; high doses of methylprednisolone (a steroid hormone) combined with droperidol (Inapsine®); and prochlorperazine (Compazine®). Continued research with other agents and combinations of these agents is under way to determine their usefulness in controlling chemotherapy-induced nausea and vomiting. However, NCI scientists believe that synthetic THC may be appropriate for some cancer patients who have chemotherapy-induced nausea and vomiting that cannot be controlled by other antiemetic agents. The expected side effects of this compound must be weighed against the possible benefits. Dronabinol often causes a “high” (loss of control or sensation of unreality), which is associated with its effectiveness; however, this sensation may be unpleasant for some individuals.

Marihuana cigarettes have been used to treat chemotherapy-induced nausea and vomiting, and research has shown that THC is more quickly absorbed from marihuana smoke than from an oral preparation. However, any antiemetic effects of smoking marihuana may not be consistent because of varying potency, depending on the source of the marihuana contained in the cigarette.

To address issues surrounding the medical uses of marihuana, the National Institutes of Health convened a meeting in February 1997 to review the scientific data concerning its potential therapeutic uses and explore the need for additional research. The group of experts concluded that more and better studies are needed to fully evaluate the potential use of marihuana as supportive care for cancer patients.

Anorexia and Cachexia

Anorexia, the loss of appetite or desire to eat, is a common symptom in cancer patients. It may occur early in the disease or later, if the cancer grows and spreads. Cachexia is a wasting condition in which the patient has weakness and a marked and progressive loss of body weight, fat, and muscle. Anorexia and cachexia frequently occur together, but cachexia may occur in patients who are eating an adequate diet but have mal-absorption of nutrients. Maintenance of body weight and adequate nutritional status can help patients feel and look better, and maintain or improve their overall health. It may also help them better tolerate cancer therapy.

There are a variety of options for supportive nutritional care of cancer patients, including changes in diet and consumption of foods, enteral or parenteral feeding (delivery of nutrients by tube), and the use of drugs. An NCI-supported study to evaluate the effects of THC and megestrol acetate (a synthetic female hormone) used alone and in combination for treatment-related and cancer-related anorexia and cachexia completed patient accrual earlier this year. Researchers will compare the appetite, weight, and rate of weight change among patients treated with THC to patients treated with megestrol acetate or with both therapies. Researchers will also evaluate the effects of the drugs alone or in combination on nausea and vomiting, assess for toxic effects of the drugs, and evaluate differences in quality of life among those patients who were treated with THC.

The Institute of Medicine (IOM), part of the National Academy of Sciences, has published a report assessing the scientific knowledge of health effects and possible medical uses of marihuana. The IOM project was funded by the White House Office of National Drug Control Policy. The IOM released its report on March 17, 1999.

Copies of the report, Marihuana and Medicine: Assessing the Science Base, are available from National Academy Press, Lockbox 285, 2101 Constitution Avenue, NW., Washington, DC 20055; (202) 334–3313 or 1–888–624–8373. The full text of the IOM report is also available at http://www.nap.edu/catalog.php?record_id=6376 on the Internet.

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Dystonia

The dystonias are movement disorders in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. The movements, which are involuntary and sometimes painful, may affect a single muscle or a group of muscles such as those in the arms, legs, or neck; or the entire body.

Early symptoms of dystonia may include deterioration in handwriting after writing several lines, foot cramps, and/or a tendency of one foot to pull up or drag; this may occur "out of the blue" or may occur after running or walking some distance. The neck may turn or pull involuntarily, especially when the patient is tired or stressed. Sometimes both eyes will blink rapidly and uncontrollably, rendering a person functionally blind. Other possible symptoms are tremor and voice or speech difficulties. The initial symptoms can be very mild and may be noticeable only after prolonged exertion, stress, or fatigue. Over a period of time, the symptoms may become more noticeable and widespread and be unrelenting.
There are several types of Dystonia including Anismus, Torsion dystonia, Cervical dystonia, Blepharospasm, Oromandibular dystonia, Cranial dystonia, Focal hand dystonia, Laryngeal dystonia and Dopa-responsive dystonia (DRD) among others.

No one treatment has been found universally effective to treat all the different types of dystonia.  Instead, physicians use a variety of therapies aimed at reducing or eliminating muscle spasms and pain.

Treatment has been limited to minimizing the symptoms of the disorder as there is yet no successful treatment for its cause. Reducing the types of movements that trigger or worsen dystonic symptoms provides some relief, as does reducing stress, getting plenty of rest, moderate exercise, and relaxation techniques. Various treatments focus on sedating brain functions or blocking nerve communications with the muscles via drugs, neuro-suppression or denervation. All current treatments have negative side effects and risks.

There are numerous types of medications that have proven helpful however they do come with a long list of side effects. Some of these medications can be sedating, especially at higher doses, and this can limit their usefulness.

No controlled study of marihuana in dystonic patients has been published, and the only study of cannabinoids was a preliminary open trial of cannabidiol (CBD) that suggested modest dose-related improvements in the five dystonic patients studied.(30) In mutant dystonic hamsters, however, the cannabinoid receptor agonist, WIN 55,212-2, can produce antidystonic effects.(153)

30. Consroe P, Sandyk R, Snider SR. 1986. Open label evaluation of cannabidiol in dystonic movement disorders. International Journal of Neuroscience 30:277-282.

153. Richter A, Loscher W. 1994. (+)-WIN55, 212-2 A novel cannabinoid receptor agonist, exerts antidystonic effects in mutant dystonic hamsters. European Journal of Pharmacology 264:371-377.

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Epilepsy

Epilepsy is a persistent (chronic) condition of the brain. It involves unpredictable abnormal electrical discharges or misfirings of brain cells (neurons). This misfiring in the brain can cause episodes of bodily convulsions, loss of coordination, loss of consciousness or altered sensory states. These episodes are commonly called seizures. People with epilepsy have persistent and recurring seizures. One may be born with epilepsy, or may acquire it as a result of disease or injury.

Epileptic seizures are often classified as partial seizures or generalized seizures. Partial seizures are more common and start in an isolated part of the brain. Partial seizures can be described as either simple or complex. When a simple partial seizure occurs, a person retains consciousness. The person with epilepsy may experience uncontrollable twitching or stiffening in a limb. There may be a tingling sensation, a change in consciousness or an odd smell without a source. The subjective sensations that may warn of an impending event are called an "aura".

Complex partial seizures cause an impairment of consciousness. During this type of seizure, a person may act confused, aimless, fidgety, emotional or disturbed. They are likely to have no memory of the event after it is over. A simple partial seizure may progress to a complex partial seizure and then become a generalized seizure as the abnormal electrical discharge spreads to the entire brain.

Generalized seizures involve abnormal discharges or misfirings in all regions of the brain and result in impairment of consciousness. Behavior during generalized seizures may range from a blank stare with little or no movement (petit mal or "absence" seizures) to dramatic bodily convulsions (grand mal seizures). During these convulsions, the patient may have difficulty breathing and turn blue. They may also bite their tongue and may lose control of urine or stool. When they regain consciousness, they do not remember the event and are very sleepy.

Epilepsy is conventionally treated with a class of drugs called anticonvulsants. Doctors prescribe anticonvulsants or antiepileptic drugs according to the types of seizures patients experience and how well the patient can tolerate the drug. Many patients have a poor response to these drugs even when taken in combination.

In addition to problems with effectiveness, there can be serious side effects resulting from the use of anticonvulsants. While these side effects do not always occur, they can include nausea, headaches, loss of hair, swelling of gum tissue, impotence, depression, poor coordination (ataxia), liver failure, depressed blood counts and even psychosis.

Some people with grand mal seizures say they can prevent their seizures entirely by smoking marihuana. Others, who suffer complex partial seizures, report that marihuana also curbs their symptoms and prevents loss of consciousness. Marihuana is not considered useful for treating petit mal or absence seizures and may even worsen them.

Some patients find that marihuana works in conjunction with other drugs they are taking. Others find that marihuana works best for them when it is used without other drugs. Either way, these epileptic patients have made marihuana a necessary part of their medical treatment.

People using marihuana to control epilepsy should be aware that withdrawal from any medication that controls seizures may leave you more susceptible to the seizures. Marihuana is no exception. Patients with epilepsy are advised to exercise caution when using oral THC because there is not sufficient knowledge about the convulsive or anti-convulsive properties of the single compound.

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Fibromyalgia

Fibromyalgia is a common syndrome in which people experience long-term, body-wide pain and tender points in joints, muscles, tendons, and other soft tissues.

Fibromyalgia has also been linked to fatigue, sleep problems, headaches, depression, anxiety, and other symptoms.

Causes, incidence, and risk factors

The cause of this disorder is unknown. Although none have been well proven, possible causes or triggers of fibromyalgia include:

Men and women of all ages get fibromyalgia, but the disorder is most common among women aged 20 to 50.

Symptoms

The primary symptom of fibromyalgia is pain.

Fatigue and problems with sleep are seen in almost all patients with fibromyalgia. Many complain that they can't get to sleep or stay asleep, and they feel tired when they wake up.

Other symptoms may include:

Our bodies naturally make pain relievers called endorphins, but they also make other substances that can trigger pain relief in the so-called endocannabinoid system. This system seems to play a key role in many processes in the body, including modulating how we feel pain. Marihuana contains cannabinoids very similar to those that occur in the body naturally.

Fibromyalgia patients typically experience body wide pain and often take multiple drugs to deal with all the symptoms of this disorder. Marihuana may treat multiple symptoms, and some patients have reported seeing results.

The two problems with herbal cannabis, Silverman and other critics say: It's a complex natural substance that contains about 60 different compounds with potentially medicinal effects, some of which may interact with one another. The other problem is that the amount of these various compounds may vary by batch, as marihuana is not synthesized but grown.

While Silverman says he has great hopes that synthetic medicines based on individual compounds in cannabis may one day help fibromyalgia patients (after appropriate randomized controlled clinical trials have been done), he argues that the real thing today is just too inconsistent.
"We think that there's probably a role for that class of compounds, the cannabinoids in general, and it's just a question of working out how that's going to be put into practice," says Mark Ware, M.D., an assistant professor in family medicine and anaesthesia at McGill University, in Montreal, and the executive director of the Canadian Consortium for the Investigation of Cannabinoids.

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G.I. Disorders (Crohn's)

Researchers investigating anecdotal evidence that cannabis relieves some of the symptoms of inflammatory bowel disease (IBD) have discovered a potential new target for cannabis-derived drugs for treatment of the disease.

This finding, published in the journal Gastroenterology today, could bring new hope for the UK’s 90,000 – 180,000 sufferers of diseases like Crohn’s and ulcerative colitis* with the possibility that cannabis-derived drugs may help to heal the gut lining, which is damaged during the course of disease. Both Crohn’s and ulcerative colitis – often referred to under the umbrella term of IBD – cause patients’ immune systems to go into overdrive, producing inflammation in different areas of the gastrointestinal tract.

This inflammation can cause pain, urgent diarrhoea, severe tiredness and loss of weight, and is most commonly diagnosed in young adults of both sexes between the ages of 15 and 25.  Patients with IBD who are also users of cannabis often report that their symptoms are alleviated following cannabis use, suggesting that the gut is able to respond to some of the molecules found in cannabis. Investigating this phenomenon, Dr Karen Wright and Professor Steve Ward from the University of Bath worked with colleagues at the Royal United Hospital in Bath to look at the interaction of cannabis with specific molecules, known as receptors, found on the surface of cells in the gut.

Examining gut samples from healthy people and IBD patients, the researchers looked at two specific receptors, called CB1 and CB2, which are known to be activated by the presence of molecules found in cannabis.  They discovered that whilst CB1 is present in healthy people, the presence of CB2 increases in IBD patients as their disease progresses. The researchers believe that the presence of CB2 receptor only during the disease-state may be linked to its known role in suppression of the immune system. In other words, it is part of the body’s natural mechanisms that attempt to restore the normal healthy state of the gut.  If so, this makes it an ideal candidate for the development of new cannabis-derived drugs to help IBD patients. They also found that the CB1 receptor helps to promote wound healing in the lining of the gut.

“This gives us the first evidence that very selective cannabis-derived treatments may be useful as future therapeutic strategies in the treatment of Crohn’s and ulcerative colitis,” said Dr Karen Wright from the University’s Department of Pharmacy and Pharmacology.

“This is because some extracts from cannabis, known as cannabinoids, closely resemble molecules that occur naturally in our body, and by developing treatments that target this system, we can help the body recover from some of the effects of these diseases.”

Ordinarily, CB1 and CB2 have the task of recognising and binding to a family of substances called “endocannabinoids” that occur naturally in our bodies. Once these receptors have detected the presence of specific molecules in their surrounding environment, a chain of biochemical signals is activated which culminates in switching immune responses on or off – depending on what their function is.

“The normal job of the CB1 and CB2 receptors is to help moderate diverse responses throughout the body, but their presence in the gut means that they could be useful targets for the development of cannabis-derived drugs for controlling the progression of IBD,” said Dr Wright.

Figures are from the National Association for Colitis and Crohn’s Disease. There is no national database of people with Crohn’s or Colitis – the figures are taken from estimates published by the British Society for Gastroenterology in 2004.

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Glaucoma

Glaucoma is a disease of the major nerve of vision, called the optic nerve. The optic nerve receives light-generated nerve impulses from the retina and transmits these to the brain, where we recognize those electrical signals as vision. Glaucoma is characterized by a particular pattern of progressive damage to the optic nerve that generally begins with a subtle loss of side vision (peripheral vision). If glaucoma is not diagnosed and treated, it can progress to loss of central vision and blindness.

Glaucoma is usually, but not always, associated with elevated pressure in the eye (intraocular pressure). Generally, it is this elevated eye pressure that leads to damage of the eye (optic) nerve. In some cases, glaucoma may occur in the presence of normal eye pressure. This form of glaucoma is believed to be caused by poor regulation of blood flow to the optic nerve.

The eye's rigid shape is normally maintained in part by IOP (intraocular pressure). Since a high IOP is the only known major risk factor for glaucoma that can be controlled, most treatments are designed to reduce IOP. Marihuana can reduce IOP when taken orally or by inhalation, but not when administered topically. While a reduction in IOP slows the rate of glaucoma symptom progression, there is no direct evidence of benefits of marihuana in the natural progression of glaucoma. Also, the reduction only lasts for a few hours, and it is not known how marihuana interacts with other drugs used to treat glaucoma.

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Gliomas

Glioma is a type of cancer that starts in the brain or spine. It is called a glioma because it arises from glial cells. The most common site of gliomas is the brain.

Massi P, Vaccani A, Bianchessi S, Costa B, Macchi P, Parolaro D
Department of Pharmacology, Chemotherapy and Medical Toxicology, University of Milan, via Vanvitelli 32, 20129 Milan, Italy.

Recently, we have shown that the non-psychoactive cannabinoid compound cannabidiol [?] (CBD) induces apoptosis of glioma cells in vitro and tumor regression in vivo. The present study investigated a possible involvement of caspase activation and reactive oxygen species (ROS) induction in the apoptotic effect of CBD. CBD produced a gradual, time-dependent activation of caspase-3, which preceded the appearance of apoptotic death. In addition, release of cytochrome c and caspase-9 and caspase-8 activation were detected. The exposure to CBD caused in glioma cells an early production of ROS, depletion of intracellular glutathione [?] and increase activity of glutathione [?] reductase and glutathione [?] peroxidase enzymes. Under the same experimental condition, CBD did not impair primary glia. Thus, we found a different sensitivity to the anti-proliferative effect of CBD in human glioma cells and non-transformed cells that appears closely related to a selective ability of CBD in inducing ROS production and caspase activation in tumor cells.

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Hepatitis C

Hepatitis C is a viral disease that leads to swelling (inflammation) of the liver.

Causes, incidence, and risk factors.

There are many different ways of contracting The hepatitis C virus (HCV).

Hepatitis C has an acute and chronic form. Most people who are infected with the virus develop chronic hepatitis C.

The following symptoms could occur with hepatitis C infection:

Benedikt Fischer, PhD, Director of the Illicit Drugs, Public Health and Policy Unit at the Centre for Addictions Research at the University of Victoria, and Jens Reimer, MD, a Research Psychiatrist at the Center for Interdisciplinary Addiction Research at the University of Hamburg, et al., stated in their Oct. 2006 article "Treatment for Hepatitis C Virus and Cannabis Use in Illicit Drug User Patients: Implications and Questions," published in the European Journal of Gastroenterology & Hepatology: "In fact, there is substantial evidence that cannabis use may help address key challenges faced by drug users in HCV treatment (e.g., nausea, depression), especially when such treatment occurs in the context of methadone maintenance treatment which may amplify these consequences.

While further research is required on the biological and clinical aspects of the benefits of cannabis use for HCV treatment, and the effectiveness of cannabis use for HCV treatment needs to be explored in larger study populations, we advocate that in the interim existing barriers to cannabis use are removed for drug users undergoing HCV treatment until the conclusive empirical basis for evidence-based guidance is available."

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HIV - AIDS

Many HIV - AIDS patients experience the involuntary loss of body weight because of diarrhea, fever, mouth or throat infections, ulcers, or adverse effects of medications. Marihuana can be used as an appetite stimulant and to combat nausea for the treatment of AIDS-related weight loss.

Smoking marihuana effectively relieves chronic HIV-associated nerve pain, including aching, painful numbness, and burning, according to a study published in the February 13, 2007, issue of Neurology®, the scientific journal of the American Academy of Neurology.

For the study, 50 people with HIV-associated sensory neuropathy, the most common HIV nerve disorder, were admitted to a California hospital and randomly assigned to smoke either marihuana or identical placebo cigarettes three times a day for five days.

The study found people who smoked marihuana reduced their daily nerve pain by 34 percent compared to 17 percent in the placebo group.
"Smoking marihuana was well tolerated and effectively relieved chronic nerve pain from HIV-associated sensory neuropathy," said study author Donald Abrams, MD, with San Francisco General Hospital in San Francisco, California. "Our findings show the amount of relief from smoking marihuana is comparable to relief provided by oral drugs currently used for chronic nerve pain."

Abrams says while some HIV patients with chronic nerve pain are able to take anticonvulsant drugs, such as lamotrigine and gabapentin, to ease pain, some patients don't respond well to these drugs. He says that's why there's heightened interest in evaluating marihuana as a treatment for chronic nerve pain.

The study also found the first marihuana cigarette reduced chronic pain by an average of 72 percent versus 15 percent with placebo. And more than half of the people who smoked marihuana reported more than a 30-percent reduction in pain compared to 24 percent in the placebo group.

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Huntington's disease

Huntington's disease is an inherited degenerative disease that usually appears in middle age and results in atrophy or loss of neurons in the caudate nucleus, putamen, and cerebral cortex. It is characterized by arrhythmic, rapid muscular contractions (chorea), emotional disturbance, and dementia (impairment in intellectual and social ability). Animal studies suggest that cannabinoids have antichoreic activity, presumably because of stimulation of CB1 receptors in the basal ganglia.(129,168)

On the basis of positive results in one of four Huntington's disease patients, CBD and a placebo were tested in a double-blind crossover study of 15 Huntington's disease patients who were not taking any antipsychotic drugs. Their symptoms neither improved nor worsened with CBD treatment. (27,164)

The effects of other cannabinoids on patients with Huntington's disease are largely unknown. THC and other CB1 agonists are more likely candidates than CBD, which does not bind to the CB1 receptor. Those receptors are densely distributed on the very neurons that perish in Huntington's disease.(152) Thus far there is little evidence to encourage clinical studies of cannabinoids in Huntington's disease.

27. Consroe P, Laguna J, Allender J, Snider S, Stern L, Sandyk R, Kennedy K, Schram K. 1991. Controlled clinical trial of cannabidiol in Huntington's disease. Pharmacology, Biochemistry and Behavior (New York) 40:701-708.
129. Miller AS, Walker JM. 1995. Effects of a cannabinoid on spontaneous and evoked neuronal activity in the substantia nigra pars reticulata. European Journal of Pharmacology 279:179-185.
152. Richfield EK, Herkenham M. 1994. Selective vulnerability in Huntington's disease: Preferential loss of cannabinoid receptors in lateral globus pallidus. Annals of Neurology 36:577-584.
164. Sandyk R, Consroe P, Stern P, Biklen D. 1988. Preliminary trial of cannabidiol in Huntington's disease. Chesher G, Consroe P, Musty R., Editors, Marihuana: An International Research Report. Canberra: Australian Government Publishing Service.
168. Sanudo-Pena MC, Walker JM. 1997. Role of the subthalamic nucleus in cannabinoid actions in the substantia nigra of the rat. Journal of Neurophysiology 77:1635-1638.

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Incontinence

Urinary incontinence, the involuntary loss of bladder control, can have a dramatic impact on one’s life!

Did you know there are over 3.3 million Canadians experiencing urinary incontinence?

Imagine not being able to travel, enjoy a movie and dinner with your partner, work out at your gym, lift your child or groceries, as you may have an accident. You cannot be away from home any length of time, you absolutely must know where the bathrooms are located in the shopping mall, you are embarrassed to have intimate relations with your mate and in some cases individuals have quit their jobs.

Several recent clinical trials indicate that cannabinoid therapy may reduce incidents of incontinence. Writing in the February 2003 issue of the journal Clinical Rehabilitation, investigators at Oxford’s Centre for Enablement in Britain reported that self-administered doses of whole-plant cannabinoid extracts improved bladder control compared to placebo in patients suffering from MS and spinal cord injury.

Investigators at London’s Institute for Neurology followed up these initial findings in an open-label pilot study of cannabis-based extracts for bladder dysfunction in 15 patients with advanced multiple sclerosis. Following cannabinoid therapy, "urinary urgency, the number of and volume of incontinence episodes, frequency and nocturia all decreased significantly," investigators determined. "Cannabis-based medicinal extracts are a safe and effective treatment for urinary and other problems in patients with advanced MS.

These findings were confirmed in 2006 in a multi-center, randomized placebo-controlled trial involving 630 patients administered oral doses of cannabis extracts or THC. Researchers reported that subjects administered cannabis extracts experienced a 38 percent reduction in incontinence episodes from baseline to the end of treatment, while patients administered THC experienced a 33 percent reduction, suggesting a "clinical effect of cannabis on incontinence episodes.

Most recently, preclinical data presented at the 2006 annual meeting of the American Urological Association indicated that cannabis analogs can reduce bladder inflammation and bladder over-activity in animals.

In light of these findings, experts have recommended the use of cannabinoids as potential 'second-line' agents for treating incontinence.

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Multiple Sclerosis

Multiple Sclerosis (MS) is an inflammatory disease of the Central Nervous System (CNS) - that's the brain and spinal cord. Predominantly, it is a disease of the "white matter" tissue. The white matter is made up of nerve fibres which are responsible for transmitting communication signals both internally within the CNS and between the CNS and the nerves supplying rest of the body.

In people affected by MS, patches of damage called plaques or lesions appear in seemingly random areas of the CNS white matter. At the site of a lesion, a nerve insulating material, called myelin, is lost. I shall explain this process in more detail later. Clinically, MS is a hard condition to characterise because it is very unpredictable and variable. Depending on which areas of the CNS are affected and how badly they are damaged, the type and severity of symptoms can vary greatly.

No two people get MS in exactly the same way and the expression of each individual's disease is as unique as their fingerprints. However, the different courses of the disease, both within an individual and within the whole population, principally differ in their timing, location and severity. Underneath similar processes (including demyelination and sometimes other forms of nerve degeneration) are going on.

Although recent research indicates that the biochemical make-up of lesions may vary between different forms of the disease, this is not the reason why people with MS (PwMS) have such widely differing symptoms - it's because nerve damage to one site usually causes completely different symptoms than damage to another.

In general, people with MS can experience partial or complete loss of any function that is controlled by, or passes through, the brain or spinal cord.

Marihuana can be used to treat symptoms associated with MS, specifically in order to relieve muscle spasticity. The spasms occurring at night can be particularly disruptive to sleep. An Indica dominant strain can be helpful for night time pain management, when the sedative side effect would be beneficial. For patients who develop a sudden onset of intense muscle spasms, a fast acting inhaled form of marihuana might be effective.

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MRSA

Methicillin-resistant Staphylococcus aureus; Community-acquired MRSA (CA-MRSA); Hospital-acquired MRSA (HA-MRSA)
Last reviewed: May 30, 2009.
U.S. National Library of Medicine
National Institutes of Health

National Center for Biotechnology Information U.S. National Library of Medicine National Institutes of Health Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterial infection that is highly resistant to some antibiotics.

MRSA is a strain of Staphylococcus aureus (S. aureus) bacteria. S. aureus is a common type of bacteria that normally live on the skin and sometimes in the nasal passages of healthy people. MRSA refers to S. aureus strains that do not respond to some of the antibiotics used to treat staph infections.

The bacteria can cause infection when they enter the body through a cut, sore, catheter, or breathing tube. The infection can be minor and local (for example, a pimple), or more serious (involving the heart, lung, blood, or bone).
Serious staph infections are more common in people with weak immune systems. This includes patients in hospitals and long-term care facilities and those receiving kidney dialysis.

MRSA infections are grouped into two types:

Symptoms

Staph skin infections cause a red, swollen, and painful area on the skin. Other symptoms may include:

Symptoms of a more serious staph infection may include:

Researchers in Italy and the U.K. tested five major marihuana chemicals called cannabinoids on different strains of MRSA (methicillin-resistant Staphylococcus aureus). All five showed germ-killing activity against the MRSA strains in lab tests. Some synthetic cannabinoids also showed germ-killing capability. The scientists note the cannabinoids kill bacteria in a different way than traditional antibiotics, meaning they might be able to bypass bacterial resistance.

At least two of the cannabinoids don't have mood-altering effects, so there could be a way to use these substances without creating the high of marihuana.

MRSA, like other staph infections, can be spread through casual physical contact or through contaminated objects. It is commonly spread from the hands of someone who has it. This could be in a health care setting, though there have also been high-profile cases of community-acquired MRSA.

It is becoming more common for healthy people to get MRSA, which is often spread between people who have close contact with one another, such as members of a sports team. Symptoms often include skin infections, such as boils. MRSA can become serious, particularly for people who are weak or ill.

In the study, published in the Journal of Natural Products, researchers call for further study of the antibacterial uses of marihuana. There are "currently considerable challenges with the treatment of infections caused by strains of clinically relevant bacteria that show multi-drug resistance," the researchers write. New antibacterials are urgently needed, but only one new class of antibacterial has been introduced in the last 30 years. "Plants are still a substantially untapped source of antimicrobial agents," the researchers conclude.

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Osteoporosis

Scientists investigating the effects of cannabis on bone health have found that its impact varies dramatically with age.
The study has found that although cannabis could reduce bone strength in young people, it may protect against osteoporosis, a weakening of the bones, in later life.

The team at the University of Edinburgh has shown that a molecule found naturally in the body, which can be activated by cannabis - called the type 1 cannabinoid receptor (CB1) - is key to the development of osteoporosis.

It is known that when CB1 comes into contact with cannabis it has an impact on bone regeneration, but until now it was not clear whether the drug had a positive or negative effect.

Researchers, funded by the Arthritis Research Campaign, investigated this by studying mice that lacked the CB1 receptor. The scientists then used compounds - similar to those in cannabis - that activated the CB1 receptor. They found that compounds increased the rate at which bone tissue was destroyed in the young.
The study also showed, however, that the same compounds decreased bone loss in older mice and prevented the accumulation of fat in the bones, which is known to occur in humans with osteoporosis. The results are published in Cell Metabolism.

Osteoporosis affects up to 30 per cent of women and 12 per cent of men at some point in life.
Stuart Ralston, the Arthritis Research Campaign Professor of Rheumatology at the University of Edinburgh, who led the study, said: "This is an exciting step forward, but we must recognise that these are early results and more tests are needed on the effects of cannabis in humans to determine how the effects differ with age in people.

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Pruritus

“Pruritus [itching] is caused by a complex process, involving different neurotransmitters, the hormonal system, blood vessels of the skin, psyche, and other systems. Some aspects of this process seem to be influenced by THC and might explain positive effects reported by a number of patients. The immunodulatory action of THC suggests an antiallergic effect.”

-Grotenhermen, Russo. Cannabis and Cannabinoids: Pharmacology, Toxicology, and Therapeutic Potential. New York: The Hawthorn Integrative Healing Press, 2002  Grotenhermen, “Review of Therapeutic Effects.” Chapter 11, p. 130

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Parkinson's disease

Dr. Evzin Ruzicka, an attending neurologist at Charles University in Prague in the Czech Republic, reported the findings here at the Movement Disorders Society's Seventh International Congress of Parkinson's Disease and Movement Disorders. Ruzicka is also a consultant at the Prague Movement Disorders Center.

"It's difficult to directly study the medical effects of cannabis in the Czech Republic, where we conducted our research, because of its illegal status," Ruzicka told Reuters Health. "Therefore, we had to conduct anonymous surveys. To our knowledge, this is the first study to assess the effect of cannabis on Parkinson's disease, and our findings suggest it may alleviate some symptoms."

Ruzicka and his colleagues chose to investigate marihuana's effects on Parkinson's disease after hearing from several patients that they had tried the drug and it had helped them.

The investigators asked all patients who were treated for Parkinson's disease at their center to complete a questionnaire that asked about cannabis use and about several Parkinson's disease symptoms, including overall symptoms; tremor while at rest; bradykinesia, or slow movement; muscle rigidity; and dyskinesias, or involuntary movements. Dyskinesias are caused by levodopa, the mainstay medication in Parkinson's treatment.

Among the 630 patients to whom the investigators sent questionnaires, 339 (54%) returned them. The responders' average age was about 66, and they had had Parkinson's disease for an average of roughly 9 years. Among the responders, 25% reported that they had used cannabis. Most had used it orally, either as fresh or dried leaves.

Within this group, 39 patients (46%) reported that their Parkinson's disease symptoms in general were relieved after they started using cannabis. In terms of specific symptoms, 26 (31%) reported an improvement in tremor while at rest, and 38 (45%) experienced a relief of bradykinesia. Relief of muscle rigidity was reported by 32 (38%), and 12 (14%) said they had an improvement in levodopa-induced dyskinesias.

The respondents reported that the improvement in symptoms occurred an average of 1.7 months after they had started using cannabis. Patients who used it for at least three months were more likely to experience symptom relief than those with shorter experience, the investigators reported.

This delay between the beginning of cannabis use and the relief of symptoms made it unlikely that the respondents were having a placebo effect, Ruzicka said. A placebo effect can occur when the individual taking a treatment experiences a benefit even if the "treatment," such as a sugar pill, contains no active ingredients.

They found no relationship between the length of cannabis use and the effect on involuntary movements. However, daily marihuana users reported more improvement in their dyskinesias than those using it less often.

The investigators speculated that the effect of cannabis on Parkinson's disease symptoms may be due to interaction among cannabis, certain brain receptors that respond to cannabis and endogenous cannabinoids or cannabis-like substances within the body.

He and colleagues plan to investigate a relationship between cannabis use and relief of Parkinson's disease symptoms by collaborating in further studies with investigators in the United Kingdom, Ruzicka told Reuters Health.

Source: Reuters Health
Author: Paula Moyer

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Sleep Apnea

Marihuana can be prescribed as a sleep aid. Indica dominant marihuana strains have a sedative effect.

Sleep apnea is a medical disorder characterized by frequent interruptions in breathing of up to ten seconds or more during sleep. The condition is associated with numerous physiological disorders, including fatigue, headaches, high blood pressure, irregular heartbeat, heart attack and stroke. Though sleep apnea often goes undiagnosed, it is estimated that approximately four percent of men and two percent of women ages 30 to 60 years old suffer from the disease.

One preclinical study is cited in the scientific literature investigating the role of cannabinoids on sleep-related apnea. Writing in the June 2002 issue of the journal of the American Academy of Sleep Medicine, researchers at the University of Illinois (at Chicago) Department of Medicine reported "potent suppression" of sleep-related apnea in rats administered either exogenous or endogenous cannabinoids. Investigators reported that doses of delta-9-THC and the endocannabinoid oleamide each stabilized respiration during sleep and blocked serotonin-induced exacerbation of sleep apnea in a statistically significant manner. No follow up investigations have taken place assessing the use of cannabinoids to treat this indication. However, several recent preclinical and clinical trials have reported on the use of THC, natural cannabis extracts and endocannabinoids to induce sleep and/or improve sleep quality.

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Spinal Cord Injury

A spinal cord injury is damage that occurs to the spinal cord that results in a loss of function.  Spinal cord injuries usually occur when vertebrae are dislocated or fractured.  The damage to the spinal cord begins at the moment of the injury when displaced bone fragments, disc material, or ligaments from the dislocation or fracture bruise or tear into spinal cord tissue.  Most injuries don't sever your spinal cord. Instead, an injury is more likely to cause fractures and compression of the vertebrae, which then crush and destroy axons.  Axons are extensions of nerve cells that carry signals up and down the spinal cord that allows the brain to communicate with the rest of the body.

Frequent causes of spinal cord injury are trauma such as car accident, gunshot wound or a bad fall.  A spinal cord injury is very different from back injuries such as ruptured disks, spinal stenosis or pinched nerves.  A person can have a severe back injury and not sustain a spinal cord injury.

There are two types of spinal cord injuries, complete and incomplete. In a complete spinal cord injury, both sides of the body are equally affected, and the spinal cord cannot relay messages below the level of the injury.  This results in being paralyzed below the level of injury.  In an incomplete injury, there is some movement and sensation below the level of injury.  An incomplete injury does not affect both sides of the body equally, as a person may be able to move one limb more than another, have more functioning on one side of the body than the other, or be able to feel parts of the body that cannot be moved.

Marihuana can reduce muscle spasms, nausea, and the frequency of sleepless nights for patients suffering from spinal cord injury.
Some benefits of medical marihuana that many patients with spinal cord injuries have reported include improvements in:

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Tourette Syndrome

Tourette's syndrome usually begins in childhood and is characterized by motor and vocal tics (involuntary rapid repetitive movements or vocalizations). It has been suggested that the symptoms might be mediated by a reduction in the activity of limbic-basal ganglia-thalamocortical circuits. These circuits, while not well understood, appear to be responsible for translating a person's intentions to move into actual movements. Damage to these structures leads to either involuntary increases in movement (as in Huntington's disease) or the inability to make voluntary movements (as in Parkinson's disease). The nature of the deficit in Tourette's syndrome is unknown.

No clear link has been established between symptoms of Tourette's syndrome and cannabinoid sites or mechanism of action. Pimozide and haloperidol, two widely used treatments for Tourette's syndrome, inhibit effects mediated by the neurotransmitter dopamine, whereas cannabinoids can increase dopamine release. (154,181) the physiological relevance, if any, of these two observations has not been established.

Clinical reports consist of four case histories indicating that marihuana use can reduce tics in Tourette's patients.(75,163) In three of the four cases the investigators suggest that beneficial effects of marihuana might have been due to anxiety-reducing properties of marihuana rather than to a specific antitic effect.(163)

75. Hemming M, Yellowlees PM. 1993. Effective treatment of Tourette's syndrome with marihuana. Journal of Psychopharmacology 7:389-391.
154. Rodriguez de Fonseca F, Carrera MRA, Navarro M, Koob G, Weiss F. 1997. Activation of corticotropin-releasing factor in the limbic system during cannabinoid withdrawal [see comments Science 1997., 276:1967-1968]. Science 276:2050-2054.
163. Sandyk R, Awerbuch G. 1988. Marihuana and Tourette's syndrome. Journal of Clinical Psychopharmacology 8:444-445.

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