The mighty Leaf that gives relief

By Margaret McCartney

Published: January 16 2010 00:04 | Last updated: January 16 2010 00:04

Cannabis and the law have a clear relationship; to take the former is to break the latter. For years, pressure has been mounting on the government to change this position. And not just for recreational reasons, but medical ones too. It is often claimed, for example, that cannabis improves the lives of multiple sclerosis sufferers.

A recent systematic review of the evidence in BMC Neurology found that cannabis did help alleviate spasticity, the uncomfortable cramp that can become constant in MS, making affected limbs hard to use. But while patients reported an improvement following treatment, objective measurements did not show any significant change.

Spasticity may not be affected by cannabis; the drug may instead be treating muscle tension and discomfort. That doesn’t mean cannabis is not useful. Indeed, another review published last year in Pain Medicine found that “cannabis treatment is moderately efficacious for the treatment of chronic pain”. But it also noted that “beneficial effects may be partially (or completely) offset by potentially serious harms”.

We can hardly boast that the legitimate medicine cabinet is untainted by side-effect-free drugs. In cannabis, the most obvious side-effect is sluggishness – more commonly known as being “stoned”. This is a real problem, but it may possibly be no worse than the sedation delivered by strong analgesics  that may be prescribed or administered.

There are more worrying risks with cannabis, notably psychosis. A review in the Lancet in 2007 suggested there was a dose-related risk – the more cannabis, the greater the danger. Some studies have also indicated the risk is highest for young people, and those with a personal or family history of psychosis. So how many people are likely to be affected? A paper in Addiction last year found that the number of men who would have to stop heavy use of cannabis to prevent one case of psychosis would approach 2,800 in the 20-24 age group and 4,700 among those aged 35-39.

For many doctors and potential patients, addiction is an even bigger concern. Should it become available on prescription, cannabis would join other legitimate drugs which have dependence as a potential harm – from diazepam to morphine. The truth is that cannabis may well end up being just as useful as any of these drugs and, just like them, require careful prescription and informed consent.

Margaret McCartney is a GP in Glasgow.

Sourced & published by Henry Sapiecha

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