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Chapter 1 Introduction cannabis through this scheme. However, in 1992 the Secretary for Health and Human Services closed the program for new patients saying that it ‘sent the wrong message’ (Mead, 2004). Seeking to drive patients away from herbal cannabis as part of its War on Drugs the federal government diverted them towards synthetic THC (dronabinol). First formulated and launched on prescription in 1985 as Marinol the federal government judged that this product had rendered smoked medicinal cannabis unnecessary. However, absorption of this orally administered drug by the gastrointestinal tract is highly variable. In contrast to smoked cannabis, patients commonly found it difficult to titrate the dose against their symptoms (Ohlsson et al., 1980). Recognising this, in 1996 the states of California and Arizona authorized seriously ill patients to use or cultivate, possess or use cannabis if recommended by a medical doctor. However, the Federal government Controlled Substances Act prohibited cannabis cultivation for any purpose and high-ranking Federal officials threatened that physicians as well as growers could face criminal prosecution. The backlash from doctors to this threat led the Drug Czar Barry McCaffrey to ask for review of the medical evidence supporting cannabis as a medicine. The report of this review Marijuana and Medicine: Assessing the Science Base was published in 1999 and included many recommendations in favour of cannabis (Joy et al., 1999). By 2008 twelve states, covering approximately 20% of the population, authorised the use of cannabis for medicinal purposes. To assist these patients, a large number Cannabis Growers Clubs were formed. However, despite this, the federal government still pursued the closure of these clubs and similar outlets with vigour. In California in 2008 over two hundred thousand patients had a written recommendation from a medical doctor supporting their medicinal marijuana use. Of these, 40% could be regarded as having a serious illness (Room et al., 2008). In this state the Federal Authorities appeared to be losing their battle. In the USA, the vehicle for regulation of research into cannabinoids is the National Institute for Drug Abuse (NIDA). Most of the research, which is supported in the USA, is directed towards mode of action studies and the cataloguing of adverse effects produced by cannabis. The majority of the research is concerned with preclinical studies and very little clinical work is supported in the USA other than investigations of adverse effects on the psychological profile of recreational users. The net effect of prohibition of cannabis in the USA has been that little or no clinical research under therapeutic benefit has been carried out to date. In 2009, in the last days of the Bush Administration, there appeared to be minimal appetite within the US government for any type of cannabis reform. Against this difficult background, as stated earlier, in 2008 13
Chapter 1 Introduction GW Pharmaceuticals commenced clinical trials in the US to evaluate the efficacy of the cannabis-based botanical medicine Sativex ® for the control of pain in terminal cancer patients. 1.6.2 Canada In 2001, Health Canada defined categories of patient eligible to receive access to medicinal cannabis. These included individuals with acute pain, violent nausea or other serious symptoms caused by multiple sclerosis, cancer, spinal injury or disease, AIDS/HIV, severe arthritis and epilepsy. With doctor’s approval, these patients could receive cannabis grown under the name CanniMed by the company Prairie Plant Systems. It was also legal for individuals to grow Cannabis for personal medical use. In 2005 Sativex ® received provisional approval with conditions for the treatment of central neuropathic pain in multiple sclerosis, and in 2007 for intractable cancer pain. 1.6.3 Mainland Europe For decades, the Dutch Government has had the most relaxed attitude to cannabis use within Europe. Possession of small quantities of cannabis for personal recreational use has been tolerated. Many people used cannabis for medicinal purposes, often growing their own plants. Much of the cannabis used would have been bought from the large number of regulated ‘coffee shops’ that offered the sale and consumption of cannabis on their premises. Under the Guidance of the Ministry for Health, Welfare and Sport, in 2003 a new source of ‘medical cannabis’ became available through pharmacies in the Netherlands. This material simply consisted of unformulated dried cannabis floral material. It contained high levels of THC and minimum amounts of other cannabinoids. The cannabinoid content was stated as being within a tightly specified range and the product was sterilised using γ-radiation. The product was much more expensive than similar, albeit less-well regulated, floral material on sale in coffee shops. Perhaps because of this, consumption was much lower than government predictions and the continued supply of this material was threatened. In November 2006, the Ministry stated that the German and Italian governments were interested in accessing the Dutch medicinal cannabis. On 9 th July 2008, the Austrian Parliament approved Cannabis cultivation for scientific purposes under the Health Ministry’s control. Possession of cannabis for recreational purposes remained an imprisonable offence. Spain has undergone a progressive decrimilisation with regard to cannabis possession. In 2001 the Catalonia region permitted the possession of cannabis for medicinal purposes and Sativex ® became available in that area. 14
Page 1 and 2: THE PROPAGATION, CHARACTERISATION A
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References Baker, R., 2002. Commerc
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References Cerniak, L., 1985. The G
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References Dayanandan, P. & Kaufman
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References Fairbairn, J.W., 1972. T
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References Ghosal, S., Singh, S., B
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References Henderson, S.M., 1973. E
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References Johnson, J.R. and Potts,
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References Mahlberg, P.G., Hammond,
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References de Meijer, E.D.M., 1994.
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References Page, C.P., Hoffman, B.,
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References Raman, A.R., 1998. The C
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References Russo, E. B., Jiang, H.
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References Struik, P.C., Amaducci,
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References UNODC. United Nations Of
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References Wilkinson, T. J., 2006.
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Appendix 8.1 Analysis of cannabinoi
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Appendix 8.1 Analysis of cannabinoi
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Appendix 8.2 Analysis of terpene co
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Appendix 8.3 A Comparison of the St
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Appendix 8.5 Definitions of Social
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