sules can cause dizziness and make it hard
to focus. “Patients suffering from neuropathic pain or depression don’t want to be
stoned — they want relief,” he says.
Controlled, randomized trials that
seek to clarify whether smoked cannabis
delivers on its medical promise — with
acceptable side effects — have been hard
to come by. But scientists in California
have recently concluded several studies in which patients with severe pain
received actual cannabis cigarettes or
cannabis cigarettes with the cannabinoids removed.
In one trial, researchers randomly
assigned 27 HIV patients to get the real
thing and 28 to get fake joints. All the
patients had neuropathic pain, in which
neurons can overreact to even mild
stimuli. About half of the people getting
real cannabis experienced a pain reduction of 30 percent or greater, a standard
benchmark in pain measurement. Only
one-quarter of volunteers getting the
placebo reported such a reduction.
“That’s about as good [a reduction] as
other drugs provide,” says Igor Grant, a
neuropsychiatrist at the University of
California, San Diego, who is among the
scientists overseeing the trials.
While such studies provide evidence
that smoked marijuana has medical
benefits, future trials are more likely to
explore the benefits of cannabis derivatives that don’t carry the baggage that
Ultimately, the fate of medical cannabis
and its derivatives will rest on the same
make-or-break requirements that every
experimental medicine faces — whether it
cures a disease or alleviates its symptoms,
and whether it’s tolerable.
“We have to be careful that marijuana
isn’t seen as a panacea that will help
everybody,” Grant says. “It probably has
a niche.… We can’t ignore the fact that
cannabis is a substance of abuse in some
Getting cannabis in When most people think of medici- nal cannabis, smoking comes to mind. though smoking works quickly and allows users to regulate their intake, it’s hardly a scientific approach: Cannabis qual- ity is often unknown, and inhaling burned materials is bad for the lungs. these and other
drawbacks have spawned new ways to consume medical marijuana.
some people inhale cannabis by using a device that heats the plant without
igniting it. this vaporization unleashes many of the same cannabinoid com-
pounds as smoking does, without the combustion by-products, researchers say.
anecdotally, patients report that the effect is prompt, on a par with smoking.
Because cannabis derivatives can pass through the lining of the mouth and
throat, a company called GW pharmaceuticals has devised a spray product
called sativex. this drug contains roughly equal amounts of two key cannabi-
noids —thC and CBD—plus other cannabis components in an alcohol solu-
tion. a dose of sativex is sprayed under the tongue; no smoking required.
in the face of these options, the “pot pill” seems almost passé. But cap-
sules of synthetic thC exist. one called Marinol has been approved in the
united states since 1985, and another called Cesamet was cleared more
recently. Doctors can prescribe the drugs for nausea, vomiting, loss of appe-
tite and weight loss. though sales of capsules have increased recently, many
users complain of psychoactive side effects and slow action. — Nathan Seppa
Medical marijuana’s various forms
Name of drug Ingredients/
thC/capsule united states,
thC, CBD and
thC and CBD/
and other ail-
needs to be
slow to act,
needs to be
slow to act,
needs to be
slow to act
heated into a
vapor and then
as a drug but
use in 14