- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Cannabis Position Paper 2013
As presented by the South African National Cannabis Wor in! Group to the Central "ru! Authority at the "epart#ent of Social "e$elop#ent

20 November 2013
Andr% du Plessis &#i'l (isser Al)yn S#it

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A$ST%ACT
/he Cannabis Position Paper 2013 contains nu#erous ;uotes and references to peer-re$ie)ed case studies detailin! historical and #odern accounts of cannabis pre$alence )ithin Southern Africa4 /he participation of ci$il society is an i#portant part of the National "ru! <aster Plan=s i#ple#entation and conse;uently there is a need for an inclusi$e body to deal )ith public policy #atters surroundin! cannabis4

/his publication atte#pts to su##arise current scientific literature about the dyna#ics of cannabis )hile pro$idin! a platfor# for an inte!rated approach that assists the Central "ru! Authority in carryin! out their #andate4 /his docu#ent )ill facilitate in creatin! an e$idence-based public discussion for all interested and affected parties4

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&'( T' )S* T&+S ,'C)-*NT
/his docu#ent can be used as a reference !uide to conte>tual prohibiti$e #easures throu!hout the South African history )ith references that include the latest peer re$ie)ed science on cannabis4 /he table of contents is hyper-lin ed for easier na$i!ation and there is a return lin in the footer of each pa!e called9 ?/A012 3+ C3N/2N/S? You are free to9 Share @ to copy7 distribute and trans#it the )or 7 to Ae#i> @ to adapt the )or 7 to #a e co##ercial use of the )or as lon! as you attribute the )or in the #anner specified by the author or licensor Bbut not in any )ay that su!!ests that they endorse you or your use of the )or C4

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TA$"* '! C'NT*NTS
Click on the headings to na)igate between sections A0S/AAC/ E3W /3 8S2 /E&S "3C8<2N/ /A012 3+ C3N/2N/S 2H2C8/&(2 S8<<AA6 1&S/ 3+ /A012S 1&S/ 3+ +&G8A2S PA2+AC2 E&S/3A6 , "2+&N&/&3N 3+ CANNA0&S Cannabis /a>ono#y Practical anato#y of cannabis /he Cannabis "ichoto#y - Correctin! the JAu#or= About Ee#p 8ltra$iolet Aadiation Cannabis /rials &n South Africa /herapeutic benefits of cannabis <2"&CA1 CANNA0&S <edicinal Eistory /he 2ndocannabinoid Syste# Cannabinoids <edical Cannabis /able of Contents /E2 E&S/3A6 3+ CANNA0&S PA3E&0&/&3N Settin! the tone for debate /he Wra!! Aeport /he Custo#s and "uties A#end#ent Act 3F of 1L22 Co##ittee on the Abuse of "a!!a Aole of cannabis in the Apartheid re!i#e South Africa=s role in international prohibition /E2 C3S/ 3+ /E2 PA3E&0&/&3N Processin! of dru!-related offences /he failure of the )ar on dru!s on its o)n ter#s 2n$iron#ental i#pact of cannabis prohibition SA"C : 8N PA3/3C31 &N/2A(2N/&3N SA"C : 8N Eistorical dru! traffic in! related accounts 8ndisclosed cannabis pro$isions )ithin the treaties 3P/&3NS +3A A2+3A< Aefor#s throu!h ne) international con$entions Possibilities for a country actin! alone "enunciation and re-accession )ith reser$ations /he Supra-national basis possibilitie "enunciation of the treaties and replace#ent )ith alternati$es Adoptin! ne) alternati$e treaties A ne) sin!le con$ention &#portant ey principles )hen draftin! a ne) Sin!le Con$ention /E2 CEANG&NG &N/2ANA/&3NA1 1AN"SCAP2 /&<21&N2 +3A A2+3A< D F G 10 1D 1F 1G 1I 22 2F 2G 2K 3F 3L D1 D2 DD DF DG DK DL F0 F1 F2 F3 FD FG FI FK GD GD GF GK I0 I1 I2 I2 I3 I3 I3 ID IF IG IG IK

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Global "ru! Policy Chan!e a rapidly chan!in! landscape Ae!ulation and control 2HA<P12S 3+ CANNA0&S A2G81A/&3N /he Netherlands Canada7 Ger#any7 &srael Cannabis decri#inalisation and its i#pact on use 2urope Australia Great 0ritain "ecri#inalisation in the 8nited States <edical Cannabis 8SA 1o)est la) enforce#ent priority B112PC : de-prioritisation Spanish Cannabis Clubs North Morea 2>istin! Possibilities With the Current 8N /reaties EAA< A2"8C/&3N SA+2 ACC2SS A costNbenefit analysis of cannabis S38/E A+A&CAN S8PP3A/ +3A A2+3A< C3NC18S&3N A038/ /E2 A8/E3AS ANN2H8A2 1 - &ndustrial Cannabis ANN2H8A2 2 - /herapeutic benefits of cannabis <2"&CA1 CANNA0&S <edicinal Eistory /he 2ndocannabinoid Syste# Cannabinoids Eistory of cannabinoid research /ypes of Cannabinoids /ypes of Cannabinoids /erpenoid 2ssential 3il Co#ponents of Cannabis +la$onoid and Phytosterol Co#ponents of Cannabis Cannabinoid Aeceptors Cannabinoid receptor type 1 Cannabinoid receptor type 2 Cannabis 2>tracts and Synthetic Cannabinoids Natural7 synthetic phar#aceutical cannabinoid e>tracts Nabilone BCesa#etC "ronabinol B<arinolC Nabi>i#ols BSati$e>C 2ffects of Cannabinoids Clinical 2ndocannabinoid "eficiency &0S and the lin bet)een the brain and !ut Cannabinoid receptors in the enteric ner$ous syste# 8nderlyin! condition Pro#otion of Eo#eostasis CANNA0&S AS A PA2(2N/A/&(2 <2AS8A2 Neurode!eneration and Protection

IL K1 K3 KD KF KG KG KI KI KI KK KK KL KL L0 L1 L2 L3 LD LF LI LK 110 111 112 11D 11F 11G 11I 11K 121 123 12D 12D 12D 12F 12G 12G 12G 12G 12K 12L 131 132 133 13D 13F 13I

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Cannabis Patents South African Cannabis Aelated Ae!istered Patents Cannabis and <edical Conditions 14 Al5hei#erʹs "isease 24 A#yotrophic 1ateral Sclerosis BA1SC 34 Chronic Pain D4 Charcot-<arie-/ooth disease BC</C Eereditary <otor and Sensory Neuropathy BE<SNC F4 "iabetes <ellitus G4 "ystonia I4 +ibro#yal!ia K4 &ncontinence L4 Gastrointestinal "isorders 104 Cancer a4 Glio#as b4 0reast Cancer c4 1un! Cancer d4 Prostate Cancer e4 0lood Cancer f4 3ral Cancer h4 1i$er Cancer i4 Pancreatic Cancer 114 Eepatitis C 124 Eu#an &##unodeficiency (irus BE&(C /he 2>perience of "octors Wor in! With A&"S:E&( Patients 1D4 Eypertension 1F4 <ethicillinNresistant Staphylococcus aureus B<ASAC 1G4 <ultiple Sclerosis 1I4 3steoporosis 1K4 Phanto# li#b syndro#e 1L4 Pruritus 204 Aheu#atoid Arthritis 214 Sleep Apnea 224 /ouretteʹs Syndro#e 3ncolo!y and Palliati$e Care 3pioids $ersus Cannabinoids "eli$ery #ethods S#o in! and Pul#onary function Safety and Side 2ffects of Cannabis Ear# Scale <edical ethics in South Africa 0ase principles of the #edical practice G13SSAA6 "2/A&12" A2+2A2NC2 1&S/ 3ther Eealth 3r!ani5ations Eealth 3r!ani5ations Supportin! 1e!al Access to <edical Cannabis

13K 1D2 1D3 1DD 1DG 1DI 1F0 1F0 1F1 1F3 1FF 1FI 1FK 1G1 1G1 1GF 1GG 1GI 1GK 1GL 1GL 1I0 1I1 1I2 1IF 1IL 1K0 1K1 1K3 1KD 1KD 1KG 1KK 1KL 1L1 1L3 1LD 1LF 1LI 201 202 20D 20F 20I 20L 210

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- San.ay Gupta -

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OSo WhatQP
- /elen Su0"an -

RSo#eone has to be the first444R
- 1os2 3u.ica! 4resident of 5ruguay -

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O4444in )or in! )ith the hearts of people7 and not loc in! the# up 444 )e should treat cannabis the )ay )e treat be$era!e alcohol7P
- 3r. 4at #obertson! 6he +77 Club -

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*.*C)T+/* S)--A%Y
/his docu#ent in$esti!ates a P2S/211 $iability of re!ulatin! cannabis in accordance )ith the spirit and purport of the +inal Constitution of the Aepublic of South Africa4

0oth sides of the debate share #any uni$ersal !oals9 S S 3itigating the negati)e effects of illicit drugs. 9uilding a safer society by co"bating cri"e that results fro" the illegal drug trade. 4rotecting the youth of South Africa! as well as other )ulnerable groups. 4ro"oting access to ade:uate health ser)ices. #educing the caseload of the cri"inal .ustice syste". 4rotecting all hu"an rights that are enshrined in the Constitution! with specific regard gi)en to principles of e:uality An e)idence-based approach to create effecti)e drug policy that pro"otes transparency and accountability.

/he cannabis plant is used for industrial applications7 inter alia! nutrition7 fibre7 rope and construction4 Co##ercial trials in South Africa in lo) /EC cannabis7 also no)n as he#p7 ha$e been a failure4 /he ;uestion of )hether he#p can be !ro)n in a sustainable #anner in South Africa is resol$ed in this docu#ent4 /he international prohibition of cannabis )as insti!ated and enforced by the racially se!re!ated and ruled South Africa in 1L1D7 ho)e$er its )idespread bannin! occurred )ith the Custo#s and 2>cise "uries A#end#ent Act of 1L234 Prior to this act $arious controls had been ai#ed at the &ndian and 0lac population=s consu#ption of cannabis4 /he prohibition of cannabis in South Africa has been a failure )hen #easured a!ainst the results achie$ed4 &n spite of the lon!standin! and concerted efforts by the South African police7 cannabis production and its use has flourished4 Statistically7 e$ery year #ore cannabis has been !ro)n and consu#ed than the year before4 While &lle!al dru! #ar ets are not confined by !eo!raphical boundaries7 localised successes should not be allo)ed to dis!uise the lar!er scale syste#atic failure to control !lobal production4

S S S S

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Cannabis is a plant7 the flo)ers of )hich are consu#ed as a dru!7 usually by s#o in! it4 /he health ris s of consu#in! cannabis are relati$ely #inor and are understood4 No one has e$er died fro# the consu#ption of cannabis4 /he #edical use of cannabis throu!h the a!es has used the effects of cannabis therapeutically4

1

4olitical! <cono"ical! Social! 6echnology! =aw

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/he costs of the prohibition are econo#ic7 social and en$iron#ental4 /he prohibition of cannabis has consu#ed an e$er lar!er slice of the ti#e and funds of the Tustice depart#ent and the police4 /he prohibition and the subse;uent unre!ulated nature of the cannabis #ar et has had ne!ati$e conse;uences4 /he enforce#ent of the prohibition of cannabis has yielded thousands of arrests and con$ictions4 Neither the arrests7 nor the con$ictions7 ha$e had a #easurable i#pact on the illicit cannabis #ar et4 /he con$ictions and associated cri#inal records ha$e a lastin! i#pact on con$icted indi$iduals4 /he hi!h nu#ber of arrests is e$idence of the inefficacy of prohibition7 the hi!h priority accorded to non-$iolent dru! possession cases and the police e>ploitin! soft easy arrest tar!ets4 /he cri#inalisation of )hat is a #edical proble# further#ore inhibits and co#plicates efforts of people see in! help4 Considerin! the relati$ely safe nature of cannabis its prohibition fails to fulfill the procedural re;uire#ent of the rule of la)7 na#ely an obTecti$ely rational lin bet)een policy !oals and effects4

(iolence acco#panyin! turf )ars for control of !an! areas is a result of the #ar et in dru!s bein! uncontrolled4 Cannabis does not cause cri#e or $iolence7 rather it is the prohibition of cannabis )hich causes cri#e and $iolence4 "ue to cannabis bein! associated )ith frin!e cultures7 the police routinely profile and search citi5ens in public locations7 often basin! their decisions to search on an indi$idual=s appearance and are not li#ited to Aastafarian colours e>pressed throu!h clothin!7 head !ear or the display of dreadloc s4 /hese suspicions are often subTecti$ely Tustified7 )hich raises #any issues concernin! social Tustice and e;uality before the la)4 Police are incenti$ised throu!h tar!et arrest nu#bers to see the con$iction of cannabis users7 rather than try to obtain #ore difficult con$ictions7 such as rape4 /his easy Jcri#inal= has also seen non-cannabis usin! tourists bein! tar!eted based solely on their appearance4 &t is a !rie$ous personal $iolation for anyone to be continually persecuted by the SAPS because of their choice in clothin! or hairstyle4

/he initial racial underpinnin! of cannabis prohibition has #anifested itself in a continued #ar!inalisation7 subTu!ation and oppression of the !eneral population4 /he end of apartheid <any youn! people ha$e found the#sel$es !a$e )ay to a broader and #ore co#ple> fallin! $icti# to prohibition of cannabis4 Cannabis ?econo#ic apartheid?4 /he unasha#ed prohibition does not pre$ent cannabis fro# bein! continuation of prohibition in the ?ne)? South sold to #inors and has brou!ht #any into contact Africa has resulted in further and on!oin! )ith cri#inals and the Tustice syste#4 discri#ination and persecution of South Africans of all races4

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8ncontrolled and unre!ulated dru! #ar ets pro$ide or!anised cri#e )ith non-;uantifiable econo#ic returns4 /he possibility e>ists to effecti$ely control the illicit trade of cannabis )ithin a le!ally #andated and re!ulated syste#4 /his points to recent international de$elop#ent loo in! into alternati$es for the outri!ht ban of cannabis4 /he so$erei!n states that ha$e altered their stance to)ard cannabis ha$e had #easured success in reducin! both consu#ption of cannabis and the cri#inality associated )ith the illicit blac #ar et4 South Africa continues perilously to i!nore the hard-)on lessons learned by these countries4

/he opportunities created for or!anised cri#e lead to corruption locally and internationally4 &t is practically co##on no)led!e that South Africa faces particular proble#s )ith corruption in both public and pri$ate sectors4 &n the public sector this leads to increased bribery7 theft and !enerally unco#petiti$e beha$iour4 /his is )ell e$idenced in on!oin! research concernin! the industrial applications of cannabis4 /his docu#ent e>a#ines the 84N4 &nternational "ru! /reaties? le!al fra#e)or in conTunction )ith )ell docu#ented cases of states circu#$entin! those treaties4

/he #aTority of cannabis consu#ers are la) abidin! citi5ens4 <any are responsible Ei!h le$el corruption steerin! research into the indi$iduals )ho )or hard7 raise fa#ilies7 cannabis plant=s a!rono#ic applications in South contribute to their co##unities7 and aspire for a Africa ha$e resulted in a 13 year failure7 )ith not safe and secure en$iron#ent4 /hey are not part a sin!le crop or report to sho) for the #illions of of any cri#e proble#4 Classifyin! the# as rands reportedly in$ested4 +ailures in Cannabis cri#inals results in social sti!#atisation4 research in South Africa ha$e left the country years behind our 0A&CS partners in ter#s of co#petiti$e !lobal industry4

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&n order to turn debates fro# ad$ersarial battles to constructi$e en!a!e#ents7 we ask:

J)hat are the ai#s of policy that )e can all a!ree on7 and )hat should our !uidin! principles beQ=
2stablishin! a consensus on shared ai#s and principles fro# the outset can defuse unnecessary conflict by appealin! to the shared concerns of all participants7 and create so#e breathin! roo# in )hich a #ore #eanin!ful discussion can ta e place4

>?t is accepted that when drug policies target specific proble"s and populations and are infor"ed by sound scientific e)idence! they can alter the course of drug use and e)en drug epide"ics.>2 @#elati)ely few ad)erse clinical effects fro" the chronic use of AcannabisB ha)e been docu"ented in hu"ans. /owe)er! the cri"inalisation of AcannabisB use "ay itself be a health ha0ard! since it "ay e$pose the users to )iolence and cri"inal acti)ity.C3 @6he war on drugs has failedD /u"ans ha)e always taken psychoacti)e substances and prohibition has ne)er kept the" fro" doing so. 6he international e)idence suggests that drug policy has )ery li"ited i"pact on the o)erall le)el of drug use. 3aking people cri"inals for taking psychoacti)e substances is in itself cri"inal! for one is dealing with! at worst! a )ice but not a cri"e.CD

2 3

Central "ru! Authority7 National "ru! <aster Plan 2013-201I7 p 13I4 S Sidney7 U 2 0ec 7 & S /e a)a7 C P Vuesenberry7 G " +ried#an7 O<ariTuana 8se and <ortalityP A# U Public Eealth4 1LLI AprilW KIBDC9 FKFXFL04 P<C&"9 P<C13K0K3I D UP de ( $an Nie er 7 /i#e to decri#inalise dru!sQ7 SA<U7 (ol4 1017 No4 27 Pa!e 27 +ebruary 20114

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"+ST '! TA$"*S
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14 24 34 D4 F4 G4 I4 K4 L4 104 114 124

"escription
Global Policy Chan!e Eistory of Cannabinoid Aesearch /ypes of Cannabinoids /erpenoid 2ssential 3il Co#ponents of Cannabis +la$onoid and Phytosterol Co#ponents of Cannabis Cannabinoid Aeceptors 2ffects of cannabinoidsF South African Cannabis Aelated Ae!istered Patents &nternational and 8nited States 3r!ani5ations in Support Additional A&"S 3r!ani5ations in Support 3ther Eealth 3r!ani5ations Eealth 3r!ani5ations Supportin! 1e!al Access to <edical Cannabis

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/rends in Phar#acolo!ical Science7 (olu#e 307 &ssue 107 3ctober 200L7 PF1F-F2I

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"+ST '! !+0)%*S
+i!ure
14 24 34 D4 F4 G4 I4 K4 L4 104 11 124 134 1D4 1F4 1G4 1K4 1L4 20 214 224 234 2D4

"escription
Ee#p - Annual 8( - Cannabis heritage o)erlayG Cape /i#es "a!!a ad$ert 1KLG Cannabis Sati$a 14 2rythe#al 8( &nde> 2urope 31 3ct 2013I 2rythe#al 8( &nde> World 30 3ct 2013 2rythe#al 8( &nde> 30 3ct 20138 Ee#p - Annual 8( - Cannabis heritage o)erlay10 A$era!e annual !round solar ener!y B1LK3-200FC Cannabis and <edical Conditions X N3A<14or! SAPS Police 3fficer 0ad!e Na#e Controllin! the 8ncontrollable /he AAC conducted research breedin! of Genetic SA Ee#p1 Austenbur! 2002 /he AAC conducted research breedin! of Genetic SA Ee#p1 Austenbur! 2002 /he AAC conducted research breedin! of Genetic SA Ee#p1 Austenbur! 2002 /he AAC conducted research breedin! of Genetic SA Ee#p1 Austenbur! 2002 "i$erse &nternational Eoldin!s AAC trials - 0athurst P2 2003:200D Panora#ic "i$erse &nternational Eoldin!s AAC trials - 0athurst P2 2003:200D 2lsenbur! AAC /rails Western Cape 200F All #aterials collected fro# he#p trials CS&A Port 2li5abeth 3ct 2010 All "aterials collected fro" he"p trials at CS?# 4ort <li0abeth Ect %717 Co##ercial he#p fiber trials destroyed )ith feed cutter 2013 Eouse of Ee#p and Ee#poriu#4 Cancer Aeality Chec
11 ,

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Ear# Scale - A su""ary of the results fro" 4rofessor Fa)id NuttGs %717 paper in 6he =ancet

< Albuisson7 < 1efY$re7 l Wald7 / Aanchin7 OA$era!ed Solar Aadiation 1LL0-200DP7 Centre for 2ner!y and Processes7 2cole des <ines de Paris : Ar#ines : CNAS7 200G4 I /2<&S 8( inde> forecast and archi$es K /2<&S 8( inde> forecast and archi$es L N3AA Center for Weather and Cli#ate Prediction 10 < Albuisson7 < 1efY$re7 l Wald7 / Aanchin7 OA$era!ed Solar Aadiation 1LL0-200DP7 Centre for 2ner!y and Processes7 2cole des <ines de Paris : Ar#ines : CNAS7 200G4 11 CANSA - South African Cancer Statistics
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P%*!AC*
/his docu#ent has been created on a $oluntary basis for public use7 is not subTect to copyri!ht and none of the authors ha$e any financial ties4 Care has been ta en to reference the contents of this docu#ent412 /he purpose of the 2013 South Afri an Cannabis Position Paper is to sti#ulate serious public discussion on re$ie)in! and refor#in! current policy4

6he Authors

South African National Cannabis Wor in! Group

12

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&+ST'%Y 1 ,*!+N+T+'N '! CANNA$+S
/o understand the history of cannabis one has to loo at the tra$els throu!h hu#an history and ho) the plant #i!rated adaptin! o$er ti#e to its !eophysical location4 2ty#olo!y traces this path and !i$es a clear picture as to the e$olution of the definition of he#p and cannabis respecti$ely4

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/he Eistory of Cannabis in South Africa

Higure 113 - Ee#p - Annual 8( - Cannabis heritage o)erlay

&t can be obser$ed fro# the na#es abo$e that he#p is lar!ely 2uropean and the rest of the )orld ept referrin! to cannabis4 &t is durin! the da)n of colonial e>pansion that the northern understandin! of the Ohe#pP )as i#pressed on the cannabis !enus4 Centuries of trade is the cause of the di$er!ence in the !enetics of cannabis7 as cannabis phenotypes de$eloped differently dependin! on en$iron#ental effects and !eophysical location4 /he first three hundred years of cannabis use and trade in Africa can be !leaned fro# the early e>plorers to Africa and early colonists trade and ad$ertisin!4

13

< Albuisson7 < 1efY$re7 l Wald7 / Aanchin7 OA$era!ed Solar Aadiation 1LL0-200DP7 Centre for 2ner!y and Processes7 2cole des <ines de Paris : Ar#ines : CNAS7 200G4

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A "o#inican priest7 Uoao dos Santos said in 1G0L that the plant )as culti$ated throu!hout Mafaria Bnear the Cape of Good EopeC and )as called Jban!ue=4 O/he Maffir )ere in the habit of eatin! its lea$es7 and those that used it to e>cess7 he said7 beca#e into>icated as if they had drun a lar!e ;uantity of )ine4P 1D

Since the slicin! up of Africa at the 0erlin Conference7 early colonists in the Scra#ble for Africa had #uch to say about the use of cannabis by African nati$es the continent )ide4

"a$id 1i$in!stone B1KGFC and the botanist Earry Uohnstone B1KLIC )ho helped for# the Cape to Cairo (ision7 noted they had obser$ed in the re!ion of the present <ala)i7 cannabis bein! planted and s#o ed41F 0oth 1i$in!stone and Uohnstone !i$e detailed if not so#e)hat colonial descriptions of the use of cannabis in Africa4

&n South Africa7 there are to)ns and areas established )ith a historical lin to the ter# da!!a7 for e>a#ple "a!!afontein71G a "a!!a /hree Sisters hi in! /rail7 1I /he "a!!a 0oere +ar# Stall7 1K "a!!a raal71L "a!!aboers Ne and the "a!!a Aand +ar#420

1D 1F

Scaffer 1ibrary of "ru! Abuse7 <ariuana - /he first /)el$e /housand 6ears7 "u /oit 04<47 OEistorical and Cultural +actors &nfluencin! Cannabis 8se A#on! &ndians in South AfricaP7 Uournal of Psychedelic "ru!s L B1LIIC9 23F-DG 1G "a!!afontein7 Gauten!4 1I "a!!a /hree Sisters /rail * Ceder$ille Scenic * 101 /rail Guise 1K "a!!a boer far# stall7 Cradoc 4 1L Wi ipedia - "a!!a raal 20 http9::5a4!eo$ie)4info:da!!aZrand710121DG

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Higure % - Fagga Ad)ert! Cape 6i"es 1an 1,8*

Sir Eenry 0ul)ar Go$ernor and Co##ander in chief in and o$er the colony of Natal (ice Ad#iral of the sa#e and Supre#e Chief o$er the Nati$e population7 co##issioned the )ritin! of the &ndian &##i!rants Co##ission report no)n as the Wra!! report of 1KKF )hich had #uch to say about "a ah4

1eander Starr Ua#eson )as the 10th Pri#e <inister of the 0ritish Cape Colony )hen this ad$ert )as printed in the Cape Ar!us7 2 Uanuary 1KLG4

"r +rances A#es published an e>tensi$e study in a <edical report in 1LFK into the effects of the cannabis sati$a on hu#ans4 &t )as conducted by her research tea# at Groote Schuur Eospital in Cape /o)n4 Eer findin!s )ere published in the South African Uournal of <ental Science in 3ctober 1LFK421

&n 2001 the South African Uournal of Science publishes a hypothesis that Sha espeare had used cannabis as inspiration based on traces of cannabis found in pipes du! up fro# his ho#e at Stratford upon A$on422 1ater in 2011 an article )as published in the +eb edition of South African <edical Uournal BSA<UC4 /he article7 )ritten by UP de ( $an Nie er 7 editor of SA<U and for#er "ean of the 8C/ faculty of Eealth Sciences7 broadly co$ers the failed )ar on dru!s and ho) South Africa needs to rethin its dru! policies423

21 22

A Clinical and <etabolic Study of Acute &nto>ication )ith Cannabis Sati$a 1LFK 0ard ?used dru!s for inspiration? * 00C Ne)s * 1 <ar 20014 23 UP de ( $an Nie er 7 /i#e to decri#inalise dru!sQ7 SA<U7 (ol4 1017 No4 27 Pa!e 27 +ebruary 20114

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Higure & I Cannabis Sati)a =.

Cannabis /a>ono#y
Min!do# X 4lantae Phylu# X 3agnoliophyta Class X 3agnoliopsidia 3rder X #osales +a#ily X Cannabaceae Genus X Cannabis

2D

2D

W4 <[ller

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Cannabis /a>ono#y
/a>ono#ically the !enera Cannabis and Eu#ulus BhopsC belon! to the sa#e fa#ily BCannabaceae7 so#eti#es no)n as CannabinaceaeC4 Generally7 cannabis is considered to be #onospecific BCannabis sati$a 14C )hich is di$ided into the se$eral subspecies BC4 sati$a subsp4 sati$a7 C4 sati$a subsp4 indica7 C4 sati$a subsp4 ruderalis7 C4 sati$a subsp4 spontaea7 C4 sati$a subsp4 afirstanaca4 Eo)e$er7 the che#ical and #orpholo!ical distinctions by )hich cannabis has been split into these subspecies are often not readily discernible7 appear to be en$iron#entally #odifiable7 and $ary in a continuous fashion4 2F Cannabis is no)n by #any different na#es7 often dependin! upon )here one li$es and )ith )hich cultural !roups one associates4 +or the purpose of this docu#ent7 )e )ill ac no)led!e that due to South African herita!e cannabis is referred to by #any na#es7 2G but for the sa e of consistency this docu#ent )ill #aintain the international botanical ter#7 Jcannabis=7 throu!hout4
2I

Cannabis plants ha$e been culti$ated in 2urope7 Asia7 Africa7 the A#ericas and Australasia throu!hout history as a source of hurd7 fibre7 seed and #edicine4 0earin! the abo$e#entioned in #ind7 the spread of cannabis can be attributed to trade routes by land and sea4 +ibre is obtained fro# cannabis ste#s7 and has been used o$er the centuries for the production of te>tiles7 rope and sac in!4 /he fibres produces are stron! and durable7 co#posed of about I0\ cellulose and reaches len!ths of 1 to G #eters4 /he fibre has been used in the past to #a e paper7 and has been proposed as a replace#ent for )ood pulp in #odern paper production4 /he hurd B)oody coreC has been used in buildin! ho#es7 co#pressed boards and $arious other industrial applications4 /he OseedsP Bthe fruit or acheneC #ay be roasted and consu#ed7 used as birdseed or an!lers bait or pressed to yield a !reenish yello)7 fi> oil )hich has been used in foodstuffs and in $arnished7 paint and soap42K Cannabis lea$es and flo)erin! tops and preparations deri$ed fro# the# ha$e #any phar#acolo!ical effects7 includin! narcotic properties4

2F 2G

8N3"C Aeco##ended #ethods for the identification and analysis of cannabis and cannabis products +or e>a#ple9 8#ya7 Patse7 <ate )ane7 Ntsan!u7 Nsan!u7 &#banTe7 <banTi7 #bhan5he7 0han!7 GanTa7 "a!!a7 #arihuana7 #ariTuana7 he#p7 Jholey herbs= and Ntu5ne )e n u u4 2I /he ter#7 Jcannabis=7 is the prefered ter# used by international le!al instru#ents7 such as the 8N Sin!le Con$ention on Narcotic "ru!s 2K Schultes7 1LI0W +airbairn7 1LIG

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Cannabinoids and terpenes are costly for the plant to produce7 so they #ust ser$e a purpose7 or they )ould ne$er ha$e e$ol$ed /EC and the )ater-soluble co#pounds )hich i#part the taste and aro#a to cannabis flo)ers protect the plant9 ; ; S 9y acting as anti-bacterial agents. #epelling or trapping insects. 6/C le)els increase as 5J-9 e$posure increases! so 6/C presu"ably protects the plant fro" 5J radiation. 6his is not an unco""on use of che"isty by plants. ; 6o assure that the flowers and seeds are not consu"ed before they "ature! plants produce a powerful array of che"icals to thwart predators. S Ence the seed "atures and drops out its resin-coated pod (achene)! it is far "ore palatable to ani"als that were repelled by the resin. S"all "a""als and birds "ay eat the seeds! and so"e of the seeds pass through the ani"alsG digesti)e syste"s and re"ain )iable. As ani"als e$crete )iable seeds on suitable ground! they spread the plant to new locations.2L 0oth cannabis and he#p produce phytocannabinoids4 /he true difference bet)een cannabis he#p and cannabis is the plant=s ability to produce7 en5y#atically7 /ECA4 Ne) disco$eries ha$e lead researchers to the hypothesis that it is the functionality of the en5y#e7 /ECA synthase7 not the absence of the !ene codin! for the en5y#e that differentiates cannabis $arieties fro# cannabis he#p $arieties4 Plant deri$ed cannabinoids7 phytocannabinoids7 are created by the cannabis plant throu!h a sin!le en5y#e cataly5ed reaction4 2ach cannabinoid has a correspondin! en5y#e cataly5in! their creation4 C0N is the only no)n cannabinoid N3/ deri$ed fro# an en5y#atic processW instead C0N is a de!radation product7 8( li!ht e>posure7 heatin!7 of /EC4
30

2L 30

2 Aosenthal7 /he <ariTuana Gro)ers Eandboo 7 Vuic A#erican Publishin!7 20107 p 3GI4 Cannabinoid +acts9 /EC7 C0"7 C0N7 C0C7 /EC(7 C0G and 3ther 8ni;ue Phyto Cannabinoids7 #ontanabiotech4co#7 2F <ar 20134

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Cannabis produces a nu#ber of different cannabinoids7 aside fro# its industrial uses4 North of latitude D0] N4 Ee#p )ill be found to produce si!nificantly lo)er le$els of /EC4 South of latitude D0] N4 in South Africa there is a particular !eophysical adaptation that e>ists )ith cannabis7 to counter the effects of 8( radiation4 Cannabis reacts to the a#ount of 8(A and 8(0 and produces #ore /EC than )hat the definition of he#p allo)s4 Cannabis appro$ed as he#p for industrial production only produces #inute a#ounts of /EC4 "ue to this lo) content7 in!estion does not yield the desired physical or psycholo!ical effect4 /ypically7 he#p contains belo) 043\ /EC7 )hile culti$ars of Cannabis !ro)n for recreational use can contain any)here fro# 2\ to o$er 20\431 Cannabis is thou!ht to ha$e ori!inated fro# the Ei#alayas )here it spread across the !lobe alon! the sil road trade route7 both east and )est7 industrial7 recreational and #edicinal uses dates bac #illennia4

31

"P West7 Ee#p and <ariTuana9 <yths , Aealities7 Northern A#erican Ee#p Council7 2I +eb 1LLK4

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Practical anato#y of cannabis
&t has been sho)n that t)o )idespread classes of plants can be discerned )ith respect to into>icant properties of cannabis432 Plants ori!inatin! fro# fairly southern countries Bappro>i#ately south of latitude D0] N4C7 )here there has been a lon! history of the use of Cannabis for dru! purposes7 are characterised by9 ; ; ; resin containing a relati)ely high proportion of into$icating cannabinoids! often "ore than half of the total! usually "ostly 6/C! considerable resin in "ale plants as well as in fe"ales (on a relati)e weight basisK fe"ales are usually larger than "ales) and relati)e slowness of induction of flowering by short day length.

&n contrast7 plants ori!inatin! fro# #ore northern locations7 )here Cannabis has been used pri#arily as a source of fibre and oil7 are characterised by ; ; S resin co"posed pri"arily of noninto$icating cannabinoids! usually "ostly C9F! notably higher resin concentration in fe"ale plants than in "ale plants! and relati)e rapidity of induction of flowering by short day length. ?t should be understood! howe)er! that che"ically inter"ediate plants are widespread.33 Although the general geographical distribution of psychoacti)e constituents in Cannabis is now fairly well understood! additional geographical e)aluation of cannabinoid distribution is still )ery desirable. 6he cannabinoids are substantially carbo$ylated in fresh "aterial! and are neutralised after har)est on ageing. 3D

&t has been reported that a relati$ely !reater proportion of the cannabinoids is decarbo>ylated in the li$in! plants in southern strains43F Strains fro# north-eastern Asia fre;uently ha$e trace a#ounts of the other)ise rare cannabinoid7 cannabi!erol #ono#ethyl ether4 3G Ei!h-/EC strains fro# southern re!ions fre;uently sho) co#plete absence of C0"73I and often ha$e appreciable ;uantities of the #inor cannabinoid7 cannabichro#ene43K 2$idence su!!ests that the production of $arious O#inorP cannabinoids depends lar!ely on the !eophysical location of the plant4 A !eo!raphical pattern is also so#e )hat probable for the abundant terpenes present3L and for the +la$onoids4D0

32 33

S#all and 0ec stead7 &LI3a7 iLI3b4 S#all and 0ec stead7iLI3aW Mrishna#urty and Maushal7 &LID4 3D Grlic and Andrec7 &LG&W Mi#ura and 3 a#ota7 &LI04 3F <echoula#7&LI04 3G S#all and 0ec stead7 iLI3a7 iLI3b4 3I Aeferences in S#all and 0ec stead7 &LI3a7 iLI3bWS#all etal47&LIF4 3K /urner et al47 &LIFb4 3L <artinetal47&LG&W Ni!a#etal47&LGFW Eood et al471LI3W Str^#ber!7 &LIDa D0 Gellert et al47&LID

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/he Cannabis "ichoto#y - Correctin! the JAu#or= About Ee#p
/he cannabis dichoto#y is the #isunderstandin! and confusion surroundin! he#p and cannabis7 based on a !eneralised understandin! that /EC is the proble# psychoacti$e co#pound4 Cannabis contains a nu#ber of cannabinoids that e>ist in the plant in $aryin! percenta!es4

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Co#poundin! the issue further7 the le$els of abo$e#entioned cannabinoids depend lar!ely on their phenotype7 and therefore it is difficult not to consider the differentiation bet)een these phenotypes and the ratios of their acti$e constituents4 _North-South !eopolitics referred to in the Canadian Senate report play out once #ore in the spread of the colonial he#p : cannabis dichoto#y4 D1 Ee#p is a class of phenotypes of Cannabis sati$a 14 that are intended for a!ricultural and industrial purposes4D2 /hey are !ro)n for their seed and fiber content as )ell as the resultin! byproducts such as oil7 seed ca e7 hurds7 etc4 &ndustrial he#p is characterised by bein! lo) in /EC Bdelta-L tetrahydrocannabinolC and hi!h in C0" BcannabidiolC4 /EC is less than 1\ and in Canada and 2urope the current le!al le$el for culti$ation is 043\4 D3 @ACBo""only used ter" for )arieties of the Cannabis plant and its products! which include fiber! hurd! oil! and seed. ?n "any countries regulatory li"its for concentrations of psychoacti)e drug co"pounds (6/C) in he"p encourage the use of strains of the plant which are bred for low (6/C) content or otherwise ha)e the 6/C re"o)ed.C DD /he secretion of /EC is #ost abundant in the flo)erin! heads and surroundin! lea$es of the cannabis plant4 /he a#ount of resin secreted is influenced by en$iron#ental conditions durin! !ro)th Bli!ht7 te#perature and hu#idityC7 se> of the plant and ti#e of har$est4 /he /EC content $aries in the different parts of the plant9 fro# 10-12 per cent in flo)ers7 1-2 per cent in lea$es7 041-043 per cent in stal s7 to less than 0403 per cent in the roots4 DF "urin! the processin! of the har$ested crop the /EC le$els drop7 due to e>posure to sunli!ht and air4 &ndustrial cannabis left to rhett in the field for a period of ti#e sho)s !reatly reduced le$els of /EC4 /he process of rettin! renders all plant #aterial unfit for hu#an consu#ption4 Any industrial product #ade fro# the seed7 hurd or fiber )ill ha$e /EC le$els that are $irtually undetectable4DG "ue to he#p bein! defined by its lo) /EC content7 and the fact that this lo) content can only be achie$ed north of D0] N47 has lead to countries south of this latitude bein! e>cluded fro# !ro)in! he#p4 /his e>clusion is based on the fact that he#p )ill ine$itably re$ert to a state )here the lo) /EC content is no lon!er achie$able4 &n other )ords7 should the /EC content of he#p e>ceed a certain threshold it cannot be classified as such any #ore4

D1 D2

Senate Special Co##ittee on &lle!al "ru!s7 CannabisL Su""ary #eport! p &1! Heb %771. +or the purpose of this discussion the ter#7 Ohe#pP )ill be used7 #eanin! cannabis of 2uropean or Canadian ori!in7 unless the conte>t indicates other)ise4 D3 OGro) Ee#pP Canadian Ee#p /rade Alliance4 DD A!riculture and A!rifood Canada7 R&ndustrial Ee#pP7 Go$ern#ent of Canada7 20134 DF Why Foes Cannabis 4otency 3atterM4 8nited Nations 3ffice on "ru!s and Cri#e4 2L Uun 200L4 DG O&ndustrial cannabis productP refers to any product #ade fro# cannabis hurd7 seed or fiber that is not intended for hu#an consu#ption4

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2uropean he#p phenotypes are not industrially $iable in South Africa due to the fact that he#p de$eloped in different 8( conditions4 /o #ost this )ould see# to be a #inor technicality re!ardin! classification4 Eo)e$er7 it plays a si!nificant role7 due lar!ely to the a#bi!uity of the distinction4

8ltra$iolet Aadiation

Higure '

- <rythe"al 5J ?nde$ <urope &1 Ect %71&

Ee#p appears to be a !eo-physical trait of cannabis phenotypes that #i!rated to Northern 2urope4 Conse;uently7 he#p e$ol$ed north of D0] N4 in !enerally a #ore for!i$in! cli#ate4 /hese re!ions typically recei$e less solar radiation than countries closer to the e;uator4

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Higure ( - <rythe"al 5J ?nde$ World &7 Ect %71&

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Higure * - <rythe"al 5J ?nde$ &7 Ect %71&

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/he !eo-physical separation of cannabis and he#p is easily $isible in this picture4

Higure + - /e"p - Annual 5J I Cannabis heritage o)erlay

&n areas )ith little 8(-0 radiation little `L-/EC is #ade fro# its precursor4 "ifferences found under these circu#stances are probably attributable to local factors7 e4!47 )ater stress7 soil #ineral balance7 etc4 &n areas of intense 8(-0 cannabinoid production is hi!h and found predo#inantly as `L-/EC4 1ocal factors play a role in the final e>pression of cannabinoid content4 DI

DI

Pate "W7 O/he phytoche#ical ecolo!y of CannabisP7 <4S4 thesis4 "ept4 0iolo!y7 8ni$4 <issouri-St4 1ouis7 1LIL4

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Higure KDK - A)erage annual ground solar energy (18,&-%77()

&ncreased stress and selection pressure fro# intense insect predation in tropical areas is also probably in$ol$ed4 While indi$idual plant production of this co#pound #ay be affected by en$iron#ental circu#stance7 the e$olutionary selection of a che#otype best adapted for these conditions has also apparently ta en place4 8(-0 selection pressures #ay be directed to)ard plant sur$i$al or reproducti$e success7 the latter perhaps in$ol$in! pollen $iability or flo)er lon!e$ity4

DK

Space)eather

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/he i#portance of this co#pound is underscored by the disco$ery

DL

of a `L-/EC-rich African strain of

Cannabis in )hich absolutely no C0" precursor could be found F04 Chan!es )ithin the nature of the cannabis plant bet)een 30] , D0] N ha$e been no)n since the 1K00s4

?n <gypt! when the 3eh"ed Ali! 4asha and Jiceroy of <gypt (1,7(I',) wished to create a na)y! he obtained cannabis seeds fro" <urope in order to obtain suitable fiber for cordage. New seed had to be brought periodically! because the he"p plants obtained soon beca"e incapable of producing good te$tile fibers. En the other hand! they began to secrete abundant :uantities of the inebriating resin.F1
/he phenotypes produced in 2urope north of D0] N are not suitable for sustainable !ro)th in South Africa4 &n +i!ure 1 this trend can be obser$ed4 North of D0] N Bcayenne and blueC he#p )ill !ro) )ith the re;uired lo)-/EC content naturally4 +or this reason in earlier ti#es europeans )ere not fa#iliar )ith the practice of s#o in!4

(arious syste#s of 8( classification ha$e been proposed7 but the #ethod of Coblent5 )ill be used here4F2 /his desi!nates radiation bet)een D00 n# Bthe appro>i#ate be!innin! of the $isible re!ionC and 31F n# as 8(-A7 31F-2K0 n# as 8(-07 and the shorter non-terrestrial ultra$iolet )a$elen!ths as 8(-C4 <ost of the 8(-0 ran!e i#pin!es on the earth?s surface and also possesses considerable biolo!ical effect7 so it is the band of #ost concern4 `L-/EC7 C0" and the $arious fla$onoids sho) hi!h le$els of 8(-0 absorption4 /his see#s to be the conse;uence of an ad$anta!e conferred to the or!anis# by the 8(-0-screenin! properties of this co#pound4 /he utility of the cannabinoids for counterin! other ecolo!ical threats BPate7 1LILC #ay e>plain obser$ations of local production $ariability4 +urther in$esti!ation of the phytoche#ical e$olution of Cannabis )ould certainly constitute a useful study of its econo#ic $alue7 but #ore far reachin! i#plications are also in$ol$ed4 /his !enus ser$es as a !ood #odel of an apparently )idespread 8(-0-copin! #echanis#4

Pate "W7 O/he phytoche#ical ecolo!y of CannabisP7 <4S4 thesis4 "ept4 0iolo!y7 8ni$4 <issouri-St4 1ouis7 1LIL4 &bid4 F1 /his chan!e fro# a fiber to a resin phenotype and $ice $ersa in response to en$iron#ental factors has also been obser$ed by 0oucher et al4 B1LIDC4 F2 &bid4
DL F0

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Pi!#entation in both plants and people appears to be an i#portant ans)er to an ubi;uitous ha5ard4 &ndeed7 the e$olution of pi!#entation and photoreacti$ation )as probably a prere;uisite to the successful establish#ent of land-based or!anis#s4 F3

@5J-9 radiation effects on photosynthesis! growth and cannabinoid production of two Cannabis sati)a che"otypesC.FD
Cannabis produces seeds7 plants are pollinated by )ind and !enetics are shared )ithin the !enus4 As such7 tryin! to breed out /EC )ould be a in to tryin! to breed out redheads or albinos fro# the hu#an !eno#e4 Naturally o$er ti#e each far#er breedin! for their respecti$e crop )ould be choosin! the healthiest and best suited plant for future use4 Clai#s #ade that the cannabis a$ailable today is 20 ti#es stron!er than cannabis of the G0=s I0=s or K0=s is nothin! #ore than scare#on!erin! or o$ersi#plification of the co#ple>ities in$ol$ed4 Scientific research into cannabis has been perfor#ed in South Africa since 1LGL for $aryin! reasonsW #edical trials7 producin! /EC for "ronabinol B<arinol7 2le$atC as )ell as he#p a!rono#ics and co##ercial trials4 /o discuss cannabis pra!#atically )e #ust first accept the !enus4 /hen apply our #inds to the four useable parts of the plant that can be used industrially4 /he har#s and benefits of hu#an consu#ption needs to be re$ie)ed alon! )ith all the science based e$idence a$ailable on cannabis4 Cannabis products li e hurd7 fibre or seed used industrially !enerally ha$e little or no detectable a#ounts of /EC in the#4 As I0\ of the cannabis plant is cellulose7 #ost products #ade fro# industrial cannabis applications can not be consu#ed for their dru! content4 +or e>a#ple cannabis fiber Ni e shoes cannot be s#o edW a Cannabric ho#e on fire )ould not !i$e off any class A or 0 no>ious fu#es and s#o in! your cannabis fibre soc s )ould contain no thrill4 As per the "ru! and "ru! /raffic in! act of 1LL2 there is no #ention of he#p4 All la)s refer to the !enus Cannabis and thus the Ee#p ar!u#ent is #oot4
/his chan!e fro# a fiber to a resin phenotype and $ice $ersa in response to en$iron#ental factors has also been obser$ed by 0oucher et al4 B1LIDC4 FD Pate7 1LLD4 Che#ical ecolo!y of Cannabis4 Uournal of the &nternational Ee#p Association 29 2L7 32-3I4
F3

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Cannabis /rials &n South Africa
Cannabis has been produced in South Africa for #edical purposes )ith trials and production runnin! fro# 1LL2 - 1LLI for the production of "ronabinol4 /he pro#ul!ation of "ru! and "ru!s /raffic in! act of 1LL2 in effect allo)ed for the #anufacture and possession of "ronabinol7 subTect to the Act=s ter#s and conditions4

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0efore 1LLL the CS&A and $arious other !o$ern#ent depart#ents started he#p fiber trials in South Africa4 <isunderstandin!s of the cannabis plant=s nature has lead to this thirteen year Ee#p fibre trials failure7 to produce any South African Ee#p 1 phenotype7 or any reported successes fro# any of the he#p fibre trials4 +ronted by /hande a Munene7 Eouse of Ee#p B1td4C and the AAC7 CS&A7 SAPS7 "A++7 2"7 "S"7 "0SA7 "/& and N2PA"4 A!rono#ic trials and co##ercial research trials perfor#ed bet)een 1LLL - 2013 ha$e focused on culti$ars of 2uropean fibre he#p seed Bin particular +edora and +uturaC in an atte#pt to introduce lo) /EC cannabis into the country for industrial purposes4 /hese trials ha$e cost in e>cess of AF00 <illion )ith little or nothin! to sho) for the research4 /he trials )ere #ana!ed by the CS&A7 "epart#ent of A!riculture and the National Ee#p +oundation4 Munene )as e#ployed as a proTect #ana!er by the CS&A bet)een 1LLL and 20014 /he CS&A o$ersees on!oin! research4 With support fro# the Eouse of Ee#p chairperson7 FF "r <a#phela Aa#phele7 $arious uplift#ent pro!ra#s )ere launched4FG /he results )ere unsatisfactory4 &n recent years Munene has been re-appointed under the #andate of the "A++ after licences )ere issued by the "epart#ent of Eealth4 /he latter describes past research as Jfailures=4 &n 2012 Munene )as appointed the African e>pert fibre consultant for the Co##on)ealth Secretariat of 2nterprise and A!riculture of the GN++ BGlobal Natural +ibre +oru#C )ith support of N2PA"4 An African chapter )as planned supported by "S"4 An e$ent )as held7 the cost or benefit of the e$ent is not no)n4 Munene has the licenses for co##ercial fiber research o$er the ne>t D years4 Ee#p fibre research falls under the auspices of the <AC B<edical research CouncilC7 "A++ B"epart#ent of A!riculture +orestry and +isheries7 "/& B"epart#ent of /rade and &ndustryC7 2" B2cono#ic "e$elop#entC7 AAC BA!ricultural research councilC the NE+ BNational Ee#p +oundationC7 Eouse of Ee#p Pty BltdC and Ee#poriu# Pty BltdC4 Plant research7 financial e>penditure and co##ercial $iability reports re!ardin! these trials are not a$ailable4 Cannabis Ee#p fibre research has been unsuccessful since 1LLL4

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Natural +ibres Mey to 2n$iron#ent and /ac lin! Po$erty - allAfrica <arch 2012 /he launch of the Ee#p ProTect - "S" 3ct 200L

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Munene=s fiber and te>tile #odels )ere used as the basis for research4 2$idence sho)s that South Africa can not co#pete in the !lobal #ar etplace4 &n spite of the failure of pre$ious initiati$es FI the "S" , CS&A supported the Global Natural +ibers +oru# the African Chapter7 FK 7 Ee#p4 Ee#p phenotypes ha$e been i#ported and !ro)n in South African a!ricultural trials for fiber and co##ercial research o$er the past 13 years4 All crops ha$e been a failure4 Ee#p cannot be !ro)n $iably in the South African cli#ate4
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"S" Co##unity uplift#ent pro!ra# launch the Ee#p ProTect 3ct 200L Global Natural +ibre +oru# BGN++C - African Chapter Hacebook FL Africa9 Natural +ibres Mey to 2n$iron#ent and /ac lin! Po$erty allAfrica 2L:03:2012 G0 Global Natural +ibre +oru# Ae!ional 2>pert Consultant - GN++ Africa

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/he reasons for failure in cannabis fibre research in South Africa include9 S S Not understanding the application of the research. Successful crops ha)e yet to be produced through trials! fibre produced in South Africa has not reached the te$tile stage. S S S S Co"plicated procedures are re:uired to produce te$tile :uality. 4rocessing facilities unsuitable for research purposes. Not identifying )iability issues in ter"s of local clothing or fibre production. Not achie)ing feasible results through continued research.

Aesearch $iable initiati$esW for e>a#ple the application of industrial cannabis in the buildin! industry9 S S S S S S Not necessary to co"pete on an international scale. /ousing can be e"ployed beneficially within a local conte$t. <cono"ic benefits in rural and urban areas. Sti"ulates .ob creation through labour intensi)e processing "ethods. 4rocessing industrial cannabis into building "aterial is relati)ely si"ple. /ar)esting "ethods unsuitable to process fibre.

/he dyna#ic nature of cannabis )arrants an inte!rated and in-depth research effort4 /o #a e infor#ed policy decisions a co#plete understandin! is necessary4 /his )ill only be achie$ed if the pri$ate and public sectors offer each other their #utual support4

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Therapeuti benefits of annabis
/he definition of cannabinoids7 and an e>planation of its ut#ost i#portant relation to the hu#an body throu!h the endocannabinoid syste# is funda#ental to understandin! the )or in!s of the cannabis plant=s effects on the hu#an body4

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Higure I Clinical Applications of "edical cannabis. NE#3=.org

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-*,+CA" CANNA$+S
<edical cannabis refers to the parts of the cannabis plant or specific cannabinoids such as /EC and C0" used as a for# of #edicine or therapy7 under super$ision or self #edicatin!4 Cannabis prohibition applies to e$eryone7 includin! the sic and dyin!4 3f all the ne!ati$e

conse;uences of prohibition7 none is as tra!ic as the denial of #edicinal cannabis to seriously ill patients )ho could benefit fro# its use4 /his includes cancer patients under!oin! che#otherapy7 A&"S patients sufferin! fro# O)astin! syndro#e7P !lauco#a patients7 and those sufferin! fro# chronic pain7 rheu#atoid arthritis and a $ariety of spastic conditions such as #ultiple sclerosis7 paraple!ia7 ;uadriple!ia7 and epilepsy4 At the ti#e of publication7 a Pub<ed search for scientific Tournal articles published in the last 20 years containin! the )ord ʺcannabisʺ re$ealed 127D01 results4 /he )ord ʺcannabinoid7ʺ increases the results to 1I71KL articles4 /hat is an a$era!e of #ore than t)o scientific publications per day o$er the last 20 years4 We couldn=t account for any substantial South African #edical cannabis research )ithin these results4

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<edicinal Eistory
Cannabis has a lon! history of #edical use in $arious countries4 G1 /he first recorded history of the #edical use of cannabis dates bac the phar#acopoeia of 2#peror Shen Nun!7 )ho )rote a boo on treat#ent #ethods in 2I3I 04C4 that included the #edical benefits of cannabis4 Ee reco##ended the substance for #any ail#ents7 includin! constipation7 !out7 rheu#atis#7 and absent-#indedness4 G2

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Grinspoon , 0a alar7 1LL3 0loo#;uist7 2d)ard B1LI1C4 3ari.uanaL 6he Second 6rip4 California9 Glencoe Press4 21 S2P 200G

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Cannabis )as used to treat a $ariety of hu#an ills in fol and for#al #edicine for thousands of years in /ur ey7 South A#erica7 2!ypt7 &ndia7 the <alays7 0ur#a and Sia#4 G3 &n the early 1K00s7 8nited States physicians used cannabis e>tracts to produce a tonic for both #edicinal and recreational purposes4 &n 1K237 Vueen (ictoria?s personal physician7 Sir Aussell Aeynolds7 not only prescribed it to her for #enstrual cra#ps but )rote in the first issue of /he 1ancet7 RWhen pure and ad#inistered carefully7 ait isb one of the of the #ost $aluable #edicines )e possess4R
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0et)een 1KD0 and 1L007 2uropean and A#erican #edical Tournals published #ore than 100 articles on the therapeutic use of the dru! no)n then as Cannabis &ndica Bor &ndian he#pC and no) si#ply as cannabis4 /here )ere 2000 cannabis #edicines prior to 1L3I )ith o$er 2K0 #anufacturers4 GF Eo)e$er7 it is only relati$ely recently that the acti$e co#ponents ha$e been identified and their #echanis#s of action ha$e be!un to be understood4 /he safety of the dru! has been attested to by nu#erous studies and reports7 includin! the 1aGuardia Aeport of 1LDD7 the Schafer Co##ission Aeport of 1LI27 a 1LLI study conducted by the 0ritish Eouse of 1ords7 the &nstitutes of <edicine report of 1LLL7 research sponsored by Eealth Canada7 and nu#erous studies conducted in the Netherlands7 )here cannabis has been ;uasi-le!al since 1LIG and is currently a$ailable fro# phar#acies by prescription4 /he use of #edical cannabis has been endorsed by nu#erous professional or!ani5ations7 includin! the A#erican Acade#y of +a#ily Physicians7 the A#erican Public Eealth Association7 and the A#erican Nurses Association4 /he di$erse historical accounts of the cannabis plant=s #edicinal and therapeutic properties e>perienced and docu#ented by hu#ans re;uires ur!ent attention4 Currently there is #ore no)led!e a$ailable on the internet re!ardin! the use of cannabis #edicinally than )as a$ailable to pre$ious !enerations4 No other plant in the history of #an ind has !ained so #uch professional #edical attention7 yet our local #edical establish#ent lac s a basic scientific understandin! of this plant=s #edicinal efficacies and applications thereof4

G3 GD

Eall , "e!enhardt7 2003W <echoula#7 1LKGW Anslin!er , Cooper7 1L3I 1ancet 1W 1K23 GF Wi ipedia4or! <edical Cannabis

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/he 2ndocannabinoid Syste#
2ndocannabinoids and their receptors are found throu!hout the body9 in the brain7 or!ans7 connecti$e tissues7 !lands7 i##une cells7 etc4 /he cannabinoid syste# perfor#s different tas s7 but the !oal is al)ays the sa#e9 ho#eostasis7 the #aintenance of a stable internal en$iron#ent despite fluctuations in the e>ternal en$iron#ent4 2ndocannabinoids and cannabinoids are also found at the intersection of the body ʹs $arious syste#s7 allo)in! co##unication and coordination bet)een different cell types4 At the site of an inTury7 for e>a#ple7 cannabinoids can be found decreasin! the release of acti$ators and sensiti5ers fro# the inTured tissue7 stabili5in! the ner$e cell to pre$ent e>cessi$e firin!7 and cal#in! nearby i##une cells to pre$ent release of infla##atory substances4 Cannabinoids pro#ote ho#eostasis at e$ery le$el of biolo!ical life7 fro# the subNcellular7 to the or!anis#7 and perhaps to the co##unity and beyond4 +or e>a#ple9 autopha!y7 a process in )hich a cell se;uesters part of its contents to be selfNdi!ested and recycled7 is #ediated by the cannabinoid syste#4 While this process eeps nor#al cells ali$e7 allo)in! the# to #aintain a balance bet)een the synthesis7 de!radation7 and subse;uent recyclin! of cellular products4 2ndocannabinoids are #olecules our bodies naturally #a e to sti#ulate the C0 1 and C02 receptors4 0oth ananda#ide and 2Narachidonoyl!lycerol B2NAGC are synthesi5ed onNde#and fro# cell #e#brane arachidonic acid deri$ati$es7 ha$e a local effect and short halfNlife before bein! de!raded by en5y#es called fatty acid a#ide hydrolase B+AAEC and #onoacyl!lycerol lipase B<AG1C4 GG

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N3A<14or! * 2#er!in! Clinical Applications for Cannabis and Cannabinoids9 A Ae$ie) of the Aecent Scientific 1iterature +ifth 2dition

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Cannabinoids
/he use of cannabis sati$a by hu#ans dates bac se$eral thousand years7 for both its psychoto#i#etic and potential #edicinal properties4 As scientific research #ethods de$eloped7 the cannabinoids present in this herb )ere characterised7 as )ell as their co#ple> interface )ith the hu#an central ner$ous syste#7 pro$ided by the acti$ation of specific receptors4 /he subse;uent description of an endo!enous cannabinoid syste# in the #a##alian brain shifted the notion of cannabis as a recreational dru! to a therapeutic alternati$e for psychiatric disorders4 Cannabinoids are a class of di$erse che#ical co#pounds that acti$ate cannabinoid receptors on cells that repress neurotrans#itter release in the brain4 GI /hese receptor proteins include the endocannabinoids Bproduced naturally in the body by hu#ans and ani#alsC7 GK the phytocannabinoids Bfound in cannabis and so#e other plantsC7 and synthetic cannabinoids Blaboratory producedC4 /he #ost notable cannabinoid is the phytocannabinoid c L-tetrahydrocannabinol B/ECC7 the pri#ary psychoacti$e co#pound of cannabis4 GL7 e>hibitin! a $ariety of effects4I2
I0

Cannabidiol BC0"C is another #aTor constituent of the plant7

representin! up to D0\ of its e>tracts4 I1 /here are #any cannabinoids isolated fro# cannabis7

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Wi i Cannabinoid Pacher P7 0at ai S7 Munos G B200GC4 R/he 2ndocannabinoid Syste# as an 2#er!in! /ar!et of Phar#acotherapyR4 4har"acol #e). FK B3C9 3KLXDG24 doi9104112D:pr4FK43424P<&" 1GLGKLDI4 GL 1a#bert "<7 +o)ler CU B200FC4 R/he endocannabinoid syste#9 dru! tar!ets7 lead co#pounds7 and potential therapeutic applicationsR4 U4 <ed4 Che#4 DK B1GC9 F0FLXKI4 doi91041021:T#0FK1K3t4 P<&" 1G0IKK2D4 I0 Ao!er Pert)ee7 ed4 B200FC4 Cannabinoids4 Sprin!er-(erla!4 p4 24 &S0N 3-FD0-22FGF-H4 I1 8N3"C A co#parati$e study on so#e che#ical and biolo!ical characteristics of $arious sa#ples of cannabis resin 01:01:1LG2 I2 2l-Alfy7 Abir /7 et al4 BUun 2010C4 RAntidepressant-li e effect of delta-L-tetrahydrocannabinol and other cannabinoids isolated fro# Cannabis sati$a 1R4 Phar#acolo!y 0ioche#istry and 0eha$ior LF BDC9 D3DXD24 doi9104101G:T4pbb42010403400D4 P<C 2KGG0D04 P<&" 20332000

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-edi al Cannabis Table of Contents
Click on a heading to na)igate to the rest of the therapeutic section

<2"&CA1 CANNA0&S <edicinal Eistory /he 2ndocannabinoid Syste# Cannabinoids Eistory of cannabinoid research /ypes of Cannabinoids /ypes of Cannabinoids /erpenoid 2ssential 3il Co#ponents of Cannabis +la$onoid and Phytosterol Co#ponents of Cannabis Cannabinoid Aeceptors Cannabinoid receptor type 1 Cannabinoid receptor type 2 Cannabis 2>tracts and Synthetic Cannabinoids Natural7 synthetic phar#aceutical cannabinoid e>tracts Nabilone BCesa#etC "ronabinol B<arinolC Nabi>i#ols BSati$e>C 2ffects of Cannabinoids Clinical 2ndocannabinoid "eficiency &0S and the lin bet)een the brain and !ut Cannabinoid receptors in the enteric ner$ous syste# 8nderlyin! condition Pro#otion of Eo#eostasis CANNA0&S AS A PA2(2N/A/&(2 <2AS8A2 Neurode!eneration and Protection Cannabis Patents South African Cannabis Aelated Ae!istered Patents

111 112 11D 11F 11G 11I 11K 121 123 12D 12D 12D 12F 12G 12G 12G 12G 12K 12L 131 132 133 13D 13F 13I 13K 1D2

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Cannabis and <edical Conditions 14 Al5hei#erʹs "isease 24 A#yotrophic 1ateral Sclerosis BA1SC 34 Chronic Pain D4 Charcot-<arie-/ooth disease BC</C Eereditary <otor and Sensory Neuropathy BE<SNC F4 "iabetes <ellitus G4 "ystonia I4 +ibro#yal!ia K4 &ncontinence L4 Gastrointestinal "isorders 104 Cancer a4 Glio#as b4 0reast Cancer c4 1un! Cancer d4 Prostate Cancer e4 0lood Cancer f4 3ral Cancer h4 1i$er Cancer i4 Pancreatic Cancer 114 Eepatitis C 124 Eu#an &##unodeficiency (irus BE&(C /he 2>perience of "octors Wor in! With A&"S:E&( Patients 1D4 Eypertension 1F4 <ethicillinNresistant Staphylococcus aureus B<ASAC 1G4 <ultiple Sclerosis 1I4 3steoporosis 1K4 Phanto# li#b syndro#e 1L4 Pruritus 204 Aheu#atoid Arthritis 214 Sleep Apnea 224 /ouretteʹs Syndro#e 3ncolo!y and Palliati$e Care 3pioids $ersus Cannabinoids "eli$ery #ethods S#o in! and Pul#onary function Safety and Side 2ffects of Cannabis Ear# Scale <edical ethics in South Africa 0ase principles of the #edical practice G13SSAA6 "2/A&12" A2+2A2NC2 1&S/ 3ther Eealth 3r!ani5ations Eealth 3r!ani5ations Supportin! 1e!al Access to <edical Cannabis

1D3 1DD 1DG 1DI 1F0 1F0 1F1 1F3 1FF 1FI 1FK 1G1 1G1 1GF 1GG 1GI 1GK 1GL 1GL 1I0 1I1 1I2 1IF 1IL 1K0 1K1 1K3 1KD 1KD 1KG 1KK 1KL 1L1 1L3 1LD 1LF 1LI 201 202 20D 20F 20I 20L 210

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T&* &+ST'%Y '! CANNA$+S P%'&+$+T+'N
Cannabis not only has a lon! history in South Africa7 but on the African continent as a )hole4 /here is a body of e$idence de#onstratin! that cannabis )as once consu#ed in a socially acceptable #anner by #any societies throu!hout history4 /he follo)in! ;uote by the Canadian Senate Aeport substantiates this clai# clearly9
I3

@Although not indigenous to Africa! the cannabis plant is part of religious! "edical and cultural traditions across al"ost the entire continent. ?n <gypt! it has been grown for o)er a 1!777 years! while the first e)idence of its presence in central and southern Africa dates back to 1'th century <thiopia where cera"ic s"oking-pipes containing traces of cannabis were disco)ered. ?n North Africa! cannabis influenced "usic! literature and e)en certain aspects of architecture since in so"e ho"es! a roo" was set aside for kif where fa"ily "e"bers gathered to sing! dance and tell stories. 6he plant was also used as a re"edy for snake bite (/ottentots)! to facilitate childbirth (Sotho) and as a re"edy for anthra$! "alaria! blackwater fe)er and blood poisoning (for"er #hodesia).C

I3

Canadian Senate report $ol 1 p12L

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Settin! the tone for debate
/o !ain a clear understandin! of cannabis= historical conte>t the chronolo!ical de$elop#ent of opinion should be !i$en brief consideration4

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/he Wra!! Aeport
&n 1KKI7 the Aeport of the &ndian &##i!ration Co##ission Bhereafter referred to as the OWra!! AeportPID or OA&&CPC )as released4 &t ser$es as an appropriate indicator of the status ;uo at the ti#e and sets the tone for future debate4 IF "espite the o$ertly racialised attitude of the publication it is a $aluable resource )hen discernin! historical fact4/hree issues )ere of particular concern to the co##ission7 i4e4 the spread of cri#e7 labourer indolence and so-called Jda!!a insanity=4 /he co##ission )as concerned about the cannabis use by the &ndian population in the Colony of Natal7 IG specifically )ith re!ard to inter-racial contact and the belief that cannabis leads to #oral de!eneration4II /he co##ission reco##ended that7 @...under sect. +7 of =aw No. % of 1,+7! the Go)ernor in Council has the power to "ake rules! inter alia! for >prohibiting the s"oking! use! or possession by! and the sale! barter or gift to! any coolies whatsoe)er or! of any portion of the he"p plant (cannabis. sati)a)! and authorising the destruction thereof! if found in such use or possession! and i"posing penalties upon coolies using! culti)ating! or possessing such plant for the purpose of s"oking the sa"e.> 6he penalties which the Go)ernor "ay i"pose "ust not e$ceed N% for each contra)ention! and a copy of the rules! thus "ade! "ust- be laid before the =egislati)e Council at its ne$t "eeting. 6he word >sati)a> indicates the culti)ated! as distinguished fro" the wild! )ariety of he"p! and there! is so"e confusion between the use of this word in the body of the section and the definition of >wild he"p> noted in the "arginal reference.C
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@We ha)e reason to think that "uch he"p is sold to ?ndians by Oaffir and storekeepersK we are aware that! in so"e parts of the Colony! white traders purchase green he"p lea)es fro" Oaffir growers and retail the"! in a dried state! to who applies for the". As we are strongly con)inced that the s"oking of he"p is as baneful to the Oaffir as to the ?ndian! we consider that it is our duty to suggest that che"ists! holding special licenses sub.ect to sta"p duty! should be the only persons allowed by law to sell any portion of the he"p plant! whether wild or culti)ated! to any person! who"soe)er! whether of white! Oaffir or ?ndian descent.C IL

ID IF

Na#ed after its chair#an Eon Walter Wra!!4 Paterson7 Crai! B200LC 4rohibition P resistance L a socio-political e$ploration of the changing dyna"ics of the southern African cannabis trade! c. 1,(7 - the present. <asters thesis7 Ahodes 8ni$ersity4 p DG4 IG <any &ndians )ere brou!ht to Natal as part of indentured labour to )or on the local estates4 A&&C B1KKIC7 Pa!e I7 Para!raph G7 states7 @the 3edical Efficers of Circles! and the 4rotector of ?""igrants ha)e seen "any ?ndians with their strength and "anhood wrecked by the pernicious drug.C II Paterson7 Crai! B200LC 4rohibition P resistance L a socio-political e$ploration of the changing dyna"ics of the southern African cannabis trade! c. 1,(7 - the present. <asters thesis7 Ahodes 8ni$ersity4 p DG4 IK A&&C B1KKIC pa!e G7 Chapter && point D4 IL A&&C B1KKIC Pa!e K7 Para!raph 104

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/he Custo#s and "uties A#end#ent Act 3F of 1L22
/he Custo#s and "uties A#end#ent Act )as the first piece of 8nion le!islation prohibitin! cocaine and cannabis4 /he Act !a$e considerable po)er to la) enforce#ent7 includin! search and sei5ure and placin! the onus of proof on the accused4K0 /he <edical7 "ental and Phar#acy Act 13 of 1L2K )as pro#ul!ated and )as #ore e>tensi$e than the Custo#s and "uties A#end#ent Act4 /he Jhabit-for#in! dru!= clause )as #entioned once durin! parlia#entary debates4 8nfortunately there is a scarcity of historical records that pertain to the debates in re the abo$e#entioned acts4

K0

Paterson7 Crai! B200LC 4rohibition P resistance L a socio-political e$ploration of the changing dyna"ics of the southern African cannabis trade! c. 1,(7 - the present. <asters thesis7 Ahodes 8ni$ersity4 p F24

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/he Aeport of the &nter-"epart#ental Co##ittee on the Abuse of "a!!a
/he Aeport of the &nter-"epart#ental Co##ittee on the Abuse of "a!!a BA&"CA"C K1 sets the tone for discussion in the latter part of the 20th century by in$esti!atin! cannabis consu#ption by different racial !roups in South Africa4 &ts purpose )as to deter#ine )hether policy )as effecti$e and to #a e reco##endations for i#pro$e#ent4K2 /he report played a role in subse;uent publications7 for e>a#ple the J"ru! "ependence and so#e of its Conco#itant Aspects in the Aepublic of South Africa= K3 that relied hea$ily on the report=s findin!s4 KD 0y $irtue of the Apartheid re!i#e the co##ittee=s #andate )as based on race and racial hierarchy4&t refers to to cannabis use as an Je$il= that needed to be dealt )ith and so doin! retains the ar!u#ent of #oral de!eneration4 As a result certain racial !roups differin! in opinion )ere associated )ith the ne!ati$e aspects of cannabis4 Cannabis )as $ie)ed as the cause of po$erty and cri#e4 Aeco##endations )ere #ade for a #uch stricter le!al approach to cannabis be ta en4 Certain racial !roups )ere portrayed as less respectable4 /his de#onstrates a loose adherence to so#e for# of racial hierarchy4 "istinction is #ade bet)een the Jnati$e= and the coloured co##unity based on the fact that the latter=s opinions )ere #ore in line )ith that of the co##ittee4 As a result the Jnati$e= population )as seen as bac )ard and less ci$ilised than the rest4 /he si!nificance of A&"CA" lies in the fact that it stren!thened the racial pre#ise of prohibition by presentin! old approaches in a ne) fashion4 /he report ser$ed only to reinforce the racial foundations inherent to Apartheid and ept cannabis la)s as useful instru#ents for the rulin! J)hite= #inority4 &t is i#portant to note that the dyna#ic nature of cannabis did not chan!e #uch since its bannin! in 1L224

K1 K2

A&"CA" Paterson7 Crai! B200LC 4rohibition P resistance L a socio-political e$ploration of the changing dyna"ics of the southern African cannabis trade! c. 1,(7 - the present. <asters thesis7 Ahodes 8ni$ersity4 p FF4 K3 "epart#ent of Social Welfare and Pensions KD Paterson7 Crai! B200LC 4rohibition P resistance L a socio-political e$ploration of the changing dyna"ics of the southern African cannabis trade! c. 1,(7 - the present. <asters thesis7 Ahodes 8ni$ersity4 p FL4

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Aole of cannabis in the Apartheid re!i#e
Eu#an ri!hts abuses of ho#ose>uals in the South African "efence +orce by health )or ers durin! the apartheid era7 presented itself throu!h !ross hu#an ri!hts $iolations at the hands of "r Aubrey 1e$in at the re#ote Greefs)ald <ilitary facility4

1enny Wild writes in her studyL @When Connie 3ulder introduced the law he called it a Qnational e"ergencyR. 6he regi"e had been conducting co"pulsory tests using AcannabisB on so called Qde)iantsR (young "en and ho"ose$uals who did not want to fight in the SAFH) at a ca"p called Greefswald! and concluded that de"oti)ation of white ar"y conscripts and social interaction between black and white youth would occur if AcannabisB was not cri"inalised.C
KF

/he e>peri#ents )ere instru#ental in ha$in! the #inister of interior brin! into effect the Abuse of dependence-producin! substances and rehabilitation centres act no4 D1 of 1LI1 dru! le!islation that )as no)n collo;uially as the O"a!!a Act4P KG7 KI7 KK "urin! the apartheid years South Africa )as relati$ely isolated fro# the rest of the )orld and substance use pri#arily re$ol$ed around locally produced substances7 notably alcohol7 tobacco and cannabis4 "urin! the 1LL0s and early 2000s South Africa )ent throu!h #aTor social and political transfor#ation4 "urin! this period lin s and trade )ith the rest of the )orld opened4 KL &t could be said that the reasons in for#in! the foundation of apartheid la) and the prohibition of cannabis )ere al#ost identical4 &n each case7 it )as a body of la)s passed to ensure that the Jnon-)hite= population could be #ade of use to the J)hite= population7 )hile tryin! to #ini#ise the threat that the for#er posed to the J)hite= rulin! class4 While apartheid la)s sou!ht to eep specific inds of people in specific social en$iron#ents7

#ini#isin! contact bet)een !roups7 the la)s a!ainst cannabis Band other J$ices= such as alcoholC ser$ed to protect the J)hite= population in circu#stances )here such interaction )as una$oidable4 L0
KF KG

G<a> &nside "r Shoc ?s cuc oo nest fresh insi!hts into the bi5arre career of "r Aubrey 1e$in 30 Au! 2001 Global Ne)s7 /&<21&N29 "r4 Aubrey 1e$in KI <unro7 South Africa and the "rea# of 1o$e to Co#e9 Vueer Se>uality and the Stru!!le7 8ni$ersity of <innesota Press7 20124 KK (an dyl7 "e Gruchy7 1apins y7 1e)in7 Aeid7 /he A$ersion ProTect - Eu#an ri!hts abuses of !ays and lesbians in the SAN"+ durin! the apartheid era7 Si#ply Said and "one7 1LLL4 KL Patterns of substance use in South Africa9 results fro# the South African Stress and Eealth study4 SA<U7 S4 Afr4 #ed4 T4 $ol4LL no4F Cape /o)n <ay 200L L0 Prohibition , Aesistance9 A Socio-Political 2>ploration of the Chan!in! "yna#ics of the Southern African Cannabis /rade7 c4 1KF0 X the present4 p!F1

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South Africa=s role in international prohibition
South Africa played a si!nificant role in the international prohibition of cannabis )hich is e$idenced in a letter sent the 8nion !o$ern#ent to the 1ea!ue of Nations OAd$isory Co##ittee on the /raffic in 3piu# and "an!erous "ru!sP in 1L239

O

4retoria No)e"ber %,th 18%&

With reference to your letter no. 1%SAS%%8(1S1+%1+ dated Septe"ber *th 18%%! on the abo)e sub.ect and to "y letter no. %8S,S,( dated Fece"ber last! forwarding copies of the #egulations pro"ulgated under 4rocla"ation no. 1,1 of 18%%! ? ha)e the honour to infor" you that! fro" the point of )iew of the 5nion of South Africa! the "ost i"portant of all the habit-for"ing drugs is ?ndian /e"p or QFaggaR and this drug is not included in the ?nternational =ist. ?t is suggested that the )arious Go)ern"ents being parties to the ?nternational Epiu" Con)ention should be asked to include in their lists of habit-for"ing drugs the followingL ?ndian he"pL including the whole or any portion of the plants cannabis indica or cannabis sati)a.

Signed! 1.C. Jan 6yen! for Secretary to the 4ri"e 3inister

P

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Subse;uently the #otion passed at the Second 3piu# Conference in 1L2D ser$in! as a the basis for international prohibition4 Sin!le Con$ention of Narcotic "ru!s /reaty of 1LG1 consolidated pre$ious treaties and broadened their scope to include cannabis and dru!s4 /he history of the prohibition of cannabis7 both nationally and internationally7 )as pri#arily dri$en by racial considerations and north south !eopolitics4

OWe conclude fro" these obser)ations that the international regi"e for the control of psychoacti)e substances! beyond any "oral or e)en racist roots it "ay initially ha)e had! is first and fore"ost a syste" that reflects the geopolitics of North-South relations in the %7th century.PL1

L1

Canadian Senate Aeport 2002

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T&* C'ST '! T&* P%'&+$+T+'N
A broader understandin! of the hu#an-cannabis relationship beyond the do#inatin! t)entieth century A#erican and colonial prohibitionist socio-le!al fra#e)or s is needed4 When there is not a )ar a!ainst cannabis bein! fou!ht7 a less distorted picture of its effects can e#er!e4 /he ele#ent of psycholo!ical distress that cannabis prohibition re!i#es produce is )orth seriously accountin! for as it can play a si!nificant role in the conflation of the effect of cannabis on a user )ith the effect of the cri#inal or social sti!#a attached to that use4 L2 "ue to prohibition=s nature its Jcost= can not be e>pressed purely in ter#s of #onetary $alue4 /o understand the full scope of its effects the i#pact of the ne!ati$e conse;uences on society as a )hole needs to be ta en into account4 3nce there is a clear understandin! of ho) prohibition has failed7 then only can the process be!in )here )e )or to the uni$ersal !oal of reducin! dru! related har#4

L2

A!!ar)al et al7 Psychoacti$e substances and the political ecolo!y of #ental distress7 Ear# Aeduction Uournal 20127 L9D

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Processin! of dru!-related offences
When calculatin! the cost it is i#portant to ta e a brief loo at the se;uence of e$ents after arrest4 When arrested for a cannabis-related offence the follo)in! process is started4

1. 6he accused is taken to the nearest police station for processing. %. Arrest reports are filled out! and the accusedRs fingerprints are taken. &. 6he drugs they were caught with are catalogued and :uantified. '. Generally the substance is recorded as an @5nknown SubstanceC after which it is sent for forensic testing. (. Fepending on the day and ti"e of day! the accused is often held in custody until their court appearance. *. A docket is assigned to an in)estigating officer before the first court appearance. ?t will be his responsibility to ensure the case is properly in)estigated! and that all e)idence is recorded in the docket. +. 6he docket is then taken to court for the initial hearing! at which the accused would be offered the opportunity to apply for bail. ,. 6he case is postponed for further in)estigation and to wait for forensic reports. L4 6he accused pays bail and goes ho"e! until the ne$t court appearance. Should the accused not be able to afford bail! they are re"anded until their ne$t appearance.

/he Anti "ru! Alliance has trac ed t)el$e rando# dru! related cases for se$eral #onths4 /hey chose cases si#ply by !oin! to court7 listenin! to )ho )as arrested for possession7 and returnin! on the dates laid do)n for those cases7 and trac in! the proceedin!s and outco#es4 A"ASA chose three courts in three different #a!isterial districts4 3ut of the t)el$e cases )e trac ed7 three accused had pre$ious con$ictions for dru!-related offences4 /hese )ere the only cases )here penalties )ere handed do)n4L3

L3

Anti "ru! Alliance South Africa - At )hat costQ 2013

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

/he failure of the )ar on dru!s on its o)n ter#s
/he theory behind the )ar on dru!s is si#ple4 /he pri#ary ai#s of reducin! a$ailability and use are to be achie$ed by9 S En the Qsupply-sideR! enforce"ent will reduce or eli"inate drug a)ailability by reducing production and supply! as well as increasing prices so that drugs beco"e less attracti)e to users. S En the Qde"and sideR! puniti)e enforce"ent against users reduces use because it acts as a "a.or deterrent! and supports health and pre)ention initiati)es by @sending a "essageC about the risks and unacceptability of drug use. 6et after F0 years of dru! )ar e>perience7 it is clear the theory is not supported by the e$idence4 Prohibition has not si!nificantly restricted production and supply4 3nce an ille!al #ar et has beco#e established7 and de#and re#ains7 prohibition has not )or ed any)here7 e$er4 LD

LD

Aeproduced and ;uoted )ith the per#ission of the /ransfor# "ru! Policy +oundation

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Higure 17 I SA4S 4olice Efficer 9adge Na"e

/he conse;uences of prohibition
/he prohibition of cannabis is pri#arily incurred by the Tustice syste#7 and is enforced by the South African Police Ser$ices4 /his in$ol$es9 ; ; ; ; ; ; ?ntelligence gathering Searching for offenders Arresting offenders 4rocessing offenders Cost of incarceration per day Court process

/he 8N 3ffice on "ru!s and Cri#e7 )hich o$ersees !lobal dru! control7 has identified fi$e ne!ati$e Qunintended conse:uencesR of the current international syste#4LF
LF

8N3"C7 JWorld Frug #eport %77,=7 200K7 chapter 24F

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/he conse;uences of prohibition
14 /he creation of a hu!e riminal bla k market - with all its attendant proble"s. 24 JPoli 5 displa ement= - scarce resources are redirected fro" health to enforce"ent. 34 JThe balloon effe t= - enforce"ent does not eli"inate drug production! transit and supply it .ust shifts it so"ewhere else. D4 JSubstan e displa ement= - enforce"ent does not eli"inate drug use! at best it "o)es users on to different drugs. F4 Pro#otin! sti3matisation and dis rimination - pre)enting drug users getting treat"ent and support.

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

/he basic econo#ics of prohibitin! a substance for )hich there re#ains hi!h de#and are the sa#e for alcohol or any other dru!4 &t pushes up the price and profit #ar!ins a$ailable7 so cri#inals !et in$ol$ed to #eet the de#and7 resultin! in the sa#e ind of illicit #ar ets )ith the sa#e inds of proble#s4 &t is i#portant to understand the distinction bet)een dru! prohibition7 )hich puts an absolute ban on the production7 supply and use of certain substances for non-scientific:#edical use7 and re!ulated dru! #ar ets under )hich so#e acti$ities are le!al and so#e re#ain prohibited Be4!4 sales to #inors7 purchase outside of licensed pre#isesC4 Prohibition is an absolutist position7 and its repeal opens the door for a )ide $ariety of possible re!ulatory options )hich can be far #ore effecti$e4 &t is also )orth notin! that since alcohol )as brou!ht bac into a le!al re!ulatory fra#e)or in the 8SA7 there ha$e been no si!nificant calls for a return to prohibition . +urther costs of the prohibition )hich are difficult to #easure includes the noc on effects on li$es of people )ho re#ain after the )ar on dru!s )ith se$ere conse;uences as to ho) the abuse of po)er by the la) has i#pacted personal socio-econo#ic !ro)th of these affected people=s li$es7 further than )hat the described 8N treaties allo)s for local enforce#ent4

S

?n 3arch %77* the South African 4olice broke the neck of %8 year old Christiaan Oansanga while "aking an arrest for cannabis in Jredenburg in the Western Cape. ?n Ectober %778 Ogothatso Ndobe was fatally shot in the back while fleeing the South African 4olice in Atteridge)ille. 6he %1 year old had been disco)ered s"oking cannabis outside his ho"e while polishing his shoes. ?t is safe to assu"e he ran because he was in fear of losing a hardwon .ob as a "essenger at a 4retoria law fir". ?n Ectober %71& Gusta) 3owers was arrested in Coffee 9ay for 7.*,gr of cannabis and subse:uently i"prisoned for si$ "onths.

S

S

Puniti$e la) enforce#ent7 and particularly the use of the #ilitary7 has beco#e an acti$e threat to public security in so#e countries4LG Pre#ier Eelen dille under#ined such public security by callin! for #artial la) as local #eans of enforce#ent7 as the local Western Cape Go$ern#ent is incapable of controllin! the !an! : dru! related proble#s )ithin the co##unities at hand4 /his approach uses a #ilitary inter$ention as a solution to the proble#4 LI Co#poundin! the #atter further7 educational fundin! )as used in an atte#pt to resol$e the proble#4LK /he i#pact of the di$ersion of funds fro# the "epart#ent of 2ducation is not yet no)n4

P%re5 Correa7 C47 JFesproporcionalidad y delitos contra la salud en 32$ico=7 C&"27 dille9 Why the ar#y should help fi!ht !an!s &31 10 Uuly 2012 LK AG# fro# education funds to fi!ht !an!s &31 1L Au! 2013
LG LI

<%>ico 2012

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'ther se ondar5 onse6uen es of prohibition ; ?ncreased a)ailability of drugs in highly regulated parts of society ieL schools and prisons. 6he lack of control o)er the illicit drug "arket places pressure on other regulatory fra"eworks of go)ern"ent. S <nforce"ent tends to lead to the geographical displace"ent of the black "arket supply. As a result large busts ha)e decreased effecti)eness on reducing supply. 6his creates new lucrati)e opportunities for the e$isting local de"and! and often lea)es local cannabis consu"ers to source fro" neighbouring regions.LL S Ac:uiring a cri"inal record decreases the offenderRs career opportunities! as "ore corporates are beco"ing inclined in doing a cri"inal background check. S S S Fenial of J?SA applications to these offenders restrict right of freedo" of "o)e"ent. <cono"ic cost of the lack of industrial and "edical research and de)elop"ent. =oss of "aterial assets through sei0ure and forfeiture to the state coffers.

LL

Wi i - 0alloon 2ffect

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2n$iron#ental i#pact of cannabis prohibition
&n Uanuary 200F7 the SAPS Air Win! recei$ed a donation of a ne) S;uirrel helicopter and three-belly tan sprayin! syste#s fro# the 8nited States4 /he S;uirrel increased the SAPS fleet of this type of aircraft to si> and the total nu#ber of helicopters to 2G4 100 /he SAPS Air Win! spray lar!e cannabis plantations )ith !lyphosate4 D701I Eectares )ere sprayed bet)een 200G and 2010 )ith the herbicide Aoundup4 101 /he en$iron#ental and health effects of these cannabis eradication pro!ra#s on the people of South Africa7 its li$estoc and its en$iron#ent has ne$er been in$esti!ated4 &n$esti!ation of these sprayin! ca#pai!ns needs ur!ent attention4 /he fact that the SAPS Air Win! is conductin! to>ic eradication of cannabis on $ast s)athes of the countryside and international nei!hbours is e>cused by the purpose of eradicatin! cannabis4 /he runoff fro# these sprayin! ca#pai!ns )ashes into N o#ati Ai$er (alley in S)a5iland7 )hich flo)s throu!h South Africa4102 3n Uan 207 200I7 <onsanto )as con$icted in +rance of false ad$ertisin! of Aoundup for presentin! it as biode!radable7 and clai#in! it left the soil clean after use4 2n$iron#ental and consu#er ri!hts ca#pai!ners brou!ht the case in 2001 on the basis that !lyphosate7 Aoundup?s #ain in!redient7 is classed as Rdan!erous for the en$iron#entR and Rto>ic for a;uatic or!anis#sR by the 2uropean 8nion4103 <onsanto appealed and the court upheld the $erdictW <onsanto appealed a!ain to the +rench Supre#e Court7 and in 200L it also upheld the $erdict4 10D A senior spo es#an for the SAPS air )in! in 2010 described Aoundup Oas safe as table saltP7 )hich it #ost definitely is not4 /he !reater en$iron#ental i#pact of cannabis prohibition e>tends itself onto unsolicited land7 lea$in! sensiti$e en$iron#ental areas and national par s da#a!ed and e$en e>posin! co##unities as )ell as school children10F to uncontrolled cannabis fields4

100 101

SAPS - 10 6ears of Policin! in a "e#ocracy 1LLF X 200F 200G 1I0 haW 200I 2G0 haW 200K 1IDF haW 200L 12IF haW 2010 FGI ha - Safer Capeto)n 102 &nfo4!o$45a State#ent by south african police ser$ice on cannabis eradication operation in the royal in!do# of s)a5iland 1K:0F:2001 103 R<onsanto +ined in +rance for ?+alse? Eerbicide AdsR4 Agence Hrance 4resse!4 3r!anic Consu#ers Association 200I-01-2G4 10D R<onsanto !uilty in ?false ad? ro)R 00C Ne)s 200L-10-1F4 10F Safer C&A - School of E&GE2A learnin!

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SA"C : 8N PA3/3C31 &N/2A(2N/&3N
"e$elopin! nations are faced )ith a co#ple> ran!e of dru! related proble#s )hile li#itin! #uch needed discussion on e>plorin! the de$elop#ent of re!ionally appropriate dru! policies that shift a)ay fro# the current prohibition-oriented approach that has lon! do#inated this real#4 @Such countries are faced with an e)er growing socio-econo"ic and scientific disparity fro" their refor"ed peers and "ust pay close attention to the 5nited Nations based global drug control fra"ework! of which practically all nations are a part of.C10G /hree 8N "ru! Con$entions B1LG17 1LI1 and 1LKKC loc into place a ri!id7 prohibitionist syste# of dru! control4 /he con$entions= le!islation has si!nificantly constrained $arious countries= efforts to e>peri#ent )ith alternati$e #ethods of dru! control7 such as the decri#inalisation of use and possession7 to reduce the har#s associated )ith dru! use and pro$ide better care for dru! addicts usin! a #edical rather than cri#inalisin! re!i#e410I Whilst they constitute a #aTor hurdle to refor#7 they are not insur#ountable4 8N /reaties are not J)ritten in stone= and can be7 and indeed often are7 fre;uently redrafted4 Eo)e$er7 despite their lac of success the current Con$entions ha$e ne$er been re-e>a#ined4 10K Countries often ad#it in pri$ate to the failin!s of the Con$entions7 the potential political costs Bsuch as )ithdra)al of 8S aidC for an indi$idual state or nation that publicly criticises these treaties has created a taboo re!ardin! refor# discussion4

6his taboo "ust now be broken.

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10G 10I

0ec ley +oundation - /he Global &nitiati$e for "ru! Policy Aefor# Ae)ritin! the 8N dru! con$entions4 2012 0ec ley +oundation - /he Global &nitiati$e for "ru! Policy Aefor# Ae)ritin! the 8N dru! con$entions4 2012 10K /ransnational institute "a$e 0e)ley-/aylor and <artin Uels#a - 1i#its of 1atitude - Series on 1e!islati$e Aefor# of "ru! Policies N r 1K <arch 2012 10L 0ec ley +oundation - /he Global &nitiati$e for "ru! Policy Aefor# Ae)ritin! the 8N dru! con$entions4 2012

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20 No$e#ber * 2013 +or Public "istribution , Co##ent

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

SA"C : 8N Eistorical dru! traffic in! related accounts
/he 8N is an international or!anisation7 established after World War && in 1LDF7 that ai#s to #aintain peace and security on an international le$el4 So#e of their obTecti$es include the alle$iation of po$erty by i#ple#entin! $arious de$elop#ent strate!ies and econo#ic de$elop#ent7 hu#anitarian efforts7 pro#otion of de#ocracy and the $alues pertainin! to it7 the protection of hu#an ri!hts and ci$il liberties7 and the pre$ention and #ediation of international conflict4 /)o &nternational le!al instru#ents !o$ern the current dru! policy in South Africa9 S &n 1LGK7 under the pro$isions of the Sin!le Con$ention7 the +nternational Nar oti s Control $oard 7+NC$8 )as created as the Jindependent and ;uasi-Tudicial #onitorin! body=4 /he 19:1 Sin3le Convention on Nar oti ,ru3s7 as a#ended by the 19;2 Proto ol7 the 19;1 Convention on Ps5 hotropi Substan es and the a!ainst &llicit /raffic in Narcotic "ru!s and Psychotropic Substances4

S

/hese treaties are i#ple#ented on a do#estic le$el by the follo)in! pieces of le!al instru#ents7 not)ithstandin! re!ulations published by !o$ern#ent !a5ette9 S &n 1LL27 the ,%)0S AN, ,%)0 T%A!!+C<+N0 ACT 1=0 of 1992 was pro"ulgated and published )ia go)ern"ent ga0ette in South Africa. ?t was a"ended by legislation on separate occasions in 188*! 188, and %77%.110 /he Prevention and Treatment of ,ru3 ,ependen 5 A t 20 of 200> pro)ides )arious "echanis"s to co"bat drug abuse by focussing on treat"ent and inter)ention.111 /he National ,ru3 -aster Plan 2013 ? 201; is the go)erning docu"ent for drug policy in South Africa and is ad"inistered by the Central Frug Authority as part of the Fepart"ent of Social Fe)elop"entRs "andate.112

S

S

/he Southern Afri an ,evelopment Communit5 7SA,C8 )as for#ed on 1I Au!ust 1LL2 as an inter!o$ern#ental or!ani5ation7 its !oal bein! to further socio-econo#ic cooperation and inte!ration a#on! 1F southern African states4 /he Southern African "e$elop#ent Co##unity BSA"CC )as established in 1LL2 and co#prises 1D #e#ber States4 &ts #e#ber States differ !reatly in ter#s of land area7 population7 inco#e le$els and official lan!ua!es4

110 111

"A8GS AN" "A8G /AA++&CM&NG AC/ 1D0 of 1LL2 Pre$ention and /reat#ent of "ru! "ependency Act 20 of 200K 112 C"A * NA/&3NA1 "A8G <AS/2A P1AN 2013 X 201I

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

/he re!ion has a population of appro>i#ately 200 #illion and a land #ass e;ual to that of the 8nited States of A#erica4 Po$erty reduction7 #ana!in! the i#pact of the hu#an i##unodeficiency $irus:ac;uired i##unodeficiency syndro#e BE&(:A&"SC and dealin! )ith political instability are a#on! the ey issue currently facin! SA"C4113 South Africa beca#e a #e#ber of +NT*%P'" in 1LL34 /he &nternational Cri#inal Police 3r!anisation B&N/2AP31C is a !lobal policin! or!anisation that ensures and pro#otes assistance bet)een do#estic police and authorities411D Au!ust 2001 The Southern Afri an ,evelopment Communit5 7SA,C8 )as for#ally launched4 /hey state their purpose as the follo)in!9 @?ncreased trafficking! production and abuse of illicit drugs in Southern Africa poses a serious threat to the political stability and social econo"ic de)elop"ent of the SAFC region. 6o strengthen! co-ordinate and har"onise e$isting national and regional progra""es as well as to initiate new ones! a 4rotocol to co"bat illicit drugs was signed in August 188* by SAFC /eads of states.P 11F ,e laration and Plan of A tion on ,ru3 Abuse and +lli it Traffi kin3 Control in Afri a 7'A)84 /his plan of action )as adopted by the 32nd 3rdinary Session of the Asse#bly of Eeads of State and Go$ern#ent in Uuly 1LLG4 &t ai#s at stren!thenin! dru! control institutions throu!h re!ional cooperation411G Zone of Peace and Co-operation in the South Atlantic (ZPCSA) . &n April 1LLG a ca#pai!n )as launched a!ainst the dru! trade a#on!st the 2D nation dPCSA4 &nfor#ation on traffic ers is e>chan!ed and #e#ber states are ur!ed to enact forfeiture la)s4 &t has been clai#ed that this a!ree#ent has de$eloped successful policies in the area of denuclearisation7 en$iron#ental protection and dru! traffic in!411I The South Afri an Communit5 *pidemiolo35 Net@ork on ,ru3 )se 7SAC*N,)8 )as established in 1LLG by the South African <edical Aesearch Council B<ACC and the "epart#ent of Psycholo!y at the 8ni$ersity of "urban-West$ille )ith fundin! fro# the World Eealth 3r!ani5ation4 SAC2N"8 is a net)or of researchers7 practitioners and policy #a ers fro# all areas of South Africa4 <e#bers of SAC2N"8 #eet e$ery si> #onths to pro$ide co##unity-le$el public health sur$eillance of alcohol and other dru! BA3"C use trends and associated conse;uences throu!h the presentation and discussion of ;uantitati$e and ;ualitati$e research data4 11K
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C4"4E4 PAAA67 A4 P1e""2<ANN7 U4 S/A&U"3< "e$elopin! the Southern African "e$elop#ent Co##unity 2pide#iolo!y Net)or on "ru! 8se9 #ethods and issues4 0ulletin on Narcotics7 $ol4 1(7 Nos4 1 and 27 200 p! KD 11D &nternational Cri#inal Police 3r!anisation B&N/2AP31C 11F Southern African "e$elop#ent Co##unity7 OSouthern African "e$elop#ent Co##unity 0usiness 1a) Eandboo O7 &nternational 0usiness Publications B2011C7 p I24 11G "eclaration and Plan of Action on "ru! Abuse and &llicit /raffic in! Control in Africa B3A8C 11I &nternational and Ae!ional Co-operation in Cri#e Pre$ention4 1LLL4 &nternational and Ae!ional Co-operation in Cri#e Pre$ention 11K Substance Abuse9 Go$ern#ent Sources

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

African Common Position on Drug Abuse and Illicit rafficking Control in Africa (!A") )as endorsed by the 3A8 Council of <inisters and Eeads of State in Uune 1LLK4 &t profiles the dru! and dru! traffic in! proble# faced by the African continent and outlines international co-operation in this field4 11L "nited #ations Drug Control Programme$ /he 8N"CP is acti$ely in$ol$ed in a $ariety of assistance pro!ra##es )ithin the SA"C re!ion4 /his structure has three #ain responsibilities9 treaty i#ple#entation7 policy i#ple#entation and research and operational acti$ities4 /he SAPS and the 8N 3ffice for "ru! Control and Cri#e Pre$ention B8N-3"CCPC ha$e si!ned an a!ree#ent on dru! la) enforce#ent4 /his a!ree#ent also #a es allo)ance for the deploy#ent of international e>perts Bfro# &nterpol7 the "2A7 8S and 0ritish custo#s depart#entC to train South African counterparts4 120 &n <arch 1LLL the SA,C %e3ional ,ru3 Control Proto ol 7S%,CP8 )as created4121 &n 2001:2002 B)ith fundin! fro# the 28C three bi-annual #eetin!s of the SA,C ,ru3 Control Committee )ere held4 A re!ional )or shop for national dru! control coordinatin! bodies )as conducted )here national dru! control strate!ies for fi$e years B"ru! <aster PlansC )ere drafted by the <e#ber States that did not ha$e the#4 /he <e#ber States that had co#pleted "ru! <aster Plans re$ie)ed the status of their i#ple#entation4 After the )or shop7 SA"C pro$ided technical ad$ice and fundin! for national )or shops for the finalisation of the "ru! <aster Plans4 122 /he 200G Proto ol on Combatin3 +lli it ,ru3 Traffi kin3 #entions that <e#ber States7 )hich ha$e not acceded to7 inter alia7 the abo$e#entioned 8nited Nations Con$entions shall do so as soon as possibleW Protocol a#endin! the Sin!le Con$ention on Narcotic "ru!s of 1LG1W /he 1LI1 Con$ention on Psychotropic SubstancesW /he 1LG1 Sin!le Con$ention on Narcotic "ru!s as a#ended by the 1LI2 and the 1LKK 8N Con$ention A!ainst &llicit /raffic in! of Narcotics "ru!s and Psychotropic Substances4123

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&nternational and Ae!ional Co-operation in Cri#e Pre$ention4 1LLL4 &nternational and Ae!ional Co-operation in Cri#e Pre$ention 120 &nternational and Ae!ional Co-operation in Cri#e Pre$ention4 1LLL4 &nternational and Ae!ional Co-operation in Cri#e Pre$ention 121 &llicit dru!s in Southern Africa9 /he +acts 122 C4"4E4 PAAA67 A4 P1e""2<ANN7 U4 S/A&U"3< "e$elopin! the Southern African "e$elop#ent Co##unity 2pide#iolo!y Net)or on "ru! 8se9 #ethods and issues4 0ulletin on Narcotics7 $ol4 1(7 Nos4 1 and 27 200 p! L1-L2 123 Protocol on co#batin! illicit dru! traffic in! in the Southern African "e$elop#ent Co##unity

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

8ndisclosed cannabis pro$isions )ithin the treaties
O"ru! Juse= is not #entioned in the penal pro$isions of the Sin!le Con$ention Barticle 3GC and the 1LI1 Con$ention Barticle 22C or in article 3 B3ffences and SanctionsC of the 1LKK Con$ention4 /his relates firstly to the fact that the treaties do not re;uire countries to Jprohibit= any of the listed substances the#sel$es4

>6he parties shall not per"it the possession of drugs e$cept under legal authorityC 12D

12D

8N3"C7 A Century of &nternational "ru! Control4

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

/here is a !ro)in! body of e$idence that not only su!!ests7 but addresses the fact that certain 84N <e#bers States ha$e been operatin! successfully )ithin the current 8nited Nations treaty fra#e)or and has been reported on e>tensi$ely by the science co##unity4 /)enty-si> A#erican state le!islatures ha$e decri#inalised cannabis to so#e e>tent4 Countries )ho ha$e follo)ed the sa#e route of decri#inalisation include Canada7 Ar!entina7 Costa Aica7 2cuador7 <e>ico7 Peru7 8ru!uay7 Great 0ritain7 /he Netherlands7 1u>e#bur!7 0el!iu#7 S)it5erland7 Portu!al7 &taly7 Spain7 2stonia7 Croatia7 C5ech Aepublic7 Ao#ania7 and Australia4 Aefor#in! "ru! Control9 2011 represents the F0th anni$ersary of the 1LG1 8N Sin!le Con$ention on Narcotic "ru!s7 )hich stands at the centre of the prohibitionist approach4 No) is the perfect ti#e to discuss ho) the 8N Con$entions can be a#ended to !i$e si!natory countries the freedo# to e>peri#ent )ith policies best suited to their special needs4 12F 3n Au!ust 2L7 2013 Ua#es <4 Cole7 8nited States "eputy Attorney General7 published a #e#orandu# for all 8nited States Attorneys readdressin! federal la) enforce#ent resources entitled RGuidance Ae!ardin! Cannabis 2nforce#entR that is intended solely as a !uide to the e>ercise of in$esti!ati$e and prosecutorial discretion4 Cole )ent further to say7 O/he "epart#ent is co##itted to usin! its li#ited in$esti!ati$e and prosecutorial resource to address the #ost si!nificant threats in the #ost effecti$e7 consistent7 and rational )ay4 &n furtherance of those obTecti$es7 as se$eral states enacted la)s relatin! to the use of cannabis for #edical purposes7 the "epart#ent in recent years has focused its efforts on certain enforce#ent priorities that are particularly i#portant to the federal !o$ern#ent4P
12G

With A#erica leadin! the )ay in state le$el decri#inalisation7 #edical and full recreational le!alisation7 the 8N is !ro)in! e$er #ore concerned )ith such #o#entous e$ents out of its le!al control and ha$e protested a!ainst such local #easures4 At the fifty-si>th session of the Co##ission on Narcotic "ru!s it )as stressed by the President of the &nternational Narcotics Control 0oard B&NC0C7 Aay#ond 6ans7 that the #o$e O)ould be a $iolation of international la)7 na#ely the 8nited Nations Sin!le Con$ention on Narcotic "ru!s of 1LG17 to )hich the 8nited States is party4P
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12F 12G

0ec ley +oundation - /he Global &nitiati$e for "ru! Policy Aefor# Ae)ritin! the 8N dru! con$entions4 2012 8SA "eputy General - Guidance Ae!ardin! Cannabis 2nforce#ent 12I 8nited Nations &nfor#ation Ser$ice7 O&NC0 President calls on the 8nited States Go$ern#ent to address initiati$es ai#ed at per#ittin! recreational dru! useP7 1D <ar 2013

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

/he &NC0 is #andated to #onitor the i#ple#entation of the three international dru! control con$entions4 6ans )ent on to state that Othe 8nited States has a treaty obli!ation to ensure the i#ple#entation of the treaties on the entirety of its territory4P
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2stablished dru! con$entions and national la) hold e;ual status4 3n the principle that the Jlast in ti#e= Bi4e4 the last la) si!ned chan!es all pre$ious la)sC applies7 national le!islation in the 8S can therefore in$alidate a co##it#ent in international la)4 "ependin! on their constitutional situation7 this #ay also be possible for other countries4

3P/&3NS +3A A2+3A<
Hro" the 9eckley Houndation - #ewriting the 5N drug con)entions. %71% 12L /he present international treaties ha$e inhibited depenalisation and pre$ented #ore thorou!h!oin! refor#s of national cannabis re!i#es4 Policies )hich do !o beyond depenalisation or decri#inalisation ha$e been characterised by inconsistencies and parado>es4 +or e>a#ple7 the "utch coffee shops #ay sell cannabis products throu!h the front door7 but are not supposed to buy their supplies at the bac door4130 % hat which is prohibited cannot be regulated&$ /here are thus ad$anta!es for !o$ern#ents in #o$in! to)ard a re!i#e of re!ulated le!al a$ailability under strict controls7 usin! the $ariety of #echanis#s a$ailable to re!ulate a le!al #ar et7 such as ta>ation7 a$ailability controls7 #ini#u# le!al a!e for use and purchase7 labelin! and potency li#its4 Another alternati$e7 )hich #ini#ises the ris of pro#otin! cannabis use7 is to allo) only s#all scale cannabis production for one=s o)n use4131

12K 12L

&bid4 0ec ley +oundation - /he Global &nitiati$e for "ru! Policy Aefor# Ae)ritin! the 8N dru! con$entions4 2012 130 0ec ley +oundation - /he Global &nitiati$e for "ru! Policy Aefor# Ae)ritin! the 8N dru! con$entions4 2012 131 /he 0ec ley +oundation7 /he Global Cannabis Co##ission Conclusions and Aeco##endations

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Aefor#s throu!h ne) international con$entions
A tea# of dru! policy analysts and international la)yers7 led by Professor Aobin Aoo#7 co##issioned by the 0ec ley +oundation7 ha$e been e>a#inin! possible alternati$es to the present situation4 /hese include refor#in! or re)ritin! current con$entions4 /he tea# ha$e de$eloped three pra!#atic options to consider approaches to a#end the con$entions4 /he three alternati$es atte#pt to preser$e the rules and structure of the current treaties in ter#s of international cooperation and controls of the international #ar et7 at the sa#e ti#e open up the options for national !o$ern#ents to i#ple#ent ne) dru! la)s for their indi$idual nation4 A country=s do#estic dru! la) )ould therefore be the responsibility of that country alone4

A series of a#end#ents to the current three 8N Con$entions )hich )ould preser$e both the present treaties= controls on international trade

'ption 1

and the prohibition of do#estic #ar ets7 but e>plicitly state that the decision )hether or not to cri#inalise non-co##ercial dru! possession or use )as for indi$idual nations to deter#ine4 A series of a#end#ents7 incorporatin! those in 3ption 17 but also statin! that it is the nation=s

'ption 2

responsibility to deter#ine )hether or not to establish a re!ulated do#estic #ar et for non-#edical use4 Aeduces the e>tent of international controls on the #ar et and supply for substances co$ered by the 1LG1 Con$ention Bopiu#7 cannabis and the coca leafC to the sa#e le$el as the controls

'ption 3

for substances co$ered by the 1LI1 con$ention Bi4e4 differentiatin! bet)een substances accordin! to their potential har# to public health and their therapeutic $aluesC4

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Possibilities for a ountr5 a tin3 alone
&t is possible for a country to independently refor# its dru! la)s4 +or e>a#ple7 in 2011 0oli$ia recently did so by )ithdra)in! fro# the 1LG1 8N Sin!le Con$ention and then i##ediately resi!nin! it )ith a specific reser$ation in order to re#o$e ille!al status of the coca leaf4 Eo)e$er7 this #o$e has been #et )ith si!nificant international conde#nation and #ay ha$e #aTor repercussions in ter#s of international aid7 )ith countries such as the 8S li ely to be less )illin! to pro$ide financial help to the country4 132

"enunciation and re-accession )ith reser$ations
Withdra)in! fro# a treaty and then i##ediately reToinin! )ith specified reser$ations4 /his has been done on a nu#ber of occasions re!ardin! other treaties and by 0oli$ia re!ardin! the 1LG1 8N Sin!le Con$ention4 /he co##ents of 0oli$ian +orei!n #inister "a$id Cho;uehuanca illustrate the support for this approach7 Oa/hisb is an atte#pt to eep the cultural and inoffensi$e practice of coca che)in! and to respect hu#an ri!hts7 but not Tust of indi!enous people7 because this is an ancient practice of all 0oli$ian peopleP4 /herefore in the 0oli$ian case7 $ast international lobbyin! is ta in! place )ith the 8S tryin! to con$ince other countries not to bac 0oli$ia=s efforts and 0oli$ia tryin! to !ain support for its bid4 /he co##ents of 0oli$ian Con!ress#an <auricio <ufo5 de#onstrate the opposition to such a step7 O&nternationally7 )e=re !i$in! a bad i#pression as a country4 /here )ill be disastrous and irre$ersible conse;uences for 0oli$ia4P 133 +ull national support for the refor# B)hich is often $ery difficult )ith the country=s parlia#ent or con!ressC is often hard to achie$e4

132 133

0ec ley +oundation - /he Global &nitiati$e for "ru! Policy Aefor# Ae)ritin! the 8N dru! con$entions4 2012 <attia Cabit5a7 J0oli$ia to )ithdra) fro# dru!s con$ention o$er co-classification=7 /he Guardian7 23 Uune 2011

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

/he Supra-national basis possibilities
A supranational union is a type of #ulti-national or!anisation )here ne!otiated po)er is dele!ated to an authority by !o$ern#ents of #e#ber states4 /he concept of a supranational union can be used to describe the 287 0A&CS and SA"C413D /he follo)in! are possibilities a$ailable to !roups of countries actin! on a supra-national basis4

"enunciation of the treaties and replace#ent )ith alternati$es
/he countries )ould each announce they are )ithdra)in! fro# the present 8N Con$entions7 but si!n ne) treaties based on 3ption 17 2 or 34 /he ne) treaties could be ne!otiated and si!ned under a body in the 8N syste#7 another international body7 or by the call of a sin!le State4 /he 1LG17 1LI1 and 1LKK Con$entions in their present for# )ould continue to be in force for those parties )ho had not Toined in the )ithdra)in! !roup of countries4 Cons9 /here )ould be a need for ne!otiation re!ardin! ho) to coordinate actions under the t)o sets of treaties4

Adoptin! ne) alternati$e treaties
Countries )ishin! to do so could si#ply adopt ne) treaties7 )ithout denouncin! the e>istin! treaties Bany of 3ptions 17 2 or 3 could be adoptedC4 /hose countries si!nin! the ne) treaty )ould re#ain obli!ed to follo) the la)s:pro$isions of the 1LG17 1LI1 and 1LKK con$entions Be!4 in ter#s of international trade and cooperationC7 to )hich they )ould still be parties7 )ith respect to their relationships )ith countries )hich )ere not parties to the ne) treaty4 /his path )ould be less directly confrontational to the international syste# than possibility $ Bsee abo$eC With respect to the chan!ed pro$isions7 on do#estic la)s on possession and use7 and also potentially on a re!ulated do#estic #ar et7 the Olast in ti#eP rule )ould be e>pected to apply7 both in their do#estic affairs7 and in the relations bet)een countries ratifyin! the ne) treaty4 Cons9 A strate!y of addin! a ne) con$ention on top of the e>istin! ones is li ely to attract so#e contro$ersy7 )ith $arious countries ar!uin! that ha$in! t)o se#i-contrastin! sets of dru! la)s under#ines the ori!inals4

13D

Wi ipedia4or! - Supranational 8nion

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

A ne) sin!le con$ention
&t is no) )idely a!reed that the !reatest har# to public health fro# psychoacti$e substances co#es fro# t)o substances7 tobacco and alcohol7 )hich are not included in the international dru! con$entions4 Co#parin! substances on the basis of har#s associated )ith hea$y use7 alcohol and tobacco are a#on! the #ost har#ful4 &n spite of this7 there is no current international treaty on alcohol4 Cons9 Eea$y lobbyin! fro# tobacco and alcohol co#panies li ely4 Perhaps it is ti#e for a ne) Sin!le Con$ention )hich pulls to!ether into a sin!le international control re!i#e the #aTor psychoacti$e substances4

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

&#portant ey principles )hen draftin! a ne) Sin!le Con$ention
14 Countries should be encoura!ed to set up re!ulatory re!i#es controllin! co##ercial production and sale of psychoacti$e substances7 in order to li#it health and social har#s fro# use of the substances4 Ae!ulatin! substances enables the control o$er in!redients and percenta!es7 #uch in the sa#e )ay as alcoholic drin s and the infor#ation of purity7 stren!th and in!redients on the pac a!in!4 "ecisions re!ardin! the for# and content of the re!i#e for a particular substance are ta en at national or sub-national:pro$incial le$el7 and the prohibition of production and sale of the substance is an option4 24 3ther countries should be re;uired to respect national decisions about the do#estic #ar et for a particular psychoacti$e substance7 includin! forbiddin! co##ercial e>port to a country )here sale of the substance is prohibited7 and re;uirin! that a country=s ad$ertisin! or pro#otion restrictions on a psychoacti$e substance be respected by #edia directed across borders4 34 An international o$ersi!ht a!ency )ould ha$e the tas s of #onitorin! production and trade in psychoacti$e substances7 patterns of use !lobally and coordinatin! international action to #ini#ise health and social har#s4 D4 Consideration should be !i$en to )hether local custo#ary production and use of traditional substances7 e4!4 hat7 coca lea$es7 cannabis lea$es7 should be e>cluded fro# the scope of the con$ention4 F4 /he treaty should include a $ariety of soft-la) reco##endations concernin! the re!ulation of do#estic #ar ets7 includin! reco##endations on prescription re!i#es7 ;uality and labellin! controls7 state licensin! and enforce#ent #echanis#s7 ta> re!i#es7 restrictions on a$ailability7 and controls on ad$ertisin! and pro#otion4 /he abo$e discussion de#onstrates that there are possible and Jpolitically acceptable= alternati$es to the present syste# of dru! control4 A debate o$er con$ention refor#s or re)rites is an effecti$e entry into the topic of dru! policy alternati$es fro# the position of )hat can be done at the international le$el4

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

T&* C&AN0+N0 +NT*%NAT+'NA" "AN,SCAP*
Q he 'ar on Drugs has failedR
Global Co""ission #eport on Frugs 4olicy! 1une %711.13F /he report su!!ested that the current !lobal approach of prohibitin! dru!s and punishin! indi$idual dru! users is not only ineffecti$e in addressin! and lessenin! the dru! proble#7 but also e>acerbates the burden that dru! abuse places on society4 &t ad$ocated a public health7 hu#an ri!hts-based approach to the dru! proble# rather than a puniti$e one7 as )ell as the decri#inalisation of indi$idual dru! use )ithin certain para#eters413G

13F 13G

Global Co##ission on "ru!s Policy4 Aeport of the Global Co##ission on "ru! Policy4 Uune 20114 /he J)ar on dru!s= has failed9 &s decri#inalisation of dru! use a solution to the proble# in South AfricaQ South African Uournal of 0ioethics and 1a) (ol F7 No 2 B2012C

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

1eaders fro# $arious South A#erican countries called for an end to the )ar on dru!s and called on the 8nited Nations to lead a !lobal debate o$er a less RprohibitionistR approach to dru!s4 13I A do5en 1atin A#erican countries issued a Toint state#ent on or!anised cri#e and dru! traffic in! Bhere is the ori!inal Spanish te>t on the <e>ican Go$ern#ent )ebsiteC4 Point I is translated here9 OWhat would be desirable! would be a significant reduction in the de"and for illegal drugs. Ne)ertheless! if that is not possible! as recent e$perience de"onstrates! the authorities of the consu"ing countries ought then to e$plore the possible alternati)es to eli"inate the e$orbitant profits of the cri"inals! including regulatory or "arket oriented options to this end.P13K +our for#er Canadian Attorney Generals note in a letter9
13L

@6he case de"onstrating the failure and har"s of AcannabisB prohibition is airtight. 6he e)idenceM 3assi)e profits for organi0ed cri"e! widespread gang )iolence! easy access to illegal cannabis for our youth! reduced co""unity safety! and significant costs to ta$payers.C /hey propose Cannabis ta>ation and re!ulation as a strate!y to co#bat or!anised cri#e4 /he 8nited States !o$ern#ent too a historic step bac fro# its lon!-runnin! dru! )ar on /hursday7 )hen "eputy Attorney General Ua#es <4 Cole infor#ed the !o$ernors of Washin!ton and Colorado that the "epart#ent of Uustice )ould allo) the states to create a re!i#e that )ould re!ulate and i#ple#ent the ballot initiati$es that le!alised the use of acannabisb for adults4 1D0 /he #ost recent Gallup poll sho)s A#ericans see cannabis le!alisation4 1D1 and escalating

13I 13K

8S-led R)ar on dru!sR ;uestioned at 84N4 - Aeuters 2G Sep 2012 Uoint State#ent on 3r!ani5ed Cri#e and Narcotics F "ec 2011 13L 0C Attorney Generals Cannabis ta>ation and re!ulation as a strate!y to co#bat or!ani5ed cri#e - 1F +eb 2012 1D0 8SA Attorney General Says "3U Will 1et - Washin!ton7 Colorado <ariTuana 1a)s Go &nto 2ffect - Euffin!tonpost 2L Au! 2013 1D1 +or +irst /i#e7 A#ericans +a$or 1e!ali5in! <ariTuana - Gallup 22 3ct 2013

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

T+-*"+N* !'% %*!'%Prohibition is a !lobal pheno#enon7 operatin! under the three 8N dru! con$entions B1LG17 1LI17 and 1LKKC that enshrine cri#inal sanctions for the production7 supply and Juse= of certain dru!s into the do#estic la) of o$er 1F0 countries and territories4 As this section illustrates7 the dru! policy refor# #o$e#ent is also a !lobal pheno#enon7 )ith countries increasin!ly adoptin! the #ore pra!#atic har# reduction paradi!# and adaptin! policy and le!islation accordin!ly4 &t is a )elco#e si!n that !lobal prohibition has passed its hi!h tide #ar and is no) on the retreat7 and pro$ides a !ro)in! body of e$idence to infor# the refor# process4 Such unilateral #o$es are still li ely to incur the )rath of the prohibitionist establish#ent7 not least the po)erful political forces of the 8S and 8N dru! a!encies4 Eo)e$er7 there ha$e been si!nificant #o$es across the )orld to date4

1LLK X 2002
8N sets a#bitious dru! prohibition tar!ets under a 10 year plan )ith the slo!an OA "ru! +ree World X We Can "o tgP

2003 X 200G
As failure beco#es increasin!ly $isible di$isions !ro) bet)een prohibitionist and refor#ist countries h Gro)in! for#al alliance bet)een 2uro #e#ber states on treaty refor#7 )ider !lobal infor#al alliance7 includin! Canada7 Australia7 and South A#erican states h <oratoriu# on aerial fu#i!ation of dru! crops

200I X 2012
h 8N 10 year plan e>pires in failure h Pro!ressi$e countries publicly challen!e the 8N dru! control syste# h 8N treaties beco#e increasin!ly redundant as states sideline 8N dru! a!encies

2013 - 201K
Coalition states redraft treaties to allo) an opt out fro# absolute prohibition and i#ple#entation of re!ulatory #odels for specific dru!s h Widespread international #o$es to)ards re!ulation of #ost dru!s h 0ilateral dru! tradin! a!ree#ents established bet)een refor# states

Global Policy
Chan!e

6able 1

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Global "ru! Policy Chan!e a rapidly chan!in! landscape
200K X 8N 3ffice on "ru!s and Cri#e ac no)led!es for the first ti#e that the dru! )ar is ha$in! #aTor ne!ati$e Qunintended conse:uences.R 1D2 200L X &nfluential 1atin A#erican Co##ission on "ru!s and "e#ocracy report released4 1D3 2010 X Acade#ic research sho)s benefits of Portu!al=s 2001 decri#inalisation of personal possession of all dru!s41DD 2011 X "ru! )ar related deaths in <e>ico since "ec 200G tops F070007 and eeps risin!7 dri$in! the debate for)ard as the failure of President Calderon=s hardline approach beco#es clear4 1DF 2011 X <aTor international i#pact as Global Co##ission on "ru! Policy report by nu#erous international states#en and )o#en calls for decri#inalisation of dru!s7 and e>peri#ents )ith le!al re!ulation41DG 2011 X /)el$e 1atin A#erican countries includin! Colo#bia7 Guate#ala7 <e>ico7 Costa Aica7 2l Sal$ador7 Pana#a7 Niara!ua7 0eli5e7 Eonduras and the "o#inican Aepublic bac ed calls to e>plore le!al re!ulation of dru!s as an option41DI 2012 X Se$eral #e#ber states brea )ith prohibitionist line at the 8N Co##ission on Narcotic "ru!s includin! C5ech Aepublic bac in! the Global Co##ission on "ru! Policy report4 1DK 2012 X Colorado and Washin!ton State $ote to le!ally re!ulate recreational acannabisb production7 supply and use #a in! the# the first places in the )orld to do so4 At the ti#e of publication the 8SA ha$e decri#inalised cannabis possession7 and 2G ha$e #edical acannabisb dispensaries4 1DL 2012 X All countries at the &bero-A#erican Su##it in Cadi5 Bincludin! Spain and Portu!alC call for the 8N to re$ie) !lobal dru! policy41F0

1D2 1D3

8N3"C JWorld Frug #eport 200K=7 chapter 24F 1atin A#erican Co##ission on "ru!s and "e#ocracy7 JFrugs and Fe"ocracyL 6owards a 4aradig" Shift= 200L 1DD "ru! "ecri#inali5ation in Portu!al91essons for Creatin! +air and Successful "ru! Policies 1DF <e>ico?s "ru! War - Center for /he National &nterest Uuly 2012 1DG Global Co##ission on "ru! Policy7 JWar on Frugs #eportR7 2011 1DI 11 current 1atin A#erican leaders call for e>ploration of le!al dru! re!ulation 1DK C5ech Aepublic bac s Global Co##ission report at the 8N 1DL Wi i - <edical Cannabis 8SA 1F0 )))4insi!htcri#e4or! * 8N A!rees to 1atA#?s Calls for "ebate on Global "ru! Policy

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

2012 X /he 8N a!rees to a 8N General Asse#bly Special Session in 201G to re$ie) !lobal dru! policy41F1 2013 X 0oli$ia reToins the 8N "ru! Con$entions )ith a reser$ation #a in! it le!al for the# to !ro) coca leaf7 despite obTections fro# other countries4 1F2 2013 X /he 3D #e#ber 3r!ani5ation of A#erican States publishes an inter-!o$ern#ental report #appin! out a credible positi$e scenario for future le!alisation and re!ulation of so#e dru!s4 1F3 2013 X 8ru!uay beco#es the first country )here the !o$ern#ent introduces a bill to le!ally re!ulate the production and supply of cannabis4 1FD 2013 X S)it5erland A chan!e to the la)7 decri#inalised cannabis7 #a in! possession of the dru! a #inor #isde#eanour that )ill not !o on a person=s cri#inal record4 1FF 2013 X Ao#ania beca#e the 10th 2uropean 8nion nation to le!alise cannabis deri$ati$es4 /he country=s dru! la) )as a#ended to allo) certain cannabis deri$ati$es to be used for specific afflictions7 such as epilepsy and #ultiple sclerosis4 1FG 2013 X Ne) dealand passed /he Psychoacti$e Substances Act4 1e!islation re!ulates the i#portation7 #anufacture and supply of psychoacti$e substances7 )hich are the acti$e in!redients in party pills7 ener!y pills and herbal hi!hs4 Ae!ulatin! psychoacti$e substances )ill help protect the health of7 and #ini#ise har# to7 indi$iduals )ho use these substances4 1FI 2013 X &reland - &ndependent /" 1u e <in! +lana!an recently published his JCannabis Ae!ulation 0ill 20134=1FK 2013 X <oroccan Net)or re!ulation to parlia#ent41FL for the <edical and &ndustrial 8se of Cannabis presents a policy for

1F1

)))4dru!policy4or! * /he 8N General Asse#bly Appro$es Aesolution Presented by <e>ico on &nternational Cooperation A!ainst "ru!s 1F2 2uropean Coalition for Uust and 2ffecti$e "ru! Policies B2NC3"C - 1F Uan 2013 1F3 3r!ani5ation of A#erican States7 J6he Frug 4roble" in the A"ericas Analytical and Scenario #eports= 2013 1FD 8ru!uay 2013 1FF S)it5erland chan!es la) to decri#inalise cannabis possession - 3 3ct 2013 1FG Ao#ania /o Allo) <edicinal 8se 3f <ariTuana "eri$ati$es Euffin!ton Post - F 3ct 2013 1FI <inistry of Eealth - Nd Uuly 2013 1FK &reland Jready for le!alisation of cannabis= - 1D No$ 2013 1FL <orocco Considers 1e!ali5in! Cannabis - 2013

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Ae!ulation and control
/here are #any #odels of re!ulationW dependin! on the substance bein! re!ulated these re!ulations can be $ery loose Bapples7 to#atoesC or $ery strict Balcohol7 tobacco7 prescription dru!sC4 /he alternati$es to the current prohibition are decri#inalisation or re!ulation and control4 1ac of consensus on the issue $ocabulary often creates confusion4 /he issue co##only arises )hen distin!uishin! bet)een decri#inalisation7 le!alisation and re!ulation4 (egulation ) Controls 14 Controls regarding who can legally produce cannabis 24 Controls regarding who can legally distribute cannabis 34 Controls regarding who can legally consu"e cannabis D4 Controls regarding where adults can legally use cannabis and under what circu"stances is such use legally per"itted

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Prohibition ) the absence of controls
6his absence of control .eopardi0es rather than pro"otes public safety. 1G0

Prohibition of a particular dru! #eans that its production7 traffic in!7 supply and possession is
#ade ille!al and is subTect to cri#inal sanctions4 /he policy tends to focus on supply side reduction )ithout properly addressin! access7 de#and and har# reduction #odels4 Accordin! to the 0ec ley +oundation the ille!al status of cannabis does not effecti$ely deter its use4

"e3alisation is a process by )hich the prohibition of a substance is ended and ulti#ately refers to
the process of refor#4 3ften the ter# is #ista enly used to refer to a policy #odel4 /he end-!oal of the le!alisation process )ould be a fra#e)or allo)in! !o$ern#ent control o$er cannabis4

%e3ulation describes !o$ern#ent inter$ention ai#ed to control cannabis )ithin the #ar etplace
and to restrict its production and a$ailability4

,e riminalisation is not clearly defined but can !enerally be understood to refer to re#o$al of
cri#inal penalties for possession of cannabis for personal use4 Culti$ation7 and possession re#ain offences and can be subTect to ci$il and ad#inistrati$e penalties4

1G0

Aeal World Aa#ifications of Cannabis 1e!ali5ation and "ecri#inali5ation

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

*.A-P"*S '! CANNA$+S %*0)"AT+'N
/he follo)in! international e>a#ples of cannabis re!ulation and control e>hibits success-stories )here puniti$e prohibition #easures )ere replaced )ith re!ulated controls4

Higure 11 - Controlling the uncontrollable

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

/he Netherlands
Aetail sale of li#ited ;uantities of cannabis BF !ra#s or lessC is allo)ed in licensed retail outlets for patrons a!e 1K or o$er4 /he <inistry of Eealth also licenses production and distribution of cannabis for ;ualified patrons4 "ata is consistent )ith reports sho)in! that adult cannabis use is no hi!her in the Netherlands than in the 8nited States and is inconsistent )ith the de#and theory that strict la)s and enforce#ent pre$ent adolescent cannabis use4 REur

findings suggest that the Futch syste" of regulated sales has achie)ed a

substantial separation of "arkets. As e$pected! "ost A"sterda" respondents obtained their cannabis in licensed coffee shops! and ,(T reported that they could not purchase other illicit drugs at their source for cannabis.R1G1
Proponents of cri#inalisation attribute their preferred dru!-control re!i#e a special po)er to affect user beha$ior4 /he findin!s cast doubt on such attributions4 "espite )idespread la)ful a$ailability of cannabis in A#sterda#7 there )ere no differences bet)een the 2 cities BA#sterda# and San +ranciscoC in a!e at onset of use7 a!e at first re!ular use7 or a!e at the start of #a>i#u# use4 /he findin!s do not support clai#s that cri#inalisation reduces cannabis use and that decri#inalisation increases cannabis use4R 1G2 /he "utch e>perience pro$ides a #oderate e#pirical case that re#o$al of cri#inal prohibitions on cannabis possession )ill not increase the pre$alence of cannabis or any other dru!4 1G3

1G1 1G2

&nternational Uournal of "ru! Policy7 (olu#e 207 &ssue G7 Pa!es DFF-F2K 200L /he li#ited rele$ance of dru! policy9 cannabis in A#sterda# and in San +rancisco4 P<&"9 1F11II0L 1G3 <acCoun A7 Aeuter P47 0ritish Uournal of Psychiatry7 20014 P<&"9 111FID2F

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Canada7 Ger#any7 &srael
+ederal health depart#ent o$ersees the licensed production and distribution of cannabis to ;ualified patrons4 No e$idence that this li#ited re!ulatory #odel has led to an increase in !eneral cannabis use or attitudes a#on! the public4 R/he data pro$ides no e$idence that strict cannabis la)s in the 8nited States pro$ide protecti$e effects co#pared to the si#ilarly restricti$e but less $i!orously enforced la)s in place in Canada7 and the re!ulated access approach in the Netherlands4R
1GD

1GD

Cross-national co#parison of adolescent drin in! and cannabis use in the 8nited States7 Canada7 and the Netherlands4 P<C2IL0FD1

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Cannabis decri#inalisation and its i#pact on use
Aeal-)orld e>a#ples of cannabis decri#inalisation re#o$es the threat of arrest for the personal possession or culti$ation of cannabis7 but #aintainin! prohibitions on co##ercial culti$ation and retail sale4

2urope
Portu!al decri#inalised use of all dru!s in 20014 3fficials )ere careful to ensure that the ne) policy re#ained )ithin the J#ainstrea# of international dru! policy= and that7 utilisin! the e>istin! fle>ibility )ithin the con$entions7 they did not brea the letter of the la)4 /he ne) National Strate!y docu#ent declared that it )as consistent )ith the pro$isions of the 1LKK Con$ention in adoptin! the strate!ic option of decri#inalisin! dru! use as )ell as possession and purchase for this use4 1GF +ollo)in! decri#inalisation7 Portu!al had the lo)est rate of lifeti#e cannabis use in people o$er 1F in the 284 /he 8S has lon! cha#pioned a hard-line dru! policy7 supportin! only international a!ree#ents that enforce dru! prohibition and i#posin! on its citi5ens so#e of the )orld?s harshest penalties for dru! possession and sales4 6et A#erica has the hi!hest rates of cocaine and cannabis use in the )orld7 and )hile #ost of the 28 has #ore liberal dru! la)s than the 8S7 it also has less dru! use4 1GG Globally7 dru! use is not distributed e$enly7 and is si#ply not related to dru! policy4 /he 8S stands out )ith hi!her le$els of use of alcohol7 cocaine7 and cannabis7 despite puniti$e ille!al dru! policies4 /he Netherlands7 )ith a less cri#inally puniti$e approach to cannabis use than the 8S7 has e>perienced lo)er le$els of use7 particularly a#on! youn!er adults4 Clearly7 by itself7 a puniti$e policy to)ards possession and use accounts for li#ited $ariation in national rates of ille!al dru! use4 1GI /his paper has sho)n that decri#inalisation does not result in lo)er prices and hi!her consu#ption rates7 nor in #ore se$ere patterns of cannabis use7 and that cri#inalisation #ay reduce the le!iti#acy of the Tudicial syste#41GK While the "utch case and other analo!ies ha$e fla)s7 they appear to con$er!e in su!!estin! that reductions in cri#inal penalties ha$e li#ited effects on dru! use7 at least for cannabis4 1GL

1GF 1GG

0ec ley +oundation - /he Global &nitiati$e for "ru! Policy Aefor# Ae)ritin! the 8N dru! con$entions4 2012 /i#e * <aia S5ala$it5 * "ru!s in Portu!al9 "id "ecri#inali5ation Wor Q * 2G Apr 200L4 1GI /o)ard a Global (ie) of Alcohol7 /obacco7 Cannabis7 and Cocaine 8se9 +indin!s fro# the WE3 World <ental Eealth Sur$eys4 P1oS <ed FBIC9 e1D14 doi910413I1:Tournal4p#ed400F01D1 1GK Wi# $an den 0rin 4 +oru#9 "ecri#inali5ation of cannabis4 Current 3pinion in Psychiatry 200K7 219122X12G 1GL 6$onne <4 /erry-<c2lrath7 Patric <4 3?<alley7 1loyd "4 Uohnston7 Sayin! No to <ariTuana9 Why A#erican 6outh Aeport Vuittin! or Abstainin! U4 Stud4 Alcohol "ru!s GL9 ILG-K0F 200K

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Australia
/here is no e$idence to date that the Be>piation : decri#inalisationC syste# has increased le$els of re!ular cannabis use or rates of e>peri#entation a#on! youn! adults4 /hese results are broadly in accord )ith our earlier analysis of trends in cannabis use in Australia4 /hey are also consistent )ith the results of si#ilar analysis in the 8nited States and the Netherlands4 1I0

Great 0ritain
Cannabis use a#on! youn! people has fallen si!nificantly since its contro$ersial reclassification in 200D7 accordin! to the latest 0ritish Cri#e Sur$ey fi!ures published today4 /he Eo#e 3ffice fi!ures sho)ed the proportion of 1G to 2D-year-olds )ho had used cannabis in the past year fell fro# 2F\ )hen the chan!e in the la) )as introduced to 21\ in 200G:0I4 1I1

"ecri#inalisation in the 8nited States
/here is little e$idence that decri#inalisation of cannabis use necessarily leads to a substantial increase in use41I2 /he a$ailable e$idence indicates that the decri#inalisation of cannabis possession had little or no i#pact on rates of use4 Althou!h rates of cannabis use increased in those 8S states that reduced #a>i#u# penalties for possession to a fine7 the pre$alence of use increased at si#ilar or hi!her rates in those states that retained #ore se$ere penalties4 /here )ere also no discernible i#pacts on the health care syste#s4 3n the other hand7 the so-called ?decri#inalisation? #easures did result in substantial sa$in!s in the cri#inal Tustice syste#4 1I3 3$erall7 the preponderance of the e$idence )hich )e ha$e !athered and e>a#ined points to the conclusion that decri#inalisation has had $irtually no effect either on the cannabis use or on related attitudes and beliefs about cannabis use a#on! A#erican youn! people4 /he data sho)s no e$idence of any increase7 relati$e to the control states7 in the proportion of the a!e !roup )ho e$er tried cannabis4 &n fact7 both !roups of e>peri#ental states sho)ed a s#all7 cu#ulati$e net decline in annual pre$alence after decri#inalisation41ID

1I0

"onnelly et al7 <ffects of the Cannabis <$piation Notice Sche"e on =e)els and 4atterns of Cannabis use in South AustraliaL <)idence fro" the National Frug Strategy /ousehold Sur)eys 18,(-188(7 1LLK4 1I1 /he Guardian * +e)er youn! people usin! cannabis after reclassification 2F 3ct 200I 1I2 <AA&U8ANA AN" <2"&C&N2 Assessin! the Science 0ase Uanet 24 Uoy7 Stanley U4 Watson7 Ur47 and Uohn A4 0enson7 Ur47 2ditors "i$ision of Neuroscience and 0eha$ioral Eealth &NS/&/8/2 3+ <2"&C&N2 1I3 Sin!le4 /he i#pact of #ariTuana decri#inali5ation9 an update4 Uournal of Public Eealth 109 DFG-DGG4 1LKL4 1ID Cited NE#3=.orgL Uohnson et al4 3ari.uana decri"inali0ationL the i"pact on youth 18+(-18,74 <onitorin! the +uture7 3ccasional Paper Series9 &nstitute for Social Aesearch7 8ni$ersity of <ichi!an9 Ann Arbor4 1LK14

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

(%* States at ti"e of going to print) <ore than a decade after the passa!e of the nation?s first state #edical cannabis la)7 California?s Prop4 21F7 a considerable body of data sho)s that no state )ith a #edical cannabis la) has e>perienced an increase in youth cannabis use since its la)=s enact#ent4 All states ha$e reported o$erall decreases X e>ceedin! F0\ in so#e a!e !roups X stron!ly su!!estin! that the enact#ent of state #edical cannabis la)s does not increase cannabis use4 &n$esti!ators at the /e>as A,< Eealth Science Center also assessed )hether the passa!e of #edical cannabis la)s encoura!es !reater recreational use4 /hey too found7 definiti$ely7 that it does not4 O3ur results indicate that the introduction of #edical cannabis la)s )as not associated )ith an increase in cannabis use a#on! either arrestees or e#er!ency depart#ent patients in cities and #etropolitan areas located in four states in the 8SA BCalifornia7 Colorado7 3re!on7 and Washin!tonC4 Consistent )ith other studies of the liberalisation of cannabis la)s7 #edical cannabis la)s do not appear to increase use of the dru!4P 1IF

<edical Cannabis 8SA

1o)est la) enforce#ent priority B112PC A de-prioritisation
<any states and localities ha$e either decri#inalised cannabis or de-prioritised the enforce#ent of cannabis la)s4 /here is no e$idence that the decri#inalisation of cannabis by certain states or the de-prioritisation of cannabis enforce#ent in #unicipalities caused an increase in cannabis use or related proble#s4 /his conclusion is consistent )ith the findin!s of nu#erous studies indicatin! that the increasin! enforce#ent of cannabis la)s has little i#pact on cannabis use rates and that the decri#inalisation of cannabis in 8S states and else)here did not increase cannabis use4 1IG &f anythin!7 it could be ar!ued that the 8S has beco#e the unli ely !lobal leader for dru! policy refor# X at least re!ardin! cannabis7 a reality bolstered by the fact that a #aTority of the 8S population no) bac cannabis le!alisation41II

1IF 1IG

"o #edical cannabis la)s encoura!e cannabis useQ &nt U "ru! Policy4 200I <ayW1KB3C91G0-I4 2pub 200G No$ 1F4 0ec ett:AC187 /E2 C3NS2V82NC2S AN" C3S/S 3+ <AA&U8ANA PA3E&0&/&3N 200L 1II )))4!allup4co# * Gallup 2013 Cannabis Poll

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Spanish Cannabis Clubs
Spain=s hundreds of Ocannabis clubsP ta e ad$anta!e of the country=s decri#inalisation policy allo)in! t)o-plants for personal use4 /he pooled allo)ances of club #e#bers are collecti$ely !ro)n by the club or!anisers7 and used to supply the club $enues )hich sell the cannabis to #e#bers at around half the price char!ed by the cri#inal #ar et4 /he clubs operate on a not-for-profit basis4 0y usin! the decri#inalisation policy to !et around the ban on production7 the Spanish clubs ha$e de#onstrated ho) cri#inality can potentially be re#o$ed fro# the #ar et co#pletely X )hile #aintainin! an acceptably self-contained and re!ulated production and supply #odel4 Eo)e$er7 the clubs= non-profit ethos is no) bein! challen!ed by entrepreneurs enterin! the scene7 atte#ptin! to !ain financially fro# the loophole4 /his has the potential to under#ine so#e of the syste#=s benefits and at the sa#e ti#e hi!hli!hts the ris of co##ercialisation4
1IK

North Morea
/he !ro)th7 sale and consu#ption of cannabis is not re!ulated by the North Morean !o$ern#ent or classified as a dru!41IL

1IK 1IL

0arriuso7 <4 JCannabis social clubs in Spain. A nor"ali0ing alternati)e underway=7 2011 Cited Wikipedia.orgL "ru! 8sers +ace +irin! S;uad * 0enTa#in A4 6oun! B1F Uanuary 2013C4 RS/A8GG12 &S /E2 2N2<67 W22" &S /E2 A2<2"69 /E2 /A8/E A038/ <AA&U8ANA &N N3A/E M3A2AR4 NMNe)s4or!4 Aetrie$ed 1K Uanuary 20134

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2>istin! Possibilities With the Current 8N /reaties
Within the 8N treaty fra#e)or 7 parties to the con$entions are afforded a certain de!ree of latitude in the for#ulation of national dru! control policies4 /he con$entions are not self-e>ecutin!7 thereby constitutin! a syste# of indirect control4 /hat is to say that )hile they i#pose obli!ations on states to apply international la)7 their pro$isions are not directly or i##ediately applicable fro# the international treaty nor therefore enforceable by a 8N body4 Aather7 states the#sel$es #ust first incorporate treaty pro$isions )ithin do#estic la)4 /his le!al reality co#bines )ith t)o other i#portant and co#ple#entary factors to !enerate a certain a#ount of do#estic policy space )ithin the prohibiti$e para#eters of the treaty fra#e)or 4 1K0

1K0

/ransnational institute "a$e 0e)ley-/aylor and <artin Uels#a - 1i#its of 1atitude - Series on 1e!islati$e Aefor# of "ru! Policies N r 1K <arch 2012

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&A%- %*,)CT+'N
3nly in a cli#ate in )hich cannabis is $ie)ed fro# a public health perspecti$e7 instead of a cri#inal Tustice perspecti$e7 can pre$ention efforts be effecti$e4 0y pro$idin!7 creatin! or allo)in! a le!ally controlled #ar et for safe7 reliable and affordable access of cannabis7 to already e>istin! consu#ers7 allo)s for basic consu#er ri!hts and protections to ensue4 6he 18,, Con)ention introduced the pro)ision to allow health or social ser)ices Qas alternati)es to con)iction or punish"entR for offences of a "inor nature! not only in cases where the offender is dependent on drugs! but for anyone in)ol)ed in "inor drug offences. 6he 18,, Con)ention specifies what constitutes a Q"inor offenceR by listing a nu"ber of aggra)ating circu"stances in article & U(! such as the use of )iolence or ar"s! in)ol)e"ent in organi0ed cri"e! recidi)is"! offender holding a public office! in)ol)e"ent of "inors! offending in penal institutions or in the pro$i"ity of schools. Absence of those factors in culti)ation! production and trafficking offences! and any personal consu"ption related offences! would fall under the category of "inor offences.1K1

1K1

8N&/2" NA/&3NS C3N(2N/&3N AGA&NS/ &11&C&/ /AA++&C &N NAAC3/&C "A8GS AN" PS6CE3/A3P&C S80S/ANC2S7 1LKK

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SA!* ACC*SS
1i e #ost consu#ers7 cannabis users see passa!es of safe access to ensure the least a#ount of har# bein! caused by bad culti$ation practices )hich could lead to #ouldy #aterial and fun!al infections4 2n$iron#ental factors such as bad herbicidal practices increases the ris s associated )ith consu#ption of blac #ar et cannabis4 Ae!ulatin! sale )ith re;uire#ent of identification and controlled purchase en$iron#ents7 restricts access to under a!e usea!e and re#o$es the e>posure to blac #ar et dealers )ho deal in $arious illicit dru!s4 A lac of control and enforce#ent of unifor# production standards increases the ris s associated )ith procure#ent of cannabis4 2nsurin! ;uality of the product and allo)in! en$iron#ents that is dedicated to safe consu#ption7 ;ualifies as a har# reduction approach in li!ht of the current har#s cannabis consu#ers face in South Africa4

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A costNbenefit analysis of cannabis
As <ilton +ried#an and o$er F00 econo#ists ha$e no) said7 Oit=s ti#e for a serious debate about )hether acannabisb prohibition #a es any sense4P
1K2

Aeplacin! acannabisb prohibition )ith a syste# of ta>ation and re!ulation si#ilar to that used for alcoholic be$era!es )ould produce co#bined sa$in!s and ta> re$enues of bet)een i10 billion and i1D billion per year in the 8SA7 finds a Uune 200F report by "r4 Ueffrey <iron7 $isitin! professor of econo#ics at Ear$ard 8ni$ersity4 /he report has been endorsed by #ore than F30 distin!uished econo#ists7 )ho ha$e si!ned an open letter to President 0ush and other public officials callin! for Oan open and honest debate about acannabisb prohibition7P addin!7 OWe belie$e such a debate )ill fa$or a re!i#e in )hich acannabisb is le!al but ta>ed and re!ulated li e other !oods4P Chief a#on! the endorsin! econo#ists are three Nobel 1aureates in econo#ics9 "r4 <ilton +ried#an of the Eoo$er &nstitute7 "r4 Geor!e A erlof of the 8ni$ersity of California at 0er eley7 and "r4 (ernon S#ith of Geor!e41K3 "ue to the lac of e$idence to base accurate esti#ates7 )e are sho)in! another country=s e>a#ple4 Althou!h dru! usa!e differs fro# country to country and )ithin specific culturesW research perfor#ed sho)s co#parable dru! usa!e across countries4

1K2 1K3

)))4prohibitioncosts4or! - /he 0ud!etary &#plications of <ariTuana Prohibition <ilton +ried#an7 F00j 2cono#ists Call for <ariTuana Ae!ulation "ebate - Uune 200F

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

S')T& A!%+CAN S)PP'%T !'% %*!'%S S S S S S S S S S S S S S S S S S Professor +rances A#es - "r7 Neurolo!ist and researcher 1KD "r Gre! <cCarthy7 re!istrar (al enbur! Eospital Cape /o)n 1KF Eelen Su5#an - <P and Eu#an Ai!hts (eteran 1KG "r <ar Gill#an - SA 0rain Aesearch &nstitute BSabriC 1KI "r 2li5abeth Grobler - Consultin! Cri#inolo!ist 1KK P3PCA8 - Police and Prisons Ci$il Ai!hts 8nion 1KL "A UP $an Nie er - South African <edical Uournal BSA<UC 1L0 /he#bu Min! 0uyele haya d)eliban5i "alindyebo 1L1 Gareth Ne)ha# - Eead of the &nstitute for Security Studies= cri#e and Tustice pro!ra##e1L2 Anti-"ru! Alliance of South Africa BA"ASAC 1L3 Statistics SA - &lle!al B0lac <ar etC Cannabis and Prostitution re$enue added to G"P 1LD CA1 Co##ission - for the pro#otion and protection of the ri!hts of cultural7 reli!ious , lin!uistic co##unities41LF <abonen! - 1oo in! to le!alise da!!a in do)nto)n Uo5i 1LG N3A<1 dA BNational 3r!anisation for Aefor# of <ariTuana 1a)s South AfricaC 1LI &nternAfrica - NG3 educatin! sustainability )ith Cannabric Eousin! 1LK Peaceful Public Protest- Callin! for the le!alisation of Cannabis 20027 20037 200D7 200F7 20127 2013 1LL 200 Uere#y Acton - /he "a!!a Party of South Africa201 /he "a!!a Couple - Cannabis re-le!alisation Petition
202

See Anne$ure & for a detailed international reference list of cannabis refor" supporters.
1KD 1KF

iol4co45a * Uudith Soal7 O1e!alise it no)7 say )orld da!!a s#o ersP7 Should doctors be dealin! in da!!a 1KG "a!!a cri#e lin fails to i#press Su5#an 1KI ?Aeap the benefits of da!!a7? state told 1KK 1e!alisin! dru!s in the spotli!ht 1KL "a!!a should be le!alised9 Popcru 1L0 /i#e to decri#inalise dru!sQ 1L1 <y )eed-s#o in! should not surprise you7 says Aba/he#bu in! 1L2 SA plan calls for study on le!alisin! da!!a 1L3 Anti "ru! Alliance SA 1LD Stats SA includes cannabis in G"P 1LF Cultural Aeli!ious 1in!uistic Co##ission - Aasta 1LG eNCA 1oo in! to le!alise da!!a in do)nto)n Uo5i 1LI N3A<14or!45a 1LK &nternAfrica4or! - Cannabric housin! 1LL Cape Canna +est 200 <archers call for le!al da!!a 201 )))4da!!aparty4or! 202 )))4petition4da!!acouple4co45a

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

C'NC")S+'N
Cannabis has been utilised $irtually throu!hout hu#an history4 2$idence supports clai#s of cannabis bein! consu#ed freely in South Africa before the arri$al of the "utch colonists4 &ssues arose in the late 1Lth century as concerns !re) o$er increased contact bet)een colonists and local populations4 /hese concerns beca#e increasin!ly political in nature and resulted in #easures O#a in! the Jnon-)hite= population of use to the colonists4P
203

0y $irtue of its roots in colonialis# the Apartheid re!i#e retained the racialised foundation of cannabis prohibition4 /he#es of discussion ha$e not de$iated #uch fro# the past and ser$ed to #aintain the racial hierarchy inherent to Apartheid4 /hrou!h stren!thened social control7 resistance to prohibition beca#e identified )ith resistance to authority and subse;uently lead to pro!ressi$e increase in the se$erity of penalties4 /he pre#ise of early prohibition plays an i#portant role re!ardin! the failure of the later )ar on dru!s4 &t fra#es the se!re!ated societal bac drop in )hich cannabis )as prohibited and sets a sensiti$e #ood for surroundin! ar!u#ents4 Apartheid still fuels the e#otional nature of current debates4 +or debates to #o$e for)ard7 prohibition needs to be $ie)ed )ithin the !reater sche#e of prohibition4 /he )ar on dru!s has failed to achie$e its obTecti$es )ith far reachin! secondary conse;uences4 /he har# caused by prohibition out)ei!hs the har# that current policy ai#s to pre$ent4 <any co##unities are faced )ith the ad$erse effects of substance abuse7 includin! corruption7 !an!steris#7 sti!#atisation7 po$erty and poor public health ser$ice4 2nforce#ent approaches focused on supply-reduction !eo!raphically decentralise the blac #ar et supply of cannabis by shiftin! it to less enforced areas4 Supply and de#and are not si!nificantly reduced by sin!le si!hted strate!ies4 2$en lar!e-scale sei5ures of cannabis and related price increases fail to ha$e any #easurable i#pact on the supply chain4 A lar!e body of e$idence supports therapeutic applications of cannabis in #any circu#stances and has lead to the de$elop#ent of #edically re!ulated sche#es in so#e Turisdictions4 <odern case studies7 Bincludin! the disco$ery of the 2ndocannabinoid Syste#C pro$ide platfor#s for updated research #ethods and Tustify further studies4

203

Paterson7 Crai! B200LC 4rohibition P resistance L a socio-political e$ploration of the changing dyna"ics of the southern African cannabis trade! c. 1,(7 - the present. <asters thesis7 Ahodes 8ni$ersity4 p 11K4

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Aside fro# therapeutic applications7 the industrial applications of cannabis need thorou!h in$esti!ation to deter#ine the scope of their $iability in South Africa4 /his in$esti!ation should ta e into account all the botanical7 procedural and econo#ic constituents associated )ith industrial cannabis and especially allo) for close scrutiny on all research conducted4 /he international consensus has chan!ed considerably o$er the past fe) years )ith e>a#ples of refor# illustrated by Portu!al7 Spain7 Colorado7 Washin!ton7 8ru!uay and Ne) dealand4 Support for policy refor# is a$ailable fro# local and international or!anisations specialisin! in the field4 Ae!ulation #easures already put in place sho) a !ro)in! #o$e to chan!e current dru! policy on a !lobal scale4 A#ple precedents ser$e as !uidin! principles on )hich to base refor#s4 /he e#otional nature of the debate fre;uently causes polarisation by pittin! one side a!ainst the other4 "iscussions fre;uently re$ol$e around the stance that so#eone is either for7 or a!ainst prohibition4 2stablishin! co##on !round )ill be an i#portant part of chan!in! the dyna#ic of discussions and creatin! a platfor# for debate4 8ni$ersal !oals such as reducin! the har# of substance abuse and protectin! the youth can be dri$in! factors in the process4 2ffecti$e en!a!e#ent re;uires collaboration bet)een the pri$ate and public sector to reach an infor#ed decision4 Atte#pts should be #ade to Tustify ar!u#ents rather than !arnerin! support for the#4 A ne) perspecti$e can be dra)n fro# this Cannabis Position Paper of 2013 )ithin South Africa4 &t is reco##ended that e>istin! policy be re$ie)ed and then refor#ed4 /he participation of the public is $ital in ensurin! the transparency of the process4

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

A$')T T&* A)T&'%S
Andr% du Plessis
director of ?nternAfrica.org7 an NG3 that reports on the hu#an settle#ent crisis in the Western Cape7 educatin! the public about the proble# and offerin! a solution9 ho#es #ade fro# cannabric s4 Ee su!!ests that industrial cannabis used in construction addresses rural po$erty and urban housin! bac lo! in a syner!istic #anner4 Eis a!ricultural e>perience e>tends fro# !ro)in! banana=s in &srael throu!h industrial cannabis to #edical cannabis4 Ee has follo)ed the cannabis trials in South Africa )ith interest and has $isited #any trial sites perfor#ed since 20004

Eis cannabis e>perience and research spans 1F years7 and has )or ed in the #edical cannabis industry in California4 Ee has first hand e>perience of Gilbasto <utlifor#e tu#ors and their treat#ent7 and has been pri$y to in )itro trials of cells bein! treated )ith cannabis in the 8SA4 Ee brin!s international cannabis e>perience and e>posure to the SANCWG4

&#i'l (isser=s

dru! policy refor# career started )hen he sustained a chronic bac inTury after )hich he Toined NE#3= VA B/he National 3r!anisation for Aefor# of <ariTuana 1a)sC in 20104 Ee ad$ocates for the responsible adult use of cannabis and currently ser$es his N3A<1 duties full-ti#e as dA Co##unity 3utreach "irector and 1ead Co-ordinator4 Eis efforts to help raise a)areness on cannabis7 #ore specifically its #edicinal uses7 has seen hi# )al bac )ards at fun)al s7 tal on radio : /(7 or!anise and pro#ote educational screenin!s and has lead hi# to or!anise the African portions of the Global Cannabis <arch in 2012 , 2013 to date4

Al)yn S#it Toined the SANCWG in his capacity as a pri$ate consultant4 Eis co##unication s

ills ha$e pro$en to be helpful in eepin! focus on the #atter at hand4 As an outside consultant he brin!s a fresh perspecti$e to the )or in!s4

Contact the authors9 infoWrefor"s.co.0a

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

ANN*.)%* 1 ? +ndustrial Cannabis
Cannabis has been produced in South Africa for #edical purposes )ith trials and production runnin! fro# 1LL2 - 1LLI for the production of "ronabinol4 /he pro#ul!ation of "ru! and "ru!s /raffic in! act of 1LL2 in effect allo)ed for the #anufacture and possession of "ronabinol7 subTect to the Act=s ter#s and conditions4

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Cannabis has been produced in South Africa for #edical purposes )ith trials and production runnin! fro# 1LL2 - 1LLI for the production of "ronabinol4 /he pro#ul!ation of "ru! and "ru!s /raffic in! act of 1LL2 in effect allo)ed for the #anufacture and possession of "ronabinol7 subTect to the Act=s ter#s and conditions4

0efore 1LLL the CS&A and $arious other !o$ern#ent depart#ents started he#p fiber trials in South Africa4

/he first e$idence that can be found for cannabis fibre research in South Africa is in a report titled7 OAesponse of he#p BCannabis sati$a 14C $arieties to conditions in North)est Pro$ince7 South AfricaP7 )hich )as released in 1LLF4 &t detailed one of the first Cannabis trials in South Africa4 /he initial cost and )hich depart#ents )ere in$ol$ed in this research does not appear to be in the public do#ain4

Higure 1% - 6he A#C conducted research breeding of Genetic SA /e"p1 #ustenburg %77%

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&n 1LLK the CS&A and AAC /obacco , Cotton &nstitute conducted a A2F #illion trial in Stutterhei#4

&n 2002 the AAC conducted research into $arieties of cannabis in North)est Pro$ince7 that conse;uently led to the breedin! of Genetic SA Ee#p14

Higure 1&

0reedin! of South African Ee#p one )as perfor#ed indoors at the A!ricultural Aesearch Council Austenbur! in a controlled positi$e pressure7 pollination en$iron#ent4 /he atte#pt to breed lo) /EC cannabis did not yield a local $ariety success4

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/he fibre ;uality of SA Ee#p1 )as ne$er tested and the breedin! pro!ra# ne$er sa) full research scope fruition4

Higure 1'! 1( - 6he A#C conducted research breeding of Genetic SA /e"p1 #ustenburg %77%

&n 2002:2003 the AAC Austenbur! trial on Aussell de 0eer?s far#7 )as interrupted by police )ho destroyed the crop due to failure by AAC to ti#eously pro$ide a license4 /he sei5ure and destruction of this research crop by the SAPS and subse;uent le!al proceedin!s ulti#ately led to the loss of the far#420D /he AAC-&&C7 CS&A and the "hone A!ricultural "e$elop#ent &nstitute publish research in 200F titled7 OPerfor#ance of four 2uropean he#p fibre culti$ars !ro)n under different a!rono#ic e>peri#ental conditions in the 2astern Cape Pro$ince7 South Africa4P /he costs of these trials are un no)n4 0et)een 1LLL and 2003 national he#p fiber proTects included e4!4 $arious !o$ern#ent depart#ents B"ACS/7 A!riculture7 Eealth7 /rade , &ndustry7 2n$iron#ental Affairs , /ouris#C7 pro$incial and national research institutions BCS&A7 AAC-&&C7 <ACC7 pri$ate sector BEouse of Ee#p7 Eoo ed on

20D

&314co45a * +ar#er to appeal da!!a Tud!#ent * 200L

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Ee#p7 SAECC and de$elop#ent a!encies B2CS2CC7 C&<2CC /he total cost of !o$ern#ent e>penditure on this research is un no)n4

Higure 1* - 9athurst trials A#C Fi)erse ?nternational %77%

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

/he A!ricultural Aesearch Council7 "i$erse &nternational Sta#ford +ar# /rust 0athurst 2astern Cape trials perfor#ed in 2003:200D failed7 see pictures4

4

Higure 1+! 1, - 9athurst trials A#C Fi)erse ?nternational %77%

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

A!ricultural Aesearch Council trials perfor#ed in the Western Cape at 2lsenbur! in 200F7 !re) s#all plots of 2uropean he#p culti$ars7 due to the si5e of each section the yields of each phenotype )as not lar!e enou!h to deduce any a!rono#ic statistics4

Higure 18 - <lsenburg A#C trials Western Cape %77(.

&n 200K the CS&A announced that it )as pilotin! a #ulti-billion-rand a!ribusiness proTect to encoura!e 2astern Cape far#ers to !ro) he#p fibre and fla> for the te>tile industry4 &n 200K for#er a!ricultural ad$isor7 /hierry-Alban Ae$ert7 refers to AGF <illion O)astedP on 20017 20027 2003 cannabis fibre trials )ith no discernible pro!ress4

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&n 200L the <inister of Social "e$elop#ent announced a A20 #illion proTect launchin! /he Ee#p ProTect at <aponya <all7 So)eto4 Go$ern#ent depart#ents and a!encies such as the "0SA7 CS&A7 AAC7 "epart#ents of A!riculture +orestry and +isheries and the "epart#ent of /rade and &ndustry )ere in$ol$ed in the process4 &n 2010 /hande a Munene )as #andated by the "epart#ent of Eealth to co-ordinate all cannabis fibre research in the country4 &n addition to four site licences for the possession of a dependence-for#in! substance she )as pro$ided )ith a Oco-ordinators licenceP as )ell7 !rantin! her control o$er four different research sites4

Higure %7 - All "aterials collected fro" he"p trials at CS?# 4ort <li0abeth Ect %717.

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Higure %1 - All "aterials collected fro" he"p trials at CS?# 4ort <li0abeth Ect %717.

/he Ee#p +ibre trials failed for the years 2010:2011 and 2011:20124 /he 2012:2013 co##ercial research trials resulted in a strin! of failures ran!in! fro# use of unsuitable soil7 plant density7 o$er )aterin!7 )ind da#a!e and incorrect har$estin! procedures that resulted in the loss of suitable fibre research #aterial4

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Higure %% - Co""ercial he"p fiber trials destroyed with feed cutter in %71&. 9artholo"eusklip Har" Western Cape! =icense holders /ouse of /e"p and /e"poriu".

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

<isunderstandin!s of the cannabis plant=s nature has lead to this thirteen year Ee#p fibre trials failure7 to produce any South African Ee#p 1 phenotype7 or any reported successes fro# any of the he#p fibre trials4 +ronted by Munene7 Eouse of Ee#p B1td4C and the AAC7 CS&A7 SAPS7 "A++7 2"7 "S"7 "0SA7 "/& and N2PA"4 A!rono#ic trials and co##ercial research trials perfor#ed bet)een 1LLL - 2013 ha$e focused on culti$ars of 2uropean fibre he#p seed Bin particular +edora and +uturaC in an atte#pt to introduce lo) /EC cannabis into the country for industrial purposes4 /hese trials ha$e cost in e>cess of AF00 <illion )ith little or nothin! to sho) for the research4 /he trials )ere #ana!ed by the CS&A7 "epart#ent of A!riculture and the National Ee#p +oundation4 Munene )as e#ployed as a proTect #ana!er by the CS&A bet)een 1LLL and 20014 /he CS&A o$ersees on!oin! research4 With support fro# the Eouse of Ee#p co-chairperson7 "r <a#phela Aa#phele7 $arious uplift#ent pro!ra#s )ere launched4 /he results )ere unsatisfactory4 &n recent years Munene has been re-appointed under the #andate of the "A++ after licences issued by the "epart#ent of Eealth4 /he latter describes past research as Jfailures=4 &n 2012 Munene )as appointed the African e>pert fibre consultant for the Co##on)ealth Secretariat of 2nterprise and A!riculture of the GN++ BGlobal Natural +ibre +oru#C )ith support of N2PA"4 An African chapter )as planned supported by "S"4 An e$ent )as held4 Munene has the licenses for co##ercial fiber research o$er the ne>t D years4 Ee#p fibre research falls under the auspices of the <AC B<edical research CouncilC7 "A++ B"epart#ent of A!riculture +orestry and +isheries7 "/& B"epart#ent of /rade and &ndustryC7 2" B2cono#ic "e$elop#entC7 AAC BA!ricultural research councilC the NE+ BNational Ee#p +oundationC7 Eouse of Ee#p Pty BltdC and Ee#poriu# Pty BltdC4 Plant research7 financial e>penditure and co##ercial $iability reports re!ardin! these trials are not a$ailable4 Cannabis Ee#p fibre research has been unsuccessful since 1LLL4 Munene=s fiber and te>tile #odels )ere used as the basis for research4 2$idence sho)s that South Africa can not co#pete in the !lobal #ar etplace4 &n spite of the failure of pre$ious initiati$es the "S" , CS&A supported the Global Natural +ibers +oru# the African Chapter7 7 7 hosted by Eouse of Ee#p4 Ee#p phenotypes ha$e been i#ported and !ro)n in South African a!ricultural trials for fiber and co##ercial research o$er the past 13 years4 All crops ha$e been a failure4 Ee#p cannot be !ro)n $iably in the South African cli#ate4

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The reasons for failure in annabis fibre resear h in South Afri a in lude:

• •

Not understanding the application of the research. Successful crops ha)e yet to be produced through trials! fibre produced in South Africa has not reached the te$tile stage. Co"plicated procedures are re:uired to produce te$tile :uality. 4rocessing facilities unsuitable for research purposes. Not identifying )iability issues in ter"s of local clothing or fibre production. Not achie)ing feasible results through continued research.

• • • •

Aeasons further research initiati$es re!ardin! the application of industrial cannabis in the buildin! industry9

• • • • • •

Not necessary to co"pete on an international scale. /ousing can be e"ployed beneficially within a local conte$t. <cono"ic benefits in rural and urban areas. Sti"ulates .ob creation through labour intensi)e processing "ethods. 4rocessing industrial cannabis into building "aterial is relati)ely si"ple. /ar)esting "ethods unsuitable to process fibre.

/he dyna#ic nature of cannabis )arrants an inte!rated and in-depth research effort4 /o #a e infor#ed policy decisions a co#plete understandin! is necessary4 /his )ill only be achie$ed if the pri$ate and public sectors offer each other their #utual support4

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Anne4ure 2 ? Therapeuti

benefits of annabis

/he definition of cannabinoids7 and an e>planation of its ut#ost i#portant relation to the hu#an body throu!h the endocannabinoid syste# is funda#ental to understandin! the )or in!s of the cannabis plant=s effects on the hu#an body4

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-*,+CA" CANNA$+S
<edical cannabis refers to the parts of the cannabis plant or specific cannabinoids such as /EC and C0" used as a for# of #edicine or therapy7 under super$ision or self #edicatin!4 Cannabis prohibition applies to e$eryone7 includin! the sic and dyin!4 3f all the ne!ati$e

conse;uences of prohibition7 none is as tra!ic as the denial of #edicinal cannabis to seriously ill patients )ho could benefit fro# its use4 /his includes cancer patients under!oin! che#otherapy7 A&"S patients sufferin! fro# O)astin! syndro#e7P !lauco#a patients7 and those sufferin! fro# chronic pain7 rheu#atoid arthritis and a $ariety of spastic conditions such as #ultiple sclerosis7 paraple!ia7 ;uadriple!ia7 and epilepsy4 At the ti#e of publication7 a Pub<ed search for scientific Tournal articles published in the last 20 years containin! the )ord ʺcannabisʺ re$ealed 127 D01 results4 /he )ord ʺcannabinoid7ʺ increases the results to 1I71KL articles4 /hat is an a$era!e of #ore than t)o scientific publications per day o$er the last 20 years4 We couldn=t account for any substantial South African #edical cannabis research )ithin these results4

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<edicinal Eistory
Cannabis has a lon! history of #edical use in $arious countries4 20F /he first recorded history of the #edical use of cannabis dates bac the phar#acopoeia of 2#peror Shen Nun!7 )ho )rote a boo on treat#ent #ethods in 2I3I 04C4 that included the #edical benefits of cannabis4 Ee reco##ended the substance for #any ail#ents7 includin! constipation7 !out7 rheu#atis#7 and absent-#indedness4 20G

20F 20G

Grinspoon , 0a alar7 1LL3 0loo#;uist7 2d)ard B1LI1C4 3ari.uanaL 6he Second 6rip4 California9 Glencoe Press4 21 S2P 200G

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Cannabis )as used to treat a $ariety of hu#an ills in fol and for#al #edicine for thousands of years in /ur ey7 South A#erica7 2!ypt7 &ndia7 the <alays7 0ur#a and Sia#4 20I &n the early 1K00s7 8nited States physicians used cannabis e>tracts to produce a tonic for both #edicinal and recreational purposes4 &n 1K237 Vueen (ictoria?s personal physician7 Sir Aussell Aeynolds7 not only prescribed it to her for #enstrual cra#ps but )rote in the first issue of /he 1ancet7 RWhen pure and ad#inistered carefully7 ait isb one of the of the #ost $aluable #edicines )e possess4R
20K

0et)een 1KD0 and 1L007 2uropean and A#erican #edical Tournals published #ore than 100 articles on the therapeutic use of the dru! no)n then as Cannabis &ndica Bor &ndian he#pC and no) si#ply as cannabis4 /here )ere 2000 cannabis #edicines prior to 1L3I )ith o$er 2K0 #anufacturers4 20L Eo)e$er7 it is only relati$ely recently that the acti$e co#ponents ha$e been identified and their #echanis#s of action ha$e be!un to be understood4 /he safety of the dru! has been attested to by nu#erous studies and reports7 includin! the 1aGuardia Aeport of 1LDD7 the Schafer Co##ission Aeport of 1LI27 a 1LLI study conducted by the 0ritish Eouse of 1ords7 the &nstitutes of <edicine report of 1LLL7 research sponsored by Eealth Canada7 and nu#erous studies conducted in the Netherlands7 )here cannabis has been ;uasi-le!al since 1LIG and is currently a$ailable fro# phar#acies by prescription4 /he use of #edical cannabis has been endorsed by nu#erous professional or!ani5ations7 includin! the A#erican Acade#y of +a#ily Physicians7 the A#erican Public Eealth Association7 and the A#erican Nurses Association4 /he di$erse historical accounts of the cannabis plant=s #edicinal and therapeutic properties e>perienced and docu#ented by hu#ans re;uires ur!ent attention4 Currently there is #ore no)led!e a$ailable on the internet re!ardin! the use of cannabis #edicinally than )as a$ailable to pre$ious !enerations4 No other plant in the history of #an ind has !ained so #uch professional #edical attention7 yet our local #edical establish#ent lac s a basic scientific understandin! of this plant=s #edicinal efficacies and applications thereof4

Eall , "e!enhardt7 2003W <echoula#7 1LKGW Anslin!er , Cooper7 1L3I 1ancet 1W 1K23 20L Wi ipedia4or! <edical Cannabis
20I

20K

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

/he 2ndocannabinoid Syste#
2ndocannabinoids and their receptors are found throu!hout the body9 in the brain7 or!ans7 connecti$e tissues7 !lands7 i##une cells7 etc4 /he cannabinoid syste# perfor#s different tas s7 but the !oal is al)ays the sa#e9 ho#eostasis7 the #aintenance of a stable internal en$iron#ent despite fluctuations in the e>ternal en$iron#ent4 2ndocannabinoids and cannabinoids are also found at the intersection of the body ʹs $arious syste#s7 allo)in! co##unication and coordination bet)een different cell types4 At the site of an inTury7 for e>a#ple7 cannabinoids can be found decreasin! the release of acti$ators and sensiti5ers fro# the inTured tissue7 stabili5in! the ner$e cell to pre$ent e>cessi$e firin!7 and cal#in! nearby i##une cells to pre$ent release of infla##atory substances4 Cannabinoids pro#ote ho#eostasis at e$ery le$el of biolo!ical life7 fro# the subNcellular7 to the or!anis#7 and perhaps to the co##unity and beyond4 +or e>a#ple9 autopha!y7 a process in )hich a cell se;uesters part of its contents to be selfNdi!ested and recycled7 is #ediated by the cannabinoid syste#4 While this process eeps nor#al cells ali$e7 allo)in! the# to #aintain a balance bet)een the synthesis7 de!radation7 and subse;uent recyclin! of cellular products4 2ndocannabinoids are #olecules our bodies naturally #a e to sti#ulate the C0 1 and C02 receptors4 0oth ananda#ide and 2Narachidonoyl!lycerol B2NAGC are synthesi5ed onNde#and fro# cell #e#brane arachidonic acid deri$ati$es7 ha$e a local effect and short halfNlife before bein! de!raded by en5y#es called fatty acid a#ide hydrolase B+AAEC and #onoacyl!lycerol lipase B<AG1C4 210

210

N3A<14or! * 2#er!in! Clinical Applications for Cannabis and Cannabinoids9 A Ae$ie) of the Aecent Scientific 1iterature +ifth 2dition

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Cannabinoids
/he use of cannabis sati$a by hu#ans dates bac se$eral thousand years7 for both its psychoto#i#etic and potential #edicinal properties4 As scientific research #ethods de$eloped7 the cannabinoids present in this herb )ere characteri5ed7 as )ell as their co#ple> interface )ith the hu#an central ner$ous syste#7 pro$ided by the acti$ation of specific receptors4 /he subse;uent description of an endo!enous cannabinoid syste# in the #a##alian brain shifted the notion of cannabis as a recreational dru! to a therapeutic alternati$e for psychiatric disorders4 Cannabinoids are a class of di$erse che#ical co#pounds that acti$ate cannabinoid receptors on cells that repress neurotrans#itter release in the brain4 211 /hese receptor proteins include the endocannabinoids Bproduced naturally in the body by hu#ans and ani#alsC7 212 the phytocannabinoids Bfound in cannabis and so#e other plantsC7 and synthetic cannabinoids Blaboratory producedC4 /he #ost notable cannabinoid is the phytocannabinoid c L-tetrahydrocannabinol B/ECC7 the pri#ary psychoacti$e co#pound of cannabis42137 21D Cannabidiol BC0"C is another #aTor constituent of the plant7 representin! up to D0\ of its e>tracts4 21F /here are #any cannabinoids isolated fro# cannabis7 e>hibitin! a $ariety of effects421G

211 212

Wi i Cannabinoid Pacher P7 0at ai S7 Munos G B200GC4 R/he 2ndocannabinoid Syste# as an 2#er!in! /ar!et of Phar#acotherapyR4 4har"acol #e). FK B3C9 3KLXDG24 doi9104112D:pr4FK43424P<&" 1GLGKLDI4 213 1a#bert "<7 +o)ler CU B200FC4 R/he endocannabinoid syste#9 dru! tar!ets7 lead co#pounds7 and potential therapeutic applicationsR4 U4 <ed4 Che#4 DK B1GC9 F0FLXKI4 doi91041021:T#0FK1K3t4 P<&" 1G0IKK2D4 21D Ao!er Pert)ee7 ed4 B200FC4 Cannabinoids4 Sprin!er-(erla!4 p4 24 &S0N 3-FD0-22FGF-H4 21F 8N3"C A co#parati$e study on so#e che#ical and biolo!ical characteristics of $arious sa#ples of cannabis resin 01:01:1LG2 21G 2l-Alfy7 Abir /7 et al4 BUun 2010C4 RAntidepressant-li e effect of delta-L-tetrahydrocannabinol and other cannabinoids isolated fro# Cannabis sati$a 1R4 Phar#acolo!y 0ioche#istry and 0eha$ior LF BDC9 D3DXD24 doi9104101G:T4pbb42010403400D4 P<C 2KGG0D04 P<&" 20332000

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Eistory of cannabinoid research
1L23 1LGD 1LK0 1LKK 1LL0 1LL2 1LL3 1LLD 1LLF 1LLI 1LLK 2000 2000 2003 200F
Cahn elucidates part of the structure of cannabinol &dentification of `L -/EC as the #ain psychoacti$e co#pound of cannabis "e$elop#ent of synthetic cannabinoids Eo)lett=s !roup identifies specific /EC bindin! sites in the brain called the C0 1 receptor <atsuda et al4 clone the C01 receptor &dentification of the C02 receptor4 "isco$ery of the endo!enous li!and ananda#ide Clonin! of the C02 receptor "e$elop#ent of a C01 anta!onist "isco$ery of endocannabinoids 2-AG and pal#itoylethanola#ide "e$elop#ent of a C02 anta!onist 2$idence of the anal!esic properties of endocannabinoids4 "e$elop#ent of noc out #ice lac in! the !ene e>pressin! C01 receptor "e$elop#ent of noc out #ice lac in! the !ene e>pressin! C0 2 receptor dy!#unt et al4and S#art et al4sho) that ananda#ide acti$ates $anilloid receptors 0iso!no et al4 clone the first endocannabinoid-biosynthesisin! en5y#es Sati$e> k appro$ed for sale in CanadaW re!ulatory appro$al is filed to sell ri#onabant in the 8SAW the Aberdeen !roup disco$ers an allosteric site on C0 1 receptors21I
6able %

21I

A brief history of cannabinoid and endocannabinoid phar#acolo!y as inspired by the )or of 0ritish scientists

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/ypes of Cannabinoids
While #uch of the product de$elop#ent is focusin! on specific cannabinoids7 #any support anecdotal reports fro# patients7 )hich contend that the natural )hole plant )or s better than a sin!le synthetic cannabinoid a!ent4 "ronabinol and acannabisb are not e;ual7 accordin! to #any reports4 21K <any patients report that acannabisb has better therapeutic acti$ity than "ronabinol7 and that acannabisb has less side effects4 "ronabinol often causes psycholo!ical Oo$erdoseP reactions7 sy#pto#s such as dysphoria7 depersonali5ation7 an>iety7 panic reactions7 and paranoia4 21L All classes cannabinoids deri$e fro# cannabi!erol-type co#pounds and differ #ainly in the )ay this precursor is cycli5ed4

21K 21L

Grinspoon , 0a alar 1LLI Ad$anta!es of polyphar#aceutical herbal Cannabis co#pared to sin!le-in!redient7 synthetic tetrahydrocannabinol

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

/ypes of Cannabinoids
/he #ost pre$alent and studied natural cannabinoids found in Cannabis are /etrahydrocannabinol B/ECC7 cannabidiol BC0"C and cannabinol BC0NC4

Cannabinoid

$oilin3 Point

Properties
C0C ste#s fro# the cannabi!erolic acid BC0GAC4 &t inhibits the upta e of ananda#ide7 )hich allo)s it to stay in the blood strea# lon!er4 <ore co##on in tropical cannabis $arieties4 2ffects include anti-infla##atory and anal!esic7 Antibiotic7 Antifun!al4 220 Cannabichro#ene is a$ailable only after decarbo>ylation4 /hrou!h e>posure to heat and air )ill result in C0CA to lose a #olecule of C32W at this point it is considered C0C4 With respect to the #edical potential of the cannabis7 C0" #ay hold the #ost pro#ise for #any serious conditions4 C0" is a non-psychoacti$e cannabinoid that is belie$ed to reduce the psychoacti$e effects of /EC4 S#o ers of cannabis )ith a hi!her C0":/EC ratio are less li ely to e>perience an>iety4 C0" #ay also inhibit cancer cell !ro)th4 An>iolytic7 Anal!esic7 Antipsychotic7 Anti &nfla##atory7 Antio>idant7 Antispas#odic <ost cannabis plants contain less than 2\ C0"A7 althou!h so#e strains yield plants )ith #ore C0"A than /ECA7 )hich7 after heatin!7 e;uals #ore C0" than /EC4 <any people prefer these strains for their #any beneficial #edicinal effects )ithout the Rhi!hR associated )ith hi!her concentrations of /EC4 /he fe) plants that do produce lar!e a#ounts of C0"A often contain o$er 10\ C0"A and only lF\ /ECA C0"A7 si#ilar to /ECA7 is the #ain constituent in cannabis that has ele$ated C0" le$els4 /ECA and C0"A hold #ost of the anti-infla##atory properties that cannabis has to offer4

C0C
BCannabichro#eneC

%%7XC

C0CA

Bcannabichro#ene acidC

%7,XC

C0"

BcannabidiolC

1*7-1,7XC

C0"A

Bcannabidiol acidC

%1+XC

220

Cannabichro#ene BC0CC9 /he <ost "isre!arded Cannabinoid

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C0"(
BCannabidi$arinC

188XC

A non-psychoacti$e cannabinoid found in Cannabis4 &t is a ho#olo! of cannabidiol BC0"C7 )ith the side-chain shortened by t)o #ethylene brid!es BCE2 unitsC4 Plants )ith relati$ely hi!h le$els of C0"( ha$e been reported in feral populations of C. indica B m C. sati)a ssp4 indica $ar4kafiristanicaC fro# north)est &ndia7 and in hashish fro# Nepal4 Si#ilarly to C0"7 it has I double bond iso#ers and 30 stereoiso#ers4 &n the study7 carried out by the 8ni$ersity of Aeadin! in collaboration )ith GW Phar#a and 3tsu a Phar#aceuticals7 cannabidi$arin stron!ly suppressed sei5ures in si> different e>peri#ental #odels co##only used in epilepsy dru! disco$ery4221 A non-psychoacti$e cannabinoid7 C0G has antibacterial effects and can alter the o$erall effects of Cannabis4 BC0GC also inhibits the upta e of GA0A4 While #ost strains of cannabis are less than 10\ C0G7 industrial acannabisb strains test #uch hi!her4 /hey ha$e been tested as hi!h as LD\ C0G )ith as lo) as 04001\ /EC4 /he precursor cannabinoid fro# )hich all others deri$e7 C0GA beco#es C0"A and /ECA by the en5y#es C0"A synthase and /ECA synthase4 &t is the precursor to /EC7 C0"7 and C0C4 C0GA is i##ediately con$erted to another cannabinoid and is not typically found in hi!h concentrations4 Eo)e$er7 if a strain is hi!h in C0GA4 Co#bustion causes it to chan!e to cannabi!erol BC0GC C0CA is a deri$ati$e of C0GA4 A recent patent clai#s that C0CA is produced pri#arily in the sessile tricho#es of the plant Bthose )ithout stal sC4 C0CA is thou!ht to possess anti-infla##atory7 antibacterial7 and antifun!al acti$ity4222 A non-psychoto#i#etic cannabinoid7 a de!radati$e product li e cannabinol4 1i!ht con$erts cannabichro#ene to C014 &t has 1G stereoiso#ers4 A psychoacti$e cannabinoid that co#es about

C0G
BCannabi!erolC

%7+XC

C0GA
BCannabi!erol acidC

%1,XC

C0G<

BCannabi!erol <ono#ethyl 2therC

C01

BCannabicyclolC

1*1XC

1,(XC
221 222

GW Phar#aceuticals - Ne) co#ponent of cannabis disco$ery could lead to better treat#ents for epilepsy 13:0L:2012 Cannabinoids * 101

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C0N

BCannabinolC

fro# the de!radation of /EC7 there is usually $ery little C0N in a fresh plant4 C0N potentiates the effects of /EC4 3>idation7 brea do)n7 product7 Sedati$e7 Antibiotic %18XC

C0NA C0(

BCannabinol acidC

A brea do)n product of /ECA by air o>idation A non-psychoacti$e cannabinoid found in #inor a#ounts in the he#p plant Cannabis sati)a4 &t is an analo! of cannabinol BC0NC )ith the sidechain shortened by t)o #ethylene brid!es B-CE2-C4 C0( is an o>idation product of tetrahydrocannabi$arin B/EC(7 /E(C Aesponsible for the #ain psychoacti$e effects patients are fa#iliar )ith4 /he co#pound is a #ild anal!esic and cellular research has sho)n the co#pound has antio>idant acti$ity4 /EC is belie$ed to interact )ith parts of the brain nor#ally controlled by the endo!enous cannabinoid neurotrans#itter ananda#ide4 2uphoriant7 Anal!esic7 Anti &nfla##atory7 Antio>idant7 Antie#etic

BCannabi$arinC

%7*XC

`L-/EC

B/etrahydrocannabinolC

1(+XC

`K-/EC

B`-K-tetrahydrocannabinolC

1+(-1+,XC

Aese#bles `L-/EC7 1ess psychoacti$e /ECA is the #ain constituent in ra) cannabis4 /ECA con$erts to `L-/EC )hen burned7 $apori5ed7 or heated for a period of ti#e at a certain te#perature4 /ECA holds #uch of the anti-infla##atory properties7 as )ell as anti-proliferati$e Binhibitin! the cell-!ro)th in tu#ors: cancer cells7C as )ell as anti-spas#odic Bsuppresses #uscle-spas#s4C /EC( is found in lar!est ;uantities in African landrace Cannabis sati$a strains4 &t is currently bein! de$eloped as a treat#ent for #etabolic disorders includin! diabetes4 /EC( has been sho)n to bloc the psychoacti$e effects of /EC4 Anal!esic7 2uphoriant4
6able &

/ECA

B/etrahydrocannabinolic acidC

1+%-1+&XC

/EC(
B/etrahydrocannabi$arinC

Y %%7XC

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/erpenoid 2ssential 3il Co#ponents of Cannabis
/erpenes are $olatile #olecules that e$aporate easily and readily announce the#sel$es to the nose4 /herein lies the basis of aro#atherapy7 a popular alternati$e-healin! #odality4 1i e their odorless cannabinoid cousins7 terpenes are oily co#pounds secreted in the acannabisb plant=s !landular tricho#es4 /erpenes and /EC share a bioche#ical precursor7 !eranyl pyrophosphate7 )hich de$elops into the cannabinoids and terpenoids that saturate the plant=s flo)er tops4 0ut unli e /EC and the other plant cannabinoids that e>ist no)here else but in acannabisb7 terpenes are ubi;uitous throu!hout the natural )orld4 Produced by countless plant species7 terpenes are pre$alent in fruits7 $e!etables7 herbs7 spices7 and other botanicals4 /erpenes are also co##on in!redients in the hu#an diet and ha$e !enerally been reco!nised as safe to consu#e4 223

223

Alternet4co# * /he Sa#e Co#pounds 0ehind <ariTuana?s "istincti$e Stin y S#ells Gi$e Clues About the Minds of Ei!h 6ou?ll 2>perience

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/erpenoid 2ssential 3il Co#ponents of Cannabis
Terpenoid n-<yrcene n-Caryophyllene $oilin3 Point 1GG-1GK]C 11L]C Properties
Anal!esic4 Anti &nfla##atory7 Antibiotic7 Anti#uta!enic Anti &nfla##atory7 Cytoprotecti$e B!astric #ucosaC7 Anti#alarial Cannabinoid a!onist7 &##une potentiator7 Antidepressant7 Anti#uta!enic Sedati$e7 Antidepressant7 An>iolytic7 &##une potentiator <e#ory boosterQ7 ACh2 inhibitor7 Sedati$e7 Antipyretic ACh2 inhibitor7 &ncreases cerebral7 blood flo)7 Sti#ulant7 Antibiotic7 Anti$iral7 Anti &nfla##atory7 Antinocicepti$e Anti &nfla##atory7 0ronchodilator7 Sti#ulant7 Antibiotic7 Antineoplastic7 ACh2 inhibitor Sedati$e7 Antibiotic7 ACh2 inhibitor7 Antio>idant7 Anti#alarial ACh2 inhibitor4 Antibiotic Antibiotic7 Anticandidal7 ACh2 inhibitor Antibiotic Anti &nfla##atory
6able '

d-1i#onene 1inalool Pule!one

1II]C 1LK]C 22D]C

17K-Cineole B2ucalyptolC

1IG]C

o-Pinene o-/erpineol /erpineol-D-ol p-Cy#ene 0orneol `-3-Carene

1FG]C 21I-21K]C 20L]C 1II]C 210]C 1GK]C

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+la$onoid and Phytosterol Co#ponents of Cannabis
!lavonoid
Api!enin Vuercetin Cannfla$in A n-Sitosterol

$oilin3 Point
1IK]C 2F0]C 1K2]C 13D]C

Properties
An>iolytic7 Anti &nfla##atory7 2stro!enic Antio>idant7 Anti#uta!enic7 Anti$iral7 Antineoplastic C3H inhibitor7 13 inhibitor Anti &nfla##atory7 F-o-reductase7 inhibitor
6able (

Cannabinoid Aeceptors
Cannabinoid receptor sites are no) no)n to e>ist in the ner$ous syste#s of all ani#als7 bodies are ho#eostatically #aintained by the endocannabinoid syste#4 0y co#parin! the !enetics of cannabinoid receptors in different species7 scientists esti#ate that the endocannabinoid syste# e$ol$ed in pri#iti$e ani#als such as the sea s;uirt4 22D

Cannabinoid %e eptor C01

"o ation

%ole

Central and peripheral ner$e &nfluence the inhibition of ter#inals neurotrans#itter release &##une cells &nfluence the release of cyto ines and cell #i!ration22F
6able *

C02

22D

3ccurrence and possible biolo!ical role of the endocannabinoid syste# in the sea s;uirt Ciona intestinalis4 - U Neuroche#4 Uun 200F P<&"9 1FL3DL3F 22F <edscape O/he 8se of <ariTuana or Synthetic Cannabinoids for the /reat#ent of Eeadache4P 2011WF1B3C9F02-F0F4

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Cannabinoid re eptor t5pe 1
C01 receptors are found pri#arily in the brain7 to be specific in the basal !an!lia and in the li#bic syste#7 includin! the hippoca#pus4 /hey are also found in the cerebellu# and in both #ale and fe#ale reproducti$e syste#s4 C0 1 receptors are absent in the #edulla oblon!ata7 the part of the brain ste# responsible for respiratory and cardio$ascular functions4 /hus7 there is not a ris of respiratory or cardio$ascular failure as there is )ith #any other dru!s4 C0 1 receptors appear to be responsible for the euphoric and anticon$ulsi$e effects of cannabis4

Cannabinoid re eptor t5pe 2
C02 receptors are al#ost e>clusi$ely found in the i##une syste#7 )ith the !reatest density in the spleen4 While found only in the peripheral ner$ous syste#7 a report does indicate that C0 2 is e>pressed by a subpopulation of #icro!lia in the hu#an cerebellu#4 C02 receptors appear to be responsible for the anti-infla##atory and possibly other therapeutic effects of cannabis422G While it #ay see# )e no) a lot about cannabinoids7 the esti#ated t)enty thousand scientific articles ha$e Tust be!un to shed li!ht on the subTect4 1ar!e !aps e>ist in our current understandin! of the co#ple>ity of interactions bet)een $arious cannabinoids7 cell types7 syste#s and indi$idual or!anis#s4 /his points to the potential need for research to re-e$aluate and adapt current #ethodolo!y and approaches4 Cannabinoid receptors are present throu!hout the body7 e#bedded in cell #e#branes7 and are belie$ed to be #ore nu#erous than any other receptor syste#4 Aesearchers ha$e identified t)o cannabinoid receptors9 C017 predo#inantly present in the ner$ous syste#7 connecti$e tissues7 !onads7 !lands7 and or!ansW and C027 predo#inantly found in the i##une syste# and its associated structures4 <any tissues contain both C01 and C02 receptors7 each lin ed to a different action4 Aesearchers speculate there #ay be a third cannabinoid receptor4

22G

Ne)s <edical Cannabinoid Aeceptors

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Cannabis 2>tracts and Synthetic Cannabinoids
2>tensi$e research has been done around cannabinoid e>tracts or!anic and synthesised4 /hese re!istered phar#aceuticals are ad#inistered throu!h a #etered oral spray and tablet for#4 While isolated cannabinoid co#pounds #ay present tar!eted deli$ery #ethods7 they often lac in efficacy )hen isolated )ithout other supportin! co#pounds of the )hole plant4

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Natural7 synthetic phar#aceutical cannabinoid e>tracts Nabilone BCesa#etC
Nabilone BCesa#etC7 is a synthetic cannabinoid )ith therapeutic use as an antie#etic and as an adTunct anal!esic for neuropathic pain4 &t #i#ics the #ain che#ical co#pound of cannabis B/ECC7 the acti$e in!redient found in naturally occurrin! Cannabis sati$a 14 22I

"ronabinol B<arinolC
&n 1LL3 South African "ru!!ists tradin! as Phar#acare7 patented dronabinol delta-L-tetrahydrocannabinol7 #ar eted as #arinol4 &t is used as an appetite sti#ulant7 antie#etic7 and anal!esic422K ; Fronabinol! the acti)e ingredient in 3A#?NE=Z (dronabinol) Capsules! is synthetic delta-8-tetrahydrocannabinol (delta-8-6/C). ; Felta-8-tetrahydrocannabinol is also a naturally occurring co"ponent of Cannabis sati)a =. %%8

/he "ru!s and "ru! /raffic in! Act of 1LL2 )as a#ended to e>clude dronabinol to enable the #anufacture of the dru!4 @Cannibis (dagga)! the whole plant or any portion thereof! e$cept dronabinol A(-)-transdelta-8 tetrahydrocannabinolB.C 230 Production of "ronabinol )as carried out in South Africa4 231 &t has been alle!ed that 237000 hectares of cannabis )as culti$ated )ithin the South African borders for the production of "ronabinol4 232

Nabi>i#ols BSati$e>C
Sati$e>7 a cannabinoid e>tract oral spray containin! /EC7 C0"7 and other cannabinoids used for neuropathic pain and spasticity in 22 countries includin! 2n!land7 Canada and Spain4 Sati$e> de$elops )hole-plant cannabinoid #edicines4

22I 22K

Wi i Nabilone <ail , Guardian * Gettin! hi!h on da!!a profits * Goo!le Cached Copy * 1D Au! 1LLK 22L +"A <arinol B"ronabinolC description 230 /he )ron! spellin! of cannabis (cannibis) is reflected as such in the "A8GS AN" "A8G /AA++&CM&NG AC/ N34 1D0 3+ 1LL2 231 WE3 World Eealth 3r!anisation Assess#ent of dronabinol 232 World War Weed * Che#ical Warfare7 Aacis#7 A&"s and Cannabis9 +ro# South Africa )ith 1o$e

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

As per an article published in the "en$er 8ni$ersity 1a) Ae$ie)7 2010 by "r4Sunil Mu#ar A!!ar)al <"7Ph"4233

OEne need only study the basic details of GWRs original process patent filed in %77%! 23Dand issued by the 5S 4atent and 6rade"ark Effice in %77,! to see how their product is nothing "ore than a highly characteri0ed! twenty-first century )ersion of hash oil with pepper"int fla)oring. 6heir patent application describes the @production of a relati)ely si"ple e$tract containing! as well as cannabinoids! only a li"ited nu"ber of non-target co"pounds! "any of which can be re"o)ed relati)ely easily in a si"ple step.C 6heir production process consists of three basic stepsL heating! e$traction! and winteri0ation. 6hey start with ho"egrown cured and dried cannabis flowers taken fro" plants @propagated fro" cuttings taken fro" the "other plants! originating fro" a single seed source.C @What is ultra-"odern here is the highly characteri0ed nature of the e$tract and opti"i0ed and :uality-controlled conditions of its productionK howe)er! the basic principles of the process are not new. GWRs patent itself refers on se)eral occasions to cannabis as a "edicinal plant and archeological e)idence indeed suggests that the culti)ation of cannabis for "edicinal use stretches into pre-history. 6aking )arieties of dried plant "aterial through the steps of heating for decarbo$ylation! e$traction (usually in oil or alcohol)! and e)en washingSwinteri0ation ha)e been perfor"ed for centuries by )arious ci)ili0ations who ha)e utili0ed cannabis preparations in ritual! "edicine! and social custo". Ne)ertheless! the co"pany was able to con)ince the W/ERs ?nternational Nonproprietary Na"es and 5nited States Applied Na"es progra"s that their cannabis e$tract! a Qbotanical drug substance!R was deser)ing of a na"e other than @"ari.uana!C @hash oil!C or @cannabis!C and thus it was granted the obfuscating na"e @nabi$i"ols.C /owe)er! this substance is essentially hash oil.C 23F @Were anyone else to produce this substance at a si"ilar scale who lacks the social capital and insider connections of GWRs e$ecuti)es! they could potentially face federal felony charges for cannabis production and be sentenced to death P23G
Sati$e> double blind studies )ere perfor#ed in South Africa in se$en #edical institutions4 23I

233 23D

Cannabis9 A Co##on)ealth <edicinal Plant 2010 GW Process patent 23F S/A/2<2N/ 3N A N3NPA3PA&2/AA6 NA<2 A"3P/2" 06 /E2 8SAN C38NC&1 23G "en$er 8ni$ersity 1a) Ae$ie)7 (ol4 KK Cannabis9 A Co##on)ealth <edicinal Plant7 1on! Suppressed7 No) at Ais of <onopoli5ation 23:0K:2010 23I A Study of Sati$e>k for Pain Aelief in Patients With Ad$anced <ali!nancy No$ 200I

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

2ffects of Cannabinoids
/EC-A /EC /EC-( C0N C0"-A C0" C0C-A C0C C0G-A C0G

Pain relief Aeduces infla##ation Suppresses appetite Sti#ulates appetite Aeduces $o#itin! and nausea Aeduces contractions in the s#all intestine Aelie$es an>iety /ran;uili5in!7 used to #ana!e psychosis Aeduced sei5ures and con$ulsions Suppresses #uscle spas#s Aides sleep Aeduces the efficacy of the i##une syste# Aeduces blood su!ar le$els Pre$ents ner$ous syste# de!eneration /reats psoriasis Aeduces ris of artery bloc a!e Mills or slo)s bacterial !ro)th /reats fun!al infection &nhibits cell !ro)th in tu#ours:cancer cells Pro#otes bone !ro)th

Anal3esi Anti?inflammator5 Anoreti Appetite Stimulant Antiemeti +ntestinal anti?prokineti An4iol5ti

Antips5 hoti Antiepilepti Antispasmodi Anti?insomnia

+mmuno suppressive Anti?diabeti

Neuroprote tive Antipsoriati Anti?is hemi Anti?ba terial Antifun3al

Anti-proliferati$e 0one sti#ulant 6able +

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Clinical 2ndocannabinoid "eficiency
Clinical endocannabinoid deficiency BC2"CC is a spectru# disorder that has been postulated and i#plicated in a ran!e of illnesses7 includin! fibro#yal!ia7 #i!raine and irritable bo)el syndro#e4 <i!raine is a debilitatin! and $ery co##on condition that affects #illions )orld)ide4 /he three conditions feature co##on clinical and bioche#ical patterns that #ay point to underlyin! C2"C4 <i!raine is thou!ht to be influenced by endocannabinoid function7 as areas suspected to be in$ol$ed )ith !eneration of #i!raines are also affected by cannabinoid acti$ityW further#ore7 the endocannabinoid ananda#ide7 )ith its role in pain #odulation and serotonin trans#ission7 is belie$ed to positi$ely affect sufferers of the condition4 23K

23K

/he 8se of <ariTuana or Synthetic Cannabinoids for the /reat#ent of Eeadache

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

<i!raine has nu#erous relationships to endocannabinoid function4 Ananda#ide BA2AC potentiates F-E/1A and inhibits F-E/2A receptors supportin! therapeutic efficacy in acute and pre$enti$e #i!raine treat#ent4 Cannabinoids also de#onstrate dopa#ine-bloc in! and anti-infla##atory effects4 A2A is tonically acti$e in the peria;ueductal !ray #atter7 a #i!raine !enerator4 /EC #odulates !luta#ater!ic neurotrans#ission $ia N<"A receptors4 +ibro#yal!ia is no) concei$ed as a central sensitisation state )ith secondary hyperal!esia4 Cannabinoids ha$e si#ilarly de#onstrated the ability to bloc spinal7 peripheral and !astrointestinal #echanis#s that pro#ote pain in headache7 fibro#yal!ia7 &0S and related disorders4 /he past and potential clinical utility of cannabis-based #edicines in their treat#ent is discussed7 as are further su!!estions for e>peri#ental in$esti!ation of C2C" $ia CS+ e>a#ination and neuro-i#a!in!423L <i!raine7 fibro#yal!ia7 &0S and related conditions display co##on clinical7 bioche#ical and pathophysiolo!ical patterns that su!!est an underlyin! clinical endocannabinoid deficiency that #ay be suitably treated )ith cannabinoid #edicines42D0 /he bioche#istry of #i!raine is hi!hly co#ple> and poorly understood7 but it is no)n that hi!h le$els of serotonin are present durin! attac s4 /EC and its endo!enous li!and7 ananda#ide7 ha$e been sho)n to inhibit serotonin in hi!h doses Balthou!h lo) doses #ay increase its productionC7 particularly in the platelets of the blood plas#a4 2D1 /he platelets contain the body=s hi!hest reser$es of serotonin7 )hich is also present in the 2NS as )ell as throu!hout the brain4 Serotonin release fro# the platelets is thou!ht to be crucial to !eneration of #i!raines7 and #i!raine is often thou!ht to be a disease of the blood on this basis4 2D2 Serotonin le$els in the platelets are also no)n to be affected in fibro#yal!ia7 althou!h it is thou!ht that deficiency of serotonin2D37 rather than o$er-abundance7 is responsible for the sufferer=s aberrant perception of pain4 /his disparity is not fully understood7 and is so#e)hat surprisin! !i$en the hi!h de!ree of co#orbidity bet)een the diseases9 in one study7 up to G3\ of pri#ary fibro#yal!ia sufferers also reported sy#pto#s of #i!raine7 2DD in another7 2242\ of pri#ary #i!raine sufferers )ere also found to ha$e fibro#yal!ia4 /his disparity #ay be partly e>plained by !ender differences7 as none of the #ale #i!raine sufferers reported sy#pto#s of fibro#yal!ia7 and the latter disease is o$er)hel#in!ly e>perienced by )o#en7 )ho co#prise L0\ of sufferers4 2DF

23L

Clinical endocannabinoid deficiency BC2C"C9 can this concept e>plain therapeutic benefits of cannabis in #i!raine7 fibro#yal!ia7 irritable bo)el syndro#e and other treat#ent-resistant conditionsQ P<&"9 1KD0D1DD 2D0 Clinical endocannabinoid deficiency BC2C"C9 200K Apr P<&"9 1KD0D1DD 2D1 Science "aily Cannabis9 Potent Anti-"epressant &n 1o) "oses -2D:10:200I 2D2 Cannabinoids bloc release of serotonin fro# platelets induced by plas#a fro# #i!raine patients 2D3-2DG B1LKFC P<&"9 2LLI0DK 2D3 Serotonin le$els7 pain threshold7 and fibro#yal!ia sy#pto#s in the !eneral population4 /he Uournal of Aheu#atolo!y P<&"9L0FKGGF 2DD +ibro#yal!ia and headache9 an epide#iolo!ical study supportin! #i!raine as part of the pbro#yal!ia syndro#e Clin Aheu#atol B200FC 2D9 FLFXG01 2DF Pre$alence of fibro#yal!ia syndro#e in #i!raine patients4 P<&"9 1GFFG2DI

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

&0S and the lin bet)een the brain and !ut
&rritable bo)el syndro#e B&0SC is a co##on !astroenteric condition that presents as bloatin!7 abdo#inal cra#ps and diarrhoea4 &t is lon! been suspected that there is a lin bet)een &0S and neuropsychiatric dysfunction7 as the condition is often co#orbid )ith psychiatric conditions such as an>iety7 depression2DG and P/S"2DIW acute sy#pto#s often arise in ti#es of #ental distress4 Eo)e$er7 as endocannabinoids are e>pressed in the enteric ner$ous syste# B2NSC7 as )ell as the areas of the brain affected by such psychiatric disorders7 their effect #ay be independent4 Serotonin also plays a part in &0S7 influencin! !ut #otility Bthe peristaltic actions of the colon7 )hich beco#e OspasticP or uncontrolled durin! bouts of &0SC7 sensiti$ity and secretion of fluid4 &nterestin!ly7 &0S-" Bcharacterised by diarrhoeaC sufferers ha$e been sho)n to ha$e increased blood serotonin le$els7 )hile sufferers of &0S-C Bcharacterised by constipationC e>perience reduced le$els of serotonin42DK

2DG

Co#orbidity of &rritable 0o)el Syndro#e in Psychiatric Patients9 A Ae$ie) - A#erican Uournal of /herapeutics9Uanuary:+ebruary 2003 - (olu#e 10 - &ssue 1 - pp G1-GI 2DI Co#orbidity of posttrau#atic stress disorder and irritable bo)el syndro#e4 Uournal of Clinical Psychiatry7 (ol FIB12C7 "ec 1LLG7 FIG-FIK4 doi9 104D0KK:UCP4$FIn120D 2DK About4co# /he 0rain Gut Connection

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Cannabinoid receptors in the enteric ner$ous syste#
&t has been de#onstrated that acti$ation of the cannabinoid receptors in the 2NS decreases hypersensiti$ity of the !ut72DL as )ell as reducin! !ut #otility and infla##ation4 <any sufferers of &0S use cannabis to alle$iate their sy#pto#s7 althou!h so#e report that sy#pto#s )orsened subse;uent to co##encin! use4 /he o$erlap bet)een instances of these conditions has led to the hypothesis that they are all e>pressions of the sa#e underlyin! so#atic disorder4 2F0 <any sufferers of &0S also report sy#pto#s of #i!raine72F1 and up to I0\ of fibro#yal!ia sufferers also present &0S sy#pto#s4 <any ha$e all three7 but it is not strictly necessary for all three to be present for an underlyin! condition to be the cause7 as #any spectru# disorders #anifest #ar edly different sy#pto#s fro# patient to patient7 and other related conditions #ay be in$ol$ed42F2

2DL

/he role of the endocannabinoid syste# in the pathophysiolo!y and treat#ent of irritable bo)el syndro#e Neuro!astroenterolo!y , <otility (olu#e 207 &ssue K7 pa!es KFIXKGK7 Au!ust 200K 2F0 /here is only one functional so#atic syndro#e4 /he 0ritish Uournal of Psychiatry B200DC1KF9 LF-LGdoi9 10411L2:bTp41KF424LF 2F1 <i!raine7 fibro#yal!ia7 and depression a#on! people )ith &0S9 a pre$alence study4 0<C Gastroenterolo!y 200G 4 doi910411KG:1DI1-230H-G-2G 2F2 Afton 14 Eassett7 Psy"W "aniel U4 Clau)7 <"4 +ibro#yal!ia and &rritable 0o)el Syndro#e9 &s /here a ConnectionQ

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8nderlyin! condition
/he idea that a dysfunctional endocannabinoid syste# is responsible for this postulated so#atic disorder first arose )ithin the last fe) years4 &n 200D7 the condition C2C" )as first proposedW 2F3 researchers su!!ested that the hi!h de!ree of co#orbidity7 alon! )ith the co##on feature of unusual cannabinoid receptor acti$ity7 pointed to an underlyin! disorder of the endocannabinoid syste#4 <any no)n conditions can be attributed to dysfunction of a specific neurotrans#itter syste#9 Al5hei#er=s is caused by deficiency of the acetylcholine neurotrans#itter7 2FD and Par inson=s by a!e-related dopa#ine deficiency42FF &t is therefore lo!ical to assu#e that deficiency of the cannabinoid neurotrans#itters )ould also cause a specific disorder7 or set of related disorders4 /he relationship )ith the serotonin si!nallin! syste# cannot be i!nored )hen researchin! the possibility of C2C"=s e>istence4 0eha$ioural studies su!!est that the effects of endocannabinoid si!nallin! are #ediated by re!ulation of the serotonin syste#9 /EC has been sho)n to inhibit serotonin release fro# the platelets in #i!raine sufferers7 as )ell as increasin! synthesis of serotonin in the brainW2FG 2-AG and cannabidiol ha$e de#onstrated si#ilar effects4 Eo)e$er7 the independent effects of cannabinoids on the cannabinoid receptors are thou!ht to be the underlyin! cause of C2C"7 despite this possibly funda#ental relationship )ith serotonin si!nallin!4 &f the e>istence of C2C" is pro$en7 tar!eted therapies can be in$esti!ated7 )hich )ould pinpoint the precise nature of the deficiency and deter#ine the appropriate ratio and dosa!e of supple#ental e>o!enous cannabinoids4 At present7 treat#ent of these conditions is usually throu!h in!estion of crude cannabis e>tract7 or throu!h s#o in!7 )hich #ay in$ol$e )ildly different cannabinoid ratios bet)een cannabis strains4 "ue to the dose-dependent effect of #any cannabinoids7 relief of sy#pto#s #ay not be ade;uate )ith so#e $arieties4

2F3

Clinical 2ndocannabinoid "eficiency BC2C"C9 Can this Concept 2>plain /herapeutic 0enefits of Cannabis in <i!raine7 +ibro#yal!ia7 &rritable 0o)el Syndro#e and other /reat#ent-Aesistant ConditionsQ Neuroendocrinol 1ett 200DW 2FB1:2C91L2X3L 2FD Acetylcholinesterase inhibitors for Al5hei#er=s disease9 anti-infla##atories in acetylcholine clothin! - A!e A!ein! BUuly 200GC 2FF Striatal dopa#ine deficiency in par inson?s disease9 Aole of a!in!4 Annals of Neurolo!y (olu#e 2G7 &ssue D7 pa!es FF1XFFI7 3ctober 1LKL 2FG /he effect of deltaL-tetrahydrocannabinol on the con$ersion of a3Ebtrypotphan to F-a3Eb hydro>ytrypta#ine in the #ouse brain4 P<&"9I0233F

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Pro#otion of Eo#eostasis
Eo#eostasis is the process by )hich the inputs and outputs of entropy e>chan!e flo) to and fro# characteristic internal7 flo) dependent structures7 essentially allo)in! the# to constantly adapt to their constantly chan!in! en$iron#ent4 /he sur$i$al ti#e of an indi$idual:population is dependant on the rate of #o$e#ent to)ards e;uilibriu# as #easured by illness and ulti#ately7 death4 2FI &t is no) no)n that this syste# #aintains ho#eostasis )ithin and across the or!ani5ational scales of all ani#als4 Within a cell7 cannabinoids control basic #etabolic processes such as !lucose #etabolis#4 Cannabinoids re!ulate intercellular co##unication7 especially in the i##une and ner$ous syste#s4 &n !eneral7 cannabinoids #odulate and coordinate tissues7 or!an and body syste#s Bincludin! the cardio$ascular7 di!esti$e7 endocrine7 e>cretory7 i##une7 #usculos eletal7 ner$ous7 reproducti$e7 and respiratory syste#sC4 /he effects of cannabinoids on consciousness are not )ell understood7 but are )ell no)n7 and underlie recreational cannabis use4 /hese effects also ha$e therapeutic possibilities42FK

2FI 2FK

2ndocannabinoids9 <ulti-scaled7 Global Eo#eostatic Ae!ulators of Cells and Society Ear# Aeduction Uournal * Ear# reduction-the cannabis parado>

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Cannabis as a pre$entati$e health #easure
/he cannabinoids in cannabis )or )ith our endocannabinoid syste# to pre$ent the de$elop#ent of debilitatin! ail#ents7 such as de!enerati$e and a!e-related diseases4 "r4 Aobert <ela#ede in his !roundbrea in! paper7 OEar# Aeduction-the Cannabis Parado>7P proposed that Othe ho#eostatic action of cannabinoids on so #any physiolo!ical structures and processes is the basis for the hypothesis that the endocannabinoid syste# is nothin! less than a naturally e$ol$ed har# reduction syste#4P2FL &n the Au!ust 200L issue of Cancer Pre$ention Aesearch7 #edical researchers reported that O10 to 20 years of cannabis use )as associated )ith a si!nificantly reduced ris of head and nec s;ua#ous cell cancer4P Eead and Nec S;ua#ous Cell Cancer BENSCCC is associated )ith the use of alcohol and tobacco7 but not cannabis and the study found that for people )ho use alcohol and tobacco7 those )ho also used cannabis had a lo)er incidence of ENSCC than those )ho did not4 2G0

@6he largest epide"iologic (case-control) study of the association between AcannabisB use and lung cancer failed to de"onstrate that "ari.uana increases the risk of de)eloping lung (or! for that "atter! upper airway) cancer. 6he 6/C in AcannabisB has well-defined anti-tu"oral effects that ha)e been shown to inhibit the growth of a )ariety of cancers in ani"al "odels and tissue culture syste"s! thus counteracting the potentially tu"origenic effects of the procarcinogens in AcannabisB s"oke.C 2G1
"r "onald /ash in

2FL 2G0

Ear# Aeduction Uournal * Ear# reduction-the cannabis parado> NC0& A population-based case-control study of #ariTuana use and head and nec 1LG3KDL0 2G1 /i#e4co# * Study9 S#o in! <ariTuana Not 1in ed )ith 1un! "a#a!e Uuly 10 2012

s;ua#ous cell carcino#a4 P<&"9

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/he a$ailable literature su!!ests that the endocannabinoid syste# #ay be tar!eted to suppress the e$olution and pro!ression of breast7 prostate and bone cancer as )ell as the acco#panyin! pain syndro#es4 Althou!h this re$ie) focuses on these three types of cancer7 acti$ation of the endocannabinoid si!nalin! syste# produces anti-cancer effects in other types of cancer includin! s in7 brain !lio#as and lun!42G2 &nterestin!ly7 cannabis trials in population based studies failed to sho) any e$idence for increased ris of respiratory sy#pto#s:chronic obstructi$e pul#onary disease or lun! cancer associated )ith s#o in! cannabis42G3 <oreo$er7 synthetic cannabinoids B` L-/ECC and the endocannabinoid syste# play a role in inhibitin! cancer cell proliferation and an!io!enesis7 reducin! tu#or !ro)th and #etastases and inducin! apoptosis Bself destruction for cancer cellsC in all three types of cancers re$ie)ed here4 /hese obser$ations raise the possibility that a dysre!ulation of the endocannabinoid syste# #ay pro#ote cancer7 by fosterin! physiolo!ical conditions that allo) cancer cells to proliferate7 #i!rate and !ro)4 /hese obser$ations also raise the e>citin! possibility that enhancin! cannabinoid tone throu!h cannabinoid-based phar#acotherapies #ay attenuate these har#ful processes to produce anti-cancer effects in hu#ans4 Eo)e$er7 the basic research findin!s are far fro# bein! co#pletely understood and further research is )arranted to better understand the co#ple>ity of dyna#ic chan!es in the endocannabinoid syste# in cancer4 2GD /hese obser$ations also raise the e>citin! possibility that enhancin! cannabinoid tone Bcode for /EC loc in! into the C01 receptorC throu!h cannabinoid based phar#acotherapies #ay attenuate these har#ful processes to produce anti-cancer effects in hu#ans4 2GF

2G2 2G3

/he endocannabinoid syste# and cancer9 therapeutic i#plication 2ffects of <ariTuana S#o in! on the 1un! 2GD /he endocannabinoid syste# and cancer9 therapeutic i#plication 2GF NC0& /he endocannabinoid syste# and cancer9 therapeutic i#plication Au! 2011 P<C9 31GFLFF

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Neurode!eneration and Protection
&n an increasin!ly a!ed population7 the incidence of neurode!enerati$e disorders such as Al5hei#er?s disease7 Par inson?s disease and Euntin!ton?s disease are on the rise4 While the aetiolo!ies of these disorders are different7 a nu#ber of co##on #echanis#s that underlie their neurode!enerati$e co#ponents ha$e been elucidatedW na#ely neuroinfla##ation7 e>citoto>icity7 #itochondrial dysfunction and reduced trophic support4 Current therapies focus on treat#ent of the sy#pto#s and atte#pt to delay the pro!ression of these diseases but there is currently no cure4 <odulation of the endo!enous cannabinoid syste# is e#er!in! as a potentially $iable option in the treat#ent of neurode!eneration4 2ndocannabinoid si!nalin! has been found to be altered in #any neurode!enerati$e disorders4 /o this end7 phar#acolo!ical #anipulation of the endo!enous cannabinoid syste#7 as )ell as application of phytocannabinoids and synthetic cannabinoids ha$e been in$esti!ated4 Si!nalin! fro# the C0 1 and C02 receptors are no)n to be in$ol$ed in the re!ulation of Ca2j ho#eostasis7 #itochondrial function7 trophic support and infla##atory status7 respecti$ely7 )hile other receptors !ated by cannabinoids such as PPAAq7 are !ainin! interest in their anti-infla##atory properties4 /hrou!h #ultiple lines of e$idence7 this e$olutionarily conser$ed neuro-si!nallin! syste# has sho)n neuroprotecti$e capabilities and is therefore a potential tar!et for neurode!enerati$e disorders42GG

2GG

0ritish Uournal of Phar#acolo!y * /he &nfluence of Cannabinoids on Generic /raits of Neurode!eneration

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Cannabis Patents
A fe) public ac no)led!e#ents of inno$ati$e industrial applications and processes throu!h the re!istration of respecti$e in$entions as patents ha$e been re!istered at patent offices7 !lobally4 /he cannabis industry is no different than any other industry )ith #any inno$ators and intellectuals re!isterin! their share of the intellectual property surroundin! the #edical7 industrial and application of cannabis4 /he #ost notable patent belo) re!ardin! cannabis as antio>idants and neuroprotectant7 has been re!istered by /he 8nited States of A#erica as represented by the "epart#ent of Eealth and Eu#an Ser$ices4

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Cannabinoids as antio4idants and neuroprote tants B Patent nr9 CA 232LG2G A1 Cannabinoids ha$e been found to ha$e antio>idant properties7 unrelated to N<"A receptor anta!onis#4 /his ne) found property #a es the cannabinoids useful in the treat#ent and prophyla>is of )ide $ariety of o>idation associated diseases7 such as ische#ic7 a!e-related7 infla##atory and autoi##une diseases4 /he cannabinoids are found to ha$e particular application as neuroprotectants7 for e>a#ple in li#itin! neurolo!ical da#a!e follo)in! ische#ic insults7 such as stro e and trau#a7 or in the treat#ent of neurode!enerati$e diseases7 such as Al5hei#er?s disease7 Par inson?s disease and E&( de#entia4 Non-psychoacti$e cannabinoids7 such as cannabidoil7 are particularly ad$anta!eous to use because they a$oid to>icity that is encountered )ith psychoacti$e cannabinoids at hi!h doses useful in the #ethod of the present in$ention4 A particular disclosed class of cannabinoids useful as neuroprotecti$e antio>idants is for#ula B&C )herein the A !roup is independently selected fro# the !roup consistin! of E7 CE37 and C3CE34 Cannabinoids as antio4idants and neuroprote tants B Patent nr9 8S GG30F0I 01 Cannabinoids ha$e been found to ha$e antio>idant properties7 unrelated to N<"A receptor anta!onis#4 /his ne) found property #a es cannabinoids useful in the treat#ent and prophyla>is of )ide $ariety of o>idation associated diseases7 such as ische#ic7 a!e-related7 infla##atory and autoi##une diseases4 /he cannabinoids are found to ha$e particular application as neuroprotectants7 for e>a#ple in li#itin! neurolo!ical da#a!e follo)in! ische#ic insults7 such as stro e and trau#a7 or in the treat#ent of neurode!enerati$e diseases7 such as Al5hei#er?s disease7 Par inson?s disease and E&( de#entia4 Non-psychoacti$e cannabinoids7 such as cannabidoil7 are particularly ad$anta!eous to use because they a$oid to>icity that is encountered )ith psychoacti$e cannabinoids at hi!h doses useful in the #ethod of the present in$ention4 A particular disclosed class of cannabinoids useful as neuroprotecti$e antio>idants is for#ula B&C )herein the A !roup is independently selected fro# the !roup consistin! of E7 CE 37 and C3CE34 Cannabinoid pat h and method for annabis transdermal deliver5 B Patent nr9 CA 23FG020 C A transder#al structure is pro$ided for deli$erin! cannabis che#icalBsC to one?s bloodstrea#4 /he structure co#prises a bac in! layer )hich carries the cannabis che#icalBsC4 /he che#icals are contained in a fil# on the bac in! layer or )ithin a ca$ity for#ed in the bac in! layer4 Alternati$ely7 an openin! in a secondary layer that o$erlies the bac in! layer #ay be used to create the ca$ity4 /he structure is applied to one?s s in so that the cannabis che#icals are in contact )ith the s in 4 A poly#er #aterial )hich is #i>ed )ith the cannabis and placed in the ca$ity or a #e#brane o$er the ca$ity #ay be used to control the flo) of cannabis che#icalBsC into the bloodstrea#4 &n an alternati$e e#bodi#ent7 a porous #aterial i#pre!nated )ith cannabis che#icalBsC #ay be used to hold the che#icalsC in the ca$ity4 0ecause of the relati$ely slo) transder#al flo) rate of cannabis #aterials7 it is preferred to utili5e per#eation enhancers in conTunction )ith the cannabis carrier or reser$oir #atri>es or s in contactin! adhesi$e layers4 S5stems and methods for produ in3 or3ani annabis tin ture B Patent nr9 8S KDDF03D 01

Syste#s and #ethods are disclosed for fabricatin! a #edicine by preparin! a cannabis plant #aterial and classifyin! the cannabis plant #aterial into an acid7 neutral7 or analo! for#W e>tractin! cannabinoids fro# the cannabis plant #aterial by either a reflu> process throu!h e$aporatin! and condensin! the cannabis plant #aterial or an ultrasonic e>traction process of the cannabis plant #aterial )ith ultrasonic )a$esW and infusin! the cannabinoids )ith an alternati$e e#ulsion4 Cannabis dru3 deliver5 and monitorin3 s5stem B Patent nr9 W3 201200G12G A1 /his in$ention relates to a ne) technolo!y that enables ad#inistration of Cannabis to patients for #edical purposes4 &n one e#bodi#ent7 this in$ention is a co#ponent of a syste# of technolo!ies7 processes and concepts that creates a ne) #ethod of producin!7 deli$erin!7 ad#inisterin! and re!ulatin! the use of #edical cannabis4

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Topi al Compositions @ith Cannabis *4tra ts B Patent nr9 8S 201302ID321 A1 /he present in$ention pro$ides a #ethod for a topical treat#ent of a s in cyst4 /he #ethod includes9 applyin! a for#ulation to the s in cyst of a #a##alW )herein the for#ulation includes9 a di#ethyl sulfo>ide e>tract of #ature7 dried7 po)dered Cannabis sati)a flo)er and bud lea$es7 )herein the #ature7 dried7 po)dered Cannabis sati$a flo)er and bud lea$es include !reater than or e;ual to about 10 )ei!ht percent of tetrahydrocannibolinic acid and ha$e been heated for appro>i#ately fi$e #inutes at a te#perature !reater than or e;ual to about 1G0] C to less than about 1L3] C Topi al Compositions @ith Cannabis *4tra ts B Patent nr9 8S 201202GDK1K A1 (arious topical co#positions includin! heat-treatin! #ature7 dried7 po)dered4 Cannabis sati$a flo)er and bud lea$es in carriers are disclosed4 (arious #ethods for the treat#ent of pain and #ethicillin-resistant Staphylococcus aureus B<ASAC infections are disclosed4 <ethods of #a in! the topical co#position7 and patches7 strips7 banda!es7 and co$erin!s containin! the topical co#position are also disclosed4 Pro esses for preparin3 a annabinoid?ri h e4tra t from annabis plant material B Patent nr9 2P 13KFFLF 01 Processes for preparin! e>tracts of natural products such as plant #aterial7 and for preparin! purified e>tracts fro# crude e>tracts of natural products7 by e>traction )ith hot !as4 Apparatus suitable for use in preparin! e>tracts of natural products are also described4 Semen annabis la4ative tea and preparation method thereof B Patent nr9 CN 1021IILLG 0 /he in$ention discloses se#en cannabis la>ati$e tea and a preparation #ethod thereof4 /he preparation #ethod co#prises the follo)in! steps of9 )ei!hin! F-20 parts of sundried oolon! tea7 F-12 parts of se#en cannabis and 3-L parts of honeysuc le7 respecti$ely e>tractin! the se#en cannabis and the honeysuc le by usin! alcohol7 dilutin! the e>tracts )ith pure )ater7 unifor#ly #i>in! the e>tracts )ith the sundried oolon! tea7 and fer#entin! the #i>ture accordin! to the traditional Pu?er tea pile-fer#entation process to obtain the se#en cannabis la>ati$e tea4 &n the in$ention7 the se#en cannabis7 the honeysuc le and the tea are or!anically co#bined by usin! tea post-fer#entation process conditions accordin! to a prescription of the traditional Chinese #edicine theory7 #edicine is co#bined )ith tea7 so that the solution and the absorpti$ity of the #edicine are !reatly increased7 and the curati$e effect of preser$in! health is enhanced4 /he #edicine can be ta en )hile the tea is drun 7 so that the incon$enience of ta in! the #edicine separately is eli#inated4 Phar#acolo!ical researches and clinical practices pro$e that the se#en cannabis la>ati$e tea has an ob$ious curati$e effect of rela>in! the bo)els4 "on3 life plateau annabis sativa?@ild @alnut t@o? omponent blendin3 hi3h?3rade r health edible oilC Patent nr9 CN 102FF0I0L A /he in$ention relates to a lon! life plateau cannabis sati$a-)ild )alnut t)o-co#ponent co#bination hi!h-!rade health edible oil4 With the present in$ention7 the edible oil in China is studied and analy5ed for #any years7 and the edible oil on the #ar et is subTected to deep in$esti!ation analysis4 &n order to sol$e the proble# of the health edible oil on the #ar et7 the ancestral infor#al prescription is studied and su##ari5ed by studyin! fol traditional Chinese #edicine accordin! to a plurality of traditional Chinese #edicine theory docu#ents4 Accordin! to the present in$ention7 cannabis sati$a Bhe#pC and )ild )alnut B)alnutC are adopted as the for#ula4 /he oil e>tracted fro# the cannabis sati$a seeds is adopted as the #ain #aterial7 the oil e>tracted fro# the )ild )alnut #eat is adopted as an au>iliary #aterial7 and the t)o co#ponents are blended to obtain the edible oil4 /he health edible oil of the present in$ention has effects of heat clearin!7 lun! #oisturi5in!7 diuresis7 intestinal tract s#oothin!7 sedation7 lun! and idney )ar#-benefitin!7 asth#a relie$in!7 intestinal tract s#oothin!7 brain tonifyin!7 intelli!ence de$elopin!7 brain nourishin! and tonifyin! of the brain)or er7 and the li e4 /he edible #ethod of the edible oil of the present in$ention is the sa#e as the edible #ethod of the co##on oil4

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Pharma euti al and osme euti al ompositions ontainin3 annabis flo@er and seed e4tra ts Patent nr9 W3 20101F02DF A1 /he present in$ention discloses a co#position for treatin! a condition )hich is adapted for application to the s in4 /he condition is characteri5ed by infla##ation of tissue4 /he co#position co#prises a #i>ture of cannabis flo)er e>tract and cannabis seed e>tract4 +nhalation of vapour of therapeuti al substan esD like eC3C annabis e4tra t B Patent nr9 W3 200303I30G A2 A #ethod of #a in! a #edica#ent )hich is a $apour co#prisin! heatin! a co#position to a te#perature not e>ceedin! F00 ]C for a ti#e of less than 10 seconds4 /he co#position is non-$olatile at IF ]C and !enerates a $apour free of pyrolysis products )hen heated in this )ay4 /he $apour is produced in a portion of air s#aller than the #ean respiratory tidal $olu#e4 A co#position suitable for usin! in such a #ethod is also disclosed4 -arked Cannabis !or +ndi atin3 -edi al -ariEuana B Patent nr9 8S 20120311IDD A1 /he in$ention in$ol$es transfor#in! Cannabis )ith a trans!eneBsC or che#icalBsC e>pressin! biolo!ical7 che#ical7 lu#inescent7 and fluorescent #ar ers fro# the 8(7 $isible7 near7 #id7 and far spectru#s of li!ht4 /his transfor#ation allo)s for the detection of <edical <ariTuana fro# other for#s of #ariTuana4 Cannabis is a !enus of flo)erin! plant that include three putati$e species Cannabis sati)a!Cannabis indica 7 and Cannabis ruderalis4 /he in$ention relates to seeds7 plants7 plant cells7 plant tissue7 and har$ested products fro# transfor#ed Cannabis4 /he in$ention also relates to plants and $arieties produced by the #ethod of essential deri$ation fro# plants of transfor#ed Cannabis and to plants of transfor#ed Cannabis reproduced by $e!etati$e #ethods7 includin! but not li#ited to tissue culture of re!enerated cells or tissue fro# transfor#ed Cannabis. (hite Eell5fun3us and fru tus annabis bevera3e food and preparation method thereof Patent nr9 CN 101K2KI3L 0 /he in$ention relates to the technical field of food be$era!es7 in particular to a )hite Tellyfun!us and fructus cannabis be$era!e food and a preparation #ethod thereof4 /he food contains the follo)in! ra) #aterials in )ei!ht percent9 3-20 percent of fructus cannabis7 0403-10 percent of )hite Tellyfun!us7 1-GF percent of s)eetener7 040F-2 percent of co#posite e#ulsion stabili5er and 040F-G percent of !els4 /he )hite Tellyfun!us and fructus cannabis be$era!e food not only has uni;ue s#ooth #outh feelin! and fra!rance but also has the functions of #oistenin! dryness and rela>in! the bo)els7 lo)erin! blood fat7 resistin! infla##ations7 resistin! radiation7 enhancin! i##unity and the li e4 Plant e4tra t from lo@?th annabis for the treatment of disease B Patent nr9 8S 20130012FIF A1

/he present in$ention relates to a plant e>tract fro# a lo)-tetrahydrocannabinol B/ECC $ariety of Cannabis sati)a subsp4 sati)a for the treat#ent of disease4 /he in$ention further relates to the production of the e>tract and phar#aceutical co#positions co#prisin! said e>tract and the uses thereof4 Plant e4tra t from lo@?T&C Cannabis for the treatment of disease B Patent nr9 8S K33IL0K 02 /he present in$ention relates to a plant e>tract fro# a lo)-tetrahydrocannabinol B/ECC $ariety of Cannabis sati)a subsp4 sati)a for the treat#ent of disease4 /he in$ention further relates to the production of the e>tract and phar#aceutical co#positions co#prisin! said e>tract and the uses thereof4 +ndustrial hempA annabis sativa B Patent nr9 W3 20130FG2GL A2 "isclosed are syste#s7 #ethods and uses of the cannabis sati$a plant4 8ses are co#prised of industrial uses and applications7 not included hu#an consu#ption7 such as the creation of bio fuel7 papers7 foods7 consu#er te>tiles7 buildin! #aterials7 personal hy!iene products7 a#on! others4 +urther applications include utili5in! the cannabis sati$a plant7 or he#p7 as an ener!y throu!h the creation of bio fuel by cellulosic fer#entation7 !asification7 and distillation a#on! others4

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South African Cannabis Aelated Ae!istered Patents
A search in South Africa=s C&PC patent office database re$eals the follo)in! patents that has been re!istered )ith cannabis or cannabinoid references4 &t is ;uestionable as to ho) so #any patents could be ha$e been filed on a substance that is still ille!al7 and i#possible to do scientific research trials on4

Patent noC

Appli ation date

0rant date

Title of invention
<2/E3" +3A PA3"8C&NG AN 2H/AA +A3< CANNA0&S P1AN/ <A//2A7 C3N/A&N&NG A /2/AAE6"A3CANNA0&N31 AN" A CANNA0&"&31 AN" CANNA0&S 2H/AAC/S PEAA<AC28/&CA1 C3<P3S&/&3N <A"2 3+ CANNA0&S 2H/AAC/S "2/2C/&3N 3+ CANNA0&S 8S2

%eferen e noC

Patent status

2003:02DKL

31-<ar 2003

2L:0L:00D

P:GK0&FIG0:dA

Granted

2003:0GILD

2L-Au! 2003

2D:11:200D

1DKIF3

Granted

2010:0KDL1

2F-No$ 2010

31:0K:2011

PF0K01dA00

Granted 6able ,

/he abo$e search returned three results for cannabis7 this search result e>pands to I1 results )hen searchin! on cannabinoids42GI

2GI

C&PC Patent Search

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Cannabis and <edical Conditions
1isted belo) are )ell researched conditions )ith supportin! peer-re$ie)ed studies that sho) the potential therapeutic $alue of cannabis4

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14 Al5hei#erʹs "isease
Al5hei#erʹs disease BA"C is a neurolo!ical disorder of un no)n ori!in that is characterised by a pro!ressi$e loss of #e#ory and learned beha$ior4 Patients )ith Al5hei#er ʹs are also li ely to e>perience depression7 a!itation and appetite loss7 a#on! other sy#pto#s4 No appro$ed treat#ents or #edications are a$ailable to stop the pro!ression of A"7 and fe) phar#aceuticals ha$e been +"ANappro$ed to treat sy#pto#s of the disease4 A re$ie) of the recent scientific literature indicates that cannabinoid therapy #ay pro$ide sy#pto#atic relief to patients afflicted )ith A" )hile also #oderatin! the pro!ression of the disease4 Writin! in the +ebruary 200F issue of the Uournal of Neuroscience7 in$esti!ators at <adrid ʹs Co#plutense 8ni$ersity and the CaTal &nstitute in Spain reported that the intracerebro$entricular ad#inistration of the synthetic cannabinoid W&N FF7212N2 pre$ented co!niti$e i#pair#ent and decreased neuroto>icity in rats inTected )ith a#yloidN beta peptide Ba protein belie$ed to induce Al5hei#erʹsC4 Additional synthetic cannabinoids )ere also found to reduce the infla##ation associated )ith Al5hei#erʹs disease in hu#an brain tissue in culture4 ʺ3ur results indicate that 444 cannabinoids succeed in pre$entin! the neurode!enerati$e process occurrin! in the disease7 ʺ in$esti!ators concluded42GK +ollo) up studies by in$esti!ators de#onstrated that the ad#inistration of the non-psychotropic plant cannabinoid cannabidiol BC0"C also #iti!ated #e#ory loss in a #ouse #odel of the disease42GL &n$esti!ators at /he Scripps Aesearch &nstitute in California in 200G reported that /EC inhibits the en5y#e responsible for the a!!re!ation of a#yloid pla;ue @ the pri#ary #ar er for Al5hei#er ʹs disease - in a #anner ʺconsiderably superiorʺ to appro$ed Al5hei#er ʹs dru!s such as donepe5il and tacrine4 ʺ3ur results pro$ide a #echanis# )hereby the /EC #olecule can directly i#pact Al5hei#er ʹs disease patholo!y7ʺ researchers concluded4 ʺ/EC and its analo!ues #ay pro$ide an i#pro$ed therapeutic aoptionb for Al5hei#erʹs disease abyb444 si#ultaneously treatin! both the sy#pto#s and the pro!ression of atheb disease4ʺ2I0 <ore recently7 in$esti!ators at 3hio State 8ni$ersity7 "epart#ent of Psycholo!y and Neuroscience7 reported that older rats ad#inistered daily doses of W&N FF7212N2 for a period of three )ee s perfor#ed si!nificantly better than nonNtreated controls on a )aterN#a5e #e#ory test4 Writin! in the Tournal Neuroscience in 200I7 researchers reported that rats treated )ith the co#pound e>perienced a F0 percent i#pro$e#ent in #e#ory and a D0 to F0 percent reduction in infla##ation co#pared to controls42I1
2GK

NC0& Aa#ire5 et al4 200F4 Pre$ention of Al5hei#erʹs disease patholo!y by cannabinoids4 /he Uournal of Neuroscience 2F9 1L0DN1L134 P<C 21L0031 2GL &srael National Ne)s4 "ece#ber 1G7 20104 ʺ&sraeli research sho)s cannabidiol #ay slo) Al5hei#erʹs disease4ʺ 2I0 2uban s et al4 200G4 A #olecular lin bet)een the acti$e co#ponent of #ariTuana and Al5hei#er ʹs disease patholo!y4 <olecular Phar#aceutics 39 II3NIII4 P<C2FG233D 2I1 <archalant et al4 200I4 AntiNinfla##atory property of the cannabinoid a!onist W&NNFF212N2 in a rodent #odel of chronic brain infla##ation4 Neuroscience4 P<C1KF2F13

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Pre$ious preclinical studies ha$e de#onstrated that cannabinoids can pre$ent cell death by antiNo>idation42I2 So#e e>perts belie$e that cannabinoidsʹ neuroprotecti$e properties could also play a role in #oderatin! A"42I3 Writin! in the Septe#ber 200I issue of the 0ritish Uournal of Phar#acolo!y7 in$esti!ators at &reland ʹs /rinity Colle!e &nstitute of Neuroscience concluded7 ʺaCbannabinoids offer a #ultifaceted approach for the treat#ent of Al5hei#erʹs disease by pro$idin! neuroprotection and reducin! neuroinfla##ation7 )hilst si#ultaneously supportin! the brainʹs intrinsic repair #echanis#s by au!#entin! neurotrophin e>pression and enhancin! neuro!enesis4 <anipulation of the cannabinoid path)ay offers a phar#acolo!ical approach for the treat#ent of A" that #ay be efficacious than current treat#ent re!i#ens4ʺ2ID &n addition to potentially #odifyin! the pro!ression of A"7 clinical trials also indicate that cannabinoid therapy can reduce a!itation and sti#ulate )ei!ht !ain in patients )ith the disease4 <ost recently7 in$esti!ators at 0erlin Ger#anyʹs Charite 8ni$ersitrt#edi5in7 "epart#ent of Psychiatry and Psychotherapy7 reported that the daily ad#inistration of 24F #! of synthetic /EC o$er a t)oN)ee period reduced nocturnal #otor acti$ity and a!itation in A" patients in an openNlabel pilot study4 2IF Clinical data presented at the 2003 annual #eetin! of the &nternational Psycho!eriatric Association reported that the oral ad#inistration of up to 10 #! of synthetic /EC reduced a!itation and sti#ulated )ei!ht !ain in lateNsta!e Al5hei#erʹs patients in an openNlabel clinical trial4 &#pro$ed )ei!ht !ain and a decrease in ne!ati$e feelin!s a#on! A" patients ad#inistered cannabinoids )ere pre$iously reported by in$esti!ators in the &nternational Uournal of Geriatric Psychiatry in 1LLI4 2IG Additional study assessin! the use of cannabinoids for Al5hei#er ʹs )ould appear to be )arranted4

2I2

Ea#pson et al4 1LLK4 Cannabidiol and deltaNLNtetrahydrocannabinol are neuroprotecti$e antio>idants4 Proceedin!s of the National Acade#y of Sciences PNAS Uuly I7 1LLK $ol4 LF no4 1D K2GK-K2I3 2I3 Science Ne)s4 Uune 117 1LLK4 ʺ<ariTuana che#ical tapped to fi!ht stro es4ʺ 2ID NC0& Ca#pbell and Go)ran4 200I4 Al5hei#erʹs diseaseW ta in! the ed!e off )ith cannabinoidsQ 0ritish Uournal of Phar#acolo!y 1F29 GFFNGG24 P<C 21L0031 2IF Walther et al4 200G4 "eltaNLNtetrahydrocannabinol for ni!htti#e a!itation in se$ere de#entia4 Physcophar#acolo!y 1KF9 F2DNF2K4 P<&"9 1GF21031 2IG (olicer et al4 1LLI4 2ffects of dronabinol on anore>ia and disturbed beha$ior in patients )ith Al5hei#er ʹs disease4 &nternational Uournal of Geriatric Psychiatry 129 L13NL1L4

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24 A#yotrophic 1ateral Sclerosis BA1SC
A#yotrophic lateral sclerosis BA1SC7 also no)n as 1ou Gehri! ʹs disease7 is a fatal neurode!enerati$e disorder that is characteri5ed by the selecti$e loss of #otor neurons in the spinal cord7 brainste#7 and #otor corte>4 An esti#ated 307000 A#ericans are li$in! )ith A1S7 )hich often arises spontaneously and afflicts other)ise healthy adults4 <ore than half of A1S patients die )ithin 24F years follo)in! the onset of sy#pto#s4 A re$ie) of the scientific literature re$eals an absence of clinical trials in$esti!atin! the use of cannabinoids for A1S treat#ent4 Eo)e$er7 recent preclinical findin!s indicate that cannabinoids can delay A1S pro!ression7 lendin! support to anecdotal reports by patients that cannabinoids #ay be efficacious in #oderatin! the disease=s de$elop#ent and in alle$iatin! certain A1SNrelated sy#pto#s such as pain7 appetite loss7 depression and droolin!4 2II Writin! in the <arch 200D issue of the Tournal A#yotrophic 1ateral Sclerosis , 3ther <otor Neuron "isorders7 in$esti!ators at the California Pacific <edical Center in San +rancisco reported that the ad#inistration of /EC both before and after the onset of A1S sy#pto#s sta$ed disease pro!ression and prolon!ed sur$i$al in ani#als co#pared to untreated controls4 2IK Additional trials in ani#al #odels of A1S ha$e sho)n that the ad#inistration of other naturally occurrin! and synthetic cannabinoids can also #oderate A1S pro!ression but not necessarily i#pact sur$i$al42IL7 2K0 3ne recent study de#onstrated that bloc in! the C0 1 cannabinoid receptor did e>tend lifespan in an A1S #ouse #odel7 su!!estin! that cannabinoids ʹ beneficial effects on A1S #ay be #ediated by nonNC01 receptor #echanis#s42K1 As a result7 e>perts are callin! for clinical trials to assess cannabinoids for the treat#ent of A1S4 Writin! in the A#erican Uournal of Eospice , Palliati$e <edicine in 20107 a tea# of in$esti!ators reported7 ʺ0ased on the currently a$ailable scientific data7 it is reasonable to thin that cannabis #i!ht si!nificantly slo) the pro!ression of A1S7 potentially e>tendin! life e>pectancy and substantially reducin! the o$erall burden of the disease4ʺ /hey concluded7 ʺ/here is an o$er)hel#in! a#ount of preclinical and clinical e$idence to )arrant initiatin! a #ulticenter rando#i5ed7 doubleNblind7 placeboNcontrolled trial of cannabis as a diseaseN#odifyin! co#pound in A1S4 ʺ2K2

2II

A#t#ann et al4 200D4 Sur$ey of cannabis use in patients )ith a#yotrophic lateral sclerosis4 /he A#erican Uournal of Eospice and Palliati$e Care 219 LFN10D4 2IK Aa#an et al4 200D4 A#yotrophic lateral sclerosis9 delayed disease pro!ression in #ice by treat#ent )ith a cannabinoid4 A#yotrophic 1ateral Sclerosis , 3ther <otor Neuron "isorders F9 33N3L4 2IL Weydt et al4 200F4 Cannabinol delays sy#pto# onset in S3"1 trans!enic #ice )ithout affectin! sur$i$al4 A#yotrophic 1ateral Sclerosis , 3ther <otor Neuron "isorders G9 1K2N1KD4 2K0 0ilsland et al4 200G4 &ncreasin! cannabinoid le$els by phar#acolo!ical and !enetic #anipulation delay disease pro!ression in S3"1 #ice4 /he +AS20 Uournal 209 1003N100F4 2K1 &bid4 2K2 Carter et al4 20104 Cannabis and a#yotrophic lateral sclerosis9 hypothetical and practical applications7 and a call for clinical trials4 A#erican Uournal of Eospice , Palliati$e <edicine 2I9 3DIN3FG4

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34 Chronic Pain
As #any as one in fi$e A#ericans li$es )ith chronic pain4 2K3 <any of these people suffer fro# neuropathic pain Bner$eNrelated painC NN a condition that is associated )ith nu#erous diseases7 includin! diabetes7 cancer7 #ultiple sclerosis7 and E&(4 &n #ost cases7 the use of standard anal!esic #edications such as opiates and NSA&"S BnonNsteroidal antiNinfla##atory dru!sC is ineffecti$e at relie$in! neuropathic pain4 +urther7 lon!Nter# use of #ost con$entional pain relie$ers7 includin! aceta#inophen7 opioids7 and NSA&"s7 is associated )ith a host of potential ad$erse side effects7 includin! stro e7 erectile dysfunction7 heartNattac 7 hepato>icity7 and accidental o$erdose death4 Sur$ey data indicates that the use of cannabis is co##on in chronic pain population 2KDand se$eral recent +"ANdesi!ned clinical trials indicate that inhaled #ariTuana can si!nificantly alle$iate neuropathic pain4 /hese include a pair of rando#i5ed7 placeboNcontrolled clinical trials de#onstratin! that s#o in! cannabis reduces neuropathy in patients )ith E&( by #ore than 30 percent co#pared to placebo42KF 7 2KG &n addition7 a 200I 8ni$ersity of California in San "ie!o doubleNblind7 placeboNcontrolled trial reported that inhaled cannabis si!nificantly reduced capsaicinNinduced pain in healthy $olunteers4 2KI A 200K 8ni$ersity of California at "a$is doubleNblind7 rando#i5ed clinical trial reported both hi!h and lo) doses of inhaled cannabis reduced neuropathic pain of di$erse causes in subTects unresponsi$e to standard pain therapies42KK +inally7 a 2010 <cGill 8ni$ersity study findin! that s#o ed cannabis si!nificantly i#pro$ed #easures of pain7 sleep ;uality and an>iety in participants )ith refractory pain for )hich con$entional therapies had failed42KL

2K3 2KD

Ne) 6or /i#es4 3ctober 217 1LLD4 ʺStudy says 1 in F A#ericans suffers fro# chronic pain4ʺ Cone et al4 200K4 8rine dru! testin! of chronic pain patients9 licit and illicit dru! patterns4 Uournal of Analytical /o>icolo!y 329 F32NFD34 2KF Abra#s et al4 200I4 Cannabis in painful E&(Nassociated sensory neuropathy9 a rando#i5ed placeboNcontrolled trial4 Neurolo!y GK9 F1FNF214 2KG 2llis et al4 200K4 S#o ed #edicinal cannabis for neuropathic pain in E&(9 a rando#i5ed7 crosso$er clinical trial4 Neuropsychophar#acolo!y 3D9 GI2NK04 2KI Wallace et al4 200I4 "oseNdependent effects of s#o ed cannabis on CapsaicinNinduced pain and hyperal!esia in healthy $olunteers4 Anesthesiolo!y 10I9 IKFNILG4 2KK Wilsey et al4 200K4 A rando#i5ed7 placeboNcontrolled7 crosso$er trial of cannabis ci!arettes in neuropathic pain4 Uournal of Pain L9 F0GNF214 2KL Ware et al4 20104 S#o ed cannabis for chronic neuropathic pain9 a rando#i5ed controlled trial4 C<AU 1K29 GLDNI014

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A re$ie) of these and other trials in 2011 in the 0ritish Uournal of Clinical Phar#acolo!y concluded7 ʺa&bt is reasonable to consider cannabinoids as a treat#ent option for the #ana!e#ent of chronic neuropathic pain )ith e$idence of efficacy in other types of chronic pain such as fibro#yal!ia and rheu#atoid arthritis as )ell4ʺ2L0 A separate re$ie) published in 2012 in /he Clinical Uournal of Pain further concluded7 O3$erall7 based on the e>istin! clinical trials database7 cannabiner!ic pain #edicines ha$e been sho)n to be #odestly effecti$e and safe treat#ents in patients )ith a $ariety of chronic pain conditions4 444 &ncorporatin! cannabiner!ic #edicine topics into pain #edicine education see#s )arranted and continuin! clinical research and e#piric treat#ent trials are appropriate4 ʺ 2L1 Preclinical data indicates that cannabinoids7 )hen ad#inistered in concert )ith one another7 are #ore effecti$e at a#elioratin! neuropathic pain than the use of a sin!le a!ent4 &n$esti!ators at the 8ni$ersity of <ilan reported in 200K that the ad#inistration of sin!le cannabinoids such as /EC or C0" produce li#ited relief co#pared to the ad#inistration of plant e>tracts containin! #ultiple cannabinoids7 terpenes BoilsC7 and fla$onoids Bpi!#entsC4 Aesearchers concluded9 ʺa/bhe use of a standardised e>tract of Cannabis sati$a 444 e$o ed a total relief of ther#al hyperal!esia7 in an e>peri#ental #odel of neuropathic pain7 s a#elioratin! the effect of sin!le cannabinoids7ʺ in$esti!ators concluded4 444 ʺCollecti$ely7 these findin!s stron!ly support the idea that the co#bination of cannabinoid and nonNcannabinoid co#pounds7 as present in aplantNderi$edb e>tracts7 pro$ide si!nificant ad$anta!es in the relief of neuropathic pain co#pared )ith pure cannabinoids alone4ʺ2L2 &n 200L7 an international tea# of in$esti!ators fro# the 8nited Min!do#7 0el!iu# and Ao#ania affir#ed these preclinical findin!s in a clinical study of intractable cancer pain patients4 /hey concluded9 ʺa&bn this study7 the /EC:C0" e>tract sho)ed a #ore pro#isin! efficacy profile than the /EC e>tract alone4 /his findin! is supported by e$idence of additional syner!y bet)een /EC and C0"4 C0" #ay enhance the anal!esic potential of /EC by #eans of potent in$erse a!onis# at C0 2 receptors7 )hich #ay produce antiN infla##atory effects7 alon! )ith its ability to inhibit i##une cell #i!ration4 444 /hese results are $ery encoura!in! and #erit further study4 ʺ2L3
2L0

1ynch and Ca#pbell4 20114 Cannabinoids for treat#ent of chronic nonNcancer painW a syste#atic re$ie) of rando#i5ed trials4 0ritish Uournal of Clinical Phar#acolo!y I29 I3FNIDD4 2L1 Sunil A!!er)al4 20124 Cannabiner!ic pain #edicine9 a concise clinical pri#er and sur$ey of rando#i5edN controlled trial results4 /he Clinical Uournal of Pain a2Npub ahead of printb4 2L2 Co#elli et al4 200K4 Antihyperal!esic effect of a Cannabis sati$a e>tract in a rat #odel of neuropathic pain4 Phytotherapy Aesearch 229 101IN102D4
2L3

Uohnson et al4 200L4 <ulticenter7 doubleNblind7 rando#i5ed7 placeboNcontrolled7 parallelN!roup study of the efficacy7 safety and tolerability of /EC9 C0" e>tract in patients )ith intractable cancerNrelated pain4 Uournal of Sy#pto# <ana!e#ent 3L9 1GIN1IL4

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A 2011 clinical trial assessin! the ad#inistration of $apori5ed plant cannabis in chronic pain patients on a daily re!i#en of #orphine or o>ycodone reported that inhaled ʺcannabis au!#ents the anal!esic effect of opioids4ʺ Authors concluded7 ʺ/he co#bination Bof opioids and cannabinoidsC #ay allo) for opioid treat#ent at lo)er doses )ith fe)er side effects4 ʺ 2LD 0ased on these findin!s7 so#e pain e>perts are no) ad$isin! that physicians reco##end cannabis therapy in addition to or in lieu of opiate #edications to ʺreduce the #orbidity and #ortality rates associated )ith prescription pain #edications4ʺ 2LF

2LD 2LF

Abra#s et al4 20114 CannabiniodNopioid interaction in chronic pain4 Clinical Phar#acolo!y , /herapeutics L09 KDDNKF14 <ar Collen4 20124 Prescribin! cannabis for har# reduction4 Ear# Aeduction Uournal L9 14

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D4 Charcot-<arie-/ooth disease BC</C Eereditary <otor and Sensory Neuropathy BE<SNC
As )e are de$elopin! an increased understandin! of the physiolo!ical function of cannabinoids it is beco#in! e$ident that they #ay be in$ol$ed in the patholo!y of so#e diseases7 particularly neurolo!ical disorders4 Cannabinoids #ay induce both !ro)th and death in a nu#ber of cells7 includin! neurons4 &n the central ner$ous syste# BCNSC7 #ost of the e>peri#ental e$idence indicates that cannabinoids #ay protect neurons fro# da#a!e induced by to>ic and trau#atic insults4 /his Oneuroprotecti$eP effect of cannabinoids #ay ha$e potential clinical rele$ance for the treat#ent of neurode!enerati$e disorders7 includin! C</:E<SN7 as )ell as a#yotrophic lateral sclerosis BA1SC7 #ultiple sclerosis B<SC7 Par inson=s disease7 and inTuries incurred )hen the brain is depri$ed of o>y!en such as in a stro e42LG

2LG

Cannabis9 old #edicine )ith ne) pro#ise for neurolo!ical disorders P<&"9 120FD0L3

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F4 "iabetes <ellitus
"iabetes #ellitus is a !roup of autoi##une diseases characterised by defects in insulin secretion resultin! in hyper!lyce#ia Ban abnor#ally hi!h concentration of !lucose in the bloodC4 /here are t)o pri#ary types of diabetes4 &ndi$iduals dia!nosed )ith type 1 diabetes Balso no)n as Tu$enile diabetesC are incapable of producin! pancreatic insulin and #ust rely on insulin #edication for sur$i$al4 &ndi$iduals dia!nosed )ith type 2 diabetes Balso no)n as adult onset diabetesC produce inade;uate a#ounts of insulin4 /ype 2 diabetes is a less serious condition that typically is controlled by diet4 3$er ti#e7 diabetes can lead to blindness7 idney failure7 ner$e da#a!e7 hardenin! of the arteries and death4 /he disease is the third leadin! cause of death in the 8nited States after heart disease and cancer4 A search of the scientific literature re$eals no clinical in$esti!ations of cannabis for the treat#ent of diabetes7 but does identify a s#all nu#ber of preclinical studies indicatin! that cannabinoids #ay #odify the disease=s pro!ression and pro$ide sy#pto#atic relief to those sufferin! fro# it4 2LI - 2LK A 200G study published in the Tournal Autoi##unity reported that inTections of F #! per day of the nonNpsychoacti$e cannabinoid C0" si!nificantly reduced the incidence of diabetes in #ice4 &n$esti!ators reported that KG\ of untreated control #ice in the study de$eloped diabetes4 0y contrast7 only 30\ of C0"Ntreated #ice de$eloped the disease4 2LL &n a separate e>peri#ent7 in$esti!ators reported that control #ice all de$eloped diabetes at a #edian of 1I )ee s Bran!e 1FN20 )ee sC7 )hile a #aTority BG0 percentC of C0"Ntreated #ice re#ained diabetesNfree at 2G )ee s4 300 3ther preclinical trials ha$e de#onstrated cannabinoids to possess additional beneficial effects in ani#al #odels of diabetes4 Writin! in the <arch 200G issue of the A#erican Uournal of Patholo!y7 researchers at the <edical Colle!e of (ir!inia reported that rats treated )ith C0" for periods of one to four )ee s e>perienced si!nificant protection fro# diabetic retinopathy4 301 /his condition7 )hich is characterised by retinal o>y!en depri$ation and a brea do)n of the bloodNretinal barrier7 is the leadin! cause of blindness in )or in!Na!e adults4

2LI

Cro>ford and 6a#a#ura4 200F4 Cannabinoids and the i##une syste#9 Potential for the treat#ent of infla##atory diseases4 Uournal of Neuroi##unolo!y 1GG9 3N1K4 2LK 1u et al4 200G4 /he cannabiner!ic syste# as a tar!et for antiNinfla##atory therapies4 Current /opics in <edicinal Che#istry 139 1D01N1D2G4 2LL Weiss et al4 200G4 Cannabidiol lo)ers incidence of diabetes in nonNobese diabetic #ice4 Autoi##unity 3L9 1D3N1F14 300 &bid 301 2lNAe#essy et al4 200G4 Neuroprotecti$e and bloodNretinal barrier preser$in! effects of cannabidiol in e>peri#ental diabetes4 A#erican Uournal of Patholo!y 1GK9 23FN2DD4

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Cannabinoids ha$e also been sho)n to alle$iate neuropathic pain associated )ith the disease4 A pair of studies published in the Tournal Neuroscience 1etters in 200D reported that #ice ad#inistered a cannabis receptor a!onist e>perienced a reduction in diabeticNrelated tactile allodynia Bpain resultin! fro# nonNinTurious sti#ulus to the s inC co#pared to nonNtreated controls4 302303

/he findin!s su!!est

that ʺcannabinoids ha$e a potential beneficial effect on e>peri#ental diabetic neuropathic pain4 ʺ A 2001 trial de#onstrated that ` L-/EC could #oderate an ani#al #odel of the disease by reducin! artificiallyNele$ated !lucose le$els and insulitis in #ice co#pared to nonNtreated controls4 30D <ost recently7 an international tea# of researchers fro# the 8nited States7 S)it5erland and &srael reported in the Uournal of the A#erican Colle!e of Cardiolo!y that the ad#inistration of C0" reduces $arious sy#pto#s of diabetic cardio#yopathy B)ea enin! of the heart #uscleC in a #ouse #odel of type 1 diabetes4 Authors concluded7 ʺA6Bhese results coupled with the e$cellent safety and tolerability profile of C9F in hu"ans! strongly suggest that it "ay ha)e great therapeutic potential in the treat"ent of diabetic co"plications.ʺ30F With the incidence of diabetes steadily increasin! in both the adult and Tu$enile population7 it )ould appear that further cannabinoid research is )arranted in the treat#ent of this disease4

302

"o!rul et al4 200D4 Cannabinoids bloc tactile allodynia in diabetic #ice )ithout attenuation of its antinocicepti$e effect4 Neuroscience 1etters 3GK9 K2NKG4 303 8lu!ol et al4 200D4 /he effect of W&N FF7212N27 a cannabinoid a!onist7 on tactile allodynia in diabetic rats4 Neuroscience 1etters I19 1GIN1I04 30D 1i et al4 20014 2>a#ination of the i##unosuppressi$e effect of deltaNLNtetrahydrocannabinol in strepto5otocinNinduced autoi##une diabetes4 &nternational &##unophar#acolo!y B&talyC D9 GLLNI124 30F AaTesh et al4 20104 Cannabidiol attenuates cardiac dysfunction7 o>idati$e stress7 fibrosis7 and infla##atory and cell death si!nalin! path)ays in diabetic cardio#yopathy4 Uournal of the A#erican Colle!e of Cardiolo!y FG9 211FN212F

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G4 "ystonia
"ystonia is a neurolo!ical #o$e#ent disorder characterised by abnor#al #uscle tension and in$oluntary7 painful #uscle contractions4 &t is the third #ost co##on #o$e#ent disorder after Par insonʹs disease and tre#or7 affectin! #ore than 3007000 people in North A#erica4 A s#all nu#ber of case reports and preclinical studies in$esti!atin! the use of cannabis and cannabinoids for sy#pto#s of dystonia are referenced in the recent scientific literature4 A 2002 case study published in the Uuly issue of /he Uournal of Pain and Sy#pto# <ana!e#ent reported i#pro$ed sy#pto#s of dystonia after s#o in! cannabis in a D2NyearNold chronic pain patient4 &n$esti!ators reported that subTect=s subTecti$e pain score fell fro# L to 5ero Bon a 5eroNtoN10 $isual analo! scaleC follo)in! cannabis inhalation7 and that the subTect did not re;uire any additional anal!esic #edication for the follo)in! DK hours4 ʺNo other treat#ent inter$ention to date had resulted in such dra#atic o$erall i#pro$e#ent in athe patientʹsb condition7ʺ in$esti!ators concluded4 30G A second case study reportin! Osi!nificant clinical i#pro$e#entP follo)in! cannabis inhalation in a sin!le 2FNyearNold patient )ith !enerali5ed dystonia due to Wilson=s disease )as docu#ented by an Ar!entinian research tea# in the Au!ust 200D issue of the Tournal <o$e#ent "isorders4 30I Also in 200D7 a Ger#an research tea# at the Eanno$er <edical School reported successful treat#ent of #usician=s dystonia in a 3KNyearNold professional pianist follo)in! ad#inistration of F #! of /EC in a placeboNcontrolled sin!leNdose trial430K

30G

ChatterTee et al4 20024 A dra#atic response to inhaled cannabis in a )o#an )ith central thala#ic pain and dystonia4 /he Uournal of Pain and Sy#pto# <ana!e#ent 2D9 DNG4 P<&"9 121K30KG 30I Aoca et al4 200D4 Cannabis sati$a and dystonia secondary to Wilson=s disease4 <o$e#ent "isorders 209 113N11F P<&"91F3L00D1 30K Cited by nor"l.org9 Uabusch et al4 200D4 "eltaNLNtetrahydrocannabinol i#pro$es #otor control in a patient )ith #usician=s dystonia BP"+C4 <o$e#ent "isorders 1L9 LL0NLL14

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&n$esti!ators reported Oclear i#pro$e#ent of #otor controlP in the subTect=s affected hand7 and noted7 @A6woB hours after 6/C intake! the patient was able to play technically de"anding literature! which had not been possible before treat"ent.C 4rior to cannabinoid treat"ent! the sub.ect had been unresponsi)e to standard "edications and was no longer perfor"ing publicly. @6he results pro)ide e)idence that [ 6/C intake [ significantly i"pro)es Asy"pto"s ofB [ focal dystonia!C in)estigators concluded. 0y contrast7 a 2002 rando#i5ed7 placeboNcontrolled study in$esti!atin! the use of the synthetic oral cannabinoid Naboline BCesa#etC in 1F patients afflicted )ith !enerali5ed and se!#ental pri#ary dystonia did not sho) a si!nificant reduction in dystonic sy#pto#s4 30L &n$esti!ators speculated that this result #ay ha$e been doseNrelated7 and that ad#inistration of a hi!her dosa!e #ay ha$e yielded a different outco#e4 At least one recent preclinical trial indicates that both synthetic cannabinoids as )ell as hi!h doses of the natural nonNpsychoacti$e cannabinoid cannabidiol BC0"C could #oderate the disease pro!ression of dystonia in ani#als4310 1i#ited references re!ardin! the use of cannabinoids for dystonia in hu#ans311 and ani#als312 in the 1LK0s and the 1LL0s also appear in the scientific literature4 &t )ould appear that additional7 lar!er clinical trials are )arranted to in$esti!ate the use of cannabis and cannabinoids for this indication4

30L

+o> et al4 20024 Aando#ised7 doubleNblind7 placeboNcontrolled trial to assess the potential of cannabinoid receptor sti#ulation in the treat#ent of dystonia4 <o$e#ent "isorders 1I9 1DFN1DL4 P<&"9 11K3FDF2 310 Cited by nor"l.orgL Aichter et al4 20024 2ffects of phar#acolo!ical #anipulations of cannabinoid receptors on se$ere dystonia in a !enetic #odel of paro>ys#al dys inesia4 2uropean Uournal of Phar#acolo!y DFD9 1DFN1F14 311 Cited by nor"l.orgL Consroe et al4 1LKG4 3pen label e$aluation of cannabidiol in dystonic #o$e#ent disorders4 &nternational Uournal of Neuroscience 309 2IIN2K24 312 Aichter et al4 1LLD4 BjCNW&N FF212N27 a no$el cannabinoid a!onist7 e>erts antidystonic effects in #utant dystonic ha#sters4 2uropean Uournal of Phar#acolo!y 2GD9 3I1N3II4 P<&"9 3IL33K1

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I4 +ibro#yal!ia
+ibro#yal!ia B+<C is a chronic pain syndro#e of un no)n etiolo!y4 /he disease is characterised by )idespread #usculos eletal pain7 fati!ue and #ultiple tender points in the nec 7 spine7 shoulders and hips4 An esti#ated 3 to G #illion A#ericans are afflicted by fibro#yal!ia7 )hich is often poorly controlled by standard pain #edications4 +ibro#yal!ia patients fre;uently selfNreport usin! cannabis therapeutically to treat sy#pto#s of the disease7313 - 31D and physicians X in instances )here it is le!al for the# do so X often reco##end the use of cannabis to treat #usculos eletal disorders4 31F - 31G /o date ho)e$er7 there are fe) clinical trials assessin! the use of cannabinoids to treat the disease4 <ost recently7 a 2011 obser$ational7 caseNcontrol trial reported that the use of cannabis is associated )ith beneficial effects on $arious sy#pto#s of fibro#yal!ia7 includin! the relief of pain and #uscle stiffness4 &n$esti!ators at the &nstitut de Aecerca Eospital del <ar in 0arcelona7 Spain7 assessed the associated benefits of cannabis in patients )ith fibro#yal!ia co#pared )ith +< patients )ho did not use the substance4 /)entyNei!ht users and nonNusers participated in the study4 Authors reported9 ʺPatients used cannabis not only to alle$iate pain but for al#ost all sy#pto#s associated to +<7 and no one reported )orsenin! of sy#pto#s follo)in! cannabis use4 444 Si!nificant relief of pain7 stiffness7 rela>ation7 so#nolence7 and perception of )ellNbein!7 e$aluated by (AS B$isual analo!ue scalesC before and t)o hours after cannabis selfNad#inistration )as obser$ed4 ʺ Cannabis users in the study also reported hi!her o$erall #ental health su##ary scores than did nonNusers4 &n$esti!ators concluded9

313 31D

S)ift et al4 200F4 Sur$ey of Australians usin! cannabis for #edical purposes4 Ear# Aeduction Uournal D9 2N1K4 Ware et al4 200F4 /he #edicinal use of cannabis in the 8M9 results of a nation)ide sur$ey4 &nternational Uournal of Clinical Practice FL9 2L1N2LF4 P<&"9 1FKFI32F 31F "ale Gierin!er4 20014 <edical use of cannabis9 e>perience in California4 &n9 Grotenher#en and Ausso B2dsC4 Cannabis and Cannabinoids9 Phar#acolo!y7 /o>icolo!y7 and /herapeutic Potential4 Ne) 6or 9 Ea)orth Press9 1F3N 1I04 31G Gorter et al4 200F4 <edical use of cannabis in the Netherlands4 Neurolo!y GD9 L1INL1L4

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ʺ/he present results to!ether )ith pre$ious e$idence see# to confir# the beneficial effects of cannabinoids on +< sy#pto#s4ʺ31I Pre$ious clinical and preclinical trials ha$e sho)n that both naturally occurrin! and endo!enous cannabinoids hold anal!esic ;ualities7 31K7 31L7 3207 321particularly in the treat#ent of pain resistant to con$entional pain therapies4 As a result7 so#e e>perts ha$e su!!ested that cannabinoids are potentially applicable for the treat#ent of chronic pain conditions such as fibro#yal!ia7 322 and ha$e theori5ed that the disease #ay be associated )ith an underlyin! clinical deficiency of the endocannabinoid syste#4 323

31I

+i5 et al4 20114 Cannabis use in patients )ith fibro#yal!ia9 2ffect on sy#pto#s relief and healthNrelated ;uality of life4 P1oS 3ne G4 31K 0urns and &nec 4 200G4 Cannabinoid anal!esia as a potential ne) therapeutic option in the treat#ent of chronic pain4 /he Annals of Phar#acotherapy D09 2F1N2G04 31L "a$id Sec o4 200F4 Anal!esia throu!h endo!enous cannabinoids4 C<AU 1I34 320 Wallace et al4 200I4 "oseNdependent effects of s#o ed cannabis on capsaicinNinduced pain and hyperal!esia in healthy $olunteers4 Anesthesiolo!y 10I9IKFNLG 321 Co> et al4 200I4 Syner!y bet)een deltaLNtetrahydrocannabinol and #orphine in the arthritic rat4 2uropean Uournal of Phar#acolo!y FGI9 12FN1304 322 1ynch and Ca#pbell4 20114 op4 cit4 323 2than Ausso4 200D4 Clinical endocannabinoid deficiency BC2C"C9 Can this concept e>plain therapeutic benefits of cannabis in #i!raine7 fibro#yal!ia7 irritable bo)el syndro#e and other treat#entNresistant conditionsQ Neuroendocrinolo!y 1etters 2F9 31N3L4

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K4 &ncontinence
8rinary incontinence is defined as a loss of bladder control4 &ncontinence can result fro# se$eral biolo!ical factors7 includin! )ea bladder #uscles and infla##ation7 as )ell as fro# ner$e da#a!e associated )ith diseases such as #ultiple sclerosis B<SC and Par inson=s disease4 <ore than one in ten A#ericans o$er a!e GF is esti#ated to suffer fro# incontinence7 particularly )o#en4 Se$eral recent clinical trials indicate that cannabinoid therapy #ay reduce incidents of incontinence4 Writin! in the +ebruary 2003 issue of the Tournal Clinical Aehabilitation7 in$esti!ators at 3>ford=s Centre for 2nable#ent in 0ritain reported that self-ad#inistered doses of )hole-plant cannabinoid e>tracts i#pro$ed bladder control co#pared to placebo in patients sufferin! fro# <S and spinal cord inTury4 32D &n$esti!ators at 1ondon=s &nstitute for Neurolo!y follo)ed up these initial findin!s in an open-label pilot study of cannabis-based e>tracts for bladder dysfunction in 1F patients )ith ad$anced #ultiple sclerosis4 +ollo)in! cannabinoid therapy7 Ourinary ur!ency7 the nu#ber of and $olu#e of incontinence episodes7 fre;uency and nocturia all decreased si!nificantly7P in$esti!ators deter#ined4 OCannabis-based #edicinal e>tracts are a safe and effecti$e treat#ent for urinary and other proble#s in patients )ith ad$anced <S4P32F /hese findin!s )ere confir#ed in 200G in a #ulti-center7 rando#i5ed placebo-controlled trial in$ol$in! G30 patients ad#inistered oral doses of cannabis e>tracts or /EC4 Aesearchers reported that subTects ad#inistered cannabis e>tracts e>perienced a 3K percent reduction in incontinence episodes fro# baseline to the end of treat#ent7 )hile patients ad#inistered /EC e>perienced a 33 percent reduction7 su!!estin! a Oclinical effect of cannabis on incontinence episodes4P 32G <ost recently7 preclinical data presented at the 200G annual #eetin! of the A#erican 8rolo!ical Association indicated that cannabis analo!s can reduce bladder infla##ation and bladder o$er-acti$ity in ani#als432I &n li!ht of these findin!s7 e>perts ha$e reco##ended the use of cannabinoids as potential Jsecond-line= a!ents for treatin! incontinence432K

32D

Wade et al4 20034 A preli#inary controlled study to deter#ine )hether )hole-plant cannabis e>tracts can i#pro$e intractable neuro!enic sy#pto#s4 Clinical Aehabilitation 1I9 21-2L4 32F 0rady et al4 200D4 An open label pilot study of cannabis-based e>tracts for bladder dysfunction in ad$anced #ultiple sclerosis4 <ultiple Sclerosis 109 D2F-D334 32G +ree#an et al4 200G4 /he effect of cannabis on ur!e incontinence in patients )ith #ultiple sclerosis9 a #ulticentre7 rando#i5ed placebo-controlled trial4 /he &nternational 8ro!ynecolo!y Uournal 1I9 G3G-GD14 32I 8ni$ersity of Pittsbur!h <edical Center Press Aelease4 <ay 217 200G4 O <ariTuana-deri$ed dru! suppresses bladder pain in ani#al #odels4P 32K Malsi and +o)ler4 200F4 /herapy insi!ht9 bladder dysfunction associated )ith #ultiple sclerosis4 Nature Clinical Practice Neurolo!y 29 DL2-F014

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L4 Gastrointestinal "isorders
Gastrointestinal BG&C disorders7 includin! functional bo)el diseases such as irritable bo)el syndro#e B&0SC and infla##atory bo)el diseases such as Crohn ʹs disease BC"C and colitis7 afflict #ore than one in fi$e A#ericans7 particularly )o#en4 While so#e G& disorders #ay be controlled by diet and phar#aceutical #edications7 others are poorly #oderated by con$entional treat#ents4 Sy#pto#s of G& disorders often include cra#pin!7 abdo#inal pain7 infla##ation of the linin! of the lar!e and:or s#all intestine7 chronic diarrhea7 rectal bleedin! and )ei!ht loss4 Patients )ith these disorders fre;uently report usin! cannabis therapeutically4 Accordin! to sur$ey data published in 2011 in the 2uropean Uournal of Gastroenterolo!y , Eepatolo!y7 ʺCannabis use is co##on a#on!st patients )ith &0" for sy#pto# relief7 particularly a#on!st those )ith a history of abdo#inal sur!ery7 chronic abdo#inal pain and:or a lo) ;uality of life inde>4 ʺ32L Se$eral anecdotal reports330 - 331 and a handful of case reports332 - 333 also e>ist in the scientific literature4 Preclinical studies de#onstrate that acti$ation of the C0 1 and C02 cannabinoid receptors e>ert biolo!ical functions on the !astrointestinal tract4 33D 2ffects of their acti$ation in ani#als include suppression of !astrointestinal #otility7 33F inhibition of intestinal secretion7 33G reduced acid reflu>733I and protection fro# infla##ation733K as )ell as the pro#otion of epithelial )ound healin! in hu#an tissue4 33L <ost recently7 a 2011 obser$ational trial published in the Uournal of the &sraeli <edical Association reported that cannabis therapy use is associated )ith a reduction in Crohn ʹs disease acti$ity and diseaseNrelated hospitalisations4 &n$esti!ators at the <eir <edical Center7 &nstitute of Gastroenterolo!y and Eepatolo!y assessed ʹdisease acti$ity7 use of #edication7 need for sur!ery7 and hospitalisation ʹ
32L

1al et al4 20114 Cannabis use a#on! patients )ith infla##atory bo)el disease4 2uropean Uournal of Gastroenterolo!y , Eepatolo!y 239 KL1NKLG4 330 Gahlin!er7 Paul <4 1LKD4 Gastrointestinal illness and cannabis use in a rural Canadian co##unity4 Uournal of Psychoacti$e "ru!s 1G9 2G3N2GF4 331 S)ift et al4 200F4 Sur$ey of Australians usin! cannabis for #edical purposes4 Ear# Aeduction Uournal D9 2N1K4 332 0aron et al4 1LL04 8lcerati$e colitis and #ariTuana4 Annals of &nternal <edicine 1129 DI14 333 Cited nor"l.orgL Ueff Eer!enrather 200F4 Cannabis alle$iates sy#pto#s of Crohn=s "isease4 3=Shau!hnessy=s 293 33D <assa and <onory4 200G4 2ndocannabinoids and the !astrointestinal tract4 Uournal of 2ndocrinolo!ical &n$esti!ation 2L BSupplC9 DINFI4 33F Ao!er Pert)ee4 20014 Cannabinoids and the !astrointestinal tract4 Gut DK9 KFLNKGI4
33G

Cited nor"l.orgL "iCarlo and &55o4 20034 Cannabinoids for !astrointestinal diseases9 potential therapeutic applications4 2>pert 3pinion on &n$esti!ational "ru!s 129 3LNDL4 33I 1eh#ann et al4 20024 Cannabinoid receptor a!onis# inhibits transient lo)er esopha!eal sphincter rela>ations and reflu> in do!s4 Gastroenterolo!y 1239 112LN113D4 33K <assa et al4 200F4 /he endocannabinoid syste# in the physiolo!y and pathophysiolo!y of the !astrointestinal tract4 Uournal of <olecular <edicine 129 LDDNLFD4 33L Wri!ht et al4 200F4 "ifferential e>pression of cannabinoid receptors in the hu#an colon9 cannabinoids pro#ote epithelial )ound healin!4 Gastroenterolo!y 12L9 D3INDF34

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before and after cannabis use in 30 patients )ith C"4 Authors reported7 ʺAll patients stated that consu#in! cannabis had a positi$e effect on their disease acti$ity ʺ and docu#ented ʺsi!nificant i#pro$e#entʺ in 21 subTects4 Specifically7 researchers found that subTects )ho consu#ed cannabis ʺsi!nificantly reduced ʺ their need for other #edications4 Participants in the trial also reported re;uirin! fe)er sur!eries follo)in! their use of cannabis4 ʺ+ifteen of the patients had 1L sur!eries durin! an a$era!e period of nine years before cannabis use7 but only t)o re;uired sur!ery durin! an a$era!e period of three years of cannabis use7ʺ authors reported4 /hey concluded9 ʺ/he results indicate that cannabis #ay ha$e a positi$e effect on disease acti$ity7 as reflected by a reduction in disease acti$ity inde> and in the need for other dru!s and sur!ery4 Prospecti$e placeboNcontrolled studies are )arranted to fully e$aluate the efficacy and side effects of cannabis in C"4ʺ 3D0 /oday7 #any e>perts belie$e that cannabinoids and:or #odulation of the endo!enous cannabinoid syste# represents a no$el therapeutic approach for the treat#ent of nu#erous G& disorders @ includin! infla##atory bo)el diseases7 functional bo)el diseases7 !astroNoesopha!ael reflu> conditions7 secretory diarrhea7 !astric ulcers and colon cancer4 3D17 3D27 3D3 Clinical trials in this arena are no) under)ay43DD

3D0

Naftali et al4 20114 /reat#ent of Crohn=s disease )ith cannabis9 an obser$ational study4 Uournal of the &sraeli <edical Association 139 DFFNDFK4 3D1 Cited nor"l.orgL <assa and <onory4 200G4 op4 cit4 3D2 &55o and Coutts4 200F4 Cannabinoids and the di!esti$e tract4 Eandboo of 2>peri#ental Phar#acolo!y 1GK9FI3NFLK4 3D3 &55o et al4 200L4 NonNpsychotropic plant cannabinoids9 ne) therapeutic opportunities fro# an ancient herb4 /rends in Phar#acolo!ical Sciences 309 F1FNF2I4 3DD Cannabis for &nfla##atory 0o)el "isease NC/010D0L10

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Higure %& - CANSA I Cancer reality Check

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104 Cancer
`L-/etrahydrocannabinol B/ECC is the pri#ary cannabinoid of acannabisb and has been sho)n to either potentiate or inhibit tu#or !ro)th7 dependin! on the type of cancer and its patho!enesis4 3DF

aC 0liomas
Glio#as Btu#ors in the brainC are especially a!!ressi$e #ali!nant for#s of cancer7 often resultin! in the death of affected patients )ithin one to t)o years follo)in! dia!nosis4 /here is no cure for !lio#as and #ost a$ailable treat#ents pro$ide only #inor sy#pto#atic relief4 A re$ie) of the #odern scientific literature re$eals nu#erous preclinical studies and one pilot clinical study de#onstratin! cannabinoidsʹ ability to act as antineoplastic a!ents7 particularly on !lio#a cell lines4 Writin! in the Septe#ber 1LLK issue of the Tournal +20S 1etters7 in$esti!ators at <adrid ʹs Co#plutense 8ni$ersity7 School of 0iolo!y7 first reported that ` L-/EC induced apoptosis Bpro!ra##ed cell deathC in !lio#a cells in culture43DG &n$esti!ators follo)ed up their initial findin!s in 20007 reportin! that the ad#inistration of both /EC and the synthetic cannabinoid a!onist W&N FF7212N2 ʺinduced a considerable re!ression of #ali!nant !lio#asʺ in ani#als43DI Aesearchers a!ain confir#ed cannabinoidsʹ ability to inhibit tu#or !ro)th in ani#als in 2003 3DK /hat sa#e year7 &talian in$esti!ators at the 8ni$ersity of <ilan7 "epart#ent of Phar#acolo!y7 Che#otherapy and /o>icolo!y7 reported that the nonNpsychoacti$e cannabinoid7 cannabidiol BC0"C7 inhibited the !ro)th of $arious hu#an !lio#a cell lines in )i)o and in )itro in a dose dependent #anner4 Writin! in the No$e#ber 2003 issue of the Uournal of Phar#acolo!y and 2>peri#ental /herapeutics +ast +or)ard7 researchers concluded7 ʺNonNpsychoacti$e C0" 444 produceasb a si!nificant antiNtu#or acti$ity both in )itro and in )i)o7 thus su!!estin! a possible application of C0" as an antineoplastic a!ent4ʺ 3DL

3DF

`L-/etrahydrocannabinol inhibits epithelial !ro)th factor-induced lun! cancer cell #i!ration in )itro as )ell as its !ro)th and #etastasis in )i)o. 3nco!ene B200KC 2I7 33LX3DG published online L Uuly 200I 3DG Gu5#an et al4 1LLK4 "eltaNLNtetrahydrocannabinol induces apoptosis in CG !lio#a cells4 P<&"9 LII1KKD 3DI Gu5#an et al4 20004 AntiNtu#oral action of cannabinoids9 in$ol$e#ent of sustained cera#ide accu#ulation and e>tracellular si!nalNre!ulated inase acti$ation4 Nature <edicine G9 313N31L4 3DK Gu5#an et al4 20034 &nhibition of tu#or an!io!enesis by cannabinoids4 /he +AS20 Uournal 1I9 F2LNF314 3DL <assi et al4 200D4 Antitu#or effects of cannabidiol7 a nonNpsychotropic cannabinoid7 on hu#an !lio#a cell lines4 Uournal of Phar#acolo!y and 2>peri#ental /herapeutics +ast +or)ard 30K9 K3KNKDF4

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&n 200D7 Gu5#an and collea!ues reported that cannabinoids inhibited !lio#a tu#or !ro)th in ani#als and in hu#an !lioblasto#a #ultifor#e BG0<C tu#or sa#ples by alterin! blood $essel #orpholo!y Be4!47 (2G+ path)aysC4 Writin! in the Au!ust 200D issue of Cancer Aesearch7 in$esti!ators concluded7 ʺ/he present laboratory and clinical findin!s pro$ide a no$el phar#acolo!ical tar!et for cannabinoidNbased therapies4ʺ 3F0 &n$esti!ators at the California Pacific <edical Center Aesearch &nstitute reported that the ad#inistration of /EC on hu#an !lioblasto#a #ultifor#e cell lines decreased the proliferation of #ali!nant cells and induced cell death #ore rapidly than did the ad#inistration of W&N FF7212N24 Aesearchers also noted that /EC selecti$ely tar!eted #ali!nant cells )hile i!norin! healthy ones in a #ore profound #anner than the synthetic alternati$e4 3F1 A separate preclinical trial reported that the co#bined ad#inistration of /EC and the phar#aceutical a!ent te#o5olo#ide B/<dC ʺenhanced autopha!yʺ Bpro!ra##ed cell deathC in brain tu#ors resistant to con$entional antiNcancer treat#ents43F2 Gu5#an and collea!ues ha$e also reported that /EC ad#inistration decreases recurrent !lioblasto#a #ultifor#e tu#or !ro)th in patients dia!nosed )ith recurrent G0<4 &n the first e$er pilot clinical trial assessin! the use of cannabinoids and G0<7 in$esti!ators found that the intratu#oral ad#inistration of /EC )as associated )ith reduced tu#or cell proliferation in t)o of nine subTects4 ʺ/he fair safety profile of /EC7 to!ether )ith its possible antiNproliferati$e action on tu#or cells reported here and in other studies7 #ay set the basis for future trials ai#ed at e$aluatin! the potential antitu#oral acti$ity of cannabinoids7ʺ in$esti!ators concluded4 3F3 Se$eral additional in$esti!ators ha$e also recently called for further e>ploration of cannabisNbased therapies for the treat#ent of !lio#a4 3FD7
3FF7 3FG

A separate case

report7 published in 2011 in the Tournal of the &nternational Society for Pediatric Neurosur!ery7 also docu#ents the spontaneous re!ression of residual brain tu#ors in t)o children coincidin! )ith the subTects use of cannabis43FI
3F0

Gu5#an et al4 200D4 Cannabinoids inhibit the $ascular endothelial !ro)th factor path)ays in !lio#as BP"+C4 Cancer Aesearch GD9 FG1INFG234 3F1 Allister et al4 200F4 Cannabinoids selecti$ely inhibit proliferation and induce death of cultured hu#an !lioblasto#a #ultifor#e cells4 Uournal of Neurooncolo!y ID9 31ND04 3F2 /orres et al4 20114 A co#bined preclinical therapy of cannabinoids and /e#o5olo#ide a!ainst !lio#a4 <olecular Cannabis /herapeutics 109 L04 3F3 Gu5#an et al4 200G4 A pilot clinical study of deltaNLNtetrahydrocannabinol in patients )ith recurrent !lioblasto#a #ultifor#e4 0ritish Uournal of Cancer B200GC LF7 1LIX2034 doi9104103K:sT4bTc4GG0323G 3FD Parolaro and <assi4 200K4 Cannabinoids as a potential ne) dru! therapy for the treat#ent of !lio#as4 2>pert Ae$ie)s of Neurotherapeutics K9 3INDL 3FF Galanti et al4 200I4 "eltaLN/etrahydrocannabinol inhibits cell cycle pro!ression by do)nre!ulation of 22+1 in hu#an !lioblasto#a #ultifor#e cells4 Acta 3ncolo!ica 129 1NL P<&"9 1IL3DKL0 3FG Calato55olo et al4 200I4 2>pression of cannabinoid receptors and neurotrophins in hu#an !lio#as4 Neurolo!ical Sciences 2K9 30DN3104 P<&"9 1K1IF0IG 3FI Cited nor"l.orgL +orou!hi et al4 20114 Spontaneous re!ression of septu# pellucidu#:forniceal pilocytic astrocyto#as NN possible role of cannabis inhalation4 Childʹs Ner$ous Syste# 2I9 GI1NGIL4

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A study published in /he Uournal of Neuroscience e>a#ined the bioche#ical e$ents in both acute neuronal da#a!e and in slo)ly pro!ressi$e7 neurode!enerati$e diseases4 /hey conducted a #a!netic resonance i#a!in! study that loo ed at /EC Bthe #ain acti$e co#pound in acannabisbC and found that it reduced neuronal inTury in rats4 /he results of this study pro$ide e$idence that the cannabinoid syste# can ser$e to protect the brain a!ainst neurode!eneration4 3FK &n addition to cannabinoidsʹ ability to #oderate !lio#a cells7 separate studies de#onstrate that cannabinoids and endocannabinoids can also inhibit the proliferation of other $arious cancer cell lines7 includin! breast carcino#a73FL7
3G07 3G17 3G27 3G3

prostate carcino#a73GD7

3GF7 3GG

colorectal carcino#a73GI7
- 3IF

3GK

!astric adenocarcino#a73GL s in carcino#a73I0 leu e#ia cells73I17

3I27 3I3

neuroblasto#a73ID

lun!

3FK

Neuroprotection by `L-/etrahydrocannabinol7 the <ain Acti$e Co#pound in <ariTuana7 a!ainst 3uabain-&nduced in $i$o 2>citoto>icity4 /he Uournal of Neuroscience7 1 Septe#ber 20017 21B1IC9 GDIF-GDIL 3FL Cafferal et al4 200G4 "eltaNLN/etrahydrocannabinol inhibits cell cycle pro!ression in hu#an breast cancer cells throu!h Cdc2 re!ulation4 Cancer Aesearch GG9 GG1FNGG214 3G0 "i <ar5o et al4 200G4 AntiNtu#or acti$ity of plant cannabinoids )ith e#phasis on the effect of cannabidiol on hu#an breast carcino#a4 Uournal of Phar#acolo!y and 2>peri#ental /herapeutics +ast +or)ard 31K9 13IFN13KI4 3G1 "e Petrocellis et al4 1LLK4 /he endo!enous cannabinoid ananda#ide inhibits hu#an breast cancer cell proliferation4 Proceedin!s of the National Acade#y of Sciences of the 8nited States of A#erica LF9 K3IFNK3K04 3G2 <cAllister et al4 200I4 Cannabidiol as a no$el inhibitor of &dN1 !ene e>pression in a!!ressi$e breast cancer cells4 <olecular Cancer /herapeutics G9 2L21N2L2I4 3G3 Cafferal et al4 20104 Cannabinoids reduce 2rb02Ndri$en breast cancer pro!ression throu!h A t inhibition4 <olecular Cancer L9 1LG4 3GD Sarfara5 et al4 200F4 Cannabinoid receptors as a no$el tar!et for the treat#ent of prostate cancer4 Cancer Aesearch GF9 1G3FN1GD14 3GF <i#eault et al4 20034 AntiNproliferati$e and apoptotic effects of ananda#ide in hu#an prostatic cancer cell lines4 Prostate FG9 1N124 3GG Aui5 et al4 1LLL4 "eltaNLNtetrahydrocannabinol induces apoptosis in hu#an prostate PCN3 cells $ia a receptorNindependent #echanis#4 P<&"9 10FI0LDK 3GI Pastos et al4 200F4 /he endo!enous cannabinoid7 ananda#ide7 induces cell death in colorectal carcino#a cells9 a possible role for cycloo>y!enaseN24 Gut FD9 1ID1N1IF04 3GK A$iello et al4 20124 Che#opre$enti$e effect of the nonNpsychotropic phytocannabinoid cannabidiol on e>peri#ental colon cancer4 Uournal of <olecular <edicine P<&"9 22231IDF 3GL Cited nor"l.orgL "i <ar5o et al4 200G4 op4 cit 3I0 Casano$a et al4 &nhibition of s in tu#or !ro)th and an!io!enesis in )i)o by acti$ation of cannabinoid receptors4 20034 Uournal of Clinical &n$esti!ation 1119 D3NF04 3I1 Po)les et al4 200F4 CannabisNinduced cytoto>icity in leu e#ic cell lines4 0lood 10F9 121DN1221 3I2 Uia et al 200G4 "eltaNLNtetrahydrocannabinolNinduced apoptosis in Uur at leu e#ic / cells in re!ulated by translocation of 0ad to #itochondria4 <olecular Cancer Aesearch D9 FDLNFG24 P<&"9 1GL0KFLD 3I3 1iu et al4 200K4 2nhancin! the in )itro cytoto>ic acti$ity of deltaLNtetrahydrocannabinol in leu e#ic cells throu!h a co#binatorial approach4 1eu e#ia and 1y#pho#a DL9 1K00N1K0L4 3ID <anuel Gu5#an4 20034 Cannabinoids9 potential anticancer a!ents BP"+C4 Nature Ae$ie)s Cancer 39 IDFNIFF4 3IF <arcu et al4 20104 Cannabidiol enhances the inhibitory effects of deltaLNtetrahydrocannabinol on hu#an !lioblasto#a cell proliferation and sur$i$al4 <olecular Cancer /herapeutics L9 1K0N1KL4

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carcino#a73IG

- 3II

uterus carcino#a73IK thyroid epithelio#a73IL pancreatic adenocarcino#a73K0

3K1

cer$ical

carcino#a73K2 oral cancer73K3 biliary tract cancer Bcholan!iocarcino#aC3KD and ly#pho#a43KF 3KG Conse;uently7 #any e>perts no) belie$e that cannabinoids ʺ#ay represent a ne) class of anticancer dru!s that retard cancer !ro)th7 inhibit an!io!enesis and the #etastatic spreadin! of cancer cells4 ʺ
3KK 3KI -

A 1LLI in;uiry by the 0ritish <edical Association found cannabis #ore effecti$e than <arinol7 and a 1LLK re$ie) by the Eouse of 1ords Science , /echnolo!y Select Co##ittee concluded that RCannabinoids are undoubtedly effecti$e as anti-e#etic a!ents in $o#itin! induced by anti-cancer dru!s4 So#e users of both find cannabis itself #ore effecti$e4R /he 1LLL &nstitutes of <edicine report su!!ested9 R&n patients already e>periencin! se$ere nausea or $o#itin!7 pills are !enerally ineffecti$e7 because of the difficulty in s)allo)in! or eepin! a pill do)n7 and slo) onset of the dru! effect4 /hus an inhalation Bbut7 preferably not s#o in!C cannabinoid dru! deli$ery syste# )ould be ad$anta!eous for treatin! che#otherapy-induced nausea4R

3IG
3II

Cited nor"l.orgL Gu5#an4 2003 op4 cit4 Preet et al4 200K4 "eltaLN/etrahydrocannabinol inhibits epithelial !ro)th factorNinduced lun! cancer cel #i!ration in )itro as )ell as its !ro)th and #etastasis in )i)o4 3nco!ene 109 33LN3DG doi9104103K:sT4onc41210GD14 3IK <anuel Gu5#an4 20034 Cannabinoids9 potential anticancer a!ents BP"+C4 Nature Ae$ie)s Cancer 39 IDFNIFF4 3IL Cited nor"l.orgL 0ae et al4 1LLK4 Antitu#or acti$ity of cannabi!erol a!ainst hu#an oral epitheloid carcino#a cells Archi$es of Phar#acal Aesearch9 219 3F3N3FG4 3K0 Carracedo et al4 200G4 Cannabinoids induce apoptosis of pancreatic tu#or cells $ia endoplas#ic reticulu# stressNrelated !enes4 Cancer Aesearch GG9 GIDKNGIFF4 3K1 <ichals i et al4 200K4 Cannabinoids in pancreatic cancer9 correlation )ith sur$i$al and pain4 &nternational Uournal of Cancer 1229 ID2NIF04 3K2 Aa#er and Ein54 200K4 &nhibition of cancer cell in$asion by cannabinoids $ia increased cell e>pression of tissue inhibitor of #atri> #etalloproteinasesN14 Uournal of the National Cancer &nstitute 1009 FLNGL4 3K3 Whyte et al4 20104 Cannabinoids inhibit cellular respiration of hu#an oral cancer cells4 Phar#acolo!y KF 32KN33F P<&"9 20F1GI3D 3KD 1eela)at et al4 20104 /he dual effects of deltaBLCNtetrahydrocannabinol on cholan!iocarcino#a cells9 antiin$asion acti$ity at lo) concentration and apoptosis induction at hi!h concentration4 Cancer &n$esti!ation 2K9 3FIN3G3 P<&"9 1LL1GIL4 3KF Gustafsson et al4 200G4 Cannabinoid receptorN#ediated apoptosis induced by ABjCN#ethananda#ide an WinFF7212 is associated )ith cera#ide accu#ulation and p3K acti$ation in #antle cell ly#pho#a4 <olecular Phar#acolo!y I09 1G12N1G204 3KG Gustafsson et al4 200K4 2>pression of cannabinoid receptors type 1 and type 2 in nonNEod! in ly#pho#a9 Gro)th inhibition by receptor acti$ation4 &nternational Uournal of Cancer 1239 102FN10334 3KI Natalya Mo!an4 200F4 Cannabinoids and cancer4 <iniNAe$ie)s in <edicinal Che#istry F9 LD1NLF24 3KK Sarafara5 et al4 200K4 Cannabinoids for cancer treat#ent9 pro!ress and pro#ise4 Cancer Aesearch GK9 33LN

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bC $reast Can er
&n$asion and #etastasis of a!!ressi$e breast cancer cells are the final and fatal steps durin! cancer pro!ression4 Clinically7 there are still li#ited therapeutic inter$entions for a!!ressi$e and #etastatic breast cancers a$ailable4 A study published in the 8S National 1ibrary of <edicine7 conducted by the California Pacific <edical Centre deter#ined that cannabidiol BC0"C inhibits hu#an breast cancer cell proliferation and in$asion4 /hey also de#onstrated that C0" si!nificantly reduces tu#or #ass4 3KL cL-/EC e>hibits anti-tu#or effects on $arious cancer cell types7 but its use in che#otherapy is li#ited by its psychotropic acti$ity4 /EC-acid )as assessed )hether there is any ad$anta!e in usin! Cannabis e>tracts Benriched in either cannabidiol or /ECC o$er pure cannabinoids4 Aesults obtained in a panel of tu#or cell lines clearly indicate that7 of the fi$e natural co#pounds tested7 cannabidiol is the #ost potent inhibitor of cancer cell !ro)th43L0 A study published in the Tournal <olecular Cancer sho)ed that /EC reduced tu#or !ro)th and tu#or nu#bers4 /hey deter#ined that cannabinoids inhibit cancer cell proliferation7 induce cancer cell apoptosis and i#pair tu#or an!io!enesis4 /he study pro$ides stron! e$idence for the use of cannabinoid based therapies for the #ana!e#ent of breast cancer4 3L1 A further study published in the Proceedin!s of the National Acade#y of Sciences of the 8nited States of A#erica BPNASC deter#ined that cannabinoids inhibit hu#an breast cancer cell proliferation4 3L2

3KL

Path)ays #ediatin! the effects of cannabidiol on the reduction of breast cancer cell proliferation7 in$asion7 and #etastasis4 0reast Cancer Aes /reat4 2012 <ayW133B1C9D01-D4 P<&"920KFLGIG 3L0 Anti-tu#or acti$ity of plant cannabinoids )ith e#phasis on the effect of cannabidiol on hu#an breast carcino#a4 Published online before print <ay 2F7 200G7 doi9 104112D:Tpet410G410F2DI UP2/ <ay 2F7 200G 3L1 Cannabinoids reduce 2rb02-dri$en breast cancer pro!ression throu!h A t inhibition4 <olecular Cancer 20107 L91LG doi910411KG:1DIG-DFLK-L-1LG 3L2 /he endo!enous cannabinoid ananda#ide inhibits hu#an breast cancer cell proliferation4 PNAS Uuly I7 1LLK $ol4 LF no4 1D K3IF-K3K0

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C "un3 Can er
1ittle is no)n about the acti$ity of cannabinoids li e /EC on epider#al !ro)th factor

receptor-o$ere>pressin! lun! cancers7 )hich are often hi!hly a!!ressi$e and resistant to che#otherapy4 /he study published in the Tournal 3nco!ene7 by Ear$ard <edical School?s 2>peri#ental <edicine "epart#ent deter#ined that /EC inhibits epithelial !ro)th factor induced lun! cancer cell #i!ration4 Additionally7 in in )i)o studies in se$ere co#bined i##unodeficient #ice7 there )as si!nificant inhibition of the subcutaneous tu#or !ro)th and lun! #etastasis of AFDL cells in /EC-treated ani#als as co#pared to $ehicle-treated controls4 /hey !o on to state that /EC should be e>plored as no$el therapeutic #olecules in controllin! the !ro)th and #etastasis of certain lun! cancers4 3L3 A study published by the 8S National 1ibrary of <edicine by the &nstitute of /o>icolo!y and Phar#acolo!y7 fro# the "epart#ent of General Sur!ery in Ger#any deter#ined that cannabinoids inhibit cancer cell in$asion4 2ffects )ere confir#ed in pri#ary tu#or cells fro# a lun! cancer patient4 3$erall7 data indicated that cannabinoids decrease cancer cell in$asi$eness4 3LD A further study published by the 8S National 1ibrary of <edicine7 conducted by Ear$ard <edical School in$esti!ated the role of cannabinoid receptors in lun! cancer cells4 /hey deter#ined its effecti$eness and su!!ested that it should be used for treat#ent a!ainst lun! cancer cells4 3LF

3L3

`L-/etrahydrocannabinol inhibits epithelial !ro)th factor-induced lun! cancer cell #i!ration in )itro as )ell as its !ro)th and #etastasis in )i)o4 3nco!ene B200KC 2I7 33LX3DG published online L Uuly 200I 3LD Cannabidiol inhibits lun! cancer cell in$asion and #etastasis $ia intercellular adhesion #olecule-14 +AS20 U4 2012 AprW2GBDC91F3F-DK4 P<&"9221LK3K1 3LF Cannabinoid receptors7 C01 and C027 as no$el tar!ets for inhibition of non-s#all cell lun! cancer !ro)th and #etastasis4 Cancer Pre$ Aes BPhilaC4 2011 UanWDB1C9GF-IF P<&"9 210LII1D

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dC Prostate Can er
Prostate cancer is a !lobal public health proble#7 and it is the #ost co##on cancer in #en and the second cause for cancer-related death4 3LG 2>peri#ental e$idence sho)s that prostate tissue possesses cannabinoid receptors and their sti#ulation results in anti-andro!enic effects4 Prostate cancer cells possess increased e>pression of both cannabinoid 1 and 2 receptors7 and sti#ulation of theseW results in a decrease in cell $iability7 increased apoptosis7 and decreased andro!en receptor e>pression and prostate-specific anti!en e>cretion4 &t )ould be of interest to conduct clinical studies utilisin! cannabinoids for patients )ith #etastatic prostate cancer7 ta in! ad$anta!e not only of its beneficial effects on prostate cancer but also of their anal!esic properties for bone #etastatic cancer pain4 /he 8S National 1ibrary of <edicine outlined #ultiple studies pro$in! the effecti$eness of cannabis on prostate cancer43LI /he potent anti-proliferati$e and cytoto>ic effects of ANA on #etastatic prostatic cancer cells #i!ht pro$ide basis for the desi!n of ne) therapeutic a!ents for effecti$e treat#ent of recurrent and in$asi$e prostatic cancers4 A study published in the 8S National 1ibrary of <edicine illustrates a decrease in prostatic cancer cells by actin! throu!h cannabinoid receptors4 3LK Another study published by the 8S National 1ibrary of <edicine deter#ined that clinical testin! of C0" a!ainst prostate carcino#a is i#portant and that cannabinoid receptor acti$ation induces prostate carcino#a cell apoptosis4 &t )as deter#ined that cannabidiol si!nificantly inhibited cell $iability4 3LL

3LG 3LI

CANSA - South African Cancer Statistics /he role of cannabinoids in prostate cancer9 0asic science perspecti$e and potential clinical applications4 &ndian U 8rol4 2012 Uan-<arW 2KB1C9 LX1D4 P<C&"9 P<C333LILF 3LK Anti-proliferati$e and apoptotic effects of ananda#ide in hu#an prostatic cancer cell lines9 i#plication of epider#al !ro)th factor receptor do)n-re!ulation and cera#ide production4 Prostate4 2003 Uun 1FWFGB1C91-124 P<&"9 12IDGKD1 3LL Non-/EC cannabinoids inhibit prostate carcino#a !ro)th in )itro and in )i)o9 pro-apoptotic effects and underlyin! #echanis#s4 0r U Phar#acol4 2013 UanW1GKB1C9IL-1024 P<&"9 22FLDLG3

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eC $lood Can er
Plant-deri$ed cannabinoids7 includin! `L-tetrahydrocannabinol7 induce apoptosis in leu e#ic cells7 althou!h the precise #echanis# re#ains unclear4 &t )as in$esti!ated that the effect of /EC on the upstrea# and do)nstrea# e$ents #odulates the e>tracellular si!nal-re!ulated inase B2AMC #odule of #ito!en-acti$ated protein inase path)ays pri#arily in hu#an Uur at leu e#ia / cells4 D00 A study published in the Tournal <olecular Phar#acolo!y recently sho)ed that cannabinoids induce !ro)th inhibition and apoptosis in #antle cell ly#pho#a4 /he study )as supported by !rants fro# the S)edish Cancer Society7 /he S)edish Aesearch Council and the Cancer Society in Stoc hol#4 D01 A further study published in the &nternational Uournal of Cancer also deter#ined and illustrated that cannabinoids e>ert antiproliferati$e and proapoptotic effects in $arious types of cancer and in #antle cell ly#pho#a4D02

D00

"eltaL-tetrahydrocannabinol-induced apoptosis in Uur at leu e#ia / cells is re!ulated by translocation of 0ad to #itochondria4 <ol Cancer Aes4 200G Au!WDBKC9FDL-G24 P<&"9 1GL0KFLD D01 Cannabinoid Aeceptor-<ediated Apoptosis &nduced by #BjC-<ethananda#ide and WinFF7212-2 &s Associated )ith Cera#ide Accu#ulation and p3K Acti$ation in <antle Cell 1y#pho#a Au!ust 2F7 200G7 doi9104112D:#ol410G402FLK D02 Gustafsson7 M47 Wan!7 H47 Se$era7 "47 2ri sson7 <47 Mi#by7 247 <erup7 <47 Christensson7 047 +ly!are7 U4 and Sander7 04 B200KC7 2>pression of cannabinoid receptors type 1 and type 2 in non-Eod! in ly#pho#a9 Gro)th inhibition by receptor acti$ation4 &nt4 U4 Cancer7 1239 102FX10334 doi9 1041002:iTc423FKD

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fC 'ral Can er
/he pri#ary cannabinoids7 `L-tetrahydrocannabinol and `K-tetrahydrocannabinol B`K-/ECC are no)n to disturb the #itochondrial function and possess antitu#or acti$ities4 /hese obser$ations pro#pted the in$esti!ation into their effects on the #itochondrial 3B2C consu#ption in hu#an oral cancer cells B/u1K3C4 /his epithelial cell line o$ere>presses bcl-2 and is hi!hly resistant to anticancer dru!s4 Cannabinoids are potent inhibitors of cellular respiration and are to>ic to hi!hly #ali!nant oral tu#ors4D03

hC "iver Can er
Eepatocellular carcino#a BECCC is the third cause of cancer-related death )orld)ide4 When these tu#ors are in ad$anced sta!es7 fe) therapeutic options are a$ailable4 /herefore7 it is essential to search for ne) treat#ents to fi!ht this disease4 &t )as obser$ed that `L-/EC and UWE-01F Ba cannabinoid receptor 2 C0 2 cannabinoid receptor-selecti$e a!onistC reduced the $iability of the hu#an ECC cell lines EepG2 Bhu#an hepatocellular li$er carcino#a cell lineC and EuE-I Bhepatocellular carcino#a cellsC7 an effect that relied on the sti#ulation of C02 receptor4 &t )as also found that `L-/EC and UWE-01F-induced autopha!y relies on tribbles ho#olo! 3 B/A03C upre!ulation7 and subse;uent inhibition of the serine-threonine inase A t:#a##alian tar!et of rapa#ycin C1 a>is and adenosine #onophosphate-acti$ated inase BA<PMC sti#ulation4 Phar#acolo!ical and !enetic inhibition of A<PM upstrea# inases supported that cal#odulin-acti$ated inase inase n )as responsible for cannabinoid-induced A<PM acti$ation and autopha!y4 ?n )i)o studies re$ealed that `L-/EC and UWE-01F reduced the !ro)th of ECC subcutaneous >eno!rafts7 an effect that )as not e$ident )hen autopha!y )as !enetically or phar#acolo!ically inhibited in those tu#ors4 <oreo$er7 cannabinoids )ere also able to inhibit tu#or !ro)th and ascites in an orthotopic #odel of ECC >eno!raft4 /he findin!s #ay contribute to the desi!n of ne) therapeutic strate!ies for the #ana!e#ent of ECC4D0D

D03

Cannabinoids inhibit cellular respiration of hu#an oral cancer cells4 Phar#acolo!y4 2010WKFBGC932K-3F4 doi9 10411FL:000312GKG4 2pub 2010 Uun 24 D0D Anti-tu#oral action of cannabinoids on hepatocellular carcino#a9 role of A<PM-dependent acti$ation of autopha!y4 Cell "eath "iffer4 2011 UulW1KBIC910LL-1114 doi9 104103K:cdd420114324 2pub 2011 Apr K4

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iC Pan reati Can er
Pancreatic adenocarcino#as are a#on! the #ost #ali!nant for#s of cancer4 A published study in /he A#erican Uournal of Cancer undertoo to in$esti!ate the action of cannabinoids7 a ne) fa#ily of potential antitu#oral a!ents7 in pancreatic cancer4 Cannabinoid receptors are e>pressed in hu#an pancreatic tu#or cell lines and tu#or biopsies at #uch hi!her le$els than in nor#al pancreatic tissue4 Cannabinoids also reduced the !ro)th of tu#or cells in t)o ani#al #odels of pancreatic cancer4 &n addition7 cannabinoid treat#ent inhibited the spreadin! of pancreatic tu#or cells4 <oreo$er7 cannabinoid ad#inistration selecti$ely increased apoptosis and /A03 e>pression in pancreatic tu#or cells but not in nor#al tissue4 &n conclusion7 results presented sho) that cannabinoids lead to apoptosis of pancreatic tu#or cells $ia a C02 receptor and de no)o synthesised cera#ide-dependent up-re!ulation of pK and the endoplas#ic reticulu# stressXrelated !enes A6H-' and 6#9&4 /hese findin!s #ay contribute to set the basis for a ne) therapeutic approach for the treat#ent of pancreatic cancer4D0F

D0F

Cannabinoids &nduce Apoptosis of Pancreatic /u#or Cells $ia 2ndoplas#ic Aeticulu# StressXAelated Genes doi9 10411FK:000K-FDI24CAN-0G-01GL Cancer Aes Uuly 17 200G

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114 Eepatitis C
Eepatitis C is a $iral disease of the li$er that afflicts an esti#ated four #illion A#ericans4 Chronic hepatitis C is typically associated )ith fati!ue7 depression7 Toint pain and li$er i#pair#ent7 includin! cirrhosis and li$er cancer4 Patients dia!nosed )ith hepatitis C fre;uently report usin! cannabis to treat both sy#pto#s of the disease as )ell as the nausea associated )ith anti$iral therapy4 D0G - D0IAn obser$ational study by in$esti!ators at the 8ni$ersity of California at San +rancisco B8CS+C found that hepatitis C patients )ho used cannabis )ere si!nificantly #ore li ely to adhere to their treat#ent re!i#en than patients )ho didnʹt use it4D0K Ne$ertheless7 no clinical trials assessin! the use of cannabinoids for this indication are a$ailable in the scientific literature4 Preclinical data indicates that the endocannabinoid syste# #ay #oderate aspects of chronic li$er diseaseD0L7 D10 and that cannabinoids #ay reduce infla##ation in e>peri#ental #odels of hepatitis4 D11 Eo)e$er7 other clinical re$ie)s ha$e reported a positi$e association bet)een daily cannabis use and the pro!ression of li$er fibrosis Be>cessi$e tissue build upC and steatosis Be>cessi$e fat buildupC in select hepatitis C patients4D127 D137 D1D As a result7 e>perts hold di$er!ent opinions re!ardin! the therapeutic use of cannabinoids for hepatitis C treat#ent4 Writin! in the 3ctober 200G issue of the 2uropean Uournal of Gastroenterolo!y7 in$esti!ators fro# Canada and Ger#any concluded that cannabis ʹ ʺpotential benefits of a hi!her li elihood of treat#ent success afor hepatitis c patientsb appear to out)ei!h aitsb ris s4 ʺ D1F 0y contrast7 other e>perts discoura!e the use of cannabis in patients )ith chronic hepatitis until further studies are perfor#ed4D1G7 D1I7 D1K7 D1L7 D20
D0G

Schnelle et al4 1LLL4 Aesults of a standardi5ed sur$ey on the #edical use of cannabis products in the Ger#anNspea in! area4 +orschende Mo#ple#entar#edi5in BGer#anyC 39 2KN3G4 D0I "a$id 0erstein4 200D4 OEepatitis C X Current state of the art and future directions4P <edScape /oday4 D0K Syl$estre et al4 200G4 Cannabis use i#pro$es retention and $irolo!ical outco#es in patients treated for hepatitis C4 2uropean Uournal of Gastroenterolo!y , Eepatolo!y4 1K9 10FIN10G34 D0L da#oraN(aldes et al4 200F4 /he endocannabinoid syste# in chronic li$er disease4 Annals of Eepatolo!y D9 2DKN2FD4 D10 Gabbey et al4 200F4 2ndocannabinoids and li$er disease X re$ie)4 1i$er &nternational 2F9 L21NL2G4 D11 1a$on et al4 20034 A no$el synthetic cannabinoid deri$ati$e inhibits infla##atory li$er da#a!e $ia ne!ati$e cyto ine re!ulation4 <olecular Phar#acolo!y GD9 133DN13DD4 D12 Ee5ode et al4 200F4 "aily cannabis s#o in! as a ris factor for pro!ression of fibrosis in chronic hepatitis C4 Eepatolo!y D29 G3NI14 D13 &shida et al4 200K4 &nfluence of cannabis use on se$erity of hepatitis C disease4 Clinical Gastroenterolo!y and Eepatolo!y G9 GLNIF4 D1D Parfieniu and +lisia 4 200K4 Aole of cannabinoids in li$er disease4 World Uournal of Gastroenterolo!y 1D9 G10LN G11D P<&"9 1KLKFILL4 D1F +ischer et al4 200G4 /reat#ent for hepatitis C $irus and cannabis use in illicit dru! user patients9 i#plications and ;uestions4 2uropean Uournal of Gastroenterolo!y , Eepatolo!y4 1K9 103LN10D2 P<&"9 1GLFIF0I4 D1G Cited nor"l.orgL Sch)abe and Sie!#und4 200F4 op4 cit4 D1I Cited nor"l.orgL Ee5ode et al4 200F4 op4 cit4 D1K Cited nor"l.orgL "a$id 0erstein4 200D4 op4 cit4 D1L Ee5ode et al4 200K4 "aily cannabis use9 a no$el ris factor of steatosis se$erity in patients )ith chronic hepatitis C4 Gastroenterolo!y 13D9 D32ND3L4 D20 Purohit et al4 20104 Aole of cannabinoids in the de$elop#ent of fatty li$er BsteatosisC4 /he AAPS Uournal 129 233N23I4

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124 Eu#an &##unodeficiency (irus BE&(C
Science denial ills4 <ore than 3007000 South Africans died needlessly in the early 2000=s because the !o$ern#ent of President <be i preferred to treat A&"S )ith !arlic and beetroot rather than antiretro$iral dru!s4D21 /he 200I 8NA&"S report esti#ated that F7I007000 South Africans had E&(:A&"S7 or Tust under 12\ of South Africa?s population of DK #illion4 D22 &n the adult population7 e>cludin! children7 the rate is 1K410\4D23 /he nu#ber of infected is lar!er than in any other sin!le country in the )orld4 /he other top fi$e countries )ith the hi!hest E&(:A&"S pre$alence are all nei!hbours of South Africa4 /he effecti$eness of cannabis for treatin! sy#pto#s related to E&(:A&"S is )idely reco!nised4 &ts $alue as an antie#etic and anal!esic has been pro$en in nu#erous studies and has been reco!nised by se$eral co#prehensi$e7 !o$ern#ent-sponsored re$ie)s7 includin! those conducted by the &nstitute of <edicine B&3<C7 the 84M4 Eouse of 1ords Science and /echnolo!y Co##ittee7 the Australian National /as +orce on Cannabis7 and others4 Sur$ey data indicates that cannabis is used by as #any one in three North A#erican patients )ith E&(:A&"S to treat sy#pto#s of the disease as )ell as the sideNeffects of $arious antiretro$iral #edications4D2D7
D2F7 D2G7 D2I

3ne recent study reported that #ore than G0 percent of E&(:A&"S patients

selfNidentify as ʺ#edical cannabis users4ʺD2K

D21 D22

Chi!)edere7 Sea!e7 Grus in7 1ee7 , 2sse> A&"S "enialis# and Public Eealth Practice Sprin!er 200K E&( and A&"S esti#ates and data7 200I and 2001 p!21D D23 South Africa - C&A - /he World +actboo 4 https9::)))4cia4!o$4 D April 200I D2D Woolrid!e et al4 200F4 Cannabis use in E&( for pain and other #edical sy#pto#s4 Uournal of Pain Sy#pto# <ana!e#ent 2L9 3FKN3GI4 D2F Prentiss et al4 200D4 Patterns of #ariTuana use a#on! patients )ith E&(:A&"S follo)ed in a public health care settin!4 Uournal of Ac;uired &##une "eficiency Syndro#es 3F9 3KNDF4 D2G 0raitstein et al4 20014 <aryNUane and her patients9 sociode#o!raphic and clinical characteristics of E&(N positi$e indi$iduals usin! #edical #ariTuana and antiretro$iral a!ents4 A&"S 129 F32NF334 D2I Ware et al4 20034 Cannabis use by persons li$in! )ith E&(:A&"S9 patterns and pre$alence of use4 Uournal of Cannabis /herapeutics 39 3N1F4 D2K 0elleN&sle and Eatha)ay4 200I4 0arriers to access to #edical cannabis for Canadians li$in! )ith E&(:A&"S4 A&"S Care 1L9 F00NF0G4

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Patients li$in! )ith E&(:A&"S #ost fre;uently report usin! cannabis to counter sy#pto#s of an>iety7 appetite loss and nausea7 and at least one study has reported that patients )ho use cannabis therapeutically are 343 ti#es #ore li ely to adhere to their antiretro$iral therapy re!i#ens than nonNcannabis users4D2L Clinical trial data indicates that cannabis use does not ad$ersely i#pact C"D and C"K / cell countsD307 D31and #ay e$en i#pro$e i##une function4D327 D33 &n 200I7 in$esti!ators at Colu#bia 8ni$ersity published clinical trial data in 200I reportin! that E&(:A&"S patients )ho inhaled cannabis four ti#es daily e>perienced ʺsubstantial increases in food inta e )ith little e$idence of disco#fort and no i#pair#ent of co!niti$e perfor#ance4 ʺ /hey concluded7 ʺS#o ed acannabisb has a clear #edical benefit in E&(N positi$e asubTectsb4 ʺ D3D /hat sa#e year7 in$esti!ators at San +rancisco General Eospital and the 8ni$ersity of California ʹs Pain Clinical Aesearch Center reported in the Tournal Neurolo!y that inhalin! cannabis si!nificantly reduced E&(Nassociated neuropathy co#pared to placebo4 Aesearchers reported that inhalin! cannabis three ti#es daily reduced patients ʹ pain by 3D percent4 /hey concluded7 ʺS#o ed cannabis )as )ell tolerated and effecti$ely relie$ed chronic neuropathic pain fro# E&(Nassociated neuropathy ain a #annerb si#ilar to oral dru!s used for chronic neuropathic pain4ʺ D3F

D2L

de Uon! et al4 200F4 <ariTuana use and its association )ith adherence to antiretro$iral therapy a#on! E&(N infected persons )ith #oderate to se$ere nausea4 Uournal of Ac;uired &##une "eficiency Syndro#es 3K9 D3NDG4 D30 Chao et al4 200K4 Aecreational dru! use and / ly#phocyte subpopulations in E&(Nuninfected and E&(N infected #en4 "ru! and Alcohol "ependence LD91GFN1I14 D31 Aachiel Schrier4 20104 2ffects of #edicinal cannabis on C"D i##unity in A&"S4 &n9 8ni$ersity of San "ie!o Eealth Sciences7 Center for <edicinal Cannabis Aesearch4 Aeport to the 1e!islature and Go$ernor of the State of California presentin! findin!s pursuant to S0KDI )hich created the C<CA and pro$ided state fundin!4 op4 cit4 D32 Abra#s et al420034 ShortNter# effects of cannabinoids in patients )ith E&(N1 infection9 a rando#i5ed7 placeboNcontrolled clinical trial4 Annals of &nternal <edicine 13L9 2FKN2GG4 D33 +o!arty et al4 200I4 <ariTuana as therapy for people li$in! )ith E&(:A&"S9 social and health aspects 1L9 2LFN3014 D3D Eaney et al4 200I4 "ronabinol and #ariTuana in E&(Npositi$e #ariTuana s#o ers9 caloric inta e7 #ood and sleep4 Uournal of Ac;uired &##une "eficiency Syndro#es DF9 FDFNFFD4 D3F Cited nor"l.orgL Abra#s et al4 200I4 Cannabis in painful E&(Nassociated sensory neuropathy9 a rando#i5ed placeboN controlled trial4

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&n 200K7 researchers at the 8ni$ersity of California in San "ie!o reported si#ilar findin!s4 Writin! in the Tournal Neuropsychophar#acolo!y7 they concluded9 ʺS#o ed cannabis si!nificantly reduced neuropathic pain intensity in E&(Nassociated polyneuropathy co#pared to placebo7 )hen added to stable conco#itant anal!esics4 <ood disturbance7 physical disability and ;uality of life all i#pro$ed si!nificantly durin! study treat#ent4 /he findin!s su!!est that cannabinoid therapy #ay be an effecti$e option for pain relief in patients )ith #edically intractable pain due to E&(4ʺ D3G <ost recently7 cannabis inhalation has been de#onstrated in clinical trial data to be associated )ith increased le$els of appetite hor#ones in the blood of subTects )ith E&( infection4 D3I &n preclinical #odels7 the lon!Nter# ad#inistration of ` L-/EC has recently been associated )ith decreased #ortality and a#eliorated disease pro!ression4ʺ D3K <any e>perts no) belie$e that ʺcannabis represents another treat#ent option in atheb health #ana!e#entʺ of patients )ith E&(:A&"S4 D3L

D3G

Cited nor"l.orgL 2llis et al4 200K4 S#o ed #edicinal cannabis for neuropathic pain in E&(9 a rando#i5ed7 crosso$er clinical trial4 op4 cit4 D3I Ai!!s et al4 20124 A pilot study of the effects of cannabis on appetite hor#ones in E&(Ninfected adult #en4 0rain Aesearch 1D319 DGNF2 P<&"9 2213330F D3K <olina et al4 20114 Cannabinoid ad#inistration attenuates the pro!ression of si#ian i##unodeficiency $irus4 A&"S Aesearch and Eu#an Aetro$iruses 2I9 FKFNFL2 P<&"9 20KIDF1L4 D3L Cited nor"l.orgL +o!arty et al4 200I4 op4 cit4

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6he <$perience of Foctors Working With A?FSS/?J 4atients
<ate S annellD -C,CDD0 Hro" working with A?FS and cancer patients! ? repeatedly saw how "ari.uana could a"eliorate a patientGs debilitating fatigue! restore appetite! di"inish pain! re"edy nausea! cure )o"iting and curtail down-to-the-bone weight loss. 6he federal obsession with a political agenda that keeps AcannabisB out of the hands of sick and dying people is appalling and irrational. -ar us AC ConantD -C,CDD1 3edical AcannabisB has been used e$tensi)ely by physicians throughout the 5nited States in the treat"ent of cancer and A?FS patients. ?t sti"ulates the appetite and pro"otes weight gain! in turn strengthening the body! co"bating chronic fatigue! and pro)iding the sta"ina and physical well-being necessary to endure or withstand both ad)erse side effects of ongoing treat"ent and other opportunistic infections. ?t has been shown effecti)e in reducing nausea! neurological pain and an$iety! and in sti"ulating appetite. When these sy"pto"s are associated with (or caused by) other therapies! "ari.uana has been useful in facilitating co"pliance with "ore traditional therapies. ?t "ay also allow indi)idual patients to engage in nor"al social interactions and a)oid the despair and isolation which fre:uently acco"panies long-ter" disco"fort and illness. . . ?n "y practice! AcannabisB has been of greatest benefit to patients with wasting syndro"e. =ikewise! for so"e of "y patients undergoing che"otherapy! when con)entional drugs fail to relie)e the se)ere nausea and )o"iting! ? often find that "ari.uana pro)ides the patient with the ability to eat and to tolerate aggressi)e cancer treat"ents. ? was one of the principal in)estigators of an HFA-super)ised trial conducted by 5ni"ed! ?nc. on the safety and efficacy of 3arinol as an appetite sti"ulant in /?JSA?FS patients suffering fro" wasting syndro"e. 3arinol is a for" of 6/C! one of the key acti)e co"ponents of "ari.uanaK it is essentially a "ari.uana e$tract. ?t was appro)ed by the HFA fi)e years ago! and has been widely prescribed by physicians treating both A?FS and cancer patients. . .
DD0 DD1

Mate Scannell7 <4"4 is the author of "eath of the Good "octor9 1essons fro# the Eeart of the A&"S 2pide#ic4 "r4 <arcus Conant is a physician )ho has practiced #edicine for 33 years in San +rancisco4 "r4 Conant is <edical "irector of the Conant <edical Group7 one of the lar!est pri$ate A&"S practices in the 8nited States4 Ee is a professor at the 8ni$ersity of California <edical Center in San +rancisco and is the author or co-author of o$er I0 publications on treat#ent of A&"S4 Ee and his collea!ues pro$ide pri#ary care for o$er F7000 E&( patients7 includin! 27000 )ith A&"S4

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? a" aware! howe)er! that 3arinol (like any "edication) is not effecti)e in treating all patients. ?n so"e cases! the reason is si"pleL 3arinol is taken orally! in pill for". 4atients suffering fro" se)ere nausea and retching cannot tolerate the pills and thus do not benefit fro" the drug. 6here are likely other reasons why s"oked "ari.uana is so"eti"es "ore effecti)e than 3arinol. 6he bodyGs absorption of the che"ical "ay be faster or "ore co"plete when inhaled. 3eans of ingestion is often critical in understanding treat"ent efficacy. Neil -C !l5nnD -C,CD -P& DD2 ?ntractable nausea and wasting syndro"e are fre:uent sy"pto"s associated with A?FS and the treat"ent of A?FS. 6he nausea! which can last for days! weeks or "onths! is one of the "ost se)ere for"s of disco"fort or pain that the hu"an being can e$perience. ?t destroys the :uality of life of the patient! whose sole ob.ecti)e is to "ake it through the ne$t hour! the ne$t day. #acked by intense )o"iting and :ueasiness! ti"e for the patient see"s to stand still. Wasting can take a si"ilar psychological and physical toll. . . ?f ? a" unable to relie)e the patientGs nausea with Acon)entionalB re"edies! ? ne$t prescribe 3arinol! a synthetic )ersion of 6/C! one of the "ain acti)e co"pounds found in "ari.uana. 3arinol is also helpful in sti"ulating appetite in patients suffering fro" A?FS wasting! as are other drugs! 3egace! anabolic steroids! and hu"an growth hor"one. ?f 3arinol does not pro)ide ade:uate relief fro" nausea andSor wasting! ? "ay suggest that the patient try a related re"edy! "ari.uana. ? fir"ly belie)e that "edical "ari.uana is "edically appropriate as a drug of last resort for a s"all nu"ber of seriously ill patients. E)er %7 years of clinical e$perience persuade "e of this fact. 6he anecdotal e)idence is o)erwhel"ing. Al"ost e)ery patient ? ha)e known to ha)e tried "ari.uana achie)ed relief fro" sy"pto"s with it. 6hat success rate far surpasses that for Co"pa0ine. Accordingly! as with any other "edication that ? consider potentially beneficial to "y patients! ? "ust discuss the option of "edical "ari.uana in detail when appropriate. Anything less is "alpractice. . . ?n "y nearly thirty years of clinical e$perience caring for the /?JSA?FS patients! "any near to or at the end of life! ? ha)e found "ari.uana to be a )aluable "edication for the alle)iation of intense suffering associated with nausea! wasting! and neuropathic pain. 3ari.uana has
DD2

"r4 Neil <4 +lynn is a Professor of Clinical <edicine at the 8ni$ersity of California at "a$is School of <edicine )here he established the 8C" A&"S and Aelated "isorders Clinic and is a #e#ber of the Chancellor?s Co##ittee on A&"S4 Ee is attendin! physician in the 8ni$ersity <edical Center?s &nfectious "iseases Clinic and at the Center for A&"S Aesearch7 2ducation and Ser$ices4 Ee is the author of nu#erous articles and a #e#ber of #any professional or!ani5ations4 "r4 Neil <4 +lynn7 is the pri#ary physician for 200 A&"S patients7 and participates in the care of appro>i#ately 17F00 A&"S patients4

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helped patients o)erco"e these potentially life threatening sy"pto"s! and has done so safely and without the debilitating side effects induced by "any "ainline therapies. ? ha)e seen "ari.uana restore patientsG will to li)e by restoring their ability to eat! gain strength! and perfor" si"ple! daily acti)ities free fro" crippling nausea or pain. 6here is no doubt in "y "ind that for so"e seriously ill patients! "ari.uana can help "ake the difference between life and deathK and that for other ter"inally ill patients! "ari.uana can "ake the difference between e$ercising control o)er their final "onths and days and passing in relati)e peace and co"fort! or dying in constant and se)ere agony (or incapacitated in a prolonged sedated ha0e! unaware of their surroundings). 3ari.uana! in short! can help sick and dying persons achie)e autono"y o)er their li)es by alle)iating the intense suffering caused by their illnesses or the side effects of their "edications. Hor so"e patients (for e$a"ple those suffering fro" operable cancer)! "edical "ari.uana "ay allow the" to continue their treat"ents and thus ser)e as a bridge to e)entual cureK for others "ari.uana "ay help pro"ote relati)e well-being and prolong a life free fro" intolerable painK and for still other patients! "ari.uana "ay help the" control the "anner and ti"ing of their deaths consistent with their )alues! beliefs and dignity. #eferenced fro" Foctor e$periences. DD3

DD3

"octor e>periences Safe Access No) - E&(:A&"S

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134 Euntin!tonʹs "isease
Euntin!tonʹs "isease BE"C is an inherited de!enerati$e brain disorder characterised by #otor abnor#alities and de#entia produced by selecti$e lesions in the cerebral corte> and7 in particular7 the striatu#4 /here are presently no no)n con$entional therapies a$ailable to alle$iate E" sy#pto#s or delay E"Nassociated striatal de!eneration4 Althou!h the ad#inistration of cannabidiol in E" patients pro$ided little sy#pto#atic relief co#pared to placebo in a sin!le clinical trial7 DDD #ore recent preclinical data indicates that cannabinoids #ay possess potential to #oderate the ad$ance#ent of the disease and si#ilar neurode!enerati$e disorders4DDF7 DDG Specifically7 e>peri#ental data published in the Uournal of Neuroscience Aesearch in 2011 reported that the co#bined ad#inistration of the plant cannabinoids /EC and C0" pro$ide neuroprotection in rat #odels of Euntin!tonʹs "isease4 Authors reported7 ʺa3bur data de#onstrate that a aone to oneb co#bination of /EC and C0"Nenriched botanical e>tracts protected striatal neurons a!ainst 444 to>icity4ʺ 0y contrast7 the ad#inistration of indi$idual7 selecti$e synthetic cannabinoid a!onists did not produce si#ilarly fa$orable outco#es4 &n$esti!ators concluded7 ʺ&n our opinion7 this data pro$ides sufficient preclinical e$idence to Tustify a clinical e$aluation of aone to one /EC to C0"b cannabisNbased #edicine 444 as a neuroprotecti$e a!ent capable of delayin! disease pro!ression in patients affected by E"7 a disorder that is currently poorly #ana!ed in the clinic7 pro#ptin! an ur!ent need for clinical trials )ith a!ents sho)in! positi$e results in preclinical studies4ʺ DDI

DDD

Consroe et al4 1LL14 Controlled clinical trial of cannabidiol in Euntin!ton ʹs "isease4 Phar#acolo!y7 0ioche#istry7 and 0eha$ior D09 I01NI0K4 DDF 1u$one et al4 200L4 Cannabidiol9 a pro#isin! dru! for neurode!enerati$e disordersQ CNS Neuroscience , /herapeutics 1F9 GFNIF P<&"9 1L22K1K04 DDG Sa!redo et al4 20124 Cannabinoids9 No$el <edicines for the /reat#ent of Euntin!ton ʹs "isease4 Aecent Patents on CNS "ru! "isco$ery I9 D1NDK P<&"9 222K03D0 DDI Sa!redo et al4 20114 Neuroprotecti$e effects of phytocannabinoidNbased #edicines in e>peri#ental #odels of Euntin!ton ʹs disease4 Uournal of Neuroscience Aesearch KL9 1F0LN1F1K P<&"9 21GIDFGL

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1D4 Eypertension
Ei!h blood pressure7 or hypertension7 afflicts an esti#ated one in four A#erican adults4 /his condition puts a strain on the heart and blood $essels and !reatly increases the ris of stro e and heart disease4 2#er!in! research indicates that the endo!enous cannabinoid syste# plays a role in re!ulatin! blood pressure7 thou!h its #echanis# of action is not )ell understood4 DDK Ani#al studies de#onstrate that ananda#ide and other endocannabinoids profoundly suppress cardiac contractility in hypertension and can nor#ali5e blood pressure7DDL DF0leadin! so#e e>perts to speculate that the #anipulation of the endocannabinoid syste# ʺ#ay offer no$el therapeutic approaches in a $ariety of cardio$ascular disorders4ʺ DF1 /he ad#inistration of natural cannabinoids has yielded conflictin! cardio$ascular effects on hu#ans and laboratory ani#als4DF27 DF37 DFD7 DFF7 DFG /he $ascular response in hu#ans ad#inistered cannabis in e>peri#ental conditions is typically characterised by a #ild increase in heart rate and blood pressure4 Eo)e$er7 co#plete tolerance to these effects de$elops ;uic ly and potential health ris s appear #ini#al4DFI7 DFK &n ani#als7 cannabinoid ad#inistration is typically associated )ith $asodilation7 transient bradycardia and hypotension7DFL as )ell as an inhibition of atherosclerosis Bhardenin! of the arteriesC pro!ression4DG07 DG17 DG2 /he ad#inistration of synthetic cannabinoids ha$e also been sho)n to lo)er blood pressure in ani#als and ha$e not been associated )ith cardioto>icity in hu#ans4 DG3 At this ti#e7 research assessin! the clinical use of cannabinoids for hypertension is in its infancy thou!h further in$esti!ation appears )arranted4DGD
DDK

Cited nor"l.orgL +ranTo Grotenher#en4 200G4 Clinical phar#acodyna#ics of cannabinoids4 &n Ausso et al B2dsC Eandboo of Cannabis /herapeutics4 0in!ha#pton7 Ne) 6or 9 Ea)orth Press4
DDL DF0
DF1

0at ai et al4 200D4 2ndocannabinoids actin! at cannabinoidN1 receptors re!ulate cardio$ascular function in hypertension4 Circulation 1109 1LLGN2204
Pacher et al4 200F4 0lood pressure re!ulation by endocannabinoids and their receptors BP"+C4 Neurophar#acolo!y DK9 1130N113K4

&bid4

DF2

Cecilia Eillard4 20004 2ndocannabinoids and $ascular function4 Uournal of Phar#acolo!y and 2>peri#ental /herapeutics4 2LD9 2IN324 DF3 Munos et al4 20004 2ndocannabinoids as cardio$ascular #odulators4 Che#istry and Physics of 1ipids 10K9 1FLN 1GK P<&"9 1110GIKL DFD Cited nor"l.orgL Aeese Uones4 20024 Cardio$ascular syste# effects of #ariTuana4 Uournal of Clinical Phar#acolo!y4 D29 FKNG34
DFF

Cited nor"l.org9 Aibuot et al4 200F4 Cardiac and $ascular effects of cannabinoids9 to)ard a therapeutic useQ Annales de Cardiolo!ie et d=An!eiolo!ie B+ranceC FD9 KLNLG4 DFG Cited nor"l.orgL Ste$en March4 200G4 Cannabis and cardioto>icity4 +orensic Science7 <edicine7 and Patholo!y4 29 13N1K4 DFI &bid4
DFK DFL DG0

Aodondi et al4 200G4 <ariTuana use7 diet7 body #ass inde> and cardio$ascular ris factors4 A#erican Uournal of Cardiolo!y LK9 DIKNDKD P<&"9 1GKL3I01

Cited nor"l.orgL Aeese Uones4 20024 op4 cit4

Steffens and <ach4 200G4 /o)ards a therapeutic use of selecti$e C02 cannabinoid receptor li!ands for atherosclerosis4 +uture Cardiol4 200G UanW2B1C9DL-F34 doi9 104221I:1DILGGIK42414DL4
DG1
DG2

DG3 DGD

Steffens et al4 200F4 1o) dose oral cannabinoid therapy reduces pro!ression of atherosclerosis in #ice4 Nature D3D9 IK2NIKG4 Cited nor"l.orgL Steffens and <ach4 200G4 Cannabinoid receptors in atherosclerosis4 Current 3pinion in 1ipidolo!y 1I9 F1LN F2G4

Cited nor"l.orgL Ste$en March4 200G4 op4 cit4 +rancois <ach4 200G4 Ne) antiNinfla##atory a!ents to reduce atherosclerosis4 Archi$es of Physiolo!y and 0ioche#istry7 (olu#e 1127 Nu#ber 27 April 200G 7 pp4 130-13IBKC

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1F4 <ethicillinNresistant Staphylococcus aureus B<ASAC
<any bacterial infections possess #ultiNdru! resistance4 Ar!uably the #ost si!nificant of these bacteria is #ethicillinNresistant Staphylococcus aureus7 #ore co##only no)n as <ASA or ʹthe superbu!4 ʹ /his bacteriu# is resistant to standard antibiotics7 includin! penicillin4 Accordin! to the Uournal of the A#erican <edical Association7 <ASA is responsible for nearly 207000 hospitalNstay related deaths annually in the 8nited States4 DGF Published data de#onstrates that cannabinoids possess stron! antibacterial properties4 &n 200K7 in$esti!ators at &talyʹs 8ni$ersita del Pie#onte 3rientale and 0ritain ʹs 8ni$ersity of 1ondon7 School of Phar#acy assessed the !er#Nfi!htin! properties of fi$e separate cannabinoids a!ainst $arious strains of #ultidru!Nresistant bacteria7 includin! <ASA4 /hey reported that all of the co#pounds tested sho)ed ʺpotent antibacterial acti$ityʺ and that cannabinoids )ere ʺe>ceptional ʺ at haltin! the spread of <ASA4DGG A second study published that sa#e year reported that nonNcannabinoid constituents in the plant also possess antibacterial properties a!ainst <ASA and #alaria4 DGI Clinical trials re!ardin! the use of cannabinoids for <ASA ha$e been reco##ended7 )ith so#e e>perts statin!7 ʺCannabis sati$a 444 represents an interestin! source of antibacterial a!ents to address the proble# of #ultidru! resistance in <ASA and other patho!enic bacteria4 ʺ DGK

DGF DGG DGI

Cited nor"l.orgL Mle$ens et al4 200I4 &n$asi$e #ethicillinNresistant Staphylococcus aureus infections in the 8nited States4 Uournal of the A#erican <edical Association 2LK9 1IG3N1II14
Appendino et al4 200K4 Antibacterial cannabinoids fro# cannabis sati$a9 a structure study4 Uournal of Natural Products I19 1D2IN1D304

Aad)an et al4 200K4 NonNcannabinoid constituents fro# a hi!h potency cannabis sati$a $ariety4 Phytoche#istry GL9 2GI2IN2G33 P<&"9 1KIID1DG DGK Cited nor"l.orgL Appendino et al4 200K4 op4 cit4

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1G4 <ultiple Sclerosis
<ultiple sclerosis B<SC is a chronic de!enerati$e disease of the central ner$ous syste# that causes infla##ation7 #uscular )ea ness and a loss of #otor coordination4 3$er ti#e7 <S patients typically beco#e per#anently disabled and7 in so#e cases7 the disease can be fatal4 Accordin! to the 8S National <ultiple Sclerosis Society7 about 200 people are dia!nosed e$ery )ee )ith the disease7 often stri in! those 20 to D0 years of a!e4 Clinical and anecdotal reports of cannabinoidsʹ ability to reduce <SNrelated sy#pto#s such as pain7 spasticity7 depression7 fati!ue7 and incontinence are plentiful in the scientific literature4 DGL7 DI07 DI17 DI27 DI37 DID7 DIF7 DIG7 DII7 DIK7 DIL7 DK0 <ost recently7 in$esti!ators at the 8ni$ersity of California in San "ie!o reported in 200K that inhaled cannabis si!nificantly reduced obTecti$e #easures of pain intensity and spasticity in patients )ith <S in a placeboNcontrolled7 rando#ised clinical trial4 &n$esti!ators concluded that ʺs#o ed cannabis )as superior to placebo in reducin! spasticity and pain in patients )ith #ultiple sclerosis and pro$ided so#e benefit beyond currently prescribed treat#ent4 ʺ DK1 Not surprisin!ly7 patients )ith #ultiple sclerosis typically report en!a!in! in cannabis therapy7 DK2 )ith one sur$ey indicatin! that nearly one in t)o <S patients use the dru! therapeutically4 DK3 3ther recent clinical and preclinical studies su!!est that cannabinoids #ay also inhibit <S pro!ression in addition to pro$idin! sy#pto# #ana!e#ent4 Writin! in the Uuly 2003 issue of the Tournal 0rain7
DGL DI0 DI1

Chon! et al4 200G4 Cannabis use in patients )ith #ultiple sclerosis4 <ultiple Sclerosis 129 GDGNGF1 P<&"9 1I0KGL12 Ao! et al4 200F4 Aando#i5ed7 controlled trial of cannabisNbased #edicine in central pain in #ultiple sclerosis4 Neurolo!y GF9 K12NK1L4

Wade et al4 200D4 "o cannabisNbased #edicinal e>tracts ha$e !eneral or specific effects on sy#pto#s in #ultiple sclerosisQ A doubleNblind7 rando#i5ed7 placeboNcontrolled study on 1G0 patients4 <ultiple Sclerosis 109 D3DNDD14 DI2 0rady et al4 200D4 An openNlabel pilot study of cannabisNbased e>tracts for bladder dysfunction in ad$anced #ultiple sclerosis4 <ultiple Sclerosis 109 D2FND334
DI3 DID DIF DIG DII DIK DIL

(aney et al4 200D4 2fficacy7 safety and tolerability of an orally ad#inistered cannabis e>tract in the treat#ent of spasticity in patients )ith #ultiple sclerosis9 a rando#i5ed7 doubleNblind7 placeboNcontrolled7 crosso$er study4 <ultiple Sclerosis 109 D1IND2D

Cannabinoids for treat#ent of spasticity and other sy#pto#s related to #ultiple sclerosis BCA<S studyC9 #ulticentre rando#ised placebo-controlled trial doi9104101G:S01D0-GI3GB03C1DI3K-1
Pa!e et al4 20034 Cannabis use as described by people )ith #ultiple sclerosis aP"+b4 Canadian Uournal of Neurolo!ical Sciences 309 201N20F4

Wade et al4 20034 A preli#inary controlled study to deter#ine )hether )holeNplant cannabis e>tracts can i#pro$e intractable neuro!enic sy#pto#s4 Clinical Aehabilitation 1I9 21N2L4
Consroe et al4 1LLI4 /he percei$ed effects of s#o ed cannabis on patients )ith #ultiple sclerosis4 2uropean Uournal of Neurolo!y 3K9 DDNDK P<&"9 L2F2ILK

<einc et al4 1LKL4 2ffects of cannabinoids on spasticity and ata>ia in #ultiple sclerosis4 Uournal of Neurolo!y 23G9 120N1224 8n!erleider et al4 1LKI4 "eltaNLN/EC in the treat#ent of spasticity associated )ith #ultiple sclerosis4 Ad$ances in Alcohol and Substance Abuse I9 3LNF0 P<&"9 2K31I01 DK0 Cited nor"l.orgL "enis Petro4 1LK04 <ariTuana as a therapeutic a!ent for #uscle spas# or spasticity4 Psychoso#atics 219 K1N KF4 DK1 Uody CoreyN0loo#4 20104 ShortNter# effects of cannabis therapy on spasticity in #ultiple sclerosis4 &n9 8ni$ersity of San "ie!o Eealth Sciences7 Center for <edicinal Cannabis Aesearch4 Aeport to the 1e!islature and Go$ernor of the State of California presentin! findin!s pursuant to S0KDI )hich created the C<CA and pro$ided state fundin!4 op4 cit4 DK2 Clar et al4 200D4 Patterns of cannabis use a#on! patients )ith #ultiple sclerosis4 Neurolo!y G29 20LKN20104 DK3 Cited nor"l.orgL Aeuters Ne)s Wire4 Au!ust 1L7 20024 ʺ<ariTuana helps <S patients alle$iate pain7 spas#s4ʺ

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in$esti!ators at the 8ni$ersity Colle!e of 1ondonʹs &nstitute of Neurolo!y reported that ad#inistration of the synthetic cannabinoid a!onist W&N FF7212N2 pro$ided ʺsi!nificant neuroprotection ʺ in an ani#al #odel of #ultiple sclerosis4 ʺ/he results of this study are i#portant because they su!!est that in addition to sy#pto# #ana!e#ent7 444 cannabis #ay also slo) the neurode!enerati$e processes that ulti#ately leads to chronic disability in #ultiple sclerosis and probably other disease7 ʺ researchers concluded4DKD Spanish researchers in 2012 reported si#ilar findin!s7 docu#entin! that ʺthe treat#ent of 2A2 #ice )ith the cannabinoid a!onist W&NFF7F12N2 reduced their neurolo!ical disability and the pro!ression of the disease4ʺ DKF &n$esti!ators ha$e also reported that the ad#inistration of oral /EC can boost i##une function in patients )ith <S4 ʺ/hese results su!!est proNinfla##atory diseaseN#odifyin! potential of cannabinoids aforb <S7ʺ they concluded4 DKG Clinical data reported in 200G fro# an e>tended openNlabel study of 1GI #ultiple sclerosis patients found that use of )hole plant cannabinoid e>tracts relie$ed sy#pto#s of pain7 spasticity and bladder incontinence for an e>tended period of treat#ent B#ean duration of study participants )as D3D daysC )ithout re;uirin! subTects to increase their dose4 DKI Aesults fro# a separate t)oNyear open label e>tension trial in 200I also reported that the ad#inistration of cannabis e>tracts )as associated )ith lon!Nter# reductions in neuropathic pain in select <S patients4 3n a$era!e7 patients in the study re;uired fe)er daily doses of the dru! and reported lo)er #edian pain scores the lon!er they too it4 DKK /hese results )ould be unli ely in patients sufferin! fro# a pro!ressi$e disease li e <S unless the cannabinoid therapy )as haltin! its pro!ression7 in$esti!ators ha$e su!!ested4 &n recent years7 health re!ulators in Canada7 "en#ar 7 Ger#any7 Spain and the 8nited Min!do# ha$e appro$ed the prescription use of plant cannabis e>tracts to treat sy#pto#s of #ultiple sclerosis4 Ae!ulatory appro$al in the 2uropean 8nion and in the 8nited States re#ains pendin!4 DKL

DKD DKF

Pryce et al4 20034 Cannabinoids inhibit neurode!eneration in #odels of #ultiple sclerosis4 0rain 12G9 21L1N 22024 de 1a!o et al4 20124 Cannabinoids a#eliorate disease pro!ression in a #odel of #ultiple sclerosis in #ice7 actin! preferentially throu!h C0B1C receptorN#ediated antiNinfla##atory effects4 Neurophar#acolo!y P<&"9 223D23IK DKG Millestein et al4 20034 &##uno#odulatory effects of orally ad#inistered cannabinoids in #ultiple sclerosis4 Uournal of Neuroi##unolo!y 13I9 1D0N1D3 P<&"9 12GGIGFK DKI Wade et al4 200G4 1on!Nter# use of a cannabisNbased #edicine in the treat#ent of spasticity and other sy#pto#s of #ultiple sclerosis4 <ultiple Sclerosis 129 G3LNGDF4 DKK Ao! et al4 200I4 3ro#ucosal deltaNLNtetrahydrocannabinol:cannabidiol for neuropathic pain associated )ith #ultiple sclerosis9 an uncontrolled7 openNlabel7 2Nyear e>tension trial4 Clinical /herapeutics 2L9 20GKN20IL P<&"9 1K03F20F4 DKL Cited nor"l.orgL Willia# <cGuinness4 ʺ<ariTuana #outh spray Sati$e> #ay hit shel$es by 20134ʺ C0S Ne)s7 Uanuary 2G7 20124

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1I4 3steoporosis
3steoporosis is a de!enerati$e s eletal disease characterised by a deterioration of bone tissue4 Patients )ith osteoporosis are at ris for sufferin! #ultiple fractures and other serious disabilities4 Appro>i#ately 10 #illion A#ericans o$er a!e F0 suffer fro# osteoporosis7 accordin! to the 8S Sur!eon General=s office7 and another 3D #illion are at ris for de$elopin! the disease4 &nitial references re!ardin! the potential use of cannabinoids to protect a!ainst the onset of osteoporosis are a$ailable in the scientific literature be!innin! in the early 1LL0s4 DL0 Writin! in the Uanuary 200G issue of the Proceedin!s of the National Acade#y of Sciences7 in$esti!ators at the 0one 1aboratory of the Eebre) 8ni$ersity in Uerusale# reported that the ad#inistration of the synthetic cannabinoid a!onist E8N30K slo)ed the de$elop#ent of osteoporosis7 sti#ulated bone buildin! and reduced bone loss in ani#als4 DL1 +ollo) up research published in the Annals of the Ne) 6or Acade#y of Sciences in 200I reported that the acti$ation of the C0 2 cannabinoid receptor reduced e>peri#entallyNinduced bone loss and sti#ulated bone for#ation4 DL2 Aesearch has reported that #ice deficient in the C0 2 cannabinoid receptor e>perienced a!eNaccelerated bone loss re#iniscent of hu#an osteoporosis4 DL3 Scientists no) speculate that the #ain physiolo!ic in$ol$e#ent of specific endocannabinoid receptors BC02 receptorsC is to #aintain ʺbone re#odelin! at balance7 thus protectin! the s eleton a!ainst a!eNrelated bone loss7ʺ
DLD

leadin! so#e e>perts to belie$e that cannabinoids #ay be ʺa pro#isin!

tar!et no$el tar!et for antiNosteoporotic dru! de$elop#ent4 ʺ DLF

DL0 DL1

(ratisla$ Schrieber4 1LLF4 2ndocrinolo!y 1LLDN1LLF4 Casopis 1e aru Ces ych BC5ech AepublicC 13D9 F3FNF3G P<&"9 IDKLFI1

3fe et al4 200G4 Peripheral cannabinoid receptor7 C027 re!ulates bone #ass4 Proceedin!s of the National Acade#y of Sciences of the 8nited States of A#erica 1039 GLGNI014 DL2 &tia 0ab4 200I4 Ae!ulation of S eletal Ae#odelin! by the 2ndocannabinoid Syste#4 Annals of the Ne) 6or Acade#y of Sciences 111G9 D1DND224 DL3 Cited nor"l.orgL 3fe et al4 200G4 op4 cit4 DLD 0ab et al4 200L4 Cannabinoids and the s eleton9 fro# #ariTuana to re$ersal of bone loss4 Annals of <edicine D19 FG0NFGI P<&"9 1LG3D02L DLF Cited nor"l.orgL &tia 0ab4 200I4 op4 cit4

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1K4 Phanto# li#b syndro#e
Patients )ho suffer a#putation of an e>tre#ity can e>perience a type of referred neuropathic pain in the a#putated 5one4 Phar#acolo!ic #ana!e#ent of this condition is co#ple> and it is based #ainly on anticon$ulsants4 /he use of cannabinoids is supported by their efficacy in alle$iatin! neuropathic pain4 Pro#isin! results ha$e been obtained in clinical practice4 DLG

1L4 Pruritus
&tchin! BpruritusC is a co##on sy#pto# associated )ith nu#erous s in diseases7 as )ell as a secondary sy#pto# of nu#erous serious conditions such as renal failure and li$er disease4 &tchin!7 unli e other s in sensations7 is !enerally a result of CNS acti$ities and typically !oes untreated by standard #edical therapies4 A re$ie) of the scientific literature re$eals three clinical trials in$esti!atin! the use of cannabinoids in the treat#ent of pruritus4 Writin! in the Au!ust 2002 issue of the A#erican Uournal of Gastroentrolo!y7 in$esti!ators fro# the 8ni$ersity of <ia#i "epart#ent of <edicine reported successful treat#ent of pruritus )ith F #! of /EC in three patients )ith cholestatic li$er disease4 DLI Prior to cannabinoid therapy7 subTects had failed to respond to standard #edications and had lost their ability to )or 4 +ollo)in! e$enin! cannabinoid ad#inistration7 all three patients reported a decrease in pruritus7 as )ell as ʺ#ar ed i#pro$e#entʺ in sleep and )ere e$entually able to return to )or 4 Aesolution of depression )as also reported in t)o out of three subTects4 ʺ` LNtetrahydrocannabinol #ay be an effecti$e alternati$e in patients )ith intractable cholestatic pruritus7 ʺ in$esti!ators concluded4 /he follo)in! year7 0ritish researchers reported in the Uune 2003 issue of the Tournal &nfla##ation Aesearch that the peripheral ad#inistration of the synthetic cannabinoid a!onist E8N211 si!nificantly reduced e>peri#entallyNinduced itch in 12 subTects4 DLK <ice scratched less4DLL

DLG

Aole of the Cannabinoid Syste# in Pain Control and /herapeutic &#plications for the <ana!e#ent of Acute and Chronic Pain 2pisodes P<C 2D30GL2 DLI Neff et al4 20024 Preli#inary obser$ation )ith dronabinol in patients )ith intractable pruritus secondary to cholestatic li$er disease4 A#erican Uournal of Gastroenterolo!y LI9 211IN211L4 DLK "$ora et al4 20034 Eista#ine induced responses are attenuated by a cannabinoid receptor a!onist in hu#an s in4 G Uune 20124 doi9 104101G:T4neurophar#4201240F4032 DLL UP2/ April 200L $ol4 32L no4 1 31D-323 2ndocannabinoid <odulation of Scratchin! Aesponse in an Acute Aller!enic <odel9 A Ne) Prospecti$e Neural /herapeutic /ar!et for Pruritus - UP2/ doi9104112D:Tpet410K41F013G

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&n$esti!ators had pre$iously reported that topical application of E8N210 on hu#an s in reduced e>peri#entallyNinduced pain and acute burnin! sensations4 F00 <ost recently7 researchers at Wrocla)7 Polandʹs 8ni$ersity of <edicine7 "epart#ent of "er#atolo!y7 reported that application of an endocannabinoidNbased topical crea# reduced ure#ic pruritus and >erosis Babnor#al dryness of the s inC in he#odialysis patients4 F01 /hree )ee s of t)iceNdaily application of the crea# ʺco#pletely eli#inated ʺ pruritus in 3K percent of trial subTects and ʺsi!nificantly reducedʺ itchin! in others4 2i!htyNone percent of patients reported a ʺco#plete reductionʺ in >erosis follo)in! cannabinoid therapy4 &n li!ht of these encoura!in! preli#inary results7 so#e der#atolo!y e>perts no) belie$e that cannabinoids and the cannabinoid syste# #ay represent ʺpro#isin! ne) a$enues for #ana!in! itch #ore effecti$ely4ʺ F02

F00 F01

"$ora et al4 20034 Cannabinoid a!onists attenuate capsaicinNinduced responses in hu#an s in4 Pain 1029 2K3N2KK4 S5epieto)s i et al4 200F4 2fficacy and tolerance of the crea# containin! structured physiolo!ical lipid endocannabinoids in the treat#ent of ure#ic pruritus9 a preli#inary study4 Acta "er#ato$enerolo!ic Croatica BCroatiaC 139 LIN103 P<&"9 1G32DD22 F02 Paus et al4 200G4 +rontiers in pruritus research9 scratchin! the brain for #ore effecti$e itch therapy4 Uournal of Clinical &n$esti!ation 11G9 11IDN11KF4

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204 Aheu#atoid Arthritis
Aheu#atoid arthritis BAAC is an infla##atory disease of the Toints characterised by pain7 stiffness7 and s)ellin!7 as )ell as an e$entual loss of li#b function4 Aheu#atoid arthritis is esti#ated to affect about one percent of the population7 pri#arily )o#en4 8se of cannabis to treat sy#pto#s of AA is co##only selfNreported by patients )ith the disease4 &n a 200F anony#ous ;uestionnaire sur$ey of #edicinal cannabis patients in Australia7 2F percent reported usin! cannabinoids to treat AA4 F03 A sur$ey of 0ritish #edical cannabis patients found that #ore than 20 percent of respondents reported usin! cannabis for sy#pto#s of arthritis4 F0D Ne$ertheless7 fe) clinical trials in$esti!atin! the use of cannabis for AA appear in the scientific literature4 &n Uanuary 200G7 in$esti!ators at the 0ritish Aoyal National Eospital for Aheu#atic "isease reported successful treat#ent of arthritis )ith cannabinoids in the firstNe$er controlled trial assessin! the efficacy of natural cannabis e>tracts on AA4F0F &n$esti!ators reported that ad#inistration of cannabis e>tracts o$er a fi$e )ee period produced statistically si!nificant i#pro$e#ents in pain on #o$e#ent7 pain at rest7 ;uality of sleep7 infla##ation and intensity of pain co#pared to placebo4 No serious ad$erse effects )ere obser$ed4 Si#ilar results had been reported in s#aller Phase && trials in$esti!atin! the use of orally ad#inistered cannabis e>tracts on sy#pto#s of AA4F0G Preclinical data also indicates that cannabinoids can #oderate the pro!ression of AA4

F03 F0D

S)ift et al4 200F4 Sur$ey of Australians usin! cannabis for #edical purposes4 Ear# Aeduction Uournal D9 2N1K4 Ware et al4 200F4 /he #edicinal use of cannabis in the 8M9 results of a nation)ide sur$ey4 &nternational Uournal of Clinical Practice FL9 2L1N2LF P<&"9 1FKFI32F F0F 0la e et al4 200G4 Preli#inary assess#ent of the efficacy7 tolerability and safety of a cannabis #edicine BSati$e>C in the treat#ent of pain caused by rheu#atoid arthritis4 Aheu#atolo!y DF9 F0NF24 F0G No author4 20034 CannabisNbased #edicines4 "ru!s in Aesearch and "e$elop#ent D9 30GN30L P<&"9 12LF2F00

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Writin! in the Au!ust 2000 issue of the Uournal of the Proceedin!s of the National Acade#y of Sciences7 in$esti!ators at 1ondonʹs Mennedy &nstitute for Aheu#atolo!y reported that cannabidiol BC0"C ad#inistration suppressed pro!ression of arthritis in )itro and in ani#als4F0I Ad#inistration of C0" after the onset of clinical sy#pto#s protected Toints a!ainst se$ere da#a!e and ʺeffecti$ely bloc ed atheb pro!ression of arthritis7ʺ in$esti!ators concluded4 "aily ad#inistration of the synthetic cannabinoid a!onist E8N320 has also been reported to protect Toints fro# da#a!e and to a#eliorate arthritis in ani#als4F0K Su##arisin! the a$ailable literature in the Septe#ber 200F issue of the Uournal of Neuroi##unolo!y7 researchers at /o yoʹs National &nstitute for Neuroscience concluded7 ʺCannabinoid therapy of AA could pro$ide sy#pto#atic relief of Toint pain and s)ellin! as )ell as suppressin! Toint destruction and disease pro!ression4ʺ F0L

F0I

<alfait et al4 20004 /he non-psychoacti$e cannabis constituent cannabidiol is an oral antiNarthritic therapeutic in #urine4 Uournal of the Proceedin!s of the National Acade#y of Sciences LI9 LFG1NLFGG4 F0K Su#ari)alla et al4 200D4 A no$el synthetic7 non-psychoacti$e cannabinoid acid BE8N320C )ith antiN infla##atory properties in #urine colla!enNinduced arthritis4 Arthritis , Aheu#atis# F09 LKFNLLK P<&"9 1F0223D3 F0L Cro>ford and 6a#a#ura4 200F4 Cannabinoids and the i##une syste#9 potential for the treat#ent of infla##atory diseases4 Uournal of Neuroi##unolo!y 1GG9 3N1K P<&"9 1G023222

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214 Sleep Apnea
Sleep apnea is a #edical disorder characterised by fre;uent interruptions in breathin! of up to ten seconds or #ore durin! sleep4 /he condition is associated )ith nu#erous physiolo!ical disorders7 includin! fati!ue7 headaches7 hi!h blood pressure7 irre!ular heartbeat7 heart attac and stro e4 /hou!h sleep apnea often !oes undia!nosed7 it is esti#ated that appro>i#ately four percent of #en and t)o percent of )o#en a!es 30 to G0 years old suffer fro# the disease4 3ne preclinical study is cited in the scientific literature in$esti!atin! the role of cannabinoids on sleepNrelated apnea4 Writin! in the Uune 2002 issue of the Tournal of the A#erican Acade#y of Sleep <edicine7 researchers at the 8ni$ersity of &llinois BChica!oC "epart#ent of <edicine reported ʺpotent suppressionʺ of sleepNrelated apnea in rats ad#inistered either e>o!enous or endo!enous cannabinoids4F10 &n$esti!ators reported that doses of ` L-/EC and the endocannabinoid olea#ide each stabilised respiration durin! sleep and bloc ed serotoninNinduced e>acerbation of sleep apnea in a statistically si!nificant #anner4 No follo) up in$esti!ations ha$e ta en place assessin! the use of cannabinoids to treat this indication4 Eo)e$er7 se$eral recent preclinical and clinical trials ha$e reported on the use of /EC7 natural cannabis e>tracts and endocannabinoids to induce sleep F117 ;uality4
F13 F12

and : or i#pro$e sleep

F10 F11

Carley et al4 20024 +unctional role for cannabinoids in respiratory stability durin! sleep4 Sleep 2F9 3LLND00 P<&"9 120I1F3L <urilloNAodri!ue5 et al4 20034 Ananda#ide enhances e>tracellular le$els of adenosine and induces sleep9 an in )i)o #icrodialysis study4 Sleep 2G9 LD3NLDI P<&"9 1DIDG3I2 F12 Nicholson et al4 200D4 2ffect of deltaNLNtetrahydrocannabinol and cannabidiol on nocturnal sleep and earlyN #ornin! beha$ior in youn! adults4 Uournal of Clinical Phar#acolo!y 2D9 30FN313 P<&"9 1F11KDKF F13 Christine Perras4 200F4 Sati$e> for the #ana!e#ent of #ultiple sclerosis sy#pto#s4 &ssues in 2#er!in! Eealth /echnolo!ies I29 1ND P<&"9 1G31IK2F

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224 /ouretteʹs Syndro#e
/ouretteʹs syndro#e B/SC is a co#ple> neuropsychiatric disorder of un no)n etiolo!y that is characterised by in$oluntary $ocal tics4 Se$erity of this condition $aries )idely a#on! patients4 /hou!h there is no cure for /ouretteʹs syndro#e7 the condition often i#pro$es )ith a!e4 2>perts esti#ate that 1007000 A#ericans are afflicted )ith /S4 A re$ie) of the scientific literature re$eals se$eral clinical trials in$esti!atin! the use of cannabinoids for the treat#ent of /S4 Writin! in the <arch 1LLL issue of the A#erican Uournal of Psychiatry7 in$esti!ators at Ger#anyʹs <edical School of Eano$er7 "epart#ent of Clinical Psychiatry and Psychotherapy7 reported successful treat#ent of /ourette ʹs syndro#e )ith a sin!le dose of 10 #! of `L-/EC in a 2FNyearNold #ale patient in an uncontrolled open clinical trial4 &n$esti!ators reported that the subTectʹs total tic se$erity score fell fro# D1 to I )ithin t)o hours follo)in! cannabinoid therapy7 and that i#pro$e#ent )as obser$ed for a total of se$en hours4 ʺ+or the first ti#e7 patientsʹ subTecti$e e>periences )hen s#o in! acannabisb )ere confir#ed by usin! a $alid and reliable ratin! scale7ʺ authors concluded4F1D &n$esti!ators a!ain confir#ed these preli#inary results in a rando#ised7 doubleNblind7

placeboNcontrolled7 crosso$er7 sin!le dose trial of /EC in 12 adult /S patients4 Aesearchers reported a ʺsi!nificant i#pro$e#ent of tics and obsessi$eNco#pulsi$e beha$ior B3C0C after treat#ent )ith `L-/EC co#pared to placebo4ʺF1F &n$esti!ators reported no co!niti$e i#pair#ent in subTects follo)in! /EC ad#inistrationF1G and concluded7 ʺ/EC is effecti$e and safe in treatin! tics and 3C0 in /S4 ʺ F1I

F1D

<ullerN(ahl et al4 1LLL4 /reat#ent of /ouretteʹs syndro#e )ith deltaNLNtetrahydrocannabinol4 A#erican Uournal of Psychiatry 1FG9 DLF4 F1F <ullerN(ahl et al4 20024 /reat#ent of /ouretteʹs syndro#e )ith "eltaNLNtetrahydrocannabinol B/ECC9 a rando#i5ed crosso$er trial4 Phar#acopsychiatry 3F9 FING1 P<&"9 11LF11DG F1G <ullerN(ahl et al4 20014 &nfluence of treat#ent of /ourette syndro#e )ith deltaLNtetrahydrocannabinol BdeltaLN/ECC on neuropsycholo!ical perfor#ance4 Phar#acopsychiatry 3D9 1LN2D P<&"9 1122LG1I F1I Cited nor"l.orgL <ullerN(ahl et al4 20024 op4 cit4

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&n$esti!ators confir#ed these results in a second rando#ised7 doubleNblind7 placeboN controlled trial in$ol$in! 2D patients ad#inistered daily doses of up to 10 #! of /EC o$er a si>N)ee period4 Aesearchers reported that subTects e>perienced a si!nificant reduction in tics follo)in! lon!Nter# cannabinoid treat#ent7F1K and suffered no detri#ental effects on learnin!7 recall or $erbal #e#ory4 F1L A trend to)ard si!nificant i#pro$e#ent of $erbal #e#ory span durin! and after therapy )as also obser$ed4 Su##arisin! their findin!s in the 3ctober 2003 issue of the Tournal 2>pert 3pinions in Phar#acotherapy7 in$esti!ators concluded that in adult /S patients7 ʺ/herapy )ith ` L-/EC should be tried if )ell established dru!s either fail to i#pro$e tics or cause si!nificant ad$erse effects4 ʺ F20

F1K

<ullerN(ahl et al4 20034 "elta LNtetrahydrocannabinol B/ECC is effecti$e in the treat#ent of tics in /ourette syndro#e9 a GN)ee rando#i5ed trial4 Uournal of Clinical Psychiatry GD9 DFLNGF P<&"9 12I1G2F0 F1L <ullerN(ahl et al4 20034 /reat#ent of /ourette syndro#e )ith deltaNLNtetrahydrocannabinol Bdelta LN/ECC9 no influence on neuropsycholo!ical perfor#ance4 Neuropsychophar#acolo!y 2K9 3KDNK P<&"9 12FKL3L2 F20 Mirsten <ullerN(ahl4 20034 Cannabinoids reduce sy#pto#s of /ourette ʹs syndro#e4 2>pert 3pinions in Phar#acotherapy D9 1I1IN2F P<&"9 1DF21DK2

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3ncolo!y and Palliati$e Care
Cannabis pro$ides pain relief and palliati$e care )here other #edicines= side effects are not desirable for the patient=s daily life4

@4roper palliati)e care will "itigate "ost peopleRs desire to dieC
"r Natalya "inat F21 OAs palliati$e #edicine practitioners7 our specialty should e#brace the scientific process7 )hich continues to docu#ent the therapeutic effects of cannabis4 As is often the case in hospice7 )e #ust be )illin! to ad$ocate for our patients )ho )ant to le!iti#ately access a #edicine that could potentially be $ery beneficial for the# and is safer than other options such as opioids4 /he #edicinal cannabis user should not be considered a cri#inal444 our le!al syste# should be usin! science and lo!ic as the basis of policy #a in! rather than political or societal bias4P F22

+or#er head of the centre for palliati$e care at the 8ni$ersity of the Wit)atersrand Cannabis in Palliati$e <edicine9 &#pro$in! Care and Aeducin! 3pioid-Aelated <orbidity - A#erican Uournal of Eospice and Palliati$e <edicine 2K <arch 2011
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Cancer patients usin! cannabis report better influence fro# the plant e>tract than fro# synthetic products4 Eo)e$er7 al#ost all the research conducted to date has been perfor#ed )ith synthetic products4

@9oth the state and pri)ate sectors Aof palliati)e careB are )astly under resourced and neglected. Hew "edical aids actually pro)ide access to this for" of care.C
"r 0rent /ippin! F23 /he consu#ption of cannabis is effecti$e in treatin! sy#pto#s associated )ith cancer and con$entional anti-cancer therapies7 such as nausea7 )ei!ht loss7 pain7 and fati!ue7 accordin! to obser$ational study data published in the Tournal 2$idence-0ased Co#ple#entary and Alternati$e <edicine4F2D OAll cancer or anti-cancer treat#ent-related sy#pto#s7 includin! nausea7 $o#itin!7 #ood disorders7 fati!ue7 )ei!ht loss7 anore>ia7 constipation7 se>ual function7 sleep disorders7 itchin!7 and pain had si!nificant i#pro$e#ent7R authors reported4 RNo si!nificant difference )as found in the le$el of infections7 #outh dryness7 cou!h7 shortness of breath7 diarrhea7 and leu ocyte count or albu#in le$el durin! the ti#e bet)een the t)o inter$ie)s4P /he population of the prolon!ed users in the current study reported si!nificant i#pro$e#ent in all aspects of supporti$e and palliati$e oncolo!y care4 /he i#pro$e#ent in sy#pto#s should push the use of cannabis in the practice of oncolo!y palliati$e treat#ent4 F2F

Specialist !eriatrician and physician at the 8ni$ersity of the Wit)atersrand "onald Gordon <edical Centre /he #edical necessity for #edicinal cannabis9 prospecti$e7 obser$ational study e$aluatin! the treat#ent in cancer patients on supporti$e or palliati$e care4 2$id 0ased Co#ple#ent Alternat <ed4 2013 Uul 1G P<&"9 23LFGIID F2F 2$idence-0ased Co#ple#entary and Alternati$e <edicine (olu#e 2013 B2D Uune 2013C /he <edical Necessity for <edicinal Cannabis9 Prospecti$e7 3bser$ational Study 2$aluatin! the /reat#ent in Cancer Patients on Supporti$e or Palliati$e Care
F23

F2D

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

3pioids $ersus Cannabinoids
3pioids and cannabinoids ha$e #any thin!s in co##on4 /hey are both a#on! the )orld=s oldest- no)n class of dru!s7 )ith docu#entation of usa!e datin! bac #any thousands of years4 /hey both produce their phar#acolo!ical effect $ia actions at specific receptors7 found throu!hout the body4F2G7
F2I

0oth of these classes of co#pounds are also #ade endo!enously in the hu#an body and

are part of the nor#al re!ulatory7 ho#eostatic processes necessary for life4 Without endorphins BopioidsC and endocannabinoids BcannabinoidsC7 our bodies )ould not function properly4 F2K O&n re$ie)in! the possible acute and lon! ter# ad$erse effects of cannabinoids as therapeutic a!ents one needs also to be #indful that other a!ents that are used for treat#ent of pain or spasticity also ha$e ad$erse effects4 3pioids produce sedation7 nausea7 constipation and dependence7 )ithdra)al fro# )hich results in serious abstinence syndro#e )ith #uch #ore se$ere effects X e4!4 se$ere autono#ic7 !astrointestinal7 and psychiatric X than the rather #ild cannabis )ithdra)al pheno#ena4 /ricyclic antidepressants and antiepileptic dru!s co##only prescribed for chronic pain ha$e psychotropic Be4!4 sedationC7 anticholiner!ic Be4!4 constipation7 di55iness7 palpitations7 $isual disturbance7 urinary retentionC7 and neuro#uscular effects4 "ru!s for spasticity produce sedation Be4!4 baclofenC7 hypotension Be4!4 ti5anidineC and serious interactions )ith antibiotics Be4!4 ti5anidine and ciproflo>acinC4 0en5odia5epines that are so#eti#es prescribed for spasticity can produce sedation7 psycho#otor incoordination7 #e#ory lapses7 and parado>ical reactions7 as )ell as dependence and )ithdra)al syndro#es4 3pioids and sedati$e-hypnotics are also dru!s of abuse7 and their ability to induce physiolo!ical dependence and serious )ithdra)al states e>ceed those of cannabis4 /herefore7 Tud!e#ents on relati$e benefits and ris s of cannabinoids as #edicines need to be $ie)ed )ithin the broader conte>t of ris -benefit of other a!ents as )ell4P
F2L

F2G

(i!ano A7 0ruera 27 Suare5-Al#a5or <24 A!e7 pain intensity and opioid dose in patients )ith ad$anced cancer4 Cancer4 1LLKW K3BGC912DD-12F04 F2I A!!ar)al SM7 Carter G/7 Sulli$an <"7 <orrill A7 du#0runnen C7 <ayer U"47 <edicinal use of cannabis in the 8nited States9 historical perspecti$es7 current trends7 and future directions4 U 3pioid <ana!4 200LWFB3C91F3-1GK P<&"9 1LGG2L2F F2K Cannabis in Palliati$e <edicine9 &#pro$in! Care and Aeducin! 3pioid-Aelated <orbidity4 A#erican Uournal of Eospice , Palliati$e <edicine F2L O<edical <ariTuana9 Clearin! A)ay the S#o eR - NC0& D <ay 20124 P<C33FKI13

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,eliver5 methods
A dru! is any substance7 synthetic or natural7 le!al or ille!al7 that is consu#ed )ith the intention of brin!in! about chan!e in a person?s beha$iour7 e#otions and thou!hts4 Substances not usually considered as dru!s #ay function as dru!s under certain circu#stances7 for e>a#ple foods7 be$era!es7 sol$ents and aerosols4 Cannabis can be ad#inistered in a nu#ber of )ays9 ; ; ; ; ; S Erally! as a li:uid or solid! that is absorbed through the sto"ach. 6opically! as a li:uid or solid! that is absorbed through the skin. Sublingually! diffusing into the blood through tissues under the tongue. ?nhaled! )apor breathed into the lungs. S"oked! s"oke breathed into lungs. ?ntra-tu"oral in.ection! \8-6/C F30

F30

Gu5#an7 "uarte etc47 OA pilot clinical study of "eltaL-tetrahydrocannabinol in patients )ith recurrent !lioblasto#a #ultifor#eP7 0ritish Uournal of Cancer7 200G Uul 1IWLFB2C91LI-20347 P<C&"9 P<C23G0G1I4

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S#o in! and Pul#onary function
Cannabis should not necessarily be $ie)ed as a ʹhar#lessʹ substance4 &ts acti$e constituents #ay produce a $ariety of physiolo!ical and euphoric effects4 As a result7 there #ay be so#e populations that are susceptible to increased ris s fro# the use of cannabis7 such as adolescents7 pre!nant or nursin! #others7 and patients )ho ha$e a fa#ily history of #ental illness4 Patients )ith hepatitis C7 decreased lun! function Bsuch as chronic obstructi$e pul#onary diseaseC7 or )ho ha$e a history of heart disease or stro e #ay also be at a !reater ris of e>periencin! ad$erse side effects fro# cannabis4 As )ith any #edication7 patients should consult thorou!hly )ith their physician before decidin! )hether the #edical use of cannabis is safe and appropriate4 F31 /he persistin! Schedule & classification of cannabis that the !o$ern#ent #aintains is itself a s#o escreen that is directly discordant )ith authoritati$e7 independent7 #edico-scientific e$idence-based assess#ents4 Publishin! in the open-access scientific literature housed in the 84S4 National &nstitutes of Eealth?s National 1ibrary of <edicine7 clinical in$esti!ators )ho o$ersa) se$en separate7 !o$ern#ent-authorised7 !old-standard desi!n clinical trials of the safety and efficacy of s#o ed and $aporised inhaled cannabis for specific indications conducted at 8ni$ersity of California #edical centers o$er a 10 years period4 +ro# 2002X2012 the study in$ol$ed o$er 300 hu#an subTects reported in an article entitled O<edical <ariTuana9 Clearin! A)ay the S#o eP that all trials independently sho)ed benefit4 /he authors concluded that the Schedule & classification of cannabis7 based on the e$idence collected and re$ie)ed7 is Onot tenable7P Onot accurate7P and one of the #ain Oobstacles to #edical pro!ress4P
F32

According to the World /ealth Ergani0ation! >6here are no recorded cases of o)erdose fatalities attributed to cannabis! and the esti"ated lethal dose for hu"ans e$trapolated fro" ani"al studies is so high that it cannot be achie)ed by ... users.>

F31

N3A<1 2#er!in! Clinical Applications for Cannabis and Cannabinoids9 A Ae$ie) of the Aecent Scientific 1iterature +ifth 2dition F32 Grant et al B2012C7 O3edical 3ari.uanaL Clearing Away the S"okeC! 3pen Neurol U4 2012W G9 1KX2F7 P<C&"9 P<C33FKI134

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Phar#acolo!y e>pert and author "r4 &$erson e>plains the enor#ous doses that ha$e been testedW O1aboratory ani#als Brats7 #ice7 do!s and #on eysC can tolerate doses of up to 1000#!: !4 /his )ould be e;ui$alent to a I0- ! person s)allo)in! I0! of the dru!-about F7000 ti#es #ore than is re;uired to produce a hi!h4 "espite )idespread illicit use of cannabis7 there are $ery fe)7 if any7 instances of people dyin! fro# an o$erdose4P
F33

A 2012 study published in UA<A and funded by National &nstitutes of Eealth loo ed at a population of F711F A#erican #en and )o#en to see )hether s#o ed cannabis has effects on the pul#onary syste# si#ilar to those fro# s#o in! tobacco4 /he researchers found9

>Eccasional and low cu"ulati)e cannabis use was not associated with ad)erse effects on pul"onary function.>
S#o in! an a$era!e of one Toint a day for se$en years7 they found7 did not )orsen pul#onary health4F3D "r4 "onald /ash in co##ented on the study7 sayin! it confir#ed findin!s fro# se$eral other studies sho)in! Rthat essentially there is no si!nificant relationship bet)een acannabisb e>posure and i#pair#ent in lun! function4R Ee noted despite containin! si#ilar no>ious in!redients7 one reason cannabis s#o e #ay not be as har#ful as tobacco s#o e #ay be due to the anti-infla##atory effects of /EC4 RWe don?t no) for sure but a $ery reasonable possibility is that /EC #ay actually interfere )ith the de$elop#ent of chronic obstructi$e pul#onary diseaseR7 /ash in elaborated4 &n his o)n research7 /ash in une>pectedly found that s#o in! up to three Toints a day appeared to ha$e no decrease in lun! function4 R? think that the botto" line is that there does not appear to be any negati)e i"pact on lung function of cannabis s"oking.R "r4 "onald /ash in F3F

F33 F3D

1esley 14 &$erson <ariTuana Science 2002 UA<A * Association 0et)een <ariTuana 2>posure and Pul#onary +unction 3$er 20 6ears 11 Uan 2012 F3F Study9 S#o in! <ariTuana Not 1in ed )ith 1un! "a#a!e Aead #ore9 Study9 S#o in! <ariTuana Not 1in ed )ith 1un! "a#a!e * /&<24co# 10 Uan 2012

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Safet5 and Side *ffe ts of Cannabis
; ; ; ; ; ; ; ; 9roncho-dilation Congestion of the con.uncti)al blood )essels Fi00iness Frowsiness <uphoria ?ncreased Appetite 6rychardia ]erosto"ia

/here has ne$er been a docu#ented hu#an fatality solely fro# o$erdosin! on tetrahydrocannabinol or cannabis in its natural for#7 F3G thou!h the synthetic /EC pill R<arinolR )as cited by the +"A as bein! responsible for D deaths bet)een Uanuary 17 1LLI and Uune 307 200F4 F3I &nfor#ation about /EC?s to>icity is pri#arily based on results fro# ani#al studies4 /he to>icity depends on the route of ad#inistration and the laboratory ani#al4 Absorption is li#ited by seru# lipids7 )hich can beco#e saturated )ith /EC7 #iti!atin! to>icity4F3K "ue to the lo) nu#ber of studies conducted on cannabis7 there is not enou!h e$idence to reach a conclusion re!ardin! the effect of cannabis on o$erall ris of death or life span4 F3L /here are #edical reports of occasional infarction7 stro e and other cardio$ascular side effects4 Cannabis?s cardio$ascular effects are not associated )ith serious health proble#s for #ost youn!7 healthy users4FD0 Accordin! to a 200G 8nited Min!do# !o$ern#ent report7 usin! cannabis is #uch less dan!erous than tobacco7 prescription dru!s7 and alcohol in social har#s7 physical har#7 and addiction4 FD1 Ear$ard?s "r4 1ester Grinspoon7 has stated in a ne)spaper editorial that Rherbal acannabisb is re#ar ably nonto>icR4FD2

F3G

Wal er7 U4<ichaelW Euan!7 Susan < B2002C4 RCannabinoid anal!esiaR4 Phar#acolo!y , /herapeutics 9F B2C9 12IX3F44 R444to date7 there are no deaths no)n to ha$e resulted fro# o$erdose of cannabis4 Bp4 12KCR F3I "eaths fro# <ariTuana $4 1I +"A-Appro$ed "ru!sR BP"+C4 200F-0G-304 Aetrie$ed 2011-02-034 F3K R2ro)id Cannabis (ault 9 /EC <aterial Safety "ata SheetR4 2ro)id4or!4 Aetrie$ed 2011-0D-204 F3L Calabria 07 et al4 B<ay 2010C4 R"oes cannabis use increase the ris of deathQ Syste#atic re$ie) of epide#iolo!ical e$idence on ad$erse effects of cannabis useR4 Frug Alcohol #e). 2L FD0 Uones7 A4 /4 B2002C4 RCardio$ascular syste# effects of #ariTuanaR4 1ournal of clinical phar"acology D2 FD1 "a$id U Nutt7 et al4 BNo$ 2010C4 R"ru! har#s in the 8M9 a #ulticriteria decision analysisR4 6he =ancet 3IG FD2 &bid4

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"r4 Stephen Aoss7 a professor of child psychiatry and addiction at Ne) 6or 8ni$ersity?s /ish Eospital e>plains reports of so#e cannabis-related deaths9 Rdeaths associated )ith the dru! are the result of acti$ities underta en )hile on the dru!7 such as dri$in! under the influenceR4 FD3 /he 8S Substance Abuse and <ental Eealth Ser$ices Ad#inistration stated in its Uuly 2001 report fro# the "ru! Abuse Warnin! Net)or <ortality "ata9 Rcannabis is rarely the only dru! in$ol$ed in a dru! abuse death4 /hus7 in #ost cases7 the proportion of cannabis-in$ol$ed cases labeled as ?3ne dru!? Bi4e47 cannabis onlyC )ill be 5ero or nearly 5ero4R
FDD7 FDF

/EC7 the principal psychoacti$e constituent of the cannabis plant7 has an e>tre#ely lo) to>icity4 A 1LLK study published in /he 1ancet reports9 R/here are no confir#ed published cases )orld)ide of hu#an deaths fro# cannabis poisonin!7 and the dose of /EC re;uired to produce F0\ #ortality in rodents is e>tre#ely hi!h co#pared )ith other co##only used dru!sR4 FDG Cannabis researcher "r4 Paul Eornby said that Ryou ha$e to s#o e so#ethin! li e 1F7000 Toints in 20 #inutes to !et a to>ic a#ount of ` L-tetrahydrocannabinolR4FDI Aecorded fatalities resultin! fro# cannabis o$erdose in ani#als are !enerally only after intra$enous inTection of hashish oil4 FDK <any studies ha$e loo ed at the effects of s#o in! cannabis on the respiratory syste#4 Cannabis s#o e contains thousands of or!anic and inor!anic che#ical co#pounds4 /his tar is che#ically si#ilar to that found in tobacco s#o e or ci!ars4 FDL 3$er fifty no)n carcino!ens ha$e been identified in cannabis s#o e4FF0 /hese include nitrosa#ines7 reacti$e aldehydes7 and polycyclic hydrocarbons7 includin! ben5aabpyrene4FF1 aCannabisb s#o e )as listed as a cancer a!ent in California in 200L4 FF2 A 2012 literature re$ie) by the 0ritish 1un! +oundation identified cannabis s#o e as a carcino!en and also found a)areness of the dan!er )as lo) co#pared )ith the hi!h a)areness of the dan!ers of s#o in! tobacco particularly a#on! youn!er users4 3ther obser$ations include increased ris fro# each cannabis ci!arette due to dra)in! in lar!e puffs of s#o e and holdin! the#W lac of research on
FD3 FDD

R/oddler?s #ariTuana coo ie in!estion )as har#less7 e>pert saysR7 Susan 24 <atthe)s7 <yEealthNe)s"aily4co#7 3 Uul 20124 Substance Abuse and <ental Eealth Ser$ices Ad#inistration7 3ffice of Applied Studies7 <ortality "ata +ro# the "ru! Abuse Warnin! Net)or 7 20017 "AWN Series "-237 "EES Publication No4 BS<AC 03-3IK14 Aoc $ille7 <"7 20024 FDF R"eaths fro# <ariTuana $4 1I +"A-Appro$ed "ru!sR4 ProCon4or!4 200F FDG W4 Eall7 N4 Solo)iT7 RAd$erse effects of cannabisR! /he 1ancet7 (ol 3F27 1D No$ 1LLK4 FDI R<edical #ariTuana9 10 health benefits that le!iti#i5e le!ali5ationR7 "a$e S#ith7 &bti#es4co#7 K Au! 20124 FDK Mochano)s i7 <4W Mata7 <4 B200FC4 R/etrahydrocannabinols in clinical and forensic to>icolo!yR4 P<&"9 1G22F12K FDL "oes <ariTuana Cause CancerQ7 Uann Gu#biner7 Psycholo!y/oday4co#7 1I +eb 20114 FF0 "oes s#o in! cannabis cause cancerQ4 Cancer Aesearch 8M7 20 Sept 20104 FF1 /ash in "47 2ffects of #ariTuana on the lun! and its i##une defenses7 8C1A School of <edicine7 1LLI4 FF2 S/A/2 3+ CA1&+3AN&A 2N(&A3N<2N/A1 PA3/2C/&3N AG2NC67 Che#icals no)n to the state to cause cancer or reproducti$e to>icity7 20 Uul 20124

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the effect of cannabis s#o e alone due to co##on #i>in! of cannabis and tobacco and fre;uent tobacco use by cannabis usersW lo) rate of addiction co#pared to tobaccoW and episodic nature of cannabis use co#pared to steady fre;uent s#o in! of tobacco4 FF3 /he re$ie) has been critici5ed by "a$id Nutt4 FFD &n contrast to the 0ritish 1un! +oundation report7 a lar!e 200G study found no lun! cancer lin to acannabisb7 e$en in hea$y s#o ers7 )hen adTustin! for se$eral confounders includin! ci!arette s#o in! and alcohol use4 FFF /here are no confir#ed published cases of hu#an deaths fro# cannabis poisonin!7 and the dose of /EC re;uired to produce F0\ #ortality in rodents is e>tre#ely hi!h )hen co#pared )ith other co##only used dru!s4 FFG "2A Chief Ad#inistrati$e 1a) Uud!e7 +rancis 6oun!7 in response to a petition to reschedule cannabis under federal la) concluded in 1LKK that7 O&n strict #edical ter#s cannabis is far safer than #any foods )e co##only consu#e4444 cannabis in its natural for# is one of the safest therapeutically acti$e substances no)n to #an4 0y any #easure of rational analysis cannabis can be safely used )ithin the super$ised routine of #edical care4P
FFI

<ore than a decade later7 the &nstitute of <edicine in$esti!ators considered the physiolo!ical ris s of usin! cannabis and concluded that Ocannabis is not a co#pletely beni!n substance4 &t is a po)erful dru! )ith a $ariety of effects4 Eo)e$er7 e>cept for the har#s associated )ith s#o in!7 the ad$erse effects of cannabis use are )ithin the ran!e of effects tolerated for other #edications4P
FFK

FF3 FFD

O/he i#pact of cannabis on your lun!sP7 0ritish 1un! Association7 20124 RS#o e )ithout fireQ Scare#on!erin! by the 0ritish 1un! +oundation o$er cannabis $s tobaccoP7 "a$id Nutt=s 0lo!9 2$idence not e>a!!eration B2012-0G-11C4 9 2$idence not 2>a!!erationR FFF Eashibe7 <4W <or!enstern7 E4W Cui7 64W /ash in7 "4 P4W dhan!7 d4 -+4W Co5en7 W4W <ac 7 /4 <4W Greenland7 S4 B200GC4 R<ariTuana 8se and the Ais of 1un! and 8pper Aerodi!esti$e /ract Cancers9 Aesults of a Population-0ased Case-Control StudyR7 P<&"9 1I03F3KL4 FFG W4 Eall7 N4 Solo)iT B1D No$e#ber 1LLKC4 RAd$erse effects of cannabisR4 =ancet 3F2 FFI 2F 6ears A!o9 "2A?s 3)n Ad#inistrati$e 1a) Uud!e Auled Cannabis Should 0e Aeclassified 8nder +ederal 1a)7 N3A<14or!7 F Sept 20134 FFK Abra#s7 (i5oso7 etc47 O(apori5ation as a S#o eless Cannabis "eli$ery Syste#9 A Pilot StudyP P<&"9 1ID2L3F0

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A cannabis s#o in! and lun! cancer ris

fro# pooled analysis in the &nternational 1un! Cancer

Consortiu#7 included data fro# si> case-control studies conducted fro# 1LLL to 2012 in the 8nited States7 Canada7 the 8nited Min!do#7 and Ne) dealand7 )ith a subTect pool of 271FL lun! cancer cases and 27LKF controls4 All of the studies )ere part of the &nternational 1un! Cancer Consortiu# B&1CC3C7 an international !roup of lun! cancer researchers )ith the ai# of sharin! co#parable data fro# on!oin! and recently co#pleted lun! cancer studies fro# different !eo!raphical areas and ethnicities4 "r4 dhan! of the 8ni$ersity of California7 1os An!eles7 perfor#ed t)o analyses4 3ne co#pared all lun! cancer cases and all controls7 re!ardless of concurrent or past tobacco use4 /hen7 to reduce confoundin! by tobacco7 she restricted the analysis to those )ho had ne$er s#o ed tobacco4

@When co"pared with cannabis s"okers who also used tobacco! habitual pot s"okers had no significant increase in cancer risk. ?n an analysis of "ari.uana s"okers that e$cluded tobacco s"okers! there were no significant differences in any of the co"parisons! including habitual )s. non-habitual useK nu"ber of .oints s"oked per dayK duration of up to %7 years or duration of "ore than %7 years.C FFL

FFL

1i Aita dhan!7 duo-+en! dhan!7 Eal <or!enstern7 Shen-Chih Chan!7 Philip 1a5arus7 <4 "a)n /eare7 Penella U4 Woll7 &rene 3rlo)7 0rian Co>7 Geoffrey 1iu7 AayTean U4 Eun!4 Cannabis s#o in! and lun! cancer ris 9 pooled analysis in the &nternational 1un! Cancer Consortiu#47 A#erican Association for Cancer Aesearch7 20134

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&arm S ale

Higure %' - A su""ary of the results fro" 4rofessor Fa)id NuttGs %717 paper in 6he =ancet

<ost people )ould a!ree that so#e dru!s are )orse than others9 heroin is probably considered to be #ore dan!erous than cannabis7 for instance4 0ecause !o$ern#ents for#ulate cri#inal and social policies based upon classifications of har#7 a ne) study published by the =ancetFG0 #a es for interestin! readin!4 Aesearchers led by Professor "a$id Nutt7 a for#er chief dru!s ad$iser to the 0ritish !o$ern#ent7 as ed dru!-har# e>perts to ran 20 dru!s Ble!al and ille!alC on 1G #easures of har# to the user and to )ider society7 such as da#a!e to health7 dru! dependency7 econo#ic costs and cri#e4 Alcohol is the #ost har#ful dru! in 0ritain7 scorin! I2 out of a possible 1007 far #ore da#a!in! than heroin or crac cocaine4 &t is the #ost har#ful to others by a )ide #ar!in7 and is ran ed fourth behind heroin7 crac 7 and #etha#pheta#ine Bcrystal #ethC for har# to the indi$idual4 /he authors point out that the #odel?s )ei!htin!s7 thou!h based on Tud!#ent7 )ere analysed and found to be stable as lar!e chan!es )ould be needed to chan!e the o$erall ran in!s4
FG0

Nutt "4U47 Min! 14A47 Phillips 14"47 O"ru! har#s in the 8M9 A #ulticriteria decision analysisP! B2010C 6he =ancet7 3IG BLIF2C 7 pp4 1FFK-1FGF4

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-edi al ethi s in South Afri a
<edical ethics is a syste# of #oral principles that apply $alues and Tud!e#ents to the practice of #edicine4 /he practice of #edicine is #onitored and re!ulated so that patients are treated accordin! to a certain standard4

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"ifferent #edical ethics are applied all o$er the )orld4 /he ethics #ay differ bet)een the Western #edical )orld and its 2astern counterpart7 and also bet)een the $arious countries4 /he $alues that co##only apply to #edical ethics in South Africa include9 ; ; ; ; Autono"yL the patient has the right to refuse or choose their treat"ent. 9eneficenceL a practitioner should act in the best interest of the patient. Non"aleficenceL @first! do no har"C. 1usticeL concerns the distribution of scarce health resources! and the decision of who gets what treat"ent. ; FignityL the patient (and the person treating the patient) has the right to hu"an dignity! as enshrined in the Hinal Constitution. ; 6ruthfulness and honestyL the concept of infor"ed consent has increased in i"portance since "a.or historical e)ents that played a "a.or role. /he Eealth Professions Council of South Africa BEPCSAC is the !o$ernin! body )hich sets out the #edical ethics in South Africa7 to )hich each and e$ery healthcare practitioner #ust adhere to4 /he EPCSA )as founded for public protection and professional !uidance4 &t is a statutory body7 established in ter#s of the Eealth Professions Act4 /he EPCSA7 to!ether )ith the t)el$e professional 0oards that operate under its Turisdiction7 is co##itted to9 ; ; ; 4ro"oting the health of South AfricaRs population. Setting and "aintaining fair standards of professional practice. Feter"ining standards of professional education and training.

/he EPCSA #ay establish disciplinary co##ittees:professional conduct co##ittees to )hich it )ill dele!ate the po)er to institute an in;uiry into any co#plaint4 FG1

FG1

O<edical 2thics South AfricaP7 Adele $an der Walt <edical 1a) and Attorneys &nc4

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$ase prin iples of the medi al pra ti e
&t is stated in the second chapter of the National Eealth Act7 that (1) <)ery health care pro)ider "ust infor" a user ofK (a) the userRs health status e$cept in circu"stances where there is substantial e)idence that the disclosure of the userRs health status would be contrary to the best interests of the userK (b) the range of diagnostic procedures and treat"ent options generally a)ailable to the userK (c) the benefits! risks! costs and conse:uences generally associated with each optionK and (d) the userRs right to refuse health ser)ices and e$plain the i"plications! risks! obligations of such refusal.

(%) 6he health care pro)ider concerned "ust! where possible! infor" the user as conte"plated in subsection (1) in a language that the user understands and in a "anner which takes into account the userRs le)el of literacy.P FG2 /he debate concernin! cannabis= therapeutic $alue spans a $ast spectru#7 and as such one #ust ta e into account that certain health care practitioners ha$e considered the le!iti#acy of such clai#s4 As a result of le!al circu#stance7 ho)e$er7 health care practitioners ha$e e>hibited the tendency to infor# patients that cannabis is not a $iable therapeutic option4 &t could possibly be due to interpreti$e proble#s4 +or e>a#ple7 the ter# J!enerally a$ailable= could solicit further debate as to )hether this includes ille!ally obtained substances as )ell4

FG2

Section G of the National Eealth Act G1 of 20034

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0"'SSA%Y
OAbuseP refers to the e>cessi$e or har#ful use of a substance i#pactin! indi$iduals and their fa#ilies socially7 #edically7 le!ally4 A $ery subTecti$e ter#4 Patterns of substance use ne!ati$ely affectin! indi$iduals7 their fa#ily #e#bers and the co##unity as a )hole4 athe opposite of responsible consu#ptionb OA,ASAP Anti-"ru! Alliance South Africa OAddi tionP refers to the fact or condition of bein! addicted to a particular substance7 thin!7 or acti$ity4 OA,P Al5hei#erʹs "isease OAN!!P African Natural +ibre +oru# OA"SP A#yotrophic 1ateral Sclerosis GAnandamideH Ananda#ide Bor arachidonyl-ethanola#ideC is an endocannabinoid or endo!enous li!and to the cannabinoid receptor4 &t )as the first to be disco$ered7 in 1LL24 OA%CP A!ricultural Aesearch Council O$%+CSP 0ra5il7 Aussia7 &ndia7 China and South Africa OCannabisP refers to any na#e7 )ord or description of any portion of the Cannabis sati$a 14 plant4 GCannabis Sativa "4P refers to O"a!!aP O"a haP O<ariTuanaP ONtsan!uP O8#yaP O<ate )aneP O<banTiP O#bhan5heP O0han!P O0an!ueP OGanTaP OEoley EerbsP OEe#pP ONsan!uP OSan!uP OPatseP O"achahP ONtun5i )e N u uP OCannabinoidsP /he ter# RcannabinoidR has different #eanin!s4 &n a #ore narro) sense7 it desi!nates the natural cannabinoids of the cannabis plant4 &n the broadest sense7 it includes all che#icals that bind to the cannabinoid receptors and related co#pounds4 /he endo!enous li!ands of the cannabinoid receptors ha$e been ter#ed endocannabinoids4 GCannabinoid %e eptorsH Se$eral cells in the brain and other or!ans contain specific protein receptors that reco!ni5e /EC and so#e other cannabinoids and tri!!er cell responses4 /here are at least t)o cannabinoid receptor types7 C01 receptors7 and C02 receptors4 C01 receptors are found in hi!h concentrations )ithin the brain and spinal cord4 OC*C,P Clinical 2ndocannabinoid "eficiency GCoolieH refers to indentured &ndian labour brou!ht to the Natal colony fro# &ndia4 2ffecti$ely property of the colony4 OC,P Crohn?s "isease OC,AP Central "ru! Authority OCannabis?derived produ tsP refer to products deri$ed fro# Cannabis7 that ha$e been processed to the point of it not bein! identifiable as any specific part of the plant any#ore4 OCNSP Central Ner$ous Syste# OCS+%P Council for Scientific and &ndustrial Aesearch O,$SAP /he "e$elop#ent 0an of Southern Africa O,A!!P "epart#ent of A!riculture +orestries and +isheries O,ependen eP - "ependence9 #odification of the ner$ous Bphysical dependenceC or e#otional syste# Bpsycholo!ical dependenceC resultin! fro# the reduction of use follo)in! continued and repeated use4 BSenate report discussion #ay 2002C areference laterb O,e riminalisationP refers to the re#o$al of certain cri#inal beha$ior7 )hether by act or o#ission7 fro# the cri#inal Tustice syste#4 /his can be separated into t)o cate!ories7 na#ely7 de .ure decri"inalisation that entails the re#o$al or a#end#ent of cri#inal le!islation and7 de facto decri"inalisation )here the beha$ior re#ains cri#inal but isn=t prosecuted4 &t #ust be ept in #ind that non-cri#inal le!islation can still re!ulate said beha$ior4 O,ru3P refers to any substance that alters bodily function4 /his ter# includes both licit and illicit dru!s7 unless other)ise indicated4a2b BSenate report >iiC O,S,P "epart#ent of Social "e$elop#ent O,T+P "epart#ent of /rade and &ndustry O*,P 2cono#ic "e$elop#ent "epart#ent G*ndo3enousH Produced by the body7 not deli$ered fro# e>ternal sources4 /he endo!enous cannabinoids are called endocannabinoids4 O0+P Gastrointestinal O0N!!P Global Natural +ibre +oru# O&armP physical inTury7 esp4 that )hich is deliberately inflicted4 O&arm %edu tionP Ear# reduction Bor har# #ini#i5ationC is a ran!e of public health policies desi!ned to reduce the har#ful conse;uences associated )ith $arious7 so#eti#es ille!al7 hu#an beha$iors

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O&,P Euntin!tonʹs "isease O+ndustrial CannabisP Cannabis !ro)n for it=s use in the production of an econo#ic !ood or ser$ice )ithin an econo#y4 Not fit for hu#an consu#ption7 fit for ani#al consu#ption4 G&ashishH Eashish is an Arabic na#e for cannabis resin or co#pressed resin !lands4 G&empH Cannabis sati$a 14 !ro)n in 2urope and Canada4 North of D0 N and potentially South of D0 S4 O<afirP refers collecti$ely to nati$es )ho )ere not included in the San or Mhoi-Mhoi tribes4 "ue to its de$elop#ent alon!side colonial7 and subse;uently apartheid !o$ern#ent7 it is currently seen as infla##atory speech4 /he colonial use of the )ord )as used to describe all blac people nati$e to Africa4 O+NC$P &nternational Narcotics Control 0oard O"e3alisationP refers to the act of #a in! la)ful G"i3andH A li!and binds to a specific receptor4 /he li!ands of the cannabinoid receptor are called cannabinoids4 /he endo!enous li!ands of the cannabinoid receptor are called endocannabinoids4 G-edi inal annabisH /his refers to cannabis that is reco##ended by a physician to be used by a patient for #edical purposes4 O-ortalit5P 14the state of bein! subTect to death 24 death7 esp4 on a lar!e scale O-%SAP <ethicillinNresistant Staphylococcus aureus B<ASAC O-SP <ultiple sclerosis OP*ST*"P Political7 econo#ic7 social7 technolo!ical7 en$iron#ental and le!islati$e7 scan4 OProhibitive pra ti eP is a ter# that is used to describe 8N and State policies ai#in! for a dru!-free society4 OPhenot5peP refers to the set of obser$able characteristics of an indi$idual resultin! fro# the interaction of its !enotype )ith the en$iron#ent44 ON*PA,P /he Ne) Partnership for Africa?s "e$elop#ent ON&!P National Ee#p +oundation O%e3ulationP refers to a syste# of control that specifies conditions under )hich culti$ation7 production7 retail7 traffic in!7 possession and use of Cannabis is per#itted4aDb G%e3ulator5 !rame@orkH - Aules created by !o$ern#ent to i#ple#ent policy rules O%AP - Aheu#atoid arthritis O%++CP Aeport indian i##i!rants co##ission 1KKF-I also no)n as the Wra!! Aeport OSA,CP Southern African "e$elop#ent Co##unity OSAPSP South African Police Ser$ices GT&CH B`L-tetrahydrocannabinolC refers to a principal cannabinoid produced by the Cannabis plant in southern cli#es4 Also no)n as dronabinol as traded in <arinol4 ` L-tetrahydrocannabinol is incorrectly referred to in the C"A report as OdrocannabinolP /EC BtetrahydrocannabinolC usually refers to the naturally e>istin! iso#er of delta-L-/EC7 but also #ay include delta-K-/EC4 OTo4i it5P OCharacteristic of a substance )hich induces into>ication7 i4e47 Jpoisonin!=4 <any substances7 includin! so#e co##on foods7 ha$e so#e le$el of to>icity4 Cannabis presents al#ost no to>icity and cannot lead to an o$erdose4P OTSP /ouretteʹs syndro#e O)NP 8nited Nations O)N',CP 8nited Nations 3ffice on "ru!s and Cri#e O(&'P World Eealth 3r!anisation O(ra33 reportP Aeport indian i##i!rants co##ission 1KKF-I

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,*TA+"*, %*!*%*NC* "+ST
&nternational and 8nited States 3r!ani5ations
Canadian Special Senate Co##ittee on &lle!al "ru!s "r4 "ean 2dell Bsur!eon and nationally syndicated radio hostC +rench <inistry of Eealth Eealth Canada Maiser Per#anente 1y#pho#a +oundation of A#erica /he <ontel Willia#s <S +oundation <ultiple Sclerosis Society BCanadaC /he <ultiple Sclerosis Society B8nited Min!do#C National Acade#y of Sciences &nstitute 3f <edicine B&3<C National Association for Public Eealth Policy National Nurses Society on Addictions Netherlands <inistry of Eealth Ne) 2n!land Uournal of <edicine Ne) South Wales BAustraliaC Parlia#entary Wor in! Party on the 8se of Cannabis for <edical Purposes "r4 Andre) Weil Bnationally reco!ni5ed professor of internal #edicine and founder of the National &nte!rati$e <edicine CouncilC
6able 8

A&"S Action Council A&"S /reat#ent Ne)s A#erican Acade#y of +a#ily Physicians A#erican <edical Student Association A#erican Nurses Association A#erican Pre$enti$e <edical Association A#erican Public Eealth Association A#erican Society of Addiction <edicine Arthritis Aesearch Ca#pai!n B8nited Min!do#C Australian <edical Association BNe) South WalesC 1i#ited Australian National /as +orce on Cannabis 0el!ian <inistry of Eealth 0ritish Eouse of 1ords Select Co##ittee on Science and /echnolo!y 0ritish Eouse of 1ords Select Co##ittee 3n Science and /echnolo!y BSecond AeportC 0ritish <edical Association

Canadian A&"S Society

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Additional A+,S 'r3aniIations
6he following organi0ations are signatories to a Hebruary 1+! 1888 letter to the 5S Fepart"ent of /ealth petitioning the federal go)ern"ent to >"ake "ari.uana legally a)ailable [ to people li)ing with A?FS.>
A&"S Action Council A&"S +oundation of Chica!o A&"S National &nterfaith Net)or BWashin!ton7 "CC A&"S ProTect Ari5ona A&"S ProTect 1os An!eles 0ein! Ali$e9 People )ith E&(:A&"S Action Co##ittee BSan "ie!o7 CAC 0oulder County A&"S ProTect B0oulder7 C3C Colorado A&"S ProTect Center for A&"S Ser$ices B3a land7 CAC Eealth +orce9 Wo#en and <en A!ainst A&"S BNe) 6or 7 N6C 1atino Co##ission on A&"S <obili5ation A!ainst A&"S BSan +rancisco7 CAC <others (oices to 2nd A&"S BNe) 6or 7 N6C National 1atina:o 1esbian7 Gay7 0ise>ual And /rans!ender Association National Nati$e A#erican A&"S Pre$ention Center North)est A&"S +oundation People of Color A!ainst A&"S Net)or BSeattle7 WAC San +rancisco A&"S +oundation Whit#an-Wal er Clinic BWashin!ton7 "CC
6able 17

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'ther &ealth 'r3aniIations
/he follo)in! or!ani5ations are si!natories to a Uune 2001 letter to the 8S "epart#ent of Eealth petitionin! the federal !o$ern#ent to Rallo) people sufferin! fro# serious illnesses s to apply to the federal !o$ern#ent for special per#ission to use #ariTuana to treat their sy#pto#s4R
Addiction /reat#ent Alternati$es A&"S /reat#ent &nitiati$es BAtlanta7 GAC A#erican Public Eealth Association A#erican Pre$enti$e <edical Association 0ay Area Physicians for Eu#an Ai!hts BSan +rancisco7 CAC California 1e!islati$e Council for 3lder A#ericans California Nurses Association California Phar#acists Association 2#brace 1ife BSanta Cru57 CAC Gay and 1esbian <edical Association Ea)aii Nurses Association Eepatitis C Action and Ad$isory Coalition 1ife 2>tension +oundation <aine A&"S Alliance <innesota Nurses Association <ississippi Nurses Association National Association of People )ith A&"S National Association for Public Eealth Policy National Wo#en?s Eealth Net)or Nebras a A&"S ProTect Ne) <e>ico Nurses Association Ne) 6or City A&"S Eousin! Net)or Ne) 6or State Nurses Association 3hio Patient Net)or 3 aloosa A&"S Support and &nfor#ation Ser$ices B+ort Walton7 +1C Physicians for Social Aesponsibility - 3re!on San +rancisco A&"S +oundation (ir!inia Nurses Association Wisconsin Nurses Association
6able 11

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&ealth 'r3aniIations Supportin3 "e3al A -edi al Cannabis

ess to
6able 1%

A+,S A tion Coun il B A&"S Action Council RA&"S Action Council supports the eli#ination of federal restrictions that bar doctors fro# prescribin! #ariTuana for #edical use by indi$iduals )ith E&(:A&"S4 444 A&"S Action Council supports reopenin! the 84S4 Public Eealth Ser$ice?s &n$esti!ational Ne) "ru! Co#passionate Access pro!ra# to pro$ide access to #edical-use #ariTuana for !reater nu#bers of ;ualified patients4
FG3

A+,S Treatment Ne@s B R/he scientific case for #edical a#ariTuanab use eeps !ro)in! stron!er4 +ar #ore dan!erous psychoacti$e dru!s7 li e #orphine7 are successfully allo)ed in #edical use4 So#eho) #ariTuana has beco#e a sy#bolic or political hard line to be #aintained by anti-dru! belie$ers re!ardless of hu#an cost4 /he costs )ill #ount until the public can or!ani5e itself to insist that those )ho ur!ently need this #edicine can obtain and use it le!ally4R FGD Alaska Nurses Asso iation B R/he Alas a Nurses Association supports the passa!e of 0allot <easure uK a)hichb 444 allo)asb patients to use #ariTuana as a #edicine if they ha$e a debilitatin! disease and an authori5ation fro# their doctor4R
FGF

Ameri an A adem5 of !amil5 Ph5si ians B R/he A#erican Acade#y of +a#ily Physicians asupportsb the use of #ariTuana 444 under #edical super$ision and control for specific #edical indications4R FGG Ameri an -edi al Student Asso iation B R/he A#erican <edical Student Association stron!ly ur!es the 8nited States Go$ern#ent 444 to #eet the treat#ent needs of currently ill A#ericans by restorin! the Co#passionate &N" pro!ra# for #edical #ariTuana7 and 444 reschedulain!b #ariTuana to Schedule && of the Controlled Substances Act7 and 444 endain!b the #edical prohibition a!ainst #ariTuana4R FGI

FG3

>#esolution in Support of Access to 3edical-5se 3ari.uana!> adopted by the 4ublic 4olicy Co""ittee of A?FS Action CouncilL No)e"ber 1(! 188* FGD A?FS 6reat"ent News! ^%,+! 1anuary %&! 188, FGF ANA #esolutionL Septe"ber 188, FGG 188*-188+ AAH4 #eference 3anual - Selected 4olicies on /ealth ?ssues FGI A3SA /ouse of Felegates #esolution ^1% L adopted 3arch 188&

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Ameri an Nurses Asso iation B R/he A#erican Nurses Association )ill9 444 Support the ri!ht of patients to ha$e safe access to therapeutic #ariTuana:cannabis under appropriate prescriber super$ision4 penali5ation4 Support the ability of health care pro$iders to discuss and:or reco##end the #edicinal use of #ariTuana )ithout the threat of inti#idation or Support le!islation to re#o$e cri#inal penalties includin! arrest and
FGK

i#prison#ent for bona fide patients and prescribers of therapeutic #ariTuana:cannabis4 R

Ameri an Preventive -edi al Asso iation B R<ariTuana should be a$ailable for appropriate #edicinal purposes7 )hen such use is in accordance )ith state la)7 and that physicians )ho reco##end and prescribe #ariTuana for #edicinal purposes in states )here such use is le!al7 should not be censured7 harassed7 persecuted or other)ise penalised by the federal !o$ern#ent4R FGL Ameri an Publi &ealth Asso iation B Ra/he APEAb encoura!es research of the therapeutic

properties of $arious cannabinoids and co#binations of cannabinoids7 and 444 ur!es the Ad#inistration and Con!ress to #o$e e>peditiously to #a e cannabis a$ailable as a le!al #edicine4R FI0 Ameri an So iet5 of Addi tion -edi ine B RAppro$ed #edical uses for #ariTuana or a/ECb for treat#ent of !lauco#a7 illnesses associated )ith )astin! such as A&"S7 the e#esis associated )ith che#otherapy7 or other uses should be carefully controlled4 /he dru! should be ad#inistered only under the super$ision of a no)led!eable physician4R
FI1

Arthritis %esear h Campai3n 7)nited <in3dom8 B RWe thin people )ho use cannabis to the pain of arthritis should be able to do so4R
FI2

Australian -edi al Asso iation 7NS(8 "imited B R/he A<A BNSWC s encoura!easb the s Carr Go$ern#ent to introduce e>e#ptions to current cannabis la)s7 )hich )ould allo) the use of the currently prohibited dru!7 in specific #edical cases to alle$iate patient sufferin! and facilitate research4R FI3

FGK FGL

ANA #esolutionL 1une %77& >3edicinal 5se of 3ari.uana> policy state"entL Fece"ber ,! 188+ FI0 #esolution ^8(1&L >Access to 6herapeutic 3ari.uanaSCannabisL> adopted No)e"ber 188( FI1 ASA3 >State"ent on 3ari.uana!> passed by ASA3 9oard of FirectorsL April 1*! 188+ FI2 A#C State"ent to 99C NewsL Ectober %&! %771 FI3 4ress release (>New Cannabis <$e"ption =aws Needed for 3edical 5se>) of the A3A (NSW) =i"itedL Septe"ber &7! 1888

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Australian National Task !or e on Cannabis B R"espite the positi$e appraisal of the therapeutic potential of cannabinoids 4447 they ha$e not been )idely used4 444 Part of the reason for this is that research on the therapeutic use of these co#pounds has beco#e a casualty of the debate in the 8nited States about the le!al status of cannabis4 444 As a co##unity )e do not allo) this type of thin in! to deny the use of opiates for anal!esia4 Nor should it be used to deny access to any therapeutic uses of cannabinoid deri$ati$es that #ay be re$ealed by phar#acolo!ical research4R
FID

$ein3 Alive B R0ein! Ali$e has al)ays supported a person?s ri!ht to choose their o)n treat#ent #odalities includin! 444 efforts to le!ali5e #edical #ariTuana4R
FIF

$el3ian -inistr5 of &ealth B RaAbesearch has sho)n that cannabis can be of #edicinal use4 444 /his is an area )here public health #ust pre$ail4R
FIG

$ritish &ouse of "ords Sele t Committee on S ien e and Te hnolo35 B RCannabis can be effecti$e in so#e patients to relie$e the sy#pto#s of <S7 and a!ainst certain for#s of pain4 /his e$idence is enou!h to Tustify a chan!e in the la)4 s /he Go$ern#ent should allo) doctors to prescribe cannabis for #edical use9 this is the conclusion of a report by the Eouse of 1ords Science and /echnolo!y Co##ittee7 published today4R
FII

$ritish &ouse of "ords Sele t Committee on S ien e and Te hnolo35 7Se ond %eport8 B RWe are concerned that the <CA a<edicines Control A!encyb approach to the licensin! of cannabis-based #edicines s place the re;uire#ents of safety and the needs of patients in an unacceptable balance4 s Patients )ith se$ere conditions such as #ultiple sclerosis are bein! denied the ri!ht to #a e infor#ed choices about their #edication4 /here is al)ays so#e ris in ta in! any #edication7 s but these concerns should not pre$ent the# fro# ha$in! access to )hat pro#ises to be the only effecti$e #edication a$ailable to the#4R
FIK

$ritish -edi al Asso iation B RPresent e$idence indicates that acannabinoidsb are re#ar ably safe dru!s7 )ith a side-effects profile superior to #any dru!s used for the sa#e indications4 444 a/he 0<Ab )ill ur!e the !o$ern#ent to consider chan!in! the <isuse of "ru!s Act to allo) the prescription of cannabinoids to patients )ith certain conditions causin! distress that are not ade;uately controlled by e>istin! treat#ents4R
FID FIF FIL

>6he health and psychological conse:uences of cannabis useL> 3arch 188' letter fro" <$ecuti)e Firector Gary Costas (1anuary &! 188*) FIG State"ent of the /ealth 3inistry! as :uoted in <$patica.co" (9russels)! Septe"ber '! %77&. FII 4ress release (>=ords SayL =egalise Cannabis for 3edical 5se>) of the /ouse of =ordsL No)e"ber 11! 188,. FIK Select Co""ittee on Science and 6echnology! Second #eportL >6herapeutic 5ses of CannabisL> 3arch 1'! %771.

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

California A adem5 of !amil5 Ph5si ians B Ra/he CA+Pb supports efforts to e>pedite access to cannabinoids for use under the direction of a physician4R
FK0

California Nurses Asso iation B R/he California Nurses Association supports A0 BAsse#bly 0illC 1F2L )hich )ould eli#inate California?s prohibition a!ainst possessin! #ariTuana or !ro)in! #ariTuana for indi$iduals usin! #ariTuana for #edical purposes4 444 /his #easure is a co#passionate alternati$e for patients 444 to obtain relief4R
FK1

California Pharma ists Asso iation B Ra/he CPAb support phar#acy participation in the le!al distribution of #edical #ariTuana4R
FK2

Canadian A+,S So iet5 7So iete anadienne du sida8 B R/he Canadian A&"S Society?s 0oard of "irectors belie$es that people li$in! )ith E&(:A&"S should ha$e access to cannabis for therapeutic purposes in the treat#ent of E&(:A&"S throu!h a co#passionate fra#e)or 4 444 aWeb fa$or a controlled le!ali5ation syste# for cannabis in Canada7 )here the production7 distribution and consu#ption are re!ulated7 desi!nated cannabis distribution centres are established and reco!ni5ed7 and appropriate pre$ention #essa!es and har# reduction strate!ies are de$eloped4R FK3 Canadian Spe ial Senate Committee on +lle3al ,ru3s B R/he Co##ittee is of the opinion that the potential therapeutic uses of #ariTuana ha$e been sufficiently docu#ented to per#it its use for therapeutic purposes4R FKD

Colorado Nurses Asso iation B R/he Colorado Nurses Association reco!ni5easb the therapeutic use of cannabis aandb support efforts to end federal policies )hich prohibit or unnecessarily restrict #ariTuana?s le!al a$ailability for le!iti#ate health care uses4 444 <ariTuana #ust be placed in a less restricti$e Schedule and #ade a$ailable to patients )ho #ay benefit fro# its use4R FKF Conne ti ut Nurses Asso iation B RaPbatients ashouldb ha$e safe access to therapeutic #ariTuana:cannabis under appropriate prescriber super$ision4R
FIL FK0 FKG

93A reportL >6herapeutic 5ses of CannabisL> No)e"ber 188+ position state"ent adopted by the Acade"yGs Congress of FelegatesL Hebruary 188' FK1 letter fro" CNA 4resident Ourt =au"ann! #N! to Go). 4ete Wilson (Septe"ber %1! 188() FK2 A4 Hinancial News article! 3ay %*! 188+ FK3 position state"ent adopted by the CASG 9oard of FirectorsL 3ay %7! %77' FKD >CannabisL Eur 4osition for a Canadian 4ublic 4olicyL #eport of the Senate Special Co""ittee on ?llegal Frugs!> presented to 4arlia"ent Septe"ber %77% FKF Colorado Nurses Association 188( Con)entional Firectory and 9ook of #eports

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

,ean *dellD -C,C B RCannabinoids and /EC also ha$e stron! pain- illin! po)ers7 )hich is one reason #edical #ariTuana should be readily a$ailable to people )ith cancer and other debilitatin! diseases4R FKI !ederation of Ameri an S ientists B R0ased on #uch e$idence7 fro# patients and doctors ali e7 on the superior effecti$eness and safety of )hole cannabis co#pared to other #edications7 s the President should instruct the N&E and the +ood and "ru! Ad#inistration to #a e efforts to enroll seriously ill patients )hose physicians belie$e that )hole cannabis )ould be helpful to their conditions in clinical trials7 both to allo) data-!atherin! and to pro$ide an alternati$e to the blac #ar et )hile the scientific ;uestions about the possible utility of cannabis are resol$ed4R FKK !lorida 0overnorJs %ed %ibbon Panel on A+,S B RAeco##endations for care9 /he state should facilitate !reater access to dru! therapies for treat#ent as )ell as pre$enti$e therapy4 /his should include access to #ariTuana )hen #edically indicated4R
FKL

!lorida -edi al Asso iation B R/he +<A ur!e the state and federal !o$ern#ents and 84S4 Public Eealth Ser$ice to open li#ited access to #edical #ariTuana by reopenin! the in$esti!ational ne) dru! pro!ra# to ne) applicants4R
FL0

!ren h -inistr5 of &ealth B R3b$iously7 it should be possible to prescribe acannabis4b +or a doctor7 that could be a real benefit4R FL1 &a@aii Nurses Asso iation B Ra/he ENAb support le!islation to re#o$e state le$el cri#inal penalties for both bona fide #edical #ariTuana patients and their healthcare pro$iders4R
FL2

&ealth Canada B R/here is no proble#7 basically7 )ith #ariTuana as a #edicine4 444 <ariTuana is no different than #orphine7 no different than codeine7 no different than Aspirin4R v /he Canadian !o$ern#ent le!ali5ed the use of #edical #ariTuana on Uuly 317 20014
FL3

FKG FKI

CNA #esolutionL Ectober %77' state"ent of Fean <dellL 3arch %! %777 FKK HAS 4etition on 3edical 3ari.uana! No)e"ber 188' FKL Hlorida Go)ernorGs #eportL 1anuary 188& FL0 H3A #esolution ^8+-*1L adopted 1une 188+ FL1 state"ents of Hrench /ealth 3inister 9ernard OouchnerL ?ndependent on Sunday! Fece"ber +! 188+ FL2 /NA #esolutionL adopted Ectober %1! 1888. FL3 state"ents of /ealth Canada spokes"an Fann 3icholsL Ettawa Citi0en! Fece"ber 18! 188+

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

+llinois Nurses Asso iation B R&t is the position of the &llinois Nurses Association to9 Support the ri!ht of patients to ha$e safe access to therapeutic cannabis under appropriate prescriber super$isionW 444 atob support le!islation to re#o$e cri#inal penalties includin! arrest and i#prison#ent for bonafide patients and prescribers of therapeutic cannabisW aand tob support federal and state le!islation to include cannabis classification as a Schedule &&& anon-prohibitedb dru!4R FLD <aiser Permanente B R<edical !uidelines re!ardin! a#ariTuana?sb prudent use should be established444 8nfortunately7 clinical research on potential therapeutic uses for #ariTuana has been difficult to acco#plish in the 8nited States7 despite reasonable e$idence for the efficacy of tetrahydrocannabinol B/ECC and #ariTuana as anti-e#etic and anti-!lauco#a a!ents and the su!!esti$e e$idence for their efficacy in the treat#ent of other #edical conditions7 includin! A&"S4R FLF "5mphoma !oundation of Ameri a B R0e it resol$ed that this or!ani5ation ur!es Con!ress and the President to enact le!islation to reschedule #ariTuana to allo) doctors to prescribe s#o able #ariTuana to patients in needW and7 0e it further resol$ed that this or!ani5ation ur!es the 8S Public Eealth Ser$ice to allo) li#ited access to #edicinal #ariTuana by pro#ptly reopenin! the &n$esti!ational Ne) "ru! co#passionate access pro!ra# to ne) applicants4R FLG -edi al So iet5 of the State of Ne@ York B RAsse#bly 0ill FILGA 444 )ould allo) certain patients 444 to use #ariTuana to treat a serious condition that is defined as a life-threatenin! condition or a condition associated )ith or a co#plication of such a condition or its treat#ent4 444 /he <edical Society belie$es that this le!islation )ould pro$ide physicians7 in consultation )ith their patient7 another treat#ent option for those patients )ho are facin! a life-threatenin! condition4R FLI -ississippi Nurses Asso iation B R/he <ississippi Nurses Association support all reasonable efforts to end federal policies )hich prohibit or unnecessarily restrict #ariTuana?s le!al a$ailability for le!iti#ate #edical usesW and be it Aesol$ed that the <ississippi Nurses Association pro$ide education to the nurses of <ississippi about the therapeutic use of #ariTuana and federal prohibition of its useW and be it Aesol$ed that the (ir!inia Nurses Association encoura!e other health care pro$ider or!ani5ations to support #edical access to #ariTuana4R FLK
FLD FLF

?NA 4osition State"entL Fece"ber %77' Oaiser 4er"anente studyL >3ari.uana 5se and 3ortality!> A"erican 1ournal of 4ublic /ealth! April 188+ FLG #esolution appro)ed by =y"pho"a Houndation 4resident 9elita CowanL 1anuary %7! 188+. FLI 3SSN_ e-newsL 3ay +! %77'

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

The -ontel (illiams -S !oundation B R<ariTuana has helped #y sy#pto#s so #uch that & ha$e beco#e an ad$ocate for the le!ali5ation of #edical #ariTuana for ;ualified patients li e #e -- those sufferin! fro# debilitatin! and:or de$astatin!ly painful diseases4 444 0ecause & do not condone brea in! any la)7 & )ould li e to see all F0 states and the federal !o$ern#ent decri#inali5e #edical #ariTuana4 & )ould also li e to see #ore research into its effects on <S -- for the treat#ent of pain and spasticity4R
FLL

-ultiple S lerosis So iet5 7Canada8 B R/he <S Society of Canada )elco#es Eealth Canadaws initiati$e pro$idin! a #ore co#passionate syste# of possession and production for indi$iduals )ho feel they #ay benefit fro# the use of #ariTuana for #edical purposes4R
G00

The -ultiple S lerosis So iet5 7)nited <in3dom8 B RPeople )ith <S ha$e clai#ed that a#ariTuanab has helped the# to relie$e a nu#ber of the sy#pto#s of <S includin! pain7 stiffness and bladder proble#s4 444 We ur!e the courts to deal sy#pathetically )ith people )ith <S )ho are char!ed )ith cannabis use )hen see in! relief fro# their sy#pto#s4R
G01

National A adem5 of S ien es +nstitute of -edi ine 7+'-8 B RScientific data indicate the potential therapeutic $alue of cannabinoid dru!s7 pri#arily /EC7 for pain relief7 control of nausea and $o#itin!7 and appetite sti#ulation4 s +or certain patients7 such as the ter#inally ill or those )ith debilitatin! sy#pto#s7 the lon!-ter# ris s aassociated )ith s#o in!b are not of !reat concern4 s a/herefore7b clinical trials of #ariTuana for #edical purposes should be conducted4 s /here are patients )ith debilitatin! sy#pto#s for )ho# s#o ed #ariTuana #i!ht pro$ide relief4 s 2>cept for the har#s associated )ith s#o in!7 the ad$erse effects of #ariTuana use are )ithin the ran!e of effects tolerated for other #edications4R
G02

National Asso iation for Publi &ealth Poli 5 B RWe s reco##end the follo)in! s actions9 /he federal !o$ern#ent should re-classify #ariTuana s out of the Schedule 1 cate!ory and allo) their prescription )here #edically appropriate4R
G03

FLK FLL

#esolution for 3ari.uana Access for 6herapeutic 5se! adopted by the 3NA /ouse of FelegatesL Ectober %+! 188( 4ress release (>6aking ActionL 3ontel on 3edical 3ari.uana P 3S 6reat"ent>) of the 3ontel Willia"s 3S Houndation. G00 3S Society Jiewpoint! 1uly %771. G01 4olicy state"entL >5se of cannabis for alle)iation of 3S sy"pto"s!> adopted August %77& G02 >3ari.uana as 3edicineL Assessing the Science 9ase!> National Acade"y 4ressL Washington! FC. 1888 G03 4osition paper adopted by the National Association for 4ublic /ealth 4olicyL No)e"ber 1(! 188,.

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

National Nurses So iet5 on Addi tion * R/he National Nurses Society on Addictions ur!es the federal !o$ern#ent to re#o$e #ariTuana fro# the Schedule & cate!ory i##ediately7 and #a e it a$ailable for physicians to prescribe4 NNSA ur!es the A#erican Nurses? Association and other health care professional or!ani5ations to support patient access to this #edicine4R G0D Netherlands -inistr5 of &ealthK B RCannabis has a beneficial effect for #any patients4 prescription fro# a doctor4R G0F v /he "utch !o$ern#ent #ade #ariTuana a$ailable by prescription on Septe#ber 17 20034 Ne@ *n3land Lournal of -edi ine B R+ederal authorities should rescind their prohibition of the #edical use of #ariTuana for seriously ill patients and allo) physicians to decide )hich patients to treat4 /he !o$ern#ent should chan!e #ariTuana?s status fro# that of a Schedule & dru! 444 to that of a Schedule && dru! 444 and re!ulate it accordin!ly4R
G0G

+ro#

Septe#ber 17 2003 phar#acies can pro$ide #edicinal cannabis to patients )ith a

Ne@ Lerse5 State Nurses Asso iation B R/he NUSNA reco!ni5es the therapeutic $alue and safety of #edically reco##ended #ariTuana and 444 supports le!al access to #edically reco##ended #ariTuana for patients in Ne) Uersey )ho are under the care of a licensed health care pro$ider4R G0I Ne@ -e4i o -edi al So iet5 B O/he Ne) <e>ico <edical Society 444 supports the #edical use of #ariTuana for patients sufferin! fro# cancer7 A&"S7 and other serious or ter#inal conditions4P G0K

Ne@ -e4i o Nurses Asso iation B RN<NA has $oted to endorse the concept of allo)in! the therapeutic use of #ariTuana in a $ariety of disease states 444 )hen con$entional treat#ents are ineffecti$e4R G0L

G0D G0F

>4osition 4aperL Access to 6herapeutic Cannabis!> appro)ed by the NNSA 9oard of FirectorsL 3ay 1! 188( State"ent of the /ealth 3inistry! as :uoted by #euters News Wire! Septe"ber 1! %77&. G0G <ditorial by N<13 editor Fr. 1ero"e Oassirer! 1anuary &7! 188+ G0I New 1ersey State Nurses Association 4ress #elease (3arch %(! %77%) G0K =etter fro" Society 4resident Allan /aynes (1anuary %1! %77%) G0L =etter fro" N3NA 4resident Ginny Guido (1uly %,! 188+)

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Ne@ South (ales 7Australia8 Parliamentar5 (orkin3 Part5 on the use of Cannabis for -edi al Purposes B R/he Wor in! Party is in sy#pathy )ith the #oti$ation and spirit of the reco##endations in the &nstitute of <edicine and Eouse of 1ords reports4 Accordin!ly7 it reco##ends the introduction in NSW of a co#passionate re!i#e to assist those sufferin! fro# aab ran!e of illnesses s to !ain the benefits associated )ith the use of cannabis )ithout facin! cri#inal sanctions7 pendin! the de$elop#ent of safer and #ore efficient #ethods to deli$er cannabinoids4R
G10

Ne@ York Count5 -edi al So iet5 B R/he definiti$e re$ie) of scientific studies 444 found #edical benefits related to pain relief7 control of nausea and $o#itin!7 and appetite sti#ulation4 444 While there are a $ariety of )ays of supplyin! #ariTuana for #edical use7 serious consideration should be !i$en to the 1LLI reco##endation 444 that the +"A reclassify #ariTuana fro# Schedule & and pro$ide a consistent7 safe supply4R
G11

Ne@ York State Nurses Asso iation B R<ariTuana has been found to be effecti$e in the treat#ent of !lauco#a by reducin! intraocular pressure and in reducin! nausea and $o#itin! caused by che#otherapy4 <ariTuana has also been effecti$e in sti#ulatin! the appetite of A&"S patients sufferin! fro# the )astin! syndro#e7 controllin! spasticity in spinal cord inTury patients7 and in controllin! sei5ures for persons sufferin! fro# epilepsy and for persons )ith #ultiple sclerosis4 444/he N6SNA Peer Assistance Co##ittee a!rees )ith the intent and content of the resolution ?1e!ali5in! <ariTuana for <edical Purposes4?R
G12

North Carolina Nurses Asso iation B RNCNA ur!es the Ad#inistration and Con!ress to #a e cannabis a$ailable as a le!al #edicine )ere sho)n to be safe and effecti$e and to i##ediately allo) access to therapeutic cannabis throu!h the &n$esti!ational Ne) "ru! Pro!ra#4R
G13

%hode +sland -edi al So iet5 B R/he <edical Society supports E-IFKK7 it is consistent )ith our belief that there is sufficient e$idence for us to support any physician-patient relationship that belie$es the use of #ariTuana )ill be beneficial to the patient4R
G1D

G10

>#eport of the Working 4arty on the 5se of Cannabis for 3edical 4urposes!> <$ecuti)e Su""ary! #eco""endation 8L August %777 G11 testi"ony of Vebulon 6aintor! representing the New _ork County 3edical Society before the New _ork City /ealth Co""itteeL Hebruary %&! %77' G12 >4osition State"ent on 3edicinal 3ari.uana!> passed by the N_SNA 9oard of FirectorsL 1une +! 188( G13 >4osition State"ent on 6herapeutic 5se of Cannabis!> adopted by the NCNAL Ectober 1(! 188* G1D Ste)e Fe6roy! Firector of Go)ern"ent and 4ublic Affairs

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

%hode +sland State Nurses Asso iation B RaWe supportb le!islation to re#o$e cri#inal penalties includin! arrest and i#prison#ent for bona fide patients and prescribers of therapeutic #ariTuana:cannabis4R G1F San !ran is o -a5orJs Summit on A+,S and &+/ B R<ariTuana #ust continue to be a$ailable to persons li$in! )ith A&"S and E&( and other diseases )ho )ish to use it for pain #ana!e#ent7 appetite sti#ulation and other #edicinal purposes4R
G1G

San !ran is o -edi al So iet5 B R/he S+<S ta es a support position on the California <edical <ariTuana &nitiati$e4R G1I /ir3inia Nurses Asso iation B R/he (ir!inia Nurses Association support all reasonable efforts to end federal policies )hich prohibit or unnecessarily restrict #ariTuana?s le!al a$ailability for le!iti#ate #edical usesW and be it Aesol$ed that the (ir!inia Nurses Association pro$ide education to the nurses of (ir!inia on the therapeutic use of #ariTuana and federal prohibition of its useW and be it Aesol$ed that the (ir!inia Nurses Association encoura!e other health care pro$ider or!ani5ations to support #edical access to #ariTuana4R G1K Andre@ (eilD -C,4 * R& consider the #ost i#portant reco##endation #ade by the &3< B&nstitute of <edicineC panel ato beb that physicians be able to prescribe #ariTuana to indi$idual patients )ith debilitatin! or ter#inal conditions4 s & belie$e such co#passionate use is Tustified4R
G1L

/ermont -edi al -ariEuana Stud5 Committee B R/here is #edical $alue in usin! #ariTuana to a#eliorate so#e sy#pto#s associated )ith se$ere illnesses and the treat#ent thereof4 444 <ariTuana is #isclassified as a afederalb Schedule & dru! and should be reclassified to per#it physicians to prescribe and phar#acies to dispense #edical #ariTuana4R (hitman?(alker Clini treat#ent re!i#ens4R
G21 G20

B RWhit#an-Wal er Clinic supports the $alid use of #ariTuana7 under a

physician?s super$ision7 to help alle$iate A&"S )astin! syndro#e and nausea associated )ith

G1F

4ress release (>6wo #hode ?sland 3edical Groups <ndorse 3edical 3ari.uana>) of the 3ari.uana 4olicy 4ro.ectL April *! %77'

G1G G1I

>3ayorGs Su""it on A?FS P /?J!> preli"inary report released 1anuary %+! 188, 3otion passed by SH3S 9oard of FirectorsL August ,! 188* G1K #esolution passed by the JNA Felegate Asse"blyL Ectober +! 188' G1L >Why ? support 3edical 3ari.uana!> in Self /ealing! 1uly 1888. G20 >#eport of the 3edical 3ari.uana Study Co""ittee!> preli"inary report to the Jer"ont General Asse"blyL Fece"ber %77% G21 Whit"an-Walker News! April 188,

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

(is onsin Nurses Asso iation B R/he Wisconsin Nurses Association ur!es the Go$ernor of Wisconsin and the Wisconsin 1e!islature to #o$e e>peditiously to #a e cannabis a$ailable as a le!ally prescribed #edicine )ere sho)n to be safe and effecti$e4R
G22

&ealth 'r3aniIations Supportin3 -edi al MCannabisN %esear h
Ameri an Can er So iet5 B RaCalifornia Senate 0illb F3F focuses on #edical #ariTuana research4 a/heb A#erican Cancer Society 444 supports S404 F3F because it is consistent )ith our lon!-held position of supportin! research of any a!ent or techni;ue for )hich there #ay be e$idence of a therapeutic ad$anta!e4R G23 Ameri an -edi al Asso iation B R/he A<A reco##end that ade;uate and )ell-controlled studies of s#o ed #ariTuana be conducted in patients )ho ha$e serious conditions for )hich preclinical7 anecdotal7 or controlled e$idence su!!ests possible efficacy in includin! A&"S )astin! syndro#e7 se$ere acute or delayed e#esis induced by che#otherapy7 #ultiple sclerosis7 spinal cord inTury7 dystonia7 and neuropathic pain4R
G2D

$ritish -edi al Lournal B R/he role of cannabinoids in #odern therapeutics re#ains uncertain7 but the e$idence s sho)s that it )ould be irrational not to e>plore it4 /he acti$e co#ponents of a plant )hich has been pri5ed as a #edicine for thousands of years should not be discarded li!htly7 and certainly not throu!h political e>pediency or as a casualty of the )ar on dru!s4R G2F California -edi al Asso iation B R/he C<A ur!e that carefully desi!ned7 controlled clinical trials of the effecti$eness of inhaled #ariTuana for #edical indications be allo)ed to proceed i##ediately4 444 /he C<A i##ediately initiate efforts at the federal le$el to facilitate the a$ailability of inhaled #ariTuana for use in conductin! clinical research to deter#ine the #edical efficacy of #ariTuana4R G2G California So iet5 on Addi tion -edi ine 7CSA-8 B RCSA< supports controlled studies of the #edical usefulness of #ariTuana7 includin! all routes of ad#inistration7 and especially supports studies on the therapeutic effects of the essential in!redients 444 of cannabis sati$a4 444 CSA< ur!es the "2A to re#o$e cannabis fro# Schedule & and #o$e it to an appropriate Schedule7 belo) Schedule & as deter#ined by )hat is therapeutic benefit4R
G22 G23 G2I

no)n about its

#esolution adopted by WNAL Ectober %8! 1888 letter fro" ACS to California State Senator 1ohn Jasconcellos (1uly %'! 188+) G2D Council on Scientific Affairs #eport ^17L 3edical 3ari.uana G2F editorial of the 931! April '! 188, G2G C3A #esolution ^17+a-8+L 3edical 3ari.uana L adopted April 188+

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- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

Con3ress of Nursin3 Pra ti e B R/he Con!ress of Nursin! Practice 444 support education for AN?s re!ardin! current e$idence based therapeutic uses of cannabis7 aandb support in$esti!ation of therapeutic efficacy of cannabis in controlled trials4R
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Lamai an National Commission on 0anEa B R/he broad ran!e of potential therapeutic applications of cannabinoids reflects the )ide distribution of cannabinoid receptors throu!hout the brain and other parts of the body4 444 Areas in )hich cannabis has been sho)n to ha$e therapeutic use are9 reducin! nausea and $o#itin!7 sti#ulatin! appetite7 pro#otin! )ei!ht !ain7 di#inishin! hi!h intraocular pressure fro# !lauco#a4 444 /here is undoubtedly need for #uch further research into the potential of the #edicinal use of cannabis and its e>tracts4R G2L 0a5 and "esbian -edi al Asso iation B RaWeb support 444 the authori5ation and i#ple#entation of clinical trials of #ariTuana for $arious aspects of A&"S treat#ent4R
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National +nstitutes of &ealth 7N+&8 (orkshop on the -edi al )tilit5 of -ariEuana B R<ariTuana loo s pro#isin! enou!h to reco##end that there be ne) controlled studies done4 /he indications in )hich $aryin! le$els of interest )as e>pressed are the follo)in!9 appetite sti#ulation:cache>ia7 nausea and $o#itin! follo)in! anticancer therapy7 neurolo!ical and #o$e#ent disorders7 anal!esia7 aandb !lauco#a4 Accordin!ly7 the N&E should consider rele$ant ad#inistrati$e #echanis#s to facilitate !rant applications in each of these areas4 Whether or not the N&E is the pri#ary source of !rant support for a proposed bona fide clinical research study7 if that study #eets 84S4 re!ulatory standards 444 protocol appro$al7 444 the study should recei$e #ariTuana4R
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Te4as -edi al Asso iation B R/he /e>as <edical Association supports B1C the physician?s ri!ht to discuss )ith his:her patients any and all possible treat#ent options related to the patients? health and clinical care7 includin! the use of #ariTuana7 )ithout the threat to the physician or patient of re!ulatory7 disciplinary7 or cri#inal sanctionsW and B2C further )ell-controlled studies of the use of #ariTuana )ith seriously ill patients )ho #ay benefit fro# such alternati$e treat#ent4RG32

G2I G2K

CSA3 >4osition on 3edical 5se of 3ari.uana in California> as it appeared in CSA3 News! Spring 188+ 3otion passed by the CN4L 3ay &1! 188* G2L #eport of the National Co""ission on Gan.a!> presented to 4arlia"ent August +! %771 G30 Gay and =esbian 3edical Association 4olicy State"ent ^7**-8(-17'L adopted 3ay 188( G31 Workshop on the 3edical 5tility of 3ari.uanaL >#eport to the FirectorL> August 188+ G32 #esolution adopted by the 63A Council on Scientific AffairsL April %8! %77'

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20 No$e#ber * 2013 +or Public "istribution , Co##ent

/A012 3+ C3N/2N/S
)))4cannabis4refor#s4co45a

- @SANCWG - Cannabis Position Paper 2013 South African National Cannabis Working Group

/ermont -edi al So iet5 B R(<SR current policy on #edical #ariTuana focuses on the need for additional scientific research7 the need for free and open discussion bet)een physicians and patients and the need to e>ercise caution in $ie) of federal cri#inal penalties for prescribin! #ariTuana or aidin! or abettin! patients to $iolate federal la)4R
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(is onsin State -edi al So iet5 B R/he S<S ur!es the National &nstitutes of Eealth BN&EC to i#ple#ent ad#inistrati$e procedures to facilitate !rant applications and the conduct of )ell-desi!ned clinical research into the #edical utility of #ariTuana4 s/he S<S belie$es that the N&E should use its resources and influence to support the de$elop#ent of a s#o e-free inhaled deli$ery syste# for #ariTuana4R G3D

G33 G3D

J3S =egislati)e 9ulletinL Hebruary 17! %77& S3S 4olicy Co"pendiu" %777-%771 - Alternati)e 3edicine.

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20 No$e#ber * 2013 +or Public "istribution , Co##ent

/A012 3+ C3N/2N/S
)))4cannabis4refor#s4co45a

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