Cannabis adversaries
While the consumption of tobacco and alcoholic beverages continues to be legal way to increase the national tax revenue of many governments worldwide, the use of cannabis products in the US and other countries is mostly illegal, but continues to cause controversies. According to an article in the Harm Reduction Journal an estimated $4 billion is spent in the US on the arrest, prosecution and incarceration of marijuana offenders each year. Marijuana arrests now constitute nearly half (45%) of the 1.5 million drug arrests in the US annually.
Proponents for the legalization of cannabis have been claiming its harmlessness for years. They have only recently been joined by pain physicians who see a great protential of cannabis receptor agonists to relieve severe, otherwise intractable pain. Cannabis receptors have been found in many tissues, and anandamide (Figure 1), a well-known physiologic agonist (a chemical that triggers the receptor in the body), has attracted interest of biochemists and physiologists alike. Currently suggested medical uses of cannabis are (1) AIDS (reduces nausea, vomiting, waste syndrome), (2) Cancer (alleviates nausea, vomiting from antineoplastic chemotherapy), (3) Glaucoma (reduces intraocular pressure), (4) Multiple Sclerosis (decreases muscle pain and spasticity), (5) pain (alleviates chronic pain that may be intractable otherwise).
Figure 1: The chemical structure of the physiological CB-receptor agonist anandamide
Opponents continue to argue that Cannabis (1) produces dependence after chronic abuse, (2) acts as a gateway drug, and (3) is associated with a higher incidence of psychosis than non-cannabis users. Other concerns include (5) decreased intellectual performance, (6) a higher risk for heart attacks, (7) the promotion of tumor growth and (8) the impairment of anti-tumor defenses by marijuana ingredients. The risk for cannabis dependence (around 10%) is lower than that for other social drugs (alcohol, nicotine), but withdrawal symptoms have been reported by 80% of the male and 60% of the female abusers seeking expert help to stop cannabis consumption. Regular users of cannabis are more likely to eventually switch to heroin, cocaine and other psychotropic drugs than are other people, although other reasons like special social environments may contribute to this observation. The risk of experiencing psychotic symptoms is increased in adoslescents who use cannabis products more often than weekly. Recent headlines indicating an adverse effect of marijuana on sperm motility may again move the scales.
In spite of these controversies a large body of experimental and clinical data has established a role for cannabis drugs in the treatment of several disorders, and at least three different presecription drugs with marijuana ingredients (Figure 2) are available in many countries of the world, including the US. While several countries like Germany and Switzerland require special prescription forms, a doctor in the US may phone in the presecription. In the Netherlands there is even less control over cannabis use in the general population because the Dutch government has made a distinction between hard (opiates, cocaine, ecstasy) and soft drugs (psilocybin mushrooms, marijuana), allowing the sale of the latter for explicit personal use in public "Coffee Shops".
 
Figure 2: Chemical structures of three synthetic medical cannabinoid drugs
Recently experts of the US Food and Drug Administration (FDA) puzzled physicians worldwide by declaring that "no sound scientific studies" support the medical use of marijuana. Experts at the Medscape Forum spoke out what others thought, namely that once again "Politics Trumps Science at the FDA". I foresee that this turn may be shortlived because too many scientists know better and too many organisations successfully support the research on medical uses of cannabis - even in the US. For many seriously ill patients, however, this official move may be detrimental because it may also impede the prudent use of cannabis drugs that has been advocated by pain physicians for many years.
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