Amin A. Muhammad Gadit  ( Department of Psychiatry, Memorial University of Newfoundland, Canada. )

Marijuana is the most commonly abused illicit drug in United States¹ and Canada. A huge number of youths in Pakistan are quite addicted to this drug. It is a dry, shredded green and brown mix of flowers, stems, seeds and leaves derived from the hemp plant cannabis sativa. It is commonly smoked as a cigarette or in a pipe. It can also be mixed in food or brewed as tea. It gives "high" effects by virtue of its action on cannabinoid receptors that are found in brain.¹ There has been an ongoing research on the medicinal properties of marijuana. It has been observed that it contains active ingredients with therapeutic potential for pain relief, nausea control, appetite stimulant and for decreasing ocular pressure. A mouth spray from this compound that has been approved in Canada and parts of Europe is being used for the relief of pain associated with cancer and for neuropathic pain in multiple sclerosis.¹
Though this substance has a potential of widespread abuse, its medicinal properties cannot be ignored in view of wider research. Investigators at the University of California Centre for Medicinal Research had announced the findings of a series of randomized, placebo-controlled clinical trials on the medical utility of inhaled cannabis.²
As a result of research, there are 19 clinical indications of  its medicinal use that include: Alzheimer\\\'s disease, Amyotrophic lateral sclerosis, chronic pain, Diabetes Mellitus, dystonia, fibromyalgia, gastrointestinal disorders, gliomas, hepatitis C, HIV, hypertension, incontinence, Methicillin-resistant staphylococcus aureus (MRSA), multiple sclerosis, osteoporosis, pruritis, Rheumatoid Arthritis, sleep apnoea, Tourette\\\'s syndrome. Despite these indications and research claims, medical use of marijuana had been assessed by several health and governmental organizations in various countries as well as by W.H.O. There is still a belief about the inconclusive nature of these claims and emphasis on additional research.³
Canada does have a programme for medicinal supply of marijuana for selected and identified patients. These patients are required to undergo a constant review and monitoring by a regulated mental health professional. In 2006, the Rhode Island General Assembly enacted legislation that mandated the health department to implement a programme to register qualified patients and their caregivers to allow possession and cultivation of limited amounts of marijuana for personal use for statutorily defined illnesses and debilitating conditions. The subsequent study findings indicated that 309 different practitioners had certified 980 patients was an indication of a level of programme effectiveness meeting patient needs.⁴
A small high quality literature supports the efficacy of medical cannabis for the treatment of neuropathic pain.⁵
In a study,⁶ it was found that 48.8% of adolescents reported ever obtaining marijuana from someone with a medical marijuana license. This gives indication for abuse of marijuana that was easily obtained from someone using it or having a license to get it for medicinal use. It was examined by a group of authors\\\' about the aberrant opioid-related behaviours in patients\\\' prescribed chronic opioid therapy for persistent pain with evidence of misuse.⁷ Another study based on systematic review highlights this issue.⁸
It was suggested that one should refrain from prescribing opioids to individuals using medical cannabis if there is a reasonable suspicion that the combination will pose a risk to the patients or others.⁵
The situation regarding drug abuse in Pakistan is on par with a number of countries in the world. Though reports about its magnitude are periodically published by the government but the true picture about its prevalence is not visible. Marijuana appears to the favourite drug among the youth who first use it for recreation and later become dependant on it. Anecdotal reports indicate that many people abuse this drug to counteract the depressive feelings or for anxiety attacks. People do use it for alleviating chronic pain conditions. However, the medicinal use under supervision is not yet in vogue. In line with some above-mentioned studies, medicinal use may lead to abuse at a greater level than the existing magnitude.
As mentioned earlier, Canada does have a provision of medicinal use of this drug under a defined protocol. Similarly in the United States, as per ruling of the Supreme Court, marijuana remains illegal under federal law and states assume their medical marijuana laws to be constitutional.⁹
On an international arena, a number of illicit drugs are being examined for their medicinal properties and there appears to be a provision where restricted use of such drugs may be allowed for medical reasons. It is however, largely unknown whether Pakistan is working on this issue at this given time or is totally oblivious like for any other healthcare sector of the country.
Would the medical doctors think about its possibility? No wonder, this may open new avenues for research and medical management.

1.NIDA InfoFacts: Marijuana. (Online) (Cited 2011 June 17). Available from URL: http://www.nida.nih.gov/infofacts/marijuana.html.
2.Armentano P. Recent Research on Medical Marijuana. (Online) (Cited 2011 June 17). Available from URL: http://intraspec.ca/medical-marijuana.php.
3.CIHR. Health Canada-CIHR Medical Marijuana Research Program (Archived). (Online) (Cited 2011 June 17). Available from URL: http:// www.cihr-irsc.gc.ca/e/4628.html.
4.Alexandre CR. The Rhode Island Medical Marijuana Program: An Exploratory Study. Policy Polit Nurs Pract 2011 Apr 20 (Epub ahead of print) (Online) (Cited 2011 June 17). Available from URL: http://www.ncbi.nim.nih.gov/pubmed/21511683.
5.Reisfield GM. Medical cannabis and chronic opioid therapy. J Pain Palliat Care Pharmacother 2010; 24: 356-61.
6.Thurstone C, Lieberman SA, Schmiege SJ. Medical marijuana diversion and associated problems in adolescent substance treatment. Drug Alcohol Depend 2011 May 10 (Epub ahead of print) (Online) (Cited 2011 June 17) Available from URL: http://www.Ncbi.nlm.nih.gov/pubmed/21565453.
7.Reisfield GM, Wasan AD, Jamison RN. The prevalence and significance of cannabis use in patients prescribed chronic opioid therapy: a review of the extant literature. Pain Med 2009; 10: 1434-41.
8.Turk DC, Swanson KS, Gatchel RJ. Predicting opioid misuse by chronic pain patients: a systematic review and literature synthesis. Clin J Pain 2008; 24: 497-508.
9.Seamon MJ. The legal status of medical marijuana. Ann Pharmacother 2006; 40: 2211-5.