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UK: A new leaf of life?
Dr Thomas Stuttaford The Times
Monday 08 Mar 2004 Cannabis has a wider medicinal role than was previously thought SOME OF William Wordsworth's friends were not averse to various drugs, and even Queen Victoria took cannabis to ease her period pains. Coleridge's search for inspiration was fuelled by laudanum, so that in time his poetry did not receive the plaudits it earned from his contemporaries. Wordsworth, better known for his addiction to daffodils, would have found plenty nodding away at Kew, where a symposium was recently held on cannabis in medicine. On returning from Kew I looked up my notes on cannabis from my early days in medicine. Then, I was recommended to prescribe it to allay coughs, especially the dry cough of tracheitis or carcinoma of the lung, and to alleviate certain forms of pain. In some cases we believed that it was to be preferred to morphia and other opiates, as it did not give rise to constipation or headache. We were warned that it could be an aphrodisiac as it removed inhibitions, but that the other "pleasurable symptoms" it induced were an advantage, especially if the patient had a terminal illness. The drug has been used medicinally for 2,000 years, but in the second half of the last century it was replaced by better analgesics and fell into disuse. Furthermore, the non-medical use of it had, and still has, dangerous disadvantages for those who carry the wrong genes. Dr William Notcutt, a consultant anaesthetist at the James Paget Hospital, Great Yarmouth, and a lecturer at the University of East Anglia, is a specialist in pain relief and has a particular interest in cannabis. Although he comes from a distinguished family of nurserymen and botanists - his grandfather grew hemp for the rope industry - his interest was fired by his work at the University of the West Indies in Kingston, Jamaica. Dr Notcutt and the other lecturers on cannabis focused on its use for the relief of pain. Although the standard, but small, trials did not provide convincing evidence that it was necessarily to be preferred when the pain stemmed from a spasticity of muscles - as, for instance, in multiple sclerosis - the opinion of patients in larger but equally strict trials was overwhelmingly in favour of its use. Other conditions giving rise to spasticity, including paraplegia from spinal cord injuries, cerebral palsy and strokes, together with joint pains from rheumatoid arthritis, were eased by cannabis, and patients preferred it to other drugs. When used medicinally, cannabis is not smoked. One of the problems in the past when using cannabis tincture was that its absorption was variable, and it has to be taken at least an hour before food. Experimental work is trying to find other methods of ensuring rapid absorption: these include sublingual sprays. Dr Mohammed Sharief, a senior lecturer and consultant neurologist at Guy's and St Thomas's, told the symposium that he had found it a useful drug to relieve pain as it had not only analgesic properties but was an effective muscle relaxant, reduced nausea and stimulated appetite. As more than 75 per cent of patients with long-term cancer need pain relief, any drug that helps in this respect without causing nausea and diminishing appetite has a place in modern pharmacy. Cannabis can be taken with opiates, and in my day there was a mixture of alcohol, morphia and cannabis to control terminal pain. The misuse of cannabis and its non-therapeutic actions was dealt with by Dr Dawn Langdon, a senior lecturer in clinical psychology at the University of London. She assured the audience that when cannabis was used therapeutically, its side-effects, such as might be found in heavy smokers, were neither common nor unpleasant. However, using it medicinally was quite different from recreational use, when it had dangers for the genetically vulnerable: those with intelligent but amiably bizarre personalities could easily be tipped over to a psychotic state. Dr Langdon gave an interesting statistic that these people were most likely to be drawn to it from their first smoke, and later become addicted.
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