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The
nonprofit American Herbal Pharmacopoeia (AHP) recently issued a draft of its comprehensive
review of medicinal cannabis for difficult-to-treat seizure conditions,
including epilepsy. AHP’s announcement in mid-March came roughly six months
after Illinois became the 20th state to legalize medical marijuana and as proposed
medicinal cannabis legislation is being debated in 15 other states.1
The
document — titled “Cannabis in the Management and Treatment of Seizures and
Epilepsy”2 — is an excerpt from AHP’s forthcoming Cannabis Therapeutic Compendium, which will
be published later this year. The compendium contains “numerous scientific
reviews [encompassing] the broad range of science regarding the therapeutic
effects and safety of cannabis”3 and is the companion document to AHP’s
historic cannabis
quality standards monograph released in December 2013, the first document of
its kind to be published in the United States for more than 70 years.4
Despite AHP’s two recent publications on cannabis,
the organization is chiefly an herbal medicine education nonprofit without
vested interests in any particular herb. AHP is known for producing meticulously
researched herb monographs and literature reviews. Its 34th monograph — on aloe
vera leaf, leaf juice, and inner leaf juice — was released in December 2012.5
“AHP is not a cannabis
advocacy organization,” explained AHP Executive Director Roy Upton (email,
March 25, 2014). “Our job is simply to provide a scientific and critical review
of the literature. How it is interpreted or used is up to the readers.”
AHP released its review of cannabis for seizures
and epilepsy amid increased news coverage of the use of medical marijuana,
particularly by children with these neurological disorders. CNN’s Chief Medical
Correspondent Sanjay Gupta, MD, brought national attention to the issue in his
August 2013 documentary WEED, which
focused on the story of a six-year-old girl in Colorado whose intractable seizures
were controlled by a cannabis extract when conventional pharmaceutical
medications failed to work.6 Dr. Gupta’s follow-up documentary (reviewed in
this month’s issue of HerbalEGram by HerbalGram
Managing Editor Ash Lindstrom) aired on March 11, 2014, the day before AHP
released its review document, and reiterated that select cannabis extracts are
effective for the management of seizures.7
“In recent months there has been considerable
attention given to the potential benefit of cannabis for treating intractable
seizure disorders including rare forms of epilepsy,” AHP noted in its press
release.3 “For this reason, the
lead author of the section, Ben Whalley, PhD, and AHP felt it important to
release this section, in its near-finalized form, into the public domain for
free dissemination.”
Dr.
Whalley, director of research at the University of Reading’s School of Pharmacy
in the United Kingdom, has published multiple papers on cannabis for the
treatment of seizure disorders with a focus on the underlying brain mechanisms of
these conditions.3
“Releasing
this section of the monograph,” Dr. Whalley stated in AHP’s press release, “provides
clinicians, patients, and their caregivers with a single document that
comprehensively summarizes the scientific knowledge to date regarding cannabis
and epilepsy and so fully support informed, evidence-based decision making."3
According
to the Maryland-based Epilepsy Foundation, approximately 2.3 million Americans
currently live with this often-debilitating neurological condition. “There is
an enormous unmet need for better treatments for children and adults with
epilepsy,” wrote Orrin Devinsky,
MD, a member of the Epilepsy Foundation’s National Board of Directors and Director of New York University’s
Comprehensive Epilepsy Center, in a commentary article accompanying a recent
press release from the Epilepsy Foundation. 8
“Approximately
one-third of people with epilepsy continue to suffer from seizures despite the
best medical, dietary, and surgical therapies,” Dr. Devinsky continued. These effects, he said, are often “compounded
by the disabling physical, cognitive and behavioral side effects from high
doses of multiple antiepileptic drugs.” 8
The
Epilepsy Foundation has publicly called on the US Drug Enforcement Agency to
reclassify cannabis,8 which is currently a Schedule I controlled substance
— a category for substances deemed to have a high potential for abuse and no accepted
medical use in the United States. This restrictive classification, the Foundation
says, significantly hampers research efforts and limits patient access to
potentially beneficial medicine.
“[A]n
end to seizures should not be determined by one’s zip code,” the
Epilepsy Foundation stated in a press release from March 20.8 “If a
patient and their healthcare professionals feel that the potential benefits of
medical marijuana for uncontrolled epilepsy outweigh the risks, then families
need to have that legal option now — not in five years or ten years."7
Although
the field of medical marijuana research in the United States is still in its
infancy, current evidence suggests cannabis may have positive effects in
seizure treatment.2 Due to the limited amount of human research,
conflicting findings, and varying study quality, however, firm conclusions
about the efficacy of cannabis for seizures and epilepsy should not be made at
this time.
“The
available literature (case studies, surveys, and pre-clinical data) on the use
of cannabis and its constituents for the treatment of epilepsy and seizures in
humans suggests there is a general consensus that cannabis exerts an
anticonvulsant effect,” Dr. Whalley stated.2 “[W]hilst high CBD and
low THC strains … appear to be effective, their long-term efficacy and safety
have not yet been properly demonstrated in well-controlled clinical trials.”
Dr. Devinsky noted that highly publicized
anecdotal reports of cannabis as a “miracle cure” for treatment-resistant
seizures, coupled with the current lack of a scientific consensus regarding its
efficacy, can put physicians in a difficult situation.
“We stand at an unusual inflection point where
families are demanding access to a medication that may or may not be
beneficial, and for which the side effects may be less than many medications
prescribed by doctors; the medical community lacks convincing efficacy or safety
data for children with epilepsy; and the Drug Enforcement Agency’s overly
conservative scheduling of marijuana hamstrings research and access,” he wrote.8
“ We urgently need data from randomized controlled trials where the biases
of companies, doctors, patients, and parents are meticulously removed.”
AHP’s document, “Cannabis in the Management and Treatment of
Seizures and Epilepsy,” can be downloaded free of charge at www.herbal-ahp.org. A printed
copy of AHP’s Standards of Identity,
Analysis, and Quality Control Cannabis monograph can be purchased for
$44.95 on AHP’s website.
—Tyler Smith
References
1. 15 states
with pending legislation to legalize medical marijuana (as of Mar. 24,
2014). ProCon.org website. Available here.
Accessed March 21, 2014.
2. Whalley B. Cannabis in the Management and Treatment of
Seizures and Epilepsy. Scotts Valley, CA: American Herbal Pharmacopoeia; March
12, 2014. Available here.
Accessed March 18, 2014.
3. AHP
Releases Cannabis in the Management and Treatment of Seizures and Epilepsy: A
Scientific Review [press release]. Scotts Valley, CA: American Herbal Pharmacopoeia; March
12, 2014. Available here.
Accessed March 18, 2014.
4. Smith T. American
Herbal Pharmacopoeia publishes historic monograph on cannabis. HerbalGram. 2013;101:24-25. Available here.
Accessed March 21, 2014.
5. Smith T. AHP
releases quality control standards monograph for aloe vera. HerbalEGram.
2013;10(1). Available here.
Accessed March 26, 2014.
6. Gupta S. Why I changed my mind on weed. CNN Website. Available here.
Accessed March 21, 2014.
7. Gupta S. Gupta: 'I am doubling down' on medical marijuana. CNN website. Available here.
Accessed March 21, 2014.
8. Epilepsy Foundation calls for increased
medical marijuana access and research [press release]. Landover, MD: Epilepsy
Foundation; March 20, 2014. Available here.
Accessed March 21, 2014. |