Donald Abrams on the Science of Medical Cannabis

Donald Abrams on the Science of Medical Cannabis I mean I went to college in the ‘60’s. That’s what prompted me to pursue this line of research because I saw that, I went to an Ivy league school and I went to Stanford School of Medicine, and I used cannabis, and I don’t think it destroyed my life. I’m Donald Abrams and I’m chief of Hematology/Oncology at San Francisco General Hospital, and a Professor of Medicine at University of California, San Francisco. In the clinic here at San Francisco General Hospital, we had a volunteer, Marie Rasbel, who was our volunteer of the year for two years in the row. She was an older woman, and she used to bring her kids as she called our patients, marijuana brownies. This was at the time when we didn’t have any effective therapies for HIV/AIDS, and many people are dying of the so called, “wasting syndrome.” I was in Amsterdam at low places at the International Aids Conference. I’m glancing at CNN, the headline news and I saw that Marie was being arrested in Sonoma for baking brownies for our patients. And when I arrived telling there was a letter directed to the director of research in the AIDS program at San Francisco General, suggesting that a clinical trial showing the benefits of medical marijuana should come from Brownie Marie’s Institution as if she were our dean. But I picked up the goblet and decided, “Well that’s a good idea.” I had found out that the federal government, the only legal source of cannabis for clinical trials, being the national institute on drug abuse was not interested or has a mandate from congress that they cannot supply cannabis to study as a treatment, because as Dr. Lechner told me when I met with him in 1996, he said we are the national institute on drug abuse, not for drug abuse. So, they have a congressional mandate only to study substances of reviews as substances of reviews, and hence, could not give me marijuana to study to see if it reversed the AIDS wasting syndrome. In California, we were fortunate at the end of the last century to have a budget surplus. And with that, Senator John Vasconcellos established a center for medicinal cannabis research at the University of California through appropriating $3million a year for three years. And that center was really developed to study cannabis as a medicine for the indications that the people of California had loaded on in 1996. And the federal government again, deciding that they are the only legal source of cannabis, sort of made arrangement so that they would supply the marijuana for this research protocols, even though they are looking at marijuana’s effectiveness, as long as they didn’t have to pay to do the studies. So the state of California, the University of California Center for Medicinal Cannabis Research would fund the research, and NIDA would supply the marijuana. And so that was a big change. The potency of the cannabis that we get from NIDA, the National Institute on Drug Abuse is low. It averages about 3.5, maybe to 4%. And street cannabis’ are cannabis that’s from the dispensaries I think is 8-12-20%. So, that’s a lower potency. But I ask NIDA, “Can’t you make more potent cannabis.” And they said, well it turns out that it’s too sticky and it gums up their machine because they automatically roll their marijuana for research into cigarettes using Pall Mall cigarette paper. So they did actually for our vaporizer study. They came up with 6.8% THC, which they managed, I don’t know if they hand rolled it or what. But they did manage to make it more potent strain. A number of the studies that we did were on painful peripheral neuropathy because it’s such a hard syndrome to treat, and they aren’t really effective therapies. Opioids don’t really work, acupunctures, plus/minus. Most people use the anti seizure medicines. And I think all the studies from the University of California Center for Medicinal Cannabis Research have shown that cannabis is very useful for peripheral neuropathy. We took patients with chronic pain, who were taking an opioid, either morphine extended release or oxycodone extended release. And we expose them to vaporize cannabis for five days, and we looked at the impact on the level of the opioid, the morphine or the oxycodone in their bloodstream, and the impact on their pain. And we’re in the process of writing that one up but it was very interesting and it supports what we’ve thought was going to happen in that the blood levels of the opioid, either the morphine or the oxycodone were actually decreased. But pain relief was increased with the cannabis. So, that’s a very interesting finding. Other studies have been conducted in patients with multiple sclerosis. Again, many patients with multiple sclerosis report decrease in spasticity, decrease in pain, increase mobility, increase mood, improved mood when participating in these studies. We’ve done a lot of research over the past 20 years when we haven’t been able to do research with actual cannabis on how cannabinoids cause their effects. And what investigators found in the 1970’s and ‘80’s was that we have receptors in our body, CB1 and CB2, that complex with these cannabinoids from the plant. Now why would we and all other animal species mind you, have these CB1 receptors? It’s not because we’re meant to smoke marijuana. What we find out is that we have our own circulating cannabinoid chemicals in our body that don’t come from the plant. They are generally produced on demand and they complex with the receptor and they cause biological action. So I drink green tea for its health benefit. And green tea has a number of different chemicals that produce this benefit. Similarly, cannabis, the plant, has a number of active compounds that’s called “cannabinoids”, and they belong to a family of 21 carbon chemicals that all have biologic activity. We believe that there are about 70 or 80 different cannabinoids in marijuana. The most well known and the most cycle active cannabinoid is delta 9 THC. And that has been extracted from the plant and put in a sesame oil capsule and has been available as a drug, driving all now for many years. However, there are other cannabinoids in the plant that have the activity. A study in Israel looked at delta 8 THC, and found that it was equally effective as an anti nausea drug for children with cancer getting chemo therapy. I think most of the interest now was on another cannabinoid called “cannabidiol”, otherwise known as CBD. This cannabinoid seems to have really potent anti inflammatory and anti pain activity without having a psychological effect or without producing a high. It’s a very exciting field and many drug companies are working to increase production of endo cannabinoids or decrease production or block the cannabinoid receptor. Now, there was an example of a drug that was approved to decrease appetite. It was approved in Europe and it was CB1 Receptor Blocker, so that the receptor could no longer bind with the bodies on endo cannabinoids. And what they found was that by blocking that CB1 receptor that patients lost weight but they got depressed and they committed suicide. And that was a bad side effect. So the drug was never approved here in the US and it’s now been taken off the market in Europe. As an oncologist, there is hardly a cancer patient that I see for whom I don’t recommend cannabis, because these are patients, especially those who were undergoing chemo therapy, who benefit from anti nausea, increase the appetite. We have many, many other anti nausea drugs but cannabis is the only drug that also increases appetite. And we know what decreases pain again, especially in conjunction with opioids, helps people sleep better and it decreases depression. So those are five reasons that a cancer patient might benefit from cannabis, and if I were not familiar with cannabis’ medicinal properties, I would have to prescribe five different medicines, all of which would have side effects, toxicity and cost. If these were something that we just discovered in the Amazon, everybody would be knocking doors down to do clinical trials to investigate its potential because it is quite an amazing medicine. I mean it is unfortunately all about politics and not science. And that’s when it comes to the health of the nation, I think a problem.