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Editors Selection IGR 9-4

Medical treatment: Marijuana

Comment by Paul Palmberg on:

17439 Medical marijuana and the developing role of the pharmacist, Seamon MJ; Fass JA; Maniscalco-Feichtl M et al., American Journal of Health-System Pharmacy, 2007; 64: 1037-1044

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Seamon et al. (723) of the Pharmacy School of Nova Southeastern University, review the current legal and medical aspects of the medical uses of marijuana from the standpoint of pharmacists. Since absorbed cannabinoids are tightly bound to plasma proteins and metabolized by hepatic mixed function oxidases, they can interfere with the transport and metabolism of other drugs.

The medical use of marijuana is currently in a legal limbo in the United States. On one hand, only the Drug Enforcement Agency (DEA) of the Federal Government can issue special licenses to physicians to authorize the use of controlled substances. Marijuana is classified as a Schedule I drug, (no accepted medical use) and is only available for research under a special license. On the other hand, each state issues the license to practice medicine and has its own drug laws and prosecutes offenders. In the eleven states that have laws allowing medical use of marijuana unofficial pharmacies supply the drug to patients who bring a note from their doctor. Federal agents may well show up and seize the supply, but local officials usually refuse to prosecute the proprietors. The Federal Supreme Court rejected a suit to limit Federal interference.

Marijuana lowers IOP for only 2-3 hours, making it highly impractical in most patients, and furthermore in the majority of patients the IOP lowering effect is lost with continued dosing

A National Institutes of Health workshop on the medical utility of marijuana in 1999 recommended resumed study of marijuana in the treatment of the nausea of cancer chemotherapy, AIDS wasting, neuropathic pain, spasticity in multiple sclerosis, and glaucoma (www.nih.gov/news/medmarijuana.htm) and some new studies were approved. The marijuana for these research studies isgrown at the University of Mississippi and supplied by the National Institute on Drug Abuse under FDA and DEA control.

Toris et al. reported that in our patient (in a Federal program since 1988) marijuana increased uveo-scleral outflow twice as much as a prostaglandin analog would be expected to do. Marijuana cigarettes reduce her IOP about 50%, and have done so for nearly 30 years (requiring ten cigarettes per day). However,marijuana lowers IOP for only two to three hours, making it highly impractical in most patients, and furthermore in the majority of patients the IOP lowering effect is lost with continued dosing. A longer-lasting derivative is needed.

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