Medical Marijuana - On and On

Form of medical marijuana won't get you high, but it's creating a buzz

By Karl Vick
Washington Post Staff Writer
Tuesday, June 1, 2010; C01

WILLITS, CALIF. -- The one-armed man loitered in the waiting room for much of the morning, flipping through magazines with impressive dexterity, quietly waiting for word that the doctor would see him. Now.

William Courtney, MD, offered the chair to the right of the desk, the one occupied during regular office hours by a steady stream of patients seeking a doctor's recommendation for marijuana. In California, such a recommendation means an adult may grow, buy and smoke marijuana, all while remaining safely within the confines of state law.

The singular peculiarity of Courtney's "pot doc" practice here in Northern California is what he recommends: Don't smoke the stuff, he tells patients. Eat it.

Marijuana, he avers to every person who appears before him, turns out to be brimming with healing compounds. It won't get you high eaten raw, but juiced with a handful of carrots to cut the bitter taste, its leaves and buds may well have restored the health of his girlfriend, who had been given a diagnosis of lupus and a butcher's bill of other disorders that lab tests show have subsided. A local sufferer of Crohn's disease credits the plant with helping reverse the debilitating intestinal disorder. And published research from accredited laboratories suggests promise in preventing diabetes, heart disease, Alzheimer's, cancers and assorted maladies arising from chronic inflammation.

Yet almost no one knows any of this beyond a handful of scientists, including two at the National Institutes of Health who were sufficiently impressed that they joined a Nobel laureate in patenting a cannabis molecule. Courtney hands a copy of their U.S. Patent 6630507 to occupants of the chair, typically midway through a jargon-rich spiel that sometimes hits the patient right in the wheelhouse and sometimes goes whizzing overhead.

"I have no idea what he's talking about," said the auto mechanic who was in the chair a few minutes earlier, seeking relief for a broken vertebra and a bum knee. "Every once in a while he says something comprehensible."

But now, with no appointment and no right arm, someone was way ahead of him. "The last time we talked you said you had a source for the high-CBD material down by San Diego," the one-armed man began. He was dressed like a workingman but used the chemists' shorthand for cannabidiol, the most promising healing molecule, yet in most of the marijuana bought and sold these days, also the most elusive. CBD tends to show up least in plant strains that are richest in THC, the molecule that produces marijuana's high.

Courtney listened to the man, attentive yet guarded, the standard posture of a licensed medical practitioner operating on the far edge of the frontier where law, medicine and cannabis meet. It is a place in which he is used to being pretty much alone, and after a few minutes, Courtney sat upright and looked his patient in the eye.

"Are you wearing a wire?" the doctor asked.

'The basis of health'

Five years ago, while still a regular physician, Courtney was as spooked as most doctors about pot. Then he came across an article in the December 2004 issue of Scientific American. It changed his life. The article highlighted a molecule in cannabis that could do something he had never seen before: send signals not only into a nerve cell, but also back out again.

The finding reversed 20 years of his understanding of how neurotransmitters work. One-way traffic was the basis for inflammation: Immune cells receive endless messages to get cracking, none to calm down. Continuous attacking can inflame otherwise healthy tissue. Two-way communication makes possible a feedback loop, encouraging a modulation, the promise of which swept over the Michigan-born microbiology major with the force of religion. "My God," he said. "It's the basis of health."

Courtney keeps a framed graphic from the article on his desk. It stands beside copies of "Non-psychotropic plant cannabinoids: new therapeutic opportunities from an ancient herb," from Trends in Pharmacological Sciences -- and of course U.S. patent 6630507.

Among the three NIH scientists awarded the 2003 patent was the late Julius Axelrod, who won a share of the Nobel for nerve research that laid the groundwork for Prozac. "It took us a while to appreciate what was going on here," said Aidan Hampson, another of the patent holders, now a scientific review officer at NIH. "And it turns out cannabinoids had not been appreciated before, but they were strong antioxidants. The idea of a panacea," he added, however, "is just crazy."

Courtney feels differently, of course, but assessing the merits behind his enthusiasm is a difficult task. He has bona fide medical credentials and an evident passion to heal. But his approach is grounded in the counterculture ethos of Mendocino County, a coastal forestland populated since the 1960s by "new settlers" who rejected the establishment of two generations ago, and have since been in front on some things -- organic farming, for instance.

So when Courtney, excited by the ancient pedigree of cannabis, says "there are 34 million years of research in that plant," he might sound like one of your stoner friends. On the other hand, his Web site, http://leavesofgrass.info, links to an assortment of establishment scientists, including the International Cannabinoid Research Society, which brings together hundreds of mainstream researchers in its annual meeting. One year, his domestic partner, Kristen Peskuski, summarized her return to near-full health -- from debilitating lupus, interstitial cystitis, rheumatoid arthritis and 40 medications a day -- after juicing fresh pot leaves over a 30-month period. Clinical tests documented the remission.

"Look at the people I'm rubbing elbows with -- Abbott, Smith, Merck," Courtney said, flipping through an ICRS program, thick as a phone book. "They know this is the future of medicine, without side effects."

Attention in scientific circles is, in fact, way up. "The amount of research published is growing algorithmically," said Allyn Howlett, a professor of physiology and pharmacology at Wake Forest University and ICRS president. Howlett has concerns about Courtney's approach. While he promotes marijuana as a good-for-you vegetable, like spinach, she regards "folk medicine" as backward and believes promising a spectrum of benefits is akin to peddling snake oil. Howlett pointed out that the pharmaceutical industry was created to standardize dosages, and the FDA to protect the consumer.

Quietly, one pharmaceutical firm has proceeded to FDA trials with a cannabinoid product. GW Pharmaceuticals, a British company, years ago bought the marijuana seed stock from a pair of Northern California botany enthusiasts who had decamped to Amsterdam, where it was safer to grow such things. After reading a GW report on a plant extremely high in CBD, Courtney for a while considered it the Grail, and looked high and low in Northern California. But in vain.

"What has happened is, almost all strains available in America through the black market are THC concentrates," said Ethan Russo, a Seattle area physician who is senior medical adviser to GW. "The CBD in almost all cases has been bred out. The reason is cannabis in this country has been cultivated for its intoxicating effect."

The company has produced an oral spray, called Sativex, approved in Canada for treatment of pain associated with multiple sclerosis and is pending in the U.K. and Spain for spasticity in MS. It has completed Phase II clinical trials in the FDA approval process as a treatment for cancer pain. The final trial awaits.

"It's going to be a few years yet," said Russo, who in the mid-'90s left his neurology practice in Montana, concerned by the toxic side effects of medicines he was prescribing. He returned from a sabbatical to Peru convinced that marijuana holds the greatest potential among medicinal plants.

"There's a tendency to discount claims when something appears to be good for everything, but there's a reason this is the case," he said. "CBD works on receptors, and as it turns out, we have cannabinoids in our bodies, endogenous cannabinoids, that turn out to be very effective at regulating immune functions, nerve functions, bone functions."

Hampson, of the NIH, likened the discovery of cannabinoids inside the body to "the opiate-endorphin story from 25 to 30 years ago. Before that, no one knew how heroin and morphine worked until they found these compounds in the brain, endorphins, and they used the same system. What were they for? To repress pain during exercise, et cetera."

Russo: "The endogenous cannabinoid system acts as a modulator in fine-tuning a lot of these systems, and if something is deranged biochemically in a person's body, it may well be that a cannabinoid system can bring things back into balance."

Stigma and red tape

Whatever potential may lurk in pot -- and most medicines start with a plant -- all agree that what Howlett called "the stigma associated with marijuana" presents powerful discouragement to scientists and firms. States may normalize access to marijuana, but the supremacy clause gives primacy to federal law that lists marijuana on Schedule 1 of the Controlled Substances Act, the tier reserved for drugs with "no currently accepted medical use."

"As far as the pharmaceutical industry goes, anything that has a controlled substance, they won't touch with a ten-foot pole," Hampson said.

Simply acquiring laboratory marijuana requires permission from an alphabet soup of agencies, including the Drug Enforcement Administration, which is famously hardheaded on the matter. It was, in fact, a sidelong mention of the DEA that cued Courtney to ask his patient about a wire. The agency must grant permission to import the device the one-armed man proposed to bring from Holland, a cannabis analyzer that might tell CBD enthusiasts exactly what they have in a particular plant.

This is a point of immense frustration in the gargantuan, perhaps $15 billion underground economy that flows from marijuana in California: No one knows for certain what they're buying. "I can't breed analytically," said Jim Hill, a pot farmer in Mendocino's Potter Valley. "I can only go by patient anecdote: 'Yeah, that really worked for me.' I can't go by graph paper."

After the DEA raided Hill's operation last October, he immediately replanted, emphatic that it was his right to supply dispensaries legally organized under state law as a "collective." Favorable court rulings have both emboldened and, in spots, professionalized California's marijuana industry. At Oakland's Harborside Health Center, pot is sold not by dealers but from a clean, white building where doors open by fingerprint scans, cameras monitor every corner, and pot brownies come in "childproof" wrappers.

"We're trying to medicalize down to the finest detail," chief operating officer Andrew DeAngelo said.

A few blocks away, the Steep Hill Medical Collective invested in a gas chromatograph-mass spectrometer in hopes of learning precisely what's in each pound of Grand Daddy and Purple Kush. In one room recently, a lab tech in a white coat bent over a console, while in another, two entrepreneurs mulled the lay of the land.

"You've got a movement that's turning into an industry," said Addison DeMoura, a Steep Hill owner.

A man in a Panama hat nodded agreement. Sixties activist Fred Gardner edits O'Shaughnessy's, a quarterly devoted to medical marijuana and named for the physician who brought cannabis to the attention of European medicos. "I think people owe it to the industry, owe it to the people, to do something honestly medical," Gardner said. "And CBD is honestly medical."

DeMoura could see it. "Twenty years ago it was just cannabis," he said. "The bridge to legalization is medical marijuana. I believe the bridge from medical marijuana to real science will be CBDs."

Meanwhile, two hours up Highway 101, William Courtney toiled in the laboratory that is Mendocino County. Maybe nowhere else in the country could a pot doc advise growing 40 plants -- enough for one juicing each day on the 45-day cycle required of the auto-flowering strain. Not only is it possible here, but a striking number of patients truly do not want to get high.

"I'm a mediator, so I don't want any psycho-activity," said a yoga enthusiast.

"I have two tokes and I pass out. It's unbearable," said the one-armed man.

Office hours over, Courtney climbed into his pickup, flicked on the radar detector intended to minimize encounters with the police, and steered over the switchbacks of the coast range toward home. His father was in from Michigan, watching the surf pound the rocks below the picture window and playing with his granddaughter, born 14 months earlier to Kristen, whose insides at one point were so bad off a doctor warned she would never bear children.

"Irv?" she called from the kitchen counter cluttered with carrots, pears, apples and Pineapple Thai. "You want a glass of juice?"

The old man looked up from the sea. "Sure," he said.

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