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
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
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
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
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
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."