* Forwarded (from: NETMAIL)
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http://www.commonlink.com/~olsen/NORML/grinspoon.html
                  Formal Testimony of Dr. Lester Grinspoon
             Before the Crime Subcommittee, Judiciary Committee,
                        U.S. House of Representatives
       August 1, 9:30 a.m., Room 2141, Rayburn House Office Building.
                                Testimony of
                           Lester Grinspoon, M.D.
          Associate Professor of Psychiatry, Harvard Medical School
          before the Crime Subcommittee of the Judiciary Committee
                        U.S. House of Representatives
                              Washington, D.C.
                               October 1, 1997
        Mr. Chairman and members of the subcommittee, I appreciate the
opportunity to appear before you this morning to share my views on the use
of marihuana as a medicine.
        In September 1928 Alexander Fleming returned from vacation to his
laboratory and discovered that one of the petri dishes he had inadvertently
left out over the summer was overgrown with staphylococci except for the
area surrounding a mold colony.  That mold contained a substance he later
named penicillin.  He published his finding in 1929, but the discovery was
ignored by the medical establishment, and bacterial infections continued to
be a leading cause of death.   Had it aroused the interest of a
pharmaceutical firm, its development might not have been delayed.  More than
10 years later, under wartime pressure to develop antibiotic substances to
supplement sulfonamide, Howard Florey and Ernst Chain initiated the first
clinical trial of penicillin (with six patients) and began the systematic
investigations that might have been conducted a decade earlier.1
        After its debut in 1941, penicillin rapidly earned a reputation as
"the wonder drug of the '40s."  There were three major reasons for that
reputation: it was remarkably non-toxic, even at high doses; it was
inexpensive to produce on a large scale; and it was extremely versatile,
acting against the microorganisms that caused a great variety of diseases,
from pneumonia to syphilis.   In all three respects cannabis suggests
parallels:
        (1)  Cannabis is remarkably safe.   Although not harmless, it is
surely less toxic than most of the conventional medicines it could replace
if it were legally available.  Despite its use by millions of people over
thousands of years, cannabis has never caused an overdose death.  The most
serious concern is respiratory system damage from smoking, but that can
easily be addressed by increasing the potency of cannabis and by developing
the technology to separate the particulate matter in marihuana smoke from
its active ingredients, the cannabinoids (prohibition, incidentally, has
prevented this technology from flourishing).   Once cannabis regains the
place in the U.S. Pharmacopoeia that it lost in 1941 after the passage of
the Marihuana Tax Act (1937), it will be among the least toxic substances in
that compendium.  Right now the greatest danger in using marihuana medically
is the illegality that imposes a great deal of anxiety and expense on people
who are already suffering.
        (2)  Medical cannabis would be extremely inexpensive.  Street
marihuana today costs $200 to $400 an ounce, but the prohibition tariff
accounts for most of that.  A reasonable estimate of the cost of cannabis as
a medicine is $20 to $30 an ounce, or about 30 to 40 cents per marihuana
cigarette.  As an example of what this means in practice, consider the
following.  Both the marihuana cigarette and an 8 mg ondansetron pill --
cost to the patient, $30 to $40 -- are effective in most cases for the
nausea and vomiting of cancer chemotherapy (although many patients find less
than one marihuana cigarette to be more useful, and they often require
several ondansetron pills).  Thus cannabis would be at least 100 times less
expensive than the best present treatment for this symptom.
        (3)  Cannabis is remarkably versatile.   Let me review briefly some
of the symptoms and syndromes for which it is useful.
Cancer Treatment
        Cannabis has several uses in the treatment of cancer.  As an
appetite stimulant, it can help to slow weight loss in cancer patients.2  It
may also act as a mood elevator.  But the most common use is the prevention
of nausea and vomiting of cancer chemotherapy.   About half of patients
treated with anticancer drugs suffer from severe nausea and vomiting, which
are not only unpleasant but a threat to the effectiveness of the therapy.
Retching can cause tears of the esophagus and rib fractures, prevent
adequate nutrition, and lead to fluid loss.  Some patients find the nausea
so intolerable they say they would rather die than go on.  The antiemetics
most commonly used in chemotherapy are metoclopramide (Reglan), the
relatively new ondansetron (Zofran), and the newer granisetron (Kytril).
Unfortunately, for many cancer patients these conventional antiemetics do
not work at all or provide little relief.
        The suggestion that cannabis might be useful arose in the early
1970s when some young patients receiving cancer chemotherapy found that
marihuana smoking reduced their nausea and vomiting.  In one study of 56
patients who got no relief from standard antiemetic agents, 78% became
symptom-free when they smoked marihuana.3  Oral tetrahydrocannabinol (THC)
has proved effective where the standard drugs were not.4,5 but smoking
generates faster and more predictable results because it raises THC
concentration in the blood more easily to the needed level.  Also, it may be
hard for a nauseated patient to take oral medicine.  In fact, there is
strong evidence that most patients suffering from nausea and vomiting prefer
smoked marihuana to oral THC.2
        Oncologists may be ahead of other physicians in recognizing the
therapeutic potential of cannabis.  In the spring of 1990, two investigators
randomly selected more than 2,000 members of the American Society of
Clinical Oncology (one-third of the membership) and mailed them an anonymous
questionnaire to learn their views on the use of cannabis in cancer
chemotherapy.  Almost half of the recipients responded.  Although the
investigators acknowledge that this group was self-selected and that there
might be a response bias, their results provide a rough estimate of the
views of specialists on the use of Marinol (dronabinol, oral synthetic THC)
and smoked marihuana.
        Only 43% said the available legal antiemetic drugs (including
Marinol) provided adequate relief to all or most of their patients, and only
46% said the side effects of these drugs were rarely a serious problem.
Forty-four percent had recommended the illegal use of marihuana to at least
one patient, and half would prescribe it to some patients if it were legal.
On average, they considered smoked marihuana more effective than Marinol and
roughly as safe.6
Glaucoma
        Cannabis may also be useful in the treatment of glaucoma, the second
leading cause of blindness in the United States.  In this disease, fluid
pressure within the eyeball increases until it damages the optic nerve.
About a million Americans suffer from the form of glaucoma (open angle)
treatable with cannabis.  Marihuana causes a dose-related, clinically
significant drop in intraocular pressure that lasts several hours in both
normal subjects and those with the abnormally high ocular tension produced
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