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Fibromyalgia and Medical Marijuana

What the experts have to say about the use of marijuana for treating fibromyalgia.

The "poor delivery" argument

Robert L. DuPont, MD, is clinical professor of psychiatry at Georgetown University Medical School and president of the Institute for Behavior and Health, a nonprofit dedicated to reducing illegal drug use. He asks, "Is smoked marijuana a reasonable, safe drug delivery system for any medicine for any illness? That's the threshold question. The answer, to me, is transparently 'no.'"

DuPont continues, "If there are any chemicals or any combination of chemicals in smoked marijuana that are ever shown to be valuable for any illness, including fibromyalgia, I'm all for it -- meaning prescribing purified chemicals in a known dose. No doctors prescribe burning leaves to treat any illness."

An estimated 400 chemicals co-exist in marijuana, but marijuana smoke has as many as 2,000 chemicals, says DuPont. "Would you really want to prescribe 2,000 chemicals in a mix where you don't know what it is and call that a medicine?"

DuPont says it's important to test the chemicals in marijuana that might treat fibromyalgia. "If one passes muster as safe and effective, that's great. Science works with purified chemicals in controlled doses."

In fact, the Institute of Medicine's 1999 report called for research into "new delivery mechanisms" for marijuana that don't involve inhaling harmful smoke.

Abrams designed a study that compared smoking cannabis to using it in a vaporizer, a smokeless delivery system. "Once we demonstrated that cannabis was effective in neuropathy patients," he says, "we knew people would say it's not right for patients to smoke a medicine." The study demonstrated that smoking and vaporization yielded pretty similar concentrations of THC in the bloodstream. It also showed there was less expired carbon monoxide -- a marker for toxic or noxious gases -- in the group that was vaporizing." He published the study in The Journal of Clinical Pharmacology and Therapeutics in 2007.

New cannabis drugs

The search for new cannabis-based drugs continues. One preliminary Canadian study made a splash in February 2008, announcing that a new marijuana-based compound -- nabilone -- significantly reduced pain and anxiety for 40 fibromyalgia patients in Manitoba. Nabilone has been used in Canada to treat nausea during chemotherapy.

Marinol is the only cannabinoid currently approved for use in the U.S. It's expensive -- about $4,000 a year -- and only an estimated 10% to 20% of the THC gets into the bloodstream after metabolism.


The hurdles of research

Researching the medical value of marijuana is not for the faint of heart. Getting funding, federal approvals, and results published -- not to mention the drug itself, which only is available from the National Institute on Drug Abuse -- are all uphill battles.

When he conducts a study, Abrams takes extra steps to ensure safety since marijuana is a controlled substance. He hospitalizes his patients, without visitors, for the duration of the research study. Even so, he says, "It's still not easy to enroll patients in medical marijuana studies. And that makes it difficult to accumulate data."

Reviewed on May 16, 2008
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