It's high time for sober debate on medical marijuana


Time for sober marijuana debate

Medical use of marijuana is a reality in many countries.

Marijuana has a long history of use as a recreational and spiritual substance, but current debate is about its medicinal value. Marijuana refers to the dried leaves, flowers, stems and seeds of the Cannabis sativa plant, which contains the mind-altering chemical delta-9-tetrahydrocannabinol (THC). The plant also contains cannabinoids, which have been subject to scientific research that has shown that they are beneficial with less risks than THC.
Marijuana contains more than 100 cannabinoids, which are chemically similar to THC, the ingredient that makes people “high” but unlike THC, cannabinoids do not give a high. Cannabinoids are similar to chemicals the body makes to regulate pleasure, memory, thinking, concentration, body movement, awareness of time, appetite, pain, and the senses.
The most compelling evidence of the positive outcomes of the use of cannabinoids is their effect on pain control, and appetite stimulation and thus weight gain in patients suffering from life-threatening illnesses such as cancer and AIDS. Cannabinoids have also been shown to reduce anxiety, control nausea and vomiting and relax tight muscles in people with multiple sclerosis.
The Food and Drug Administration (FDA) of the US has approved the use of at least three extracts as pharmaceutical cannabinoids in drugs for seizures, nausea and vomiting.
One cell culture study in rats suggests that purified extracts can slow the growth of cancer cells, while another study revealed increased cancer-killing effects of radiation therapy if the extracts are integrated during treatment.

LEGAL LANDSCAPE
Scientists continue conducting pre-clinical and clinical trials with marijuana and its extracts to treat symptoms of illnesses such as epilepsy, substance use disorders and mental disorders.
Various countries have various laws on the possession, distribution, cultivation and medical use of marijuana, and where medical use is permitted, how it can be used and for what conditions.
In the US, where more and more states are legalising marijuana, a case in point is the Californian law, which allows a doctor to prescribe marijuana for patients suffering from AIDS, anorexia, arthritis, cancer, migraines, seizures, severe nausea, glaucoma, and chronic pain.
The California Medical Association strongly supports its use in the treatment of neuropathic pain, which is caused by injury to the nerves and can be debilitating. Nevertheless, despite being legalised in some states in the US, marijuana use still remains federally illegal. Uruguay and Canada are the only countries that have fully legalised the consumption and sale of recreational cannabis.
In South Africa, the constitutional court ruled in favour of legalisation of cannabis consumption, but not legal sales. The court said that the right to privacy was violated by prohibiting the possession, purchase, or cultivation of cannabis for personal consumption by an adult in a private dwelling. But there is still a challenge – the law must be repealed to align with the court ruling. A policy of limited enforcement has also been adopted in many other countries.
It is evident that medical use of marijuana and/or its extracts is a reality in a substantial number of countries and is gaining traction.
In Kenya, opinion on the legalisation and use of marijuana has become widespread with views from both sides of the divide. However, any discussion on medical use of marijuana and/or its extracts must aim to have the law align to this requirement. It is high time that sober, well-structured discussions among all stakeholders are held.

Dr Weru is a consultant palliative medicine physician at the Aga Khan University Hospital, Nairobi